Digestive Endoscopy最新文献

{"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":"<p>By Nayantara Coelho-Prabhu, MD FACG AGAF FASGE, Mayo Clinic Rochester</p><p>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.</p><p>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":"Best Reviewers Award for 2024","authors":"","doi":"10.1111/den.15031","DOIUrl":"https://doi.org/10.1111/den.15031","url":null,"abstract":"<p>\u0000 <b>Best Reviewers for 2024</b>\u0000 </p><p>\u0000 <b>Yusuke Horiuchi</b>\u0000 </p><p>\u0000 <b>Ken Inoue</b>\u0000 </p><p>\u0000 <b>Fumiaki Ishibashi</b>\u0000 </p><p>\u0000 <b>Takuya Ishikawa</b>\u0000 </p><p>\u0000 <b>Yasuharu Maeda</b>\u0000 </p><p>\u0000 <b>Akinori Maruta</b>\u0000 </p><p>\u0000 <b>Yosuke Minoda</b>\u0000 </p><p>\u0000 <b>Jun Miyoshi</b>\u0000 </p><p>\u0000 <b>Yasuhisa Mori</b>\u0000 </p><p>\u0000 <b>Takeshi Okamoto</b>\u0000 </p><p>\u0000 <b>Taishi Okumura</b>\u0000 </p><p>\u0000 <b>Shunsuke Omoto</b>\u0000 </p><p>\u0000 <b>Tatsunori Satoh</b>\u0000 </p><p>\u0000 <b>Hisashi Shiga</b>\u0000 </p><p>\u0000 <b>Ayaka Takasu</b>\u0000 </p><p>\u0000 <b>Yuki Tanisaka</b>\u0000 </p><p>\u0000 <b>Yosuke Toya</b>\u0000 </p><p>\u0000 <b>Daisuke Yamaguchi</b>\u0000 </p><p>\u0000 <b>Kazuki Yamamoto</b>\u0000 </p><p>\u0000 <b>Shinji Yoshii</b>\u0000 </p><p>\u0000 <b>\u0000 <i>Distinguished Reviewers - Reviewers who have received DEN Best Reviewers Award 3 or more times -</i>\u0000 </b>\u0000 </p><p><i>Seiichiro Abe, Osamu Dohi, Mitsuru Esaki, Motohiro Esaki, Yoshihiro Furuichi, Waku Hatta, Takuto Hikichi, Kenichiro Imai, Hirotoshi Ishiwatari, Hiroshi Kawakami, Hideki Kobara, Hiroki Kurumi, Masaki Kuwatani, Kosuke Minaga, Masanao Nakamura, Hiroki Sato, Yuto Shimamura, Mitsushige Sugimoto, Kazunori Takada, Yoji Takeuchi, Toshio Uraoka, Yasushi Yamasaki</i>.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"563-565"},"PeriodicalIF":5.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926145","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 Gastrointestinal Endoscopy","authors":"","doi":"10.1111/den.15036","DOIUrl":"https://doi.org/10.1111/den.15036","url":null,"abstract":"&lt;p&gt;WEO Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES&lt;/p&gt;&lt;p&gt;Michael B. Wallace MD MPH&lt;/p&gt;&lt;p&gt;John C. Anderson Professor of Medicine, Mayo Clinic Florida&lt;/p&gt;&lt;p&gt;Artificial intelligence (AI) is rapidly transforming the field of gastrointestinal (GI) endoscopy, enhancing diagnostic accuracy, efficiency, and workflow optimization. AI-driven technologies, including deep learning algorithms and computer-aided detection and diagnosis (CADe/CADx), are being increasingly integrated into endoscopic practice, particularly in areas such as adenoma detection, polyp classification, Barrett's esophagus evaluation, early gastric cancer detection, indeterminate bile duct strictures, and bowel preparation classification. This review explores these key areas and the implications of AI on endoscopic workflows.&lt;/p&gt;&lt;p&gt;Colorectal cancer (CRC) prevention relies heavily on the detection and removal of adenomatous colon polyps during colonoscopy. AI-powered CADe systems have been developed to enhance adenoma detection rates (ADR) by identifying subtle lesions that may be overlooked by endoscopists. Studies have shown that AI-assisted colonoscopy increases ADR, reduces polyp miss rates, and improves overall procedural quality. By providing real-time visual alerts and bounding boxes around suspected polyps, AI enables more effective and standardized detection.&lt;/p&gt;&lt;p&gt;Beyond detection, AI plays a critical role in polyp characterization (CADx), aiding endoscopists in distinguishing between neoplastic and non-neoplastic lesions. AI algorithms trained on large datasets of histologically confirmed polyps can provide real-time classification, potentially reducing the need for unnecessary polypectomies. Technologies such as narrow-band imaging (NBI) and confocal laser endomicroscopy, when combined with AI, can enhance the accuracy of in vivo histological assessments. While nearly all polyps in the proximal colon should be removed endoscopically, making pre resection diagnosis less relevant, there remains a value in the rectosigmoid where small hyperplastic polyps can be left in Situ when the endoscopist is confident that they are hyperplastic. Furthermore, large polyps must be stratified into those that are noninvasive, superficially invasive, and deeply invasive to guide therapies such as standard endoscopic mucosal resection, endoscopic submucosal dissection and surgery respectively.