Gastrointestinal endoscopy最新文献

Background and aims: Pre-therapeutic evaluation of ampullary carcinomas (AC) is important to choose the optimal therapeutic strategy. Our aim was to assess the ability of endoscopic ultrasound (EUS) and computed tomography (CT) to predict pTNM stage of resected AC.

Methods: We analyzed data collected in the Fédération Française de Cancérologie Digestive AC cohort, a French multicentric prospective cohort of patients with resected AC. Our main outcome was assessing diagnostic performances of EUS to predict pT and pN, and CT to predict pN.

Results: Among the 389 patients included in the cohort, data for usT, usN and ctN, along with pathology results, were available for 143, 160 and 185 patients, respectively. To predict pT1, values for sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were 68%, 87%, 53%, and 93% respectively for EUS, with an accuracy of 84%. To predict pT2, values were 58%, 75%, 56% and 75% respectively, with an accuracy of 68%. To predict pT3-T4, values were 62%, 79%, 71%, and 71% respectively, with an accuracy of 71%. To predict pN0, values for Se, Sp, PPV, NPV and accuracy were 88%, 38%, 60%, 75% and 64% respectively for EUS. To predict pN0, values for Se, Sp, PPV, NPV and accuracy were 94%, 39%, 63%, 85% and 68% respectively for CT.

Conclusions: Although the overall performance of both modalities was low, we found that both EUS and CT had good NPV for the prediction of pN0 and EUS had a good NPV for predicting pT1.

Background and aims: Colorectal endoscopic submucosal dissection (ESD) is an effective curative technique for superficial colorectal lesions but remains technically demanding, with variable procedure times. This study aimed to develop and validate a pre-procedure predictive model for colorectal ESD duration in the era of traction-assisted strategies.

Methods: We retrospectively analyzed prospectively collected data from patients who underwent colorectal ESD at Edouard Herriot Hospital (Lyon, France). The derivation cohort included 423 cases (January-December 2024) and an independent temporal validation cohort 148 cases (January-May 2025). A generalized linear model with a gamma distribution and log-link function identified independent pre-procedural predictors of ESD duration. Variables were selected based on univariate significance and the Akaike Information Criterion. Model calibration and discrimination were assessed using R², mean absolute error, and classification accuracy at predefined thresholds (60, 90, 120 minutes). A point-based score (Lyon ESD Dissection Score, LEDs) and nomogram were derived from model coefficients.

Results: Median procedure time in the derivation cohort was 50 minutes (IQR 30-90). Independent predictors of ESD duration included dissection speed of endoscopists, lesion location (flexures, appendix, cecum, ileocecal valve), predicted lesion size, and suspected fibrosis (all p < 0.05). The LEDs provides a direct estimation of the expected procedure time in minutes based on these variables, showing a strong correlation between predicted and observed durations (R² = 0.52). Classification accuracy was 76.1%, 82.2%, and 88.1% for thresholds of 60, 90, and 120 minutes, respectively. Validation confirmed good performance (R² = 0.48) with 91.8% accuracy for procedures ≥120 minutes.

Conclusion: This validated pre-procedure scoring system accurately predicts colorectal ESD duration, especially for longer procedures. It may facilitate scheduling, optimize resource use, and improve workflow in endoscopy units.