Gastrointestinal endoscopy最新文献

英文中文

EUS-guided hepaticojejunostomy in patients with history of total gastrectomy: a multicenter retrospective feasibility study (with video) 内镜超声引导下对有全胃切除术史的患者进行肝空肠吻合术：一项多中心回顾性可行性研究。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.gie.2024.07.011

Daniele Balducci MD , Jean-Philippe Ratone MD , Marion Schaefer MD , Sébastien Godat MD , Enrique Perez-Cuadrado-Robles MD , Solene Hoibian MD , Yanis Dahel MD , Meddy Dalex MD , Jean-Baptiste Chevaux MD , Fabrice Caillol MD , Marc Giovannini MD

Background and Aims

EUS-guided hepaticogastrostomy (EUS-HGS) is an effective biliary drainage technique for patients with altered anatomy or duodenal strictures. EUS-guided hepaticojejunostomy (EUS-HJS) can be used to create a fistula between the left hepatic duct and the jejunum in patients with a history of total gastrectomy. No specific data on this technique have been published. The aim of this study was to assess the feasibility and safety of EUS-HJS in patients with a history of total gastrectomy.

Methods

This retrospective multicenter study included all adult patients who underwent EUS-HJS at 3 tertiary French centers and 1 tertiary Swiss center between May 2011 and February 2023. The primary outcome was clinical success, which was defined as the disappearance of pruritus, jaundice, and/or cholangitis. An improvement in bilirubin >30% within the first week and/or bilirubin normalization within 1 month after the procedure were also considered indicators of clinical success. Secondary outcomes were technical success, rate of adverse events, need for endoscopic revision, possibility of resuming anticancer treatment, median survival, and technical differences compared with EUS-HGS.

Results

Twenty-one patients with history of complete gastrectomy who underwent EUS-HJS were included. Technical success was achieved in 100% of patients (95% confidence interval [CI], 85-100). Clinical success was achieved in 80% of patients (95% CI, 58-92). The incidence of recorded adverse events was 33% (95% CI, 17-55), with cholangitis being the most frequent adverse event. Seven patients (39%) were able to benefit from anticancer treatment after the procedure. Median survival time was 6 months (interquartile range, 1.5-12).

Conclusions

EUS-HJS is an effective and feasible procedure for patients whose anatomy has been altered by total gastrectomy.

背景和目的：内镜超声引导肝胃造口术（EUS-HGS）是一种有效的胆道引流技术，适用于解剖结构改变或十二指肠狭窄的患者。内镜超声引导下肝空肠吻合术（EUS-HJS）可用于在有全胃切除术史的患者的左肝管和空肠之间建立瘘管。关于这项技术的具体数据尚未公布。本研究旨在评估 EUS-HJS 在全胃切除术患者中的可行性和安全性：这项回顾性多中心研究纳入了 2011 年 5 月至 2023 年 2 月期间在三家法国三级医疗中心和一家瑞士三级医疗中心接受 EUS-HJS 治疗的所有成年患者。主要结果是临床成功，即瘙痒、黄疸和/或胆管炎消失。胆红素在术后一周内改善超过 30% 和/或术后一个月内胆红素恢复正常也被视为临床成功的指标。次要结果包括技术成功率、不良事件发生率、内镜翻修需求、恢复抗癌治疗的可能性、中位生存率以及与 EUS-HGS 相比的技术差异：共纳入了 21 例通过 EUS-HJS 进行全胃切除术的患者。100%的患者获得了技术成功（95% CI 85%-100%）。80%的患者取得了临床成功（95% CI 58%-92%）。记录的不良事件发生率为 33% (95% CI 17%-55%)，胆管炎是最常见的并发症。七名患者（39%）在术后接受了抗癌治疗。中位生存期为6个月（IQR 1.5-12）：结论：对于因全胃切除术而导致解剖结构改变的患者来说，EUS-HJS 是一种有效且可行的手术。

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引用次数: 0

Dedicated devices for performance of EUS-guided gastroenterostomy: Are they really needed? 用于eus引导胃肠造口术的专用设备：它们真的需要吗？

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.gie.2024.09.025

Enrique Vazquez-Sequeiros MD, PhD

引用次数: 0

A little confusion about statistical methods and could we believe the results of overfitted logistic regression models? 统计方法有点混乱，我们能相信过拟合逻辑回归模型的结果吗？

