Pub Date : 2025-02-01DOI: 10.1016/j.gie.2024.10.060
Kai Deng MD
{"title":"Acetic acid–enhanced magnifying endoscopy with narrow-band imaging: A simple, efficient, and nontoxic alternative chromoendoscopy for pit pattern analysis in colorectal neoplasm?","authors":"Kai Deng MD","doi":"10.1016/j.gie.2024.10.060","DOIUrl":"10.1016/j.gie.2024.10.060","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 425-426"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074351","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.2024.07.010
Felix W. Leung MD , Ramsey Cheung MD , Shai Friedland MD , Naom Jacob MD, PhD , Joseph W. Leung MD , Jennifer Y. Pan MD, MS , Susan Y. Quan MD , James Sul MD , Andrew W. Yen MD, MAS , Nora Jamgotchian MS , Yu Chen PhD , Vivek Dixit PhD , Aliya Shaikh MBBS , David Elashoff PhD , Angshuman Saha PhD , Holly Wilhalme MS
Background and Aims
Water exchange (WE) and cap-assisted colonoscopy separately have been shown to reduce pain during insertion in unsedated patients. We hypothesized that compared with WE, WE cap-assisted colonoscopy (WECAC) could significantly lower real-time maximum insertion pain (RTMIP).
Methods
Veterans without escort were recruited, randomized, blinded, and examined at 3 U.S. Veterans Affairs sites. The primary outcome was RTMIP, defined as the highest segmental pain (0 = no pain, 10 = most severe pain) during insertion.
Results
Randomization (WECAC, 143; WE, 137) produced an even distribution of a racially diverse group of men and women of low socioeconomic status. The intention-to-treat analysis reported results of WECAC and WE for cecal intubation (93% and 94.2%, respectively), mean RTMIP (2.9 [standard deviation {SD}, 2.5] and 2.6 [SD, 2.4]), proportion of patients with no pain (28.7% and 27.7%), mean insertion time (18.6 minutes [SD, 15.6] and 18.8 minutes [SD, 15.9]), and overall adenoma detection rate (48.3% and 55.1%); all P values were >.05. When RTMIP was binarized as "no pain" (0) versus "some pain" (1-10) or "low pain" (0-7) versus "high pain" (8-10), different significant predictors of RTMIP were identified.
Conclusions
Unsedated colonoscopy was appropriate for unescorted veterans. WE alone was sufficient. Adding a cap did not reduce RTMIP. Patient-specific factors and application of WE with insertion suction of infused water contributed to high and low RTMIP, respectively. For unescorted patients, selecting those with low anxiety, avoiding low body mass index, history of depression or self-reported poor health, and complying with the steps of WE can minimize RTMIP to ensure success of unsedated colonoscopy. (Clinical trial registration number: NCT03160859.)
背景和目的：水交换（WE）和帽子辅助结肠镜检查（CAC）可分别减轻无镇静患者插入时的疼痛。我们假设，与WE相比，WECAC可显著降低实时最大插入疼痛（RTMIP）：在美国退伍军人事务部的三个地点招募了无陪护的退伍军人，对其进行随机、盲法检查。主要结果是 RTMIP，即插入过程中的最大节段疼痛（0 = 无痛，10 = 最剧烈疼痛）：随机[WECAC（n = 143）和WE（n = 137）]产生了均匀分布的不同种族低社会经济地位男性和女性群体。意向治疗分析报告了 WECAC（列在第一位）和 WE（列在第二位）的结果：盲肠插管率[93%，94.2%]；RTMIP 平均值（标清）[2.9 (2.5)，2.6 (2.4)]；无痛比例（28.7%，27.7%）；插入时间[18.6 (15.6)，18.8 (15.9) 分钟]；总体 ADR（55.2%，62.8%），所有 P 值均大于 0.05。当 RTMIP 被二分类为 "无痛"（0） vs. "有些痛"（1-10），或 "低痛"（0-7） vs. "高痛"（8-10）时，发现了不同的 RTMIP 重要预测因素（见正文）：结论：对无陪护的退伍军人来说，无痛结肠镜检查是合适的。仅有 WE 就足够了。结论：对于无人陪同的退伍军人，无麻醉结肠镜检查是合适的。患者的具体因素和应用 WE 并插入抽吸注入的水分别导致了高和低 RTMIP。对于无陪护的患者，选择焦虑程度低的患者、避免低体重指数、有抑郁症病史或自述健康状况不佳的患者，并遵守 WE 的步骤，可以最大限度地减少 RTMIP，确保无陪护结肠镜检查的成功。
