Endoscopic assessment of the regular arrangement of collecting venules (RAC) is a simple and reliable tool for predicting the absence of Helicobacter pylori (H. pylori) infection in the stomach, particularly in Asian populations. While initial studies in Western countries have yielded similar findings, RAC assessment has not yet been widely adopted in these settings. This study aims to evaluate the diagnostic accuracy of RAC in determining H. pylori status in a non-Asian population. This prospective, multicenter study was conducted in 12 hospitals across non-Asian countries. Patients with no history of H. pylori infection or eradication were included, regardless of proton pump inhibitor (PPI) use. All participants underwent high-definition upper endoscopy without magnification or virtual chromoendoscopy. Endoscopists were trained using a 20-image test to identify the RAC pattern. H. pylori status was determined by histology and/or immunohistochemistry. A total of 648 patients were included, with an H. pylori infection prevalence of 34.7%. The RAC+ pattern was observed in 31.5% of patients, with no significant differences between those receiving PPI treatment and those who were not (p = 0.55). Absence of pathological endoscopic findings was significantly associated with a RAC+ pattern (p = 0.01). The sensitivity and negative predictive value (NPV) of RAC+ for ruling out H. pylori infection were 0.97 (95% CI: 0.94-0.99), reaching 1.00 when discordant images were reviewed by a blinded expert endoscopist. No significant differences in sensitivity or NPV were found between PPI users and non-users, or between regions with high and low H. pylori prevalence. The presence of the RAC pattern along the minor gastric curvature, as assessed with white-light endoscopy, accurately identifies patients without H. pylori infection in non-Asian countries, regardless of PPI use. A simple blood-vessel pattern seen during a routine stomach endoscopy can almost always rule out infection with Helicobacter pylori: findings from 648 patients examined at 12 Western hospitals Helicobacter pylori (H. pylori) is a bacteria that can infect the stomach and is linked to various gastrointestinal problems. Detecting whether a person has this infection can be challenging. A specific pattern observed during a stomach examination called the “Regular Arrangement of Collecting Venules” (RAC) can help predict the absence of H. pylori. Earlier work in Asian hospitals showed that when RAC is visible, H. pylori infection is very unlikely—but Western endoscopists have rarely used this sign. This international study involved 648 patients from 12 hospitals in non-Asian countries. None of the participants had a known history of H. pylori infection or treatment. The patients underwent a stomach examination using high-definition endoscopy to look for the RAC pattern. Endoscopists were trained to recognize the RAC pattern before the study. Results showed that the RAC pattern was present in about 31.5% of patients. Notably, there was no difference between patients who were using acid-reducing medication (PPIs) and those who were not. Additionally, patients with the RAC pattern were less likely to show signs of gastric lesions. The ability of the RAC pattern to correctly indicate the absence of H. pylori was very high (97%), and in some cases, it reached 100% when reviewed by an expert. These findings suggest that using white-light endoscopy to look for the RAC pattern is a reliable way to identify patients who do not have H. pylori, even in Western clinical practice and regardless of medication use.
The diagnostic procedure of gastrointestinal endoscopy serves essential functions in handling gastrointestinal disorders. Classic endoscopic approaches encounter multiple problems because they depend on human operators and yield ambiguous results during lesion detection. The development of artificial intelligence systems has risen as an efficient technology to enhance diagnosis precision and procedural efficiency during endoscopic procedures. The objective of this review is to assess how artificial intelligence (AI) technology influences gastrointestinal (GI) endoscopic procedures for both lesion identification and classification, and malignant polyp identification, as well as clinical intervention operations. The research investigates obstacles that exist alongside AI implementation problems in clinical gastroenterological practices and determines forthcoming guidelines. A thorough literature survey was conducted through accessing databases, including PubMed alongside Scopus as well as ScienceDirect, Elsevier, and Springer. Studies after 2019 were evaluated for the AI performance in GI endoscopic examination. The use of AI in endoscopic visual examinations boosts both the diagnostic accuracy of esophagogastroduodenoscopy and colonoscopy lesions and exceeds traditional analysis methods. AI technology enhances predictions of malignant polyp status, which helps doctors make treatment decisions while lowering the number of unnecessary biopsies. Several obstacles, including technical boundaries and biased data, and regulatory obstacles, together with clinical implementation obstacles, still continue to exist. The advancement of artificial intelligence through GI endoscopy has led to an improvement of diagnostic outcomes and treatment efficiency alongside better clinical choice capabilities. AI will implement its complete role in routine clinical practice, but needs research about current challenges and regulatory adjustments, and technological improvements to boost patient outcomes. Artificial intelligence in gastrointestinal endoscopy The objective of this review is to assess how AI technology influences GI endoscopic procedures for both lesion identification and classification and malignant polyp identification as well as clinical intervention operations. The research investigates obstacles that exist alongside AI implementation problems in clinical gastroenterological practices and determines forthcoming guidelines. A thorough literature survey conducted through accessing databases including PubMed alongside Scopus as well as ScienceDirect, Elsevier, and Springer. Studies after 2019 were evaluated for the AI performance in GI endoscopic examination. The use of AI in endoscopic visual examinations boosts both diagnostic accuracy of esophagogastroduodenoscopy and colonoscopy lesions and exceeds traditional analysis methods. AI technology enhances predictions of malignant polyp status which helps doctors make treatment decisions while lowering the number of unnecessary biopsies. Several obstacles including technical boundaries and biased data and regulatory obstacles together with clinical implementation obstacles still continue to exist.
