Endoscopy International Open最新文献

Background and study aims: Device-assisted enteroscopy (DAE) has seen a rapid increase in demand in recent years. European Society of Gastrointestinal Endoscopy (ESGE) DAE key performance indicators (KPIs) have been published as well as some national datasets. Data suggest variation in practice and service provision impacts outcomes. The aim of this study was to review DAE services in Ireland according to ESGE KPIs and wider outcomes.

Methods: DAE data from records at Tallaght and Connolly Hospital from January 2015 to May 2024 were retrospectively collated.

Results: Overall, 941 studies were included. 798 (85%) were index procedures and 548 (58%) were on men with a mean age of 61. Double-balloon enteroscopy was used in 864 (92%), 745 (79%) were anterograde (ADBE), and 196 (21%) were retrograde (RDBE). Mean depths of insertion were 201 cm ± 101 cm for ADBE and 101 cm ± 67 cm for RDBE. Of the procedures, 868 (92%) used conscious sedation; median doses of midazolam and fentanyl were 5 mg and 75 µg, respectively, with a mean comfort score (Modified Gloucester Scale) of 1.45 ± 0.67. Overall yield was 63%. Therapeutic intervention was performed in 385 (41%), 98% successfully, whereas 91% of detected lesions were tattooed. Significant adverse events occurred in < 1%. ESGE major KPIs by intention to treat (result/target) were: approved indication (94%/95%), depth-of-insertion tattoo (64%/80%), lesion detection (59%/50%-70%), lesion marking (91%/95%), complications (3.3%/< 5%), and adequate comfort (98%/> 90%). All minor KPIs were met. KPIs were consistent between both high-volume Irish-centers and were comparable to the three high-volume UK centers published in the recent DEEP-UK study, all of which performed better than lower-volume UK centers. Conscious sedation was used predominantly in our cohort with acceptable outcomes.

Conclusions: DAE requirement is increasing. Our study suggests that a high-volume model ensures compliance with international KPIs. These data also suggest that conscious sedation is a viable option for the majority of DAEs without reducing effectiveness, while maintaining comfort.

Background and study aims: Distal malignant biliary strictures (dMBSs) are a common indication for endoscopic retrograde cholangiopancreatography (ERCP). The present study aimed to evaluate adherence of Italian endoscopic centers to European Society of Gastrointestinal Endoscopy (ESGE) guidelines on management of dMBS.

Patients and methods: This prospective cohort, observational, multicenter study was promoted by the Italian Society of Digestive Endoscopy. All consecutive patients with dMBS were included in the registry. Clinical and technical data were recorded. Clinical follow-up was performed at 7 and 30 days, and then every 3 months. Adherence to the eight ESGE recommendations (defined as full-, intermediate- and poor-adherence if > 85%, ≥ 65% to ≤85%, and < 65%, respectively) was considered the primary outcome.

Results: Seventeen Italian endoscopy centers were included. Between January 2020 and January 2022, 827 patients were included. Full adherence to the guidelines was reported for post-ERCP acute pancreatitis prophylaxis, retreatments, and preoperative biliary drainage. Intermediate adherence was reported for type of stent used in palliative drainage (85% SEMS and 15% plastic stents). Poor adherence was reported for type of stent used in preoperative drainage (56% self-expandable metal stents [SEMSs]), availability of pathological diagnosis in case of U-SEMS placement (45% of U-SEMSs placed without pathologically diagnosis), antibiotic prophylaxis (70.6%), and sphincterotomy (88%).

Conclusions: Adherence to ESGE guidelines needs to be improved in specific areas, including excessive use of plastic stents, use of U-SEMS without pathological diagnosis, and routine performance of sphincterotomy and use of antibiotic prophylaxis. (ClinicalTrials.gov ID: NCT05761496).

Background and study aims: Missed high-grade dysplasia (HGD) or adenocarcinoma in Barrett's esophagus (BE) may have serious consequences, although the attributes of post-endoscopy Barrett's neoplasia (PEBN) remain unexplored. We analyzed the characteristics of Barrett's neoplasia (BN) eluding detection during screening endoscopy.

