Gastrointestinal endoscopy最新文献

{"title":"Lumen-Apposing Metal Stents for Partial Reversal of Roux-en-Y Gastric Bypass: A Multicenter Study.","authors":"Kambiz Kadkhodayan, Azhar Hussain, Saurabh Chandan, Sagar J Pathak, Mohamad Khaled Almujarkesh, Abdullah Abassi, Artur Viana, Gustavo Bellovincentelli, Mustafa Arain, Natalie Cosgrove, Maham Hayat, Deepanshu Jain, Muhammad Usman Baig, Dushyant S Dahiya, Dennis Yang, Kartik Sampath, Mohammad Bilal, Reem Z Sharaiha, Muhammad Hasan, Shayan S Irani","doi":"10.1016/j.gie.2025.10.004","DOIUrl":"https://doi.org/10.1016/j.gie.2025.10.004","url":null,"abstract":"<p><strong>Background and aims: </strong>Roux-en-Y gastric bypass (RYGB) is an effective treatment of obesity, however some patients will develop debilitating post-operative complications requiring surgical reversal that can be technically challenging and highly morbid. Endoscopic ultrasound (EUS)-guided placement of lumen-apposing metal stent (LAMS) offers a minimally invasive option that creates a gastro-gastric fistula. Partial re-direction of food into the native stomach, results in improvement of nutritional status, and may serve either as a bridge to surgery or as definitive therapy.</p><p><strong>Methods: </strong>We report a prospective series of 16 patients with complications related to RYGB, from four tertiary care centers, who underwent EUS-guided LAMS placement and creation of a gastro-gastric fistula due to either severe protein-calorie malnutrition, dumping syndrome or postprandial hyper insulinemic hypoglycemia.</p><p><strong>Results: </strong>Technical and clinical success was achieved in 16 patients (100%) and 15 patients (93.75%) respectively. The median procedure duration was 30 minutes (Range 18-76). Mean body mass index (BMI) increased significantly from the time of placement of LAMS to mean follow up of 15.8 months (range 3-62), 21.2 kg/m² (range 12.5-33.4) to 24.4 kg/m² (range 19.9-32.3), (Mean Difference [MD]: 3.19, P=0.002). Additionally, there was a statistically significant increase in mean hemoglobin (Hb) and serum albumin at follow up. While there were no procedure related adverse events, LAMS related complications occurred in 4 patients and included pain, tissue ingrowth and stent migration.</p><p><strong>Conclusion: </strong>EUS-guided LAMS placement is a safe, efficacious and minimally invasive strategy for partial reversal of RYGB as either a bridge to definitive surgical reversal or as destination therapy.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274327","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":"Clinical Impact of Routine Esophagram after Peroral Endoscopic Myotomy: A Systematic Review and Meta-analysis.","authors":"Ernesto Robalino Gonzaga, Saurabh Chandan, Abdullah Abbasi, Mohammed S Abdul, Sagar Pathak, Smit S Deliwala, Shahab R Khan, Deepanshu Jain, Natalie Cosgrove, Mustafa A Arain, Kambiz K Kadkhodayan, Maham Hayat, Muhammad K Hasan, Dennis Yang","doi":"10.1016/j.gie.2025.09.053","DOIUrl":"https://doi.org/10.1016/j.gie.2025.09.053","url":null,"abstract":"<p><strong>Background and aims: </strong>Peroral endoscopic myotomy (POEM) hasf become a major treatment for esophageal motility disorders. Early routine post-POEM esophagram is frequently performed to assess for adverse events (AEs), although the clinical benefit remains questionable. We conduct a systematic review and meta-analysis to evaluate the clinical impact of routine esophagram after POEM in asymptomatic patients.