Endoscopy International Open最新文献

Background and study aims We compared the ability of adenoma detection rate (ADR) and adenoma per colonoscopy (APC) to assess endoscopist detection, using statistical principles and simulations. Patients and methods We simulated a population of endoscopists and patients to compare the ability of ADR versus APC for capturing true endoscopist ability (TEA). We compared these rates with and without adjustment for patient and exam factors using multivariable models, and adjustment for imprecision due to low volume using empirical Bayes (shrinkage). Power calculations were used to compare the ability of ADR and APC to distinguish higher from lower rates over two time periods for an endoscopist. Results APC and ADR had similar discriminatory ability for assessing TEA. This increased with higher volumes and after adjusting for risk factors and low volume using shrinkage. Higher APC and ADRs had higher power for comparing endoscopist detection over two time periods, but APC was superior to ADR. For example, there was 29% power to distinguish APCs (n = 200 colonoscopies) 0.10 from 0.15, similar to the power (28%) to distinguish corresponding ADRs: 10% and 14%. However, at same volume (n = 200), the power to distinguish higher APC rates (0.50 vs.0.75) was greater (89%) than the power (78%) for corresponding ADRs (39% vs.53%). Conclusions Adjusting for patient and exam factors and/or using shrinkage techniques for lower-volume endoscopists can increase the correlation between TEA for both ADR and APC. For higher detection rates, APC offers more power than ADR in distinguishing differences in detection ability.

Background and study aims Because more than a few patients have intraductal papillary mucinous neoplasms of the pancreas (IPMNs) with mural nodules (MNs) that are benign, clinical plans should be determined by using histocytological specimens especially, for patients with high risk for surgery or with a small MN. Patients and methods This study included 27 patients to evaluate the efficacy of peroral pancreatoscopy using a SpyGlass DS system (POPS-DS) for patients with MN-positive IPMN, mainly focusing on the ability of POPS-DS to detect malignancy. Results Biopsy specimens obtained under POPS-DS guidance could be used for histological evaluation of all patients with MNs in the main pancreatic duct and 67% of the patients with MNs in the branch ducts, whereas fluid specimens collected during POPS-DS could be used for histocytological evaluation for all patients. For the 13 patients who underwent surgery just after POPS-DS, the sensitivity, specificity, and accuracy of POPS-DS to detect malignancy were 89%, 100%, and 92%, respectively. For the 12 patients who underwent surveillance without surgery, the cumulative 3-year progression rates for nine benign IPMNs and three malignant ones determined using POPS-DS were 0% and 100%, respectively. However, the sensitivity of POPS to detect IPMN epithelium in the resection margin was 20%. Only one patient developed procedure-related pancreatitis (mild). Conclusions POPS-DS could be used to accurately detect malignancy in patients with MN-positive IPMN. Therefore, histocytological evaluation using POPS-DS can contribute to selection of patients for whom surgery would be appropriate.

Background and study aims Although deep vein thrombosis (DVT) and pulmonary embolism (PE) are major postoperative complications, risk of DVT/PE after endoscopic procedures remains unknown. This study aimed to identify risks of DVT/PE after colorectal endoscopic submucosal dissection (ESD) and double-balloon endoscopy (DBE). Patients and methods Patients who were scheduled to undergo DBE and colorectal ESD were prospectively enrolled in this study. Before enrollment, all patients were confirmed to have no DVT on whole-leg ultrasonography (US) or contrast-enhanced computed tomography (CECT). All patients routinely underwent whole-leg US after ESD or DBE. The primary endpoint was incidence of DVT after colorectal ESD and DBE. The preplanned sample size was 170 patients in the colorectal ESD group and 75 in the DBE group. Results Between September 2020 and June 2022, 170 patients who had colorectal ESD and 75 who had DBE were recruited for this study; however, 238 patients (ESD, n = 167; DBE, n = 71) were analyzed. Of these 238 patients, DVT occurred in only one patient after colorectal ESD and incidence of DVT was 0.4% (95% confidence interval [CI] 0-1.2) in total, including 0.6% (95% CI 0-1.8) after colorectal ESD and 0% after DBE. Conversely, no PE occurred in the entire cohort. Conclusions This prospective study demonstrated that risk of DVT/PE following highly invasive endoscopic procedures including colorectal ESD and DBE is very low.

