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Bariatric procedures and microbiota: patient selection and outcome prediction. 减肥手术和微生物群:患者选择和结果预测。
IF 2.6 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2021-07-20 eCollection Date: 2021-01-01 DOI: 10.1177/26317745211014746
Pierluigi Puca, Valentina Petito, Lucrezia Laterza, Loris Riccardo Lopetuso, Matteo Neri, Federica Del Chierico, Ivo Boskoski, Antonio Gasbarrini, Franco Scaldaferri

Obesity is a major health issue throughout the world and bariatric surgery plays a key role in its management and treatment. The role of microbiota in determining the pathogenesis of obesity has been widely studied, while its role in determining the outcome of bariatric surgery is an emerging issue that will be an outcome in near future studies. Studies on mice first showed the key role of microbiota in determining obesity, highlighting the fat mass increase in mice transplanted with microbiota from fat individuals, as well as the different microbiota composition between mice undergone to low-fat or high-fat diets. This led to characterize the asset of microbiota composition in obesity: increased abundance of Firmicutes, reduced abundance of Bacteroidetes and other taxonomical features. Variations on the composition of gut microbiome have been detected in patients undergone to diet and/or bariatric surgery procedures. Patients undergone to restricting diets showed lower level of trimethylamine N-oxide and other metabolites strictly associated to microbiome, as well as patients treated with bariatric surgery showed, after the procedure, changes in the relative abundance of Bacteroidetes, Firmicutes and other phyla with a role in the pathogenesis of obesity. Eventually, studies have been led about the effects that the modification of microbiota could have on obesity itself, mainly focusing on elements like fecal microbiota transplantation and probiotics such as inulin. This series of studies and considerations represent the first step in order to select patients eligible to bariatric surgery and to predict their outcome.

