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Prevalence of work-related musculoskeletal disorders and its determinants among endoscopists in India. 印度内镜医师中与工作相关的肌肉骨骼疾病的发病率及其决定因素。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1007/s12664-024-01625-y
Balaji Musunuri, Ganesh Bhat, Athish Shetty, Shiran Shetty, Ganesh C Pai
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引用次数: 0
Prevention, detection and management of adverse events of third-space endoscopy. 第三空间内窥镜检查不良事件的预防、检测和管理。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-11 DOI: 10.1007/s12664-024-01665-4
Rohan Yewale, Amit Daphale, Ashish Gandhi, Amol Bapaye

Third space endoscopy (TSE) or sub-mucosal endoscopy using a mucosal flap valve (SEMF) enables the endoscopist to operate in the deeper layers of the gastrointestinal tract or gain access to the mediastinal/peritoneal cavity for natural orifice transoral endoscopic surgery (NOTES). TSE procedures are essentially endoscopic surgical procedures with a variable learning curve. Adverse events (AEs) during TSE are specific and follow a certain pattern across the spectrum of TSE procedures. These can be broadly categorized according to either type of AE, time of presentation relative to the procedure or according to degree of severity. Three major categories of AEs encountered during TSE include insufflation related AEs, mucosal injuries (MIs) and bleeding. Other relevant AEs include infectious complications, aspiration pneumonia, post-procedural chest/abdominal pain, atelectasis, cardiac arrhythmias, pleural effusion and pulmonary embolism. Reported incidence of AEs during TSE procedures varies according to the type and complexity of procedure. Acquaintance regarding potential risk factors, technical tips and precautions, alarm signs for early recognition, assessment of degree of severity, morphological characterization of AEs and finally, expeditious selection of appropriate management strategy are crucial and imperative for successful clinical outcomes. The current review discusses the current evidence and practical guidelines for prevention, early detection and management of TSE-related AEs.

第三空间内窥镜(TSE)或使用粘膜瓣阀的粘膜下内窥镜(SEMF)使内窥镜医师能够在胃肠道深层进行手术,或进入纵隔/腹膜腔进行自然孔经口内窥镜手术(NOTES)。TSE 手术本质上是内窥镜外科手术,学习曲线不尽相同。TSE 过程中发生的不良事件(AEs)是特定的,在整个 TSE 过程中都遵循一定的模式。这些不良事件可根据不良事件的类型、相对于手术的出现时间或严重程度进行大致分类。在 TSE 过程中会遇到的三大类 AE 包括充气相关 AE、粘膜损伤 (MI) 和出血。其他相关的 AE 包括感染性并发症、吸入性肺炎、术后胸痛/腹痛、肺不张、心律失常、胸腔积液和肺栓塞。根据手术类型和复杂程度的不同,TSE 手术中 AEs 的报告发生率也不尽相同。了解潜在的风险因素、技术提示和预防措施、早期识别的报警信号、严重程度评估、AEs 形态学特征,最后迅速选择适当的管理策略,这些对于成功的临床结果至关重要,势在必行。本综述讨论了预防、早期发现和处理 TSE 相关 AE 的现有证据和实用指南。
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引用次数: 0
Endoscopic ultrasound-guided vascular interventions: A review (with videos). 内窥镜超声引导下的血管介入治疗:回顾(附视频)。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1007/s12664-024-01681-4
Praveer Rai, Pankaj Kumar, Umair Shamsul Hoda, Kartik Balankhe

Endoscopic ultrasound (EUS) has evolved from a diagnostic to an interventional modality, allowing precise vascular access and therapy. EUS-guided vascular access of the portal vein has received increasing attention in recent years as a diagnostic and therapeutic tool. EUS-guided portal pressure gradient directly measures the hepatic vein portal pressure gradient and is crucial for understanding of liver function and prognostication of liver disease. EUS facilitates the sampling of portal venous blood to obtain circulating tumor cells (CTCs) in pancreatobiliary malignancies. This technique aids in the diagnosis and staging of cancers. EUS-guided interventions have a substantial potential for diagnosing portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma. EUS-guided coil and glue embolization have higher efficacy for the treatment of gastric varices than direct endoscopic glue. Pseudoaneurysm (PsA), a rare vascular complication of acute and chronic pancreatitis, is typically managed with interventional radiology (IR)-guided embolization and surgery. EUS is increasingly used in specialized centers for non-variceal gastrointestinal bleeding, particularly for pseudoaneurysm-related bleeding. There is limited data on EUS-guided intervention for bleeding ectopic varices, rectal varices and Dieulafoy lesions, but it is becoming more widely accepted. In this extensive review, we evaluated both current and potential future applications of EUS-guided vascular interventions, including EUS-guided gastric variceal bleed therapy, rectal and ectopic varices, pseudoaneurysmal bleeding, splenic artery embolization, portal pressure gradient measurement, portal vein sampling for CTCs, fine needle aspiration of PVTT, intrahepatic portosystemic shunt placement, liver tumor ablation and EUS-guided cardiac intervention.

