Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"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":"26 2","pages":"Pages 121-129"},"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":"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":"26 2","pages":"Pages 130-137"},"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}

{"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":"26 1","pages":"Page 1"},"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":"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":"26 2","pages":"Pages 145-152"},"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":"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":"26 1","pages":"Pages 21-29"},"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":"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":"26 1","pages":"Pages 12-20"},"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":"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":"26 3","pages":"Pages 237-243"},"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":"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":"26 4","pages":"Pages 359-361"},"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":"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":"26 2","pages":"Pages 201-204"},"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":"26 2","pages":"Pages 94-98"},"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}