Understanding endoscopists' perspectives and routine practice offers opportunities to improve bowel cleansing for colonoscopy. To elucidate Italian endoscopists' perceptions of bowel preparation quality, focusing on defining high-quality cleansing (HQC) and its perceived benefits in clinical practice and for diagnostic outcomes. Nationwide, cross-sectional, web-based survey. A nationwide, web-based cross-sectional survey was undertaken in Italy between August and September 2024 among gastroenterologists with special interest in endoscopy. Participants were recruited via telephone screening; of 498 gastroenterologists contacted, 150 respondents completed an online questionnaire; analyses were descriptive. The survey results revealed that all respondents (100%) routinely evaluate and document cleansing in the endoscopy report and almost all (99%) used validated scales. The majority (72%) of endoscopists aimed for HQC, which they defined as a segment score of ⩾8-9 on the Boston Bowel Preparation Scale or 'excellent' on the Aronchick scale. Almost all (93%) considered HQC important in every colonoscopy regardless of indication. All respondents considered that HQC allows higher identification rates for adenomas and sessile serrated lesions, reduces procedure time, and improves overall clinical efficiency; 99% considered that HQC allows for more appropriate surveillance intervals. On a scale of 1-10 to rate confidence with the diagnostic reliability of the exam (1 = not at all confident, 10 = very confident), the respondents' levels of confidence improved with high-quality bowel preparation; mean scores were 2.1 with inadequate preparation, 6.6 with good cleansing and 9.2 with high-quality bowel cleansing. The survey revealed that the vast majority of Italian endoscopists consider HQC essential across all clinical indications. The results support the transition from 'good' to 'high-quality' cleansing as the new standard in clinical colonoscopy practice. High-quality bowel preparation in Italy Understanding endoscopists’ perspectives and routine practice offers opportunities to improve bowel cleansing for colonoscopy. A survey of Italian endoscopists was conducted to elucidate perceptions of bowel preparation quality, focusing on defining high-quality cleansing (HQC) and its benefits in clinical practice and for diagnostic outcomes. The survey results revealed that all respondents (100%) routinely evaluate and document cleansing in the endoscopy report and almost all (99%) used validated scales. The majority (72%) of endoscopists aimed for HQC, which they defined as a segment score of ⩾8–9 on the Boston Bowel Preparation Scale or “excellent” on the Aronchick scale. Almost all (93%) considered HQC important in every colonoscopy regardless of indication. All respondents considered that HQC allows higher identification rates for adenomas and sessile serrated lesions, reduces procedure time, and improves overall clinical efficiency; 99% considered that HQC allows for more appropriate surveillance intervals. On a scale of 1 to 10 to rate confidence with the diagnostic reliability of the exam (1 = not at all confident, 10 = very confident), the respondents’ levels of confidence improved with high-quality bowel preparation; mean scores were 2.1 with inadequate preparation, 6.6 with good cleansing, and 9.2 with high-quality bowel cleansing. The survey revealed that the vast majority of Italian endoscopists consider HQC essential across all clinical indications. The results support the transition from “good” to “high-quality” cleansing as the new standard in clinical colonoscopy practice.
Reports suggest that the rate of adverse events (AEs) post-endoscopic sphincterotomy (ES) to be as high as 10%, with gastrointestinal bleeding being most common after post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. The aim of this study was to characterize the incidence of bleeding in patients with thrombocytopenia following ES. Retrospective observational cohort study. Patients with thrombocytopenia (defined as <150,000 platelets/μL) who underwent ES between May 2017 and December 2020 were identified at a tertiary care medical center. The incidence of immediate (intraprocedural oozing >5 min or requiring intervention) or delayed (clinical bleeding with associated hemoglobin drop within 14 days) post-ES bleeding was determined via manual chart review. A total of 221 patients with a mean platelet count of 108,000 ± 13,000 platelets/μL underwent ERCP with ES. Immediate bleeding occurred in 11 (5%) patients with no significant drop in hemoglobin or transfusion requirement. Two patients (0.9%), both of whom were noted to have immediate bleeding, also developed delayed bleeding. Presence of malignancy was associated with an increased risk of bleeding (36.4% versus 11.4%, p = 0.037) while platelet count was not. In a cohort of patients with thrombocytopenia, rates of immediate and delayed bleeding are similar to previously reported AE rates of ES in the general patient population. Careful attention should be given to patients with a history of active malignancy as well as those who develop immediate bleeding as they appear to be at increased risk for bleeding complications. Risk of bleeding in patients with low platelet counts after sphincterotomy during endoscopic retrograde cholangiopancreatography procedures The sphincter that controls the flow of bile into the small bowel is often cut for a variety of clinical indications (sphincterotomy) during a procedure called endoscopic retrograde cholangiopancreatography (ERCP). One of the complications of this maneuver is bleeding. The physiology of bleeding is complex, and the risk of bleeding cannot be well captured by a single condition or laboratory test. It was presumed that low platelet counts would increase a patient’s risk of bleeding during a procedure, but emerging data suggests that many endoscopic procedures are safer than previously understood in these patients. However, there is limited data for sphincterotomy and ERCP. This study from a single, academic center evaluates the outcomes of all patients who underwent sphincterotomy with platelets that were below the normal threshold. Overall, the data shows that sphincterotomy appears to be as safe in patients with low platelets as the general population. Patients with active cancer may be at slightly higher risk for bleeding. Additional precautions may be needed in this group, however further studies are needed to confirm this finding.
Endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Billroth II gastroenterostomy (B-II GE) has been challenging, requiring flexibility in technical approaches during execution. The study aims to assess the effectiveness of enhanced techniques in performing ERCP on this patient group in Vietnam. A total of 42 Vietnamese patients with B-II GE performed an ERCP using a duodenoscope or a modification of ERCP equipment (a cap-fitted regular forward-viewing endoscope) if the former failed. The effectiveness and safety of the ERCP technique were assessed, particularly in patients who underwent the forward-viewing endoscope method. A total of 39 out of 42 patients had the Vater's papilla identified, among whom 12 patients (30.8%) achieved successful cannulation into the bile duct using a side-viewing endoscope, significantly lower than the success rate using a forward-viewing endoscope (25/27, counted 92.6%, with p < 0.001). After successful cannulation, the rate of stone clearance, the procedural time, and the hospitalization duration of the patients were equivalent between the two methods and were not dependent on the number or size of the stones. On the other hand, post-ERCP complications in patients utilizing forward-viewing endoscopy included acute pancreatitis (22.2%), post-sphincterotomy bleeding (3.7%), septicemia (4.8%), and perforation (0%). These complications were mild and amenable to conservative endoscopic and medical management, and no mortality was observed. The rates of complications and adverse events after ERCP are comparable between the two treatment methods, even though the end-viewing endoscope is used after the failure of the side-viewing endoscope. Alter ERCP utilizing a cap-fitted forward-viewing endoscope can be a primary choice for treating common bile duct stones in patients with a Billroth II gastric resection history because of high efficacy and acceptable complications. It requires a high level of procedural expertise that requires multiple training sessions. The promising change in the treatment approach for common bile duct stones in Vietnamese patients with a history of Billroth II gastrectomy Endoscopic retrograde cholangiopancreatography (ERCP) treating common bile duct stones in Vietnamese patients with a history of Billroth II gastrectomy is challenging due to changes in gastric anatomy and the limited visibility of the side-viewing endoscope. The researchers tried different techniques, including using a special type of forward-viewing endoscope with cap assistance. We found that using a forward-viewing endoscope was more successful in reaching certain areas compared to a side-viewing one. Although there were some complications, they were manageable, and the overall results were similar between the two methods. The study suggests that using a modified approach with a forward-viewing endoscope with cap assistance can be a good option for treating common bile duct stones in patients with a history of Billroth II gastric resection, but it requires skilled practitioners.
