Endoscopy最新文献

{"title":"Long-term risk of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric cancer.","authors":"Jong Sun Park, Eunyoung Angela Lee, Ji Hyun Park, Bumhee Park, Jong Hoon Park, Min Jae Yang, Sun Gyo Lim, Sung Jae Shin, Sung Soo Ahn, Gil Ho Lee, Choong-Kyun Noh","doi":"10.1055/a-2936-0365","DOIUrl":"10.1055/a-2936-0365","url":null,"abstract":"<p><strong>Background: </strong>There is currently no consensus on long-term risk stratification for metachronous gastric neoplasms (MGNs) occurring beyond 5 years following endoscopic submucosal dissection (ESD). This study aimed to investigate the time-dependent changes in predictive factors for MGN after curative ESD for early gastric cancer (EGC) and analyze the clinicopathological features of late MGNs.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent ESD for early gastric neoplasms between March 2005 and June 2020. MGN was defined as a new gastric neoplasm detected at a different site >12 months after ESD. Survival data were collected and analyzed using multivariable and time-split Cox hazard regression models.</p><p><strong>Results: </strong>Among 5571 patients treated with ESD, 876 were included, with a median follow-up of 58 months. The cumulative incidence of MGN was 10.8% at 5 years and continued to accumulate beyond 5 years (26.7% at 10 years). All MGNs were stage I and there was no gastric cancer-related mortality. Cox regression analysis identified family history of gastric cancer (adjusted hazard ratio [aHR] 2.12, 95%CI 1.32-3.41) and extensive intestinal metaplasia (aHR 6.50, 95%CI 3.73-11.36) as independent predictors of MGN. Histological upgrade was not associated with MGN during the first 5 years, but emerged as a significant risk factor in the late period (interaction <i>P</i> = 0.005).</p><p><strong>Conclusion: </strong>MGNs may develop even beyond 5 years following ESD with curative resection in patients with EGC. These findings highlight the long-term risk of MGN after ESD, providing a framework for clinical risk estimation.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705758","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":"Expired endoscopic devices remain sterile and functional: an international multicentre study challenging current shelf-life criteria.","authors":"Enrique Rodriguez de Santiago, David Villaescusa Arenas, Elia Gómez G de la Pedrosa, Marina García-Castellanos, João A Cunha Neves, Anastasia Tsalouka, Christoph Römmele, Mathieu Pioche, Marianna Arvanitakis, Javier Tejedor-Tejada, Glòria Fernández-Esparrach, Andrei Voiosu, Patricia Pedregal-Pascual, Eduardo Valdivielso Cortázar, Mikel Fiallegas Cano, Miguel Pantaleón Sánchez, Heiko Pohl, Sílvia Ferraz, Neil Robert O'Morain, Kareem Khalaf, Alexander Meining, Douglas Graham Penman, Pedro J Rosón, Francesc Bas-Cutrina, Luca Elli, Matilde Topa, Rosa Sáiz-Chumillas, Federico Soria, Guillermo Vilariño-Feltrer, Vicente Pons-Beltran, Ana Garcia Garcia de Paredes, Oliva Ros-Fargas, Isabel Tort-Ausina, Konstantinos Triantafyllou, Arnaud Lemmers, Mário Dinis-Ribeiro, Fausto R Pons, Dorothea Henniger, Enrique Vazquez-Sequeiros, Alberto Campillo-Fernández, Vicente Lorenzo-Zúñiga","doi":"10.1055/a-2977-6099","DOIUrl":"https://doi.org/10.1055/a-2977-6099","url":null,"abstract":"<p><p>Background and study aims Expired medical devices represent an environmental and economic concern, yet their magnitude and true shelf life remain poorly defined. We aimed to quantify the volume and cost of expired endoscopic devices and evaluate their sterility and functionality beyond the labelled expiry date. Methods We conducted an investigator-initiated, prospective study (December 2023-May 2025) across 25 endoscopy units from Europe, Canada, and the USA. Expired devices were inventoried during one-week audits. An institutional questionnaire assessed storage practices. Microbiological sterility and ex vivo functionality were assessed in randomly selected samples. Physicomechanical testing