VideoGIE最新文献

{"title":"Endoscopic submucosal dissection of a giant gastric polyp","authors":"Fatih Aslan MD , Orhun Cig Taskin MD , Ahmet Bahadır Ak MD , Mete Manici MD","doi":"10.1016/j.vgie.2025.03.033","DOIUrl":"10.1016/j.vgie.2025.03.033","url":null,"abstract":"","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 8","pages":"Pages 392-397"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633460","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":"Tip-fixing underwater endoscopic mucosal resection without submucosal injection for a laterally spreading colon polyp","authors":"Koichi Okamoto MD, PhD,&nbsp;Tomoyuki Kawaguchi MD, PhD,&nbsp;Kaizo Kagemoto MD, PhD,&nbsp;Yoshifumi Kida MD, PhD,&nbsp;Yasuhiro Mitsui MD, PhD,&nbsp;Masahiro Sogabe MD, PhD,&nbsp;Yasushi Sato MD, PhD,&nbsp;Tetsuji Takayama MD, PhD","doi":"10.1016/j.vgie.2025.03.034","DOIUrl":"10.1016/j.vgie.2025.03.034","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Underwater endoscopic mucosal resection (EMR) has become a popular endoscopic resection method for intermediate-to-large colorectal polyps. However, the snare tip can sometimes slip when opening or closing the snare, resulting in increased risk of piecemeal resection. To address this issue, we report our technique of tip-fixing underwater EMR without submucosal injection for a laterally spreading colon polyp.</div></div><div><h3>Methods</h3><div>Degassed water was infused using a mechanical water pump to completely fill the lumen. By projecting the tip of the snare by 2 mm, a mucosal incision was made on the oral side of the lesion using a cutting current. The snare was positioned appropriately around the lesion. After the lesion was captured, resection was performed using electrocautery.</div></div><div><h3>Results</h3><div>Complete en bloc resection was achieved with no adverse events, and the mucosal defect was completely closed using clips. Pathological findings indicated a low-grade tubulovillous adenoma with negative margins.</div></div><div><h3>Conclusions</h3><div>In previous tip-in EMR studies, a spot-shaped mucosal incision was created at the oral normal mucosa with prior submucosal injections using the snare tip to fix the snare. However, submucosal injection was not required in our technique of tip-fixing underwater EMR. Essentially, intraluminal water serves as a heat sink which, when combined with a relatively thicker wall resulting from the relaxation of mucosal tension by removing intraluminal air, may protect against thermal injury of the deeper colonic wall even while making a precut with the snare tip. However, excessive snare exposure, overapplication of cautery, or deep snare driving could cause perforation, especially in thin-walled areas such as the right-sided colon or small intestine.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 8","pages":"Pages 425-427"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633550","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":"Artificial intelligence system for EUS navigation and anatomical landmark recognition","authors":"Gianenrico Rizzatti PhD,&nbsp;Giulia Tripodi MD,&nbsp;Sara Sofia De Lucia MD,&nbsp;Antonio Pellegrino MD,&nbsp;Ivo Boskoski PhD,&nbsp;Alberto Larghi PhD,&nbsp;Cristiano Spada PhD","doi":"10.1016/j.vgie.2025.03.027","DOIUrl":"10.1016/j.vgie.2025.03.027","url":null,"abstract":"<div><h3>Background and Aims</h3><div>The use of artificial intelligence (AI) has been introduced in several medical fields with promising results, including endoscopy. In the field of EUS, studies using AI are still limited and have mostly focused on the identification and characterization of pancreatic masses. Recently, AI systems based on deep learning have been developed to identify anatomical landmarks during diagnostic EUS.</div></div><div><h3>Methods</h3><div>The Endoangel system (Wuhan ENDOANGEL Medical Technology, Wuhan, China), built using deep convolutional neural networks (DCNNs), is able to provide navigation hints and identify anatomical landmarks in real time during diagnostic EUS. The system was trained with more than 550 EUS procedures and uses a DCNN that processes images through multiple layers by extracting features, introducing nonlinearity, reducing complexity, and making predictions via fully connected layers.</div></div><div><h3>Results</h3><div>The AI EUS system was tested in 3 patients undergoing diagnostic EUS. In each case, the correct recognition of anatomical landmarks by the AI EUS system was judged by a single expert performing the EUS examination. The system did not recognize pathologic alterations such as pancreatic masses or cystic lesions.</div></div><div><h3>Conclusions</h3><div>The AI EUS DCNN-based system is able to correctly identify EUS anatomical landmarks. In the near future, this system might play an important role in EUS training and quality control. In addition, many other features might progressively be added, with the next ideal step being the identification of pathologic alterations.