Gastrointestinal endoscopy最新文献

Background and aims: Piecemeal endoscopic mucosal resection (EMR) is the standard of care for large, nonpedunculated colon polyps but is associated with recurrence rates of 9% to 31%. Current guidelines recommend 6-month surveillance for all patients, although this may not be necessary for lower-risk cases.

Methods: We retrospectively reviewed patients who underwent piecemeal EMR of ≥20-mm colon polyps between 2018 and 2021. Patients were stratified into 6- or 12-month surveillance groups based on polyp features. Recurrence rates and associated factors were compared.

Results: Among 193 patients, recurrence was higher in the 6-month (31.5%) than in the 12-month group (14.3%, P < .05). Among patients with recurrence, the 6-month follow-up group had more tubulovillous adenomas (P < .05) on index colonoscopy. Tubulovillous histology in the initial polyp was the only factor associated with recurrence.

Conclusions: A risk-stratified approach may safely extend surveillance to 12 months for lower-risk patients after piecemeal EMR, reducing unnecessary procedures without compromising care.

Background and aims: Among the newly established endoscopic submucosal dissection (ESD) techniques, underwater ESD (UW-ESD) using saline solution and traction-assisted ESD (T-ESD) aim to address the limitations of conventional ESD (C-ESD) for the resection of colorectal lesions. However, their comparative efficacy and safety remain uncertain.

Methods: A systematic review and network meta-analysis of randomized controlled trials was conducted to compare UW-ESD and T-ESD. Main outcomes included R0 resection, dissection speed, and adverse events (AEs). We conducted indirect comparisons between UW-ESD and T-ESD and direct comparisons with C-ESD. Results were presented as risk ratios (RR) and standard mean deviations (SMDs) with 95% confidence intervals (CIs).

Results: Four RCTs including 543 ESDs (98 UW-ESDs, 171 T-ESDs, and 274 C-ESDs) were analyzed. For R0 resection, no significant difference was observed between UW-ESD and T-ESD (RR = 0.99; 95% CI, 0.92-1.07), and both were comparable to C-ESD (UW-ESD: RR = 1.02; 95% CI, 0.98-1.07; T-ESD: RR = 1.01; 95% CI, 0.96-1.07). Dissection speed was significantly higher with UW-ESD compared with both T-ESD (SMD = 0.36; 95% CI, 0.14-0.87) and C-ESD (SMD = 0.54; 95% CI, 0.15-0.92). No significant difference in AEs was observed between UW-ESD and T-ESD (RR = 1.80; 95% CI, 0.14-23.16), and both were comparable to C-ESD (UW-ESD: RR = 0.48; 95% CI, 0.06-4.15; T-ESD: RR = 0.86; 95% CI, 0.22-3.37).

Conclusions: UW-ESD and T-ESD are both effective and safe strategies for colorectal lesion resection; however, UW-ESD is the only technique that has demonstrated superior dissection speed.

Background and aims: The newly developed self-assembling peptide (SAP) is expected to exert hemostatic effects on the gastrointestinal tract and promote ulcer healing. However, its efficacy in preventing postprocedural hemorrhage after colorectal endoscopic submucosal dissection (ESD) remains uncertain. This study aimed to determine whether SAP could reduce hematochezia, including delayed bleeding (DB), and prevent its occurrence after colorectal ESD.

Methods: This multicenter retrospective study included 1597 patients with 1654 colorectal ESD-related lesions treated between January 2017 and July 2024. Initially, 1419 lesions were analyzed and categorized into non-SAP and SAP groups. Subsequently, the differences between lesions with and without postprocedural hematochezia and DB were explored. Factors associated with hematochezia and DB were examined using univariate and multivariate logistic regression analyses.

Results: A total of 719 and 700 lesions were assigned to the non-SAP and SAP groups, respectively. The use of SAP was associated with a significant reduction in hematochezia. In addition, SAP significantly reduced DB. SAP was identified as a significant factor in the prevention of hematochezia and DB after colorectal ESD.

Conclusions: The application of SAP significantly reduced the occurrence of hematochezia and DB after colorectal ESD. Furthermore, SAP was a significant factor associated with the reduction of hematochezia and DB. Therefore, SAP may be appropriate for the prevention of post-ESD bleeding in the colon.

Background and aims: Endoscopic treatment of intrahepatic benign biliary strictures (BBSs) remains challenging despite repeated balloon dilation and long-term stent placement. The small-caliber, branching, and tortuous anatomy of intrahepatic ducts limits the feasibility of fully covered self-expandable metallic stents. Recently, endoscopic laser stricturoplasty (LAS) has emerged as a promising therapeutic option. We report a case series of 4 patients who underwent successful peroral cholangioscopy-guided LAS (POCS-LAS).

Methods: This retrospective pilot study was conducted at Juntendo University Hospital. Patients who underwent POCS-LAS for intrahepatic BBSs between December 2024 and June 2025 were reviewed to evaluate the feasibility and safety of the procedure.

Results: Six POCS-LAS sessions using a holmium:yttrium-aluminum-garnet laser were performed in 4 patients with postoperative intrahepatic BBSs (2 choledochojejunostomies, 1 right hepatectomy, and 1 cholecystectomy). All procedures were performed with the patient under saline irrigation with a median duration of 100 minutes. Technical success, defined as successful passage of the POCS through the stricture, was achieved in all cases. No adverse events were reported. Three patients became stent-free, and 1 patient remains under treatment.

Conclusions: This pilot study suggests that POCS-LAS is a technically feasible and potentially effective treatment for intrahepatic BBSs.