Shivakumar Vignesh, Shivangi Kothari, Lars Aabakken, Michael Mwachiro, Akutu Munyika, Purnima Bhat, Douglas Faigel
Telemedicine is a broad term that encompasses all aspects of utilizing information and communication technologies to provide health services at distant sites. The primary goal of telementoring is the education and training of gastrointestinal (GI) endoscopists particularly in areas where there is a shortage of endoscopy trainers. Telementoring in GI endoscopy can help to provide teaching and skills training both in simulator-based learning, and endoscopic skills training in the context of patient care. This position statement aims to outline the role of telementoring within GI endoscopy, offering a general model for the introduction and evaluation of a telementoring program that incorporates both simulators for junior trainees and skills training for practicing endoscopists. We hope to highlight its utility and implementation in remote locations. WEO recognizes that telementoring is valuable to expand access to high-quality endoscopy training especially in parts of the world where there is a shortage of endoscopy trainers and this document can serve as a guide in the planning and implementation of telementoring programs.
{"title":"WEO Position Statement on Telementoring in Gastrointestinal Endoscopy","authors":"Shivakumar Vignesh, Shivangi Kothari, Lars Aabakken, Michael Mwachiro, Akutu Munyika, Purnima Bhat, Douglas Faigel","doi":"10.1111/den.70060","DOIUrl":"10.1111/den.70060","url":null,"abstract":"<div>\u0000 \u0000 <p>Telemedicine is a broad term that encompasses all aspects of utilizing information and communication technologies to provide health services at distant sites. The primary goal of telementoring is the education and training of gastrointestinal (GI) endoscopists particularly in areas where there is a shortage of endoscopy trainers. Telementoring in GI endoscopy can help to provide teaching and skills training both in simulator-based learning, and endoscopic skills training in the context of patient care. This position statement aims to outline the role of telementoring within GI endoscopy, offering a general model for the introduction and evaluation of a telementoring program that incorporates both simulators for junior trainees and skills training for practicing endoscopists. We hope to highlight its utility and implementation in remote locations. WEO recognizes that telementoring is valuable to expand access to high-quality endoscopy training especially in parts of the world where there is a shortage of endoscopy trainers and this document can serve as a guide in the planning and implementation of telementoring programs.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The incidence of esophageal adenocarcinoma (EAC) arising in patients with long-segment Barrett's esophagus (LSBE) in Japan remains to be elucidated. This study aims to investigate the incidence of EAC in Japanese LSBE cases.
Methods
This is a multicenter prospective cohort study involving 32 hospitals throughout Japan. Consecutive patients with Barrett's esophagus with a maximal length of ≥ 3 cm were prospectively enrolled. The study was initiated in June 2011, and the eligible cases were scheduled to undergo subsequent annual endoscopies for 10 years, concluding in December 2021. The cancer incidence was calculated with 95% confidence intervals and expressed as %/year of follow-up.
Results
The initial registry comprised 343 participants. After excluding 16 cases with prevalent EAC and 60 cases with < 1 year of follow-up, a total of 267 cases with LSBE were followed up for 1–10 years (58.0 ± 35.5 months), making the total patient-years 1290.4. During the observation period, 13 new EACs were identified, leading to an estimated EAC incidence of 1.01 (0.57–1.73)%/year. All the incident EAC cases were diagnosed as early cancers. Individuals who developed EAC demonstrated a higher prevalence of ever smoking (76.9% vs. 33.5%, p = 0.002) compared to those who did not.
Conclusions
This prospective, 10-year follow-up study revealed a substantial EAC incidence in Japanese LSBE cases, 1.01 (0.57–1.73)%/year, similar to values reported in Western countries. This result is a significant indicator for developing effective endoscopy surveillance for Japanese LSBE. UMIN000016043.
