Endoscopy International Open最新文献

Background and study aims Patients with primary sclerosing cholangitis and inflammatory bowel disease (IBD) have a high risk of colorectal cancer. There is no agreement on the best technique for surveillance for colorectal neoplasia. We aimed to assess whether chromoendoscopy and/or high-definition endoscopy is associated with increased detection of neoplasia in patients with primary sclerosing cholangitis undergoing surveillance compared with when they were not used. Patients and methods This was a single-center, retrospective, observational study designed to analyze differences in the detection of neoplasia (adenomatous and serrated) among patients with primary sclerosing cholangitis and IBD who underwent annual surveillance between 2010 and 2020. Multilevel logistic regression was used to adjust for confounders. Results Ninety-one patients were identified, resulting in 359 colonoscopies with 360 person-years of follow up. Over the study period, 22 of 91 patients (24%) had at least one neoplastic lesion identified; however, the mean neoplastic lesion rate was 0.87 (54/63) for the primary sclerosing cholangitis-ulcerative colitis subgroup compared with 0.24 (4/17) for the primary sclerosing cholangitis-Crohn's disease subgroup. Chromoendoscopy was associated with a significantly higher detection rate for neoplasia (odds ratio [OR] 5.58, 95% confidence interval [CI] 2.08-14.9, P =0.001), and this association remained after adjusting for confounders, including high-definition endoscopy. High-definition endoscopes had a higher rate of neoplasia detection, but the significance was lost after adjustment for confounders, including chromoendoscopy (OR 1.93, 95% CI 0.69-5.40, P =0.21). Conclusions Chromoendoscopy is associated with a higher detection rate for neoplasia in patients with primary sclerosing cholangitis and IBD even with high-definition colonoscopes.

[This corrects the article DOI: 10.1055/a-2406-7492.].

Background and study aims Despite the common occurrence of non-neoplastic findings (NNFs) in individuals with a positive fecal immunochemical test (FIT), few studies have reported on these findings. The aim of this cross-sectional study was to determine the prevalence of colonic NNFs in three cohorts of Danish clinical trial participants who underwent colon capsule endoscopy (CCE). Patients and methods Retrospectively collecting NNFs from CCE reports of three Danish trials, we classified them into five categories: diverticula, vascular abnormalities, inflammation, erosions/ulcerations, and others. The statistical analysis included 516 participants from three trials, with a mean age ranging from 59.2 to 63.9 years. The participants in the three trials were FIT-positive screening or symptomatic individuals. Results NNFs were reported in more than half of the CCE procedures (50.6% to 77.9%), with colonic diverticula being the most common NNF appearing in 40.9% to 66.9% of the CCE reports. Vascular abnormalities and erosions/ulcerations were also common depending on the specific trial. Conclusions NNFs are common and may be an indicator of more widespread disease. Furthermore, NNFs may develop into clinically significant conditions despite their benign appearance. This paper expands on the limited literature about prevalence of NNFs and underscores the additional value of CCE video recordings beyond detecting polyps.

Background and study aims Although esophagogastroduodenoscopy (EGD) is a widely used technique, the procedure is often associated with discomfort. This study aimed to analyze painful situations, their frequency, and factors associated with patient discomfort during EGD. Patients and methods This prospective observational study included patients scheduled to undergo EGD. Seven endoscopists recruited patients scheduled for EGD screening or surveillance. Each endoscopist enrolled 20 patients, performing 10 EGD procedures using ultraslim endoscopes and 10 with standard-sized endoscopes. Data regarding painful situations and frequency were collected using specialized buttons pressed by the patients during EGD. A survey about overall discomfort was conducted after the procedure. Results We analyzed data from 140 patients. Esophageal insertion and duodenal observation were associated with the highest incidence of pressing the pain button, accounting for 59.3% and 40.7% of the cases, respectively. The factor associated with pressing the pain button during esophageal insertion was endoscopist experience (< 10 years). In contrast, younger age and female sex were the factors associated with pressing the pain button during duodenal observation. In the post-procedure survey, 63.6% of patients reported discomfort. Factors associated with patient discomfort included pressing the pain button during esophageal insertion (odds ratio [OR]: 2.84, P = 0.01) and previous painful EGD experience (OR: 2.41, P = 0.03). Concusions This study provides objective data on painful situations, their frequency, and related factors during EGD. Further research and interventions focusing on pain reduction during endoscopic procedures are warranted. The results of this study will help endoscopists manage painful situations and potentially improve skills.

