Pub Date : 2025-02-01DOI: 10.1016/j.gie.2024.08.025
Eric Swei MD, MS , Zachary Kassir MD , Apurva Pravin Shrigiriwar MBBS , Alex Schlacterman MD , Chen-Shuan Chung MD , Francesco Vito Mandarino MD , Prashant Kedia MD , Helmut Messman MD , Rishi Pawa MBBS , Pankaj Desai MD , Payal Saxena MD , Redeat Assefa MD, MSc, MPH , Martha Arevalo-Mora MD , Francesco Azzolini MD , Paulo Giorgio Arcidiacono MD , Sandra Nagl MD , Mohamad-Noor Abu-Hammour MD , Miguel Puga-Tejada MD, MSc , Jorge Baquerizo-Burgos MD , Maria Egas-Izquierdo MD , Mouen Khashab MD
Background and Aims
Patients with sigmoid-type achalasia can be challenging to treat with peroral endoscopic myotomy (POEM). A short myotomy improves technical success; however, outcomes have not previously been evaluated.
Methods
This was a multicenter, international, retrospective study of patients who underwent POEM with short (≤4 cm) or standard esophageal myotomy. Outcomes included clinical and technical success, procedural adverse events, and reflux rates.
Results
A total of 109 patients with sigmoid achalasia (sigmoid, n = 74; advanced sigmoid, n = 35) underwent POEM across 13 centers (short myotomy, n = 59; standard, n = 50). Technical success was 100% across both groups. Patients who underwent short myotomy had a significantly shorter mean procedure time (57.7 ± 27.8 vs 83.1 ± 44.7 minutes, P = .0005). A total of 6 adverse events were recorded in 6 patients (5.5%; 4 mild, 2 moderate); the adverse event rate was not significantly different between short and standard groups. Ninety-eight patients had follow-up data (median, 3.6 months; interquartile range, 1-14 months). Clinical success was 94% (short, 93%; standard, 95%; P = .70) and did not differ based on achalasia subtype or sigmoid achalasia severity. Twenty-one (22%) patients reported post-POEM reflux and 44% (16 of 36) had objective evidence of pathologic reflux. Rates of pathologic reflux were significantly increased in the standard versus short group (odds ratio, 18.0; 95% confidence interval, 2.0-159.0; P = .009).
Conclusions
POEM with short myotomy is effective and safe for the short-term treatment of sigmoid and advanced sigmoid achalasia. Short myotomy may lead to less reflux than standard myotomy.
{"title":"Short esophageal myotomy versus standard myotomy for treatment of sigmoid-type achalasia: results of an international multicenter study","authors":"Eric Swei MD, MS , Zachary Kassir MD , Apurva Pravin Shrigiriwar MBBS , Alex Schlacterman MD , Chen-Shuan Chung MD , Francesco Vito Mandarino MD , Prashant Kedia MD , Helmut Messman MD , Rishi Pawa MBBS , Pankaj Desai MD , Payal Saxena MD , Redeat Assefa MD, MSc, MPH , Martha Arevalo-Mora MD , Francesco Azzolini MD , Paulo Giorgio Arcidiacono MD , Sandra Nagl MD , Mohamad-Noor Abu-Hammour MD , Miguel Puga-Tejada MD, MSc , Jorge Baquerizo-Burgos MD , Maria Egas-Izquierdo MD , Mouen Khashab MD","doi":"10.1016/j.gie.2024.08.025","DOIUrl":"10.1016/j.gie.2024.08.025","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Patients with sigmoid-type achalasia can be challenging to treat with peroral endoscopic myotomy (POEM). A short myotomy improves technical success; however, outcomes have not previously been evaluated.