Pub Date : 2026-01-01DOI: 10.1016/j.tige.2025.250955
Tomasz Klimczak , Wojciech Ciesielski , Bartłomiej Gostyński , Mar Ríos Gutiérrez , Anton Osnytskyy , Dominik Przychodniak , Alina Yanushkevich , Adam Durczyński , Janusz Strzelczyk , Piotr Hogendorf
BACKGROUND AND AIMS
Managing proton pump inhibitor (PPI)–resistant gastroesophageal reflux disease (GERD) remains challenging, with limited nonsurgical treatment options. A sequential approach using antireflux mucosectomy (ARMS) followed by repeat antireflux mucosal ablation (reARMA) has emerged as a promising strategy for patients unresponsive to initial intervention.
METHODS
We conducted a retrospective study of 36 patients with PPI-refractory GERD who underwent endoscopic ARMS. Patients with persistent symptoms after ARMS were considered for reARMA. Symptom severity was assessed using the Frequency Scale for the Symptoms of GERD, GERD-Health Related Quality of Life scores, acid exposure time, and DeMeester scores.
RESULTS
ARMS alone achieved clinical success in 25 patients (69%), with significant reductions in symptom scores, including the Frequency Scale for the Symptoms of GERD (mean reduction from 14 to 6.17; P < 0.001) and GERD-Health Related Quality of Life (P < 0.001). Among 11 patients with persistent symptoms, reARMA led to therapeutic success in 8 cases (73%), with similar significant improvements in all assessed metrics (P < 0.001). No major perioperative or postoperative complications were observed.
CONCLUSION
The sequential ARMS-reARMA protocol offers a minimally invasive and effective strategy for managing PPI-resistant GERD. reARMA serves as a valuable second-line endoscopic option, potentially reducing the need for surgical intervention. Further studies are warranted to validate these findings, optimize patient selection, and assess long-term outcomes.
{"title":"Sequential Endoscopic Antireflux Mucosectomy–Repeat Antireflux Mucosal Ablation Approach: A New Paradigm in Managing Refractory Gastroesophageal Reflux Disease Symptoms?","authors":"Tomasz Klimczak , Wojciech Ciesielski , Bartłomiej Gostyński , Mar Ríos Gutiérrez , Anton Osnytskyy , Dominik Przychodniak , Alina Yanushkevich , Adam Durczyński , Janusz Strzelczyk , Piotr Hogendorf","doi":"10.1016/j.tige.2025.250955","DOIUrl":"10.1016/j.tige.2025.250955","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Managing proton pump inhibitor (PPI)–resistant gastroesophageal reflux disease (GERD) remains challenging, with limited nonsurgical treatment options. A sequential approach using antireflux mucosectomy (ARMS) followed by repeat antireflux mucosal ablation (reARMA) has emerged as a promising strategy for patients unresponsive to initial intervention.</div></div><div><h3>METHODS</h3><div>We conducted a retrospective study of 36 patients with PPI-refractory GERD who underwent endoscopic ARMS. Patients with persistent symptoms after ARMS were considered for reARMA. Symptom severity was assessed using the Frequency Scale for the Symptoms of GERD, GERD-Health Related Quality of Life scores, acid exposure time, and DeMeester scores.</div></div><div><h3>RESULTS</h3><div>ARMS alone achieved clinical success in 25 patients (69%), with significant reductions in symptom scores, including the Frequency Scale for the Symptoms of GERD (mean reduction from 14 to 6.17; <em>P</em> < 0.001) and GERD-Health Related Quality of Life (<em>P</em> < 0.001). Among 11 patients with persistent symptoms, reARMA led to therapeutic success in 8 cases (73%), with similar significant improvements in all assessed metrics (<em>P</em> < 0.001). No major perioperative or postoperative complications were observed.</div></div><div><h3>CONCLUSION</h3><div>The sequential ARMS-reARMA protocol offers a minimally invasive and effective strategy for managing PPI-resistant GERD. reARMA serves as a valuable second-line endoscopic option, potentially reducing the need for surgical intervention. Further studies are warranted to validate these findings, optimize patient selection, and assess long-term outcomes.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 2","pages":"Article 250955"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.tige.2025.250958
Dennis Yang , Maham Hayat , Peter V. Draganov
The field of advanced endoscopy is rapidly evolving, driven by technological advancements and the growing demand for complex therapeutic procedures. One-year advanced endoscopy fellowship programs were originally established to address the increasing complexity of these procedures, supplementing the limited exposure provided during standard gastroenterology training. However, challenges remain in defining and assessing competency in these technically and cognitively demanding procedures, inculcating innovative curriculum changes to accommodate emerging techniques while striving to maintain high standards in most common advanced endoscopy procedures. As the field continues to expand, and more novel procedures are being performed standardizing training, competency assessment, and credentialing processes is increasingly important. This review explores the evolving landscape of advanced endoscopy training, highlighting existing gaps and discussing strategies to enhance education, assessment, and credentialing to ensure high-quality, standardized training for future interventional endoscopists.
