Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"title":"Preoperative Prediction of Subtype and Artificial Intelligence–Driven Endomicroscopy Detection of Advanced Neoplasia in Intraductal Papillary Mucinous Neoplasms","authors":"Bryn D. Koehler ,&nbsp;Wei Chen ,&nbsp;Ashwini K. Esnakula ,&nbsp;Wendy L. Frankel ,&nbsp;Ahmed Abdelbaki ,&nbsp;Stacey Culp ,&nbsp;Ziwei Li ,&nbsp;Wei-Lun Chao ,&nbsp;Phil A. Hart ,&nbsp;Timothy M. Pawlik ,&nbsp;Zarine K. Shah ,&nbsp;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> &lt; 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}

{"title":"Raising the BARS: First US Experience of the Bariatric Anastomotic Reduction System (BARS) for Endoscopic Gastrojejunal Anastomosis Revision","authors":"Stephen A. Firkins ,&nbsp;Leandro Sierra ,&nbsp;Akash Khurana ,&nbsp;Arjun Chatterjee ,&nbsp;Roma Patel ,&nbsp;Bailey Flora ,&nbsp;Erika Staneff ,&nbsp;Roberto Simons-Linares","doi":"10.1016/j.tige.2025.250944","DOIUrl":"10.1016/j.tige.2025.250944","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 1","pages":"Article 250944"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420448","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}

{"title":"Training and Credentialing in Metabolic and Bariatric Endoscopy","authors":"Mark H. Hanscom","doi":"10.1016/j.tige.2026.250967","DOIUrl":"10.1016/j.tige.2026.250967","url":null,"abstract":"<div><div>Metabolic and bariatric endoscopy is an established but evolving field, with increased adoption of existing endoscopic bariatric and metabolic therapies and new techniques on the horizon. In turn, it is important for training programs and privileging institutions to adapt to ensure that standards of treatment are upheld and patient outcomes are maintained. In this review, we aim to summarize the status of training and credentialing in metabolic and bariatric endoscopy.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 2","pages":"Article 250967"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397418","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}

{"title":"Preface: Colorectal Endoscopic Submucosal Dissection in the West: Charting the Roadmap for Safe, Effective, and Widespread Adoption","authors":"Trent J. Walradt,&nbsp;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}

{"title":"Innovations in Advanced Endoscopy Training: Enhancing Skill Acquisition and Performance","authors":"Kevin P. Shah,&nbsp;Terrance J. Rodrigues,&nbsp;Rajesh N. Keswani","doi":"10.1016/j.tige.2026.250966","DOIUrl":"10.1016/j.tige.2026.250966","url":null,"abstract":"<div><div>The educational landscape for advanced endoscopy trainees (AETs) continues to evolve alongside endoscopic innovations in diagnostics and therapeutics. As procedural complexity increases, educational strategies for AETs must adapt to support the development of cognitive, technical, and nontechnical skills. Effective skill acquisition requires a foundation of mastery learning, deliberate practice, feedback, and management of cognitive load, with attention to nontechnical competencies such as communication, teamwork, and situational awareness. To ensure that AETs are competent prior to independent practice, a range of educational interventions has been implemented. Current and emerging educational interventions help to ensure competency of AETs prior to independent practice. Established educational interventions, including audit and feedback, simulation-based training, video-based feedback, and online learning with feedback, have demonstrated value in enhancing skills acquisition and performance. Novel, emerging approaches, including artificial intelligence-assisted training, virtual and augmented reality, telemonitoring with remote supervision, and advanced data analytics with quality dashboards, offer personalized, adaptable, and scalable solutions tailored to trainee needs. Moving forward, priorities for AET educational interventions include cross-institutional collaboration, standardized training benchmarks, and the integration of informatics and technology to support competency-based performance and delivery of high-quality patient care.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 2","pages":"Article 250966"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397417","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}

{"title":"Cystic Lesions and the Risk of Pancreatic Adenocarcinoma","authors":"Pranav Prabhala ,&nbsp;Gordon P. Bensen ,&nbsp;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 &lt;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}

{"title":"The Rise of Peroral Endoscopic Myotomy: Achalasia Treatment Trends, Institutional Adoption Patterns, and Current Procedural Terminology Coding in a Nationwide Cohort (2014-2024)","authors":"Mohammad Abuassi ,&nbsp;Kobina Essilfie-Quaye ,&nbsp;Ashraf Almomani ,&nbsp;Carson Creamer ,&nbsp;Harsimran Kalsi ,&nbsp;Tony Brar ,&nbsp;Yaseen Perbtani","doi":"10.1016/j.tige.2025.250946","DOIUrl":"10.1016/j.tige.2025.250946","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Achalasia is a chronic esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation and absent peristalsis. The emergence of peroral endoscopic myotomy (POEM) has significantly altered achalasia treatment paradigms, although variation in adoption remain. This study evaluated nationwide trends in achalasia management, the impact of the 2022 Current Procedural Terminology (CPT) coding change for POEM, and institutional differences in procedure adoption.</div></div><div><h3>METHODS</h3><div>A retrospective cohort analysis using the TriNetX database was conducted on adult patients diagnosed with achalasia from 2014 to 2024. Annual incidence and prevalence, treatment patterns, and institutional (academic vs nonacademic) utilization trends were analyzed. Interrupted time series analysis assessed the effect of the 2022 CPT code implementation on POEM adoption.</div></div><div><h3>RESULTS</h3><div>Achalasia incidence proportion increased from 8.36 to 16.1 per 100,000 over the study period. POEM utilization increased substantially (0.42%-3.21%), whereas utilization rates of laparoscopic Heller myotomy and pneumatic dilation remained relatively stable, with Heller myotomy demonstrating a decline in recent years (from a peak of 1.46% in 2019 to 0.94% in 2024). Botulinum toxin injection use also increased significantly (0.33%-1.38%). Interrupted time series analysis showed no significant immediate (<em>P</em> = 0.337) or trend-altering (<em>P</em> = 0.150) effects from CPT coding changes. Academic institutions consistently demonstrated higher and earlier POEM adoption than nonacademic centers.</div></div><div><h3>CONCLUSION</h3><div>POEM adoption has steadily increased over the past decade, driven primarily by clinical efficacy rather than reimbursement policy. Differences in adoption persist between academic and nonacademic institutions, underscoring the need for expanded training and equitable access to advanced therapeutic options.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 1","pages":"Article 250946"},"PeriodicalIF":0.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420374","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}

