Digestive Endoscopy最新文献

{"title":"Smartphone application for artificial intelligence-based evaluation of stool state during bowel preparation before colonoscopy","authors":"Atsushi Inaba,&nbsp;Kensuke Shinmura,&nbsp;Hiroki Matsuzaki,&nbsp;Nobuyoshi Takeshita,&nbsp;Masashi Wakabayashi,&nbsp;Hironori Sunakawa,&nbsp;Keiichiro Nakajo,&nbsp;Tatsuro Murano,&nbsp;Tomohiro Kadota,&nbsp;Hiroaki Ikematsu,&nbsp;Tomonori Yano","doi":"10.1111/den.14827","DOIUrl":"10.1111/den.14827","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Colonoscopy (CS) is an important screening method for the early detection and removal of precancerous lesions. The stool state during bowel preparation (BP) should be properly evaluated to perform CS with sufficient quality. This study aimed to develop a smartphone application (app) with an artificial intelligence (AI) model for stool state evaluation during BP and to investigate whether the use of the app could maintain an adequate quality of CS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>First, stool images were collected in our hospital to develop the AI model and were categorized into grade 1 (solid or muddy stools), grade 2 (cloudy watery stools), and grade 3 (clear watery stools). The AI model for stool state evaluation (grades 1–3) was constructed and internally verified using the cross-validation method. Second, a prospective study was conducted on the quality of CS using the app in our hospital. The primary end-point was the proportion of patients who achieved Boston Bowel Preparation Scale (BBPS) ≥6 among those who successfully used the app.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The AI model showed mean accuracy rates of 90.2%, 65.0%, and 89.3 for grades 1, 2, and 3, respectively. The prospective study enrolled 106 patients and revealed that 99.0% (95% confidence interval 95.3–99.9%) of patients achieved a BBPS ≥6.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The proportion of patients with BBPS ≥6 during CS using the developed app exceeded the set expected value. This app could contribute to the performance of high-quality CS in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1338-1346"},"PeriodicalIF":5.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141510844","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":"Comparative clinical feasibility of antireflux mucosectomy and antireflux mucosal ablation in the management of gastroesophageal reflux disease: Retrospective cohort study","authors":"Ah Young Lee,&nbsp;Seong Hwan Kim,&nbsp;Joo Young Cho","doi":"10.1111/den.14832","DOIUrl":"10.1111/den.14832","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>No definitive treatment has been established for refractory gastroesophageal reflux disease (GERD). Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) using argon plasma coagulation are promising methods. However, no study has compared these two. This study compared the efficacy and safety of the two procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter, retrospective, observational study included 274 patients; 96 and 178 patients underwent ARMA and ARMS, respectively. The primary outcome was subjective symptom improvement based on GERD questionnaire (GERDQ) scores. The secondary outcomes included changes in the presence of Barrett's esophagus, Los Angeles grade for reflux esophagitis, flap valve grade, and proton pump inhibitor withdrawal rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The ARMS group had higher baseline GERDQ scores (10.0 vs. 8.0, <i>P</i> &lt; 0.001) and a greater median postprocedure improvement than the ARMA group (4.0 vs. 2.0, <i>P</i> = 0.002), and even after propensity score matching adjustment, these findings remained. ARMS significantly improved reflux esophagitis compared with ARMA, with notable changes in Los Angeles grade (<i>P</i> &lt; 0.001) and flap valve grade scores (<i>P</i> &lt; 0.001). Improvement in Barrett's esophagus was comparable between the groups (<i>P</i> = 0.337), with resolution rates of 94.7% and 77.8% in the ARMS and ARMA groups, respectively. Compared with the ARMA group, the ARMS group experienced higher bleeding rates (<i>P</i> = 0.034), comparable stricture rates (<i>P</i> = 0.957), and more proton pump inhibitor withdrawals (<i>P</i> = 0.008).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both ARMS and ARMA showed improvements in GERDQ scores, endoscopic esophagitis, flap valve grade, and the presence of Barrett's esophagus after the procedures. However, ARMS demonstrated better outcomes than ARMA in terms of both subjective and objective indicators.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1328-1337"},"PeriodicalIF":5.