DEN open最新文献

{"title":"Endoscopic findings of gallbladder lesions evaluated with image-enhanced endoscopy: A preliminary study using resected gallbladders","authors":"Kiyoyuki Kobayashi,&nbsp;Maki Ayaki,&nbsp;Takako Nomura,&nbsp;Kaho Nakatani,&nbsp;Masaki Tokumo,&nbsp;Yasutaka Kokudo,&nbsp;Toshiaki Morito,&nbsp;Ichiro Ishikawa,&nbsp;Akihiro Kondo,&nbsp;Yasuhisa Ando,&nbsp;Hironobu Suto,&nbsp;Minoru Oshima,&nbsp;Ryota Nakabayashi,&nbsp;Toshiaki Kono,&nbsp;Naoki Fujita,&nbsp;Hiroki Yamana,&nbsp;Hideki Kamada,&nbsp;Masafumi Ono,&nbsp;Keiichi Okano,&nbsp;Hideki Kobara","doi":"10.1002/deo2.70136","DOIUrl":"https://doi.org/10.1002/deo2.70136","url":null,"abstract":"<p>The diagnosis of gallbladder (GB) lesions relies on imaging findings. Transpapillary cholangioscopy can potentially be used to diagnose GB lesions; however, the images obtained remain unclear. This study aimed to characterize the endoscopic findings of GB lesions. We examined the endoscopic features of GB lesions in 50 consecutive patients who underwent cholecystectomy. GB specimens were obtained immediately following cholecystectomy, opened on the side opposite the liver bed, and flushed with saline solution. Each lesion was assessed using a high-resolution endoscope equipped with white light and narrow-band imaging magnification. For elevated lesions, both the surface structure (classified as regular, irregular, or absent) and vascular structure (dilation, meandering, caliber change, non-uniformity, and loose vessel areas) were assessed. Twelve of the 50 patients had elevated lesions, including cholesterol polyp (<i>n</i> = 4), hyperplastic polyp (<i>n</i> = 1), xanthogranulomatous cholecystitis (<i>n</i> = 1), and GB carcinoma (<i>n</i> = 6). Advanced GB carcinoma, as opposed to T1 GB carcinoma, demonstrated a papillary surface with destructive areas and neovascularization on narrow-band imaging magnification. Endoscopic images of each GB lesion were characterized, and the differences between GB carcinomas and benign lesions were identified. This preliminary classification may contribute to innovative imaging diagnosis and targeted biopsy for diagnosing GB lesions under direct vision.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901054","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":"Effects of artificial intelligence assistance on endoscopist performance: Comparison of diagnostic performance in superficial esophageal squamous cell carcinoma detection using video-based models","authors":"Naoki Aoyama,&nbsp;Keiichiro Nakajo,&nbsp;Maasa Sasabe,&nbsp;Atsushi Inaba,&nbsp;Yuki Nakanishi,&nbsp;Hiroshi Seno,&nbsp;Tomonori Yano","doi":"10.1002/deo2.70083","DOIUrl":"https://doi.org/10.1002/deo2.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Superficial esophageal squamous cell carcinoma (ESCC) detection is crucial. Although narrow-band imaging improves detection, its effectiveness is diminished by inexperienced endoscopists. The effects of artificial intelligence (AI) assistance on ESCC detection by endoscopists remain unclear. Therefore, this study aimed to develop and validate an AI model for ESCC detection using endoscopic video analysis and evaluate diagnostic improvements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Endoscopic videos with and without ESCC lesions were collected from May 2020 to January 2022. The AI model trained on annotated videos and 18 endoscopists (eight experts, 10 non-experts) evaluated their diagnostic performance. After 4 weeks, the endoscopists re-evaluated the test data with AI assistance. Sensitivity, specificity, and accuracy were compared between endoscopists with and without AI assistance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Training data comprised 280 cases (140 with and 140 without lesions), and test data, 115 cases (52 with and 63 without lesions). In the test data, the median lesion size was 14.5 mm (range: 1–100 mm), with pathological depths ranging from high-grade intraepithelial to submucosal neoplasia. The model's sensitivity, specificity, and accuracy were 76.0%, 79.4%, and 77.2%, respectively. With AI assistance, endoscopist sensitivity (57.4% vs. 66.5%) and accuracy (68.6% vs. 75.9%) improved significantly, while specificity increased slightly (87.0% vs. 91.6%). Experts demonstrated substantial improvements in sensitivity (59.1% vs. 70.0%) and accuracy (72.1% vs. 79.3%). Non-expert accuracy increased