Pub Date : 2025-03-01DOI: 10.1016/j.gie.2024.10.003
Samuel Han MD, MS , Jingwen Zhang MS , Valerie Durkalski-Mauldin PhD , Lydia D. Foster MS , Jose Serrano MD, PhD , Gregory A. Coté MD , Ji Young Bang MD , Shyam Varadarajulu MD , Vikesh K. Singh MD , Mouen Khashab MD , Richard S. Kwon MD , James M. Scheiman MD , Field F. Willingham MD , Steven A. Keilin MD , J. Royce Groce MD , Peter J. Lee MBBS , Somashekar G. Krishna MD , Amitabh Chak MD , Adam Slivka MD, PhD , Daniel Mullady MD , Georgios I. Papachristou MD, PhD
Background and Aims
Difficult biliary cannulation (DBC) is a known risk factor for developing post-ERCP pancreatitis (PEP). To better understand how DBC increases PEP risk, we examined the interplay between technical aspects of DBC and known PEP risk factors.
Methods
This was a secondary analysis of a multicenter, randomized controlled trial comparing rectal indomethacin alone with the combination of rectal indomethacin and prophylactic pancreatic duct (PD) stent placement for PEP prophylaxis in high-risk patients. Participants were categorized into 3 groups: DBC with high preprocedure risk for PEP, DBC without high preprocedure risk for PEP, and non-DBC at high preprocedure risk for PEP.
Results
In all, 1601 participants (84.1%) experienced DBC, which required a mean of 12 cannulation attempts (standard deviation, 10) and mean duration of 14.7 minutes (standard deviation, 14.9). PEP rate was highest (20.7%) in DBC with a high preprocedure risk, followed by non-DBC with a high preprocedure risk (13.5%), and then DBC without a high preprocedure risk (8.8%). Increasing number of PD wire passages (adjusted odds ratio [aOR], 1.97; 95% confidence interval [CI], 1.25-3.1) was associated with PEP in DBC, but PD injection, pancreatic sphincterotomy, and number of cannulation attempts were not associated with PEP. Combining indomethacin with PD stent placement lowered the risk of PEP (aOR, .61; 95% CI, .44-.84) in DBCs. This protective effect was evident in up to at least 4 PD wire passages.
Conclusions
DBC confers higher PEP risk in an additive fashion to preprocedural risk factors. PD wire passages appear to add the greatest PEP risk in DBCs, but combining indomethacin with PD stent placement reduces this risk, even with increasing PD wire passages.
背景和目的：胆道插管困难 (DBC) 是ERCP术后胰腺炎 (PEP) 的已知风险因素。为了更好地了解 DBC 如何增加 PEP 风险，我们研究了 DBC 技术方面与已知 PEP 风险因素之间的相互作用：这是一项多中心随机对照试验的二次分析，该试验比较了单独使用直肠吲哚美辛与联合使用直肠吲哚美辛和预防性胰管 (PD) 支架置入术对高危患者进行 PEP 预防。参与者被分为 3 组：1）术前有高 PEP 风险的 DBC；2）术前无高风险的 DBC；3）术前有高风险的非 DBC：共有 1601 人（84.1%）经历过 DBC，平均需要 12 次（标清 10 次）插管尝试，平均持续时间为 14.7 分钟（标清 14.9 分钟）。在术前风险较高的 DBC 中，PEP 率最高（20.7%），其次是术前风险较高的非 DBC（13.5%），然后是术前风险不高的 DBC（8.8%）。PD线通过次数的增加（aOR：1.97，95% CI：1.25-3.1）与DBC的PEP相关，但PD注射、胰腺括约肌切开术和插管尝试次数与PEP无关。将吲哚美辛与胰十二指肠支架植入术结合使用可降低 DBC 的 PEP 风险（aOR：0.61，95% CI：0.44-0.84）。这种保护作用在至少 4 个 PD 线程中都很明显：结论：在手术前风险因素的叠加作用下，DBC会带来更高的PEP风险。PD导丝穿刺似乎增加了DBC的最大PEP风险，但将吲哚美辛与PD支架置入术结合使用可降低这一风险，即使PD导丝穿刺次数增加也是如此。
