Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"title":"Improving Adenoma Detection and Resection: The Role of Tools, Techniques and Simulation-Based Mastery Learning","authors":"Tonya Kaltenbach ,&nbsp;Lila Krop ,&nbsp;Tiffany Nguyen-Vu ,&nbsp;Roy Soetikno","doi":"10.1016/j.tige.2024.03.004","DOIUrl":"10.1016/j.tige.2024.03.004","url":null,"abstract":"<div><p>This comprehensive review addresses the critical role of colonoscopy in colorectal cancer (CRC) prevention. With CRC as one of the most common cancer types in men and women, high-quality colonoscopy is vital to reduce CRC incidence and mortality. Persistent gaps in quality, evidenced by interval CRCs and large variations in both provider adenoma detection rate (ADR) and resection methods, highlight the need to prioritize colonoscopy quality improvement through feedback and training.</p><p>This review delves into key factors influencing colonoscopy quality with lesion detection and removal. Excellent bowel preparation is necessary for effective colonoscopy, impacting lesion detection, ADR, procedure time, and complication risk. Optimal inspection techniques, encompassing provider maneuvers and utilization of technological devices such as distal attachment devices and artificial intelligence, hold promise in enhancing inspection quality. For optimal lesion resection, we explore cold snare polypectomy as a safe, cost-effective, and efficacious technique, particularly for diminutive and small polyps, and endoscopic mucosal resection for large (≥20 mm) polyps.</p><p>We outline the importance and critical need for quality assurance programs and to implement education science principles into endoscopy training. Innovative simulation-based mastery learning training, which includes various educational strategies to engage endoscopists in deliberate practice with assessment and feedback, holds great potential to efficiently scale the practice of high-quality colonoscopy to improve ADR and resection methods.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590030724000187/pdfft?md5=e0ec301472183f7511a6a9054ed4f413&pid=1-s2.0-S2590030724000187-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273584","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":"Low Body Mass Index and Risk of Endoscopy-Related Adverse Events: A United States Cohort Propensity Score—Matched Study","authors":"Saurabh Chandan ,&nbsp;Rahul Karna ,&nbsp;Aakash Desai ,&nbsp;Babu P. Mohan ,&nbsp;Dushyant Singh Dahiya ,&nbsp;Daryl Ramai ,&nbsp;Antonio Facciorusso ,&nbsp;Mohammad Bilal ,&nbsp;Douglas G. Adler ,&nbsp;Gursimran S. Kochhar","doi":"10.1016/j.tige.2023.12.001","DOIUrl":"10.1016/j.tige.2023.12.001","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Patients with a low body mass index (LBMI) are often encountered in routine outpatient gastrointestinal (GI) endoscopy practice, and the assessment of procedure-related risks in this subset of individuals remains paramount. Although the risk of endoscopy-related adverse events (AEs) has been reported in patients with obesity, the association between LBMI and AEs has not been established.</p></div><div><h3>Methods</h3><p>We conducted a retrospective cohort study using TriNetX, a multi-institutional database, to assess the risk of endoscopy-related AEs in patients with LBMI (&lt;18.4 kg/m²) compared with patients with a nonobese body mass index (18.5-29.9 kg/m²) (control cohort) after low-risk outpatient diagnostic esophagogastroduodenoscopy (EGD), colonoscopy, or percutaneous endoscopic gastrostomy (PEG) tube placement. One-to-one (1:1) propensity score matching was performed. The primary endpoints were to assess the risk of GI bleeding, perforation, or aspiration pneumonia within 30 days. Risk was expressed as adjusted odds ratios (aORs) with 95% confidence intervals.</p></div><div><h3>Results</h3><p>A total of 28,677, 18,449, and 3076 patients with LBMI underwent EGD, colonoscopy, and PEG tube placement, respectively. After propensity score matching, compared with the control cohort, patients with LBMI undergoing EGD and colonoscopy with or without biopsies were at an increased risk for GI bleeding (aOR 1.36 and 2.21), perforation (aOR 1.96 and 2.65), and aspiration pneumonia (aOR 3.13 and 2.71), respectively. Additionally, patients in the LBMI PEG cohort were found to be at an increased risk for aspiration pneumonia (aOR 1.33).</p></div><div><h3>Conclusion</h3><p>Our study shows that, when compared with nonobese controls, patients with LBMI are at an increased risk of endoscopy-related AEs. Appropriate precautions must be considered while performing routine endoscopic procedures to offset these risks in such patients.