Endoscopy International Open最新文献

Background and study aims: Artificial intelligence (AI) and mucosal exposure devices like Endocuff have independently improved the adenoma detection rate (ADR) during colonoscopy. This meta-analysis evaluated the combined effect of Endocuff and AI versus AI alone on colorectal neoplasia detection rates.

Methods: We searched PubMed, Embase, and Web of Science for randomized controlled trials (RCTs) comparing the impact of Endocuff+AI versus AI alone on colorectal neoplasia detection. Primary outcome was ADR; secondary outcomes included advanced adenoma detection rate (AADR), sessile serrated lesion detection rate (SSLDR), cecal intubation time, and withdrawal time. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

Results: Three RCTs with 2404 subjects were included (n = 1198 Endocuff+AI vs. n = 1206 AI alone). ADR was significantly higher in the Endocuff+AI group than in the AI alone group (54% vs. 48%, respectively) (RR 1.12, 95% CI 1.03-1.21, P = 0.01, I ² = 0%). There was a trend toward higher AADR (12.3% vs. 10%, RR 1.23, 95% CI 0.96-1.59, P = 0.10, I ² = 17%) and SSLDR (17.6% vs. 15.5%, RR 1.16, 95% CI 0.96-1.40, P = 0.13, I ² = 0%) in the Endocuff+AI group compared with the AI alone group, but it did not reach statistical significance. Both cecal intubation time (MD -0.61 minutes; 95% CI -1.54-0.33; P = 0.20; I ² = 87%) and withdrawal time (MD -0.42 minutes; 95% CI -1.01-0.17; P = 0.17, I ² = 60%) were similar between the two groups.

Conclusions: Endocuff combined with AI was superior to AI alone in improving the adenoma detection rate without increasing intubation or withdrawal times.

Background and study aims: Endocut Q (effect 2, effect 3 and effect 4) commonly is used for endoscopic mucosal resection (EMR) when removing colorectal polyps. However, there is debate over the type of electrosurgical setting of Endocut Q being recommended in clinical practice. We performed a randomized controlled trial to assess effectiveness and safety of three effects with EMR for removal of non-pedunculated 10- to 20-mm colorectal polyps.

Patients and methods: Patients with non-pedunculate colorectal polyps undergoing EMR were randomly allocated into effect 2, effect 3, and effect 4 groups. The primary outcome was rates of intra-procedural bleeding. Secondary outcomes were rates of post-procedural bleeding, perforation, complete resection, en bloc resection, R0 resection, and residual polyps.

Results: A total of 2637 eligible patients were included in the study and randomly assigned into the effect 2, effect 3, or effect 4 group. There were no significant differences among the three groups in baseline characteristics ( P > 0.05). In addition, no significant differences were observed in rates of post-procedural bleeding, perforation, complete resection, en bloc resection, R0 resection, residual polyps, or post-polypectomy syndrome ( P > 0.05). However, the rate of intra-procedural bleeding was significantly lower in the effect 2 group than in the effect 3 and effect 4 groups (4.0% vs. 12.2% vs. 12.7%, P < 0.01).

Conclusions: Endocut Q (effect 2, effect 3 and effect 4) was effective and safe for removing 10- to 20-mm non-pedunculated colorectal polyps. However, effect 2 may be superior to effect 3 and effect 4 in reducing intra-procedural bleeding.

Background and study aims: Peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) are established treatments for esophageal motility disorders. However, previous comparative studies have been limited by small sample sizes, restricting generalizability. This study aimed to evaluate perioperative outcomes of POEM and LHM in the United States using a population-based database.

Patients and methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) from 2016 to 2022. Patients with achalasia or non-achalasia spastic esophageal disorders who underwent POEM or LHM were included. Inverse probability of treatment weighting (IPTW) analysis was applied to enhance comparability across treatments. Trends in the number of procedures and assessed outcomes included serious adverse events (SAEs), reintervention, mortality, length of stay, and cost.

Results: A total of 18,694 patients were identified (6,554 POEM and 12,140 LHM). Overall rates of SAEs, reintervention, and 30-day mortality were 7.9%, 5.0%, and 0.08%, respectively. IPTW analysis revealed significantly lower rates of SAEs (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.70-0.88) and reintervention (OR 0.79, 95% CI 0.68-0.93) in the POEM group. Length of stay and cost were also more favorable in the POEM group. Mortality was not significantly different ( P  = 0.97). Subgroup analysis supported these findings when considering either achalasia (n = 15,971) or non-achalasia spastic esophageal disorders (n = 2,723) individually.

Conclusions: In this nationwide cohort, LHM remained more commonly performed in the United States. However, our results confirm that POEM demonstrated favorable outcomes in management of esophageal motility disorders.

Background and study aims: Residual bile duct stones may persist despite negative cholangiographic findings after endoscopic retrograde cholangiopancreatography, increasing risk of recurrence and complications. This systematic review and meta-analysis aimed to determine the detection rate of residual stones identified by peroral cholangioscopy (POC), alongside stone characteristics and baseline patient features.

Methods: A comprehensive search was conducted in MEDLINE, Cochrane Library, EMBASE, and LILACS through August 2024. Eligible studies included patients undergoing POC after negative occlusion cholangiography. The primary outcome was the pooled residual stone detection rate. Secondary outcomes included residual stone characteristics, adverse events (AEs), and baseline clinical parameters. Subgroup analysis was performed according to cholangioscopy technique used.

