Endoscopy International Open最新文献

Background and study aims: Preventing post-procedural bleeding (PPB) after endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) is crucial for minimizing post-endoscopic complications. We aimed to evaluate the rate of PPB in large colorectal lesions removed via EMR or ESD, followed by application of a resorbable plant-based hemostatic powder (HaemoCer PLUS).

Patients and methods: This prospective pilot study was conducted at three tertiary care centers from November 2021 to February 2024. HaemoCer PLUS was applied at the end of the procedure and spread over the post-resection surface. No endoscopic clips were used after resection.

Results: The study included 50 patients with a mean lesion diameter of 52.28 mm (standard deviation 18.29 mm). Fifty-six percent of the polyps were in the rectum and 86% were classified as adenomas. ESD was used to remove 20 lesions, hybrid ESD for eight, Hot-EMR for 17, and cold-EMR for five. All patients received HaemoCer PLUS application for PPB prevention. Delayed bleeding was observed in 6% of cases, including one case of ESD and two cases of hot-snare resection. PPB occurred 24 hours after the procedure and no bleeding cases were reported more than 30 days post-endoscopy. Univariate analysis showed no statistically significant associations between post-procedural bleeding and lesion size, patient age, or endoscopic resection technique.

Conclusions: Use of a novel resorbable plant-based hemostatic powder could be a beneficial method for reducing delayed bleeding complications, particularly in high-risk groups characterized by specific lesions and patient factors.

Background and study aims: Complex perihilar and intrahepatic biliary strictures present significant therapeutic challenges during endoscopic retrograde cholangiopancreatography (ERCP), with traditional two-dimensional fluoroscopy limiting spatial visualization. This prospective cohort study evaluated feasibility and clinical utility of novel three-dimensional (3D) fluoroscopic imaging utilizing cone beam computed tomography (CBCT) in ERCP for managing complex biliary strictures.

Patients and methods: Twenty consecutive patients with complex biliary strictures underwent ERCP with CBCT at a single tertiary center between September 2023 and December 2024. All patients had previously failed selective cannulation attempts. Using a specialized fluoroscopic system, 360-degree rotational imaging was performed. Primary outcomes included technical success (selective cannulation rate) and clinical success (successful stenting without percutaneous drainage).

Results: Stricture etiology was malignant in 60% and benign in 40%. CBCT achieved selective cannulation in 100% of cases and clinical success in 90%. Two patients required percutaneous drainage. 3D reconstruction influenced surgical planning in 10% of cases. Standard ERCP resulted in median entrance skin dose (ESD) of 156.0 mGy (range 67.3-273.0) and dose area product (DAP) of 44.4 (range 21.1-94.0] . The 3D reconstruction from CBCT contributed an additional median ESD of 174.0 mGy (range 137.0-240.0) and DAP of 53.1 Gy·cm ² (range 41.8-73.8).

Conclusions: ERCP with CBCT is technically feasible with high selective cannulation rates in complex biliary strictures. Although the technique requires additional radiation exposure, it may provide value in cases with difficult selective cannulation and surgical mapping for malignancies. Further studies are needed to define optimal patient selection and evaluate long-term outcomes.

Background and study aims: Gastric adenoma and cancer are common in Asia, with early detection critical for prognosis. Synchronous multiple early gastric cancers (SMEGCs) occur in 6% to 14% of cases, but their clinicopathological characteristics remain unclear. This study analyzed synchronous multiple gastric neoplasms treated by endoscopic resection or surgery to aid early detection.

Patients and methods: Among 2,991 cases of early gastric cancer or adenoma diagnosed at our institution, 173 patients with 346 synchronous lesions (January 2016-March 2024) were analyzed. All lesions were mucosal or submucosal. Lesions were categorized as "1st" (larger) and "2nd" (smaller), and clinicopathological characteristics were compared using Chi-square and Fisher's exact tests with Cramér's V.

Results: Patients had a mean age of 73.2 years; 72.8% were male. Most lesions were in the lower/middle stomach, differentiated (92.2%), depressed (52.9%), and brownish on narrow-band imaging (65.3%). Mean tumor diameter was 13.4 mm. Although 1st lesions were larger, other features showed high concordance (≥ 0.25 Cramér's V) in location, morphology, histology, invasion depth, and coloration. Survival was 94.8% (nine unrelated deaths).

Conclusions: Synchronous multiple gastric neoplasms tend to have similar endoscopic and histopathologic features and often occur within the same belt-like region along the short axis of the stomach. This pattern was named boundary equal lesions trends (BELT). When detecting one lesion, considering BELT is essential.