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138617468","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":"The Impact of Frailty on ERCP-Related Adverse Events: Findings From a National Cohort","authors":"Umer Farooq ,&nbsp;Zahid Ijaz Tarar ,&nbsp;Abdallah El Alayli ,&nbsp;Faisal Kamal ,&nbsp;Alexander Schlachterman ,&nbsp;Anand Kumar ,&nbsp;David E. Loren ,&nbsp;Thomas E. Kowalski","doi":"10.1016/j.tige.2023.12.010","DOIUrl":"10.1016/j.tige.2023.12.010","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure that has evolved from being primarily diagnostic to predominantly therapeutic, leading to an increased potential for ERCP-related adverse events. </span>Frailty<span> is an independent predictor of adverse outcomes, and its impact on ERCP-related outcomes requires investigation. This study evaluated the impact of frailty on ERCP-related adverse events.</span></p></div><div><h3>Methods</h3><p><span>The National Inpatient Sample from 2016 to 2019 was used to identify adult patients who underwent ERCP. Frailty was defined using the Frailty Risk Score. Outcomes were categorized into procedure-related adverse events, sedation-related adverse events, and hospitalization outcomes. Multivariate linear or logistic regression was used as appropriate. Stata, version 14.2, was used to perform analyses considering a 2-sided </span><em>P</em> &lt; 0.05 to be statistically significant.</p></div><div><h3>Results</h3><p><span>Among a total of 693,730 ERCPs performed, 870,30 (12.54%) were frail. Frail patients had higher odds of procedure-related adverse events, including hemorrhage (9.1/1000 vs 4.9/1000) and duodenal perforation, but not post-ERCP pancreatitis, </span>bile duct<span><span><span><span> perforation, cholecystitis, and </span>cholangitis. Frailty imparted a higher risk of sedation-related respiratory failure, </span>aspiration pneumonia, and the requirement of </span>intubation<span> and mechanical ventilation. Inpatient mortality was higher among frail patients (4.54% vs 1.03%), and they had prolonged hospital stays and higher hospitalization costs.</span></span></p></div><div><h3>Conclusion</h3><p>Frailty is associated with worse outcomes in patients<span> undergoing ERCP, with higher risks of hemorrhage and sedation-related adverse events, in addition to increased resource utilization. Therefore, the findings of this study suggest strict adherence to guidelines governing anticoagulant management during the peri-endoscopic period, and sedative administration should be carefully monitored. Preprocedural optimization measures and diligent monitoring can minimize resource utilization and decrease periprocedural morbidity.</span></p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139392813","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: Endoscopy in Resource-Limited Settings","authors":"Mark Topazian ,&nbsp;Lars Aabakken","doi":"10.1016/j.tige.2024.06.003","DOIUrl":"10.1016/j.tige.2024.06.003","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961111","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":"Endoscopic Tissues Sampling of Solid Pancreatic Lesions for Molecular Analysis","authors":"Divya M. Chalikonda,&nbsp;Uzma D. Siddiqui","doi":"10.1016/j.tige.2024.09.001","DOIUrl":"10.1016/j.tige.2024.09.001","url":null,"abstract":"<div><div>Endoscopic ultrasound (EUS)–guided tissue acquisition of solid pancreatic lesions is the diagnostic gold standard for most pancreas lesions. Since this technique was initially developed, there have been several iterations of the device technology and advancements in understanding technique to maximize diagnostic yield while minimizing adverse events. We describe the current literature on techniques for EUS-guided tissue acquisition, including fine-needle biopsy vs fine-needle aspiration, suction vs slow pull, fanning vs torque technique, and the use of rapid onsite cytopathology in obtaining a diagnosis. Additionally, modern medicine has allowed for use of these specimens to guide personalized cancer treatment for patients. Unique to this review, we have included a discussion on next-generation sequencing, organoids, and single-cell analysis and how EUS specimens perform in these novel downstream analyses.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533696","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":"Clinical Efficacy and Safety of a Novel Stent for Fistula Management Following Sleeve Gastrectomy","authors":"Carlos Noronha Ferreira ,&nbsp;Daniela Reis ,&nbsp;Patrícia Santos ,&nbsp;Carolina Simões ,&nbsp;Miguel Moura ,&nbsp;Filipe Damião ,&nbsp;Nuno Ladeira ,&nbsp;Luís Jasmins ,&nbsp;Nicodemos Fernandes ,&nbsp;Vítor Magno Pereira ,&nbsp;Olavo Costa Gomes ,&nbsp;Helena Nogueira ,&nbsp;António Chiado ,&nbsp;João Raposo ,&nbsp;João Lopes ,&nbsp;Amelia Almeida ,&nbsp;Luís Carrilho-Ribeiro ,&nbsp;João Coutinho ,&nbsp;Rui Tato Marinho","doi":"10.1016/j.tige.2023.07.005","DOIUrl":"10.1016/j.tige.2023.07.005","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Management of fistulas<span> after bariatric surgery<span><span> has shifted from a surgical to a primarily endoscopic approach. We aimed to determine the efficacy of a novel stent for the closure of fistulas and stent-related adverse events in patients with fistulas after </span>sleeve gastrectomy (SG).