{"title":"Training in Advanced Endoscopy: Current Methods, Challenges, and Emerging Innovations","authors":"Dennis Yang , Maham Hayat , Peter V. Draganov","doi":"10.1016/j.tige.2025.250958","DOIUrl":"10.1016/j.tige.2025.250958","url":null,"abstract":"<div><div>The field of advanced endoscopy is rapidly evolving, driven by technological advancements and the growing demand for complex therapeutic procedures. One-year advanced endoscopy fellowship programs were originally established to address the increasing complexity of these procedures, supplementing the limited exposure provided during standard gastroenterology training. However, challenges remain in defining and assessing competency in these technically and cognitively demanding procedures, inculcating innovative curriculum changes to accommodate emerging techniques while striving to maintain high standards in most common advanced endoscopy procedures. As the field continues to expand, and more novel procedures are being performed standardizing training, competency assessment, and credentialing processes is increasingly important. This review explores the evolving landscape of advanced endoscopy training, highlighting existing gaps and discussing strategies to enhance education, assessment, and credentialing to ensure high-quality, standardized training for future interventional endoscopists.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 2","pages":"Article 250958"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.tige.2025.250962
Parth Aphale, Himanshu Shekhar, Shashank Dokania
{"title":"Re-evaluating the “Practical Randomized Trial” of Needle-Knife Fistulotomy: The Need for Broader Contextualization and Objective Performance Metrics","authors":"Parth Aphale, Himanshu Shekhar, Shashank Dokania","doi":"10.1016/j.tige.2025.250962","DOIUrl":"10.1016/j.tige.2025.250962","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 2","pages":"Article 250962"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.tige.2025.250956
Bryn D. Koehler , Wei Chen , Ashwini K. Esnakula , Wendy L. Frankel , Ahmed Abdelbaki , Stacey Culp , Ziwei Li , Wei-Lun Chao , Phil A. Hart , Timothy M. Pawlik , Zarine K. Shah , Somashekar G. Krishna
Background and Aims
Nongastric subtypes of branch duct (BD)-intraductal papillary mucinous neoplasms (IPMNs) are associated with high-grade dysplasia/invasive adenocarcinoma (HGD/IC) and disease progression. We evaluated preoperative prediction of gastric vs nongastric BD-IPMN subtypes and assessed a needle-based confocal laser endomicroscopy–guided artificial intelligence (nCLE-AI) algorithm for detecting HGD/IC in pathologist-reclassified BD-IPMNs.
METHODS
Participants with resected BD-IPMNs were enrolled from prospective studies (2015-2024). Phase 1: lesions were reclassified by subtype and dysplasia grade through blinded pathologist review, with discordant cases receiving mucin immunostaining and consensus review. Phase 2: using this reclassified pathology data, preoperative clinical and morphological features were analyzed to predict BD-IPMN subtypes. Phase 3: nCLE-AI performance in detecting HGD/IC within reclassified gastric and nongastric BD-IPMNs was evaluated using preoperative endomicroscopy videos.
