Techniques and Innovations in Gastrointestinal Endoscopy最新文献_第4页

Percutaneous Endoscopic Vacuum Therapy for Patients With Postoperative Enterocutaneous Fistulas: A Retrospective Study 经皮内镜真空治疗术后肠皮瘘的回顾性研究

IF 0.9 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-09-28 DOI: 10.1016/j.tige.2025.250947

Marcus Kantowski , Nathaniel Melling , Thomas Roesch , Chengcheng Christine Zhang

BACKGROUND AND AIMS

Enterocutaneous fistulas following intestinal surgery are a feared complication with high morbidity and mortality. The therapeutic management of these fistulas is challenging. Percutaneous endoscopic vacuum therapy may be a new promising approach. Therefore, we aimed to evaluate the feasibility, effectiveness, and safety of percutaneous endoscopic vacuum therapy in patients with postoperative enterocutaneous fistulas.

METHODS

Patients with postoperative enterocutaneous fistulas treated with percutaneous endoscopic vacuum therapy were included and analyzed retrospectively. The primary endpoint was successful fistula closure using percutaneous endoscopic vacuum therapy.

RESULTS

This study included 44 patients, with a median follow-up of 5.9 months. Most patients (n = 35 of 44, 79.5%) received combined endoscopic treatments. The median duration of percutaneous endoscopic therapy was 37 days (range, 1-370 days), with a median of 6 endoscopic interventions (range, 1-15). Percutaneous endoscopic vacuum therapy was successful in 30 patients (68.2%). The remaining 14 patients (31.8%) required surgical revision, and of these, 10 (71.4%) achieved complete healing postoperatively. The overall success rate was 90.1% (n = 40 of 44). Procedure-related complications (anastomotic stenosis and duodenal ulcer bleeding) occurred in 6 patients (n = 6 of 44, 13.6%); 4 were treated endoscopically, while 2 required reoperation. The 30-day mortality rate was 20.5% (n = 9 of 44), and none of the deaths were treatment-related.

CONCLUSIONS

Percutaneous endoscopic vacuum therapy is feasible, effective, and safe for endoscopic treatment of postoperative enterocutaneous fistulas. Given the complexity of this severe condition, developing an individualized, multidisciplinary therapeutic concept based on clinical conditions and fistula morphology is crucial for the successful treatment.

背景和目的：肠道手术后并发皮肤瘘是一种令人恐惧的并发症，具有很高的发病率和死亡率。这些瘘管的治疗管理是具有挑战性的。经皮内窥镜真空治疗可能是一种有前景的新方法。因此，我们旨在评估经皮内镜真空治疗术后肠皮瘘患者的可行性、有效性和安全性。方法回顾性分析经皮内镜真空治疗术后肠皮瘘患者的临床资料。主要终点是通过经皮内镜真空治疗成功闭合瘘管。结果本研究纳入44例患者，中位随访5.9个月。大多数患者（n = 35 / 44, 79.5%）接受联合内镜治疗。经皮内镜治疗的中位持续时间为37天（范围1-370天），中位数为6次内镜干预（范围1-15次）。经皮内镜真空治疗成功30例（68.2%）。其余14例（31.8%）患者需要手术翻修，其中10例（71.4%）患者术后完全愈合。总成功率为90.1% （n = 40 / 44）。6例发生手术相关并发症（吻合口狭窄和十二指肠溃疡出血）（n = 6 / 44, 13.6%）；4例经内镜治疗，2例再次手术。30天死亡率为20.5% (n = 9 / 44)，死亡均与治疗无关。结论经皮真空内镜治疗术后肠皮瘘可行、有效、安全。鉴于这种严重疾病的复杂性，基于临床条件和瘘管形态发展个性化的多学科治疗理念对于成功治疗至关重要。

