Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"title":"Confocal Laser Endomicroscopy Is a Useful Alternative “Optical” Biopsy Modality in Diagnosis of Gastric Intestinal Metaplasia","authors":"YUTAKA TOMIZAWA , JOO HA HWANG , BRYAN BALMADRID , LISA STRATE","doi":"10.1016/j.tige.2022.07.004","DOIUrl":"https://doi.org/10.1016/j.tige.2022.07.004","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 1","pages":"Pages 102-104"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750273","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":"Outcomes of Endoscopic Resection for Colorectal Polyps With High-Grade Dysplasia or Intramucosal Cancer","authors":"Sonmoon Mohapatra ,&nbsp;Erik Almazan ,&nbsp;Paris Charilaou ,&nbsp;Luisa Recinos ,&nbsp;Mehak Bassi ,&nbsp;Arkady Broder ,&nbsp;Kevan Salimian ,&nbsp;Mouen A. Khashab ,&nbsp;Saowanee Ngamruengphong","doi":"10.1016/j.tige.2023.01.003","DOIUrl":"https://doi.org/10.1016/j.tige.2023.01.003","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span><span>Little is known about the outcomes of endoscopic resection<span> (ER) for patients with colorectal adenomas (CRAs) with high-grade </span></span>dysplasia (HGD) or intramucosal cancer (IMCA). This study aimed to estimate the rate of local/malignant recurrence, identify the </span>predictive factors<span> for local recurrence (LR), and evaluate the treatment outcomes of recurrence after ER for HGD/IMCA.</span></p></div><div><h3>Methods</h3><p>A retrospective review was performed to identify patients who underwent ER for HGD/IMCA in 2 academic medical centers. Risk factors for LR were determined by Cox regression analysis.</p></div><div><h3>Results</h3><p><span>Overall, 188 lesions with HGD/IMCA were included; 61 lesions were removed by en-bloc ER (e-ER), whereas 127 lesions were removed in a piecemeal ER (p-ER). The mean lesion size was 20.3 mm. Of the 125 patients who underwent follow-up, local adenoma recurrence occurred in 31 (23%), and malignant recurrence occurred in 2 (1.6%) patients at a median follow-up of 16 months. HGD/IMCA ≥ 4 cm removed by p-ER have the greatest hazard ratio (HR = 21.5; 95% CI 2.5-180.5; </span><em>P</em> = 0.005) for LR, compared with the HGD/IMCA &lt; 4 cm removed by e-ER. Surgery was performed in 3.2% of patients after a complete ER, all after p-ER. Of all patients who had LR, 22.6% (7/31 patients) had recurrent adenomas despite repeat ER attempts after a mean of 1.9 ± 0.79 procedures from the index ER.</p></div><div><h3>Conclusion</h3><p>Our study demonstrates a high rate of LR (23%) after ER of CRAs with HGD/IMCA with a rate of malignant recurrence of 1.6%, especially after p-ER. Thus, e-ER should be preferred for these lesions whenever technically feasible.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 2","pages":"Pages 119-126"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750513","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":"Mucosal Impedance Spectroscopy for Objective Real-time Assessment of Mucosal Health","authors":"Priyanka Arora ,&nbsp;Jaspreet Singh ,&nbsp;Anuraag Jena ,&nbsp;Surinder Kumar ,&nbsp;Viren Sardana ,&nbsp;Siddhartha Sarkar ,&nbsp;Lileswar Kaman ,&nbsp;Arunanshu Behera ,&nbsp;Divya Dahiya ,&nbsp;Ritambhra Nada ,&nbsp;Cherring Tandup ,&nbsp;H.S. Jatana ,&nbsp;Usha Dutta","doi":"10.1016/j.tige.2023.03.007","DOIUrl":"https://doi.org/10.1016/j.tige.2023.03.007","url":null,"abstract":"<div><h3>Background and Aims</h3><p>There is a need for a real-time objective tool to assess the mucosal health of the gastrointestinal (GI) tract during endoscopy<span>. Our aim was to develop, design, and validate a low-cost mucosal impedance (MI) device and determine its role in differentiating diseased mucosa from normal mucosa.</span></p></div><div><h3>Methods</h3><p>A biocompatible catheter was designed and developed after multiple iterations. It was validated with a commercially available catheter and histopathological analysis in a blinded manner. Patients undergoing resection of the GI tract were recruited after consent, and the resected specimens were analyzed ex vivo for MI within 10 minutes of resection. An average of 3 MI readings of the visually diseased segment and adjacent normal segment were analyzed. MI values of diseased and non-diseased mucosa were compared.