Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"title":"Reducing the Carbon Footprint of Colorectal Cancer Screening","authors":"Swapna Gayam ,&nbsp;Aasma Shaukat","doi":"10.1016/j.tige.2024.03.006","DOIUrl":"https://doi.org/10.1016/j.tige.2024.03.006","url":null,"abstract":"<div><p>Climate change is the largest public health threat of the 21st century. Gastrointestinal endoscopy is the second overall waste generator and third highest hazardous waste generator in a hospital setting, making it essential for all gastroenterologists to reexamine their practices to reduce this negative impact. Colorectal cancer (CRC) is a major contributor to the gastrointestinal disease burden, and CRC screening is a vital component of age-appropriate cancer screening in the United States. Along the spectrum of colon cancer screening methods, considerations regarding their environmental impact are gaining prominence. Consequently, focusing mitigation strategies on CRC screening is justified. Mitigation strategies focused on CRC screening are likely to have a measurable impact on reducing the environmental impact of endoscopy, given the stark volume of procedures performed in the United States. In this paper, we review the different CRC screening options and strategies to reduce the environmental impact of these processes.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Pages 193-200"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590030724000205/pdfft?md5=7584464c43c9e215d3f8b0814d130d0c&pid=1-s2.0-S2590030724000205-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140647020","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":"Semaglutide Is an Independent Predictor of Retained Solid Gastric Contents, but Same-Day Colonoscopy Mitigates Effect","authors":"Haarika Korlipara ,&nbsp;Jason Chua ,&nbsp;Adam Buckholz ,&nbsp;Jacob Jamison ,&nbsp;Ariel Gonzalez ,&nbsp;Sonal Kumar ,&nbsp;Marissa Weber ,&nbsp;Sanjay Salgado ,&nbsp;Reem Sharaiha ,&nbsp;Carolyn Newberry","doi":"10.1016/j.tige.2024.07.001","DOIUrl":"10.1016/j.tige.2024.07.001","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Glucagon-like peptide-1 receptor agonists are commonly prescribed for diabetes and obesity; however, their use may complicate anesthetized procedures due to delayed gastric emptying. This study sought to define rates of retained solid gastric contents, a risk factor for periprocedural complications, in a population taking semaglutide.</div></div><div><h3>METHODS</h3><div>This is a retrospective cohort study comparing individuals undergoing upper endoscopy over a 5-year period at a tertiary care center who were prescribed semaglutide, a long-acting glucagon-like peptide-1 receptor agonist, for &gt;4 weeks against a matched control cohort not on the medication. Multivariant logistic regression and multivariable propensity-matched association analysis were conducted to compare outcomes of interest, including retained solid gastric contents, endoscopic complications, and endoscopic outcomes.</div></div><div><h3>RESULTS</h3><div>In total, 1212 patients comprised the study population (602 on semaglutide, 610 not on semaglutide). On multivariant logistic regression analyzing causes of delayed gastric emptying, semaglutide was an independent risk factor for retained solid gastric contents (odds ratio [OR], 4.74; 95% CI, 2.40-9.35; <em>P</em> &lt; 0.0001). On multivariable propensity-matched association analysis utilizing demographic and clinical characteristics, semaglutide use was associated with an absolute increase of 6% of retained solid gastric contents (coefficient, 0.0644; 95% CI, 0.034-0.095; <em>P</em> &lt; 0.0001). Same-day colonoscopy was protective against this finding (OR, 0.41; 95% CI, 0.23-0.73; <em>P</em> = 0.003). Intubation was rare and not associated with semaglutide use (OR, 0.70; 95% CI, 0.30-1.64; <em>P</em> = 0.41). No periprocedural aspiration events occurred.</div></div><div><h3>CONCLUSION</h3><div>Semaglutide was an independent risk factor for retained solid gastric contents, even when accounting for confounding factors. This was negated in patients undergoing same-day colonoscopy, indicating an opportunity for preprocedural fasting protocols in the absence of medication hold.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 4","pages":"Pages 316-322"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Step-Up Strategy for Endoscopic Hemostasis Using PuraStat After Endoscopic Sphincterotomy Bleeding (STOP Trial)","authors":"","doi":"10.1016/j.tige.2024.03.005","DOIUrl":"10.1016/j.tige.2024.03.005","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>Recently, a novel self-assembling peptide hemostatic<span> gel (PuraStat) has become available. Although PuraStat for endoscopic sphincterotomy (EST) bleeding has been evaluated and reported mainly in case reports and several retrospective studies, no prospective evaluation has been reported. The aim of the present study was to prospectively evaluate the safety and efficacy of PuraStat for persistent EST bleeding &gt;120 seconds as a first-line endoscopic </span></span>hemostasis technique.