significantly (65.8% vs. 73.3%), with slight improvements in sensitivity (56.1% vs. 63.7%) and specificity (81.9% vs. 89.2%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI assistance enhances ESCC detection and improves endoscopists' diagnostic performance, regardless of experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897156","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":"Long-term results of palliative placement of very low-axial force self-expandable metallic stents for malignant colorectal obstruction","authors":"Rika Kyo,&nbsp;Takashi Sasaki,&nbsp;Shuntaro Yoshida,&nbsp;Hiroyuki Isayama,&nbsp;Tomonori Yamada,&nbsp;Toshiyuki Enomoto,&nbsp;Yorinobu Sumida,&nbsp;Toshio Kuwai,&nbsp;Masafumi Tomita,&nbsp;Takeaki Matsuzawa,&nbsp;Rintaro Moroi,&nbsp;Toshiyasu Shiratori,&nbsp;Yoshihisa Saida","doi":"10.1002/deo2.70126","DOIUrl":"https://doi.org/10.1002/deo2.70126","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Stent placement is a standard option for palliative decompression in patients with malignant colorectal obstruction. Long-term stent placement is associated with perforation, migration, and stent occlusion. Perforation is associated with life expectancy. Several studies have shown that stents with a high axial force (AF), which is defined as the force required to maintain the stent straight after it has bent, are associated with a higher perforation rate. Therefore, we evaluated the long-term outcomes of using a very low AF stent (Niti-S Enteral Colonic Uncovered stent D-type) for palliative purposes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eighty-one consecutive patients with malignant colorectal obstruction in 33 medical institutions were evaluated. A stent with very low AF was placed using an endoscope system. We evaluated the adverse events (including perforation, migration, and stent occlusion), 1-year survival rate, and cumulative patency rate. Univariate analysis was conducted using Fisher's exact test. The overall survival and cumulative patency rates were assessed using the Kaplan–Meier method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 1-year cumulative survival rate was 37.8% after stent placement. The 3-month, 6-month, and 1-year cumulative patency rates after stenting were 93.6%, 84.2%, and 75.8%, respectively. The major adverse events included stent migration (6.2%), stent occlusion (9.9%), and perforation (2.5%). Chemotherapy was administered in 26 cases (32.1%) after stenting, and bevacizumab was administered in five cases. However, no cases of perforation occurred following bevacizumab administration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results suggest that very low AF stents are safe and effective. Therefore, they may be a suitable option for applications, such as palliation. (UMIN 000011304)</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897106","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":"Assessing the effectiveness of texture and color enhancement imaging versus white-light endoscopy in detecting gastrointestinal lesions: A systematic review and meta-analysis","authors":"Muhammad Shahzil,&nbsp;Talha Bin Kashif,&nbsp;Zainab Jamil,&nbsp;Muhammad Ali Khaqan,&nbsp;Luqman Munir,&nbsp;Zunaira Amjad,&nbsp;Muhammad Saad Faisal,&nbsp;Ammad Javaid Chaudhary,&nbsp;Hassam Ali,&nbsp;Shahryar Khan,&nbsp;Ikponmwosa Enofe","doi":"10.1002/deo2.70128","DOIUrl":"https://doi.org/10.1002/deo2.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Gastrointestinal cancers account for 26% of cancer incidence and 35% of cancer-related deaths globally. Early detection is crucial but often limited by white light endoscopy (WLE), which misses subtle lesions. Texture and color enhancement imaging (TXI), introduced in 2020, enhances texture, brightness, and color, addressing WLE's limitations. This meta-analysis evaluates TXI's effectiveness compared to WLE in gastrointestinal lesion lesion detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis were conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of CENTRAL, PubMed, Embase, and Web of Science identified randomized controlled trials and observational studies comparing TXI with WLE. Outcomes included lesion detection rates, color differentiation, and visibility scores. The risk of bias was assessed using the Cochrane ROB 2.0 tool and Newcastle-Ottawa tools, and evidence certainty was evaluated using Grading of