</p></div><div><h3>Results</h3><p>The in-house catheter was validated with a commercially available impedance measuring device. It showed a high degree of positive correlation (rho = 0.616; <em>P</em><span> &lt; 0.001). Two hundred and thirty-two patients (age 46 ± 15 years; 68% females) (180 inflammatory and 52 malignant pathology) who were undergoing abdominal surgery were enrolled. The median impedance value of diseased segments was significantly lower than that of the adjacent normal segments of gut in 130 paired samples [1832(727)Ω vs 2604(1295)Ω; </span><em>P</em> &lt; 0.001]. The MI value of segments containing malignant tissue (n = 50) and inflamed tissue (n = 80) was significantly lower than the MI value of adjacent normal segments of the GI tract [1880(977)Ω vs 2583(1431)Ω; <em>P</em> &lt; 0.001 and 1787(557)Ω vs 2515(1244)Ω; <em>P</em> &lt; 0.001, respectively]. There was a 24% reduction in visually diseased segments [median reduction 712(661)Ω] from adjacent normal segments. A biocompatible endoscopic catheter (3-mm diameter) has been developed and tested in 3 patients and was found to differentiate diseased from normal mucosa.</p></div><div><h3>Conclusion</h3><p>Impedance spectroscopy is an effective real-time, simple, objective tool to differentiate diseased gut mucosa from healthy mucosa.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 3","pages":"Pages 228-235"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749835","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":"Initial Multicenter Experience of Traction Wire Endoscopic Submucosal Dissection","authors":"Abel Joseph ,&nbsp;Michel Kahaleh ,&nbsp;Andrew A. Li ,&nbsp;Gregory B. Haber ,&nbsp;Prashant Kedia ,&nbsp;Mai Ego Makiguchi ,&nbsp;Neil R. Sharma ,&nbsp;Joo Ha Hwang ,&nbsp;Amitabh Chak ,&nbsp;Ahmad M. Al-Taee ,&nbsp;David Braun ,&nbsp;Shaffer Mok ,&nbsp;Neal A. Mehta ,&nbsp;Emre Gorgun ,&nbsp;John Vargo ,&nbsp;Seiichiro Abe ,&nbsp;Yutaka Saito ,&nbsp;Tyler Stevens ,&nbsp;Amit Bhatt","doi":"10.1016/j.tige.2022.10.002","DOIUrl":"https://doi.org/10.1016/j.tige.2022.10.002","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Endoscopic submucosal dissection (ESD) is a technically challenging and time-consuming procedure. A major limitation of ESD is the lack of a “second hand” to provide traction. We have developed a novel retraction device, a traction wire (TW), for ESD. This study was conducted to assess the efficacy, safety, and efficiency of TW-ESD.</p></div><div><h3>Methods</h3><p>We initially evaluated TW-ESD in a randomized live pig study. After the device was approved for clinical use, we used it in patients<span> undergoing ESD at 8 academic centers in the United States and Japan. Data on demographics, procedural performance, histopathology, and clinical follow-up were collected and analyzed retrospectively.</span></p></div><div><h3>Results</h3><p>Porcine study: In total, 12 ESDs were performed in random order in 3 live pigs. ESDs performed with TW had significantly shorter submucosal dissection time (7.0 ± 1.9 minutes vs 18.3 ± 3.4 minutes; <em>P</em> &lt; 0.001) and shorter total ESD time (21.5 ± 4.1 minutes vs 29.5 ± 7.7 minutes; <em>P</em><span>= 0.049). TW was successfully deployed in all 103 study patients. The median device deployment time was 2 minutes (2, 3.0), and the median procedure time was 100.5 (65.50, 175.75) minutes. En-bloc and R0 resection rates were 98.1% (101/103) and 90.29% (93/103), respectively. The median ease of deployment and retrieval of the device on a 100-mm visual analog scale was 100 (80, 100). The median degree to which the device improved ease of procedure was 90 (77.5, 100). No adverse events related to the TW were seen.</span></p></div><div><h3>Conclusion</h3><p>The TW device was safe and efficient to use in ESD.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 1","pages":"Pages 21-29"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749992","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":"Strategies to Curb the Increasing Burden of Early Onset Colorectal Cancer","authors":"Timothy Yen ,&nbsp;Theodore R. Levin ,&nbsp;Swati G. Patel","doi":"10.1016/j.tige.2023.01.008","DOIUrl":"https://doi.org/10.1016/j.tige.2023.01.008","url":null,"abstract":"<div><p><span>The incidence of early onset colorectal cancer (EoCRC), defined as colorectal cancer (CRC) in patients<span> under age 50, has been increasing in the United States. This is due to a birth </span></span>cohort effect<span><span> in which the younger generation has experienced an accelerating rise in EoCRC for reasons currently unknown, although epidemiologic research points to several traditional and emerging generation-specific risk factors. There are