Pub Date : 2025-02-04DOI: 10.1016/j.gie.2025.01.035
Patrick Yachimski, Jingwen Zhang, Gregory A Coté, Steven A Edmundowicz, Sachin Wani, Raj Shah, Ji Young Bang, Shyam Varadarajulu, Vikesh K Singh, Mouen Khashab, Richard S Kwon, James M Scheiman, Field F Willingham, Steven A Keilin, Georgios I Papachristou, Amitabh Chak, Adam Slivka, Daniel Mullady, Vladimir Kushnir, James Buxbaum, Rajesh Keswani, Timothy B Gardner, Nauzer Forbes, Amit Rastogi, Andrew Ross, Joanna Law, Yen-I Chen, Alan Barkun, Zachary L Smith, Jose Serrano, Bret Petersen, Andrew Y Wang, John R Saltzman, Rebecca L Spitzer, Collins Ordiah, Cathie Spino, Lydia D Foster, Valerie Durkalski-Mauldin, B Joseph Elmunzer
Background and aims: Endoscopic retrograde cholangiopancreatography (ERCP) carries potential for serious adverse events and there is risk for unplanned health encounters following the procedure. The primary objective of this study was to identify the rate of 30-day hospital admission following outpatient ERCP in patients at elevated risk for post-ERCP pancreatitis based on patient- and procedure-related risk factors. We also explored whether pancreatitis rates and length of hospital stay differ with delayed hospitalization (vs admission immediately after ERCP) and identified factors associated with 30-day hospital admission.
Methods: High-risk patients in the SVI trial who underwent outpatient ERCP were identified. The primary outcome was hospital admission within 30 days following outpatient ERCP. Patient and procedural factors associated with 30-day hospital admission were explored by univariable analysis followed by multivariable analysis, controlling for potential known confounders.
Results: Among 768 patients at high risk for post-ERCP pancreatitis who underwent outpatient ERCP and were discharged home, 21.9% required hospitalization within 30 days. Compared to patients who underwent outpatient ERCP but were admitted immediately to the hospital post-procedure, patients who were discharged after ERCP and admitted later had a higher incidence of post-ERCP pancreatitis (40.5% vs 30.9%, P=0.04), moderate-severe post-ERCP pancreatitis (24.4% vs 13.8 %, P <0.01), and longer length of hospital stay (6.2 days vs 3.7 days, P<0.001). Factors associated with 30-day hospitalization included patient age (OR 0.98, 95% CI 0.97, 0.99), biliary stent placement (OR 1.62, 95% CI 1.05, 2.48), and attempt at pancreatic duct cannulation (OR 1.64, 95% CI 1.02, 2.64).
Conclusions: High-risk patients who undergo outpatient ERCP and are discharged home are at considerable risk for hospital admission within 30 days and have increased rate of pancreatitis and longer length of hospital stay compared to outpatients admitted to the hospital immediately following ERCP, and some factors may predict this outcome. These findings should influence decision making and informed consent when electing to proceed with high-risk ERCP, recognizing that patients with sphincter of Oddi dysfunction were over-represented in this cohort, which may limit generalizability to a typical ERCP practice.
{"title":"Thirty-day hospital admission following high-risk outpatient ERCP: incidence and analysis of risk factors based on a secondary analysis of the Stent Versus Indomethacin trial dataset.","authors":"Patrick Yachimski, Jingwen Zhang, Gregory A Coté, Steven A Edmundowicz, Sachin Wani, Raj Shah, Ji Young Bang, Shyam Varadarajulu, Vikesh K Singh, Mouen Khashab, Richard S Kwon, James M Scheiman, Field F Willingham, Steven A Keilin, Georgios I Papachristou, Amitabh Chak, Adam Slivka, Daniel Mullady, Vladimir Kushnir, James Buxbaum, Rajesh Keswani, Timothy B Gardner, Nauzer Forbes, Amit Rastogi, Andrew Ross, Joanna Law, Yen-I Chen, Alan Barkun, Zachary L Smith, Jose Serrano, Bret Petersen, Andrew Y Wang, John R Saltzman, Rebecca L Spitzer, Collins Ordiah, Cathie Spino, Lydia D Foster, Valerie Durkalski-Mauldin, B Joseph Elmunzer","doi":"10.1016/j.gie.2025.01.035","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.035","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) carries potential for serious adverse events and there is risk for unplanned health encounters following the procedure. The primary objective of this study was to identify the rate of 30-day hospital admission following outpatient ERCP in patients at elevated risk for post-ERCP pancreatitis based on patient- and procedure-related risk factors. We also explored whether pancreatitis rates and length of hospital stay differ with delayed hospitalization (vs admission immediately after ERCP) and identified factors associated with 30-day hospital admission.