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BACKGROUND: Real-time prediction of histologic features of small colorectal polyps may prevent resection and/or pathologic evaluation and therefore decrease colonoscopy costs. Previous studies showed that computer-aided diagnosis (CADx) was highly accurate, though it did not outperform expert endoscopists. OBJECTIVE: To assess the diagnostic performance of histologic predictions by general endoscopists before and after assistance from CADx in a real-life setting. DESIGN: Prospective, multicenter, single-group study. (ClinicalTrials.gov: NCT04437615). SETTING: 6 centers across the United States. PARTICIPANTS: 1252 consecutive patients undergoing colonoscopy and 49 general endoscopists with variable experience in real-time prediction of polyp histologic features. INTERVENTION: Real-time use of CADx during routine colonoscopy. MEASUREMENTS: The primary end points were the sensitivity and specificity of CADx-unassisted and CADx-assisted histologic predictions for adenomas measuring 5 mm or less. For clinical purposes, additional estimates according to location and confidence level were provided. RESULTS: The CADx device made a diagnosis for 2695 polyps measuring 5 mm or less (96%) in 1252 patients. There was no difference in sensitivity between the unassisted and assisted groups (90.7% vs. 90.8%; P = 0.52). Specificity was higher in the CADx-assisted group (59.5% vs. 64.7%; P < 0.001). Among all 2695 polyps measuring 5 mm or less, 88.2% and 86.1% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be resected and discarded without pathologic evaluation. Among 743 rectosigmoid polyps measuring 5 mm or less, 49.5% and 47.9% (P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be left in situ without resection. LIMITATION: Decision making based on CADx might differ outside a clinical trial. CONCLUSION: CADx assistance did not result in increased sensitivity of optical diagnosis. Despite a slight increase, the specificity of CADx-assisted diagnosis remained suboptimal. PRIMARY FUNDING SOURCE: Olympus America Corporation served as the clinical study sponsor.
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Inteligencia Artificial , Pólipos del Colon , Colonoscopía , Diagnóstico por Computador , Sensibilidad y Especificidad , Humanos , Pólipos del Colon/patología , Estudios Prospectivos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Adenoma/patología , Adenoma/diagnóstico , Neoplasias Colorrectales/patología , Competencia Clínica , AdultoRESUMEN
BACKGROUND AND AIMS: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used in diabetes and obesity management. Although GLP-1RAs delay gastric emptying, their impact on visibility during EGD remains uncertain. METHODS: A 1:1 matched case-control study was conducted. Individuals undergoing EGD who were taking GLP-1RAs were matched to nonusers based on demographic characteristics and diabetes status. A validated scale (POLPREP) was used to determine gastric mucosal visibility scores. RESULTS: A total of 84 pairs (N = 168) were included. GLP-1RA users had significantly lower visibility scores, with a 2.42 times higher likelihood of lower scores compared with nonusers. In addition, GLP-1RA users had a higher incidence of retained gastric contents (13.1% vs 4.8%; adjusted odds ratio, 4.62; P = .025) and aborted procedures due to this issue. No anesthesia-related adverse events were observed. CONCLUSIONS: GLP-1RA use at the time of endoscopy exhibited higher odds of lower gastric mucosal visibility scores, retained contents, and aborted procedures. Further research is warranted.
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OBJECTIVES: Previous studies have indicated that point-of-care ultrasonography (POCUS) of the gastric antrum can predict the adequacy of fasting before surgery and anesthesia. The aim of this study was to evaluate the utility of gastric POCUS in patients undergoing upper gastrointestinal (GI) endoscopy procedures. METHODS: We performed a single-center cohort study in patients undergoing upper GI endoscopy. Consenting patient's gastric antrum was scanned before anesthetic care for endoscopy to determine the cross-sectional area (CSA) and qualitatively determine safe and unsafe contents. Further, an estimate of residual gastric volume was determined using the formula and the nomogram methods. Subsequently, gastric secretions aspirated during endoscopy were quantified and further correlated with nomogram and formula-based assessments. No patient required a change in the primary anesthetic plan except for using rapid sequence induction in those with unsafe contents on POCUS scans. RESULTS: Qualitative ultrasound measurements consistently determined safe and unsafe gastric residual contents in 83 patients enrolled in the study. Unsafe contents were determined by qualitative scans in 4 out of 83 cases (5%) despite adequate fasting status. Quantitatively, only a moderate correlation was demonstrated between measured gastric volumes and nomogram (r = .40, 95% CI: 0.20, 0.57; P = .0002) or formula-based (r = .38, 95% CI: 0.17, 0.55; P = .0004) determinations of residual gastric volumes. CONCLUSION: In daily clinical practice, qualitative POCUS determination of residual gastric content is a feasible and useful technique to identify patients at risk of aspiration before upper GI endoscopy procedures.
