Gastrointestinal endoscopy最新文献

英文中文

Virtual reality intervention to improve quality of care during colonoscopy: a hybrid type 1 randomized controlled trial 虚拟现实干预提高结肠镜检查护理质量：混合 1 型随机对照试验。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2024-11-01 DOI: 10.1016/j.gie.2024.05.023

Background and Aims

Effective management of patients’ pain, anxiety, and discomfort during colonoscopy is crucial for successful completion of the procedure, patient adherence to follow-up examinations, and patient satisfaction. Virtual reality (VR) interventions, as a nonpharmacologic and innovative solution, have demonstrated promising results in managing these outcomes. Nevertheless, there is limited evidence on their effectiveness and implementation. This trial aimed to test clinical effectiveness and identify factors to facilitate the implementation of VR during colonoscopy.

Methods

A hybrid type 1 effectiveness implementation, parallel randomized controlled, open-label trial was conducted. Fifty patients were randomized (1:1) to a VR or a control group. The effectiveness (pain, anxiety, discomfort, medication use, and satisfaction) and implementation (reach, adoption, implementation, and maintenance) outcomes were assessed before, during, and after colonoscopy.

Results

Patients in the VR group reported significantly lower pain (P = .043) and discomfort (P <.0001) during colonoscopy, had a higher number of completed colonoscopies without sedation (P = .003), and showed higher satisfaction (P = .032). The major barrier to the implementation and maintenance of the VR intervention was inadequate VR content design. Staff were most worried about altered patient communications, unclear responsibilities, increasing workload, and patient safety. Patients expressed willingness to reuse VR glasses and to suggest them to other patients.

Conclusions

VR can be used as a nonpharmacologic method for pain management and for overcoming anxiety and discomfort during colonoscopy. VR can improve patients’ satisfaction and diminish the need for sedative medications; accordingly, it has the potential to promote cooperation and compliance among patients and increase screening colonoscopy rates. (Clinical trial registration number: NCT05723861.)

背景和目的：有效控制结肠镜检查过程中患者的疼痛、焦虑和不适感对于顺利完成手术、患者坚持随访检查以及患者满意度至关重要。虚拟现实（VR）干预作为一种非药物性的创新解决方案，在控制这些结果方面取得了可喜的成果。然而，有关其有效性和实施情况的证据还很有限。本试验旨在测试结肠镜检查的临床有效性，并确定促进结肠镜检查期间实施 VR 的因素：方法：进行了一项有效性-实施性混合型、平行随机对照、开放标签试验。50 名患者被随机（1:1）分配到 VR 组或对照组。在结肠镜检查前、检查过程中和检查后，对有效性（疼痛、焦虑、不适、药物使用和满意度）和实施性（接触、采用、实施和维持）结果进行了评估：结果：VR 组患者的疼痛感（P=0.043）和不适感（P=0.043）明显降低：结肠镜检查期间，VR 可作为一种非药物方法用于疼痛控制和克服焦虑与不适。VR 可以提高患者的满意度，减少对镇静药物的需求；因此，它有可能促进患者的合作和依从性，提高结肠镜筛查率。

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引用次数: 0

Virtual indigo carmine chromoendoscopy images: a novel modality for peroral cholangioscopy using artificial intelligence technology (with video) 虚拟靛蓝胭脂红内镜图像：利用人工智能技术进行口周胆道镜检查的新模式（附视频）。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2024-11-01 DOI: 10.1016/j.gie.2024.06.013

Background and Aims

Accurately diagnosing biliary strictures is crucial for surgical decisions, and although peroral cholangioscopy (POCS) aids in visual diagnosis, diagnosing malignancies or determining lesion margins via this route remains challenging. Indigo carmine is commonly used to evaluate lesions during GI endoscopy. We aimed to establish the utility of virtual indigo carmine chromoendoscopy (VICI) converted from POCS images using artificial intelligence.

Methods

This single-center, retrospective study analyzed 40 patients with biliary strictures who underwent POCS using white-light imaging (WLI) and narrow-band imaging (NBI). A cycle-consistent adversarial network was used to convert the WLI into VICI of POCS images. Three experienced endoscopists evaluated WLI, NBI, and VICI via POCS in all patients. The primary outcome was the visualization quality of surface structures, surface microvessels, and lesion margins. The secondary outcome was diagnostic accuracy.

Results

VICI showed superior visualization of the surface structures and lesion margins compared with WLI (P < .001) and NBI (P < .001). The diagnostic accuracies were 72.5%, 87.5%, and 90.0% in WLI alone, WLI and VICI simultaneously, and WLI and NBI simultaneously, respectively. WLI and VICI simultaneously tended to result in higher accuracy than WLI alone (P = .083), and the results were not significantly different from WLI and NBI simultaneously (P = .65).

