Gastrointestinal endoscopy最新文献

Background and aims: For small colorectal polyps, cold snare polypectomy (CSP) carries a higher risk of immediate postpolypectomy bleeding (IPPB) compared with hot snare polypectomy (HSP), but is associated with a significantly lower risk of delayed postpolypectomy bleeding (DPPB). Given these trade-offs, we evaluated the cost-effectiveness of CSP versus HSP for small (4-10 mm), pedunculated colorectal polyps.

Methods: Cost-effectiveness analysis was conducted over a 2-week time horizon using a decision tree model, based on the Multicenter Randomized Taiwan Cold Polypectomy Study and published literature. Incremental cost-effectiveness ratio (ICER) was calculated for a base case patient undergoing CSP versus HSP, with analysis performed using TreeAge Pro Healthcare 2024.

Results: IPPB was defined as perioperative bleeding requiring clipping, whereas DPPB referred to bleeding within 2 weeks requiring transfusion or endoscopic intervention. DPPB was evaluated at the patient level (386 participants: 192 CSP, 194 HSP), and IPPB at the polyp level (647 polyps: 306 CSP, 341 HSP). In the base case (61.8-year-old with a ≤10 mm pedunculated polyp), CSP versus HSP yielded an ICER of $35,684/quality-adjusted life year (QALY). Sensitivity analyses showed CSP remained cost-effective when IPPB risk after CSP was <21.64% or DPPB risk with HSP exceeded 0.76%.

Conclusions: CSP is cost-effective compared with HSP for small pedunculated polyps at a willingness-to-pay threshold of $100,000/QALY. Despite a higher IPPB risk, CSP's lower DPPB risk underlies its favorable economic profile. Our findings support CSP as the preferred technique for small pedunculated polyps, while emphasizing that patient- and polyp-specific clinical factors should be considered alongside cost-effectiveness in practice.

Background and aims: Surveillance after complete eradication of dysplastic Barrett's esophagus (BE) is important, given the risk of recurrent intestinal metaplasia and neoplasia; however, the optimal surveillance strategy remains unclear. This study aims to ascertain the yield of random biopsy specimens of the neosquamous epithelium (NE) and gastric cardia for detecting dysplasia.

Methods: In this prospective single-center study, patients undergoing postendoscopic eradication therapy surveillance for dysplastic BE were included. High-definition white-light, narrow-band, and near-focus imaging were used for esophageal assessment. Targeted biopsy sampling was performed on visible abnormalities, followed by 6 random cardia biopsy specimens and 4-quadrant NE biopsy specimens taken at 1-cm intervals.

Results: Seventy-one patients underwent 119 surveillance endoscopies after complete eradication of intestinal metaplasia, yielding 2892 biopsy samples (66 targeted, 714 random cardia, 2112 NE). Targeted biopsy procedures detected intestinal metaplasia in 15.2% (10/66) and dysplasia in 3% (2/66) of biopsy specimens, leading to further treatment in 8 patients. In contrast, intestinal metaplasia was detected in 2.4% (17/714) of random cardia biopsy specimen and 0.4% (9/2112) of random NE biopsy specimen. No dysplasia was detected via random cardia or NE biopsy specimen. The total cost to detect 1 case of intestinal metaplasia via random biopsy specimens was $3144, whereas the cost to detect 1 case of dysplasia using the random biopsy strategy exceeded $29,673.

Conclusions: Targeted biopsy sampling of the NE and gastric cardia are important in detecting early BE recurrence. Additional random NE and cardia biopsy samples provide no added benefit in dysplasia detection but incur unnecessary time and cost expenditures. We recommend targeted biopsy sampling as the primary surveillance strategy after complete eradication of intestinal metaplasia and eliminating random biopsy sampling in expert centers.

Background and aims: Data comparing the location of polyp yield in patients with positive stool test results can aid screening test selection. We conducted a cross-sectional analysis of New Hampshire Colonoscopy Registry data to compare the location, left versus right side of the colon, of neoplasia detected on colonoscopy after a multitarget stool DNA (mt-sDNA) test or a fecal immunochemical test (FIT), compared with a reference group undergoing colonoscopy without a stool test.

Methods: Our outcomes were advanced lesions (adenomas and/or serrated polyps, including cancer), advanced adenomas, or advanced serrated polyps stratified by location. We examined the prevalence of left- versus right-sided lesions across 3 cohorts.

Results: As compared to colonoscopy (n = 68,645), both FIT+ (n = 584) and mt-sDNA+ (n = 1176) patients had higher proportions of advanced lesions and advanced adenomas on both sides of the colon (P < .001). Mt-sDNA+ patients had significantly higher risks for right-sided advanced serrated polyps (odds ratio [OR], 3.21; 95% confidence interval [CI], 2.67-3.85; colonoscopy [reference]) and right-sided advanced lesions (OR, 3.13; 95% CI, 2.66-3.68; colonoscopy [reference]) as compared to FIT+ (advanced serrated polyps: OR, 1.38; 95% CI, 0.99-1.99 and advanced lesions: OR, 1.84; 95% CI, 1.43-2.37) or colonoscopy (reference). In our main analysis, the colonoscopy-only group had significantly higher odds of each outcome on the right side than the left side; in comparison, the odds for FIT+ and mt-sDNA+ patients were more evenly distributed throughout the colon.

Conclusions: Our data suggest that FIT+ tests are associated with higher detection of both right- and left-sided advanced adenomas as compared to colonoscopy without a prior stool test. Furthermore, mt-sDNA+ patients had higher proportions of left- and right-sided advanced adenomas and advanced serrated polyps, particularly on the right side.