Journal of Gastroenterology and Hepatology最新文献

Background: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has become a popular alternative for patients in whom performing endoscopic retrograde cholangiopancreatography (ERCP) is difficult; however, EUS-BD for malignant hilar biliary obstruction (MHBO) remains controversial, particularly for bilateral drainage. This study aimed to examine the efficacy of EUS-guided bilateral stent-in-stent deployment (EUS-SIS) in patients with unresectable MHBO.

Methods: This retrospective study investigated consecutive patients with MHBO in whom ERCP was difficult or failed and EUS-SIS was attempted. A total of 20 patients met the inclusion criteria. Study outcomes included technical and clinical success, recurrent biliary obstruction (RBO), and other adverse events associated with EUS-SIS.

Results: The technical success rate of EUS-SIS was 75% (15/20). The main reason for the technical failure was the inability to advance the guidewire into the contralateral intrahepatic bile duct. Clinical success was achieved in all technically successful cases. The early and late adverse event rates were 5% (1/20) and 7% (1/15), respectively. The incidence rate of RBO was 33% (5/15), and reintervention for RBO via the EUS-BD route was successful in all cases. The median time to RBO was 161 days, and the median overall survival was 191 days.

Conclusions: EUS-SIS was promising for performing bilateral drainage when ERCP failed in patients with MHBO. However, to establish this technique as a widely accepted treatment, its technical success rate needs to be improved.

Background: Early esophageal cancer is prone to lymphovascular invasion (LVI) and ductal involvement (DI), which seriously affects the prognosis of patients. Therefore, identifying the potential risk factors for LVI/DI is crucial. This study aims to clarify endoscopic appearances which are predictive for LVI/DI in patients with node-negative superficial esophageal squamous cell carcinoma (SESCC).

Methods: A total of 401 lesions were included for model development. Endoscopic image features were selected through multivariate logistic regression and LASSO (least absolute shrinkage and selection operator) regression analysis, and the optimal model was determined by calculating cNRI (continuous net reclassification improvement) and IDI (integrated discrimination improvement). Additionally, internal and external validation were performed using data from 173 and 133 lesions, respectively.

Results: Five endoscopic image features, including lesion length, macroscopic type, surface granularity, surface nodularity, and surface erosion, were identified as predictive factors and were incorporated into the nomogram. The nomogram demonstrated substantial predictive efficacy, as evidenced by the AUC (area under curve) values of 0.854 (95% CI: 0.809-0.899) for the training set, 0.821 (95% CI: 0.749-0.894) for the internal validation set, and 0.860 (95% CI: 0.765-0.955) for the external validation set. Calibration curves showed good agreement between the nomogram predictions and actual observations. DCA (decision curve analysis) and CICs (clinical impact curves) confirmed the nomogram's clinical applicability.

Conclusions: We constructed a nomogram based on preoperative endoscopic image features for predicting the risks of LVI/DI in patients with node-negative SESCC, which may aid in clinical decision-making.

Objectives: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is effective and safe for poor surgical candidates; however, it remains technically challenging with potential serious adverse events. This study evaluated the learning curve for EUS-GBD for safe and effective procedures.

Methods: From January 2016 to January 2024, 146 patients underwent EUS-GBD performed by three endosonographers. We analyzed the baseline characteristics, procedural outcomes, and learning curves using cumulative sum (CUSUM) analysis.

Results: No significant differences were found among the three operators regarding technical success (96.4% vs. 94% vs. 95.1%; p = 0.85), clinical success (96.4% vs. 92% vs. 95.1%; p = 0.61), mean procedure time (8.0 ± 5.7 vs. 9.9 ± 7.9 vs. 9.9 ± 5.1 min; p = 0.24), or procedural adverse events (12.7% vs. 20% vs. 9.8%; p = 0.35). CUSUM analysis revealed that proficiency in procedure time was achieved after performing 27 procedures. Comparing procedure time before and after achieving technical proficiency, technical success (90.6% vs. 98.8%, p = 0.04), clinical success (89.1% vs. 98.8%, p = 0.02), and procedure time (14.45 ± 6.13 min vs. 5.09 ± 2.23 min, p < 0.01) were improved. Adverse event proficiency was reached in 23 procedures, with notable improvements post-proficiency; technical success (87.5% vs. 99%, p = 0.02), clinical success (85.4% vs. 99%, p = 0.01), and procedure time were also improved (15.04 ± 6.43 min vs. 6.33 ± 3.99 min, p < 0.01).

Conclusions: Based on CUSUM analysis, approximately 23 procedures may be required to achieve technical proficiency in EUS-GBD with regard to minimizing adverse events, while 27 procedures are necessary to reach proficiency in terms of procedure time.