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The adoption of artificial intelligence assisted endoscopy in the Middle East: challenges and future potential 中东采用人工智能辅助内窥镜检查:挑战和未来潜力
4区 医学 Q1 Medicine Pub Date : 2023-10-01 DOI: 10.21037/tgh-23-37
Ahmed El-Sayed, Sara Salman, Laith Alrubaiy
: The use of artificial intelligence (AI) in endoscopy has shown immense potential to enhance diagnostic accuracy, streamline procedures, and improve patient outcomes. There are potential uses in every field of endoscopy, from improving adenoma detection rate (ADR) in colonoscopy to reducing read time in capsule endoscopy or minimizing blind spots in gastroscopy. Indeed, some of these systems are already licensed and in commercial use across the world. In the Middle East, where healthcare systems are rapidly evolving, there is a growing interest in adopting AI technologies to revolutionise endoscopic practices. This article provides an overview of the advancements, potential opportunities and challenges associated with the implementation of AI in endoscopy within the Middle East region. Our aim is to contribute to the ongoing dialogue surrounding the implementation of AI in endoscopy and consider some of the factors that are particularly relevant in the Middle Eastern context, including the need to train the models for local populations, cost and training, as well as trying to ensure equity of access for patients. It provides valuable insights for healthcare professionals, policymakers, and researchers interested in leveraging AI to enhance endoscopic procedures, improve patient care, and address the unique healthcare needs of the Middle East population.
人工智能(AI)在内窥镜检查中的应用在提高诊断准确性、简化程序和改善患者预后方面显示出巨大的潜力。从提高结肠镜的腺瘤检出率(ADR)到缩短胶囊内镜的阅读时间或减少胃镜的盲点,内镜在各个领域都有潜在的应用。事实上,其中一些系统已经获得许可,并在全球范围内投入商业使用。在中东,医疗保健系统正在迅速发展,人们对采用人工智能技术革新内窥镜检查越来越感兴趣。本文概述了中东地区在内窥镜检查中实施人工智能的进展、潜在机遇和挑战。我们的目标是为围绕在内窥镜检查中实施人工智能的持续对话做出贡献,并考虑在中东背景下特别相关的一些因素,包括为当地人口培训模型的必要性、成本和培训,以及努力确保患者获得公平机会。它为医疗保健专业人员、政策制定者和研究人员提供了有价值的见解,这些研究人员有兴趣利用人工智能来增强内窥镜手术、改善患者护理和解决中东人口独特的医疗保健需求。
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引用次数: 0
Surgical management of pancreatic ductal adenocarcinoma: a narrative review 胰腺导管腺癌的外科治疗:综述
4区 医学 Q1 Medicine Pub Date : 2023-10-01 DOI: 10.21037/tgh-23-27
Elad Sarfaty, Nazanin Khajoueinejad, Makda G. Zewde, Allen T. Yu, Noah A. Cohen
Background and Objective Pancreatic ductal adenocarcinoma (PDAC) is the third-leading cause of cancer-related death in the United States and is projected to become the second-leading cause of cancer-related death by 2030. Despite advances in systemic and radiation therapy, for patients with surgically resectable PDAC, complete surgical resection is the only potentially curative treatment option. The conduct of a safe, technically excellent pancreatectomy is essential to achieve optimal perioperative outcomes and long-term survival. In this narrative review, evidence from large, well-executed studies and clinical trials examining the technical aspects of pancreatectomy is reviewed. Methods A search was conducted in PubMed, Medline, and Cochrane Review databases to identify English-language randomized clinical trials, meta-analyses, and systematic reviews assessing surgical aspects of pancreatectomy for PDAC published between 2010 to 2023. Key Content and Findings We identified retrospective and prospective studies evaluating the technical aspects of surgery for PDAC. In this review, we evaluate data on surgical techniques of pancreatectomy for PDAC, including the role of minimally invasive techniques, extent of lymphadenectomy, reconstruction options after pancreatoduodenectomy, and the role of surgical drainage. Conclusions Surgical resection has a critical role in the treatment of operable PDAC. While pancreatic cancer surgery is an active area of research, conducting a technically excellent surgical resection maintains paramount importance for both oncological and perioperative outcomes. In this review, we summarize the latest evidence on surgical technique for operable PDAC.
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引用次数: 0
Hepatic epithelioid hemangioendothelioma: is it actually "indolent"? 肝上皮样血管内皮瘤:它真的 "不活跃 "吗?
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-25 eCollection Date: 2023-01-01 DOI: 10.21037/tgh-22-82
Alexander H Yang, Nathalie H Urrunaga
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引用次数: 0
Efficacy of a two-dose hepatitis B vaccination with a novel immunostimulatory sequence adjuvant (Heplisav-B) on patients with chronic liver disease: a retrospective study. 使用新型免疫刺激序列佐剂(Heplisav-B)对慢性肝病患者进行两剂乙肝疫苗接种的疗效:一项回顾性研究。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-25 eCollection Date: 2023-01-01 DOI: 10.21037/tgh-22-12
Joshua Y Kwon, Nader Daoud, Hassan Ghoz, Maria L Yataco, Francis A Farraye