included matched case-control comparison with non-expired counterparts. Results We identified 1,448 expired devices (median per centre, 42; range 3-262), with an estimated cost of €192,141.67. Of these, 273 underwent microbiological testing, 210 ex vivo functional assessment, and 57 physicomechanical evaluation. No microorganism growth was detected in any evaluated device (100%, 95% CI 98.6-100). All but one overtube retained functionality (99.5%; 95% CI 97.4-99.9). Physicomechanical testing showed no clinically relevant differences compared with non-expired devices. Only six centres (24%) reported written protocols to minimise accumulation of expired accessories, and three (12%) had electronic tracking systems. Conclusions Expired endoscopic consumables are frequent and costly, with suboptimal inventory management within endoscopy units. In this multicentre bench and ex vivo study, analysed devices preserved sterility and functional performance beyond their labelled expiry dates. These findings challenge current shelf-life assumptions and support further regulatory evaluation, but should not be interpreted as evidence supporting routine clinical use of expired devices.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147499","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":"Endoscopic ultrasound-guided gastroenterostomy: an international consensus on current and expanding indications, techniques, periprocedural care, and institutional requirements.","authors":"Giuseppe Vanella, Albrecht Neesse, Cecilia Binda, Jeanin E van Hooft, Antonio Facciorusso, Manuel Perez-Miranda, Giovanni Marchegiani, Michiel Bronswijk, Marco Spadaccini, Alexander Arlt, Lucio Carrozza, Pedro Moutinho-Ribeiro, Chiara Coluccio, Tajana Pavic, Fausto Catena, Enrique Pérez-Cuadrado-Robles, Maria Cristina Conti Bellocchi, Roy L J van Wanrooij, Edoardo Forti, Andrada Seicean, Andrea Lisotti, Marcello Maida, Aurelio Mauro, Schalk W van der Merwe, Stefano Mazza, Margherita Pizzicannella, Giacomo Emanuele Maria Rizzo, Gianfranco Donatelli, Daniela Scimeca, Serena Stigliano, Edoardo Troncone, Andrea Anderloni, Carlo Fabbri, Ilaria Tarantino, Joan B Gornals, Lorenzo Fuccio","doi":"10.1055/a-2948-2876","DOIUrl":"10.1055/a-2948-2876","url":null,"abstract":"<p><strong>Background: </strong> Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) and related EUS-guided anastomoses are increasingly used for gastric outlet obstruction (GOO) and other complex gastrointestinal scenarios, but the indications, technical standards, and periprocedural care remain heterogeneous.</p><p><strong>Methods: </strong> An international panel of 66 experts (i-EUS) developed statements using a structured modified Delphi process. Literature searches were performed up to 30 April 2025. Comparative PICO-framed questions with extractable evidence underwent structured evidence synthesis and GRADE assessment, whereas procedural, technical, and organizational statements were classified as consensus based. Consensus was predefined as ≥ 85 % agreement.</p><p><strong>Results: </strong> Of 25 draft statements, 20 reached consensus and five did not. Six endorsed statements were GRADE based and 14 were consensus based. For malignant GOO, EUS-GE was recommended over duodenal stenting because of greater durability and fewer reinterventions, and suggested over surgical bypass because of comparable efficacy and fewer overall adverse events. Consensus-based statements addressed expert-center requirements, supervised training, catheter-based target-loop distension, freehand lumen-apposing metal stent (LAMS) deployment, fluoroscopy availability, antithrombotic management, refeeding, postprocedural imaging, recurrent obstruction, and misdeployment. Conditional recommendations addressed LAMS-diameter selection, selected benign GOO, EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE)/EUS-directed transgastric interventions (EDGI) in Roux-en-Y gastric bypass (RYGB), and malignant afferent limb syndrome. No formal recommendation was issued for peritoneal carcinomatosis, routine tracheal intubation, antibiotic prophylaxis, EUS-directed entero-enterostomy (EDEE) in non-RYGB anatomy, or EUS-guided coloenterostomy.