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Endoscopic Submucosal Dissection of a Large Rectal Lesion by Using a Novel Traction Device to Facilitate Traction Adjustments 使用便于牵引调整的新型牵引装置对大面积直肠病变进行内窥镜粘膜下剥离术
IF 0.7 Pub Date : 2024-06-04 DOI: 10.1055/s-0044-1787126
Hironori Aoki, Kohei Takizawa, Rajvinder Singh, T. Tanuma, Shin Ichihara, Jiro Watari
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引用次数: 0
Timing It Right: Endoscopic Necrosectomy for Infected Necrotizing Pancreatitis 把握时机:感染性坏死性胰腺炎的内镜坏死组织切除术
IF 0.7 Pub Date : 2024-06-04 DOI: 10.1055/s-0044-1782232
Ashutosh Ishan Yadav, S. S. Rana
The endoscopic step-up drainage approach involving initial drainage followed by, if required, direct endoscopic necrosectomy (DEN) is the preferred management approach for symptomatic pancreatic necrotic collections. However, limited data suggests that immediate DEN during initial stent placement may hasten clinical recovery by quicker resolution of systemic inflammatory response. However, because of concerns about adverse effects, especially gastric perforation and bleeding, most endoscopists prefer delayed DEN. In this news and views, we discuss a recently published randomized controlled trial that compared upfront necrosectomy at the index intervention versus as a step-up for patients with infected necrotizing pancreatitis.
内镜下阶梯式引流方法包括初始引流,必要时进行直接内镜坏死切除术(DEN),这是治疗无症状胰腺坏死积液的首选方法。然而,有限的数据表明,在初始支架置入期间立即进行内镜坏死切除术可加快全身炎症反应的消退,从而加速临床康复。然而,由于担心不良反应,尤其是胃穿孔和出血,大多数内镜医师更倾向于延迟 DEN。在本篇新闻和观点中,我们讨论了最近发表的一项随机对照试验,该试验比较了在指数介入时对感染性坏死性胰腺炎患者进行先期坏死切除术与作为介入治疗的升级方案。
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引用次数: 0
Endoscopic Ultrasound-Guided Liver Biopsy (EUS-LB): An Endoscopic Solution to the Unmet Needs of Liver Tissue Acquisition and Beyond 内窥镜超声引导肝活检(EUS-LB):满足肝组织采集及其他未满足需求的内窥镜解决方案
IF 0.7 Pub Date : 2024-06-04 DOI: 10.1055/s-0044-1785498
Shivam Khare, A. Arora, Jijo Varghese, Ashish Kumar, Sunila Jain, Ashiesh Khandelwal, Arpita Mittal, Sunayana Misra, S. Anikhindi, Mandhir Kumar, P. Ranjan, Praveen Sharma, Naresh Bansal, M. Sachdeva, S. Giri, Srijaya S.
Aim and Objective Endoscopic ultrasound-guided liver biopsy (EUS-LB) is now increasingly being used across the globe as a method of liver tissue acquisition. This method is widely accepted by many professionals as it can overcome many shortcomings of percutaneous liver biopsy and transjugular liver biopsy. The aim of the study is to obtain the adequate and optimal biopsy rate associated with EUS-LB. Materials and Methods This is a retrospective observational study. Consecutive patients undergoing EUS-LB during the study period who were willing to consent were taken up for the study. Results Total 91 patients were taken up for the study. Median age of study population was 44 years out of which 39 patients were males and 52 were females (42.9 and 57.1%). Adequate biopsy rate (according to European Association for the Study of Liver Disease criteria) and optimal biopsy rate (according to American Association for the Study of Liver Diseases criteria) were 89 (81/91) and 60.4% (55/91), respectively. Rate of conclusive diagnosis was 95.6% (86/91). The commonest diagnosis encountered was nonalcoholic steatohepatitis) (23, 25.3%), followed by autoimmune hepatitis (17, 18.7%). Additional diagnostic information was obtained by endosonography during EUS-LB in 21 patients (23.1%). Gallstone disease was found in four (4.8%) patients, chronic calcific pancreatitis in two (1.9%) patients, significant abdominal lymphadenopathy defined as lymph node more than 1.5 cm in five (5.8%) patients, and esophageal or gastric varices in ten (10.6%) patients. One case of self-limiting biopsy site ooze was seen in EUS-LB and the patient was having cirrhosis. Conclusion This study showed a high diagnostic outcome and safety profile with EUS-LB technique. EUS-LB can achieve excellent histological yield when performed with optimal technique. Moreover, it is possible to obtain additional information during the procedure from diagnostic endosonography that is done as a part of EUS-LB.
