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Rescue Strategies for the Inevitable Challenge of Difficult Biliary Cannulation: Choosing Between Transpancreatic Sphincterotomy and the Double-Guidewire Technique 胆道插管困难不可避免的挑战：经腹膜括约肌切开术与双导丝术的选择。
IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Digestive Endoscopy
Pub Date : 2025-12-16 DOI: 10.1111/den.70082
Ryota Sagami, Kazuhiro Mizukami
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引用次数: 0
AI-Assisted Real-Time Cytologic Diagnosis During EUS-FNA of Pancreatic Masses (With Video) 人工智能辅助下胰腺肿块EUS-FNA实时细胞学诊断（附视频）。
IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Digestive Endoscopy
Pub Date : 2025-12-15 DOI: 10.1111/den.70081
Reiko Ashida, Takamichi Kuwahara, Takashi Koshikawa, Katsunori Hashimoto, Nozomi Okuno, Shin Haba, Yuki Kawaji, Takashi Tamura, Yasunobu Yamashita, Masahiro Itonaga, Yuka Kiriyama, Kenji Yamao, Kazuo Hara, Masayuki Kitano

Background

Rapid on-site evaluation enhances the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), but the cytopathologists are limited. This study aimed to assess the diagnostic capability of an artificial intelligence-assisted ROSE (AI-ROSE) for EUS-FNA.

Methods

The study included 137 patients who underwent EUS-FNA of a pancreatic mass between April 2019 and August 2021. Participants were divided into training (n = 96), validation (n = 15), and test cohorts (n = 26). From the training/validation cohort, 5157/615 digital images of cell clusters were extracted and divided into 288 × 288-pixel patches. These cell clusters were annotated and labeled into five classes. A semantic segmentation architecture was developed. From the test cohort, 120 cell clusters were extracted to compare diagnostic performance between AI-ROSE and 21 endosonographers and 5 cytotechnologists with varying experience levels in ROSE.

Results

In total, 1,097,840 training, 31,817 validation, and 1920 test regions were extracted. In the test cohort, AI-ROSE accuracy for three-category classification (class 1/2, class 3, and class 4/5) was 89.8%. For two-category classification (class 1/2/3 and class 4/5), sensitivity, specificity, and accuracy were 89.3%, 98.1%, and 95.1%, respectively. In the comparison cohort, AI-ROSE accuracy for two-category classification was 93.3%, significantly higher than all endosonographers (68.3%; range, 45.8%–86.7%) and cytotechnologists (76.3%; range, 72.5%–78.3%). The AI-ROSE evaluation time for 120 cell clusters was 6.04 s, much shorter than that of all endosonographers (1800; 480–6000 s) and cytotechnologists (2160; 1020–3600 s).

Conclusions

The AI-ROSE model shows remarkable speed and accuracy in diagnosing pancreatic cell clusters, enabling rapid decision-making during EUS-FNA. UMIN-CTR; No. 000042212.

背景：快速的现场评估提高了内镜超声引导下细针穿刺（EUS-FNA）的诊出率，但细胞病理学家有限。本研究旨在评估人工智能辅助玫瑰（AI-ROSE）对EUS-FNA的诊断能力。方法：该研究纳入了2019年4月至2021年8月期间接受EUS-FNA治疗的137例胰腺肿块患者。参与者被分为训练组（n = 96）、验证组（n = 15）和测试组（n = 26）。从训练/验证队列中提取5157/615张细胞团的数字图像，并将其划分为288 × 288像素的小块。这些细胞簇被注释并标记为五类。开发了语义分割体系结构。从测试队列中提取了120个细胞团，以比较AI-ROSE与21名内超声医师和5名具有不同ROSE经验水平的细胞技术人员之间的诊断性能。结果：总共提取了1,097,840个训练区域，31,817个验证区域和1920个测试区域。在测试队列中，AI-ROSE对三类分类（1/2类、3类和4/5类）的准确率为89.8%。对于两类分类（1/2/3级和4/5级），敏感性、特异性和准确性分别为89.3%、98.1%和95.1%。在比较队列中，AI-ROSE对两类分类的准确率为93.3%，显著高于所有腔内超声医师（68.3%，范围45.8%-86.7%）和细胞技师（76.3%，范围72.5%-78.3%）。120个细胞团的AI-ROSE评估时间为6.04 s，远短于所有超声医师（1800;480-6000 s）和细胞工艺师（2160;1020-3600 s）。结论：AI-ROSE模型在诊断胰腺细胞簇方面具有显著的速度和准确性，可以在EUS-FNA过程中快速决策。UMIN-CTR;没有。000042212。
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引用次数: 0
How Should We Approach GLP-1 Receptor Agonist Users During Endoscopy? 内窥镜检查中我们应该如何接近GLP-1受体激动剂使用者？
IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Digestive Endoscopy
Pub Date : 2025-12-15 DOI: 10.1111/den.70083
Shun Ito, Sho Suzuki
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引用次数: 0
Beyond Detection: AI in Gastric Endoscopy 超越检测：人工智能在胃镜检查中的应用。
IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Digestive Endoscopy
Pub Date : 2025-12-14 DOI: 10.1111/den.70074
Avinash Tiwari
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引用次数: 0
Analysis of the Yield of Intestinal Metaplasia Based on Biopsy Numbers and Follow-Up Endoscopy in a Large Series of Asian Patients With Barrett's Esophagus 基于活检数据和随访内镜对大量亚洲Barrett食管患者肠化生率的分析。
IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Digestive Endoscopy
Pub Date : 2025-12-10 DOI: 10.1111/den.70077
Ying-Nan Tsai, Chi-Yang Chang, Chia-Chi Chen, Ching-Tai Lee, Ming-Hung Hsu, I-Wei Chang, Jaw-Town Lin, Hsiu-Po Wang, Sin-Hua Moi, Wen-Lun Wang