</p><p><strong>Methods: </strong>High-risk patients in the SVI trial who underwent outpatient ERCP were identified. The primary outcome was hospital admission within 30 days following outpatient ERCP. Patient and procedural factors associated with 30-day hospital admission were explored by univariable analysis followed by multivariable analysis, controlling for potential known confounders.</p><p><strong>Results: </strong>Among 768 patients at high risk for post-ERCP pancreatitis who underwent outpatient ERCP and were discharged home, 21.9% required hospitalization within 30 days. Compared to patients who underwent outpatient ERCP but were admitted immediately to the hospital post-procedure, patients who were discharged after ERCP and admitted later had a higher incidence of post-ERCP pancreatitis (40.5% vs 30.9%, P=0.04), moderate-severe post-ERCP pancreatitis (24.4% vs 13.8 %, P <0.01), and longer length of hospital stay (6.2 days vs 3.7 days, P<0.001). Factors associated with 30-day hospitalization included patient age (OR 0.98, 95% CI 0.97, 0.99), biliary stent placement (OR 1.62, 95% CI 1.05, 2.48), and attempt at pancreatic duct cannulation (OR 1.64, 95% CI 1.02, 2.64).</p><p><strong>Conclusions: </strong>High-risk patients who undergo outpatient ERCP and are discharged home are at considerable risk for hospital admission within 30 days and have increased rate of pancreatitis and longer length of hospital stay compared to outpatients admitted to the hospital immediately following ERCP, and some factors may predict this outcome. These findings should influence decision making and informed consent when electing to proceed with high-risk ERCP, recognizing that patients with sphincter of Oddi dysfunction were over-represented in this cohort, which may limit generalizability to a typical ERCP practice.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-04DOI: 10.1016/j.gie.2025.01.038
Matthew T Moyer
{"title":"At the Focal Point: ERCP in Altered Anatomy: Managing a Large Bile Duct Stone in a Type 4 Hiatal Hernia using a Savary wire.","authors":"Matthew T Moyer","doi":"10.1016/j.gie.2025.01.038","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.038","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-04DOI: 10.1016/j.gie.2025.01.037
Masau Sekiguchi, Marcus Westerberg, Christian Löwbeer, Anna Forsberg
Background and aims: In colorectal cancer screening using the fecal immunochemical test (FIT), the optimal follow-up following first-round colonoscopy for a positive FIT, particularly after negative colonoscopy, is unknown. Hence, utilizing Screening of Swedish Colons (SCREESCO) study data, we aimed to elucidate the risk factors for the detection of colorectal neoplasia in second-round colonoscopy, which can affect recommendations for the optimal follow-up.
Methods: We performed a cross-sectional analysis using data from SCREESCO participants undergoing colonoscopy after a positive two-stool FIT, with a positivity cut-off value of ≥10 μg/g feces, in both the first and second rounds separated by a two-year interval. We assessed the associations between colorectal neoplasia detection in second-round colonoscopy and participant characteristics, FIT concentrations, first-round colonoscopy results, and endoscopists' adenoma detection rates (ADRs), which were categorized as very low, low, intermediate, and high.
Results: This study included 343 individuals. Despite negative first-round colonoscopies (n=230), colorectal cancer and advanced colorectal neoplasia (ACN) were detected in 0.9% and 8.3% of participants in the second-round colonoscopy, respectively. An association was demonstrated between the first-round endoscopists' ADRs and the risk of the second-round ACN detection. The multivariable odds ratios of the first-round intermediate and high ADRs, compared with the very low ADR, for the second-round ACN detection, were 0.17 (95% confidence interval: 0.02-0.79) and 0.19 (95% confidence interval: 0.04-0.86), respectively.
Discussion: The impact of endoscopists' ADRs on ACN detection in subsequent-round colonoscopies underscores the importance of considering ADR for optimal follow-up after first-round colonoscopy in a FIT-based screening program.