{"title":"Percutaneous Endoscopic Vacuum Therapy for Patients With Postoperative Enterocutaneous Fistulas: A Retrospective Study","authors":"Marcus Kantowski , Nathaniel Melling , Thomas Roesch , Chengcheng Christine Zhang","doi":"10.1016/j.tige.2025.250947","DOIUrl":"10.1016/j.tige.2025.250947","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Enterocutaneous fistulas following intestinal surgery are a feared complication with high morbidity and mortality. The therapeutic management of these fistulas is challenging. Percutaneous endoscopic vacuum therapy may be a new promising approach. Therefore, we aimed to evaluate the feasibility, effectiveness, and safety of percutaneous endoscopic vacuum therapy in patients with postoperative enterocutaneous fistulas.</div></div><div><h3>METHODS</h3><div>Patients with postoperative enterocutaneous fistulas treated with percutaneous endoscopic vacuum therapy were included and analyzed retrospectively. The primary endpoint was successful fistula closure using percutaneous endoscopic vacuum therapy.</div></div><div><h3>RESULTS</h3><div>This study included 44 patients, with a median follow-up of 5.9 months. Most patients (n = 35 of 44, 79.5%) received combined endoscopic treatments. The median duration of percutaneous endoscopic therapy was 37 days (range, 1-370 days), with a median of 6 endoscopic interventions (range, 1-15). Percutaneous endoscopic vacuum therapy was successful in 30 patients (68.2%). The remaining 14 patients (31.8%) required surgical revision, and of these, 10 (71.4%) achieved complete healing postoperatively. The overall success rate was 90.1% (n = 40 of 44). Procedure-related complications (anastomotic stenosis and duodenal ulcer bleeding) occurred in 6 patients (n = 6 of 44, 13.6%); 4 were treated endoscopically, while 2 required reoperation. The 30-day mortality rate was 20.5% (n = 9 of 44), and none of the deaths were treatment-related.</div></div><div><h3>CONCLUSIONS</h3><div>Percutaneous endoscopic vacuum therapy is feasible, effective, and safe for endoscopic treatment of postoperative enterocutaneous fistulas. Given the complexity of this severe condition, developing an individualized, multidisciplinary therapeutic concept based on clinical conditions and fistula morphology is crucial for the successful treatment.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"28 1","pages":"Article 250947"},"PeriodicalIF":0.9,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384188","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}

引用次数: 0

The Rise of Peroral Endoscopic Myotomy: Achalasia Treatment Trends, Institutional Adoption Patterns, and Current Procedural Terminology Coding in a Nationwide Cohort (2014-2024) 经口内窥镜下肌切开术的兴起：贲门失弛缓症的治疗趋势、机构采用模式和目前全国队列的手术术语编码（2014-2024）

IF 0.9 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-09-14 DOI: 10.1016/j.tige.2025.250946

Mohammad Abuassi , Kobina Essilfie-Quaye , Ashraf Almomani , Carson Creamer , Harsimran Kalsi , Tony Brar , Yaseen Perbtani

BACKGROUND AND AIMS

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.

METHODS

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.

RESULTS

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 (P = 0.337) or trend-altering (P = 0.150) effects from CPT coding changes. Academic institutions consistently demonstrated higher and earlier POEM adoption than nonacademic centers.

CONCLUSION

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.

背景和目的贲门失弛缓症是一种慢性食管运动障碍，以食管下括约肌松弛受损和蠕动缺失为特征。经口内窥镜下肌切开术（POEM）的出现显著改变了贲门失弛缓症的治疗模式，尽管采用的方法仍存在差异。本研究评估了失弛缓症管理的全国趋势，2022年现行程序术语（CPT）编码变更对POEM的影响，以及程序采用的制度差异。方法采用TriNetX数据库对2014 - 2024年诊断为贲门失弛缓症的成人患者进行回顾性队列分析。分析了年发病率和患病率、治疗模式和机构（学术与非学术）利用趋势。中断时间序列分析评估了2022年CPT代码实施对POEM采用的影响。结果贲门失弛缓症的发病率在研究期间从8.36 / 10万增加到16.1 / 10万。POEM的使用率大幅上升（0.42%-3.21%），而腹腔镜Heller肌切开术和气动扩张术的使用率保持相对稳定，近年来Heller肌切开术的使用率呈下降趋势（从2019年的峰值1.46%下降到2024年的0.94%）。肉毒毒素注射剂的使用率也显著增加（0.33% ~ 1.38%）。中断时间序列分析显示，CPT编码变化没有显著的直接影响（P = 0.337）或趋势改变（P = 0.150）。学术机构比非学术中心一贯表现出更高、更早的诗歌采用率。结论：在过去的十年中，诗的使用稳步增加，主要是由临床疗效而不是报销政策驱动的。学术机构和非学术机构之间在采用方面的差异仍然存在，这强调了扩大培训和公平获得先进治疗选择的必要性。

{"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 , Kobina Essilfie-Quaye , Ashraf Almomani , Carson Creamer , Harsimran Kalsi , Tony Brar , 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":"2025-09-14","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}