</p><p><strong>Conclusions: </strong> These i-EUS recommendations provide a practical framework for EUS-GE and related anastomoses in expert settings. The evidence base remains limited, and prospective comparative studies are needed to refine patient selection, training requirements, and long-term outcomes.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863883","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":"Cholangioscopy-guided lithotripsy versus mechanical lithotripsy for large common bile duct stones during balloon enteroscopy-assisted ERCP after gastrectomy with a native papilla.","authors":"Tadahisa Inoue, Akinori Maruta, Yuhei Iwasa, Naoki Mita, Toji Murabayashi, Hiroshi Mori, Yumi Murashima, Rena Kitano, Hironao Ichikawa, Shinya Uemura, Keisuke Iwata, Masanao Nakamura, Kiyoaki Ito","doi":"10.1055/a-2975-5309","DOIUrl":"https://doi.org/10.1055/a-2975-5309","url":null,"abstract":"<p><strong>Background: </strong>Balloon enteroscopy-assisted ERCP (BE-ERCP) for large common bile duct stones in patients with surgically altered anatomy (SAA) remains challenging. Mechanical lithotripsy (ML) is commonly used, but stone capture and fragmentation can often be difficult. This study evaluated the usefulness of a peroral cholangioscopy-guided lithotripsy (POCL)-first strategy compared with a conventional ML-first strategy.</p><p><strong>Methods: </strong>This study used a registry of patients with large common bile duct stones and SAA after gastrectomy in whom BE-ERCP was performed at seven institutions in Japan. From this registry, patients treated with an ML-first or POCL-first strategy were included. Outcomes were compared between patients treated with a POCL-first strategy and those treated with an ML-first strategy. The primary outcome was complete stone clearance during the initial session.</p><p><strong>Results: </strong>A total of 104 patients were analyzed: 39 in the POCL-first group and 65 in the ML-first group. Complete stone clearance during the initial session was achieved in 95% of the POCL-first group and 62% of the ML-first group (risk difference, 33.3%; 95% CI, 17.3-46.0%). POCL-first was associated with fewer patients requiring ≥2 sessions among those achieving final clearance (5% vs 32%; risk difference, -27.1%; 95% CI, -40.3 to -11.3). Adverse event rates did not differ significantly. After adjustment, POCL-first was associated with a higher probability of initial-session complete stone clearance (adjusted risk ratio, 1.40; 95% CI, 1.08-1.83).</p><p><strong>Conclusions: </strong>In this retrospective cohort of postgastrectomy patients with an accessible native papilla, a POCL-first strategy during BE-ERCP was associated with higher initial-session complete stone clearance, supporting prospective evaluation.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135372","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":"Risk stratification model for surveillance interval extension after hot endoscopic mucosal resection of large nonpedunculated colon polyps.","authors":"Kanika Garg, Thomas J Wang, Benjamin Schwartz, Agnieszka Maniak, Neal A Mehta, Christopher G Chapman, Joshua Melson, Douglas K Rex, John J Guardiola, Douglas Pleskow, Michael B Wallace, Stuart R Gordon, Daniel von Renteln, Mouen A Khashab, Saowanee Ngamruengphong, Aleksandar Gavrić, Dennis Yang, John Levenick, Matthew Moyer, Irving Waxman, Heiko Pohl, Ajaypal Singh","doi":"10.1055/a-2955-8379","DOIUrl":"10.1055/a-2955-8379","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend uniform 6-month surveillance after endoscopic mucosal resection (EMR) of large nonpedunculated colon polyps (LNPCPs). We aimed to develop and validate a risk stratification model to identify lesions at lower recurrence risk.