Endoscopy International Open最新文献

{"title":"More than 20 procedures are necessary to learn small bowel capsule endoscopy: Learning curve pilot study of 535 trainee cases.","authors":"Anders Bo Nielsen, Michael Dam Jensen, Jacob Broder Brodersen, Jens Kjeldsen, Christian B Laursen, Lars Konge, Stig Borbjerg Laursen","doi":"10.1055/a-2308-1613","DOIUrl":"10.1055/a-2308-1613","url":null,"abstract":"<p><p><b>Background and study aims</b> The number of procedures needed to acquire a sufficient level of skills to perform an unassisted evaluation of small bowel capsule endoscopy (SBCE) is unknown. We aimed to establish learning curves, diagnostic accuracy, and the number of procedures needed for reviewing small bowel capsule endoscopies unassisted. <b>Methods</b> An expert panel developed a 1-day course including lessons (examination, anatomy, and pathology) and hands-on training. After completing the course, participants received 50 cases in a randomized sequence. An interactive questionnaire about landmarks, findings, and diagnosis followed each case. After submitting the questionnaire, participants received feedback. Data are presented using CUSUM (cumulative sum control chart) learning curves and sensitivity/specificity analyses compared with expert opinions. <b>Results</b> We included 22 gastroenterologists from 11 different Danish hospitals. A total of 535 cases were reviewed (mean: 28; range: 11-50). CUSUM plots demonstrated learning progression for diagnosis and findings during the course, but none of the participants reached a learning plateau with sufficient competencies. The sensitivity for all findings was 65% (95% confidence interval [CI] 0.51-0.82) for the first 20 procedures and 67% (95% CI 0.58-0.73) from case 21 until completion or dropout. The specificity was 63% (95% CI 0.52-0.74) for the first 20 procedures and 57% (95% CI 0.37-0.77) for the rest. <b>Conclusions</b> Our data indicate that learning SBCE may be more difficult than previously recognized due to low discriminative abilities after 20 cases except for the identification of CD. This indicates that 20 SBCE cases may not be sufficient to achieve competency for reviewing SBCE without supervision.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"12 5","pages":"E697-E703"},"PeriodicalIF":2.6,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11136552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174064","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":"Hepaticogastrostomy for benign indications: An option in selected cases.","authors":"Jacques Deviere","doi":"10.1055/a-2303-6758","DOIUrl":"10.1055/a-2303-6758","url":null,"abstract":"","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"12 5","pages":"E684-E685"},"PeriodicalIF":2.6,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11108656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141074933","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":"White light computer-aided optical diagnosis of diminutive colorectal polyps in routine clinical practice.","authors":"Emanuele Rondonotti, Irene Maria Bambina Bergna, Silvia Paggi, Arnaldo Amato, Alida Andrealli, Giulia Scardino, Giacomo Tamanini, Nicoletta Lenoci, Giovanna Mandelli, Natalia Terreni, SImone Rocchetto, Alessandra Piagnani, Dhanai Di Paolo, Niccolò Bina, Emanuela Filippi, Luciana Ambrosiani, Cesare Hassan, Loredana Correale, Franco Radaelli","doi":"10.1055/a-2303-0922","DOIUrl":"10.1055/a-2303-0922","url":null,"abstract":"<p><p><b>Background and study aims</b> Artificial Intelligence (AI) systems could make the optical diagnosis (OD) of diminutive colorectal polyps (DCPs) more reliable and objective. This study was aimed at prospectively evaluating feasibility and diagnostic performance of AI-standalone and AI-assisted OD of DCPs in a real-life setting by using a white light-based system (GI Genius, Medtronic Co, Minneapolis, Minnesota, United States). <b>Patients and methods</b> Consecutive colonoscopy outpatients with at least one DCP were evaluated by 11 endoscopists (5 experts and 6 non-experts in OD). DCPs were classified in real time by AI (AI-standalone OD) and by the endoscopist with the assistance of AI (AI-assisted OD), with histopathology as the reference standard. <b>Results</b> Of the 480 DCPs, AI provided the outcome \"adenoma\" or \"non-adenoma\" in 81.4% (95% confidence interval [CI]: 77.5-84.6). Sensitivity, specificity, positive and negative predictive value, and accuracy of AI-standalone OD were 97.0% (95% CI 94.0-98.6), 38.1% (95% CI 