Techniques and Innovations in Gastrointestinal Endoscopy最新文献

英文中文

General Anesthesia Does Not Affect Functional Lumen Imaging Probe Measurements in Nonadvanced Achalasia 全麻不影响非晚期失弛缓症的功能性管腔成像探头测量

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2025.250936

SALIH SAMO , FALAK HAMO , KYLE YUQUIMPO , AJAY BANSAL , PETER J. KAHRILAS , AMY PICHOFF

引用次数: 0

Endoscopic Surveillance Patterns and Management of Helicobacter pylori in Newly Diagnosed Gastric Intestinal Metaplasia 新诊断的胃肠道化生幽门螺杆菌的内镜监测模式和处理

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2024.250904

SHIVRAM CHANDRAMOULI , ANNIE L. WANG , DAVID A. LEIMAN

引用次数: 0

Cover 封面

IF 0.9 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/S2590-0307(25)00043-1

引用次数: 0

Advancing Hemostatic Powder Technologies for Management of Gastrointestinal Bleeding: Challenges and Solutions 推进止血粉技术用于胃肠道出血的管理：挑战和解决方案

IF 0.9 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2025.250940

Kiandokht Bashiri , Alireza Meighani , Mark C. Mattar , Reezwana Chowdhury , Sadegh Poozesh

Hemostatic powder spray (HPS) such as Hemospray or EndoClot is used for endoscopic treatment of both upper and lower Gastrointestinal (GI) bleeding, demonstrating high immediate hemostasis rates across various types, including nonvariceal, variceal, and tumor-related hemorrhages. Compared to conventional therapies, HPS exhibits significantly higher odds of primary hemostasis and is particularly effective in challenging cases such as diffuse hemorrhage, refractory gastric variceal bleeding, and malignant bleeding where there is no single focal area suitable for cauterization or clipping. Despite its clinical effectiveness, several challenges impede its broader application, including moisture-induced powder clumping, limited adhesion in the humid GI environment, transient hemostatic effects, and frequent catheter clogging. Additionally, existing CO₂-propelled delivery systems with fixed mixing ratios restrict adaptability across diverse clinical scenarios. This review systematically examines these limitations and proposes comprehensive solutions to enhance HPS's performance. Key advancements discussed include optimized powder formulations, suspension-based delivery systems, and the utilization of alternative propellant gases to mitigate clumping and improve adhesion. Furthermore, innovative delivery mechanisms such as hybrid mixing systems, adjustable catheter tips, and the integration of real-time feedback mechanisms are explored to increase precision and efficacy. By addressing these technical and operational challenges, this review outlines a strategic pathway for optimizing HPS’s functionality and expanding its clinical utility in managing GI bleeding, aiming to improve patient outcomes and procedural reliability.

止血粉末喷雾（HPS），如止血喷雾或EndoClot，用于内镜治疗上消化道和下消化道出血，在各种类型（包括非静脉曲张、静脉曲张和肿瘤相关出血）中显示出高的即时止血率。与传统治疗方法相比，HPS具有更高的原发性止血几率，并且在弥漫性出血、难治性胃静脉曲张出血和恶性出血等难治性病例中特别有效，这些病例没有适合烧灼或夹住的单一病灶区域。尽管其临床效果良好，但一些挑战阻碍了其更广泛的应用，包括潮湿诱导的粉末结块，潮湿胃肠道环境中的有限粘连，短暂止血效果以及频繁的导管堵塞。此外，现有的固定混合比例的二氧化碳推进输送系统限制了不同临床场景的适应性。这篇综述系统地检查了这些限制，并提出了全面的解决方案，以提高HPS的性能。讨论的关键进展包括优化的粉末配方，基于悬浮的输送系统，以及替代推进剂气体的利用，以减轻结块和提高附着力。此外，研究人员还探索了混合混合系统、可调节导管尖端和实时反馈机制的集成等创新输送机制，以提高精度和效率。通过解决这些技术和操作上的挑战，本综述概述了优化HPS功能和扩大其在胃肠道出血管理中的临床应用的战略途径，旨在改善患者预后和手术可靠性。