several racial/ethnic and geographic differences in the presentation of EoCRC with disparate outcomes. A subset of EoCRC patients have a familial or hereditary cause of EoCRC, although the etiology for most EoCRC remains to be discovered. Our current approach to prevention and early detection includes early screening for familial CRC<span>, germline genetic testing for all cases of EoCRC, triage of alarm symptoms with prompt evaluation of red flag signs and symptoms (such as hematochezia, </span></span>iron deficiency anemia<span><span>, and unexplained weight loss), offering a menu of average-risk screening options to those age 45 and older, and performing outreach/navigation to improve opportunistic screening uptake. Unfortunately, full actualization of these approaches remains suboptimal, and the increasing burden of EoCRC demands immediate action. Opportunities to improve prevention and early detection of EoCRC include initiating organized screening approaches through leveraging the electronic health record, centralization of care in medical homes, outreach using blockchain or social media technology, and biotechnological innovations in diagnosis and </span>risk stratification.</span></span></p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 3","pages":"Pages 246-258"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750016","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":"Combined Endoscopic-Percutaneous Rendezvous for Biliary Continuity for Restoration of Completely Transected Common Bile Duct","authors":"Arunkumar Krishnan,&nbsp;Yousaf Hadi,&nbsp;Aslam Syed,&nbsp;Sardar Momin Shah-Khan,&nbsp;Mohamed Zitun,&nbsp;Shailendra Singh,&nbsp;Shyam Thakkar","doi":"10.1016/j.tige.2022.11.001","DOIUrl":"https://doi.org/10.1016/j.tige.2022.11.001","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 1","pages":"Pages 56-60"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750162","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: Colorectal Cancer Screening Part II","authors":"Aasma Shaukat","doi":"10.1016/j.tige.2023.07.002","DOIUrl":"https://doi.org/10.1016/j.tige.2023.07.002","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 4","pages":"Page 301"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49758933","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":"Improving Dysplasia Detection in Barrett's Esophagus","authors":"Erik A. Holzwanger ,&nbsp;Alex Y. Liu ,&nbsp;Prasad G. Iyer","doi":"10.1016/j.tige.2023.01.002","DOIUrl":"https://doi.org/10.1016/j.tige.2023.01.002","url":null,"abstract":"<div><p><span><span>The incidence of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) continues to increase in Western countries, and </span>EAC<span><span> continues to have an overall 5-year survival rate of less than 20%. This is predominantly due to most EAC cases being diagnosed at advanced stages, after the onset of alarm symptoms. The rationale behind endoscopic surveillance of BE follows the paradigm that metaplasia (BE) progresses to EAC via the development of low- (LGD) and then high-grade </span>dysplasia<span> (HGD). Hence, endoscopic surveillance is recommended to enable early detection of dysplasia and EAC. Numerous endoscopic eradication therapy (EET) modalities, such as </span></span></span>radiofrequency ablation<span> (RFA), cryotherapy<span>, and endoscopic resection<span>, enable effective treatment of dysplasia and early-stage EAC. Indeed, randomized trials have conclusively shown that endoscopic treatment of BE-HGD and BE-LGD with RFA reduces progression to EAC. Additionally, EET effectively treats early-stage EAC.</span></span></span></p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 2","pages":"Pages 157-166"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49765371","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":"Distal Cap-assisted Endoscopic Mucosal Resection for Non-lifting Colorectal Polyps: An International, Multicenter Study","authors":"Scott R. Douglas ,&nbsp;Douglas K. Rex ,&nbsp;Alessandro Repici ,&nbsp;Melissa Kelly ,&nbsp;J. Wes Heinle ,&nbsp;Marco Spadaccini ,&nbsp;Matthew T. Moyer","doi":"10.1016/j.tige.2023.03.009","DOIUrl":"https://doi.org/10.1016/j.tige.2023.03.009","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Submucosal fibrosis is a commonly encountered problem associated with complex polyps referred for endoscopic mucosal resection (EMR). Previous biopsies, submucosal tattoo injection, and previous unsuccessful attempts at polyp resection have all been shown to induce submucosal fibrosis, which makes subsequent EMR more difficult and increases the risk of recurrence.