Gastrointestinal endoscopy最新文献

英文中文

A single-center pilot study on the efficacy and safety of acetic acid–enhanced magnifying endoscopy with narrow-band imaging for diagnosis of colorectal epithelial neoplasms 醋酸增强放大内镜与窄带成像诊断结直肠上皮肿瘤的有效性和安全性的单中心试点研究。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-02-01 DOI: 10.1016/j.gie.2024.08.010

Takeshi Shimizu MD, Taku Yamagata MD, Yoshihide Kanno MD, Megumi Tanaka MD, Tomohiro Shimada MD, Daichi Komabayashi MD, Hiroki Sato MD, Yuta Shibuya MD, Kei Ito MD, PhD

Background and Aims

We investigated the ideal acetic acid (AA) concentration for AA-enhanced narrow-band imaging magnifying endoscopy (ANBI-ME) in the diagnosis of superficial colorectal neoplasms and evaluated its clinical efficacy.

Methods

During the exploratory phase, we investigated 4 concentrations (1.5%, 2.25%, 3.0%, and 4.5%) in rotation by performing ANBI-ME on 50 superficial colorectal neoplasms at each concentration. A favorable AA concentration was determined by evaluating the diagnostic accuracy, AA whitening duration (AD), peristalsis, and bleeding after endoscopic resection. In the validation phase, we assessed interobserver agreements for ANBI-ME with the determined AA concentration and intermethodologic agreements between that and subsequently conducted crystal violet–stained magnifying endoscopy (CV-ME) with the exploratory set and 98 additional patients.

Results

The diagnostic accuracies were 89.3% (42/47) for 1.5% AA, 92.0% (46/50) for 2.25% AA, 96.8% (61/63) for 3.0% AA, and 97.8% (46/47) for 4.5% AA, with no significant difference (P = .26). A significant positive correlation was observed between AA concentration and AD (P < .001). No significant differences in hyperperistalsis or post-resection bleeding were observed. The optimal AA concentration was determined to be 4.5%. In the validation analysis, the accuracy rates were 72.4% (105/145) with the use of AMBI-ME and 68.3% (99/145) with the use of CV-ME (P = .43). Strong agreements were noted between observers (κ: 0.87 for ANBI-ME, 0.83 for CV-ME) and between the methods (κ: 0.87 and 0.81 for each observer).

Conclusions

For diagnosing colorectal lesions, an AA concentration of 4.5% in ANBI-ME was safe and effective. Its diagnostic performance was similar to CV-ME, and future large-sample studies may confirm its potential as a reliable alternative endoscopic diagnostic method.

背景和目的：我们研究了AA增强窄带成像（NBI）放大内镜（ANBI-ME）诊断浅表结直肠肿瘤的理想醋酸（AA）浓度，并评估了其临床疗效：在探索阶段，我们对四种浓度（1.5%、2.25%、3.0% 和 4.5%）进行了轮换研究，在每种浓度下对 50 例表浅大肠肿瘤进行了 ANBI-ME。通过评估诊断准确性、AA 增白持续时间（AD）、蠕动和内镜切除术后出血情况，确定有利的 AA 浓度。在验证阶段，我们评估了ANBI-ME与确定的AA浓度之间的观察者间一致性，以及与随后进行的水晶紫染色放大内镜检查（CV-ME）之间的方法间一致性：1.5% AA 的诊断准确率为 89.3%（42/47），2.25% 为 92.0%（46/50），3.0% 为 96.8%（61/63），4.5% 为 97.8%（46/47），无显著差异（p = 0.26）。AA 浓度与 ADs 之间存在明显的正相关性（p < 0.001）。在肠蠕动过快或切口后出血方面没有观察到明显差异。最佳 AA 浓度被确定为 4.5%。在验证分析中，使用 AMBI-ME 的准确率为 72.4%（105/145），使用 CV-ME 的准确率为 68.3%（99/145）（p = 0.43）。两名观察者之间（κ，ANBI-ME 为 0.87；CV-ME 为 0.83）以及两种方法之间（κ，每位观察者为 0.87 和 0.81）的准确率非常一致：结论：在诊断结直肠病变时，ANBI-ME 中 4.5% 的 AA 浓度是安全有效的。其诊断效果与 CV-ME 不相上下，未来的大样本研究可能会证实其作为可靠的替代内镜诊断方法的潜力。

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引用次数: 0

Application of endoscopic purse-string sutures in refractory nonvariceal GI bleeding: a multicenter study (with video) 在难治性非静脉曲张性消化道出血中应用内窥镜荷包缝合术：一项多中心研究（附视频）。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-02-01 DOI: 10.1016/j.gie.2024.09.020