</p><p><strong>Methods: </strong>This retrospective multicenter study utilizing prospectively maintained databases across 12 centers (2017-2024) evaluated LNPCPs ≥20 mm removed by hot EMR. Overall, 20 variables were included in multivariate Cox regression with stepwise selection to identify recurrence predictors. Validation was performed in a separate single-center cohort.</p><p><strong>Results: </strong>The derivation cohort included 463 patients with 491 LNPCPs. Multivariate analysis identified four independent predictors: evidence of prior resection (hazard ratio [HR] 1.97, 95%CI 1.04-3.72; P = 0.03), absence of margin ablation (HR 1.96, 95%CI 1.22-3.23; P = 0.01), villous histology (HR 1.77, 95%CI 1.09-2.86; P = 0.02), and ileocecal valve (ICV) involvement (HR 2.66, 95%CI 1.29-5.45; P = 0.01). Validation in a separate cohort (169 patients, 187 polyps) demonstrated effective risk stratification performance (P < 0.01). In the validation cohort, low-risk polyps (no prior resection, margin ablation performed, no villous histology, no ICV involvement) had recurrence risks of 2.2%, 5.4%, and 9.7% at 6, 12, and 18 months, respectively, compared with 10.6%, 23.1%, and 28.1% in high-risk polyps. No patients in either cohort developed high-grade dysplasia or invasive adenocarcinoma during follow-up.</p><p><strong>Conclusions: </strong>A simple four-factor model incorporating prior resection, margin ablation, villous histology, and ICV involvement stratified recurrence detection risk after hot EMR. Absence of high-risk features may help identify patients at lower recurrence risk and provides a framework for future prospective studies evaluating risk-adapted surveillance strategies.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975928","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":"Stabilizing scope position in complex gastrointestinal endoscopy.","authors":"Talal Alenezi, Navya Pendyala, Anand R Kumar, Alexander Schlachterman, Thomas E Kowalski, Faisal Kamal","doi":"10.1055/a-2945-4345","DOIUrl":"https://doi.org/10.1055/a-2945-4345","url":null,"abstract":"","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126782","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":"High rate of neoplasia diagnosis at endoscopic reassessment and incidence of progression in patients with ultra-long Barrett esophagus referred to expert centers.","authors":"Eva P D Verheij, Maartje T P M Houben, Sanne N van Munster, Bas L A M Weusten, Lorenza Alvarez Herrero, Alaa Alkhalaf, Erik J Schoon, Wouter L Curvers, Arun D Koch, Manon C W Spaander, Pauline A Zellenrath, Wouter B Nagengast, Jessie Westerhof, Martin H M G Houben, Sybren L Meijer, Jacques J G H M Bergman, Roos E Pouw","doi":"10.1055/a-2940-4598","DOIUrl":"https://doi.org/10.1055/a-2940-4598","url":null,"abstract":"<p><strong>Background: </strong> Surveillance recommendations for Barrett esophagus (BE) are based on BE length, since the risk of progression to dysplasia or esophageal adenocarcinoma (EAC) has been shown to increase with greater BE length. The 2023 European Society for Gastrointestinal Endoscopy (ESGE) Guideline on BE advises referral to Barrett expert centers (BECs) for surveillance of ultra-long ( ≥ 10 cm) BE. This study evaluated the outcomes of expert care for patients with ultra-long BE in the Netherlands.</p><p><strong>Methods: </strong> This retrospective, nationwide cohort study including patients referred with ultra-long nondysplastic BE (NDBE) to Dutch BECs. Outcome parameters were number of cases upgraded to dysplasia/esophageal adenocarcinoma (EAC) at expert endoscopic reassessment, and number of cases with progression to high-grade dysplasia (HGD)/EAC during surveillance after a confirmed diagnosis of NDBE at expert endoscopic reassessment.