</div></div><div><h3>Methods</h3><div>This was a multicenter, international, retrospective study of patients who underwent POEM with short (≤4 cm) or standard esophageal myotomy. Outcomes included clinical and technical success, procedural adverse events, and reflux rates.</div></div><div><h3>Results</h3><div>A total of 109 patients with sigmoid achalasia (sigmoid, n = 74; advanced sigmoid, n = 35) underwent POEM across 13 centers (short myotomy, n = 59; standard, n = 50). Technical success was 100% across both groups. Patients who underwent short myotomy had a significantly shorter mean procedure time (57.7 ± 27.8 vs 83.1 ± 44.7 minutes, <em>P</em> = .0005). A total of 6 adverse events were recorded in 6 patients (5.5%; 4 mild, 2 moderate); the adverse event rate was not significantly different between short and standard groups. Ninety-eight patients had follow-up data (median, 3.6 months; interquartile range, 1-14 months). Clinical success was 94% (short, 93%; standard, 95%; <em>P</em> = .70) and did not differ based on achalasia subtype or sigmoid achalasia severity. Twenty-one (22%) patients reported post-POEM reflux and 44% (16 of 36) had objective evidence of pathologic reflux. Rates of pathologic reflux were significantly increased in the standard versus short group (odds ratio, 18.0; 95% confidence interval, 2.0-159.0; <em>P</em> = .009).</div></div><div><h3>Conclusions</h3><div>POEM with short myotomy is effective and safe for the short-term treatment of sigmoid and advanced sigmoid achalasia. Short myotomy may lead to less reflux than standard myotomy.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 377-384.e2"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055353","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.2024.08.037
Andreas Wannhoff Dr , Konstantinos Kouladouros Dr , Ronald Koschny Prof , Benjamin Walter Prof , Zita Zoll , Karsten Büringer Dr , Susanne Blank Dr , Ulrike Schempf Dr , Karel Caca Prof , Dörte Wichmann Dr
Background and Aims
Boerhaave syndrome, an effort rupture of the esophagus, is a rare but serious condition. Endoscopic vacuum therapy (EVT) is a new therapeutic approach for GI perforation. We aimed to evaluate EVT for treatment of Boerhaave syndrome.
Methods
This retrospective study was conducted at 5 tertiary hospitals in southern Germany. All patients treated for Boerhaave syndrome since 2010 were identified and included. Treatment success and outcomes were assessed and compared between the different modes of primary treatment.
Results
Fifty-seven patients with Boerhaave syndrome were identified (median age, 68 years; n = 16 female). The primary treatment was EVT in 25 cases, surgery in 14, and endoscopic stenting in 15. Primary EVT was successful in 20 (80.0%) of the 25 patients. Two patients were switched to surgical treatment, 1 was switched to esophageal stenting, and 2 patients died. The mortality rate was lower (P = .160) in patients treated primarily with EVT (n = 2 [8.0%]) compared with patients in the non-EVT group (n = 8 [25.0%]). Treatment success was significantly higher (P = .007) for primary EVT (80.0%) than for non-EVT (43.8%). Primary EVT was associated with treatment success in multivariable analysis.
Conclusions
EVT showed a high success rate for treatment of Boerhaave syndrome and was associated with treatment success.