Background: Patients with chronic liver disease (CLD) are more likely to have severe morbidity and mortality due to superimposed acute or chronic hepatitis B virus (HBV) infection and should receive routine vaccination against the virus. Heplisav-B is a two-dose, inactivated, yeast-derived vaccine that uses a novel immunostimulatory adjuvant. Our primary objective was to determine the efficacy of hepatitis B vaccination with Heplisav-B in patients with CLD.

Methods: This retrospective cohort analysis included patients ≥18 years old with CLD who received Heplisav-B from January 2018 to January 2021. All patients had anti-HBs <10 IU/L prior to vaccination and received two doses of Heplisav-B. Post-vaccination anti-HBs of ≥10 IU/L was considered successful vaccination. Basic demographic information, laboratory markers, and medical history were collected from the electronic health record.

Results: A total of 120 patients were included in analysis. The average age of patients was 59 years, 37% were female, and the most common etiology of liver disease was nonalcoholic fatty liver disease. Median days from 2nd vaccination to post-vaccination HBsAb levels was 121 days. 81/120 (67.5%) of patients had evidence of active immunity after receipt of Heplisav-B. On multivariable analysis, age >50 was associated with reduced odds of successful vaccination (OR =0.19, 95% CI: 0.03-0.76).

Conclusions: In patients with CLD, Heplisav-B's overall efficacy (67.5%) is greater than reports of Engerix-B (33-45%), and thus is an effective hepatitis B vaccine in this patient population, particularly in cirrhotic patients. Further studies regarding this vaccine are needed in patients with CLD and after liver transplantation.

背景:慢性肝病(CLD)患者更有可能因合并急性或慢性乙型肝炎病毒(HBV)感染而导致严重的发病率和死亡率,因此应常规接种乙型肝炎病毒疫苗。Heplisav-B 是一种使用新型免疫刺激佐剂的两剂酵母衍生灭活疫苗。我们的主要目的是确定 CLD 患者接种 Heplisav-B 乙型肝炎疫苗的疗效:这项回顾性队列分析包括 2018 年 1 月至 2021 年 1 月期间接种 Heplisav-B 的年龄≥18 岁的 CLD 患者。所有患者均有抗-HBs 结果:共有 120 名患者纳入分析。患者平均年龄为 59 岁,37% 为女性,最常见的肝病病因是非酒精性脂肪肝。从第二次接种疫苗到接种后 HBsAb 水平的中位天数为 121 天。81/120(67.5%)例患者在接种 Heplisav-B 后有主动免疫的证据。多变量分析显示,年龄大于 50 岁与成功接种的几率降低有关(OR =0.19,95% CI:0.03-0.76):结论:在慢性阻塞性肺病患者中,Heplisav-B 的总体有效率(67.5%)高于 Engerix-B 的报告(33-45%),因此在这一患者群体中是一种有效的乙肝疫苗,尤其是在肝硬化患者中。还需要在慢性肝病患者和肝移植患者中进一步研究这种疫苗。
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引用次数: 0
Hepatic epithelioid hemangioendothelioma: pitfalls in the treatment of a rare liver malignancy. 肝上皮样血管内皮瘤:治疗罕见肝脏恶性肿瘤的陷阱。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-25 eCollection Date: 2023-01-01 DOI: 10.21037/tgh-22-80
Epameinondas Dogeas
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引用次数: 0
Image enhanced colonoscopy: updates and prospects-a review. 图像增强结肠镜检查:最新进展和前景综述。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-23-17
Dariush Shahsavari, Muhammad Waqar, Viveksandeep Thoguluva Chandrasekar

