Gastrointestinal endoscopy最新文献

{"title":"Laparoscopic endoscopic cooperative surgery for fixed and folded rectal stricture in Crohn's patient.","authors":"Tenghui Zhang, Bosi Yuan, Yi Li","doi":"10.1016/j.gie.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.007","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143003759","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":"Computer-Assisted Classification of the Squamocolumnar Junction.","authors":"Hannah R Phillips, Jeffrey R Fetzer, Sanket Bhattarai, Sandra Algarin Perneth, D Chamil C Codipilly, Derek W Ebner, Adam C Bledsoe, Amrit Kamboj, Daniel A Schupack, Victor Chedid, Nayantara Coelho-Prabhu, Diana Snyder, Karthik Ravi, Kevin Buller, Cadman L Leggett","doi":"10.1016/j.gie.2025.01.020","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.020","url":null,"abstract":"<p><strong>Background and aims: </strong>An irregular z-line is characterized by a squamocolumnar junction (SCJ) that extends proximally above the gastroesophageal junction (GEJ) by < 1 centimeter (cm), while Barrett's esophagus (BE) is defined as a columnar lined esophagus (CLE) that extends proximally by ≥1 cm with the presence of specialized intestinal metaplasia (IM) on biopsy. Measurement of CLE is most accurate for lengths ≥1 cm, and as such, guidelines do not recommend biopsy of an irregular z-line when seen on endoscopy. However, a CLE is often estimated by visual inspection rather than direct measurement, making this characterization imprecise. In this study, we present methodology to standardize the characterization of the SCJ, hypothesizing that the shape of the z-line can be used as a surrogate classifier. We present a computer-generated algorithm capable of automated segmentation and shape complexity quantification of the z-line.</p><p><strong>Methods: </strong>849 images of the z-line were selected and manually segmented. We used the nnUNet framework to train a model to segment the z-line. An additional dataset of 58 videos containing the z-line were obtained from the Mayo Clinic Endoscopy video library. A high-quality image containing the z-line was selected from each video. Ten gastroenterologists (5 esophageal experts) rated each of the 58 video/image pairs containing the z-line as \"regular\" or \"irregular,\" including their degree of confidence. Fleiss kappa statistics was used to determine interobserver variability. The \"ground truth\" classification was determined by the esophageal expert majority vote. A wavelet decomposition model was then used to determine the threshold of irregularity based on the ground truth. Heat maps were generated for each z-line to determine localized areas of complexity.</p><p><strong>Results: </strong>Fair agreement, with a Fleiss' kappa of 0.39, was observed between the 10 endoscopists when rating the z-line as \"regular\" vs \"irregular\" using this dataset. Moderate agreement was observed between the 5 esophageal experts with a Fleiss' kappa statistic of 0.42, and fair agreement was observed between the 5 non-esophageal experts with a Fleiss' kappa statistic of 0.31. The wavelet energy coefficient optimal threshold to classify an SCJ as irregular was determined to be 1.53×10ˆ7 with an accuracy of 78%.</p><p><strong>Conclusion: </strong>Our computer-generated model was capable of auto-segmentation and classification of the z-line. We established a threshold of complexity using wavelet energy coefficient to standardize the classification of the SCJ.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143003692","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":"A lumen-apposing metal stent for diarrhea?","authors":"Přemysl Falt, Ondřej Urban","doi":"10.1016/j.gie.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.008","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143003650","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":"Successful One-Time Removal of Nearly One Hundred Intrahepatic and Extrahepatic Bile Ducts Stones with Endoscopic Sphincterotomy in a Short Time.","authors":"Bingni Wei, Bingxin Xu, Xujin Chen, Cheng Yang, Qiang Zhan","doi":"10.1016/j.gie.2025.01.012","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.012","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143003774","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-assisted secondary duodenal stent placement in a patient with duodenal obstruction after duodenal stent insertion.","authors":"Maofeng Sun, Lei Shi, Xiao Tong, Changqin Xu, Shulei Zhao","doi":"10.1016/j.gie.2025.01.015","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.015","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143003734","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":"First Documented Case: ERCP Detection of Right Hepatic Duct-Duodenal Fistula Post-Billroth II Gastrectomy.","authors":"Ziyu Liu, Lei Ma, Guangwei Qiu, Huihong Zhai","doi":"10.1016/j.gie.2025.01.009","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.009","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143003755","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":"Yield