{"title":"Endoscopic vacuum therapy for the treatment of Boerhaave syndrome: a multicenter analysis","authors":"Andreas Wannhoff Dr , Konstantinos Kouladouros Dr , Ronald Koschny Prof , Benjamin Walter Prof , Zita Zoll , Karsten Büringer Dr , Susanne Blank Dr , Ulrike Schempf Dr , Karel Caca Prof , Dörte Wichmann Dr","doi":"10.1016/j.gie.2024.08.037","DOIUrl":"10.1016/j.gie.2024.08.037","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Boerhaave syndrome, an effort rupture of the esophagus, is a rare but serious condition. Endoscopic vacuum therapy (EVT) is a new therapeutic approach for GI perforation. We aimed to evaluate EVT for treatment of Boerhaave syndrome.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted at 5 tertiary hospitals in southern Germany. All patients treated for Boerhaave syndrome since 2010 were identified and included. Treatment success and outcomes were assessed and compared between the different modes of primary treatment.</div></div><div><h3>Results</h3><div>Fifty-seven patients with Boerhaave syndrome were identified (median age, 68 years; n = 16 female). The primary treatment was EVT in 25 cases, surgery in 14, and endoscopic stenting in 15. Primary EVT was successful in 20 (80.0%) of the 25 patients. Two patients were switched to surgical treatment, 1 was switched to esophageal stenting, and 2 patients died. The mortality rate was lower (<em>P</em> = .160) in patients treated primarily with EVT (n = 2 [8.0%]) compared with patients in the non-EVT group (n = 8 [25.0%]). Treatment success was significantly higher (<em>P</em> = .007) for primary EVT (80.0%) than for non-EVT (43.8%). Primary EVT was associated with treatment success in multivariable analysis.</div></div><div><h3>Conclusions</h3><div>EVT showed a high success rate for treatment of Boerhaave syndrome and was associated with treatment success.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 365-374"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106344","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.2024.07.014
Tarek Odah MD , Asrita Vattikonda MD , Mark Stark MD , Bhaumik Brahmbhatt MD , Frank J. Lukens MD , Dilhana Badurdeen MD , Jana G. Hashash MD, MSc , Francis A. Farraye MD, MSc
Background and Aims
Video capsule endoscopy (VCE) is valuable for assessing conditions like GI bleeding, anemia, and inflammatory bowel disease. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are prescribed for diabetes and weight loss, with their pharmacologic effects including delayed gastric emptying. This study investigates the impact of GLP-1RA use on VCE outcomes in patients with diabetes.
Methods
This retrospective cohort study involves patients with diabetes undergoing VCE while on GLP-1RAs matched in a 1:1 ratio with control subjects, who are not on GLP-1RAs, based on demographics and diabetes-related factors. The primary outcome was gastric transit time in VCE studies, whereas secondary outcomes were incomplete small-bowel evaluation and small-bowel transit time.
Results
In the GLP-1RA cohort with 68 patients, 5 (7%) experienced failure to pass the video capsule through the stomach; all control subjects passed the video capsule successfully (P = .06). GLP-1RA patients had a longer gastric transit time (99.3 ± 134.2 minutes) compared with control subjects (25.3 ± 31.6 minutes, P < .001). Multivariate analysis revealed GLP-1RA use was associated with an increased gastric transit time by 74.5 minutes (95% confidence interval, 33.8-115.2; P < .001) compared with control subjects, after adjusting for relevant factors. Sixteen GLP-1RA patients (23.5%) experienced incomplete passage of the video capsule through the small intestine, a significantly higher rate compared with 3 patients in the control group (4.4%, P < .01).
Conclusions
GLP-1RA use is associated with a prolonged gastric transit time and a higher rate of incomplete small-bowel evaluation during VCE. Future studies may be crucial for evaluating strategies to mitigate these effects.
