Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"title":"Immediate Direct Endoscopic Necrosectomy Versus Delayed Direct Endoscopic Necrosectomy","authors":"Abdullah A. Al-Shahrani ,&nbsp;Benjamin W. Warren ,&nbsp;Samuel Han ,&nbsp;Steven A. Edmundowicz ,&nbsp;Mihir S. Wagh ,&nbsp;Sachin B. Wani ,&nbsp;Hazem T. Hammad ,&nbsp;Augustin R. Attwell ,&nbsp;Raj J. Shah","doi":"10.1016/j.tige.2024.06.008","DOIUrl":"10.1016/j.tige.2024.06.008","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Lumen-apposing metal stents (LAMSs) are effective in resolving walled-off necrosis (WON) of the pancreas and enable direct endoscopic necrosectomy (DEN). However, optimal DEN timing is controversial. We aimed to study if early DEN shortens WON resolution time.</div></div><div><h3>METHODS</h3><div>We retrospectively reviewed patients who underwent LAMS placement for WON at a tertiary center. We collected patient demographics, WON characteristics, DEN sessions, and outcomes. We compared those who underwent immediate DEN (iDEN; index DEN at LAMS placement) and delayed DEN (dDEN; index DEN on a separate day from LAMS placement). We identified predictors for resolution time via linear regression, and constructed Nelson-Aalen cumulative hazards curves showing resolution time stratified by index DEN timing.</div></div><div><h3>RESULTS</h3><div>Between January 2011 and June 2019, 175 patients underwent LAMS placement for peripancreatic fluid collections, 155 (88.6%) of which were WON. Of these, 50 (32.3%) required DEN. The majority were male (80%) with an average age of 52.5 years. WON size and double-pigtail stent use through LAMS were similar. Overall, the mean time to WON resolution was 90.6 days, 44.5 (iDEN) versus 100.7 (dDEN), <em>P</em> = 0.02, with similar DEN sessions (<em>P</em> = 0.64). The average length of stay was 0.9 in iDEN versus 14.7 days in dDEN (<em>P</em> = 0.03). All had WON resolution with a similar adverse event rate (18.5% iDEN vs 25.1% dDEN, <em>P</em> = 0.45). In multivariate analysis, double-pigtail stent use suggested greater complexity and longer WON resolution time (<em>P</em> = 0.005).</div></div><div><h3>CONCLUSION</h3><div>Despite similar DEN sessions, LAMS with iDEN significantly reduced resolution time compared with dDEN. Only one-third of WON patients treated with LAMS placement required DEN.</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":"141840013","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":"Cost-Effectiveness Analysis of Endoscopic Sleeve Gastroplasty","authors":"Michael Daniel ,&nbsp;Cassandra Fritz ,&nbsp;Tsehay Abebe ,&nbsp;Ahmad N. Bazarbashi ,&nbsp;Shelby Sullivan ,&nbsp;Su-Hsin Chang ,&nbsp;Vladimir Kushnir","doi":"10.1016/j.tige.2024.06.001","DOIUrl":"10.1016/j.tige.2024.06.001","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><p>Obesity is prevalent in the United States. Endoscopic sleeve gastroplasty (ESG) has been shown to produce effective weight loss and improvement in obesity-related disease. The cost effectiveness of ESG is currently unclear in patients with obesity with and without type 2 diabetes (T2DM).</p></div><div><h3>METHODS</h3><p>A decision analytic model with time horizon of 5 years and lifetime, from a health system's perspective was constructed to compare ESG to no weight loss intervention (no ESG) in patients with obesity aged 35-45 years with a body mass index of ≥30 kg/m² with or without T2DM. Parameters were obtained based on peer-reviewed data. One-way and 2-way sensitivity analyses were performed for variations in T2DM resolution and ESG costs.</p></div><div><h3>RESULTS</h3><p>For the 5-year time horizon in patients with T2DM, ESG produced 4.28 quality-adjusted life years (QALYs) and cost $77,874, compared with 3.99 QALYs and a cost of $73,738 for no ESG, resulting in an incremental cost-effectiveness ratio (ICER) of $13,922 per QALY. For the lifetime horizon, ESG produced 29.57 QALYs and a lifetime cost of $451,261, compared with 26.69 QALYs and a lifetime cost of $493,806 for no ESG, resulting in a negative ICER (ie, cost saving). The 5-year time horizon in patients without T2DM demonstrated that ESG produced 4.42 QALYs, compared with 4.08 QALYs with no ESG, resulting in an ICER of $39,116 per QALY gained. For the lifetime horizon ESG produced 34.21 QALYs, compared with 31.60 QALYs for no ESG, resulting ICER of $4752.</p></div><div><h3>CONCLUSION</h3><p>This cost-effectiveness analysis suggests that ESG is cost effective in 5 years and cost saving over a lifetime for patients with obesity and type 2 diabetes. ESG remains cost effective at 5 years and over a lifetime in patients without T2DM.