Digestive Endoscopy最新文献

{"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}

{"title":"“Cold-water” immersion endoscopic resection: Novel therapeutic technique for nonampullary duodenal lesions","authors":"Yuya Asada,&nbsp;Shunsuke Yoshii,&nbsp;Ryu Ishihara","doi":"10.1111/den.14831","DOIUrl":"10.1111/den.14831","url":null,"abstract":"<p>Underwater conditions have recently been used during duodenal endoscopic treatment<span>¹</span>; however, peristalsis remains a problem. Although antispasmodic medications can be administered, their effects are sometimes inefficient. Contraindications of butylscopolamine include glaucoma, arrhythmia, and prostatic hypertrophy, and glucagon is associated with the development of diabetes mellitus. The cooling effect of cold water was reported to suppress peristalsis in the esophagus and large intestine via the activation of temperature-sensitive ion channels.<span>^{2, 3}</span> This report presents two patients with nonampullary duodenal lesions with severe peristalsis who were successfully resected using underwater endoscopic mucosal resection with cold water (CW-UEMR) (Video S1). A 75-year-old man had a protruding lesion at the superior duodenal angle with a diameter of 4 mm (Fig. 1a–c). A 54-year-old man had a 10 mm tubular adenoma in the descending duodenum (Fig. 1d–f). In both patients, endoscopic resection via UEMR was attempted using room-temperature saline. However, stable visualization could not be maintained because of severe peristalsis, even after the intravenous administration of glucagon. Thereafter, 60 mL of saline cooled to ~0°C (in ice water) was applied using an endoscopic channel (Fig. 2). The peristalsis was suppressed, and en bloc resection was achieved in a stable visual field within a few minutes. Neither patient experienced adverse events. As the underwater intraluminal pressure is low and the duodenal lumen is narrow, maintaining the visual field is difficult during underwater endoscopic procedures, especially in patients with severe peristalsis. Although the optimal approach to achieving the cooling effect may remain unclear, and caution may be required regarding hypothermia when using large amounts of cold water, CW-UEMR is an easy-to-use technique that is inexpensive and requires no special devices. In addition, UEMR with room-temperature saline can easily be converted to CW-UEMR as necessary. This novel technique is useful during endoscopic resection.</p><p>Author R.I. has received honoraria for lectures from Olympus Corporation, FUJIFILM Medical Co., Ltd, Daiichi Sankyo Co., Ltd, Miyarisan Pharmaceutical Co., Ltd, AI Medical Service Inc., AstraZeneca, and Ono Pharmaceutical Co., Ltd. The other authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 8","pages":"953-954"},"PeriodicalIF":5.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14831","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312421","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":"TOKYO criteria 2024 for the assessment of clinical outcomes of endoscopic biliary drainage","authors":"Hiroyuki Isayama,&nbsp;Tsuyoshi Hamada,&nbsp;Toshio Fujisawa,&nbsp;Mitsuharu Fukasawa,&nbsp;Kazuo Hara,&nbsp;Atsushi Irisawa,&nbsp;Shigeto Ishii,&nbsp;Ken Ito,&nbsp;Takao Itoi,&nbsp;Yoshihide Kanno,&nbsp;Akio Katanuma,&nbsp;Hironari Kato,&nbsp;Hiroshi Kawakami,&nbsp;Hirofumi Kawamoto,&nbsp;Masayuki Kitano,&nbsp;Hirofumi Kogure,&nbsp;Saburo Matsubara,&nbsp;Tsuyoshi Mukai,&nbsp;Itaru Naitoh,&nbsp;Takeshi Ogura,&nbsp;Shomei Ryozawa,&nbsp;Takashi Sasaki,&nbsp;Masaaki Shimatani,&nbsp;Hideyuki Shiomi,&nbsp;Kazuya Sugimori,&nbsp;Mamoru Takenaka,&nbsp;Ichiro Yasuda,&nbsp;Yousuke Nakai,&nbsp;Naotaka Fujita,&nbsp;Kazuo Inui,&nbsp;the Research Group of Evaluation Criteria for Endoscopic Biliary Drainage","doi":"10.1111/den.14825","DOIUrl":"10.1111/den.14825","url":null,"abstract":"<p>The consensus-based TOKYO criteria were proposed as a standardized reporting system for endoscopic transpapillary biliary drainage. The primary objective was to address issues arising from the inconsistent reporting of stent outcomes across studies, which has complicated the comparability and interpretation of study results. However, the original TOKYO criteria were not readily applicable to recent modalities of endoscopic biliary drainage such as biliary drainage based on endoscopic ultrasound or device-assisted endoscopy. There are increasing opportunities for managing hilar biliary obstruction and benign biliary strictures through endoscopic drainage. Biliary ablation has been introduced to manage benign and malignant biliary strictures. In addition, the prolonged survival times of cancer patients have increased the importance of evaluating overall outcomes during the period requiring endoscopic biliary drainage rather than solely focusing on the patency of the initial stent. Recognizing these unmet needs, a committee has been established within the Japan Gastroenterological Endoscopy Society to revise the TOKYO criteria for current clinical practice. The revised criteria propose not only common reporting items for endoscopic biliary drainage overall, but also items specific to various conditions and interventions. The term “stent-demanding time” has been defined to encompass the entire duration of endoscopic biliary drainage, during which the overall stent-related outcomes are evaluated. The revised TOKYO criteria 2024 are expected to facilitate the design and reporting of clinical studies, providing a goal-oriented approach to the evaluation of endoscopic biliary drainage.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1195-1210"},"PeriodicalIF":5.