Colonoscopy has been proven to be a successful approach in both identifying and preventing colorectal cancer. The incorporation of advanced imaging technologies, such as image-enhanced endoscopy (IEE), plays a vital role in real-time diagnosis. The advancements in endoscopic imaging technology have been continuous, from replacing fiber optics with charge-coupled devices to the introduction of chromoendoscopy in the 1970s. Recent technological advancements include "push-button" technologies like autofluorescence imaging (AFI), narrowed-spectrum endoscopy, and confocal laser endomicroscopy (CLE). Dye-based chromoendoscopy (DCE) is falling out of favor due to the longer time required for application and removal of the dye and the difficulty of identifying lesions in certain situations. Narrow band imaging (NBI) is a technology that filters the light used for illumination leading to improved contrast and better visibility of structures on the mucosal surface and has shown a consistently higher adenoma detection rate (ADR) compared to white light endoscopy. CLE has high sensitivity and specificity for polyp detection and characterization, and several classifications have been developed for accurate identification of normal, regenerative, and dysplastic epithelium. Other IEE technologies, such as blue laser imaging (BLI), linked-color imaging (LCI), i-SCAN, and AFI, have also shown promise in improving ADR and characterizing polyps. New technologies, such as Optivista, red dichromatic imaging (RDI), texture and color enhancement imaging (TXI), and computer-aided detection (CAD) using artificial intelligence (AI), are being developed to improve polyp detection and pathology prediction prior to widespread use in clinical practice.

结肠镜检查已被证明是一种识别和预防结直肠癌的成功方法。结合先进的成像技术,如图像增强内窥镜(IEE),在实时诊断中起着至关重要的作用。内窥镜成像技术的进步是持续的,从用电荷耦合器件取代光纤到20世纪70年代引入彩色内窥镜。最近的技术进步包括“按钮”技术,如自体荧光成像(AFI)、窄光谱内窥镜和共聚焦激光内窥镜(CLE)。由于染料染色内窥镜(DCE)的应用和去除染料所需的时间较长,并且在某些情况下难以识别病变,因此DCE正在失宠。窄带成像(NBI)是一种过滤用于照明的光的技术,可以提高对比度和更好地看到粘膜表面的结构,并且与白光内窥镜相比,一直显示出更高的腺瘤检出率(ADR)。CLE对于息肉的检测和表征具有很高的敏感性和特异性,并且已经开发了几种分类来准确识别正常,再生和发育不良的上皮。其他IEE技术,如蓝色激光成像(BLI)、联色成像(LCI)、i-SCAN和AFI,也显示出改善不良反应和表征息肉的希望。Optivista、红色二色成像(RDI)、纹理和色彩增强成像(TXI)以及使用人工智能(AI)的计算机辅助检测(CAD)等新技术正在开发中,以改善息肉的检测和病理预测,然后再广泛应用于临床实践。
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引用次数: 0
Systematic review with meta-analysis of transverse vs. vertical midline extraction incisional hernia risk following laparoscopic colorectal resections. 系统评价与meta分析腹腔镜结肠直肠癌切除术后横向与垂直中线提取切口疝的风险。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-22-75
Amiya Ahsan, Hussameldin M Nour, Dimitra V Peristeri, Sameh Abogabal, Christie Swaminathan, Muhammad S Sajid

Background: The aim of this article is to explore the risk of incisional hernia (IH) occurrence at the site of specimen extraction following laparoscopic colorectal resection (LCR), highlighting the comparison between transverse incision versus midline vertical abdominal incision.