{"title":"Prospective randomized controlled trial of water exchange plus cap versus water exchange colonoscopy in unsedated veterans","authors":"Felix W. Leung MD , Ramsey Cheung MD , Shai Friedland MD , Naom Jacob MD, PhD , Joseph W. Leung MD , Jennifer Y. Pan MD, MS , Susan Y. Quan MD , James Sul MD , Andrew W. Yen MD, MAS , Nora Jamgotchian MS , Yu Chen PhD , Vivek Dixit PhD , Aliya Shaikh MBBS , David Elashoff PhD , Angshuman Saha PhD , Holly Wilhalme MS","doi":"10.1016/j.gie.2024.07.010","DOIUrl":"10.1016/j.gie.2024.07.010","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Water exchange (WE) and cap-assisted colonoscopy separately have been shown to reduce pain during insertion in unsedated patients. We hypothesized that compared with WE, WE cap-assisted colonoscopy (WECAC) could significantly lower real-time maximum insertion pain (RTMIP).</div></div><div><h3>Methods</h3><div>Veterans without escort were recruited, randomized, blinded, and examined at 3 U.S. Veterans Affairs sites. The primary outcome was RTMIP, defined as the highest segmental pain (0 = no pain, 10 = most severe pain) during insertion.</div></div><div><h3>Results</h3><div>Randomization (WECAC, 143; WE, 137) produced an even distribution of a racially diverse group of men and women of low socioeconomic status. The intention-to-treat analysis reported results of WECAC and WE for cecal intubation (93% and 94.2%, respectively), mean RTMIP (2.9 [standard deviation {SD}, 2.5] and 2.6 [SD, 2.4]), proportion of patients with no pain (28.7% and 27.7%), mean insertion time (18.6 minutes [SD, 15.6] and 18.8 minutes [SD, 15.9]), and overall adenoma detection rate (48.3% and 55.1%); all <em>P</em> values were >.05. When RTMIP was binarized as \"no pain\" (0) versus \"some pain\" (1-10) or \"low pain\" (0-7) versus \"high pain\" (8-10), different significant predictors of RTMIP were identified.</div></div><div><h3>Conclusions</h3><div>Unsedated colonoscopy was appropriate for unescorted veterans. WE alone was sufficient. Adding a cap did not reduce RTMIP. Patient-specific factors and application of WE with insertion suction of infused water contributed to high and low RTMIP, respectively. For unescorted patients, selecting those with low anxiety, avoiding low body mass index, history of depression or self-reported poor health, and complying with the steps of WE can minimize RTMIP to ensure success of unsedated colonoscopy. (Clinical trial registration number: NCT03160859.)</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 402-413.e2"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758142","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.2024.06.037
The ASGE Standards of Practice Committee, Nirav C. Thosani MD, MHA , (ASGE Standards of Practice Committee Chair), Madhav Desai MD, MPH , Wasif M. Abidi MD, PhD , Natalie Cosgrove MD , Nauzer Forbes MD, MSc, FASGE , Sara Ghoneim MD , Calvin Lee MD , Jorge D. Machicado MD, MPH , Jared Magee DO, MPH , Neil B. Marya MD , Saowanee Ngamruengphong MD, FASGE , Michael D. Rice MD , Wenly Ruan MD , Monica Saumoy MD, MS , Sunil G. Sheth MD, FASGE , Nikhil R. Thiruvengadam MD , Bashar J. Qumseya MD, MPH, FASGE , (previous ASGE Standards of Practice Committee Chair)
