Endoscopy最新文献

{"title":"Endoscopic Vacuum Therapy for the Management of Non-Variceal Upper Gastrointestinal Bleeding: A Valuable Resource for the Endoscopist's Toolbox.","authors":"Paulo Ferreira Mega, Eduardo Guimarães Hourneaux de Moura, Alexandre Moraes Bestetti, Daryl Ramai, Atul Kumar, Ludhmila Abrahão Hajjar, Christopher C Thompson, Diogo Turiani Hourneaux de Moura","doi":"10.1055/a-2544-6448","DOIUrl":"https://doi.org/10.1055/a-2544-6448","url":null,"abstract":"<p><strong>Background and study aims: </strong>Endoscopic Vacuum Therapy (EVT) is a well-established method for managing gastrointestinal perforations. During the COVID epidemic, case reports demonstrated the effective use of EVT in controlling COVID related diffuse duodenal bleeding. Due to its unique mechanism of action, this approach may also be effective for other types of Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB). This study aims to assess EVT in the treatment of NVUGIB.</p><p><strong>Patients and methods: </strong>This retrospective analysis of a prospectively collected database includes patients who underwent EVT for the treatment of NVUGIB. The primary outcome was clinical success. Secondary outcomes included technical success and safety. Subgroup analysis comparing outcomes for patients with and without COVID was conducted.</p><p><strong>Results: </strong>A total of 19 patients underwent EVT for NVUGIB, with 57.9% having failed other therapies. Technical success occurred in all patients, and clinical success was achieved in 89.5%. There was no difference in clinical success rates between patients with or without COVID (88% versus 91%, respectively). No procedure-related adverse events occurred.</p><p><strong>Conclusion: </strong>EVT appears to be safe and effective in the management of NVUGIB. This approach could be particularly useful in refractory or diffuse bleeding. Larger studies are warranted to validate these findings.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biliary drainage prior to pancreatoduodenectomy with Endoscopic Ultrasound-guided choledochoduodenostomy vs conventional Endoscopic Retrograde Cholangiopancreatography: a propensity score matched study and surgeon-survey.","authors":"Jeska A Fritzsche, Mike J P de Jong, Bert A Bonsing, Olivier Busch, Freek Daams, Wouter J M Derksen, Lydi van Driel, Sebastiaan Festen, Erwin-Jan M van Geenen, Frederik J H Hoogwater, Akin Inderson, Sjoerd D Kuiken, Mike S L Liem, Daan J Lips, Maarten W Nijkamp, Hjalmar Van Santvoort, Peter D Siersema, Martijn W J Stommel, Niels G Venneman, Robert C Verdonk, Frank P Vleggaar, Roeland F de Wilde, Marc G Besselink, Roy L J van Wanrooij, Rogier P Voermans","doi":"10.1055/a-2543-5672","DOIUrl":"https://doi.org/10.1055/a-2543-5672","url":null,"abstract":"<p><p>Background Preoperative endoscopic biliary drainage may lead to complications (16%-24%), potentially hampering surgical exploration. Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) may reduce drainage-related complications, however it is unknown whether EUS-CDS could in itself hamper surgical exploration as series with surgeon reported outcomes are lacking. Aim is to assess the impact of preoperative EUS-CDS on pancreatoduodenectomy. Method Consecutive patients who underwent pancreatoduodenectomy after preoperative biliary drainage were included in all eight centers that performed EUS-CDS in the mandatory Dutch Pancreatic Cancer Audit (Jan 2020-Dec 2022). Primary outcome was major postoperative complications. Secondary outcomes included bile leak grade B/C, postoperative pancreatic fistula (POPF) grade B/C, and overall postoperative complications. A propensity score matching (1:3) analysis was performed. Surgeons who performed a pancreatoduodenectomy after EUS-CDS were asked to complete a survey. Results Overall, 937 patients with pancreatoduodenectomy after preoperative biliary drainage were included (42 EUS-CDS, 895 ERCP). Major postoperative complications occurred in eight patients (19%) in the EUS-CDS group and 292 patients (33%) in the ERCP group (RR 0.50; 95%CI, 0.23-1.07). No significant differences were observed in overall complications (RR 0.95; 95%CI, 0.51-1.76), bile leak (RR 1.25; 95%CI, 0.31-4.98) or POPF (RR 0.62; 95%CI, 0.25-1.56). Results were similar after matching. The survey was completed for 29 pancreatoduodenectomies; surgery was not (n=13, 45%), 'slightly' (n=8, 28%), 'clearly' (n=5, 17%) or 'severely' (n=2, 7%) more complex because of the EUS-CDS. Conclusion This early experience suggests that preoperative biliary drainage with EUS-CDS does not increase the rate of complications after pancreatoduodenectomy and only infrequently hampers surgical exploration.