of Esophageal Biopsy Patterns for the Diagnosis of Eosinophilic Esophagitis.","authors":"Mayssan Muftah, Davis Hartnett, Brent Hiramoto, Ryan Leung, Ryan Flanagan, Jennifer X Cai, Wai-Kit Lo, Walter W Chan","doi":"10.1016/j.gie.2025.01.018","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.018","url":null,"abstract":"<p><strong>Background and aims: </strong>The pattern of inflammation in eosinophilic esophagitis (EoE) is patchy, necessitating multiple biopsies to optimize diagnostic yield. Current consensus-based guidelines recommend 6 total biopsies at two sites: distal and either middle or proximal esophagus, although based on limited data. We aimed to determine whether this biopsy protocol sufficiently captures EoE diagnoses by evaluating the distribution of eosinophilia in a large EoE cohort.</p><p><strong>Methods: </strong>This was a retrospective study of consecutive, newly-diagnosed EoE patients with ≥2 esophageal segments biopsied. Demographics, clinical characteristics/history, endoscopic findings, and histologic results were manually reviewed. Distribution (proximal, middle, and/or distal) of eosinophilia (>15 eosinophils/hpf) was assessed. Predictors for non-distal disease (<15 eosinophils/hpf on distal biopsies) were evaluated using multivariable logistic regression.</p><p><strong>Results: </strong>511 newly-diagnosed EoE patients with ≥2 segments biopsied were included. All patients had distal esophageal biopsy. Overall, 286 (56.0%) had ≥1 site with <15 eosinophils/hpf, including 51 (10%) non-distal disease. Among patients with three segments biopsied (n=60), 19 (31.7%) had eosinophilia at only one site, including 6 (10%) isolated mid esophageal disease and no isolated proximal eosinophilia. Discordant mid and proximal biopsy results were found in 18 (30%) patients, with 17/18 (94.4%) mid esophageal eosinophilia. On multivariable analysis, increasing age (OR:1.02, CI:1.002-1.04, p=0.03) and male gender (OR:1.89, CI:1.002-3.55, p=0.049) independently predict non-distal disease.</p><p><strong>Conclusions: </strong>Isolated segmental eosinophilia is common in EoE, including up to 10% non-distal disease. Discordant mid and proximal biopsy findings are prevalent, with no isolated proximal eosinophilia. Standard protocol should include routine biopsies of both distal and middle esophagus to maximize diagnostic yield.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143003811","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":"Endoscopy and Anesthesia Outcomes Associated with Glucagon-Like Peptide-1 Receptor Agonist use in Patients Undergoing Outpatient Upper Endoscopy.","authors":"Sarjukumar Panchal, Nadim Mahmud, Joshua H Atkins, Hansol Kang, Alexandra Leto, Anna Goebel, Namrita Trivedi, Ahmed Chatila, Wei-Wen Hsu, Gregory G Ginsberg, Octavia Pickett-Blakeley, Inuk Zandvakili","doi":"10.1016/j.gie.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.004","url":null,"abstract":"<p><strong>Background and aims: </strong>Glucagon-like peptide-1 receptor agonists (GLP1RAs) can cause delayed gastric emptying, raising concern for retained gastric contents (RGCs) during endoscopy and adverse anesthesia events. We aimed to determine associations between GLP1RA and endoscopy and anesthesia outcomes.</p><p><strong>Methods: </strong>This single-center retrospective cohort study examined patients prescribed GLP1RA who underwent outpatient endoscopy stratified by exposure at the time of endoscopy. The GLP1RA group had ≥6 weeks of exposure as confirmed by pharmacy dispensation reports. The control group were patients not on GLP1RA at the time of endoscopy (prescription never filled, discontinued ≥6 weeks prior, or started post-endoscopy). The outcomes were the presence of solid RGCs, aborted procedures or any adverse anesthesia events.</p><p><strong>Results: </strong>598 patients were included in the study with 360 on GLP1RA and 298 controls. Baseline characteristics including age, sex, chronic opiate use, gastroparesis and prior gastric surgery were similar, but diabetes mellitus was more prevalent in the GLP1RA group (68% vs. 57%, p=0.005). The odds of solid RGCs was significantly higher in the GLP1RA group in multivariate analysis (OR 3.80; 95% CI 1.57-9.21; p=0.003), but odds were not increased in patients undergoing concurrent colonoscopy. More patients in the GLP1RA group had procedures aborted (1.3% vs. 0%, p=0.021), but rates of hypoxia were similar (0.2% vs. 0.3%, p=0.341). There were no cases of pulmonary aspiration.</p><p><strong>Conclusion: </strong>Patients on GLP1RAs have increased rates of solid RGCs during upper endoscopy, but not with concurrent colonoscopy, and higher rates of aborted procedures, but similar rates of adverse anesthesia events.