Techniques and Innovations in Gastrointestinal Endoscopy最新文献

英文中文

Endoscopic Ultrasound-guided Biliary Interventions 超声内镜下胆道介入治疗

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 Epub Date: 2025-03-13 DOI: 10.1016/j.tige.2025.250916

Hiroyuki Isayama, Ko Tomishima, Shigeto Ishii, Yusuke Takasaki, Mako Ushio, Toshio Fujisawa

Endosonographic/endoscopic ultrasound–guided biliary drainage/anastomosis (EUS-BD/A) is widely accepted as a salvage procedure when conventional endoscopic retrograde cholangiopancreatography (ERCP) fails or is difficult. Although this procedure carries risks of severe adverse events (AEs), including perforation and bile leakage due to unattached organs, the risk of postprocedural pancreatitis in EUS-BD/A is extremely low. The intrahepatic bile duct approach is more challenging than extrahepatic because it involves penetrating the liver parenchyma. To establish EUS-BD/A as a standard primary biliary drainage procedure, it is essential to confirm its feasibility compared with ERCP, evaluate expanded indications, develop dedicated devices, and establish AE management strategies. EUS-BD/A showed similar technical and clinical success rates and AE rates, with ERCP and incidence of pancreatitis was significantly lower. Expanded indications for EUS-BD/A include primary drainage, preoperative use, pediatric patients, patients with massive ascites, and reintervention for stent occlusion; however, further evidence is required to support these indications. The development of devices to improve technical success and reduce AE rates is critical to establishing this procedure, but current devices remain insufficient for EUS-BD/A. In Japan, dedicated devices for EUS-BD/A include sharp-tip bougie dilators, drill-type dilators, sharp-tip balloon dilators, and covered self-expandable metallic stents with effective anchoring. Reducing the gap between the device and guidewire is particularly important for endosonographic/endoscopic ultrasound–guided hepaticogastrostomy. Management of AEs and the establishment of follow-up strategies are crucial as well. We herein summarize the prevention and management of AEs, including mediastinitis due to esophageal puncture, bile leakage, bleeding, and perforation, and introduce our follow-up strategy. Our ultimate goal is to establish EUS-BD/A as a standard primary biliary drainage procedure. Continuous efforts are necessary to advance various aspects of EUS-BD/A.

超声内镜/超声内镜引导胆道引流/吻合术（EUS-BD/A）被广泛接受为常规内镜逆行胆管造影（ERCP）失败或困难时的一种救助性手术。尽管该手术存在严重不良事件（ae）的风险，包括未附着器官引起的穿孔和胆漏，但EUS-BD/A术后胰腺炎的风险极低。肝内胆管入路比肝外胆管入路更具挑战性，因为它需要穿透肝实质。为了将EUS-BD/A作为标准的初级胆道引流手术，必须与ERCP进行比较，确认其可行性，评估扩大适应症，开发专用设备，建立AE管理策略。EUS-BD/A的技术和临床成功率和AE率相似，ERCP和胰腺炎发生率明显较低。EUS-BD/A的扩大适应症包括初级引流、术前使用、儿科患者、大量腹水患者和支架闭塞的再干预；然而，需要进一步的证据来支持这些适应症。提高技术成功率和降低AE率的设备的开发对于建立这一程序至关重要，但目前的设备仍然不足以满足EUS-BD/A。在日本，用于EUS-BD/A的专用设备包括尖尖膨胀式扩张器、钻式扩张器、尖尖球囊式扩张器和有效锚定的有盖自膨胀金属支架。减少器械与导丝之间的间隙对于超声内镜下肝胃造口术尤为重要。ae的管理和后续战略的制定也至关重要。我们在此总结ae的预防和处理，包括食管穿刺、胆漏、出血和穿孔引起的纵隔炎，并介绍我们的随访策略。我们的最终目标是建立EUS-BD/A作为标准的初级胆道引流手术。需要继续努力推进eu - bd /A的各个方面。

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引用次数: 0

Endoscopic Ultrasound-Guided Gallbladder Drainage for Acute Cholecystitis and for Expanded Indications: Technique and Outcomes 超声内镜下胆囊引流治疗急性胆囊炎及扩大适应症：技术和结果

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 Epub Date: 2025-01-27 DOI: 10.1016/j.tige.2025.250912

Andrea Anderloni , Cecilia Binda , Aurelio Mauro , Stefano Mazza , Carlo Fabbri , Anthony Y.B. Teoh