Colorectal cancer (CRC) incidence is rising globally, intensifying pressure on endoscopy services. Colon capsule endoscopy (CCE) offers a non-invasive alternative. Despite several systematic reviews showing reasonable polyp detection rates, clinical scepticism remains. This meta-review and umbrella meta-analysis aim to synthesise evidence on CCE's diagnostic accuracy in polyp and CRC detection, using CT colonography or colonoscopy as the reference standard. We conducted a systematic search of EMBASE, MEDLINE and PubMed for systematic reviews evaluating the diagnostic accuracy of CCE in detecting polyps and CRC. A qualitative thematic review and synthesis were conducted following PRISMA guidelines. A bivariate generalised linear mixed model with random effects was used for pooled diagnostic accuracy estimates, and meta-regression was performed using restricted maximum likelihood estimation. Nine systematic reviews encompassing 28 unique studies (3472 participants) were included. For polyps of any size, the pooled per-patient sensitivity was 0.79 (95% CI: 0.69-0.86), specificity was 0.77 (95% CI: 0.71-0.82), and the area under the curve (AUC) was 0.81. For polyps ⩾6 mm, sensitivity and specificity were 0.80 and 0.87 (AUC 0.81), and for polyps ⩾10 mm, 0.88 and 0.95 (AUC 0.95), respectively. Second-generation CCE (CCE2) improved diagnostic accuracy across all polyp sizes. For polyps of any size, CCE2 achieved a sensitivity of 0.90, specificity of 0.81 and AUC of 0.82. For polyps ⩾ 6 mm and ⩾10 mm, AUCs were 0.92 and 0.94, respectively. CCE2 showed high sensitivity for detecting any polyp size and polyps ⩾6 mm, with low heterogeneity (p > 0.05, I 2 < 25%). CRC detection sensitivity was 0.96 (95% CI: 0.73-1.00) after excluding cases where the capsule failed to reach the rectum due to battery exhaustion. CCE2 has high diagnostic accuracy for polyps and colorectal cancer detection. While technical challenges persist, CCE2 shows promise as a complementary diagnostic tool to help address the increasing demands for endoscopy services. Colon capsule endoscopy (CCE) is a camera pill that patients swallow to check the inside of their colon without needing a traditional colonoscopy. Although this method is less invasive, it hasn’t been widely adopted, partly because doctors are unsure how accurate it is in spotting problems like polyps (small growths) or bowel cancer. This study reviewed and combined data from nine major research reviews involving 3,472 patients. The goal was to find out how good CCE is at detecting polyps and colorectal cancer (bowel cancer) compared to standard tests like colonoscopy and CT colonography. The results showed that second-generation CCE devices (CCE2) performed well. For larger polyps (over 10 mm), the camera pill correctly identified them in 88% of cases and correctly ruled them out in 95% of cases. When it came to detecting bowel cancer, the accuracy was even higher, around 96%, as long as the capsule finished the test (seen the whole colon) before the battery ran out. The newer version of the capsule (CCE2) was better than older models, especially in detecting both small and large polyps. This suggests that, with current technology, CCE can be a reliable tool for detecting bowel problems early. In summary, CCE2 offers a promising alternative for bowel screening, particularly when regular colonoscopy is delayed or difficult. It could help ease pressure on healthcare services while still delivering accurate results.
Celiac disease (CeD) is a widely diffused chronic autoimmune disorder triggered by the ingestion of gluten, in genetically predisposed individuals. Small bowel capsule endoscopy (SBCE) plays a pivotal role as a noninvasive tool for diagnosing and monitoring CeD. This review aims to summarize the current and potential future role of SBCE in the field of CeD. SBCE offers the advantage of visualizing the entire small bowel, allowing the extent of disease involvement to be described. According to international guidelines, SBCE has a defined role in cases of inconclusive histopathology or when clinical suspicion persists despite negative duodenal biopsies. To date, more and more interest is shown toward its role in monitoring CeD, specifically in terms of mucosal healing, early detection of complications such as ulcerative jejunitis, or performing differential diagnosis among other small bowel diseases that mimic CeD. With the rise of artificial intelligence systems being applied in this field, the future role of SBCE in CeD is expected to improve diagnostic accuracy and streamline the evaluation process, allowing its use as a routine tool for monitoring and early diagnosis of CeD-related complications. The environmental impact of SBCE is still under debate, but increasing evidence is suggesting ways to apply circular economy to the capsule lifecycle, turning it into a more sustainable device. In conclusion, SBCE is increasingly recognized as a critical tool in the diagnosis and monitoring of CeD.
The faecal immunochemical test (FIT) is an immunoassay used to detect human blood in the stool. The role of FIT as a screening tool for small bowel pathology remains unclear. This study aimed to investigate the role of FIT in predicting small bowel pathology in patients with iron deficiency anaemia (IDA). This was a single tertiary centre prospective study. The inclusion criterion was adults (⩾18 years and <80 years) with IDA who were referred to secondary care for endoscopic investigations. All patients had a FIT test done in primary care. Eligible patients were invited to have a small bowel capsule endoscopy (SBCE) prior to endoscopy. Patients with subsequent upper or lower gastrointestinal tract malignancy were excluded from the study. IDA was defined as a Hb < 131 g/L for men and <110 g/L for women with ferritin <30 µg/L and/or iron levels <11 µmol/L. A further 100 patients with recurrent/refractory IDA who did not have a FIT test done and had an SBCE were used as the control group. In total 179 patients were included in the final analysis with a median age of 64.5 years (interquartile range (IQR 51-75)); haemoglobin 101 (IQR 90-111) and ferritin 11(7-20). In the prospective FIT group of 79 patients, there were 35 (44%) patients with significant findings on SBCE which was classed as contributing to IDA. These findings included angioectasia in n = 21 (26.6%) patients which was the most common finding. The other findings included erosions and ulcers = 5 (7.6%); inflammatory strictures = 3 (3.8%); active Crohn's n = 1 (1.3%); visible blood with no clear source n = 3 (3.8%) and bleeding angioectasia n = 1 (1.3%). A positive FIT (>10) had a sensitivity, specificity, positive predictive value and negative predictive value of 34.29%, 54.55%, 37.5% and 51.08%, respectively. In the control group (n = 100), 37% of the patients had significant pathology on SBCE. On logistic regression, age (OR 1.06; 95% CI: 1.03-1.11) was the only factor related to the probability of having a positive finding on SBCE. Over a third of the patients with IDA have significant findings on SBCE. However, in this study, we did not find that FIT conferred any additional benefit in the detection of small bowel pathology.