Conclusions

VICI in POCS proved valuable for visualizing surface structures and lesion margins and contributed to higher diagnostic accuracy comparable to NBI. In addition to NBI, VICI may be a novel supportive modality for POCS.

背景和目的：准确诊断胆道狭窄对手术决策至关重要，虽然经口胆道镜（POCS）有助于直观诊断，但通过该途径诊断恶性肿瘤或确定病变边缘仍具有挑战性。靛胭脂红通常用于评估消化道内窥镜检查中的病变。我们的目的是利用人工智能确定从 POCS 图像转换而来的虚拟靛蓝胭脂虫内镜（VICI）的实用性：这项单中心回顾性研究分析了 40 名胆道狭窄患者，他们使用白光成像（WLI）和窄带成像（NBI）接受了 POCS 检查。研究使用 "周期一致性对抗网络"（CycleGAN）将白光成像转换为 POCS 图像的 VICI。三名经验丰富的内镜医师通过 POCS 对所有患者的 WLI、NBI 和 VICI 进行了评估。主要结果是表面结构、表面微血管和病变边缘的可视化质量。次要结果是诊断准确性：结果：VICI 对表面结构和病变边缘的显示优于 WLI（PC 结论：POCS 中的 VICI 被证明对病变边缘的显示更准确：事实证明，POCS 中的 VICI 对观察表面结构和病变边缘很有价值，其诊断准确性高于 NBI。除 NBI 外，VICI 也可能是 POCS 的一种新型辅助方法。

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引用次数: 0

Deciphering the clinical spectrum of gastric disease in patients with juvenile polyposis syndrome 解读幼年息肉病综合征患者胃病的临床表现。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2024-11-01 DOI: 10.1016/j.gie.2024.05.015

Background and Aims

Juvenile polyposis syndrome (JPS) is a rare hereditary autosomal dominant cancer-predisposition syndrome caused by germline pathogenic variants (PVs) located in SMAD4 or BMPR1A genes. Accurate clinical and endoscopic data regarding the evolution of gastric lesions remain sparse.

Methods

Clinical, endoscopic, genetic, and pathologic data from patients with SMAD4 or BMPR1A PVs included between 2007 and 2020 in the French network on rare digestive polyposis (RENAPOL [French National Polyposis Register]) database were prospectively collected to address uncertainties regarding gastric involvement.

Results

Thirty-six patients were included: 25 (69.5%) had SMAD4 PVs, and 11 had BMPR1A PVs. For SMAD4 PV carriers, median age at inclusion was 43.0 years (range, 10-78 years). At baseline EGD, 22 (88%) of 25 patients exhibited at least 1 gastric juvenile polyp, and 5 (20%) of 25 had macroscopic signs of inflammatory gastritis. Early gastric disease was mostly located under the cardia, then progressed to the gastric antrum and body. During a mean follow-up period of 55.0 months, 12 of 25 patients had gastric disease progression (ie, new juvenile polyps [91.6%], diffuse gastric involvement [41.6%], inflammatory flat progression [25%]). Among 62 biopsies, low-grade dysplasia was observed in 5 (7.5%) samples from 2 patients. Nine carriers (36%) underwent gastrectomy (mean age, 47.2 years) due to diffuse gastric involvement or worsening clinical symptoms. Gastric adenocarcinoma (T1) was found in 1 gastrectomy specimen. Among the 11 patients with BMPR1A PVs, 2 had gastric hamartomatomas at baseline EGD, none with dysplasia or symptoms.

Conclusions

Gastric involvement in JPS seems to be progressive over a lifetime, initiates in the cardia area, and mostly involves SMAD4 PV carriers.

背景和目的：幼年性息肉病综合征（JPS）是一种罕见的遗传性常染色体显性癌症易感综合征，由位于SMAD4或BMPR1A基因的种系致病变体（PV）引起。精确的临床和内镜表现以及胃部病变的演变过程仍不为人所知：方法：前瞻性地收集了法国罕见消化道息肉病网络（RENAPOL）数据库在 2007 年至 2020 年间收录的 SMAD4 或 BMPR1A PV 患者的临床、内镜、遗传和病理数据，以解决胃部受累方面的不确定性：结果：共纳入 36 例患者：25例（69.5%）为SMAD4 PV，11例为BMPR1A PV。SMAD4 PV携带者的中位年龄为43.0岁[10-78岁]。在基线食管胃十二指肠镜（EGD）检查中，22/25（88%）人至少有一个胃幼年息肉，5/25（20%）人有炎症性胃炎的宏观症状。早期胃病大多位于贲门下，然后发展到胃窦和胃体。在平均 55.0 个月的随访期间，有 12/25 例患者的胃病出现进展（即新的幼年息肉（91.6%）、弥漫性胃受累（41.6%）、炎性扁平进展（25%））。在 62 份活检样本中，2 名患者的 5 份样本（7.5%）出现低度发育不良。9名携带者（36%）因胃部弥漫性受累或临床症状恶化而接受了胃切除术（平均年龄47.2岁）。在一份胃切除术标本中发现了胃腺癌（T1）。在11例患有BMPR1A PV的患者中，2例在基线胃肠道造影时发现胃火腿肠瘤，但无一伴有发育不良或症状：结论：JPS患者的胃部受累似乎是终身进行性的，从贲门部位开始，主要涉及SMAD4 PV携带者。

