Endoscopy International Open最新文献

Background and study aims: Device-assisted enteroscopy (DAE) offers a comprehensive examination of the gastrointestinal tract, yet its diagnostic and therapeutic success is dependent on adequate bowel preparation. Current methods for assessing preparation quality are subjective and limited to specific gastrointestinal segments. Although prior research explored artificial intelligence models for colon preparation classification, this study aimed to develop a convolutional neural network (CNN) for automatic evaluation of bowel cleanliness in DAE, addressing both small bowel and colon cleansing.

Patients and methods: We retrospectively analyzed 28 procedures (single balloon, double-balloon, and motorized spiral enteroscopy from January 2023 to May 2024). Bowel preparation was graded as excellent (≥ 90% visible mucosa), satisfactory (50%-90%), or unsatisfactory (< 50%). A dataset of 88,623 images (training: 90%, testing: 10%) was used, covering both small bowel and colon areas. CNN performance was evaluated against expert consensus using sensitivity, specificity, accuracy, and area under a receiver operating characteristic (AUC-ROC).

Results: The CNN demonstrated the following performance metrics: excellent cleansing (sensitivity: 97.8%, specificity: 80.3%, accuracy: 90.6%, AUC-ROC: 0.95), satisfactory cleansing (sensitivity: 81.8%, specificity: 97.9%, accuracy: 92.7%, AUC-ROC: 0.95), and unsatisfactory cleansing (sensitivity: 68.7%, specificity: 99.5%, accuracy: 96.8%, AUC-ROC: 0.96).

Conclusions: Current bowel cleanliness assessment methods are subjective and region-specific. This study presents the first CNN capable of panendoscopic bowel cleanliness evaluation during DAE, achieving high accuracy and demonstrating potential for real-time clinical application. This study marks a key step toward standardizing cleanliness assessment and endoscopy quality improvement.

Background and study aims: Indigo carmine chromoendoscopy (IC) enhances diagnosis of early gastric cancer (EGC), but its clinical application is limited by procedure complexity and time. We developed a deep-learning system using a cycle-consistent generative adversarial network (CycleGAN) to generate virtual IC images from white-light endoscopy (WLE) and evaluated visibility of EGC in video-based virtual IC in a pilot study.

Patients and methods: We collected 4,096 endoscopic still images (2,089 WLE, 2,007 real IC) from 262 patients with gastric neoplasms. A CycleGAN model was trained to convert WLE into virtual IC images, and videos with 512 × 512 pixels at 30 frames per second were generated for five EGC cases. For each case, WLE, real IC, and virtual IC videos were prepared and evaluated by 16 endoscopists (6 experts, 10 non-experts). Visibility relative to WLE was rated using a 7-point Likert-type scale (-3 to +3), with positive values indicating improved visibility.

Results: A total of 160 evaluations were performed. Median [IQR] visibility score was 1 [0-2)] for real IC and 0 [-1 to 1] for virtual IC ( P < 0.001). In virtual IC, 46.3% of cases achieved a score of +1 or higher. Scores significantly varied by endoscope system ( P < 0.001).

Conclusions: Virtual IC improved visibility compared with WLE in nearly half the assessments, although its efficacy did not equal real IC. Optimizing performance for specific endoscope systems may enhance its clinical utility as a practical alternative for improving EGC detection.

Techniques of interventional endoscopy such as implantation of stents, leak closure by clips, or endoscopic suturing can help in reducing risk of an unfavorable outcome for patients with fistulas in the gastrointestinal tract. One method is endoscopic internal drainage (EID), which has been reported to have remarkable success. Because dislocation can reduce success, endoscopic suture techniques have been applied; however, devices could be cumbersome and/or expensive. The purpose of this experimental study was to evaluation the new endoscopic suturing needle-holder SutuArt for fixation of internal drains at a gastric fistula site. This suturing system is a through-the-scope needle-holder, which can be rotated within the working channel 360 degrees and maneuvered with the endoscope tip in many positions. The experiment was performed using an explanted porcine stomach with attached esophagus. Three consecutive running stitches were performed to provide sufficient fixation of the drain at an experimental "fistula" site. Afterward, the force was measured to dislocate the fixed drain. The results of 12 measurements (median duration 23 minutes; range: 19-44) at 6.7 Newton were compared with the reference value of 12 Newton (full-thickness open-stitch), thus withstanding a substantial pulling force. In conclusion, this study demonstrates the conceptual possibility of using an endoscopic needle holder for suture-fixation of a drain. Further clinical investigations are required to establish a full feasibility test of the concept.