{"title":"Cancer Incidence in Japanese Patients With Long-Segment Barrett's Esophagus—Japan Nationwide 10-Year Prospective Cohort Study","authors":"Norihisa Ishimura, Nobuyuki Matsuhashi, Junko Fujisaki, Takao Endo, Tomoyuki Koike, Akira Dobashi, Kenro Kawada, Ryu Ishihara, Kazuhiro Matsueda, Ken-Ichi Mukaisho, Takahisa Furuta, Yuji Amano, Kenta Watanabe, Ken Haruma, Shinji Tanaka, Haruhiko Ogata, Yoshikazu Kinoshita, Katsunori Iijima","doi":"10.1111/den.70070","DOIUrl":"10.1111/den.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The incidence of esophageal adenocarcinoma (EAC) arising in patients with long-segment Barrett's esophagus (LSBE) in Japan remains to be elucidated. This study aims to investigate the incidence of EAC in Japanese LSBE cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a multicenter prospective cohort study involving 32 hospitals throughout Japan. Consecutive patients with Barrett's esophagus with a maximal length of ≥ 3 cm were prospectively enrolled. The study was initiated in June 2011, and the eligible cases were scheduled to undergo subsequent annual endoscopies for 10 years, concluding in December 2021. The cancer incidence was calculated with 95% confidence intervals and expressed as %/year of follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The initial registry comprised 343 participants. After excluding 16 cases with prevalent EAC and 60 cases with < 1 year of follow-up, a total of 267 cases with LSBE were followed up for 1–10 years (58.0 ± 35.5 months), making the total patient-years 1290.4. During the observation period, 13 new EACs were identified, leading to an estimated EAC incidence of 1.01 (0.57–1.73)%/year. All the incident EAC cases were diagnosed as early cancers. Individuals who developed EAC demonstrated a higher prevalence of ever smoking (76.9% vs. 33.5%, <i>p</i> = 0.002) compared to those who did not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This prospective, 10-year follow-up study revealed a substantial EAC incidence in Japanese LSBE cases, 1.01 (0.57–1.73)%/year, similar to values reported in Western countries. This result is a significant indicator for developing effective endoscopy surveillance for Japanese LSBE. UMIN000016043.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Saito, T. Sakamoto, E. Dekker, et al. “First report from the International Evaluation of Endoscopic classification Japan NBI Expert Team: International multicenter web trial,” Digestive Endoscopy 36, no. 5 (2024): 591–599.
The affiliation for authors A.P. and H.M. (affiliation 16) was incorrect. It should have read: “University Hospital of Augsburg, Augsburg, Germany.”
We apologize for this error.
Y. Saito， T. Sakamoto， E. Dekker等，“来自国际内镜分类评估日本NBI专家团队的第一份报告：国际多中心网络试验”，《消化内镜》36期，第2期。5(2024): 591-599。作者A.P.和H.M.的归属（归属16）是不正确的。它应该是：“奥格斯堡大学医院，奥格斯堡，德国。”我们为这个错误道歉。
{"title":"Correction to First Report From the International Evaluation of Endoscopic Classification Japan NBI Expert Team: International Multicenter Web Trial","authors":"","doi":"10.1111/den.70068","DOIUrl":"10.1111/den.70068","url":null,"abstract":"<p>Y. Saito, T. Sakamoto, E. Dekker, et al. “First report from the International Evaluation of Endoscopic classification Japan NBI Expert Team: International multicenter web trial,” <i>Digestive Endoscopy</i> 36, no. 5 (2024): 591–599.</p><p>The affiliation for authors A.P. and H.M. (affiliation 16) was incorrect. It should have read: “University Hospital of Augsburg, Augsburg, Germany.”</p><p>We apologize for this error.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Argon Plasma Coagulation for Intraductal Papillary Mucinous Carcinoma Using an Ultrathin Endoscope With a Transparent Hood","authors":"Kazuki Hirano, Kosuke Maehara, Tsunao Imamura","doi":"10.1111/den.70069","DOIUrl":"10.1111/den.70069","url":null,"abstract":"<p>Watch a video of this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endoscopic submucosal dissection (ESD) for lesions extending into the appendiceal orifice remains technically challenging due to limited accessibility and risks of perforation or appendicitis [1]. Although techniques such as traction methods [2] and tapered hoods [3] have been reported, a standardized strategy has not yet been established. Herein, we report successful underwater ESD (UESD) [4] for a colorectal tumor involving the appendiceal orifice using the continuous irrigation method (CIM) [5], which provides improved visualization and facilitates precise mucosal incision and submucosal dissection by generating water pressure (Video S1). A 47-year-old woman underwent colonoscopy following positive fecal occult blood test results. The procedure revealed a flat, isochromatic lesion measuring 35 mm (type 0-IIa) in