Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 2","pages":"Article 250916"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146834757","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":"Reopenable Clip-Over-the-Line Method for Troubleshooting Iatrogenic Gastrointestinal Perforations","authors":"Takeshi Yasuda, Narutoshi Ando, Tamae Hashimoto, Yoshiaki Kanai, Yoichi Sakamoto, Yuki Endo, Tomohiro Soda, Takako Akazawa, Tsuguhiro Matsumoto, Norihito Yamauchi, Akira Muramatsu, Hiromu Kutsumi","doi":"10.1016/j.tige.2024.250901","DOIUrl":"10.1016/j.tige.2024.250901","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 1","pages":"Article 250901"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158116","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":"Comparative Efficacy and Safety of Needle-Knife Fistulotomy vs Standard Cannulation: A Practical Randomized Controlled Trial","authors":"Aleksey Novikov ,&nbsp;Shuji Mitsuhashi ,&nbsp;Muhammad Hassaan Bashir ,&nbsp;Mena Bakhit ,&nbsp;Ian Holmes ,&nbsp;Alexander Schlachterman ,&nbsp;Austin Chiang ,&nbsp;David Loren ,&nbsp;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> &lt; 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}

{"title":"Endoscopic Ultrasound-guided Biliary Interventions","authors":"Hiroyuki Isayama,&nbsp;Ko Tomishima,&nbsp;Shigeto Ishii,&nbsp;Yusuke Takasaki,&nbsp;Mako Ushio,&nbsp;Toshio Fujisawa","doi":"10.1016/j.tige.2025.250916","DOIUrl":"10.1016/j.tige.2025.250916","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 2","pages":"Article 250916"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785197","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":"Understanding Patients’ Current Acceptability of Artificial Intelligence During Colonoscopy for Polyp Detection: A Single-Center Study","authors":"Kathryn A. Schmidt ,&nbsp;Shubham Sood ,&nbsp;Saam Dilmaghani ,&nbsp;Cadman Leggett ,&nbsp;Ross Dierkhising ,&nbsp;Mayank Goyal ,&nbsp;Barbara A. Barry ,&nbsp;Xuan Zhu ,&nbsp;Nayantara Coelho-Prabhu","doi":"10.1016/j.tige.2024.250905","DOIUrl":"10.1016/j.tige.2024.250905","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Research into potential applications of artificial intelligence (AI) in healthcare have witnessed a meteoric rise. A primary application in gastroenterological care is colonoscopy. Before AI tools become ubiquitous in healthcare, it is critical to appreciate the perspective of the potential beneficiaries, particularly patients. This study evaluated patient acceptability of AI in colonoscopy, particularly for polyp detection and diagnosis.</div></div><div><h3>METHODS</h3><div>In this cross-sectional survey study, patients undergoing outpatient colon cancer screening or surveillance colonoscopies at Mayo Clinic, Rochester, from September 2023 to February 2024 completed an electronic self-administered survey via tablet computer including questions regarding AI in colonoscopy. The primary outcome was patient perspectives on AI, and secondary outcomes included patient factors influencing their perspective. Statistical analyses were performed using Pearson's chi-square test and ordinal logistic regression.</div></div><div><h3>RESULTS</h3><div>Five hundred eight participants completed the survey. Younger age, male gender, and higher education were associated with higher AI familiarity and perceived importance, while males and those who believed in AI's positive outcomes were more comfortable with AI-assisted polyp detection.</div></div><div><h3>CONCLUSION</h3><div>This study is the first to assess patient perceptions of AI in colonoscopy. While patients generally believe AI can improve health outcomes, there is uncertainty about its current use, indicating a gap in knowledge and awareness. Key findings highlight that beliefs in AI's efficacy are linked to increased comfort with AI-assisted procedures, with significant demographic variations in perceptions, particularly across gender, age, and education. Addressing disparities through targeted education and transparent communication is crucial for fostering patient acceptance and trust in AI-assisted colonoscopy.