Surgical Endoscopy And Other Interventional Techniques最新文献

Objective: To compare the clinical outcomes and learning curve characteristics of the traditional bilateral areolar approach (BAA) and the modified areolar approach (MAA) in endoscopic thyroidectomy and to assess the advantages and potential for clinical dissemination of the modified technique.

Methods: We retrospectively reviewed 79 female patients who underwent endoscopic radical thyroidectomy for thyroid cancer. Patients were assigned to the BAA group or the MAA group according to the incision placement. Perioperative parameters were compared between groups, such as operative time, intraoperative blood loss, number of lymph nodes harvested, incidence of postoperative complications, and patient satisfaction. A cumulative sum analysis (CUSUM) was performed to construct learning curves and evaluate the progression of surgical proficiency.

Results: Compared with the BAA group, the MAA group demonstrated a significantly shorter operative time (P < 0.001), reduced intraoperative blood loss (P = 0.029), and a lower rate of short-term postoperative complications (P = 0.05). The CUSUM learning curve inflection point occurred earlier in the MAA group (20th case vs. 26th case), indicating more rapid acquisition of the technique.

Conclusion: By optimizing incision placement and instrument alignment, the modified areolar approach shortens operative time, minimizes intraoperative trauma, and decreases complication rates. Its shorter learning curve and greater procedural stability facilitate faster mastery of endoscopic thyroidectomy, supporting its wider clinical adoption.

Background and aims: Schwannomas are rarely seen in the upper gastrointestinal tract. The diagnostic and therapeutic strategies for digestive schwannomas have not been studied comprehensively enough. We aimed to investigate the clinical and endoscopic features of upper gastrointestinal schwannomas (UGIS). Additionally, the safety and efficacy of endoscopic resection (ER) for UGIS were evaluated.

Methods: From March 2013 to June 2025, the patients who underwent ER for UGIS in our center were enrolled. Clinical characteristics, endoscopic ultrasound (EUS) and histopathological results were analyzed retrospectively. The rate of en-bloc resection, complete resection and recurrence were used to evaluate ER outcomes.

Results: In total, 54 patients (36 females, 18 males) were enrolled with a mean age of 51.6 ± 12.8 years. The mean tumor size was 21.7 mm (SD: 10.6 mm). Thirty-nine lesions were located at the gastric body, seven in the gastric antrum, two in the gastric angle and six in the esophagus. Twenty-two patients suffered from digestive symptoms including abdominal pain (11/54, 20.4%), abdominal distention (9/54, 16.7%) and acid reflux (2/54, 3.7%). The endoscopic morphology of UGIS was diverse with a predominance of hemisphere-type (32/54, 59.3%). Under EUS, most tumors presented as hypoechoic lesions (50/54, 92.6%). The rate of en-bloc and complete resection was 88.9% and no local residue or recurrence was observed during a following-up duration of 56.0 ± 39.7 months. Histopathological results revealed all tumors showed positive for S-100. For gastric schwannomas, the occurrence of digestive symptoms was more common in those tumors exhibiting extraluminal growing pattern (extraluminal vs. intraluminal = 14/23 vs. 7/25, P = 0.022).

Conclusions: UGIS demonstrates characteristic appearance under EUS. Confirmed diagnosis of UGIS depends on immunohistochemistry tests. The occurrence of clinical symptoms in gastric schwannomas might be associated with tumor growing pattern. ER is an effective treatment to manage UGIS with favorable long-term outcomes.

Background and aims: Endoscopic variceal ligation (EVL) is associated with relatively high rebleeding rates in patients with large esophageal varices (EVs). However, objective and clinically applicable methods for measuring esophageal variceal diameter (EVD) remain limited. This study aimed to introduce a novel non-invasive EVD measurement technique and to compare the efficacy of balloon-occluded esophageal varices obliteration (BEVO) with EVL in patients with high-risk EVs (HREVs), focusing on rebleeding and survival outcomes across different EVD subgroups.

Methods: EVD was measured endoscopically using an artificial intelligence-assisted virtual ruler. In this prospective randomized controlled trial, patients with HREVs of varying diameters treated between December 2020 and January 2024 were randomly assigned to receive BEVO (n = 107) or EVL (n = 107). Primary and secondary outcomes included rebleeding rates, number of treatment sessions, adverse events, and overall survival.

Results: Compared with EVL, BEVO was associated with significantly lower total rebleeding rates (13.08% vs. 27.10%, P = 0.010) and late rebleeding rates (11.21% vs. 23.36%, P = 0.019). Among patients with EVD ≥ 10 mm, EVL was associated with significantly higher rebleeding rates (9.09% vs. 25.35%, P = 0.03), with this difference becoming more pronounced in those with EVD ≥ 15 mm (17.65% vs. 100.00%, P < 0.0001). Multivariate Cox regression analysis identified EVL, compared to BEVO, as an independent predictor of rebleeding (HR 2.21, 95% CI 1.17-4.18, P = 0.015). Patients treated with EVL required more treatment sessions than those treated with BEVO (P = 0.028). Furthermore, patients without rebleeding demonstrated significantly higher survival rates than those with rebleeding (94.15% vs. 69.76%, P < 0.001).

