iGIE最新文献

{"title":"Randomized crossover trial comparing through-the-scope balloon enteroscopy via colonoscope with standard colonoscopy on depth of ileal insertion","authors":"M. Ammar Kalas MD ,&nbsp;Luis O. Chavez MD ,&nbsp;Ihsan Al-Bayati MD ,&nbsp;Nancy Casner MS ,&nbsp;Alok K. Dwivedi PhD ,&nbsp;Sherif E. Elhanafi MD ,&nbsp;Marc J. Zuckerman MD","doi":"10.1016/j.igie.2025.06.002","DOIUrl":"10.1016/j.igie.2025.06.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Retrograde enteroscopy for evaluation of the small bowel can be performed using through-the-scope balloon-assisted enteroscopy (TTSE). TTSE consists of a balloon catheter designed for anchoring in the small bowel, inserted through the instrument channel of a standard colonoscope. We aimed to assess the ability of TTSE to improve the depth of maximal ileal insertion (DMI) compared with the colonoscope alone (C1).</div></div><div><h3>Methods</h3><div>We performed a prospective, randomized, crossover study to compare the DMI between TTSE and enteroscopy using the adult colonoscope alone. After measuring the DMI by the randomized sequence, the endoscopist switched the technique and measured the DMI again. The primary end point of the study was a comparison of DMI (centimeters) between the colonoscope with TTSE (DMI-N) and the colonoscope alone (DMI-C).</div></div><div><h3>Results</h3><div>A total of 18 subjects were enrolled, with 9 randomized to colonoscope alone first (C1) followed by TTSE (N2) and 9 to TTSE first (N1) followed by colonoscope alone (C2). The mean (standard deviation) of DMI was DMI-C1: 69.4 (40.3), DMI-N2: 107.2 (62.4), DMI-N1: 92.2 (31.3), and DMI-C2: 102.8 (29.1). Overall, TTSE showed a trend toward an increased DMI compared with the colonoscope alone (difference = 13.61; 95% confidence interval, −3.12 to 30.34; <em>P</em> = .06). In the stratified analyses by the randomization sequence (ie, C1N2), TTSE produced a significant increase in DMI (difference = 37.8; 95% confidence interval, 14.08-61.48; <em>P</em> = .006) compared with the colonoscope alone.</div></div><div><h3>Conclusions</h3><div>As per design-based analysis, the TTSE technique produced an increased DMI ranging between 13.6 and 37.8 cm more than with the standard colonoscope, which trended toward significance. Retrograde enteroscopy using TTSE may help improve DMI compared with colonoscope alone.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 242-248"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099191","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":"Hemorrhagic pouchitis after bowel preparation with sodium phosphate—based enema: a case report","authors":"Shanshan Wang MD ,&nbsp;Huaibin M. Ko MD ,&nbsp;Bo Shen MD","doi":"10.1016/j.igie.2025.06.006","DOIUrl":"10.1016/j.igie.2025.06.006","url":null,"abstract":"<div><div>Proper bowel preparation is crucial for endoscopic evaluation and intervention of the ileal pouch; yet, evidence on optimal regimens remains unclear. Although guidelines recommend the polyethylene glycol (PEG) regimens in patients with inflammatory bowel disease, sodium phosphate-based (NaP) enemas often are used for convenience. Although oral NaP has been linked to mucosal injury, similar effects from enemas have not been documented, to our knowledge. We report a case of hemorrhagic pouchitis after an NaP enema use in a patient with Crohn’s disease of the pouch who required repeated endoscopic stricturotomy. Endoscopic hemostatic agents were applied and stricture therapy was deferred to avoid further injury. No other prohemorrhagic causes besides NaP enema were identified. One month later, repeat pouchoscopy using PEG preparation showed no signs of active or recent bleeding, and endoscopic stricturotomy was successfully delivered. NaP enema should be used with caution in patients with an ileal pouch, as they can induce mucosal injury or mimic worsening pouchitis, potentially leading to misdiagnosis and inappropriate management.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 261-263"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099347","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 submucosal dissection of a gastric adenocarcinoma of fundic-gland type","authors":"Lady Katherine Mejia Perez MD ,&nbsp;Kyungran Justina Cho MD, PhD ,&nbsp;Erica Savage MD ,&nbsp;Amit Bhatt MD","doi":"10.1016/j.igie.2025.04.003","DOIUrl":"10.1016/j.igie.2025.04.003","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 252-254"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099193","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":"Hot versus cold snare endoscopic mucosal resection for nonampullary duodenal lesions: consolidating the cold revolution into clinical practice","authors":"Andrawus Beany MD, MPH ,&nbsp;Enrik John Torres Aguila MD, MBA ,&nbsp;Anna Agnieszka Wawer PhD ,&nbsp;Dauda Bawa MD ,&nbsp;Jin Tan MBBS ,&nbsp;Rajvinder Singh MPhil","doi":"10.1016/j.igie.2025.05.002","DOIUrl":"10.1016/j.igie.2025.05.