</p></div><div><h3>Methods</h3><p>This single-arm, prospective study was conducted between November 2022 and August 2023. As the primary technique for endoscopic hemostasis, PuraStat was applied first. If hemostasis failed, other techniques were used. The primary outcome of the present study was to evaluate the technical success rate of the application of PuraStat to the bleeding site. Clinical success was defined as the absence of oozing for 180 seconds after PuraStat application. Adverse events associated with procedures and secondary hemorrhage were secondary outcomes. PuraStat application was performed using the embankment method.</p></div><div><h3>Results</h3><p><span>During the study period, 1080 endoscopic retrograde cholangiopancreatography procedures were performed. A total of 108 patients experienced complications with EST bleeding. Among them, endoscopic hemostasis was required in 51 patients. These patients enrolled in this prospective study. All patients successfully underwent PuraStat application without PuraStat dislocation into the third part of the </span>duodenum. The technical success rate of endoscopic hemostasis using PuraStat was 98% (50/51). As possible factors associated with secondary hemorrhage, biliary stents, including plastic or metal stents, were deployed in 60.7% (31/51). Finally, severe adverse events associated with the procedures were not observed in any patients, although mild acute pancreatitis was observed in 2 patients, and conservative treatment was successful.</p></div><div><h3>Conclusion</h3><p>In conclusion, PuraStat application may be safe for oozing after EST without increasing the frequency of acute pancreatitis.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 3","pages":"Pages 224-229"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140269325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sphincterotomy vs Sham Procedure for Pain Relief in Sphincter of Oddi Dysfunction: Systematic Review and Meta-analysis","authors":"Dennis Wang,&nbsp;Kayla Dadgar,&nbsp;Mohammad Yaghoobi","doi":"10.1016/j.tige.2023.10.003","DOIUrl":"10.1016/j.tige.2023.10.003","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span><span>Endoscopic sphincterotomy (ES) used to be part of </span>sphincter of Oddi dysfunction (SOD) management, but recent studies changed attitudes about its utility. We conducted a </span>systematic review and meta-analysis of randomized sham-controlled trials (RCTs) investigating ES for biliary SOD-related pain.</p></div><div><h3>Methods</h3><p>Articles were retrieved from PubMed, Medline, Embase, and CENTRAL. We included RCTs comparing ES with a sham procedure<span> on post-cholecystectomy patients ≥18 years old with biliary SOD. Standardized data collection sheets were used, as well as the Risk of Bias 2 tool. A random-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Subgroups included normal vs abnormal sphincter of Oddi manometry (SOM) and type II vs III SOD.</span></p></div><div><h3>Results</h3><p>From 517 articles retrieved, 4 RCTs were included, encompassing 376 patients. Overall, no difference existed between ES and the sham procedure in improving biliary SOD-related pain overall (RR 1.32, 95% CI 0.77-2.26, <em>P</em> = .31) and for the normal (RR 0.83, 95% CI 0.42-1.65, <em>P</em> = .60) and abnormal SOM subgroups (RR 1.90, 95% CI 0.84-4.29, <em>P</em><span> = .12). ES was numerically favored over the sham procedure in patients with type II (RR 2.51, 95% CI 1.32-4.81, </span><em>P</em> = .005) but not type III SOD (RR 1.02, 95% CI 0.32-3.27, <em>P</em> = .98). However, there was no significant subgroup difference between these type-based subgroups (<em>P</em> = .18, I² = 43.2%).</p></div><div><h3>Conclusion</h3><p>ES does not improve biliary SOD-related pain overall or for type II vs III SOD or normal vs abnormal SOM subgroups. This meta-analysis confirms that there is no proven role for SOM or ES in managing SOD.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 1","pages":"Pages 30-37"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135564556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preface: Optimizing and Sustaining High-Quality Colorectal Cancer Screening","authors":"Audrey H. Calderwood","doi":"10.1016/j.tige.2024.03.002","DOIUrl":"10.1016/j.tige.2024.03.002","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 2","pages":"Page 93"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outside the Training Paradigm: Challenges and Solutions for Endoscopy Provision in Resource-Limited Settings","authors":"Sandie Thomson ,&nbsp;Chris Hair ,&nbsp;Ganiyat Kikelomo Oyeleke","doi":"10.1016/j.tige.2024.06.002","DOIUrl":"10.1016/j.tige.2024.06.002","url":null,"abstract":"<div><p>Limited-resource settings pose problems for the provision of health services. Experience with the challenges of the provision of endoscopy services and potential solutions are presented by authors who have taught and practiced in such settings in Africa and the Pacific Islands. The concept of limited-resource settings is defined in the context of health services in general. The situation regarding endoscopy provision details and discusses the unique challenges of