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.gie.2024.08.006

Xiongjian Wu PhD, Lixing Huang MD

引用次数: 0

Response 响应。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.gie.2024.09.015

David Uihwan Lee MD, Andrew Canakis DO, Raymond E. Kim MD

引用次数: 0

Comparison of flexible endoscopic needle-knife septotomy and peroral endoscopic myotomy for treatment of Zenker's diverticulum 比较柔性内窥镜针刀隔膜切除术和口周内窥镜肌切开术治疗禅克氏憩室。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.gie.2024.08.035

Yara Sarkis MD , Sarah Stainko FNP , Anthony Perkins MSc , Mohammad A. Al-Haddad MD, MSc , John M. DeWitt MD

Background and Aims

Treatment of Zenker’s diverticulum (ZD) has evolved from flexible endoscopic septotomy (FES) to peroral endoscopic myotomy for ZD (Z-POEM). In this study, we compare the efficacy and safety of flexible endoscopic needle-knife septotomy (FENKS) and Z-POEM for symptomatic ZD.

Methods

Consecutive patients at a single institution who underwent endoscopic ZD treatment by FENKS or Z-POEM were identified. Demographics, clinical characteristics, procedure technique, technical and clinical success, and adverse events (AEs) within 30 days were reviewed and compared between the 2 groups. AEs were classified by the AGREE classification. Baseline and postprocedure Dakkak and Bennett (DB) scores were reported at 6, 12, and 24 months. Clinical success (DB score ≤1) was assessed by per-protocol (PP) and intention-to-treat analyses (ITT).

Results

Sixty patients (55% men; mean age, 72 ± 12 years) underwent FENKS (n = 21) or Z-POEM (n = 39) between 2016 and 2023. Baseline clinical characteristics were similar, and overall technical success was 98.3%. Clinical success by PP and ITT analyses at 6, 12, and 24 months after each intervention were similar between both groups. The FENKS group had a higher prevalence (29% vs 5%, P = .018) and severity (P = .032) of AEs and were more likely to be hospitalized after treatment (71% vs 33%, P = .007). During a median follow-up of 18 months, reintervention was required for 5 cases (10%), 2 (9%) in the FENKS and 3 (7.6%) in the Z-POEM group (P = 1.0) a mean 7.6 ± 4.4 months after initial therapy.

Conclusions

Treatment of ZD with Z-POEM appears to be safer than FENKS with similar short and midterm clinical success.

背景和目的：泽纳克氏憩室（ZD）的治疗方法已从柔性内窥镜隔膜切除术（FES）发展到口腔内窥镜肌切开术（Z-POEM）。在这项研究中，我们比较了FES与针刀隔膜切除术（FENKS）和Z-POEM治疗症状性ZD的有效性和安全性：方法：研究人员对一家医疗机构中通过 FENKS 或 Z-POEM 进行内镜 ZD 治疗的连续患者进行了鉴定。对两组患者的人口统计学、临床特征、手术技术、技术和临床成功率以及 30 天内的不良事件（AEs）进行回顾和比较。不良反应按 AGREE 分类法进行分类。在 6 个月、12 个月和 24 个月时报告基线和术后 Dakkak 和 Bennett（DB）评分。临床成功率（DB评分≤1）通过协议分析（PP）和意向治疗分析（ITT）进行评估：60名患者（55%为男性，平均72±12岁）在2016年至2023年间接受了FENKS（21人）或Z-POEM（39人）治疗。基线临床特征相似，总体技术成功率为98.3%。根据干预后6、12和24个月的PP和ITT分析，两组的临床成功率相似。FENKS组的AE发生率（29%对5%，P=0.018）和严重程度（P=0.032）更高，治疗后更有可能住院（71%对33%，P=0.007）。在中位随访18个月期间，FENKS组（2人，9%）和Z-POEM组（3人，7.6%）中有5人（10%）需要再次干预（p=1.0），平均为初始治疗后7.6 ± 4.4个月：结论：用 Z-POEM 治疗 ZD 似乎比 FENKS 更安全，而且中短期临床疗效相似。

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引用次数: 0

Top tips for the management of iatrogenic colon perforations 处理先天性结肠穿孔的绝招。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.gie.2024.08.027