Methods: Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases, EMBASE, MEDLINE, PubMed and Cochrane Library were performed to find all types of comparative studies reporting the incidence of IH at the specimen extraction site of transverse or vertical midline incision following LCR. The analysis of the pooled data was done using the RevMan statistical software.

Results: Twenty-five comparative studies (including 2 randomised controlled trials) on 10,362 patients fulfilled the inclusion criteria. There were 4,944 patients in the transverse incision group and 5,418 patients in the vertical midline incision group. In the random effects model analysis, the use of transverse incision for specimen extraction following LCR reduced the risk of IH development (odds ratio =0.30, 95% CI: 0.19-0.49, Z=4.88, P=0.00001). However, there was significant heterogeneity (Tau2=0.97; Chi2=109.98, df=24, P=0.00004; I2=78%) among included studies. The limitation of the study is due to lack of RCTs, this study includes both prospective and retrospective studies along with 2 RCTs which makes the meta-analysis potentially biased in source of evidence.

Conclusions: Transverse incision used for specimen extraction following LCR seems to reduce the risk of postoperative IH incidence compared to vertical midline abdominal incisions.

背景:本文的目的是探讨腹腔镜结肠直肠切除术(LCR)后标本提取部位发生切口疝(IH)的风险,重点介绍横向切口与腹部中线垂直切口的比较。方法:按照PRISMA指南进行分析。系统检索医学数据库EMBASE、MEDLINE、PubMed和Cochrane图书馆,查找LCR术后横切线或垂直中线切口取标本部位IH发生率的各类比较研究。使用RevMan统计软件对汇总数据进行分析。结果:25项比较研究(包括2项随机对照试验)10362例患者符合纳入标准。横向切口组4944例,垂直中线切口组5418例。在随机效应模型分析中,LCR术后采用横切口取标本降低了IH发生的风险(优势比=0.30,95% CI: 0.19-0.49, Z=4.88, P=0.00001)。然而,存在显著的异质性(Tau2=0.97;Chi2=109.98, df=24, P=0.00004;I2=78%)。本研究的局限性是由于缺乏随机对照试验,本研究包括前瞻性和回顾性研究以及2个随机对照试验,这使得荟萃分析在证据来源上可能存在偏差。结论:与垂直腹部中线切口相比,LCR术后采用横向切口取标本似乎降低了IH发生率。
{"title":"Systematic review with meta-analysis of transverse <i>vs.</i> vertical midline extraction incisional hernia risk following laparoscopic colorectal resections.","authors":"Amiya Ahsan,&nbsp;Hussameldin M Nour,&nbsp;Dimitra V Peristeri,&nbsp;Sameh Abogabal,&nbsp;Christie Swaminathan,&nbsp;Muhammad S Sajid","doi":"10.21037/tgh-22-75","DOIUrl":"https://doi.org/10.21037/tgh-22-75","url":null,"abstract":"<p><strong>Background: </strong>The aim of this article is to explore the risk of incisional hernia (IH) occurrence at the site of specimen extraction following laparoscopic colorectal resection (LCR), highlighting the comparison between transverse incision versus midline vertical abdominal incision.</p><p><strong>Methods: </strong>Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases, EMBASE, MEDLINE, PubMed and Cochrane Library were performed to find all types of comparative studies reporting the incidence of IH at the specimen extraction site of transverse or vertical midline incision following LCR. The analysis of the pooled data was done using the RevMan statistical software.</p><p><strong>Results: </strong>Twenty-five comparative studies (including 2 randomised controlled trials) on 10,362 patients fulfilled the inclusion criteria. There were 4,944 patients in the transverse incision group and 5,418 patients in the vertical midline incision group. In the random effects model analysis, the use of transverse incision for specimen extraction following LCR reduced the risk of IH development (odds ratio =0.30, 95% CI: 0.19-0.49, Z=4.88, P=0.00001). However, there was significant heterogeneity (Tau<sup>2</sup>=0.97; Chi<sup>2</sup>=109.98, df=24, P=0.00004; I<sup>2</sup>=78%) among included studies. The limitation of the study is due to lack of RCTs, this study includes both prospective and retrospective studies along with 2 RCTs which makes the meta-analysis potentially biased in source of evidence.</p><p><strong>Conclusions: </strong>Transverse incision used for specimen extraction following LCR seems to reduce the risk of postoperative IH incidence compared to vertical midline abdominal incisions.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5b/c2/tgh-08-22-75.PMC10184032.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9841112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Artificial intelligence in colonoscopy: where have we been and where should we go? 结肠镜检查中的人工智能:我们已经走到了哪里,我们应该走到哪里?
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-23-25
Babu P Mohan, Douglas G Adler
© Translational Gastroenterology and Hepatology. All rights reserved. Transl Gastroenterol Hepatol 2023;8:23 | https://dx.doi.org/10.21037/tgh-23-25 The use of artificial intelligence (AI) in colonoscopy has gathered significant attention in recent years. Successful execution and publication of randomized trials have paved the way to Food and Drug Administration (FDA) approval of a handful of computer-vision based AI assistant tools in colonoscopy (1). However, it is yet to take a lead role as a helpful aid to the endoscopist on a day-today basis. Especially so in the private gastroenterology [gastrointestinal (GI)] practice setting where the majority of the population-based screening colonoscopies are performed (2). Although a good number of private practice settings in the US have tried some of the commercially available AI assistants in colonoscopy, most of them (to the best of our knowledge) have abandoned its ongoing use due to prolonged overall procedure time. A very important limitation in private GI practice. In fact, in a meta-analysis of six randomized controlled trials (RCTs) evaluating the use of real-time