Background and study aims: Several guidelines recommend discontinuation of routine surveillance colonoscopy after age 75 years. Because Japan has one of the longest life expectancies, we considered ceasing at age 80 years. We compared patients aged 75 to 79 years with those aged 70 to 74 years, regarding adenoma detection rate (ADR), mean number of adenomas per colonoscopy, and adverse events.

Patients and methods: This propensity score-matching (PSM) study included patients aged 70 to 79 years with a performance status of 0 to 1 who underwent colonoscopies at Toyoshima Endoscopy Clinic between 2017 and 2024. Patients aged 75 to 79 years were matched with those aged 70 to 74 years for baseline characteristics using the propensity score. ADR, mean number of adenomas per colonoscopy, frequency of respiratory depression, hypotension, and delayed post-polypectomy bleeding were compared between the two groups.

Results: During the study period, 3415 patients were included. The ADR in patients aged 75 to 79 years was higher than that in patients aged 70 to 74 years (66.5% vs 62.2%, P = 0.021). Mean number of adenomas per colonoscopy in patients aged 75 to 79 years was higher than that in patients aged 70 to 74 years (1.54 vs 1.38, P = 0.014). The two groups did not show significant differences in respiratory depression (2.6% vs 2.3%), hypotension (0.8% vs 1.0%) or delayed post-polypectomy bleeding (0.2% vs 0.4%).

Conclusions: Colonoscopies for patients aged 75 to 79 are safe and effective in Japan.

Background and study aims: Patients with inflammatory bowel disease (IBD) frequently undergo colonoscopy, each requiring bowel preparation. European Society of Gastrointestinal Endoscopy (ESGE) 2019 guidelines recommended high- or low-volume polyethylene glycol (PEG)-based bowel prep for IBD patients; however other non-PEG-based preparations (sulphate and picosulphate-based) have now been studied in IBD.

Methods: We searched CENTRAL, ClinicalTrials.gov, Embase, MEDLINE, and the World Health Organization International Clinical Trials Registry Platform for randomized controlled trials (RCTs) up to December 2024. Primary outcome was bowel prep success; secondary outcomes included tolerability, acceptability, cecal intubation rates (CIR) and safety. Pooled estimates used risk ratio (RR) and GRADE to assess evidence certainty.

Results: Ten RCTs (1479 IBD patients) were included. There was no difference in prep success (relative risk [RR] 0.98, 95% confidence interval [CI] 0.88-1.09; I ² = 33%, 2 RCTs; moderate certainty evidence) between 2 L vs. 4 L PEG, but higher acceptability for 2 L (RR 0.69, 95% CI 0.59-0.80; I ² = 18%, 2 RCTs; high certainty evidence). Low-volume non-PEG vs. PEG are probably similar for prep success (RR 0.96, 95% CI 0.90-1.01; I ² = 6%,3 RCTs; moderate certainty evidence). The evidence on tolerability and acceptability was very uncertain. Subgroup analysis revealed comparable effectiveness of picosulphate-based (RR 0.89, 95% CI 0.78-1.01; I ² = 0%,1 RCT) and sulphate-based preps (RR 0.98, 95% CI 0.91-1.05; I ² = 28%, 2 RCTs) compared with low-volume PEG. Safety data were inconsistently reported.

Conclusions: High-certainty evidence supports low-volume PEG as comparably successful to high-volume PEG, with higher acceptability. Moderate-certainty evidence indicates similar success between non-PEG and PEG-based preps. Both low-volume PEG and non-PEG-based preps are supported for use in IBD, broadening options beyond current ESGE guidelines.

Background and study aims: It is currently unclear whether obstruction location affects clinical and procedure outcomes after endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) in patients with malignant gastric outlet obstruction (GOO). Therefore, we compared clinical outcomes of EUS-GE for malignant GOO located in the stomach with obstruction located in the duodenum.

Patients and methods: In this nationwide, multicenter, retrospective study, we included consecutive patients who underwent EUS-GE as palliative treatment for malignant GOO. Main outcomes were clinical success, serious adverse events (SAEs) recurrence of obstructive symptoms, and LAMS dysfunction.

Results: Between 2018 and 2023, 298 patients underwent EUS-GE. Clinical success was achieved in 73 of 82 patients with a gastric obstruction (94%) and in 174 of 216 patients with a duodenal obstruction (87%). No association was found between location of obstruction and clinical success (odds ratio [OR] 2.62, 95% confidence interval [CI] 0.91 to 7.52, P = 0.073) or SAEs (OR 0.26, 95% CI 0.06 to 1.20, P = 0.083). Recurrent obstructive symptoms occurred more frequently in patients with a gastric obstruction (hazard ratio 1.74, 95% CI 1.09 to 2.77, P = 0.020). LAMS dysfunction did not differ between the groups (7 patients [9%] with a gastric obstruction and 11 patients [5%] with a duodenal obstruction).