内窥镜超声(EUS)已从一种诊断方式发展成为一种介入方式,可实现精确的血管通路和治疗。近年来,EUS 引导下的门静脉血管通路作为一种诊断和治疗工具受到越来越多的关注。EUS 引导下的门静脉压力梯度可直接测量肝静脉门静脉压力梯度,对于了解肝功能和肝病预后至关重要。在胰胆管恶性肿瘤中,EUS 方便了门静脉血液取样,以获取循环肿瘤细胞(CTC)。这项技术有助于癌症的诊断和分期。EUS 引导下的介入治疗在诊断肝细胞癌患者的门静脉肿瘤血栓(PVTT)方面具有很大的潜力。EUS 引导下的线圈和胶水栓塞治疗胃静脉曲张的疗效高于直接内镜胶水栓塞。假性动脉瘤(PsA)是急性和慢性胰腺炎的一种罕见血管并发症,通常采用介入放射学(IR)引导的栓塞和手术治疗。越来越多的专科中心使用 EUS 治疗非静脉胃肠道出血,尤其是假性动脉瘤相关出血。关于 EUS 引导下介入治疗异位静脉曲张、直肠静脉曲张和 Dieulafoy 病变出血的数据有限,但它正被越来越广泛地接受。在这篇内容广泛的综述中,我们评估了 EUS 引导下血管介入治疗的当前应用和未来可能的应用,包括 EUS 引导下的胃静脉曲张出血治疗、直肠和异位静脉曲张、假性动脉瘤出血、脾动脉栓塞、门静脉压力梯度测量、门静脉四氯化碳取样、PVTT 的细针抽吸、肝内门脉分流置管、肝肿瘤消融和 EUS 引导下的心脏介入治疗。
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引用次数: 0
Prognostic and predictive significance of p53 and ATRX in neuroendocrine neoplasms of GIT and pancreas and their utility as an adjunct to accurate diagnosis-An eight-year retrospective study. p53和ATRX在消化道和胰腺神经内分泌肿瘤中的预后和预测意义及其作为精确诊断辅助手段的实用性--一项为期八年的回顾性研究。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1007/s12664-024-01678-z
Divya Achutha Ail, Roopa Rachel Paulose

Introduction: Neuroendocrine neoplasms of gastrointestinal tract (GIT) and pancreas are heterogenous tumors. World Health Organization (WHO) 2019 classification introduced Grade (G)3 neuroendocrine tumor (NET) distinct from neuroendocrine carcinoma (NEC), based on molecular differences and to triage the patients for appropriate therapy. This distinction largely relies on morphology, which can be challenging at times. Genomic profiling has revealed TP53 and RB1 mutations in NECs, while death domain-associated protein 6 (DAXX) and alpha-thalassemia/mental retardation X-linked (ATRX), in G3NET. Their role as biological markers in differentiating these entities and their significance as prognostic markers are not yet established. This study aims at analyzing the diagnostic and prognostic role of p53 and ATRX in neuroendocrine neoplasms of GIT and pancreas.

Methodology: A single-centre, eight-year retrospective study of neuroendocrine neoplasm of GIT and pancreas comprised G2NET, G3NET and NEC. Tumor slides were stained by immunohistochemistry for p53 and ATRX. Strong nuclear staining of > 50% of tumor cells for p53 was considered mutated. Nuclear staining of ATRX in < 5% of tumor cells was considered ATRX loss. Expression of p53 and ATRX was analyzed and correlated with tumor grades and patient survival.

Results: Fifty-five patients with gastro-entero-pancreatic neuroendocrine neoplasm were studied, comprising G2NET (58%), G3NET (16%) and NEC (26%). Median age of diagnosis was 59 years with male predominance. The pancreas was the most common site followed by the small bowel. NEC showed lower survival compared to G3 and G2NET. Mutated p53 immunohistochemical expression was more frequent among NEC than G3NET. Patients with mutated p53 had significantly lower survival irrespective of the grade (p = 0.001). There was no association of ATRX loss with grade or survival.