RESULTS
Among 63 resected BD-IPMNs (mean diameter, 35.0 ± 10.1 mm), 38% were classified as HGD/IC. Phase 1: the interobserver agreement among pathologists for subtype classification was moderate (k = 0.52; 95% CI, 0.27-0.77). Phase 2: multivariable analysis of preoperative variables revealed that Kyoto high-risk stigmata (adjusted odds ratio [aOR], 11.568; p = 0.007), unifocal lesions (aOR, 8.354; p = 0.041), and lower body mass index (aOR, 1.37; p = 0.04) predicted nongastric subtype. Phase 3: the nCLE-AI algorithm using presurgical endomicroscopy imaging showed comparable sensitivity for detecting HGD/IC in nongastric and gastric IPMN subtypes (83% vs 82%; p = 0.92), but significantly higher specificity (100% vs 44%; p = 0.06) and accuracy (87% vs 53%; p < 0.02) in the nongastric subtype.
CONCLUSION
Moderate interobserver variability in BD-IPMN subtype classification among pathologists highlights the need for immunohistochemistry and consensus review in challenging cases. Preoperative clinical variables can predict the nongastric subtype, which is associated with a less favorable prognosis. nCLE-AI shows improved performance in detecting HGD/IC in nongastric BD-IPMNs, where accurate risk stratification is particularly important due to the higher risk of progression.
{"title":"Preoperative Prediction of Subtype and Artificial Intelligence–Driven Endomicroscopy Detection of Advanced Neoplasia in Intraductal Papillary Mucinous Neoplasms","authors":"Bryn D. Koehler , Wei Chen , Ashwini K. Esnakula , Wendy L. Frankel , Ahmed Abdelbaki , Stacey Culp , Ziwei Li , Wei-Lun Chao , Phil A. Hart , Timothy M. Pawlik , Zarine K. Shah , Somashekar G. Krishna","doi":"10.1016/j.tige.2025.250956","DOIUrl":"10.1016/j.tige.2025.250956","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Nongastric subtypes of branch duct (BD)-intraductal papillary mucinous neoplasms (IPMNs) are associated with high-grade dysplasia/invasive adenocarcinoma (HGD/IC) and disease progression. We evaluated preoperative prediction of gastric vs nongastric BD-IPMN subtypes and assessed a needle-based confocal laser endomicroscopy–guided artificial intelligence (nCLE-AI) algorithm for detecting HGD/IC in pathologist-reclassified BD-IPMNs.</div></div><div><h3>METHODS</h3><div>Participants with resected BD-IPMNs were enrolled from prospective studies (2015-2024). Phase 1: lesions were reclassified by subtype and dysplasia grade through blinded pathologist review, with discordant cases receiving mucin immunostaining and consensus review. Phase 2: using this reclassified pathology data, preoperative clinical and morphological features were analyzed to predict BD-IPMN subtypes. Phase 3: nCLE-AI performance in detecting HGD/IC within reclassified gastric and nongastric BD-IPMNs was evaluated using preoperative endomicroscopy videos.</div></div><div><h3>RESULTS</h3><div>Among 63 resected BD-IPMNs (mean diameter, 35.0 ± 10.1 mm), 38% were classified as HGD/IC. Phase 1: the interobserver agreement among pathologists for subtype classification was moderate (k = 0.52; 95% CI, 0.27-0.77). Phase 2: multivariable analysis of preoperative variables revealed that Kyoto high-risk stigmata (adjusted odds ratio [aOR], 11.568; <em>p</em> = 0.007), unifocal lesions (aOR, 8.354; <em>p</em> = 0.041), and lower body mass index (aOR, 1.37; <em>p</em> = 0.04) predicted nongastric subtype. Phase 3: the nCLE-AI algorithm using presurgical endomicroscopy imaging showed comparable sensitivity for detecting HGD/IC in nongastric and gastric IPMN subtypes (83% vs 82%; <em>p</em> = 0.92), but significantly higher specificity (100% vs 44%; <em>p</em> = 0.06) and accuracy (87% vs 53%; <em>p</em> < 0.02) in the nongastric subtype.