Endoscopy International Open最新文献

[This corrects the article DOI: 10.1055/a-2645-7506.].

Background and study aims: Local injection of a small amount of blue dye into the submucosa can facilitate recognizing the dissection line in endoscopic submucosal dissection (ESD). Amber-red color imaging (ACI), which hardly affects the submucosal blue color, is suitable for the entire ESD. This study aimed to clarify characteristics of ACI during ESD.

Patients and methods: Nine endoscopic images were selected during submucosal dissection in four cases of gastric ESD to evaluate endoscopic ACI and white light imaging (WLI). Visibility of the dissection line and the submucosal vessel were evaluated by eight endoscopists using a 5-point Likert scale. The blue submucosal area of each endoscopic image and color signal surrounding the submucosa were compared between ACI and WLI. In addition, the color signals in gradient dilutions of blue solutions were compared in ex vivo experiments.

Results: Visibility of the dissection line was better in ACI than in WLI and visibility of the submucosal vessels was slightly better in ACI. The size ratio of the blue area in ACI and WLI (i.e., ACI/WLI) ranged from 0.53 to 0.65, indicating that the blue area in the ACI was narrower. The red signal intensity of the surroundings with respect to the submucosa was greater in ACI than in WLI, which was related to the narrower blue area in ACI. Ex vivo experiments corroborated this observation.

Conclusions: ACI highlights the submucosa in blue only where sufficient solution is injected, which facilitates recognition of the dissection line during ESD.

Background and study aims: Analyses of colonoscopy (CS) and esophagogastroduodenoscopy (EGD) complications is crucial for further promoting use of endoscopy. This study analyzed rates of severe complications of CS compared with those of EGD using big data.

Patients and methods: As a study population, we retrospectively used commercially anonymized health insurance claims data covering 3,050,954 patients from January 2010 to December 2020. Patients ≥ 50 years old who underwent CS or EGD without treatment were included in the study. The main outcomes were differences in rates of hemorrhage, perforation, and fatal events between EGD and CS, and risk factors of each complication comparing CS with EGD.

Results: Among 290,470 CSs (male: 182,910, female: 107,560, median age [range]: 58 [50-75]) and 726,075 EGDs (male: 412,365, female: 313,710, 58 [50-75]), rates of hemorrhage, perforation, and fatal events for EGD and CS were 0.0069% vs. 0.0069% ( P = 0.558), 0.0006% vs. 0.0024% ( P = 0.008), and 0.00028% vs. 0.00034% ( P = 0.648), respectively. Rates of hemorrhage for cases aged 50 to 64 and 65 to 75 years were 0.0059% vs. 0.0110% ( P = 0.042) for EGD and 0.0061% vs. 0.0108% for CS ( P = 0.264). Risks of hemorrhage for comparing CS to EGD were significant for biopsy (adjusted odds ratio [aOR] 95% confidence interval [CI] 2.75 [1.15-6.21]; P = 0.017) and antithrombotics (aOR 12.48; 95% CI 1.80-247.14; P = 0.026). Those for perforation were significant for ages 50 to 64 years (aOR 9.58; 95% CI 2.17-66.10; P = 0.006) and male sex (11.76 [1.85-222.65], P = 0.025).

Conclusions: Compared with EGD, CS had a higher rate of perforation but not hemorrhage. Complication rates in CS did not differ by age.

[This corrects the article DOI: 10.1055/a-2641-5725.].

Background and study aims: Data on colorectal endoscopic mucosal resection (C-EMR) training during advanced endoscopy fellowship remain limited. We aimed to determine the number of procedures required by an "average" advanced endoscopy trainee (AET) to achieve competence in cognitive and technical C-EMR skills.

Methods: AETs from advanced endoscopy training programs (AETPs) were graded on every C-EMR using a standardized assessment tool. Cumulative sum (CUSUM) analysis was used to generate individual and aggregate learning curves to estimate the minimum number of cases required to achieve competence for overall, technical, and cognitive components of C-EMR. AETs completed a self-assessment questionnaire on C-EMR competence at the end of their training.

Results: A total of 22 AETs among 16 AETPs participated in this study. Nineteen AETs (86%) reported formal training in C-EMR with a mean number of 32 ± 22 cases prior to their AETP. In aggregate, 637 C-EMRs were performed (median of 32 per AET; interquartile range 17-45). Learning curve analyses revealed substantial variability in minimum volume of procedures needed to attain competence across different C-EMR skills (range: 19-39). A minimum of 19 cases were required to achieve overall competence using the global assessment score. All AETs reported feeling comfortable performing C-EMR independently at the end of AETP, yet only three (14%) achieved competence in their overall performance.

Conclusions: The relatively low number of C-EMRs performed by many AETs may be insufficient to achieve competence. The estimated thresholds for an average AET to achieve competence in C-EMR provide a framework for AETPs in determining the minimal standards for case volume exposure during training.

Background and study aims: Magnifying endoscopy with narrow-band imaging (ME-NBI) is regularly used in neoplasia diagnostics although its use in assessment of esophageal inflammatory changes is uncommon. The aim of this study was to evaluate the efficacy of eosinophilic esophagitis reference score and ME-NBI signs in predicting inflammation using gastroscopy with dual focus in patients with dysphagia.

Patients and methods: We conducted a prospective cohort study in adults undergoing gastroscopy with esophageal biopsies because of dysphagia/food bolus impaction. Number of eosinophiles and lymphocytes were calculated per high-power field. We used logistic regression with forward stepwise selection to determine the most relevant predictors (endoscopic signs) of inflammation. To assess the predictive value of endoscopic signs for eosinophilic or lymphocytic infiltration, we calculated sensitivity, specificity, and predictive values.

