Pub Date : 2025-01-01DOI: 10.1016/j.tige.2025.250921
Sridhar Sundaram , Surinder Singh Rana
Peripancreatic fluid collections (PFCs) are common complications associated with acute and chronic pancreatitis. Symptomatic PFCs need drainage, and endoscopic ultrasound (EUS) is the current standard of care. Various factors like the size, location, presence of debris in the collection, and general condition of the patient drive the choice of technique for EUS-guided transmural PFC drainage. While plastic stents were initially used, specially designed lumen-apposing and biflanged metal stents have revolutionized therapy for pancreatic necrotic collections. Minimally invasive approach in the form of endoscopic necrosectomy is now established as part of the step-up approach for performing debridement. PFCs are also often associated with disconnected pancreatic duct, which is a difficult situation to manage with evolving evidence. Pancreatic ductal obstruction due to strictures and stones represent indications for endoscopic intervention with stent placement to reduce ductal hypertension. EUS-guided pancreatic duct drainage represents an alternative in patients where endoscopic retrograde cholangiopancreatography fails or is not feasible. Either transmural or transpapillary approaches have been described. In this review, we discuss the role of EUS in drainage of PFCs along with technical tips for the same. We also discuss in detail technical steps and accessories and provide a critical appraisal on evidence for EUS-guided pancreatic duct drainage.
{"title":"Endoscopic Ultrasound-Guided Pancreatic Fluid Collection Drainage and Pancreatic Ductal Drainage","authors":"Sridhar Sundaram , Surinder Singh Rana","doi":"10.1016/j.tige.2025.250921","DOIUrl":"10.1016/j.tige.2025.250921","url":null,"abstract":"<div><div>Peripancreatic fluid collections (PFCs) are common complications associated with acute and chronic pancreatitis. Symptomatic PFCs need drainage, and endoscopic ultrasound (EUS) is the current standard of care. Various factors like the size, location, presence of debris in the collection, and general condition of the patient drive the choice of technique for EUS-guided transmural PFC drainage. While plastic stents were initially used, specially designed lumen-apposing and biflanged metal stents have revolutionized therapy for pancreatic necrotic collections. Minimally invasive approach in the form of endoscopic necrosectomy is now established as part of the step-up approach for performing debridement. PFCs are also often associated with disconnected pancreatic duct, which is a difficult situation to manage with evolving evidence. Pancreatic ductal obstruction due to strictures and stones represent indications for endoscopic intervention with stent placement to reduce ductal hypertension. EUS-guided pancreatic duct drainage represents an alternative in patients where endoscopic retrograde cholangiopancreatography fails or is not feasible. Either transmural or transpapillary approaches have been described. In this review, we discuss the role of EUS in drainage of PFCs along with technical tips for the same. We also discuss in detail technical steps and accessories and provide a critical appraisal on evidence for EUS-guided pancreatic duct drainage.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 3","pages":"Article 250921"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107474","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 : 2025-01-01DOI: 10.1016/j.tige.2025.250942
Ali Lahooti , Chino Aneke-Nash , Kate E. Johnson , Anam Rizvi , Muhammad U. Baig , Alpana Shukla , Carolyn Newberry , Emily Smith , Jude M. Sharaiha , Mark Hanscom , Kartik Sampath , David L. Carr-Locke , SriHari Mahadev , Sonal Kumar , Robert Schwartz , Samuel M. Kim , Reem Z. Sharaiha
BACKGROUND AND AIMS
Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure for obesity, a risk factor for atherosclerotic cardiovascular disease (ASCVD). However, its impact on cardiovascular risk remains underexplored. This study evaluates ESG’s effects on ASCVD risk and obesity-related comorbidities.
METHODS
In this cohort study, 168 adults with obesity (aged 30-79 years; body mass index, ≥30 kg/m2 or ≥27 kg/m2; with comorbidities) underwent ESG at a single tertiary care facility from 2013 to 2024. Patients were evaluated at baseline and 12 months after procedure using the Pooled Cohort Equations (PCEs) for patients aged 40-79 years and the Predicting Risk of Cardiovascular Disease Events (PREVENT) equations for those aged 30-79 years. Changes in body weight, glycemic control, blood pressure, lipid profile (total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides), and liver enzymes (alanine aminotransferase) were also analyzed.