&lt;/p&gt;&lt;p&gt;AI has also been recently shown to facilitate polyps size classification which is notoriously variable and has impact on surveillance recommendations particularly for polyps 10 mm or larger. Having objective measures of size should further standardize surveillance recommendations.&lt;/p&gt;&lt;p&gt;Barrett's esophagus (BE) is a precursor to esophageal adenocarcinoma, requiring precise surveillance and risk stratification. AI-based systems have been developed to detect BE and its progression to dysplasia by analyzing endoscopic images with high sensitivity and specificity. These algorithms can ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"566-568"},"PeriodicalIF":5.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926144","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":"Dual thin grasping forceps-assisted over-the-scope clip closure for delayed perforation in the remnant stomach after endoscopic submucosal dissection","authors":"Minami Hashimoto,&nbsp;Takuto Hikichi,&nbsp;Takumi Yanagita","doi":"10.1111/den.15022","DOIUrl":"10.1111/den.15022","url":null,"abstract":"<p>Watch a video of this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 7","pages":"787-789"},"PeriodicalIF":5.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774966","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":"Endoscopic removal of migrated gastric band ring after Fobi pouch gastric bypass","authors":"Povilas Kavaliauskas,&nbsp;Aurelijus Grigaliunas,&nbsp;Gintautas Brimas","doi":"10.1111/den.15017","DOIUrl":"10.1111/den.15017","url":null,"abstract":"<p>Watch a video of this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 7","pages":"790-791"},"PeriodicalIF":5.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712365","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":"Clinical Practice Guidelines for post-ERCP pancreatitis 2023","authors":"Shuntaro Mukai,&nbsp;Yoshifumi Takeyama,&nbsp;Takao Itoi,&nbsp;Tsukasa Ikeura,&nbsp;Atsushi Irisawa,&nbsp;Eisuke Iwasaki,&nbsp;Akio Katanuma,&nbsp;Katsuya Kitamura,&nbsp;Mamoru Takenaka,&nbsp;Morihisa Hirota,&nbsp;Toshihiko Mayumi,&nbsp;Toshio Morizane,&nbsp;Ichiro Yasuda,&nbsp;Shomei Ryozawa,&nbsp;Atsushi Masamune","doi":"10.1111/den.15004","DOIUrl":"10.1111/den.15004","url":null,"abstract":"<p>The Clinical Practice Guidelines for post-ERCP pancreatitis (PEP) 2023 provide updated recommendations for the prevention, diagnosis, and management of PEP. Endoscopic retrograde cholangiopancreatography (ERCP), a valuable procedure for diagnosing and treating pancreatobiliary diseases, can result in PEP as the most common adverse event. Since the first guidelines were published in 2015, advances in techniques and new research findings have necessitated this revision. The guidelines developed using the GRADE methodology target adult patients undergoing ERCP. They offer a comprehensive framework for clinicians to minimize the risk of PEP. For high-risk patients, endoscopic ultrasound before ERCP is recommended to avoid unnecessary procedures. The guidelines also discuss procedural and patient-related risk factors for PEP, highlighting that operator experience does not significantly affect PEP rates if performed under the supervision of skilled endoscopists. The diagnostic criteria include monitoring serum pancreatic enzyme levels postprocedure, and early computed tomography is advised in suspected cases. For treatment, the guidelines recommend following acute pancreatitis protocols. Key preventive measures include the use of temporary pancreatic duct stents and rectal nonsteroidal anti-inflammatory drugs, both of which are supported by strong evidence for reducing the incidence of PEP. Overall, these guidelines aim to enhance clinical outcomes by reducing PEP incidence and improving its management through evidence-based practices.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 6","pages":"573-587"},"PeriodicalIF":5.