Gastrointestinal endoscopy最新文献

Background and aims: The detection of gastric intestinal metaplasia (GIM), gastric intraepithelial neoplasia (GIN), and early gastric cancer (EGC) using white light endoscopy (WLE) is unsatisfactory. This study assessed the value of optical enhancement combined with magnification endoscopy (ME-OE) versus WLE for detecting GIM, GIN and EGC.

Methods: Patients at high risk for gastric cancer were randomly assigned to ME-OE group or WLE group at 1: 1. Suspicious GIM, GIN and EGC lesions were targeted biopsied in both groups. The diagnostic yield, diagnostic efficacy and agreement of suspicious lesions were compared between the two groups.

Results: A total of 285 patients were finally analyzed. The per-patient diagnostic yields of GIM/GIN/EGC were 36.6% and 23.8% in ME-OE and WLE groups, respectively (P = 0.018). The per-lesion diagnostic yield of GIM/GIN/EGC in ME-OE group was higher than that in WLE group (66.7% vs 48.7%, P = 0.017). Sensitivity (82.8% vs 54.3%, P = 0.003), specificity (84.2% vs 81.4%, P = 0.738), positive predictive value (88.9% vs 70.4%, P = 0.038), negative predictive value (76.2% vs 68.6%, P = 0.419), and accuracy (83.3% vs 69.2%, P = 0.028) for GIM were compared between the two groups. The intra-observer agreements of experienced endoscopists were excellent for ME-OE (κ = 0.81, κ = 0.83) and good for WLE (κ = 0.63, κ = 0.62). The inter-observer agreements of experienced endoscopists were good for both groups, with κ-values of 0.75 and 0.61, respectively.

Conclusion: ME-OE showed better performance for detecting GIM than WLE in high-risk populations.

Background and aims: Endoscopic ultrasound-guided pelvic abscess drainage (EUS-PAD) with lumen-apposing metal stents (LAMS) is an alternative approach for post-surgical and inflammatory pelvic collections. We assess the safety and efficacy of EUS-PAD with LAMS in a large population of complicated acute diverticulitis (AD).

Methods: We retrieved consecutive patients who underwent EUS drainage attempts for complicated AD from 2019-2023 in three referral centers. All cases have been considered suitable for EUS-PAD after multidisciplinary discussion. Continuous variables are expressed as median [interquartile range].

Results: Sixty-six patients were retrieved; in 13 cases EUS-PAD was not indicated since no or small abscess was found. Fifty-three patients (29 female; age 74 [62-83] year-old] were finally included. Forty (75.5%) patients had pelvic abscess, while 13 (24.5%) had a para-colonic abscess, with a median size of 50 [40-60] mm. Trans-rectal and trans-colonic EUS-PAD were performed in 34 (64.2%) and 19 (35.8%) cases, respectively. Technical and clinical success rates were 92.5% and 88.7%; incidence of adverse events was 3.8% (one bleeding, one late migration). LAMS were removed after 19 [14-28] days. Median follow-up was 12 [8-12] months. Four (7.5%) patients underwent urgent Hartmann sigmoidectomy, while 12 (22.6%) patients required elective surgery; two (3.8%) patients presented recurrent diverticular abscesses. No procedure-related or disease-specific mortality was observed.

Conclusion: EUS-PAD could be considered a safe and effective rescue strategy in case of failed or contraindicated percutaneous approach for the management of complicated AD to reduce the need for urgent surgery. Comparative data is necessary to confirm these observations.

Background and aims: Endoscopists frequently experience musculoskeletal injuries, particularly in the distal upper extremities, due to substantial forces, awkward postures, and repetitive movements during procedures. A significant but underexplored risk factor is the repetitive exchange of endoscopic instruments. This study aimed to develop and evaluate an automatic endoscopic instrument insertion and transfer device, "INSERTrument," to reduce ergonomic strain and assess its impact on wrist movements and postures.

Methods: The INSERTrument was evaluated during in vivo gastric endoscopic submucosal dissection (ESD) procedures on porcine models, conducted by two experienced endoscopists. Outcomes included the number of wrist snaps, total instrument exchange time, and the percentage of time spent in high-risk wrist postures. Inertial measurement units (IMUs) were used to objectively analyze wrist joint angles. The device's performance was compared to conventional manual methods across various endoscopic instruments.

Results: The INSERTrument significantly reduced the number of wrist snaps per instrument exchange (7.3 ± 1.0 vs. 69.3 ± 8.3; p < 0.05) and per ESD procedure (68.6 ± 9.4 vs. 656.0 ± 71.8; p < 0.05), achieving an average reduction of approximately 90% compared to the conventional manual method. The total instrument exchange time per ESD was also significantly reduced in the INSERTrument group compared to the conventional group (127.6 ± 19.4 sec vs. 151.6 ± 10.9 sec; p < 0.05). IMU data revealed that the INSERTrument significantly decreased the percentage of time spent in high-risk wrist postures (10.4 ± 2.4% vs. 44.4 ± 5.1%; p<0.05).

Conclusions: The use of INSERTrument minimized repetitive wrist movements and high-risk postures associated with endoscopic instrument exchanges. These findings suggest that INSERTrument could improve the ergonomics of endoscopic procedures, potentially reducing the incidence of musculoskeletal injuries among endoscopists. Further studies are warranted to explore the long-term benefits and clinical implications of this device in routine endoscopic practice.

Background and aims: To compare the advantages of long slim metal stents (LSMS) versus conventional metal stents in bilateral endoscopic side-by-side (SBS) deployment for malignant hilar biliary obstruction (MHBO).

Methods: 140 consecutive MHBO patients treated by endoscopic bilateral SBS deployment at a high-volume tertiary referral center were analyzed retrospectively, including 50 patients in LSMS group and the other 90 patients in conventional SBS group as control. Propensity score matching (PSM) at a 1:2 ratio was used to reduce selection bias. Primary outcomes were stent patency.

Results: After PSM, no significant difference was obseved in stent patency (267 vs. 268 days, P=0.969) or overall survival (OS) (225 vs. 211 days, P=0.883) between the two groups. The technical success rate was 100% in both groups, and the clinical success rate was 91.1% in LSMS group and 92.9% in control group (P=0.735). Early and late adverse events were similar (24.4% vs. 34.3%, P=0.423; 42.2% vs. 38.6%, P=0.697), while the procedure time and bilateral metal stenting time in LSMS group were significantly shorter (41.0 min vs. 57.5 min, P=0.000; 19.0 min vs. 28.5 min, P=0.000). The success rate of endoscopic bilateral revisionary stent insertion in LSMS group was also higher (100% vs. 33.3%, P=0.000).

Conclusions: Bilateral LSMS placement is a viable option for MHBO patients with advantages of less operative difficulty and easier future re-intervention over conventional SBS stenting.