World Journal of Gastrointestinal Endoscopy最新文献

{"title":"Endoscopic removal of an embedded chicken bone in the esophagus: A case report.","authors":"Qi Luo, Lin Tang, Lian-Song Ye, Zhi-Jie Jiang, Yi Mou, Bing Hu","doi":"10.4253/wjge.v17.i2.102501","DOIUrl":"10.4253/wjge.v17.i2.102501","url":null,"abstract":"<p><strong>Background: </strong>Sharp foreign body ingestion can cause gastrointestinal tract mucosa injury and requires proper endoscopic removal. Typically, protective devices are used to reduce mucosal damage. This case presents an alternative approach for the endoscopic removal of a large, irregular, and sharp foreign body (chicken bone) when traditional protective devices are inadequate, thus contributing to the management of such ingestions.</p><p><strong>Case summary: </strong>A 57-year-old male presented with a history of swallowing an irregular and sharp-pointed chicken bone. Emergent endoscopy showed it was tightly embedded in the esophageal wall, with minor bleeding. The chicken bone was grasped and moved cautiously using a foreign forceps. It was loosened after repeated attempts but could not pass through the pharynx. Considering possible mucosal damage, it was carefully pushed into the stomach cavity and then wrapped in a condom. The chicken bone was retrieved uneventfully by grasping the open edge of the condom with foreign forceps. No additional damage was found, except for primary esophageal injuries caused by the embedded chicken bone. The patient was discharged on the following day. Our experience demonstrated that condoms can be an alternative as a protective device under such conditions.</p><p><strong>Conclusion: </strong>Condoms can serve as an alternative when traditional protective devices are unsuitable. Because of its smooth and oily nature, it can provide mucosal protection and lubrication during endoscopic removal.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 2","pages":"102501"},"PeriodicalIF":1.4,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic ultrasound-guided treatment of isolated gastric varices.","authors":"Khellaf Amalou, Ryma Rekab, Ahlem Belloula, Khadidja Saidani","doi":"10.4253/wjge.v17.i2.100556","DOIUrl":"10.4253/wjge.v17.i2.100556","url":null,"abstract":"<p><p>In this letter we comment on the article by Zhang <i>et al</i> published in the recent issue of the W<i>orld Journal of Gastrointestinal Endoscopy</i> 2024. We focus specifically on the management of gastric varices (GV), which is a significant consequence of portal hypertension, is currently advised to include beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt for secondary prophylaxis or active bleeding. Although it has been studied, direct endoscopic injection of cyanoacrylate glue has limitations, such as the inability to fully characterize GV endoscopically and the potential for distant glue embolism. In order to achieve this, endoscopic ultrasound has been used to support GV characterization, real-time therapy imaging, and Doppler obliteration verification.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 2","pages":"100556"},"PeriodicalIF":1.4,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult juvenile polyp bleeding detected by extravascular contrast leakage and treated with endoscopic clipping: A case report.","authors":"Fumiya Kataoka, Takayuki Nakanishi, Hiroshi Araki, Shoichi Ichino, Makoto Kamei, Hiroyuki Makino, Ryotaro Nagao, Takayuki Asano, Atsushi Tagami, Hisataka Moriwaki","doi":"10.4253/wjge.v17.i2.101135","DOIUrl":"10.4253/wjge.v17.i2.101135","url":null,"abstract":"<p><strong>Background: </strong>Juvenile polyps (JPs) are non-neoplastic polyps. In adults, JPs present with hematochezia in only approximately half the patients and are often found incidentally during endoscopic screening. JPs have no mucosal fascia at the tip, and spontaneous shedding and massive gastrointestinal hemorrhage may occur. Thus, the JP bleeding detected in this case by extravascular contrast leakage on computed tomography scans and treated with endoscopic clipping is rare.