目的和目标 内窥镜超声引导肝活检(EUS-LB)作为一种获取肝组织的方法,目前在全球范围内得到越来越广泛的应用。这种方法克服了经皮肝穿刺活检和经颈静脉肝穿刺活检的许多缺点,因此被许多专业人士广泛接受。本研究旨在获得与 EUS-LB 相关的适当和最佳活检率。材料和方法 这是一项回顾性观察研究。在研究期间,连续接受 EUS-LB 检查并愿意同意的患者均被纳入研究对象。结果 共有 91 名患者参与研究。研究对象的中位年龄为 44 岁,其中男性 39 人,女性 52 人(分别占 42.9% 和 57.1%)。充分活检率(根据欧洲肝病研究协会标准)和最佳活检率(根据美国肝病研究协会标准)分别为 89 (81/91) 和 60.4% (55/91)。确诊率为 95.6%(86/91)。最常见的诊断是非酒精性脂肪性肝炎(23,25.3%),其次是自身免疫性肝炎(17,18.7%)。有 21 名患者(23.1%)通过 EUS-LB 期间的内镜检查获得了其他诊断信息。4例(4.8%)患者发现胆石症,2例(1.9%)患者发现慢性钙化性胰腺炎,5例(5.8%)患者发现明显的腹部淋巴结肿大,即淋巴结超过1.5厘米,10例(10.6%)患者发现食管或胃静脉曲张。有一例患者在 EUS-LB 检查中发现活检部位有自限性渗液,该患者患有肝硬化。结论 本研究显示 EUS-LB 技术具有较高的诊断效果和安全性。如果采用最佳技术,EUS-LB 可获得极佳的组织学结果。此外,作为 EUS-LB 的一部分,还可在手术过程中通过诊断性内窥镜检查获得更多信息。
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引用次数: 0
Correlative Factors of Severity of Air Bubbles in the Large Intestine during Colonoscopy 结肠镜检查中大肠气泡严重程度的相关因素
IF 0.7 Pub Date : 2024-04-02 DOI: 10.1055/s-0044-1779617
Takaaki Yoshikawa, Atsushi Yamauchi, Kumi Itami, Shinichiro Odo, Yoshihiro Soma, Kosuke Tanaka, Kazuki Negoro, Yuki Mori, Kazuki Osawa, Ryou Itou, Yuya Kawai, Sota Nakagami, S. Azuma, Toshihiro Morita, Kenshiro Hirohashi, K. Kuriyama, Ken Takahashi, Tadayuki Kou, Toshiro Katayama, S. Yazumi
Objectives The condition of air bubbles in the large intestine is an influential factor for good quality of colonoscopy. However, the correlative factors of severity of air bubbles during colonoscopy in the large intestine are not established. Therefore, this study aimed to elucidate the correlative factors influencing the severity of air bubbles in the large intestine. Materials and Methods A total of 314 examinees who underwent colonoscopy between August and September 2022 were enrolled (median age [range], 65 [18–88] years). Air bubbles were scored using the Colon Endoscopic Bubble Scale (CEBuS) and the clinical factors associated with the CEBuS scores, especially in the ileocecum, were analyzed. Results In this study, 39.8% (125/314) of examinees harbored severe air bubbles in the ileocecum. Multiple linear regression analysis revealed that the CEBuS scores in the ileocecum were positively associated with the interval time from completion of bowel preparation to intubation of the cecum (p = 0.0016) and a history of cholecystectomy (p = 0.0198). Logistic regression analysis between no, mild, and moderate air bubbles group (n = 189) and severe air bubbles group (n = 125) also showed that severity was positively associated with the interval time from completion of bowel preparation to intubation of the cecum (p = 0.0332) and a history of cholecystectomy (p = 0.0095). Conclusion Interval time and history of cholecystectomy were associated with severity of air bubbles in the large intestine after bowel preparation.
