Pub Date : 2024-11-01DOI: 10.1016/j.gie.2024.05.020
Yue Ma MD, Renyi Zhou MD
{"title":"Reflection on the high recurrence rate of adenomas after cold snare EMR","authors":"Yue Ma MD, Renyi Zhou MD","doi":"10.1016/j.gie.2024.05.020","DOIUrl":"10.1016/j.gie.2024.05.020","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"100 5","pages":"Pages 960-961"},"PeriodicalIF":6.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592532","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 : 2024-11-01DOI: 10.1016/j.gie.2024.04.2904
Background and Aims
Studies have shown that hydrothermal duodenal mucosal ablation results in improved glycemic control. Recellularization via electroporation therapy (ReCET) is a novel endoscopic procedure that uses electroporation to induce cellular apoptosis and subsequent reepithelization. In this study, we aimed to eliminate exogenous insulin treatment in type 2 diabetes (T2D) patients through a single ReCET procedure combined with a glucagon-like peptide-1 receptor agonist. Feasibility, safety, and (dose) efficacy of ReCET were assessed.
Methods
This first-in-human study included patients with T2D on basal insulin (age, 28-75 years; body mass index, 24-40 kg/m2; glycosylated hemoglobin, ≤64 mmol/mol; C-peptide, ≥0.2 nmol/L). The electroporation dose was optimized during the study, starting with single 600 V and ending with double 750 V treatments. All patients underwent ReCET, after which insulin was discontinued and semaglutide (glucagon-like peptide-1 receptor agonist) was initiated. The primary endpoints were feasibility (procedure time [from catheter in to catheter out], technical success rate), safety, and efficacy (patients off insulin at 6 months; HbA1c, ≤58 mmol/mol).
Results
Fourteen patients underwent endoscopic ReCET. The median procedure time was 58 (interquartile range, 49-73) minutes. ReCET demonstrated a technical success rate of 100%. No device-related severe adverse events or severe hypoglycemic events were observed. At the 12-month follow-up, 12 (86%) patients remained off exogenous insulin therapy, with significant improvements in glycemic control and metabolic parameters. The 2 patients in whom insulin therapy was reintroduced both received ReCET at the lowest voltage (single 600 V).
Conclusion
These results suggest that ReCET is feasible and safe. In combination with semaglutide, ReCET may be a promising therapeutic option to replace insulin therapy in selected T2D patients while improving glycemic control and metabolic health.
{"title":"Recellularization via electroporation therapy of the duodenum combined with glucagon-like peptide-1 receptor agonist to replace insulin therapy in patients with type 2 diabetes: 12-month results of a first-in-human study","authors":"","doi":"10.1016/j.gie.2024.04.2904","DOIUrl":"10.1016/j.gie.2024.04.2904","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Studies have shown that hydrothermal duodenal mucosal ablation results in improved glycemic control. Recellularization via electroporation therapy (ReCET) is a novel endoscopic procedure that uses electroporation to induce cellular apoptosis and subsequent reepithelization. In this study, we aimed to eliminate exogenous insulin treatment in type 2 diabetes (T2D) patients through a single ReCET procedure combined with a glucagon-like peptide-1 receptor agonist. Feasibility, safety, and (dose) efficacy of ReCET were assessed.</div></div><div><h3>Methods</h3><div>This first-in-human study included patients with T2D on basal insulin (age, 28-75 years; body mass index, 24-40 kg/m<sup>2</sup>; glycosylated hemoglobin, ≤64 mmol/mol; C-peptide, ≥0.2 nmol/L). The electroporation dose was optimized during the study, starting with single 600 V and ending with double 750 V treatments. All patients underwent ReCET, after which insulin was discontinued and semaglutide (glucagon-like peptide-1 receptor agonist) was initiated. The primary endpoints were feasibility (procedure time [from catheter in to catheter out], technical success rate), safety, and efficacy (patients off insulin at 6 months; HbA1c, ≤58 mmol/mol).</div></div><div><h3>Results</h3><div>Fourteen patients underwent endoscopic ReCET. The median procedure time was 58 (interquartile range, 49-73) minutes. ReCET demonstrated a technical success rate of 100%. No device-related severe adverse events or severe hypoglycemic events were observed. At the 12-month follow-up, 12 (86%) patients remained off exogenous insulin therapy, with significant improvements in glycemic control and metabolic parameters. The 2 patients in whom insulin therapy was reintroduced both received ReCET at the lowest voltage (single 600 V).</div></div><div><h3>Conclusion</h3><div>These results suggest that ReCET is feasible and safe. In combination with semaglutide, ReCET may be a promising therapeutic option to replace insulin therapy in selected T2D patients while improving glycemic control and metabolic health.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"100 5","pages":"Pages 896-904"},"PeriodicalIF":6.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858272","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 : 2024-11-01DOI: 10.1016/j.gie.2024.05.005
Background and Aims
Limited data exist regarding the long-term outcomes of endoscopic therapy (ET) with or without chemoradiation therapy (CRT) for T1b esophageal adenocarcinoma (EAC). Our aim was to identify the risk factors for lymph node metastasis (LNM) in T1b EAC and assess how the chosen treatment modality affects overall survival (OS) and cancer-specific survival (CSS).
