Endoscopy International Open最新文献

Background and study aims: The eCura system has been shown to accurately delineate early gastric cancers with negligible risk of lymph node metastases, which, therefore, would be considered endoscopically cured. However, this classification was based predominantly on data from high-incidence Eastern countries. We sought to assess whether these criteria can be safely applied in a Western population.

Patients and methods: Data were retrospectively recorded for patients who underwent gastrectomy in four Australian tertiary centee over two decades. Demographic data, lesion characteristics (size, differentiation, invasion depth, lymphovascular invasion, and ulceration) as well as number of lymph node metastases was recorded. Patients given neoadjuvant chemotherapy were excluded.

Results: A total of 1,465 gastrectomy specimens were reviewed, including in 558 patients who underwent resection of gastric adenocarcinoma without neoadjuvant chemotherapy (mean age 67.9, 64.2% male). Of these, 101 (18.1%, confidence interval [CI] 15.4%-21.9%) had T1 disease (T1a = 30, T1b = 71). Of the lesions, 11.5% (n = 64, CI 9.1%-14.4%) met the 2021 Japanese "absolute criteria" for endoscopic resection, with 7.8% of these (n = 5, CI 3.4%-17%) having positive lymph nodes at gastrectomy. Of them, 9.9% (n = 55, CI 7.6%-12.6%) would have been considered eCura A or B, with none of these having positive lymph nodes at gastrectomy.

Conclusions: The eCura system for defining endoscopic curability could have been safely applied in this Western population. Even in Western countries, patients with early gastric cancer that meets Japanese guidelines for endoscopic resection should, where possible, undergo en bloc endoscopic submucosal dissection. Lesions classified histologically as eCuraA or B should be considered endoscopically cured.

Background and study aims: Axis deviation and helical stricture following sleeve gastrectomy may result in functional gastric outlet obstruction, leading to significant patient morbidity. Conventional endoscopic therapies, such as balloon dilation and self-expandable metal stents (SEMS), have demonstrated limited efficacy and are frequently associated with recurrence and complications. This study aimed to assess clinical outcomes of endoscopic stricturotomy as a minimally invasive technique for managing axis-related stenosis after sleeve gastrectomy.

Patients and methods: This retrospective case series included adult patients (≥ 18 years) who underwent endoscopic stricturotomy for axis-related stenosis at a tertiary academic center from 2019 to 2024. Diagnosis of helical stricture was confirmed via endoscopic and radiologic assessments. Clinical data were obtained through electronic chart review and structured telephone interviews. Symptom severity was evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and quality of life was assessed using a visual analog scale (VAS). Statistical analysis included the Shapiro-Wilk test and paired t-test or Wilcoxon signed-rank test, with P < 0.05 considered significant.

Results: Eight patients (mean age 53 years; 62.5% female) were included, with a mean time of 31.3 months between surgery and stricturotomy. All GCSI domains showed significant symptom improvement. The global GCSI score improved from 35.44 to 21.66 ( P = 0.014), and VAS scores increased from 3.0 to 7.75. Complications included two cases of intraoperative pneumoperitoneum and one delayed gastric fistula, all managed non-surgically.

Conclusions: Endoscopic stricturotomy is a promising, minimally invasive treatment for axis-related gastric outlet obstruction post-sleeve gastrectomy. Prospective studies are warranted to confirm long-term outcomes.

Background and study aims: Endoscopic transmural drainage with subsequent endoscopic necrosectomy (EN) has become the first-line treatment for acute necrotizing pancreatitis with walled-off necrosis (WON). There is a growing interest in incorporating EN at the index intervention; however, data about the safety of EN are limited. This case series evaluated the rate and type of adverse events (AEs) associated with EN.

Patients and methods: We retrospectively included consecutive patients with WON from 2012 to 2024 who underwent EN in our tertiary referral center. An AE was defined as any event leading to premature cessation of necrosectomy or requiring intervention either during the procedure or within 24 hours of the procedure.

Results: A total of 235 patients and 880 EN procedures (median: 3, interquartile range: 2-5) were recorded. The median age of patients was 57.5 years, of whom 116 were female (49.3%). Snares were used in most procedures (90.9%), EndoRotor in 4.3%, and both were used in 4.8% of procedures. A total of 14 AEs (1.6%) were identified in 11 different patients (4.7%): 13 bleeds and one pneumoperitoneum. In-hospital mortality was significantly higher in the AE group (45.5%) than in the non-AE group (10.3%, P = 0.0004).

Conclusions: AEs are rare in EN but are associated with increased mortality.

Background and study aims: Evidence on gastric endoscopic submucosal dissection (ESD) under glucocorticoids or immunomodulators (GC/IM) is limited. We evaluated whether GC/IM use affects gastric ESD outcomes.

Patients and methods: We retrospectively analyzed 411 consecutive ESDs (April 2017-April 2022). GC/IM users (n = 32) were compared with controls (n = 379); 1:3 propensity-score matching yielded 27 vs 81 patients. The primary outcome was overall complications, defined as a composite of pain, fever, delayed bleeding, and delayed perforation. Secondary outcomes were each component, intra-procedure perforation, hospital stay, and use of symptom-directed treatments (analgesics, antipyretics, antibiotics).