the cecum (Figure 1a–c). The lesion was suspected to be a sessile serrated lesion (SSL) and extended into the appendiceal orifice (Figure 1d). ESD was planned using a small-caliber tapered conical hood to improve access to the appendiceal orifice. After lesion marking (Figure 2a), mucosal incision began on the appendiceal side. However, bleeding and bubbles obscured the endoscopic view; therefore, CIM was initiated. CIM rapidly cleared the visual field and utilized water pressure to effectively separate the lesion from the appendiceal orifice, facilitating accurate incision (Figure 2b–d). Circumferential incision and subsequent submucosal dissection were successfully completed under stable visualization provided by CIM (Figure 2e–l). The procedure lasted 91 min.
The pathological diagnosis was SSL. CIM is a simple approach that improves visualization by clearing air bubbles and bleeding during UESD. Additionally, CIM supports mucosal incision and submucosal dissection through the water pressure effect and facilitates hemostasis via temporary compression, thus enabling safe and efficient en bloc resection of lesions involving the appendiceal orifice.
Takahiro Muramatsu wrote and edited the manuscript. Takahiro Muramatsu approved the manuscript. Takahiro Muramatsu, Masakatsu Fukuzawa, and Takao Itoi reviewed the literature and revised the manuscript for intellectual content.
The authors received no specific funding for this work.
Informed consent was obtained from the patient for the publication of this report.
{"title":"Underwater Endoscopic Submucosal Dissection via Continuous Irrigation Method for a Colorectal Tumor Involving the Appendiceal Orifice","authors":"Takahiro Muramatsu, Masakatsu Fukuzawa, Takao Itoi","doi":"10.1111/den.70071","DOIUrl":"10.1111/den.70071","url":null,"abstract":"<p>Endoscopic submucosal dissection (ESD) for lesions extending into the appendiceal orifice remains technically challenging due to limited accessibility and risks of perforation or appendicitis [<span>1</span>]. Although techniques such as traction methods [<span>2</span>] and tapered hoods [<span>3</span>] have been reported, a standardized strategy has not yet been established. Herein, we report successful underwater ESD (UESD) [<span>4</span>] for a colorectal tumor involving the appendiceal orifice using the continuous irrigation method (CIM) [<span>5</span>], which provides improved visualization and facilitates precise mucosal incision and submucosal dissection by generating water pressure (Video S1). A 47-year-old woman underwent colonoscopy following positive fecal occult blood test results. The procedure revealed a flat, isochromatic lesion measuring 35 mm (type 0-IIa) in the cecum (Figure 1a–c). The lesion was suspected to be a sessile serrated lesion (SSL) and extended into the appendiceal orifice (Figure 1d). ESD was planned using a small-caliber tapered conical hood to improve access to the appendiceal orifice. After lesion marking (Figure 2a), mucosal incision began on the appendiceal side. However, bleeding and bubbles obscured the endoscopic view; therefore, CIM was initiated. CIM rapidly cleared the visual field and utilized water pressure to effectively separate the lesion from the appendiceal orifice, facilitating accurate incision (Figure 2b–d). Circumferential incision and subsequent submucosal dissection were successfully completed under stable visualization provided by CIM (Figure 2e–l). The procedure lasted 91 min.</p><p>The pathological diagnosis was SSL. CIM is a simple approach that improves visualization by clearing air bubbles and bleeding during UESD. Additionally, CIM supports mucosal incision and submucosal dissection through the water pressure effect and facilitates hemostasis via temporary compression, thus enabling safe and efficient en bloc resection of lesions involving the appendiceal orifice.</p><p>Takahiro Muramatsu wrote and edited the manuscript. Takahiro Muramatsu approved the manuscript. Takahiro Muramatsu, Masakatsu Fukuzawa, and Takao Itoi reviewed the literature and revised the manuscript for intellectual content.</p><p>The authors received no specific funding for this work.</p><p>Informed consent was obtained from the patient for the publication of this report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Percutaneous transhepatic liver abscess drainage (PTAD) and endoscopic ultrasound-guided liver abscess drainage (EUS-LAD) have several limitations. Recently, because of technical improvements in echoendoscope maneuvers, EUS-guided access for the right hepatic lobe has been reported. The aim of this multicenter, retrospective study was to compare clinical outcomes of PTAD and EUS-LAD including the right hepatic lobe in West Japan.