Conclusion: In this study population, BEVO demonstrated superior efficacy to EVL in preventing rebleeding in HREVs, particularly those with EVD ≥ 10 mm. These findings suggest BEVO as a promising therapeutic strategy, warranting further validation in multicenter studies.

Clinical trial number: ChiCTR2000039974.

Background: The Endoluminal Functional Lumen Imaging Probe (EndoFLIP™) is increasingly utilized in the diagnostic evaluation of gastroesophageal reflux disease (GERD). At our Center, EndoFLIP™ is routinely performed before Bravo™ pH monitoring during preoperative esophagogastroduodenoscopy to exclude major motility disorders in patients being considered for antireflux surgery. According to Lyon Consensus 2.0, the presence of Los Angeles (LA) grade B or higher esophagitis is diagnostic for GERD, obviating the need for pH testing. In select cases, bypassing pH monitoring reduces costs, improves workflow efficiency, and expedites symptom management. This study aimed to evaluate whether EndoFLIP™ measurements independently predict Bravo™ pH positivity and to assess the diagnostic accuracy of distensibility index (DI) thresholds.

Methods: We conducted a single-center retrospective review of adults with native anatomy who underwent 96-h Bravo™ pH monitoring and concomitant EndoFLIP™ at index EGD between October 2022 and August 2024. Patients with positive (Bravo +) and negative (Bravo-) studies were compared. Diagnostic accuracy of DI values (DI50, DI60, DI70) was assessed using receiver operating characteristic (ROC) curves, with area under the curve (AUC) and 95% confidence intervals (CI).

Results: A total of 171 patients were included (64 Bravo + , 107 Bravo-). LA grade B esophagitis was more common among Bravo + patients (7.8% vs. 0%, p = 0.007). Median DI60 was significantly higher in Bravo + patients (4.0 vs. 3.4 mm²/mmHg, p = 0.016). ROC analysis showed DI50 and DI60 yielded good discrimination for Bravo + (AUC 0.67 and 0.65) with high specificity (94%). In males, DI50 and DI60 both performed well (AUC 0.69), whereas in females, DI70 provided the strongest diagnostic value (AUC 0.69, 95% CI 0.49-0.89). The cut-off points for DI50, DI60, and DI70 in the overall sample were 4.2 (95% CI: 3.8-4.6), 4.7 (95% CI: 4.3-5.1), and 3.8 (95% CI: 3.5-4.3), respectively.

Conclusion: DI60 values are significantly associated with Bravo + testing. Across the overall cohort and male sex, DI50 and DI60 demonstrated a strong diagnostic performance, while DI70 showed better performance in females.

Background: Magnifying endoscopy is a reliable method for the differential diagnosis of colorectal tumors due to its high resolution and enhanced contrast, which allow for more precise detection and characterization. However, accurate assessment of tumor differentiation still requires significant expertise. To address this, we developed an AI-assisted diagnosis model (AADM) based on the Japan NBI Expert Team (JNET) classification and evaluated its diagnostic performance in comparison to endoscopists with varying levels of experience.

Methods: A total of 2645 magnified images from 219 patients were collected for training and testing the model. The study employed an improved DeepLabV3 + model, a deep learning network that combines an encoder-decoder architecture with Atrous Spatial Pyramid Pooling (ASPP). We compared the model with six endoscopists with varying experience.

Results: The AADM achieved an accuracy of 0.938 (Macro/Micro-average), with type-specific accuracies of 0.978 for Type 1, 0.891 for Type 2A, 0.912 for Type 2B, and 0.971 for Type 3. Sensitivity was 0.915/0.876 (Macro/Micro-average), and specificity was 0.954/0.959 (Macro/Micro-average). The area under the receiver operating characteristic curve (AUC) was 0.935/0.917 (Macro/Micro-average). The diagnostic performance of the AADM was superior to that of junior endoscopists (accuracy: 0.938 vs. 0.866, P < 0.05) and comparable to senior endoscopists (accuracy: 0.938 vs. 0.937, P > 0.05). Additionally, junior endoscopists significantly improved their accuracy from 0.866 to 0.951 after receiving assistance from the AADM (P < 0.01).

Conclusion: The AADM demonstrated good diagnostic capability for JNET classification, facilitating more convenient and accurate diagnoses of colorectal tumors. AADM shows potential for optimizing surgical approach selection in colorectal tumor management. Further studies are needed to assess its effectiveness and cost-efficiency in real-world clinical settings.

Background: Single stapled anastomotic techniques have a growing interest in the field of colorectal surgery. This concept was developed to lower the leakage rate in colorectal anastomosis by avoiding cross stapling and eliminating dog ears. The bow tie technique is developed as an easier alternative to create a single stapled anastomosis because endoscopic suturing or transanal surgery is avoided.

Methods: A retrospective analysis of prospective observed data was performed in a cohort of all patients who underwent surgery with a colorectal anastomosis between 01-01-2023 and 31-12-2024. Primary outcome parameters were technical feasibility and anastomotic leakage defined as any clinical, radiologic or intraoperative sign of anastomotic leakage. Completeness of linear stapler line resection in the anastomotic donut and air leak test were secondary outcome parameters.