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引用次数: 0

Real-Life Application of Artificial Intelligence for Automatic Characterization of Biliary Strictures: A Transatlantic Experience 人工智能在胆道狭窄自动表征中的实际应用：跨大西洋经验

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2024.250902

Mariano González-Haba Ruiz , Pedro Pereira , Jessica Widmer , Tiago Ribeiro , Belén Agudo Castillo , Filipe Vilas-Boas , João Ferreira , Miguel Mascarenhas Saraiva , Guilherme Macedo

引用次数: 0

White Light Imaging to Narrow Band Imaging via Style Transfer: A Feasibility Test for Enhancing Colonoscopic Diagnostics 白光成像到窄带成像通过风格转移：提高结肠镜诊断的可行性测试

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2025.250927

JUN SEO LEE , DONGHEON LEE , EUN HYO JIN , HAE YEON KANG , JI YEON SEO , JI MIN CHOI

引用次数: 0

Accuracy and Safety of Endoscopic Ultrasound–Guided Liver Biopsy in Patients with Metabolic Dysfunction–Associated Liver Disease 超声内镜下肝活检在代谢功能障碍相关肝病患者中的准确性和安全性

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2025.250918

JEROME C. EDELSON , ERIC M. MONTMINY , CARL L. KAY , TYLER H. DOTY , MATTHEW J. SCHWARTZ , DON C. ROCKEY

引用次数: 0

Glucagon-like Peptide-1 Receptor Agonists Are Not Associated With Increased Incidence of Pneumonia After Endoscopic Procedures 胰高血糖素样肽-1受体激动剂与内镜手术后肺炎发病率增加无关

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2025.250925

Natalia Tejada , Ishak Mansi , Silvio W. de Melo Jr

BACKGROUND AND AIMS

Despite their favorable cardiometabolic effects, use of glucagon-like peptide-1 receptor agonists (GLP1-RAs), have raised concerns for increasing the risk of aspiration pneumonia after upper esophagogastroduodenoscopy (EGD)/colonoscopy due to slowing gastrointestinal motility. Such risks are yet to be confirmed. This study aimed to examine the association of GLP1-RA use with risk of aspiration pneumonia or any pneumonia in patients undergoing these procedures.

METHODS

This retrospective, propensity score (PS)–matched cohort study, with active control design, used data from the Veterans Health Administration of veterans who underwent EGD/colonoscopy procedures during fiscal years 2016-2021 while using GLP1-RA or dipeptidyl peptidase 4 inhibitors (DPP4i), as active comparators. A PS was created using 60 baseline characteristics encompassing demographics, laboratory investigations, medication use, and comorbidities that may increase risk of aspiration or infection. Our 2 coprimary outcomes were incidence of any pneumonia and incidence of aspiration pneumonia within 30 days of the procedure.

RESULTS

Of 59,280 EGD/colonoscopy procedures (22,570 GLP1-RA users and 36,710 DPP4i users), we successfully matched 15,943 pairs of patients. Mean (SD) age of patients was 66 (8) years and mean (SD) weighted Charlson comorbidity index was 4.8 (3.2). In the PS-matched cohort, 48 (0.3%) GLP1-RA users had pneumonia vs 57 (0.4%) DPP4i users (odds ratio, 0.84; 95% CI, 0.57-1.23), and 7 (0.04%) GLP1-RA users had aspiration pneumonia vs 9 (0.06%) DPP4i users (odds ratio, 0.78; 95% CI, 0.29-2.09).

CONCLUSION

Risks of aspiration pneumonia or any pneumonia after EGD/colonoscopy procedures were similar in GLP1-RA users and active comparators. Withholding GLP1-RA prior to endoscopic procedures may not be necessary.