Methods
We analyzed patients with histologically confirmed T1b EAC diagnosed between 2004 and 2018 using the Surveillance, Epidemiology, and End Results database. Focusing on T1bN0M0 staging, the patients were divided into 2 groups (ET [n = 174] and surgery [n = 769]), and OS and CSS rates were calculated.
Results
Of 1418 patients with T1b EAC, 228 cases (16.1%) exhibited LNM at diagnosis. Notable risk factors for LNM included poorly differentiated tumor and lesion size ≥20 mm. For T1bN0M0 cases, ET was commonly performed from 2009 to 2018 (odds ratio [OR], 4.3), especially for patients aged ≥65 years (OR, 3.1) with tumor size <20 mm (OR, 2.3). During the median 50 months of follow-up, age ≥65 years (hazard ratio [HR], 1.9), ET (HR, 1.5), and CRT (HR, 1.4) were associated with poorer OS. Factors linked to decreased CSS were age ≥65 years (subhazard ratio [SHR], 1.6), poorly differentiated tumors (SHR, 1.5), and CRT (SHR, 1.5).
Conclusions
In T1b EAC, tumor size ≥20 mm and poor differentiation are notable risk factors for LNM. ET exhibited comparable CSS outcomes to surgery for carefully selected T1bN0M0 lesions. CRT did not provide additional survival benefit for these lesions; however, large-scale studies are required to validate this finding.
{"title":"Predictors for lymph node metastasis and survival of patients with T1b esophageal adenocarcinoma treated with surgery and endoscopic therapy: an analysis of the Surveillance, Epidemiology, and End Results database","authors":"","doi":"10.1016/j.gie.2024.05.005","DOIUrl":"10.1016/j.gie.2024.05.005","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Limited data exist regarding the long-term outcomes of endoscopic therapy (ET) with or without chemoradiation therapy (CRT) for T1b esophageal adenocarcinoma (EAC). Our aim was to identify the risk factors for lymph node metastasis (LNM) in T1b EAC and assess how the chosen treatment modality affects overall survival (OS) and cancer-specific survival (CSS).</div></div><div><h3>Methods</h3><div>We analyzed patients with histologically confirmed T1b EAC diagnosed between 2004 and 2018 using the Surveillance, Epidemiology, and End Results database. Focusing on T1bN0M0 staging, the patients were divided into 2 groups (ET [n = 174] and surgery [n = 769]), and OS and CSS rates were calculated.</div></div><div><h3>Results</h3><div>Of 1418 patients with T1b EAC, 228 cases (16.1%) exhibited LNM at diagnosis. Notable risk factors for LNM included poorly differentiated tumor and lesion size ≥20 mm. For T1bN0M0 cases, ET was commonly performed from 2009 to 2018 (odds ratio [OR], 4.3), especially for patients aged ≥65 years (OR, 3.1) with tumor size <20 mm (OR, 2.3). During the median 50 months of follow-up, age ≥65 years (hazard ratio [HR], 1.9), ET (HR, 1.5), and CRT (HR, 1.4) were associated with poorer OS. Factors linked to decreased CSS were age ≥65 years (subhazard ratio [SHR], 1.6), poorly differentiated tumors (SHR, 1.5), and CRT (SHR, 1.5).</div></div><div><h3>Conclusions</h3><div>In T1b EAC, tumor size ≥20 mm and poor differentiation are notable risk factors for LNM. ET exhibited comparable CSS outcomes to surgery for carefully selected T1bN0M0 lesions. CRT did not provide additional survival benefit for these lesions; however, large-scale studies are required to validate this finding.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"100 5","pages":"Pages 849-856"},"PeriodicalIF":6.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140908521","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 : 2024-11-01DOI: 10.1016/j.gie.2024.08.019
