iGIE最新文献

{"title":"Deep sight: enhancing periprocedural adverse event recording in endoscopy by structuring text documentation with privacy-preserving large language models","authors":"Isabella C. Wiest MD, MSc ,&nbsp;Dyke Ferber MD ,&nbsp;Stefan Wittlinger MSc ,&nbsp;Matthias P. Ebert MD ,&nbsp;Sebastian Belle MD ,&nbsp;Jakob Nikolas Kather MD, MSc","doi":"10.1016/j.igie.2024.08.001","DOIUrl":"10.1016/j.igie.2024.08.001","url":null,"abstract":"<div><h3>Background and Aims</h3><div>The assessment of adverse events from endoscopic procedures is essential for successful interventions, ensuring accurate follow-up, adverse event management, and processing for quality control. Despite the critical need for structured documentation, the current practice often relies on free-text recordings, which poses challenges for scalable intervention analysis; however, the introduction of large language models (LLMs) offers a promising solution by enabling the automatic extraction of adverse event details from procedural reports without altering existing documentation practices.</div></div><div><h3>Methods</h3><div>We analyzed 672 endoscopy reports, using OpenAI’s GPT-4 and Llama-2–based models to structure the data in JavaScript Object Notation for efficient analysis. We used an automated LLM pipeline to extract adverse events such as bleeding, perforation, and aspiration. The dataset was divided into a proof-of-concept set (PoC-S) with n = 171 reports, on which we explored prompt engineering to improve the performance of the models. The final analysis was run on an additional external test set of 501 reports.</div></div><div><h3>Results</h3><div>GPT-4 showed high accuracy, with a sensitivity of 97% and specificity of 92% in the PoC-S and 91% and 96%, respectively, in the test set. GPT-4 use in real-world settings is limited by privacy concerns. Conversely, Llama-2–based models, especially the Llama-2 variants fine-tuned for German language, demonstrated comparable performance (PoC-S: sensitivity of 94%; specificity of 92%, in the test set (TS): sensitivity of 89%; specificity of 93%) and offered a viable privacy-compliant alternative. The model effectiveness was further influenced by the method of prompt engineering, with experiments showing that the specificity and sensitivity could vary substantially based on the inclusion of specific prompt features, underscoring the importance of tailored prompt design.</div></div><div><h3>Conclusions</h3><div>Applying LLMs to extract structured medical information, particularly from endoscopy reports, offers an efficient, scalable, and adaptable documentation method that captures adverse events accurately with a low error rate. It facilitates immediate quality reporting and reduces manual documentation efforts.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 447-452.e5"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of over-the-scope endoscopic suturing device for closure of defects after endoscopic submucosal dissection: a systematic review and meta-analysis","authors":"Tahne Vongsavath DO ,&nbsp;Kyaw Min Tun DO ,&nbsp;Syed Mohsin Saghir MD ,&nbsp;Jay Bapaye MD ,&nbsp;Renuka Verma MD ,&nbsp;Chun-Han Lo MD ,&nbsp;Ahmad Gill MD ,&nbsp;Banreet Singh Dhindsa MD ,&nbsp;Saurabh Chandan MD ,&nbsp;Douglas G. Adler MD, FACG, AGAF, FASGE","doi":"10.1016/j.igie.2024.09.007","DOIUrl":"10.1016/j.igie.2024.09.007","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Endoscopic submucosal dissection (ESD) is used for closure of GI lesions after endoscopic resection techniques such as EMR. Generally, a large defect is left that can increase the risk of postprocedural bleeding or perforation, and it has been managed by techniques such as endoscopic placement of clips to reapproximate the defect edges. An over-the-scope suturing system (OSS), OverStitch created by Apollo Endosurgery, has been designed for similar utility in ESD closure. The goal of its design is to achieve full-thickness closure and exchange of suture without endoscopic removal. The goal of this study was to evaluate the technical success and efficacy of using OSS in the closure of ESD.