Method
This retrospective, multicenter study included consecutive patients with liver abscesses between January 2019 and November 2024. The primary outcome in this study was the clinical success rate compared between EUS-LAD and PTAD.
Results
During the study period, 1012 consecutive patients developed liver abscesses. Of them, 734 patients were excluded, 43 underwent EUS-LAD and 235 patients underwent PTAD. After propensity score-matched analysis, the clinical success rate was significantly higher in the EUS-LAD group (97.7%, 42/43) than in the PTAD group (79.1%, 34/43) (p = 0.007). After a propensity score-matched analysis, 25 patients were included in each group. The clinical success rate was significantly higher in the EUS-LAD group (100%, 25/25) than in the PTAD group (84%, 21/25) (p = 0.037). Adverse events were also significantly higher in the PTAD group (16%, 5/25) than in the EUS-LAD group (p = 0.025). In addition, the median length of hospital stay was significantly shorter in the EUS-LAD group (15 days) than in the PTAD group (22 days) (p = 0.005).
Conclusions
EUS-LAD using a metal stent might be one of the options, but further randomized, controlled trials are needed.
{"title":"EUS-Guided Versus Percutaneous Transhepatic Drainage of Liver Abscesses: A Multicenter Endohepatology Study in Western Japan (EPIC-LA Study)","authors":"Takeshi Ogura, Taira Kuroda, Takanori Matsuura, Jun Kitadai, Koh Kitagawa, Masahiro Itonaga, Kotaro Takeshita, Tomoaki Matsumori, Tomoya Emori, Mamoru Takenaka, Hajime Imai, Koichiro Mandai, Shuhei Shintani, Nao Fujimori, Hideyuki Shiomi, Masanori Asada, Ryota Sagami, Hirotsugu Maruyama, Tsukasa Ikeura, Masaaki Shimatani, Hidefumi Nishikiori, Kazuyuki Matsumoto, Masahito Kokubu, Hideki Kamada, Yusuke Ishida, Akitoshi Hakoda, Masayuki Kitano","doi":"10.1111/den.70067","DOIUrl":"10.1111/den.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Percutaneous transhepatic liver abscess drainage (PTAD) and endoscopic ultrasound-guided liver abscess drainage (EUS-LAD) have several limitations. Recently, because of technical improvements in echoendoscope maneuvers, EUS-guided access for the right hepatic lobe has been reported. The aim of this multicenter, retrospective study was to compare clinical outcomes of PTAD and EUS-LAD including the right hepatic lobe in West Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This retrospective, multicenter study included consecutive patients with liver abscesses between January 2019 and November 2024. The primary outcome in this study was the clinical success rate compared between EUS-LAD and PTAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the study period, 1012 consecutive patients developed liver abscesses. Of them, 734 patients were excluded, 43 underwent EUS-LAD and 235 patients underwent PTAD. After propensity score-matched analysis, the clinical success rate was