Feifan Chen MD , Yifan Jia MD , Ling Xiao MD , Li Yang MD , Jinlin Yang MD , Jianmei Zeng MD , Limao Xu MD , Xue Xiao MD, PhD

Background and Aims

Nonvariceal GI bleeding (GIB) is a common medical emergency. Endoscopic hemostasis is recommended, but some patients experienced recurrent bleeding after conventional endoscopic hemostasis. Originally, the purse-string suture (PSS) was used for lesion closure during EMR. Here, we evaluated the effectiveness of the endoscopic PSS in controlling refractory bleeding.

Methods

We retrospectively collected data from 3 hospitals of patients who underwent endoscopic PSS for refractory nonvariceal GIB. Clinical success was defined as no recurrent bleeding, and patients were discharged according to medical advice.

Results

From October 2017 to May 2024, 36 patients who received PSS treatments were included. Of these 36 patients, 83.3% (30) achieved clinical success. In refractory upper GIB, the clinical success rate was 81.25% (26/32), and in lower GIB, the clinical success rate was 100% (4/4).

Conclusions

The endoscopic PSS is effective in treating refractory nonvariceal GIB.

背景和目的：非静脉曲张性消化道出血是一种常见的急症。建议使用内镜止血，但一些患者在常规内镜止血后会再次出血。最初，在内镜粘膜切除术（EMR）中使用荷包线缝合（PSS）来缝合病灶。我们的目的是了解内镜下荷包缝合术是否能有效控制难治性出血：我们回顾性地收集了 3 家医院接受内镜下 PSS 治疗难治性非静脉曲张性消化道出血患者的数据。临床成功定义为无复发性出血，患者遵医嘱出院：从2017年10月至2024年5月，共纳入36例接受PSS治疗的患者。83.3%（30/36）的患者取得了临床成功。难治性上消化道出血患者的临床成功率为81.25%（26/32），下消化道出血患者的临床成功率为100%（4/4）：结论：内镜 PSS 可有效治疗难治性非静脉曲张性消化道出血。

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引用次数: 0

Rates of repeat EGD in nondiabetic adults with glucagon-like peptide-1 receptor agonist prescription: a retrospective matched cohort study 胰高血糖素样肽-1 受体激动剂处方非糖尿病成人的重复 EGD 率：一项回顾性匹配队列研究。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-02-01 DOI: 10.1016/j.gie.2024.10.004

Abbinaya Elangovan MD , Pearl Aggarwal MD , David C. Kaelber MD , Raj Shah MD

Background and Aims

Data on endoscopic outcomes in adults without diabetes who are taking glucagon-like peptide-1 receptor agonists (GLP-1RAs) are limited. Therefore, we compared repeat EGD in this population with those not taking GLP-1RAs using a retrospective matched case-control study.

Methods

Using the TriNetX health research platform (Cambridge, Mass, USA), we analyzed adults with a body mass index ≥27 kg/m² without diabetes who underwent diagnostic EGD. The study group included individuals with ≥3 GLP-1RA prescriptions and undergoing EGD ≥30 days after the initial GLP-1RA prescription. The control group included individuals who were never prescribed GLP-1RAs but had an EGD after the prescription of other weight loss medications. Outcomes were compared using the risk ratio (RR) in matched cohorts.

Results

No significant difference in repeat EGD (5.4% vs 4.2%; RR, 1.28; 95% confidence interval [CI], .95-1.71) or new diagnosis of gastroparesis (1.1% vs .6%; RR; 2.00; 95% CI, .94-4.27) was noted between the groups.

Conclusions

GLP-1RAs may not substantially increase the risk of repeat endoscopy in individuals without diabetes.

背景和目的：有关服用胰高血糖素样肽受体激动剂（GLP-1 RA）的非糖尿病成人内镜检查结果的数据有限，因此我们旨在通过回顾性匹配病例对照研究，将这一人群的重复食管胃十二指肠镜检查（EGD）结果与未服用 GLP-1 的人群进行比较：方法：使用 TriNetX（马萨诸塞州剑桥市），对体重指数≥27 kg/m2 且无糖尿病的成人进行诊断性 EGD 分析。研究组包括 GLP-1 处方≥3 次且首次 GLP-1 处方后 EGD ≥30 天的患者。对照组从未处方过 GLP-1 RAs，但在处方其他减肥药物后进行了胃肠道造影检查。结果采用匹配队列的风险比进行比较：结果：两组间在重复胃肠镜检查（5.4% vs 4.2%，RR 1.28，0.95-1.71）或新诊断胃痉挛（1.1% vs 0.6%，RR 2.00，0.94-4.27）方面无明显差异：结论：GLP-1 RAs 可能不会大幅增加非糖尿病患者重复内镜检查的风险。

