Digestive Endoscopy最新文献

Endoscopic full-thickness resection (EFTR) has emerged as a preferred therapeutic modality for the treatment of submucosal tumors, including gastrointestinal stromal tumors [1]. Despite its growing use, post-EFTR closure remains technically challenging due to difficulties in approximating and securing the mucosal edges [2, 3]. These challenges often hinder effective closure and increase the risk of complications.

To overcome these limitations, we have developed a novel closure technique employing a dual-channel endoscope, designed to facilitate precise and efficient wound approximation. The two working channels of the endoscope (GIF-2TQ26OM) are designated as Channel A and Channel B, with titanium clips deployed through each referred to as A-clips and B-clips, respectively.

During the closure procedure, only a single A-clip is used throughout. This clip is employed to grasp and retract the mucosa (or mucosa with the muscularis propria) from one side of the defect, aligning it linearly with the opposing edge (Figure 1B). Once proper alignment is achieved, one or more B-clips are applied to approximate the bilateral mucosal edges and secure the closure (Figure 1C,E). The A-clip is then released and repositioned to repeat the process on the next section of the defect (Figure 1D). After completing the placement of B-clips, the A-clip performs the final approximation to complete the closure. Figure 2 is an illustration.

This technique has been successfully applied in clinical practice, as demonstrated in the accompanying video (Video S1), confirming its feasibility and effectiveness in real-world EFTR cases.

The dual-channel endoscopic technique offers multiple advantages: improved mucosal alignment, reduced clip span, shorter procedural time, and enhanced surgical precision. Collectively, these benefits contribute to increased procedural efficiency and potentially lower complication rates.

Geng Qin designed and performed the research, collected and analyzed the data. Geng Qin and Shiyu Du offered funding support. Guanyu Chen drafted and revised the manuscript.

The authors declare no conflicts of interest.

Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, presents substantial diagnostic and management challenges because of its variable clinical course and the limitations of conventional endoscopy. Although endoscopic procedures are crucial for diagnosis and surveillance, their inherent subjectivity and inter-observer variability complicate disease assessment. Recent advances in artificial intelligence (AI) offer promising solutions to these challenges by enabling automated, precise, and objective image analysis. AI technologies have demonstrated success in diagnosing IBD, distinguishing it from other gastrointestinal disorders, and facilitating early identification of neoplasia in IBD patients, improving clinical decision-making and potentially reducing the need for invasive procedures. Furthermore, AI applications for evaluating endoscopic images have enhanced the accuracy of disease severity assessments such as the Mayo Endoscopic Score and Ulcerative Colitis Endoscopic Index of Severity by overcoming issues related to observer variability. Integration of AI with advanced endoscopic technologies, including image-enhanced and magnified endoscopy, further improves lesion characterization and offers insights into mucosal healing, which is crucial for optimizing treatment. While AI's potential in IBD management is substantial, challenges remain in its clinical implementation, necessitating further validation through real-world data and regulatory approval. This review explores the evolving role of AI in transforming IBD diagnosis, surveillance, and assessment, with a focus on enhancing patient care through improved precision and efficiency.

Underwater endoscopic mucosal resection (UEMR) is effective for 10–20 mm colorectal polyps [1]. However, snaring is difficult for lesions at colonic flexures because the proximal edge is hidden by folds. We report a case of successful en bloc UEMR using a multiloop traction device (MLTD) (Boston Scientific, Tokyo, Japan).

A 72-year-old man with hypopharyngeal cancer underwent fluorodeoxyglucose (FDG) positron emission tomography, which revealed FDG accumulation in the rectosigmoid colon. Colonoscopy revealed a 20-mm protruding lesion. UEMR using SnareMasterPlus (15 mm; Olympus Medical Systems, Tokyo, Japan) was attempted. However, visualization of the oral side of the lesion was challenging, as the lesion extended across the flexure of the rectosigmoid junction (Figures 1a and 2a). Retroflex observation allowed the visualization of the oral side of the tumor; however, poor maneuverability prevented suitable snaring. Therefore, we attached MLTD to the normal mucosa 5 mm oral to the lesion using a SureClip (Micro-Tech, Nanjing, China) (Figure 1b), and subsequently hooked and anchored it to the colonic wall at the opposite side of the lesion with the second clip (Figure 1c). The traction force reduced the steep angle of the rectosigmoid junction and improved the visualization of the oral margin of the lesion in forward view (Figures 1d and 2b). We performed reliable snaring by directly observing the lesion margins (Figure 1e). The traction force optimized the visualization of the resected wound, which facilitated subsequent clipping (Figure 1f). Pathology confirmed a low-grade tubulovillous adenoma with negative resection margins.

Submucosal injection in the oral edge might also have improved lesion visibility; however, considering that unsuccessful injection carries the risk of irreversibly worsening the situation (e.g., impaired visibility due to bleeding), we first attempted this traction method, which can be undone if needed. This method has been reported in colorectal ESD [2] and duodenal UEMR cases [3], and we further confirmed its usefulness even in colorectal UEMR.

Kazuki Matsuyama performed the procedures and drafted the manuscript. Minoru Kato revised the manuscript critically. Tomoki Michida supervised manuscript preparation. All the authors have read and approved the final version of this manuscript.

Informed consent was obtained from the patient for the publication of his information and imaging data.

The authors declare no conflicts of interest.