</p><p><strong>Results: </strong> 168 patients were referred with ultra-long NDBE, namely with Barrett length (median and interquartile range [IQR]), circumference (C) 11 cm (9-12), maximum (M) 12 cm (10-14). Upon expert endoscopic reassessment, 28 /168 (17 %) patients were diagnosed with dysplasia/EAC, among whom 5 /168 (3 %) had HGD/EAC in a visible lesion. In 11 patients no Seattle protocol biopsies were obtained, thus 129 patients had an NDBE diagnosis based on Seattle protocol biopsies. Of these, 95 /129 (74 %) had > 1 surveillance endoscopy at the BEC. During surveillance 20 patients progressed to LGD (n = 11, 12 %), HGD (n = 4, 4 %) or EAC (n = 5, 5 %); all progressors underwent endoscopic therapy.</p><p><strong>Conclusion: </strong> Expert care with dedicated BE endoscopy programs and experienced endoscopists may be beneficial for patients with ultra-long BE.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126758","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":"Aggressive hydration plus Nonsteroidal Anti-Inflammatory Drugs versus Nonsteroidal Anti-Inflammatory Drugs alone for preventing post-ERCP pancreatitis: a meta-analysis.","authors":"Daniele Balducci, Marco Valvano, Michele Montori, Antonio Vinci, Francesco Martini, Maria Eva Argenziano, Andrea Sorge, Matheus C Franco, Dario Quintini, Gabriele Capurso, Marco Spadaccini, Silvia Carrara, Alessandro Repici, Cesare Hassan, Marianna Arvanitakis, Mario Capasso, Marta Mosca, Marco Marzioni, Giuseppe Tarantino, Antonio Benedetti, Luca Maroni","doi":"10.1055/a-2974-3642","DOIUrl":"https://doi.org/10.1055/a-2974-3642","url":null,"abstract":"<p><strong>Background & aims: </strong>Post-ERCP pancreatitis (PEP) remains the most frequent adverse event after ERCP. Although rectal NSAIDs and aggressive intravenous hydration are guideline-endorsed, the incremental benefit of adding hydration to NSAIDs is uncertain. We performed a meta-analysis of randomized controlled trials (RCTs) comparing NSAIDs plus aggressive hydration versus NSAIDs alone for PEP prevention.</p><p><strong>Methods: </strong>A systematic search in MEDLINE, Scopus, and Cochrane Library databases was performed for RCTs comparing NSAIDs plus aggressive hydration versus NSAIDs alone in adults undergoing ERCP. For the primary outcome a random-effects meta-analysis was conducted to estimate the PEP pooled risk ratios (RRs) with 95% CIs. Supplementary analyses included pooled arm-specific PEP incidence, sensitivity analyses for few trials and sparse events, and trial sequential analysis (TSA).</p><p><strong>Results: </strong>Eight RCTs with a total of 1,903 patients were included. The pooled arm-specific incidence of PEP was 2.8% (95% CI 0.4%-6.7%) with NSAIDs plus aggressive hydration and 7.6% (95% CI 5.2%-10.4%) with NSAIDs alone.. The DerSimonian-Laird random-effects analysis suggested a directionally favorable but statistically inconclusive estimate with combination prophylaxis (RR 0.66, 95% CI 0.40-1.08; I²=18%),whereas the pooled risk difference was -3.8% (95% CI -6.3 to -1.4). . The REML/Hartung-Knapp analysis was also inconclusive (RR 0.73, 95% CI 0.45-1.18). Trial sequential analysis showed that the required information size (RIS) had not been reached.</p><p><strong>Conclusions: </strong>Compared with NSAIDs alone, the addition of aggressive hydration resulted in a directionally lower but statistically inconclusive relative risk of PEP. Although the pooled risk difference favored combination therapy, the small-sample-robust and trial-sequential analyses remained inconclusive. The available evidence therefore does not establish superiority.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126767","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":"Short- and Long-Term Outcomes of Underwater Versus Conventional Colorectal Endoscopic Submucosal Dissection: A Large Retrospective Real-World Cohort Study.","authors":"Shoma Murata, Teppei Masunaga, Motoki Sasaki, Mai Owada, Ai Katsumi, Maya Ishizawa, Yuki Kubo, Rei Mizobe, Yuri Imura, Anna Tojo, Hinako Sakurai, Kurato Miyazaki, Kumiko Kirita, Mari Mizutani, Yusaku Takatori, Teppei Akimoto, Shintaro Kawasaki, Noriko Matsuura, Tomohisa Sujino, Atsushi Nakayama, Kaoru Takabayashi, Yasuhiro Ito, Takanori Kanai, Naohisa Yahagi, Motohiko Kato","doi":"10.1055/a-2975-5095","DOIUrl":"https://doi.org/10.1055/a-2975-5095","url":null,"abstract":"<p><strong>Background: </strong>Underwater techniques are increasingly used in colorectal endoscopic submucosal dissection (ESD), but real-world data remain limited. We compared underwater and conventional colorectal ESD.