肥胖是世界范围内的一个主要健康问题,减肥手术在其管理和治疗中起着关键作用。微生物群在确定肥胖发病机制中的作用已被广泛研究,而其在决定减肥手术结果中的作用是一个新兴问题,将在不久的将来的研究中得到结果。对小鼠的研究首次显示了微生物群在决定肥胖方面的关键作用,强调了移植了脂肪个体微生物群的小鼠脂肪量的增加,以及低脂或高脂饮食小鼠之间微生物群组成的不同。这导致表征肥胖中微生物群组成的资产:厚壁菌门的丰度增加,拟杆菌门的丰度减少和其他分类特征。在接受节食和/或减肥手术的患者中发现了肠道微生物组组成的变化。限制饮食的患者三甲胺n -氧化物和其他与微生物组密切相关的代谢物水平较低,以及接受减肥手术的患者手术后,拟杆菌门、厚壁菌门等与肥胖发病有关的门的相对丰度发生了变化。最终,关于微生物群改变对肥胖本身可能产生的影响的研究已经开始,主要集中在粪便微生物群移植和菊粉等益生菌方面。这一系列的研究和考虑是选择适合减肥手术的患者并预测其结果的第一步。
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引用次数: 0
Multichannel impedance monitoring for distinguishing nonerosive reflux esophagitis with minor changes on endoscopy in children. 内镜下多通道阻抗监测对儿童非糜烂性反流性食管炎的鉴别价值。
IF 2.6 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2021-07-15 eCollection Date: 2021-01-01 DOI: 10.1177/26317745211030466
Fujino Junko, David Moore, Taher Omari, Grace Seiboth, Rammy Abu-Assi, Paul Hammond, Richard Couper
Objectives: There are reports describing the relationship between baseline impedance level and esophageal mucosal integrity at endoscopy, such as erosive and nonerosive reflux esophagitis. However, many children with symptoms of gastroesophageal reflux disease have normal findings or minor changes on esophagogastroduodenoscopy. We aimed to examine whether modest changes at esophagogastroduodenoscopy can be evaluated and correlated with esophageal multichannel intraluminal impedance monitoring. Methods: Patients (ages 0–17 years) with upper gastrointestinal symptoms who underwent combined esophagogastroduodenoscopy and multichannel intraluminal impedance monitoring at the Women’s and Children’s Hospital, Adelaide, Australia, between 2014 and 2016 were retrospectively studied and the following data were collected and used for analysis: demographics, multichannel intraluminal impedance data, included baseline impedance. Endoscopic findings were classified by modified Los Angeles grading, Los Angeles N as normal, Los Angeles M as with minimal change such as the erythema, pale mucosa, or friability of the mucosa following biopsy. Patients on proton pump inhibitor were excluded. Results: Seventy patients (43 boys; 61%) were enrolled with a mean age of 7.9 years (range 10 months to 17 years). Fifty-one patients (72.9%) were allocated to Los Angeles N, while Los Angeles M was evident in 19 patients (27.1%). Statistically significant differences were observed in the following parameters: frequency of acid and nonacid reflux and baseline impedance in channels 5 and 6. The median values of the data were 18.3 episodes, 16.0 episodes, 2461.0 Ω, 2446.0 Ω in Los Angeles N, 36.0 episodes, 31.0 episodes, 2033.0 Ω, 2009.0 Ω in Los Angeles M, respectively. Conclusion: Lower baseline impedance is helpful in predicting minimal endoscopic changes in the lower esophagus. A higher frequency of acid and nonacid reflux episodes was also predictive of minimal endoscopic change in the lower esophagus.
目的:有报道描述了内镜下基线阻抗水平与食管粘膜完整性之间的关系,例如糜烂性和非糜烂性反流性食管炎。然而,许多有胃食管反流病症状的儿童在食管胃十二指肠镜检查中表现正常或有轻微变化。我们的目的是研究食管胃十二指肠镜下的适度变化是否可以评估,并与食管多通道腔内阻抗监测相关。方法:回顾性研究2014年至2016年在澳大利亚阿德莱德妇女儿童医院接受食管胃十二指肠镜联合检查和多通道腔内阻抗监测的上消化道症状患者(0-17岁),收集以下数据进行分析:人口统计学、多通道腔内阻抗数据,包括基线阻抗。内镜检查结果按照改良的Los Angeles分级进行分类,Los Angeles N为正常,Los Angeles M为最小变化,如红斑、黏膜苍白或活检后粘膜易碎。排除使用质子泵抑制剂的患者。结果:70例患者(男孩43例;61%)入组,平均年龄7.9岁(10个月至17岁)。洛杉矶N组51例(72.9%),洛杉矶M组19例(27.1%)。在以下参数中观察到统计学上的显著差异:酸反流和非酸反流的频率以及通道5和6的基线阻抗。数据中位数分别为洛杉矶N区18.3、16.0、2461.0 Ω、2446.0 Ω,洛杉矶M区36.0、31.0、2033.0 Ω、2009.0 Ω。结论:较低的基线阻抗有助于预测内镜下食管的微小变化。较高频率的酸反流和非酸反流也预示着食管下部的内镜改变很小。
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引用次数: 1
Artificial intelligence in inflammatory bowel disease endoscopy: current landscape and the road ahead. 人工智能在炎症性肠病内窥镜检查中的应用:现状和未来的道路。
IF 2.6 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2021-07-14 eCollection Date: 2021-01-01 DOI: 10.1177/26317745211017809
Suneha Sundaram, Tenzin Choden, Mark C Mattar, Sanjal Desai, Madhav Desai

Inflammatory bowel disease is a complex chronic inflammatory disorder with challenges in diagnosis, choosing appropriate therapy, determining individual responsiveness, and prediction of future disease course to guide appropriate management. Artificial intelligence has been examined in the field of inflammatory bowel disease endoscopy with promising data in different domains of inflammatory bowel disease, including diagnosis, assessment of mucosal activity, and prediction of recurrence and complications. Artificial intelligence use during endoscopy could be a step toward precision medicine in inflammatory bowel disease care pathways. We reviewed available data on use of artificial intelligence for diagnosis of inflammatory bowel disease, grading of severity, prediction of recurrence, and dysplasia detection. We examined the potential role of artificial intelligence enhanced endoscopy in various aspects of inflammatory bowel disease care and future perspectives in this review.