Conclusion: G3NETs are genetically different from NECs. Use of immunohistochemistry for p53 in addition to histomorphology may facilitate accurate categorization of NEC and G3NET. Mutated p53 may also be used as an independent prognostic marker in neuroendocrine tumors of GIT and pancreas.

导言:胃肠道(GIT)和胰腺的神经内分泌肿瘤是一种异质性肿瘤。世界卫生组织(WHO)2019 年的分类引入了有别于神经内分泌癌(NEC)的 3 级(G)神经内分泌肿瘤(NET),其依据是分子差异和对患者进行适当的治疗分流。这种区分在很大程度上依赖于形态学,而形态学有时具有挑战性。基因组分析发现,NEC 中存在 TP53 和 RB1 突变,而 G3NET 中存在死亡结构域相关蛋白 6 (DAXX) 和阿尔法地中海贫血/智力低下 X 连锁 (ATRX)。它们作为生物学标志物在区分这些实体中的作用及其作为预后标志物的意义尚未确定。本研究旨在分析p53和ATRX在消化道和胰腺神经内分泌肿瘤中的诊断和预后作用:方法:对G2NET、G3NET和NEC等消化道和胰腺神经内分泌肿瘤进行为期8年的单中心回顾性研究。肿瘤切片采用免疫组化法对 p53 和 ATRX 进行染色。超过50%的肿瘤细胞的p53核染色为突变。结果显示 ATRX 的核染色:研究了55例胃-肠-胰神经内分泌肿瘤患者,包括G2NET(58%)、G3NET(16%)和NEC(26%)。确诊年龄中位数为59岁,男性居多。胰腺是最常见的肿瘤部位,其次是小肠。与G3和G2NET相比,NEC的存活率较低。与G3NET相比,NEC中p53免疫组化突变表达更为常见。无论级别如何,p53突变患者的生存率都明显较低(p = 0.001)。ATRX缺失与分级和生存率没有关系:结论:G3NET在遗传学上不同于NEC。结论:G3NET与NEC在基因上有所不同。除了组织形态学外,使用免疫组化方法检测p53可能有助于对NEC和G3NET进行准确分类。突变的p53也可作为消化道和胰腺神经内分泌肿瘤的独立预后标志物。
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引用次数: 0
Diagnostic performance of blue laser imaging for early detection of gastric cancer: A systematic review and meta-analysis. 蓝色激光成像在早期胃癌检测中的诊断性能:系统综述与荟萃分析。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-28 DOI: 10.1007/s12664-023-01495-w
Mohammed Rifat Shaik, Andrew Canakis, Nishat Anjum Shaik, Shivanand Bomman, Dushyant Singh Dahiya, Emily Gorman, Mohammad Bilal, Saurabh Chandan

Background: Gastric cancer (GC) is associated with a significant global health burden and high mortality rates when diagnosed at later stages. The diagnosis often occurs at advanced stages when treatment options are limited and less effective. Early detection strategies are crucial to improving survival rates and outcomes for patients. Blue laser imaging (BLI) is an image-enhanced endoscopy technique that utilizes white light and narrow-band light to detect pathological changes in the mucosal architecture. This study aims at investigating the diagnostic performance of BLI for the detection of GC.

Methods: A comprehensive search was conducted across multiple databases from inception until March 2023. Studies assessing the diagnostic efficacy of BLI for GC detection were included. The sensitivity, specificity and accuracy of BLI were calculated using pooled proportions and 95% confidence intervals (CI) with a random-effects model. Heterogeneity among the included studies was assessed using the I2 statistic.

Results: Six studies were included in the pooled analysis. There were 708 patients with 380 GC lesions. Most of the lesions involved the lower two-thirds of the stomach. The pooled performance metrics of BLI for GC detection were as follows: sensitivity of 91.9% (95% CI 83.3-96.3%; I2 = 82.3%), specificity of 93.4% (95% CI 82.0-97.8%; I2 = 87.9%) and accuracy of 95.4% (95% CI 72.6-99.8%; I2 = 73.6%).

Conclusion: BLI demonstrates high diagnostic efficacy for the detection of GC. BLI can be a valuable tool in clinical practice. However, large-scale, randomized controlled studies are needed to further establish the role of BLI in routine clinical practice for GC detection.