背景和目的尽管胰高血糖素样肽-1受体激动剂（GLP1-RAs）具有良好的心脏代谢作用，但由于胃肠道运动减慢，使用胰高血糖素样肽-1受体激动剂（GLP1-RAs）增加了上食管胃十二指肠镜(EGD)/结肠镜检查后吸入性肺炎的风险。这些风险尚未得到证实。本研究旨在检查GLP1-RA的使用与吸入性肺炎或任何肺炎的风险之间的关系。方法：这项回顾性、倾向评分（PS）匹配的队列研究采用主动对照设计，使用退伍军人健康管理局的数据，这些退伍军人在2016-2021财政年度接受EGD/结肠镜检查，同时使用GLP1-RA或二肽基肽酶4抑制剂（DPP4i）作为主动比较物。PS使用60个基线特征创建，包括人口统计学、实验室调查、药物使用和可能增加误吸或感染风险的合并症。我们的两个主要结局是任何肺炎的发病率和手术后30天内吸入性肺炎的发病率。在59,280例EGD/结肠镜检查中（22,570例GLP1-RA使用者和36,710例DPP4i使用者），我们成功匹配了15,943对患者。患者平均（SD）年龄66(8)岁，平均（SD）加权Charlson合并症指数为4.8（3.2）。在ps匹配的队列中，48名（0.3%）GLP1-RA使用者患有肺炎，57名（0.4%）DPP4i使用者(优势比，0.84；95% CI, 0.57-1.23)， GLP1-RA使用者有7例（0.04%）吸入性肺炎，而DPP4i使用者有9例（0.06%）吸入性肺炎(优势比，0.78；95% ci, 0.29-2.09)。结论：GLP1-RA使用者和活性对照者在EGD/结肠镜检查后发生吸入性肺炎或任何肺炎的风险相似。在内窥镜手术前保留GLP1-RA可能没有必要。

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引用次数: 0

Over-the-Scope Clip versus Standard Endoscopic Therapy as First-Line Intervention for Nonvariceal Upper Gastrointestinal Bleeding: A Cost-Effectiveness Analysis 非静脉曲张上消化道出血的内镜下夹与标准内镜治疗的一线干预：成本-效果分析

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2025.250935

Sneh Sonaiya , Sahib Singh , Tooba Laeeq , Vaishnavi Modi , Magnus Chun , Pranav Patel , Vignan Manne , Babu P. Mohan

BACKGROUND AND AIMS

Recent studies have indicated the superiority of the Over-The-Scope Clip (OTSC) as a first-line treatment compared with standard endoscopic therapy (ST) for nonvariceal upper gastrointestinal bleeding (NVUGIB). Given the high cost of OTSCs, we assessed the cost-effectiveness of OTSCs vs ST for NVUGIB.

METHODS

We conducted an incremental cost-effectiveness analysis comparing OTSCs with ST as the first-line hemostatic intervention for NVUGIB over a 30-day period using a decision tree model based on pooled randomized controlled trial data. All costs were derived from Centers for Medicare & Medicaid Services reimbursement data and published literature. Analysis was performed using TreeAge Pro Healthcare 2024.

RESULTS

Pooled data of 443 patients (216 OTSCs; 227 ST) were analyzed. For the base case of a 69.8-year-old patient with Forrest Ia, Ib, IIa, or IIb NVUGIB, OTSCs resulted in an incremental cost-effectiveness ratio (ICER) of −$45,454 per quality-adjusted life year (QALY), indicating cost savings. For NVUGIB with stigmata of active bleeding (Forrest Ia or Ib), OTSCs yielded an ICER of −$85,046 per QALY. For acute NVUGIB with high risk of rebleeding (complete Rockall score ≥ 7), OTSCs yielded an ICER of −$112,960 per QALY. OTSCs remained cost-effective compared with ST when the per-OTSC cost was ≤$927 or when ≤2.3 OTSCs were utilized.

CONCLUSION

At a willingness-to-pay of $100,000 per QALY, OTSCs are cost-saving compared with ST for Forrest Ia, Ib, IIa, or IIb NVUGIB, as well as NVUGIB with stigmata of active bleeding or high rebleeding risk. Reducing OTSC costs (≤$927) and optimizing usage (≤2 clips) further improve the economic viability of OTSCs. Our findings support OTSCs as a first-line hemostatic intervention for high-risk NVUGIB to improve clinical and economic outcomes.

