DEN open最新文献

{"title":"Propofol-alone sedative efficacy in observational biliopancreatic endoscopic ultrasound","authors":"Hisaki Kato,&nbsp;Yuki Kawasaki,&nbsp;Kazuya Sumi,&nbsp;Yuki Shibata,&nbsp;Norihiro Nomura,&nbsp;Jun Ushio,&nbsp;Junichi Eguchi,&nbsp;Takayoshi Ito,&nbsp;Haruhiro Inoue","doi":"10.1002/deo2.70025","DOIUrl":"https://doi.org/10.1002/deo2.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Appropriate sedative and analgesic selection is essential to reduce patient discomfort and body movement to safely conduct endoscopic ultrasonography (EUS). However, few cases have examined sedation with propofol in EUS, and few studies the need for combined analgesia. In this study, we retrospectively evaluated the usefulness and safety of propofol without analgesics for sedation in biliopancreatic observational EUS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective study included 516 observational biliopancreatic EUS procedures using propofol alone performed between April 2021 and March 2023. The primary and secondary endpoints were the observational biliopancreatic EUS results obtained with propofol alone and adverse event occurrence, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median examination time and total propofol dose were 22 (range: 10–67) min and 186.5 (range: 50–501) mg, respectively. The median starting Richmond Agitation-Sedation Scale and Visual Analog Scale scores were −5 (range: −5–1) and 0 (range: 0–10), respectively. The median recovery time was 22 (range: 5–80) min. Adverse events occurred in 60 (11.6%) patients. Trainee-performed examination (odds ratio [OR] 3.52, 95% confidence interval [CI]: 1.63–7.60, <i>p</i> = 0.0014) and examination length (&gt;22 min; OR 1.67, 95% CI: 0.95–2.92, <i>p</i> = 0.07) were risk factors for adverse events.</p>\u0000 \u0000 <p>High body mass index (OR 1.87, 95% CI: 1.10–3.16, <i>p</i> = 0.02) and extended examination time (OR 4.23, 95% CI: 2.08–8. 57, <i>p</i> &lt; 0.001) were risk factors for delayed recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>During observational biliopancreatic EUS, propofol is useful as a single sedative and offers high patient satisfaction and relative safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447573","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 novel puzzle ring replacement technique of a lumen-apposing metal stent with a double-pigtail plastic stent to prevent walled-off necrosis recurrence (with video)","authors":"Shuntaro Mukai,&nbsp;Atsushi Sofuni,&nbsp;Takayoshi Tsuchiya,&nbsp;Reina Tanaka,&nbsp;Ryosuke Tonozuka,&nbsp;Kenjiro Yamamoto,&nbsp;Yukitoshi Matsunami,&nbsp;Kazumasa Nagai,&nbsp;Hiroyuki Kojima,&nbsp;Hirohito Minami,&nbsp;Kyoko Asano,&nbsp;Takao Itoi","doi":"10.1002/deo2.70020","DOIUrl":"https://doi.org/10.1002/deo2.70020","url":null,"abstract":"<p>Replacing a lumen-apposing metal stent (LAMS) with a double-pigtail plastic stent (DPS) after treatment for walled-off necrosis contributes to the prevention of recurrence. However, the success rate is not very high. To overcome this issue, we devised a novel stent-replacement technique. In the final treatment procedure, a 7-F DPS was placed in the lumen of the LAMS. Subsequently, the walled-off necrosis shrank, and granulation formed over the pigtail portion, which fixed the DPS. The LAMS alone was removed with grasping forceps, leaving the DPS in the lumen of the LAMS (i.e., a puzzle-ring technique; direct or rotary removal technique). Between August 2021 and August 2023, 18 patients were evaluated for recurrence prevention using this novel technique (median duration of LAMS placement, 37 days). In 17 patients (94.4%), the LAMS was successfully replaced with a 7-F DPS (direct technique 14, rotary technique 3; median removal procedure time, 3 min). No recurrence was observed during the median observation period of 385 days. Before using this technique (April 2012 to August 2022), the technical success rate of replacement of LAMS with 7-F DPS was significantly lower (61.8% [42/68, <i>p</i> = 0.02]). Recurrence of pancreatic fluid collection occurred in 15.3% (4/26) of the patients who could not undergo replacement with a 7-F DPS. The novel puzzle ring technique, which improves the success rate of LAMS for DPS replacement, may be useful in reducing recurrence after walled-off necrosis treatment.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142435318","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":"Value of image enhancement of endoscopic ultrasound for diagnosis of gastrointestinal subepithelial lesions","authors":"Hirofumi Yamazaki,&nbsp;Yasunobu Yamashita,&nbsp;Takaaki Tamura,&nbsp;Yuki Kawaji,&nbsp;Takashi Tamura,&nbsp;Masahiro Itonaga,&nbsp;Reiko Ashida,&nbsp;Toshio Shimokawa,&nbsp;Fumiyoshi Kojima,&nbsp;Keiji Hayata,&nbsp;Takao Maekita,&nbsp;Mikitaka Iguchi,&nbsp;Masayuki Kitano","doi":"10.1002/deo2.70026","DOIUrl":"https://doi.org/10.1002/deo2.