背景:胃癌(GC)对全球健康造成重大负担,晚期确诊时死亡率很高。确诊时往往已是晚期,此时的治疗方案有限且效果较差。早期检测策略对于提高患者的生存率和治疗效果至关重要。蓝激光成像(BLI)是一种图像增强内窥镜技术,利用白光和窄带光来检测粘膜结构的病理变化。本研究旨在探讨蓝激光成像在检测 GC 方面的诊断性能:方法:从开始到 2023 年 3 月,对多个数据库进行了全面检索。方法:从开始到 2023 年 3 月,在多个数据库中进行了全面搜索,纳入了评估 BLI 检测 GC 诊断效果的研究。采用随机效应模型,使用汇总比例和 95% 置信区间 (CI) 计算 BLI 的灵敏度、特异性和准确性。使用I2统计量评估了纳入研究之间的异质性:共有六项研究纳入了汇总分析。共有708名患者,380处GC病变。大多数病变涉及胃的下三分之二。BLI检测GC的汇总性能指标如下:敏感性91.9%(95% CI 83.3-96.3%;I2 = 82.3%),特异性93.4%(95% CI 82.0-97.8%;I2 = 87.9%),准确性95.4%(95% CI 72.6-99.8%;I2 = 73.6%):结论:BLI对检测GC具有很高的诊断效力。BLI在临床实践中是一种有价值的工具。然而,要进一步确定 BLI 在常规临床实践中检测 GC 的作用,还需要进行大规模的随机对照研究。
{"title":"Diagnostic performance of blue laser imaging for early detection of gastric cancer: A systematic review and meta-analysis.","authors":"Mohammed Rifat Shaik, Andrew Canakis, Nishat Anjum Shaik, Shivanand Bomman, Dushyant Singh Dahiya, Emily Gorman, Mohammad Bilal, Saurabh Chandan","doi":"10.1007/s12664-023-01495-w","DOIUrl":"10.1007/s12664-023-01495-w","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer (GC) is associated with a significant global health burden and high mortality rates when diagnosed at later stages. The diagnosis often occurs at advanced stages when treatment options are limited and less effective. Early detection strategies are crucial to improving survival rates and outcomes for patients. Blue laser imaging (BLI) is an image-enhanced endoscopy technique that utilizes white light and narrow-band light to detect pathological changes in the mucosal architecture. This study aims at investigating the diagnostic performance of BLI for the detection of GC.</p><p><strong>Methods: </strong>A comprehensive search was conducted across multiple databases from inception until March 2023. Studies assessing the diagnostic efficacy of BLI for GC detection were included. The sensitivity, specificity and accuracy of BLI were calculated using pooled proportions and 95% confidence intervals (CI) with a random-effects model. Heterogeneity among the included studies was assessed using the I<sup>2</sup> statistic.</p><p><strong>Results: </strong>Six studies were included in the pooled analysis. There were 708 patients with 380 GC lesions. Most of the lesions involved the lower two-thirds of the stomach. The pooled performance metrics of BLI for GC detection were as follows: sensitivity of 91.9% (95% CI 83.3-96.3%; I<sup>2</sup> = 82.3%), specificity of 93.4% (95% CI 82.0-97.8%; I<sup>2</sup> = 87.9%) and accuracy of 95.4% (95% CI 72.6-99.8%; I<sup>2</sup> = 73.6%).</p><p><strong>Conclusion: </strong>BLI demonstrates high diagnostic efficacy for the detection of GC. BLI can be a valuable tool in clinical practice. However, large-scale, randomized controlled studies are needed to further establish the role of BLI in routine clinical practice for GC detection.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139982882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Advanced endoscopic resection for early gastrointestinal cancers in India: Challenges and opportunities await! 印度早期胃肠道癌症的先进内窥镜切除术:挑战与机遇并存!
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1007/s12664-024-01686-z
Sridhar Sundaram, Akhil Mahajan, Prachi Patil
{"title":"Advanced endoscopic resection for early gastrointestinal cancers in India: Challenges and opportunities await!","authors":"Sridhar Sundaram, Akhil Mahajan, Prachi Patil","doi":"10.1007/s12664-024-01686-z","DOIUrl":"10.1007/s12664-024-01686-z","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy and safety of self-expandable metallic stents for management of benign gastric outlet obstruction-A prospective study. 自膨胀金属支架治疗良性胃出口梗阻的有效性和安全性--一项前瞻性研究。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-21 DOI: 10.1007/s12664-024-01639-6
Alok Kumar Singh, V Krishnapriya, Sanjeev Sachdeva, Amarender S Puri, Ajay Kumar, Ujjwal Sonika, Siddharth Srivastava, Ashok Dalal

Introduction: We aimed at evaluating the safety and efficacy of self-expandable metallic stent (SEMS) insertion for managing patients with benign gastric outlet obstruction (GOO).