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143003752","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 Clinical Utility of Incorporating Next-Generation Sequencing Results in the Management Algorithm of Pancreatic Cysts.","authors":"Alex R Jones, Olgert Bardhi, Patricio Polanco, Daniel Ellis, Christofer Bishop, Veronica Coleman, Blake Foley, Gaurav Khatri, Markus Goldschmiedt, John Mansour, Dutch Vanderveldt, Aatur Singhi, Nisa Kubiliun, Tarek Sawas","doi":"10.1016/j.gie.2025.01.005","DOIUrl":"https://doi.org/10.1016/j.gie.2025.01.005","url":null,"abstract":"<p><strong>Background & aims: </strong>Pancreatic cysts often pose challenges in predicting malignant progression. Next-generation sequencing has become an appealing ancillary diagnostic test. The diagnostic performance is well characterized, but the impact on clinical management remains unclear. We aim to evaluate the efficacy of integrating NGS into cyst management algorithms.</p><p><strong>Methods: </strong>This single-center retrospective study included 441 adult patients who were seen at our high-risk pancreatic lesion clinic between 2016 and 2022 and had NGS data available. Performance characteristics of PancreaSeq were calculated. The clinical utility of PancreaSeq in guiding surgical management and differentiating cyst type was evaluated.</p><p><strong>Results: </strong>High-risk mutations (n=25) demonstrated 72.7% (95% CI: 49.8% - 89.3%) sensitivity, 97.8% (95% CI: 96% - 99%) specificity, and area under receiver operating curve 0.85 (95% CI: 0.76 - 0.95) in predicting advanced neoplasia. NGS detected KRAS or GNAS mutations in 179/324 (55.3%) and VHL mutations in 15/324 (3.4%) with unclear cyst type, facilitating decision regarding surveillance versus clinic discharge. Among 27 patients with isolated pancreatic duct dilation, 12 (48.1%) had mutations consistent with mucinous neoplasms leading to a diagnosis of main duct intraductal papillary mucinous neoplasm. These findings resulted in surgical management for six patients. Overall, 115 of 441 (26.1%) patients had some management change after undergoing NGS.</p><p><strong>Conclusion: </strong>NGS informed surgical decision-making, cyst type differentiation, and evaluation of pancreatic duct dilation, leading to changes in management. Indeed, NGS emerges as a useful tool in select patients with pancreatic lesions by improving diagnostic precision and guiding patient care paths.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143003780","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":"Quadrant, necrosis, and infection criteria for the risk stratification of walled-off necrosis: external validation using multi-institutional data.","authors":"Hideyuki Shiomi, Tomotaka Saito, Tsuyoshi Hamada, Ryota Nakano, Shunsuke Omoto, Mamoru Takenaka, Masahiro Tsujimae, Atsuhiro Masuda, Shogo Ota, Shinya Uemura, Takuji Iwashita, Sho Takahashi, Toshio Fujisawa, Kentaro Suda, Saburo Matsubara, Kensaku Yoshida, Akinori Maruta, Yuhei Iwasa, Keisuke Iwata, Nobuhiko Hayashi, Tsuyoshi Mukai, Hiroyuki Isayama, Ichiro Yasuda, Yousuke Nakai","doi":"10.1016/j.gie.2024.12.037","DOIUrl":"https://doi.org/10.1016/j.gie.2024.12.037","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopic ultrasound-guided peripancreatic fluid drainage (EUS-PFD) with on-demand endoscopic necrosectomy, increasingly utilized to manage walled-off necrosis (WON), is associated with substantial morbidity and mortality. This multicenter study aimed to externally validate recently developed quadrant (an abdominal quadrant distribution), necrosis, and infection (QNI) criteria for risk stratification in this setting.</p><p><strong>Methods: </strong>Of 423 patients with pancreatic fluid collections treated in a large multi-institutional cohort between 2010 and 2020, 212 with available preprocedural computed tomography images were included. Clinical outcomes between high- and low-risk groups defined according to QNI criteria were compared.</p><p><strong>Results: </strong>The clinical success rate did not differ significantly between the QNI-high and QNI-low groups (74.4% vs. 83.5%, respectively; P = 0.12). Time to clinical success was longer in the QNI-high group compared with the QNI-low group (median, 68 vs. 46 days, respectively; P = 0.0016). Compared with the QNI-low group, the QNI-high group was associated with higher rates of percutaneous interventions, direct endoscopic necrosectomy, mortality, and adverse events. The QNI-high group was independently associated with time to clinical success (hazard ratio 0.64, 95% confidence interval 0.46-0.87; P =0.005) in multivariable Cox proportional hazards regression analysis, and with the risk of ≥grade III adverse events (odds ratio 2.93, 95% confidence interval 1.04-8.20; P = 0.04) in multivariable logistic regression analysis.</p><p><strong>Conclusions: </strong>The QNI criteria effectively stratified time to clinical success and the risk of adverse outcomes for patients receiving EUS-PFD of WON. Further investigations could elucidate appropriate management strategies based on QNI-based risk stratification.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964403","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}