Mark Benson MD

引用次数: 0

Development and validation of a machine learning–based, point-of-care risk calculator for post-ERCP pancreatitis and prophylaxis selection 开发并验证基于机器学习的医护点风险计算器，用于ERCP 后胰腺炎和预防措施的选择。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.gie.2024.08.009

Todd Brenner MD , Albert Kuo BS , Christina J. Sperna Weiland MD, PhD , Ayesha Kamal MD , B. Joseph Elmunzer MD, MPH , Hui Luo MD , James Buxbaum MD , Timothy B. Gardner MD, MS , Shaffer S. Mok MD , Evan S. Fogel MD , Veit Phillip MD , Jun-Ho Choi MD , Guan W. Lua MD , Ching-Chung Lin MD , D. Nageshwar Reddy MD , Sundeep Lakhtakia MD , Mahesh K. Goenka MD , Rakesh Kochhar MD , Mouen A. Khashab MD , Erwin J.M. van Geenen MD, PhD , Venkata S. Akshintala MD

Background and Aims

A robust model of post-ERCP pancreatitis (PEP) risk is not currently available. We aimed to develop a machine learning–based tool for PEP risk prediction to aid in clinical decision making related to periprocedural prophylaxis selection and postprocedural monitoring.

Methods

Feature selection, model training, and validation were performed using patient-level data from 12 randomized controlled trials. A gradient-boosted machine (GBM) model was trained to estimate PEP risk, and the performance of the resulting model was evaluated using the area under the receiver operating curve (AUC) with 5-fold cross-validation. A web-based clinical decision-making tool was created, and a prospective pilot study was performed using data from ERCPs performed at the Johns Hopkins Hospital over a 1-month period.

Results

A total of 7389 patients were included in the GBM with an 8.6% rate of PEP. The model was trained on 20 PEP risk factors and 5 prophylactic interventions (rectal nonsteroidal anti-inflammatory drugs [NSAIDs], aggressive hydration, combined rectal NSAIDs and aggressive hydration, pancreatic duct stenting, and combined rectal NSAIDs and pancreatic duct stenting). The resulting GBM model had an AUC of 0.70 (65% specificity, 65% sensitivity, 95% negative predictive value, and 15% positive predictive value). A total of 135 patients were included in the prospective pilot study, resulting in an AUC of 0.74.

Conclusions

This study demonstrates the feasibility and utility of a novel machine learning–based PEP risk estimation tool with high negative predictive value to aid in prophylaxis selection and identify patients at low risk who may not require extended postprocedure monitoring.

背景和目的：目前还没有关于ERCP术后胰腺炎（PEP）风险的可靠模型。我们的目标是开发一种基于机器学习的 PEP 风险预测工具，以帮助与围手术期预防选择和手术后监测相关的临床决策：方法：使用来自 12 项随机对照试验的患者级数据进行特征选择、模型训练和验证。训练梯度增强型机器（GBM）模型来估计PEP风险，并通过接收者操作曲线下面积（AUC）和5倍交叉验证来评估模型的性能。我们创建了一个基于网络的临床决策工具，并利用约翰-霍普金斯医院在一个月内进行的ERCP数据开展了一项前瞻性试验研究：共有 7389 名患者被纳入 GBM，PEP 率为 8.6%。该模型根据 20 个 PEP 风险因素和 5 种预防性干预措施（直肠非甾体类抗炎药 [NSAID]、积极补液、直肠非甾体类抗炎药和积极补液联合应用、胰管 [PD] 支架植入术以及直肠非甾体类抗炎药和胰管支架植入术联合应用）进行了训练。由此得出的 GBM 模型的 AUC 为 0.70（特异性 65%，敏感性 65%，阴性预测值 95%，阳性预测值 15%）。前瞻性试点研究共纳入 135 名患者，得出的 AUC 为 0.74：这项研究证明了基于机器学习的新型 PEP 风险评估工具的可行性和实用性，该工具具有较高的阴性预测值，可帮助选择预防措施，并识别可能不需要延长术后监测时间的低风险患者。

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引用次数: 0

Appendiceal cast due to fecal impaction in the appendix 阑尾内粪便嵌塞导致阑尾铸型。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.gie.2024.07.022