Methods: This prospective interventional study included 23 patients. All consecutive treatment-naïve symptomatic patients with benign GOO were recruited. Fully covered SEMS were deployed across the stricture under fluoroscopic and endoscopic guidance. Technical success, clinical success and sustained treatment response (STR) were assessed. Technical success was defined as the successful deployment of SEMS at the desired anatomic location. Clinical success was defined as the resolution of symptoms and an increase in Gastric Outlet Obstruction Scoring System (GOOSS) of at least 1 point from the baseline score on Day 7. STR was assessed at four and eight weeks post stent removal in patients who had a response at week four. Factors associated with stent migration and non-response at week four were also assessed.

Results: The median age of the study population was 30 years (range 19-65 years). Males constituted 65.22%. Most patients presented with vomiting (100%) and abdominal pain (95.65%). Peptic stricture was most common etiology for GOO (60.9%) followed by tubercular (26.1%) and corrosive (13%). Most common site of obstruction was junction of first and second part of duodenum (69.57%) followed by pyloric (30.43%). Median length of stricture was 2 cm (range 1.5-4). Technical success was achieved in all 23 patients (100%). Clinical success was achieved in 21 patients (91.3%). Response at Day 28 was seen in 20 patients (86.95%). Eighteen of 20 (90%) patients who had a response at week four had STR at week four and week eight after stent removal. Stent migration occurred in five (21.7%) patients. On univariate analysis, stricture length, calibre and stent length were found to predict migration.

Conclusions: Fully covered SEMS was an effective and safe management modality in patients with benign GOO. Stent migration remains a troublesome disadvantage.

简介:我们的目的是评估插入自膨胀金属支架(SEMS)治疗良性胃出口梗阻(GOO)患者的安全性和有效性:我们的目的是评估插入自膨胀金属支架(SEMS)治疗良性胃出口梗阻(GOO)患者的安全性和有效性:这项前瞻性介入研究共纳入 23 名患者。方法:这项前瞻性介入研究共纳入 23 名患者,他们都是连续接受治疗但无症状的良性胃出口梗阻患者。在透视和内窥镜引导下,将全覆盖的 SEMS 置入狭窄处。对技术成功率、临床成功率和持续治疗反应(STR)进行了评估。技术成功定义为在理想的解剖位置成功部署 SEMS。临床成功的定义是症状缓解,胃出口梗阻评分系统(GOOSS)比第 7 天的基线评分至少提高 1 分。对于在第四周有反应的患者,在支架移除后的四周和八周对 STR 进行评估。此外,还评估了与支架移位和第四周无反应相关的因素:研究对象的中位年龄为 30 岁(19-65 岁不等)。男性占 65.22%。大多数患者伴有呕吐(100%)和腹痛(95.65%)。消化道狭窄是导致胃食管返流最常见的病因(60.9%),其次是结核性(26.1%)和腐蚀性(13%)。最常见的梗阻部位是十二指肠第一段和第二段交界处(69.57%),其次是幽门(30.43%)。狭窄的中位长度为 2 厘米(1.5-4 厘米不等)。所有 23 名患者(100%)都取得了技术成功。21 名患者(91.3%)取得了临床成功。有 20 名患者(86.95%)在第 28 天出现反应。在第 4 周出现反应的 20 名患者中,有 18 名(90%)在第 4 周和第 8 周移除支架后出现 STR。5名患者(21.7%)发生了支架移位。单变量分析发现,狭窄长度、口径和支架长度可预测移位:结论:对良性 GOO 患者而言,全覆盖 SEMS 是一种有效、安全的治疗方式。结论:全覆盖 SEMS 是一种有效、安全的良性 GOO 患者治疗方法,但支架移位仍是一个令人头疼的缺点。
{"title":"Efficacy and safety of self-expandable metallic stents for management of benign gastric outlet obstruction-A prospective study.","authors":"Alok Kumar Singh, V Krishnapriya, Sanjeev Sachdeva, Amarender S Puri, Ajay Kumar, Ujjwal Sonika, Siddharth Srivastava, Ashok Dalal","doi":"10.1007/s12664-024-01639-6","DOIUrl":"10.1007/s12664-024-01639-6","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed at evaluating the safety and efficacy of self-expandable metallic stent (SEMS) insertion for managing patients with benign gastric outlet obstruction (GOO).</p><p><strong>Methods: </strong>This prospective interventional study included 23 patients. All consecutive treatment-naïve symptomatic patients with benign GOO were recruited. Fully covered SEMS were deployed across the stricture under fluoroscopic and endoscopic guidance. Technical success, clinical success and sustained treatment response (STR) were assessed. Technical success was defined as the successful deployment of SEMS at the desired anatomic location. Clinical success was defined as the resolution of symptoms and an increase in Gastric Outlet Obstruction Scoring System (GOOSS) of at least 1 point from the baseline score on Day 7. STR was assessed at four and eight weeks post stent removal in patients who had a response at week four. Factors associated with stent migration and non-response at week four were also assessed.</p><p><strong>Results: </strong>The median age of the study population was 30 years (range 19-65 years). Males constituted 65.22%. Most patients presented with vomiting (100%) and abdominal pain (95.65%). Peptic stricture was most common etiology for GOO (60.9%) followed by tubercular (26.1%) and corrosive (13%). Most common site of obstruction was junction of first and second part of duodenum (69.57%) followed by pyloric (30.43%). Median length of stricture was 2 cm (range 1.5-4). Technical success was achieved in all 23 patients (100%). Clinical success was achieved in 21 patients (91.3%). Response at Day 28 was seen in 20 patients (86.95%). Eighteen of 20 (90%) patients who had a response at week four had STR at week four and week eight after stent removal. Stent migration occurred in five (21.7%) patients. On univariate analysis, stricture length, calibre and stent length were found to predict migration.</p><p><strong>Conclusions: </strong>Fully covered SEMS was an effective and safe management modality in patients with benign GOO. Stent migration remains a troublesome disadvantage.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Lumen-apposing metal stents: A primer on indications and technical tips. 腔隙封闭金属支架:适应症和技术提示入门。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-05-08 DOI: 10.1007/s12664-024-01562-w
Sridhar Sundaram, Suprabhat Giri, Kenneth Binmoeller