Douglas G. Adler MD, FACG, AGAF, FASGE
{"title":"Best of EUS 2024","authors":"Douglas G. Adler MD, FACG, AGAF, FASGE","doi":"10.1016/j.gie.2024.08.019","DOIUrl":"10.1016/j.gie.2024.08.019","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"100 5","pages":"Pages 814-816"},"PeriodicalIF":6.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055348","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 : 2024-11-01DOI: 10.1016/j.gie.2024.04.2903
Background and Aims
Lymph node metastasis significantly affects the prognosis of early gastric cancer patients. EUS plays a crucial role in the preoperative assessment of early gastric cancer. This study evaluated the efficacy of EUS in identifying lymph node metastasis in early gastric cancer patients and developed a risk score model to aid in choosing the best treatment options.
Methods
We retrospectively analyzed the effectiveness of EUS for detecting lymph node metastasis in early gastric cancer patients. A risk score model for predicting lymph node metastasis preoperatively was created using independent risk factors identified through binary logistic regression analysis and subsequently validated. Receiver operating characteristic curves were generated for both the development and validation cohorts.
Results
The overall accuracy of EUS in identifying lymph node metastasis was 85.3%, although its sensitivity (29.2%) and positive predictive value (38.7%) were relatively low. Patients were categorized based on preoperative risk factors for lymph node metastasis, including tumor size of ≥20 mm, lymph nodes of ≥10 mm, body mass index of ≥24 kg/m2, and lymph node metastasis on CT scans. A 7-point risk score model was developed to assess the likelihood of lymph node metastasis. The areas under the receiver operating characteristic curve for the development and validation sets were 0.842 and 0.837, respectively, with sensitivities of 64% and 79%, respectively.
Conclusions
We developed a practical risk score model based on preoperative factors to help EUS predict lymph node metastasis in early gastric cancer patients, guiding the selection of optimal treatment approaches for these patients.
背景和目的：淋巴结转移严重影响早期胃癌患者的预后。内镜超声检查（EUS）在早期胃癌的术前评估中起着至关重要的作用。本研究评估了 EUS 识别早期胃癌患者淋巴结转移的效果，并建立了一个风险评分模型，以帮助选择最佳治疗方案：我们对 EUS 检测早期胃癌患者淋巴结转移的有效性进行了回顾性分析。利用二元逻辑回归分析确定的独立风险因素，建立了预测术前淋巴结转移的风险评分模型，并随后进行了验证。结果显示，EUS识别淋巴结转移的总体准确率为99.9%：尽管 EUS 的敏感性（29.2%）和阳性预测值（38.7%）相对较低，但 EUS 识别淋巴结转移的总体准确率为 85.3%。根据术前淋巴结转移的风险因素对患者进行分类，包括肿瘤大小≥20 mm、淋巴结≥10 mm、体重指数≥24 kg/m2、CT扫描发现淋巴结转移。建立了一个 7 点风险评分模型来评估淋巴结转移的可能性。开发集和验证集的 ROC 曲线下面积（AUC）分别为 0.842 和 0.837，灵敏度分别为 64% 和 79%：我们根据术前因素建立了一个实用的风险评分模型，帮助 EUS 预测早期胃癌患者的淋巴结转移情况，从而指导这些患者选择最佳治疗方法。
{"title":"Establishment and validation of a risk score model based on EUS: assessment of lymph node metastasis in early gastric cancer","authors":"","doi":"10.1016/j.gie.2024.04.2903","DOIUrl":"10.1016/j.gie.2024.04.2903","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Lymph node metastasis<span> significantly affects the prognosis of early gastric cancer patients. EUS plays a crucial role in the preoperative assessment of early gastric cancer. This study evaluated the efficacy of EUS in identifying lymph node metastasis in early gastric cancer patients and developed a risk score model to aid in choosing the best treatment options.