Best Practice & Research Clinical Gastroenterology最新文献_第6页

Endoscopic pyloromyotomy for treatment of gastroparesis: A new standard or still an experimental approach? 内镜幽门切开术治疗胃瘫：新标准还是试验性方法？

IF 3.2 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101910

{"title":"Endoscopic pyloromyotomy for treatment of gastroparesis: A new standard or still an experimental approach?","authors":"","doi":"10.1016/j.bpg.2024.101910","DOIUrl":"10.1016/j.bpg.2024.101910","url":null,"abstract":"<div><p><span>Gastroparesis (GP) can be a severe and debilitating disease. Its </span>pathophysiology<span> is complex and not completely understood. Two principal mechanisms are responsible for the development of symptoms – gastric hypomotility and pylorospasm. Pylorus<span><span> targeted therapies aim to decrease presumably elevated pyloric tone – pylorospasm. There is a growing body of evidence about their role in the treatment algorithm of GP. G-POEM (endoscopic pyloromyotomy) is an extensively studied pylorus targeted therapy. Its efficacy ranges between 56 and 80% and the number of recurrences among those with treatment effect seems low. G-POEM is a safe procedure with very low frequency of severe </span>adverse events<span>. At present, G-POEM should not be considered as an experimental approach and may be offered to all patients with refractory and severe GP. Nevertheless, G-POEM is not a first line treatment. Conservative measures such as diet modification and pharmacotherapy should always be tried before G-POEM is considered. Further research must focus on better patient selection as at present there are no standardized criteria. Functional imaging such as impedance planimetry (EndoFlip) may hold promise in this regard.</span></span></span></p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"71 ","pages":"Article 101910"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140585091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Emerging indications for third space endoscopy 第三空间内窥镜检查的新适应症

IF 3.2 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101911

引用次数: 0

How to close mucosal incisions? 如何缝合粘膜切口？

IF 3.2 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101938

Rastislav Hustak

{"title":"How to close mucosal incisions?","authors":"Rastislav Hustak","doi":"10.1016/j.bpg.2024.101938","DOIUrl":"10.1016/j.bpg.2024.101938","url":null,"abstract":"<div><p>This article provides an overview of the techniques for closure of the mucosal entry point following advanced procedures in the third space. The outbreak of natural orifice transluminal endoscopic surgery (NOTES) has significantly impacted the treatment of various benign and malignant conditions. Reliable and secure closure of the mucosal entrance is essential for avoiding serious adverse events.</p><p>Although small defects are typically closed using through-the-scope clips (TTSCs) or over-the-scope clips (OTSCs), challenges may occur with larger or transmural defects. Alternative methods, such as specialised stitches and full-thickness suturing systems, have been developed to address these challenges with promising results. Each method has its own pros and cons, and the choice of closure technique depends on various factors such as anatomical location, endoscopist expertise, costs, and clinical context.</p><p>By understanding the technical specifications of each closure device, endoscopists can make decisions that enhance patient outcomes and minimise the risk of complications associated with the approximation of defect edges. Continued research is essential to optimise the evolution of newer closure devices and techniques for advancing NOTES.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"71 ","pages":"Article 101938"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Navigating the learning landscape: Comprehensive training in third space endoscopy - training, techniques, and practical recommendations 学习导航：第三空间内窥镜培训、技术和实用建议的综合培训

IF 3.2 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101918

{"title":"Navigating the learning landscape: Comprehensive training in third space endoscopy - training, techniques, and practical recommendations","authors":"","doi":"10.1016/j.bpg.2024.101918","DOIUrl":"10.1016/j.bpg.2024.101918","url":null,"abstract":"<div><p>Third space endoscopy (TSE), including ESD, POEM, or STER are advanced procedures requiring precise endoscopic control and tissue recognition. Despite its increasing adoption, evidence-based curricula, and standardized training protocols for TSE are lacking. This review explores training methods, cognitive skills, and technical proficiency requirements for endoscopists performing TSE, with a primary emphasis on POEM. Generally, it seems wise to recommend a step-up approach to TSE training, starting with ex-vivo models or POEM simulators; mechanical and virtual reality (VR) simulators are commonly used during early training. Preclinical training involving ex-vivo and live animal models is suggested to prepare trainees for safe and effective procedures. Studies suggest varying numbers of procedures for training, with approximately 20–40 cases needed before a first plateau is achieved in terms of complications and speed. The duration of on-patient clinical training varies depending on prior experience. Mentorship programs, workshops, and case discussions may facilitate dynamic knowledge transfer. In addition, adverse event management is a crucial aspect of any TSE training program. Existing evidence supports the use of preclinical models and emphasizes the importance of specialized training programs for TSE in alignment with our proposed step-up training approach. This review outlines practical recommendations for the theoretical knowledge and technical skills required before commencing TSE training, covering clinical understanding, diagnostic and outcome assessment, procedural requirements, and the role of mentorship programs.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"71 ","pages":"Article 101918"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1521691824000404/pdfft?md5=2973dab4291362866783e9ff021359d7&pid=1-s2.0-S1521691824000404-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141057091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Endoscopic removal of gastrointestinal lesions by using third space endoscopy techniques 利用第三空间内窥镜技术在内窥镜下切除胃肠道病灶

