DEN open最新文献

{"title":"Prognostic factors and long-term outcomes with endoscopic submucosal dissection for colorectal tumors in patients aged 75 years or older","authors":"Takaya Miura,&nbsp;Satohiro Matsumoto,&nbsp;Azumi Sato,&nbsp;Shu Kojima,&nbsp;Goya Sasaki,&nbsp;Mina Morino,&nbsp;Keita Matsumoto,&nbsp;Hitomi Kashima,&nbsp;Yudai Koito,&nbsp;Takehiro Ishii,&nbsp;Shuhei Yoshikawa,&nbsp;Haruka Otake,&nbsp;Takeshi Uehara,&nbsp;Masanari Sekine,&nbsp;Takeharu Asano,&nbsp;Hiroyuki Miyatani,&nbsp;Hirosato Mashima","doi":"10.1002/deo2.70137","DOIUrl":"https://doi.org/10.1002/deo2.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Studies regarding the long-term outcomes of endoscopic submucosal dissection (ESD) performed in older patients with colorectal tumors are limited. Therefore, in this study, we aimed to analyze the long-term outcomes of older patients with colorectal tumors who underwent ESD and identify prognostic factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The data of patients aged ≥ 75 years who underwent ESD for colorectal tumors (adenoma and Tis/T1 colorectal cancer) at a single center were retrospectively analyzed. Prognostic factors for overall survival were analyzed using the Kaplan–Meier method and the Cox proportional hazard model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 156 patients included, 51 patients died during the follow-up period, among whom two deaths were due to colorectal cancer. The univariate analysis revealed that an age ≥83 years, Charlson Comorbidity Index ≥2, prognostic nutritional index &lt;46, and neutrophil-to-lymphocyte ratio (NLR) ≥3 were associated with poor overall survival. The multivariate analysis identified Charlson Comorbidity Index ≥2 (hazard ratio: 2.26; 95% confidence interval (CI): 1.24–4.13; <i>p </i>= 0.0008) and NLR ≥3 (hazard ratio, 1.98; 95% CI: 1.02–3.81; <i>p </i>= 0.042) as independent prognostic factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CCI and NLR may be useful parameters for decision-making in older patients undergoing colorectal ESD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914429","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 duodenal pyloric gland adenoma with high-grade dysplasia arising from ectopic gastric mucosa","authors":"Kenichiro Nakachi,&nbsp;Hironobu Nagumo,&nbsp;Tetsuro Okura,&nbsp;Wataru Ohno,&nbsp;Takashi Ashikawa,&nbsp;Tomoyuki Funato,&nbsp;Toshiyasu Shiratori,&nbsp;So Nakaji,&nbsp;Shion Ando","doi":"10.1002/deo2.70135","DOIUrl":"https://doi.org/10.1002/deo2.70135","url":null,"abstract":"<p>Superficial non-ampullary duodenal epithelial tumor is a rare disease, but its frequency has reportedly been increasing in recent years. We report a case of duodenal pyloric gland adenoma with high-grade dysplasia arising from ectopic gastric mucosa. Esophagogastroduodenoscopy detected a 5-mm raised lesion on the anterior surface of the duodenal bulb. The lesion was diagnosed as gastric foveolar metaplasia with biopsy. A second esophagogastroduodenoscopy was performed 13 years later. The nodule showed a two-stage elevation and a biopsy revealed EGM. The lesion was followed up with EGD almost every year, with enlargement observed each time. Endoscopic submucosal dissection was performed. Histopathological examination revealed pyloric gland adenoma with high-grade dysplasia. Ectopic gastric mucosa was observed in the tumor pathologically and transformation of the EGM into a tumor was followed endoscopically over time.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914430","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":"Feasibility of a novel slim gastroscope for endoscopic submucosal dissection: A case series (with video)","authors":"Marina Kim,&nbsp;Yohei Minato,&nbsp;Darshan Parekh,&nbsp;Hideyuki Chiba,&nbsp;Ryoju Negishi,&nbsp;Shunya Takayanagi,&nbsp;Kohei Ono,&nbsp;Yuki Kano,&nbsp;Yoshiaki Kimoto,&nbsp;Nao Takeuchi,&nbsp;Shinya Nagae,&nbsp;Ken Ohata","doi":"10.1002/deo2.70139","DOIUrl":"https://doi.org/10.1002/deo2.70139","url":null,"abstract":"<p>Endoscopic submucosal dissection has transformed early-stage gastrointestinal tumor treatment. This series showcases a novel slim gastroscope's efficacy in tackling challenging lesions.</p><p>Retrospective analysis of 17 patients undergoing endoscopic submucosal dissection using the novel slim gastroscope for pharyngeal, esophageal, gastric, duodenal, and rectal lesions at our tertiary care center between November 2022 and July 2023. The slim scope has an outer diameter of 7.9 mm, an accessory channel diameter of 3.2 mm, and a downward bending angle of 160 degrees. Primary outcomes were en-bloc and R0 resection rate and secondary outcomes were procedure time, adverse events, and specimen/defect size.