Objectives

Intestinal metaplasia (IM) is a premalignant lesion within the columnar-lined esophagus (CLE). The detection of IM stratifies the risk of cancer progression. We aim to investigate the random biopsy yield of IM in Asian patients with CLE.

Methods

A total of 117,526 consecutive esophagogastroduodenoscopies (EGDs) in the outpatient setting were retrospectively screened. The histopathological findings independently reviewed by two pathologists were correlated with the clinical and endoscopic features and the number of biopsies.

Results

Among 5963 EGDs, 3135 patients (5.1%) were diagnosed with CLE. A total of 4675 EGDs involving 8994 biopsies (median = 1, range 1–9) exhibited a 35.1% yield of IM per endoscopy. The yield of IM was higher in cases of long-segment CLE (74.8%) compared with short-segment (32.9%). IM detection was significantly associated with male gender (odds ratio, 95% confidence interval = 1.58, 1.37–1.83), chronological age (1.02, 1.02–1.03), longer segment CLE (1.75, 1.58–1.94), and number of biopsies per endoscopy (1.40, 1.32–1.49). One biopsy during each EGD resulted in a 26% IM yield, which was significantly lower than the yields after three biopsies (2.85, 2.25–3.62) and after following the Seattle protocol (2.86, 2.34–3.50). In 1772 patients without IM on index endoscopy, subsequent endoscopies increased the IM detection rate by 6%, with 4% attributed to the second endoscopy and 2% to the third through eighth endoscopy.

Conclusions

This study provides insights into the number of biopsies needed to characterize IM in Barrett's esophagus. Further research is needed to optimize biopsy strategies, particularly in Asian countries.

目的：肠上皮化生（IM）是一种位于柱状内衬食道（CLE）内的癌前病变。IM的检测将癌症进展的风险分层。我们的目的是研究亚洲CLE患者IM的随机活检率。方法：回顾性筛选门诊共117,526例连续食管胃十二指肠镜检查（EGDs）。由两名病理学家独立审查的组织病理学结果与临床和内窥镜特征以及活检次数相关。结果：5963例egd中，3135例（5.1%）诊断为CLE。4675例egd涉及8994例活组织检查（中位数= 1，范围1-9），每次内镜检查的IM发生率为35.1%。长节段CLE的IM率（74.8%）高于短节段CLE（32.9%）。IM检测与男性性别（优势比，95%可信区间= 1.58,1.37-1.83）、实足年龄（1.02,1.02-1.03）、较长节段CLE（1.75, 1.58-1.94）和每次内镜活检次数（1.40,1.32-1.49）显著相关。每次EGD期间一次活检导致26%的IM产率，显著低于三次活检后的产率（2.85,2.25-3.62）和遵循西雅图方案后的产率（2.86,2.34-3.50）。在1772例索引内镜未发现IM的患者中，后续内镜使IM检出率提高了6%，其中第二次内镜检出率为4%，第三次至第八次内镜检出率为2%。结论：本研究提供了鉴定Barrett食管IM所需活检数量的见解。需要进一步的研究来优化活检策略，特别是在亚洲国家。
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引用次数: 0
Severe Gastric Atrophy Can Potentially Increase the Risk of Esophageal Squamous Cell Carcinoma 严重的胃萎缩可能增加患食管鳞状细胞癌的风险。
IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Digestive Endoscopy
Pub Date : 2025-12-10 DOI: 10.1111/den.70076
Masaki Murata, Mitsushige Sugimoto
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引用次数: 0
Green Endoscopy 绿色的内窥镜检查。
IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Digestive Endoscopy
Pub Date : 2025-12-10 DOI: 10.1111/den.70080
Robin Baddeley, Bu' Hussain Hayee

“Green Endoscopy” is now a worldwide movement that has captured the energy and imagination of the endoscopy community. It describes the effort to lessen the environmental impact of clinical practice by altering equipment, clinical pathways, and purchasing. While many suggestions or recommendations have been put forward, there is still much to be done in order to understand and regulate these attempts, to avoid unintended consequences and further environmental harm. This review highlights current thinking as well as fundamentals of environmental science and analysis, pertaining to our rapidly growing field.

