Endoscopy International Open最新文献

Background and study aims: Data on respiratory complications associated with GLP-1 receptor agonist (GLP-1 RA) use before endoscopic procedures are limited.

Patients and methods: We conducted a retrospective cohort study using TriNetX in adults with diabetes or obesity on GLP-1 RAs within 3 months of endoscopy, comparing them with non-GLP-1 RA users. Propensity score matching and Cox proportional hazards models were used to assess outcomes.

Results: Among 46,948 patients, no significant differences in post-endoscopy aspiration pneumonitis (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.54-1.56) or pneumonia (HR 1.01, 95% CI 0.83-1.24) were found between groups.

Conclusions: GLP-1 RA use before endoscopy does not increase respiratory complications, supporting continued preoperative medication use.

Background and study aims: Texture and color enhancement imaging (TXI) is a novel optical technology designed to improve visibility during endoscopy by highlighting subtle differences in morphology and color. This systematic review and meta-analysis aimed to determine whether TXI, compared with conventional white light imaging (WLI), can improve important colonoscopy quality indicators, specifically the adenoma detection rate (ADR) and adenomas per colonoscopy (APC).

Patients and methods: We searched PubMed, EMBASE, and the Cochrane Central for studies comparing TXI to WLI in patients undergoing colonoscopy for any indication. Risk ratios (RRs) and mean differences (MDs) were computed using a random-effects model.

Results: We included 1541 patients from three studies, of which two were randomized controlled trials (RCTs). TXI was used in 775 patients (50.3%). Indications for colonoscopy varied, including positive fecal immunochemical test (FIT), surveillance, and diagnostic workup for abdominal symptoms. In the pooled data, TXI significantly increased both ADR (57,8% versus 43.6%; RR 1.32; 95% confidence interval [CI] 1.20-1.46; P < 0.001; I ² = 0%) and APC (MD 0.50; 95% CI 0.37-0.64; P < 0.001; I ² = 0%), compared with WLI. Furthermore, TXI was more effective at detecting nonpolypoid/flat adenomas, proximal/right-sided adenomas, and adenomas ≥ 10 mm in size. Colonoscopies with TXI had shorter withdrawal times.

Conclusions: Our meta-analysis demonstrates that TXI significantly improves detection of colorectal adenomas in patients undergoing colonoscopy for various indications. TXI has the potential to improve overall quality of colonoscopy and contribute to colorectal cancer prevention.

Background and study aims: Intrabiliary radiofrequency ablation (IB-RFA) is a therapeutic option for cases of positive margin or recurrence after endoscopic papillectomy (EP) for superficial neoplasia. We report our experience concerning safety and efficiency of IB-RFA.

Patients and methods: This was a single tertiary center retrospective study. All patients who underwent IB-RFA indicated for residual or recurrent neoplasia after EP were included. We assessed morbidity (<30 days) and late complications (>30 days). Secondary outcomes were clinical success and late recurrence (absence of recurrence at the papillectomy site 12 months after IB-RFA and recurrence beyond 12 months, respectively).

Results: Twenty-five patients were included and underwent IB-RFA for deep positive margins (20/25, 80%) or relapse (5/25, 20%) and 40 sessions were delivered. The morbidity rate was 8% (2/24) (1 pancreatitis, 1 bleeding). Acute pancreatitis was significantly more common in the absence of pancreatic stenting (0% vs. 22%, P =0.046). One patient for whom pancreatic stenting failed died from acute severe pancreatitis in the first month (mortality rate=4%). Late complications occurred in 12 of 24 patients (50%) concerning only biliary stricture, all of which were managed endoscopically without sequelae. The clinical success rate was 92% (22/24), and late recurrence occurred in two of 24 patients (8%).

Conclusions: IB-RFA is relatively safe and efficient in cases of residual or recurrent neoplasia after EP and is an alternative to surgery in well-selected cases. Biliary stricture occurred frequently (50%) but could be managed endoscopically without sequelae in all cases. In cases of pancreatic stenting failure and because of the risk of severe and potentially lethal acute pancreatitis, IB-RFA should be postponed.

Background and study aims Endoscopic gallbladder therapy is increasingly used in high-risk surgical patients, but data in advanced liver disease are lacking. Patients and methods We performed a single-center retrospective analysis of patients with cirrhosis undergoing endoscopic transpapillary gallbladder drainage (ET-GBD) with cystic duct stenting (n = 55). Short-term outcomes were assessed at Day 30. Long-term outcomes were assessed at 6 months and 1 and 3 years or last known follow-up. Subgroup analyses were completed by location (inpatient vs. outpatient). Results A total of 52 patients, mean MELD-Na 16, underwent successful ET-GBD (38 inpatient, 14 outpatient). Most patients (n = 48) experienced immediate symptomatic relief. Short-term adverse event rate was 7.7% and 30-day mortality was 1.9%. At 6 months, 86.5% of patients had a favorable outcome; unfavorable outcomes included death (n = 2), recurrent cholecystitis and/or need for urgent cholecystectomy (n = 5). At the end of the study, 80% of patients experienced a favorable outcome including five patients bridged to liver transplant and 20 who had their stent in place with adequate symptom control. Of those with imaging, 65% of patients experienced resolution of cholelithiasis. Recurrent cholecystitis ( P = 1.00) and stone resolution ( P = 0.35) did not differ in patients with one or two cystic duct stents in place. Conclusions Transpapillary gallbladder stenting is technically feasible and associated with high rates of clinical success in patients with decompensated liver disease. Stone resolution is common after transpapillary gallbladder stenting and may portend favorable patient outcomes.

