Digestion最新文献

{"title":"Management of T1 Colorectal Cancer.","authors":"Hidenori Tanaka, Ken Yamashita, Yuji Urabe, Toshio Kuwai, Shiro Oka","doi":"10.1159/000540594","DOIUrl":"10.1159/000540594","url":null,"abstract":"<p><strong>Background: </strong>Approximately 10% of patients with submucosal invasive (T1) colorectal cancer (CRC) have lymph node metastasis (LNM). The risk of LNM can be stratified according to various histopathological factors, such as invasion depth, lymphovascular invasion, histological grade, and tumor budding.</p><p><strong>Summary: </strong>T1 CRC with a low risk of LNM can be cured by local excision via endoscopic resection (ER), whereas surgical resection (SR) with lymph node dissection is required for high-risk T1 CRC. Current guidelines raise concern that many patients receive unnecessary SR, even though most patients achieve a radical cure. Novel diagnostic techniques for LNM, such as nomograms, artificial intelligence systems, and genomic analysis, have been recently developed to identify more low-risk T1 CRC cases. Assessing the curability and the necessity of additional treatment, including SR with lymph node dissection and chemoradiotherapy, according to histopathological findings of the specimens resected using ER, is becoming an acceptable strategy for T1 CRC, particularly for rectal cancer. Therefore, complete resection with negative vertical and horizontal margins is necessary for this strategy. Advanced ER methods for resecting the muscle layer or full thickness, which may guarantee complete resection with negative vertical margins, have been developed.</p><p><strong>Key message: </strong>Although a necessary SR should not be delayed for T1 CRC given its unfavorable prognosis when SR with lymph node dissection is performed, the optimal treatment method should be chosen based on the risk of LNM and the patient's life expectancy, physical condition, social characteristics, and wishes.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"122-130"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Efficacy and Safety of Treatments for Exocrine Pancreatic Insufficiency: A Systematic Literature Review.","authors":"Paula Chu, Jasmina Mioc, Peter O'Donovan, Owen Henry","doi":"10.1159/000541326","DOIUrl":"10.1159/000541326","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Exocrine pancreatic insufficiency (EPI) is caused by multiple clinical conditions such as cystic fibrosis and chronic pancreatitis (CP). Standard management of EPI includes pancreatic enzyme replacement therapy (PERT) along with consultation with a dietitian. While PERTs have been on the market for several decades, newer publications on their clinical efficacy and safety raised the need for a comprehensive review of the literature. We aimed to identify the available evidence on the clinical efficacy and safety of treatments for EPI to understand the current treatment landscape and unmet need in patients with EPI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic literature review (SLR) was conducted in Embase, Medline, and Evidence-Based Medicine databases from 2010 to 2022; conference proceedings from 2020 to 2022 were also searched. Articles were screened independently by two reviewers at abstract and full-text stage against predefined eligibility criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 26 journal publications and two conference abstracts, reporting on 22 randomized control trials, four observational studies, and two single-arm interventional studies. The most reported treatment was pancrelipase, specifically Creon® (n = 12). Fourteen studies reported coefficient of fat absorption (CFA) results. Across studies, patients experienced a considerable increase in CFA post-initiation of treatment regardless of intervention or timepoint. Mean change in CFA ranged from 7.5% in patients with CP who received placebo to 36% in patients with CP treated with Creon®. Ten studies reported coefficient of nitrogen absorption (CNA). Where reported, pancrelipase (including Creon®) increased CNA levels in EPI patients compared to placebo. Only one study compared PERT brands head-to-head: no significant differences were reported in the CNA-72 h values (Creon® 82.0% [SE: 1.2] vs. Zenpep® 80.9% [SE: 1.2]). Loss of body weight and low body mass index (BMI) are important features of EPI. Overall, treatment with PERT increased BMI and body weight, or limited their decline, with increases ranging from 0.1 to 6.1 kg. Based on the 18 studies that reported safety outcomes, PERT was considered safe and well tolerated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This SLR confirmed that PERT is an effective and tolerable