“绿色内窥镜”现在是一项世界性的运动，它吸引了内窥镜界的能量和想象力。它描述了通过改变设备、临床途径和采购来减少临床实践对环境影响的努力。虽然提出了许多建议或建议，但为了了解和管理这些尝试，以避免意外后果和进一步的环境危害，仍有许多工作要做。这篇综述强调了当前的思想以及环境科学和分析的基础，与我们快速发展的领域有关。
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引用次数: 0
Significance of White Opaque Substance in Superficial Nonampullary Duodenal Epithelial Tumors 白色不透明物质在浅表非壶腹十二指肠上皮肿瘤中的意义。
IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Digestive Endoscopy
Pub Date : 2025-12-08 DOI: 10.1111/den.70075
Hikaru Kuribara, Naomi Kakushima, Hiroyuki Hisada, Dai Kubota, Yuko Miura, Hiroya Mizutani, Daisuke Ohki, Chihiro Takeuchi, Seiichi Yakabi, Keiko Niimi, Yousuke Tsuji, Junichi Nawa, Tetsuo Ushiku, Nobutake Yamamichi, Mitsuhiro Fujishiro

Objectives

White opaque substance (WOS) is an endoscopic finding related to histological grade among superficial nonampullary duodenal epithelial tumors (SNADETs). However, the significance of WOS distribution and chronological changes is unknown.

Methods

Images of two different esophagogastroduodenoscopy (EGD) examinations before treatment for SNADETs were evaluated for the chronological change of WOS distribution. WOS distribution was classified into None, Partial, Whole and Marginal according to the degree of WOS. The frequency of chronological change and their relationship to lesion characteristics, including histological grade and epithelial subtypes (intestinal or gastric), were analyzed.

Results

Among 187 lesions, 27 were gastric-types and 160 were intestinal-types, 130 were low-grade adenoma (LGA) and 57 were high-grade adenoma or adenocarcinoma. The median interval between the EGDs was 49 days. Chronological change was more frequently observed in intestinal-types compared with gastric-types (26% vs. 5%, p = 0.01). Gastric-types mostly showed None WOS with no chronological change. Univariate analysis showed that tumor diameter of 10 mm or smaller, intestinal-type, interval between EGD, and LGA were related to chronological change. Multivariate analyses showed that intestinal-type and LGA were significant factors (p < 0.05). The most frequent change was None to Marginal (33%) among intestinal-type lesions with chronological change of WOS distribution.

Conclusion

This study revealed that WOS easily changes among LGA, especially in small intestinal-type lesions. As WOS is a variable finding, diagnosing histologic grade and epithelial subtypes of SNADETs should be based not only on the distribution of WOS, but also on a comprehensive assessment, including white-light endoscopy and image-enhanced endoscopy with magnification.

目的：白色不透明物质（WOS）是浅表性非壶腹性十二指肠上皮肿瘤（SNADETs）的内镜检查结果，与组织学分级有关。然而，WOS分布和时间变化的意义尚不清楚。方法：对snadet治疗前两次不同食管胃十二指肠镜（EGD）检查的图像进行评价，观察WOS分布的时间变化。根据WOS的严重程度，将WOS分布分为无WOS、部分WOS、整体WOS和边际WOS。分析了时间变化的频率及其与病变特征的关系，包括组织学分级和上皮亚型（肠或胃）。结果：187例病变中，胃型27例，肠型160例，低级别腺瘤（LGA） 130例，高级别腺瘤或腺癌57例。egd的中位间隔为49天。肠型比胃型更常观察到时间变化（26%比5%，p = 0.01）。胃型多为无WOS，无时间变化。单因素分析显示，肿瘤直径小于10mm、肠道类型、EGD和LGA之间的时间间隔与时间变化有关。多因素分析显示肠道类型和LGA是影响WOS变化的重要因素(p)。结论：WOS易在LGA中发生变化，尤其是小肠类型病变。由于WOS是一个可变的发现，诊断snadet的组织学分级和上皮亚型不仅要根据WOS的分布，还需要综合评估，包括白光内镜和放大内镜下的图像增强。
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Predissection Surface Clip Traction: A Simple and Effective Traction Method Without Trimming for Colorectal Endoscopic Submucosal Dissection 解剖前表面夹牵引：一种简单有效的无需修剪的结肠内镜下粘膜下剥离牵引方法。
IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Digestive Endoscopy
Pub Date : 2025-12-04 DOI: 10.1111/den.70073
Yoshinori Horikawa, Koichi Hamada, Naoto Tamai

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Usefulness of a Gel-Mixed Contrast Agent for Gastrointestinal Fluoroscopic Imaging and Stent Placement 凝胶混合造影剂在胃肠道透视成像和支架置入中的作用。
IF 4.7 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Digestive Endoscopy
Pub Date : 2025-12-03 DOI: 10.1111/den.70072
Yuki Kawasaki, Jun Ushio, Haruhiro Inoue

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引用次数: 0
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