</p><p><strong>Case summary: </strong>A previously healthy 31-year-old male patient presented with a 2-day history of bloody stools. Upon hospital arrival, rectal examination revealed fresh blood, and abdominal computed tomography scans showed extravascular contrast leakage from the lower rectum's left-side wall. His blood pressure was slightly low at 104/62 mmHg. However, his pulse rate (69 bpm) and oxygen level (99% on room air) were within normal limits. Emergency endoscopy revealed a pedunculated lesion in the rectum covered by a non-neoplastic mucosal epithelium. No neoplastic lesions were observed at the tip of the polyp; however, pulsatile bleeding was detected at the distal end. We performed endoscopic hemostasis by clipping the stem and then performed a polypectomy above the stem to examine the lesion tissue. Histopathological evaluation revealed a cystically dilated gland without neoplastic lesions. A subsequent total colonoscopy revealed two JPs with characteristic edematous, smooth, and reddish surfaces close to the hemorrhagic lesion. Subsequent histopathological evaluation indicated findings characteristic of JP, such as severe inflammatory cell infiltration of the stroma and cystic dilatation of the glandular ducts.</p><p><strong>Conclusion: </strong>There are no reports of adult JPs presenting with contrast extravasation where endoscopic hemostasis was successful, as in this case.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 2","pages":"101135"},"PeriodicalIF":1.4,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of endoscopic submucosal dissection and transanal endoscopic microsurgery for stage 1 rectal neuroendocrine tumors.","authors":"Jun Weng, Jun Chi, Yan-Hua Lv, Ruo-Bing Chen, Guo-Liang Xu, Xian-Feng Xia, Kun-Hao Bai","doi":"10.4253/wjge.v17.i2.99906","DOIUrl":"10.4253/wjge.v17.i2.99906","url":null,"abstract":"<p><strong>Background: </strong>Stage 1 rectal neuroendocrine tumors (NETs) are best treated with endoscopic submucosal dissection (ESD) or transanal endoscopic microsurgery (TEM) for local resection.</p><p><strong>Aim: </strong>To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs.</p><p><strong>Methods: </strong>This retrospective observational analysis included patients with clinical stage 1 rectal NETs (cT1N0M0, less than 20 mm) who underwent ESD or TEM. The ESD and TEM groups were matched to ensure that they had comparable lesion sizes, lesion locations, and pathological grades. We assessed the differences between groups in terms of <i>en bloc</i> resection rate, R0 resection rate, adverse event rate, recurrence rate, and hospital stay and cost.</p><p><strong>Results: </strong>Totally, 128 Lesions (ESD = 84; TEM = 44) were included, with 58 Lesions within the matched groups (ESD = 29; TEM = 29). Both the ESD and TEM groups had identical <i>en bloc</i> resection (100.0% <i>vs</i> 100.0%, <i>P</i> = 1.000), R0 resection (82.8% <i>vs</i> 96.6%, <i>P</i> = 0.194), adverse event (0.0% <i>vs</i> 6.9%, <i>P</i> = 0.491), and recurrence (0.0% <i>vs</i> 3.4%, <i>P</i> = 1.000) rates. Nevertheless, the median hospital stay [ESD: 5.5 (4.5-6.0) <i>vs</i> TEM: 10.0 (7.0-12.0) days; <i>P</i> < 0.001], and cost [ESD: 11.6 (9.8-12.6) <i>vs</i> TEM: 20.9 (17.0-25.1) kilo-China Yuan, <i>P</i> < 0.001] were remarkably shorter and less for ESD.</p><p><strong>Conclusion: </strong>Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs. ESD exhibits shorter hospital stay and fewer costs than TEM.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 2","pages":"99906"},"PeriodicalIF":1.4,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a predictive model for endoscopic improvement of Crohn's disease.","authors":"Hua-Gang Wang, Cang-La Nima, Qi Zhou","doi":"10.4253/wjge.v17.i2.100665","DOIUrl":"10.4253/wjge.v17.i2.100665","url":null,"abstract":"<p><strong>Background: </strong>At present, there is a lack of non-invasive indicators to evaluate the changes in endoscopic activity between two visits for patients with Crohn's disease (CD).</p><p><strong>Aim: </strong>To develop a model for predicting whether endoscopic activity will improve in CD patients.</p><p><strong>Methods: </strong>This is a single-center retrospective study that included patients diagnosed with CD from January 2014 to December 2022. The patients were randomly divided into a modeling group (70%) and an internal validation group (30%), with an external validation group from January 2023 to March 2024. Univariate and binary logistic regression analyses were conducted to identify independent risk factors, which were used to construct a nomogram model. The model's performance was evaluated using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA). Additionally, further sensitivity analyses were performed.