Results: Total of 184 patients with colorectal anastomosis were included. In 6 cases of TME the bow tie technique was not feasible. Anastomotic leakage occurred in 3.6% after sigmoidectomy, 0% after anterior resection with PME and in 9.6% after low anterior resection with TME. Linear stapler was completely resected in all cases and in 5 cases a positive air leak was reported.

Conclusion: The bow tie technique is technical feasible, facilitates a single stapled anastomosis and has promising results on anastomotic leakage in the high colorectal anastomosis. Limitation of the technique is a minimum length of the rectal stump.

Background: Robotic surgeries have become increasingly popular in the last 20 years, spurring technological innovations.

Objective: In this observational study, we compared the workload of Intuitive's da Vinci Single Port (SP) with the da Vinci Xi.

Methods: We evaluated two surgeons during 24 total low anterior resection surgeries at a large academic hospital, with 12 surgeries utilizing the SP and 12 with the Xi. Surveys were administered to both surgeons and their teams before and after each surgery. Surgeons self-evaluated their workloads (mental demand, physical demand, temporal demand, success/performance, effort, frustration, difficulty, fatigue) and the usability of each platform (efficiency and precision of the surgical instruments and camera, touchpad usage, confidence) via survey.

Results: Analysis revealed statistically significant differences in mental and physical workloads (p-value ≤ 0.05) during the vascular dissection subsection, with higher demands in the SP than the Xi and the circulating nurse noting greater effort levels in the SP than the Xi. The robot platform significantly affected robot usability, with surgeons stating that the Xi was more precise and efficient in surgical instrument and camera usage than the SP, leading to higher confidence scores in the Xi.

Limitations: Only two surgeons were surveyed, and the da Vinci SP was novel and likely associated with a learning curve.

Conclusions: Usability differences may explain differences in workloads and confidence. Understanding these differences between the robots can aid in selecting optimal cases for each platform.

Background: Head and neck squamous cell carcinoma (HNSCC) have poor outcomes in advanced stages. Early detection and minimally invasive treatment are essential. Endoscopic laryngo-pharyngeal surgery (ELPS), guided by narrowband imaging, is widely used in Asia, but its prognostic value remains unclear.

Methods: We retrospectively analyzed 111 patients with superficial HNSCC who were treated with ELPS between 2014 and 2023. Patient background, treatment results, complications, and prognostic factors were assessed.

Results: The median observation period was 56 months. En bloc resection was achieved in 96.4% of cases, and the 5-year overall survival (OS) was 91.6%. Tumor thickness > 1000 μm was associated with metastasis in univariate analysis, whereas multivariate analysis identified tumor size > 20 mm and lymphatic invasion as independent predictors. Patients with a body mass index < 18.5 had poorer OS, primarily owing to comorbidities rather than HNSCC. Adverse events occurred in 26.1% of patients, most of which were transient laryngeal edema. One patient required a temporary tracheotomy, but no permanent tracheostomy was needed. ELPS was feasible and safe, even in patients with prior chemoradiotherapy (CRT), as no fatal complications were observed.

Conclusions: ELPS provides favorable mid- to long-term outcomes and can be safely applied to selected patients, including those with prior CRT. Tumor size and lymphatic invasion are key prognostic factors. These findings support ELPS as a minimally invasive, function-preserving treatment option for superficial HNSCC with careful patient selection.

Background: The increasing use of advanced endoscopic resection techniques, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), brings significant post-procedural challenges, particularly delayed bleeding and impaired wound healing. This study aimed to evaluate the efficacy of PuraStat, a synthetic peptide hydrogel, in promoting mucosal healing following endoscopic resections in the oesophagus and stomach of a porcine model.

Methods: In this prospective, randomised, evaluator-blinded preclinical study, 21 pigs underwent EMR and ESD in both the oesophagus and stomach (2 EMR and 2 ESD per animal). Animals were randomised to receive either PuraStat or saline on each resection site. Healing was evaluated after 8 days using follow-up endoscopy, gross pathology, and histopathological analysis. The primary endpoint was re-epithelialisation-to-defect ratio; secondary outcomes included macroscopic wound size reduction and granulation tissue characteristics.

Results: A total of 84 lesions were assessed. Lesions treated with PuraStat demonstrated significantly greater re-epithelialisation/defect ratios compared to controls (p = 0.03), particularly after EMR. Endoscopic evaluation demonstrated a 33% mean reduction in wound size in the PuraStat group (p = 0.001). However, as endoscopic measurements carry an estimated error margin of up to ± 10%, its precision may be limited. Histopathological analysis of post-resection defect area reduction did not show statistically significant difference between groups (p = 0.055). No adverse events were observed, and PuraStat was well tolerated.

Conclusions: Application of PuraStat hydrogel after endoscopic resections was associated with improved re-epithelialisation, particularly in EMR-induced lesions. These findings indicate potential role of PuraStat in support of healing of mucosal post-resection defects in upper gastrointestinal tract, warranting its further validation in clinical trials.