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141530278","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":"Effective use of the two-devices-in-one-channel technique for stent exchange following endoscopic ultrasound-guided hepaticogastrostomy","authors":"Yasuhiro Kuraishi,&nbsp;Ichitaro Horiuchi,&nbsp;Akira Nakamura","doi":"10.1111/den.14875","DOIUrl":"10.1111/den.14875","url":null,"abstract":"<p>Plastic stent (PS) exchange after endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is considered a routine procedure. However, when biliary access through the existing fistula is lost, additional fistuloplasty is required to restore drainage. Guidewire insertion alongside the existing PS before removal is therefore recommended to maintain access and prevent this complication.<span>¹</span> The two-devices-in-one-channel technique is effective for trans-papillary biliary cannulation, particularly in cases involving juxtapapillary diverticulum.<span>^{2, 3}</span> We recently employed this approach in a challenging case of PS exchange post-EUS-HGS.</p><p>A 70-year-old man suffered acute cholangitis from choledochojejunal anastomotic stricture after extended cholecystectomy. Initial biliary drainage using balloon-assisted endoscopy failed because the scope could not reach the anastomosis, and percutaneous trans-hepatic biliary drainage (PTBD) was subsequently performed. To internalize biliary drainage, EUS-HGS was conducted by placing a 7F PS (ThroughPass TYPE IT; Gadelius Medical, Tokyo, Japan) into the left intrahepatic bile duct to remove the PTBD tube (Fig. 1). During the scheduled PS exchange using a duodenoscope (TJF-Q290V; Olympus, Tokyo, Japan), however, guidewire insertion into the bile duct alongside the stent proved challenging. The scope's position was distant from the fistula despite various manipulations, including air aspiration, and the steep downward angle of the PS further complicated guidewire insertion. We employed the two-devices-in-one-channel technique, inserting a tapered catheter (PR-110Q-1; Olympus) loaded with a 0.025 inch guidewire along with small biopsy forceps (FB45Q-1; Olympus) into the same scope channel (Fig. 2). The forceps grasped the proximal PS flange and pulled it towards the scope, allowing the scope to be positioned closer to the fistula and aligning the fistula axis with the catheter. This approach enabled successful guidewire insertion into the bile duct alongside the stent. After removing the existing PS and balloon dilating the anastomosis, a new PS was successfully placed (Video S1). The two-devices-in-one-channel technique demonstrated effectiveness in overcoming a significant challenge associated with PS exchange post-EUS-HGS.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 9","pages":"1056-1058"},"PeriodicalIF":5.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14875","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141510785","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":"Successful endoscopic retrieval of migrated biliary plastic stent via hepaticogastrostomy route using uneven double-lumen catheter and stent retriever","authors":"Shingo Hirai,&nbsp;Yoshinobu Okabe,&nbsp;Shinichiro Yoshioka","doi":"10.1111/den.14868","DOIUrl":"10.1111/den.14868","url":null,"abstract":"<p>Our patient was an 80-year-old man with dementia and a history of distal gastrectomy and Roux-en-Y reconstruction after gastric cancer. He developed cholangitis due to common bile duct stones for which transpapillary endoscopic treatment using short single-balloon enteroscopy was unsuccessful. Managing percutaneous transhepatic biliary drainage was difficult; therefore, we chose endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS). A guidewire (0.025 inch GW) tip was advanced into the duodenum via the HGS route, and the straight-type plastic stent (PS) migrated during its antegrade placement. Another antegrade straight-type PS (7F, 10 cm) was placed across the papilla, and a tapered tip and 4-fold-flanged single-pigtail bile duct stent for EUS inferior drainage<span>¹</span> (7F, 14 cm) were placed via the EUS-HGS route, and the cholangitis improved. At the family's request, the migrated PS was followed. Eleven months later, the patient developed acute cholangitis due to the PS obstruction. The obstructed stray PS causing cholangitis was to be retrieved by the HGS route (Video S1).<span>²</span> The GW was placed in the bile duct via the HGS route and the inside stent with thread was removed. Next, we attempted to retrieve the migrated PS using grasping and basket forceps via the same route; however, capturing the PS was extremely difficult (Fig. 1a). After the PS was moved to the papillary side using a balloon catheter, an uneven double-lumen catheter was placed in the bile duct via the HGS route and the GW was successfully inserted into the lumen of the migrated PS through the side hole of the catheter (Fig. 1b). Thereafter, we successfully recovered the PS using a Soehendra stent retriever (Cook Medical, Bloomington, IN) (Fig. 1c). Although it is often difficult to retrieve a migrated stent via the HGS route, the combined use of an uneven catheter and the Soehendra stent retriever<span>³</span> was successful in this case (Fig. 2).