共找到 20 条结果
暂无摘要（点击查看详情）
Adenoma detection rate (ADR) is a key colonoscopy quality metric. We previously created an automated ADR reporting tool, but inconsistent documentation hinders its quality. This study aims to evaluate the impact of structured colonoscopy report templates and educational tutorials on ADR metrics recorded by the reporting tool. We introduced structured colonoscopy report templates and an educational tutorial across 5 endoscopy centers. ADR-qualifying colonoscopies 120 days before and after intervention were analyzed. The Qlik analytics system-based automated ADR calculator (QlikTech Inc, King of Prussia, Pa, USA) was used to review screening colonoscopies and calculate ADR. A total of 5382 colonoscopies were performed during the study period. Among 1436 ADR-qualifying colonoscopies, the reporting of ADR increased from 28.8% to 34.6% (P = .019), and reporting of polyp detection rate improved from 67.8% to 71.7% (P = .031) using the automated ADR reporting tool. The tool was not significantly associated with increased reporting in multivariate analysis. An increase in reporting of ADR was noted after the intervention period, with results durable up to 120 days after the intervention. However, multivariate analysis suggests the possibility of confounding factors beyond the intervention alone. Educational interventions on structured colonoscopy reporting improved quality metrics.
暂无摘要（点击查看详情）
In this study, we developed an artificial intelligence (AI) system to support the diagnosis of early gastric cancer using magnifying endoscopy with narrow-band imaging (NBI), with the goal of improving the diagnostic accuracy of upper gastrointestinal endoscopy. This study aimed to evaluate the diagnostic performance of the AI-based system compared with endoscopists. A total of 500 cases, including early gastric cancer and noncancer cases, were used to develop the diagnostic support AI system. We evaluated the AI system with models created using k-fold cross-validation. We determined the diagnostic performance of the AI system and 10 endoscopists (5 experts and 5 nonexperts) for detecting early gastric cancer and compared the diagnostic performance between the AI system and endoscopists. Histopathologic diagnosis was used as the reference standard for cancerous lesions, while magnifying endoscopic diagnosis with high confidence served as the reference standard for noncancerous lesions. The median (interquartile range [IQR]) sensitivity for the AI system and all endoscopists was 100% (100%-100%) and 76.8% (65.5%-78.9%), respectively. The sensitivity of the AI system was significantly higher than that of the endoscopists (P = .002). The median (IQR) specificity for the AI system and all endoscopists was 100% (99.0%-100%) and 86.0% (72.0%-91.8%), respectively. The specificity of the AI system was also significantly higher (P = .01). This study demonstrates the feasibility of applying the diagnostic support AI system during magnified observation with NBI and suggests that it could enhance the diagnostic accuracy of upper gastrointestinal endoscopy for early gastric cancer.
暂无摘要（点击查看详情）
Fully covered self-expandable metal stents (FcSEMSs) have become the mainstay of treatment for a variety of biliary pathologies. However, FcSEMSs have been associated with a greater rate of stent migration than other types of stents. A technique of anchoring double-pigtail plastic stents (DPPSs) has been proposed to minimize migration of biliary FcSEMSs. Herein, we evaluated the efficacy of anchoring DPPSs among patients treated with biliary FcSEMSs. We performed a systematic review using PubMed, EMBASE, and Web of Science from database inception through August 2023. Full-text articles comparing FcSEMSs with or without anchoring DPPSs were included. We evaluated the following outcomes: (1) stent migration; (2) stent occlusion; (3) duration of stent patency; (4) cholangitis; (5) unplanned reinterventions; and (6) adverse events. Meta-analysis was carried out using random-effect models and reported as odds ratios (ORs) with corresponding 95% confidence intervals (95% CIs). Four studies encompassing 489 patients were included. Patients with anchoring DPPSs had a 67% reduction in FcSEMS migration compared with those without anchoring DPPSs (OR: 0.33; 95% CI, 0.19-0.57; I 2 0%). Anchoring DPPSs increased the mean duration of FcSEMS patency by 83 days compared with FcSEMSs alone (95% CI, 46-120; I 2 94%). No differences in other clinical end points or adverse events were observed. Anchoring DPPSs reduced the risk of FcSEMS migration and increased the duration of FcSEMS patency without an increased risk of adverse events. Future studies are needed to corroborate these findings, determine the optimal DPPS technique, and to compare DPPS placement with other antimigratory modalities.