</div></div><div><h3>Methods</h3><div>A comprehensive literature review across multiple databases was performed. Studies including OverStitch and ESD information were evaluated, with 7 articles meeting predetermined eligibility of quality for inclusion. Statistical analysis was completed by using CMA version 3.0 software (Biostat, Englewood, NJ, USA). The primary evaluated end point was technical success and efficacy of instrument use in patients undergoing ESD closure with OSS. The secondary evaluated end point was the overall rate of adverse events related to the use of OSS.</div></div><div><h3>Results</h3><div>Overall, the pooled rates for instrumental efficacy and technical success were 95.8% (95% CI [confidence interval], 80.6%-99.2%; <em>P</em> = .04) and 99.2% (95% CI, 79.8%-100.0%; <em>P</em> = 1.00), respectively. The pooled rate of adverse events was .9% (95% CI, 0%-24.8%; <em>P</em> = .99) with pain reported as the most common adverse event.</div></div><div><h3>Conclusions</h3><div>OSS seems to be an effective and safe tool in the closure of defects after ESD. However, its design also makes it large and difficult to maneuver. Although it allows for replacement of the suture kit without endoscopic removal, there have been multiple reported episodes of device failure. Further randomized controlled trials are warranted as OSS becomes more widely used.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 527-532.e2"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel endoscopic suturing device: comparison with endoclips and hand-sewn techniques for gastrostomy closure in an ex vivo porcine model","authors":"Jun Hee Lee MD ,&nbsp;Ji Yoon Kim MD ,&nbsp;Taebin Kwon MS ,&nbsp;Hyuk Soon Choi MD, PhD ,&nbsp;Bora Keum MD, PhD ,&nbsp;Hoon Jai Chun MD, PhD ,&nbsp;Daehie Hong PhD ,&nbsp;Hyunsoo Chung MD, PhD","doi":"10.1016/j.igie.2024.10.004","DOIUrl":"10.1016/j.igie.2024.10.004","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 487-489"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing peritoneal visualization in peroral endoscopic myotomy with fundoplication using novel robotic peritoneal pressure optimization","authors":"Ayah Matar MD,&nbsp;Farimah Fayyaz MD,&nbsp;Preethi Jagannath MD,&nbsp;Jose Antonio Almario MD,&nbsp;Mouen Khashab MD","doi":"10.1016/j.igie.2024.09.005","DOIUrl":"10.1016/j.igie.2024.09.005","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 470-472"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexpected clipping failure of a full-thickness resection device during endoscopic full-thickness resection","authors":"Yasutoshi Shiratori MD, MPH, PhD ,&nbsp;Aaron Tokayer MD ,&nbsp;Anthony Kalloo MD","doi":"10.1016/j.igie.2024.08.006","DOIUrl":"10.1016/j.igie.2024.08.006","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 475-477"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From obscurity to prominence in the scope world","authors":"Taisuke Fujita BA ,&nbsp;Linda S. Lee MD","doi":"10.1016/j.igie.2024.10.006","DOIUrl":"10.1016/j.igie.2024.10.006","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 533-538"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EUS-based shear wave elastography of the spleen for detection of clinically significant portal hypertension","authors":"Jad P. AbiMansour MD ,&nbsp;Jerry Yung-Lun Chin MBBS ,&nbsp;Eric J. Vargas MD ,&nbsp;Jyotroop Kaur MBBS ,&nbsp;Barham K. Abu Dayyeh MD, MPH ,&nbsp;Ryan J. Law DO ,&nbsp;Vishal Garimella MBBS ,&nbsp;Michael J. Levy MD ,&nbsp;Andrew C. Storm MD ,&nbsp;Ross Dierkhising MS ,&nbsp;Alina Allen MD ,&nbsp;Vinay Chandrasekhara MD","doi":"10.1016/j.igie.2024.09.002","DOIUrl":"10.1016/j.igie.2024.09.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>A measurement of spleen stiffness has been demonstrated to improve the detection of clinically significant portal hypertension (CSPH). In this study, we evaluated the performance of EUS-guided shear wave elastography (EUS-SWE) for detecting CSPH.