{"title":"Impact of difficult biliary cannulation on post-ERCP pancreatitis: secondary analysis of the stent versus indomethacin trial dataset","authors":"Samuel Han MD, MS , Jingwen Zhang MS , Valerie Durkalski-Mauldin PhD , Lydia D. Foster MS , Jose Serrano MD, PhD , Gregory A. Coté MD , Ji Young Bang MD , Shyam Varadarajulu MD , Vikesh K. Singh MD , Mouen Khashab MD , Richard S. Kwon MD , James M. Scheiman MD , Field F. Willingham MD , Steven A. Keilin MD , J. Royce Groce MD , Peter J. Lee MBBS , Somashekar G. Krishna MD , Amitabh Chak MD , Adam Slivka MD, PhD , Daniel Mullady MD , Georgios I. Papachristou MD, PhD","doi":"10.1016/j.gie.2024.10.003","DOIUrl":"10.1016/j.gie.2024.10.003","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Difficult biliary cannulation (DBC) is a known risk factor for developing post-ERCP pancreatitis (PEP). To better understand how DBC increases PEP risk, we examined the interplay between technical aspects of DBC and known PEP risk factors.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of a multicenter, randomized controlled trial comparing rectal indomethacin alone with the combination of rectal indomethacin and prophylactic pancreatic duct (PD) stent placement for PEP prophylaxis in high-risk patients. Participants were categorized into 3 groups: DBC with high preprocedure risk for PEP, DBC without high preprocedure risk for PEP, and non-DBC at high preprocedure risk for PEP.</div></div><div><h3>Results</h3><div>In all, 1601 participants (84.1%) experienced DBC, which required a mean of 12 cannulation attempts (standard deviation, 10) and mean duration of 14.7 minutes (standard deviation, 14.9). PEP rate was highest (20.7%) in DBC with a high preprocedure risk, followed by non-DBC with a high preprocedure risk (13.5%), and then DBC without a high preprocedure risk (8.8%). Increasing number of PD wire passages (adjusted odds ratio [aOR], 1.97; 95% confidence interval [CI], 1.25-3.1) was associated with PEP in DBC, but PD injection, pancreatic sphincterotomy, and number of cannulation attempts were not associated with PEP. Combining indomethacin with PD stent placement lowered the risk of PEP (aOR, .61; 95% CI, .44-.84) in DBCs. This protective effect was evident in up to at least 4 PD wire passages.</div></div><div><h3>Conclusions</h3><div>DBC confers higher PEP risk in an additive fashion to preprocedural risk factors. PD wire passages appear to add the greatest PEP risk in DBCs, but combining indomethacin with PD stent placement reduces this risk, even with increasing PD wire passages.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 3","pages":"Pages 617-628"},"PeriodicalIF":6.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399940","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}
Visual gaze pattern (VGP) analysis quantifies endoscopists’ specific eye movements. VGP during colonoscopy may be associated with polyp detection. However, the optimal VGP to maximize detection performance remains unclear. This study evaluated the optimal endoscopic VGP that enabled the highest colorectal adenoma detection rate.
Methods
This randomized controlled trial was conducted between July and December 2023. We developed an eye-tracking and feedback (ETF) system that instructed endoscopists to correct their gaze toward the periphery of an endoscope screen with an audible alert. Patients who underwent colonoscopy were randomly assigned to 4 groups: 3 intervention groups, in which the endoscopist’s gaze was instructed to a different level of the peripheral screen area using the ETF system (the periphery of 4 × 4, 5 × 5, and 6 × 6 divisions of the screen), and a control group in which the endoscopist did not receive instructions. The primary outcome was the number of adenomas detected per colonoscopy (APC).