Methods: We retrospectively reviewed endoscopic images of BN, including HGD and adenocarcinoma, diagnosed at six centers in Nagano prefecture. Eligible patients had index endoscopic images obtained 7 to 36 months before BN diagnosis. Causes of PEBN were classified as perceptual error, in which BN was missed despite images taken where it was eventually diagnosed, or exposure error, whereby no images were obtained in the area of BN development.

Results: Among the 91 patients with BN, 31 were judged as having PEBN. The majority of PEBN cases were attributed to perceptual error (22 patients, 71%). Lesions within long-segment BE (LSBE) were significantly more likely to be overlooked due to exposure error (67% vs. 18%, P = 0.02), whereas lesions at the 0 to 3 o'clock position in short-segment BE (SSBE) tended to be missed due to perceptual error (76% vs. 33%, P = 0.04). Notably, 39% of perceptual error cases were misdiagnosed as esophagitis on index endoscopy. In the nine patients requiring surgery for PEBN, eight cases were attributed to perceptual error.

Conclusions: PEBN occurring in LSBE was mostly overlooked because of inadequate observation, whereas PEBN at the 0 to 3 o'clock position in SSBE was frequently misdiagnosed as esophagitis. Bearing these results in mind may improve quality of endoscopic screening and reduce incidence of PEBN.

Background and study aims: Biliary drainage is performed in palliative malignant biliary obstruction (MBO) to improve patient quality of life and enable chemotherapy. This study aimed to create and validate a prognostic score after biliary drainage in patients with palliative MBO.

Patients and methods: Patients undergoing endoscopic or percutaneous drainage for palliative MBO were included in a multicenter, retrospective study. Probability factors associated with 30-day mortality were evaluated by univariable and multivariable logistic regression in the derivation cohort and a prognostic score was built and evaluated in an independent validation cohort.

Results: The derivation cohort included 262 patients, 55% male, 61% of whom had pancreatic adenocarcinoma, mean age 72 years. Probability factors associated with 30-day mortality identified in the derivation cohort were World Health Organization performance status of 3-4 (odds ratio [OR] 7.7 [2.57-25.0] ; +3 points), liver metastases (OR 2.7 [1.06-6.98] ; +1 point), other metastases (OR 3.85 [1.57-9.97] ; +2 points), leukocytes >12G/l (OR 2.4 [0.94-6.08]; +1 point), total bilirubin > 10.8 mg/dL (OR 4.3 [1.45-15.20] ; +2 points) and creatininemia > 5.0 mg/dL (OR 7.3 [2.89-19.86]; +3 points). The multivariable model showed good discrimination, with an area under the receiver operating curve (AUROC) of 0.86 (95% confidence interval 0.80-0.93). The prognostic score was used to define two groups of patients, with a low (0-4 points) or high-probability (> 4 points) of 30-day mortality (3% and 32%, respectively). The AUROC in the validation cohort (192 patients) was 0.72, with 30-day mortality of 7% in the low- probability group and 22% in the high- probability group ( P = 0.02).

Conclusions: This score could be used in routine clinical practice to identify patients who have better survival outcomes after biliary drainage in palliative MBO.

Background and study aims: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a nonsurgical treatment option for managing pancreatic lesions. We sought to evaluate the safety and efficacy of EUS-RFA for large (≥4 cm) branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs).

Patients and methods: Patients with a definitive diagnosis of BD-IPMN who declined or were unfit for surgery underwent EUS-RFA in a single-arm prospective trial. Ablation was performed using a 19G EUS-RFA needle. RFA applications were delivered up to a maximum threshold of 45 seconds or 400 ohms impedance. Safety was assessed using AGREE guidelines. Potential for efficacy was assessed using cyst volume and cyst fluid KRAS GNAS mutations using next-generation sequencing (NGS). Adverse events (AEs) were analyzed per RFA session, while response was analyzed per BD-IPMN.