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引用次数: 0

EUS-guided shear wave elastography for fibrosis screening in patients with obesity and metabolic dysfunction–associated steatotic liver disease: a pilot study (with video) 内镜超声剪切波弹性成像用于肥胖和代谢功能障碍相关性脂肪肝（MASLD）患者的纤维化筛查：一项试点研究（附视频）。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-02-01 DOI: 10.1016/j.gie.2024.10.054

Thomas J. Wang MD , Pichamol Jirapinyo MD, MPH , Raj Shah MD , Kimberly Schuster BA , David J. Papke MD, PhD , Christopher C. Thompson MD, MSc , Laura Doyon MD , David B. Lautz MD , Marvin Ryou MD

Background and Aims

Liver fibrosis staging is challenging in patients with obesity and metabolic dysfunction–associated steatotic liver disease (MASLD). Liver biopsies are invasive, whereas noninvasive tests such as vibration-controlled transient elastography (VCTE) can be inaccurate in patients with obesity. We hypothesized that EUS-guided shear wave elastography (EUS-SWE) is more accurate for liver fibrosis staging in patients with MASLD and obesity; the aim of this pilot study was to test this hypothesis and establish optimal fibrosis stage cutoffs for EUS-SWE.

Methods

This was a multicenter, cross-sectional study from prospectively collected data. Consecutive patients who underwent EUS-SWE with subsequent liver biopsy were included. EUS-SWE was compared with Fibrosis-4 Index (FIB-4) and VCTE. Area under the receiver-operating characteristic (AUROC) curve analysis was performed, and 90% sensitivity and specific cutoffs were calculated to determine optimal cutoffs.

Results

Sixty-two patients were included. Mean body mass index was 40.74 kg/m². EUS-SWE was superior to FIB-4 in discriminating significant fibrosis (F2; AUROC, .87 vs .61; P < .0048) and advanced fibrosis (F3; AUROC, .93 vs .63; P < .0001), but not cirrhosis (F4; AUROC, .95 vs .81; P = .099). EUS-SWE was superior to VCTE in predicting advanced fibrosis and cirrhosis (P = .0067 and P = .0022, respectively). The 90% sensitivity cutoffs for EUS-SWE were 7.50, 8.48, and 11.30 for F2, F3, and F4, and the 90% specificity cutoffs were 9.82, 10.20, and 14.60.

Conclusions

In this pilot study, EUS-SWE was superior to FIB-4 and VCTE for liver fibrosis staging in patients with MASLD and obesity. (Clinical trial registration number: NCT05728697.)

背景和目的：对肥胖和代谢功能障碍相关性脂肪性肝病（MASLD）患者进行肝纤维化分期具有挑战性。肝活检是侵入性的，而振动控制瞬态弹性成像（VCTE）等非侵入性检测在肥胖症患者中可能不准确。我们假设内镜超声剪切波弹性成像（EUS-SWE）对肥胖症患者的肝纤维化分期更为准确，本试验研究旨在验证这一假设，并为 EUS-SWE 确定最佳纤维化分期临界值：这是一项根据前瞻性收集的数据进行的多中心横断面研究。研究纳入了接受 EUS-SWE 检查并随后进行肝活检的连续患者。EUS-SWE 与纤维化-4 指数（FIB-4）和 VCTE 进行了比较。进行了接收者操作特征曲线下面积（AUROC）分析，并计算了90%的灵敏度和特异性临界值，以确定最佳临界值：结果：共纳入 62 名患者。平均体重指数为 40.74kg/m2。EUS-SWE 在鉴别明显纤维化方面优于 FIB-4（F2；AUROC 0.87 vs 0.61，pConclusions）：在这项试验性研究中，EUS-SWE在对肥胖症MASLD患者的肝纤维化分期方面优于FIB-4和VCTE（临床试验注册号：NCT05728697）。

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引用次数: 0

Under pressure: changing our way of caring

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-02-01 DOI: 10.1016/j.gie.2024.10.017

Eric M. Pauli MD

引用次数: 0

Preprocedural arterial embolization as a novel proactive approach for safe endoscopic submucosal dissection 手术前动脉栓塞是安全进行内镜粘膜下剥离的一种新型主动方法。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-02-01 DOI: 10.1016/j.gie.2024.09.011

Sandip Pal MD, DM, Srikant Mohta MD, DM, Shuvro Roy Choudhury MD

引用次数: 0

Through-the-scope proximal flange fixation: “Edging” toward single-session procedures for all?