炎症性肠病是一种复杂的慢性炎症性疾病,在诊断、选择合适的治疗、确定个体反应性和预测未来疾病进程以指导适当的管理方面具有挑战性。人工智能已经在炎症性肠病内窥镜领域进行了研究,在炎症性肠病的不同领域,包括诊断、评估粘膜活性、预测复发和并发症,都有很好的数据。在内窥镜检查中使用人工智能可能是在炎症性肠病护理途径中向精准医学迈出的一步。我们回顾了关于使用人工智能诊断炎症性肠病、严重程度分级、预测复发和不典型增生检测的现有数据。在这篇综述中,我们研究了人工智能增强内窥镜在炎症性肠病护理的各个方面的潜在作用和未来的展望。
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引用次数: 8
Artificial intelligence for identification and characterization of colonic polyps. 人工智能用于结肠息肉的识别和表征。
IF 2.6 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2021-06-29 eCollection Date: 2021-01-01 DOI: 10.1177/26317745211014698
Nasim Parsa, Michael F Byrne

Colonoscopy remains the gold standard exam for colorectal cancer screening due to its ability to detect and resect pre-cancerous lesions in the colon. However, its performance is greatly operator dependent. Studies have shown that up to one-quarter of colorectal polyps can be missed on a single colonoscopy, leading to high rates of interval colorectal cancer. In addition, the American Society for Gastrointestinal Endoscopy has proposed the "resect-and-discard" and "diagnose-and-leave" strategies for diminutive colorectal polyps to reduce the costs of unnecessary polyp resection and pathology evaluation. However, the performance of optical biopsy has been suboptimal in community practice. With recent improvements in machine-learning techniques, artificial intelligence-assisted computer-aided detection and diagnosis have been increasingly utilized by endoscopists. The application of computer-aided design on real-time colonoscopy has been shown to increase the adenoma detection rate while decreasing the withdrawal time and improve endoscopists' optical biopsy accuracy, while reducing the time to make the diagnosis. These are promising steps toward standardization and improvement of colonoscopy quality, and implementation of "resect-and-discard" and "diagnose-and-leave" strategies. Yet, issues such as real-world applications and regulatory approval need to be addressed before artificial intelligence models can be successfully implemented in clinical practice. In this review, we summarize the recent literature on the application of artificial intelligence for detection and characterization of colorectal polyps and review the limitation of existing artificial intelligence technologies and future directions for this field.

结肠镜检查仍然是大肠癌筛查的金标准检查,因为它能够发现和切除结肠中的癌前病变。然而,它的性能很大程度上取决于操作符。研究表明,单次结肠镜检查可能会遗漏多达四分之一的结肠息肉,从而导致间隔期结直肠癌的高发病率。此外,美国胃肠内镜学会对小型结直肠息肉提出了“切除后丢弃”和“诊断后离开”的策略,以减少不必要的息肉切除和病理评估的成本。然而,在社区实践中,光学活检的表现并不理想。随着机器学习技术的进步,人工智能辅助的计算机辅助检测和诊断越来越多地被内窥镜医师使用。计算机辅助设计在实时结肠镜检查中的应用,提高了腺瘤的检出率,同时减少了撤离时间;提高了内镜医师光学活检的准确性,同时减少了诊断时间。这些都是朝着标准化和提高结肠镜检查质量以及实施“切除后丢弃”和“诊断后离开”战略迈出的有希望的一步。然而,在人工智能模型在临床实践中成功实施之前,需要解决诸如实际应用和监管批准等问题。本文综述了近年来人工智能在结肠直肠息肉检测和表征中的应用,并对现有人工智能技术的局限性和该领域的未来发展方向进行了综述。
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引用次数: 8
Artificial intelligence for the detection of polyps or cancer with colon capsule endoscopy. 人工智能用于结肠胶囊内窥镜检查息肉或癌症。
IF 2.6 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2021-06-13 eCollection Date: 2021-01-01 DOI: 10.1177/26317745211020277
Alexander R Robertson, Santi Segui, Hagen Wenzek, Anastasios Koulaouzidis