Background and study aims Endoscopic ultrasound (EUS) is vital for early pancreatic cancer diagnosis. Advances in artificial intelligence (AI), especially deep learning, have improved medical image analysis. We developed and validated the Modified Faster R-CNN (M-F-RCNN), an AI algorithm using EUS images to assist in diagnosing pancreatic cancer. Methods We collected EUS images from 155 patients across three endoscopy centers from July 2022 to July 2023. M-F-RCNN development involved enhancing feature information through data preprocessing and utilizing an improved Faster R-CNN model to identify cancerous regions. Its diagnostic capabilities were validated against an external set of 1,000 EUS images. In addition, five EUS doctors participated in a study comparing the M-F-RCNN model's performance with that of human experts, assessing diagnostic skill improvements with AI assistance. Results Internally, the M-F-RCNN model surpassed traditional algorithms with an average precision of 97.35%, accuracy of 96.49%, and recall rate of 5.44%. In external validation, its sensitivity, specificity, and accuracy were 91.7%, 91.5%, and 91.6%, respectively, outperforming non-expert physicians. The model also significantly enhanced the diagnostic skills of doctors. Conclusions: The M-F-RCNN model shows exceptional performance in diagnosing pancreatic cancer via EUS images, greatly improving diagnostic accuracy and efficiency, thus enhancing physician proficiency and reducing diagnostic errors.

Background and study aims Diagnostic performance of a computer-aided diagnosis (CAD) system for deep submucosally invasive (T1b) colorectal cancer was excellent, but the "regions of interest" (ROI) within images are not obvious. Class activation mapping (CAM) enables identification of the ROI that CAD utilizes for diagnosis. The purpose of this study was a quantitative investigation of the difference between CAD and endoscopists. Patients and methods Endoscopic images collected for validation of a previous study were used, including histologically proven T1b colorectal cancers (n = 82; morphology: flat 36, polypoid 46; median maximum diameter 20 mm, interquartile range 15-25 mm; histological subtype: papillary 5, well 51, moderate 24, poor 2; location: proximal colon 26, distal colon 27, rectum 29). Application of CAM was limited to one white light endoscopic image (per lesion) to demonstrate findings of T1b cancers. The CAM images were generated from the weights of the previously fine-tuned ResNet50. Two expert endoscopists depicted the ROI in identical images. Concordance of the ROI was rated by intersection over union (IoU) analysis. Results Pixel counts of ROIs were significantly lower using 165K[x103] [108K-227K] than by endoscopists (300K [208K-440K]; P < 0.0001) and median [interquartile] of the IoU was 0.198 [0.024-0.349]. IoU was significantly higher in correctly identified lesions (n = 54, 0.213 [0.116-0.364]) than incorrect ones (n=28, 0.070 [0.000-0.2750, P = 0.033). Concusions IoU was larger in correctly diagnosed T1b colorectal cancers. Optimal annotation of the ROI may be the key to improving diagnostic sensitivity of CAD for T1b colorectal cancers.

Background and study aims Killian-Jamieson diverticulum (KJD) is a rare type of esophageal diverticulum that occurs in a specific area called the Killian-Jamieson space. Although surgery has been the conventional treatment for symptomatic KJD, minimally invasive endoscopic techniques, particularly Killian-Jamieson per-oral endoscopic myotomy (KJ-POEM), have emerged as an alternative. The aim of the study was to evaluate the effectiveness and safety of KJ-POEM in treating KJD. Patients and methods This was an international, multicenter, retrospective study that included patients who underwent KJ-POEM for symptomatic KJD from October 16, 2018 to April 12,2023. The primary outcome was clinical success, defined as complete or near-complete resolution of symptoms (i.e., post-procedure Kothari-Haber Score ≤ 2).  Secondary outcomes were technical success (defined as successful completion of all procedural steps), rate and severity of adverse events (AEs), total procedure duration, and symptom recurrence during follow-up. Results A total of 13 patients (mean age 65.23 years, 6 female) with KJD and a mean pre-procedure Kothari-Haber Score of 6 (standard deviation [SD] 2.16) underwent KJ-POEM across 10 participating centers. Clinical success and technical success were achieved in all cases (100%) with a mean post-procedure Kothari-Haber Score of 0.91 (SD 0.99). There were no AEs and no cases of injury to the recurrent laryngeal nerve. Mean length of hospital stay was 1.09 days (SD 0.74). Mean follow-up time was 9.41 months (SD 10.07) post-procedure. There was no post-procedure symptom recurrence any patient. Conclusions KJ-POEM is a safe and effective alternative treatment for symptomatic KJD with excellent short/mid-term outcomes.

