Endoscopy International Open最新文献

[This corrects the article DOI: 10.1055/a-2641-5725.].

Background and study aims: Data on colorectal endoscopic mucosal resection (C-EMR) training during advanced endoscopy fellowship remain limited. We aimed to determine the number of procedures required by an "average" advanced endoscopy trainee (AET) to achieve competence in cognitive and technical C-EMR skills.

Methods: AETs from advanced endoscopy training programs (AETPs) were graded on every C-EMR using a standardized assessment tool. Cumulative sum (CUSUM) analysis was used to generate individual and aggregate learning curves to estimate the minimum number of cases required to achieve competence for overall, technical, and cognitive components of C-EMR. AETs completed a self-assessment questionnaire on C-EMR competence at the end of their training.

Results: A total of 22 AETs among 16 AETPs participated in this study. Nineteen AETs (86%) reported formal training in C-EMR with a mean number of 32 ± 22 cases prior to their AETP. In aggregate, 637 C-EMRs were performed (median of 32 per AET; interquartile range 17-45). Learning curve analyses revealed substantial variability in minimum volume of procedures needed to attain competence across different C-EMR skills (range: 19-39). A minimum of 19 cases were required to achieve overall competence using the global assessment score. All AETs reported feeling comfortable performing C-EMR independently at the end of AETP, yet only three (14%) achieved competence in their overall performance.

Conclusions: The relatively low number of C-EMRs performed by many AETs may be insufficient to achieve competence. The estimated thresholds for an average AET to achieve competence in C-EMR provide a framework for AETPs in determining the minimal standards for case volume exposure during training.

Background and study aims: Magnifying endoscopy with narrow-band imaging (ME-NBI) is regularly used in neoplasia diagnostics although its use in assessment of esophageal inflammatory changes is uncommon. The aim of this study was to evaluate the efficacy of eosinophilic esophagitis reference score and ME-NBI signs in predicting inflammation using gastroscopy with dual focus in patients with dysphagia.

Patients and methods: We conducted a prospective cohort study in adults undergoing gastroscopy with esophageal biopsies because of dysphagia/food bolus impaction. Number of eosinophiles and lymphocytes were calculated per high-power field. We used logistic regression with forward stepwise selection to determine the most relevant predictors (endoscopic signs) of inflammation. To assess the predictive value of endoscopic signs for eosinophilic or lymphocytic infiltration, we calculated sensitivity, specificity, and predictive values.

Results: In total 219 patients (71.2% male) were enrolled to the study. Most frequent endoscopic findings were furrows (121/219, 55%), positive NBI signs (106/219, 48%), and edema (102/219, 47%). Logistic regression analysis showed that furrows and NBI signs were the most significant predictors of eosinophilic infiltration. Edema was the only significant predictor of lymphocyte infiltration.

Conclusions: Positive NBI signs and furrows were the best predictors of eosinophile infiltration, whereas lymphocytic infiltration was predicted by edema. Given that NBI is already widely available, we encourage use of both white light and NBI in patients with suspected esophageal inflammation.

Background and study aims: This study addressed the need for improved diagnostic tools to identify malignancy in suspicious biliary strictures. Traditional cytological morphology is often indecisive, prompting exploration of next-generation sequencing (NGS) for enhanced sensitivity. Our aim was to evaluate NGS's additional value in classifying biliary brushes and biopsies and its impact on clinical decision making (CDM).

Patients and methods: In this retrospective single-center cohort study, patients were included from 2019 to 2022 in whom morphologic interpretation and NGS were performed on cytological or histological material from suspicious biliary strictures. Sensitivity and specificity of NGS were calculated for benign or atypical vs. suspicious for malignancy or malignant morphology in biliary brushes and biopsies. In addition, changes in CDM after NGS outcome were evaluated.

Results: In total 109 samples from 106 patients were included in the study. NGS correctly identified 42 of 75 malignancies (56%). Sensitivity and specificity of morphology for brushes were 56% (95% confidence interval [CI] 43%-68%) and 94% (95% CI 79%-99%), respectively. Adding NGS resulted in sensitivity and specificity of 78% (95% CI 66%-87%) and 94% (95% CI 79%-99%). For biopsies, sensitivity and specificity of morphology were 67% (95% CI 35%-90%) and 67% (95% CI 9%-99%) and adding NGS did not alter these results. The outcome of NGS resulted in a change of classification of morphology in 36% and a change in CDM in 8%.