Interventional endoscopic ultrasound (EUS) is constantly evolving, thanks to its efficacy for the treatment of several clinical conditions, leading to an extension of applications and indications over the years. Among these, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has become the preferred treatment for acute cholecystitis (AC) in high surgical risk patients, thanks to the introduction of electrocautery-enhanced lumen-apposing metal stents, which allowed a higher standardization of the technique, although still improving. Despite the significant progress made over the past 10 years, there are still a number of debated issues, above all due to application of this technique in a wider variety of broadened indications, beyond AC. Indeed, increasing evidences are emerging on EUS-GBD as treatment in case of distant malignant biliary obstruction in both primary and rescue scenarios. Additionally, there is preliminary evidence on AC prevention following the implantation of fully-covered self-expandable metal stents during endoscopic retrograde cholangiopancreatography in the malignant setting and on the treatment of gallstone-related diseases in not surgically fit patients. With an emphasis on technical considerations and outcomes, this review attempts to update the current indications for EUS-GBD and provide an overview of potential new fields of application for this technique.

介入内镜超声（EUS）不断发展，由于其治疗几种临床病症的疗效，导致多年来的应用和适应症的扩展。其中，超声内镜下胆囊引流术（EUS-GBD）已成为高手术风险患者急性胆囊炎（AC）的首选治疗方法，这是由于电灼增强腔内金属支架的引入，使得该技术的标准化程度更高，尽管仍在改进中。尽管在过去10年中取得了重大进展，但仍存在许多争议问题，首先是由于该技术在AC以外的更广泛适应症中的应用。确实，越来越多的证据表明EUS-GBD在原发性和抢救情况下可用于远处恶性胆道梗阻的治疗。此外，有初步证据表明，在恶性背景的内镜逆行胆管造影术中植入全覆盖自膨胀金属支架可预防AC，以及在不适合手术的患者中治疗胆结石相关疾病。本综述着重于技术考虑和结果，试图更新EUS-GBD目前的适应症，并概述该技术潜在的新应用领域。

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引用次数: 0

A Distinct Breath Metabolome Signature Is Linked With Eosinophilic Esophagitis: A Proof-of-Concept Study Assessing Volatile Organic Compounds 独特的呼吸代谢组特征与嗜酸性粒细胞性食管炎有关：一项评估挥发性有机化合物的概念验证研究

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 Epub Date: 2025-01-27 DOI: 10.1016/j.tige.2025.250913

CLAIRE A. BEVERIDGE , XUEFENG ZHANG , ANDREI I. IVANOV , JONATHAN MARK BROWN , SCOTT GABBARD , FLORIAN RIEDER

引用次数: 0

Artificial Intelligence Advances Digital Pathomics for Confocal Endomicroscopy Diagnosis of Pancreatic Cysts 人工智能在胰腺囊肿共聚焦内镜诊断中的数字病理学进展

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 Epub Date: 2025-04-21 DOI: 10.1016/j.tige.2025.250924

Ahmed Abdelbaki , Ziwei Li , Tai-Yu Pan , Justin Lee , Arpita Chowdhury , Stacey Culp , Bipul Gnyawali , Tassiana G. Maloof , Aayush B. Vishwanath , Sohil Narasimha Reddy , Dylan Mink , Wei Chen , Phil A. Hart , Timothy M. Pawlik , Wei-Lun Chao , Somashekar G. Krishna

BACKGROUND AND AIMS

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy (nCLE) provides real-time optical biopsies enabling diagnosis and risk stratification of intraductal papillary mucinous neoplasms (IPMNs). However, the clinical implementation of Endoscopic ultrasound-nCLE is hindered by time-consuming image review and interobserver variability. We aimed to optimize artificial intelligence (AI) models to accurately detect diagnostic structures to address these gaps.

METHODS

Participants with definitive IPMN diagnoses were selected from prospective studies (2015-2023). Two observers labeled endomicroscopy images used to develop AI models to detect informative segments. Performance was assessed using area under the curve, sensitivity, specificity, and accuracy.

RESULTS

In 66 endomicroscopy videos of IPMNs, 291,045 frames were analyzed, with 15.5% showing papillary or vascular structures and 84.5% lacking structures. Four classification (pattern recognition) and segmentation (image division) models were tested to evaluate binary detection outcomes (papillae vs other) and ternary detection outcomes (papillae, vascularity, and nonstructure). The classification model DINOv2-ViT-G outperformed all others for the binary outcome, achieving an area under the curve of 0.942, sensitivity of 80.6%, specificity of 90.6%, and accuracy of 89.3%. For the ternary outcome, only classification models were used because labeling areas for segmentation models to detect vascularity was impractical. DINOv2-ViT-G similarly demonstrated the best performance, with sensitivities for detecting papillae, vascularity, and nonstructure of 81.7%, 82.0%, and 80.5%, respectively. The DINOv2-ViT-G model reduced nCLE video duration to 1.85 minutes of high-yield, structure-containing segments, saving 4.27 minutes (70%) per IPMN case (P < 0.001).