</p><p>100% successful en bloc and R0 resections were achieved with no significant adverse events. The median lesion size was 15 mm (2–40 mm), and the median procedure time was 30 min (5–105 min). Various strategies, including multiple tunnels, pocket creation,​ and endoscopic intermuscular dissection, were employed.</p><p>The novel slim gastroscope is feasible for endoscopic submucosal dissection in many locations including the pharynx and duodenum and in certain complex lesions (large gastric lesions, rectal lesions with deep submucosal invasion, and circumferential esophageal lesions). This warrants further investigation through larger comparative studies to validate its efficacy and safety in a broader patient population.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143909362","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 management of acute cholecystitis in high-risk surgical patients: A comprehensive review article","authors":"Akinori Maruta,&nbsp;Takuji Iwashita,&nbsp;Kensaku Yoshida,&nbsp;Shogo Shimizu,&nbsp;Masahito Shimizu","doi":"10.1002/deo2.70133","DOIUrl":"https://doi.org/10.1002/deo2.70133","url":null,"abstract":"<p>Acute cholecystitis is frequently encountered in daily clinical practice, and early cholecystectomy is the standard therapy. In high-risk surgical patients, such as those with advanced age, deteriorated performance status, or underlying diseases, conservative treatment is typically preferred to manage acute cholecystitis. However, in patients with a disease that is refractory to conservative treatment, drainage procedures are necessary to control the infection. At present, there are three basic approaches for gallbladder drainage: percutaneous transhepatic gallbladder drainage, endoscopic transpapillary gallbladder drainage, and endoscopic ultrasound gallbladder drainage. Each of these methods has advantages and disadvantages. Therefore, the appropriate treatment method is determined on a case-by-case basis, and no consistent strategy for gallbladder drainage has been established. This review aimed to summarize the characteristics of each drainage method and compare the clinical outcomes of the three procedures for acute cholecystitis in high-risk surgical patients.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143909229","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":"Clinical backgrounds and outcomes of patients with Barrett's esophageal adenocarcinoma treated via endoscopic submucosal dissection in Kyushu, Japan: A retrospective multicenter cohort study","authors":"Fumisato Sasaki,&nbsp;Kazuhiro Mizukami,&nbsp;Taro Akashi,&nbsp;Naoyuki Yamaguchi,&nbsp;Ryosuke Gushima,&nbsp;Hideaki Miyamoto,&nbsp;Shohei Uehara,&nbsp;Yoichiro Ono,&nbsp;Takashi Hisabe,&nbsp;Yuzuru Kinjo,&nbsp;Yuichiro Nasu,&nbsp;Kensuke Fukuda,&nbsp;Taisuke Inada,&nbsp;Yorinobu Sumida,&nbsp;Takashi Akutagawa,&nbsp;Tadashi Miike,&nbsp;Sho Suzuki,&nbsp;Hiroki Fukuya,&nbsp;Michita Mukasa,&nbsp;Mitsuru Esaki,&nbsp;Shinsuke Kumei,&nbsp;Yosuke Minoda,&nbsp;Tetsu Kinjo,&nbsp;Daisuke Yamaguchi,&nbsp;Yoshio Fukuda,&nbsp;Kazutoshi Hashiguchi,&nbsp;Hiroki Yano,&nbsp;Hiroshi Fujita,&nbsp;Ryo Shimoda,&nbsp;GI-Kysuhu study group","doi":"10.1002/deo2.70102","DOIUrl":"https://doi.org/10.1002/deo2.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Most esophageal cancers in Japan are squamous cell carcinomas; however, there has been some concern regarding a recent increase in Barrett's esophageal adenocarcinoma (BEA). This study aimed to clarify the clinical characteristics and outcomes of patients treated via endoscopic submucosal dissection (ESD) in Kyushu, including changes over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter, retrospective, observational study was conducted among 21 institutes situated in Kyushu. Data from patients who underwent ESD for BEA or esophageal squamous cell carcinoma between January 2010 and December 2023 were extracted from the pathology database and reviewed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The total number of esophageal ESD cases increased from 2299 over the first 7 years to 4009 over the second seven. The incidence of BEA increased from 3.6% (86/2299) over the earlier period to 4.7% (197/4009; <i>p</i> = 0.034) over the latter. We analyzed data from 283 patients (287 lesions). Smaller tumor-sized lesions were detected over the latter period (14.2 ± 11.6 vs. 11.2 ± 9.5 cm², <i>p</i> = 0.022), significantly reducing treatment times (122.1 ± 81.2 vs. 93.2 ± 53.3 min <i>p</i> &lt; 0.001). The procedure was safe, with low incidence rates, over both the earlier and later periods (respectively), of perforation (0% vs. 1.0%), delayed bleeding (1.2% vs. 2.0%), and pneumonia (4.7% vs. 4.6%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The proportion of esophageal ESD procedures to treat BEA has increased in Japan's Kyushu region. This procedure has a comparable safety profile to similar ESD procedures used to treat other conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143908868","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 pilot study on anti-reflux mucoplasty with valve as novel endoscopic therapy for gastroesophageal reflux disease","authors":"Kazuki Yamamoto,&nbsp;Haruhiro Inoue,&nbsp;Ippei Tanaka,&nbsp;Rei Miyake,&nbsp;Masachika Saino,&nbsp;Kei Ushikubo,&nbsp;Miyuki Iwasaki,&nbsp;Yohei Nishikawa,&nbsp;Satoshi Abiko,&nbsp;Boldbaatar Gantuya,&nbsp;Manabu Onimaru,&nbsp;Mayo Tanabe","doi":"10.1002/deo2.70131","DOIUrl":"https://doi.org/10.1002/deo2.70131","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Endoscopic anti-reflux therapies like anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation have shown efficacy for gastroesophageal reflux disease (GERD) in systematic reviews and meta-analyses. Anti-reflux mucoplasty (ARM-P), a refinement of ARMS, incorporates immediate closure of the resection site to reduce complications. Recently, anti-reflux mucosal valvuloplasty (ARMV), which employs endoscopic submucosal dissection to create a mucosal valve, was introduced but retains ARMS's limitations, requiring extensive incisions (three-quarters to four-fifths circumference). To address these challenges, we developed anti-reflux mucoplasty with valve (ARM-P/V), integrating ARMV's valvuloplasty with ARM-P's closure technique to improve safety and reduce complications. This pilot study evaluates the safety, feasibility, and efficacy of ARM-P/V.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study reviewed data from patients undergoing ARM-P/V for proton pump inhibitor (PPI)-refractory or PPI-dependent GERD at Showa University Koto Toyosu Hospital, Tokyo, from April to August 2024. Symptom severity and quality of life were assessed using validated questionnaires (GERD-Health Related Quality of Life Questionnaire [GERD-HRQL], GERD Questionnaire [GerdQ], and Frequency Scale for the Symptoms of GERD [FSSG]), comparing pre- and post-treatment scores. PPI discontinuation rates were also analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen patients (mean age 55.4 years) underwent ARM-P/V. Within 3 months, 72.2% (13/18) reduced or discontinued PPI use. GERD-HRQL scores improved from 20.3 to 10.9 (<i>p</i> = 0.004), GerdQ from 10.4 to 6.9 (<i>p</i> &lt; 0.001), and FSSG from 24.0 to 13.2 (<i>p</i> &lt; 0.001). No severe complications (Clavien-Dindo Grade ≥3), delayed bleeding or dysphagia requiring balloon dilation were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ARM-P/V demonstrates safety, technical feasibility, and short-term efficacy in GERD treatment. As a refinement of ARMV, it offers a promising alternative to current techniques.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905129","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 features of deficient mismatch repair/microsatellite instability-high and BRAF-mutated colorectal cancer","authors":"Rika Omote,&nbsp;Shizuma Omote,&nbsp;Ryohei Sumii,&nbsp;Joichiro Horii,&nbsp;Isao Fujita,&nbsp;Hideaki Miyaso,&nbsp;Tatsuya Toyokawa,&nbsp;Masaru Inagaki","doi":"10.1002/deo2.70132","DOIUrl":"https://doi.org/10.1002/deo2.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Recent advancements in genome analyses, including the BRAF gene and mismatch repair (MMR) gene/microsatellite instability (MSI), have revealed the biological diversity of colorectal cancer (CRC). BRAF-mutated CRC has a poor prognosis; however, cases exhibiting deficient MMR (dMMR)/MSI-high (MSI-H) and BRAF gene mutations have demonstrated significant prognostic improvement following recent immune checkpoint inhibitor therapy. Therefore, the diagnosis of these subtypes is important. This study aimed to identify the endoscopic features of dMMR/MSI-high and BRAF-mutated CRCs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 292 CRC cases. Clinicopathological findings, focusing on dMMR/MSI-H and BRAF-mutated subtypes, were determined. Endoscopic images were analyzed for the presence of yellow slough. Surface material characteristics were assessed through a histopathological evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 256 cases analyzed, 27 were dMMR/MSI-H CRC, including 12 BRAF-mutant cases. Yellow slough was observed in 83.3% of dMMR/MSI-H and BRAF-mutated CRCs, compared with 13.3% dMMR/MSI-H and BRAF wild-type CRCs and 1.3% pMMR/MSS and BRAF wild-type CRCs. Histological examination showed a correlation of yellow slough with coagulative necrosis and thicker surface layers in dMMR/MSI-high and BRAF-mutated CRCs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Yellow slough on endoscopy may help identify dMMR/MSI-H- and BRAF-mutated CRC and allow the initiation of appropriate molecular testing and immunotherapy</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143905128","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 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}