computer aided tools in colonoscopy, the withdrawal time was significantly greater in comparison to standard colonoscopy when AI was utilized (1). We should ensure that we all talk the same language when it comes to AI. AI encompasses every aspect of machine learning, where computer-based algorithms and softwares make tasks easier. A set of learning inputs are used to pre-train the system, and the system then generates outcome predictions on an unknown new data input. Computer vision is a branch of machine learning that is specific for identifying objects from an image or a video. Computer vision is the backbone of all ‘face-recognition’ technology, self-driving cars, and is also the concept that goes behind identifying polyps or pretty much anything of interest (like bleeding, or ulcers) in an image (whether it comes from a video capsule image, a colonoscopy image, or any endoscopy image). Convolutional neural networks (CNN) belong to deeplearning (a subset of machine learning) methods where the algorithms are connected by multiple arrays of ‘logisticregression’ connections or ‘nodes’. Only certain data detail at a specific numerical (to the decimal point in almost all cases) cut-off would get transmitted to the next level, so on and so forth to generate a final outcome, when all analyzed features of input data is broken up and evaluated through the CNN framework. With regards to colonoscopy and polyp detection, various terms have been used to describe the role of computer-aided systems, such as computer aided detection (CADe) and computer aided diagnosis (CADx). The difference in these terms is just the output parameter. Detection detects a polyp, whereas diagnosis characterizes the polyp (3). The machine learning algorithm is however agnostic to these terms. Randomized trials have, indeed, demonstrated better adenoma detection ra
{"title":"Artificial intelligence in colonoscopy: where have we been and where should we go?","authors":"Babu P Mohan,&nbsp;Douglas G Adler","doi":"10.21037/tgh-23-25","DOIUrl":"https://doi.org/10.21037/tgh-23-25","url":null,"abstract":"© Translational Gastroenterology and Hepatology. All rights reserved. Transl Gastroenterol Hepatol 2023;8:23 | https://dx.doi.org/10.21037/tgh-23-25 The use of artificial intelligence (AI) in colonoscopy has gathered significant attention in recent years. Successful execution and publication of randomized trials have paved the way to Food and Drug Administration (FDA) approval of a handful of computer-vision based AI assistant tools in colonoscopy (1). However, it is yet to take a lead role as a helpful aid to the endoscopist on a day-today basis. Especially so in the private gastroenterology [gastrointestinal (GI)] practice setting where the majority of the population-based screening colonoscopies are performed (2). Although a good number of private practice settings in the US have tried some of the commercially available AI assistants in colonoscopy, most of them (to the best of our knowledge) have abandoned its ongoing use due to prolonged overall procedure time. A very important limitation in private GI practice. In fact, in a meta-analysis of six randomized controlled trials (RCTs) evaluating the use of real-time computer aided tools in colonoscopy, the withdrawal time was significantly greater in comparison to standard colonoscopy when AI was utilized (1). We should ensure that we all talk the same language when it comes to AI. AI encompasses every aspect of machine learning, where computer-based algorithms and softwares make tasks easier. A set of learning inputs are used to pre-train the system, and the system then generates outcome predictions on an unknown new data input. Computer vision is a branch of machine learning that is specific for identifying objects from an image or a video. Computer vision is the backbone of all ‘face-recognition’ technology, self-driving cars, and is also the concept that goes behind identifying polyps or pretty much anything of interest (like bleeding, or ulcers) in an image (whether it comes from a video capsule image, a colonoscopy image, or any endoscopy image). Convolutional neural networks (CNN) belong to deeplearning (a subset of machine learning) methods where the algorithms are connected by multiple arrays of ‘logisticregression’ connections or ‘nodes’. Only certain data detail at a specific numerical (to the decimal point in almost all cases) cut-off would get transmitted to the next level, so on and so forth to generate a final outcome, when all analyzed features of input data is broken up and evaluated through the CNN framework. With regards to colonoscopy and polyp detection, various terms have been used to describe the role of computer-aided systems, such as computer aided detection (CADe) and computer aided diagnosis (CADx). The difference in these terms is just the output parameter. Detection detects a polyp, whereas diagnosis characterizes the polyp (3). The machine learning algorithm is however agnostic to these terms. Randomized trials have, indeed, demonstrated better adenoma detection ra","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/23/dd/tgh-08-23-25.PMC10432228.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10040379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endoscopic mucosal resection: tips and tricks for gastrointestinal trainees. 内镜下粘膜切除术:胃肠道学员的技巧。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-23-23
Tessa Herman, Bryant Megna, Kumar Pallav, Mohammad Bilal

