Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"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":"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}

{"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":"26 3","pages":"Pages 206-215"},"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":"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":"26 1","pages":"Pages 56-67"},"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":"26 3","pages":"Pages 230-236"},"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":"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":"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":"26 3","pages":"Pages 244-251"},"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":"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":"26 2","pages":"Pages 177-192"},"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":"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":"26 4","pages":"Pages 306-315"},"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}