IF 3.2 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101931

引用次数: 0

Cricopharyngeal achalasia and upper oesophageal endoscopic myotomy (CP-POEM) 环咽贲门失弛缓症和上食道内窥镜肌切开术（CP-POEM）

IF 3.2 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101937

Eduardo Albeniz, Fermin Estremera-Arevalo

引用次数: 0

Traditional septotomy or Z-POEM for Zenker's diverticulum 传统的隔膜切除术或 Z-POEM 治疗禅克氏憩室

IF 3.2 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101943

M.F. Kaminski , A. Budnicka , A. Przybysz , N.D. Pilonis

{"title":"Traditional septotomy or Z-POEM for Zenker's diverticulum","authors":"M.F. Kaminski , A. Budnicka , A. Przybysz , N.D. Pilonis","doi":"10.1016/j.bpg.2024.101943","DOIUrl":"10.1016/j.bpg.2024.101943","url":null,"abstract":"<div><p>Zenker's diverticulum (ZD), also known as a cricopharyngeal pouch, is a pulsion pseudodiverticulum located dorsally at the pharyngoesophageal junction. The pathophysiology of ZD involves cricopharyngeal spasm, incoordination, impaired upper esophageal sphincter opening, and structural changes in the cricopharyngeal muscle, leading to symptoms such as dysphagia, regurgitation of undigested food, foreign body sensation, halitosis, unintentional weight loss, and respiratory issues. Treatment for symptomatic ZD typically involves myotomy of the cricopharyngeal muscle. Endoscopic techniques, particularly flexible endoscopy septotomy (FES) and Zenker peroral endoscopic myotomy (Z-POEM), have become preferred options due to their minimally invasive nature. This review discusses the techniques and clinical outcomes of FES and Z-POEM, focusing on specific clinical scenarios to guide the choice between these methods. Additionally, the variability in FES techniques, the effectiveness of Z-POEM, and the impact of different diverticulum sizes on treatment outcomes are analyzed, providing a comprehensive overview of current therapeutic approaches for ZD.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"71 ","pages":"Article 101943"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

POEM for non-achalasia spastic oesophageal motility disorders POEM 用于治疗非achalasia 痉挛性食道运动障碍

IF 3.2 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101909

{"title":"POEM for non-achalasia spastic oesophageal motility disorders","authors":"","doi":"10.1016/j.bpg.2024.101909","DOIUrl":"10.1016/j.bpg.2024.101909","url":null,"abstract":"<div><p>Non-achalasia oesophageal motility disorders (NAOMD) represent a heterogeneous group of rare diseases, including oesophagogastric junction outflow obstruction, distal oesophageal spasm, and hypercontractile oesophagus. Despite the differing aetiological, manometric and pathophysiological characteristics, these disorders are unified by similar clinical presentation, including dysphagia and chest pain. The management of these disorders remain a challenge for the clinician. Pharmacotherapy, botulinum toxin injection, endoscopic dilation, and laparoscopic Heller myotomy have been employed, with limited efficacy in the majority of patients. Currently, there are no controlled studies in literature that suggest which is the best management of these diseases. Since its introduction in clinical practice, PerOral Endoscopic Myotomy (POEM) has emerged as a very promising, minimally invasive and effective treatment for oesophageal achalasia. No longer after the first uses, POEM has been successfully used also for the management of selected patients with NAOMD, However, currently available data are limited by small study sample sizes and short-term follow-up.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"71 ","pages":"Article 101909"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1521691824000313/pdfft?md5=dc0dc0e7a10f7e65d1a2ba110f1d051c&pid=1-s2.0-S1521691824000313-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140584994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

POEM in the esophagus - How to deal with the post-POEM reflux 食道中的 POEM - 如何处理 POEM 后反流问题

IF 3.2 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101917

引用次数: 0

Complications related to third space endoscopic procedures 与第三空间内窥镜手术有关的并发症

IF 3.2 3区医学

Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101908

引用次数: 0