Conclusions: NGS in brushes contributed to more accurate/sensitive diagnoses of malignancy than morphology alone. There was a limited impact on CDM change, but in the future, NGS will undoubtedly play a bigger role when targeted therapy is incorporated in standard treatment and more sensitive NGS panels for cholangiocarcinoma are developed.

Background and study aims: Fully-covered-self-expandable-metal-stents (FC-SEMS) are commonly used for non-malignant biliary stricture treatment. Removal failure related to hyperplastic tissue development over the distal margin of the stent has been described but few data are available. FC-SEMS-in-FC-SEMS technique has been described in case reports to overcome FC-SEMS removal failure. Aims of this study were investigating technical success, clinical success, and safety of the FC-SEMS-in-FC-SEMS technique and identification of risk factors for FC-SEMS removal failure in patients with non-malignant distal biliary stricture.

Patients and methods: Endoscopic retrograde cholangiopancreatography (ERCP) procedures performed between January 1, 2020 and May 31, 2023 for FC-SEMS removal in non-malignant distal biliary strictures were retrospectively identified and analyzed. Cases of FC-SEMS-in-FC-SEMS technique were evaluated.

Results: FC-SEMS-in-FC-SEMS technique was used in 15 patients. FC-SEMS removal was achieved after a single treatment in 13 patients (86.7%). In the remaining two patients (13.3%), it was necessary to repeat treatment to achieve FC-SEMS removal, with an overall technical and clinical success of 100%. No significant adverse events were recorded. Among the 50 patients undergoing ERCP for FC-SEMS removal during the study period (median dwell stenting period of 306.5 days; Q1-Q3:160-392), failure was observed in 15 cases (30%). Previous biliary stenting and dwell stenting period > 300 days were identified as risk factors for FC-SEMS removal failure.

Conclusions: FC-SMES-in-FC-SEMS technique appears to be safe and effective to overcome FC-SEMS removal failure in patients with non-malignant distal biliary strictures. Reducing dwell stenting period, especially in patients with personal history of previous biliary stenting, may reduce risk of FC-SEMS removal failure.

Background and study aims: Submucosal tunneling endoscopic resection (STER) has emerged as an innovative approach for the treatment of giant submucosal tumors (SMTs) in the esophagus. However, complications such as esophageal fistula or submucosal infection remain a concern. This article explores how preventive wound drainage can play a significant role in reducing these complications.

Patients and methods: We devised an innovative and straightforward method for negative pressure drainage. This approach involves positioning the drainage device with metal clips before closing the esophageal mucosa wound. A retrospective analysis was conducted on 46 patients with giant SMTs who underwent the STER procedure, among whom 28 had drainage and 18 had no drainage. Patient characteristics, adverse events, and risk factors were comprehensively evaluated.

Results: In 46 patients, the transverse diameter of the tumor exceeded 5 cm. No significant difference was observed in age, gender, tumor size, surgical scope, or mucosal injury between the two groups studied ( P > 0.05). Esophageal fistula or submucosal infection rates in the drainage group were lower than those in the no drainage group (2/28 vs 14/18, P < 0.05). Subgroup analyses revealed that multiple injuries in the esophageal mucosa combined with full-thickness resection of the esophageal muscle layer were the immediate causes of esophageal fistula or submucosal infection following STER surgery.

Conclusions: In the context of STER for giant esophageal submucosal tumors with muscular layer full-thickness resection and mucosal injury, preventive drainage is an effective strategy for minimizing postoperative esophageal fistula and submucosal infection complications.

Background and study aims: Intragastric balloon (IGB) is a minimally invasive and reversible endoscopic option for treating obesity. This systematic review and meta-analysis compared the effectiveness of IGB versus standard medical therapy (SMT) for obesity management, including studies with a minimum treatment duration of 6 months. Subgroup analyses were performed based on IGB type, baseline mean body mass index (BMI), and use of pharmacological therapy in the SMT group.

Methods: We searched for randomized controlled trials (RCTs) in MEDLINE, EMBASE, and Cochrane Library databases. Outcomes were evaluated at 6, 9, and 12 months after initiation of treatment. A random-effects model was used to calculate the pooled mean difference (MD) with 95% confidence interval (CI) for continuous outcomes.