Colorectal cancer is common and can be devastating, with long-term survival rates vastly improved by early diagnosis. Colon capsule endoscopy (CCE) is increasingly recognised as a reliable option for colonic surveillance, but widespread adoption has been slow for several reasons, including the time-consuming reading process of the CCE recording. Automated image recognition and artificial intelligence (AI) are appealing solutions in CCE. Through a review of the currently available and developmental technologies, we discuss how AI is poised to deliver at the forefront of CCE in the coming years. Current practice for CCE reporting often involves a two-step approach, with a 'pre-reader' and 'validator'. This requires skilled and experienced readers with a significant time commitment. Therefore, CCE is well-positioned to reap the benefits of the ongoing digital innovation. This is likely to initially involve an automated AI check of finished CCE evaluations as a quality control measure. Once felt reliable, AI could be used in conjunction with a 'pre-reader', before adopting more of this role by sending provisional results and abnormal frames to the validator. With time, AI would be able to evaluate the findings more thoroughly and reduce the input required from human readers and ultimately autogenerate a highly accurate report and recommendation of therapy, if required, for any pathology identified. As with many medical fields reliant on image recognition, AI will be a welcome aid in CCE. Initially, this will be as an adjunct to 'double-check' that nothing has been missed, but with time will hopefully lead to a faster, more convenient diagnostic service for the screening population.

结直肠癌很常见,可能是毁灭性的,早期诊断大大提高了长期生存率。结肠胶囊内窥镜(CCE)越来越被认为是结肠监测的可靠选择,但由于一些原因,包括CCE记录的读取过程耗时,广泛采用一直很慢。自动图像识别和人工智能(AI)是CCE中很有吸引力的解决方案。通过对当前可用和正在开发的技术的回顾,我们讨论了人工智能在未来几年如何在CCE的前沿提供服务。当前CCE报告的实践通常包括两步方法,“预读者”和“验证者”。这需要熟练和有经验的读者投入大量的时间。因此,CCE处于有利地位,可以从持续的数字创新中获益。这可能首先涉及对已完成的CCE评估进行自动人工智能检查,作为质量控制措施。一旦感觉可靠,AI就可以与“预阅读器”一起使用,然后通过向验证器发送临时结果和异常帧来发挥更多的作用。随着时间的推移,人工智能将能够更彻底地评估发现,减少人类读者所需的输入,并最终自动生成高度准确的报告和治疗建议,如果需要的话,对于任何已确定的病理。与许多依赖图像识别的医疗领域一样,人工智能在CCE中将是一个受欢迎的援助。最初,这将作为“双重检查”的辅助手段,以确保没有遗漏任何东西,但随着时间的推移,有望为筛查人群提供更快、更方便的诊断服务。
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引用次数: 9
Bariatric and metabolic endoscopy: impact on obesity and related comorbidities. 减肥和代谢内窥镜:对肥胖和相关合并症的影响。
IF 2.6 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2021-06-09 eCollection Date: 2021-01-01 DOI: 10.1177/26317745211019156
Amit Mehta, Reem Z Sharaiha

The global obesity pandemic is among the most significant public health crises today. Furthermore, obesity remains a major risk factor for many weight-related comorbid conditions including cardiovascular disease, type 2 diabetes mellitus, liver disease, and cancer. Endoscopic bariatric therapies are currently on the rise as a new tool in the fight against the obesity epidemic, offering patients an alternative to more invasive surgery and a more effective option than diet and lifestyle modifications. The aim of this review article is to summarize the current literature regarding endoscopic bariatric therapies and their impact on obesity and its associated metabolic complications.

全球肥胖流行病是当今最严重的公共卫生危机之一。此外,肥胖仍然是许多体重相关合并症的主要危险因素,包括心血管疾病、2型糖尿病、肝脏疾病和癌症。内窥镜减肥疗法作为对抗肥胖流行病的一种新工具,目前正在兴起,它为患者提供了一种比更具侵入性的手术更有效的选择,而且比改变饮食和生活方式更有效。这篇综述文章的目的是总结目前关于内窥镜减肥疗法及其对肥胖及其相关代谢并发症的影响的文献。
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引用次数: 6
Clearance of circulating tumor DNA in a high-risk stage-IV rectal carcinoma patient with synchronous liver metastases after conversion surgery is correlated with pathologic complete response. 高风险 IV 期直肠癌患者在转化手术后出现同步肝转移,其循环肿瘤 DNA 的清除率与病理完全反应相关。
IF 2.6 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2021-06-02 eCollection Date: 2021-01-01 DOI: 10.1177/26317745211020279
Yingying Huang, Wenzhuo Jia, Lijun Wang, Qiuxiang Ou, Xue Wu, Baocai Xing