{"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}

{"title":"Endoscopic Assessment of Large Colorectal Lesions","authors":"Naoto Tamai,&nbsp;Kazuki Sumiyama","doi":"10.1016/j.tige.2025.250931","DOIUrl":"10.1016/j.tige.2025.250931","url":null,"abstract":"<div><div>Endoscopic submucosal dissection (ESD) has emerged as an important therapeutic strategy for colorectal lesions that cannot be resected en bloc using endoscopic mucosal resection or underwater endoscopic mucosal resection, enabling en bloc resection with precise histopathologic evaluation. However, the determination of appropriate indications for ESD of large colorectal lesions remains a significant challenge. This article aimed to provide a comprehensive summary of the indications for colorectal ESD and the role of endoscopic evaluation in formulating optimal treatment strategies. Colorectal lesions with deep submucosal invasion are often associated with extensive submucosal fibrosis, presenting considerable technical difficulties during ESD. Performing ESD on such lesions has been linked to an increased additional surgical intervention and a heightened risk of procedure-related complications. Therefore, thorough preoperative assessment of the lesion is essential to ensure an appropriate treatment strategy while minimizing unnecessary risks. Accurate evaluation of colorectal lesions through white-light imaging, advanced imaging modalities such as narrow-band imaging, and chromoendoscopy are critical for assessing lesion characteristics. Furthermore, the application of artificial intelligence in lesion characterization has shown potential as a supportive tool in facilitating clinical decision-making regarding the indications for ESD. Artificial intelligence may assist endoscopists by enhancing the accuracy of lesion assessment and contributing to improved treatment planning. A comprehensive understanding of the morphologic and pathologic features of large colorectal lesions is vital to identify patients who would benefit most from ESD, while minimizing the risk of complications. This review highlights the necessity of meticulous endoscopic evaluation to enable appropriate lesion selection, ensuring the safe and effective application of ESD for large colorectal lesions and ultimately contributing to improved patient outcomes.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 4","pages":"Article 250931"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686087","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}

{"title":"International Survey Assessing Gender Disparities in Advanced Therapeutic Endoscopy","authors":"Katarzyna M. Pawlak ,&nbsp;Kareem Khalaf ,&nbsp;Erin Brennand ,&nbsp;Andrei Voiosu ,&nbsp;Theodor Voiosu ,&nbsp;Giulio Antonelli ,&nbsp;Sharan B. Malipatil ,&nbsp;Caleb Na ,&nbsp;Ahmed H. Mokhtar ,&nbsp;Balqis Alabdulkarim ,&nbsp;Maryam Mahjoob ,&nbsp;Arjun Kundra ,&nbsp;Jeanin van Hooft ,&nbsp;Uzma Siddiqui ,&nbsp;Roberta Maselli ,&nbsp;Jeffrey D. Mosko ,&nbsp;Jennifer Telford ,&nbsp;Nauzer Forbes ,&nbsp;Natalia Causada Calo","doi":"10.1016/j.tige.2025.250917","DOIUrl":"10.1016/j.tige.2025.250917","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Underrepresentation of women in advanced therapeutic endoscopy is a multifactorial issue. We aim to evaluate the concerns about fluoroscopy use across genders and assess its impact on the representation of women in advanced therapeutic endoscopy.</div></div><div><h3>METHODS</h3><div>An international survey was distributed in August of 2023 to endoscopic retrograde cholangiopancreatography (ERCP)–performing physicians. The primary outcome was the frequency of concerns related to fluoroscopy exposure. Secondary outcomes included the reasons or implication of these concerns. Subgroup analyses were performed across gender.</div></div><div><h3>RESULTS</h3><div>ERCP-performing physicians revealed a gender disparity in therapeutic endoscopy, with 72.8% male respondents and 27.2% female respondents. Most participants were staff (67.6%), predominantly men (70.6%). The average age was 38.2 years, with a median institutional ERCP volume of 550 cases. Awareness of fluoroscopy safety standards was 56.1%, but only 51.6% received formal training. Concerns about radiation included cancer risk (73.4%) and fertility (43.9%). Usage of protective equipment was inadequate: thyroid dosimeters (21.9% always used), pelvic dosimeters (13.1%), and leaded goggles (8.4%). Female respondents specifically noted delayed family planning (27.6%) and fear of working while pregnant (40.4%), whereas male respondents focused on general health risks. Additionally, 68.4% of institutions recorded fluoroscopy time, but only 56.1% reported dosimeter use.</div></div><div><h3>CONCLUSION</h3><div>Gender disparities in fluoroscopy exposure concerns warrant the need for improved training and safety standards to foster equity in therapeutic endoscopy. Addressing these issues through targeted education and policy changes will not only enhance awareness of radiation risks but also promote a more inclusive environment for both male and female practitioners.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 2","pages":"Article 250917"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783683","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}