treatment option for patients with EPI. However, nutritional parameters and health-related quality of life data were sparsely reported, and future clinical trials should look to incorporate these data given their importance in clinical practice and patient outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Exocrine pancreatic insufficiency (EPI) is caused by multiple clinical conditions such as cystic fibrosis and chronic pancreatitis (CP). Standard management of EPI includes pancreatic enzyme replacement therapy (PERT) along with consultation with a dietitian. While PERTs have been on the market for several decades, newer publ","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"45-61"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening Colonoscopy to Reduce the Incidence and Mortality of Colorectal Cancer.","authors":"Naoya Tada, Naoto Tamai, Kazuki Sumiyama","doi":"10.1159/000542113","DOIUrl":"10.1159/000542113","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) is a major concern because of its increasing incidence and mortality worldwide. Therefore, effective screening strategies are necessary to reduce its incidence.</p><p><strong>Summary: </strong>In addition to fecal immunochemical tests and computed tomography colonography, screening colonoscopy is expected to significantly contribute to the reduction of CRC. However, the timing of colonoscopy for CRC screening is not well-defined because of the lack of sufficient data. Additionally, the effectiveness of colonoscopy is affected by various factors known as quality indicators (QIs), such as the performance of the endoscopist; therefore, there are concerns regarding quality assurance. The adenoma detection rate (ADR) is a well-known QI of colonoscopy. Substantial evidence has suggested that improving the ADR could reduce the incidence and mortality of postcolonoscopy CRC.</p><p><strong>Key messages: </strong>Recent technological advancements have led to the development of image-enhanced endoscopy and the incorporation of artificial intelligence, and their ability to improve the ADR has been assessed. This review focused on screening colonoscopies and QIs and their ability to improve the ADR and incidence and mortality of CRC.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"100-106"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveillance and Endoscopic Resection of Ulcerative Colitis-Associated Neoplasia: A Japanese Perspective.","authors":"Yu Hashimoto, Syota Tomaru, Yuki Itoi, Keigo Sato, Hiroko Hosaka, Hirohito Tanaka, Shiko Kuribayashi, Yoji Takeuchi, Toshio Uraoka","doi":"10.1159/000543250","DOIUrl":"10.1159/000543250","url":null,"abstract":"<p><strong>Background: </strong>Patients with a long history of ulcerative colitis (UC) are at risk of developing a serious complication known as UC-associated neoplasia (UCAN). Because the treatment strategy for UCAN greatly differs from that for sporadic tumors, UCAN needs to be distinguished from sporadic tumors. This article provides an overview of the current status and future challenges regarding the surveillance colonoscopy (SC) and endoscopic submucosal dissection (ESD) of neoplastic lesions in patients with UC.</p><p><strong>Summary: </strong>To reduce the risk of associated mortality, the current guidelines recommend initiating SC using chromoendoscopy with high-definition colonoscopy 8-10 years after the confirmation of a UC diagnosis. However, the endoscopic diagnosis of UCAN is occasionally challenging and requires a stepwise approach using multiple endoscopic modalities. The worldwide consensus is that a diagnosis of high-grade dysplasia or higher is an indication for proctocolectomy. Although the management of low-grade dysplasia (LGD) remains controversial, the SCENIC consensus statement recommends the complete removal of \"endoscopically resectable\" LGD, followed by monitoring. ESD was developed in Japan, allows for the removal of complex gastrointestinal lesions, facilitates the treatment of LGD, and enables precise pathological evaluations to differentiate between UCAN and sporadic tumors and to determine the grade of dysplasia in UCAN. Close endoscopic surveillance should follow complete endoscopic resection. A Japanese expert consensus meeting recommended the performance of follow-up SC 6-12 months after complete resection with ESD.</p><p><strong>Key messages: </strong>The roles of ESD for UCAN are to treat LGD and to enable the histopathological examination of complete excisional biopsy specimens to differentiate between UCAN and sporadic tumors and grade the dysplasia of UCAN. In future, prospective cohort studies are needed to better assess the clinical outcomes of ESD in patients with UC.