Benign gastric outlet obstruction (bGOO) presents a significant therapeutic challenge, with etiologies ranging from peptic strictures to complex postsurgical or inflammatory conditions. While surgery has historically offered durable outcomes, its morbidity in frail populations underscores the need for effective, less invasive alternatives. This review critically examines the current literature up to April 2025 on surgical, endoscopic, and endoscopic ultrasound-guided interventions for bGOO, evaluating technical success, clinical outcomes, recurrence rates, and adverse events. Endoscopic balloon dilation shows excellent efficacy in simple peptic strictures but has limited efficacy in anatomically complex cases. Fully covered self-expandable metal stents can provide temporary relief but are associated with significant migration risk. Among emerging techniques, endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) stands out by combining the anatomical efficacy of surgery with the minimal invasiveness of endoscopy. Recent studies report technical and clinical success rates exceeding 95%, with lower recurrence and complication rates compared to traditional approaches. Comparative data increasingly support EUS-GJ as the preferred option in refractory or high-risk patients. Tailoring treatment strategies based on etiology, anatomical complexity, and patient condition is essential. EUS-GJ is redefining the therapeutic landscape of bGOO, offering a minimally invasive and durable alternative to surgery in carefully selected cases. Novel therapeutic approaches improve outcomes for patients with obstructive gastrointestinal symptoms caused by benign diseases Some people may develop a gastrointestinal obstruction at the exit of the stomach, caused by scarring, inflammation, or previous surgery. This condition, known as benign gastric outlet obstruction (bGOO), can lead to symptoms such as nausea, vomiting, weight loss, and malnutrition. While surgery has long been the standard treatment, it may not be suitable for elderly or frail patients due to its associated risks. This review examines more modern and less invasive therapies, including an innovative technique called endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ), which creates a new pathway for food to bypass the obstruction. Recent studies show that EUS-GJ is highly effective, safe, and associated with faster recovery times. It may soon become the first-line treatment for selected patients with benign gastric outlet obstruction.
Colon capsule endoscopy (CCE) was introduced by NHS England at scale during the COVID-19 pandemic to support colorectal diagnostics recovery. However, little was known about the patient experience of CCE. To explore the experiences of CCE during the NHS England pilot, to better understand what a patient-centered service for the future should look like. A qualitative study to explore the patient and clinician experiences of CCE. Focus group discussions (n = 25 participants) and semi-structured interviews (n = 7), selected purposively on the basis of maximum variation, generated qualitative material exploring patient understanding, preferences and experiences. To place their experiences in context, we conducted asynchronous focus group discussions with clinicians (n = 16). Analysis was thematic. Most patients valued CCE's convenience and would repeat it, although for some their experiences would deter them from having the procedure again. Anxieties included fear when swallowing the capsule; concerns about it becoming stuck and/or whether the recording was working; what to do when the capsule was inside them; and worries about the novelty of the treatment. Women expressed greater discomfort, pain and anxieties during bowel preparation and the procedure than men. Participants highlighted the need for a more balanced description of the procedure than indicated in information leaflets and videos. They particularly felt the possibility of further investigations could be better explained. Healthcare professionals may underestimate patient concerns. CCE has the potential to expand colorectal diagnostic capacity but requires patients to be well informed and supported throughout the process. Gender differences in experiences of CCE are notable and could be partially addressed by providing more specific information, consistent with women's experiences. What is already known on this topic Colon capsule endoscopy (CCE) was introduced by NHS England as a pilot from 2020, but patient experiences remain underexplored. There are also no defined key performance indicators to inform the development of a high-quality, patient-centred CCE service for the NHS. What this study adds This study finds patients view CCE positively and may prefer it over colonoscopy, though many report discomfort and anxiety. They also feel poorly informed.During the pandemic. healthcare professionals may have underestimated patients’ concerns about the procedure. How this study might affect research, practice or policy Patients’ experience of CCE differs from colonoscopy.Relevant information, shared decision making and support are required throughout the CCE process.Information on the procedure may require rewriting to reflect the experiences of women.Acceptance of CCE, including at home or primary care use, depends on addressing these needs and managing expectations about potential follow-up procedures.
The utilization of artificial intelligence (AI) in gastrointestinal (GI) endoscopy has witnessed significant progress and promising results in recent years worldwide. From 2019 to 2023, the European Society of Gastrointestinal Endoscopy has released multiple guidelines/consensus with recommendations on integrating AI for detecting and classifying lesions in practical endoscopy. In Vietnam, since 2019, several preliminary studies have been conducted to develop AI algorithms for GI endoscopy, focusing on lesion detection. These studies have yielded high accuracy results ranging from 86% to 92%. For upper GI endoscopy, ongoing research directions comprise image quality assessment, detection of anatomical landmarks, simulating image-enhanced endoscopy, and semi-automated tools supporting the delineation of GI lesions on endoscopic images. For lower GI endoscopy, most studies focus on developing AI algorithms for colorectal polyps' detection and classification based on the risk of malignancy. In conclusion, the application of AI in this field represents a promising research direction, presenting challenges and opportunities for real-world implementation within the Vietnamese healthcare context.