Results: In total 219 patients (71.2% male) were enrolled to the study. Most frequent endoscopic findings were furrows (121/219, 55%), positive NBI signs (106/219, 48%), and edema (102/219, 47%). Logistic regression analysis showed that furrows and NBI signs were the most significant predictors of eosinophilic infiltration. Edema was the only significant predictor of lymphocyte infiltration.

Conclusions: Positive NBI signs and furrows were the best predictors of eosinophile infiltration, whereas lymphocytic infiltration was predicted by edema. Given that NBI is already widely available, we encourage use of both white light and NBI in patients with suspected esophageal inflammation.

Background and study aims: This study addressed the need for improved diagnostic tools to identify malignancy in suspicious biliary strictures. Traditional cytological morphology is often indecisive, prompting exploration of next-generation sequencing (NGS) for enhanced sensitivity. Our aim was to evaluate NGS's additional value in classifying biliary brushes and biopsies and its impact on clinical decision making (CDM).

Patients and methods: In this retrospective single-center cohort study, patients were included from 2019 to 2022 in whom morphologic interpretation and NGS were performed on cytological or histological material from suspicious biliary strictures. Sensitivity and specificity of NGS were calculated for benign or atypical vs. suspicious for malignancy or malignant morphology in biliary brushes and biopsies. In addition, changes in CDM after NGS outcome were evaluated.

Results: In total 109 samples from 106 patients were included in the study. NGS correctly identified 42 of 75 malignancies (56%). Sensitivity and specificity of morphology for brushes were 56% (95% confidence interval [CI] 43%-68%) and 94% (95% CI 79%-99%), respectively. Adding NGS resulted in sensitivity and specificity of 78% (95% CI 66%-87%) and 94% (95% CI 79%-99%). For biopsies, sensitivity and specificity of morphology were 67% (95% CI 35%-90%) and 67% (95% CI 9%-99%) and adding NGS did not alter these results. The outcome of NGS resulted in a change of classification of morphology in 36% and a change in CDM in 8%.

Conclusions: NGS in brushes contributed to more accurate/sensitive diagnoses of malignancy than morphology alone. There was a limited impact on CDM change, but in the future, NGS will undoubtedly play a bigger role when targeted therapy is incorporated in standard treatment and more sensitive NGS panels for cholangiocarcinoma are developed.

Background and study aims: Fully-covered-self-expandable-metal-stents (FC-SEMS) are commonly used for non-malignant biliary stricture treatment. Removal failure related to hyperplastic tissue development over the distal margin of the stent has been described but few data are available. FC-SEMS-in-FC-SEMS technique has been described in case reports to overcome FC-SEMS removal failure. Aims of this study were investigating technical success, clinical success, and safety of the FC-SEMS-in-FC-SEMS technique and identification of risk factors for FC-SEMS removal failure in patients with non-malignant distal biliary stricture.

Patients and methods: Endoscopic retrograde cholangiopancreatography (ERCP) procedures performed between January 1, 2020 and May 31, 2023 for FC-SEMS removal in non-malignant distal biliary strictures were retrospectively identified and analyzed. Cases of FC-SEMS-in-FC-SEMS technique were evaluated.

Results: FC-SEMS-in-FC-SEMS technique was used in 15 patients. FC-SEMS removal was achieved after a single treatment in 13 patients (86.7%). In the remaining two patients (13.3%), it was necessary to repeat treatment to achieve FC-SEMS removal, with an overall technical and clinical success of 100%. No significant adverse events were recorded. Among the 50 patients undergoing ERCP for FC-SEMS removal during the study period (median dwell stenting period of 306.5 days; Q1-Q3:160-392), failure was observed in 15 cases (30%). Previous biliary stenting and dwell stenting period > 300 days were identified as risk factors for FC-SEMS removal failure.

Conclusions: FC-SMES-in-FC-SEMS technique appears to be safe and effective to overcome FC-SEMS removal failure in patients with non-malignant distal biliary strictures. Reducing dwell stenting period, especially in patients with personal history of previous biliary stenting, may reduce risk of FC-SEMS removal failure.

Background and study aims: Submucosal tunneling endoscopic resection (STER) has emerged as an innovative approach for the treatment of giant submucosal tumors (SMTs) in the esophagus. However, complications such as esophageal fistula or submucosal infection remain a concern. This article explores how preventive wound drainage can play a significant role in reducing these complications.

Patients and methods: We devised an innovative and straightforward method for negative pressure drainage. This approach involves positioning the drainage device with metal clips before closing the esophageal mucosa wound. A retrospective analysis was conducted on 46 patients with giant SMTs who underwent the STER procedure, among whom 28 had drainage and 18 had no drainage. Patient characteristics, adverse events, and risk factors were comprehensively evaluated.

Results: In 46 patients, the transverse diameter of the tumor exceeded 5 cm. No significant difference was observed in age, gender, tumor size, surgical scope, or mucosal injury between the two groups studied ( P > 0.05). Esophageal fistula or submucosal infection rates in the drainage group were lower than those in the no drainage group (2/28 vs 14/18, P < 0.05). Subgroup analyses revealed that multiple injuries in the esophageal mucosa combined with full-thickness resection of the esophageal muscle layer were the immediate causes of esophageal fistula or submucosal infection following STER surgery.

Conclusions: In the context of STER for giant esophageal submucosal tumors with muscular layer full-thickness resection and mucosal injury, preventive drainage is an effective strategy for minimizing postoperative esophageal fistula and submucosal infection complications.