暂无摘要（点击查看详情）
Asian Americans demonstrate lower colonoscopy screening rates than the general U.S. population, highlighting complex cultural and social barriers. We aim to compare the effect of a video-based instructional tool versus standard of care on bowel preparation quality and patient-related factors. A randomized controlled trial enrolled Cantonese/Mandarin-speaking patients who underwent outpatient colonoscopies between July and November 2023. Participants (n = 132) were randomly assigned to 2 groups: 1 receiving standard preparation guidance and the other a link to a video educational tool. Primary outcome was Boston Bowel Preparation Scale (BBPS) with secondary outcomes including total procedure time, withdrawal time, patients' anxiety levels, and self-perception of preparation quality. Of 169 participants enrolled (81 video, 88 control), 31 were excluded because of cancellations, no-shows, or consent withdrawal, resulting in 66 per group. Eleven video group participants did not watch the video and were reassigned to the control group per protocol. Final analysis included 77 in the control group and 55 in the video group, with a 55.5% male composition, averaging 60 years. In the per-protocol analysis, the median BBPS was the same in both groups (P = .064). The mean (95% confidence interval) withdrawal times exhibited no significant difference (P = .74), with averages of 14.4 (12.2-16.7) and 14.8 (12.9-16.9) minutes for the control and video groups, respectively. However, there was a significant difference in patient perception of preparation quality (P = .05), with averages of 9 (8.1-9) and 9.5 (9.3-9.7) for the control and experimental groups, respectively. Our study suggests that a video-based instructional tool improves Cantonese/Mandarin-speaking participants' perception of colonoscopy preparation quality. There was a trend toward improved BBPS in patients who watched the video, while total procedure and withdrawal times were comparable in both groups. Further research is needed to assess the impact of educational videos and other tools on bowel preparation in this patient population.
Pheochromocytomas are catecholamine-secreting adrenal tumors that are rarely biopsied due to the potential risk of hypertensive crisis and procedural adverse events. We report an unusual case of a 66-year-old woman with an enlarging left adrenal mass and elevated plasma and urine metanephrines. After multidisciplinary discussion, tissue diagnosis was deemed necessary for surgical planning, and she underwent endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) before a planned cortical-sparing adrenalectomy. EUS revealed a 25-mm, well-encapsulated, homogeneous, isoechoic left adrenal lesion without vascularity. Two passes with a 22-gauge needle were performed under intensive hemodynamic monitoring, and there was no hemodynamic instability. Cytology and immunohistochemistry confirmed pheochromocytoma, and the patient subsequently underwent an uneventful laparoscopic adrenalectomy. Although biopsy of suspected pheochromocytoma is not standard practice, this case highlights that EUS-FNA may be a feasible and potentially safe diagnostic approach in select patients. Further study is needed to clarify its role in the evaluation of adrenal masses.
Pharyngeal squamous cell carcinoma (SCC) is increasingly detected at earlier stages in Japan, largely due to routine image-enhanced endoscopy and systematic pharyngeal examination. Endoscopic submucosal dissection (ESD) is now a preferred minimally invasive treatment option for superficial SCC, with excellent outcomes. Despite this, the technique remains underutilized in the West, even though the incidence of pharyngeal cancer continues to rise. This review brings together current evidence on pharyngeal ESD, indications, technique, outcomes, and adverse events. Across contemporary series, en bloc and R0 resection rates are consistently high, with serious adverse events occurring infrequently. Nonetheless, pharyngeal ESD involves unique challenges stemming from complex anatomy, specialized anesthesia, and specific exposure techniques. We highlight practical barriers limiting adoption in the West, particularly limited knowledge in optical diagnosis, and propose targeted education to close the knowledge gap. As demand increases for minimally invasive, organ-preserving treatments, pharyngeal ESD is poised to have an important role for the treatment of early pharyngeal SCC in Western practice.
Traditional endoscopic self-expandable metal stent (SEMS) placement necessitates fluoroscopy guidance when treating gastrointestinal obstruction. This study was performed to report the safety and efficacy of radiation-free peroral cholangioscopy-guided SEMS placement in the treatment of 2 cases with gastrointestinal obstruction. This study included 2 patients with gastrointestinal obstruction due to cholangiocarcinoma and sigmoid colon cancer. Peroral cholangioscopy was applied for radiation-free guidewire insertion and SEMS placement. The guidewire insertion and SEMS placement were successfully accomplished by radiation-free peroral cholangioscopy in both cases. It resulted in significant relief of gastrointestinal obstruction symptoms. In addition, no adverse events such as bleeding or perforation were observed intraoperatively and postoperatively. Radiation-free peroral cholangioscopy may safely and effectively assist SEMS placement to relieve the symptoms of obstruction caused by gastrointestinal tumors.
An intramural duodenal hematoma (IDH) is an uncommon clinical entity that can be an adverse event of therapeutic esophagogastroduodenoscopy (EGD). Herein, we present a case of a 60-year-old man who presented to the hospital with vomiting, diarrhea, and overt gastrointestinal bleeding with melena and small-volume hematemesis. EGD was pursued and revealed a bleeding duodenal ulcer that was therapeutically intervened upon to achieve hemostasis. After endoscopy, his hospital course was complicated by an intramural duodenal hematoma, which presented with abdominal pain and worsening anemia without recurrent overt gastrointestinal bleeding. After consultation with interventional radiology and surgery, he ultimately improved with supportive care and was discharged home without further endoscopic or procedural intervention. An IDH is an uncommon gastrointestinal pathology that should be considered after endoscopy in the setting of abdominal pain and anemia without overt bleeding. Conservative management often leads to successful outcomes, but multidisciplinary care should be considered in the setting of further adverse events.