目的 大肠内气泡的情况是影响结肠镜检查质量的一个因素。然而,大肠镜检查过程中大肠气泡严重程度的相关因素尚未确定。因此,本研究旨在阐明影响大肠气泡严重程度的相关因素。材料和方法 2022 年 8 月至 9 月期间,共有 314 名受检者接受了结肠镜检查(中位年龄 [范围],65 [18-88] 岁)。使用结肠内镜气泡量表(CEBuS)对气泡进行评分,并分析与 CEBuS 评分相关的临床因素,尤其是回盲部。结果 在这项研究中,39.8% 的受检者(125/314)回盲部存在严重气泡。多元线性回归分析显示,回盲部的 CEBuS 评分与完成肠道准备到插管盲肠的间隔时间(p = 0.0016)和胆囊切除术史(p = 0.0198)呈正相关。无气泡、轻度气泡和中度气泡组(n = 189)与严重气泡组(n = 125)之间的逻辑回归分析也显示,严重程度与完成肠道准备到插管盲肠的间隔时间(p = 0.0332)和胆囊切除术史(p = 0.0095)呈正相关。结论 间隔时间和胆囊切除术史与肠道准备后大肠气泡的严重程度有关。
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引用次数: 0
A Case of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma with Special Endoscopic Morphology 具有特殊内镜形态的胃黏膜相关淋巴组织淋巴瘤病例
IF 0.7 Pub Date : 2024-03-30 DOI: 10.1055/s-0044-1785497
Xin Sun, Yanbo Zhen, Pan Pan, Liang Liu
A 59-year-old man was hospitalized due to a complaint of intermittent upper abdominal distension that persisted over the duration of 2 years. Endoscopy revealed a fl at depressed (type 0-IIa þ IIc) and whitish lesion approximately 2.0 (cid:2) 2.5cm in size in the anterior wall of the antrum ( ► Fig. 1 ). Reddish spots were sparsely distributed in the mucosa of the lesion. No gastric mucosa atrophy was observed. Magnifying endoscopy with narrow-band imaging (NBI) showed a nice demarcation line between the lesion and the surrounding mucosa. The morphology of the lesion surface was irregular, with minimal residual glandular fossa, as well as damage and loss of the gastric pit structure, suggesting destruction of glands. The microvessels were bifurcated, sparse, and tortuous; “ tree like appearance ” of the abnormal vessels can be seen in the NBI ( ► Fig. 2 ). The 20-MHz mini-probe endoscopic ultrasound showed that all layers of the gastric wall were intact without abnormal echo ( ► Fig. 3 ). Histopathological examination of the biopsy specimen revealed a dense small-to-medium-sized lymphoid in fi ltration. Immunohistochemistry
一名59岁的男子因间歇性上腹部胀痛住院治疗,该症状持续了2年之久。内镜检查发现,咽鼓管前壁有一个约 2.0 (cid:2) 2.5 厘米大小的凹陷性(0-IIa þ IIc 型)白色病灶(► 图 1)。病变部位的粘膜上稀疏分布着淡红色斑点。未观察到胃黏膜萎缩。放大内镜和窄带成像(NBI)显示病灶和周围粘膜之间有一条清晰的分界线。病灶表面形态不规则,腺窝残留极少,胃凹陷结构受损和消失,提示腺体已被破坏。微血管分叉、稀疏且迂曲;在 NBI 中可以看到异常血管的 "树状外观"(► 图 2)。20 兆赫微型探头内镜超声显示胃壁各层完整,无异常回声(► 图 3)。活检标本的组织病理学检查显示有密集的中小型淋巴细胞。免疫组化
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引用次数: 0
Concurrent Colonic Schwannoma and Primary Mature Cystic Teratoma of Ovary with Goiter Carcinoid in a Young Woman 一名年轻女性同时患有结肠室管膜瘤和卵巢原发性成熟囊性畸胎瘤以及甲状腺类癌
IF 0.7 Pub Date : 2024-02-06 DOI: 10.1055/s-0043-1777738
Yeehua Cao, Jun Liu, Xiao Cui, Liang Liu
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引用次数: 0
Concurrent Colonic Schwannoma and Primary Mature Cystic Teratoma of Ovary with Goiter Carcinoid in a Young Woman 一名年轻女性同时患有结肠室管膜瘤和卵巢原发性成熟囊性畸胎瘤以及甲状腺类癌
IF 0.7 Pub Date : 2024-02-06 DOI: 10.1055/s-0043-1777738
Yeehua Cao, Jun Liu, Xiao Cui, Liang Liu
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引用次数: 0
Effect of Time-Limited Training on Endoscopic Submucosal Dissection in an Ex Vivo Porcine Stomach Model: A Prospective Randomized Controlled Study 限时训练对体内猪胃模型内镜黏膜下剥离术的影响:前瞻性随机对照研究
IF 0.7 Pub Date : 2024-02-02 DOI: 10.1055/s-0043-1778083
Xu Liu, Xiaodong Shao, Xiaodan Shi, Wenjing Kou, Yayuan Luo, Yanou Bai
