Techniques and Innovations in Gastrointestinal Endoscopy最新文献

英文中文

Traction-Assisted Endoscopic Submucosal Dissection of Colonic Lesions: A North American Experience

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2024.250900

Farid Abushamat, Fares Ayoub, Mai A. Khalaf, Tara Keihanian, Salmaan Jawaid, Mohamed O. Othman

BACKGROUND AND AIMS

Traction-assisted endoscopic submucosal dissection (TA-ESD) is a proposed technique to improve the efficiency of endoscopic submucosal dissection (ESD). Multiple studies primarily from Asian centers yielded mixed results in terms of procedure time, en bloc resection rate, and R0 resection rate of TA-ESD in comparison with those of conventional endoscopic submucosal dissection (C-ESD). We performed the first comparison of TA-ESD with C-ESD at a high-volume North American center.

METHODS

This was a retrospective cohort-matched study of all patients who underwent colonic ESD at a single center in the United States by a single operator. The study group were patients who underwent TA-ESD and were matched with a C-ESD case on a 1:1 basis based upon location within the colon, lesion size, and scope stabilization device usage. The baseline characteristics and procedure-related outcomes were compared between the groups.

RESULTS

In total, 138 colonic ESD cases were included (69 TA-ESD and 69 C-ESD). There were no significant differences in the baseline characteristics between the groups. Mean procedure time was 91.0 minutes (SD: 32.5) for TA-ESD and 85.4 minutes (SD: 39.3) for C-ESD (P = 0.36). En bloc resection was achieved in 69 (100%) of the TA-ESDs and 67 (97.1%) of the C-ESDs (P = 0.15). R0 resection was achieved in 52 (75.4%) of the TA-ESDs and 48 (69.6%) of the C-ESDs (P = 0.45).

CONCLUSION

We did not show a significant difference in procedure time, en bloc resection, R0 resection, or adverse events. Further randomized prospective studies that are sufficiently powered and stratified by operator experience level are needed to further elucidate the utility of the technique.

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引用次数: 0

Reopenable Clip-Over-the-Line Method for Troubleshooting Iatrogenic Gastrointestinal Perforations

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2024.250901

Takeshi Yasuda, Narutoshi Ando, Tamae Hashimoto, Yoshiaki Kanai, Yoichi Sakamoto, Yuki Endo, Tomohiro Soda, Takako Akazawa, Tsuguhiro Matsumoto, Norihito Yamauchi, Akira Muramatsu, Hiromu Kutsumi

引用次数: 0

Endoscopic Surveillance Patterns and Management of Helicobacter pylori in Newly Diagnosed Gastric Intestinal Metaplasia

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2024.250904

SHIVRAM CHANDRAMOULI , ANNIE L. WANG , DAVID A. LEIMAN

引用次数: 0

Real-Life Application of Artificial Intelligence for Automatic Characterization of Biliary Strictures: A Transatlantic Experience

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2024.250902

Mariano González-Haba Ruiz , Pedro Pereira , Jessica Widmer , Tiago Ribeiro , Belén Agudo Castillo , Filipe Vilas-Boas , João Ferreira , Miguel Mascarenhas Saraiva , Guilherme Macedo

引用次数: 0

Advanced Machine Learning Voice-Based Biomarkers for Characterization of Barrett's Esophagus

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2024.250903

AMRIT K. KAMBOJ , MANOJ K. YARLAGADDA , MAYO CLINIC BARRETT'S ESOPHAGUS AND VOICE WORKING GROUP , KEIKO ISHIKAWA , DIANA M. ORBELO , MARY PIETROWICZ , CADMAN L. LEGGETT

引用次数: 0

Endoscopic Repair for Sleeve Gastrectomy Leaks Is Associated With a High Rate of Leak Resolution 袖状胃切除术渗漏的内镜修复与高渗漏解决率有关

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-10-15 DOI: 10.1016/j.tige.2024.09.004

Khalid Fahoum , Tamara Kahan , Olivia Delau , Matthew Fasullo , Ki-Yoon Kim , Lauren Khanna , Gregory Haber , Paresh C. Shah , Tamas Gonda

BACKGROUND AND AIMS

Staple line leaks following sleeve gastrectomy have significant morbidity and mortality. Endoscopic repair approaches are increasingly being used and studied, but follow-up time is limited, and more data are needed. Our primary aim was to describe long-term outcomes following repair; secondary aims were to compare repair approaches and assess factors associated with clinical success.