</span></span></p></div><div><h3>Methods</h3><p>Fifteen patients who developed fistulas following SG between July 2016 and December 2020 and managed at a tertiary care hospital by a primarily endoscopic approach were retrospectively evaluated. The technical and clinical success of a novel stent for the exclusion and definitive closure of fistulas and the need for endoscopic and surgical reinterventions and adverse events were analyzed.</p></div><div><h3>Results</h3><p><span>Fifteen patients with median age of 47 (20-61) years, 11 (73%) females, were included. Fistulas were located at the cardia in 12 (80%) patients, with a median diameter of 4 (2-15) mm. Concomitant stricture of the gastric tube was detected in 8 (53%) patients. A single stent was placed in 13 (87%) patients. Endoscopic reinterventions were required in 5 (33%), and a surgical toilette was needed for 3 (20%) patients. After a median stent implantation duration of 6 (3-21) weeks, fistula closure was documented in all 15 (100%) patients. The concomitant stricture of the gastric tube that occurred in 8 (53%) patients was also successfully managed. Adverse events related to </span>stent placement<span> or removal occurred in 5 (33%) patients and were managed endoscopically. Stent dysfunction occurred in 1 (7%) patient. One patient died due to bleeding from an aortoesophageal fistula 3 cm above the proximal edge of the stent.</span></p></div><div><h3>Conclusion</h3><p>The novel stent is effective in closing fistulas after SG. The unique stent design is associated with a low risk of migration, allows for the management of concomitant strictures in the gastric tube, and facilitates stent removal.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128604647","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":"Randomized Double-blind Sham-controlled Trial of a Novel Silicone-filled Endoscopically Placed Device for Weight Loss","authors":"Richard I. Rothstein ,&nbsp;Branko Kopjar ,&nbsp;George E. Woodman ,&nbsp;James M. Swain ,&nbsp;Nestor de la Cruz-Muñoz ,&nbsp;Vladimir M. Kushnir ,&nbsp;Auora D. Pryor ,&nbsp;Wayne J. English ,&nbsp;Elizabeth A. Odstrcil ,&nbsp;Shelby Sullivan","doi":"10.1016/j.tige.2023.10.002","DOIUrl":"10.1016/j.tige.2023.10.002","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Although obesity affects over 40% of adults in the United States and is a driver of preventable chronic diseases and health care costs, most patients are left untreated.</p></div><div><h3>Methods</h3><p>This was a randomized, double-blind, sham-controlled trial to investigate the safety and efficacy of a novel, endoscopically placed intragastric device for weight reduction<span>, the TransPyloric Shuttle, implanted for 1 year in 270 patients with Class I and II obesity. An additional 32 treatment patients were enrolled in an Open-Label group. The co-primary efficacy endpoints were percent total body weight loss (%TBWL) in the Treatment group compared with the Sham group and a proportion of treatment patients achieving ≥5% TBWL at 12 months.</span></p></div><div><h3>Results</h3><p>The mean %TBWL at 12 months was 9.5% (95% CI, 8.2-10.8) in the Treatment group (<em>n</em> = 181) compared with 2.8% (95% CI, 1.1-4.5) in the Sham group (<em>n</em> = 89). In the Treatment group, 67.0% (95% CI, 59.3-74.4) of patients achieved ≥5% TBWL compared with 29.3% (95% CI, 19.3-39.4) in the Sham group. Patients in the Treatment group achieved lower blood pressure, total cholesterol, and low-density lipoprotein cholesterol compared with the Sham group. Early withdrawals occurred in 22% and 11% patients in the Treatment and Sham groups, respectively. Device- or procedure-related serious adverse events occurred in 6 patients (2.8%), and no deaths occurred.</p></div><div><h3>Conclusion</h3><p>Treatment with a novel endoscopically placed intragastric device resulted in meaningful weight loss and improvement in cardiometabolic outcomes in patients with Class I and II obesity (ClinicalTrials.gov number NCT02518685).