Endoscopy International Open最新文献

[This corrects the article DOI: 10.1055/a-2733-3468.].

Background and study aims: This study aimed to evaluate interobserver and intraobserver agreement in Size/Morphology/Site/Access (SMSA) scoring among practicing endoscopists with varying levels of experience.

Patients and methods: A total of 102 fully independent endoscopists participated in the study. Ten short video clips of colonic polyps of varying size and complexity were recorded using Olympus 290 colonoscopes and included white light, near focus, narrow band imaging, and chromoendoscopy where applicable. These videos were embedded in an online questionnaire. Endoscopists were asked to assign SMSA scores based on three variables-size, morphology, and access-with the site provided for standardization. A subgroup of five participants repeated the assessment after 2 to 3 weeks to evaluate intraobserver consistency. Data were analyzed using Fleiss' kappa via SPSS (v26), and Kappa interpretation followed the Landis and Koch classification.

Results: Overall interobserver agreement for SMSA level across all participants was fair (κ = 0.346). Among individual parameters, morphology had the highest agreement (κ = 0.505, moderate), followed by access (κ = 0.408, moderate) and size (κ = 0.241, fair). Subgroup analysis of experienced endoscopists (> 1000 lifetime colonoscopies) yielded slightly improved kappa values, with morphology still demonstrating the highest consistency. Intraobserver agreement showed moderate to almost perfect reliability for size (κ = 0.444 to 1.000) and moderate to substantial agreement for SMSA level (κ = 0.429 to 0.846).

Conclusions: Morphology was the most consistently scored parameter. Although the SMSA tool remains valuable, efforts such as standardized training and simplification of variable categories may be warranted to improve interobserver consistency and enhance clinical-utility.

Background and study aims: Emergency endoscopic interventions for upper gastrointestinal hemorrhage are frequently hampered by presence of blood clots and food debris. This study aimed to assess whether integration of an additional suction channel (ASC) onto a standard gastroscope enhances efficiency of aspirating clots and viscous fluids.

Patients and methods: A 5.3-mm suction catheter was used as an ASC mounted on a 2.8-mm standard gastroscope. Suction efficacy was evaluated using gastroscopes with working channel diameters of 2.8 mm, 3.7 mm, and 6 mm in vitro. Defined volumes of water, fruit yogurt, and coagulated blood were aspirated, and time required for complete evacuation was measured. Each setup was tested with and without the BioVac system.

Results: The ASC significantly enhanced suction performance across all test media. Notably, the 2.8-mm gastroscope with ASC outperformed all other configurations in aspirating water and yogurt. For clotted blood, the ASC significantly improved evacuation times compared with all other setups besides 6-mm + BioVac.

Conclusions: A standard gastroscope equipped with an ASC significantly enhances suction performance in an in vitro model, outperforming gastroscopes with larger working channels. These findings warrant further validation in an ex vivo model to determine their clinical applicability.

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.