</div></div><div><h3>CONCLUSION</h3><div>Moderate interobserver variability in BD-IPMN subtype classification among pathologists highlights the need for immunohistochemistry and consensus review in challenging cases. Preoperative clinical variables can predict the nongastric subtype, which is associated with a less favorable prognosis. nCLE-AI shows improved performance in detecting HGD/IC in nongastric BD-IPMNs, where accurate risk stratification is particularly important due to the higher risk of progression.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 2","pages":"Article 250956"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145876251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.tige.2025.250960
Trent J. Walradt, Hiroyuki Aihara
{"title":"Preface: Colorectal Endoscopic Submucosal Dissection in the West: Charting the Roadmap for Safe, Effective, and Widespread Adoption","authors":"Trent J. Walradt, Hiroyuki Aihara","doi":"10.1016/j.tige.2025.250960","DOIUrl":"10.1016/j.tige.2025.250960","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 2","pages":"Article 250960"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.tige.2025.250959
Pranav Prabhala , Gordon P. Bensen , Timothy B. Gardner
BACKGROUND AND AIMS
The rate of pancreatic cyst-related malignant transformation to pancreatic ductal adenocarcinoma (PDAC) is unknown, resulting in intensive surveillance and resection strategies often leading to overdiagnosis, unnecessary intervention, and financial strain on both the patient and health system. This study aimed to determine how frequently biopsy-proven PDAC arises from pancreatic cysts, thereby helping establish the true prevalence of cyst-related pancreatic cancer (CR-PC).
METHODS
We identified consecutive patients with biopsy-proven PDAC from 2013 to 2023 who presented to our multidisciplinary pancreas tumor clinic. All cross-sectional imaging and endoscopic ultrasound examinations were evaluated for the presence of pancreatic cysts, and fine needle aspiration and/or operative pathology specimens were evaluated for the presence of intraductal mucin and pancreatic cystic lesions; cumulatively, all of these were deemed cyst-related risk factors for PDAC. Patients were classified as definitive, probable, possible or non–CR-PC based on standardized a priori definitions.
RESULTS
A total of 824 patients with PDAC were evaluated. Of these,186 (22.6%) had cyst-related risk factors, with 72 patients (38.7%) undergoing operative resection. Of those with cyst-related risk factors, 31 (3.8%) had definitive CR-PC, 22 (2.7%) had probable CR-PC, 26 (3.2%) had possible CR-PC, and 107 (13%) had non–CR-PC. Thus, of a total of 824 PDAC patients, 79 (9.6%) had either definitive, probable, or possible CR-PC.
CONCLUSION
In patients with biopsy-proven PDAC, the rate of definitive, probable, or possible CR-PC is <10%, suggesting that current cyst surveillance guidelines should be reconsidered.
{"title":"Cystic Lesions and the Risk of Pancreatic Adenocarcinoma","authors":"Pranav Prabhala , Gordon P. Bensen , Timothy B. Gardner","doi":"10.1016/j.tige.2025.250959","DOIUrl":"10.1016/j.tige.2025.250959","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>The rate of pancreatic cyst-related malignant transformation to pancreatic ductal adenocarcinoma (PDAC) is unknown, resulting in intensive surveillance and resection strategies often leading to overdiagnosis, unnecessary intervention, and financial strain on both the patient and health system. This study aimed to determine how frequently biopsy-proven PDAC arises from pancreatic cysts, thereby helping establish the true prevalence of cyst-related pancreatic cancer (CR-PC).