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"146-152"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DYRK2 regulates epithelial-mesenchymal transition restriction in pancreatic cancer liver metastasis by inhibiting Twist.","authors":"Hang Pan, Yin Liu, Kejiu Bao, Yulin Wang, Yuping Zhang, Lina Zhou","doi":"10.1159/000541039","DOIUrl":"https://doi.org/10.1159/000541039","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the underlying variables and molecular pathways leading to pancreatic cancer liver metastasis.</p><p><strong>Methods: </strong>Hs766T and Hs766T-L3 cells were used to create in vitro and in vivo pancreatic cancer liver metastasis models. DYRK2 involvement in pancreatic cancer metastasis was investigated using cell adhesion assays, wound healing assays, and migration and invasion assays. To examine the link between DYRK2 expression and epithelial-mesenchymal transition, Western blot, quantitative real-time PCR, immunofluorescence assays, and immunoprecipitation (IP) were utilized. We found that mice with DYRK2 overexpression had a lower incidence of liver metastasis compared to controls.</p><p><strong>Results: </strong>DYRK2 expression decreased pancreatic cancer tumorigenic activities, including proliferation, migration, and invasion. By analyzing the expression levels of epithelial-mesenchymal transition markers and IP results after overexpressing DYRK2, we found that DYRK2 decreased Twist levels by increasing Twist ubiquitination, thereby inhibiting epithelial-mesenchymal transition.</p><p><strong>Conclusions: </strong>Our findings provide theoretical and experimental support for the ongoing development of DYRK2-based targeted therapies for pancreatic cancer liver metastases.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-18"},"PeriodicalIF":3.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Prognosis of Sporadic Neoplasias Detected in Patients with Ulcerative Colitis.","authors":"Noriko Yamamoto, Ken Yamashita, Yudai Takehara, Shin Morimoto, Fumiaki Tanino, Yuki Kamigaichi, Hidenori Tanaka, Koji Arihiro, Fumio Shimamoto, Shiro Oka","doi":"10.1159/000537756","DOIUrl":"10.1159/000537756","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with ulcerative colitis (UC) develop not only UC-associated neoplasias but also sporadic neoplasias (SNs). However, few studies have described the characteristics of SNs in patients with UC. Therefore, this study aimed to evaluate the clinical features and prognosis of SNs in patients with UC.</p><p><strong>Methods: </strong>A total of 141 SNs in 59 patients with UC, detected by surveillance colonoscopy at Hiroshima University Hospital between January 1999 and December 2021, were included. SNs were diagnosed based on their location, endoscopic features, and histopathologic findings along with immunohistochemical staining for Ki67 and p53.</p><p><strong>Results: </strong>Of the SNs, 91.5% were diagnosed as adenoma and 8.5% were diagnosed as carcinoma (Tis carcinoma, 3.5%; T1 carcinoma, 5.0%). 61.0% of the SNs were located in the right colon, 31.2% were located in the left colon, and 7.8% were located in the rectum. When classified based on the site of the lesion, 70.9% of SNs occurred outside and 29.1% within the affected area. Of all SNs included, 95.7% were endoscopically resected and 4.3% were surgically resected. Among the 59 patients included, synchronous SNs occurred in 23.7% and metachronous multiple SNs occurred in 40.7% during surveillance. The 5-year cumulative incidence of metachronous multiple SNs was higher in patients with synchronous multiple SNs (54.2%) than in those without synchronous multiple SNs (46.4%).</p><p><strong>Conclusion: </strong>Patients with UC with synchronous multiple SNs are at a higher risk of developing metachronous multiple SNs and may require a closer follow-up by total colonoscopy than patients without synchronous SNs.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"213-223"},"PeriodicalIF":3.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139989597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing the Gap: A Critical Examination of Adherence, Inconsistency, and Improvements in Colonoscopy Reporting Practices.","authors":"Thomas J Lux, Katja Herold, Ioannis Kafetzis, Phillip Sodmann, Zita Sassmanshausen, Alexander Meining, Alexander Hann","doi":"10.1159/000538113","DOIUrl":"10.1159/000538113","url":null,"abstract":"<p><strong>Introduction: </strong>Comprehensive and standardized colonoscopy reports are crucial in colorectal cancer prevention, monitoring, and research. This study investigates adherence to national and international guidelines by analyzing reporting practices among 21 endoscopists in 7 German centers, with a focus on polyp reporting.