Gastrointestinal (GI) endoscopy and visceral surgery have been tightly merging to change GI disease diagnosis and the course of treatment. In addition to facilitating minimally invasive therapeutic procedures and improving postoperative outcomes, this synergistic strategy increases diagnostic precision. Recent technical advancements, such as high-definition endoscopic imaging, robotic-assisted surgery, and artificial intelligence integration, have refined patient care. The historical development, current therapeutic application, interdisciplinary collaborations, and potential future directions of integrating endoscopy and visceral surgery are covered in this review. It also discusses the difficulties in putting advanced approaches into clinical practice, including the need for specialized training and ethical issues. It is important to fully realize how endoscopic and surgical cooperation could translate into GI healthcare.
Delayed gastrointestinal transit time (TT), frequently observed in diabetes mellitus (DM), may hinder bowel preparation quality and visualization in video capsule endoscopy (VCE). The study aim was to compare VCE preparation adequacy and completion rates between patients with and without DM. Retrospective analysis of a prospectively maintained database, including all consecutive VCEs performed in patients aged ⩾35 years. Patients were divided into two groups based on a DM diagnosis reported at admission and confirmed by medication records. Clinico-demographic characteristics, bowel preparation quality, TTs, and completion rates were compared between the groups. Logistic regression analysis was performed to identify independent risk factors for inadequate bowel preparation. Out of 672 included VCEs, 189 (28.1%) patients had DM and 483 (71.9%) were controls. Completion rates were comparable (DM-98.4% vs controls-99.0%, p = 0.553). Gastric TT was similar (DM-37.5 ± 45.5 vs controls-34.3± 48.6 min, p = 0.420), while small bowel TT was longer (DM-261.8 ± 95.6 vs controls-244.9 ± 98.4 min, p = 0.040). DM patients had higher inadequate preparation rates (31.2% vs controls-23.4%, p = 0.040). In a multivariate analysis adjusted for age and gender, DM was not independently associated with inadequate preparation. However, DM treated with insulin (26.5% of patients with DM) was significantly associated with inadequate bowel preparation (Odds ratio (OR) 2.355, p = 0.006). Glucagon-like peptide-1 receptor agonist usage (11.8% of patients with DM patients) compared to no-DM controls achieved borderline significance as a risk factor for preparation inadequacy (OR 2.148, 95% CI 0.887-5.201, p = 0.090). VCE appears to be feasible in patients with DM, with similar completion rates and gastric TTs despite slightly prolonged small bowel TTs. However, DM treated with insulin is a significant risk factor for inadequate bowel preparation, suggesting the need for a more intensive preparation protocol within this patient group.
Colorectal cancer (CRC) screening programmes commonly use the Faecal immunochemical test (FIT) followed by colonoscopy. When colonoscopy is not feasible, computed tomography colonography (CTC) serves as an alternative. However, CTC has limitations, such as lower sensitivity for smaller polyps and radiation exposure. Colon capsule endoscopy (CCE) is a non-invasive alternative that may improve polyp detection in FIT-positive individuals. To evaluate the feasibility of CCE in FIT-positive participants from the Dutch CRC screening programme who are unable or unwilling to undergo colonoscopy. Prospective multicentre, interventional study. FIT-positive participants ingested the PillCam® Colon 2 capsule. Colonoscopy was recommended if polyp(s) ⩾6 or suspected malignancy were detected. The primary outcome was the per-patient polyp detection rate (PDR) for polyps ⩾6 mm. Of 169 FIT-positive participants unable to undergo colonoscopy, 54.4% were ineligible for CCE due to contraindications. CCE was performed in 13 participants, with a completion rate of 69.2% and adequate bowel preparation in 38.5. A total of 54 polyps were detected, 46.3% of which were ⩾6 mm. The per-patient detection rate for polyps ⩾6 mm was 76.9%. In 84.6% of cases, follow-up colonoscopy was advised. CCE findings matched colonoscopy in 66.7% of cases; in the remaining 33.3%, polyps were found to be < 6 mm during colonoscopy. One participant was diagnosed with a pT4bN0M0 adenocarcinoma after CCE revealed a tumorous obstruction. Despite a high per-patient PDR, this study indicates that CCE is less suitable for FIT-positive individuals unable or unwilling to undergo colonoscopy due to high comorbidity and frequent contraindications. Inadequate bowel preparation, likely due to reduced gastrointestinal motility, further limited feasibility. Given the elevated risk of advanced neoplasia in this population, many still required follow-up colonoscopy. Therefore, CCE may be better suited for lower-risk populations with fewer procedural limitations. Overview of Medical Research in the Netherlands, NL-OMON55511.