{"title":"American Society for Gastrointestinal Endoscopy clinical practice guideline development policy and checklist","authors":"The ASGE Standards of Practice Committee, Nirav C. Thosani MD, MHA , (ASGE Standards of Practice Committee Chair), Madhav Desai MD, MPH , Wasif M. Abidi MD, PhD , Natalie Cosgrove MD , Nauzer Forbes MD, MSc, FASGE , Sara Ghoneim MD , Calvin Lee MD , Jorge D. Machicado MD, MPH , Jared Magee DO, MPH , Neil B. Marya MD , Saowanee Ngamruengphong MD, FASGE , Michael D. Rice MD , Wenly Ruan MD , Monica Saumoy MD, MS , Sunil G. Sheth MD, FASGE , Nikhil R. Thiruvengadam MD , Bashar J. Qumseya MD, MPH, FASGE , (previous ASGE Standards of Practice Committee Chair)","doi":"10.1016/j.gie.2024.06.037","DOIUrl":"10.1016/j.gie.2024.06.037","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 261-266"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544922","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.2024.10.008
The ASGE Standards of Practice Committee, Madhav Desai MD, MPH , Wenly Ruan MD , Nirav C. Thosani MD , Manuel Amaris MD , J. Stephen Scott MD , Ahmed Saeed MD , Barham Abu Dayyeh MD, MPH, FASGE , Marcia Irene Canto MD, MHS, MASGE , Wasif Abidi MD, PhD , Omeed Alipour MD , Stuart K. Amateau MD, PhD, FASGE , Natalie Cosgrove MD , Sherif E. Elhanafi MD , Nauzer Forbes MD, MSc, FASGE , Divyanshoo R. Kohli MD , Richard S. Kwon MD, FASGE , Larissa L. Fujii-Lau MD , Jorge D. Machicado MD, MPH , Neil B. Marya MD , Bashar J. Qumseya MD, MPH, FASGE
This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for strategies to diagnose and manage GERD. This document was developed using the Grading of Recommendations Assessment, Development, and Evaluation framework and serves as an update to the 2014 ASGE guideline on the role of endoscopy in the management of GERD. This updated guideline addresses the indications for endoscopy in patients with GERD as well as in the emerging population of patients who develop GERD after sleeve gastrectomy or peroral endoscopic myotomy. It also discusses how to endoscopically evaluate gastroesophageal junctional integrity in a comprehensive and uniform manner. Importantly, this guideline also discusses management strategies for GERD including the role of lifestyle interventions, proton pump inhibitors (PPIs), and endoscopic antireflux therapy (including transoral incisionless fundoplication [TIF], radiofrequency energy, and combined hiatal hernia repair and TIF [cTIF]) in the management of GERD. The ASGE suggests upper endoscopy for the evaluation of GERD in patients with alarm symptoms, with multiple risk factors for Barrett’s esophagus, and with a history of sleeve gastrectomy. The ASGE recommends careful endoscopic evaluation, reporting, and photo-documentation of objective GERD findings with attention to gastroesophageal junction landmarks and integrity in patients who undergo upper endoscopy to improve care. In patients with GERD symptoms, the ASGE recommends lifestyle modifications. In patients with symptomatic and confirmed GERD with predominant heartburn symptoms, the ASGE recommends medical management including PPIs at the lowest dose for the shortest duration possible while initiating discussion about long-term management options. In patients with confirmed GERD with small hiatal hernias (≤2 cm) and Hill grade I or II who meet specific criteria, the ASGE suggests evaluation for TIF as an alternative to chronic medical management. In patients with persistent GERD with large hiatal hernias (> 2cm) and Hill grade III or IV, the ASGE suggests either cTIF or surgical therapy based on multidisciplinary review. This document summarizes the methods, analyses, and decision processes used to reach the final recommendations and represents the official ASGE recommendations on the above topics.