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The American Society for Gastrointestinal Endoscopy's Gastrointestinal Endoscopy Editorial Board reviewed a systematic literature search of original endoscopy-related articles published during 2020 in Gastrointestinal Endoscopy and 10 other high-impact medical and gastroenterology journals. Votes from each individual board member were tallied to identify a consensus list of the 10 most significant topic areas in GI endoscopy over the calendar year of study using 4 criteria: significance, novelty, impact on national health, and impact on global health. The 10 areas identified were as follows: artificial intelligence in endoscopy, coronavirus disease 2019 and GI practice, third-space endoscopy, lumen-apposing metal stents, single-use duodenoscopes and other disposable equipment, endosonographic needle technology and techniques, endoscopic closure devices, advances in GI bleeding management, improvements in polypectomy techniques, and bariatric endoscopy. Each board member contributed a summary of important articles relevant to 1 to 2 topic areas, leading to a collective summary that is presented in this document of the "top 10" endoscopic advances of 2020.
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COVID-19 , Gastroenterología , Inteligencia Artificial , Endoscopía , Endoscopía Gastrointestinal , Humanos , SARS-CoV-2RESUMEN
The American Society for Gastrointestinal Endoscopy's GIE Editorial Board reviewed original endoscopy-related articles published during 2019 in Gastrointestinal Endoscopy and 10 other leading medical and gastroenterology journals. Votes from each individual member were tallied to identify a consensus list of 10 topic areas of major advances in GI endoscopy. Individual board members summarized important findings published in these 10 areas of disinfection, artificial intelligence, bariatric endoscopy, adenoma detection, polypectomy, novel imaging, Barrett's esophagus, third space endoscopy, interventional EUS, and training. This document summarizes these "top 10" endoscopic advances of 2019.
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Adenoma , Esófago de Barrett , Gastroenterología , Inteligencia Artificial , Endoscopía Gastrointestinal , HumanosRESUMEN
The American Society for Gastrointestinal Endoscopy's Gastrointestinal Endoscopy Editorial Board reviewed original endoscopy-related articles published during 2018 in Gastrointestinal Endoscopy and 10 other leading medical and gastroenterology journals. Votes from each individual member were tallied to identify a consensus list of 10 topic areas of major advances in GI endoscopy. Individual board members summarized important findings published in these 10 areas of adenoma detection, bariatric endoscopy, EMR/submucosal dissection/full-thickness resection, artificial intelligence, expandable metal stents for palliation of biliary obstruction, pancreatic therapy with lumen-apposing metal stents, endoscope reprocessing, Barrett's esophagus, interventional EUS, and GI bleeding. This document summarizes these "Top 10" endoscopic advances of 2018.
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Endoscopía Gastrointestinal/tendencias , Gastroenterología/tendencias , Adenoma/diagnóstico , Inteligencia Artificial/tendencias , Cirugía Bariátrica/tendencias , Esófago de Barrett/diagnóstico , Esófago de Barrett/terapia , Colestasis/terapia , Neoplasias Colorrectales/diagnóstico , Desinfección , Resección Endoscópica de la Mucosa/tendencias , Endosonografía/tendencias , Equipo Reutilizado , Hemorragia Gastrointestinal/terapia , Humanos , Quiste Pancreático/terapia , Stents Metálicos Autoexpandibles , Ultrasonografía Intervencional/tendenciasRESUMEN
BACKGROUND AND AIM: Direct percutaneous endoscopic jejunostomy (DPEJ) is a useful method to provide nutrition to patients with a variety of gastrointestinal (GI) problems. The present study describes a new method of DPEJ using balloon-assisted-enteroscopy. METHODS: This observational, retrospective, single-arm case study conducted at a tertiary care hospital during a 15-month period included 25 patients (12 females, 13 males, mean age 54 years, age range 31-79 years) with necrotizing pancreatitis, n = 7; complex upper GI surgery, n = 6; complex fistula, n = 6; impossibility to place a gastrostomy tube, n = 5; and bowel obstruction, n = 1. The new DPEJ technique focused on three key components: (i) use of balloon-assisted overtube; (ii) use of fluoroscopy; (iii) leaving the overtube in place during the entire procedure (and also for DPEJ removal). RESULTS: Technical success was 96%. Mean time of the procedure was 30.5 min (range 24 to 45 min). Clinical success was 100% (24/24); all DPEJ could be used for their intended purpose. CONCLUSIONS: This new method of inserting a DPEJ using balloon enteroscopy and fluoroscopy was safe and successful. Future comparative studies are now warranted.