{"title":"Endoscopist adenoma detection rate associated with neoplasia detection during subsequent-round colonoscopy in fecal immunochemical test-based colorectal cancer screening: cross-sectional analysis of the SCREESCO randomized controlled trial.","authors":"Masau Sekiguchi, Marcus Westerberg, Christian Löwbeer, Anna Forsberg","doi":"10.1016/j.gie.2025.01.037","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.037","url":null,"abstract":"<p><strong>Background and aims: </strong>In colorectal cancer screening using the fecal immunochemical test (FIT), the optimal follow-up following first-round colonoscopy for a positive FIT, particularly after negative colonoscopy, is unknown. Hence, utilizing Screening of Swedish Colons (SCREESCO) study data, we aimed to elucidate the risk factors for the detection of colorectal neoplasia in second-round colonoscopy, which can affect recommendations for the optimal follow-up.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis using data from SCREESCO participants undergoing colonoscopy after a positive two-stool FIT, with a positivity cut-off value of ≥10 μg/g feces, in both the first and second rounds separated by a two-year interval. We assessed the associations between colorectal neoplasia detection in second-round colonoscopy and participant characteristics, FIT concentrations, first-round colonoscopy results, and endoscopists' adenoma detection rates (ADRs), which were categorized as very low, low, intermediate, and high.</p><p><strong>Results: </strong>This study included 343 individuals. Despite negative first-round colonoscopies (n=230), colorectal cancer and advanced colorectal neoplasia (ACN) were detected in 0.9% and 8.3% of participants in the second-round colonoscopy, respectively. An association was demonstrated between the first-round endoscopists' ADRs and the risk of the second-round ACN detection. The multivariable odds ratios of the first-round intermediate and high ADRs, compared with the very low ADR, for the second-round ACN detection, were 0.17 (95% confidence interval: 0.02-0.79) and 0.19 (95% confidence interval: 0.04-0.86), respectively.</p><p><strong>Discussion: </strong>The impact of endoscopists' ADRs on ACN detection in subsequent-round colonoscopies underscores the importance of considering ADR for optimal follow-up after first-round colonoscopy in a FIT-based screening program.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 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.
{"title":"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","authors":"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","doi":"10.1016/j.gie.2024.08.010","DOIUrl":"10.1016/j.gie.2024.08.010","url":null,"abstract":"<div><h3>Background and Aims</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = .26). A significant positive correlation was observed between AA concentration and AD (<em>P</em> < .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 (<em>P</em> = .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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 416-424"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Application of endoscopic purse-string sutures in refractory nonvariceal GI bleeding: a multicenter study (with video)","authors":"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","doi":"10.1016/j.gie.2024.09.020","DOIUrl":"10.1016/j.gie.2024.09.020","url":null,"abstract":"<div><h3>Background and Aims</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>The endoscopic PSS is effective in treating refractory nonvariceal GIB.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 446-451"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142283754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 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.
{"title":"Rates of repeat EGD in nondiabetic adults with glucagon-like peptide-1 receptor agonist prescription: a retrospective matched cohort study","authors":"Abbinaya Elangovan MD , Pearl Aggarwal MD , David C. Kaelber MD , Raj Shah MD","doi":"10.1016/j.gie.2024.10.004","DOIUrl":"10.1016/j.gie.2024.10.004","url":null,"abstract":"<div><h3>Background and Aims</h3><div>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.</div></div><div><h3>Methods</h3><div>Using the TriNetX health research platform (Cambridge, Mass, USA), we analyzed adults with a body mass index ≥27 kg/m<sup>2</sup> 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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>GLP-1RAs may not substantially increase the risk of repeat endoscopy in individuals without diabetes.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 441-445"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 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.)
{"title":"EUS-guided shear wave elastography for fibrosis screening in patients with obesity and metabolic dysfunction–associated steatotic liver disease: a pilot study (with video)","authors":"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","doi":"10.1016/j.gie.2024.10.054","DOIUrl":"10.1016/j.gie.2024.10.054","url":null,"abstract":"<div><h3>Background and Aims</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Sixty-two patients were included. Mean body mass index was 40.74 kg/m<sup>2</sup>. EUS-SWE was superior to FIB-4 in discriminating significant fibrosis (F2; AUROC, .87 vs .61; <em>P</em> < .0048) and advanced fibrosis (F3; AUROC, .93 vs .63; <em>P</em> < .0001), but not cirrhosis (F4; AUROC, .95 vs .81; <em>P</em> = .099). EUS-SWE was superior to VCTE in predicting advanced fibrosis and cirrhosis (<em>P</em> = .0067 and <em>P</em> = .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.</div></div><div><h3>Conclusions</h3><div>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.)</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 456-462.e1"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gie.2024.10.017
Eric M. Pauli MD
{"title":"Under pressure: changing our way of caring","authors":"Eric M. Pauli MD","doi":"10.1016/j.gie.2024.10.017","DOIUrl":"10.1016/j.gie.2024.10.017","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 375-376"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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