背景和目的最近的研究表明，与标准内镜治疗（ST）相比，超镜夹（OTSC）作为治疗非静脉曲张性上消化道出血（NVUGIB）的一线治疗方法具有优势。考虑到OTSCs的高成本，我们评估了OTSCs与ST治疗NVUGIB的成本效益。方法：我们采用基于合并随机对照试验数据的决策树模型，对30天内OTSCs与ST作为NVUGIB一线止血干预进行了增量成本-效果分析。所有费用均来自医疗保险中心；医疗补助服务报销数据和已发表文献。使用TreeAge Pro Healthcare 2024进行分析。结果443例患者(216例OTSCs；227 ST)进行分析。对于69.8岁的Forrest Ia， Ib， IIa或IIb NVUGIB患者的基本病例，OTSCs导致每个质量调整生命年（QALY）的增量成本-效果比（ICER）为- 45,454美元，表明成本节省。对于伴有活动性出血（Forrest Ia或Ib）的NVUGIB， OTSCs的ICER为- 85,046美元/ QALY。对于再出血风险高的急性NVUGIB（完全Rockall评分≥7），OTSCs的ICER为- 112,960美元/ QALY。当每个otsc成本≤927美元或使用≤2.3个ottsc时，与ST相比，OTSCs仍具有成本效益。结论：在每个QALY支付意愿为10万美元的情况下，对于Forrest Ia， Ib， IIa或IIb NVUGIB，以及有活动性出血或高再出血风险的NVUGIB，与ST相比，OTSCs节省了成本。降低OTSC成本（≤927美元）和优化使用（≤2夹子）进一步提高了OTSC的经济可行性。我们的研究结果支持OTSCs作为高风险NVUGIB的一线止血干预措施，以改善临床和经济结果。

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引用次数: 0

Training in Colorectal Endoscopic Submucosal Dissection: US Perspectives 结肠内镜下粘膜下剥离训练：美国视角

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2025.250934

Fredy Nehme , Phillip S. Ge

Endoscopic submucosal dissection (ESD) was established in Japan in the early 2000s for the removal of early neoplastic gastrointestinal lesions with high en bloc and curative resection rates. Although ESD has gained widespread use in Asia, its adoption in the West has been gradual. The procedural complexity, steep learning curve, and limited training resources have been major obstacles. Nonetheless, ESD has been gaining popularity in the United States. The growing body of evidence on the efficacy and safety of ESD, technological advancements in endoscopy, and the establishment of effective training systems are contributing to increased adoption of ESD in the West. More endoscopists are showing interest and have started to adopt this technique, with excellent clinical outcomes. Although there is currently no standardized approach for ESD training in the United States, several pathways and training opportunities have emerged to facilitate broader adoption. These programs aim to bridge the proficiency gap by enhancing the trainee’s cognitive and technical skills. This article aimed to review the current state of colorectal ESD training in the West.

内镜下粘膜夹层（ESD）于21世纪初在日本建立，用于早期胃肠道肿瘤病变的切除，具有很高的整体切除率和治愈率。尽管ESD在亚洲得到了广泛的应用，但在西方的采用却是渐进的。程序的复杂性、陡峭的学习曲线和有限的培训资源一直是主要障碍。尽管如此，ESD在美国越来越受欢迎。越来越多的证据表明ESD的有效性和安全性，内窥镜技术的进步以及有效培训系统的建立正在促进ESD在西方的采用。越来越多的内窥镜医生表现出兴趣，并开始采用这种技术，并取得了良好的临床效果。虽然目前在美国没有标准化的可持续发展教育培训方法，但已经出现了几种途径和培训机会，以促进更广泛的采用。这些项目旨在通过提高受训者的认知和技术技能来弥合熟练程度的差距。本文旨在综述西方国家结肠直肠ESD培训的现状。

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