Digestive Endoscopy最新文献

We extend our sincere congratulations to Dr. Nishikawa and his team for their pioneering work on the Endoscopic Pressure Study Integrated System (EPSIS) for the diagnosis of achalasia and gastroesophageal reflux disease.¹ This innovative approach holds great promise for advancing our understanding and diagnostic capabilities in esophageal motility disorders.

Although the authors focused on the esophagogastric junction, we believe EPSIS has broader applications. It could be highly beneficial for studying functional dyspepsia and gastroparesis. The EPSIS device measures gastric pressure, making it a promising tool for assessing gastric body compliance during routine endoscopy.

Gastric compliance disorders are a significant pathophysiological aspect of functional dyspepsia. Studies have shown reduced gastric compliance in functional dyspepsia, with barostats indicating a rapid increase in gastric pressure with lower balloon volumes. However, measuring this with a gastric barostat is challenging due to the device's limited availability and poor patient tolerance.²

Interestingly, there is a continuum between functional dyspepsia and gastroparesis, with overlapping profiles in 40% of cases.³ Although gastric peroral endoscopic myotomy (G-POEM) effectively treats gastroparesis, about 45% of patients face long-term failure, with unclear underlying causes.

Our recent research indicates that gastric distensibility is significantly reduced in nonresponders to G-POEM, as evidenced by gastric volumetry.⁴ Additionally, gastric emptying scintigraphy meal repartition analysis shows poor utilization of the gastric body and fundus as meal storage areas in nonresponders to G-POEM, which may be related to poor relaxation of the gastric body and fundus.⁵

We believe EPSIS, as described in this study,¹ could be useful in confirming these indicators in the pretherapeutic assessment of gastroparetic patients. This could help to determine if impaired gastric accommodation predicts G-POEM failure. We look forward to further developments in this field and how EPSIS can be integrated into broader clinical practice.

Authors declare no conflict of interest for this article.

With technological advances in endoscopic ultrasonography, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) was introduced as a treatment option for acute cholecystitis. Recently, new studies have emerged, suggesting that EUS-GBD has a lower adverse event rate and reintervention rate, when compared to percutaneous drainage and endoscopic transpapillary gallbladder drainage. There is growing interest in the different technical aspects of EUS-GBD, such as the puncture approach, choice of stents, and long-term management. There are also cohorts on performing EUS-GBD in potential surgical candidates. This review article gathers the latest evidence on EUS-GBD, including its indications, procedural techniques, choice of equipment, outcomes, postprocedural care, and the controversial extended indications.

WEO Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES

Surinder Singh Rana MD, D.M, FAMS, AGAF, FASGE, Master ISG, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India

Dr. Surinder Rana is a Professor of Gastroenterology at the Post Graduate Institute of Medical Education and Research, which is a premier Medical Education Institute in India. Dr. Rana has over 500 publications in peer-reviewed journals. He is a well-known researcher, endoscopist and educator who is involved in several international and national educational conferences and endoscopy workshops.

Delayed perforation (DP) is reported to occur in 0.1–0.4% of colorectal endoscopic submucosal dissection (ESD).^{1, 2} DP can be fatal due to peritonitis and most cases of colorectal DP result in surgery. Various endoscopic closures after ESD are reported for preventing DP.^{3, 4} However, few reports showed the success of endoscopic closure for DP.⁵ In this report, we present a case of DP closed with SureClip Traction Band (SCTB; Micro-Tech Co., Nanjing, China). The patient was a 61-year-old woman. She took prednisolone 10 mg/day for Wegener's granulomatosis. A polypoid lesion of 25 mm was detected in the transverse colon (Fig. 1a). En bloc resection was performed with ESD. The ESD defect was closed using MANTIS Closure Device (Boston Scientific, Marlborough, MA, USA) and SureClip (Micro-Tech Co.), considering the negative impact of prednisolone for would healing (Fig. 1b,c). However, tight complete closure was not achieved due to difficult operability. On the day after ESD, the patient presented abdominal pain and computed tomography (CT) showed free air (Fig. 1d). Because of the localized peritonitis, we decided to close it endoscopically. Although no perforation was found, we performed additional closure with SureClip (Fig. 1e,f). However, 3 days after ESD, free air increased with CT (Fig. 2a). Endoscopic closure was performed again and contrast medium leakage was observed (Fig. 2b). The ulcer base was hard and previous clips remained, making closure difficult. Normal mucosa at the edge of the ulcer on the anal side was captured with SCTB. Then the band was gripped with SureClip and deployed at the oral side of the ulcer for closing the ESD defect. Finally, complete closure could be performed with additional SCTB and SureClip (Fig. 2c–f, Video S1). The patient was discharged 11 days after ESD.

Author N.Y. had a grant from Fujifilm and received a lecture fee from Fujifilm. The other authors have no conflicts of interest for this article.