</p><p><strong>Results: </strong>One hundred seventy patients were included in the training group, while 64 were included in the external validation group. A binary logistic stepwise regression analysis revealed that the changes in the amplitudes of albumin (ALB) and fibrinogen (FIB) were independent risk factors for endoscopic improvement. A nomogram model was developed based on these risk factors. The area under the curve of the model for the training group, internal validation group, and external validation group were 0.802, 0.788, and 0.787, respectively. The average absolute errors of the calibration curves were 0.011, 0.016, and 0.018, respectively. DCA indicated that the model performs well in clinical practice. Additionally, sensitivity analysis demonstrated that the model has strong robustness and applicability.</p><p><strong>Conclusion: </strong>Our study shows that changes in the amplitudes of ALB and FIB are effective predictors of endoscopic improvement in patients with CD during follow-up visits compared to their previous ones.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 2","pages":"100665"},"PeriodicalIF":1.4,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of etomidate added to propofol target-controlled infusion in bidirectional endoscopy: A randomized clinical trial.","authors":"Hui-Rong Luo, An-Di Chen, Jing-Fang Lin, Peng Ye, Ying-Jie Chen, Ming-Xue Lin, Pin-Zhong Chen, Xiao-Hui Chen, Xiao-Chun Zheng","doi":"10.4253/wjge.v17.i2.100722","DOIUrl":"10.4253/wjge.v17.i2.100722","url":null,"abstract":"<p><strong>Background: </strong>Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation; however, it frequently leads to cardiovascular adverse events and respiratory depression. Propofol target-controlled infusion (TCI) can provide safe sedation but may require higher dosages of propofol. On the contrary, etomidate offers hemodynamic stability.</p><p><strong>Aim: </strong>To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.</p><p><strong>Methods: </strong>A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups: P, 0.1EP, and 0.15EP. Patients in the P group received propofol TCI only, with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL. Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection, respectively, followed by propofol TCI.</p><p><strong>Results: </strong>Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups (P group: 78 mmHg, 0.1EP group: 82 mmHg, 0.15EP group: 88 mmHg; <i>P</i> < 0.05). Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups (P group: 260.6 mg, 0.1EP group: 228.1 mg, 0.15EP group: 201.2 mg; <i>P</i> < 0.05). The induction time was longer in the P group than in the other groups (P group: 1.9 ± 0.7 minutes, 0.1EP group: 1.2 ± 0.4 minutes, 0.15EP group: 1.1 ± 0.3 minutes; <i>P</i> < 0.01). The recovery time was shorter in the 0.15EP group than in the other groups (P group: 4.8 ± 2.1 minutes, 0.1EP group: 4.5 ± 1.6 minutes, 0.15EP group: 3.9 ± 1.4 minutes; <i>P</i> < 0.01). The incidence of hypotension (P group: 36.4%, 0.1EP group: 29.1%, 0.15EP group: 11.8%; <i>P</i> < 0.01) and injection pain was lower in the 0.15EP group than in the other groups (<i>P</i> < 0.05). Furthermore, the incidence of respiratory depression was lower in the 0.15EP group than in the P group (<i>P</i> < 0.05). Additionally, the satisfaction of the patient, endoscopist, and anesthesiologist was higher in the 0.15EP group than in the other groups (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption, which is followed by fewer cardiovascular adverse events and respiratory depression, along with higher patient, endoscopist, and anesthesiologist satisfaction.