Colorectal cancer is the third most common cancer worldwide, and its incidence continues to grow. Approximately one-third of patients with colorectal cancer develop liver metastases during the natural course of disease. Complete surgical resection is associated with very low mortality in colorectal liver metastasis patients, but only a small fraction of colorectal liver metastasis patients fulfill the selection criteria for surgical treatment. We herein describe a high-risk stage-IV rectal carcinoma patient who was initially unresectable according to the National Comprehensive Cancer Network guidelines with a clinical risk score of 4 but received conversion surgery combined with systemic chemotherapy and achieved a favorable long-term clinical outcome (pathologic complete response) of approximately 28 months. Furthermore, serial circulating tumor DNA monitoring using next-generation sequencing provided a comprehensive view of the patient's clinical and pathologic status for better clinical decision support over the course of the disease. The absence of circulating tumor DNA/cells after conversion surgery was correlated with pathologic complete response. This case study not only demonstrated that a curative oncosurgical approach could be considered for high-risk colorectal liver metastasis patients under specific circumstances but also highlighted the role of circulating tumor DNA monitoring to gain further insight into the evolution of a patient's response over time.

结直肠癌是全球第三大常见癌症,其发病率持续增长。大约三分之一的结直肠癌患者在自然病程中会出现肝转移。完全手术切除与结直肠癌肝转移患者极低的死亡率有关,但只有一小部分结直肠癌肝转移患者符合手术治疗的选择标准。我们在本文中描述了一名高风险的IV期直肠癌患者,根据美国国家综合癌症网络指南,该患者最初无法切除,临床风险评分为4分,但接受了转化手术联合全身化疗,并在约28个月的时间里取得了良好的长期临床疗效(病理完全反应)。此外,利用新一代测序技术对循环肿瘤DNA进行连续监测,可以全面了解患者的临床和病理状态,从而在病程中为临床决策提供更好的支持。转换手术后循环肿瘤DNA/细胞的缺失与病理完全反应相关。这项病例研究不仅证明了在特定情况下可以考虑对高风险结直肠肝转移患者采取根治性手术治疗方法,还强调了循环肿瘤DNA监测的作用,有助于进一步了解患者的反应随时间的演变情况。
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引用次数: 0
Insights into the endoscopic management of esophageal achalasia. 食管贲门失弛缓症的内镜治疗。
IF 2.6 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2021-05-05 eCollection Date: 2021-01-01 DOI: 10.1177/26317745211014706
Elizabeth Brindise, Mouen A Khashab, Rami El Abiad

Achalasia is a primary esophageal motility disorder characterized by the loss of inhibitory neurons in the myenteric plexus, resulting in impaired relaxation of the esophagogastric junction. Achalasia is an incurable disease, and the treatment modalities are aimed at disruption of the esophagogastric junction and vary widely from pharmacological to endoscopic to surgical. Traditional endoscopic therapy includes pneumatic dilation, botulinum toxin injection, and peroral endoscopic myotomy. This review aims to provide an overview of the endoscopic management of achalasia, while focusing on the utilization of peroral endoscopic myotomy and other novel approaches.