Results: We included 15 RCTs (1961 patients). Compared with SMT, IGB significantly improved the percentage of excess weight loss at 6 months (MD 16.80; 95% CI 9.22-24.38), 9 months (MD 14.36; 95% CI 7.67-21.04), and 12 months (MD 13.10; 95% CI 10.43-15.77). IGB also showed superior results in percentage of total weight loss, absolute weight loss, and BMI reduction at all time points compared with SMT. There were significant subgroup differences for some outcomes according to IGB type and baseline mean BMI.

Conclusions: In obese adults, IGB is more effective than SMT for weight loss at 6, 9, and 12 months.

Background and study aims: The current standard of care for patients who are found to have malignancy within a resected colorectal polyp segment is surgical resection. Our study aimed to illustrate the efficacy and safety of using endoscopic full thickness resection (EFTR) to achieve histologically complete (R0) resection and formal staging in malignant polypectomy scars.

Patients and methods: This was a prospective case series of 14 patients who underwent scar consolidation via EFTR following piecemeal polypectomy or endoscopic mucosal resection (EMR) of a malignant colorectal polyp. Variables collected assessed R0 resection, technical success of the procedure, residual disease within the scar, recurrence during follow up, and adverse events (AEs).

Results: Of the 14 patient cases reviewed, there was 100% technical success and residual malignancy (RM) found in 14%. Of the two patients with residual disease, one achieved R0 resection with EFTR whereas the other did not and subsequently underwent surgery with no histopathological evidence of malignancy in the resected tissue. There was one AE of rectal bleeding that did not require any surgical intervention or blood transfusions.

Conclusions: EFTR could offer endoscopists a safe, efficacious, and minimally invasive mechanism for formal tumor (T) staging of malignancies found within polypectomy segments. Further studies with larger sample sizes are needed to assess outcomes in patients with residual neoplastic disease.

Background and study aims: Achalasia is a condition related to failure of relaxation of the lower esophageal sphincter (LES). Treatment is based on reducing LES pressure. Although treatment is traditionally surgical, poor candidates for this modality may be treated with peroral endoscopic myotomy (POEM). However, POEM is associated with a relatively high incidence of gastroesophageal reflux disease (GERD). For cases refractory to proton pump inhibitors (PPIs), transoral incisionless fundoplication (TIF) is one of the endoscopic therapies proposed.

Patients and methods: This was a pilot single-center prospective cohort study including 10 patients with post-POEM GERD refractory to clinical management who underwent endoscopic treatment with the TIF procedure between February and November 2021. We included patients ≥ 18 years old who developed GERD after POEM.

Results: Technical success was achieved in all 10 cases treated with TIF. In 6- and 12-month follow-up, seven patients (70%) reduced PPI use. Two patients (20%) had no esophagitis initially, increasing to five (55%) at 6 months and four (44%) at 12 months. Symptom evaluation and GERD-HRQL questionnaire showed a significant score reduction at 6 months and a downward trend at 12 months. Mean Eckardt score showed a decreasing trend, although mean dysphagia score showed a slight tendency to increase in 1 year. The procedure was considered safe, with no adverse events.

Conclusions: Use of TIF seems to be a feasible alternative for treating GERD after POEM, improving both clinical and endoscopic parameters and pHmetry in a considerable percentage of cases.

Background and study aims: Simethicone has been extensively utilized in endoscopy examinations and therapies; however, consensus regarding its impact on endoscopy cleaning is still lacking. The aim of this study was to assess impact of simethicone use during endoscopic examination on efficacy of endoscope cleaning.

Methods: This was a prospective real-world study that involved use of varying concentrations of simethicone in the endoscope biopsy channel and auxiliary water channel.

Results: All simethicone residual amounts and adenosine triphosphate (ATP) values were analyzed every month for 1 year. Use of 1% and 2% concentrations of simethicone generally resulted in variations in residual simethicone levels between the two channels. There was no significant alteration in ATP values in any concentration between the two channels. However, there was a significant difference in ATP values between the two channels at the concentration of 1% simethicone. After 1 year of usage, suspected adherent was observed in the 2% simethicone group, whereas no crystals were detected adhering to the biopsy channel walls in the 1% group or the control group. Sensitivity analysis suggested that the study results did not differ between the gastroscopy and colonoscopy subgroups.

Conclusions: Simethicone may remain in the biopsy and water infusion channels, regardless of whether it is used or not. It is recommended to utilize a simethicone concentration of 1% or less when administering it through the biopsy or auxiliary water channels of the endoscope.