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 2","pages":"100722"},"PeriodicalIF":1.4,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic calabash technique for gastric mesenchymal tumours: A low hanging fruit or a novel endoscopic technique?","authors":"David Rea, Caroline Tham, Tony Ck Tham","doi":"10.4253/wjge.v17.i2.101676","DOIUrl":"10.4253/wjge.v17.i2.101676","url":null,"abstract":"<p><p>The term subepithelial lesions encompasses a wide array of pathology of which numerous benign and malignant pathologies are grouped. A subset of these lesions are termed gastric mesenchymal tumours of which some have innate malignant potential. Currently there is various guidance on the recommended approach to the investigation and management of these lesions and there exists multiple methods of resection. Lin <i>et al</i> have developed and proposed a new method of resection of these gastric mesenchymal tumours within the field of endoscopy, a procedure they have termed endoscopic calabash ligation and resection. This editorial aims to outlay the current landscape for gastric mesenchymal tumours with regards to the various guidelines and resection techniques while comparing Lin <i>et al</i>'s new technique to those that are already established in the field of endoscopy. Advancements in endoscopy that maintain or improve patient outcomes compared to the gold standard approach are exciting developments. Lin <i>et al</i>'s study suggests that their technique is comparable in regard to patient outcomes while simultaneously being more efficient in its use of hospital resources including procedural time. Whilst the data and analysis proposed in the study is promising, there are areas that need to be addressed before advocating the procedure for widespread use. However, with further studies and analysis this may be foreseeable in the future.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 2","pages":"101676"},"PeriodicalIF":1.4,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic full-thickness resection of rectal schwannoma: A case report.","authors":"Ying-Jie Zhang, Meng-Xia Yuan, Wu Wen, Yi Jian, Chuan-Ming Zhang, Jing Yuan, Lin He","doi":"10.4253/wjge.v17.i2.102075","DOIUrl":"10.4253/wjge.v17.i2.102075","url":null,"abstract":"<p><strong>Background: </strong>Rectal schwannoma (RS) is a rare subtype of schwannoma that presents diagnostic challenges owing to its clinical rarity. The absence of typical symptoms, specific signs, and distinctive radiographic findings often hinders clinicians from reaching a definitive diagnosis before surgical intervention. Herein, we report a case of RS who underwent complete resection through endoscopic full-thickness resection (EFTR) and discuss the clinical, imaging, and pathological features for differential diagnosis.</p><p><strong>Case summary: </strong>A 71-year-old Chinese woman presented to our outpatient clinic with a 4-year history of a rectal mucosal mass for a follow-up surveillance colonoscopy. A neurogenic tumor with extraluminal growth was considered based on the imaging findings. Resection was required, and an EFTR was performed. On endoscopic exploration, a smooth surface extruding mass was identified at the rectum. The patient was discharged 48 hours after the operation without infection or bleeding. Based on the pathological and immunohistochemical findings of the resected mass, a rectal benign schwannoma was diagnosed. The patient did not undergo any adjuvant therapy. Nearly one year later, a follow-up surveillance colonoscopy and an abdominal and pelvic plain plus enhancement scan were performed, and no tumor recurrence or metastasis was noted.</p><p><strong>Conclusion: </strong>EFTR is safe and effective for resecting gastrointestinal stromal tumors, especially those with extraluminal growth and no lymph node involvement.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 2","pages":"102075"},"PeriodicalIF":1.4,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leucine-rich alpha-2 glycoprotein as a superior biomarker to C-reactive protein for detecting small bowel lesions in Crohn's disease.","authors":"Masashi Ohno, Atsushi Nishida, Akinori Otsuki, Yoshihiro Yokota, Takayuki Imai, Shigeki Bamba, Osamu Inatomi","doi":"10.4253/wjge.v17.i2.100793","DOIUrl":"10.4253/wjge.v17.i2.100793","url":null,"abstract":"<p><strong>Background: </strong>Achievement of endoscopic healing (EH) is significant in the clinical practice of inflammatory bowel disease as it is correlated with improved prognosis. Existing biomarkers, including C-reactive protein (CRP), have relatively low accuracy for predicting EH, especially in small intestinal lesions in Crohn's disease (CD); thus, noninvasive and more accurate biomarkers are required. Leucine-rich alpha-2 glycoprotein (LRG), a 50-kD protein, is produced under inflammatory conditions and has been reported to be useful in assessing disease activity in inflammatory bowel disease. However, the usefulness of LRG in small intestinal lesions in CD remains inconclusive.