Techniques and Innovations in Gastrointestinal Endoscopy最新文献

International collaborations have significant impacts on patient care, endoscopy education, and research. These collaborations can be mutually enriching for all parties involved. Resource-limited settings may suffer from inadequate infrastructure or expertise to meet societal needs, yet they offer unique opportunities that can benefit collaborating partners. Unfortunately, there is often a lack of clear guidance on how to establish collaborations between professionals in the global South and their European or American counterparts. This review aims to address this issue by describing the key elements of successful partnerships, identifying reasons for failure, highlighting hidden pitfalls, and offering strategies for beneficial and productive collaboration. The review emphasizes the importance of understanding cultural differences and provides recommendations for all parties involved in a collaboration. Our goal is to provide an essential guide for fostering strong, mutually beneficial partnerships in international collaborations between resource-rich and resource-limited settings.

This comprehensive review addresses the critical role of colonoscopy in colorectal cancer (CRC) prevention. With CRC as one of the most common cancer types in men and women, high-quality colonoscopy is vital to reduce CRC incidence and mortality. Persistent gaps in quality, evidenced by interval CRCs and large variations in both provider adenoma detection rate (ADR) and resection methods, highlight the need to prioritize colonoscopy quality improvement through feedback and training.

This review delves into key factors influencing colonoscopy quality with lesion detection and removal. Excellent bowel preparation is necessary for effective colonoscopy, impacting lesion detection, ADR, procedure time, and complication risk. Optimal inspection techniques, encompassing provider maneuvers and utilization of technological devices such as distal attachment devices and artificial intelligence, hold promise in enhancing inspection quality. For optimal lesion resection, we explore cold snare polypectomy as a safe, cost-effective, and efficacious technique, particularly for diminutive and small polyps, and endoscopic mucosal resection for large (≥20 mm) polyps.

We outline the importance and critical need for quality assurance programs and to implement education science principles into endoscopy training. Innovative simulation-based mastery learning training, which includes various educational strategies to engage endoscopists in deliberate practice with assessment and feedback, holds great potential to efficiently scale the practice of high-quality colonoscopy to improve ADR and resection methods.

The need for endoscopic service has been well established within gastroenterology globally, and it is equally critical in areas with limited resources. We highlight the educational situation in underserved areas, pertinent goals to aim for, current initiatives and programs, as well as limitations and potential for improvement. Gastroenterology training for medical and surgical endoscopists includes variable components of basic and advanced endoscopies. Various models for training have been used, including traditional 1- to 3-year fellowships, short courses for upskilling, exchange programs, bolus or apprenticeship training, and training camps. There is a steadily increasing demand for endoscopic procedures in the region. We highlight the successes and challenges of current models, which are at various levels, including trainee, institutional, and even geopolitical. In addition, we explore the role that national and international societies as well as industry partners and other stakeholders play in influencing and implementing training. Given the diversity in access to resources as well as endoscopic capacity, we also highlight some of the innovative ways that have been used to provide and continue endoscopy training. Successful training also involves curriculum development, adoption of guidelines, and discussions on assessment of competency as well as having a glimpse into the future of endoscopy training in resource-limited settings. Ultimately, the goal is to ensure harmonized and quality training efforts across the various settings.

Background and Aims

Patients with a low body mass index (LBMI) are often encountered in routine outpatient gastrointestinal (GI) endoscopy practice, and the assessment of procedure-related risks in this subset of individuals remains paramount. Although the risk of endoscopy-related adverse events (AEs) has been reported in patients with obesity, the association between LBMI and AEs has not been established.

Methods

We conducted a retrospective cohort study using TriNetX, a multi-institutional database, to assess the risk of endoscopy-related AEs in patients with LBMI (<18.4 kg/m²) compared with patients with a nonobese body mass index (18.5-29.9 kg/m²) (control cohort) after low-risk outpatient diagnostic esophagogastroduodenoscopy (EGD), colonoscopy, or percutaneous endoscopic gastrostomy (PEG) tube placement. One-to-one (1:1) propensity score matching was performed. The primary endpoints were to assess the risk of GI bleeding, perforation, or aspiration pneumonia within 30 days. Risk was expressed as adjusted odds ratios (aORs) with 95% confidence intervals.

Results

A total of 28,677, 18,449, and 3076 patients with LBMI underwent EGD, colonoscopy, and PEG tube placement, respectively. After propensity score matching, compared with the control cohort, patients with LBMI undergoing EGD and colonoscopy with or without biopsies were at an increased risk for GI bleeding (aOR 1.36 and 2.21), perforation (aOR 1.96 and 2.65), and aspiration pneumonia (aOR 3.13 and 2.71), respectively. Additionally, patients in the LBMI PEG cohort were found to be at an increased risk for aspiration pneumonia (aOR 1.33).

Conclusion

Our study shows that, when compared with nonobese controls, patients with LBMI are at an increased risk of endoscopy-related AEs. Appropriate precautions must be considered while performing routine endoscopic procedures to offset these risks in such patients.