Results
In total, 189 patients were enrolled. The APC and adenoma detection rate were significantly higher in the 6 × 6 group than in the control group (1.82 ± 2.41 vs 0.59 ± 1.17, P = .002; 68.9% vs 30.8%, P = .002). The APC and the number of screen divisions were positively correlated (R = 0.985, P = .0152). The rate at which the endoscopist gazed at the periphery of the screen was positively correlated with the number of divisions (R = 0.964, P = .0363).
Conclusions
Colorectal adenoma detection was improved by correcting the endoscopist’s gaze to the periphery of the screen, especially by dividing the screen into 6 × 6 segments.
{"title":"Optimal visual gaze pattern of endoscopists for improving adenoma detection during colonoscopy (with video)","authors":"Mizuki Nagai MD , Fumiaki Ishibashi MD, PhD , Kosuke Okusa DrEng , Kentaro Mochida MD , Eri Ozaki MD, PhD , Tetsuo Morishita MD, PhD , Sho Suzuki MD, PhD","doi":"10.1016/j.gie.2024.09.028","DOIUrl":"10.1016/j.gie.2024.09.028","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Visual gaze pattern (VGP) analysis quantifies endoscopists’ specific eye movements. VGP during colonoscopy may be associated with polyp detection. However, the optimal VGP to maximize detection performance remains unclear. This study evaluated the optimal endoscopic VGP that enabled the highest colorectal adenoma detection rate.</div></div><div><h3>Methods</h3><div>This randomized controlled trial was conducted between July and December 2023. We developed an eye-tracking and feedback (ETF) system that instructed endoscopists to correct their gaze toward the periphery of an endoscope screen with an audible alert. Patients who underwent colonoscopy were randomly assigned to 4 groups: 3 intervention groups, in which the endoscopist’s gaze was instructed to a different level of the peripheral screen area using the ETF system (the periphery of 4 × 4, 5 × 5, and 6 × 6 divisions of the screen), and a control group in which the endoscopist did not receive instructions. The primary outcome was the number of adenomas detected per colonoscopy (APC).</div></div><div><h3>Results</h3><div>In total, 189 patients were enrolled. The APC and adenoma detection rate were significantly higher in the 6 × 6 group than in the control group (1.82 ± 2.41 vs 0.59 ± 1.17, <em>P</em> = .002; 68.9% vs 30.8%, <em>P</em> = .002). The APC and the number of screen divisions were positively correlated (<em>R</em> = 0.985, <em>P</em> = .0152). The rate at which the endoscopist gazed at the periphery of the screen was positively correlated with the number of divisions (<em>R</em> = 0.964, <em>P</em> = .0363).</div></div><div><h3>Conclusions</h3><div>Colorectal adenoma detection was improved by correcting the endoscopist’s gaze to the periphery of the screen, especially by dividing the screen into 6 × 6 segments.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 3","pages":"Pages 639-646.e3"},"PeriodicalIF":6.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344842","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 : 2025-03-01DOI: 10.1016/j.gie.2024.10.063
Ivo Boskoski MD, PhD, Steven Shamah MD
{"title":"Automated endoscopic restrictive procedure: a pilot trial with more to come","authors":"Ivo Boskoski MD, PhD, Steven Shamah MD","doi":"10.1016/j.gie.2024.10.063","DOIUrl":"10.1016/j.gie.2024.10.063","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 3","pages":"Page 692"},"PeriodicalIF":6.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520765","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 : 2025-03-01DOI: 10.1016/j.gie.2025.01.001
