Digestive Endoscopy最新文献

{"title":"WEO Newsletter: Travel Report: The Maghreb","authors":"Purnima Bhat","doi":"10.1111/den.70020","DOIUrl":"https://doi.org/10.1111/den.70020","url":null,"abstract":"<p>WEO have successfully launched training centres throughout Sub-Saharan Africa, mostly in English-speaking countries. In 2023, a visit to Senegal resulted in establishment of our first francophone centre and highlighted the need for training in this region. Regional endoscopy training in Africa has been provided by groups from Egypt and South Africa, providing a model for continent-based training that are both socially and environmentally sustainable. With the aim of investigating both the need for training and the capabilities for provision of training in North Africa, we evaluated current state of endoscopy in the Maghreb: Morocco, Algeria, Tunis.</p><p>Morocco is a Mediterranean kingdom in north-west Africa, that gained its independence from the French in 1956. While the political capital is Rabat, the economic capital is the coastal city of Casablanca. The most populated city of Morocco, Casablanca is home to 3.2 million people.</p><p>There are several hundred endoscopists in Morocco, who offer standard diagnostic and therapeutic endoscopy, with ERCP available in most public hospitals and EUS in some. To increase health and sciences education and healthcare services in the country, Mohammed VI Foundation for sciences and health was created by the king. It is a non-profit semi-public foundation managing universities in Casablanca, Rabat and Dakhla and multiple healthcare facilities. The Foundation has a strong orientation toward collaboration with African countries.</p><p>Bordering Morocco to the east, Algeria is a modern country with an increasingly relaxed border policy that reflects its growing peaceful development. It took a little work to get an entry visa and a couple of hours in immigration to enter the country, but it was worth it. The initial connection came from Dr. Mohammed Omar, Chair of the WEO Middle East Committee who knew Dr. Imad Bougedouma. Just to prove that the world is a tiny place, I discovered over coffee that Imad had spent a week in Oslo for training and is known to Prof Aabakken, President of WEO, who has an Algerian sand painting in his office as proof.</p><p>An ex-colony of France, Algeria won its independence after a long and bloody war in 1962, but plunged into a decade-long destructive civil war until 2002. The last twenty-three years of peace has resulted in increasing social development including universal health care, universal education and a rapidly developing middle class.</p><p>GI training in Algeria is confined to the public hospital system alone and starts immediately after internship, continuing for four years with the final year focussed on endoscopy. There are three training public hospitals in Algiers, and only a few key hospitals around the country additionally. With the largest land mass of any country in Africa, Algeria has a significant shortage of proceduralists compounded by distance. For new skills acquisition, a shortage of trainers and centres is apparent. The medical system is two-tiered ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 9","pages":"1019-1023"},"PeriodicalIF":4.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WEO Newsletter: The Impact of Artificial Intelligence on Management of Inflammatory Bowel Disease: An Expert Commentary","authors":"","doi":"10.1111/den.15072","DOIUrl":"https://doi.org/10.1111/den.15072","url":null,"abstract":"&lt;p&gt;By Nayantara Coelho-Prabhu, MD FACG AGAF FASGE, Mayo Clinic Rochester&lt;/p&gt;&lt;p&gt;The complexity of IBD, including both Crohn's disease (CD) and ulcerative colitis (UC), lies in its heterogeneity in presentation, unpredictable disease course, and varying responses to therapy. Current approaches rely on a combination of clinical indices, imaging, endoscopy, histology, and biomarkers—many of which are subjective and variably interpreted. This subjectivity results in difficulties with establishing standards of care, and often is the root cause of complications. Also, there is an increasing focus on achieving healing in IBD across all aspects of the disease including clinical, radiologic, endoscopic and histologic (STRIDE-II). To achieve this, we must establish standardization across these targets. These challenges present a fertile ground for AI applications aimed at improving accuracy, efficiency, and personalization in IBD management.