Endoscopy International Open最新文献

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.

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.].