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Enteroscopía de Doble Balón/métodos , Nutrición Enteral/métodos , Neoplasias Gastrointestinales/cirugía , Yeyunostomía/métodos , Adulto , Anciano , Endoscopía Gastrointestinal/métodos , Nutrición Enteral/instrumentación , Femenino , Fluoroscopía/métodos , Estudios de Seguimiento , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/mortalidad , Humanos , Yeyunostomía/instrumentación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Tasa de Supervivencia , Centros de Atención Terciaria , Resultado del TratamientoRESUMEN
BACKGROUND AND STUDY AIMS: The over-the-scope clip (OTSC; Ovesco Endoscopy, Tübingen, Germany) is deployed after suctioning tissue into the cap.âThe tissue may then be resected endoscopically. The aim of this study was to evaluate the efficacy and safety of the OTSC for the endoscopic resection of gastrointestinal tumors. PATIENTS AND METHODS: This was a retrospective, observational cohort study of patients undergoing endoscopic resection of submucosal lesions. RESULTS: Eight patients underwent endoscopic resection of neuroendocrine tumors (NETs) of the duodenum (nâ=â4), rectum (nâ=â1), or stomach (nâ=â2), or granular cell tumor (GCT) of the esophagus (nâ=â1). The mean size of the lesions was 13.4âmm (range 9â-â20âmm). Application of the clip was successful in all patients. A successful endoscopic resection was accomplished in all. A complete resection (R0) was accomplished in 7/8 patients (87.5â%). A full-thickness resection was achieved in 2/8 (25.0â%), one in a patient with a gastric NET and the other in a patient with GCT of the esophagus. There were no complications. CONCLUSIONS: This case series suggests that the OTSC system may be a valuable tool for the resection of submucosal lesions, but further prospective and randomized studies are necessary to assess the indications and outcome.
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Disección/métodos , Neoplasias Duodenales/cirugía , Neoplasias Esofágicas/cirugía , Tumor de Células Granulares/cirugía , Tumores Neuroendocrinos/cirugía , Neoplasias del Recto/cirugía , Neoplasias Gástricas/cirugía , Anciano , Disección/efectos adversos , Disección/instrumentación , Endoscopía Gastrointestinal/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasia Residual , Estudios RetrospectivosAsunto(s)
Endoscopía Gastrointestinal , Factor de Impacto de la Revista , Publicaciones Periódicas como Asunto , Adenoma/diagnóstico , Esófago de Barrett/patología , Esófago de Barrett/cirugía , Pólipos del Colon/patología , Colonoscopía/métodos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/cirugía , Manejo de la Enfermedad , Desinfección , Resección Endoscópica de la Mucosa , Endosonografía , Contaminación de Equipos , Humanos , Enfermedades Inflamatorias del Intestino/patología , Microscopía Confocal , Miotomía , Cirugía Endoscópica por Orificios Naturales , Obesidad/cirugía , Quiste Pancreático/terapia , Stents , Cirugía Asistida por ComputadorRESUMEN
Video 1Duodenocolonic stenting video.