Background and study aims: Pancreatic ductal adenocarcinoma (PDAC) is a poor prognostic malignancy. Comprehensive genomic profiling (CGP) has improved outcomes in many cancers, but widespread uptake in PDAC remains elusive. This study investigated the feasibility of using endoscopic ultrasound with fine-needle biopsy (EUS-FNB) for CGP in advanced PDAC.

Patients and methods experimental design: A multicenter prospective cohort study was conducted to assess the feasibility of using DNA and RNA extracted from fresh frozen or archival formalin-fixed paraffin-embedded (FFPE) EUS-FNB for CGP on advanced PDAC using the TSO-500 gene panel testing. Results of the CGP were reviewed at a molecular tumor board (MTB) and subsequent treatment recommendations were forwarded to the referring clinicians.

Results: CGP was successful in 129 of 143 patients (90%) enrolled between May 2020 to September 2023. Fresh frozen EUS-FNB provided suitable genetic material for CGP in 123 of 133 patients (92%). Conversely, CGP was successful on FFPE biopsy blocks from only six of 16 patients (38%). Fifty-two of 143 patients (36%) had a potentially targetable mutation detected, and eight of these patients (6%) were treated with targeted therapy based on their EUS-FNB-derived molecular profile. Patients who received personalized therapy had a significant ( P < 0.0001) increase in survival versus standard or no therapy at 12 and 36 months. Median patient survival on standard therapy was 9.47 months versus > 18 months for personalized therapy.

Conclusions: This real-world study confirms the feasibility and utility of CGP using EUS-FNB in advanced PDAC. It illustrates the importance of timely access to personalized therapy informed by CGP, which can impact the treatment pathway and improve survival outcomes.

Background and study aims: During the COVID-19 pandemic the National Health Service introduced colon capsule endoscopy (CCE) as an alternative to colonoscopy in patients awaiting 3-year post-polypectomy surveillance. We determined the safety, diagnostic accuracy, and utility of CCE in this clinical setting.

Patients and methods: Consenting patients awaiting 3-year post-polypectomy surveillance underwent CCE or colonoscopy. For those having CCE, risk-based guidance was developed directing to: 1) immediate colorectal endoscopic intervention; 2) deferred intervention; or 3) discharge. The safety, comparative and paired diagnostic accuracy, and colonoscopy capacity spared by CCE were determined.

Results: There were 464 CCE and 78 colonoscopy patients recruited. CCE patients were younger (mean 62 years versus 68 years). CCE was safely tolerated in 99% of patients. More ≥ 10 mm and 6- to 9-mm polyps were detected in the CCE cohort than the colonoscopy comparator cohort. This was on an intention to investigate basis and in those who had complete and adequately prepared examinations. Two hundred and five CCE patients had an urgent colonoscopy or flexible sigmoidoscopy and their paired findings were matched. Per patient sensitivities for ≥ 10 mm and 6- to 9-mm polyps were 92% and 90%, respectively. Two-thirds of patients entered a modified management pathway after CCE with 25% being discharged and 27% having a procedure deferral for up to 3 years. CCE completion and bowel preparation adequacy rates were 78% and 73% respectively. No colorectal cancer was detected.

Conclusions: CCE is a safe diagnostic of colorectal polyps. In surveillance, its "filter function" complements existing colorectal diagnostic services by providing capacity and choice.