Background and study aims Bowel obstruction is a common complication in advanced cancer patients. Patients are restricted in quality of life (QOL) due to nausea, vomiting, or abdominal pain. Prospective data on the feasibility and benefit of decompressive percutaneous endoscopic gastrostomy (dPEG) are scarce. Patients and methods Patients suffering from symptomatic bowel obstruction due to advanced cancer were included prospectively in a single-center study when other treatments to eliminate the obstruction were impossible. Patients were given a questionnaire the day before dPEG (d-1) and, if the procedure was successful, the day after (d+1) and 14 days after the procedure (d14). Furthermore, lifetime after dPEG was assessed. Results 53 patients were included. dPEG was technically feasible in 34 of 53 (64.2%). Significant improvement could be shown for nausea and vomiting when comparing d-1 to d+1 (nausea ( P = 0.002), vomiting ( P < 0.001)) and when comparing d-1 to d14 ( P = 0.021 and P = 0.003, respectively). Comparing d+1 to d14, there was no further improvement. QOL improved significantly from 8.1 (mean) on d-1 to 5.9 (mean) on d+1 ( P < 0.001). Median survival after successful dPEG was 27 days (range 2-353). Conclusions dPEG is an effective method for quickly relieve symptoms of malignant bowel obstruction in advanced cancer patients. However, the technical success rate is limited and needs to be improved. Prospective studies comparing endoscopic and computed tomography-guided procedures are needed to avoid unsuccessful procedures in patients with advanced cancer and limited life expectancy.

Background and study aims This was a prospective study of efficacy and safety of motorized spiral enteroscopy (MSE) to perform biliary endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy at five European centers. Patients and methods Consecutive patients with biliary indications for enteroscopy-assisted ERCP were enrolled. Objectives were technical success, adverse event (AE) rate, and patient radiation exposure. Results Eighty-nine patients were enrolled and one was excluded for a pancreatic indication. All participants had variations of Billroth II reconstruction (29.5%) or Roux-en-Y reconstruction (70.5%), either with naive papilla (39%) or hepaticojejunostomy (61%). Main indications were anastomotic stricture treatment and/or biliary stone removal. Enteroscopy to reach the bile duct was possible in 65 of 88 patients (74%), bile duct cannulation in 54 of 88 (61%), and therapeutic ERCP was technically successful in 48 of 88 (54%). In Billroth II variations, technical success was achieved in 13 of 26 patients (50%) compared with 35 of 62 (57%, P = 0.5792 Chi square) in Roux-en-Y reconstructions (including bariatric gastric bypass). ERCP with intact papilla was successful in 17 of 34 patients (50%) compared with 31 of 54 (57%, P = 0.4968 Chi square) in hepaticojejunostomy. The study was prematurely terminated July 2023 because MSE was withdrawn by the manufacturer for safety issues. Overall, in 12 of 88 patients (14%), AEs were recorded and six (7%) were considered serious. Only one serious AE was attributable to MSE enteroscopy: perforation of the proximal esophagus during enteroscope insertion. Conclusions This prospective multicenter study was prematurely discontinued due to withdrawal of the MSE by the manufacturer because of safety issues. Technical success of MSE-assisted biliary ERCP in different types of surgically altered anatomy was 54%, which was lower than anticipated. There was one esophageal perforation attributable to use of MSE. (clinicaltrials.gov: NCT05129449).

Background and study aims Participation in and quality of colorectal cancer (CRC) screening varies greatly and it is unclear how much of CRC screening guideline quality metrics reach patients. The aims of this prospective observational study were to provide data from everyday practice in Austria. Patients and methods All employees aged ≥ 50 years were invited and received a stool-based-test (FIT (cut-off 25 mcg Hb/g) and M2PK), which could be dropped off at the workplace. All individuals with positive tests were called and offered a colonoscopy near their workplace/home in ≤ 3 weeks performed by unselected endoscopists. Non-attendees received email and telephone reminders. Results Of 10,239 eligible employees (2706 males, 7533 females), 2390 (23%) (plus 673 < 50 years) median age 53 (interquartile range 50;56) participated in the stool-based screening (18% males, 25% females). Of 3063 tests, 747 (24%) were positive. The follow-up rate for 616 individuals who accepted or eventually underwent colonoscopy was 84% (n = 517). The adenoma detection rate (ADR) was 20.5% (31% in men, 17% in women) and varied substantially, ranging from 15% in hospitals (excluding the study center) to 18.5% among office-based endoscopists, and up to 36% in the study center. Most European Society of Gastrointestinal Endoscopy-recommended performance indicators were unmet, including the polyp detection rate (PDR), ADR, reporting of polyp characteristics, and bowel preparation adequacy. Conclusions There is a serious gap between recommended standards and real-world CRC screening colonoscopy quality. Implementation of CRC screening should not only be accompanied by strategies to increase participation rates but focus on implementation of rigorous, mandatory colonoscopy quality assurance programs.