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 358-363"},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364695","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":"Identifying the impossible: piecemeal cold snare resection perforation","authors":"Hyun Jae Kim MD ,&nbsp;Douglas Motomura MD ,&nbsp;Eric C.S. Lam MD, MSc ,&nbsp;Neal Shahidi MD, PhD","doi":"10.1016/j.vgie.2025.03.028","DOIUrl":"10.1016/j.vgie.2025.03.028","url":null,"abstract":"<div><h3>Background and Aim</h3><div>Piecemeal cold snare resection (CSR) is an increasingly adopted technique for large nonpedunculated colorectal polyps because of its favorable safety profile. Although adverse events are rare, perforation after CSR has been reported infrequently. We present a video case of intraprocedural perforation during piecemeal CSR.</div></div><div><h3>Methods</h3><div>A 63-year-old woman with quiescent colonic Crohn disease underwent dysplasia surveillance, revealing multiple flat polyps, including 2 adjacent large 0-IIA transverse colon polyps. Piecemeal CSR was performed using chromoinjectate and a 10-mm cold snare. Careful inspection of the resection base with submucosal chromoendoscopy revealed a type IV deep mural injury, despite the absence of electrocautery. The defect was closed using through-the-scope clips. The patient was observed and discharged with antibiotics, with no delayed adverse events at follow-up. Histopathology confirmed sessile serrated lesions without dysplasia.</div></div><div><h3>Conclusion</h3><div>This case demonstrates that perforation, although rare, can occur during CSR. Endoscopists should perform meticulous resection base assessments, as the absence of cautery may obscure signs of deep mural injury.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 8","pages":"Pages 422-424"},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633549","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":"Tips on pre-emptive hemostasis of large vessels during endoscopic full-thickness resection of a large gastrointestinal stromal tumor","authors":"Abdullah Abbasi MD ,&nbsp;Maham Hayat MD ,&nbsp;Saurabh Chandan MD ,&nbsp;Sagar Pathak MD ,&nbsp;Muhammad K. Hasan MD ,&nbsp;Kambiz K. Kadkhodayan MD ,&nbsp;Peter V. Draganov MD ,&nbsp;Dennis Yang MD","doi":"10.1016/j.vgie.2025.03.030","DOIUrl":"10.1016/j.vgie.2025.03.030","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Exposed endoscopic full-thickness resection is often necessary for the management of large subepithelial lesions or those extending deep into the GI wall. Despite advances in endoscopy, our toolbox for the prevention and management of bleeding from large vessels remains limited. This video case report demonstrates the successful removal of a large gastrointestinal stromal tumor in the fundus, with a focus on our endoscopic approach to the management of large peritoneal vessels.</div></div><div><h3>Methods</h3><div>An exposed endoscopic full-thickness resection procedure was performed using a needle-type and insulated tip electrocautery knife. Endoscopic ligation of blood vessels was performed using through-the-scope clips, whereas closure of the gastric wall defect was accomplished with over-the-scope suturing.</div></div><div><h3>Results</h3><div>An 82-year-man with multiple comorbidities was found to have gastric fundal gastrointestinal stromal tumor on computed tomography and confirmed on endoscopic ultrasound fine-needle aspiration. After multidisciplinary discussion, he was planned for endoscopic resection. Given the size of the lesion and exophytic component, exposed endoscopic full-thickness resection was performed. Large peritoneal feeding vessels were identified. For pre-emptive hemostasis, through-the-scope clips were used for ligation before vessel transection. This approach was effective and resulted in sufficient mechanical tamponade to permit adequate visualization for targeted intervention when bleeding ensued. The remainder of the lesion was subsequently dissected without any issues. Closure of the large full-thickness defect was achieved using the over-the-scope suturing system.</div></div><div><h3>Conclusions</h3><div>We present pre-emptive endoscopic hemostatic strategies when encountering large vessels. Innovation and development of dedicated devices are urgently needed to increase the efficiency and safety of these procedures as we continue to expand our therapeutic boundaries.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 349-352"},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364693","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":"A multistep approach for managing a complex esophageal perforation","authors":"Shiran Shetty DM,&nbsp;Dronamraju Sujay Prabhath MD,&nbsp;Balaji Musunuri DNB,&nbsp;Praveen M.C.S. MD,&nbsp;Abhay Mahajan MD,&nbsp;Santanu Mishra PharmD","doi":"10.1016/j.vgie.2025.03.029","DOIUrl":"10.1016/j.vgie.2025.03.029","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Esophageal perforation in adults is associated with significant morbidity and mortality, with optimal treatment approaches remaining debated. Outcomes are linked to timely diagnosis and appropriate interventions. Common therapeutic options, such as esophageal clips, stents, and suturing, may be ineffective for large perforations. We aimed to show the need for a multistep approach in dealing with difficult perforations.