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-02-01 DOI: 10.1016/j.gie.2024.08.038

Michiel Bronswijk MD, Giuseppe Vanella MD, PhD, Roy L.J. van Wanrooij MD, PhD, Schalk Van der Merwe MD, PhD

引用次数: 0

EUS for the evaluation of esophageal injury after catheter ablation for atrial fibrillation 内窥镜超声评估心房颤动导管消融术后的食管损伤。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-02-01 DOI: 10.1016/j.gie.2024.08.036

Karl Akiki MD , William B. Minteer MD , Vinay Chandrasekhara MD , Tala Mahmoud MD , Ryan J. Law MD , Elizabeth Rajan MD , Alan M. Sugrue MB, BCh, BAO , Ammar M. Killu MBBS , Ferga C. Gleeson MB, BCh , Barham K. Abu Dayyeh MD, MPH , Michael J. Levy MD , Mark Topazian MD , Andrew C. Storm MD

Background and Aims

Atrial fibrillation (AF) ablation is an increasingly used rhythm control strategy that can damage adjacent structures in the mediastinum including the esophagus. Atrioesophageal fistulas and esophagopericardial fistulas are life-threatening adverse events that are believed to progress from early esophageal mucosal injury (EI). EUS has been proposed as a superior method to EGD to survey EI and damage to deeper structures. We evaluated the safety of EUS in categorizing postablation EI and quantified EUS-detected lesions and their correlation with injury severity and clinical course.

Methods

We retrospectively reviewed 234 consecutive patients between 2006 and 2020 who underwent AF ablation followed by EUS for the purpose of EI screening. The Kansas City classification was used to classify EI (type 1, type 2a/b, or type 3a/b).

Results

EUS identified pleural effusions in 31.6% of patients, mediastinal adventitia changes in 22.2%, mediastinal lymphadenopathy in 14.1%, pulmonary vein changes in 10.6%, and esophageal wall changes in 7.7%. EGD revealed 175 patients (75%) without and 59 (25%) with EI. Patients with type 2a/b EI and no EI were compared with multivariate logistic regression, and the presence of esophageal wall abnormality on EUS (odds ratio [OR], 72.85; 95% confidence interval [CI], 13.9-380.7), female sex (OR, 3.97; 95% CI 1.3-12.3), and number of energy deliveries (OR, 1.01; 95% CI, 1.003-1.03) were associated with EI type 2a or 2b. Preablation use of proton pump inhibitors was not associated with a decreased risk of EI.

Conclusions

EUS safely assesses mediastinal damage after ablation for AF and may excel over EGD in evaluating mucosal lesions of uncertain significance, with a reduced risk of gas embolization in the setting of a full-thickness injury (enterovascular fistula). We propose an EUS-first guided approach to post-AF ablation examination, followed by EGD if it is safe to do so.

背景和目的：心房颤动（房颤）消融是一种使用率越来越高的节律控制策略，它可能会损伤纵隔内的邻近结构，包括食管。寰食管瘘和食管心包瘘是威胁生命的并发症，被认为是由早期食管粘膜损伤（EI）发展而来。内镜超声（EUS）被认为是比胃肠造影（EGD）更优越的检查 EI 和深层结构损伤的方法。我们旨在评估 EUS 在对消融术后 EI 进行分类方面的安全性，并量化 EUS 检测到的病变及其与损伤严重程度和临床病程的相关性。采用堪萨斯城分类法（KCC）对 EI 进行分类（1 型、2a/b 型、3a/b 型）：EUS 发现了胸腔积液（31.6%）、纵隔增生改变（22.2%）、纵隔淋巴结病（14.1%）、肺静脉改变（10.6%）和食管壁改变（7.7%）。胃食管造影显示，175 名（75%）患者无食道梗阻，59 名（25%）患者有食道梗阻。通过多变量逻辑回归对 2a/b 型 EI 患者和无 EI 患者进行了比较，结果显示，EUS 显示食管壁异常（OR 72.85 (95% CI 13.9-380.7)）、女性（OR 3.97 (95% CI 1.3-12.3)）和能量分娩次数（OR 1.01 (95% CI 1.003-1.03)）与 2a 或 2b 型 EI 的存在相关。消融前使用 PPI 与 EI 风险降低无关：EUS可安全评估房颤消融术后的纵隔损伤，在评估意义不明的粘膜病变方面可能优于EGD，在全厚度损伤（肠血管瘘）的情况下可降低气体栓塞的风险。我们建议在心房颤动消融术后检查中首先采用 EUS 引导的方法，然后在安全的情况下再进行 EGD 检查。