</p><p><strong>Methods: </strong>We identified and assessed German, European, American, and World Health Organization-provided statements to identify key elements in colonoscopy reporting. Board-certified gastroenterologists rated the relevance of each element and estimated their reporting frequency. Adherence to the identified report elements was evaluated for 874 polyps from 351 colonoscopy reports ranging from March 2021 to March 2022.</p><p><strong>Results: </strong>We identified numerous recommendations for colonoscopy reporting. We categorized the reasoning behind those recommendations into clinical relevance, justification, and quality control and research. Although all elements were considered relevant by the surveyed gastroenterologists, discrepancies were observed in the evaluated reports. Particularly diminutive polyps or attributes which are rarely abnormal (e.g., surface integrity) respectively rarely performed (e.g., injection) were sparsely documented. Furthermore, the white light morphology of polyps was inconsistently documented using either the Paris classification or free text. In summary, the analysis of 874 reported polyps revealed heterogeneous adherence to the recommendations, with reporting frequencies ranging from 3% to 89%.</p><p><strong>Conclusion: </strong>The inhomogeneous report practices may result from implicit reporting practices and recommendations with varying clinical relevance. Future recommendations should clearly differentiate between clinical relevance and research and quality control or explanatory purposes. Additionally, the role of computer-assisted documentation should be further evaluated to increase report frequencies of non-pathological findings and diminutive polyps.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"224-231"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140119120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulation of Intestinal Motility in an Adolescent Rat Model of Irritable Bowel Syndrome.","authors":"Reiko Kyodo, Takahiro Kudo, Natsuki Ito, Kazuhide Tokita, Nobuyasu Arai, Masamichi Sato, Tamaki Ikuse, Keisuke Jimbo, Yoshikazu Ohtsuka, Toshiaki Shimizu","doi":"10.1159/000534732","DOIUrl":"10.1159/000534732","url":null,"abstract":"<p><strong>Introduction: </strong>The pathophysiology of irritable bowel syndrome (IBS) remains unknown. This study aimed to evaluate colonic motility and serotonin system response to restraint stress (RS) among adolescent rats who underwent neonatal maternal separation (NMS) to clarify the features of pathogenesis in adolescents with IBS.</p><p><strong>Methods: </strong>Male rats were exposed to NMS as chronic stress, and a normally handled (NH) group was used as control. Four groups were created by adding RS as acute stress treatment to the NMS and NH groups. To realize the RS treatment, the subjects were restrained for 1 h at the age of 5 weeks, and hourly fecal pellet discharge was determined. After euthanization and proximal colon intestinal tissue collection, 5-hydroxytryptamine (5-HT) and 5-hydroxytryptamine receptor 3 (5-HT3R) concentrations, enterochromaffin (EC) cell density, and the expression of mRNA-encoding slc6a4 were examined.</p><p><strong>Results: </strong>The amount of fecal pellet discharge during RS increased significantly in the RS and NMS+RS groups compared with that in the NH and NMS groups, respectively. The 5-HT concentration in the intestinal tissue of rats in the RS and NMS groups increased significantly compared with that of rats in the NH group. EC cell density also increased significantly in the NMS and NMS+RS groups compared with that in the NH and RS groups. However, combined stress did not result in any significant differences in the expression of 5-HT3R and mRNA-encoding slc6a4.</p><p><strong>Conclusions: </strong>The combination of juvenile and acute stress effectively induced increased 5-HT concentration or EC cell density via the 5-HT pathway in the proximal colon of adolescent rats.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"99-106"},"PeriodicalIF":4.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10994574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107590528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between Helicobacter pylori Eradication and Barrett's Esophagus Elongation.","authors":"Kenta Hashigami, Yugo Iwaya, Tadanobu Nagaya, Daichi Hara, Atsuhiro Hirayama, Takuma Okamura, Taiji Akamatsu, Takeji Umemura","doi":"10.1159/000536443","DOIUrl":"10.1159/000536443","url":null,"abstract":"<p><strong>Introduction: </strong>Helicobacter pylori eradication therapy may worsen gastroesophageal reflux disease that is a significant risk factor for Barrett's esophagus. However, the relationship between eradication therapy and Barrett's esophagus remains controversial. This study evaluated the impact of Helicobacter pylori eradication on the lengthening of Barrett's esophagus.