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are we ready to change our surveillance strategy for primary sclerosing cholangitis patients?","authors":"Arnaud Lemmers","doi":"10.1055/a-2541-3986","DOIUrl":"https://doi.org/10.1055/a-2541-3986","url":null,"abstract":"","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cold snare endoscopic mucosal resection versus standard hot technique for large flat non-pedunculated colonic lesions: Results of the CS-EMR 2019 randomized controlled trial.","authors":"Oscar Nogales, Carlos Carbonell-Blanco, Sheyla Montori Pina, Maria Pellisé, Juan Martínez-Sempere, Fausto Riu Pons, Carolina Mangas-Sanjuan, Maria Daca-Alvarez, Hugo Uchima, Javier Aranda Hernández, Alberto Alvarez Delgado, Enrique Rodriguez de Santiago, Jose Santiago Garcia, Angel Cañete Ruiz, Pablo Miranda Garcia, Henar Nuñez Rodriguez, Alberto Herreros de Tejada, Eduardo Valdivielso Cortázar, Pedro De María, David Busquets, Alfonso Elosua, Liseth Rivero-Sánchez, Maria Lopez-Ibanez, Marco Antonio Alvarez-Gonzalez, Eduardo Albéniz","doi":"10.1055/a-2542-9759","DOIUrl":"https://doi.org/10.1055/a-2542-9759","url":null,"abstract":"<p><strong>Backgrounds and aims: </strong>Cold snare EMR (CS-EMR) in large flat non-pedunculated colonic lesions (LFNPCLs) is an alternative to the standard EMR procedure with a better safety profile, but scientific evidence on its efficacy is unavailable.</p><p><strong>Primary objective: </strong>To compare the recurrence rate between the two techniques at six months.</p><p><strong>Secondary objectives: </strong>comparison of the safety profile and several procedure-related outcomes.</p><p><strong>Patients and methods: </strong>This was a noninferiority, multicentric, open-label, randomized controlled trial of consecutive large (>20 mm) LFNPCLs without suspicious features of submucosal invasion.</p><p><strong>Results: </strong>A total of 229 patients were randomized to receive CS-EMR (n=115) or EMR (n=114), with adenomas (76.4%) and a median size of 25 mm. The trial was stopped early by clinical consensus according to a safety monitoring board. At first surveillance colonoscopy (n=220) the recurrence rate (RR) was significantly greater in the CS-EMR group than in the EMR group: 33.0% vs. 16.2% (p=0.004) and 34.7% vs. 14.8% (p=0.001) in the ITT and PP analyses, respectively. According to the subgroup analysis, the RR was significantly greater for LFNPCLs >30 mm (18.2% EMR vs. 43.1% CS-EMR). There was no difference in the rate of adverse events. The use of clips was more common in the EMR group (2.21 vs. 1.30).</p><p><strong>Conclusions: </strong>Compared with the conventional hot technique, the RR of LFNPCL after CS-EMR was significantly greater. A similar safety profile was found between groups.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital Mortality in Patients with Lower Gastrointestinal Bleeding: Development and Validation of a Prediction Score.","authors":"Elton Dajti, Leonardo Frazzoni, Sílvia Castellet-Farrús, Jordi Guardiola, Emanuele Sinagra, Andrea Anderloni, Francesco Ferrara, Paraskevas Gkolfakis, Marine Camus Duboc, Francesco Vito Mandarino, Anahita Sadeghi, Vicente Lorenzo-Zúñiga, Sandra Perez, Konstantinos Triantafyllou, Maria Paula Curado, Antonio Facciorusso, Giulia Collatuzzo, Cesare Hassan, Franco Radaelli, Lorenzo Fuccio","doi":"10.1055/a-2541-2312","DOIUrl":"https://doi.org/10.1055/a-2541-2312","url":null,"abstract":"<p><strong>Background and study aims: </strong>Lower gastrointestinal bleeding (LGIB) is a common condition linked to increased morbidity, healthcare costs, and mortality. Currently, no prospectively validated prognostic model exists to predict mortality in LGIB patients. Our aim was to develop and validate a risk score that could accurately predict in-hospital mortality of patients admitted for LGIB.