Endoscopic resection via antral submucosal tunneling for en bloc removal of tumors in the duodenal bulb.

To overcome difficulties in the removal of duodenal bulb lesions, especially those in anatomically challenging locations, we developed the endoscopic resection via antral submucosal tunneling (ERAST) technique. In this study, we evaluated the feasibility and safety of ERAST for the removal of superficial and subepithelial lesions in the duodenal bulb. This was a single-center retrospective study of 10 patients with lesions in the bulb. Submucosal tunneling from the gastric antrum to the duodenum was performed to facilitate en bloc tumor resection in the bulb. The en bloc resection rate, postoperative bleeding, and perforation were the primary endpoints. Ten lesions (four superficial and six subepithelial), with an average size of 19.1 ± 9.2 mm, were resected en bloc by ERAST. Esophagogastroduodenoscopy follow-up after 2 months indicated complete wound healing in all patients. In our primary experience, ERAST was found to be a feasible and safe endoscopic resection technique for the removal of lesions in the duodenal bulb, especially those that are difficult to access.

A snare combined with endoclips to assist in endoscopic submucosal dissection for intraepithelial neoplasia in the entire colon and rectum.

OBJECTIVE: The use of mucosal traction to assist in colonic and rectal endoscopic submucosal dissection (ESD), especially for deep colonic ESD, is challenging. We developed a method of inverse insertion of a snare into the endoscopic working channel to deliver it into the colon together with the endoscope. With this method, two types of mucosal traction, per-anal external traction (PET) and per-anal internal traction (PIT), could be achieved using a snare with endoclips to assist in ESD (ESD-SE). Here, we aimed to examine its safety and feasibility. METHODS: From January 2017 to September 2018, 50 colonic and rectal intraepithelial neoplasias in 50 patients were treated with ESD-SE. Data on lesion location and size, operation time, en bloc resection and R0 resection rates, and operative complications were collected. RESULTS: Among 50 lesions, 15 lesions were located in the deep colon/proximal colon, and 35 lesions were in the distal colon. The median (interquartile range) size of lesions, submucosal dissection time, and total operation time were 4.5 (3.0-5.0) cm, 32 (18-81) min, and 50 (33-108) min, respectively. All lesions were completely resected, with R0 resection rates of 100%. No intraoperative and postoperative complications occurred. Postoperative pathology revealed 40 and 10 cases of high-grade and low-grade intraepithelial neoplasia, respectively. CONCLUSIONS: The approach using insertion of a selective snare into the colon together with the endoscope, especially into the deep colon, was safe and simple. Use of the snare combined with endoclips could effectively assist in total colonic ESD. Further research is warranted.

[Application of Quality Control Circle in Reducing Incidence of Leakage in Digestive Endoscopy].

To study the role of the activity in reducing the incidence of water leakage in digestive endoscopy, through the activity of the quality control circle (QCC), the reasons for water leakage and high maintenance cost are analyzed deeply. Then, the author formulated and implemented targeted measures to intervene in the non-standard aspects of daily management of endoscopy. Then targeted measures has been taken to improve the nonstandard daily management.Results demonstrate that the application of the quality control circle can significantly reduce the incidence of water leakage in the digestive endoscope and control the other faults caused by the leakage. This not only reduces the high maintenance cost of endoscopy, improves the utilization rate and turnover rate of endoscopy, but also fully explores personal potential, enhances team cohesion, and improves quality management awareness.

Artificial Intelligence-Assisted Colonoscopy for Detection of Colon Polyps: a Prospective, Randomized Cohort Study.

BACKGROUND AND AIMS: Improving the rate of polyp detection is an important measure to prevent colorectal cancer (CRC). Real-time automatic polyp detection systems, through deep learning methods, can learn and perform specific endoscopic tasks previously performed by endoscopists. The purpose of this study was to explore whether a high-performance, real-time automatic polyp detection system could improve the polyp detection rate (PDR) in the actual clinical environment. METHODS: The selected patients underwent same-day, back-to-back colonoscopies in a random order, with either traditional colonoscopy or artificial intelligence (AI)-assisted colonoscopy performed first by different experienced endoscopists (> 3000 colonoscopies). The primary outcome was the PDR. It was registered with clinicaltrials.gov . (NCT047126265). RESULTS: In this study, we randomized 150 patients. The AI system significantly increased the PDR (34.0% vs 38.7%, p < 0.001). In addition, AI-assisted colonoscopy increased the detection of polyps smaller than 6 mm (69 vs 91, p < 0.001), but no difference was found with regard to larger lesions. CONCLUSIONS: A real-time automatic polyp detection system can increase the PDR, primarily for diminutive polyps. However, a larger sample size is still needed in the follow-up study to further verify this conclusion. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT047126265.