Colonoscopy is a commonly performed procedure in the United Kingdom and the gold standard for diagnosis and therapy in the gastrointestinal tract. Increased levels of pain during colonoscopy have been associated with reduced completion rates and difficulties in maintaining attendance for repeat procedures. Multiple factors play a role in causing discomfort intra-procedurally: patient factors, such as gender, anatomy and pre-procedure anxiety; operator factors, such as patient position and level of experience and other factors, such as bowel preparation and total procedure time. A literature search was performed to identify papers that explained how patient, operator and endoscopy factors influenced pain and discomfort in endoscopy. A further search then also identified papers describing solutions to pain and discomfort that have been explored. After review of the literature, key methods are selected and discussed in this paper. Solutions and aids that can resolve and improve pain and discomfort include endoscopic methods such as variable stiffness and ultrathin scopes. Operator improvements in techniques and ergonomics alongside the use of newer technologies such as propelled endoscopy, computer-assisted endoscopy and task distraction. To improve patient experience and outcomes, the investigation and research into improving techniques to reduce pain is crucial. This review aims to identify the modifiable and non-modifiable factors associated with intra-procedural discomfort during colonoscopy. We discuss established methods of improving pain during colonoscopy, in addition to newer technologies to mitigate associated discomfort.
Bile leakage following hepatectomy is a challenging issue that poses difficulties for hepatobiliary surgeons. Endoscopic treatment is the primary method for managing this complication, although its effectiveness is still uncertain. The aim of this study was to assess the effectiveness and risk factors of endoscopic treatment for bile leakage after hepatectomy. A retrospective cohort study. A retrospective study was performed on 15 patients who experienced bile leakage following hepatectomy and were successfully treated with endoscopic retrograde cholangiography (ERCP). The primary focus was to examine how factors like the site of bile leakage, the position of biliary drainage, and late-set leakage impact early clinical success (ECS). Out of the 15 cases, 10 successfully achieved ECS through endoscopic treatment. The highest success rate (80.0%, 4 out of 5) was seen when biliary drainage was performed by bridging, while drainage placed near the leakage site had a success rate of 75.0% (6 out of 8). The best outcomes occurred when bile leakage was located in the tertiary or higher branch bile ducts, with an 83.3% success rate (5 out of 6). Additionally, early-onset leakage had a higher ECS success rate compared to late-onset bile leakage (75.0% (6/8) vs 57.1% (4/7)). Among the 15 cases, 12 involved extensive liver resections of more than two segments, 14 included segments 7 or 8, 11 had received preoperative adjuvant therapy, and 9 had undergone transarterial chemoembolization (TACE). In cases with late-onset bile leakage, 6 out of 7 (85.7%) had undergone TACE. Bile leakage caused by TACE was more likely to be accompanied by bile duct-bronchial fistula, and the healing process took significantly longer. Endoscopic management of bile leakage following liver resection is both safe and effective, making it a preferred first-line treatment. Improved results can be obtained by placing a stent to bridge and drain near the leakage site. Extensive liver resection, resection involving segments 7 or 8 of the liver, and preoperative adjuvant therapies are significant risk factors for bile leakage, particularly TACE, which may lead to bile duct-bronchial fistulas and extended recovery periods. Analysis of the efficacy and influencing factors of endoscopic retrograde cholangiopancreatography in patients experiencing bile leakage after partial hepatectomy Hepatectomy is one of the main methods for treating benign and malignant liver diseases. However, bile leakage occurs in some patients after partial hepatectomy. Endoscopic retrograde cholangiopancreatography (ERCP) is the main treatment for post-hepatectomy bile leakage (PHBL). Due to the lack of large-sample clinical studies, the success rate of ERCP is not clear. The factors affecting the success of endoscopic treatment are also not clear. This study retrospectively analyzed the clinical data of 15 patients with PHBL successfully treated by ERCP, and explored the role of endoscopic treatment in the treatment of PHBL and the factors affecting the success rate. The results showed that endoscopic treatment of PHBL was safe and effective and could be used as the first-line treatment for PHBL.
Primary small intestinal lymphoma (PSIL) is a rare malignancy with heterogeneous clinical and pathological features, making accurate diagnosis challenging. To investigate the clinical value of double-balloon enteroscopy (DBE) combined with endoscopic ultrasonography (EUS) in the diagnosis of small intestinal lymphoma. Retrospective cohort study. We retrospectively reviewed 21 patients with pathologically confirmed PSIL who underwent both DBE and EUS at the Department of Small Intestinal Endoscopy, The Sixth Affiliated Hospital of Sun Yat-sen University, between September 2022 and May 2025. Clinical data were collected and analyzed in combination with pathological findings. A total of 21 patients were included (12 males, 9 females; median age of 52 years, range 31-87 years. Subtypes of B-cell lymphomas included diffuse large B-cell lymphoma (n = 5), follicular lymphoma (n = 3), and mucosa-associated lymphoid tissue lymphoma (n = 6). T-cell lymphomas included peripheral T-cell lymphoma (n = 7). Endoscopic findings were classified into five categories (1): hypertrophic type (2), exophytic tumor type (3), follicular/polypoid type (4), ulcerative type, and (5) diffusion type. EUS classification included superficial spreading (38.1%, 8/21), diffuse infiltrative (42.9%, 9/21), and nodular (19.0%, 4/21). DBE combined with EUS provides complementary morphological and structural information for the diagnosis of PSIL, improving clinical recognition and subtype characterization. Future multicenter studies with larger cohorts are warranted to validate these findings and establish standardized diagnostic protocols.