Hidetaka Hamamoto MD, Tomoki Matsuda MD, PhD, Mareyuki Endo MD, PhD, Junichi Akahira MD, PhD

引用次数: 0

Prospective, randomized controlled study evaluating a double-balloon interventional endoscopic platform for colorectal endoscopic submucosal dissection (with video) 前瞻性随机对照研究，评估治疗结肠直肠癌的双球囊介入内窥镜平台。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.gie.2024.07.001

Sergey V. Kantsevoy MD, PhD, FJGES, Angela Palmer RN, BSN, CGRN, Deborah Hockett RN, BSN, April Vilches RN, BSN

Backgrounds and Aims

Endoscopic submucosal dissection (ESD) can be challenging and time-consuming. A double-balloon interventional platform (DBIP) was designed to assist with navigation, stabilization, traction, and device delivery during complex colorectal polypectomy. We compared traditional ESD (T-ESD) with DBIP-assisted ESD (DBIP-ESD) in a prospective, randomized trial.

Methods

Patients with colorectal polyps ≥2 cm were randomly assigned (1:1) to DBIP-ESD or T-ESD. The primary study endpoint was the mean total procedure time difference between groups. Secondary endpoints were intraprocedural time points, en bloc resection rate, procedure cost, adverse events, and 3-month assessment. A sample size of 200 subjects for ≥80% power was calculated. Interim analysis for early study termination was planned at 70% enrollment if the primary endpoint was met (P ≤ .05).

Results

One hundred forty-seven patients were enrolled between February 2019 and February 2020. Seven patients dropped out, and the interim analysis was performed on 140 patients (71 DBIP-ESD, 69 T-ESD). Demographics, comorbidities, and lesion size, location, and classification were similar between groups. The mean procedure time decreased with DBIP-ESD (88.6 ± 42.7 minutes) versus T-ESD (139.5 ± 83.2 minutes; difference of ∼51 minutes [36.5%]; P < .001], with procedural savings of $610.16 (11.4%) per patient after DBIP cost. The DBIP increased dissection speed by 49.0% (15.1 ± 8.0 vs 7.7 ± 6.6 cm²/h, P < .001). En bloc resection was superior with the addition of DBIP (97.2% vs 87.0%, P = .030). The mean navigation time with DBIP-ESD for sutured defect closure decreased by 7.7 minutes (P < .001). There were no adverse events in the DBIP-ESD group.

Conclusions

DBIP-ESD decreased the total procedure time, improved the en bloc resection rate, and facilitated sutured defect closure, making DBIP a promising and cost-effective tool to improve colorectal ESD adoption. (Clinical trial registration number: NCT 03846609.)

背景与目的：内镜黏膜下剥离术（ESD）具有挑战性且耗时。研究目的：在一项前瞻性随机试验中比较传统的（T-ESD）和 DBIP 辅助的 ESD（DBIP-ESD）：方法：将结肠直肠息肉≥2厘米的患者随机分配（1:1）到DBIP-ESD或T-ESD。主要研究终点：组间平均手术总时间差异。次要终点：术中时间点、全灶切除率、手术费用、不良事件和 3 个月评估。计算得出的样本量为 200 例受试者，功率≥ 80%。如果达到主要终点（P≤0.05），则计划在入选率达到70%时进行中期分析，提前终止研究：147名患者于2019年2月至2020年2月期间入组。7名患者退出。对 140 名患者（71 名 DBIP-ESD 患者，69 名 T-ESD 患者）进行了中期分析。两组患者的人口统计学、合并疾病、病变大小/位置/分类相似。DBIP（88.6±42.7 分钟）与 T-ESD（139.5±83.2 分钟）相比，平均手术时间缩短[51 分钟，36.5%，p2/小时，p< 0.001]。DBIP的全切效果更好（97.2% vs 87.0%，p=0.030）。使用DBIP进行缝合缺损闭合的平均导航时间减少了7.7分钟（p结论：DBIP缩短了手术总时间，提高了全切率，促进了缝合缺损闭合，使DBIP成为改善结肠直肠ESD采用率的一种有前途且具有成本效益的工具。

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引用次数: 0

Machine-based learning still has a lot to learn 基于机器的学习还有很多需要学习的地方。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.gie.2024.09.036

Eric M. Goldberg MD

引用次数: 0

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