</p></div><div><h3>Methods</h3><p>We conducted a multicenter, international, retrospective study of 61 distal cap-assisted endoscopic mucosal resection (EMR-DC) cases done for the indication of a non-lifting colorectal lesion occurring after a previous biopsy, tattoo, or attempted resection at 3 tertiary referral centers.</p></div><div><h3>Results</h3><p>EMR-DC was preceded by attempted polypectomy<span> or EMR in 88.5% of cases, submucosal tattoo injection in 2%, previous biopsy in 5%, and both biopsy and tattoo in 5%. Complete macroscopic resection was achieved in 100% of EMR-DC procedures in an average procedure time of 49.5 minutes. The adenoma recurrence rate for these adherent lesions at surveillance (average 6.6 months) was only 9.8%. Two serious adverse events occurred (3.3%) within 30 days of the procedure: one instance of postprocedural bleeding and one episode of post-polypectomy syndrome.</span></p></div><div><h3>Conclusion</h3><p>This large, multicenter series demonstrates EMR-DC to be a safe, effective, and efficient approach to a difficult and common clinical problem: adherent and non-lifting polyps. It may offer several advantages over more expensive or invasive endoscopic techniques used for this indication. The use of EMR-DC for larger adherent polyps with adjuvant techniques such as hot avulsion or cold forceps avulsion with adjuvant snare tip soft coagulation for smaller adherent sections may represent an ideal approach.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 3","pages":"Pages 236-242"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749840","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":"Prospective Evaluation of a Standardized Approach to Improve Procedure Speed in Esophageal Endoscopic Submucosal Dissection","authors":"Firas Bahdi ,&nbsp;Michael M. Mercado ,&nbsp;Xiaofan Huang ,&nbsp;Kristen A. Staggers ,&nbsp;Noor Zabad ,&nbsp;Mohamed O. Othman","doi":"10.1016/j.tige.2023.01.006","DOIUrl":"https://doi.org/10.1016/j.tige.2023.01.006","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>Endoscopic submucosal dissection (ESD) of esophageal lesions is limited by the lengthy procedure time, technique's complexity, and need for specialized training. We propose a standardized esophageal ESD technique that takes advantage of specimen self-retraction to improve visualization and procedure speed by starting the margins’ </span>incision at the anal side, followed by the laterals and the proximal.</p></div><div><h3>Methods</h3><p>This was a prospective clinical trial<span> of all consecutive patients who underwent a standardized esophageal ESD of esophageal lesions at a single tertiary referral center between December 2016 and January 2021. The primary outcome was the entire procedure speed calculated as centimeters squared per hour. Secondary outcomes included the rates of en bloc resection, R0 resection, and adverse events. Linear regression analysis was conducted to test the association between the entire procedure speed and tumor location, number of knives used, year of procedure, and pathology results.</span></p></div><div><h3>Results</h3><p>Thirty-two patients prospectively enrolled in our study. The mean patient age was 65 ± 10.9 years. The mean specimen surface area was 17.9 ± 12.7 cm². The mean entire procedure speed was 11 ± 5.9 cm²/h. The mean total procedure time was 93.5 ± 31 minutes. The entire procedure speed was significantly faster with procedures performed over the last 3 years (+5.86 cm²/h; <em>P</em><span> = 0.003) or Barrett's esophagus (+7.77 cm</span>²/h; <em>P</em> = 0.001). En-bloc and R0 resection rates were 100% and 68.8%, respectively. There were only 2 early bleeding events (6.3%) and 4 stricture formations (12.5%). All adverse events were successfully managed endoscopically.</p></div><div><h3>Conclusion</h3><p>Our standardized esophageal ESD technique offered our operator a remarkable entire procedure speed with continuous annual improvement and an acceptable safety profile. Future controlled multicenter studies are warranted to confirm the results’ generalizability and help promote wider adoption of esophageal ESD (ClinicalTrials.gov identifier: NCT04547881).</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 2","pages":"Pages 127-134"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749991","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}