引用次数: 0

Outcomes of Invisible Dysplasia Found on Random Biopsy Referred for Chromoendoscopy in a Community Practice 在一个社区实践中，随机活检发现的不可见的发育不良转诊为色内窥镜检查

IF 0.9 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-09-12 DOI: 10.1016/j.tige.2025.250945

Suvithan Rajadurai , Samir A. Shah

引用次数: 0

Raising the BARS: First US Experience of the Bariatric Anastomotic Reduction System (BARS) for Endoscopic Gastrojejunal Anastomosis Revision 提高BARS：美国首次应用barric吻合器复位系统（BARS）进行胃空肠内镜吻合术翻修

IF 0.9 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-09-10 DOI: 10.1016/j.tige.2025.250944

Stephen A. Firkins , Leandro Sierra , Akash Khurana , Arjun Chatterjee , Roma Patel , Bailey Flora , Erika Staneff , Roberto Simons-Linares

引用次数: 0

Concurrent Colonoscopy Does Not Affect Results of Wireless Ambulatory pH Monitoring 同时结肠镜检查不影响无线动态pH监测结果

IF 0.9 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-09-08 DOI: 10.1016/j.tige.2025.250943

Chasen Cottle , Manar Al Jawish , Swathi Eluri , Maoyin Pang , Andree Koop

引用次数: 0

International Survey Assessing Gender Disparities in Advanced Therapeutic Endoscopy 评估高级治疗性内窥镜中性别差异的国际调查

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2025.250917

Katarzyna M. Pawlak , Kareem Khalaf , Erin Brennand , Andrei Voiosu , Theodor Voiosu , Giulio Antonelli , Sharan B. Malipatil , Caleb Na , Ahmed H. Mokhtar , Balqis Alabdulkarim , Maryam Mahjoob , Arjun Kundra , Jeanin van Hooft , Uzma Siddiqui , Roberta Maselli , Jeffrey D. Mosko , Jennifer Telford , Nauzer Forbes , Natalia Causada Calo

BACKGROUND AND AIMS

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

背景和目的女性在晚期治疗性内窥镜检查中的代表性不足是一个多因素问题。我们的目的是评估不同性别对透视使用的关注，并评估其对高级治疗性内窥镜中女性代表性的影响。方法于2023年8月对进行内窥镜逆行胆管造影（ERCP）的医师进行国际调查。主要结果是与透视暴露相关的担忧频率。次要结局包括这些担忧的原因或含义。跨性别进行亚组分析。结果执行sercp的医生在治疗性内窥镜检查中存在性别差异，男性受访者占72.8%，女性受访者占27.2%。大多数参与者是工作人员（67.6%），主要是男性（70.6%）。平均年龄为38.2岁，中位机构ERCP量为550例。了解透视安全标准的比例为56.1%，但接受过正规培训的比例仅为51.6%。对辐射的担忧包括癌症风险（73.4%）和生育风险（43.9%）。防护设备的使用不足：甲状腺剂量计（21.9%总是使用）、盆腔剂量计（13.1%）和含铅护目镜（8.4%）。女性受访者特别提到推迟计划生育（27.6%）和害怕在怀孕期间工作（40.4%），而男性受访者则关注一般健康风险。此外，68.4%的机构记录了透视时间，但只有56.1%的机构报告了剂量计的使用。结论：在透视暴露方面的性别差异需要改进培训和安全标准，以促进治疗性内窥镜检查的公平性。通过有针对性的教育和政策改革来解决这些问题，不仅可以提高人们对辐射风险的认识，还可以为男性和女性从业者创造一个更包容的环境。

{"title":"International Survey Assessing Gender Disparities in Advanced Therapeutic Endoscopy","authors":"Katarzyna M. Pawlak , Kareem Khalaf , Erin Brennand , Andrei Voiosu , Theodor Voiosu , Giulio Antonelli , Sharan B. Malipatil , Caleb Na , Ahmed H. Mokhtar , Balqis Alabdulkarim , Maryam Mahjoob , Arjun Kundra , Jeanin van Hooft , Uzma Siddiqui , Roberta Maselli , Jeffrey D. Mosko , Jennifer Telford , Nauzer Forbes , 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}

引用次数: 0

Endoscopic Band Ligation With Sclerotherapy Versus Milligan–Morgan Hemorrhoidectomy for the Treatment of Mixed Hemorrhoids 治疗混合痔的内窥镜带状结扎术和硬化疗法与米利根-摩根痔疮切除术的比较

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2025.250914

Minghua Ai , Weizheng Wang , Jie Li , Xiaoping Tan , Qing Zhang

BACKGROUND AND AIMS

To compare the clinical efficacy of endoscopic band ligation with sclerotherapy (EBS) with that of Milligan–Morgan hemorrhoidectomy (MMH) in the treatment of mixed hemorrhoids.