HemoPill is a commercially available ingestible electronic capsule that detects hematin and blood through photometric measurements. An examination with HemoPill requires no special preparation and can be done bedside. Its major advantage is noninvasive luminal blood detection, requiring only a small amount of blood or hematin (> 20 mL) for a positive result, making it especially suitable in multimorbid and/or geriatric patients not primarily fit for endoscopic diagnostic allowing rapid and uncomplicated bleeding detection. Recent clinical reports showed that HemoPill is useful in stratifying patients with anemia and bleeding in the setting of an Emergency Department. The second generation with an extended battery capacity of 9 hours opens the possibility of detecting blood in the middle and lower gastrointestinal tract. Herein we report another advantage of the extended battery capacity allowing noninvasive bleeding detection in the middle and lower gastrointestinal tract, leading to early endoscopic diagnosis of gastrointestinal malignancies with occult bleeding in comorbid patients with severe anemia.

Background and study aims: Autoimmune atrophic gastritis (AIG) is a rare chronic autoimmune disease characterized by gastric mucosa inflammation and atrophy. Limited clinical data exist about AIG, especially in western populations. In addition, there are no western series on the magnifying endoscopic features in AIG. This study presents a cohort of 63 patients with AIG, reporting their clinical, laboratory, and endoscopic findings.

Patients and methods: A retrospective analysis was conducted on patients diagnosed with AIG at Kingston Health Sciences Centre, Canada, between January 2016 and December 2023. Data collected from medical records included age, sex, presenting symptoms, laboratory findings, endoscopic features, histopathology reports, and concomitant autoimmune diseases.

Results: The study included 63 patients with autoimmune gastritis. Positive anti-parietal cell antibodies were found in the majority of patients (84.13%), whereas positive anti-intrinsic factor antibodies were less prevalent (25.40%). Deficiencies in vitamin B12 (49.21%) and iron (76.19%) were observed, along with a high prevalence of anemia (71.43%) and concomitant autoimmune diseases (58.73%). The dominant magnification pattern of atrophy in the body was oval/slit in 57.14% of patients (n=36), followed by tubular in 30.16% (n=19) and foveolar in 12.70% (n=8). Prevalence of neoplasia in our study was 42.86% (n=27).

Conclusion: This study offers insights into the clinical, laboratory, and magnifying endoscopic features of patients with AIG. It demonstrates the three main magnifying endoscopic appearances of AIG and highlights the significant prevalence of gastric neoplasia, even in the low-risk Western population. These findings emphasize the importance of the endoscopic exam in identifying AIG and notably present the key magnifying endoscopy findings in a Western setting for the first time.

Background and study aims Patients with symptomatic cholelithiasis can be stratified according to the 2019 European Society for Gastrointestinal Endoscopy (ESGE) guideline into low-, intermediate- and high-likelihood groups for presence of choledocholithiasis. For the intermediate group, endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) is recommended to assess whether an endoscopic retrograde cholangiopancreatography (ERCP) is necessary prior to cholecystectomy. The aim of the study was to investigate adherence to the guideline for diagnostic and treatment strategy for cholelithiasis in daily clinical practice. Patients and methods A multicenter, retrospective cross-sectional observational study of the diagnostic pathway of patients with suspicion of choledocholithiasis was conducted between 2019 and 2021. Patients were stratified according to the ESGE guideline "Endoscopic management of common bile duct stones". Results A total of 305 patients were included in the analysis and stratified into low- (17%), intermediate- (40%) and high- (43%) likelihood of choledocholithiasis. In these three categories, 182 patients (60%) underwent ERCP. Adherence to the ESGE guideline recommendation was 59.7% overall and was the highest in the intermediate-likelihood group (83.6%), compared with 45.1% in the low- and 43.2% in the high-likelihood group, respectively ( P < 0.001). In the high-likelihood group, 49% underwent additional imaging. In 195 patients who underwent additional imaging, 55 ERCPs (28.2%) could be avoided. Conclusions This study shows that stratification according to the ESGE guideline is useful to reduce the number of unnecessary additional imaging procedures and ERCPs in patients with a suspicion of choledocholithiasis. It seems worthwhile to perform EUS prior to ERCP in the same session.

Background and study aims Endoscopic mucosal resection (EMR) is a safe and minimally invasive procedure to remove colorectal non-pedunculated polyps. Recurrence rates are relatively high and differ among endoscopists. We aimed to evaluate whether endoscopists are able to predict recurrence based on thorough inspection of images of mucosal defects after an assumed complete EMR. Methods We developed an online survey in which endoscopists were invited to indicate whether they expected recurrence to develop when inspecting 30 post-EMR defect images. All EMRs were considered to be complete resections by the performing endoscopist. Participating endoscopists were scored based on the number of correct answers regarding presence or absence of recurrence found at first surveillance colonoscopy. Results A total of 140 endoscopists responded to the survey (response rate 25%). A total of 124 respondents with a mean age of 46.5 years evaluated the 30 images. The overall score in the cohort was 70%, indicating that respondents were able to correctly predict recurrence in three-quarters of cases with an overall level of certainty of 53.4%. When comparing results of experienced and less experienced endoscopists based on the number of endoscopic submucosal dissections and/or EMRs performed yearly, no difference (71% versus 69%, P = 0.23) was found. Conclusions This study shows that recurrences after presumed complete EMR can reasonably well be predicted by both experienced and less experienced endoscopists when evaluating images with mucosal defects. Thorough inspection of the post-EMR defect may reduce recurrence rates by recognizing and subsequent treatment of suspect areas.