</p><p><strong>Methods: </strong>PubMed was searched from inception to November 2024. The primary outcome was to evaluate the incidence of intramural and extramural esophageal leaks after POEM. Secondary outcomes included radiographic findings on routine esophagram after POEM and the rate in which radiographic findings resulted in a change in management. A random-effects model was used and outcomes were represented as pooled rates, along with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Fourteen studies with 2153 patients were included. Most patients (mean age ranged from 39.4 to 59.3 years) had achalasia (90.6%) with mean baseline Eckardt score ranging between 3.0-12. Patients underwent routine esophagram within 24-72 hours after POEM. The pooled rates of intramural and extramural esophageal leaks were 2.3% (95% CI: 0.8-6.1; I²=79.4) and 1.4% (95% CI: 0.8-2.5; I²=81.6), respectively. Pneumoperitoneum and pneumomediastinum were the two most common findings on imaging, with pooled rates of 42.0% (95% CI: 26.5-59.2) and 33.7% (95% CI: 12.4-64.6), respectively. Collectively, the frequency in which routine imaging findings resulted in a change in management was 3.4% (95%CI: 1.7-6.8; I²=81.6).</p><p><strong>Conclusion: </strong>Esophageal leakage is a very uncommon AE after POEM. Routine esophagram rarely impacted immediate post-procedural care in asymptomatic patients. Selective imaging may result in higher diagnostic yield, improved cost-efficiency, and mitigate the risk of unwarranted additional testing due to incidental radiographic findings.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274357","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":"Erratum to Bilevel positive airway pressure ventilation in patients susceptible to hypoxemia during procedural sedation for colonoscopy: a prospective randomized controlled study, Gastrointestinal Endoscopy Volume 99, Issue 6, June 2024. Pages 989-997.","authors":"Shuailei Wang, Tianqiang Sheng, Guoqing Yuan, Huixin Li, Xiaoguang Guo, Jianming Mai, Chaojin Chen, Gangjian Luo","doi":"10.1016/j.gie.2025.08.004","DOIUrl":"https://doi.org/10.1016/j.gie.2025.08.004","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250583","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 artificial intelligence-assisted colonoscopy on gastroenterology fellow performance: A pragmatic randomized controlled trial.","authors":"Patrick W Chang, Denis D Nguyen, Niwen Kong, Daniel Wang, Sarah Wang, Justin Ong, Maziar M Amini, Nisha Sharma, Aileen Bui, Omar Bakr, Dara Bruce, Helen Lee, Jennifer L Dodge, Ara B Sahakian, James L Buxbaum","doi":"10.1016/j.gie.2025.09.045","DOIUrl":"https://doi.org/10.1016/j.gie.2025.09.045","url":null,"abstract":"<p><strong>Background and aims: </strong>The substantial miss rate during screening and surveillance colonoscopy, particularly for the right side, underscores the need to improve training. The role of artificial intelligence (AI) assisted colonoscopy in the training environment has not been thoroughly defined. This study explores the impact of artificial intelligence on colonoscopy performed by trainees in a Gastroenterology (GI) fellowship program.</p><p><strong>Methods: </strong>Between March and October 2023, we randomly assigned GI fellows to artificial intelligence (AI) enhanced versus conventional colonoscopy (CC) rooms daily. Consecutive colonoscopies performed by fellows were included unless there were attending interventions, inadequate bowel preparation or incomplete colonoscopy. The primary endpoint was adenoma detection rate (ADR) defined as the proportion of colonoscopies with one or more adenomas detected. Additional outcomes included adenoma detection on the right side (RADR) and left side (LADR), the polyp detection rate (PDR), procedure (colonoscope insertion to withdrawal) and withdrawal (cecum to withdrawal) times. Mean ADR differences for the AI versus CC procedures were estimated utilizing generalized linear models.</p><p><strong>Results: </strong>A total of 1,045 colonoscopies were performed by 16 fellows. Overall ADR was similar for AI (40.5±3.9%) vs. CC (35.0±3.6%); mean difference 5.5% (95% CI: -4.3 to 15.3%). The right sided ADR was higher in AI (24.1%) versus CC (16.5%); mean difference: 7.6% (95% CI: 1.7 to 13.5%). Among 130 screening colonoscopies, ADR for AI was 49.1% vs 26.7% for CC; mean difference: 22.3% (95% CI: -2.7 to 47.4%) while RADR was higher for AI (AI: 35.1% vs CC: 13.7%); mean difference: 21.0% (95% CI: 7.6% to 35.2%). This was most pronounced for first and second year fellows. There was no difference in procedural or withdrawal time with the addition of AI.