Journal of Gastroenterology and Hepatology最新文献

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.

Eosinophilic gastrointestinal disorders (EGIDs) comprise eosinophilic oesophagitis (EoE) and non-EoE EGIDs; these diseases may be increasing in prevalence and are likely underdiagnosed. Mortality is not increased in EoE but is in gastric and small intestinal EGIDs. A subtle increase in eosinophils has also been observed in other GI diseases including functional dyspepsia in the duodenum. Targeted drug therapy can markedly reduce eosinophil infiltration, although symptom response is more variable, suggesting that non–eosinophil pathways play a role in pathogenesis. Current standard therapies for EoE supported by randomized trials include proton pump inhibitors, corticosteroids (topical), diet restriction, and dupilumab, inhibiting IL-4/IL-13 signaling. In non-EoE EGIDs where little randomized trial data exist, management is based on a combination of dietary elimination and corticosteroids or immunomodulators; mast cell stabilizers and antihistamine therapy may have a role. The role of combination therapies is unclear. Pharmacologic approaches in testing include new steroid preparations and delivery systems; dupilumab in eosinophilic gastritis; and anti-IL-13, anti-IL-5, anti-IL-2, and anti-IL-15 receptor targeting monoclonal antibodies.

Subepithelial lesions (SELs) of the upper gastrointestinal tract are commonly detected during endoscopic examinations and encompass a broad spectrum of benign, potentially malignant, and malignant tumors. While most SELs are asymptomatic and incidentally found, accurate diagnosis remains challenging due to their subepithelial location, necessitating advanced imaging and tissue acquisition techniques. Endoscopic ultrasound (EUS) plays a crucial role in differentiating SELs, but its diagnostic accuracy remains limited. In response to the need for standardized clinical management, the Korean College of Helicobacter and Upper Gastrointestinal Research has developed evidence-based practice guidelines for the diagnosis and endoscopic treatment of SELs. These guidelines were established through a systematic review of existing literature and expert consensus, resulting in 11 key recommendations addressing diagnostic strategies, surveillance intervals, biopsy techniques, and indications for endoscopic or surgical resection.