Gastrointestinal endoscopy最新文献

Background & aims: Pancreatic cysts often pose challenges in predicting malignant progression. Next-generation sequencing has become an appealing ancillary diagnostic test. The diagnostic performance is well characterized, but the impact on clinical management remains unclear. We aim to evaluate the efficacy of integrating NGS into cyst management algorithms.

Methods: This single-center retrospective study included 441 adult patients who were seen at our high-risk pancreatic lesion clinic between 2016 and 2022 and had NGS data available. Performance characteristics of PancreaSeq were calculated. The clinical utility of PancreaSeq in guiding surgical management and differentiating cyst type was evaluated.

Results: High-risk mutations (n=25) demonstrated 72.7% (95% CI: 49.8% - 89.3%) sensitivity, 97.8% (95% CI: 96% - 99%) specificity, and area under receiver operating curve 0.85 (95% CI: 0.76 - 0.95) in predicting advanced neoplasia. NGS detected KRAS or GNAS mutations in 179/324 (55.3%) and VHL mutations in 15/324 (3.4%) with unclear cyst type, facilitating decision regarding surveillance versus clinic discharge. Among 27 patients with isolated pancreatic duct dilation, 12 (48.1%) had mutations consistent with mucinous neoplasms leading to a diagnosis of main duct intraductal papillary mucinous neoplasm. These findings resulted in surgical management for six patients. Overall, 115 of 441 (26.1%) patients had some management change after undergoing NGS.

Conclusion: NGS informed surgical decision-making, cyst type differentiation, and evaluation of pancreatic duct dilation, leading to changes in management. Indeed, NGS emerges as a useful tool in select patients with pancreatic lesions by improving diagnostic precision and guiding patient care paths.

Background and aims: Endoscopic ultrasound-guided peripancreatic fluid drainage (EUS-PFD) with on-demand endoscopic necrosectomy, increasingly utilized to manage walled-off necrosis (WON), is associated with substantial morbidity and mortality. This multicenter study aimed to externally validate recently developed quadrant (an abdominal quadrant distribution), necrosis, and infection (QNI) criteria for risk stratification in this setting.

Methods: Of 423 patients with pancreatic fluid collections treated in a large multi-institutional cohort between 2010 and 2020, 212 with available preprocedural computed tomography images were included. Clinical outcomes between high- and low-risk groups defined according to QNI criteria were compared.

Results: The clinical success rate did not differ significantly between the QNI-high and QNI-low groups (74.4% vs. 83.5%, respectively; P = 0.12). Time to clinical success was longer in the QNI-high group compared with the QNI-low group (median, 68 vs. 46 days, respectively; P = 0.0016). Compared with the QNI-low group, the QNI-high group was associated with higher rates of percutaneous interventions, direct endoscopic necrosectomy, mortality, and adverse events. The QNI-high group was independently associated with time to clinical success (hazard ratio 0.64, 95% confidence interval 0.46-0.87; P =0.005) in multivariable Cox proportional hazards regression analysis, and with the risk of ≥grade III adverse events (odds ratio 2.93, 95% confidence interval 1.04-8.20; P = 0.04) in multivariable logistic regression analysis.

Conclusions: The QNI criteria effectively stratified time to clinical success and the risk of adverse outcomes for patients receiving EUS-PFD of WON. Further investigations could elucidate appropriate management strategies based on QNI-based risk stratification.

Background and aims: Analysis of national colonoscopy quality using automatically uploaded data from a national database, including exploring performance variation.

Methods: Data on all colonoscopies performed in the UK 01/03/2019-29/02/2020 and recorded in the National Endoscopy Database were analysed. Unadjusted key performance indicators were calculated and proportions of endoscopists achieving national standards were determined. Regression models tested associations between case-mix (patient age, sex, indication) and colonoscopy quality. Endoscopist factors (specialty, annual procedure numbers, withdrawal times) were added to case-mix adjusted models, with results presented as adjusted odds ratios (aOR) with 95% confidence intervals.

Results: 592,764 colonoscopies were analysed. Rates of caecal intubation (93.5%, 95% CI 93.4-93.6), polyp detection (37.3%, 95% CI 37.2-37.4), and moderate/severe patient discomfort (4.8%, 95% CI 4.7-4.8) had all improved since the 2011 national audit (p<0.01 for all). 63.9% of endoscopists met all minimum standards for caecal intubation, polyp detection, and discomfort, but only 46.4% did so among those performing fewer than 100 colonoscopies annually. Overall, surgeons recorded lower caecal intubation and polyp detection rates than gastroenterologists (p<0.01); however, those performing over 100 annual colonoscopies achieved KPIs similar to gastroenterologists. Endoscopists with longer withdrawal times were almost twice as likely to identify polyps (aOR 1.9, 95% CI 1.7-2.2) and detected more large polyps (aOR 1.6, 95% CI 1.3-2.0).

Conclusions: UK colonoscopy quality has improved, yet almost 40% of endoscopists still fell short of minimum standards. Variation in quality was strongly associated with endoscopist procedure volumes; mandating minimum annual procedures and emphasising longer withdrawal times could improve overall quality.

Background and aims: Efficacy and safety of EUS-guided placement of lumen-apposing metal stents (LAMS) has been reported yet advantage of using 15-mm LAMS over 10-mm LAMS yet to be explored.

Methods: International, retrospective, case-matched study of patients with intra-abdominal abscess who underwent EUS-guided drainage with 15-mm (case) and 10-mm (control) LAMS between 03/2019 and 09/2022.

Results: 51 patients underwent EUS-guided drainage using LAMS [15-mm 29 (57%), 10-mm 22 (43%)]. The most common location of the abscess was peri-pancreatic 43%. Technical success rate was achieved in 97% of cases and 100 % of controls (p=0.412), while clinical success was achieved in 98% and 96%, respectively, (OR 1.3; p=0.089). AE occurred in 7.8% of the cases. Patients with 15-mm LAMS underwent fewer total endoscopic procedures (mean 2.5 vs.3.6; P < 0.023).

Conclusion: Both sizes showed comparable clinical success and safety profiles, with a significant trend of the need for fewer endoscopic procedures with the 15-mm LAMS.