Results: Nine studies comprising 485 procedures were included. The pooled residual stone detection rate was 27% (95% confidence interval 23%-31%), with higher detection using digital single-operator cholangioscopy (32%) compared with direct peroral cholangioscopy (25%) and Mother-Baby systems (24%). Residual stones had a mean size of 4.51 mm, with an average of 1.55 stones per positive procedure. Mild AEs occurred in 3% of cases, with no serious complications reported. Baseline characteristics showed an average initial stone size of 12.89 mm, a mean common bile duct diameter of 15.28 mm, and lithotripsy use in 57% of cases.

Conclusions: POC identified residual stones in over one-fourth of patients following negative cholangiography. Detection rates were highest with digital systems. The procedure demonstrated a strong safety profile and may play an important role in confirming complete ductal clearance.

Background and study aims: Proper evaluation of patients with melena, no hematemesis, and nondiagnostic esophagogastroduodenoscopy (EGD) is poorly defined. Guidelines recommend colonoscopy, but the additional diagnostic yield is low. Owing to the high likelihood of proximal small bowel bleeding, push enteroscopy (PE) may be beneficial.

Patients and methods: We conducted a prospective, multicenter cohort study from four referral centers. Consecutive patients with melena, no hematemesis, and negative EGD results underwent PE followed by colonoscopy. For patients with culprit lesions found on PE and who were at risk of undergoing colonoscopy, colonoscopy was not performed and results were presumed to be negative. Diagnostic yields of both investigations were compared.

Results: Of 221 eligible patients who underwent EGD, 77 (34.8%) with nondiagnostic results were included in the analyses. Mean age of participants was 67.8 years and 51.9% were men. Culprit lesions were identified on PE in 27 of 77 patients (35.0%). Colonoscopy was performed in 59 patients and the source of bleeding was found in 10 patients (12.9%). Diagnostic yield of PE was significantly greater than that of colonoscopy ( P = 0.005). Combining PE and colonoscopy increased diagnostic yield to 48%, which was significantly greater than the yields of PE ( P = 0.002) or colonoscopy ( P < 0.0001) alone.

Conclusions: PE is beneficial for patients with melena and nondiagnostic EGD. It should be considered before or in combination with colonoscopy for these patients.

[This corrects the article DOI: 10.1055/a-2638-6177.].

Background and study aims: Migration remains a frequent and challenging situation following esophageal stent placement. The aims of this study were to evaluate efficiency and safety of a new anchorage technique using through-the-scope (TTS) clips to prevent esophageal stent migration.

Patients and methods: This was a retrospective case-control analysis of a prospective, monocentric database. Patients with a fully-covered esophageal stent, fixed or not for benign or malignant indications, were included. Fixation of the stent at the oral flange was achieved with TTS clips, placed for a bite in submucosal space after injection with saline and mucosal incision using the tip of a snare.

Results: A total of 52 patients were included, 24 stents with anchorage (fixed group) and 28 without (control group). Fixation was more frequently performed for benign disease (75.0% fixed group vs. 39.29% for control, P = 0.021). Median length of stent dwell time was 41.5 days in the fixed group and 30.5 days for controls ( P = 0.263). The overall migration rate was comparable (45.83% in the fixed group vs. 35.71% for controls, P = 0.647). A higher rate of early migration was observed in the control group (60.0% vs 18.18%, P = 0.080). A prior history of radio-chemotherapy was predictive of migration. There was no increased complication rate at placement or at removal in the treated group.

Conclusions: The new esophageal stent fixation technique appears to be simple, inexpensive, feasible, and safe. Although there is no impact on overall migration, there does seem to be a reduction in early migration.

[This corrects the article DOI: 10.1055/a-2655-6550.].

Background and study aims: Remimazolam is a new ultra-short-acting benzodiazepine with a favorable safety-profile when used for sedation in endoscopy. The aim of this project was to investigate efficacy of remimazolam with fentanyl compared with midazolam with fentanyl for sedation in colonoscopy among fecal immunochemical test (FIT)-positive screening participants.

Patients and methods: The study was a prospective, single-blinded, randomized controlled trial. FIT-positive participants undergoing colonoscopy were randomized to intravenous remimazolam + fentanyl (RF) or midazolam + fentanyl (MF). Primary outcome was total time from start of medication until discharge. Secondary outcomes included time to reach cecum, need for post-procedure recovery, patient-reported pain and satisfaction, need for additional medication, and procedure completion.

Results: A total of 205 patients were included and randomized 1:1 (RF:103, MF:102). Mean age was 62.6 years, whereas female/male ratio was 97/108. Mean time from start of medication until discharge was 29.9 minutes (RF) versus 35.0 minutes (MF) (95% confidence interval 0.77-0.94, P = 0.012). Mean time to reach the cecum was 15.4 minutes (RF) compared with 20.2 minutes (MF) ( P = 0.001). Proportion of patients requiring postoperative observation was lower for RF 0.97% vs 9.8% for MF ( P = 0.022). Patients receiving remimazolam reported an average lower pain score (mean 2.25 (RF) vs 3.25 (MF) P = 0.012) and higher overall satisfaction score (4.65 vs 4.33, P = 0.012).

Conclusions: This study shows clear superiority of the combination of remimazolam with fentanyl over midazolam with fentanyl for conscious sedation in screening colonoscopy, obtaining shorter procedure time, less postoperative need for observation, lower patient pain scores, and higher patient satisfaction.