</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 8","pages":"959-960"},"PeriodicalIF":5.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14868","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422081","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":"Controversies in endoscopic ultrasonography-guided management of walled-off necrosis","authors":"Yousuke Nakai,&nbsp;Tomotaka Saito,&nbsp;Tsuyoshi Hamada,&nbsp;Tatsuya Sato,&nbsp;Ryunosuke Hakuta,&nbsp;Naminatsu Takahara,&nbsp;Hiroyuki Isayama,&nbsp;Ichiro Yasuda,&nbsp;Mitsuhiro Fujishiro","doi":"10.1111/den.14869","DOIUrl":"10.1111/den.14869","url":null,"abstract":"<p>Walled-off necrosis (WON) develops as local complications after acute necrotizing pancreatitis. Although less invasive interventions such as endoscopic ultrasonography (EUS)-guided drainage and endoscopic necrosectomy are selected over surgical interventions, delayed and step-up interventions are still preferred to avoid procedure-related adverse events. However, there is a controversy about the appropriate timing of drainage and subsequent necrosectomy. The advent of large-caliber lumen-apposing metal stents has also brought about potential advantages of proactive interventions, which still needs investigation in future trials. When step-up interventions of necrosectomy and additional drainage are necessary, a structured or protocoled approach for WON has been reported to improve safety and effectiveness of endoscopic and/or percutaneous treatment, but has not been standardized yet. Finally, long-term outcomes such as recurrence of WON, pancreatic endocrine, and exocrine function are increasingly investigated in association with disconnected pancreatic duct syndrome. In this review we discuss current evidence and controversy on EUS-guided management of WON.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"29-39"},"PeriodicalIF":5.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14869","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422079","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":"Scissor-assisted vs. conventional endoscopic submucosal dissection for colorectal lesions: Systematic review and meta-analysis","authors":"Pedro Henrique Veras Ayres da Silva,&nbsp;Angelo So Taa Kum,&nbsp;Igor Logetto Caetité Gomes,&nbsp;Nelson Tomio Miyajima,&nbsp;Alexandre Moraes Bestetti,&nbsp;Diego Paul Cadena Aguirre,&nbsp;Megui Marilia Mansilla Gallegos,&nbsp;Hiram Menezes Nascimento Filho,&nbsp;Igor Valdeir Gomes de Sousa,&nbsp;Wanderley Marques Bernardo,&nbsp;Eduardo Guimarães Hourneaux de Moura","doi":"10.1111/den.14829","DOIUrl":"10.1111/den.14829","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Colorectal endoscopic submucosal dissection (ESD) is a technically complex procedure. The scissor knife mechanism may potentially provide easier and safer colorectal ESD. The aim of this meta-analysis is to evaluate the efficacy and safety of scissor-assisted vs. conventional ESD for colorectal lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A search strategy was conducted in MEDLINE, Embase, and Lilacs databases from January 1990 to November 2023 according to PRISMA guidelines. Fixed and random-effects models were used for statistical analysis. Heterogeneity was assessed using <i>I</i>² test. Risk of bias was assessed using the ROBINS-I and RoB-2 tools. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of five studies (three retrospective and two randomized controlled trials, including a total of 1575 colorectal ESD) were selected. The intraoperative perforation rate was statistically lower (risk difference [RD] −0.02; 95% confidence interval [CI] −0.04 to −0.01; <i>P</i> = 0.001; <i>I</i>² = 0%) and the self-completion rate was statistically higher (RD 0.14; 95% CI 0.06, 0.23; <i>P</i> = 0.0006; <i>I</i>² = 0%) in the scissor-assisted group compared with the conventional ESD group. There was no statistical difference in R0 resection rate, en bloc resection rate, mean procedure time, or delayed bleeding rate between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Scissor knife-assisted ESD is as effective as conventional knife-assisted ESD for colorectal lesions with lower intraoperative perforation rate and a higher self-completion rate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1213-1224"},"PeriodicalIF":5.