</p><p><strong>Materials and methods: </strong>We conducted a retrospective analysis of consecutive patients who successfully underwent Helicobacter pylori eradication between 2004 and 2017. Endoscopic images obtained before and after eradication therapy were compared for Barrett's esophagus length according to the Prague C&amp;M criteria and the presence of reflux esophagitis based on the Los Angeles classification.</p><p><strong>Results: </strong>A total of 340 patients were analyzed (mean age: 66.9 ± 12.9 years) for a median follow-up of 55 months (interquartile range: 29.8-89.3). At the initial endoscopic assessment, 187 patients (55%) had a hiatal hernia, and all patients had gastric atrophy (C-0 to I: 2%, C-II to III: 47%, O-I to III: 51%). Reflux esophagitis was detected in 7 patients (2%) before eradication and in 21 patients (6%) afterward, which was a significant increase (p = 0.007). Barrett's esophagus was identified in 69 patients (20%) before eradication, with a median length of C0M1. Elongation after treatment was observed in only 2 patients (0.6%). We observed no significant increase in either the prevalence (p = 0.85) or the median length (p = 0.5) of Barrett's esophagus.</p><p><strong>Conclusions: </strong>Only 0.6% of patients exhibited Barrett's esophagus lengthening after Helicobacter pylori eradication therapy, suggesting no significant impact of the treatment on the development or elongation of Barrett's esophagus.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"186-191"},"PeriodicalIF":3.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139641826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Endoscopy.","authors":"Haruhiro Inoue, Yuto Shimamura","doi":"10.1159/000534831","DOIUrl":"10.1159/000534831","url":null,"abstract":"<p><strong>Background: </strong>Functional endoscopy signifies a significant advancement in gastrointestinal examination, integrating motor function assessments alongside routine endoscopy findings. Traditional gastrointestinal endoscopy primarily focuses on the detection of early-stage cancer by identifying morphological changes within the gastrointestinal tract. These alterations include modifications in lumen structure, color tone, and surface patterns, which can be diagnosed using endoscopic images that assess these morphological changes. In contrast, functional endoscopy aims to dynamically evaluate the peristaltic movements of the digestive tract and the presence or movement of reflux of digestive fluids during the endoscopic procedure. It also seeks to identify morphological changes such as hiatal hernias, as observed in conventional endoscopy. Consequently, relying solely on endoscopic images proves inadequate for diagnosis, necessitating continuous observation of these dynamic movements.</p><p><strong>Summary: </strong>The endoscopic pressure study integrated system (EPSIS) serves as an exemplar of functional endoscopy. It incorporates a stress test to assess the functionality of the lower esophageal sphincter (LES) through intragastric insufflation. A crucial element of EPSIS evaluation is the identification of the scope holding sign (SHS), which signifies LES contraction. EPSIS also encompasses the observation of esophageal peristaltic waves and the auditory detection of burping, providing a comprehensive diagnostic approach while observing the sphincter from a retroflex view on the stomach side. By integrating these dynamic findings, functional endoscopy offers an efficient method for diagnosing functional gastrointestinal diseases, such as gastroesophageal reflux disease (GERD).</p><p><strong>Key messages: </strong>Functional endoscopy combines motor function assessments with traditional endoscopy, enhancing the diagnostic capabilities of gastrointestinal examinations. Traditional endoscopy focuses on identifying morphological changes, while functional endoscopy evaluates dynamic movements, reflux, and sphincter functionality. EPSIS exemplifies functional endoscopy, featuring a stress test and the SHS for LES contraction assessment. EPSIS provides a comprehensive approach to diagnose GERD by integrating dynamic observations.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"58-61"},"PeriodicalIF":3.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10777710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138440501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}