28.9-48.1), 80.1% (95% CI 75.2-84.2), 83.3% (95% CI 69.2-92.0), and 80.5% (95% CI 68.7-82.8%), respectively. Compared with AI-standalone, the specificity of AI-assisted OD was significantly higher (58.9%, 95% CI 49.7-67.5) and a trend toward an increase was observed for other diagnostic performance measures. Overall accuracy and negative predictive value of AI-assisted OD for experts and non-experts were 85.8% (95% CI 80.0-90.4) vs. 80.1% (95% CI 73.6-85.6) and 89.1% (95% CI 75.6-95.9) vs. 80.0% (95% CI 63.9-90.4), respectively. <b>Conclusions</b> Standalone AI is able to provide an OD of adenoma/non-adenoma in more than 80% of DCPs, with a high sensitivity but low specificity. The human-machine interaction improved diagnostic performance, especially when experts were involved.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"12 5","pages":"E676-E683"},"PeriodicalIF":2.6,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11108657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141074885","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":"Adherence to follow-up and resource use after abnormal FIT-screening: Evaluation of the Danish colorectal cancer screening program.","authors":"Susanne Fogh Jørgensen, Pernille Thordal Larsen, Rune Erichsen, Berit Andersen, Matejka Rebolj, Sisse Njor","doi":"10.1055/a-2297-9622","DOIUrl":"https://doi.org/10.1055/a-2297-9622","url":null,"abstract":"<p><p><b>Background and study aims</b> The effectiveness of colorectal cancer screening programs depends on adherence to surveillance protocols for screening-positive individuals. We evaluated adherence in the Danish population-based screening program and estimated the volume of diagnostic resources required to achieve this adherence. <b>Patients and methods</b> In this register- and population-based study, we included individuals with a positive fecal immunochemical test (FIT) screening from 2014 to 2017 and followed them until mid-2022. All endoscopic, imaging, and surgical procedures performed at public and private hospitals were identified. Adherence to national protocols was reported in terms of proportions and timeliness. Use of diagnostic and surveillance procedures was estimated during a 4-year post-screening period. <b>Results</b> Among 82,221 individuals with a positive FIT test, 84% had a baseline colonoscopy within 1 month. After removal of intermediate or high-risk adenomas, 12% and 6%, respectively, did not have any follow-up. Only ~50% had timely surveillance. Approximately 10% to 20%, depending on their referral diagnosis, did not have a second surveillance colonoscopy. In addition, 12% with a negative colonoscopy had a second colonoscopy within 4 years. <b>Conclusions</b> High adherence to baseline colonoscopy after positive FIT-screening is followed by lower adherence throughout the adenoma surveillance program. Better adherence to the guidelines could potentially improve the effectiveness and efficiency of the screening program.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"12 5","pages":"E649-E658"},"PeriodicalIF":2.6,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11068436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856779","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":"Reply to Chandrasekhara and Aggarwal.","authors":"Matheus de Oliveira Veras, Diogo Turiani Hourneaux de Moura, Eduardo Guimarães Hourneaux de Moura","doi":"10.1055/a-2295-3143","DOIUrl":"https://doi.org/10.1055/a-2295-3143","url":null,"abstract":"","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"12 5","pages":"E640-E641"},"PeriodicalIF":2.6,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11068433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848210","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":"Perspectives on biliary radiofrequency ablation: Review of a recent meta-analysis.","authors":"Manik Aggarwal, Vinay Chandrasekhara","doi":"10.1055/a-2289-9788","DOIUrl":"https://doi.org/10.1055/a-2289-9788","url":null,"abstract":"","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"12 5","pages":"E639"},"PeriodicalIF":2.6,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11068435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854032","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":"Using a customized GPT to provide guideline-based recommendations for management of pancreatic cystic lesions.","authors":"Yuri Gorelik, Itai Ghersin, Tarek Arraf, Offir Ben-Ishay, Amir Klein, Iyad