METHODS

We conducted an observational cohort study of patients who underwent endoscopic repair of a sleeve gastrectomy leak from 2017 to 2023 at our tertiary care center. Patients without available follow-up were excluded. Electronic medical records were reviewed to obtain baseline and clinical characteristics; long-term outcomes were ascertained from the electronic medical record and telephonic conversations with patients. Repairs were classified as drainage when transmural stents were placed and as closure when clips, sutures, and/or an intraluminal stent was placed.

RESULTS

A total of 30 patients were included. The majority were females (77%) and Whites (74%), with a median age of 41.0 years (IQR, 35.1-51.8 years). The majority of patients (70%) initially underwent drainage, while the rest underwent closure. Median follow-up time was 1.2 years (IQR, 0.6 -1.6 years). Success rates for the initial repair approach without crossover or requiring surgical repair were 71.4% for drainage and 22.2% for closure (P = 0.02). Overall, 24 (80%) patients had leak resolution at the last follow-up, and the median number of endoscopies was 3 (IQR, 2-4).

CONCLUSION

Our study demonstrates a high rate of long-term leak resolution following endoscopic repair of sleeve gastrectomy leaks. An initial drainage approach may be associated with higher clinical success, although this was not noted in the multivariable analysis. Prospective randomized multicenter studies are needed to further evaluate and compare repair approaches.

背景和目的袖带胃切除术后绦虫线漏的发病率和死亡率都很高。内镜修复方法的使用和研究越来越多，但随访时间有限，需要更多数据。我们的主要目的是描述修复后的长期预后；次要目的是比较修复方法并评估与临床成功相关的因素。方法我们对 2017 年至 2023 年期间在我们的三级医疗中心接受内镜修复袖状胃切除术漏的患者进行了一项观察性队列研究。没有随访的患者被排除在外。研究人员查阅了电子病历，以获得基线和临床特征；通过电子病历和与患者的电话交谈确定了长期结果。放置经膜支架的修复分为引流修复，放置夹子、缝合线和/或腔内支架的修复分为闭合修复。大多数患者为女性（77%）和白人（74%），中位年龄为 41.0 岁（IQR，35.1-51.8 岁）。大多数患者（70%）最初接受了引流术，其余患者则接受了闭合术。中位随访时间为 1.2 年（IQR，0.6-1.6 年）。在没有交叉或需要手术修复的情况下，初始修复方法的成功率为：引流 71.4%，闭合 22.2%（P = 0.02）。结论：我们的研究表明，袖带胃切除术渗漏内镜修复后，长期渗漏解决率很高。最初的引流方法可能与临床成功率较高有关，但在多变量分析中并未注意到这一点。需要进行前瞻性随机多中心研究，以进一步评估和比较修复方法。

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引用次数: 0

The Endoscopic Role and Indications of Through-the-Scope Tack and Suture System for Gastrointestinal Closure 用于胃肠道缝合的镜下粘合剂和缝合系统的内窥镜作用和适应症

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-10-11 DOI: 10.1016/j.tige.2024.09.005

Andrew Canakis , Abdulhameed Al-Sabban , Shayan S. Irani

The development of endoscopic closure devices has revolutionized management options for gastrointestinal defects. The endoscopists’ toolbox has expanded from through-the-scope clips to over-the-scope clips and over-the-scope suturing. The over-the-scope devices are somewhat limited by the target location, maneuverability, and need for device withdrawal for application. The introduction of a novel through-the-scope helix tack suture system enhances the toolbox for defect closure as this device can provide closure throughout the gastrointestinal tract without the need for endoscope withdrawal. Its user-friendly design and compatibility with standard endoscopes allows for complex tissues approximation in challenging locations. Since its approval by the Federal Drug Agency in December 2020, studies have investigated its utility for all types of defects, including perforations, leaks, fistulas, endoscopic resections sites, and even stent fixation. In this review, we will investigate the versatility of this device to understand its role in primary defect closure.