</div></div><div><h3>METHODS</h3><div>We identified consecutive patients with biopsy-proven PDAC from 2013 to 2023 who presented to our multidisciplinary pancreas tumor clinic. All cross-sectional imaging and endoscopic ultrasound examinations were evaluated for the presence of pancreatic cysts, and fine needle aspiration and/or operative pathology specimens were evaluated for the presence of intraductal mucin and pancreatic cystic lesions; cumulatively, all of these were deemed cyst-related risk factors for PDAC. Patients were classified as definitive, probable, possible or non–CR-PC based on standardized a priori definitions.</div></div><div><h3>RESULTS</h3><div>A total of 824 patients with PDAC were evaluated. Of these,186 (22.6%) had cyst-related risk factors, with 72 patients (38.7%) undergoing operative resection. Of those with cyst-related risk factors, 31 (3.8%) had definitive CR-PC, 22 (2.7%) had probable CR-PC, 26 (3.2%) had possible CR-PC, and 107 (13%) had non–CR-PC. Thus, of a total of 824 PDAC patients, 79 (9.6%) had either definitive, probable, or possible CR-PC.</div></div><div><h3>CONCLUSION</h3><div>In patients with biopsy-proven PDAC, the rate of definitive, probable, or possible CR-PC is <10%, suggesting that current cyst surveillance guidelines should be reconsidered.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 2","pages":"Article 250959"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145876250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/S2590-0307(25)00058-3
{"title":"Cover","authors":"","doi":"10.1016/S2590-0307(25)00058-3","DOIUrl":"10.1016/S2590-0307(25)00058-3","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 1","pages":"Article 250963"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-07DOI: 10.1016/j.tige.2025.250954
Fazia Khattak , Debvarsha Mandal , Ashesh Das , Shriya D. Tayade , Sailesh I.S. Kumar , Sumaiya Mehveen , Ritwik Roy , Krupa Patel , Umair Hayat , Emma M. Sam
BACKGROUND AND AIMS
Selective biliary cannulation is one of the most crucial steps in endoscopic retrograde cholangiopancreatography (ERCP), and the standard transpapillary cannulation (STC) technique carries a risk of post-ERCP pancreatitis (PEP). Primary needle-knife fistulotomy (PNF) has been recently shown as a safer alternative technique to reduce PEP by avoiding papillary trauma to the pancreatic orifice. A prior meta-analysis suggested a trend toward lower PEP incidence with PNF without a significant difference in overall cannulation success. This systematic review and meta-analysis, including only randomized controlled trials, incorporates recent data to show the efficacy and safety of PNF compared with STC.
METHODS
A systematic search of PubMed, Embase, Scopus, and the Cochrane Library identified randomized controlled trials comparing PNF with STC for ERCP through March 2025. Data were analyzed using Review Manager 5.4. Pooled risk ratios (RRs) with 95% CIs were calculated using the Mantel-Haenszel test. Fixed- or random-effects models were used based on heterogeneity (I2). Statistical significance was set at P < 0.05. Risk of bias was assessed using the Cochrane risk of bias tool 2.0. This review is registered with the International Prospective Register of Systematic Reviews (CRD420251051410).
RESULTS
PNF was associated with a significantly lower risk of PEP compared with standard cannulation (RR, 0.30; 95% CI, 0.14-0.63; absolute risk difference, 4.5%; 95% CI, 2.0%-7.0%; number needed to treat = 23). This corresponded to a 70% relative risk reduction in pancreatitis with PNF as the initial technique and minimal I2 (I² = 10%). Biliary cannulation success rates were comparable (risk difference, 0.07; 95% CI, −0.01 to 0.15; P = 0.09) with substantial I2 (I² = 77%). Rates of procedure-related complications, such as cholangitis, bleeding, and perforation, were not significantly different (RR, 1.01; 95% CI, 0.41-2.51; P = 0.98).
CONCLUSION
This meta-analysis provides robust evidence that PNF significantly reduces the risk of PEP compared with standard cannulation without increasing the risk of other adverse events.