Khamaysi","doi":"10.1055/a-2289-9334","DOIUrl":"10.1055/a-2289-9334","url":null,"abstract":"<p><p><b>Background and study aims</b> Rising prevalence of pancreatic cysts and inconsistent management guidelines necessitate innovative approaches. New features of large language models (LLMs), namely custom GPT creation, provided by ChatGPT can be utilized to integrate multiple guidelines and settle inconsistencies. <b>Methods</b> A custom GPT was developed to provide guideline-based management advice for pancreatic cysts. Sixty clinical scenarios were evaluated by both the custom GPT and gastroenterology experts. A consensus was reached between experts and review of guidelines and the accuracy of recommendations provided by the custom GPT was evaluated and compared with experts. <b>Results</b> The custom GPT aligned with expert recommendations in 87% of scenarios. Initial expert recommendations were correct in 97% and 87% of cases, respectively. No significant difference was observed between the accuracy of custom GPT and the experts. Agreement analysis using Cohen's and Fleiss' Kappa coefficients indicated consistency among experts and the custom GPT. <b>Conclusions</b> This proof-of-concept study shows the custom GPT's potential to provide accurate, guideline-based recommendations for pancreatic cyst management, comparable to expert opinions. The study highlights the role of advanced features of LLMs in enhancing clinical decision-making in fields with significant practice variability.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"12 4","pages":"E600-E603"},"PeriodicalIF":2.2,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11052646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856782","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":"Vade Mecum in ERCP, a roadmap to success: Tips from experts for excelling in ERCP.","authors":"Sara Teles de Campos, Marianna Arvanitaki, Ivo Boskoski, Jacques Deviere","doi":"10.1055/a-2290-1479","DOIUrl":"https://doi.org/10.1055/a-2290-1479","url":null,"abstract":"<p><p><b>Background and study aims</b> Training in endoscopic retrograde cholangiopancreatography (ERCP) is operator-dependent and traditionally, the apprenticeship model, in which experts are considered to be role models, has been adopted for it. The aim of this study was to develop a practical guide compiling tips from experts to help guide trainees to succeed in ERCP. <b>Methods</b> A web-based survey was created to understand the professional development of ERCP experts, the investments they made, the obstacles they overcame, and the quotes that guided their professional life. ERCP experts worldwide were invited to participate. <b>Results</b> Fifty-three experts (of 71; 74.6%) from 24 countries answered the survey. Experts started ERCP training early (average age 31 years; range, 24-52 years) and it often was combined with training for endoscopic ultrasound. A long training period (average 21 months; range, 3-120 months) was needed to achieve competence, frequently in another department, and it was commonly complemented with research in the field (76.5%). \"Time and practice\" were the most worthwhile investments they made to achieve success. \"Sports\" were an area outside endoscopy frequently considered to be important to acquire the skills necessary to excel in ERCP. \"Lack of dedicated time for training\" and \"peer competition\" were the biggest obstacles the experts faced. Several pieces of advice were given to the experts, such as to be resilient, careful, patient, responsible, and hard-working. \"Personal life\" was mentioned as an undeniably crucial factor for achieving long-term success that should not be forgotten. <b>Conclusions</b> This survey is the first to provide insight regarding the professional trajectory of renowned ERCP experts worldwide, providing valuable recommendations to help trainees excel in ERCP.