Results: Thirty BD-IPMNs (mean diameter 4.6 ± 1.7 cm; 80% multilocular) in 25 participants (mean age 74.1 ± 8.3 years) underwent 41 EUS-RFA sessions. AEs occurred in 12.2% of procedures (5/41), the majority being AGREE Grade 3A (9.8%, 4/41). During a mean follow-up of 18 ± 5 months, 22 of 28 BD-IPMNs (78.6%) achieved ≥ 50% reduction in cyst volume, and 11 (39.3%) demonstrated complete (≥90%) response. Among 26 BD-IPMNs that revealed KRAS GNAS mutations, follow-up NGS was performed in 17, with 88.2% showing loss of detectable mutations.

Conclusions: EUS-RFA in large, predominantly multilocular BD-IPMNs shows promising volumetric efficacy. Safety may be improved through refined energy delivery and technical advances. Molecular response remains exploratory and requires further validation. Long-term studies assessing progression-free outcomes are needed to define its role as an organ-preserving therapeutic option.

Background and study aims: Data on survival for elderly Western patients undergoing endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) are scarce.

Patients and methods: A multicenter, prospective, cohort study (2016-2022) was conducted in 26 Spanish hospitals that included patients aged > 70 years treated with ESD for EGC. The primary endpoint was overall survival in octogenarians compared with the previous decade; secondary outcomes included safety and technical success.

Results: A total of 217 patients were included, 135 in their 70s (Group A) and 82 in their 80s (Group B). Group B had higher comorbidity (73.2% vs 46.7%; P < 0.001) and greater anticoagulant use (39.5% vs 17.3%; P < 0.001). Technical success and intraprocedural adverse events were similar, but delayed bleeding was higher in Group B (22.8% vs 8.2%; P = 0.003). No intraprocedural deaths occurred, but three patients in Group B (3.6%) died within 30 days (2 post-ESD, 1 post-surgery). Of 169 patients followed (77.9%), 28 died (16%), including two cancer-related deaths in Group B. Five-year overall survival (OS) was 78% in Group A and 57% in Group B ( P = 0.03); median survival in Group B was 58.5 months. Multivariate analysis identified American Society of Anesthesiologists performance status (ASA-PS) ≥ III as the only independent risk factor for lower OS (hazard ratio 3.9; 95% confidence interval 1.3-11.3; P = 0.014).

Conclusions: Octogenarians with EGC benefit from ESD in a Western setting in terms of disease-free survival, but have lower long-term survival due to comorbidities, underscoring the importance of pre-procedure risk assessment. ESD is a proven safe technique, but in the subgroup of patients aged ≥ 80 years with severe comorbidities (ASA-PS ≥ IV), periprocedural mortality is increased and the indication should be carefully evaluated.

Background and study aims: Delay or absence of follow-up after luminal or pancreatobiliary stent placement can lead to adverse events. Few studies have investigated patient factors that impact compliance. The aim of this study was to identify patient-related predictors of compliance and non-compliance for luminal or pancreatobiliary stent removal at a single center.

Patients and methods: Patients who underwent esophagogastroduodenoscopy, endoscopic ultrasound, and/or endoscopic retrograde cholangiopancreatography with temporary stent placement for disease from March 2020 to March 2024 were included. Compliance was defined as stent removal or imaging confirming stent passage within 6 months (plastic stents or any cystgastrostomy stents) or 12 months (metal biliary stents) of the index procedure. Social and demographic risk factors potentially associated with stent removal and non-compliance were analyzed.

Results: One hundred fifty-one cases fit the inclusion criteria, of which 118 involved compliant patients (78%) and 33 (22%) involved non-compliant patients. Time to stent removal was 57 ± 43 days in the compliant group and 324 ± 156 days in the non-compliant group ( P < 0.001). Common procedure indications included pancreatitis-related complications (n = 61), biliary obstruction (n = 55), and bile leak (n = 35). Predictors of non-compliance included male sex (0.047), history of drug use (P = 0.033), and absence of a working phone number ( P = 0.017) or email address ( P = 0.003), electronic medical record access ( P < 0.001), or primary care provider ( P = 0.034) before the procedure.

Conclusions: Patient-specific risk factors for non-compliance of stent removal were identified. Patients with such risk factors may require extra education and communication efforts.