{"title":"Primary Needle-Knife Fistulotomy Reduces Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis—A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Fazia Khattak , Debvarsha Mandal , Ashesh Das , Shriya D. Tayade , Sailesh I.S. Kumar , Sumaiya Mehveen , Ritwik Roy , Krupa Patel , Umair Hayat , Emma M. Sam","doi":"10.1016/j.tige.2025.250954","DOIUrl":"10.1016/j.tige.2025.250954","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Selective biliary cannulation is one of the most crucial steps in endoscopic retrograde cholangiopancreatography (ERCP), and the standard transpapillary cannulation (STC) technique carries a risk of post-ERCP pancreatitis (PEP). Primary needle-knife fistulotomy (PNF) has been recently shown as a safer alternative technique to reduce PEP by avoiding papillary trauma to the pancreatic orifice. A prior meta-analysis suggested a trend toward lower PEP incidence with PNF without a significant difference in overall cannulation success. This systematic review and meta-analysis, including only randomized controlled trials, incorporates recent data to show the efficacy and safety of PNF compared with STC.</div></div><div><h3>METHODS</h3><div>A systematic search of PubMed, Embase, Scopus, and the Cochrane Library identified randomized controlled trials comparing PNF with STC for ERCP through March 2025. Data were analyzed using Review Manager 5.4. Pooled risk ratios (RRs) with 95% CIs were calculated using the Mantel-Haenszel test. Fixed- or random-effects models were used based on heterogeneity (I<sup>2</sup>). Statistical significance was set at <em>P</em> < 0.05. Risk of bias was assessed using the Cochrane risk of bias tool 2.0. This review is registered with the International Prospective Register of Systematic Reviews (CRD420251051410).</div></div><div><h3>RESULTS</h3><div>PNF was associated with a significantly lower risk of PEP compared with standard cannulation (RR, 0.30; 95% CI, 0.14-0.63; absolute risk difference, 4.5%; 95% CI, 2.0%-7.0%; number needed to treat = 23). This corresponded to a 70% relative risk reduction in pancreatitis with PNF as the initial technique and minimal I<sup>2</sup> (I² = 10%). Biliary cannulation success rates were comparable (risk difference, 0.07; 95% CI, −0.01 to 0.15; <em>P</em> = 0.09) with substantial I<sup>2</sup> (I² = 77%). Rates of procedure-related complications, such as cholangitis, bleeding, and perforation, were not significantly different (RR, 1.01; 95% CI, 0.41-2.51; <em>P</em> = 0.98).</div></div><div><h3>CONCLUSION</h3><div>This meta-analysis provides robust evidence that PNF significantly reduces the risk of PEP compared with standard cannulation without increasing the risk of other adverse events.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 1","pages":"Article 250954"},"PeriodicalIF":0.9,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145796648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-11DOI: 10.1016/j.tige.2025.250952
Khalid Ahmed , Ahmed Dirweesh , Zachary D. Leslie , Yasmin Ali , Nabeel Azeem , Eric Wise , Cyrus Jahansouz , Martin Freeman , Stuart K. Amateau
BACKGROUND AND AIMS
Right-sided malignant colonic obstruction frequently requires emergent intervention and is associated with high perioperative morbidity and mortality. Self-expanding metallic stents (SEMSs) have been extensively studied in left-sided disease, but their role in right-sided obstruction remains poorly defined. Our aim was to evaluate nationwide trends, patient characteristics, and outcomes associated with SEMS use in right-sided malignant colonic obstruction.
METHODS
Using the Nationwide Readmissions Database (2016-2022), we identified patients with right-sided malignant colonic obstruction. Patients were stratified by SEMS placement. Weighted univariate and multivariable logistic regression analyses were used to compare demographics, hospital characteristics, and 90-day postoperative outcomes.
RESULTS
Among 24,146 patients, only 251 (1.0%) underwent SEMS placement. SEMS-treated patients were more likely to be in-state residents (95.0% vs 89.6%), from large metropolitan areas (70.5% vs 53.4%), and from higher-income quartiles (31.0% vs 22.3%; all P < 0.01). SEMS placement was associated with significantly lower stoma rates (<4.0% vs 9.1%; P < 0.01) and higher rates of deep vein thrombosis (8.0% vs 3.8%; P < 0.01). Multivariable analysis showed that SEMS reduced need for stoma (adjusted odds ratio, 0.19; 95% CI, 0.07-0.50), while metastatic disease increased stoma risk (adjusted odds ratio, 2.36; 95% CI, 2.12-2.63).
CONCLUSIONS
SEMS use in right-sided malignant obstruction was associated with a significantly lower need for stoma formation and comparable short-term outcomes. Despite potential benefits, utilization remains low. Further prospective studies are warranted to better define patient selection criteria and long-term oncologic outcomes.