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Despite advances in cross-sectional imaging and endoscopic technology, bile duct strictures remain a challenging clinical entity. It is crucial to make an early determination of benign or malignant nature of biliary strictures. Early diagnosis not only helps with further management but also minimizes mortality and morbidity associated with delayed diagnosis. Conventional imaging and endoscopic techniques, particularly endoscopic retrograde cholangiopancreatography (ERCP) and tissue sampling techniques play a key in establishing a diagnosis. Indeterminate biliary strictures (IDBSs) have no definite mass on imaging or absolute histopathological diagnosis and often warrant utilization of multiple diagnostics to ascertain an etiology. In this review, we discuss possible etiologies, clinical presentation, diagnosis, and management of IDBSs. Based on available data and expert opinion, we depict an evidence based diagnostic algorithm for management of IDBSs. Areas of focus include use of traditional tissue sampling techniques such as ERCP with brush cytology, intraductal biopsies, fluorescence in situ hybridization and flow cytometry. We also describe the role of endoscopic ultrasound (EUS)-guided fine needle aspiration and biopsies, cholangioscopy, confocal laser endomicroscopy, and intraductal EUS in management of IDBSs.
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Colestasis , Humanos , Constricción Patológica/etiología , Hibridación Fluorescente in Situ , Colestasis/diagnóstico por imagen , Colestasis/etiología , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Biopsia/efectos adversosRESUMEN
Background and Aim: Overt obscure gastrointestinal bleeding (OOGIB) is defined as continued bleeding with unknown source despite esophagogastroduodenoscopy (EGD) and colonoscopy evaluation. Small bowel evaluation through video capsule endoscopy (VCE) or double balloon enteroscopy (DBE) is often warranted. We studied the timing of DBE in hospitalized OOGIB patients regarding diagnostic yield, therapeutic yield, and GI rebleeding. Methods: We performed a retrospective review of DBEs performed at a tertiary medical center between November 2012 and December 2020. The inclusion criterion was first admission for OOGIB undergoing DBE. Those without previous EGD or colonoscopy were excluded. Patients were stratified into two groups: DBE performed within 72 h of OOGIB (emergent) and beyond 72 h of OOGIB (nonemergent). Propensity score matching was used to adjust for the difference in patients in the two groups. Logistic regression analysis was used to assess factors associated with diagnostic and therapeutic yield. Kaplan-Meir survival curve showed GI bleed-free survival following initial bleed and was compared using the log rank test. Results: A total of 154 patients met the inclusion criterion, of which 62 had emergent DBE and 92 had nonemergent DBE. The propensity-score-matched sample consisted of 112 patients, with 56 patients each in the emergent and nonemergent groups. Univariate and multivariable logistic regression analysis showed a significant association between VCE and emergent DBE and diagnostic and therapeutic yield (P < 0.05). Emergent DBE patients had increased GI bleed-free survival compared to those in the nonemergent group (P = 0.009). Conclusion: Our data demonstrate that emergent DBE during inpatient OOGIB can impact the overall diagnostic yield, therapeutic yield, and GI rebleeding post DBE.
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BACKGROUND: Obscure gastrointestinal (GI) bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal pathology. Standard endoscopy as well as push endoscopy can be a challenge in those with altered anatomy given inaccessible areas as well as perforation risk. Single and double balloon enteroscopy can be warranted in this patient population in instances of obscure GI bleed. AIM: To assess the safety and diagnostic efficacy of balloon enteroscopy for obscure GI bleeding in patients with surgically altered anatomy. METHODS: A search was conducted through PubMed, MEDLINE, Google Scholar, Scopus, and Embase with the key words "enteroscopy," "obscure bleeding," and "altered anatomy," to identify relevant articles in English with no restricted time frame. A search within the Reference Citation Analysis database was conducted to ensure inclusion of the latest high impact articles. Study types included in the review were prospective and retrospective reviews, case series, and case reports. The reference lists of these papers were also reviewed to find further papers that were applicable. The authors extracted the data from the studies that fit inclusion criteria. Data of interest included type of study, type of procedure, and type of altered anatomy, as well as the number of patients with any diagnostic or therapeutic intervention. Data was also recorded on procedure tolerance and complications. The data was analyzed with descriptive statistics. RESULTS: Our literature search yielded 14 studies that were included. There were 68 procedures performed with 61 unique patients subjected to these procedures. Forty-four (65%) of the procedures were double balloon, 21 (31%) were single balloon, and 3 (4%) were classified as through the scope balloon assisted. The most common altered anatomy types included Gastric Bypass Roux-en-Y, Pylorus Sparing Whipple, Orthotopic Liver Transplantation with Roux-en-Y, and Gastrojejunostomy Roux-en-Y. The procedures were successfully performed in each patient. There were 5 (7%) procedures that were complicated by perforation. Amongst the available data, the diagnostic yield was 48/59 (81%) and a therapeutic yield of 39/59 (66%). One patient was recommended surgical revision of their altered anatomy following enteroscopy. CONCLUSION: Balloon enteroscopy is a useful diagnostic modality in investigating obscure GI bleeding within those with surgically altered anatomy; however, precautions must be taken as this population may have increased perforation risk.