{"title":"American Society for Gastrointestinal Endoscopy guideline on the diagnosis and management of GERD: summary and recommendations","authors":"The ASGE Standards of Practice Committee, Madhav Desai MD, MPH , Wenly Ruan MD , Nirav C. Thosani MD , Manuel Amaris MD , J. Stephen Scott MD , Ahmed Saeed MD , Barham Abu Dayyeh MD, MPH, FASGE , Marcia Irene Canto MD, MHS, MASGE , Wasif Abidi MD, PhD , Omeed Alipour MD , Stuart K. Amateau MD, PhD, FASGE , Natalie Cosgrove MD , Sherif E. Elhanafi MD , Nauzer Forbes MD, MSc, FASGE , Divyanshoo R. Kohli MD , Richard S. Kwon MD, FASGE , Larissa L. Fujii-Lau MD , Jorge D. Machicado MD, MPH , Neil B. Marya MD , Bashar J. Qumseya MD, MPH, FASGE","doi":"10.1016/j.gie.2024.10.008","DOIUrl":"10.1016/j.gie.2024.10.008","url":null,"abstract":"<div><div>This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for strategies to diagnose and manage GERD. This document was developed using the Grading of Recommendations Assessment, Development, and Evaluation framework and serves as an update to the 2014 ASGE guideline on the role of endoscopy in the management of GERD. This updated guideline addresses the indications for endoscopy in patients with GERD as well as in the emerging population of patients who develop GERD after sleeve gastrectomy or peroral endoscopic myotomy. It also discusses how to endoscopically evaluate gastroesophageal junctional integrity in a comprehensive and uniform manner. Importantly, this guideline also discusses management strategies for GERD including the role of lifestyle interventions, proton pump inhibitors (PPIs), and endoscopic antireflux therapy (including transoral incisionless fundoplication [TIF], radiofrequency energy, and combined hiatal hernia repair and TIF [cTIF]) in the management of GERD. The ASGE suggests upper endoscopy for the evaluation of GERD in patients with alarm symptoms, with multiple risk factors for Barrett’s esophagus, and with a history of sleeve gastrectomy. The ASGE recommends careful endoscopic evaluation, reporting, and photo-documentation of objective GERD findings with attention to gastroesophageal junction landmarks and integrity in patients who undergo upper endoscopy to improve care. In patients with GERD symptoms, the ASGE recommends lifestyle modifications. In patients with symptomatic and confirmed GERD with predominant heartburn symptoms, the ASGE recommends medical management including PPIs at the lowest dose for the shortest duration possible while initiating discussion about long-term management options. In patients with confirmed GERD with small hiatal hernias (≤2 cm) and Hill grade I or II who meet specific criteria, the ASGE suggests evaluation for TIF as an alternative to chronic medical management. In patients with persistent GERD with large hiatal hernias (> 2cm) and Hill grade III or IV, the ASGE suggests either cTIF or surgical therapy based on multidisciplinary review. This document summarizes the methods, analyses, and decision processes used to reach the final recommendations and represents the official ASGE recommendations on the above topics.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 267-284"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846371","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.2024.09.034
Wei-Zhen Tang MD, Zhe-Ming Kang MD, Tai-Hang Liu PhD
{"title":"Comparative efficacy of short versus standard esophageal myotomy in sigmoid-type achalasia treatment","authors":"Wei-Zhen Tang MD, Zhe-Ming Kang MD, Tai-Hang Liu PhD","doi":"10.1016/j.gie.2024.09.034","DOIUrl":"10.1016/j.gie.2024.09.034","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Page 481"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074425","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.2024.09.005
Katarzyna M. Pawlak MD, PhD, Mateusz Jagielski MD, PhD, Kareem Khalaf H.BsC, MD, Jacek Piątkowski MD, PhD, Jacek Szeliga MD, PhD, Marek Jackowski MD, PhD
Pub Date : 2025-02-01DOI: 10.1016/j.gie.2024.09.042
Giacomo Emanuele Maria Rizzo MD , Mario Traina MD , Dario Ligresti MD , Lucio Carrozza MD , Gabriele Rancatore MD , Rosa Liotta MD , Alessandro Bertani PhD , Ilaria Tarantino MD
Background and Aims
Pulmonary masses are a diagnostic challenge in the field of EUS tissue acquisition, especially through transesophageal EUS-guided fine-needle biopsy sampling (EUS-FNB). Our study evaluated the feasibility, diagnostic performance, and safety of EUS-FNB of pulmonary lesions.
