Techniques and Innovations in Gastrointestinal Endoscopy最新文献

BACKGROUND AND AIMS

METHODS

RESULTS

CONCLUSION

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.

BACKGROUND AND AIMS

METHODS

RESULTS

CONCLUSION

Background and Aims

Recently, a novel self-assembling peptide hemostatic gel (PuraStat) has become available. Although PuraStat for endoscopic sphincterotomy (EST) bleeding has been evaluated and reported mainly in case reports and several retrospective studies, no prospective evaluation has been reported. The aim of the present study was to prospectively evaluate the safety and efficacy of PuraStat for persistent EST bleeding >120 seconds as a first-line endoscopic hemostasis technique.

Methods

This single-arm, prospective study was conducted between November 2022 and August 2023. As the primary technique for endoscopic hemostasis, PuraStat was applied first. If hemostasis failed, other techniques were used. The primary outcome of the present study was to evaluate the technical success rate of the application of PuraStat to the bleeding site. Clinical success was defined as the absence of oozing for 180 seconds after PuraStat application. Adverse events associated with procedures and secondary hemorrhage were secondary outcomes. PuraStat application was performed using the embankment method.

Results

During the study period, 1080 endoscopic retrograde cholangiopancreatography procedures were performed. A total of 108 patients experienced complications with EST bleeding. Among them, endoscopic hemostasis was required in 51 patients. These patients enrolled in this prospective study. All patients successfully underwent PuraStat application without PuraStat dislocation into the third part of the duodenum. The technical success rate of endoscopic hemostasis using PuraStat was 98% (50/51). As possible factors associated with secondary hemorrhage, biliary stents, including plastic or metal stents, were deployed in 60.7% (31/51). Finally, severe adverse events associated with the procedures were not observed in any patients, although mild acute pancreatitis was observed in 2 patients, and conservative treatment was successful.

Conclusion

In conclusion, PuraStat application may be safe for oozing after EST without increasing the frequency of acute pancreatitis.

Background and Aims

Endoscopic sphincterotomy (ES) used to be part of sphincter of Oddi dysfunction (SOD) management, but recent studies changed attitudes about its utility. We conducted a systematic review and meta-analysis of randomized sham-controlled trials (RCTs) investigating ES for biliary SOD-related pain.

Methods

Articles were retrieved from PubMed, Medline, Embase, and CENTRAL. We included RCTs comparing ES with a sham procedure on post-cholecystectomy patients ≥18 years old with biliary SOD. Standardized data collection sheets were used, as well as the Risk of Bias 2 tool. A random-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Subgroups included normal vs abnormal sphincter of Oddi manometry (SOM) and type II vs III SOD.

Results

From 517 articles retrieved, 4 RCTs were included, encompassing 376 patients. Overall, no difference existed between ES and the sham procedure in improving biliary SOD-related pain overall (RR 1.32, 95% CI 0.77-2.26, P = .31) and for the normal (RR 0.83, 95% CI 0.42-1.65, P = .60) and abnormal SOM subgroups (RR 1.90, 95% CI 0.84-4.29, P = .12). ES was numerically favored over the sham procedure in patients with type II (RR 2.51, 95% CI 1.32-4.81, P = .005) but not type III SOD (RR 1.02, 95% CI 0.32-3.27, P = .98). However, there was no significant subgroup difference between these type-based subgroups (P = .18, I² = 43.2%).

Conclusion

ES does not improve biliary SOD-related pain overall or for type II vs III SOD or normal vs abnormal SOM subgroups. This meta-analysis confirms that there is no proven role for SOM or ES in managing SOD.

Limited-resource settings pose problems for the provision of health services. Experience with the challenges of the provision of endoscopy services and potential solutions are presented by authors who have taught and practiced in such settings in Africa and the Pacific Islands. The concept of limited-resource settings is defined in the context of health services in general. The situation regarding endoscopy provision details and discusses the unique challenges of manpower, endoscopy facilities, endoscope and accessory equipment inventory, and endoscopy reporting. Health services quality is related to wealth and how it is deployed. Simplistically wealth means health, and poverty illness. Low-income and Low middle–income countries have the biggest challenges. One is the health professional workforce. The number of gastroenterologists per 100,000 in South Africa, an upper middle–income country, is 0.33 compared with 3.9 in the United States. Hence, endoscopy provision is by general surgeons and physicians. Upper and lower gastrointestinal endoscopic capacity in East Africa was 106 and 45 procedures per 100,000 persons per year, respectively which is <10% of that reported from high-income countries. Outside major teaching hospitals, most endoscopy is practiced in uncustomized single rooms often in a surgery complex. Endoscope inventory is more expensive than in the United States as is maintenance and repair as they are out of the country resulting in many units being below the minimum requirements to run a sustained service. Electronic reporting systems are few and not standardized. The World Gastroenterology Organisation and the World Endoscopy Organization should be the overarching advocates to support public–private partnerships and develop solutions for sustainable inventory acquisition. Endoscopy must be monitored electronically to assess procedural competency and provide desperately needed information to influence health policy.

BACKGROUND AND AIMS

With the rising incidence of colorectal cancer in younger individuals, guidelines now recommend initiating average-risk screening at age 45 years. We sought to assess the impact of this younger screening population on established and emerging colonoscopy quality metrics.

METHODS

We compared all well-described lesion detection rates by colonic segment removed during initial, average-risk screening colonoscopies in the San Antonio Market military healthcare network from July 2019 to September 2022.

RESULTS

A total of 2165 colonoscopies met the inclusion criteria, with 755 (34.9%) colonoscopies performed on patients aged 45-49 years old. The detection rates for adenomas, proximal adenomas, advanced adenomas, and adenomas per colonoscopy were lower in the 45-49 years old group (33.4%, 18.7%, 3.8%, and 0.58, respectively) compared with the 50-75 years old group (42.7%, 24.2%, 7.7%, and 1.11, respectively; all P < 0.05). There was no difference in serrated polyp detection in the 45-49 years old group (11.5%) compared with the 50-75 years old group (12.5%; P = 0.287). There were no differences in withdrawal times, cecal intubation rates, or bowel preparation adequacy across age groups.

CONCLUSION

In our screening population, we found that adenoma-based colonoscopy quality metrics were significantly lower in the 45-49 years old population compared to the traditional screening age cohort, while there was no difference in serrated polyp detection. Endoscopists should anticipate a small decline in colonoscopy quality benchmarks as the screening population becomes younger, although these results require validation through multicenter, prospective monitoring.