Traction-assisted closure technique for peroral endoscopic myotomy.
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Traction-assisted closure technique for peroral endoscopic myotomy.
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Endoscopic resection (ER) is well established for serrated lesions in patients with noninflammatory bowel disease; however, limited evidence supports its outcomes in patients with ulcerative colitis (UC). We evaluated the short- and long-term outcomes of ER for serrated polyps in patients with UC and assessed the risk of metachronous UC-associated neoplasia (UCAN).
We retrospectively analyzed 127 patients with UC who underwent ER for colorectal neoplasms between 2004 and 2024. Serrated polyps were categorized as sessile serrated lesions (SSLs), traditional serrated adenomas (TSAs), or unclassified serrated adenomas (USAs). Short-term outcomes, including en bloc and R0 resection rates, were compared between UCAN and sporadic neoplasia (SN). Long-term outcomes, including metachronous UCAN, were also analyzed.
Among the 127 patients, 25 serrated lesions (13 SSLs, eight TSAs, and four USAs) were identified. The en bloc and R0 resection rates for serrated lesions were 96% and 92%, respectively, comparable to those for UCAN and SN. Over a median follow-up of 68 months, one patient with TSA developed invasive cancer 34 months post-ER, and two patients with USA developed UC-associated dysplasia. No metachronous UCAN was observed in the patients with SSL. The 5-year cumulative UCAN occurrence rate in the serrated lesion group was 18%, comparable to that in the UCAN group (29%) but significantly higher than that in the SN group (2%).
Because the outcomes of ER were comparable to those of UCAN and SN, ER appears acceptable for serrated lesions in UC. However, TSA and USA may require stricter post-ER surveillance.
Paneth cell metaplasia (PCM), a metaplastic change associated with chronic inflammation in ulcerative colitis (UC), may be linked to UC-associated neoplasia (UCAN). However, no endoscopic method currently exists for detecting PCM. This study aimed to develop and validate a novel endoscopic staining technique—CV-SCAN—for identifying PCM and UCAN, and to explore the molecular characteristics of the stained areas.
This retrospective observational study included 131 patients with UC undergoing surveillance colonoscopy. CV-SCAN involved spraying an ultra-diluted solution (0.006%) of crystal violet from the descending colon to the rectum. Biopsies were obtained from stained and non-stained areas and evaluated histologically and molecularly. RNA expression profiles were analyzed via microarray and real-time RT-PCR. The diagnostic performance of CV-SCAN for detecting PCM was assessed, along with its correlation with UCAN history.
CV-SCAN visualized sharply demarcated, purple-stained areas corresponding to PCM or UCAN. PCM was significantly associated with a history of UCAN. Uniform, dark staining was characteristic of PCM, while UCAN showed heterogeneous staining with small round pits. CV-SCAN achieved a sensitivity of 81.3% and a specificity of 84.9% for PCM detection. Molecular analysis revealed upregulation of Paneth cell–specific (DEFA5, DEFA6), small intestinal (CCL25, APOC3), and UCAN-associated (IL17RC) genes, along with downregulation of SATB2 in stained areas.
CV-SCAN is a novel and effective endoscopic staining method for detecting PCM and UCAN in patients with UC. It enables risk stratification through direct visualization of precancerous changes and may facilitate early detection and targeted surveillance.
The early prediction of secondary loss of response (SLOR) after infliximab (IFX) treatment in Crohn's disease (CD) patients can help optimize treatment strategies. This study developed and validated a multimodal deep learning model that uses baseline endoscopic ulcer lesions to predict SLOR. Additionally, a deep learning–based ulcer detection model was established to automatically identify ulcer lesions.
A total of 385 CD patients from three centers were retrospectively analyzed. An ulcer detection model was developed to identify endoscopic ulcer lesions from 12,092 endoscopic images. Following lesion localization, 2189 ulcer images were selected and used to train feature fusion models, while clinical data were incorporated to construct a multimodal model for SLOR prediction. These models were validated in two external test cohorts.
The ulcer detection model achieved precision values of 0.853 in the validation cohort. The multimodal model outperformed the clinical model in predicting SLOR with areas under the ROC curve (AUCs) of 0.892, 0.847, and 0.824 in the internal validation cohort, external test cohort 1, and external test cohort 2, respectively. Gradient-weighted class activation mapping (Grad-CAMs) revealed highly pronounced activation of the ulcerated area in SLOR patients in the model, providing crucial support for model prediction.
The ulcer detection model effectively identifies ulcer lesions, increasing diagnostic efficiency. The multimodal model, which integrates baseline endoscopic images and clinical data, offers a potential tool for early SLOR prediction.
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There have been little quantitative studies of ergonomics in the upper gastrointestinal endoscopy. We aimed to identify the ergonomic characteristics of both diagnostic (esophagogastroduodenoscopy; EGD) and therapeutic (endoscopic submucosal dissection; ESD) endoscopy in terms of the movement range of the endoscopist's hand/arm holding the endoscope and muscle activity during procedures, in a preclinical setting.
(1) Optical reflective markers attached to the standard flexible endoscope were traced using a multiple motion capture system during EGD and ESD. The data were processed to generate three-dimensional XYZ coordinate data for each procedure. (2) Wireless electromyogram electrodes were attached to eight muscles in the left hand, forearm, shoulder, neck and back. Muscle activation during EGD and ESD was assessed as % maximal voluntary contraction (%MVC).
(1) The motion capture was performed during 13 EGDs and 12 ESDs. On all XYZ axes, the movement range of the endoscope was significantly smaller during ESD than EGD (X; p < 0.001, Y; p = 0.015, Z; p < 0.001). (2) The EMG was recorded during 15 EGDs and eight ESDs. The higher mean %MVC of the pronator teres muscle (52.1%) and the extensor carpi radialis muscle (39.3%) was observed during all procedures. The %MVC tended to be higher during ESD (34.1%) than EGD (28.9%) in an analysis including all muscles (p = 0.078).
Our study is the first to show therapeutic endoscopy had the smaller movement range of the endoscope, but the larger muscle activity than diagnostic endoscopy. These data could deepen our ergonomic understanding of endoscopy and help to optimize endoscopic techniques and/or relevant working environment.
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