内窥镜闭合装置的发展彻底改变了胃肠道缺损的治疗方案。内镜医师的工具箱从镜下夹扩大到镜上夹和镜下缝合。由于目标位置、可操作性和应用时需要拔出器械等原因，镜下器械在一定程度上受到了限制。新型镜下螺旋粘合缝合系统的引入增强了缺陷缝合的工具箱，因为这种装置可以在整个胃肠道内进行缝合，而无需撤出内窥镜。它的设计方便用户使用，并与标准内窥镜兼容，可在具有挑战性的位置对复杂组织进行近似缝合。自 2020 年 12 月获得联邦药品管理局批准以来，已有研究对其在各种类型的缺陷中的实用性进行了调查，包括穿孔、渗漏、瘘管、内镜切除部位，甚至支架固定。在这篇综述中，我们将研究这种装置的多功能性，以了解它在初级缺陷闭合中的作用。

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引用次数: 0

Endoscopic Transpapillary Gallbladder Drainage With 2 Stents Versus 1 Stent Reduces Reinterventions: A Multicenter Study 内镜下经乳头胆囊引流2个支架vs 1个支架减少再干预：一项多中心研究

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-10-11 DOI: 10.1016/j.tige.2024.09.006

James D. Haddad , Natalie Wilson , Vijay S. Are , Shawn L. Shah , Danny Issa , Tarek Sawas , Mohammad Bilal , Thomas Tielleman

BACKGROUND AND AIMS

Endoscopic transpapillary gallbladder drainage (ETGBD) is a therapeutic option for gallstone-related gallbladder disease in nonsurgical candidates. However, the optimal stenting strategy and follow-up has not been established. We aimed to determine whether there was a decreased need for unplanned reintervention in patients undergoing placement of two transpapillary gallbladder stents compared with that in those undergoing placement of one stent.

METHODS

We performed a multicenter retrospective analysis of patients undergoing ETGBD between June 2013 and October 2022. The primary outcome was clinical success as defined by resolution of symptoms without the need for another drainage strategy. Secondary outcomes included the adverse events of postendoscopic retrograde cholangiopancreatography pancreatitis, cholangitis, bleeding, perforation, or death. Factors associated with placement of two stents, unplanned reintervention, and adverse events were assessed.

RESULTS

We included 75 patients who underwent ETGBD, with a median follow-up of 407 days (IQR: 71-1504 days). Technical and clinical success were 88.2% and 81.3%, respectively. Unplanned reintervention was significantly lower in the double stenting group (0% vs 25.4%; P = 0.02). Use of a 7 French stent (odds ratio [OR]: 15.5; 95% CI: 1.9-125; P = 0.01) and presence of a percutaneous cholecystostomy tube (OR: 10.8; 95% CI: 2.8-41.3; P = 0.001) were associated with placement of two stents. There was no significant difference in adverse events between groups (OR: 0.9; 95% CI: 0.09-8.8; P = 0.94).

CONCLUSION

ETGBD is safe and effective in nonoperative candidates. Single transpapillary gallbladder stenting is associated with more unplanned reinterventions, and 7 French stent diameter and previous percutaneous cholecystostomy tube may be associated with ability to place a second stent. Endoscopists should consider planned exchange of solitary transpapillary gallbladder stents or interval placement of a second stent if placement of two stents was unsuccessful at the index procedure.

背景和目的：内镜下经乳头胆囊引流术（ETGBD）是非手术候选人胆结石相关胆囊疾病的一种治疗选择。然而，最佳支架置入策略和随访尚未确定。我们的目的是确定与放置一个支架的患者相比，放置两个经乳头胆囊支架的患者是否需要减少计划外的再干预。方法：我们对2013年6月至2022年10月期间接受ETGBD的患者进行了多中心回顾性分析。主要结局是临床成功，定义为症状的解决，而不需要另一个引流策略。次要结局包括内镜下逆行胆管造影术后胰腺炎、胆管炎、出血、穿孔或死亡等不良事件。评估与放置两个支架、计划外再干预和不良事件相关的因素。结果我们纳入了75例ETGBD患者，中位随访时间为407天（IQR: 71-1504天）。技术和临床成功率分别为88.2%和81.3%。双支架组的意外再干预率显著降低(0% vs 25.4%；P = 0.02)。使用7 French支架(优势比[OR]: 15.5；95% ci: 1.9-125；P = 0.01)和存在经皮胆囊造瘘管(OR: 10.8；95% ci: 2.8 ~ 41.3；P = 0.001)与放置两个支架相关。两组间不良事件发生率无显著差异(OR: 0.9；95% ci: 0.09-8.8；P = 0.94)。结论etgbd在非手术患者中是安全有效的。单次经乳头胆囊支架植入与更多的意外再介入有关，7 French支架直径和既往经皮胆囊造瘘管可能与放置第二次支架的能力有关。内窥镜医师应考虑计划更换单独的经乳头胆囊支架或间隔放置第二个支架，如果两个支架在索引手术中放置不成功。