</p><p><strong>Conclusion: </strong>This pragmatic randomized controlled trial demonstrates that AI assisted colonoscopy improves RADR for gastroenterology trainees. Overall ADR was not significantly different between groups. We propose a use case via AI assisted colonoscopy for trainees guiding improvement of adenoma detection in the right colon and standardizing a critically needed colorectal cancer screening quality metric.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191142","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":"EFFICACY AND SAFETY OF A SELF-ASSEMBLING PEPTIDE HAEMOSTATIC GEL IN THE TREATMENT OF BLEEDING IN EUS-GUIDED DRAINAGE AND DIRECT ENDOSCOPIC NECROSECTOMY OF PANCREATIC FLUID COLLECTIONS.","authors":"Germana de Nucci, Vincenzo Colace, Giuseppe Fierro, Roberta Muscia, Raffaella Reati, Daniela Morganti, Maurizio Vecchi, Davide Bona, Gianpiero Manes","doi":"10.1016/j.gie.2025.09.046","DOIUrl":"https://doi.org/10.1016/j.gie.2025.09.046","url":null,"abstract":"<p><strong>Background and study aim: </strong>EUS-guided drainage and direct endoscopic necrosectomy (DEN) are primary treatment modalities for symptomatic pseudocysts and walled-off pancreatic necrosis (WOPN). Bleeding is a serious adverse event associated with drainage, also due to lack of effective endoscopic haemostatic techniques. Purastat demonstrated excellent results to manage gastrointestinal bleeding. Our aim was to evaluate the efficacy and safety of this haemostatic gel in managing bleeding secondary to EUS-guided drainage and DEN of pancreatic fluid collections (PFCs).</p><p><strong>Patients and methods: </strong>In this multicenter, retrospective, observational study 27 patients underwent Purastat treatment because of active bleeding during or after PFCs EUS-guided drainage or WOPN DEN sessions between 2017 and 2024.</p><p><strong>Results: </strong>38 bleeding episodes were recorded. The bleeding type was oozing in 36 cases and spurting in 2 cases. Purastat was successfully applied in 100% of patients and achieved successful haemostasis in 96.5% of cases.</p><p><strong>Conclusions: </strong>This novel haemostatic gel is a safe andeffectiveto manage oozing bleedings related to PFCs EUS-guided drainage or DEN.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191088","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":"Corrigendum to \"Underwater coagulation: is it time to retire the coagulation forceps? [Gastrointestinal Endoscopy. 2024. volume 100, no. 5. p. 959]\".","authors":"R de Sire, A Capogreco, D Massimi, L Alfarone, E Mastrorocco, C Hassan, R Maselli, A Repici","doi":"10.1016/j.gie.2025.07.043","DOIUrl":"https://doi.org/10.1016/j.gie.2025.07.043","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148883","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 Transmural Drainage of a Pancreatic Pseudocyst in a Three-Year-Old Child.","authors":"David Kleparnik, Premysl Falt, Jana Volejnikova, Daryl Ramai, Lumir Kunovsky, Eva Karaskova","doi":"10.1016/j.gie.2025.09.044","DOIUrl":"https://doi.org/10.1016/j.gie.2025.09.044","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185516","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 submucosal dissection combined with endoscopic closure of gastrointestinal fistulas, including those refractory to prior treatment: results after descriptive series.","authors":"Eukene Rojo, Pierre Lafeuille, Jérémie Jacques, Timothée Wallenhorst, Florian Rostain, Alexandru Lupu, Jérôme Rivory, Mathieu Pioche","doi":"10.1016/j.gie.2025.09.037","DOIUrl":"https://doi.org/10.1016/j.gie.2025.09.037","url":null,"abstract":"<p><strong>Background and aims: </strong>Several endoscopic techniques are available for the closure of fistulas but reported long-term efficacy is disappointing. Endoscopic submucosal dissection (ESD) combined with endoscopic closure showed promising results. We evaluated the results of this combined technique in a larger number of consecutive patients.