背景和目的右侧恶性结肠梗阻经常需要紧急干预，并且与高围手术期发病率和死亡率相关。自膨胀金属支架（SEMSs）在左侧疾病中的应用已被广泛研究，但其在右侧梗阻中的作用仍不明确。我们的目的是评估全国范围内与SEMS治疗右侧恶性结肠梗阻相关的趋势、患者特征和结果。方法使用全国再入院数据库（2016-2022），我们确定了右侧恶性结肠梗阻患者。患者按SEMS放置分层。加权单变量和多变量logistic回归分析用于比较人口统计学、医院特征和90天术后结果。结果24146例患者中，只有251例（1.0%）接受了SEMS安置。接受sems治疗的患者更可能是州内居民（95.0%对89.6%），来自大城市地区（70.5%对53.4%），以及来自高收入四分位数（31.0%对22.3%；所有P <； 0.01）。SEMS放置与较低的造瘘率（4.0% vs 9.1%; P < 0.01）和较高的深静脉血栓形成率（8.0% vs 3.8%; P < 0.01）相关。多变量分析显示，SEMS减少了对造口术的需求（校正优势比为0.19；95% CI为0.07-0.50），而转移性疾病增加了造口术的风险（校正优势比为2.36；95% CI为2.12-2.63）。结论：ssems用于右侧恶性梗阻的造口需求明显降低，短期疗效相当。尽管有潜在的好处，但利用率仍然很低。进一步的前瞻性研究是必要的，以更好地确定患者选择标准和长期肿瘤预后。
{"title":"Nationwide Analysis of Right-Sided Colonic Stenting: Rarely Used but Reduces Stoma Creation Significantly","authors":"Khalid Ahmed , Ahmed Dirweesh , Zachary D. Leslie , Yasmin Ali , Nabeel Azeem , Eric Wise , Cyrus Jahansouz , Martin Freeman , Stuart K. Amateau","doi":"10.1016/j.tige.2025.250952","DOIUrl":"10.1016/j.tige.2025.250952","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Right-sided malignant colonic obstruction frequently requires emergent intervention and is associated with high perioperative morbidity and mortality. Self-expanding metallic stents (SEMSs) have been extensively studied in left-sided disease, but their role in right-sided obstruction remains poorly defined. Our aim was to evaluate nationwide trends, patient characteristics, and outcomes associated with SEMS use in right-sided malignant colonic obstruction.</div></div><div><h3>METHODS</h3><div>Using the Nationwide Readmissions Database (2016-2022), we identified patients with right-sided malignant colonic obstruction. Patients were stratified by SEMS placement. Weighted univariate and multivariable logistic regression analyses were used to compare demographics, hospital characteristics, and 90-day postoperative outcomes.</div></div><div><h3>RESULTS</h3><div>Among 24,146 patients, only 251 (1.0%) underwent SEMS placement. SEMS-treated patients were more likely to be in-state residents (95.0% vs 89.6%), from large metropolitan areas (70.5% vs 53.4%), and from higher-income quartiles (31.0% vs 22.3%; all <em>P</em> < 0.01). SEMS placement was associated with significantly lower stoma rates (<4.0% vs 9.1%; <em>P</em> < 0.01) and higher rates of deep vein thrombosis (8.0% vs 3.8%; <em>P</em> < 0.01). Multivariable analysis showed that SEMS reduced need for stoma (adjusted odds ratio, 0.19; 95% CI, 0.07-0.50), while metastatic disease increased stoma risk (adjusted odds ratio, 2.36; 95% CI, 2.12-2.63).</div></div><div><h3>CONCLUSIONS</h3><div>SEMS use in right-sided malignant obstruction was associated with a significantly lower need for stoma formation and comparable short-term outcomes. Despite potential benefits, utilization remains low. Further prospective studies are warranted to better define patient selection criteria and long-term oncologic outcomes.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 1","pages":"Article 250952"},"PeriodicalIF":0.9,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-11DOI: 10.1016/j.tige.2025.250951
Avinash Tiwari
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