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A Rare Case of Gastric Mass Due to Adrenal Tuberculosis Presenting Without Typical Clinical Manifestations of Addison's Disease.
IF 6.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-07 DOI: 10.1016/j.gie.2025.02.005
Chuwei Zheng, Xiaowen Li, Liming Shao, Xia Ji, Jinming Zhang, Muxin Yu
{"title":"A Rare Case of Gastric Mass Due to Adrenal Tuberculosis Presenting Without Typical Clinical Manifestations of Addison's Disease.","authors":"Chuwei Zheng, Xiaowen Li, Liming Shao, Xia Ji, Jinming Zhang, Muxin Yu","doi":"10.1016/j.gie.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.gie.2025.02.005","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382158","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}
引用次数: 0
Cholangioscopy-Based Treatment and Diagnosis of an Infrequent Cause of Jaundice: Common Bile Duct Polyp.
IF 6.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-04 DOI: 10.1016/j.gie.2025.01.039
Liying Tao, Hongguang Wang, Qingmei Guo, DongYue Wang, GuangYao Shi, Xiang Guo, Liu Lin
{"title":"Cholangioscopy-Based Treatment and Diagnosis of an Infrequent Cause of Jaundice: Common Bile Duct Polyp.","authors":"Liying Tao, Hongguang Wang, Qingmei Guo, DongYue Wang, GuangYao Shi, Xiang Guo, Liu Lin","doi":"10.1016/j.gie.2025.01.039","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.039","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":"143364307","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}
引用次数: 0
SURVEILLANCE FINDINGS IN HIGH-RISK PATIENTS AFTER BASELINE COMPUTER-ASSISTED DETECTION COLONOSCOPY: A PROPENSITY SCORE MATCHING ANALYSIS.
IF 6.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-04 DOI: 10.1016/j.gie.2025.01.036
Thomas Kl Lui, Michael Kl Ko, Elvis Wp To, Wai K Leung

Background and aims: The impact of CADe application on surveillance colonoscopy findings remains unknown. We compare surveillance colonoscopy findings in patients with high-risk lesions detected at baseline, with or without the application of CADe.

Methods: We included patients with high-risk baseline lesions and had undergone surveillance colonoscopy. High-risk baseline lesions included advanced adenoma, advanced serrated lesion, or three or more adenomas at baseline colonoscopy. Patients were divided into two groups according to baseline use of CADe (vs conventional), and matched by propensity score matching (PSM) in 1:2 ratio for surveillance interval, baseline characteristics and index colonoscopy findings. The primary outcome was metachronous advanced adenoma (AA) rate.

Results: Of 403 patients with high-risk baseline lesions and surveillance colonoscopy, 162 patients were included after PSM. In patients with baseline use of CADe, both the AA detection rate (11.1% vs 24.1%, p=0.05) and the number of AA per colonoscopy (0.1 vs 0.3, p=0.01) were significantly lower than those with conventional colonoscopy. Similar pattern was observed for detection rate of adenoma (44.4% vs 63.0%, p=0.02) and the mean number of adenomas detected per colonoscopy (adenoma: 0.6 vs 1.2, p=0.01). The cumulative incidence of patients with any metachronous adenoma or serrated lesion was significantly lower in patients with baseline use of CADe than conventional colonoscopy (log rank p=0.05).

Conclusions: Patients who had CADe use at baseline colonoscopy had significantly lower rates of metachronous lesions, including advanced adenoma, on surveillance colonoscopy.

{"title":"SURVEILLANCE FINDINGS IN HIGH-RISK PATIENTS AFTER BASELINE COMPUTER-ASSISTED DETECTION COLONOSCOPY: A PROPENSITY SCORE MATCHING ANALYSIS.","authors":"Thomas Kl Lui, Michael Kl Ko, Elvis Wp To, Wai K Leung","doi":"10.1016/j.gie.2025.01.036","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.036","url":null,"abstract":"<p><strong>Background and aims: </strong>The impact of CADe application on surveillance colonoscopy findings remains unknown. We compare surveillance colonoscopy findings in patients with high-risk lesions detected at baseline, with or without the application of CADe.</p><p><strong>Methods: </strong>We included patients with high-risk baseline lesions and had undergone surveillance colonoscopy. High-risk baseline lesions included advanced adenoma, advanced serrated lesion, or three or more adenomas at baseline colonoscopy. Patients were divided into two groups according to baseline use of CADe (vs conventional), and matched by propensity score matching (PSM) in 1:2 ratio for surveillance interval, baseline characteristics and index colonoscopy findings. The primary outcome was metachronous advanced adenoma (AA) rate.</p><p><strong>Results: </strong>Of 403 patients with high-risk baseline lesions and surveillance colonoscopy, 162 patients were included after PSM. In patients with baseline use of CADe, both the AA detection rate (11.1% vs 24.1%, p=0.05) and the number of AA per colonoscopy (0.1 vs 0.3, p=0.01) were significantly lower than those with conventional colonoscopy. Similar pattern was observed for detection rate of adenoma (44.4% vs 63.0%, p=0.02) and the mean number of adenomas detected per colonoscopy (adenoma: 0.6 vs 1.2, p=0.01). The cumulative incidence of patients with any metachronous adenoma or serrated lesion was significantly lower in patients with baseline use of CADe than conventional colonoscopy (log rank p=0.05).</p><p><strong>Conclusions: </strong>Patients who had CADe use at baseline colonoscopy had significantly lower rates of metachronous lesions, including advanced adenoma, on surveillance colonoscopy.</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":"143364328","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}
引用次数: 0
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 data set.
IF 6.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-04 DOI: 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: ERCP carries potential for serious adverse events, and there is risk for unplanned health encounters after the procedure. The primary objective of this study was to identify the rate of 30-day hospital admission after 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 lengths of hospital stay differ with delayed hospitalization (versus admission immediately after ERCP) and identified factors associated with 30-day hospital admission.