&lt;/p&gt;&lt;p&gt;Endoscopic assessment remains central to IBD diagnosis and monitoring. However, the qualitative nature of inflammation scoring and interobserver variability in all scoring systems such as the Mayo Endoscopic Score or SES-CD has long plagued clinical and research settings. This has been the impetus to develop automated scoring systems that aim to standardize these scores. The first iteration of these models used still images to train convoluted neural networks (CNNs) and then reported on their successful scoring of test data still images. These systems utilized expert scoring as the gold standard, and they were found to have excellent performance in distinguishing Mayo 0-1 from Mayo 2-3 scores, similar to human experts. The next step was that CNNs were trained to read video segments, obtained from pharmaceutical randomized trials that had captured video segments, scored by central readers. Because the earlier systems were compared to human gold standard, which has low interoperator agreement, the next step in this evolution was to consider disease outcome as a measure of validity. Again, clinical trial videos were used and the CNNs were trained to report a cumulative disease score that was correlated with outcomes with more meaningful results. The goal is to be able to predict responders from non-responders. AI can detect subtle visual features on endoscopy, which can be harnessed to make histologic inference without the need for biopsy. Such predictive CNNs have been developed using white light images as well as enhanced imaging techniques including endocytoscopy, narrow band imaging (vascular patterns) and I-scan. These can predict relapse rates based on real-time endoscope imaging with great accuracy. In capsule enteroscopy, AI has been developed to accurately identify and quantify small bowel ulcerations, and significantly reduce capsule reading time, for both trainees and experts. These recent AI-driven computer vision tools have demonstrated the ability to automatically segment mucosal features, detect ulcera","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 7","pages":"807-809"},"PeriodicalIF":5.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144598393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Method for Effective Closure of Mucosal Defects After Endoscopic Full-Thickness Resection Using a Dual-Channel Endoscope","authors":"Geng Qin,&nbsp;Guanyu Chen,&nbsp;Shiyu Du","doi":"10.1111/den.15080","DOIUrl":"10.1111/den.15080","url":null,"abstract":"<p>Endoscopic full-thickness resection (EFTR) has emerged as a preferred therapeutic modality for the treatment of submucosal tumors, including gastrointestinal stromal tumors [<span>1</span>]. Despite its growing use, post-EFTR closure remains technically challenging due to difficulties in approximating and securing the mucosal edges [<span>2, 3</span>]. These challenges often hinder effective closure and increase the risk of complications.</p><p>To overcome these limitations, we have developed a novel closure technique employing a dual-channel endoscope, designed to facilitate precise and efficient wound approximation. The two working channels of the endoscope (GIF-2TQ26OM) are designated as Channel A and Channel B, with titanium clips deployed through each referred to as A-clips and B-clips, respectively.</p><p>During the closure procedure, only a single A-clip is used throughout. This clip is employed to grasp and retract the mucosa (or mucosa with the muscularis propria) from one side of the defect, aligning it linearly with the opposing edge (Figure 1B). Once proper alignment is achieved, one or more B-clips are applied to approximate the bilateral mucosal edges and secure the closure (Figure 1C,E). The A-clip is then released and repositioned to repeat the process on the next section of the defect (Figure 1D). After completing the placement of B-clips, the A-clip performs the final approximation to complete the closure. Figure 2 is an illustration.</p><p>This technique has been successfully applied in clinical practice, as demonstrated in the accompanying video (Video S1), confirming its feasibility and effectiveness in real-world EFTR cases.</p><p>The dual-channel endoscopic technique offers multiple advantages: improved mucosal alignment, reduced clip span, shorter procedural time, and enhanced surgical precision. Collectively, these benefits contribute to increased procedural efficiency and potentially lower complication rates.</p><p>Geng Qin designed and performed the research, collected and analyzed the data. Geng Qin and Shiyu Du offered funding support. Guanyu Chen drafted and revised the manuscript.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 10","pages":"1123-1124"},"PeriodicalIF":4.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underwater Endoscopic Mucosal Resection With a Multiloop Traction Device for a Colorectal Tumor at the Flexure","authors":"Kazuki Matsuyama,&nbsp;Minoru Kato,&nbsp;Tomoki Michida","doi":"10.1111/den.15079","DOIUrl":"10.1111/den.15079","url":null,"abstract":"<p>Underwater endoscopic mucosal resection (UEMR) is effective for 10–20 mm colorectal polyps [<span>1</span>]. However, snaring is difficult for lesions at colonic flexures because the proximal edge is hidden by folds. We report a case of successful en bloc UEMR using a multiloop traction device (MLTD) (Boston Scientific, Tokyo, Japan).