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712362","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":"What has changed and remained the same in the past 55 years regarding the prediction and prevention of postendoscopic retrograde cholangiopancreatography pancreatitis?","authors":"Mamoru Takenaka,&nbsp;Masatoshi Kudo","doi":"10.1111/den.15025","DOIUrl":"10.1111/den.15025","url":null,"abstract":"&lt;p&gt;Although 55 years have passed since endoscopic retrograde cholangiopancreatography (ERCP) was first reported in 1968,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; post-ERCP pancreatitis (PEP) remains a major clinical challenge. A systematic review of 108 randomized controlled trials conducted between 1977 and 2012 revealed a 9.7% incidence of PEP among 13,296 patients in the control group.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Further, a prospective multicenter observational study involving 3739 cases reported a PEP incidence of 6.9%.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Notably, several studies have documented an increasing trend in PEP incidence over time. An analysis of 1.22 million hospitalizations in the United States from 2011 to 2017 showed rising hospitalization and fatality rates associated with PEP.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; This trend may be attributed to the development and increased use of new therapeutic devices such as metal stents and cholangioscopes over the past 55 years. Meanwhile, there has been significant progress in understanding and preventing PEP, with studies identifying predictive factors and preventive strategies for PEP. Unlike 55 years ago, clinicians can now assess patient-related and procedure-related risk factors for PEP before ERCP and consider appropriate preventive measures. However, effective prediction and prevention require a comprehensive understanding of the latest advancements.&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Kato &lt;i&gt;et al&lt;/i&gt;. present an in-depth review titled “Current status and issues for prediction and prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis.”&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; This article explores the latest prediction models, scoring systems, and newly identified patient factors. The following is a summary of changes and enduring aspects regarding PEP over the past 55 years.&lt;/p&gt;&lt;p&gt;In the early days of ERCP, knowledge about the risk factors for PEP was limited. There was no awareness that groups, such as young women, were at higher risk of developing PEP. Today, extensive research has identified various risk factors, often broadly categorized as patient-related factors (e.g. younger age or female sex) and procedure-related factors (e.g. difficult cannulation, repeated pancreatic duct instrumentation, or pancreatic duct guidewire placement). In recent years, anatomical factors such as large pancreatic parenchymal volume, high pancreatic fat content, and specific duodenal papilla morphology have been reported as risk factors for PEP.&lt;/p&gt;&lt;p&gt;As also emphasized by Kato &lt;i&gt;et al&lt;/i&gt;.,&lt;sup&gt;5&lt;/sup&gt; it is rare for patients undergoing ERCP to possess only a single risk factor, and several studies have reported the prediction of PEP using a prediction model and scoring system. In addition, artificial intelligence has been reported to be a helpful option for dealing with the increasingly complex risk factors of PEP in an integrated manner. The development of PEP prediction models has been reported, with fu","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"373-375"},"PeriodicalIF":5.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694565","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":"Guidelines for endoscopic management of nonvariceal upper gastrointestinal bleeding (second edition)","authors":"Mitsuhiro Fujishiro,&nbsp;Mikitaka Iguchi,&nbsp;Satoshi Ono,&nbsp;Kohei Funasaka,&nbsp;Yasuhisa Sakata,&nbsp;Tatsuya Mikami,&nbsp;Mikinori Kataoka,&nbsp;Shunji Shimaoka,&nbsp;Tomoki Michida,&nbsp;Yoshinori Igarashi,&nbsp;Shinji Tanaka","doi":"10.1111/den.15019","DOIUrl":"10.1111/den.15019","url":null,"abstract":"<p>The Japan Gastroenterological Endoscopy Society has prepared Guidelines for Endoscopic Practice in Nonvariceal Upper Gastrointestinal Bleeding as part of the initiative to develop evidence-based endoscopic practice guidelines. Hemorrhagic gastroduodenal (peptic) ulcers are the primary cause of nonvariceal upper gastrointestinal bleeding. With the advent of a super-aged society, the cases caused by <i>Helicobacter pylori</i> are on the decline, whereas those caused by drugs (e.g. aspirin) have been increasing. Endoscopic hemostasis is currently the