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Among subepithelial lesions (SELs), gastrointestinal stromal tumors (GISTs) should be identified and surgically treated at an early stage. However, it is difficult to diagnose SELs smaller than 20 mm. In recent years, endoscopic ultrasound (EUS) elastography (EUS-EG) and contrast-enhanced harmonic EUS (CH-EUS) have been reported to be useful for the diagnosis of SELs, although the diagnostic accuracy of a combination of EUS techniques with image enhancement is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with SELs who underwent EUS-guided tissue acquisition, EUS shear-wave elastography (EUS-SWE), EUS strain elastography (EUS-SE), and CH-EUS from January 2019 to June 2023 were enrolled. To assess the diagnostic accuracy for differentiating GISTs from other SELs, shear-wave velocity on EUS-SWE, the strain ratio on EUS-SE, and vascularity on CH-EUS were determined and their diagnostic accuracies were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-three patients were enrolled. When the cut-off value was set at 3.27 m/s, the sensitivity, specificity, and diagnostic accuracy of shear-wave velocity were 28.6%, 86.2%, and 34.9%, respectively. When the cut-off value was set at 3.79, the sensitivity, specificity, and diagnostic accuracy of the strain ratio were 93.1%, 64.3%, and 83.7%, respectively. The sensitivity, specificity, and diagnostic accuracy of CH-EUS were 79.3%, 92.3%, and 83.7%, respectively. When EUS-SE was combined with CH-EUS, the sensitivity and diagnostic accuracy were the highest among binary combinations of image enhancement modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EUS-SE and CH-EUS are useful for differentiating GISTs from other SELs. Furthermore, the use of both modalities may further improve the identification of GISTs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142429836","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":"Lumen-apposing metal stents for anastomosis creation throughout the gastrointestinal tract: A large single-center experience","authors":"Emine Gökce,&nbsp;Lindsey Devisscher,&nbsp;Niki Rashidian,&nbsp;Enrico Palmeri,&nbsp;Pieter Hindryckx","doi":"10.1002/deo2.419","DOIUrl":"https://doi.org/10.1002/deo2.419","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The introduction of lumen-apposing metal stents (LAMSs) has revolutionized the field of therapeutic endoscopic ultrasound. This study aims to evaluate the efficacy and safety of LAMS in creating an endoscopic ultrasound-guided anastomosis between two segments of the gastrointestinal (GI) tract.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from all consecutive LAMS procedures for anastomosis creation between two segments of the GI, conducted between October 2019 and February 2024, were retrospectively analyzed for technical success (defined as correct deployment of the LAMS in the target), clinical success (defined as achievement of the intended clinical goal), and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 145 LAMS procedures were performed in 136 patients. Indications for LAMS procedures included the need for endoscopic access to or reversal of surgically excluded segments of the GI tract (<i>n</i> = 73, 50.3%), and the alleviation of any GI outflow obstruction (<i>n</i> = 72, 49.7%). The overall technical and clinical success rates were very high (97.2% and 95.2%, respectively). Adverse events were observed in 20/145 (13.8%) cases, including 11 (7.6%) minor events (AGREE &lt;3) and nine (6.2%) major events (AGREE ≥3). Major events included stent migration (<i>n</i> = 1), persisting fistula (<i>n</i> = 3), and bleeding (<i>n</i> = 4). All adverse events were successfully managed, and there were no procedure-related deaths. Loss of LAMS patency occurred in 4/145 (2.8%) cases and could be endoscopically managed in all cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The creation of anastomoses with LAMS between two segments of the GI tract appears to be effective and safe, with a low reintervention rate due to loss of LAMS patency.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.419","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142429851","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":"Impact of advanced endoscopy training on colonoscopy quality and efficiency","authors":"Takashi Watanabe,&nbsp;Tatsuro Murano,&nbsp;Hiroaki Ikematsu,&nbsp;Kensuke Shinmura,&nbsp;Masashi Wakabayashi,&nbsp;Nobuhisa Minakata,&nbsp;Sasabe Maasa,&nbsp;Tomohiro Mitsui,&nbsp;Hiroki Yamashita,&nbsp;Atsushi Inaba,&nbsp;Hironori Sunakawa,&nbsp;Keiichiro Nakajo,&nbsp;Tomohiro Kadota,&nbsp;Tomonori Yano","doi":"10.1002/deo2.70027","DOIUrl":"https://doi.org/10.1002/deo2.