Background and study aims: This study aimed to assess both short-term safety and long-term outcomes of whole circumferential endoscopic submucosal dissection (WC-ESD) for esophageal squamous cell carcinoma (ESCC) with tumor length > 50 mm, and to evaluate effectiveness of aggressive prophylactic dilation combined with steroid therapy in preventing esophageal stricture.

Patients and methods: A retrospective review was conducted on 67 patients who underwent WC-ESD for superficial ESCC between 2009 and 2019 at a single Japanese center. Patients were categorized into > 50-mm and ≤ 50-mm groups. The primary endpoint was incidence of post-ESD stricture in the main analysis excluding surgery/chemoradiotherapy cases within 90 days; sensitivity analysis included all patients. Secondary endpoints were number of dilations, steroid use, and long-term survival outcomes (overall survival [OS], disease-specific survival [DSS], relapse-free survival [RFS]).

Results: Stricture incidence was not significantly different (> 50 mm vs. ≤ 50 mm: 13% vs. 18%, P = 0.708; sensitivity: 21% vs. 15%, P = 0.538). Although dilations were more frequent in the > 50-mm group (96% vs. 83%), median sessions were similar (8 vs. 7.5). Prophylactic dilation plus steroids reduced refractory strictures (25%→7%, P = 0.03). For pT1a-EP/LPM cases, 5-year OS, DSS, and RFS were 100% in both groups. In pT1a-MM/pT1b cases, survival was comparable, although OS tended to be lower with > 50-mm lesions (68.9% vs. 100%, P = 0.07).

Conclusions: WC-ESD for superficial ESCC with a tumor length > 50 mm did not increase adverse events and provided comparable long-term survival. These findings support feasibility beyond guideline limits and emphasize further refinement of stricture prevention.

Background and study aims: Olympus's new endoscopic system, EVIS X1, features five-LED illumination and a novel complementary metal-oxide-semiconductor (CMOS) image sensor distinct from conventional charge-coupled devices (CCDs), potentially improving colorectal adenoma detection rates (ADRs). This study compared ADR and related indicators between the EVIS X1 system and the conventional EVIS LUCERA ELITE, a xenon-light system.

Patients and methods: Of 4,915 colonoscopies performed between September 2020 and April 2023, 814 EVIS X1 and 953 LUCERA cases met inclusion criteria. After propensity score matching to balance baseline characteristics, 660 patients per group were analyzed. Outcomes included ADR, polyp detection rate (PDR), adenomas per colonoscopy (APC), and polyps per colonoscopy (PPC). Subgroup analysis assessed the impact of CMOS-equipped scopes within the X1 group.

Results: ADR was slightly higher in the X1 group (36.1%) than the LUCERA group (32.1%), although not statistically significant ( P = 0.147). APC (0.77 vs. 0.61, P = 0.034) and PPC (0.95 vs. 0.75, P = 0.023) were significantly higher with X1. Within the X1 group, scopes with CMOS sensors achieved a significantly higher ADR (41.9%) compared with those without. Mean size of polyps detected was smaller with CMOS than with CCD scopes. Multivariate analysis identified age > 60 years, male sex, positive fecal occult blood test, and use of the X1 system with CMOS scopes as independent predictors of higher ADR.

Conclusions: The EVIS X1 system may have the potential to improve adenoma detection, particularly when used with CMOS sensor-equipped scopes. These findings suggest potential benefits for colorectal cancer screening, although further large-scale studies are warranted for validation.

Background and study aims: Esophageal refractory benign strictures are challenging to manage. Fully-covered metallic stents (FCSEMS) are swiftly efficient but subject to high migration rates. Because new through-the-scope suturing devices (TTSS) are now available, an alternative to over-the-scope/through-the-scope clips (OTSC/TTSC) or over-the-scope suturing devices (OTSS) can be trialed to anchor FCSEMS and prevent their dislodgement.

Methods: We performed a preclinical comparison on a porcine model of the ability to prevent FCSEMS migration with TTSS, OTSC, and TTSC. Given the promising results, we then performed stent anchoring with TTSS to selected patients with refractory benign strictures. We hereby present these initial procedures and their outcomes.