Introduction Endoscopic submucosal dissection (ESD) is the first choice for superficial tumor resection. There is no report on whether the training effect is affected by limiting the operation time of each ESD operation. This study aimed to prospectively evaluate the efficiency of time-limited ESD training by using an ex vivo porcine stomach model. Methods ESD was performed in accordance with the standard procedure on ex vivo porcine stomach model. The time-limited group required each operation time to be controlled within 30 minutes, and the nonlimited group did not limit the operation time. The en bloc resection rate, surface area of the resected specimen, procedure speed, and perforation rate were compared in the two groups. Results Compared with the en bloc resection rate in the time-limited group, that in the nonlimited group was significantly higher in ESD-1 and ESD-2. In each ESD procedure, the median resection area in the nonlimited group was significantly larger than that in the time-limited group. The difference in median procedure speed between the two groups in ESD-1 to ESD-4 did not reach significance in the statistical analysis. The speed of ESD-5 in the time-limited group was significantly higher than that of the nonlimited group. The perforation rate of the time-limited group was similar to that of the nonlimited group. Conclusion Limiting the training time does not help the trainees to complete large resection of lesions and reduce the perforation rate, but it may help to improve the operation speed.
引言 内镜黏膜下剥离术(ESD)是浅表肿瘤切除术的首选。目前还没有关于限制每次ESD操作时间是否会影响训练效果的报道。本研究旨在通过使用体外猪胃模型,前瞻性地评估限时ESD训练的效率。方法 按照标准程序在体外猪胃模型上进行 ESD 操作。限时组要求每次操作时间控制在 30 分钟内,非限时组不限制操作时间。比较两组的全切率、切除标本的表面积、手术速度和穿孔率。结果 与有时间限制组的全切率相比,ESD-1 和 ESD-2 无时间限制组的全切率明显更高。在每种ESD手术中,非限时组的中位切除面积明显大于限时组。在统计分析中,ESD-1 至 ESD-4 两组的中位手术速度差异未达到显著性。有时间限制组的ESD-5速度明显高于无时间限制组。限时组的穿孔率与非限时组相似。结论 限制训练时间并不能帮助受训者完成大面积病灶切除和降低穿孔率,但可能有助于提高操作速度。
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引用次数: 0
Effect of Time-Limited Training on Endoscopic Submucosal Dissection in an Ex Vivo Porcine Stomach Model: A Prospective Randomized Controlled Study 限时训练对体内猪胃模型内镜黏膜下剥离术的影响:前瞻性随机对照研究
IF 0.7 Pub Date : 2024-02-02 DOI: 10.1055/s-0043-1778083
Xu Liu, Xiaodong Shao, Xiaodan Shi, Wenjing Kou, Yayuan Luo, Yanou Bai
Introduction Endoscopic submucosal dissection (ESD) is the first choice for superficial tumor resection. There is no report on whether the training effect is affected by limiting the operation time of each ESD operation. This study aimed to prospectively evaluate the efficiency of time-limited ESD training by using an ex vivo porcine stomach model. Methods ESD was performed in accordance with the standard procedure on ex vivo porcine stomach model. The time-limited group required each operation time to be controlled within 30 minutes, and the nonlimited group did not limit the operation time. The en bloc resection rate, surface area of the resected specimen, procedure speed, and perforation rate were compared in the two groups. Results Compared with the en bloc resection rate in the time-limited group, that in the nonlimited group was significantly higher in ESD-1 and ESD-2. In each ESD procedure, the median resection area in the nonlimited group was significantly larger than that in the time-limited group. The difference in median procedure speed between the two groups in ESD-1 to ESD-4 did not reach significance in the statistical analysis. The speed of ESD-5 in the time-limited group was significantly higher than that of the nonlimited group. The perforation rate of the time-limited group was similar to that of the nonlimited group. Conclusion Limiting the training time does not help the trainees to complete large resection of lesions and reduce the perforation rate, but it may help to improve the operation speed.