Lumen-apposing metal stents have ushered a new frontier for interventional endoscopic ultrasound. Initial use for the drainage of pancreatic fluid collections has rapidly expanded to the bile duct, gallbladder and small bowel. Intra-luminal applications for short strictures have also emerged. Electrocautery enhancement has made the stent delivery speedy. While the advent of lumen-apposing metal stents (LAMS) has brought a paradigm shift in the practice of interventional endoscopic ultrasound, their use is associated with certain technicalities that any advanced endosonologist should know. Understanding indications for LAMS is critical and their use in appropriate settings. Troubleshooting in tricky situations is always a challenge and the background considerations for their use include knowing the target organ, cautery and puncture technique, managing partially opened LAMS and also managing maldeployment. In this review, we discuss the intricacies and technical tips for the use of lumen-apposing metal stents.

腔镜金属支架为介入性内窥镜超声开辟了一个新领域。最初用于引流胰腺积液的支架已迅速扩展到胆管、胆囊和小肠。此外,还出现了用于治疗短小狭窄的腔内应用。电烧增强技术使支架的输送更加快捷。腔隙贴合金属支架(LAMS)的出现为介入性内窥镜超声实践带来了范式转变,但其使用也涉及到一些技术问题,任何高级内镜医师都应了解这些问题。了解 LAMS 的适应症及其在适当情况下的使用至关重要。在棘手的情况下排除故障始终是一项挑战,其使用的背景考虑因素包括了解目标器官、烧灼和穿刺技术、处理部分打开的 LAMS 以及处理部署不当。在这篇综述中,我们将讨论使用腔隙贴合金属支架的复杂性和技术诀窍。
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引用次数: 0
Clinical audit of endoscopic sub-mucosal dissection performed for complex lateral spreading colorectal tumors from a region non-endemic for colorectal cancer. 对非结直肠癌流行地区复杂的侧向扩散结直肠肿瘤进行内镜黏膜下剥离术的临床审计。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-05 DOI: 10.1007/s12664-024-01631-0
Jaseem Ansari, Harsh Bapaye, Jimil Shah, Hameed Raina, Ashish Gandhi, Jay Bapaye, Ajay B R, Arun Arora Pagadapelli, Amol Bapaye

Background: Endoscopic resection is currently the treatment of choice for laterally spreading tumors (LSTs). Endoscopic sub-mucosal dissection (ESD) can achieve higher enbloc resection and R0 resection, albeit at a slightly higher risk of complications. Given scarce data on ESD from India, we performed a retrospective analysis of our experience with colorectal ESD (CR-ESD) to know its clinical efficacy and complications as well as to assess the learning curve of CR-ESD in non-endemic-areas.

