Surgical Endoscopy And Other Interventional Techniques最新文献

Introduction: Bariatric surgery remains underutilized despite rising global obesity rates, with less than 2% of eligible patients undergoing procedures annually. Magnetic compression anastomosis (MCA) offers potential advantages over traditional techniques, including reduced operative time and improved healing. However, delayed patency has limited its application. This study evaluates the novel OTOLoc™ system, which enables immediate patency in Roux-en-Y gastric bypass (RYGB) via self-forming magnets (SFMs), addressing a key limitation of prior MCA approaches.

Methods: A prospective, open-label, multicenter study (NCT06199635) was conducted across two centers (India and Chile). Fourteen patients with moderate-to-severe obesity underwent RYGB with SFM-assisted jejuno-jejunal anastomosis. Primary outcomes included 30-day freedom from anastomotic adverse events (AEs; leaks, bleeding, obstruction). Secondary outcomes encompassed weight loss, comorbidity resolution, and nutritional status. Technical success was defined as anastomosis creation without conversion to sutures/staplers.

Results: All 14 procedures (median age: 42 years, BMI: 41.4 kg/m²) were technically successful, with a median operative time of 55 min and magnet placement time of 12 min. No device-related AEs occurred. Four procedure-related serious AEs (e.g., pulmonary embolism, gastro-jejunostomy bleeding) resolved without reoperation. At 3 months, median weight loss was 24.4 kg (21.2% total body weight loss), with no anastomotic complications. All magnets were excreted naturally within 30 days.

Conclusion: The OTOLoc™ system safely facilitated immediate-patency magnetic anastomoses in RYGB, with no device-related complications and promising short-term efficacy. Larger studies comparing SFMs to stapled anastomoses are warranted to validate these findings and assess long-term outcomes.

Background: Dieulafoy's lesion (DL) is an uncommon cause of nonvariceal upper gastrointestinal bleeding (NVUGIB). The weekend effect refers to the phenomenon where patients admitted on weekends experience clinically poorer outcomes. This study aimed to explore the weekend effect on clinical outcomes after endoscopic hemostasis for DL in the upper gastrointestinal tract, and whether this relationship was mediated by the experience of the endoscopist.

Methods: This retrospective analysis included patients with DL of the upper gastrointestinal tract who underwent standard endoscopic hemostasis treatment between April 2007 and June 2025. Univariate and multivariate analysis, propensity score matching (PSM), and mediation analysis were used to explore the relationships between the weekend effect, the experience of the endoscopist and the rebleeding rate of DL.

Results: A total of 283 patients were included in this study, consisting of 212 patients in the weekday admission group and 71 patients in the weekend admission group. Multivariate analysis showed weekend admission was an independent risk factor for rebleeding of DL. After matching, the baseline characteristics of 64 patients in the weekday admission group and 64 patients in the weekend admission group were balanced. The rebleeding rate of DL in the weekend admission group was significantly higher than that in the weekday admission group (31.3% vs. 10.9%, P = 0.005). Patients admitted on weekends were more likely to be treated by less-experienced endoscopists compared to those admitted on weekdays (48.4% vs. 25.0%, P = 0.006). Moreover, a significant indirect effect of the weekend effect on rebleeding of DL through less-experienced endoscopists was found, and the proportions mediated were 17.42%.

Conclusion: The weekend effect was significantly associated with the higher rebleeding rate in patients with DL of the upper gastrointestinal tract, and less-experienced endoscopists on weekends might be playing a mediating role in this relationship.

Background: Application of artificial intelligence (AI) in magnetically controlled capsule endoscopy (MCCE) is increasing. The aim of this study was to develop an AI system that can automatically detect Helicobacter pylori (H. pylori) infection in MCCE images and to evaluate the diagnostic performance of the system.

Methods: This study prospectively enrolled subjects with known H. pylori infection status for MCCE examination between April 2022 and March 2023. The MCCE images were collected and prepared for the data set (80% for training, 10% for validation and 10% for testing). Four convolutional neural network models (i.e., MobileNetV2, DenseNet264, ShuffleNetV2 and ResNet50) were applied in the AI system respectively. We evaluated their diagnostic performance and identify the optimal model by calculating the accuracy, sensitivity, specificity, and average reading time for per image.

Results: A total of 142 subjects were registered including 71 H. pylori-positive and 71 H. pylori-negative. The numbers of images in the training set, validation set and testing set were 25,985 (114 patients), 2767 (14 patients), and 3027 (14 patients), respectively. The accuracy, sensitivity, specificity, and average reading time for per image of each CNN model were as follows: MobileNetV2 model, 95.7, 98.1, 93.3% and 0.01176 s; DenseNet264 model, 95.3, 98.5, 92.2% and 0.04572 s; ShuffleNetV2 model, 95.7, 98.5, 93.1% and 0.00588 s; ResNet50 model, 95.1, 95.8, 94.5% and 0.01110 s, respectively.