CONCLUSION

Optimized AI models for structure identification enhance the clinical utility of nCLE by generating high-yield diagnostic segments, ensuring consistent and accurate interpretation, reducing manual effort, and enabling the development of fully autonomous systems in the future.

超声引导的针基共聚焦激光内镜（nCLE）提供实时光学活检，可用于导管内乳头状粘液瘤（IPMNs）的诊断和风险分层。然而，内窥镜超声- ncle的临床实施受到耗时的图像审查和观察者之间的差异的阻碍。我们的目标是优化人工智能（AI）模型，以准确地检测诊断结构，以解决这些差距。方法从前瞻性研究（2015-2023）中选择确诊IPMN的参与者。两名观察员标记了用于开发人工智能模型以检测信息片段的内窥镜图像。使用曲线下面积、灵敏度、特异性和准确性来评估性能。结果66个IPMNs内镜视频共分析291045帧，15.5%显示乳头状或血管结构，84.5%无结构。测试了四种分类（模式识别）和分割（图像分割）模型，以评估二值检测结果（乳头状体与其他）和三值检测结果（乳头状体、血管性和非结构性）。DINOv2-ViT-G分类模型在二元结果上优于其他分类模型，曲线下面积为0.942，灵敏度为80.6%，特异性为90.6%，准确率为89.3%。对于三元结果，只使用分类模型，因为标记区域的分割模型检测血管是不切实际的。DINOv2-ViT-G同样表现出最好的性能，对乳头、血管和非结构的检测灵敏度分别为81.7%、82.0%和80.5%。DINOv2-ViT-G模型将nCLE视频时间缩短至1.85分钟，高产量，含结构片段，每个IPMN病例节省4.27分钟（70%）(P <；0.001)。结论：优化后的人工智能模型可以生成高产量的诊断片段，确保一致和准确的解释，减少人工工作量，并使未来开发完全自主的系统成为可能，从而提高nCLE的临床应用。

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引用次数: 0

Facilitating Colorectal Endoscopic Submucosal Dissection: Devices and Techniques 促进结肠内镜下粘膜下剥离：设备和技术

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 Epub Date: 2025-06-01 DOI: 10.1016/j.tige.2025.250932

Teppei Akimoto , Naohisa Yahagi , Motohiko Kato

Colorectal endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic treatment that achieves a high R0 resection rate regardless of lesion size. However, its widespread adoption is limited by technical difficulties, promoting the development of various devices and techniques to support the procedure. Fundamental tools include ESD knives, transparent caps, and injection solutions. Among these, traction is especially critical for creating the mucosal flap, which is considered the most technically demanding step of ESD. Numerous traction methods and devices have been introduced, particularly for colorectal ESD. Recently, increasing attention has been paid to the use of dedicated traction devices, the pocket creation method, and buoyancy and water jet pressure under saline conditions. Nevertheless, the selection and application of these devices and techniques remain complex and underexplored. This narrative review outlines the features of available devices and techniques, discusses their appropriate selection, and provides practical tips to facilitate safe and effective colorectal ESD.

结肠内镜下粘膜下剥离术（ESD）是一种微创内镜治疗方法，无论病变大小，均可获得较高的R0切除率。然而，它的广泛采用受到技术困难的限制，促进了各种设备和技术的发展，以支持该程序。基本工具包括防静电刀、透明帽和注射液。其中，牵引对于粘膜瓣的创建尤为关键，这被认为是ESD技术要求最高的步骤。许多牵引方法和设备已经被引入，特别是结肠直肠ESD。最近，越来越多的人开始关注专用牵引装置的使用、造袋方法以及盐水条件下的浮力和水射流压力。然而，这些设备和技术的选择和应用仍然很复杂，而且尚未得到充分探索。本文概述了现有设备和技术的特点，讨论了它们的适当选择，并提供了实用的技巧，以促进安全有效的结肠直肠ESD。

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引用次数: 0

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 Epub Date: 2025-06-28 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

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 Epub Date: 2025-07-09 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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IF 0.9 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 Epub Date: 2025-10-27 DOI: 10.1016/S2590-0307(25)00043-1

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IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2025-01-01 Epub Date: 2025-04-05 DOI: 10.1016/j.tige.2025.250918

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