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"12 4","pages":"E613-E620"},"PeriodicalIF":2.6,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11052645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847260","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":"Impact of temperature-controlled endobiliary radiofrequency ablation for inoperable hilar cholangiocarcinoma: A propensity score-matched analysis.","authors":"Il Sang Shin, Jong Ho Moon, Yun Nah Lee, Jun Ho Myeong, Tae Hoon Lee, Jae Kook Yang, Young Deok Cho, Sang-Heum Park","doi":"10.1055/a-2276-1897","DOIUrl":"10.1055/a-2276-1897","url":null,"abstract":"<p><p><b>Background and study aims</b> Endobiliary radiofrequency ablation (RFA) can be an effective palliative treatment, but few studies have evaluated its outcomes for malignant obstruction in the hilar bile duct, which has a thin wall and complex duct-vascular contacts. We evaluated the efficacy and safety of temperature-controlled endobiliary RFA, which can reduce the risk of unintentional thermal injury by maintaining the temperature of the ablation segment, in the treatment of inoperable hilar cholangiocarcinoma (CCA). <b>Patients and methods</b> After propensity score matching, 64 patients with inoperable hilar CCA were categorized to the RFA + stent group (endobiliary RFA with stenting; n=32) or stent-only group (stenting only; n=32). The evaluated outcomes were the median time to recurrent biliary obstruction (RBO), overall survival (OS), and adverse events (AEs). <b>Results</b> Technical success was achieved in all patients. The clinical success rate was 93.8% in the RFA + stent group and 87.5% in the stent-only group ( <i>P</i> =0.672). The median time to RBO was 242 days in the RFA + stent group and 168 days in the stent-only group ( <i>P</i> =0.031). The median OS showed a non-significant tendency to be higher in the RFA + stent group (337 versus 296 days; <i>P</i> =0.260). Overall AE rates were comparable between the two groups (12.5% vs 9.4%, <i>P</i> =1.000). <b>Conclusions</b> Temperature-controlled endobiliary RFA resulted in favorable stent patency without increasing the rate of AEs but it did not significantly increase OS in patients with inoperable hilar CCA (Clinical trial registration number: KCT0008576).</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"12 4","pages":"E535-E544"},"PeriodicalIF":2.6,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891391","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":"Outcomes predictors in endoscopic ultrasound-guided choledochoduodenostomy with lumen-apposing metal stent: Systematic review and meta-analysis.","authors":"Alessandro Fugazza, Kareem Khalaf, Marco Spadaccini, Antonio Facciorusso, Matteo Colombo, Marta Andreozzi, Silvia Carrara, Cecilia Binda, Carlo Fabbri, Andrea Anderloni, Cesare Hassan, Todd Baron, Alessandro Repici","doi":"10.1055/a-2271-2145","DOIUrl":"10.1055/a-2271-2145","url":null,"abstract":"<p><p><b>Background and study aims</b> EUS-guided choledochoduodenostomy (EUS-CDS) is a minimally invasive procedure used to treat malignant biliary obstruction (MBO) by transduodenal placement of a lumen-apposing metal stent (LAMS) into the extrahepatic bile duct. To identify factors that contribute to safe and effective EUS-CDS using LAMS, we performed a systematic review of the literature and meta-analysis. <b>Methods</b> The methodology of our analysis was based on PRISMA recommendations. Electronic databases (Medline, Scopus, EMBASE) were searched up to November 2022. Full articles that included patients with distal malignant biliary obstruction who underwent EUS-CDS using LAMS after failed endoscopic retrograde cholangiopancreatography were eligible. Random-effect meta-analysis was performed reporting pooled rates of technical success, clinical success, and adverse events (AEs) by means of a random model. Multivariate meta-regression and subgroup analysis were performed to assess possible associations between the outcomes and selected variables to assess the correlation between outcomes and different variables. Results were also stratified according to stent size. <b>Results</b> Twelve studies with 845 patients were included in the meta-analysis. Pooled technical and clinical success rates were 96% (95% confidence interval [CI] 94%-98%; I ² = 52.29%) and 96% (95%CI 95%-98%), respectively, with no significant association with baseline characteristics, such are sex, age, common bile duct diameter, or stent size. The pooled AE rate was 12% (95%CI: 8%-16%; I ² = 71.62%). The AE rate was significantly lower when using an 8 × 8 mm stent as compared with a 6 × 8 mm LAMS (odds ratio 0.59, 0.35-0.99; <i>P</i> = 0.04), with no evidence of heterogeneity (I ² = 0%). <b>Conclusions</b> EUS-CDS with LAMS is a safe and effective option for relief of MBO. Selecting an appropriate stent size is crucial for achieving optimal safety outcomes.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"12 3","pages":"E456-E462"},"PeriodicalIF":2.6,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10978093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140318038","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}