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422080","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":"WEO Newsletter: Strategies for effective endoscopic closure of gastrointestinal defects","authors":"","doi":"10.1111/den.14858","DOIUrl":"10.1111/den.14858","url":null,"abstract":"&lt;p&gt;Gaurav Kakked MD and Christopher G. Chapman MD&lt;/p&gt;&lt;p&gt;Endoscopic techniques have advanced significantly, offering new avenues for treating gastrointestinal defects ranging from full-thickness perforations to more superficial lesions. Effective management of these defects is crucial to prevent complications and improve patient outcomes. This article provides a guide on the strategies and considerations necessary for successful endoscopic closure of gastrointestinal defects.&lt;/p&gt;&lt;p&gt;The first step in managing gastrointestinal defects is to clearly define the type of defect being treated:&lt;/p&gt;&lt;p&gt;• Full-thickness defects, such as acute perforations, postoperative leaks, and fistulas, involve all layers of the gastrointestinal wall (Figure 1A–C). Full-thickness defects are “higher stakes” as they permit spillage of gastrointestinal contents into the sterile abdominal cavity, leading to peritonitis, abscesses, and potential septic complications. Full-thickness defects tend to be complex and their closure requires a multidisciplinary approach including nutritional support, infection control and, potentially, surgical, endoscopic, or radiological intervention.&lt;/p&gt;&lt;p&gt;• Non-full-thickness defects include endoscopic resection defects and submucosal incisions. These tend to be “lower stakes” as they remain sterile, but successful closure is important to prevent delayed complications such as perforation or bleeding.&lt;/p&gt;&lt;p&gt;Differentiating between these two types of defect is crucial as it dictates the risk/benefit profile, approach, tools, and techniques used during the closure process.&lt;/p&gt;&lt;p&gt;The anatomical location and size of the defect significantly affects the approach and can determine what devices will be appropriate for use. If a defect is in a hard-to-reach area, such as the proximal esophagus, gastric fundus, duodenum/jejunum, or right colon, then through-the-scope (TTS) approaches might be the only available option. Recent advances have introduced TTS suture-based devices that allow for deep submucosal and intramuscular fixation, expanding the possibilities for effective closure even in difficult-to-reach areas.&lt;/p&gt;&lt;p&gt;If a defect is smaller in size, even if it is full thickness such as an acute perforation, then TTS or over-the-scope (OTS) clipping may be sufficient. While closure of larger-size defects (&gt;2–3 cm) can be attempted with multiple TTS clips, we are quick to consider endoscopic suturing (TTS or OTS) and/or stent placement.&lt;/p&gt;&lt;p&gt;Another point to bear in mind is that acute perforation can be one of the full-thickness defects most amenable to closure because of the presence of healthy tissue at the margin of the defect. Thus, the “clock is ticking” after an acute perforation and emergent endoscopy is necessary to attempt closure while the adjacent tissue is still healthy. However, leaks and fistulas tend to be complex with unhealthy (fibrotic or inflamed) tissue; thus direct endoscopic closure techniques are often ineffective, and transit","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 6","pages":"751-755"},"PeriodicalIF":5.3,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14858","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141401389","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":"Effect of bowel preparation completion time on bowel cleansing efficacy: Prospective randomized controlled trial of different bowel preparation completion times precolonoscopy","authors":"Hye Min Kim,&nbsp;Hyo Suk Kim,&nbsp;Young Eun An,&nbsp;Jae Hyuck Chang,&nbsp;Tae Ho Kim,&nbsp;Chang Whan Kim,&nbsp;Tae-Geun Gweon","doi":"10.1111/den.14830","DOIUrl":"10.1111/den.14830","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The elapse time between the completion of bowel cleansing and colonoscopy is one of the important factors for proper bowel cleansing. Although several studies have reported that a short time interval resulted in a favorable bowel cleansing, no randomized controlled trial (RCT) has been conducted to determine the effect of the elapse time. Consequently, we performed an RCT to investigate the efficacy of bowel preparation of participants who underwent colonoscopy according to the different time intervals between the completion of bowel preparation and colonoscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this single-center RCT, study participants were randomized to complete bowel preparation either 2–4 h or 4–8 h before colonoscopy. The primary end-point was successful bowel preparation, rated using the Boston Bowel Preparation Scale (BBPS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 504 individuals were included (2–4 h, 255; 4–8 h, 249). The rate of successful bowel preparation in the 2–4 h group showed noninferiority compared with that of the 4–8 h group (97.6% vs. 95.2%; rate difference, 2.5% [−0.8% to 5.7%]; <i>P</i>_{for noninferiority} <i>&lt;</i> 0.001, <i>P</i>_{for superiority} = 0.136). The rate for perfect cleansing (a BBPS score of 9) was higher in the 2–4 h group (56.5% vs. 39.8%, <i>P</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>When bowel cleansing was finished 2–4 h before the start of colonoscopy, the overall bowel cleansing was noninferior, and perfect cleansing was superior, compared to that when cleansing was finished 4–8 h before colonoscopy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1347-1354"},"PeriodicalIF":5.