</p><p><strong>Patients and methods: </strong>Patient data from a nationwide cohort study in 15 centers in Italy (2019-2020) were used to derivate the risk score (Acute Lower gastrointestinal Bleeding and In-hospital mortality, ALIBI score); the model was then externally validated in a cohort of consecutive patients hospitalized for LGIB in 12 centers from six countries (Italy, Spain, France, Greece, Iran, Brazil) in 2020-2024. The main outcome was in-hospital mortality; we also reported rebleeding rates and in-hospital mortality rate stratified by risk score and timing of colonoscopy.</p><p><strong>Results: </strong>Among 1,198 patients in the derivation cohort, 105 (8.8%) rebled, 41 (3.4%) died. Age, Charlson Comorbidity Index (CCI), in-hospital onset, hemodynamic instability, and creatinine levels were independent predictors of in-hospital mortality. The model demonstrated excellent discrimination (AUROC=0.813, 95%-CI: 0.752-0.874) and calibration. In the validation cohort (n=752 patients), the model's good discrimination (AUROC=0.792, 95%-CI: 0.720-0.863) and calibration were confirmed. Patients were categorized as low (0-4 points, 1% mortality), intermediate (5-9 points, 4.6% mortality), or high risk (10-13 points, 19.1% mortality).</p><p><strong>Conclusions: </strong>A new validated score effectively predicts in-hospital mortality in LGIB patients, aiding in risk stratification and management.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical failure of endoscopic ultrasound choledocoduodenostomy: Multicenter case-control study on rescue techniques, consequences and risk factors.","authors":"Clara Beunon, Antoine Debourdeau, Marion Schaefer, Timothee Wallenhorst, Enrique Perez-Cuadrado-Robles, Arthur Belle, Jean-Michel Gonzalez, Marine Camus Duboc, Fabrice Caillol, Hervé-Pierre Toudic, Mathieu Pioche, Jean Baptiste Danset, Adrien Sportes, Bertrand Brieau, Emmanuel Ben Soussan, Mathilde Petiet, Antoine Martin, Sarra Oumrani, Frederique Maire, Arnaud Lemmers, Frederic Prat, Ludovic Caillo, Romain Gerard, Jérémie Albouys, Diane Lorenzo","doi":"10.1055/a-2541-2973","DOIUrl":"https://doi.org/10.1055/a-2541-2973","url":null,"abstract":"<p><p>Background and study aims We aimed to identify risk factors and salvage technique for technical failures of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and evaluate the short and long-term consequences in patients with biliary obstruction. Patients and methods This retrospective multicenter study included EUS-CDS from 2018 to 2024. Cases were defined as technical failure and classified as follow: type1 (digestive-flange mispositioned), type2 (biliary-flange mispositioned), type3 (stent deployment failure), type4 (catheter-LAMS through the bile duct), and type5 (others). Controls were successful EUS-CDS in the same center and period. The primary endpoint was to to identify risk factors for failure. Secondary endpoints were to describe the endoscopic rescue techniques to evaluate immediate and long-term consequences. Results Technical failures occurred in 7% (95%CI[5;9]). In 23 centers, 296 patients were included (53% male, 71±16 years): 100 cases (type1 [26%], type2 [41%], type3 [11%], type4 [6%], and type5 [16%]) and 196 controls. Risk factors in multivariate analysis for technical failures included CBD diameter ≤15mm, duodenal stenosis, Wired technique and low operator experience (≤10 LAMS). Endoscopic salvage was successful in 77% of cases, with 53% using a covered metal stent and 22% using a new LAMS. Early failures were mild in 50% of cases, but 12% resulted in death within 30 days. Immediate endoscopic salvage reduced severe clinical adverse event (p<0.00001) and increased success rates (p<0.0004). Conclusions EUS-CDS failures are not rare and are severe in half of the cases. Recognizing risk factors, identifying failures during the procedure, and knowing endoscopic salvage methods are crucial.