manpower, endoscopy facilities, endoscope and accessory equipment inventory, and endoscopy reporting. Health services quality is related to wealth and how it is deployed. Simplistically wealth means health, and poverty illness. Low-income and Low middle–income countries have the biggest challenges. One is the health professional workforce. The number of gastroenterologists per 100,000 in South Africa, an upper middle–income country, is 0.33 compared with 3.9 in the United States. Hence, endoscopy provision is by general surgeons and physicians. Upper and lower gastrointestinal endoscopic capacity in East Africa was 106 and 45 procedures per 100,000 persons per year, respectively which is &lt;10% of that reported from high-income countries. Outside major teaching hospitals, most endoscopy is practiced in uncustomized single rooms often in a surgery complex. Endoscope inventory is more expensive than in the United States as is maintenance and repair as they are out of the country resulting in many units being below the minimum requirements to run a sustained service. Electronic reporting systems are few and not standardized. The World Gastroenterology Organisation and the World Endoscopy Organization should be the overarching advocates to support public–private partnerships and develop solutions for sustainable inventory acquisition. Endoscopy must be monitored electronically to assess procedural competency and provide desperately needed information to influence health policy.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 3","pages":"Pages 270-282"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590030724000369/pdfft?md5=16b264d7200da4b5e6f4191afde07f65&pid=1-s2.0-S2590030724000369-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950405","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":"Adenoma-Based Colonoscopy Quality Metrics for the 45–49 Years Old Military Screening Population","authors":"","doi":"10.1016/j.tige.2024.02.002","DOIUrl":"10.1016/j.tige.2024.02.002","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><p><span>With the rising incidence of colorectal cancer in younger individuals, guidelines now recommend initiating average-risk screening at age 45 years. We sought to assess the impact of this younger screening population on established and emerging </span>colonoscopy quality metrics.</p></div><div><h3>METHODS</h3><p>We compared all well-described lesion detection rates by colonic segment removed during initial, average-risk screening colonoscopies in the San Antonio Market military healthcare network from July 2019 to September 2022.</p></div><div><h3>RESULTS</h3><p><span>A total of 2165 colonoscopies met the inclusion criteria, with 755 (34.9%) colonoscopies performed on patients aged 45-49 years old. The detection rates for adenomas<span>, proximal adenomas, advanced adenomas, and adenomas per colonoscopy were lower in the 45-49 years old group (33.4%, 18.7%, 3.8%, and 0.58, respectively) compared with the 50-75 years old group (42.7%, 24.2%, 7.7%, and 1.11, respectively; all </span></span><em>P</em> &lt; 0.05). There was no difference in serrated polyp detection in the 45-49 years old group (11.5%) compared with the 50-75 years old group (12.5%; <em>P</em><span> = 0.287). There were no differences in withdrawal times, cecal intubation<span> rates, or bowel preparation adequacy across age groups.</span></span></p></div><div><h3>CONCLUSION</h3><p>In our screening population, we found that adenoma-based colonoscopy quality metrics were significantly lower in the 45-49 years old population compared to the traditional screening age cohort, while there was no difference in serrated polyp detection. Endoscopists should anticipate a small decline in colonoscopy quality benchmarks as the screening population becomes younger, although these results require validation through multicenter, prospective monitoring.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 3","pages":"Pages 216-223"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopy and Its Alternatives in Resource-Limited Countries in Africa","authors":"Akwi Asombang ,&nbsp;Purnima Bhat","doi":"10.1016/j.tige.2024.06.004","DOIUrl":"10.1016/j.tige.2024.06.004","url":null,"abstract":"<div><p>Endoscopy service provision in low-income countries is sparse and inadequate to meet patient demands. Although novel endoscopic therapeutics have dramatically changed the way diseases are treated in the developed world, in low-resource countries, even basic services such as upper gastrointestinal (GI) endoscopy and colonoscopy are lacking. The need for endoscopy is apparent with high rates of upper GI bleeding from varices and peptic ulcers, and the rapidly growing rates of inflammatory bowel disease and GI cancers in these regions. There are limited alternatives to endoscopy available and are in general more risky and less efficacious. In Africa, the barriers to endoscopy service provision vary across the continent and serve as a model for challenges to overcome in providing health services in limited-resource environments. Although the clinical need for endoscopy grows, there has not been a parallel