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Few reports have detailed improvements in the quality of colonoscopies with continuous training post-fellowship completion. We examined the changes in colonoscopy performance among trainees during our advanced endoscopy training program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Screening or surveillance colonoscopies performed by 11 trainees who participated in our 3-year advanced endoscopy training program between April 2015 and March 2020 were retrospectively analyzed. Quality and efficiency metrics of colonoscopies were evaluated annually.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether, 297, 385, and 438 colonoscopies were enrolled in the first, second, and third training years, respectively. The mean insertion times were 8.6, 7.6, and 6.9 min in the first, second, and third training years, respectively, with significant improvement from the first to second year (<i>p</i> = 0.03) and from the first to third year (<i>p</i> &lt; 0.01). The adenoma detection rate, proximal adenoma detection rate, and mean number of adenomas per patient exhibited a tendency to improve annually; however, the difference was not significant. Polypectomy efficiency was 10.5%, 11.2%, and 13.0%, with significant improvements from the first to third year (<i>p</i> &lt; 0.01) and from the second to third year (<i>p</i> = 0.02). Insertion time and polypectomy efficiency showed significant improvements, especially among trainees experienced with &lt;500 colonoscopies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Through our advanced endoscopy training program, there has been an improvement in the quality and efficiency of colonoscopy for trainees who have completed their fellowships, particularly those with &lt;500 colonoscopies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142429837","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":"All-in-one sphincterotome with high rotation performance and freely bendable blade for endoscopic sphincterotomy in patients with surgically altered anatomy (a case series with video)","authors":"Yasuhito Kunogi,&nbsp;Atsushi Irisawa,&nbsp;Akira Yamamiya,&nbsp;Manabu Ishikawa,&nbsp;Tomoya Sakamoto,&nbsp;Yasunori Inaba,&nbsp;Ken Kashima,&nbsp;Fumi Sakuma,&nbsp;Koh Fukushi,&nbsp;Takumi Maki,&nbsp;Kazunori Nagashima,&nbsp;Yoko Abe,&nbsp;Shuichi Kitada,&nbsp;Akane Yamabe,&nbsp;Keiichi Tominaga","doi":"10.1002/deo2.70019","DOIUrl":"10.1002/deo2.70019","url":null,"abstract":"<p>A new type of sphincterotome released to the market recently has high rotation performance and a freely bendable blade. It is devised to be singly capable of accommodating not only normal anatomy but also cases with surgically altered anatomy. This study was undertaken for clinical evaluation of the usefulness of this new sphincterotome. Eight cases in a reconstructed intestine for which cannulation or endoscopic sphincterotomy (EST) had been performed were extracted from 32 cases for which endoscopic retrograde cholangiopancreatography-related procedures were performed using the sphincterotome developed during November 2023 through February 2024. The cases were investigated retrospectively. Among these, EST was applied to six cases. Cannulation was performed using the developed sphincterotome in the native papilla in four cases. The primary endpoints were the success rate of cannulation in surgically altered anatomy and the success rate of EST. Secondary endpoints were complications and usability for operators. Usability for operators was evaluated by questionnaire for several items on a 5-point scale. EST was conducted successfully in all six cases subjected to EST. Mild hemorrhage was observed in one case (17%) as an adverse event after EST. Deep cannulation to the native papilla with the developed sphincterotome was conducted successfully in three cases (75.0%). Evaluation results by operators were 4.4 ± 0.55 for rotation performance, 4.00 ± 0.63 for incision performance, 4.29 ± 0.49 for deep cannulation performance, and 4.07 ± 0.19 for overall evaluation. In conclusion, this developed sphincterotome might be very useful for EST and cannulation in cases with surgically altered anatomy.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396236","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 ultrasound-guided choledochoduodenostomy versus hepaticogastrostomy combined with gastroenterostomy in malignant double obstruction (CABRIOLET_Pro): A prospective comparative study","authors":"Giuseppe Vanella,&nbsp;Roberto Leone,&nbsp;Francesco Frigo,&nbsp;Michiel Bronswijk,&nbsp;Roy L. J. van Wanrooij,&nbsp;Domenico Tamburrino,&nbsp;Giulia Orsi,&nbsp;Giulio Belfiori,&nbsp;Marina Macchini,&nbsp;Michele Reni,&nbsp;Luca Aldrighetti,&nbsp;Massimo Falconi,&nbsp;Gabriele Capurso,&nbsp;Schalk van der Merwe,&nbsp;Paolo Giorgio Arcidiacono","doi":"10.1002/deo2.70024","DOIUrl":"10.1002/deo2.