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Endoscopic mucosal resection (EMR) has increasingly gained acceptance as a minimally invasive intervention for the treatment of duodenal lesions. Despite the overall good results, there can be significant morbidity associated with performing EMR in the duodenum. Data comparing hot snare and cold snare approaches in the duodenum are currently scarce. Our aim was to assess the efficacy and safety of hot snare EMR (H-EMR) versus cold snare EMR (C-EMR) for the resection of nonampullary duodenal lesions.</div></div><div><h3>Methods</h3><div>A retrospective analysis of a prospectively collected database of duodenal lesions treated using EMR at a single tertiary medical center between 2010 and 2023 was performed. Patient demographics, lesion and procedure characteristics, outcomes, and adverse events were analyzed. The primary outcomes studied included complete resection, as assessed by the endoscopist through visual confirmation of complete polyp resection, as well as recurrence and adverse events, including perforation and bleeding. Cost savings were assessed thereafter.</div></div><div><h3>Results</h3><div>Seventy-one cases of nonampullary duodenal lesions resected using the EMR technique were included (46 H-EMR; 25 C-EMR). Fifty-one lesions were resected en bloc (31 H-EMR vs 20 C-EMR), whereas 20 lesions were resected in a piecemeal fashion (15 H-EMR vs 5 C-EMR). Similar demographics and lesion and procedure characteristics were observed in both cohorts. Complete resection was 100%, and no delayed perforations occurred in either cohort. Lesions resected via H-EMR had greater rates of immediate perforation (2.2% vs 0%; <em>P</em> = 1.0) and delayed bleeding (9.1% vs 0%; <em>P</em> = .28) compared with C-EMR. Interestingly, recurrence rates were greater in the H-EMR arm (15.2% vs 8%; <em>P</em> = .70). C-EMR technique achieved a crude cost savings from clips alone of $135 U.S. dollars per patient compared with the H-EMR technique.</div></div><div><h3>Conclusions</h3><div>Although both cohorts demonstrated excellent complete resection, there was a trend toward lower adverse events and recurrence rates, as well as cost savings, when C-EMR technique was used for nonampullary duodenal lesions.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 235-241"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099190","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":"Bringing therapeutic endoscopy to the world of inflammatory bowel disease","authors":"Bo Shen MD ,&nbsp;Phillip S. Ge MD","doi":"10.1016/j.igie.2025.07.002","DOIUrl":"10.1016/j.igie.2025.07.002","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 270-289"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099197","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":"Impact of an endoscopic retrograde cholangiopancreatography radiation safety initiative on pregnant and nonpregnant staff dose exposures: a quality improvement initiative","authors":"Rabia de Latour MD ,&nbsp;Yakira David MD ,&nbsp;Shivangi Kothari MD ,&nbsp;Murad Ali MD","doi":"10.1016/j.igie.2025.04.002","DOIUrl":"10.1016/j.igie.2025.04.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Endoscopic retrograde cholangiopancreatography (ERCP) is a vital procedure for the management of hepatobiliary disease that requires fluoroscopy and results in radiation exposure to the interventional endoscopy team. Prevention of radiation-induced injury is crucial. Prompted by the pregnancy of our advanced endoscopist, who chose to continue performing ERCP throughout the pregnancy, we conducted a radiation safety and quality improvement initiative and evaluated the impact of this on mean fluoroscopy times and radiation dose exposure to the staff present in the procedure room.</div></div><div><h3>Methods</h3><div>ERCPs performed between June 2018 and March 2020 were reviewed. ERCPs performed from June 2018 to June 2019 were categorized as “preinitiative” and those performed from July 2019 to March 2020 were categorized as “postinitiative.” Interventions included purchase of a new fluoroscopy bed, new lead skirt for the bed and c-arm receiver, mindful fluoroscopy use by attending physician only, appropriate wear of dosimeter badges, and quality evaluation of personal protective equipment such as lead shielding. Data were collected on mean fluoroscopy time per procedure and each provider’s monthly radiation dosage.