significantly higher in the EUS-LAD group (97.7%, 42/43) than in the PTAD group (79.1%, 34/43) (<i>p</i> = 0.007). After a propensity score-matched analysis, 25 patients were included in each group. The clinical success rate was significantly higher in the EUS-LAD group (100%, 25/25) than in the PTAD group (84%, 21/25) (<i>p</i> = 0.037). Adverse events were also significantly higher in the PTAD group (16%, 5/25) than in the EUS-LAD group (<i>p</i> = 0.025). In addition, the median length of hospital stay was significantly shorter in the EUS-LAD group (15 days) than in the PTAD group (22 days) (<i>p</i> = 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EUS-LAD using a metal stent might be one of the options, but further randomized, controlled trials are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Therapy for cT1N0M0 Local Failure After Chemoradiotherapy: Evolution of ESD and PDT as Organ-Preserving Strategies","authors":"Yuichiro Ikebuchi, Hajime Isomoto","doi":"10.1111/den.70065","DOIUrl":"10.1111/den.70065","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yoonchan Lee, Dongwook Oh, Seung-Mo Hong, Sung Hyun Cho, Gunn Huh, Tae Jun Song, Dong-Wan Seo
Background
The role of endoscopic papillectomy (EP) for ampullary neuroendocrine tumors (Amp-NETs) remains uncertain due to concerns regarding lymph node (LN) metastasis and recurrence. This study evaluated the long-term outcomes of EP for Amp-NETs, focusing on recurrence and procedural safety.
Methods
Patients with histologically confirmed Amp-NETs who underwent EP at a single tertiary center between 2004 and 2018 were retrospectively reviewed. Inclusion criteria were tumor size < 3 cm and absence of radiologic evidence of LN or distant metastasis. Outcomes assessed included recurrence, procedure-related adverse events, and recurrence-free survival (RFS).
Results
Thirty-four patients were included. En bloc resection was achieved in 33 patients (97.1%), while complete resection was achieved in 19 patients (55.9%). Over a median follow-up of 68.5 months, recurrence occurred in three patients (9.1%). All recurrences occurred exclusively in patients with positive resection margins (20%, 3/15), whereas no recurrence was observed in margin-negative patients (0%, 0/19). Early adverse events occurred in 13 patients (38.2%; bleeding n = 12, pancreatitis n = 3), while late adverse events developed in 4 patients (11.8%; papillary stricture), all of which were managed successfully with endoscopic treatment.
Conclusion
EP is a safe and effective option for small, well-differentiated Amp-NETs without radiologic evidence of LN metastasis. Although the incomplete resection rate is concerning, the absence of recurrence in margin-negative patients supports EP as a viable treatment option in carefully selected cases. Patients with positive margins warrant close surveillance and consideration of additional surgery.