Douglas G. Adler MD
{"title":"A note from the Editor-in-Chief","authors":"Douglas G. Adler MD","doi":"10.1016/j.gie.2025.01.001","DOIUrl":"10.1016/j.gie.2025.01.001","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 3","pages":"Page 495"},"PeriodicalIF":6.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520825","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 : 2025-03-01DOI: 10.1016/j.gie.2024.11.016
Pegah Hosseini-Carroll MD, FASGE , Jason A. Dominitz MD, MHS, MASGE , Brian C. Jacobson MD, MPH, FASGE , Folasade P. May MD, PhD, MPhil , Rachel B. Issaka MD, MAS , Colleen M. Schmitt MD, MHS, MASGE , Tonya L. Adams MD , Iman J. Boston MD, MBA , Juan Carlos Bucobo MD, FASGE , Lukejohn Day MD, FASGE , Inessa B. Khaykis MD, FASGE , Mark J. Marino MD , Douglas K. Rex MD, MASGE , Edward Sun MD, MBA, FASGE , Javelle A. Wynter MD , Jennifer A. Christie MD, MASGE
{"title":"American Society for Gastrointestinal Endoscopy Colorectal Cancer Screening Project National Summit","authors":"Pegah Hosseini-Carroll MD, FASGE , Jason A. Dominitz MD, MHS, MASGE , Brian C. Jacobson MD, MPH, FASGE , Folasade P. May MD, PhD, MPhil , Rachel B. Issaka MD, MAS , Colleen M. Schmitt MD, MHS, MASGE , Tonya L. Adams MD , Iman J. Boston MD, MBA , Juan Carlos Bucobo MD, FASGE , Lukejohn Day MD, FASGE , Inessa B. Khaykis MD, FASGE , Mark J. Marino MD , Douglas K. Rex MD, MASGE , Edward Sun MD, MBA, FASGE , Javelle A. Wynter MD , Jennifer A. Christie MD, MASGE","doi":"10.1016/j.gie.2024.11.016","DOIUrl":"10.1016/j.gie.2024.11.016","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 3","pages":"Pages 511-519"},"PeriodicalIF":6.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520826","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 : 2025-03-01DOI: 10.1016/j.gie.2024.08.042
Kai Liu MD , Wei Zhang MD , Li Gao MD , Jiawei Bai MD , Xin Dong MD , Yue Wang MD , Hui Chen MD , Jiaqiang Dong MD , Nian Fang MD , Ying Han MD , Zhiguo Liu MD
Background and Aims
Hemostatic powder (HP) is a novel hemostasis modality for nonvariceal GI bleeding. This meta-analysis was performed to evaluate the efficacy of HP monotherapy versus conventional endoscopic treatment (CET) for nonvariceal GI bleeding.
Methods
PubMed, EMBASE, and Cochrane Library databases were systematically searched from inception to October 16, 2023. The primary outcomes were the initial hemostatic rate and the 30-day recurrent bleeding rate. After the meta-analysis, a trial sequential analysis (TSA) was also conducted to decrease the risk of random errors and validate the result.
Results
The meta-analysis included 8 studies, incorporating 653 patients in total. Given significant heterogeneity, all analyses were segregated into malignancy-related and nonmalignancy-related GI bleeding lesions. For the former, HP monotherapy significantly improved the initial hemostasis rate and 30-day recurrent bleeding rate compared with CET (relative risk [RR], 1.50; 95% confidence interval [CI], 1.28-1.75; P < .001; RR, .32; 95% CI, .12-.86; P = .02, respectively), and TSA supported the results. For nonmalignancy-related GI bleeding, HP monotherapy and CET have similar initial hemostasis and 30-day recurrent bleeding rates (RR, 1.08; 95% CI, .98-1.19; P = .11; RR, 1.15; 95% CI, .46-2.90; P = .76, respectively), but the TSA failed to confirm the results.
Conclusions
HP monotherapy surpassed CET in terms of the initial hemostasis rate and 30-day recurrent bleeding rate for patients with malignancy-related GI bleeding. However, their relative efficacy for nonmalignancy-related GI bleeding remains unresolved.