Methods: Retrospective analysis of prospectively maintained datasheet performed. All patients with large (>2cm), complex or recurrent colorectal LST who underwent ESD at our center between 2012 and 2021 were included in the study. Various baseline lesion-related parameters, procedure-related parameters, enbloc resection (ER) rates, R0 margins and adverse event rates were retrieved. CUSUM analysis was performed to calculate the minimum required procedures to achieve competency in CR-ESD.

Results: Total 149 patients were included in the study; mean patient age was 61.36±18.21 years. Most patients had lesions in rectum (n=102; 68.5%) followed by sigmoid colon (n=25; 16.8%). The mean lesion size was 46.62 ± 25.46 mm and the mean procedure duration for ESD was 219.30 ± 150.05 min. ER was achieved in 94.6% of lesions. R0 resection was achieved in 132 patients (88.6%). Overall, six (4%) adverse events were noted, of which one required surgical intervention. As many as 105 patients (70.5%) had adenomatous lesions on histology. Seventy-four patients underwent follow-up colonoscopy, of which three had a recurrence of adenomatous lesions and five had post-resection stricture requiring endoscopic dilation. CUSUM curve analysis calculated the learning curve for ESD was 47 resections for ER and 55 for the occurrence of AEs, with a composite CUSUM at 47 procedures.

Conclusion: CR-ESD even in non-endemic area is associated with high en bloc resection rates, R0 resection rates and acceptable complication profile. Approximately 50 cases of CR-ESD are required to achieve competency.

背景:内镜下切除术是目前治疗侧向扩散肿瘤(LST)的首选方法。内镜下粘膜下剥离术(ESD)可实现更高的全切和 R0 切除,但并发症风险略高。鉴于印度有关ESD的数据很少,我们对结肠直肠ESD(CR-ESD)的经验进行了回顾性分析,以了解其临床疗效和并发症,并评估非流行地区CR-ESD的学习曲线:方法:对前瞻性保存的数据表进行回顾性分析。研究纳入了2012年至2021年间在本中心接受ESD治疗的所有大(>2厘米)、复杂或复发性结直肠LST患者。研究人员检索了各种基线病变相关参数、手术相关参数、整块切除(ER)率、R0切缘率和不良事件发生率。进行CUSUM分析以计算达到CR-ESD能力所需的最低手术要求:研究共纳入 149 名患者,患者平均年龄为(61.36±18.21)岁。大多数患者的病灶位于直肠(102 人;68.5%),其次是乙状结肠(25 人;16.8%)。病灶的平均大小为(46.62±25.46)毫米,ESD的平均手术时间为(219.30±150.05)分钟。94.6%的病变实现了ER。132名患者(88.6%)实现了R0切除。总体而言,共出现了六例(4%)不良事件,其中一例需要手术干预。多达 105 名患者(70.5%)的组织学检查结果为腺瘤性病变。74名患者接受了后续结肠镜检查,其中3人腺瘤病变复发,5人切除后出现狭窄,需要进行内镜扩张。CUSUM曲线分析计算出ESD的学习曲线为ER切除47次,AE发生55次,综合CUSUM为47次:结论:即使在非疫区,CR-ESD 也具有较高的全切率、R0 切除率和可接受的并发症情况。大约需要 50 例 CR-ESD 才能达到合格标准。
{"title":"Clinical audit of endoscopic sub-mucosal dissection performed for complex lateral spreading colorectal tumors from a region non-endemic for colorectal cancer.","authors":"Jaseem Ansari, Harsh Bapaye, Jimil Shah, Hameed Raina, Ashish Gandhi, Jay Bapaye, Ajay B R, Arun Arora Pagadapelli, Amol Bapaye","doi":"10.1007/s12664-024-01631-0","DOIUrl":"10.1007/s12664-024-01631-0","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic resection is currently the treatment of choice for laterally spreading tumors (LSTs). Endoscopic sub-mucosal dissection (ESD) can achieve higher enbloc resection and R0 resection, albeit at a slightly higher risk of complications. Given scarce data on ESD from India, we performed a retrospective analysis of our experience with colorectal ESD (CR-ESD) to know its clinical efficacy and complications as well as to assess the learning curve of CR-ESD in non-endemic-areas.</p><p><strong>Methods: </strong>Retrospective analysis of prospectively maintained datasheet performed. All patients with large (>2cm), complex or recurrent colorectal LST who underwent ESD at our center between 2012 and 2021 were included in the study. Various baseline lesion-related parameters, procedure-related parameters, enbloc resection (ER) rates, R0 margins and adverse event rates were retrieved. CUSUM analysis was performed to calculate the minimum required procedures to achieve competency in CR-ESD.</p><p><strong>Results: </strong>Total 149 patients were included in the study; mean patient age was 61.36±18.21 years. Most patients had lesions in rectum (n=102; 68.5%) followed by sigmoid colon (n=25; 16.8%). The mean lesion size was 46.62 ± 25.46 mm and the mean procedure duration for ESD was 219.30 ± 150.05 min. ER was achieved in 94.6% of lesions. R0 resection was achieved in 132 patients (88.6%). Overall, six (4%) adverse events were noted, of which one required surgical intervention. As many as 105 patients (70.5%) had adenomatous lesions on histology. Seventy-four patients underwent follow-up colonoscopy, of which three had a recurrence of adenomatous lesions and five had post-resection stricture requiring endoscopic dilation. CUSUM curve analysis calculated the learning curve for ESD was 47 resections for ER and 55 for the occurrence of AEs, with a composite CUSUM at 47 procedures.</p><p><strong>Conclusion: </strong>CR-ESD even in non-endemic area is associated with high en bloc resection rates, R0 resection rates and acceptable complication profile. Approximately 50 cases of CR-ESD are required to achieve competency.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Capsule endoscopy for small bowel bleed: Current update. 胶囊内镜治疗小肠出血:最新进展。
IF 2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-02 DOI: 10.1007/s12664-024-01637-8
Uday C Ghoshal, Akash Roy, Mahesh K Goenka