背景和目的：视频胶囊内镜（VCE）对于评估胃肠道出血、贫血和炎症性肠病等疾病具有重要价值。胰高血糖素样肽-1 受体激动剂（GLP-1 RA）是治疗糖尿病和减肥的处方药，其药理作用包括延迟胃排空。本研究调查了使用 GLP-1 RA 对糖尿病患者 VCE 结果的影响：这项回顾性队列研究涉及服用 GLP-1 RA 期间接受 VCE 的糖尿病患者，并根据人口统计学和糖尿病相关因素与未服用 GLP-RA 的对照组进行 1:1 比对。VCE研究的主要结果是胃转运时间，次要结果是不完全小肠评估和小肠转运时间：在 68 名 GLP-1 RA 患者中，有 5 人（7%）经历了 VCE 无法通过胃部的情况，而所有对照组患者都成功通过了胃部（P=0.06）。与对照组（25.3±31.6 分钟，P）相比，GLP-1 RA 患者的胃通过时间更长（99.3±134.2 分钟）：使用 GLP-1 RA 与 VCE 期间胃转运时间延长和小肠评估不完整率升高有关。未来的研究可能对评估减轻这些影响的策略至关重要。
{"title":"Glucagon-like peptide-1 receptor agonists and capsule endoscopy in patients with diabetes: a matched cohort study","authors":"Tarek Odah MD , Asrita Vattikonda MD , Mark Stark MD , Bhaumik Brahmbhatt MD , Frank J. Lukens MD , Dilhana Badurdeen MD , Jana G. Hashash MD, MSc , Francis A. Farraye MD, MSc","doi":"10.1016/j.gie.2024.07.014","DOIUrl":"10.1016/j.gie.2024.07.014","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Video capsule endoscopy (VCE) is valuable for assessing conditions like GI bleeding, anemia, and inflammatory bowel disease. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are prescribed for diabetes and weight loss, with their pharmacologic effects including delayed gastric emptying. This study investigates the impact of GLP-1RA use on VCE outcomes in patients with diabetes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study involves patients with diabetes undergoing VCE while on GLP-1RAs matched in a 1:1 ratio with control subjects, who are not on GLP-1RAs, based on demographics and diabetes-related factors. The primary outcome was gastric transit time in VCE studies, whereas secondary outcomes were incomplete small-bowel evaluation and small-bowel transit time.</div></div><div><h3>Results</h3><div>In the GLP-1RA cohort with 68 patients, 5 (7%) experienced failure to pass the video capsule through the stomach; all control subjects passed the video capsule successfully (<em>P</em> = .06). GLP-1RA patients had a longer gastric transit time (99.3 ± 134.2 minutes) compared with control subjects (25.3 ± 31.6 minutes, <em>P</em> < .001). Multivariate analysis revealed GLP-1RA use was associated with an increased gastric transit time by 74.5 minutes (95% confidence interval, 33.8-115.2; <em>P</em> < .001) compared with control subjects, after adjusting for relevant factors. Sixteen GLP-1RA patients (23.5%) experienced incomplete passage of the video capsule through the small intestine, a significantly higher rate compared with 3 patients in the control group (4.4%, <em>P</em> < .01).</div></div><div><h3>Conclusions</h3><div>GLP-1RA use is associated with a prolonged gastric transit time and a higher rate of incomplete small-bowel evaluation during VCE. Future studies may be crucial for evaluating strategies to mitigate these effects.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 393-401"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878631","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.2024.09.019
Wen-Feng Hsu MD, PhD , Wei-Yuan Chang MD, MS , Chen-Ya Kuo MD , Li-Chun Chang MD, PhD , Hsuan-Ho Lin MD, MS , Ming-Shiang Wu MD, PhD , Han-Mo Chiu MD, PhD
Background and Aims
Cecal intubation in colonoscopy relies on self-reporting. We developed an artificial intelligence–based cecum recognition system (AI-CRS) for post-hoc verification of cecal intubation and explored its impact on adenoma metrics.
Methods
Quality metrics, including cecal intubation rate (CIR), adenoma detection rate (ADR), and other ADR-related metrics, were compared both before (2015-2018) and after (2019-2022) the implementation of the AI-CRS.
Results
Although the CIR did not change significantly after the implementation of the AI-CRS, the ADR and advanced ADR significantly increased. Although the ADR significantly increased in all segments, the most significant increase in advanced ADR was observed in the proximal colon. Implementation of the AI-CRS was associated with a higher likelihood of detecting adenoma (adjusted odds ratio, 1.35; 95% confidence interval, 1.26-1.45) and advanced adenoma (adjusted odds ratio, 1.23; 95% confidence interval, 1.07-1.41), respectively.
Conclusions
Implementation of a post-hoc verification of cecal intubation using an AI-CRS significantly improved various adenoma metrics in screening colonoscopy.