Conclusions: The AI system based on the ShuffleNetV2 model achieved better performance, highlighting its potential for future application to help clinicians detect H. pylori infection in MCCE examination.

Introduction: Esophagogastroduodenoscopy (EGD) with endoscopic mucosal resection (EMR) is commonly used for evaluating and managing gastrointestinal lesions. This study aimed to assess the 30-day risk of bleeding and other adverse outcomes following EGD-EMR in cirrhotic patients.

Methods: This retrospective cohort study utilized data from the US Collaborative Network to evaluate bleeding risk following EGD-EMR in cirrhotic patients. One-to-one propensity score matching was performed, with the primary outcome being bleeding within 30 days post-procedure.

Results: Each cohort included 1,045 patients. Cirrhotic patients had higher risk of post-EGD-EMR bleeding (OR 1.65, 95% CI 1.21-2.25, P = 0.002) and were more likely to require a blood transfusion (OR 2.54, 95% CI 1.21-5.31, P = 0.011). However, ICU admissions (OR 1.33, P = 0.29) and endoscopic reinterventions (OR 1.31, P = 0.25) did not differ significantly. Patients with decompensated cirrhosis had a higher bleeding risk compared to controls (OR 1.62, 95% CI 1.05-2.51, P = 0.03), while those with compensated cirrhosis showed no increased risk (OR 1.16, P = 0.55).

Discussion: This study found increased post-procedural bleeding in cirrhotic patients, particularly those with decompensated cirrhosis. Careful pre-procedural management of coagulopathy is crucial to minimize complications in these patients.

Introduction: The rapid expansion of robotic-assisted surgery (RAS) necessitates comprehensive training of residents. Historically, training programs focused on teaching essential technical skills, neglecting procedure-specific proctor courses. Establishing a step-by-step framework for procedural training promises a uniform, safe, and efficient teaching process. This study aims to identify the key steps and complexities crucial for teaching the robotic-assisted low-anterior resection (RA-LAR) effectively and thereby enhancing the national standardized RAS training program for surgical residents in the Netherlands.

Methods: A list of operation phases and procedural key steps to perform the RA-LAR was compiled, together with a description of four skill levels. Using the Delphi method, experts rated the procedural key steps on a Likert scale and granted them one of four skill levels. The operation phases were queried through multiple-choice questions. Round one, two, and four consisted of online questionnaires; round three, an online meeting.

Results: Consensus was achieved after four rounds. Of the 21 invited experts, 13 participated in the first round (62%) and 11 in the second round (52%). From these 11 experts, 9 (82%) completed the third and fourth rounds (100%). High internal consistency among experts was indicated in Delphi round one by Cronbach's alpha values of 0.94 for procedural key steps and 0.86 for skill levels. 11 operation phases, 27 procedural key steps, and corresponding skill levels were established for the RA-LAR.

Conclusion: For the RA-LAR, national consensus was reached on the operation phases, procedural key steps, and their corresponding skill levels. A teaching framework is now ready for testing efficacy in training of surgical residents in robotic-assisted surgery.

Object: The aim of this study was to elucidate the disparities in long-term survival outcomes between endoscopic therapy and gastrectomy in T1b gastric cancer (GC) patients METHODS: Data pertaining to T1b GC patients from 2010-2020 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Additionally, clinical characteristics and survival metrics for pertinent patients were collated from the Chinese multicenter database. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using various methodologies [unadjusted, stable inverse probability-weighted treatment (IPTW), and propensity score matching (PSM)] among the endoscopy, gastrectomy, and chemoradiotherapy cohorts. Variable selection was conducted through the Least Absolute Shrinkage and Selection Operator (Lasso) regression, culminating in the development and validation of a prognostic model across distinct cohorts RESULTS: In all, 2020 GC patients were identified through the SEER database. Multiple comparative frameworks were employed to scrutinize the differences in outcomes among gastrectomy, endoscopy, and chemoradiotherapy modalities. The analyses revealed no statistically significant disparity in long-term survival between gastrectomy and endoscopy while demonstrating that the efficacy of chemoradiotherapy was markedly inferior to that of endoscopy. Further validation was achieved by analyzing data from 116 patients from the Chinese multicenter database, corroborating the aforementioned findings. Subsequently, Lasso regression facilitated the variable selection for the prognostic model, which ultimately included race, gender, age, histologic grade, tumor dimensions, and treatment strategy. The model demonstrated satisfactory predictive accuracy for OS among T1b GC patients CONCLUSION: The long-term survival advantage conferred by gastrectomy in patients with T1b GC was found to be commensurate with that achieved through endoscopic therapy. The prognostic model formulated in this study exhibited robust performance in forecasting the OS of T1b GC patients.

Background: Pancreatoduodenectomy (PD) is a major abdominal surgery. While laparoscopic PD (LPD) is gaining acceptance globally, its feasibility and safety in low-resource settings require further evaluation. This study aimed to identify the benefits and drawbacks of LPD compared to open PD (OPD) in a developing African country.