Results: Overall complications were more frequent with GC/IM than controls (44.4% vs 21.0%; P = 0.024; relative risk [RR] 2.11, 95% confidence interval 1.16-3.84), driven by pain (40.7% vs 18.5%; P = 0.035) and fever (11.1% vs 1.2%; P = 0.047). Rates of major complications did not differ (delayed bleeding 3.7% vs 2.5%; delayed perforation 0% vs 0%). Intra-procedure perforation was numerically higher (7.4% vs 3.7%) without significance. Median (interquartile range) hospital stay showed a small, non-significant difference (9 [7-12] vs 8 [7-9] days; P = 0.064). Symptom management was used more often with GC/IM (analgesics 25.9% vs 3.7%, P = 0.002; antipyretics 7.4% vs 2.5%, P = 0.270; antibiotics 7.4% vs 3.7%, P = 0.597).

Conclusions: In patients receiving GC/IM, gastric ESD was associated with a higher incidence of minor, clinically managed events-chiefly pain and transient fever-whereas major complications remained uncommon. With close monitoring and prompt symptom-directed care, gastric ESD appeared clinically feasible, albeit with slightly greater resource use and observation time.

Background and study aims: Scissor-type knives have shown safety and efficacy in endoscopic submucosal dissection (ESD) procedures, particularly in studies from Japan. However, the safety and efficacy of these devices in international settings, particularly outside Japan, is not well established.

Patients and methods: This was a prospective, multicenter, observational study conducted across nine international centers, encompassing a total of 461 lesions from 460 patients. In subgroup analysis, 162 lesions came from four institutions in Japan (Japanese institutions group, JAG) and 299 lesions from five institutions outside Japan (non-Japanese institutions group [NJAG]). After 1:1 propensity score matching resulted in 120 matched pairs of lesions, key outcomes were compared between groups.

Results: The overall perforation rate during ESD procedures was 0.87%. Intraoperative perforations were observed more frequently in NJAG than JAG (3 vs. 1 event, 1.9% vs. 0.33%, respectively), although not statistically significant ( P = 0.127). Overall incidence of delayed bleeding was also 0.87%, with no delayed bleeding reported in NJAG. Post propensity matching analysis revealed a significantly slower median resection speed in NJAG compared with JAG (9.12 0.86-56.57 vs 26.21 1.95-93.54 mm²/min, P < 0.001). Both histological complete resection and curative resection rates were significantly lower in NJAG than in JAG with rates of 88.3% vs 98.3% for histological complete resection and 83.3% vs 95% for curative resection (both P < 0.01).

Conclusions: Use of scissor-type knives in colorectal ESD outside Japan demonstrated a favorable safety profile. However, certain performance outcomes, such as resection speed and resection success rates, were inferior to Japanese institutions.

Endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) using the current plastic stent (PS) system requires multiple steps for stent deployment and carries the risk of bile leakage from the puncture site. In this study, we developed a single-step PS system that includes a 3F electrocautery metal tip on the inner sheath mounted with a 7F/4-cm double-pigtail PS and experimentally evaluated it on a gallbladder model mimicking EUS-GBD. We assessed procedure time, intra-gallbladder pressure-drop ratios, and bile leakage using a newly developed single-step PS system, comparing it with the current PS system during drainage attempts on a gallbladder model. Mean duration times for the three attempts were 2 minutes 59 seconds and 27 seconds for the current PS system and the newly developed PS system groups, respectively ( P < 0.001). Mean intra-gallbladder pressure-drop ratios were 86.7% in the current PS system group and 7.6% in the newly developed PS system group ( P < 0.001). The newly developed PS system prevented bile leakage from the puncture site. The newly developed PS system saved significant time, maintained intra-gallbladder pressure, and prevented bile leakage during the procedure when compared with the current PS system.

Background and study aims: Biliary stents are widely used in endoscopic retrograde cholangiopancreatography (ERCP), yet their impact on the native bile microbiome under non-infectious conditions remains unclear. We aimed to characterize stent-associated alterations in the biliary microbiome using 16S rRNA gene sequencing.

Patients and methods: We analyzed bile samples collected during ERCP from 35 patients without clinical or laboratory evidence of acute cholangitis. Patients were categorized into a control group (n = 25; naïve papillae) and an endoscopic biliary stenting (EBS) group (n = 10; previously stented). Microbial composition was assessed using high-throughput 16S rRNA sequencing after propensity score matching to balance background characteristics.

Results: Beta diversity differed significantly between groups (PERMANOVA, P < 0.01), despite no significant differences in alpha diversity. The EBS group demonstrated increased relative abundance of Firmicutes and Fusobacteriota , and depletion of Proteobacteria . Notably, Enterococcus was significantly enriched in the EBS group (log fold change 6.74; q < 0.01), whereas Sphingomonas was reduced.

Conclusions: Endoscopic biliary stenting is associated with distinct bile microbiome alterations, characterized by enrichment of Enterococcus species in clinically stable patients. These findings suggest that stents may predispose to opportunistic colonization, providing a potential mechanistic link to future cholangitis. Recognizing such preclinical dysbiosis may inform tailored antimicrobial strategies and future stent design.