贲门失弛缓症是一种原发性食管运动障碍,其特征是肌肠丛中抑制性神经元的丧失,导致食管胃连接处松弛受损。贲门失弛缓症是一种无法治愈的疾病,治疗方式主要是破坏食管胃交界处,从药理学到内窥镜再到外科手术,治疗方式各不相同。传统的内窥镜治疗包括气动扩张、肉毒杆菌毒素注射和经口内窥镜肌切开术。本文综述了贲门失弛缓症的内镜治疗,并重点介绍了经口内窥镜下肌切开术和其他新方法的应用。
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引用次数: 3
Safety and efficacy of band ligation and auto-amputation as adjunct to EMR of colonic large laterally spreading tumors, and polyps not amenable to routine polypectomy. 结扎和自动截肢辅助EMR治疗结肠大外侧扩散肿瘤和常规息肉切除术无法治疗的息肉的安全性和有效性。
IF 2.6 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2021-03-30 eCollection Date: 2021-01-01 DOI: 10.1177/26317745211001750
Stephanie Romutis, Bassem Matta, Jonathan Ibinson, John Hileman, Smiljana Istvanic, Asif Khalid
<p><strong>Introduction: </strong>The safety and efficacy of colonic band ligation and auto-amputation (1) as adjunct to endoscopic mucosal resection of large laterally spreading tumors and (2) for polyps not amenable to routine polypectomy due to polyp burden or difficult location remain unknown.</p><p><strong>Methods: </strong>An institutional review board-approved retrospective single-institution study was undertaken of patients undergoing colonic band ligation and auto-amputation from 2014 to date. Patients with indications of 'endoscopic mucosal resection for laterally spreading tumors' and 'polyp not amenable to snare polypectomy' were included in the study. Data were collected on patient demographics, colonoscopy details (laterally spreading tumors/polyp characteristics, therapies applied, complications), pathology results, and follow-up (polyp eradication based on endoscopic appearance and biopsy results).</p><p><strong>Results: </strong><i>Patients undergoing endoscopic mucosal resection for laterally spreading tumors</i>: Thirty-two patients (31 males, aged 68 ± 9.17 years) underwent endoscopic mucosal resection-band ligation and auto-amputation of 34 laterally spreading tumors (40 ± 10.9 mm). A median of 2 ± 1.09 bands were placed. Follow-up colonoscopy and biopsy results confirmed complete eradication in 21 laterally spreading tumors (70%). Nine (30%) laterally spreading tumors required additional endoscopic therapy to achieve complete eradication. Four (13%) patients underwent surgery for cancer, and two of them had resection specimens negative for cancer or residual adenoma. One patient suffered post-polypectomy syndrome. <i>Patients undergoing band ligation and auto-amputation for polyps not amenable to snare polypectomy</i>: Seven patients underwent band ligation and auto-amputation due to serrated polyposis syndrome (one patient) and innumerable polyps, or polyps in difficult locations (extension into diverticula: two patients; terminal ileum: two patients; appendiceal orifice: one patient; anal canal: one patient). The patient with serrated polyposis syndrome achieved dramatic decrease in polyp burden, but not eradication. Follow-up in five of the six remaining patients documented polyp eradication. The patient with serrated polyposis syndrome suffered from rectal pain and tenesmus following placement of 18 bands.</p><p><strong>Conclusions: </strong>Band ligation and auto-amputation in the colon may be a safe and effective adjunct to current endoscopic mucosal resection and polypectomy methods and warrants further study.</p><p><strong>Plain language summary: </strong>Colonoscopy with rubber band placement to aid in complete removal of large polyps and polyps in technically challenging locationsColonoscopy is a commonly performed procedure for the early detection of colon and rectal cancer, and prevention through polyp removal.During colonoscopy, sometimes situations are encountered making polyp removal difficult. These can inclu
导读:结肠束结扎和自动截肢的安全性和有效性(1)作为内镜下粘膜切除术的辅助手术(2)对于由于息肉负担或难以定位而无法常规切除的息肉,尚不清楚。方法:采用经机构审查委员会批准的回顾性单机构研究,对2014年至今接受结肠结扎和自动截肢手术的患者进行研究。有“内镜下粘膜切除术治疗侧方扩散肿瘤”和“不适于圈套息肉切除术的息肉”指征的患者被纳入研究。收集患者人口统计学、结肠镜检查细节(肿瘤/息肉的横向扩散特征、应用的治疗方法、并发症)、病理结果和随访(基于内镜表现和活检结果的息肉根除)的数据。结果:行内镜下粘膜切除术治疗侧移性肿瘤32例(男性31例,年龄68±9.17岁),行内镜下粘膜切除术-结扎自动切除34例(40±10.9 mm)侧移性肿瘤。中位数为2±1.09条。随访结肠镜检查和活检结果证实21例(70%)肿瘤完全根除。9例(30%)横向扩散的肿瘤需要额外的内镜治疗才能完全根除。4例(13%)患者因癌症接受手术治疗,其中2例切除标本未见癌或残留腺瘤。一名患者出现息肉切除术后综合征。因不适合套筒息肉切除术而行结扎自动截肢的患者:7例患者因锯齿状息肉综合征(1例)和大量息肉,或息肉位于困难部位(延伸至憩室:2例;回肠末端:2例;阑尾孔:1例;肛管:1例)。锯齿状息肉病综合征患者的息肉负担显著减少,但没有根除。其余6名患者中有5名随访记录息肉根除。锯齿状息肉综合征患者在放置18个带后出现直肠疼痛和下坠。结论:结扎和结肠自动截肢可能是目前内镜下粘膜切除术和息肉切除术的一种安全有效的辅助方法,值得进一步研究。简单的语言总结:结肠镜检查与橡皮筋放置,以帮助完全切除大息肉和息肉在技术上具有挑战性的位置结肠镜检查是一种常用的程序,用于早期发现结肠和直肠癌,并通过息肉切除进行预防。在结肠镜检查中,有时会遇到难以切除息肉的情况。这些可能包括存在较大的息肉,或者息肉所在的区域在技术上具有挑战性或高风险。特别具有挑战性的情况是,经过大量的努力,仍然有息肉组织残留,不能用常规技术去除。我们感兴趣的是探索一种技术,在将一小部分结肠内膜吸进装在结肠镜尖端的盖子后,用橡皮筋放置。随着时间的推移,橡皮筋会勒死组织,并随着被捕获的组织脱落,自然地排出结肠。为了评估这项技术的有效性,我们研究了在我们的胃肠科接受过这项手术的患者。我们确定了32例患者34个4cm至6cm的大息肉,我们在无法完全切除息肉后在息肉组织上放置橡皮筋。在随访的结肠镜检查中,21例息肉完全切除成功。在额外的治疗后,我们也能够在剩余的9个大息肉中完全切除息肉。4名患者接受了手术,因为在对息肉组织的分析中发现了癌症。在6例息肉位于困难部位(如部分位于阑尾腔内)的患者中,有5例使用橡皮筋将息肉组织完全切除。在我们的研究人群中,有两名患者有轻微的不良事件,并通过简单的措施加以控制。我们相信我们的结果显示了我们所描述的技术的前景,这种技术应该在更大规模的研究中进行测试。
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引用次数: 0
How should we do colon capsule endoscopy reading: a practical guide. 我们应该如何做结肠胶囊内窥镜阅读:实用指南。
IF 2.6 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2021-03-23 eCollection Date: 2021-01-01 DOI: 10.1177/26317745211001983
Anastasios Koulaouzidis, Konstantinos Dabos, Michael Philipper, Ervin Toth, Martin Keuchel