Endoscopic mucosal resection (EMR) is a minimally invasive, specialized endoscopic technique that is useful in resecting superficial gastrointestinal lesions that are unable to be removed by standard polypectomy. This is typically accomplished using a submucosal injection that lifts the lesion away from the muscularis propria to allow for safe resection of the polyp, either via piecemeal or en bloc resection. Over the years, several techniques exist to perform EMR including conventional EMR or hot EMR, cold EMR and underwater EMR. Despite its established advantages and safety over conventional techniques such as surgery, the adoption of endoscopic resection (and thus the education and training of gastroenterology trainees) is lagging. The goal of this article is to offer a comprehensive review of the basic principles of colonic EMR. We review the concepts of optical diagnosis including the various polyp classification systems available to determine the polyp morphology and histology. We also discuss the technical aspects of performing colonic EMR. We also outline the common adverse events associated with EMR including bleeding, perforation, postpolypectomy syndrome, and residual or recurrent polyps, and discuss preventative measures that can be taken to mitigate adverse events. Lastly, we offer practical tips for trainees who want to undertake EMR in their clinical practice.

内镜下粘膜切除术(EMR)是一种微创、专门的内镜技术,可用于切除标准息肉切除术无法切除的浅表胃肠道病变。这通常是通过粘膜下注射来完成的,将病变从固有肌层上抬起,允许通过局部或整体切除安全切除息肉。多年来,已有几种EMR技术,包括常规EMR或热EMR、冷EMR和水下EMR。尽管内窥镜切除比手术等传统技术具有既定的优势和安全性,但其采用(以及对胃肠病学受训者的教育和培训)滞后。本文的目的是提供结肠电子病历的基本原则的全面审查。我们回顾了光学诊断的概念,包括各种可用于确定息肉形态和组织学的息肉分类系统。我们还讨论了结肠电子病历的技术方面。我们还概述了与EMR相关的常见不良事件,包括出血,穿孔,息肉切除术后综合征,残余或复发的息肉,并讨论了可以采取的预防措施,以减轻不良事件。最后,我们为希望在临床实践中从事电子病历的学员提供实用提示。
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引用次数: 0
EndoFLIP assessment of pyloric sphincter in children: a single-center experience. 儿童幽门括约肌内窥镜评估:单中心经验。
IF 3 4区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.21037/tgh-22-58
Mara Popescu, Emily White, Mohamed Mutalib