{"title":"Long-Term Outcomes Following Endoscopic Papillectomy for Ampullary Neuroendocrine Tumors","authors":"Yoonchan Lee, Dongwook Oh, Seung-Mo Hong, Sung Hyun Cho, Gunn Huh, Tae Jun Song, Dong-Wan Seo","doi":"10.1111/den.70064","DOIUrl":"10.1111/den.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The role of endoscopic papillectomy (EP) for ampullary neuroendocrine tumors (Amp-NETs) remains uncertain due to concerns regarding lymph node (LN) metastasis and recurrence. This study evaluated the long-term outcomes of EP for Amp-NETs, focusing on recurrence and procedural safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with histologically confirmed Amp-NETs who underwent EP at a single tertiary center between 2004 and 2018 were retrospectively reviewed. Inclusion criteria were tumor size < 3 cm and absence of radiologic evidence of LN or distant metastasis. Outcomes assessed included recurrence, procedure-related adverse events, and recurrence-free survival (RFS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-four patients were included. En bloc resection was achieved in 33 patients (97.1%), while complete resection was achieved in 19 patients (55.9%). Over a median follow-up of 68.5 months, recurrence occurred in three patients (9.1%). All recurrences occurred exclusively in patients with positive resection margins (20%, 3/15), whereas no recurrence was observed in margin-negative patients (0%, 0/19). Early adverse events occurred in 13 patients (38.2%; bleeding <i>n</i> = 12, pancreatitis <i>n</i> = 3), while late adverse events developed in 4 patients (11.8%; papillary stricture), all of which were managed successfully with endoscopic treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EP is a safe and effective option for small, well-differentiated Amp-NETs without radiologic evidence of LN metastasis. Although the incomplete resection rate is concerning, the absence of recurrence in margin-negative patients supports EP as a viable treatment option in carefully selected cases. Patients with positive margins warrant close surveillance and consideration of additional surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kenneth Weicong Lin, Kwong Ming Fock, James Weiquan Li
Computer-aided diagnosis (CADx) systems have emerged as promising tools to support real-time optical characterization of colorectal polyps during colonoscopy. This narrative review critically evaluates their clinical utility and limitations, focusing on two key strategies: “resect and discard” and “leave in situ.” While CADx offers potential benefits, such as cost reduction, increased diagnostic consistency, and support for nonexpert endoscopists, its performance in clinical settings remains variable and often below established thresholds by societies like ESGE and ASGE. Key metrics such as positive predictive value, negative predictive value, sensitivity, and specificity fluctuate widely across studies and CADx platforms, influenced by system training data, disease prevalence, and human–AI interactions. Importantly, trust and explainability issues hinder adoption, with studies revealing underutilization of accurate CADx predictions due to clinician skepticism. Additionally, CADx systems struggle to reliably differentiate sessile serrated lesions from hyperplastic polyps, partly due to limitations in histopathological ground truth and data set representation. Cost-effectiveness analyses show promise, but practical implementation is challenged by equipment, regulatory, and training costs. Finally, emerging applications of CADx in predicting invasion depth in colorectal cancer show potential but require more robust validation. Overall, while CADx technologies may enhance diagnostic confidence and aid decision-making, especially for less experienced endoscopists, their widespread clinical integration depends on addressing human–AI interaction challenges, improving system transparency, and refining models to include underrepresented lesion types.
{"title":"Computer-Aided Diagnosis of Colorectal Polyps: Clinical Usefulness and Limitations","authors":"Kenneth Weicong Lin, Kwong Ming Fock, James Weiquan Li","doi":"10.1111/den.70056","DOIUrl":"10.1111/den.70056","url":null,"abstract":"<div>\u0000 \u0000 <p>Computer-aided diagnosis (CADx) systems have emerged as promising tools to support real-time optical characterization of colorectal polyps during colonoscopy. This narrative review critically evaluates their clinical utility and limitations, focusing on two key strategies: “resect and discard” and “leave in situ.” While CADx offers potential benefits, such as cost reduction, increased diagnostic consistency, and support for nonexpert endoscopists, its performance in clinical settings remains variable and often below established thresholds by societies like ESGE and ASGE. Key metrics such as positive predictive value, negative predictive value, sensitivity, and specificity fluctuate widely across studies and CADx platforms, influenced by system training data, disease prevalence, and human–AI interactions. Importantly, trust and explainability issues hinder adoption, with studies revealing underutilization of accurate CADx predictions due to clinician skepticism. Additionally, CADx systems struggle to reliably differentiate sessile serrated lesions from hyperplastic polyps, partly due to limitations in histopathological ground truth and data set representation. Cost-effectiveness analyses show promise, but practical implementation is challenged by equipment, regulatory, and training costs. Finally, emerging applications of CADx in predicting invasion depth in colorectal cancer show potential but require more robust validation. Overall, while CADx technologies may enhance diagnostic confidence and aid decision-making, especially for less experienced endoscopists, their widespread clinical integration depends on addressing human–AI interaction challenges, improving system transparency, and refining models to include underrepresented lesion types.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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