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes after radical endoscopic resection of high-risk T1 esophageal adenocarcinoma: an international multicenter retrospective cohort study.","authors":"Man Wai Chan, Rehan Haidry, Benjamin Norton, Massimiliano di Pietro, Andreas V Hadjinicolaou, Maximilien Barret, Paul Doumbe Mandengue, Stefan Seewald, Raf Bisschops, Philippe Nafteux, Michael J Bourke, Sunil Gupta, Pradeep Mundre, Arnaud Lemmers, Clémence Vuckovic, Oliver Pech, Philippe Leclercq, Emmanuel Coron, Sybren L Meijer, Jacques Bergman, Roos E Pouw","doi":"10.1055/a-2538-9316","DOIUrl":"https://doi.org/10.1055/a-2538-9316","url":null,"abstract":"<p><p>Introduction Post-endoscopic resection (ER) management of high-risk T1 esophageal adenocarcinoma (EAC) is debated, with conflicting reports on lymph node metastases (LNM) We aimed to assess outcomes following radical ER for high-risk T1 EAC. Methods We identified patients who underwent radical ER (tumor-negative deep margin) of high-risk T1 EAC, followed by surgery or endoscopic surveillance, between 2008-2019 across 11 international centers. Results In total, 106 patients (86 men, 70 ±11 years) were included. Of these, 26 patients (64 ±11 yrs) underwent additional surgery, with residual T1 EAC in 5 (19%) and LNM in 2 (8%) cases. After median 47 (IQR 32-79) months follow-up, 2/26 (8%) developed LNM/distant metastasis (DM), with 1 (4%) EAC-related death. There was 1/26 (4%) unrelated death and 4/26 (15%) were lost to follow-up. Eighty patients (71 ±9 yrs) entered endoscopic surveillance. Over 46 (IQR 25-59) months follow-up, 5/80 (6%) developed LNM/DM, with 4/80 (5%) EAC-related deaths. There were 15/80 (19%) unrelated deaths, and 10/80 (13%) were lost to follow-up. Overall rates during follow-up were 6% (95% CI 2-12) for LNM, 7% (95% CI 3-13) for LNM/DM, 5% (95% CI 2-11) for EAC-related mortality, and 20% (95% CI 13-29) for overall mortality. Conclusion Our findings present low rates of LNM after radical ER of high-risk T1 EAC, consistent with other endoscopy-focused studies. Post-surgical patients are still at risk for metastasis and disease-specific mortality. These results suggest that endoscopic surveillance is suitable for selected cases, but further prospective studies are needed to refine patient selection and confirm optimal outcomes.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development and ex-vivo evaluation of a computer-aided quality control system for Barrett's esophagus endoscopy.","authors":"Martijn R Jong, Tim J M Jaspers, Rixta A H van Eijck van Heslinga, Jelmer B Jukema, Carolus H J Kusters, Tim G W Boers, Roos E Pouw, Lucas C Duits, Peter H N de With, Fons van der Sommen, Albert Jeroen De Groof, Jacques Bergman","doi":"10.1055/a-2537-3510","DOIUrl":"https://doi.org/10.1055/a-2537-3510","url":null,"abstract":"<p><p>Background Timely detection of neoplasia in Barrett's esophagus (BE) remains challenging. While computer-aided detection (CADe) systems have been developed to assist endoscopists, their effectiveness depends heavily on the quality of the endoscopic procedure. This study introduces a novel computer-aided quality (CAQ) system for BE, evaluating its stand-alone performance and integration with a CADe system. Method The CAQ system was developed using 7,463 images from 359 BE patients. It assesses objective quality parameters (e.g., blurriness, illumination) and subjective parameters (mucosal cleanliness, esophageal expansion) and can exclude low-quality images when integrated with a CADe system. To evaluate CAQ stand-alone performance, the Endoscopic Image Quality test set, consisting of 647 images from 51 BE patients across 8 hospitals, was labeled for objective and subjective quality. To assess the benefit of the CAQ system as a preprocessing filter of a CADe system, the Barrett CADe test set was developed. It consisted of 956 video frames from 62 neoplastic patients and 557 frames from 35 non-dysplastic patients, in 12 Barrett referral centers. Results As stand-alone tool, the CAQ system achieved Cohen's Kappa scores of 0.73, 0.91, and 0.89 for objective quality, mucosal cleanliness, and esophageal expansion, comparable to inter-annotator scores of 0.73, 0.93, and 0.83. As preprocessing filter, the CAQ system improved CADe sensitivity from 82% to 90% and AUC from 87% to 91%, while maintaining specificity at 75%As preprocessing filter, the CAQ system improved CADe sensitivity and AUC from 82% and 87% to 90% and 91%. Conclusion This study presents the first CAQ system for automated quality control in BE. The system effectively distinguishes poorly from well-visualized mucosa and enhances neoplasia detection when integrated with CADe.