</div></div><div><h3>Methods</h3><div>EUS-SWE measurements of the spleen were compared between patients with and without CSPH. Receiver-operating characteristic curve analysis was performed and quantified by the area under the receiver-operating characteristic curve (AUROC).</div></div><div><h3>Results</h3><div>Of 142 patients with EUS-SWE spleen measurements, 13 (9.2%) had CSPH and 129 (90.8%) did not. Patients with CSPH had a significantly higher mean spleen stiffness (37.6 ± 8.5 kPA vs 29.1 ± 9.9 kPA, <em>P</em> = .003). The AUROC was .74.</div></div><div><h3>Conclusions</h3><div>SWE is a promising technology that can readily be incorporated into standard EUS examination for assessment of portal hypertension.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 507-511"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adequacy, safety, and technical determinants of a modified EUS-guided liver biopsy sampling technique in patients with or without cirrhosis: a pilot study","authors":"Biswa Ranjan Patra MD, DM,&nbsp;Shashank Pujalwar MD, DM,&nbsp;Sidharth Harindranath MD, DM,&nbsp;Shubham Gupta MD, DM,&nbsp;Arun Vaidya MD, DM,&nbsp;Prajakta Mane BSc, PGDMLT,&nbsp;Akash Shukla MD, DM","doi":"10.1016/j.igie.2024.10.003","DOIUrl":"10.1016/j.igie.2024.10.003","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Technique-related factors of EUS-guided liver biopsy sampling (EUS-LB) as a determinant of specimen yield have not been studied. We used a modified technique to study adequacy, safety, and technical determinants in patients with or without cirrhosis.</div></div><div><h3>Methods</h3><div>EUS-LB was performed with a 19-gauge Franseen-tip needle by wet heparinized suction. One or 2 passes with a variable number of actuations were taken, with an endpoint of the aspiration of blood. Primary outcomes were tissue core adequacy and definitive histologic diagnosis. Secondary outcomes were a correlation between the number and depth of actuations with total specimen length (TSL), longest specimen length (LSL), and adverse events (AEs). Early and late AEs were also accessed.</div></div><div><h3>Results</h3><div>Adequate samples were seen in 48 of 50 patients, and a histologic diagnosis could be achieved in 49 of 50 patients. Mean TSL, LSL, and depth of actuation were 7.98 ± 3.74 cm, 1.89 ± .80 cm, and 4.29 ± .98 cm, respectively. The median number of complete portal tracts was 23 (range, 7-50) and number of actuations was 7 (range, 4-12). The correlation between TSL with number and depth of actuation was r = .71 versus r = .53 and r = .55 versus r = .51 and for LSL was r = .28 versus r = .11 and r = .74 versus r = .55 in noncirrhotic and cirrhotic patients, respectively. No major and 7 (14%) minor AEs were observed.</div></div><div><h3>Conclusions</h3><div>This modified EUS-LB technique resulted in adequate tissue acquisition and is safe in noncirrhotic and cirrhotic patients. Technical factors like the number and depth of actuations determine specimen yield.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 512-520"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the boundaries of EUS: EUS-guided fiducial placement and fine-needle biopsy in oligometastatic disease of the adrenal gland","authors":"Ricardo Marrero Torres MD ,&nbsp;Hari Gopakumar MD ,&nbsp;Dushyant Singh Dahiya MD ,&nbsp;Aqsa Khan MD ,&nbsp;Uday Patel DO ,&nbsp;Sahib Singh MD ,&nbsp;Talia Malik MD ,&nbsp;Marzena Muller MD ,&nbsp;Mariajose Rojas de Leon MD ,&nbsp;Neil R. Sharma MD","doi":"10.1016/j.igie.2024.08.002","DOIUrl":"10.1016/j.igie.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><div>Radiation therapy, including Intensity Modulated Radiation Therapy (IMRT) and Stereotactic Body Radiation Therapy (SBRT), is a crucial treatment for various malignancies, though side effects often arise from radiation exposure to healthy tissues. Fiducial markers are used in SBRT to optimize tumor targeting and minimize damage to surrounding tissues. Traditionally, fiducials are placed surgically or percutaneously, but EUS offers a safer, less invasive, and potentially cost-effective alternative. While fiducial placement within the pancreas has been well-studied, there are limited data on EUS-guided fiducial marker placement in non-GI organs, particularly the adrenal glands.