{"title":"Effect of a novel artificial intelligence–based cecum recognition system on adenoma detection metrics in a screening colonoscopy setting","authors":"Wen-Feng Hsu MD, PhD , Wei-Yuan Chang MD, MS , Chen-Ya Kuo MD , Li-Chun Chang MD, PhD , Hsuan-Ho Lin MD, MS , Ming-Shiang Wu MD, PhD , Han-Mo Chiu MD, PhD","doi":"10.1016/j.gie.2024.09.019","DOIUrl":"10.1016/j.gie.2024.09.019","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Cecal intubation in colonoscopy relies on self-reporting. We developed an artificial intelligence–based cecum recognition system (AI-CRS) for post-hoc verification of cecal intubation and explored its impact on adenoma metrics.</div></div><div><h3>Methods</h3><div>Quality metrics, including cecal intubation rate (CIR), adenoma detection rate (ADR), and other ADR-related metrics, were compared both before (2015-2018) and after (2019-2022) the implementation of the AI-CRS.</div></div><div><h3>Results</h3><div>Although the CIR did not change significantly after the implementation of the AI-CRS, the ADR and advanced ADR significantly increased. Although the ADR significantly increased in all segments, the most significant increase in advanced ADR was observed in the proximal colon. Implementation of the AI-CRS was associated with a higher likelihood of detecting adenoma (adjusted odds ratio, 1.35; 95% confidence interval, 1.26-1.45) and advanced adenoma (adjusted odds ratio, 1.23; 95% confidence interval, 1.07-1.41), respectively.</div></div><div><h3>Conclusions</h3><div>Implementation of a post-hoc verification of cecal intubation using an AI-CRS significantly improved various adenoma metrics in screening colonoscopy.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 452-455"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142283755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gie.2024.10.027
Babu P. Mohan MD
{"title":"Is this the end game in the treatment of gastric varices?","authors":"Babu P. Mohan MD","doi":"10.1016/j.gie.2024.10.027","DOIUrl":"10.1016/j.gie.2024.10.027","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 341-342"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074453","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.2024.08.034
The ASGE IBD Endoscopy Consensus Panel, Bo Shen MD , Maria T. Abreu MD , Erica R. Cohen MD , Francis A. Farraye MD, MSc , Monika Fischer MD , Paul Feuerstadt MD , Saurabh Kapur MD , Huaibin M. Ko MD , Gursimran S. Kochhar MD , Xiuli Liu MD, PhD , Uma Mahadevan MD , Deborah L. McBride BS , Udayakumar Navaneethan MD , Miguel Regueiro MD , Tim Ritter MD , Prateek Sharma MD , Gary R. Lichtenstein MD
Endoscopy plays a key role in diagnosis, monitoring of disease activity, assessment of treatment response, dysplasia surveillance, postoperative evaluation, and interventional therapy for patients with inflammatory bowel disease (IBD). Clinical practice patterns in the endoscopic management of IBD vary. A panel of experts consisting of IBD specialists, endoscopists, and GI pathologists participated in virtual conferences and developed this modified Delphi-based consensus document to address endoscopic aspects of IBD management.
{"title":"Endoscopic diagnosis and management of adult inflammatory bowel disease: a consensus document from the American Society for Gastrointestinal Endoscopy IBD Endoscopy Consensus Panel","authors":"The ASGE IBD Endoscopy Consensus Panel, Bo Shen MD , Maria T. Abreu MD , Erica R. Cohen MD , Francis A. Farraye MD, MSc , Monika Fischer MD , Paul Feuerstadt MD , Saurabh Kapur MD , Huaibin M. Ko MD , Gursimran S. Kochhar MD , Xiuli Liu MD, PhD , Uma Mahadevan MD , Deborah L. McBride BS , Udayakumar Navaneethan MD , Miguel Regueiro MD , Tim Ritter MD , Prateek Sharma MD , Gary R. Lichtenstein MD","doi":"10.1016/j.gie.2024.08.034","DOIUrl":"10.1016/j.gie.2024.08.034","url":null,"abstract":"<div><div>Endoscopy plays a key role in diagnosis, monitoring of disease activity, assessment of treatment response, dysplasia surveillance, postoperative evaluation, and interventional therapy for patients with inflammatory bowel disease (IBD). Clinical practice patterns in the endoscopic management of IBD vary. A panel of experts consisting of IBD specialists, endoscopists, and GI pathologists participated in virtual conferences and developed this modified Delphi-based consensus document to address endoscopic aspects of IBD management.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 2","pages":"Pages 295-314"},"PeriodicalIF":6.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142462625","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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