Conclusions: In this study, EUS-GE in patients with a gastric obstruction had comparable technical and clinical efficacy and a similar safety profile to EUS-GE for duodenal obstruction. However, gastric obstruction was associated with recurrent symptoms of obstruction unrelated to LAMS dysfunction.

Background and study aims: Mapping biopsy (MB) aids in diagnosing superficial mucosal spread of biliary tract cancer. However, conventional MB is technically challenging, which can reduce the diagnostic yield. This study aimed to assess the usefulness of MB using the newly developed Endosheather (ES) (Piolax, Tokyo, Japan).

Patients and methods: We retrospectively analyzed data from patients who had biliary tract cancer with hilar biliary obstruction and underwent MB. Outcome measures included the overall technical success rate, quality of specimens, impact of MB results on the treatment strategy, and adverse events (AEs), which were compared between the conventional (Conv) group and the ES group.

Results: A total of 91 patients were included. The overall technical success rate was significantly higher in the ES group (92%, 43/47) than in the Conv group (59%, 26/44) ( P < 0.05). The rate of samples containing both biliary epithelium and stromal tissue was significantly higher in the ES group than in the Conv group (77% [67/87] vs. 47% [32/68]; P < 0.05). MB results affected the treatment strategy in one patient (2.3%) in the Conv group and five patients (11%) in the ES group ( P = 0.11). There was no significant difference between the two groups in terms of AEs.

Conclusions: MB using ES significantly improved technical success and specimen quality, providing valuable information for preoperative assessment of patients with biliary tract cancer.

Background and study aims: Endoscopic resection of large, broad-based pedunculated and semi-pedunculated polyps can be technically difficult. Conventional snare resection risks immediate bleeding and piecemeal excision. We evaluated the safety and efficacy of a scissor-type endoscopic submucosal dissection (ST-ESD) knife for these lesions.

Patients and methods: A single-center retrospective study was conducted of all patients who underwent ST-ESD resection of pedunculated or semi-pedunculated polyps with head size ≧ 20 mm and stalk width ≧ 10 mm. Primary outcomes were en bloc resection, intraprocedural and delayed bleeding, and perforation. Secondary outcomes were R0 resection and recurrence at first follow-up.

Results: Fifty-eight resections were identified (75.6% male; median age 60 years). Median head size was 30 mm (range 20-70) with median stalk width 15 mm (range 10-50). Of them, 74.1% were in the sigmoid colon. Successful resection was achieved in 52 of 58 (89.7%); 44 (75.9%) by ST-ESD alone and eight (13.8%) snare-assisted. Six (10.3%) were abandoned; five due to visible muscle retraction and one dense stalk fibrosis. All successful resections were en bloc with R0 in 52 of 52 (100%). Minor intraprocedural bleeding occurred in nine of 58 (15.5%) and was controlled endoscopically. Forty-seven of 52 defects (90.4%) were closed prophylactically with endoscopic clips. There were no incidences of delayed bleeding or perforation. Histopathology was benign in 51 of 52 (98.1%). One adenocarcinoma was treated surgically for high-risk features. Endoscopic follow-up was available in 41 of 52 (78.8%) with no recurrence seen. Zero of six abandoned cases referred for surgery contained evidence of malignancy in the surgical specimen.

Conclusions: ST-ESD is safe and effective for resection of large, broad-based pedunculated and semi-pedunculated colorectal polyps.

The limitations of single-channel endoscopy in complex gastrointestinal disease prompted design of the over-the-scope endoscopic assisting platform (OTS-EAP), a low-profile cap that converts any diagnostic endoscope into a dual-channel therapeutic system. Ex-vivo bending tests and in-vivo porcine studies evaluated safety and feasibility for three tasks: 1) high-flow irrigation and suction of clot/chyme; 2) radiation-free, direct-visual stent delivery; and 3) purse-string closure of large endoscopic submucosal dissection defects. OTS-EAP preserved endoscope flexibility and torque; rapid valve-switching cleared the field within seconds, stents were deployed precisely under endoscopic view, and dual-instrument coordination simplified defect closure. The platform offers an inexpensive, radiation-sparing "third hand" for emergencies, bleeding, stenting, and suturing, warranting clinical translation.