Methods
Fifty-three patients were enrolled in a prospective registry. All EUS procedures were performed by experienced endosonographers. Outcomes were specimen adequacy, diagnostic accuracy, diagnostic sensibility, diagnostic specificity, and safety.
Results
The mean patient age was 70 ± 10.4 years, and 71.7% were men. The mean lesion size was 52.4 ± 23.3 mm, and patients mostly had a single lesion (86.8%). Most patients had an advanced stage at diagnosis (stage IV, 41.82%), and the most common lung cancer was non–small cell lung carcinoma (69.4%). The diagnostic adequacy rate was 92.86%, and diagnostic accuracy was 87.5%. Adverse events were reported in 3 procedures.
Conclusions
Transesophageal EUS-FNB is a feasible and safe diagnostic method of tissue sampling for lung masses reachable by EUS.
背景和目的：肺部肿块是内窥镜超声（EUS）组织采集领域的诊断难题，尤其是通过经食道EUS-FNB（细针活检）。我们的研究评估了肺部病变 EUS-FNB 的可行性、诊断性能和安全性：方法：53 名患者被纳入前瞻性登记。所有 EUS 手术均由经验丰富的内镜医师进行。结果：患者平均年龄（70±10.0）岁，平均年龄（70±10.0）岁，平均年龄（70±10.0）岁，平均年龄（70±10.0）岁，平均年龄（70±10.0）岁：平均年龄（70±10.4）岁，男性占 71.7%。平均病灶大小为（52.4±23.3）毫米，患者多为单发病灶（86.8%）。大多数患者确诊时已是晚期（IV 期，41.82%），最常见的肺癌是非小细胞肺癌（69.4%）。诊断充分率为92.86%，诊断准确率为87.5%。3例手术出现不良反应：结论：经食管 EUS-FNB 是对 EUS 可触及的肺部肿块进行组织取样的一种可行且安全的诊断方法。
{"title":"EUS-guided transesophageal fine-needle biopsy sampling of lung masses: diagnostic performance and safety","authors":"Giacomo Emanuele Maria Rizzo MD , Mario Traina MD , Dario Ligresti MD , Lucio Carrozza MD , Gabriele Rancatore MD , Rosa Liotta MD , Alessandro Bertani PhD , Ilaria Tarantino MD","doi":"10.1016/j.gie.2024.09.042","DOIUrl":"10.1016/j.gie.2024.09.042","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Pulmonary masses are a diagnostic challenge in the field of EUS tissue acquisition, especially through transesophageal EUS-guided fine-needle biopsy sampling (EUS-FNB). Our study evaluated the feasibility, diagnostic performance, and safety of EUS-FNB of pulmonary lesions.</div></div><div><h3>Methods</h3><div>Fifty-three patients were enrolled in a prospective registry. All EUS procedures were performed by experienced endosonographers. Outcomes were specimen adequacy, diagnostic accuracy, diagnostic sensibility, diagnostic specificity, and safety.</div></div><div><h3>Results</h3><div>The mean patient age was 70 ± 10.4 years, and 71.7% were men. The mean lesion size was 52.4 ± 23.3 mm, and patients mostly had a single lesion (86.8%). Most patients had an advanced stage at diagnosis (stage IV, 41.82%), and the most common lung cancer was non–small cell lung carcinoma (69.4%). The diagnostic adequacy rate was 92.86%, and diagnostic accuracy was 87.5%. Adverse events were reported in 3 procedures.</div></div><div><h3>Conclusions</h3><div>Transesophageal EUS-FNB is a feasible and safe diagnostic method of tissue sampling for lung masses reachable by EUS.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 436-440.e3"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377751","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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