</span></div></div><div><h3>Methods</h3><div>We retrospectively analyzed the effectiveness of EUS for detecting lymph node metastasis in early gastric cancer patients. A risk score model for predicting lymph node metastasis preoperatively was created using independent risk factors identified through binary logistic regression analysis and subsequently validated. Receiver operating characteristic curves were generated for both the development and validation cohorts.</div></div><div><h3>Results</h3><div><span>The overall accuracy of EUS in identifying lymph node metastasis was 85.3%, although its sensitivity (29.2%) and positive predictive value (38.7%) were relatively low. Patients were categorized based on preoperative risk factors for lymph node metastasis, including tumor size of ≥20 mm, lymph nodes of ≥10 mm, body mass index of ≥24 kg/m</span><sup>2</sup>, and lymph node metastasis on CT scans. A 7-point risk score model was developed to assess the likelihood of lymph node metastasis. The areas under the receiver operating characteristic curve for the development and validation sets were 0.842 and 0.837, respectively, with sensitivities of 64% and 79%, respectively.</div></div><div><h3>Conclusions</h3><div>We developed a practical risk score model based on preoperative factors to help EUS predict lymph node metastasis in early gastric cancer patients, guiding the selection of optimal treatment approaches for these patients.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"100 5","pages":"Pages 857-866"},"PeriodicalIF":6.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864400","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 : 2024-11-01DOI: 10.1016/j.gie.2024.06.003
The ASGE Standards of Practice Committee, Jorge D. Machicado MD, MPH , Sunil G. Sheth MD, FASGE , Jean M. Chalhoub MD , Nauzer Forbes MD, MSc, FASGE , Madhav Desai MD, MPH , Saowanee Ngamruengphong MD, FASGE , Georgios I. Papachristou MD, PhD , Vaibhav Sahai MBBS, MS , Ibrahim Nassour MD, MSCS , Wasif Abidi MD, PhD , Omeed Alipour MD , Stuart K. Amateau MD, PhD, FASGE , Nayantara Coelho-Prabhu MD, FASGE , Natalie Cosgrove MD , Sherif E. Elhanafi MD , Larissa L. Fujii-Lau MD , Divyanshoo R. Kohli MD , Neil B. Marya MD , Swati Pawa MD, FASGE , Bashar J. Qumseya MD, MPH, FASGE (ASGE Standards of Practice Committee Chair)
{"title":"American Society for Gastrointestinal Endoscopy guideline on role of endoscopy in the diagnosis and management of solid pancreatic masses: methodology and review of evidence","authors":"The ASGE Standards of Practice Committee, Jorge D. Machicado MD, MPH , Sunil G. Sheth MD, FASGE , Jean M. Chalhoub MD , Nauzer Forbes MD, MSc, FASGE , Madhav Desai MD, MPH , Saowanee Ngamruengphong MD, FASGE , Georgios I. Papachristou MD, PhD , Vaibhav Sahai MBBS, MS , Ibrahim Nassour MD, MSCS , Wasif Abidi MD, PhD , Omeed Alipour MD , Stuart K. Amateau MD, PhD, FASGE , Nayantara Coelho-Prabhu MD, FASGE , Natalie Cosgrove MD , Sherif E. Elhanafi MD , Larissa L. Fujii-Lau MD , Divyanshoo R. Kohli MD , Neil B. Marya MD , Swati Pawa MD, FASGE , Bashar J. Qumseya MD, MPH, FASGE (ASGE Standards of Practice Committee Chair)","doi":"10.1016/j.gie.2024.06.003","DOIUrl":"10.1016/j.gie.2024.06.003","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"100 5","pages":"Pages e1-e78"},"PeriodicalIF":6.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142283732","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 : 2024-11-01DOI: 10.1016/j.gie.2024.06.002