</div></div><div><h3>Methods</h3><div>This retrospective case series evaluated EUS-guided fiducial marker placement in the left adrenal gland in 6 patients from 2020 to 2023. Patients were selected following multidisciplinary tumor board discussions, and all procedures were performed using a 22-gauge Menghini-tip needle under EUS guidance. Data were collected on patient demographics, tumor characteristics, technical success, and clinical outcomes following fiducial placement.</div></div><div><h3>Results</h3><div>The procedure was technically successful in all patients, with no reported adverse events. Four fiducials were placed in each patient, aiding SBRT planning. Five patients proceeded with SBRT, and 80% achieved a complete local response on radiological follow-up. No significant fiducial migration was noted. The findings suggest that EUS-guided fiducial placement for adrenal tumors is safe and effective.</div></div><div><h3>Conclusion</h3><div>This is the first case series demonstrating the safety and technical success of EUS-guided fiducial placement in the adrenal gland. This technique offers an alternative to more invasive approaches, facilitating precision radiotherapy for adrenal metastases, and highlights the expanding role of interventional endoscopists in oncology care. Further prospective studies are needed to validate these findings and expand their clinical application.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 521-526"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unsedated transnasal endoscopy experience at a tertiary referral center in India","authors":"Ravi Teja Pasam MBBS, MPH ,&nbsp;Srilekha Chava MBBS ,&nbsp;Nagabhushanam Gollapalli MD, DM ,&nbsp;Bhaskar Rao Uppala MD, DM ,&nbsp;Jagan Mohan Rao Kodali MRCP, FRCP","doi":"10.1016/j.igie.2024.09.001","DOIUrl":"10.1016/j.igie.2024.09.001","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Unsedated transnasal endoscopy (uTNE) was developed in the 1990s but has not gained widespread use. We present our experience with uTNE at a tertiary referral center in India.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted with prospectively collected data of patients who underwent uTNE for predominantly diagnostic EGD at our center between January 2014 and September 2017. Patients received 2% lidocaine spray over the back of the throat, xylometazoline, and 10% lidocaine sprays in the nostril 10 minutes before uTNE. Successful completion of TNE without the need for sedation, conversion to peroral EGD (PO-EGD), epistaxis, and tolerance of the procedure compared with prior PO-EGD were the outcomes of interest. Unsedated PO-EGD (uPO-EGD) is the standard of care at our center. Logistic regression was used for analysis.</div></div><div><h3>Results</h3><div>Successful completion of uTNE (414/440 patients) was significantly associated with male sex (odds ratio [OR], 2.67; 95% confidence interval [CI], 1.16-6.14). Conversion to PO-EGD (4.32%) was significantly associated with age (OR, .96; 95% CI, .94-.99), year of endoscopy (OR, .44; 95% CI, .24-.82), and male sex (OR, .33; 95% CI, .12-.89) in multivariable analysis. Rate of epistaxis was 6.76%, and 93.09% of patients (229/246) tolerated uTNE better than prior PO-EGD. There were no life-threatening or major adverse events requiring prolonged hospitalization.</div></div><div><h3>Conclusions</h3><div>uTNE should be offered as an alternative to uPO-EGD for diagnostic EGD. Studies comparing tolerance and adverse events of uTNE with those of sedated PO-EGD are required given the costs and potential adverse events associated with sedation.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 562-566.e2"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}