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Malignant double obstruction, defined as the simultaneous presence of biliary and gastric outlet obstruction, represents a challenging clinical scenario. Previous retrospective experiences have demonstrated shorter dysfunction-free survival (DyFS) of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) versus EUS-hepaticogastrostomy (EUS-HGS) in this setting, but no prospective evidence is available.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty consecutive patients with malignant double obstruction, treated with EUS-gastroenterostomy (and EUS-guided biliary drainage, following a previously failed ERCP, were enrolled in a prospective observational study (ClinicalTrials.gov NCT04813055) comparing EUS-CDS versus EUS-HGS. Efficacy and safety were evaluated, with Biliary Dysfunctions as the primary outcome and DyFS using Kaplan-Meier estimates as a primary measure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty patients (75% with pancreatic cancer, 50% with metastatic disease) with EUS-gastroenterostomy were included (seven EUS-CDS and 13 EUS-HGS). No significant difference was detected at baseline. Technical success was 100% in both groups. EUS-CDS compared to EUS-HGS showed similar clinical success (100% vs. 92.3%, <i>p</i> = 0.5), a higher rate of post-procedural adverse events (42.9% vs. 7.7%, <i>p</i> = 0.067, mostly related to severe/fatal cholangitis in the EUS-CDS group) and a higher rate of biliary dysfunctions during follow-up (71.4% vs. 16.7%, <i>p</i> = 0.002).</p>\u0000 \u0000 <p>DyFS was significantly shorter in the EUS-CDS group (39 [15–62] vs. 268 [192–344] days, <i>p</i> = 0.0023), with a 30-days DyFS probability of 57.1% vs. 100% (hazard ratio = 7.8 [1.4–44.2]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this prospective comparison of patients with malignant double obstruction undergoing EUS-gastroenterostomy, treating jaundice with EUS-CDS versus EUS-HGS resulted in a reduced probability of survival without biliary events and an increased risk of biliary dysfunctions (number needed to harm = 1.8), with detection of severe/fatal cholangitis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396237","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 efficacy (at and beyond 1 year) of gastric peroral endoscopic myotomy for refractory gastroparesis: A systematic review and meta-analysis","authors":"Francesco Vito Mandarino,&nbsp;Alberto Barchi,&nbsp;Noemi Salmeri,&nbsp;Francesco Azzolini,&nbsp;Ernesto Fasulo,&nbsp;Giuseppe Dell'Anna,&nbsp;Edoardo Vespa,&nbsp;Emanuele Sinagra,&nbsp;Jeremie Jacques,&nbsp;Silvio Danese","doi":"10.1002/deo2.70021","DOIUrl":"10.1002/deo2.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although gastric peroral endoscopic myotomy (G-POEM) has shown substantial efficacy in patients with medically refractory gastroparesis (GP), comprehensive long-term data on its effectiveness are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review and meta-analysis including observational studies assessing long-term efficacy after G-POEM in patients with refractory GP. Our primary outcome was the pooled rate of clinical success 1-year after G-POEM. Secondary outcomes included clinical success at 2 and 3 years and the rate of adverse events according to the American Society for Gastrointestinal Endoscopy classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen studies, involving 952 patients with refractory GP undergoing G-POEM, were eligible. The pooled 1 year-clinical success was 0.72 (95% confidence interval [CI]: 0.56, 0.85, I² = 94.9%). The clinical success was 0.67 (95% CI: 0.47, 0.97, I² = 95.8%) when considering only studies defining success as 1 point decrease in Gastroparesis Cardinal Symptoms Index score and at least 25% decrease in two subscales. For patients who had 1-year success, the pooled clinical success at 2 and 3 years were 0.71 (95% CI: 0.45, 0.92, I² = 94.9%) and 0.58 (95% CI: 0.19, 0.92, I² = 97.1%), respectively. The pooled rate of adverse events was 0.08 (95% CI: 0.06, 0.10, I² = 0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>G-POEM is associated with successful outcomes in about 70% of treated cases after 1 year, with durable long-term effects lasting up to 3 years. In the future, new uniform outcome definitions and strict patient selection criteria are warranted to delineate G-POEM outcomes more accurately.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383026","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":"Safety of edoxaban for delayed bleeding in gastrointestinal endoscopic procedures with a high risk of bleeding","authors":"Ken-ichi Mizuno,&nbsp;Junji Yokoyama,&nbsp;Osamu Shibata,&nbsp;Yuichi Kojima,&nbsp;Yuzo Kawata,&nbsp;Kazuya Takahashi,&nbsp;Kentaro Tominaga,&nbsp;Ikarasi Satoshi,&nbsp;Hayashi Kazunao,&nbsp;Shuji Terai","doi":"10.1002/deo2.70018","DOIUrl":"10.1002/deo2.