The ASGE Standards of Practice Committee, Jorge D. Machicado MD, MPH , Sunil G. Sheth MD, FASGE , Jean M. Chalhoub MD , Nauzer Forbes MD, MSc, FASGE , Madhav Desai MD, MPH , Saowanee Ngamruengphong MD, FASGE , Georgios I. Papachristou MD, PhD , Vaibhav Sahai MBBS, MS , Ibrahim Nassour MD, MSCS , Wasif Abidi MD, PhD , Omeed Alipour MD , Stuart K. Amateau MD, PhD, FASGE , Nayantara Coelho-Prabhu MD, FASGE , Natalie Cosgrove MD , Sherif E. Elhanafi MD , Larissa L. Fujii-Lau MD , Divyanshoo R. Kohli MD , Neil B. Marya MD , Swati Pawa MD, FASGE , Bashar J. Qumseya MD, MPH, FASGE
This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for the role of endoscopy in the diagnosis and management of pancreatic masses. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework and addresses needle selection (fine-needle biopsy [FNB] needle vs FNA needle), needle caliber (22-gauge vs 25-gauge needles), FNB needle type (novel or contemporary [fork-tip and Franseen] vs alternative FNB needle designs), and sample processing (rapid on-site evaluation [ROSE] vs no ROSE). In addition, this guideline addresses stent selection (self-expandable metal stents [SEMS] vs plastic stents), SEMS type (covered [cSEMS] vs uncovered [uSEMS]), and pain management (celiac plexus neurolysis [CPN] vs medical analgesic therapy). In patients with solid pancreatic masses undergoing EUS-guided tissue acquisition (EUS-TA), the ASGE recommends FNB needles over FNA needles. With regard to needle caliber, the ASGE suggests 22-gauge over 25-gauge needles. When an FNB needle is used, the ASGE recommends using either a fork-tip or a Franseen needle over alternative FNB needle designs. After a sample has been obtained, the ASGE suggests against the routine use of ROSE in patients undergoing an initial EUS-TA of a solid pancreatic mass. In patients with distal malignant biliary obstruction undergoing drainage with ERCP, the ASGE suggests using SEMS over plastic stents. In patients with proven malignancy undergoing SEMS placement, the ASGE suggests using cSEMS over uSEMS. If malignancy has not been histopathologically confirmed, the ASGE recommends against the use of uSEMS. Finally, in patients with unresectable pancreatic cancer and abdominal pain, the ASGE suggests the use of CPN as an adjunct for the treatment of abdominal pain. This document outlines the process, analyses, and decision approaches used to reach the final recommendations and represents the official ASGE recommendations on the above topics.
美国消化内镜学会（American Society for Gastrointestinal Endoscopy，ASGE）的这一临床实践指南为内镜在胰腺肿块诊断和管理中的作用提供了循证方法。本文件采用建议分级评估、发展和评价框架（Grading of Recommendations Assessment, Development and Evaluation framework）制定，涉及针头选择（细针活检针[FNB] vs FNA针）、针头口径（22号针头 vs 25号针头）、FNB针头类型（新型或现代[叉尖和Franseen] 针头 vs 其他FNB针头设计）和样本处理（快速现场评估[ROSE] vs 无ROSE）。此外，该指南还涉及支架选择（自膨胀金属支架 [SEMS] vs 塑料支架）、SEMS 类型（有盖 [cSEMS] vs 无盖 [uSEMS]）和疼痛处理（腹腔神经丛神经溶解术 [CPN] vs 药物镇痛疗法）。对于在 EUS 引导下进行组织采集 (EUS-TA) 的胰腺实性肿块患者，ASGE 建议使用 FNB 针而不是 FNA 针。关于针头口径，ASGE 建议使用 22 号针头而非 25 号针头。在使用 FNB 针时，ASGE 建议使用叉尖针或 Franseen 针，而不是其他设计的 FNB 针。在获得样本后，ASGE 建议对初次接受胰腺实体肿块 EUS-TA 的患者不要常规使用 ROSE。对于接受 ERCP 引流的远端恶性胆道梗阻患者，ASGE 建议使用 SEMS 而不是塑料支架。对于已证实患有恶性肿瘤并接受 SEMS 置入术的患者，ASGE 建议使用 cSEMS 而不是 uSEMS。如果恶性肿瘤未经组织病理学证实，ASGE 建议不要使用 uSEMS。最后，对于无法切除且伴有腹痛的胰腺癌患者，ASGE 建议使用 CPN 作为治疗腹痛的辅助手段。本文件概述了得出最终建议的过程、分析和决策方法，并代表了美国胰腺学会对上述主题的官方建议。