</p><p>A 72-year-old man with hypopharyngeal cancer underwent fluorodeoxyglucose (FDG) positron emission tomography, which revealed FDG accumulation in the rectosigmoid colon. Colonoscopy revealed a 20-mm protruding lesion. UEMR using SnareMasterPlus (15 mm; Olympus Medical Systems, Tokyo, Japan) was attempted. However, visualization of the oral side of the lesion was challenging, as the lesion extended across the flexure of the rectosigmoid junction (Figures 1a and 2a). Retroflex observation allowed the visualization of the oral side of the tumor; however, poor maneuverability prevented suitable snaring. Therefore, we attached MLTD to the normal mucosa 5 mm oral to the lesion using a SureClip (Micro-Tech, Nanjing, China) (Figure 1b), and subsequently hooked and anchored it to the colonic wall at the opposite side of the lesion with the second clip (Figure 1c). The traction force reduced the steep angle of the rectosigmoid junction and improved the visualization of the oral margin of the lesion in forward view (Figures 1d and 2b). We performed reliable snaring by directly observing the lesion margins (Figure 1e). The traction force optimized the visualization of the resected wound, which facilitated subsequent clipping (Figure 1f). Pathology confirmed a low-grade tubulovillous adenoma with negative resection margins.</p><p>Submucosal injection in the oral edge might also have improved lesion visibility; however, considering that unsuccessful injection carries the risk of irreversibly worsening the situation (e.g., impaired visibility due to bleeding), we first attempted this traction method, which can be undone if needed. This method has been reported in colorectal ESD [<span>2</span>] and duodenal UEMR cases [<span>3</span>], and we further confirmed its usefulness even in colorectal UEMR.</p><p>Kazuki Matsuyama performed the procedures and drafted the manuscript. Minoru Kato revised the manuscript critically. Tomoki Michida supervised manuscript preparation. All the authors have read and approved the final version of this manuscript.</p><p>Informed consent was obtained from the patient for the publication of his information and imaging data.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 10","pages":"1125-1126"},"PeriodicalIF":4.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Remimazolam and Propofol for Sedation in Endoscopic Retrograde Cholangiopancreatography: A Systematic Review and Meta-Analysis With Trial Sequential Analysis","authors":"In Jung Kim,&nbsp;Geun Joo Choi,&nbsp;Hyoung-Chul Oh,&nbsp;Hyun Kang","doi":"10.1111/den.15078","DOIUrl":"10.1111/den.15078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Sedation for endoscopic retrograde cholangiopancreatography (ERCP) is challenging owing to patient comorbidities and procedural complexity. Remimazolam, a novel benzodiazepine, has potential safety benefits. We aimed to systematically compare the efficacy and safety of remimazolam and propofol for ERCP sedation through a meta-analysis and trial sequential analysis (TSA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched Ovid-MEDLINE, Ovid-Embase, Cochrane Central, and Google Scholar for randomized controlled trials (RCTs) that compared efficacy and safety of remimazolam and propofol in ERCP sedation. Sensitivity analysis and TSA were also performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five RCTs (965 participants) were included. In these trials, remimazolam significantly reduced hypoxia (risk ratio [RR], 0.522; 95% confidence interval [CI] 0.348–0.783; Grading of Recommendations, Assessment, Development, and Evaluation [GRADE], high), hypotension (RR, 0.507; 95% CI 0.396–0.649; GRADE, high), and bradycardia (RR, 0.475; 95% CI 0.308–0.732; GRADE, high). However, it increased tachycardia (RR, 3.363; 95% CI, 1.466–7.714; GRADE, moderate) and body movement (RR, 2.744; 95% CI, 1.216–6.193; GRADE, moderate). Delirium and agitation (RR, 0.586; 95% CI, 0.157–2.179; GRADE, moderate) and completion rate (RR, 1.009; 95% CI, 0.97–1.042; GRADE, moderate) were comparable. Recovery quality was higher in remimazolam group (mean difference, 1.541; 95% CI, 0.057–3.024; GRADE, low). Other outcomes, including induction and recovery times, were similar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Remimazolam demonstrated superior safety profile than propofol for ERCP sedation, significantly reducing hypoxia, hypotension, and bradycardia with high certainty evidence and TSA confirmation. Despite the higher incidence of tachycardia and body movement associated with remimazolam, the completion rate and risk of delirium or agitation were similar for both sedatives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 10","pages":"1054-1067"},"PeriodicalIF":4.