{"title":"Efficacy of hemostatic powder monotherapy versus conventional endoscopic treatment for nonvariceal GI bleeding: a meta-analysis and trial sequential analysis","authors":"Kai Liu MD , Wei Zhang MD , Li Gao MD , Jiawei Bai MD , Xin Dong MD , Yue Wang MD , Hui Chen MD , Jiaqiang Dong MD , Nian Fang MD , Ying Han MD , Zhiguo Liu MD","doi":"10.1016/j.gie.2024.08.042","DOIUrl":"10.1016/j.gie.2024.08.042","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Hemostatic powder (HP) is a novel hemostasis modality for nonvariceal GI bleeding. This meta-analysis was performed to evaluate the efficacy of HP monotherapy versus conventional endoscopic treatment (CET) for nonvariceal GI bleeding.</div></div><div><h3>Methods</h3><div>PubMed, EMBASE, and Cochrane Library databases were systematically searched from inception to October 16, 2023. The primary outcomes were the initial hemostatic rate and the 30-day recurrent bleeding rate. After the meta-analysis, a trial sequential analysis (TSA) was also conducted to decrease the risk of random errors and validate the result.</div></div><div><h3>Results</h3><div>The meta-analysis included 8 studies, incorporating 653 patients in total. Given significant heterogeneity, all analyses were segregated into malignancy-related and nonmalignancy-related GI bleeding lesions. For the former, HP monotherapy significantly improved the initial hemostasis rate and 30-day recurrent bleeding rate compared with CET (relative risk [RR], 1.50; 95% confidence interval [CI], 1.28-1.75; <em>P</em> < .001; RR, .32; 95% CI, .12-.86; <em>P</em> = .02, respectively), and TSA supported the results. For nonmalignancy-related GI bleeding, HP monotherapy and CET have similar initial hemostasis and 30-day recurrent bleeding rates (RR, 1.08; 95% CI, .98-1.19; <em>P</em> = .11; RR, 1.15; 95% CI, .46-2.90; <em>P</em> = .76, respectively), but the TSA failed to confirm the results.</div></div><div><h3>Conclusions</h3><div>HP monotherapy surpassed CET in terms of the initial hemostasis rate and 30-day recurrent bleeding rate for patients with malignancy-related GI bleeding. However, their relative efficacy for nonmalignancy-related GI bleeding remains unresolved.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 3","pages":"Pages 539-550.e14"},"PeriodicalIF":6.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142283739","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 : 2025-03-01DOI: 10.1016/j.gie.2024.10.029
Sahib Singh MD , Babu P. Mohan MD , Rakesh Vinayek MD , Sudhir Dutta MD , Dushyant Singh Dahiya MD , Sumant Inamdar MD , Vishnu Charan Suresh Kumar MD , Ganesh Aswath MD , Neil Sharma MD , Douglas G. Adler MD
Background and Aims
Effect of underwater endoscopic submucosal dissection (UESD) on clinical outcomes as compared with conventional ESD (CESD) remains unclear. We conducted a meta-analysis of the available data.
Methods
Online databases were searched for studies comparing UESD with CESD for colorectal lesions. The outcomes of interest were en-bloc resection, R0 resection, procedure time (minutes), dissection speed (mm2/min), and adverse events. Pooled odds ratios (ORs) and standardized mean difference (SMD), along with 95% confidence intervals (CIs) were calculated.
Results
Seven studies with 1401 patients (UESD, 452; CESD, 949) were included. Mean patient age was 69 years, and 57% of patients were men. UESD had both a shorter procedure time (SMD, –1.33; 95% CI, –2.34 to –.32; P = .010) and greater dissection speed (SMD, 1.01; 95% CI, .35-1.68; P = .003) when compared with CESD. No significant differences were observed between the 2 groups with respect to en-bloc resection (OR, 1.13; 95% CI, .37-3.41), R0 resection (OR, 2.36; 95% CI, .79-7.05), delayed bleeding (OR, 1.34; 95% CI, .65-2.74), perforation (OR, 1.13; 95% CI, .64-2.00), and postresection electrocoagulation syndrome (OR, .38; 95% CI, .10-1.42).
Conclusions
UESD was faster in patients with colorectal lesions but had comparable rates of en-bloc resection, R0 resection, and adverse events when compared with CESD.
