Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"title":"Comparing Endoscopic Suture vs Clip vs No Intervention in Esophageal Stent Migration: A Network Meta-Analysis","authors":"Manesh Kumar Gangwani ,&nbsp;Zohaib Ahmed ,&nbsp;Muhammad Aziz ,&nbsp;Dushyant Singh Dahiya ,&nbsp;Abeer Aziz ,&nbsp;Hassam Ali ,&nbsp;Umar Hayat ,&nbsp;Amir Humza Sohail ,&nbsp;Wade Lee-Smith ,&nbsp;Mohammad Aadil Qamar ,&nbsp;Faisal Kamal ,&nbsp;Sumant Inamdar ,&nbsp;Yaseen Alastal ,&nbsp;Douglas Adler","doi":"10.1016/j.tige.2023.10.004","DOIUrl":"10.1016/j.tige.2023.10.004","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>Stent migration is a consequential complication associated with </span>esophageal stent placement. We aimed to compare endoscopic suturing vs clips vs no intervention to determine the optimal strategy.</p></div><div><h3>Methods</h3><p><span>A literature search was performed using the MEDLINE, Embase, Cochrane, Web of Science, and Global Index Medicus databases. Direct head-to-head comparator analysis and network meta-analysis of all available groups were performed using the random-effects model. A </span><em>P</em> value less than 0.05 was considered statistically significant.</p></div><div><h3>Results</h3><p>Ten studies with 1019 participants were included in the final analysis. The direct meta-analysis revealed comparable stent migration rates between endoscopic suturing and clips, with an odds ratio (OR) of 1.07 (95% CI 0.07-14.8, <em>P</em> = 0.96), signifying no significant difference in their efficacy. When compared with the no intervention group, endoscopic suturing demonstrated a lower stent migration rate, with an OR of 0.33 (95% CI 0.17-0.62, <em>P</em> &lt; 0.001). Conversely, endoscopic clips did not exhibit a statistically significant advantage over the no intervention group, displaying an OR of 0.29 (95% CI 0.06-1.48, <em>P</em> = 0.14). The results were consistent in the network meta-analysis. The rankings of interventions, as reflected by the <em>P</em> scores, underscored the superior effectiveness of endoscopic suturing with a score of 0.78, followed closely by endoscopic clips at 0.70, whereas the no intervention approach lagged behind with a score of only 0.03.</p></div><div><h3>Conclusion</h3><p>Our findings indicate that stent fixation with sutures significantly prevents stent migration, with no clear advantage of one modality over another. However, it is essential to acknowledge that the feasibility of implementing endoscopic suture fixation in every case is constrained by cost, time, and technical expertise.</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":"139299911","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 Ultrasound Can Measure Esophageal Remodeling in Eosinophilic Esophagitis","authors":"Simon S. Rabinowitz ,&nbsp;Jeremy Weedon ,&nbsp;Evan Grossman ,&nbsp;Steven M. Schwarz ,&nbsp;Sairaman Nagarajan ,&nbsp;Frank Gress","doi":"10.1016/j.tige.2023.12.005","DOIUrl":"10.1016/j.tige.2023.12.005","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>Although esophageal widening is a normal consequence of growth in pediatric individuals, esophageal remodeling plays a major role in the morbidity of pediatric and adult </span>eosinophilic esophagitis<span> (EoE). However, the disease is defined by esophageal dysfunction and mucosal eosinophilia. One potential explanation is the difficulty in quantitating remodeling.</span></p></div><div><h3>Methods</h3><p><span><span>This prospective, IRB-approved longitudinal study evaluated endoscopic ultrasound (EUS) in 78 children, adolescents, and young adults referred to a single academic medical center for esophageal indications. Patients with proven EoE had serial EUS exams that measured total wall thickness (TWT) and esophageal wall sublayers during routine </span>endoscopies to manage their disease. Student </span><em>t</em> tests and mixed linear models were employed to compare groups.</p></div><div><h3>Results</h3><p>TWTs from the distal (2.3 ± 0.5 vs 1.7 ± 0.3, <em>P</em> &lt; 0.01) and mid esophagus (2.1 ± 0.5 vs 1.6 ± 0.3, <em>P</em> &lt; 0.05) were increased in active EoE patients &gt; 10 years of age compared with similarly aged controls. After achieving clinical and histologic remission, their TWTs were significantly decreased (distal: 1.9 ± 0.4 vs 2.3 ± 0.5, <em>P</em> &lt; 0.05; mid: 1.7 ± 0.4 vs 2.1 ± 0.5, <em>P</em><span> &lt; 0.05). Mixed linear models further demonstrated that during active EoE, TWTs, esophageal muscle<span><span> layers, and the mucosa and </span>submucosa were thickened in older adolescents at both sites (</span></span><em>P</em> &lt; 0.05 for each). In remission, TWTs returned to control values.</p></div><div><h3>Conclusion</h3><p>This pilot study demonstrates that EUS, a unique application of point-of-care ultrasound, can identify the esophageal remodeling that occurs in older adolescents with active EoE. Furthermore, EUS has defined this remodeling as a transmural phenomenon that occurs in the mid and distal esophagus and can completely reverse with adequate treatment.