In this article, we aim to provide general principles as well as personal views for colonic capsule endoscopy. To allow an in-depth understanding of the recommendations, we also present basic technological characteristics and specifications, with emphasis on the current as well as the previous version of colonic capsule endoscopy and relevant software. To date, there is no scientific proof to support the optimal way of reading a colonic capsule endoscopy video, or any standards or guidelines exist. Hence, any advice is a mixture of recommendations by the capsule manufacturer and experts' opinion. Furthermore, there is a paucity of data regarding the use of term(s) (pre-reader/reader-validator) in colonic capsule endoscopy. We also include a couple of handy tables in order to get info at a glance.

在本文中,我们旨在提供结肠胶囊内窥镜检查的一般原则和个人观点。为了深入了解这些建议,我们还介绍了基本的技术特点和规格,重点介绍了当前以及以前版本的结肠胶囊内窥镜和相关软件。迄今为止,没有科学证据支持阅读结肠胶囊内窥镜视频的最佳方式,也没有任何标准或指南存在。因此,任何建议都是胶囊制造商的建议和专家意见的混合体。此外,关于在结肠胶囊内窥镜检查中使用术语(预阅读器/阅读器-验证器)的数据也很缺乏。我们还包括一些方便的表格,以便一目了然地获得信息。
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引用次数: 24
期刊
Therapeutic Advances in Gastrointestinal Endoscopy
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