</div></div><div><h3>Results</h3><div>In the preinitiative group, 198 ERCPs were performed. Mean fluoroscopy time was 12.1 minutes per case. In the postinitiation group, 110 ERCPs were performed, with a mean fluoroscopy time of 6.3 minutes per case (48% reduction, <em>P</em> &lt; .01). For all providers, the average monthly shallow dose equivalent went from 102.49 to 31.35 milli–roentgen equivalent man (69.5% reduction, <em>P</em> &lt; .01). The fetal dosimeter badge worn at waist level of the pregnant provider under the lead shield detected less than the lowest detectable reading every month.</div></div><div><h3>Conclusions</h3><div>Quality improvement initiatives coupled with adequate personal protective equipment can result in significant improvement in the radiation exposure of advanced endoscopy staff during ERCP. Performing ERCP during pregnancy is a potentially feasible option if proper techniques and policy are implemented to protect the fetus.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 225-234"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099230","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":"Celebrating the impact of advanced practice providers (APPs) in gastroenterology: honoring APP week 2025!","authors":"Sarah Enslin PA-C, MS ,&nbsp;Alice Saji DNP, MSN, FNP-C ,&nbsp;Vivek Kaul MD","doi":"10.1016/j.igie.2025.07.003","DOIUrl":"10.1016/j.igie.2025.07.003","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 296-298"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099199","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":"Colon insufflation and visualization management using a novel rectal seal device","authors":"Julia Ding MD ,&nbsp;Nabil Shalabi PhD ,&nbsp;Colin Tracey BS ,&nbsp;Julian Maldonado MD ,&nbsp;Manish Gala MD ,&nbsp;Niora Fabian DVM ,&nbsp;Andrew Pettinari BVMS ,&nbsp;Giovanni Traverso MB, BChir, PhD","doi":"10.1016/j.igie.2025.05.004","DOIUrl":"10.1016/j.igie.2025.05.004","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Inadequate insufflation is a common problem during colonoscopies, with gas leakage from the anus hindering luminal visualization. This study examines the prevalence of this problem through a survey of gastroenterologists, which motivated the development of our insufflation leakage management rectal seal device, RECSEAL.</div></div><div><h3>Methods</h3><div>The RECSEAL was developed based on the need identified from gastroenterologists regarding the rate and management methods of inadequate insufflation. The RECSEAL, measuring 55 mm in diameter and 50 mm in length, was designed and silicone injection-molded to safely insert and reside in the anal canal without migrating or hindering movement of the colonoscope. To evaluate the RECSEAL, a colonoscope was outfitted with a pressure sensor to measure colonic pressure while visualizing the lumen in a bench, ex vivo, and in vivo in pig models. In the ex vivo study, a small injury was introduced to the anal sphincter to simulate poor anal tone.</div></div><div><h3>Results</h3><div>The survey reported a rate of inadequate insufflation of 6.6% that required intervention using gluteal pressure maneuvers. In bench testing and the ex vivo model, the RECSEAL maintained lumen pressures in which both an intact and an injured anal sphincter showed significantly higher (<em>P</em> &lt; .0001) mean pressures with the RECSEAL (32-33 mm Hg) than the control (0.3-3.6 mm Hg). The seal improved lumen visualization in the collapsed colon with inadequate insufflation. The RECSEAL was shown to be feasible in an in vivo model.</div></div><div><h3>Conclusions</h3><div>The flexible RECSEAL allowed higher luminal pressures in the colon and may improve colon insufflation and visualization.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 218-224"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099229","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":"Bridge the GAPPS (gastric adenocarcinoma and proximal polyposis syndrome)","authors":"Suchapa Arayakarnkul MD ,&nbsp;David Brauer MD, MPHS ,&nbsp;Christopher J. LaRocca MD ,&nbsp;Daniela Guerrero Vinsard MD","doi":"10.1016/j.igie.2025.06.001","DOIUrl":"10.1016/j.igie.2025.06.001","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 257-258"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099195","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":"X-ray vision in 2025","authors":"Linda S. Lee MD ,&nbsp;Brian Fleming MBA","doi":"10.1016/j.igie.2025.07.001","DOIUrl":"10.1016/j.igie.2025.07.001","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 290-295"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099198","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}