</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":"138993266","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 Ultrasound-Guided Liver Biopsy Is Safe and Effective in Post Liver Transplant Patients","authors":"JOSHUA L. HUDSON ,&nbsp;AMY BROWNLEE ,&nbsp;NEIL D. SHAH ,&nbsp;TODD H. BARON","doi":"10.1016/j.tige.2024.06.006","DOIUrl":"10.1016/j.tige.2024.06.006","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":"141707162","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":"Peroral Endoscopic Myotomy for the Management of Esophageal Diverticula: Tunneling Forward","authors":"Matt Pelton ,&nbsp;Michel Kahaleh ,&nbsp;Amy Tyberg","doi":"10.1016/j.tige.2023.12.003","DOIUrl":"10.1016/j.tige.2023.12.003","url":null,"abstract":"<div><p>Diverticular peroral endoscopic myotomy<span><span> (D-POEM) has emerged as a minimally invasive, safe, and effective option for Zenker's diverticula<span> (ZDs) and several other types of esophageal diverticula<span>. D-POEM involves submucosal dissection to create tunnels on the luminal and diverticular aspects of the diverticular septum, allowing for precise visualization of the septum. The operator then performs a myotomy, releasing the diverticula and reconnecting the diverticular and esophageal lumens. Approaches for D-POEM vary on the basis of the location of the initial </span></span></span>incision<span> for the submucosal dissection; in the long D-POEM approach, operators begin submucosal dissection 1-2 cm above the septum, whereas in the ultra-short D-POEM approach, operators begin submucosal dissection directly on the septum. Observational studies and systematic reviews demonstrate consistent technical success (93.4%-100%), high clinical success (87.1%-94.1%), few adverse events (4.6%-16.9%), and low recurrence rates (0.9%-4.4%). Meta-analyses of observational studies comparing D-POEM with surgical approaches (flexible endoscopic septotomy and rigid endoscopic septotomy) have found that D-POEM may have higher rates of clinical success (RR 1.13, CI 1.05-1.22 and RR 1.11, CI 1.03-1.18) with comparable technical success, adverse event, and recurrence rates. However, further rigorous prospective and randomized trials are warranted. Early comparisons of the ultra-short and long approaches to D-POEM have not found significant differences in efficacy. Outside of ZD, D-POEM should be further investigated for Killian-Jamieson, epiphrenic, and Rokitansky diverticula</span></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":"139025575","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":"Development of an Automated Endoscopic Retrograde Cholangiopancreatography Quality Report Card Using an Integrated Analytics Suite","authors":"","doi":"10.1016/j.tige.2024.03.007","DOIUrl":"10.1016/j.tige.2024.03.007","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><p>Quality indicators (QIs) are essential for evaluating the safety and effectiveness of endoscopy but are difficult to measure accurately for endoscopic retrograde cholangiopancreatography (ERCP). We developed a fully automated, real-time endoscopy analytics tool using Health Level-7 standards that collects ERCP QIs from an endoscopy reporting system to generate an ERCP quality report card in a third-party analytics suite.</p></div><div><h3>METHODS</h3><p>ERCP report data were collected between June 2021 and December 2022 from 4 referral centers. Discrete data elements from endoscopy reports generated in the EndoPro reporting platform were imported into the Qlik analytics suite, and QI data were aggregated into a report card. The collected data were manually validated to confirm accuracy.</p></div><div><h3>RESULTS</h3><p>Pooled data were successfully used to generate a comprehensive institutional ERCP quality report card comprising a total of 2146 ERCPs performed by 12 endoscopists. Manual review confirmed high accuracy (96.5%-100%) of automatic extraction of ERCP QIs from endoscopy reports. Multiple procedural data elements were successfully extracted, including cannulation difficulty, success rate, and administration of post-ERCP pancreatitis prophylaxis for procedures with biliary and pancreatic indication. Generation of the report card required minimal additional work on the part of the performing endoscopist and was updated in real time.</p></div><div><h3>CONCLUSION</h3><p>We developed an automated ERCP analytics tool that accurately and automatically extracts QI data into a succinct ERCP quality report card without the need for manual data extraction or natural language processing. The use of the Health Level-7 standard provides a framework for the creation of similar tools in other electronic health records. This tool allows for accurate ERCP quality and performance data evaluation at individual and institutional levels.</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/S2590030724000217/pdfft?md5=d5468471c598744e8a9f817bc39b143e&pid=1-s2.0-S2590030724000217-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140404952","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":"Magnetic Compression Anastomosis for Esophageal Obstruction: Indications, Contraindications, Methodologies, and Technique Strategies","authors":"","doi":"10.1016/j.tige.2024.02.001","DOIUrl":"10.1016/j.tige.2024.02.001","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>There are several limitations to the application of conventional endoscopic therapy for refractory </span>esophageal stenosis<span><span><span> and even atresia<span>, and the secondary option of surgery involving reanastomosis also has drawbacks. Magnetic compression anastomosis (MCA) is a novel technique that relies on magnetic attraction for </span></span>recanalization and the repair of </span>esophageal obstruction. We evaluate and discuss the clinical value and implementation strategies of the MCA technique as a promising countermeasure for esophageal obstruction.