</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/S2590030724000357/pdfft?md5=7a35690a07a3ad25989ed8724c19fd4f&pid=1-s2.0-S2590030724000357-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961110","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":"Peroral Endoscopic Myotomy (POEM) and Its Use in Esophageal Dysmotility","authors":"Arvind Rengarajan ,&nbsp;A. Aziz Aadam","doi":"10.1016/j.tige.2023.12.004","DOIUrl":"10.1016/j.tige.2023.12.004","url":null,"abstract":"<div><p><span>The aim of this review is to provide an overview of peroral endoscopic myotomy<span> (POEM) and its utilization in major motor disorders of the esophagus. POEM, a relatively novel endoscopic technique, involves a mucosal </span></span>incision<span> followed by submucosal tunneling to access esophageal muscle<span> layers, enabling selective myotomy and mitigating the consequences of motor disorders of the esophagus. A number of recent studies have demonstrated noninferiority in shorter myotomy lengths in nonspastic (type I and II) achalasia<span> as compared with standard-length myotomy, which has ramifications for procedural length, reflux disease, and more. Long-term data on POEM as a treatment<span> modality for achalasia have demonstrated its robustness in providing a durable and sustainable treatment response. Challenges of POEM include the learning curve associated with mastering this technique, as well as the management of possible procedural complications including ineffective myotomy, blown-out myotomy, and/or gastroesophageal reflux disease. In conclusion, POEM has been demonstrated to be an effective and durable treatment option for achalasia and has an increasing role in other motility disorders of the esophagus.</span></span></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":"139013515","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 Role of Functional Lumen Imaging Probe (FLIP) Before Submucosal Tunnel Myotomy","authors":"Gassan Kassim,&nbsp;William L. Hasler","doi":"10.1016/j.tige.2023.12.007","DOIUrl":"10.1016/j.tige.2023.12.007","url":null,"abstract":"<div><p><span><span>Peroral endoscopic myotomy (POEM) is increasingly employed as therapy for sphincteric abnormalities of the </span>gastrointestinal tract<span><span>, including achalasia<span><span>, gastroparesis, </span>Zenker's diverticulum, and other esophageal dysmotility syndromes. The capabilities of functional lumen imaging probe (FLIP) testing include measurement of sphincteric distensibility, diameter, cross-sectional area (CSA), and pressure in these disorders before and after POEM. FLIP can also characterize phasic </span></span>contractility<span> in non-sphincteric regions, including the esophageal body and pre-pyloric gastric antrum. Increases in distensibility and CSA after POEM are associated with reductions in symptoms and improvements in gut transit, including esophageal barium clearance in achalasia and gastric emptying in gastroparesis. Several studies have identified FLIP metrics that are associated with successful POEM outcomes in these 2 conditions. Intraprocedural FLIP can determine the adequacy of the initial myotomy and suggest the need for additional </span></span></span>incision before mucosotomy closure. However, the definition of pre-myotomy FLIP parameters that can be used for reliable patient selection for subsequent POEM remains incomplete. Future investigations to establish normal sphincter parameters in healthy controls, standardize FLIP methods across sites, and adopt the technology in multicenter trials are warranted.</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":"139026378","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":"Extending the Reach of Colorectal Screening to all Populations in the United States","authors":"Seo Hyun Kim ,&nbsp;Divya P. Prajapati ,&nbsp;Samir Gupta","doi":"10.1016/j.tige.2024.03.003","DOIUrl":"10.1016/j.tige.2024.03.003","url":null,"abstract":"<div><p>In this narrative review, we provide an overview of the current reach of colorectal cancer (CRC) screening in the US population; how persistent inequities in CRC across age and sociodemographic groups and changes in epidemiology, as well as population structure, have increased the urgency of achieving optimal reach; and current and future strategies for optimizing the reach and impact of screening across the population. CRC screening saves lives, but reach across the population, including across age and sociodemographic groups, is