Small intestine, hitherto an obscure area for endoscopists before 2000, is now easily evaluated non-invasively using capsule endoscopy and invasively by device-assisted enteroscopies. Major advances in understanding the causes and management of small bowel diseases have been in obscure gastrointestinal (GI) bleed, currently re-named as small bowel bleed, after the discovery of capsule endoscopy. The current article is a narrative review of the technology of capsule endoscopy, its advantages and limitations, future perspective and Indian studies on its utility in patients with small bowel bleed. Till date, eight large series reporting 2319 patients with obscure GI bleed (1554 overt and 765 occult) undergoing capsule endoscopy have been reported from India. Overall yield of capsule endoscopy to detect lesions in these studies varied from 43.5% to 90%. The major causes detected in various studies for small bowel bleed include vascular malformation, portal hypertensive enteropathy, ulcer, stricture, tumor, polyps, etc. Hookworm can cause both occult as well as overt small bowel bleed as shown mainly from India. Capsule endoscopy has also been quite safe in patients with small bowel bleed as despite 0.6% to 15% retention of imaging capsule in Indian studies, development of clinically evident small bowel obstruction has rarely been reported. The major limitations of capsule endoscopy include lack of maneuvrability and therapeutic capability. Research is in progress to overcome some of the limitations of the current capsule endoscopy system. It is concluded that discovery of capsule endoscopy has brought a new paradigm in GI endoscopy and explored a hitherto unexplored area of GI tract, i.e. small bowel that continued to be a black box for the endoscopists.

2000 年以前,小肠对于内镜医师来说还是一个模糊的领域,而现在,胶囊内镜可以轻松地对其进行无创评估,设备辅助肠镜可以对其进行有创评估。在胶囊内镜发现之后,对小肠疾病的病因和治疗方面的重大进展主要体现在不明显的胃肠道(GI)出血上,目前已被重新命名为小肠出血。本文对胶囊内镜技术、其优势和局限性、未来展望以及印度关于胶囊内镜在小肠出血患者中应用的研究进行了叙述性回顾。迄今为止,印度已有八项大型系列研究报告了2319例接受胶囊内镜检查的不明显消化道出血患者(1554例显性和765例隐性)。在这些研究中,胶囊内镜检测病变的总有效率从43.5%到90%不等。各种研究中发现的小肠出血的主要原因包括血管畸形、门脉高压性肠病、溃疡、狭窄、肿瘤、息肉等。钩虫既可引起隐性小肠出血,也可引起显性小肠出血,这主要是在印度发现的。在印度的研究中,尽管有 0.6% 到 15% 的造影胶囊滞留,但很少有临床上明显的小肠梗阻发生的报道。胶囊内镜检查的主要局限性包括缺乏可操作性和治疗能力。目前正在进行研究,以克服现有胶囊内窥镜系统的一些局限性。总之,胶囊内窥镜的发现为消化道内窥镜检查带来了新的范例,探索了消化道迄今为止尚未开发的领域,即小肠,而小肠对内窥镜医生来说仍然是一个黑盒子。
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Indian Journal of Gastroenterology
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