</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136093698","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: Peroral Endoscopic Myotomy for Benign Gastrointestinal Disorders—Best Clinical Practices and Recent Updates","authors":"Ryan Law","doi":"10.1016/j.tige.2023.12.006","DOIUrl":"10.1016/j.tige.2023.12.006","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139191931","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":"Limitations of the Location-Based and Polyp-Based Resect and Discard Strategies","authors":"","doi":"10.1016/j.tige.2024.05.002","DOIUrl":"10.1016/j.tige.2024.05.002","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><p>Location-based resect and discard (LBRD) and polyp-based resect and discard (PBRD) are 2 recently proposed strategies to minimize the cost of colonoscopy screening and surveillance. Our study applied these strategies to our colonoscopy database retrospectively to determine the applicability of these strategies in our screening and surveillance colonoscopy population.</p></div><div><h3>METHODS</h3><p>In total, 6024 elective screening, surveillance, or diagnostic colonoscopies performed at the University of California, Irvine, were analyzed. We compared the LBRD and PBRD recommendations with longer and shorter 2020 United States Multi-Society Task Forces (USMSTF) surveillance interval recommendations. The primary outcome was the achievement of the 90% agreement threshold set by the American Society of Gastrointestinal Endoscopy Preservation and Incorporation of Valuable Endoscopic Innovations.</p></div><div><h3>RESULTS</h3><p>The LBRD strategy achieved 88.0% and 71.6% concordance with the longer and shorter 2020 USMSTF recommendation guidelines, respectively. The PBRD strategy only applied to 65.4% of procedures, with the remaining procedures still requiring pathologic evaluation. Among the applicable procedures, the PBRD strategy achieved 94.2% and 38.6% concordance with the longer and shorter USMSTF recommendation guidelines, respectively.</p></div><div><h3>CONCLUSION</h3><p>The PBRD strategy met the 90% preservation and incorporation of valuable endoscopic innovations threshold only when using the longer USMSTF recommendations, but concordance dropped to 38.6% when using the shorter surveillance intervals, which are commonly used in the United States. Although resect and discard may decrease reliance on pathology, these 2 strategies do not achieve the level of concordance required to replace the use of pathology for diminutive polyps in our population.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590030724000333/pdfft?md5=a576291e9600e83e679506d39e812bc6&pid=1-s2.0-S2590030724000333-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141396950","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":"An Electronic Medical Record Prediction Model to Identify Inadequate Bowel Preparation in Patients at Outpatient Colonoscopy","authors":"Jared A. Sninsky ,&nbsp;J. Vincent Toups ,&nbsp;Cary C. Cotton ,&nbsp;Anne F. Peery ,&nbsp;Shifali Arora","doi":"10.1016/j.tige.2023.12.008","DOIUrl":"10.1016/j.tige.2023.12.008","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span><span><span>Inadequate bowel preparation during </span>colonoscopy is associated with decreased </span>adenoma detection, increased costs, and patient procedural risks. The aim of this study was to develop a prediction model for identifying patients at high risk of inadequate bowel preparation for potential clinical integration into the </span>electronic medical record (EMR).</p></div><div><h3>Methods</h3><p>A retrospective study was conducted using outpatient screening/surveillance colonoscopies at the University of North Carolina from 2017 to 2022. Data were extracted from the EMRs of <em>Epic</em> and <em>ProVation</em><span>, including demographic, socioeconomic, and clinical variables. Logistic regression, LASSO regression, and gradient boosting machine models were evaluated and validated in a held-out testing set.</span></p></div><div><h3>Results</h3><p>The dataset included 23,456 colonoscopies, of which 6.25% had inadequate bowel preparation. The reduced LASSO regression model demonstrated an area under the curve of 0.65 (95% CI 0.63-0.67) in the held-out testing set. The relative risk of inadequate bowel prep in the high-risk group determined by the model was 2.42 (95% CI 2.07-2.82) compared with patients identified as low risk. The model calibration in the testing set revealed that among patients categorized as having 0%-11%, 11%-22%, and 22%-33% predicted risk of inadequate prep, the respective proportions of patients with inadequate prep were 5.5%, 19.3%, and 33.3%. Using the reduced LASSO model, a rudimentary code for a potential Epic FHIR application called <em>PrepPredict</em> was developed.</p></div><div><h3>Conclusion</h3><p>This study developed a prediction model for inadequate bowel preparation with the potential to integrate into the EMR for clinical use and optimize bowel preparation to improve patient care.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139189412","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}