highly variable. CRC screening participation in the United States remains at under 60% and has been stagnant over time. Lower screening participation is observed for individuals of younger age; of American Indian/Alaska Native, Asian, and Hispanic backgrounds; with Medicaid insurance; and with recent immigration. Addressing suboptimal reach is increasingly important due to changing CRC epidemiology and US population structure. Recent trends demonstrate increases in early (&lt;50 years) and middle age (50-60 years) onset of CRC and nonlocalized-stage CRC, as well as persistent inequities in CRC outcomes among multiple racial/ethnic groups. These trends exist in a context where the US population is increasingly composed of individuals from diverse backgrounds associated with lower screening rates and higher rates of adverse CRC outcomes. Screening reach can be optimized by building on successes of previous impactful policies, implementing evidence-based interventions for screening, and developing novel strategies that address challenges at patient, clinician, healthcare system, and policy levels. Gastroenterologists, other clinicians, and public health advocates have a major role in leading positive change at each of these levels. Overall, the need to optimize the reach of CRC screening represents a pressing opportunity for improving health equity across all populations in the United States.</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/S2590030724000175/pdfft?md5=a559ef75ac2e110d0900ec33d59ea3b9&pid=1-s2.0-S2590030724000175-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140272497","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":"Safety and Efficacy of Endoscopic Sleeve Gastroplasty for the Treatment of Obesity Among Ethnic-Minority Populations","authors":"JENNIFER PHAN ,&nbsp;DANNY ISSA","doi":"10.1016/j.tige.2024.09.003","DOIUrl":"10.1016/j.tige.2024.09.003","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":"142533694","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 Therapy of Solid and Cystic Neoplasms of the Pancreas","authors":"Brandon Rodgers ,&nbsp;Charles Vining ,&nbsp;Matthew T. Moyer","doi":"10.1016/j.tige.2024.08.002","DOIUrl":"10.1016/j.tige.2024.08.002","url":null,"abstract":"<div><div>Endoscopic ultrasound (EUS) has evolved as a powerful endoscopic tool with a variety of applications for the assessment, and increasingly, treatment of abdominal diseases. EUS has progressively improved as an interventional procedure with applications in pancreaticobiliary access, treatment of pancreatic fluid collections and necrosis, gallbladder drainage, gastrojejunostomy, and endohepatology. Here we address interventional EUS and its role in pancreatic cyst ablation as well as EUS-guided solid tumor ablation and treatment. EUS-guided pancreatic cyst chemoablation has been shown to be an effective, safe, and durable option for the treatment of appropriately selected, mucinous-type, pancreatic cysts when approached as part of a high volume multidisciplinary program. In the treatment of solid pancreatic lesions, multiple endoscopic therapies have shown promise with most attention focused on the treatment of pancreatic neuroendocrine tumors. More advanced tumors and malignancies have also been treated with encouraging, but limited, results, and this area of interventional EUS is in need of prospective studies with standardized definitions of safety and treatment responses as development continues.</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":"142533695","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: Endoscopic Evaluation and Management of Solid and Cystic Pancreatic Lesions","authors":"Koushik K. Das","doi":"10.1016/j.tige.2024.09.002","DOIUrl":"10.1016/j.tige.2024.09.002","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":"142533699","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: Barrett's Esophagus","authors":"Vani J.A. Konda","doi":"10.1016/j.tige.2023.01.005","DOIUrl":"https://doi.org/10.1016/j.tige.2023.01.005","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750070","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":"Health Literacy Does Not Influence the Selection of Colorectal Cancer Screening Methods: A Cross-Sectional Analysis","authors":"Umer Farooq ,&nbsp;Raymond Lee ,&nbsp;Diana Franco ,&nbsp;Ayokunle T. Abegunde","doi":"10.1016/j.tige.2022.11.003","DOIUrl":"https://doi.org/10.1016/j.tige.2022.11.003","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750406","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}