Recommendations Assessment, Development, and Evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen studies with 16,634 participants were included. TXI significantly improved color differentiation (mean difference: 3.31, 95% confidence interval [CI]: 2.49–4.13), visibility scores (mean difference: 0.50, 95% CI: 0.36–0.64), and lesion detection rates (odds ratio [OR]: 1.84, 95% CI: 1.52–2.22) compared to WLE. Subgroup analyses confirmed TXI's advantages across pharyngeal, esophageal, gastric, and colorectal lesions. TXI also enhanced adenoma detection rates (OR: 1.66, 95% CI: 1.31–2.12) and mean adenoma detection per procedure (mean difference: 0.48, 95% CI: 0.25–0.70).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>TXI improves gastriontestinal lesion lesion detection by enhancing visualization and color differentiation, addressing key limitations of WLE. These findings support its integration into routine endoscopy, with further research needed to compare TXI with other modalities and explore its potential in real-time lesion detection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892955","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":"“Cat scratch colon” causing cecal perforation as a rare complication due to barotrauma during colonoscopy: A case report and literature review","authors":"Hitoshi Hara,&nbsp;Yashuhide Muto,&nbsp;Tomoki Kido,&nbsp;Ryohei Miyata,&nbsp;Moe Tokuda,&nbsp;Tomohiro Maesono,&nbsp;Takahiro Ajihara,&nbsp;Takuma Naritomi,&nbsp;Michio Itabashi","doi":"10.1002/deo2.70125","DOIUrl":"https://doi.org/10.1002/deo2.70125","url":null,"abstract":"<p>“Cat scratch colon” (CSC), characterized by spontaneous bright-red linear markings or mucosal laceration with bleeding due to air insufflation barotrauma, is a rare complication during colonoscopy. These mucosal lacerations can present as superficial tears that do not generally have clinical repercussions or as deeper tears that damage the muscularis and cause perforation. CSC occurs in the colon with submucosal stiffening disease, such as collagenous colitis; however, in cases unrelated to these diseases, CSC appears in the cecum or ascending colon for anatomical reasons. Herein, we report a case of CSC that caused cecal perforation. A 79-year-old woman underwent a colonoscopy for anal bleeding. Although insertion of the colonoscope was easy, as soon as the cecum expanded with air insufflation, the cecal mucosa was torn, and bleeding occurred. The endoscopist determined these findings as shallow mucosal tears and inactive bleeding, and a colonoscopy was completed. She visited our hospital 2 days after colonoscopy with a complaint of abdominal pain that appeared in the morning after colonoscopy. Computed tomography revealed inflammation around the cecum, with free air. Emergency surgery was performed to diagnose an iatrogenic colonic perforation caused by colonoscopy. During surgery, a necrotic area was found in the cecal wall, requiring ileocecal resection. The resected specimen showed cecal mucosal tears with necrosis, which were pathologically consistent with cecal rupture resulting from mucosal laceration. The postoperative course was uneventful. When CSC is encountered along with endoscopic findings of deep mucosal tears in the colon, the possibility of perforation after colonoscopy should be considered.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883930","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":"Olmesartan-induced gastritis with no lower gastrointestinal symptoms: A case report","authors":"Satoshi Kosaka,&nbsp;Miki Kamiyama,&nbsp;Masahiro Ochi","doi":"10.1002/deo2.70124","DOIUrl":"https://doi.org/10.1002/deo2.70124","url":null,"abstract":"<p>A 74-year-old man with decreased appetite, weight, and heartburn was referred to our hospital. His medications included olmesartan. Esophagogastroduodenoscopy (EGD) revealed antral-dominant erosive gastritis and nodular mucosa. A gastric biopsy revealed inflammatory cell infiltration. The serum anti-<i>Helicobacter pylori</i> immunoglobulin G antibody test result was negative. Famotidine was ineffective in relieving his symptoms, and esomeprazole failed to prevent overt gastric bleeding, which required endoscopic hemostasis. The working diagnosis was drug-induced gastritis, particularly olmesartan-induced gastritis. His appetite loss started to improve within a week of olmesartan withdrawal. The