{"title":"American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the diagnosis and management of solid pancreatic masses: summary and recommendations","authors":"The ASGE Standards of Practice Committee, Jorge D. Machicado MD, MPH , Sunil G. Sheth MD, FASGE , Jean M. Chalhoub MD , Nauzer Forbes MD, MSc, FASGE , Madhav Desai MD, MPH , Saowanee Ngamruengphong MD, FASGE , Georgios I. Papachristou MD, PhD , Vaibhav Sahai MBBS, MS , Ibrahim Nassour MD, MSCS , Wasif Abidi MD, PhD , Omeed Alipour MD , Stuart K. Amateau MD, PhD, FASGE , Nayantara Coelho-Prabhu MD, FASGE , Natalie Cosgrove MD , Sherif E. Elhanafi MD , Larissa L. Fujii-Lau MD , Divyanshoo R. Kohli MD , Neil B. Marya MD , Swati Pawa MD, FASGE , Bashar J. Qumseya MD, MPH, FASGE","doi":"10.1016/j.gie.2024.06.002","DOIUrl":"10.1016/j.gie.2024.06.002","url":null,"abstract":"<div><div>This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for the role of endoscopy in the diagnosis and management of pancreatic masses. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework and addresses <em>needle selection</em> (fine-needle biopsy [FNB] needle vs FNA needle), <em>needle caliber</em> (22-gauge vs 25-gauge needles), <em>FNB needle type</em> (novel or contemporary [fork-tip and Franseen] vs alternative FNB needle designs), and <em>sample processing</em> (rapid on-site evaluation [ROSE] vs no ROSE). In addition, this guideline addresses <em>stent selection</em> (self-expandable metal stents [SEMS] vs plastic stents), <em>SEMS type</em> (covered [cSEMS] vs uncovered [uSEMS]), and <em>pain management</em> (celiac plexus neurolysis [CPN] vs medical analgesic therapy). In patients with solid pancreatic masses undergoing EUS-guided tissue acquisition (EUS-TA), the ASGE recommends FNB needles over FNA needles. With regard to needle caliber, the ASGE suggests 22-gauge over 25-gauge needles. When an FNB needle is used, the ASGE recommends using either a fork-tip or a Franseen needle over alternative FNB needle designs. After a sample has been obtained, the ASGE suggests against the routine use of ROSE in patients undergoing an initial EUS-TA of a solid pancreatic mass. In patients with distal malignant biliary obstruction undergoing drainage with ERCP, the ASGE suggests using SEMS over plastic stents. In patients with proven malignancy undergoing SEMS placement, the ASGE suggests using cSEMS over uSEMS. If malignancy has not been histopathologically confirmed, the ASGE recommends against the use of uSEMS. Finally, in patients with unresectable pancreatic cancer and abdominal pain, the ASGE suggests the use of CPN as an adjunct for the treatment of abdominal pain. This document outlines the process, analyses, and decision approaches 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":"100 5","pages":"Pages 786-796"},"PeriodicalIF":6.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142462539","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 : 2024-11-01DOI: 10.1016/j.gie.2024.06.004
Background and Aims
Despite the benefits of artificial intelligence in small-bowel (SB) capsule endoscopy (CE) image reading, information on its application in the stomach and SB CE is lacking.
Methods
In this multicenter, retrospective diagnostic study, gastric imaging data were added to the deep learning–based SmartScan (SS), which has been described previously. A total of 1069 magnetically controlled GI CE examinations (comprising 2,672,542 gastric images) were used in the training phase for recognizing gastric pathologies, producing a new artificial intelligence algorithm named SS Plus. A total of 342 fully automated, magnetically controlled CE examinations were included in the validation phase. The performance of both senior and junior endoscopists with both the SS Plus–assisted reading (SSP-AR) and conventional reading (CR) modes was assessed.