暂无摘要（点击查看详情）
Large biliary stones (>25 mm) present significant therapeutic challenges, with standard endoscopic techniques frequently failing to achieve complete ductal clearance. Conventional 3F electrohydraulic lithotripsy (EHL) probes often require multiple sessions or result in incomplete fragmentation. We present a novel approach using a 4.5F EHL probe (Walz Elektronik GmbH, Rohrdorf, Germany) for successful management of large refractory biliary stones. Three female patients (aged 57, 59, and 67 years) with large biliary stones (35-45 mm) previously refractory to standard techniques underwent direct cholangioscopy with a 4.5F EHL probe fragmentation using an 11F cholangioscope (eyeMAX; Micro-Tech, Ann Arbor, Mich, USA). The 4.5F probe delivers energy up to 950 mJ with greater surface area contact than standard 3F probes. Complete ductal clearance was achieved in all 3 cases within a single session, with successful fragmentation where conventional techniques had failed. Procedure durations ranged from 49 to 94 minutes. No adverse events occurred in any case. The 4.5F EHL probe represents a significant advancement for managing large refractory biliary stones, potentially reducing repeat procedures and obviating surgical intervention.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Interventional gastroenterologists typically perform colonoscopies at lower volumes than general gastroenterologists, and we sought to determine whether this disparity affects their overall adenoma detection rates (ADRs). Our study aimed to identify any difference in ADR between interventional gastroenterologists and general gastroenterologists. A retrospective cohort study from January 2020 to January 2023 was performed to determine ADRs for interventional gastroenterologists and general gastroenterologists at a single academic tertiary care center, as well as assessing for other quality indicators of screening colonoscopy. We reviewed 9755 screening colonoscopies. On univariate analysis, ADR differed between groups (46.9% vs 41.5%, P = .033), but on multivariate analysis, provider type was not associated with ADR (odds ratio = 0.99; 95% confidence interval, 0.80-1.22; P = .919). ADR was similar between interventional and general gastroenterologists after adjustment for patient characteristics, supporting inclusion of interventional gastroenterologists in colorectal cancer screening practices.
Underwater endoscopic mucosal resection (UEMR) has been widely adopted for the treatment of superficial nonampullary duodenal epithelial tumors (SNADETs). The aim of this study was to identify predictors of local recurrence and piecemeal resection in UEMR for SNADETs. This is a retrospective single-center study. Patients who underwent UEMR for SNADETs between November 2017 and October 2024 were included. We documented clinicopathologic characteristics of patients and lesions, noted procedure-related outcomes, and evaluated local recurrence. Kaplan-Meier analysis was used to assess recurrence-free survival, and logistic regression analysis was performed to identify the predictors of piecemeal resection. Among the 367 patients, the rate of piecemeal resection was 11.2%, and the rate of en bloc resection with histologically tumor-free horizontal and vertical margins (R0) was 65.1%. No intraoperative perforations occurred; intraoperative bleeding was observed in 1.9%. Kaplan-Meier analysis of recurrence-free survival showed significantly poorer outcomes in the piecemeal resection group than the en bloc resection group (log-rank test, P < .001; Wilcoxon test, P < .001). According to multivariate logistic regression analysis, each 1-mm increase in lesion size (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.11-1.31; P < .001) and a flat macroscopic type (OR, 12.49; 95% CI, 1.45-107.98; P = .02) were significant independent predictors of piecemeal resection. Piecemeal resection was a risk factor for local recurrence in UEMR for SNADETs. In addition, each 1-mm increase in lesion size and a flat macroscopic type were significant independent predictors of piecemeal resection.
Histologic examination is considered the reference standard for diagnosing cancer. However, bile ducts and other narrow passages in the human body are difficult to biopsy. Current biopsy forceps collect tissue that is directly in front of and perpendicular to the instrument. In bile ducts, this is particularly challenging because angling the forceps is limited by tight spaces. This study presents a novel biopsy device and methodology capable of collecting tissue from areas parallel to the instrument. We designed a biopsy device featuring a 4-lumen tube that can pass through the biopsy channel of an endoscope. The device includes several key components: a cutting blade, a mechanism to actuate the blade, a vacuum window for suction, and a tissue window for collecting samples. Testing was conducted using a bile duct phantom and a model constructed with porcine tissue. The device was successfully manufactured and tested in a controlled, ex vivo environment. It demonstrated the ability to navigate narrow conduits like bile ducts effectively. In addition, the device was able to suction tissue parallel to the instrument, cut it precisely, and retrieve it for histologic analysis. This newly developed biopsy device offers the ability to obtain tissue samples from areas parallel to the biopsy instrument. The lateral biopsy window significantly expands the surface area for tissue collection, a critical feature for narrow conduits like bile ducts. This advancement is especially important for improving early cancer diagnosis in such areas, where delays can lead to worse prognosis.