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引用次数: 0

Comparison of EMR versus endoscopic submucosal dissection for Barrett’s neoplasia and esophageal adenocarcinoma: a systematic review and meta-analysis 内镜下黏膜切除术与内镜下黏膜下剥离术治疗巴雷特氏肿瘤和食管腺癌的比较：系统综述与 Meta 分析》（Endoscopic Mucosal Resection versus Endoscopic Submucosal Dissection for Barrett's Neoplasia and Esophageal Adenocarcinoma）。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2024-11-01 DOI: 10.1016/j.gie.2024.06.012

Background and Aims

EMR and endoscopic submucosal dissection (ESD) are both accepted resection strategies for Barrett’s esophagus–related neoplasia and esophageal adenocarcinoma (EAC). However, a lack of consensus exists regarding which technique offers superior outcomes. This study aims to systematically review the evidence comparing EMR versus ESD in treating Barrett’s neoplasia and EAC.

Methods

We searched 3 databases (Embase, MEDLINE, Cochrane Central) through October 2023. We included studies comparing the efficacy of EMR and ESD for Barrett’s neoplasia and EAC. Primary outcomes include en bloc, R0, and curative resection; complete remission of dysplasia (CRD), and local recurrence. Secondary outcomes encompass adverse events.

Results

Our search identified 905 records. Eleven studies were included in the final analyses. Data showed significantly higher en bloc resection rates with ESD (odds ratio [OR], 31.53; 95% confidence interval [CI], 10.02-99.19; P < .01; 7 studies). R0 resection rates were significantly higher with ESD (OR, 5.92; 95% CI, 2.75-12.77; P < .01; 8 studies). Curative resection rates tended to be higher with ESD (OR, 3.49; 95% CI, 0.86-14.14; P = .080; 4 studies). There was no significant difference in CRD rates (OR, 0.92; 95% CI, 0.37-2.26; P = .86; 3 studies). Local recurrence rates tended to be lower with ESD (OR, 0.35; 95% CI, 0.11-1.04; P = .058; 10 studies). As for adverse events, there was no significant difference in bleeding, perforation, and postoperative stricture rates.

Conclusions

This systematic review and meta-analysis demonstrates that ESD achieves higher en bloc, R0, and curative resection rates, with a tendency toward lower recurrence rates. These results suggest that ESD may be a more effective option for managing Barrett’s neoplasia and EAC. (International Prospective Register of Systematic Reviews [PROSPERO] registration number: CRD42023426486.)

背景和目的：内镜下粘膜切除术（EMR）和内镜下粘膜下剥离术（ESD）都是治疗巴雷特食管相关肿瘤和食管腺癌（EAC）的公认切除策略。然而，关于哪种技术能提供更好的疗效，目前还缺乏共识。本研究旨在系统回顾在治疗巴雷特瘤和 EAC 时，EMR 与 ESD 的比较证据：我们检索了三个数据库（Embase、MEDLINE、Cochrane Central），直至 2023 年 10 月。我们纳入了比较 EMR 和 ESD 对 Barrett 肿瘤和 EAC 疗效的研究。主要结果包括全切、R0、根治性切除、发育不良完全缓解（CRD）和局部复发。次要结果包括不良事件：我们的搜索发现了 905 条记录。最终分析纳入了 11 项研究。数据显示，ESD的全块切除率明显更高[几率比（OR）=27.36（95% 置信区间（CI）：7.12-105.21），p结论：这项系统综述和荟萃分析表明，ESD可实现更高的整块切除率、R0切除率和治愈率，并有降低复发率的趋势。这些结果表明，ESD 可能是治疗巴雷特肿瘤和 EAC 的更有效选择。

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引用次数: 0

Confocal laser endomicroscopy for the diagnosis of gastric adenocarcinoma of the fundic gland type 共焦激光内窥镜诊断胃底腺癌。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2024-11-01 DOI: 10.1016/j.gie.2024.06.025

引用次数: 0

A note from the Editor-in-Chief 主编的说明

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2024-11-01 DOI: 10.1016/j.gie.2024.08.013

Douglas G. Adler MD, FACG, AGAF, FASGE (Editor-in-Chief)