RESULTS
Of the 168 patients (median age, 48 years; 74% female; body mass index, 36.0 kg/m2), 129 and 159 met inclusion criteria for PCEs and PREVENT equations, respectively. At 12 months, median PCEs ASCVD risk score decreased from 3.3% to 3.0% (21% reduction, P < 0.001), while the PREVENT 10-year cardiovascular disease risk score declined from 3.1% to 2.4% (20% reduction; P < 0.001), with similar reductions in 30-year risk scores and greater improvements in high/intermediate-risk patients and those aged >50 years. Patients achieved a median total body weight loss of 13.5% (IQR, 8.1%-18.6%), with significant metabolic improvements, and >80% experienced diabetes resolution. There was 1 (0.6%) moderate adverse event.
CONCLUSION
Adults who underwent ESG showed significant improvements in ASCVD risk and obesity-related comorbidities at 12 months after procedure. These findings suggest that ESG may be an effective intervention for managing obesity and mitigating cardiovascular risk in patients with obesity. ClincialTrials.gov identifier: NCT04494048.
{"title":"Endoscopic Sleeve Gastroplasty Reduces Atherosclerotic Cardiovascular Disease Risk: A Cohort Study Using Pooled Cohort Equations and Predicting Risk of Cardiovascular Disease Events Models","authors":"Ali Lahooti , Chino Aneke-Nash , Kate E. Johnson , Anam Rizvi , Muhammad U. Baig , Alpana Shukla , Carolyn Newberry , Emily Smith , Jude M. Sharaiha , Mark Hanscom , Kartik Sampath , David L. Carr-Locke , SriHari Mahadev , Sonal Kumar , Robert Schwartz , Samuel M. Kim , Reem Z. Sharaiha","doi":"10.1016/j.tige.2025.250942","DOIUrl":"10.1016/j.tige.2025.250942","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure for obesity, a risk factor for atherosclerotic cardiovascular disease (ASCVD). However, its impact on cardiovascular risk remains underexplored. This study evaluates ESG’s effects on ASCVD risk and obesity-related comorbidities.</div></div><div><h3>METHODS</h3><div>In this cohort study, 168 adults with obesity (aged 30-79 years; body mass index, ≥30 kg/m<sup>2</sup> or ≥27 kg/m<sup>2</sup>; with comorbidities) underwent ESG at a single tertiary care facility from 2013 to 2024. Patients were evaluated at baseline and 12 months after procedure using the Pooled Cohort Equations (PCEs) for patients aged 40-79 years and the Predicting Risk of Cardiovascular Disease Events (PREVENT) equations for those aged 30-79 years. Changes in body weight, glycemic control, blood pressure, lipid profile (total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides), and liver enzymes (alanine aminotransferase) were also analyzed.</div></div><div><h3>RESULTS</h3><div>Of the 168 patients (median age, 48 years; 74% female; body mass index, 36.0 kg/m<sup>2</sup>), 129 and 159 met inclusion criteria for PCEs and PREVENT equations, respectively. At 12 months, median PCEs ASCVD risk score decreased from 3.3% to 3.0% (21% reduction, <em>P</em> < 0.001), while the PREVENT 10-year cardiovascular disease risk score declined from 3.1% to 2.4% (20% reduction; <em>P</em> < 0.001), with similar reductions in 30-year risk scores and greater improvements in high/intermediate-risk patients and those aged >50 years. Patients achieved a median total body weight loss of 13.5% (IQR, 8.1%-18.6%), with significant metabolic improvements, and >80% experienced diabetes resolution. There was 1 (0.6%) moderate adverse event.</div></div><div><h3>CONCLUSION</h3><div>Adults who underwent ESG showed significant improvements in ASCVD risk and obesity-related comorbidities at 12 months after procedure. These findings suggest that ESG may be an effective intervention for managing obesity and mitigating cardiovascular risk in patients with obesity. ClincialTrials.gov identifier: NCT04494048.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 4","pages":"Article 250942"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018506","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 1","pages":"Article 150898"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146520327","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 4","pages":"Article 250931"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146728659","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 : 2025-01-01DOI: 10.1016/S2590-0307(25)00032-7
{"title":"Cover","authors":"","doi":"10.1016/S2590-0307(25)00032-7","DOIUrl":"10.1016/S2590-0307(25)00032-7","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 3","pages":"Article 250937"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144713651","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 1","pages":"Article 250904"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146520324","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 1","pages":"Article 150899"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146520329","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 : 2025-01-01DOI: 10.1016/j.tige.2025.250941
Aleksey Novikov , Shuji Mitsuhashi , Muhammad Hassaan Bashir , Mena Bakhit , Ian Holmes , Alexander Schlachterman , Austin Chiang , David Loren , Thomas Kowalski
BACKGROUND AND AIMS
Current literature suggests that needle-knife fistulotomy (NKF) technique should be reserved for expert advanced endoscopists. The aim of this study was to evaluate the efficacy and safety of NKF compared with those of standard cannulation (SC) for primary biliary access performed by advanced endoscopists with a range of experience, including advanced endoscopy trainees.