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized comparison of precut papillotomy versus an endoscopic ultrasound-guided rendezvous procedure for difficult biliary access in malignant distal biliary obstruction.","authors":"Vinay Dhir, Vivek Kumar Singh, Ankit Dalal, Gaurav Kumar Patil, Amit Maydeo","doi":"10.1055/a-2515-1712","DOIUrl":"10.1055/a-2515-1712","url":null,"abstract":"<p><p>Difficult biliary cannulation (DBC) is a marker for prolonged procedure time and a higher rate of adverse events (AEs) during endoscopic retrograde cholangiopancreatography (ERCP). We previously showed that endoscopic ultrasound-assisted rendezvous (EUS-RV) procedures had a higher single-session success rate than precut papillotomy (PCP) in cases of DBC. The present randomized study aimed to compare the technical success and AE rates of the two approachesThis was an open-label randomized controlled trial in a tertiary care setting. Patients with malignant distal biliary obstruction (MDBO) and DBC were enrolled. The patients were randomized to PCP with a needle-knife or EUS-RV. The primary outcome was technical success; secondary outcomes were the AE rate, procedure duration, and length of hospital stay (LOS).208 patients were enrolled, 104 in each group. There were no statistically significant differences in technical success (93.3% PCP vs. 97.1% EUS-RV; <i>P</i> = 0.33; odds ratio [OR] 0.4, 95%CI 0.1-1.6) and overall AE rate (11.5% PCP vs. 5.8% EUS-RV; <i>P</i>=0.14; OR 0.5, 95%CI 0.8-5.9). Pancreatitis was higher in the PCP group (8.7% vs. 1.9%; <i>P</i>=0.06; OR 4.8, 95%CI 1.0-22.9). The mean duration of the procedure was significantly higher for EUS-RV (47 vs. 27 minutes; <i>P</i><0.001). LOS was similar in the two groups (1.2 PCP vs. 1.1 days EUS-RV; <i>P</i>=0.25).Both PCP and EUS-RV have comparable rates of success, AEs, mortality, and LOS. EUS-RV could be used as an alternative to PCP in patients with MDBO and DBC.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of margin thermal ablation after cold-forceps avulsion with snare-tip soft coagulation for non-lifting large non-pedunculated colorectal polyps.","authors":"Francesco Vito Mandarino, Timothy O'Sullivan, Julia Louisa Gauci, Clarence Kerrison, Anthony Whitfield, Brian Lam, Varan Perananthan, Sunil Gupta, Oliver Cronin, Renato Medas, David J Tate, Eric Y Lee, Nicholas G Burgess, Michael J Bourke","doi":"10.1055/a-2535-7559","DOIUrl":"https://doi.org/10.1055/a-2535-7559","url":null,"abstract":"<p><strong>Background and study aims: </strong>Non-lifting large non-pedunculated colorectal polyps (NL-LNPCPs) account for 15% of LNPCP and are effectively managed by Endoscopic Mucosal Resection with adjunctive Cold-forceps Avulsion with adjuvant Snare-Tip soft coagulation (CAST). However, recurrence rates > 10% at surveillance colonoscopy is a significant limitation. We aimed to compare the outcomes of CAST with MTA versus CAST alone for NL-LNPCPs.</p><p><strong>Patient and methods: </strong>Prospective observational data on consecutive patients with NL-LNPCPs treated by EMR and CAST at a single tertiary center was retrospectively evaluated. Two cohorts were established: the pre-MTA period (January 2012-June 2017) and the MTA period (July 2017-October 2023). The primary outcome was the residual/recurrent adenoma (RRA) rate at first surveillance colonoscopy (SC1). Secondary outcomes included RRA at SC2 and adverse events.</p><p><strong>Results: </strong>Over 142 months, 300 patients underwent EMR and CAST for LNPCP: 103 lesions pre-MTA and 197 with MTA. At SC1 and SC2, recurrence was lower in the MTA cohort compared to the pre-MTA cohort (5.0% vs. 18.8%, p<0.001 and 0.8% vs. 10.0%, p<0.001, respectively). Adverse events were similar between the two cohorts [deep mural injury types III-V (pre-MTA 2.9% vs MTA 5.6%, p=0.29), delayed bleeding (pre-MTA 8.7% vs MTA 7.1%, p=0.49)]. On multivariate analysis, MTA was the only variable independently associated with a reduced likelihood of recurrence (OR 0.20, 95% CI 0.07-0.54; P = 0.001).</p><p><strong>Conclusions: </strong>For NL-LNPCPs, MTA in combination with CAST is safe and effective and reduces recurrence at SC1 in comparison to CAST alone.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}