</p><p><strong>Methods: </strong>This retrospective observational study included consecutive colorectal ESD lesions at a tertiary referral center between May 2010 and September 2024. The analysis used propensity score overlap weighting. Procedural outcomes included dissection speed, procedure time, resection outcomes, and adverse events. Intraoperative perforation and long-term outcomes were assessed descriptively.</p><p><strong>Results: </strong>Among 1,649 lesions, 1,635 were included in the main analysis (conventional, 914; underwater, 721). Dissection speed was higher in the underwater group (speed ratio, 1.23; 95% CI, 1.14-1.32; p<0.001), whereas procedure time was similar. Failure to complete ESD was less frequent in the underwater group, with no clear differences in en bloc resection, R0 resection, or adverse events. Among 56 intraoperative perforation cases, all perforation sites were closed endoscopically, no emergent surgery was required, and short-term clinical outcomes showed no clear differences. Median survival follow-up was 3.09 [IQR, 0.48-7.39] and 2.10 [IQR, 0.56-3.72] years in the conventional and underwater groups, respectively; overall death occurred in 27/824 (3.3%) and 3/622 (0.5%) patients, with no colorectal cancer-related deaths.</p><p><strong>Conclusions: </strong>The underwater technique was associated with higher dissection speed, although this did not translate into a shorter procedure time or clear improvements in other procedural outcomes. These findings suggest a potential technical advantage during dissection, while its clinical relevance remains to be established.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126801","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":"Colonoscopy quality indicators among nurse endoscopists and physicians in population-based colorectal cancer screening in Sweden.","authors":"Anna M Forsberg, Jóhann P Hreinsson, Peter T Schmidt, Johannes Blom","doi":"10.1055/a-2949-7463","DOIUrl":"https://doi.org/10.1055/a-2949-7463","url":null,"abstract":"<p><p>BACKGROUND : In Sweden, a nationwide colorectal cancer (CRC) screening program for individuals aged 60-74 started in 2021; to meet the increasing demand for colonoscopy, nurse endoscopists may play a key role - provided they maintain high technical quality. This observational study aimed to evaluate the nurse endoscopists' performance in the screening program, focusing on core quality indicators. METHODS : Data were extracted from the Swedish Quality Register for Colonoscopies and Colorectal Cancer Screening (SveReKKS), including all screening colonoscopies performed between 1 April 2019 and 31 August 2025. Key quality indicators - adenoma detection rate (ADR), cecal and ileal intubation rates, bowel preparation, sedation use, and complications - were compared between nurse and physician endoscopists using generalized linear mixed-effects models with a logit link. RESULTS : Of 27 978 colonoscopies, 42 % were performed by nurses. Nurses had a higher ADR (57 % vs. 46 %; odds ratio [OR] 1.55, 95 %CI 1.47-1.62), and 3.6 % of the nurses had an ADR < 25 %, compared with 11.2 % of the physicians. Nurses also had higher odds of ileal intubation (OR 1.2, 95 %CI 1.1-1.2) and longer withdrawal times. CONCLUSIONS : Nurse endoscopists demonstrated high quality colonoscopy performance in CRC screening and represent a valuable resource to meet increasing service demands without compromising clinical standards.</p>","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126755","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}