背景和目的：与传统ESD相比，水下内镜黏膜下剥离术（UESD）对临床结果的影响仍不明确。我们对现有数据进行了荟萃分析：我们在在线数据库中搜索了对结肠直肠病变进行 UESD 和 CESD 比较的研究。相关结果包括全切、R0切除、手术时间（分钟）、剥离速度（mm2/分钟）和不良事件。计算了汇总的几率比（OR）、标准化平均差（SMD）以及 95% 的置信区间（CI）：共有 7 项研究纳入了 1401 名患者（n=452 名 UESD 患者，n=949 名 CESD 患者）。平均年龄为 69 岁，57% 的患者为男性。UESD 与 CESD 相比，手术时间更短（SMD -1.33, 95% CI -2.34 to -0.32，p = 0.010），解剖速度更快（SMD 1.01, 95% CI 0.35 to 1.68，p = 0.003）。两组患者在全切（OR 1.13，95% CI 0.37 至 3.41）、R0 切除（OR 2.36，95% CI 0.79 至 7.05）、延迟出血（OR 1.34，95% CI 0.65 至 2.74）、穿孔（OR 1.13，95% CI 0.64 至 2.00）和切除后电凝综合征（OR 0.38，95% CI 0.10 至 1.42）方面无明显差异：讨论：与CESD相比，UESD对结直肠病变患者的治疗速度更快，但全切率、R0切除率和不良事件发生率相当。
{"title":"Underwater versus conventional endoscopic submucosal dissection for colorectal lesions: systematic review and meta-analysis","authors":"Sahib Singh MD , Babu P. Mohan MD , Rakesh Vinayek MD , Sudhir Dutta MD , Dushyant Singh Dahiya MD , Sumant Inamdar MD , Vishnu Charan Suresh Kumar MD , Ganesh Aswath MD , Neil Sharma MD , Douglas G. Adler MD","doi":"10.1016/j.gie.2024.10.029","DOIUrl":"10.1016/j.gie.2024.10.029","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Effect of underwater endoscopic submucosal dissection (UESD) on clinical outcomes as compared with conventional ESD (CESD) remains unclear. We conducted a meta-analysis of the available data.</div></div><div><h3>Methods</h3><div>Online databases were searched for studies comparing UESD with CESD for colorectal lesions. The outcomes of interest were en-bloc resection, R0 resection, procedure time (minutes), dissection speed (mm<sup>2</sup>/min), and adverse events. Pooled odds ratios (ORs) and standardized mean difference (SMD), along with 95% confidence intervals (CIs) were calculated.</div></div><div><h3>Results</h3><div>Seven studies with 1401 patients (UESD, 452; CESD, 949) were included. Mean patient age was 69 years, and 57% of patients were men. UESD had both a shorter procedure time (SMD, –1.33; 95% CI, –2.34 to –.32; <em>P</em> = .010) and greater dissection speed (SMD, 1.01; 95% CI, .35-1.68; <em>P</em> = .003) when compared with CESD. No significant differences were observed between the 2 groups with respect to en-bloc resection (OR, 1.13; 95% CI, .37-3.41), R0 resection (OR, 2.36; 95% CI, .79-7.05), delayed bleeding (OR, 1.34; 95% CI, .65-2.74), perforation (OR, 1.13; 95% CI, .64-2.00), and postresection electrocoagulation syndrome (OR, .38; 95% CI, .10-1.42).</div></div><div><h3>Conclusions</h3><div>UESD was faster in patients with colorectal lesions but had comparable rates of en-bloc resection, R0 resection, and adverse events when compared with CESD.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 3","pages":"Pages 551-557.e5"},"PeriodicalIF":6.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142462628","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 : 2025-03-01DOI: 10.1016/j.gie.2024.10.009
Zubin Dev Sharma MD, DNB
{"title":"Top tips for diagnostic rectal EUS and assessment of rectal sphincters","authors":"Zubin Dev Sharma MD, DNB","doi":"10.1016/j.gie.2024.10.009","DOIUrl":"10.1016/j.gie.2024.10.009","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 3","pages":"Pages 647-649"},"PeriodicalIF":6.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142462634","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 : 2025-03-01DOI: 10.1016/j.gie.2024.10.047
Li Wang MD, Zu-Qiang Liu MD, Shao-Bin Luo MD, Quan-Lin Li MD, Ping-Hong Zhou MD
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