METHODS

This study was a retrospective, single-center investigation conducted at the First Hospital of Yangtze University. From September 2022 to March 2023, 46 patients who underwent EBS for mixed hemorrhoids were selected in an observation group, whereas 32 patients who underwent MMH for mixed hemorrhoids were allocated to a control group. Surgical-related parameters and adverse events were compared between the 2 groups, and the relationship between the number of endoscopic bands used and pain levels was analyzed.

RESULTS

The observation group demonstrated significantly shorter surgical and hospitalization durations than the control group (P < 0.05). Furthermore, the 2 groups showed decreased postoperative visual analog scale scores, with the observation group exhibiting consistently lower scores at 24 hours, 48 hours, and 1 week postoperatively (P < 0.05). Additionally, visual analog scale scores in the observation group at 4 hour postsurgery were correlated with the number of endoscopic ligation bands applied (R² = 0.1253; P = 0.0158). No significant differences in postoperative anal swelling, overall efficacy, or patient satisfaction were observed between the 2 groups (all P > 0.05). However, the observation group experienced significantly less intraoperative (0% vs 84.4%; P = 0.000) and postoperative bleeding (6.5% vs 34.4%; P = 0.002) and a lower postoperative infection rate (0% vs 9.4%; P = 0.034) than the control group.

CONCLUSION

EBS provides clinical efficacy comparable with that of MMH in the treatment of mixed hemorrhoids. Moreover, the EBS approach is a potentially less invasive and shorter surgical procedure with relatively reduced hospitalization time, lower complication risk, and faster recovery.

背景和目的比较内镜下带状结扎联合硬化剂注射（EBS）与米利根-摩根痔切除术（MMH）治疗混合痔的临床疗效。自2022年9月至2023年3月，46名接受EBS治疗混合痔的患者被选入观察组，32名接受MMH治疗混合痔的患者被分配到对照组。结果观察组的手术时间和住院时间明显短于对照组（P <0.05）。此外，两组的术后视觉模拟量表评分均有所下降，观察组在术后 24 小时、48 小时和 1 周的评分持续较低（P < 0.05）。此外，观察组在术后 4 小时的视觉模拟量表评分与使用的内窥镜结扎带数量相关（R2 = 0.1253；P = 0.0158）。两组患者在术后肛门肿胀、总体疗效或患者满意度方面无明显差异（均为 P > 0.05）。然而，观察组的术中出血量（0% vs 84.4%；P = 0.000）和术后出血量（6.5% vs 34.4%；P = 0.002）明显少于对照组，术后感染率（0% vs 9.4%；P = 0.034）也低于对照组。此外，EBS 方法可能是一种创伤更小、时间更短的手术方法，住院时间相对缩短，并发症风险更低，恢复更快。