Patients and methods: This randomized controlled trial included patients with oncologic indications for PD. Participants were randomized into two groups: LPD and OPD. The primary endpoint was length of hospital stay, postoperative morbidity and mortality, blood loss, and the need for transfusion of blood products. The secondary outcomes were the operative time in minutes, pain VAS scores, duration to ambulation, gastrointestinal (GIT) recovery, and the quality of oncological resection.

Results: A total of 68 patients were initially screened for eligibility, of whom 48 were randomized and underwent pancreatoduodenectomy (LPD: n = 30; OPD: n = 18). Twenty patients discontinued the intervention after randomization due to withdrawal or peri-induction instability, resulting in a dropout rate of 29.4%. The duration of hospital stay was significantly shorter in the LPD group (8.1 ± 5.6 days) than the OPD group (10.6 ± 6.1 days, p = 0.049). LPD also demonstrated lower intraoperative blood loss, reduced transfusion rates, faster gastrointestinal recovery, and earlier ambulation. Oncologic outcomes, including margin status and lymph node yield, were comparable between groups.

Conclusion: LPD resulted in a significantly shorter hospital stay compared to OPD, confirming its benefit in postoperative recovery. Despite a longer operative time, LPD showed advantages in blood loss, transfusion needs, and functional recovery, while maintaining comparable oncologic safety. These findings support the feasibility and potential value of LPD in selected patients, even within a resource-constrained setting.

Background: Intraoperative neuromonitoring (IONM) has been increasingly used in thyroid surgery, yet its clinical value remains controversial.

Objectives: This randomized controlled trial aimed to evaluate the efficacy and safety of IONM in thyroid cancer surgery.

Methods: The standardized four-step monitoring protocol was used in the IONM group. Primary endpoints included RLN injury rates and postoperative voice function recovery. Secondary endpoints included surgical parameters (operation time, blood loss), complication rates, and oncological outcomes. Voice function was assessed using VHI-10 scoring and maximum phonation time (MPT). Patients were followed up for a median of 6 months.

Results: The IONM group demonstrated significantly lower rates of temporary vocal cord paralysis (2.0% vs 10.0%, P = 0.038) and higher nerve identification rates (100% vs 96.0%) compared to the control group. Voice function recovery was notably faster in the IONM group, with smaller changes in VHI-10 scores (Δ = 4.2 ± 1.5 vs 7.6 ± 2.1, P < 0.001) and shorter MPT recovery time (14.2 ± 3.5 vs 25.6 ± 5.2 days, P < 0.001). Although operation time was longer in the IONM group (125.6 ± 18.3 vs 108.4 ± 15.7 min, P < 0.001), no significant differences were found in blood loss (45.3 ± 12.6 ml vs 48.7 ± 13.2 ml, P = 0.183), complication rates, or oncological outcomes between the groups.

Conclusion: IONM technology greatly lowers the risk of temporary recurrent laryngeal nerve injury and speeds up voice function recovery in thyroid cancer surgery. Although operation times are slightly extended, the technique is safe and preserves oncological integrity.

Background: Anastomotic leakage and ureteral injury are serious complications in colorectal surgery, negatively impacting both short- and long-term outcomes. Indocyanine green (ICG) fluorescence has gained attention for intraoperative intestinal perfusion assessment and ureteral navigation. This study evaluated whether these ICG fluorescence-based techniques reduce surgeons' mental workload.

Methods: We retrospectively assessed surgeons' workload using the NASA Task Load Index (TLX) during laparoscopic colorectal surgeries performed between January and December 2022. Anastomotic blood flow was assessed either using the ICG fluorescence method (n = 158) or the conventional method (n = 29). Moreover, patients undergoing left-sided colorectal surgery were divided into two groups based on the use of fluorescent ureteral navigation (n = 29) versus nonfluorescent navigation (n = 72).

Results: Surgeons using ICG fluorescence for blood flow assessment reported significantly lower TLX scores across all domains, including weighted workload (WWL): 12.3 (IQR: 10.5-17.3) vs. 46.8 (IQR: 21.6-54.4), P < 0.0001. Similarly, fluorescent ureteral navigation was associated with significantly lower frustration (20 [12.5-35] vs. 30 [20-55], P = 0.0093) and WWL (20.3 [17.2-36.5] vs. 29 [19.0-43.9], P = 0.0412) compared with the nonfluorescent group. Among surgeons not certified by the Japan Society for Endoscopic Surgery, fluorescent guidance resulted in lower frustration and WWL (P = 0.0053 and P = 0.0092, respectively). No significant differences were observed among certified surgeon.

Conclusion: ICG fluorescence-based techniques for anastomotic perfusion and ureteral navigation effectively reduce mental workload for surgeons, especially for those without endoscopic surgical certification. These methods may serve as supportive tools in promoting safe and ergonomic colorectal surgery.