first-line treatment for nonvariceal upper gastrointestinal bleeding, and various methods have been devised for this purpose. It is recommended to stabilize the vital signs of the patient before and after endoscopic hemostasis with appropriate management based on an assessment of the severity of illness, in addition to the administration of acid secretion inhibitors. These guidelines describe the evaluation and initial treatment of nonvariceal upper gastrointestinal bleeding, as well as the selection of endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding and its management after endoscopic hemostasis. This is achieved by classifying nonvariceal upper gastrointestinal bleeding into two main categories, namely, peptic ulcer and other types of gastrointestinal bleeding. We prepared statements for any available literature with supporting evidence, including the levels of evidence and recommendations. New evidence has been pooled since the publication of the first edition in this area; however, the levels of evidence and recommendations mostly remain low.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"447-469"},"PeriodicalIF":5.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671741","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":"Submucosal marking peroral endoscopic myotomy: Novel method of peroral endoscopic myotomy","authors":"Hideomi Tomida,&nbsp;Yoshiou Ikeda,&nbsp;Yoichi Hiasa","doi":"10.1111/den.15018","DOIUrl":"10.1111/den.15018","url":null,"abstract":"<p>Watch a video of this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 7","pages":"792-794"},"PeriodicalIF":5.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671744","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":"Development and validation of a risk score for incomplete resection during endoscopic papillectomy: PANETH score","authors":"Cecilia Binda,&nbsp;Antonio Facciorusso,&nbsp;Stefano Fabbri,&nbsp;Massimiliano Mutignani,&nbsp;Andrea Tringali,&nbsp;Roberto Di Mitri,&nbsp;Alessandro Fugazza,&nbsp;Romano Sassatelli,&nbsp;Armando Gabbrielli,&nbsp;Paolo Giorgio Arcidiacono,&nbsp;Francesco Maria Di Matteo,&nbsp;Chiara Coluccio,&nbsp;Marco Di Marco,&nbsp;Cristiano Spada,&nbsp;Alberto Fantin,&nbsp;Claudio De Angelis,&nbsp;Raffaele Macchiarelli,&nbsp;Francesco Perri,&nbsp;Mauro Manno,&nbsp;Luigi Cugia,&nbsp;Alessandro Mussetto,&nbsp;Alessandro Repici,&nbsp;Ilaria Tarantino,&nbsp;Andrea Anderloni,&nbsp;Carlo Fabbri,&nbsp;i-EUS group","doi":"10.1111/den.15005","DOIUrl":"10.1111/den.15005","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic papillectomy (EP) is the gold standard treatment for ampullary adenomas. However, EP is still burdened by a nonnegligible rate of incomplete resections (IR). Different predictors have been linked to higher rates of IR, but the interaction between these factors is still unclear. The aim of the study was to develop a scoring system (hereby called PANETH score) able to quantify the risk of IR after EP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent EP in 19 Italian centers in 2016–2021 were included. IR was defined as the presence of residual tumor in lateral or endoampullary margins after EP. Predictors for IR were analyzed by logistic regression and were used to obtain an easy-to-use numeric score. The performance of the model was evaluated with a receiver operating characteristic curve analysis and tested by means of 10-fold cross-validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 430 patients were included. On multivariate analysis, laterally spreading tumor (odds ratio [OR] 5.81, 3.21–7.65; <i>P</i> = 0.02), intraductal extension (OR 6.92, 3.33–9.87; <i>P</i> &lt; 0.0001), and bile duct dilation (OR 2.61, 1.22–4.32; <i>P</i> = 0.004) were significant predictors of IR. The score was calculated by the sum of regression coefficients of each predictor. A ≥3 score indicated a 4-fold risk of IR (<i>P</i> &lt; 0.0001). The internal validation resulted in an area under the curve of 0.83 and an overall error rate of 0.11.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The proposed PANETH score may represent a reliable and easily applicable tool to predict the risk of IR after EP to optimize patient selection and risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 7","pages":"749-757"},"PeriodicalIF":5.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671738","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}