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引用次数: 0

Pancreatic Cancer Screening: A Narrative Review 胰腺癌筛查：叙述性综述

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.08.001

Jihane Meziani, Gwenny M. Fuhler, Marco J. Bruno, Djuna L. Cahen, Kasper A. Overbeek

Pancreatic cancer (PC) is one of the most lethal cancer types. Despite advancements that have led to some modest improvements in survival rates over the past decade, PC still has a dismal prognosis. Patients diagnosed with early-stage disease have higher survival rates. Unfortunately, PC seldom manifests itself early, and symptoms prompting diagnostic investigations usually develop when the disease is already advanced. PC screening may lead to better patient outcomes through detection of asymptomatic early-stage cancers and precursor lesions. Population-based screening is deemed unfeasible because of the low incidence of PC. However, screening of individuals with an inherited lifetime risk of ≥5%-10% for developing PC may prove beneficial. In the context of high-risk individuals, screening is referred to as surveillance. Yet, critical aspects such as suitable candidates for surveillance, the ideal time to initiate and discontinue surveillance, as well as the most effective surveillance method, preferred surveillance modalities, and optimal surveillance interval remain unclear. Herein, we summarize the current state of knowledge regarding PC surveillance by reviewing current expert consensus statements and guidelines. In addition, we review the management of identified lesions, the yield in different cohorts, and future directions to improve the outcomes of individuals at high-risk of developing PC.

胰腺癌（PC）是致死率最高的癌症类型之一。尽管在过去十年中取得了一些进展，使存活率略有提高，但胰腺癌的预后仍然不容乐观。早期诊断的患者生存率更高。不幸的是，PC 很少在早期出现，通常在疾病晚期才会出现促使诊断检查的症状。PC 筛查可通过检测无症状的早期癌症和前驱病变，为患者带来更好的治疗效果。由于 PC 发病率较低，基于人群的筛查被认为是不可行的。不过，对终生遗传性 PC 风险≥5%-10% 的个体进行筛查可能会证明是有益的。在高危人群中，筛查被称为监测。然而，监测的合适人选、启动和终止监测的理想时间、最有效的监测方法、首选监测模式和最佳监测间隔等关键问题仍不明确。在此，我们通过回顾当前的专家共识声明和指南，总结了有关 PC 监测的知识现状。此外，我们还回顾了对已发现病变的管理、不同队列的收益以及改善 PC 高危人群预后的未来方向。

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引用次数: 0

Reducing the Carbon Footprint of Colorectal Cancer Screening 减少大肠癌筛查的碳足迹

IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.03.006

Swapna Gayam , Aasma Shaukat

Climate change is the largest public health threat of the 21st century. Gastrointestinal endoscopy is the second overall waste generator and third highest hazardous waste generator in a hospital setting, making it essential for all gastroenterologists to reexamine their practices to reduce this negative impact. Colorectal cancer (CRC) is a major contributor to the gastrointestinal disease burden, and CRC screening is a vital component of age-appropriate cancer screening in the United States. Along the spectrum of colon cancer screening methods, considerations regarding their environmental impact are gaining prominence. Consequently, focusing mitigation strategies on CRC screening is justified. Mitigation strategies focused on CRC screening are likely to have a measurable impact on reducing the environmental impact of endoscopy, given the stark volume of procedures performed in the United States. In this paper, we review the different CRC screening options and strategies to reduce the environmental impact of these processes.

气候变化是 21 世纪最大的公共卫生威胁。在医院环境中，消化道内窥镜检查是第二大废物产生者和第三大有害废物产生者，因此所有消化内科医生都必须重新审视自己的工作，以减少这种负面影响。结肠直肠癌（CRC）是造成胃肠道疾病负担的主要因素，在美国，CRC 筛查是适龄癌症筛查的重要组成部分。在各种结肠癌筛查方法中，对其环境影响的考虑日益突出。因此，将缓解策略的重点放在 CRC 筛查上是合理的。鉴于美国内镜检查的数量巨大，以 CRC 筛查为重点的缓解策略很可能会对减少内镜检查对环境的影响产生可衡量的影响。在本文中，我们回顾了不同的 CRC 筛查方案以及减少这些过程对环境影响的策略。

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