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引用次数: 0

Effects of glucagon-like peptide-1 receptor agonists on endoscopy outcomes: systematic review and meta-analysis 胰高血糖素样肽-1 受体激动剂对内镜检查结果的影响：系统回顾与荟萃分析。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-02-01 DOI: 10.1016/j.gie.2024.10.011

Sahib Singh MD , Syed Hamaad Rahman DO , Nihal Khan MD , Anjali Rajagopal MD , Nouman Shafique MD , Poonam Tawde MD , Vaishali Bhardwaj MD , Vishnu Charan Suresh Kumar MD , Ganesh Aswath MD , Sumant Inamdar MD , Sudhir Dutta MD , Abu Hurairah MD , Babu P. Mohan MD

Background and Aims

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are known to cause delayed gastric emptying; however, the effect on clinical outcomes during upper endoscopy and colonoscopy remains unclear. We conducted a meta-analysis to reconcile the data.

Methods

Online databases were searched for studies evaluating GLP-1RAs versus a control group (no GLP-1RAs) in patients undergoing endoscopy. The outcomes of interest were rate of retained gastric contents (RGCs), aborted procedures, aspiration events, and subjective bowel preparation quality. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random-effects model.

Results

Twenty-three studies with 77,152 patients (4449 in the GLP-1RA arm and 72,703 in the control arm) were included. Mean patient age ranged from 47.6 to 72 years, and 58.4% were women. As compared with the control group, the GLP-1RA group had higher odds of RGCs (OR, 15.39; 95% CI, 4.65-50.99; P < .01) and aborted procedures (OR, 13.86; 95% CI, 4.42-43.43; P < .01). No significant differences were observed between the 2 groups in terms of aspiration events (OR, 21.06; 95% CI, .13-3379.01; P = .24) and subjective bowel preparation quality (OR, .94; 95% CI, .67-1.31; P = .83).

Conclusions

Although statistical significance was reached in terms of visible RGCs and early termination of endoscopies in patients on GLP-1RAs, these events were overall rare. GLP-1RAs do not appear to pose significant risk, as the odds of developing aspiration were comparable in the 2 groups.

背景和目的：众所周知，胰高血糖素样肽-1受体激动剂（GLP-1RAs）可导致胃排空延迟，但其对上内镜/结肠镜检查临床结果的影响仍不明确。我们进行了一项荟萃分析，以核对相关数据：我们在在线数据库中搜索了对接受内镜检查的患者进行评估的研究，评估对象为 GLP-1RAs 与对照组（无 GLP-1RAs）。研究结果包括胃内容物残留率（RGC）、手术流产率、吸入事件和主观肠道准备质量。采用随机效应模型估算了汇总的几率比（ORs）和95%置信区间（CIs）：共有 23 项研究纳入了 77,271 名患者（GLP-1 RA 组 4,449 人，对照组 72,703 人）。平均年龄从 47.6 岁到 72 岁不等，58.4% 为女性。与对照组相比，GLP-1 RA 组发生 RGC（OR 15.39，95% CI 4.65-50.99，p < 0.01）和流产（OR 13.86，95% CI 4.42-43.43，p < 0.01）的几率更高。在吸入事件（OR 21.06，95% CI 0.13-3379.01，P=0.24）和主观肠道准备质量（OR 0.94，95% CI 0.67-1.31，P=0.83）方面，两组间未观察到明显差异：虽然在使用 GLP-1RAs 的患者中，可见 RGC 和提前终止内镜检查的情况具有统计学意义，但这些事件总体上很少发生。GLP-1RA似乎不会带来重大风险，因为两组患者发生吸入的几率相当。

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引用次数: 0

American Society for Gastrointestinal Endoscopy position statement on periendoscopic management of patients on glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-02-01 DOI: 10.1016/j.gie.2024.10.057

Reem Z. Sharaiha MD, MSc , Alpana P. Shukla MD , Sudipta Sen MD, FASA , Walter C. Chan MD, MPH , David T. Broome MD , Diana Anca MD , Wasif Abidi MD, PhD , Neil Marya MD , Muniraj Thiruvengadam MD, PhD, FRCP , Nirav Thosani MD, MHA , Allison R. Schulman MD, MPH

引用次数: 0

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