Results
SS Plus was designed to recognize 5 types of gastric lesions and 17 types of SB lesions. SS Plus reduced the number of CE images required for review to 873.90 (median, 1000; interquartile range [IQR], 814.50-1000) versus 44,322.73 (median, 42,393; IQR, 31,722.75-54,971.25) for CR. Furthermore, with SSP-AR, endoscopists took 9.54 minutes (median, 8.51; IQR, 6.05-13.13) to complete the CE video reading. In the 342 CE videos, SS Plus identified 411 gastric and 422 SB lesions, whereas 400 gastric and 368 intestinal lesions were detected with CR. Moreover, junior endoscopists remarkably improved their CE image reading ability with SSP-AR.
Conclusions
Our study shows that the newly upgraded deep learning–based algorithm SS Plus can detect GI lesions and help improve the diagnostic performance of junior endoscopists in interpreting CE videos.
背景与目的：尽管人工智能（AI）在小肠（SB）胶囊内镜（CE）图像读取方面有很多优势，但在胃和小肠CE方面的应用还缺乏相关信息：在这项多中心、回顾性诊断研究中，胃部成像数据被添加到基于深度学习（DL）的智能扫描（SS）中。在识别胃部病变的训练阶段，共使用了 1,069 次磁控胃肠道 (GI) CE 检查（包括 2,672,542 张胃部图像），产生了一种名为 SS Plus 的新人工智能算法。验证阶段包括 342 次全自动磁控 CE（FAMCE）检查。评估了高级和初级内镜医师在 SS Plus 辅助读片（SSP-AR）和传统读片（CR）模式下的表现：结果：SS Plus 可识别 5 种胃部病变和 17 种 SB 病变。SS Plus 将所需的 CE 图像数量减少到 873.90 (1000)（中位数，IQR 814.50-1,000），而 CR 则减少到 44,322.73 (42,393)（中位数，IQR 31,722.75-54,971.25）。此外，使用 SSP-AR 时，内镜医师完成 CE 视频阅读的时间为 9.54 分钟（8.51）（中位数，IQR 6.05-13.13）。在 342 个 CE 视频中，SS Plus 发现了 411 个胃部病变和 422 个 SB 病变，而 CR 发现了 400 个胃部病变和 368 个肠道病变。此外，使用 SSP-AR 后，初级内镜医师的 CE 图像阅读能力显著提高：我们的研究表明，新升级的基于 DL 的算法 SS Plus 可以检测出消化道病变，有助于提高初级内镜医师解读 CE 视频的诊断能力。
{"title":"A new artificial intelligence system for both stomach and small-bowel capsule endoscopy","authors":"","doi":"10.1016/j.gie.2024.06.004","DOIUrl":"10.1016/j.gie.2024.06.004","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Despite the benefits of artificial intelligence in small-bowel (SB) capsule endoscopy (CE) image reading, information on its application in the stomach and SB CE is lacking.</div></div><div><h3>Methods</h3><div>In this multicenter, retrospective diagnostic study, gastric imaging data were added to the deep learning–based SmartScan (SS), which has been described previously. A total of 1069 magnetically controlled GI CE examinations (comprising 2,672,542 gastric images) were used in the training phase for recognizing gastric pathologies, producing a new artificial intelligence algorithm named SS Plus. A total of 342 fully automated, magnetically controlled CE examinations were included in the validation phase. The performance of both senior and junior endoscopists with both the SS Plus–assisted reading (SSP-AR) and conventional reading (CR) modes was assessed.</div></div><div><h3>Results</h3><div>SS Plus was designed to recognize 5 types of gastric lesions and 17 types of SB lesions. SS Plus reduced the number of CE images required for review to 873.90 (median, 1000; interquartile range [IQR], 814.50-1000) versus 44,322.73 (median, 42,393; IQR, 31,722.75-54,971.25) for CR. Furthermore, with SSP-AR, endoscopists took 9.54 minutes (median, 8.51; IQR, 6.05-13.13) to complete the CE video reading. In the 342 CE videos, SS Plus identified 411 gastric and 422 SB lesions, whereas 400 gastric and 368 intestinal lesions were detected with CR. Moreover, junior endoscopists remarkably improved their CE image reading ability with SSP-AR.</div></div><div><h3>Conclusions</h3><div>Our study shows that the newly upgraded deep learning–based algorithm SS Plus can detect GI lesions and help improve the diagnostic performance of junior endoscopists in interpreting CE videos.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"100 5","pages":"Pages 878.e1-878.e14"},"PeriodicalIF":6.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293316","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}
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