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319160","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":"Novel three-traction strings device with endoscopic submucosal dissection for the removal of a large rectal sessile serrated adenoma","authors":"Su-zhu Zhu,&nbsp;Ben-hua Wu,&nbsp;De-feng Li","doi":"10.1111/den.14859","DOIUrl":"10.1111/den.14859","url":null,"abstract":"<p>A 65-year-old woman presented with a large rectal laterally spreading tumor (4 × 5 cm) (Fig. 1A). Endoscopic submucosal dissection (ESD) was proposed to remove the lesion. Herein we present a novel three-traction strings device aiding in the ESD procedure (Video S1). This traction device included one central rubber ring and three subsidiary rubber rings obtained from a rubber glove, while the three subsidiary rubber rings were attached with the central rubber ring (Video S1 and Fig. 1B). After submucosal injection and a circumferential mucosal incision was completed, the middle subsidiary rubber ring was fixed at the anal side of the lesion, while the remaining two subsidiary rubber rings were fixed at both lateral sides of the lesion using a reopenable clip (Anrei, Zhejiang, China) (Fig. 1C). The central rubber ring extended beyond the oral side of the lesion, and was fixed at the upstream colonic wall (Fig. 1C). The traction device provided adequate visual field during the entire procedure by colonic air insufflation and inhalation-sustaining traction force (Fig. 1D–G). Consequently, the lesion was removed en bloc without complication (Fig. 1H). The operation duration was about 45 min. Histopathologic findings revealed tubule-villous adenoma with high-grade intraepithelial neoplasia (Fig. 1I).</p><p>It is challenging in ESD to remove the large colorectal lesion due to not being capable to maintain good visibility.<span>¹</span> Traction techniques have been reported to assist the ESD procedure.<span>^2-5</span> Compared with other traction devices, this traction device has some advantages. First, it is easily obtained and manipulated. Second, it is low cost. Third, it maintains a triangular structure during the entire procedure, which is more stable for mechanical principles (Fig. 2). An imperfection is needed to distinguish central rubber ring and subsidiary rubber rings carefully due to their same color. Therefore, we will improve it with different colors between the central rubber ring and subsidiary rubber rings.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 8","pages":"957-958"},"PeriodicalIF":5.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14859","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312423","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":"Advancements in minimally invasive endoscopic treatment: Navigating deeper layers for upper gastrointestinal lesion","authors":"Yuto Shimamura,&nbsp;Haruhiro Inoue,&nbsp;Kazuki Yamamoto,&nbsp;Kaori Owada,&nbsp;Ippei Tanaka","doi":"10.1111/den.14828","DOIUrl":"10.1111/den.14828","url":null,"abstract":"<p>The field of minimally invasive endoscopic treatment has seen a continual progression, marked by significant advancements in treatment devices and the refinement of endoscopic techniques. While endoscopic resection has become the standard for treating superficial gastrointestinal neoplasms, a proactive approach becomes imperative when dealing with lesions that extend beyond the submucosal layer and deeper into the muscularis propria. The ongoing evolution of endoscopic closure techniques has facilitated the introduction of advanced procedures such as endoscopic muscularis dissection, endoscopic subserosal dissection, and endoscopic full-thickness resection. This evolution is achieved by the commitment to improve the efficacy and precision in treating challenging lesions. Nevertheless, there is currently a lack of definitive guidelines or consensus regarding the specifics of deeper layer dissection. Drawing from prior research and clinical insights, this review discusses indications, techniques, clinical outcomes, and future perspectives of deeper layer dissection.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1094-1104"},"PeriodicalIF":5.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14828","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312422","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}