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 2","pages":"Article 250905"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349020","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":"Endoscopic Ultrasound-Guided Gallbladder Drainage for Acute Cholecystitis and for Expanded Indications: Technique and Outcomes","authors":"Andrea Anderloni ,&nbsp;Cecilia Binda ,&nbsp;Aurelio Mauro ,&nbsp;Stefano Mazza ,&nbsp;Carlo Fabbri ,&nbsp;Anthony Y.B. Teoh","doi":"10.1016/j.tige.2025.250912","DOIUrl":"10.1016/j.tige.2025.250912","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 2","pages":"Article 250912"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601225","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":"A Distinct Breath Metabolome Signature Is Linked With Eosinophilic Esophagitis: A Proof-of-Concept Study Assessing Volatile Organic Compounds","authors":"CLAIRE A. BEVERIDGE ,&nbsp;XUEFENG ZHANG ,&nbsp;ANDREI I. IVANOV ,&nbsp;JONATHAN MARK BROWN ,&nbsp;SCOTT GABBARD ,&nbsp;FLORIAN RIEDER","doi":"10.1016/j.tige.2025.250913","DOIUrl":"10.1016/j.tige.2025.250913","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 2","pages":"Article 250913"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601231","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":"Artificial Intelligence Advances Digital Pathomics for Confocal Endomicroscopy Diagnosis of Pancreatic Cysts","authors":"Ahmed Abdelbaki ,&nbsp;Ziwei Li ,&nbsp;Tai-Yu Pan ,&nbsp;Justin Lee ,&nbsp;Arpita Chowdhury ,&nbsp;Stacey Culp ,&nbsp;Bipul Gnyawali ,&nbsp;Tassiana G. Maloof ,&nbsp;Aayush B. Vishwanath ,&nbsp;Sohil Narasimha Reddy ,&nbsp;Dylan Mink ,&nbsp;Wei Chen ,&nbsp;Phil A. Hart ,&nbsp;Timothy M. Pawlik ,&nbsp;Wei-Lun Chao ,&nbsp;Somashekar G. Krishna","doi":"10.1016/j.tige.2025.250924","DOIUrl":"10.1016/j.tige.2025.250924","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>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.</div></div><div><h3>METHODS</h3><div>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.</div></div><div><h3>RESULTS</h3><div>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 (<em>P</em> &lt; 0.001).</div></div><div><h3>CONCLUSION</h3><div>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.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 3","pages":"Article 250924"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107531","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":"A Novel Cleansing Solution for High-Quality Upper Gastrointestinal Endoscopy: A Multicenter Randomized Controlled Trial","authors":"Noemi Gualandi ,&nbsp;Giulia Gibiino ,&nbsp;Giuliano Francesco Bonura ,&nbsp;Matteo Secco ,&nbsp;Paola Soriani ,&nbsp;Alessandro Cucchetti ,&nbsp;Cecilia Binda ,&nbsp;Valentina Zadro ,&nbsp;Pablo Cortegoso Valdivia ,&nbsp;Paolo Biancheri ,&nbsp;Mauro Manno ,&nbsp;Carlo Fabbri","doi":"10.1016/j.tige.2025.250928","DOIUrl":"10.1016/j.tige.2025.250928","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Esophagogastroduodenoscopy (EGD) is the gold standard examination for upper gastrointestinal (GI) disease diagnosis; however, intraluminal bubbles and mucus may reduce visibility. Mucolytic and tensioactive agents before EGD improve gastric visualization. We compared the efficacy of a novel cleansing preparation vs fasting on upper GI tract visualization during EGD.</div></div><div><h3>METHODS</h3><div>We conducted a multicenter, prospective, randomized controlled trial on consecutive adult outpatients undergoing EGD. Patients were randomized 1:1 to drink 50 mL of simethicone 150 mg, N-acetylcysteine 250 mg, and 10% acetic acid solution (Lumevis, Biofarmatec srl, Palermo, Italy) before the EGD or to fasting. The primary outcome was overall mucosal vision quality score, defined as the sum of 1-10 visual analog scale scores (0 = no visualization; 10 = perfect visualization) for each segment (esophagus, stomach, and duodenum) before washing. Secondary outcomes included adverse event rate, patient satisfaction, and EGD duration.</div></div><div><h3>RESULTS</h3><div>Patients were randomized to cleansing solution (<em>n</em> = 60) or fasting (<em>n</em> = 60). Cleansing preparation administration before EGD was associated with a higher overall mucosal vision quality score compared with fasting only (median visual analog scale score 23 [range, 21-25] vs 19 [range, 16-23], <em>P</em> = 0.001). No adverse events were reported in both groups. Patient satisfaction and EGD duration were similar between the cleansing preparation and fasting only.</div></div><div><h3>CONCLUSION</h3><div>Compared with fasting only, the administration of this novel cleansing solution was associated with improved mucosal visualization of the upper GI tract.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 3","pages":"Article 250928"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298000","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}