</div></div><div><h3>Methods</h3><div>An 85-year-old male presented with chest pain and dyspnea, following an endoscopic procedure. He was hemodynamically stable but had leukocytosis (14,400/μL). CT thorax confirmed esophageal perforation with right-sided hydropneumothorax. Due to poor performance status, surgery was deferred. Endoscopy revealed a 4-cm midesophageal perforation. A fully covered self-expandable metal stent (SEMS) was initially placed. However, the perforation persisted after SEMS removal. To address the defect, endoluminal vacuum therapy (ENDOVAC) was attempted using a modified ENDOVAC with sponge attached to a Ryle’s tube and connected to a negative pressure wound therapy device. The sponge was replaced every 3 days, with adjustments to match the defect size. Despite 4 ENDOVAC sessions and defect reduction, complete closure was not achieved. Definitive closure was achieved using a through-the-scope tack-and-suture device. Tacks were placed 5 to 10 mm from the defect margins, securing healthy tissue, and deployed using a push catheter in a zig-zag pattern for optimal coverage. Sutures were tightened sequentially to eliminate slack and ensure closure.</div></div><div><h3>Results</h3><div>Postprocedure, an oral gastrograffin study confirmed no leaks, and then he was resumed on oral feeds. Follow-up chest x-ray showed resolution of hydropneumothorax, with no complaints or adverse events reported.</div></div><div><h3>Conclusions</h3><div>This case demonstrates the successful management of a complex esophageal perforation using a multistep endoscopic intervention approach. Failure of defect closure using clips required use of a covered metal stent, endoscopic vacuum therapy, along with tack-and-suture device to achieve complete closure of defect.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 8","pages":"Pages 387-391"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633459","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":"Percutaneous cholangioscopy-assisted rendezvous endoscopic retrograde cholangiography technique for a difficult postliver transplant anastomotic stricture","authors":"Pankaj Singh DM Gastroenterology,&nbsp;Vikas Singla DM Gastroenterology,&nbsp;Akash Goel DNB Gastroenterology,&nbsp;Muzaffar Rashid Shawl DNB Gastroenterology,&nbsp;Shahnawaz Bashir MD Radiodiagnosis","doi":"10.1016/j.vgie.2025.03.025","DOIUrl":"10.1016/j.vgie.2025.03.025","url":null,"abstract":"<div><h3>Background and Aims</h3><div>In cases of postliver transplant biliary stricture with double-duct anastomsis, double-duct stenting is absolutely necessary to preserve graft function.</div></div><div><h3>Methods</h3><div>We present a successful technique of percutaneous cholangioscopy-assisted rendezvous ERCP for difficult anastomotic stricture after failure of cholangioscopy-guided wire negotiation and percutaneous transhepatic biliary drainage.</div></div><div><h3>Results</h3><div>We achieved successful completion of biliary drainage through right anterior sectoral duct and right posterior duct stenting with subsequent dilatation of the stricture. There was resolution of the anastomotic stricture on follow-up.</div></div><div><h3>Conclusions</h3><div>Cholangioscopy-assisted rendezvous endoscopic retrograde cholangiography technique is a reasonable option for a difficult post-transplant anastomotic stricture when conventional methods fail.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 8","pages":"Pages 402-405"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633381","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":"Hybrid endoscopic submucosal dissection and endoscopic full-thickness resection for R0 resection of T1 colonic adenocarcinoma","authors":"Rahul Karna MD ,&nbsp;Iman Afraz MBBS ,&nbsp;Juan C. Manivel MD ,&nbsp;Daniela Guerrero Vinsard MD ,&nbsp;Mohammad Bilal MD","doi":"10.1016/j.vgie.2025.03.026","DOIUrl":"10.1016/j.vgie.2025.03.026","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Malignant colorectal polyps limited to superficial submucosa can undergo endoscopic resection as a curative strategy. Endoscopic full-thickness resection (EFTR) allows en bloc resection of malignant polyps; however, the technique is challenging in lesions with submucosal invasion or those &gt;20 mm in size.</div></div><div><h3>Methods</h3><div>This original article and accompanying video reviews the technique for hybrid endoscopic submucosal dissection (ESD) and EFTR to allow R0 resection of T1 colonic adenocarcinoma.