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contribution of Endoscopy in the Diagnosis and Treatment of Patients With Primary Sclerosing Cholangitis","authors":"Mamoru Takenaka,&nbsp;Masatoshi Kudo","doi":"10.1111/den.15074","DOIUrl":"10.1111/den.15074","url":null,"abstract":"&lt;p&gt;Primary sclerosing cholangitis (PSC) is an autoimmune liver and biliary disease characterized by fibrotic narrowing of the bile ducts, leading to chronic bile stasis and eventually progressing to cirrhosis. However, to date, the etiology of PSC remains unknown.&lt;/p&gt;&lt;p&gt;A diagnosis of PSC is made based on the following major findings: typical bile duct images and elevated serum alkaline phosphatase level; minor findings include the presence of inflammatory bowel disease (IBD) as well as histopathological findings of the liver [&lt;span&gt;1, 2&lt;/span&gt;]. Regarding the treatment, liver transplantation is the only curative treatment, and ursodeoxycholic acid and bezafibrate are used as symptomatic treatments.&lt;/p&gt;&lt;p&gt;It means that endoscopy is not essential for the diagnosis and treatment of PSC; however, there are situations where endoscopic findings or treatment can contribute.&lt;/p&gt;&lt;p&gt;However, because endoscopic intervention for patients with PSC involves a high risk, appropriate patient selection is extremely important, so it is necessary to have a deep knowledge of the findings on the contribution of endoscopes to PSC to date.&lt;/p&gt;&lt;p&gt;In the latest issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Mizuno et al. presented an in-depth and interesting review, titled “Endoscopic management of primary sclerosing cholangitis” [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this article, we discuss the contribution of endoscopic examinations in patients with PSC in light of this review.&lt;/p&gt;&lt;p&gt;Typical bile duct images are a key factor in the diagnosis of PSC. For a long time, bile duct imaging has been carried out using endoscopic retrograde cholangiography (ERC); however, it is impossible to inject contrast medium into all of the bile ducts, so it is impossible to evaluate the degree of all bile ducts. In addition, in cases where many bile duct strictures exist or the strictures are severe, there remains a risk of the contrast medium not being excreted, leading to postprocedural cholangitis or pancreatitis. Further, the management of cholangitis that occurs in conjunction with PSC can be extremely challenging. In addition, the corresponding radiation exposure not only affects endoscopists but also medical staff; thus, performing ERC without actual necessity is unacceptable [&lt;span&gt;4, 5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Magnetic resonance cholangiopancreatography (MRCP) has been reported to have both high diagnostic sensitivity and specificity and is recommended as the first-line diagnostic method for PSC [&lt;span&gt;1-3&lt;/span&gt;]; thus, it is difficult to justify performing ERC for the sole purpose of cholangiography.&lt;/p&gt;&lt;p&gt;The greatest contribution of ERC to the diagnosis of PSC is that it can be used to obtain tissue samples for differentiation of PSC from bile duct cancer. The findings of bile duct stenosis in PSC are sometimes very similar to those in bile duct cancer. Moreover, it is reported that patients with PSC are at risk of developing bile duct cancer, with cumulative risks of 6%, 14%, and 20% at 10, 20, and 30 y","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 10","pages":"1089-1091"},"PeriodicalIF":4.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Gastrointestinal Endoscopy: The Japan Gastroenterological Endoscopy Society Position Statements","authors":"Yuichi Mori,&nbsp;Ryu Ishihara,&nbsp;Haruhiko Ogata,&nbsp;Hiromu Kutsumi,&nbsp;Yutaka Saito,&nbsp;Kazuki Sumiyama,&nbsp;Masau Sekiguchi,&nbsp;Hisao Tajiri,&nbsp;Mitsuhiro Fujishiro,&nbsp;Koji Matsuda,&nbsp;Tomonori Yano,&nbsp;Rika Aoki,&nbsp;Misaki Ishiyama,&nbsp;Atsushi Imagawa,&nbsp;Masami Omae,&nbsp;Yasushi Oda,&nbsp;Motohiko Kato,&nbsp;Taku Sakamoto,&nbsp;Maasa Sasabe,&nbsp;Akiko Shiotani,&nbsp;Shiho Suzuki,&nbsp;Naoto Tamai,&nbsp;Takuto Hikichi,&nbsp;Toshiaki Hirasawa,&nbsp;Mai Makiguchi,&nbsp;Masashi Misawa,&nbsp;Yohei Yabuuchi,&nbsp;Daisuke Yamaguchi,&nbsp;Masayoshi Yamada,&nbsp;Yoshinori Igarashi,&nbsp;Shinji Tanaka","doi":"10.1111/den.15075","DOIUrl":"10.1111/den.15075","url":null,"abstract":"<div>\u0000 \u0000 <p>Research and development of artificial intelligence (AI) in the field of gastrointestinal endoscopy is progressing rapidly. In Japan alone, there are more than 10 AI-assisted endoscopic medical devices that have received regulatory approval, and numerous randomized controlled trials have been published both domestically and internationally. However, the adoption of AI in clinical practice has not been smooth due to factors such as insufficient evaluation of the balance between clinical benefits and harms, unclear cost-effectiveness, the lack of reliable guidelines, and the absence of established reimbursement systems for medical fees. Considering this situation, the Japan Gastroenterological Endoscopy Society (JGES) presents its perspective on the status of AI in endoscopic practice in the form of the following position statements. This comprises nine statements developed by the JGES AI Committee in collaboration with a diverse panel of members. These statements comprehensively address issues related to the quality of endoscopic examinations, cost-effectiveness, clinical disadvantages, preparatory knowledge, medical safety, and legal responsibilities. They have been developed to be practical and useful in actual endoscopy settings.