</p><p><strong>Aim: </strong>To determine the usefulness of LRG for EH in small bowel lesions in CD and compare it with CRP.</p><p><strong>Methods: </strong>This study included 133 consecutive patients with CD who underwent balloon-assisted enteroscopy between June 2021 and March 2024 at Shiga University of Medical Science Hospital (Otsu, Japan). We retrospectively analyzed endoscopic scores in each of the ileum and colon and four markers including LRG, CRP, albumin, and Harvey-Bradshaw index (HBI). Spearman's rank correlation coefficient and receiver operating characteristic analysis were performed.</p><p><strong>Results: </strong>Either active ileal or colonic lesions exhibited significant differences in LRG, CRP, albumin, and HBI compared with EH. CRP, albumin, and HBI showed a worse correlation with endoscopic activity in the ileum than that in the colon; however, LRG did not show a worse correlation (colon, <i>r</i> = 0.5218; ileum, <i>r</i> = 0.5602). Receiver operating characteristic analysis revealed that LRG for EH in the ileum and colon had the same cutoff values of 12.4 μg/mL. Comparing the areas under the curve of LRG and CRP for predicting EH in the ileum revealed a significantly higher areas under the curve of LRG (95% confidence interval, 0.017-0.194; <i>P</i> = 0.024), whereas the two showed no significant difference in the colon.</p><p><strong>Conclusion: </strong>LRG is a useful biomarker in assessing the endoscopic activity of CD and is more useful than CRP in the small intestine.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 2","pages":"100793"},"PeriodicalIF":1.4,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discordance between endoscopic and histopathologic assessment in ileal Crohn's disease.","authors":"Scott D Lee, Brian Mau, Cody J Avalos, Kindra D Clark-Snustad, Kendra J Kamp, Xianyong Gui","doi":"10.4253/wjge.v17.i2.101284","DOIUrl":"10.4253/wjge.v17.i2.101284","url":null,"abstract":"<p><strong>Background: </strong>Discordance between endoscopic and histologic assessments in Crohn's disease (CD) have been observed, however the prevalence and cause are unclear.</p><p><strong>Aim: </strong>To assess if a protocolized approach to biopsy collection facilitates understanding of this discordance in patients with ileal CD.</p><p><strong>Methods: </strong>Patients with known ileal CD underwent colonoscopy with endoscopic disease activity assessment. Three protocolized biopsies were taken respectively from an ulcer edge, 7-mm, and 14-mm away from the ulcer edge in patients with discrete ileal ulcer(s). In patients with no ulcers as controls, the same 3-site biopsy protocol was applied in a randomly selected area of endoscopically-unremarkable terminal ileal mucosa. A blinded pathologist assessed mucosal inflammation in each biopsy using 3 validated histologic indices.</p><p><strong>Results: </strong>Twenty-four participants had visible ulcer(s) on endoscopy and 12 served as no-ulcer controls. Of biopsies taken from an ulcer edge, only 67% showed histologic evidence of active (neutrophilic) inflammation, and 33% showed histologic features of ulcer or erosion; all were from either large (<i>n</i> = 4) or very large (<i>n</i> = 4) ulcers. In the no-ulcer controls, no biopsies showed histologic features of ulcer or erosion, but 8% showed active inflammation.</p><p><strong>Conclusion: </strong>A striking discordance exists between endoscopic and histologic assessments for mucosal inflammation in patients with active ileal CD, even in biopsies targeted at an ulcer edge, while a higher concordance is seen in patients with no endoscopic disease activity. It remains unclear how to incorporate histologic disease activity into the treatment paradigm. Further research is needed to optimize biopsy protocols and histologic assessments for CD.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 2","pages":"101284"},"PeriodicalIF":1.4,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}