growth in the number of trained endoscopists with most regions having only one endoscopist for every 400,000 people. Many countries do not have a formal GI training program. Infrastructure investment remains insufficient, not fit-for-purpose, and endoscopy equipment is not consistently available in many regions. Nevertheless, some units continue to provide endoscopy services in challenging environments, modifying workflow to suit the limited structure, and adapting to local constraints while still trying to maintain endoscopy standards for their patients. The challenges are further amplified in bringing services to remote areas where, in some countries, more than 75% of the population resides, requiring innovative approaches such as mobile endoscopy units. Endoscopy is an essential life-saving medical service that is scarcely available in low-income countries. By examining the challenges to the development of endoscopy services throughout Africa, we hope to understand better the mechanisms by which GI medical services can be optimally delivered in low-and-middle–income countries.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 3","pages":"Pages 283-297"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590030724000382/pdfft?md5=e3f93ac47df789439541f14697c0563f&pid=1-s2.0-S2590030724000382-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950404","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 an Automated, Real-time Adenoma Detection Rate and Colonoscopy Quality Metrics Calculator","authors":"Todd A. Brenner ,&nbsp;Branislav Bujnak ,&nbsp;Matthew Alverson ,&nbsp;Alexandra T. Strauss ,&nbsp;Anmol Singh ,&nbsp;Saowanee Ngamruengphong ,&nbsp;Mouen Khashab ,&nbsp;Vikesh Singh ,&nbsp;Eun Ji Shin ,&nbsp;Venkata S. Akshintala","doi":"10.1016/j.tige.2023.07.004","DOIUrl":"10.1016/j.tige.2023.07.004","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>High-quality colonoscopy reduces the risk of death from colorectal cancer. The </span>adenoma detection rate (ADR) is the principal measure of colonoscopy quality but is onerous to calculate. We report the development of a fully automated platform for calculation of the ADR and other key colonoscopy quality indicators without the need for manual data entry.</p></div><div><h3>Methods</h3><p>Endoscopy<span> and pathology reports from 6 centers were collected over a 3-month period and collated using a novel data transfer interface. Text-based classification parameters were developed to identify average-risk screening colonoscopies, adenomatous pathology, cecal intubation, and withdrawal time. Automated quality metrics calculators based on these classifications were built into a web-based reporting platform, and the resulting quality metrics were benchmarked against those produced through a manual record review. Confirmation of the calculator's performance was performed in a validation cohort with data collected over a 1-month period, 6 months after the initial study.</span></p></div><div><h3>Results</h3><p>The study included 3809 colonoscopies (mean age 56.1 ± 6.40 years, 53.7% female, 38 endoscopists). The automated calculator yielded an ADR of 45.1% compared with 44.3% on manual review. Correct classification of ADR-qualifying screening colonoscopies was achieved with high predictive value, with a sensitivity of 0.918 and specificity of 1.0. The cecal intubation rate was 95.8%, and the average withdrawal time was 10:05 minutes.</p></div><div><h3>Conclusion</h3><p>We demonstrate the feasibility and performance of a colonoscopy quality reporting platform capable of calculating the ADR and other key metrics using novel, fully automated pathology report integration and a text query-based classification accessible in a wide range of practice settings.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 1","pages":"Pages 2-11"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120976849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric Peroral Endoscopic Myotomy (G-POEM) for the Management of Gastroparesis","authors":"Ernesto Robalino Gonzaga ,&nbsp;Peter V. Draganov ,&nbsp;Dennis Yang","doi":"10.1016/j.tige.2023.09.002","DOIUrl":"10.1016/j.tige.2023.09.002","url":null,"abstract":"<div><p><span><span>Gastroparesis is a chronic debilitation condition characterized by delayed gastric emptying. Medically refractory gastroparesis poses a significant burden on patients and the </span>health care<span> system. Managing these patients can be challenging, partly due to the overlap of symptoms with other functional disorders and the lack of a consistent association between symptoms and the degree of gastric dysmotility. Gastric </span></span>peroral endoscopic myotomy (G-POEM) has recently emerged as a novel therapeutic option for managing gastroparesis. This review provides an overview of G-POEM for medically refractory gastroparesis, discussing patient selection, technical aspects of the procedure, clinical outcomes, and future directions.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 1","pages":"Pages 46-55"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135760566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}