METHODS
In total, 186 patients were randomly assigned to either NKF or SC as means of primary biliary access and 137 patients were included in the final analysis (clinicaltrials.gov; NCT06694038). The primary outcome was incidence of post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Secondary outcomes were biliary access success, time to biliary access, incidence of bleeding, and incidence of perforation.
RESULTS
Of the 137 procedures included in the study, 99 (72.3%) were carried out by advanced endoscopy trainees under supervision, 26 (19.0%) by advanced endoscopists without significant previous NKF experience, and 12 (8.8%) by an experienced advanced endoscopist with expertise in NKF. In the group that was randomized to SC, 6 (8.22%) patients developed pancreatitis vs 5 (7.81%) patients randomized to NKF arm (P = 0.93). Average time to biliary access within 20 minutes was significantly shorter with SC at 268 seconds (95% CI, 198-338 seconds) vs 380 seconds (95% CI, 292-466 seconds; P < 0.05) in the NKF arm.
CONCLUSION
NKF is a safe and effective technique for primary biliary access during ERCP performed by advanced endoscopists with a wide range of experience, with post-ERCP pancreatitis equivalent to SC. NKF, in this study, took slightly longer than SC to achieve bile duct access. Use of either or both techniques resulted in a 100% successful bile duct cannulation in patients with favorable anatomy.
{"title":"Comparative Efficacy and Safety of Needle-Knife Fistulotomy vs Standard Cannulation: A Practical Randomized Controlled Trial","authors":"Aleksey Novikov , Shuji Mitsuhashi , Muhammad Hassaan Bashir , Mena Bakhit , Ian Holmes , Alexander Schlachterman , Austin Chiang , David Loren , Thomas Kowalski","doi":"10.1016/j.tige.2025.250941","DOIUrl":"10.1016/j.tige.2025.250941","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Current literature suggests that needle-knife fistulotomy (NKF) technique should be reserved for expert advanced endoscopists. The aim of this study was to evaluate the efficacy and safety of NKF compared with those of standard cannulation (SC) for primary biliary access performed by advanced endoscopists with a range of experience, including advanced endoscopy trainees.</div></div><div><h3>METHODS</h3><div>In total, 186 patients were randomly assigned to either NKF or SC as means of primary biliary access and 137 patients were included in the final analysis (clinicaltrials.gov; NCT06694038). The primary outcome was incidence of post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Secondary outcomes were biliary access success, time to biliary access, incidence of bleeding, and incidence of perforation.</div></div><div><h3>RESULTS</h3><div>Of the 137 procedures included in the study, 99 (72.3%) were carried out by advanced endoscopy trainees under supervision, 26 (19.0%) by advanced endoscopists without significant previous NKF experience, and 12 (8.8%) by an experienced advanced endoscopist with expertise in NKF. In the group that was randomized to SC, 6 (8.22%) patients developed pancreatitis vs 5 (7.81%) patients randomized to NKF arm (<em>P</em> = 0.93). Average time to biliary access within 20 minutes was significantly shorter with SC at 268 seconds (95% CI, 198-338 seconds) vs 380 seconds (95% CI, 292-466 seconds; <em>P</em> < 0.05) in the NKF arm.</div></div><div><h3>CONCLUSION</h3><div>NKF is a safe and effective technique for primary biliary access during ERCP performed by advanced endoscopists with a wide range of experience, with post-ERCP pancreatitis equivalent to SC. NKF, in this study, took slightly longer than SC to achieve bile duct access. Use of either or both techniques resulted in a 100% successful bile duct cannulation in patients with favorable anatomy.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 4","pages":"Article 250941"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144865231","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 3","pages":"Article 250924"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146242821","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}
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