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Background and study aims Obesity prevalence continues to rise in the United States with Roux-en-Y gastric bypass (RYGB) surgery being one of the most common bariatric procedures. With this trend, more patients with altered upper gastrointestinal (UGI) anatomy have required endoscopic intervention including direct percutaneous endoscopic jejunostomy (DPEJ) placement. We aimed to assess the safety and success rates of DPEJ in RYGB patients. Patients and methods All patients at a tertiary care referral center who underwent DPEJ during an 8-year period were queried from a prospectively maintained registry of all enteroscopy procedures. Duplicate cases and altered upper UGI anatomy subtypes other than RYGB were excluded. The final cohort consisted of two groups: RYGB vs native anatomy (NA). Demographic, procedural, readmission, follow-up, and complication data were recorded. Comparative analysis was performed. Results Seventy-two patients were included where 28 had RYGB and 44 had NA. Both groups had similar baseline and pre-procedure data. Procedure success rate was 89â% in RYGB patients and 98â% in NA patients ( P â=â0.13). There were no intraprocedural complications. Early and late postprocedural complication rates were similar between the groups (both 4â% vs 7â%). Average follow-up times in the RYGB and NA groups were 12.97â±â9.35 and 13.44â±â9.21 months, respectively. Although readmission rates at 1 and 6 months were higher in the NA versus the RYGB group (21â% vs 7â% and 25â% vs 15â%), these differences were not significant. Conclusions DPEJ can be successful and safely placed in RYGB patients with no significant difference in procedure success, complication, or readmission rates when compared to control.
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Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangitis/terapia , Hipofaringe/patología , Enfermedades Faríngeas/etiología , Complicaciones Posoperatorias/terapia , Colangiopancreatografia Retrógrada Endoscópica/instrumentación , Colangitis/diagnóstico , Colangitis/etiología , Constricción Patológica , Glosectomía , Humanos , Laringectomía , Masculino , Persona de Mediana Edad , Disección del Cuello , Enfermedades Faríngeas/diagnóstico , Complicaciones Posoperatorias/diagnósticoRESUMEN
INTRODUCTION: Alterations in the composition of the human gut microbiome and its metabolites have been linked to gut epithelial neoplasia. We hypothesized that differences in mucosa-adherent Barrett's microbiota could link to risk factors, providing risk of progression to neoplasia. METHODS: Paired biopsies from both diseased and nonaffected esophagus (as well as gastric cardia and gastric juice for comparison) from patients with intestinal metaplasia (n = 10), low grade dysplasia (n = 10), high grade dysplasia (n = 10), esophageal adenocarcinoma (n = 12), and controls (n = 10) were processed for mucosa-associated bacteria and analyzed by 16S ribosomal ribonucleic acid V4 gene DNA sequencing. Taxa composition was tested using a generalized linear model based on the negative binomial distribution and the log link functions of the R Bioconductor package edgeR. RESULTS: The microbe composition of paired samples (disease vs nondisease) comparing normal esophagus with intestinal metaplasia, low grade dysplasia, high grade dysplasia, and adenocarcinoma showed significant decreases in the phylum Planctomycetes and the archaean phylum Crenarchaeota (P < 0.05, false discovery rate corrected) in diseased tissue compared with healthy controls and intrasample controls (gastric juice and unaffected mucosa). Genera Siphonobacter, Balneola, Nitrosopumilus, and Planctomyces were significantly decreased (P < 0.05, false discovery rate corrected), representing <10% of the entire genus community. These changes were unaffected by age, tobacco use, or sex for Crenarcha. DISCUSSSION: There are similar significant changes in bacterial genera in Barrett's esophageal mucosa, dysplasia, and adenocarcinoma compared with controls and intrapatient unaffected esophagus. Further work will establish the biologic plausibility of these specific microbes' contributions to protection from or induction of esophageal epithelial dysplasia.