</div></div><div><h3>Results</h3><div>In the case example, ESD was performed to make a 35-mm lesion pliable. This step allowed the lesion to be pulled into the cap and complete en bloc resection using the full-thickness resection device.</div></div><div><h3>Conclusions</h3><div>The case highlights that hybrid ESD-EFTR technique is feasible and allows for en bloc removal of superficially invasive submucosal colon adenocarcinoma with lesions &gt;20 mm in size. Initial mucosal incision and partial submucosal dissection can make the lesions with underlying submucosal invasion pliable and hence amenable to full-thickness resection using a full-thickness resection device.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 376-379"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364703","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":"Multipoint adjustable traction for endoscopic submucosal dissection using a helix tack suturing system: a case series","authors":"Kambiz S. Kadkhodayan MD ,&nbsp;Shayan Irani MD ,&nbsp;Saurabh Chandan MD ,&nbsp;Sagar Pathak MD ,&nbsp;Abdullah Abbasi MD ,&nbsp;Maham Hayat MD ,&nbsp;Muhammad K. Hasan MD ,&nbsp;Dennis Yang MD","doi":"10.1016/j.vgie.2025.03.001","DOIUrl":"10.1016/j.vgie.2025.03.001","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Optimal exposure of the submucosal plane is essential for effective endoscopic submucosal dissection (ESD). The application of traction improves visualization and resection efficiency, but most described techniques rely on nonadaptive single-point fixation.</div></div><div><h3>Methods</h3><div>We describe a novel multipoint, adjustable traction technique using the X-Tack Endoscopic Helix Tacking System. Three tacks are placed around the lesion margin, and a fourth tack is secured to the contralateral wall of the colon. By pulling on the polypropylene suture, upward, multipoint traction or “parachuting effect” was achieved. This resulted in lesion stability and improved submucosal exposure during colorectal ESD.</div></div><div><h3>Results</h3><div>The traction technique was successfully applied in 3 patients.</div></div><div><h3>Conclusions</h3><div>Multipoint adjustable traction using the helix tack system resulted in improved submucosal visualization, lesion stability, and adaptability during ESD. Further research is needed.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 372-375"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364702","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":"Coagulation forceps-sparing techniques for pre-emptive sealing of blood vessels during third-space endoscopy","authors":"Zaheer Nabi MD, DNB, FASGE, FISG, FSGEI,&nbsp;Pradev Inavolu MD, DM,&nbsp;Rajesh Goud PhD,&nbsp;Santhosh Darisetty MD,&nbsp;D. Nageshwar Reddy MD, DM","doi":"10.1016/j.vgie.2025.03.002","DOIUrl":"10.1016/j.vgie.2025.03.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Intraprocedural bleeding is a significant concern during third-space endoscopy, particularly in procedures like peroral endoscopic myotomy and endoscopic submucosal dissection. Although coagulation forceps can be used to effectively manage large blood vessels, their use necessitates frequent instrument exchanges, disrupting procedural flow and increasing costs. This review describes several distinct coagulation techniques to achieve coagulation without the need for hemostatic forceps.</div></div><div><h3>Methods</h3><div>The following coagulation techniques were used: noncontact coagulation (SprayCoag E 5.5), saline immersion coagulation (SprayCoag E 5.5), contact coagulation with low-dose energy (PreciseSect E 0.9-1) or retracted tip of knife (SwiftCoag E 4), microwave coagulation using a bipolar device (10 W), and application of a novel self-assembling peptide (PuraStat).</div></div><div><h3>Results</h3><div>All the techniques effectively coagulated the blood vessels, with a low incidence of breakthrough bleeding and need for adjunctive hemostatic techniques reported. The transition from air to saline lowers impedance, thereby reducing voltage, which in turn diminishes the dissection effect while enhancing coagulation efficiency. The dissection power of SprayCoag and other coagulation modes (SwiftCoag or PreciseSect) could be adjusted by increasing the target distance or reducing the energy dose, respectively. Use of a novel bipolar device enables coagulation using microwave energy and application of self-assembling peptide gel minimizes the need for an electrosurgical unit for coagulation.</div></div><div><h3>Conclusions</h3><div>Several coagulation techniques effectively seal large blood vessels during submucosal dissection procedures, reducing reliance on hemostatic forceps. Further studies comparing these methods with conventional approaches are warranted to confirm their broader clinical applicability.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"10 7","pages":"Pages 380-385"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364704","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}