Background and study aims: This study aimed to conduct a clinical audit of adverse events (AEs) arising from gastrointestinal endoscopy, utilizing the AGREE classification for AEs and establishing its correlation with the ASGE classification. This study further integrated the economic repercussions of AEs into the AGREE classification through the AIG-AGREE modification. Patients and methods: A prospective observational study was conducted at the Asian Institute of Gastroenterology, Hyderabad, India, from July 1, 2021, to December 31, 2021. The study included all patients who underwent diagnostic or therapeutic endoscopic procedures. AEs were categorized using the American Society of Gastrointestinal Endoscopy (ASGE) and AGREE classifications. A quality indicator questionnaire containing 15 questions was graded based on the latest ASGE and European Society of Gastrointestinal Endoscopy guidelines. The grading scale ranged from 1 to 3 (poor), 4 to 6 (average), 7 to 9 (excellent), to 10 (outstanding). In addition, the AIG-AGREE modification divided the economic impact into five scales (α, β, γ, δ, and ε) based on multiples of the baseline amount. (ClinicalTrials.gov Identifier: NCT05228353) Results: Over the 6-month study period, a total of 42,471 endoscopic procedures were performed, identifying 220 AEs. Analysis revealed a significant positive correlation (Pearson correlation coefficient = 0.79; P < 0.001) between the grades of AEs in the AGREE and ASGE classifications. The median score for all quality indicators was 8, indicating excellent services based on feedback from 13,042 surveyed patients. Notably, patients with more severe AEs (AGREE III-V) exhibited higher economic impact categories (β, γ, δ, ε) compared with those with less severe AEs (AGREE I-II). Conclusions: The AIG-AGREE modification stands as a pioneering effort that highlights the importance of considering economic factors in the evaluation of AEs in gastrointestinal endoscopy.

Background and study aims Topical hemostatic agents emerged as a new treatment modality for gastrointestinal bleeding. The aim of this study was to assess the safety and efficacy of PuraStat for control of active bleeding and for prevention of bleeding after different operative endoscopy procedures. Patients and methods A national, multicenter, observational registry was established to collect data from ten Italian centers from June 2021 to February 2023. Demographics, type of application (active gastrointestinal bleeding or prevention after endoscopic procedures, site, amount of gel used, completeness of coverage of the treated area), outcomes (rates of intraprocedural hemostasis and bleeding events during 30-day follow-up), and adverse events (AEs) were prospectively analyzed. Results Four hundred and one patients were treated for active gastrointestinal bleeding or as a preventive measure after different types of operative endoscopy procedures. Ninety-one treatments for active bleeding and 310 preventive applications were included. In 174 of 401 cases (43.4%), PuraStat was the primary treatment modality. Complete coverage was possible in 330 of 401 (82.3%) with difficulty in application in seven of 401 cases (1.7%). Hemostasis of active bleedings was achieved in 90 of 91 patients (98.9%). In 30-day follow-up 3.9% patients in whom PuraStat was used for prophylaxis had a bleeding event compared with 7.7% after hemostasis. No AEs related to the use of PuraStat were reported. Conclusions PuraStat is a safe and effective hemostat both for bleeding control and for bleeding prevention after different operative endoscopy procedures. Our results suggest that the possible applications for the use of PuraStat may be wider compared with current indications.

Background and study aims Endoscopic ultrasound-guided biopsy via fine-needle biopsy/fine-needle aspiration (FNB/FNA) is currently the standard method to sample tumors in the mediastinum and abdomen. Although specimens obtained with these needles are acceptable, a histological diagnosis is not always possible. Recently, a new EUS-guided core needle biopsy (EUS-CNB) device became available. Herein, we describe the first experience with its use in a transmural fashion. Patients and methods This was a case series of patients who underwent EUS-CNB at an academic center. All patients provided written informed consent and were observed in the hospital ≥ 48 hours after the procedure. Results A total of 8 patients underwent EUSC-CNB: five in the pancreas, two in the retroperitoneum, and one in the mediastinum. The diagnostic accuracy of EUS-CNB was 100% after one actuation. In four patients, same-session FNB and EUS-CNB were obtained from the same lesion with superior tissue sample in the latter. No adverse events were documented. Conclusions To our knowledge this is the first report on transmural use of EUS-CNB in gastroenterology. Our findings suggest that the device is effective and safe. Larger studies comparing it with FNA/FNB needles will be required to further assess performance and safety.