Dynamic changes in liver function tests have been proposed to correctly reclassify the risk of choledocholithiasis; however, information is scarce and insufficient to recommend its use. Retrospective cohort of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) due to moderate and high risk of choledocholithiasis according to the 2019 American Society of Gastrointestinal Endoscopy (ASGE) guidelines. We evaluated whether significant changes in liver function tests (bilirubin, transaminases, or alkaline phosphatase), defined as an increase or a reduction ⩾30 or ⩾50% between two measurements taken with a difference of 24-72 h can correctly reclassify the risk of choledocholithiasis beyond the ASGE guidelines. The net reclassification index (NRI) was calculated for patients with and without choledocholithiasis. Among 1175 patients who underwent ERCP, 170 patients were included in the analysis (59.4% women, median 59.5 years). Among patients without a diagnosis of choledocholithiasis, the number of patients correctly reclassified by transaminases was slightly higher than those incorrectly reclassified (NRI = 0.24 for aspartate amino transaminase and 0.20 for alanine amino transaminase). However, among patients with a diagnosis of choledocholithiasis, it led to incorrect reclassification in a greater number of cases (NRI = -0.21 and -0.14, respectively). The benefits of reclassification were minimal for bilirubin and alkaline phosphatase, or for value changes >50%. A subgroup analysis showed similar findings in patients without a history of cholecystectomy and in those with normal bile duct. Dynamic changes in liver function tests do not improve choledocholithiasis risk classification beyond the 2019 ASGE criteria. New criteria should continue to be sought to optimize risk stratification.
Digestive endoscopy (DE) is uncomfortable for most patients. Lorazepam is a potent benzodiazepine with anxiolytic and sedative effects. This study aims to determine the sedative effect of sublingual lorazepam versus placebo as a premedication in patients who underwent DE. This is a mono-center, double-blind, and randomized controlled trial. A lorazepam sublingual tablet was made by researchers and physical tests were done on it, then the double-blind placebo-controlled trial was done to investigate the efficacy of 2 mg sublingually administered lorazepam as a premedication for endoscopy. Lorazepam or a placebo tablet was administered sublingually 30 min before the endoscopy. The patients, nurses, and physicians were blinded to the patient group. The depth of sedation was evaluated according to the American Society of Anesthesiology. In all, 116 patients were randomly assigned to take either lorazepam (n = 58) or a placebo (n = 58). The results of physical properties tests were acceptable according to United States Pharmacopeia. There were no statistical differences between groups regarding age and gender. In the lorazepam group, 75.8% of patients showed mild sedation, and 24.2% of patients showed no sedation. All of the patients in the placebo had no sedation (p = 0.001). Time of procedure (p < 0.001), intraoperative O2 saturation (p < 0.001), intraoperative heart rate (p < 0.001), and intraoperative blood pressure (p < 0.001) were significantly lower in the lorazepam group. No significant or dangerous side effects were observed except a bit of giddiness and dizziness. The results of this study showed that prescription of sublingual lorazepam 25-30 min before endoscopy provided mild sedation. IRCT201611039014N130 (05/11/2016); https://en.irct.ir/trial/9568.
In recent years, various novel surgical and non-surgical therapeutic options have been developed for treating obesity. Due to its disputed success, intragastric botulinum toxin A (BTX-A) injection is still being debated. We aim to contribute to this controversial issue in the literature by sharing our center's findings regarding intragastric BTX-A injections in the treatment of obesity. Patients with a body mass index (BMI) of greater than 25 kg/m2 and at least one obesity-related complication, or a BMI of greater than 30 kg/m2 without complications, were eligible for the study if they were between the ages of 18 and 65. Following the same procedure, two endoscopists administered BTX-A to all patients. All patients were evaluated for obesity by measuring their lipid profile, hormone profile, and insulin resistance level before treatment. In our study on 82 patients, we saw a significant mean weight loss (-9.2 kg, p < 0.001) in the second month, and there was no additional mean weight loss in the sixth month of follow-up. In addition, this result seems to be independent of the patient's insulin resistance. We did not see any serious side effects in any of the patients. Although the use of intragastric injection of BTX-A in the treatment of obesity is a controversial issue, we showed in our study that it causes significant weight loss. Further studies are needed on this subject, as it can be a safe method when the ideal dose and application site are combined with appropriate patient selection.