{"title":"Endoscopic Band Ligation With Sclerotherapy Versus Milligan–Morgan Hemorrhoidectomy for the Treatment of Mixed Hemorrhoids","authors":"Minghua Ai , Weizheng Wang , Jie Li , Xiaoping Tan , Qing Zhang","doi":"10.1016/j.tige.2025.250914","DOIUrl":"10.1016/j.tige.2025.250914","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>To compare the clinical efficacy of endoscopic band ligation with sclerotherapy (EBS) with that of Milligan–Morgan hemorrhoidectomy (MMH) in the treatment of mixed hemorrhoids.</div></div><div><h3>METHODS</h3><div>This study was a retrospective, single-center investigation conducted at the First Hospital of Yangtze University. From September 2022 to March 2023, 46 patients who underwent EBS for mixed hemorrhoids were selected in an observation group, whereas 32 patients who underwent MMH for mixed hemorrhoids were allocated to a control group. Surgical-related parameters and adverse events were compared between the 2 groups, and the relationship between the number of endoscopic bands used and pain levels was analyzed.</div></div><div><h3>RESULTS</h3><div>The observation group demonstrated significantly shorter surgical and hospitalization durations than the control group (<em>P <</em> 0.05). Furthermore, the 2 groups showed decreased postoperative visual analog scale scores, with the observation group exhibiting consistently lower scores at 24 hours, 48 hours, and 1 week postoperatively (<em>P <</em> 0.05). Additionally, visual analog scale scores in the observation group at 4 hour postsurgery were correlated with the number of endoscopic ligation bands applied (<em>R</em><sup>2</sup> = 0.1253; <em>P</em> = 0.0158). No significant differences in postoperative anal swelling, overall efficacy, or patient satisfaction were observed between the 2 groups (all <em>P ></em> 0.05). However, the observation group experienced significantly less intraoperative (0% vs 84.4%; <em>P</em> = 0.000) and postoperative bleeding (6.5% vs 34.4%; <em>P</em> = 0.002) and a lower postoperative infection rate (0% vs 9.4%; <em>P</em> = 0.034) than the control group.</div></div><div><h3>CONCLUSION</h3><div>EBS provides clinical efficacy comparable with that of MMH in the treatment of mixed hemorrhoids. Moreover, the EBS approach is a potentially less invasive and shorter surgical procedure with relatively reduced hospitalization time, lower complication risk, and faster recovery.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 2","pages":"Article 250914"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687023","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}

引用次数: 0

Endoscopic Assessment of Large Colorectal Lesions 内镜下评估大肠癌病变

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2025.250931

Naoto Tamai, Kazuki Sumiyama

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.

内镜下粘膜剥离术（ESD）已成为内镜下粘膜切除术或水下内镜下粘膜切除术无法切除的结直肠病变的重要治疗策略，使整块切除术具有精确的组织病理学评估。然而，确定大结直肠病变ESD的合适适应症仍然是一个重大挑战。本文旨在全面总结结肠ESD的适应症以及内镜评估在制定最佳治疗策略中的作用。结肠直肠深部粘膜下病变常伴有广泛的粘膜下纤维化，在ESD中存在相当大的技术困难。在此类病变上实施ESD会增加额外的手术干预，并增加手术相关并发症的风险。因此，全面的术前评估病变是必要的，以确保适当的治疗策略，同时尽量减少不必要的风险。通过白光成像、窄带成像等先进成像方式以及彩色内镜对结直肠病变进行准确评估是评估病变特征的关键。此外，人工智能在病变表征中的应用已显示出作为促进ESD适应症临床决策的支持工具的潜力。人工智能可以通过提高病变评估的准确性和改进治疗计划来帮助内窥镜医生。全面了解大肠癌病变的形态和病理特征对于确定从ESD中获益最多的患者至关重要，同时将并发症的风险降至最低。这篇综述强调了仔细的内镜评估的必要性，以确保适当的病变选择，确保ESD在大肠癌病变中的安全有效应用，并最终有助于改善患者的预后。

{"title":"Endoscopic Assessment of Large Colorectal Lesions","authors":"Naoto Tamai, 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}

引用次数: 0

IF 0.9 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01

引用次数: 0

Traction-Assisted Endoscopic Submucosal Dissection of Colonic Lesions: A North American Experience 牵引辅助内镜下结肠病变粘膜剥离：北美经验

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 DOI: 10.1016/j.tige.2024.250900

Farid Abushamat, Fares Ayoub, Mai A. Khalaf, Tara Keihanian, Salmaan Jawaid, Mohamed O. Othman

BACKGROUND AND AIMS

Traction-assisted endoscopic submucosal dissection (TA-ESD) is a proposed technique to improve the efficiency of endoscopic submucosal dissection (ESD). Multiple studies primarily from Asian centers yielded mixed results in terms of procedure time, en bloc resection rate, and R0 resection rate of TA-ESD in comparison with those of conventional endoscopic submucosal dissection (C-ESD). We performed the first comparison of TA-ESD with C-ESD at a high-volume North American center.

METHODS

This was a retrospective cohort-matched study of all patients who underwent colonic ESD at a single center in the United States by a single operator. The study group were patients who underwent TA-ESD and were matched with a C-ESD case on a 1:1 basis based upon location within the colon, lesion size, and scope stabilization device usage. The baseline characteristics and procedure-related outcomes were compared between the groups.

