Gastrointestinal endoscopy最新文献

Background and aims: The infection risk associated with endoscopic ultrasound-directed transgastric intervention (EDGI) and endoscopic ultrasound guided gastroenterostomy (EUS-GE) is unknown. We aim to investigate the effect of prophylactic antibiotics in EDGI and EUS-GE on infection-related outcomes.

Methods: A multi-center, retrospective chart review was conducted on patients who had undergone EDGI or EUS-GE between June 2017 and September 2023. Statistical significance was set at p<0.05.

Results: A total of 263 patients (147 EUS-GE, 116 EDGI) were identified. Prophylactic antibiotics were given in 58.9% of patients. There was no significant difference in the rate of transient (17.4% vs 12.0%, p=0.23) or persistent signs of infection (4.5% vs 3.7%, p=1.00) in patients with and without prophylactic antibiotics, respectively. The length of stay and readmission rates were also not significantly different between the two groups.

Conclusion: Prophylactic antibiotics for EDGI and EUS-GE did not significantly improve infection-related outcomes.

Background and aims: Surgical reversal of Roux-en-Y gastric bypass is associated with significant morbidity. Endoscopic ultrasound (EUS)-guided creation of gastro-gastric (GG) fistulas, using lumen apposing metal stents (LAMS) offers a minimally invasive alternative, but the inability to leave stents in long-term and fistula closure soon after stent removal limits durability.

Methods: Consecutive patients underwent parallel-LAMS septotomy for partial reversal of the RYGB between 2023 and 2025 at two tertiary centers. Technical and clinical outcomes were assessed.

Results: Six patients (mean age 64.5 years), mean BMI of 21.9 ± 3.9 kg/m2 underwent parallel-LAMS septotomy. Technical and clinical success was achieved in all 6 patients (100%). All anastomoses were durable on median follow-up of 24 weeks (range 16-50). There were no major adverse events.

Conclusion: Parallel-LAMS septotomy provides a safe and effective endoscopic approach to achieve a durable GG anastomosis, thereby partially reversing RYGB without reliance on in-dwelling stents.

Background and aims: Pre-therapeutic evaluation of ampullary carcinomas (AC) is important to choose the optimal therapeutic strategy. Our aim was to assess the ability of endoscopic ultrasound (EUS) and computed tomography (CT) to predict pTNM stage of resected AC.

Methods: We analyzed data collected in the Fédération Française de Cancérologie Digestive AC cohort, a French multicentric prospective cohort of patients with resected AC. Our main outcome was assessing diagnostic performances of EUS to predict pT and pN, and CT to predict pN.

Results: Among the 389 patients included in the cohort, data for usT, usN and ctN, along with pathology results, were available for 143, 160 and 185 patients, respectively. To predict pT1, values for sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were 68%, 87%, 53%, and 93% respectively for EUS, with an accuracy of 84%. To predict pT2, values were 58%, 75%, 56% and 75% respectively, with an accuracy of 68%. To predict pT3-T4, values were 62%, 79%, 71%, and 71% respectively, with an accuracy of 71%. To predict pN0, values for Se, Sp, PPV, NPV and accuracy were 88%, 38%, 60%, 75% and 64% respectively for EUS. To predict pN0, values for Se, Sp, PPV, NPV and accuracy were 94%, 39%, 63%, 85% and 68% respectively for CT.

Conclusions: Although the overall performance of both modalities was low, we found that both EUS and CT had good NPV for the prediction of pN0 and EUS had a good NPV for predicting pT1.

Background and aims: Colorectal endoscopic submucosal dissection (ESD) is an effective curative technique for superficial colorectal lesions but remains technically demanding, with variable procedure times. This study aimed to develop and validate a pre-procedure predictive model for colorectal ESD duration in the era of traction-assisted strategies.

Methods: We retrospectively analyzed prospectively collected data from patients who underwent colorectal ESD at Edouard Herriot Hospital (Lyon, France). The derivation cohort included 423 cases (January-December 2024) and an independent temporal validation cohort 148 cases (January-May 2025). A generalized linear model with a gamma distribution and log-link function identified independent pre-procedural predictors of ESD duration. Variables were selected based on univariate significance and the Akaike Information Criterion. Model calibration and discrimination were assessed using R², mean absolute error, and classification accuracy at predefined thresholds (60, 90, 120 minutes). A point-based score (Lyon ESD Dissection Score, LEDs) and nomogram were derived from model coefficients.

Results: Median procedure time in the derivation cohort was 50 minutes (IQR 30-90). Independent predictors of ESD duration included dissection speed of endoscopists, lesion location (flexures, appendix, cecum, ileocecal valve), predicted lesion size, and suspected fibrosis (all p < 0.05). The LEDs provides a direct estimation of the expected procedure time in minutes based on these variables, showing a strong correlation between predicted and observed durations (R² = 0.52). Classification accuracy was 76.1%, 82.2%, and 88.1% for thresholds of 60, 90, and 120 minutes, respectively. Validation confirmed good performance (R² = 0.48) with 91.8% accuracy for procedures ≥120 minutes.

Conclusion: This validated pre-procedure scoring system accurately predicts colorectal ESD duration, especially for longer procedures. It may facilitate scheduling, optimize resource use, and improve workflow in endoscopy units.