引言 内镜黏膜下剥离术(ESD)是浅表肿瘤切除术的首选。目前还没有关于限制每次ESD操作时间是否会影响训练效果的报道。本研究旨在通过使用体外猪胃模型,前瞻性地评估限时ESD训练的效率。方法 按照标准程序在体外猪胃模型上进行 ESD 操作。限时组要求每次操作时间控制在 30 分钟内,非限时组不限制操作时间。比较两组的全切率、切除标本的表面积、手术速度和穿孔率。结果 与有时间限制组的全切率相比,ESD-1 和 ESD-2 无时间限制组的全切率明显更高。在每种ESD手术中,非限时组的中位切除面积明显大于限时组。在统计分析中,ESD-1 至 ESD-4 两组的中位手术速度差异未达到显著性。有时间限制组的ESD-5速度明显高于无时间限制组。限时组的穿孔率与非限时组相似。结论 限制训练时间并不能帮助受训者完成大面积病灶切除和降低穿孔率,但可能有助于提高操作速度。
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引用次数: 0
Impact of Artificial Intelligence in Colorectal Polyp Detection and Characterization 人工智能对结直肠息肉检测和定性的影响
IF 0.7 Pub Date : 2023-12-13 DOI: 10.1055/s-0043-1777330
S. Afzalpurkar, Mahesh K Goenka, Rakesh Kochhar
Abstract Colorectal cancer (CRC) is the third most common cancer in the world. Colonoscopy has contributed significantly to reduction of incidence and mortality of CRC. Integration of artificial intelligence (AI) into colonoscopy practice has addressed the various shortcomings of screening colonoscopies. AI-assisted colonoscopy will help in real-time recognition of type of polyp with probable histology. This will not only save time but will also help to mitigate human errors. Computer-aided detection and computer-aided characterization are two applications of AI, which are being studied extensively with a goal of improvement of polyp and adenoma detection rates. Several studies are being conducted across the globe, which either involve simple decision-making algorithms or complex patterns through neural networks, which imitate the human brain. Most data are collected retrospectively and the research is limited to single-center studies, which might have bias. Therefore, the future research on AI in colonoscopy should aim to develop more sophisticated convolutional neural network and deep learning models that will help to standardize the practice and ensure the same degree of accuracy with all the colonoscopies, irrespective of experience of performing endoscopists. In this review, we will take a closer look at the current state of AI and its integration into the field of colonoscopy.
摘要 大肠癌(CRC)是全球第三大常见癌症。结肠镜检查在降低 CRC 发病率和死亡率方面做出了巨大贡献。将人工智能(AI)融入结肠镜检查实践解决了结肠镜筛查的各种缺陷。人工智能辅助结肠镜检查将有助于实时识别息肉类型和可能的组织学。这不仅可以节省时间,还有助于减少人为错误。计算机辅助检测和计算机辅助特征描述是人工智能的两项应用,目前正在对这两项应用进行广泛研究,目的是提高息肉和腺瘤的检出率。全球正在开展多项研究,这些研究或涉及简单的决策算法,或涉及通过神经网络模仿人脑的复杂模式。大多数数据都是回顾性收集的,而且研究仅限于单中心研究,可能存在偏差。因此,未来有关结肠镜检查的人工智能研究应着眼于开发更复杂的卷积神经网络和深度学习模型,这将有助于规范操作,并确保所有结肠镜检查都具有相同的准确度,而与内镜医师的经验无关。在这篇综述中,我们将仔细研究人工智能的现状及其与结肠镜检查领域的结合。
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引用次数: 0
期刊
Journal of Digestive Endoscopy
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