RESULTS

In total, 138 colonic ESD cases were included (69 TA-ESD and 69 C-ESD). There were no significant differences in the baseline characteristics between the groups. Mean procedure time was 91.0 minutes (SD: 32.5) for TA-ESD and 85.4 minutes (SD: 39.3) for C-ESD (P = 0.36). En bloc resection was achieved in 69 (100%) of the TA-ESDs and 67 (97.1%) of the C-ESDs (P = 0.15). R0 resection was achieved in 52 (75.4%) of the TA-ESDs and 48 (69.6%) of the C-ESDs (P = 0.45).

CONCLUSION

We did not show a significant difference in procedure time, en bloc resection, R0 resection, or adverse events. Further randomized prospective studies that are sufficiently powered and stratified by operator experience level are needed to further elucidate the utility of the technique.

背景和目的超声辅助内镜下粘膜剥离术（TA-ESD）是一种提高内镜下粘膜剥离术（ESD）效率的技术。主要来自亚洲中心的多项研究在手术时间、整体切除率和R0切除率方面与传统内镜下粘膜下剥离（C-ESD）相比得出了不同的结果。我们在北美大容量中心进行了首次TA-ESD与C-ESD的比较。方法：这是一项回顾性队列匹配研究，研究对象为在美国同一中心接受结肠ESD手术的所有患者。研究组是接受TA-ESD的患者，根据结肠内位置、病变大小和范围稳定装置的使用情况，以1:1的比例匹配C-ESD病例。比较两组患者的基线特征和手术相关结果。结果共纳入结肠ESD 138例，其中ta型ESD 69例，c型ESD 69例。两组间基线特征无显著差异。TA-ESD平均手术时间为91.0分钟（SD: 32.5）， C-ESD平均手术时间为85.4分钟（SD: 39.3）（P = 0.36）。整体切除69例（100%）TA-ESDs和67例（97.1%）C-ESDs （P = 0.15）。52例TA-ESDs（75.4%）和48例C-ESDs（69.6%）实现R0切除（P = 0.45）。结论：我们在手术时间、整体切除、R0切除或不良事件方面没有显示出显著差异。为了进一步阐明该技术的实用性，需要进一步的随机前瞻性研究，这些研究需要有足够的动力，并根据操作人员的经验水平进行分层。

{"title":"Traction-Assisted Endoscopic Submucosal Dissection of Colonic Lesions: A North American Experience","authors":"Farid Abushamat, Fares Ayoub, Mai A. Khalaf, Tara Keihanian, Salmaan Jawaid, Mohamed O. Othman","doi":"10.1016/j.tige.2024.250900","DOIUrl":"10.1016/j.tige.2024.250900","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Traction-assisted endoscopic submucosal dissection (TA-ESD) is a proposed technique to improve the efficiency of endoscopic submucosal dissection (ESD). Multiple studies primarily from Asian centers yielded mixed results in terms of procedure time, en bloc resection rate, and R0 resection rate of TA-ESD in comparison with those of conventional endoscopic submucosal dissection (C-ESD). We performed the first comparison of TA-ESD with C-ESD at a high-volume North American center.</div></div><div><h3>METHODS</h3><div>This was a retrospective cohort-matched study of all patients who underwent colonic ESD at a single center in the United States by a single operator. The study group were patients who underwent TA-ESD and were matched with a C-ESD case on a 1:1 basis based upon location within the colon, lesion size, and scope stabilization device usage. The baseline characteristics and procedure-related outcomes were compared between the groups.</div></div><div><h3>RESULTS</h3><div>In total, 138 colonic ESD cases were included (69 TA-ESD and 69 C-ESD). There were no significant differences in the baseline characteristics between the groups. Mean procedure time was 91.0 minutes (SD: 32.5) for TA-ESD and 85.4 minutes (SD: 39.3) for C-ESD (<em>P</em> = 0.36). En bloc resection was achieved in 69 (100%) of the TA-ESDs and 67 (97.1%) of the C-ESDs (<em>P</em> = 0.15). R0 resection was achieved in 52 (75.4%) of the TA-ESDs and 48 (69.6%) of the C-ESDs (<em>P</em> = 0.45).</div></div><div><h3>CONCLUSION</h3><div>We did not show a significant difference in procedure time, en bloc resection, R0 resection, or adverse events. Further randomized prospective studies that are sufficiently powered and stratified by operator experience level are needed to further elucidate the utility of the technique.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 1","pages":"Article 250900"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158124","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}

引用次数: 0