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 10","pages":"1116-1122"},"PeriodicalIF":4.7,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Promise and Challenges of CAD-Assisted Diagnosis in Achalasia","authors":"Niroshan Muwanwella,&nbsp;Krish Ragunath","doi":"10.1111/den.15076","DOIUrl":"10.1111/den.15076","url":null,"abstract":"&lt;p&gt;Since its inception 60 years ago [&lt;span&gt;1&lt;/span&gt;], Artificial Intelligence (AI) has undergone complex evolvement. The last decade has seen its most rapid advancement, and AI is now an essential part of everyday life. The introduction of computer-aided diagnosis (CAD) to the realm of endoscopy brings a paradigm shift to medical diagnostics. Two of the most important applications of AI in endoscopy are computer-aided detection (CADe) and computer-aided diagnosis (CADx) [&lt;span&gt;2&lt;/span&gt;]. Both these applications are developed by training AI models to detect vascular and mucosal patterns on mucosal lesions. However, in conditions such as achalasia, where specific lesions are not seen, this model of detection will not work. Therein lies a good reason for the study developed by Shiwaku and colleagues, which marks a different phase of CAD [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The study under discussion presents compelling evidence of CAD's potential to enhance the sensitivity and specificity of achalasia diagnosis, particularly among non-expert endoscopists. These findings highlight a transformative step in the democratization of medical expertise, where technology bridges the gap between novice and experienced clinicians. However, as with any innovation, the translation of these results into real-world clinical practice warrants careful scrutiny.&lt;/p&gt;&lt;p&gt;One of the most striking outcomes of this study is the dramatic improvement in sensitivity among inexperienced endoscopists, rising from 66.9% to 91.9% with CAD assistance. Even experienced practitioners benefited from CAD, with their sensitivity increasing from 79.5% to 90.8%. These findings suggest that CAD has the potential to mitigate diagnostic variability and significantly reduce the rate of missed achalasia cases. Given the availability of highly effective treatments, such as peroral endoscopic myotomy (POEM), improving early and accurate diagnosis is undoubtedly beneficial for optimizing patient outcomes.&lt;/p&gt;&lt;p&gt;Yet, despite these promising results, significant questions remain regarding CAD's application in real-world clinical settings. The study's limitations underscore certain critical challenges. Achalasia is a rare disease, and the artificially high prevalence of cases in this study (50% of the sample) does not reflect the reality of routine endoscopic practice. In an actual clinical setting, where achalasia cases are far less frequent, the performance of CAD may differ. The concern here is whether CAD will maintain its diagnostic power when faced with the complexities and unpredictability of daily endoscopic practice, where the pre-test probability of achalasia is much lower.&lt;/p&gt;&lt;p&gt;Another point of concern is the reliance on pre-selected video data, captured by a single expert. While this controlled setting ensures consistency in the dataset, it does not account for the real-life variability in endoscopic image quality, patient presentation, and operator technique. Additionally, the study does not addre","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 10","pages":"1092-1093"},"PeriodicalIF":4.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Balloon Dilation Using a Novel Nonslip Balloon Catheter in a Patient With Pancreaticojejunal Anastomotic Stricture","authors":"Koh Kitagawa,&nbsp;Yuki Motokawa,&nbsp;Hitoshi Yoshiji","doi":"10.1111/den.15077","DOIUrl":"10.1111/den.15077","url":null,"abstract":"<p>Watch a video of this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 10","pages":"1127-1129"},"PeriodicalIF":4.7,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peranal Endoscopic Myectomy for the Recurrent Rectal Adenoma After Multiple Endoscopic Resections","authors":"Yoshiaki Ando,&nbsp;Takashi Kanesaka,&nbsp;Ryu Ishihara","doi":"10.1111/den.15071","DOIUrl":"10.1111/den.15071","url":null,"abstract":"<p>Watch a video of this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 10","pages":"1130-1131"},"PeriodicalIF":4.7,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}