Methods: High-risk patients in the Stent Versus Indomethacin trial who underwent outpatient ERCP were identified. The primary outcome was hospital admission within 30 days after outpatient ERCP. Patient and procedural factors associated with 30-day hospital admission were explored by means of 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 with patients who underwent outpatient ERCP but were admitted immediately to the hospital after the procedure, patients who were discharged after ERCP and admitted later had a higher incidence of post-ERCP pancreatitis (40.5% vs 30.9%; P = .04), moderate to severe post-ERCP pancreatitis (24.4% vs 13.8%; P < .01), and longer length of hospital stay (6.2 d vs 3.7 d; P < .001). Factors associated with 30-day hospitalization included patient age (odds ratio [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 an increased rate of pancreatitis and longer length of hospital stay compared with outpatients admitted to the hospital immediately after 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 data set.","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":"10.1016/j.gie.2025.01.035","url":null,"abstract":"<p><strong>Background and aims: </strong>ERCP carries potential for serious adverse events, and there is risk for unplanned health encounters after the procedure. The primary objective of this study was to identify the rate of 30-day hospital admission after 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 lengths of hospital stay differ with delayed hospitalization (versus admission immediately after ERCP) and identified factors associated with 30-day hospital admission.</p><p><strong>Methods: </strong>High-risk patients in the Stent Versus Indomethacin trial who underwent outpatient ERCP were identified. The primary outcome was hospital admission within 30 days after outpatient ERCP. Patient and procedural factors associated with 30-day hospital admission were explored by means of 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 with patients who underwent outpatient ERCP but were admitted immediately to the hospital after the procedure, patients who were discharged after ERCP and admitted later had a higher incidence of post-ERCP pancreatitis (40.5% vs 30.9%; P = .04), moderate to severe post-ERCP pancreatitis (24.4% vs 13.8%; P < .01), and longer length of hospital stay (6.2 d vs 3.7 d; P < .001). Factors associated with 30-day hospitalization included patient age (odds ratio [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 an increased rate of pancreatitis and longer length of hospital stay compared with outpatients admitted to the hospital immediately after 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}
引用次数: 0
At the Focal Point: ERCP in Altered Anatomy: Managing a Large Bile Duct Stone in a Type 4 Hiatal Hernia using a Savary wire.
IF 6.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-04 DOI: 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}
引用次数: 0
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.
IF 6.7 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-02-04 DOI: 10.1016/j.gie.2025.01.037
Masau Sekiguchi, Marcus Westerberg, Christian Löwbeer, Anna Forsberg

Background and aims: In colorectal cancer screening with the fecal immunochemical test (FIT), the optimal follow-up after first-round colonoscopy for a positive FIT, particularly after negative colonoscopy, is unknown. Therefore, using 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 2-stool FIT, with a positivity cutoff value of ≥10 μg/g feces, in both the first and second rounds separated by a 2-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 second-round ACN detection. The multivariable odds ratios of the first-round intermediate and high ADRs, compared with the very low ADR, for second-round ACN detection were 0.17 (95% confidence interval [CI], 0.02-0.79) and 0.19 (95% CI, 0.04-0.86), respectively.

Conclusions: 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 an 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":"10.1016/j.gie.2025.01.037","url":null,"abstract":"<p><strong>Background and aims: </strong>In colorectal cancer screening with the fecal immunochemical test (FIT), the optimal follow-up after first-round colonoscopy for a positive FIT, particularly after negative colonoscopy, is unknown. Therefore, using 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 2-stool FIT, with a positivity cutoff value of ≥10 μg/g feces, in both the first and second rounds separated by a 2-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 second-round ACN detection. The multivariable odds ratios of the first-round intermediate and high ADRs, compared with the very low ADR, for second-round ACN detection were 0.17 (95% confidence interval [CI], 0.02-0.79) and 0.19 (95% CI, 0.04-0.86), respectively.</p><p><strong>Conclusions: </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 an 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}
引用次数: 0
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 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。
{"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,&nbsp;Taku Yamagata MD,&nbsp;Yoshihide Kanno MD,&nbsp;Megumi Tanaka MD,&nbsp;Tomohiro Shimada MD,&nbsp;Daichi Komabayashi MD,&nbsp;Hiroki Sato MD,&nbsp;Yuta Shibuya MD,&nbsp;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> &lt; .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}
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 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 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 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
期刊
Gastrointestinal endoscopy
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