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14825","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285560","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":"Scoring system for prediction of mortality after endoscopic ligation in esophageal variceal bleeding","authors":"Yoshihiro Furuichi,&nbsp;Ryohei Nishiguchi,&nbsp;Koichiro Sato","doi":"10.1111/den.14822","DOIUrl":"10.1111/den.14822","url":null,"abstract":"&lt;p&gt;Liver cirrhosis (LC) is the final stage of chronic liver disease. It is classified as compensated or decompensated cirrhosis based on the presence or absence of jaundice, ascites, encephalopathy, and gastrointestinal bleeding including esophageal varices (EVs). The transition rate from the asymptomatic compensatory period to the symptomatic decompensated period has been reported to be 5–7%/year and ascites is often an early symptom of decompensation. Portal hypertension (PH) is defined as the clinical state in which portal pressure is elevated due to some etiology. Moreover, clinically significant portal hypertension (CSPH) is defined as a decompensated LC state, and the diagnostic criterion is the hepatic venous pressure gradient (HVPG) ≥10 mmHg. Furthermore, severe PH, defined as an HVPG ≥12 mmHg, is a risk factor for EVs bleeding.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; EVs bleeding is a major concern in patients with LC that constitutes a serious decompensating event with high mortality.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; It is very important to decrease the recurrence rate of EVs in patients with LC, because liver transplantation is limited in Japan compared with that in Western countries. Endoscopic variceal ligation (EVL) is the standard method for the treatment of EVs bleeding. However, complications such as liver failure, renal failure, infection, and rebleeding may occur after EVL. The incidence of rebleeding is about 60%&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; and the in-hospital mortality rate is reported as between 15% and 20%.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;For predicting mortality, HVPG measurement is also a helpful technique, but this measurement is invasive and requires the clinical experience of a physician. Recently, the usefulness of liver or spleen stiffness measured by transient elastography (TE) is often reported,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; and CSPH is highly suspected when TE in the liver is &gt;15 kPa.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In the Baveno VII workshop consensus, it is also stated that splenic TE ≥50 kPa has the risk of CSPH and splenic TE ≤40 kPa is a low probability of high-risk varices.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; However, TE is expensive ultrasonography and not widely used in general hospitals. Against this background, as a method to easily determine prognosis from blood examination results, Xavier &lt;i&gt;et al&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; showed that the albumin–bilirubin index was a good predictor of mortality during hospitalization or within 30 days (area under the curve 0.81, &lt;i&gt;P&lt;/i&gt; &lt; 0.01) in 111 patients with LC complicated with acute upper gastrointestinal bleeding. International guidelines, such as the Baveno VII workshop consensus, on managing variceal bleeding, recommend using prognostic scores like the Child–Pugh and Model for End-stage Liver Disease (MELD).&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; In these guidelines, Child–Pugh class C and MELD score ≥18 are defined as risk factors for rebleeding. However, unfortunately, these scores do not specifically fo","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1115-1117"},"PeriodicalIF":5.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14822","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263413","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 EsophyX2.0 and MUSE systems for transoral incisionless fundoplication: Technical aspects and outcomes up to 3 years","authors":"Sabrina Gloria Giulia Testoni,&nbsp;Giuseppe Pantaleo,&nbsp;Federico Contu,&nbsp;Francesco Azzolini,&nbsp;Lorella Fanti,&nbsp;Pier Alberto Testoni","doi":"10.1111/den.14810","DOIUrl":"10.1111/den.14810","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We compared the efficacy and safety of transoral incisionless fundoplication (TIF) with the EsophyX2.0 and MUSE systems for treatment of gastroesophageal reflux disease (GERD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>TIF outcomes from prospective protocols (Esophy2.0X: 2007–2012; MUSE: 2015–2019) were retrospectively compared regarding technical success, moderate/severe adverse events, morpho-functional findings up to 1 year, and clinical outcomes up to 3 years. Inclusion criteria were: (i) at least 6-month symptomatic GERD, full/partial response to proton pump inhibitors (PPI), esophagitis, and nonerosive reflux disease/hypersensitive esophagus (both protocols); (ii) hiatal hernia &lt;3 cm (Esophy2.0X) and ≤2.5 cm (MUSE); and (iii) Barrett's esophagus &lt;3 cm (MUSE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the 50 EsophyX2.0 and 46 MUSE procedures, technical success and adverse event rates were similar, but MUSE-related adverse events (4.4%) were life-threatening. At 12 months, hiatal hernia recurred more frequently after EsophyX2.0 (<i>P</i> = 0.008). At 6 months, significantly fewer total and acid refluxes were reported after both TIF, but not more significantly at 1 year. Symptoms improved after both TIF up to 1 year (<i>P</i> &lt; 0.0001), but to a greater extent in MUSE patients up to 3 years (<i>P</i> &lt; 0.0001 vs. <i>P</i> &lt; 0.01 for EsophyX2.0). The rates of 3-year off-PPI therapy patients were 73.5% in the MUSE and 53.3% in the EsophyX2.0 series (<i>P</i> = 0.069).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although no conclusion could be drawn from this limited study, the MUSE technique seemed more effective in the long term in patients with hiatal hernia; however, there were more severe adverse events than with EsophyX2.0.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1232-1244"},"PeriodicalIF":5.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14810","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141179880","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}