erosions healed on EGD 2 months later. Over the next 10 months, he remained in his usual state until olmesartan was inadvertently administered. Subsequent EGD revealed a mild gastritis relapse. We diagnosed olmesartan-induced gastritis and discontinued olmesartan treatment. Mucosal healing was confirmed by EGD 1 year later. Olmesartan is known to cause angiotensin II receptor blocker-induced enteropathy. Although angiotensin II receptor blocker-induced enteropathy affects the stomach, angiotensin II receptor blocker-induced gastritis without lower gastrointestinal symptoms is rare. The characteristic endoscopic appearance may provide a clue to the correct diagnosis.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883926","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":"Rectal metastasis from lung cancer diagnosed by endoscopic ultrasound-guided fine needle biopsy: A case report","authors":"Shinji Mukawa,&nbsp;Yudai Koya,&nbsp;Tomoyuki Murakami,&nbsp;Koichiro Miyagawa,&nbsp;Yuki Maruno,&nbsp;Koki Yamaguchi,&nbsp;Shun Hanada,&nbsp;Shinji Oe,&nbsp;Masaru Harada","doi":"10.1002/deo2.70127","DOIUrl":"https://doi.org/10.1002/deo2.70127","url":null,"abstract":"<p>A 73-year-old man visited our hospital due to hyperintestinal peristalsis and diarrhea. He had been undergoing regular annual checkups for dust lung disease. Contrast-enhanced computed tomography scan showed edematous thickening of the rectal wall with contrast effect. A colonoscopy revealed a submucosal tumor-like protrusion in the Rb lesion of the rectum without neoplastic epithelial changes. Forceps biopsies of the overlying mucosa were non-diagnostic; however, endoscopic ultrasound-guided fine needle biopsy revealed that the specimen was poorly differentiated non-small cell invasive carcinoma. Then, we performed a chest computed tomography and a newly detected mass lesion in the upper lobe of the right lung. Based on immunohistochemical analysis and image findings, the patient was diagnosed with rectal metastasis from lung cancer. Subsequently, sputum cytology confirmed the diagnosis of lung adenocarcinoma. Rectal submucosal tumor-like protrusions are occasionally encountered. When a non-exposed rectal tumor is identified, it is important to differentiate metastatic diseases, consider endoscopic ultrasound-guided fine needle biopsy, and make a definitive diagnosis through detailed immunohistochemical evaluation and systemic imaging surveillance.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883928","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":"A case of hemobilia caused by a pseudoaneurysm resulting in obstructive cholangitis in a patient who underwent plastic stent placement for pancreatic cancer (with video)","authors":"Yusuke Seyama,&nbsp;Akinori Sugaya,&nbsp;Ken Koyama,&nbsp;Hiroyuki Honda,&nbsp;Hajime Ishibashi,&nbsp;Masaharu Yamaoka,&nbsp;Mitsuharu Ozeki,&nbsp;Mitsuhide Goto,&nbsp;Masahiro Araki,&nbsp;Kenji Amagai","doi":"10.1002/deo2.70130","DOIUrl":"https://doi.org/10.1002/deo2.70130","url":null,"abstract":"<p>Hemobilia, or hemorrhage within the biliary system, is an uncommon cause of stent obstruction associated with bile duct strictures that are rarely observed with plastic stents. Reports of a pseudoaneurysm as a cause of hemobilia after plastic stent placement are also rare. We present a rare case of hemobilia caused by a pseudoaneurysm that resulted in obstructive cholangitis in a patient who underwent plastic stent placement for bile duct invasion caused by pancreatic cancer. A 78-year-old man with a history of stroke who was using antiplatelet therapy presented with obstructive jaundice caused by locally advanced pancreatic cancer and underwent endoscopic plastic stent placement in the bile duct followed by concurrent chemoradiotherapy. Second-line chemotherapy was administered as the disease progressed; however, he experienced obstructive cholangitis and was admitted to our hospital. Hemobilia was identified as the underlying cause; notably, it was not evident during the initial evaluation and was diagnosed during endoscopic stent replacement. Emergency angiography revealed a pseudoaneurysm of the posterior superior pancreaticoduodenal artery, which was successfully treated using coil embolization. Cholangitis and hemobilia resolved, and the patient was discharged without bleeding recurrence.