</p><p><strong>Methods: </strong>Patients with gastrointestinal fistulas, including those with previous failed treatment, were retrospectively included. During the procedure, injection and circumferential incision around the fistulous hole was performed, followed by dissection of the fistulous track as deep as possible creating a mucosal flap. The flap was finally removed and the edges closed using several closure devices. The primary outcome was long-term (> 3 months) success of fistula healing. Secondary outcomes included technical success, safety, and factors associated with success. To evaluate risk factors for long-term failure, patients treated in our previous descriptive study were included in the univariable analysis.</p><p><strong>Results: </strong>We included 32 patients (66% refractory) in the present study. Technical success was 78%. 28/32 (88%) completed > 3 months follow-up. Among them, 43% (12/28) achieved long-term closure with 8 months median follow-up (interquartile range 5-18). In naïve patients, technical success rate was 91% (10/11) and long-term closure was 78% (7/9). Adverse events occurred in 3 patients (9%). Risk factors for long-term failure were evaluated in 51 patients (23 previously treated in our first descriptive study and 28 patients with complete follow-up from the present evaluation). Age (p = 0.01), surgical (p = 0.007) or oncological origin (p = 0.001) and previous treatment attempts (p = 0.007) were significantly associated to failure.</p><p><strong>Conclusion: </strong>ESD with closure is safe and effective to cure fistulas, and could be considered part of the first-line treatment for naïve patients. In refractory patients, although of moderate efficacy, this technique could represent an alternative approach prior to salvage surgery.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182054","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 Rare Perirectal Manifestation of Sarcoidosis Diagnosed with Trans-Rectal Ultrasound.","authors":"Cameron Amini, Barton Lane, Olga Ioffe, Raya Murray, Farhan Ali, Peter Darwin","doi":"10.1016/j.gie.2025.09.042","DOIUrl":"https://doi.org/10.1016/j.gie.2025.09.042","url":null,"abstract":"","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181916","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":"Transoral Outlet Reduction for the Treatment of Dumping Syndrome After Roux-En-Y Gastric Bypass: A Systematic Review and Meta-Analysis.","authors":"Douglas G Adler","doi":"10.1016/j.gie.2025.09.036","DOIUrl":"https://doi.org/10.1016/j.gie.2025.09.036","url":null,"abstract":"<p><strong>Background and aims: </strong>Dumping syndrome (DS) is one of the significant limitations of the Roux-En-Y Gastric Bypass (RYGB) 's long-term success. Our study aimed to review the effectiveness and safety of transoral outlet reduction (TORe) for DS.</p><p><strong>Methods: </strong>From inception to May 2024, an individualized search strategy for major databases was developed. The primary and secondary outcomes of our interest were TORe's technical and clinical success rates, peri-procedural adverse events, and reintervention rates.</p><p><strong>Results: </strong>Four studies with 241 patients were included. The pooled technical success rate was 100% (CI: 99.08%-100%). The pooled mean Sigstad's score difference calculated before and after the procedure was 13.13 (CI: 11.90, 15.56, p < 0.01), reflecting clinical success. The pooled periprocedural adverse event rate was 10.46% (CI: 0.42%-28.30%), and the pooled reintervention rate was 7.99% (CI: 1.46%-18.05%).</p><p><strong>Conclusion: </strong>Our study concludes that TORe is an effective and safe procedure for treating DS among RYGB patients.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181992","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}