Results: In preclinical trials, TTSS provided significantly higher resistance to traction than OTSC, TTSC, and no anchoring. We performed eight FCSEMS anchoring with TTSS among six patients, with encouraging technical and clinical outcomes.

Conclusions: This is the first preclinical and clinical description of the benefits of TTSS for FCSEMS anchoring in esophageal refractory benign strictures. Safe and efficient anchoring with TTSS could allow using double-silicon-layered FCSEMS that can be left in place several months for management of refractory benign strictures. This work paves the way for prospective studies assessing FCSEMS anchoring with TTSS.

Background and study aims: Esophagogastric junction (EGJ) lesions are uncommon and histologically diverse. Among these, EGJ hyperplastic lesions are rare and generally considered benign. However, their nonspecific appearance makes accurate endoscopic identification challenging. Endoscopic resection is both a diagnostic and therapeutic approach, yet risk factors for neoplastic transformation in EGJ lesions remain unclear. This study aimed to identify predictive factors for neoplastic transformation in hyperplastic EGJ lesions.

Patients and methods: This multicenter, retrospective study included patients with hyperplastic EGJ lesions endoscopically resected across 13 European hospitals. Data were collected from endoscopy and pathology reports. Neoplastic transformation was defined by presence of dysplasia or adenocarcinoma. A multivariable logistic regression model was conducted to assess predictive factors for neoplastic transformation in resected hyperplastic lesions.

Results: From January 2015 to October 2024, 91 EGJ hyperplastic lesions were included. Polypectomy/endoscopic mucosal resection (EMR) was performed in 86% of cases, endoscopic submucosal dissection (ESD) in 19%. En bloc resection was successfully achieved in 93% of cases, whereas R0 resection rates were confirmed in 84% of cases. Twenty-one lesions (23%) showed neoplastic transformation on histology. Independent predictive factors for neoplastic transformation in hyperplastic lesions included non-polypoid morphology (odds ratio [OR] 5.48; P = 0.025), presence of surface ulceration (OR 11.5; P = 0.0005) and lesion size (OR 5.48; P = 0.021). Lesion size > 12 mm was identified as a significant predictor of neoplastic transformation in hyperplastic lesions.

Conclusions: EGJ hyperplastic lesions showed a non-negligible risk of neoplastic transformation. These findings highlight the need for careful endoscopic assessment to predict malignancy while promoting appropriate management strategies to ensure adequate R0 resection in case of undetected local malignancy.

Background and study aims: This study aimed to develop a clinical prediction model to assess the 24-hour post-ERCP complication risk in patients with common bile duct stones (CBDs), guiding clinical decision-making for ERCP as a day surgery.

Patients and methods: Retrospective data from The First Hospital of Lanzhou University (2010-2019) and prospective multicenter data on post-ERCP complications (2020-2023) were collected and registered on ClinicalTrials.gov (NCT04234126, NCT04242394). The ADASYN method was used for dataset balancing. Machine learning algorithms, including KNN, XGBoost, RF, SVM, and NB, were compared with traditional models. External validation was performed with retrospective data from other ERCP centers (2015-2017) and The First Hospital of Lanzhou University (2019-2020), with registration under NCT02510495. The optimal model was selected based on the ROC curve (AUC), and an online prediction tool was developed.

Results: A logistic regression (LR) model incorporating seven feature variables-mechanical lithotripsy, pancreatic duct cannulation, bile duct dilation, residual stones, white blood cell count, alanine aminotransferase (ALT) level, and pancreatic duct stent placement-was identified as the optimal model, The model yielded specificity, sensitivity, accuracy, and AUC values of 0.835, 0.655, 0.807, and 0.819 in the external validation set, with a second external validation set providing additional results of 0.799, 0.714, 0.784, and 0.805. Patients were stratified into high- and low-risk groups. An online calculator was developed ( https://borujin.shinyapps.io/dynnomapp/ ).

Conclusions: The results indicate that the proposed LR model, utilizing the top seven risk factors, could serve as an effective tool for predicting occurrence of complications in day surgery.