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883925","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":"A UK single-center pilot experience using a novel robotic inchworm colonoscopy system","authors":"Jabed F. Ahmed,&nbsp;Sergio Coda,&nbsp;Purushothaman Premchand,&nbsp;Saswata Banerjee,&nbsp;Nisha Patel","doi":"10.1002/deo2.70123","DOIUrl":"https://doi.org/10.1002/deo2.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Colonoscopy is the gold standard investigation in the lower gastrointestinal tract. However, 75% of patients can experience pain with moderate sedation. The application of robotic technology aims to overcome difficulties faced including better utilization of rooms for advanced procedures and to achieve a complete colonoscopy in patients restricted by pain and technical challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This pilot study, the first at a UK-National Health Service Hospital between January 2023 to August 2024 with one expert endoscopist performing the robotic colonoscopy (RC). Patients with failed previous standard colonoscopy (SC) along with index diagnostic procedures deemed potentially difficult were recruited. Procedures were performed outside the endoscopy unit similar to an outpatient clinical room.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-three patients were recruited (41 men:52 women), mean age of 53.8 years over 20 months. The commonest indications for RC were rectal bleeding (26.9%), failed SC (22.6%), and change in bowel habits (17.2%). Twenty-one patients had failed the previous SC with 14 patients achieving completion with subsequent RC (66% improvement). The average cecal intubation time of 41.07 min with an average total procedure time of 76.48 min. A significant improvement in patient discomfort score was reported (4.71 SC vs. 1.71 RC; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RC provides a significantly more comfortable colonoscopy and has great potential to improve safety in colonoscopy from this early cohort of patients. Direct visualization, biopsy, and polypectomy are still possible with RC. This study has demonstrated a viable alternative to SC. With no sedation it allows procedures to be conducted outside the traditional endoscopy unit such as outpatients. The study highlights a learning curve to reduce cecal intubation time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883927","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":"A meta-analysis of the effectiveness and safety of endoscopic ultrasound-guided choledochoduodenostomy employing electrocautery-enhanced lumen-apposing metal stents for biliary drainage after failed endoscopic retrograde cholangiopancreatography","authors":"Safiya Ibnawadh,&nbsp;Abdulrahman Alfadda,&nbsp;Abdulrahman Ibnawadh","doi":"10.1002/deo2.70105","DOIUrl":"https://doi.org/10.1002/deo2.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-biliary drainage and choledochoduodenostomy (EUS-CDD) are increasingly being used as alternative procedures for biliary drainage in patients in whom endoscopic retrograde cholangiopancreatography fails. Novel electrocautery-enhanced lumen-apposing metal stents (EC-LAMS) are expected to be widely used for EUS-CDD. We performed a systematic review and meta-analysis to evaluate the technical and clinical success of EUS-CDD using EC-LAMS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a comprehensive search of several databases from inception to May 2022 to search for relevant studies on the effectiveness and safety of endoscopic ultrasound-guided biliary drainage using EC-LAMS. The pooled rates of technical success, clinical success, and early and late adverse events were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten studies with a total of 481 patients were included in this analysis. The overall technical success rate was 94.3%, 95% confidence interval [CI] (91.5%–96.2%), The overall clinical success rate was 94.9%, 95% CI (92%–96.7%). The overall early adverse event rate was 5.1%, 95% CI (3.4%–7.8%), and the overall late adverse event rate was 10.8%, 95% CI (6.6%–17.2%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with biliary obstruction with failed endoscopic retrograde cholangiopancreatography, EUS-CDD using EC-LAMS is a good alternate management option with a high success rate and relatively low adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865862","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}