引用次数: 0

Plastic stents for palliative biliary drainage: we have come full circle 用于姑息性胆道引流的塑料支架：我们已经走过了一个完整的历程

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2024-11-01 DOI: 10.1016/j.gie.2024.05.028

Shyam Menon MSc, MD, MBA, FASGE, AGAF

引用次数: 0

ERCP credentialing ERCP认证

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2024-11-01 DOI: 10.1016/j.gie.2024.06.005

Peter B. Cotton MD, FRCP, FRCS

引用次数: 0

Clinical outcomes of peroral endoscopic myotomy with and without septotomy for management of epiphrenic diverticula: an international multicenter experience (with video) 口腔内窥镜肌切开术（含或不含隔膜切开术）治疗虹吸管憩室的临床效果 - 一项国际多中心经验

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2024-11-01 DOI: 10.1016/j.gie.2024.05.010

Background and Aims

There are few data favoring the need for septotomy at the time of peroral endoscopic myotomy (POEM) or if POEM alone is sufficient. Our aim was to compare POEM outcomes with and without septotomy (POEM+S or POEM-S) in patients with symptomatic epiphrenic diverticula (ED) and an underlying motility disorder.

Methods

This was an international, multicenter retrospective study involving 21 centers between January 2014 and January 2023. Patients with ED and an underlying motility disorder who underwent POEM were included. The primary outcome was clinical success (Eckardt score [ES] ≤3 or a 1-point drop in ES for patients with baseline ES <3) without the need for repeat surgical/endoscopic interventions during follow-up.

Results

A total of 85 patients (mean age, 64.29 ± 17.1 years; 32 [37.6%] female) with ED and underlying motility disorder underwent POEM+S (n = 47) or POEM–S (n = 38). Patients in the POEM+S group had a significantly higher mean pre-POEM ES (7.3 ± 2.1 vs 5.8 ± 2; P = .002). The most common indication for POEM was achalasia (51% in the POEM+S cohort and 51.8% in the POEM–S cohort; P = .7). A posterior approach was favored in the POEM+S group (76.6% vs 52.6%; P = .02). A similar rate of technical success was seen in both groups (97.9% vs 100%; P = .1). The rate of adverse events was similar between the 2 cohorts (4.2% vs 8.1%; P = .6). The median length of hospital stay after POEM–S was significantly longer compared with POEM+S (2 days [interquartile range (IQR), 1-4 days] vs 1 day [IQR, 1-2 days]; P = .005). Clinical success was equivalent between the 2 groups (83% vs 86.8%; P = .6) at a median follow-up duration of 8 months (IQR, 3-19 months).

Conclusions

In patients with ED and an underlying motility disorder, both POEM+S and POEM–S are equally safe and effective, with similar procedure duration and a low recurrence rate at short-term follow-up. Future comparative prospective studies with long-term follow-up are required to validate these findings.

背景和目的很少有数据支持在进行口腔内镜下肌切开术（POEM）时需要进行隔膜切开术，或者仅进行口腔内镜下肌切开术就足够了。我们的目的是比较对有症状的虹膜上腔憩室（ED）和潜在运动障碍患者进行和不进行隔肌切开术（POEM+S 或 POEM-S）的 POEM 结果。研究纳入了接受POEM手术的ED和潜在运动障碍患者。主要结果是临床成功（埃卡特评分[ES] ≤3，或基线ES <3的患者ES下降1分），且随访期间无需重复手术/内镜干预。结果共有85名患有ED和潜在运动障碍的患者（平均年龄为64.29 ± 17.1岁；32名[37.6%]女性）接受了POEM+S（n = 47）或POEM-S（n = 38）治疗。POEM+S 组患者在 POEM 前的平均 ES 值明显更高（7.3 ± 2.1 vs 5.8 ± 2；P = .002）。POEM最常见的适应症是贲门失弛缓症（POEM+S组为51%，POEM-S组为51.8%；P = .7）。POEM+S 组更倾向于采用后入路（76.6% 对 52.6%；P = .02）。两组的技术成功率相似（97.9% vs 100%；P = .1）。两组的不良事件发生率相似（4.2% vs 8.1%；P = .6）。与 POEM+S 相比，POEM-S 的中位住院时间明显更长（2 天 [四分位数间距 (IQR)，1-4 天] vs 1 天 [IQR, 1-2 天]；P = .005）。结论在患有 ED 和潜在运动障碍的患者中，POEM+S 和 POEM-S 同样安全有效，手术时间相似，短期随访时复发率较低。未来需要进行长期随访的前瞻性比较研究来验证这些发现。

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IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy

Pub Date : 2024-11-01 DOI: 10.1016/j.gie.2024.07.026

Sandra Baile-Maxía MD, PhD, Rodrigo Jover MD, PhD

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