Background: Gastrointestinal complaints are common in children with neurodisabilities, vomiting, retching and poor feed tolerance are frequently reported. Endolumenal functional lumen imaging probe (EndoFLIP) is used to assess compliance and distensibility of the pylorus and can predict response to Botulinum Toxin in adult with gastroparesis. We aimed to review pyloric muscle measurements using EndoFLIP in children with neuromuscular disabilities and significant foregut symptoms and to assess the clinical response to intrapyloric Botulinum Toxin.

Methods: Retrospective review of clinical notes of all children who underwent pyloric EndoFLIP assessment in Evelina London Children's Hospital from March 2019 to January 2022. EndoFLIP catheter was inserted at the time of endoscopy via existing gastrostomy tract.

Results: A total of 335 measurement from 12 children were obtained, mean age 10.7±4.2 years. Measurements (pre and post Botox) were obtained with 20, 30 and 40 mL balloon volume. Diameter (6.5, 6.6), (7.8, 9.4) and (10.1, 11.2), compliance (92.3, 147.9), (89.7, 142.9) and (77, 85.4) mm3/mmHg, distensibility (2.6, 3.8), (2.7, 4.4) and (2.1, 3) mm2/mmHg and balloon pressure was (13.6, 9.6), (20.9, 16.2) and (42.3, 35) mmHg. Eleven children reported clinical symptom improvement after Botulinum Toxin injection. Balloon pressure was positively correlated to diameter (r=0.63, P<0.001).

Conclusions: Children with neurodisabilities who present with symptoms suggestive of poor gastric emptying do have a low pyloric distensibility and poor compliance. EndoFLIP via existing gastrostomy tract is quick and easy to perform. Intrapyloric Botulinum Toxin appears to be safe and effective in this cohort of children leading to clinical and measurements improvement.

背景:胃肠道主诉在神经障碍儿童中很常见,呕吐、干呕和食物耐受性差经常被报道。内镜功能管腔成像探针(EndoFLIP)用于评估幽门的顺应性和扩张性,并可预测成人胃轻瘫患者对肉毒杆菌毒素的反应。我们的目的是回顾使用EndoFLIP在患有神经肌肉残疾和明显前肠症状的儿童中进行幽门肌测量,并评估幽门内肉毒杆菌毒素的临床反应。方法:回顾性分析2019年3月至2022年1月在Evelina伦敦儿童医院接受幽门内窥镜检查的所有儿童的临床记录。EndoFLIP导管在内镜检查时通过现有胃造口道插入。结果:共获得12例患儿335次测量,平均年龄10.7±4.2岁。测量(肉毒杆菌注射前和注射后)用20ml、30ml和40ml球囊容积获得。直径(6.5,6.6),(7.8,9.4)和(10.1,11.2),顺应性(92.3,147.9),(89.7,142.9)和(77,85.4)mm3/mmHg,膨胀性(2.6,3.8),(2.7,4.4)和(2.1,3)mm2/mmHg,球囊压力为(13.6,9.6),(20.9,16.2)和(42.3,35)mmHg。11例儿童报告注射肉毒杆菌毒素后临床症状改善。球囊压力与球囊直径呈正相关(r=0.63, p)。结论:出现胃排空不良症状的神经功能障碍儿童幽门扩张度低,依从性差。EndoFLIP通过现有的胃造口道进行,快速简便。在这组儿童中,幽门内肉毒杆菌毒素似乎是安全有效的,导致临床和测量的改善。
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引用次数: 2
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Translational gastroenterology and hepatology
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