</span></p></div><div><h3>Methods</h3><p><span><span>In this study, we retrospectively enrolled 7 patients with esophageal stenosis or atresia who underwent MCA from December 2015 to June 2023. Gastroscopic combined with laparoscopic-assisted gastroesophageal MCA and jejunostomy were performed for patient 1; </span>laparotomy and gastroscopic-assisted MCA and jejunostomy were performed for patient 2; laparoscopic </span>gastrostomy<span> combined with endoscopic-assisted MCA was performed for patients 3 and 4; thoracotomy combined with MCA and gastrostomy were performed for patient 5; and endoscopic-assisted MCA was performed for patients 6 and 7.</span></p></div><div><h3>Results</h3><p>Anastomosis and recanalization were successfully performed for all patients. A total of 42.86% (3/7) of the patients underwent subsequent conventional endoscopic treatment, including balloon dilatation<span> and stent implantation. The incidences of postoperative pulmonary infection and anastomotic leakage were both 14.29% (1/7), and no other adverse events occurred. The magnetic complexes were removed at a median of postoperative day 18. All patients resumed oral feeding.</span></p></div><div><h3>Conclusion</h3><p>MCA appears to be a safe and effective therapy for the management of severe esophageal stenosis, refractory stenosis, and atresia of different etiologies, locations, lengths, and patterns, with the advantages of less trauma, high safety, and effectiveness. When making the operative proposal, diverse and individualized magnetic compression devices and methods should be flexibly adopted according to the patient's individual characteristics, history, obstruction distance, and obstruction patterns.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139892766","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":"Patient Perception of Endoscopic and Medical Therapies for Weight Loss","authors":"MONICA SAUMOY ,&nbsp;YINGLIN GAO ,&nbsp;KELLY ALLISON ,&nbsp;PETER F. CRONHOLM ,&nbsp;OCTAVIA PICKETT-BLAKELY ,&nbsp;MICHAEL L. KOCHMAN ,&nbsp;NIKHIL R. THIRUVENGADAM","doi":"10.1016/j.tige.2023.11.001","DOIUrl":"https://doi.org/10.1016/j.tige.2023.11.001","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":"140647021","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-Guided High-Pressure Spray “Power-Wash” for Detection of Gastric Intestinal Metaplasia and Dysplasia","authors":"Charles J. Lightdale ,&nbsp;Patricia Tiscornia-Wasserman ,&nbsp;Amrita Sethi ,&nbsp;Julian A. Abrams ,&nbsp;Monika Laszkowska ,&nbsp;Arshish Dua ,&nbsp;Judith Kim ,&nbsp;Ali Soroush ,&nbsp;Haley M. Zylberberg ,&nbsp;John T. Nathanson ,&nbsp;Chin Hur","doi":"10.1016/j.tige.2023.12.009","DOIUrl":"10.1016/j.tige.2023.12.009","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":"https://www.sciencedirect.com/science/article/pii/S2590030724000011/pdfft?md5=735a882b6de3e7cfc56ec30153aac413&pid=1-s2.0-S2590030724000011-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139457617","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":"Colonoscopy Quality, Innovation, and the Assessment of New Technology","authors":"Sanjay R.V. Gadi ,&nbsp;Sriya S. Muralidharan ,&nbsp;Jeremy R. Glissen Brown","doi":"10.1016/j.tige.2024.03.001","DOIUrl":"10.1016/j.tige.2024.03.001","url":null,"abstract":"<div><p>Colonoscopy serves a vital role in screening and surveillance for colorectal cancer and has seen incredible innovations in the past several decades. Amidst a growing landscape of emerging technologies, it has become increasingly critical to develop a process for the evaluation and adoption of new technology into the endoscopy suite. In this paper, we propose a framework for assessing a new colonoscopy technology utilizing quality improvement principles applied in procedural and integration assessments. After defining key quality indicators in colonoscopy, we follow the arc of innovation across preprocedural, intraprocedural, and postprocedural advancements in colonoscopy to highlight the process and outcome measures that constitute the procedural assessment. This discussion is followed by case studies in key structure and balance measures that serve to assess the feasibility of integrating novel technology into the endoscopy suite. At both assessment levels, we explore the advent of artificial intelligence in colonoscopy, citing relevant examples in computer-aided detection and computer-aided diagnosis. We highlight innovations that have been successfully adopted into clinical practice alongside technologies that had limited uptake or were otherwise retired from standard of care. In doing so, we illustrate the iterative nature of this process of innovation and technological development.</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/S2590030724000151/pdfft?md5=71fd0181c3155ca30ac9f8dfa195781a&pid=1-s2.0-S2590030724000151-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140270971","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":"Pediatric Therapeutic Endoscopic Procedures Performed by Adult Trained Advanced Endoscopists Are Safe and Effective","authors":"Omeed Alipour,&nbsp;Bryan Balmadrid,&nbsp;Yutaka Tomizawa","doi":"10.1016/j.tige.2023.09.004","DOIUrl":"10.1016/j.tige.2023.09.004","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":"135407916","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}