Background and study aims Endoscopic sphincterotomy can be challenging especially in patients with surgically altered anatomy. Although a rotatable sphincterotome (r-sphincterotome) may be useful, its rotational function is often inadequate. We evaluated the feasibility of a newly designed r-sphincterotome equipped with a well-conceived cutting wire. Methods We measured the movement and dynamics of both the newly designed r-sphincterotome and two existing r-sphincterotomes using in-house equipment. Ideally, the rotational force exerted at the proximal end should transmit directly to the distal end. But it is often challenging, particularly within the constraints of a bent endoscope and working channel. We collected data regarding deviation from the ideal value 10 times for each sphincterotome. Results The deviation from the ideal value was significantly lower with the newly designed r-sphincterotome than with the conventional r-sphincterotomes (44.9 ± 27.8 vs. 73.7 ± 44.6 and 130.1 ± 71.4 degrees, respectively; P < 0.001). The newly designed r-sphincterotome rotated smoothly and consistently at a constant speed, mirroring the input rotation. Conclusions We evaluated the feasibility of the newly designed r-sphincterotome using an experimental model. We believe that the findings from these experiments may contribute to easier and more precise sphincterotomies.

Background and study aims Although small hypervascular tumors are suspected to be pancreatic neuroendocrine tumors (p-NENs), their diagnosis and treatment are challenging. This study evaluated the usefulness of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for diagnosis of small p-NENs. Methods All p-NEN lesions that underwent EUS-TA at our hospital between April 2018 and December 2023 were retrospectively analyzed. The diagnostic sensitivity of EUS-TA and the concordance rate of grading with EUS-TA and surgical specimens were examined. The lesions were grouped by size. Results The diagnostic sensitivity of EUS-TA was analyzed for 82 lesions, of which 44 were compared with postoperative specimens for grading. The definitive diagnosis was neuroendocrine tumor (NET) in 75 lesions, neuroendocrine carcinoma in five lesions, and mixed neuroendocrine non-neuroendocrine neoplasm in two lesions. Thirty tumors were ≤10 mm, 30 were 10 to 20 mm, and 22 were >20 mm, and the diagnostic sensitivities were 96.7%, 96.7%, and 90.9%, respectively. Concordance rates for grading were 94.4%, 82.4%, and 77.8% for tumors ≤10 mm, 10 to 20 mm, and ≥20 mm, respectively, with Cohen's kappa coefficients of 0.64, 0.48, and 0.40, respectively. Conclusions EUS-TA showed adequate diagnostic sensitivity and grading agreement for p-NENs of all sizes, allowing for determination of appropriate treatment.

Background and study aims: Live swine have a high degree of coagulation and aggregation and using them for training about how to manage intraoperative bleeding during endoscopic submucosal dissection (ESD) is unsatisfactory. This study aimed to identify the appropriate heparin dose in an intraoperative bleeding model and validate its applicability. Methods: First, we explored the dose of heparin required for a swine bleeding model in which the activated clotting time reached and maintained the upper limit of measurement (1500 s) after 10 minutes. Second, we compared intraoperative bleeding and hematoma frequency during ESD for 2-cm lesions between the heparinized bleeding model and control groups. Intraoperative bleeding was classified according to the Forrest classification. Results: The combination of a bolus (300 U/kg), continuous infusion (300 U/kg/h), and a bolus dose (150 U/kg) of heparin 10 minutes after the first infusion was identified as the dose for the bleeding model. Five ESDs were performed in each heparinized bleeding model and the control group. The median number of intraoperative bleeds was significantly higher in the heparinized model than in the control group (5 interquartile range [IQR] 4-7 vs. 3 [IQR 0-4, P = 0.028). All of the intraoperative bleeding events oozing (Forrest Ib) rather than spurting (Forrest Ia). The median number of hematomas was significantly higher in the heparinized model group than in the control group (3 [IQR 1-4] vs. 0 [IQR 0-1], P = 0.023). Conclusions: High doses of heparin significantly increased intraoperative bleeding and hematoma during swine ESD.