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>There are limited reports on the safety of gastrointestinal endoscopic procedures in individuals taking edoxaban, one of the direct oral anticoagulants. We clarified the incidence of delayed bleeding in patients who were on edoxaban in the perioperative period of gastrointestinal endoscopic procedures with a high risk of bleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an investigator-initiated, single-center, open-label, prospective, single-arm study. Patients on warfarin or edoxaban undergoing endoscopy with a high risk of bleeding were enrolled from June 2018 to September 2021. Warfarin was replaced with edoxaban in patients on warfarin. Patients taking other direct oral anticoagulants, and antiplatelet drugs, were excluded. The primary endpoint was severe delayed bleeding (Common Terminology Criteria for Adverse Events [CTCAE] grades III–V) and the secondary endpoints included thromboembolism, all adverse events, any delayed bleeding (CTCAE grades I or II), and hospital stay durations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-one patients on edoxaban underwent high-risk endoscopy. Three cases (14%) experienced CTCAE grade III delayed bleeding, requiring endoscopic hemostasis. No CTCAE grade I-II delayed bleeding or thromboembolic events occurred. Cholangitis and aspiration pneumonia (conservatively treated) occurred during the hospital stay. The median length of hospital stay was 8 days (range 3—24 days). Patients with delayed bleeding had higher systolic blood pressure at admission and longer hospital stays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The delayed bleeding incidence in high-risk endoscopic procedures for patients on edoxaban was acceptable. Higher blood pressure may be associated with increased risk, but further research is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383027","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":"Propofol sedation safety concerns in pediatric endoscopy: Special considerations in the Japanese medical environment","authors":"Daisuke Murakami,&nbsp;Masayuki Yamato","doi":"10.1002/deo2.70000","DOIUrl":"10.1002/deo2.70000","url":null,"abstract":"<p>To the Editor,</p><p>Kudo and colleagues<span>¹</span> clearly demonstrated that intravenous propofol anesthesia significantly shortened procedure time in pediatric endoscopy, with no adverse events observed. Subsequent to the revision of Japanese guidelines for endoscopic sedation,<span>²</span> gradual adoption of propofol sedation in adult endoscopic procedures is noted. Importantly, however, this guideline explicitly excludes pediatric populations. Additionally, this guideline refrains from explicitly stating whether non-anesthesiologists can safely administer propofol sedation in endoscopy units. Gastroenterologists should understand that propofol is not recommended for anesthetic induction below the age of 3 years or for anesthetic maintenance below 2 months of age. As discussed in this paper, propofol is contraindicated for pediatric intensive care unit sedation due to the risk of propofol infusion syndrome; thus, excessive use should be avoided. Actually, our hospital witnessed an accidental intensive care unit death of a pediatric patient sedated with propofol.</p><p>Our concern stems from the fact that current evidence regarding safe propofol sedation for endoscopy is based predominantly on international reports. The Japanese medical environment differs significantly from those abroad. While anesthesiologists in many other countries routinely administer sedation, the current structure and resource allocation in Japan makes it practically infeasible to have anesthesiologists permanently stationed in endoscopy units. Unlike benzodiazepines, propofol has a narrow pharmacological range between states of sedation with maintained respiration and that of general anesthesia where spontaneous breathing ceases, making it prone to easily induce over-sedation. Therefore, the guideline also emphasizes the use of various devices supporting safe propofol administration; consequently, continuous administration via a target-controlled infusion pump is recommended, and the importance of capnography and/or electroencephalography is stressed (in Japan, widespread adoption of this monitoring in pediatric patients is insufficient). The methodology in Kudo et al.<span>¹</span> did not address these recommendations.</p><p>Given the aforementioned precautions for propofol use in pediatric patients, endoscopic sedation in children using propofol warrants more careful consideration, prioritizing safety.</p><p>None.</p><p>- Approval of the research protocol by an Institutional Reviewer Board: N/A.</p><p>- Informed consent: N/A.</p><p>- Registry and the Registration No. of the study/trial: N/A.</p><p>- Animal studies: N/A.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335061","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}