Objectives:One of the most notable challenges in endoscopic procedures is maintaining correct orientation.Mental rotation exercise(MRE)has been suggested as a potential aid for improving orientation.However,there is a...Objectives:One of the most notable challenges in endoscopic procedures is maintaining correct orientation.Mental rotation exercise(MRE)has been suggested as a potential aid for improving orientation.However,there is a lack of research on designing MREs with varying difficultylevels for training purposes.Furthermore,few studies provide solid evidence linking MRE difficultylevels with cognitive load measurements.This study aims to address this gap by investigating the correlation between the MRE difficultylevels and participants’cognitive load,as measured by pupil dilation.Method:We recruited 33 participants to perform MREs on a computer equipped with a screen-mounted eye-tracker.The test consisted of 15 MREs,with the first10 relatively easy(traditional cube)and the next 5 more complex(invented molecule).The participants’eye movements during MREs were recorded.The participants’MRE scores and pupil dilation were obtained and compared between two MRE difficultylevels.Results:The participants who performed traditional cube MREs achieved significantlybetter MRE scores(0.77±0.11 vs.0.58±0.03,p<0.001)and lower pupil dilation(0.27±0.04 pixels vs.0.47±0.09 pixels,p<0.001)than did those who performed the invented molecule MREs.Moreover,there were significant negative correlations(r=0.62,p=0.015)between pupil dilation and MRE scores.Conclusions:The results revealed a significantnegative correlation between MRE scores and pupil dilation.The more challenging MRE questions led to worse MRE scores but increased pupil dilation.The MRE difficultylevels can be evaluated not only by the degrees or dimensions with which the objects were rotated but also by the participants’MRE scores and pupil dilation.The results of this study provide a basis for training orientation skills in endoscopy using MREs.By incorporating MREs with varying difficultylevels,customized training programs can be developed to enhance camera navigation in endoscopic and laparoscopic procedures.展开更多
This review comprehensively summarized the potential of artificial intelligence(AI)in the management of esophageal cancer.It highlighted the significance of AI-assisted endoscopy in Japan where endoscopy is central to...This review comprehensively summarized the potential of artificial intelligence(AI)in the management of esophageal cancer.It highlighted the significance of AI-assisted endoscopy in Japan where endoscopy is central to both screening and diagnosis.For the clinical adaptation of AI,several challenges remain for its effective translation.The establishment of high-quality clinical databases,such as the National Clinical Database and Japan Endoscopy Database in Japan,which covers almost all cases of esophageal cancer,is essential for validating multimodal AI models.This requires rigorous external validation using diverse datasets,including those from different endoscope manufacturers and image qualities.Furthermore,endoscopists’skills significantly affect diagnostic accuracy,suggesting that AI should serve as a supportive tool rather than a replacement.Addressing these challenges,along with country-specific legal and ethical considerations,will facilitate the successful integration of multimodal AI into the management of esophageal cancer,particularly in endoscopic diagnosis,and contribute to improved patient outcomes.Although this review focused on Japan as a case study,the challenges and solutions described are broadly applicable to other high-incidence regions.展开更多
BACKGROUND Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases.However,a series of ethical issues have emerged,such as exp...BACKGROUND Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases.However,a series of ethical issues have emerged,such as expanding treatment indications,which affect the fair distribution of medical resources.There is limited research on ethical issues in the field of digestive endoscopy.AIM To investigate the level of ethical awareness among gastrointestinal endoscopy practitioners and analyze the ethical issues involved in gastrointestinal endoscopy technology.METHODS A questionnaire survey was performed to collect relevant data(gender,age,degree of education,professional title,personnel category,the level of understanding medical ethical principles,ethics training and its learning pathways)from gastrointestinal endoscopy practitioners at the Second Hospital of Dalian Medical University and Dalian Friendship Hospital,including licensed physicians and nurses(including trainees and graduate students).RESULTS The majority of gastrointestinal endoscopy practitioners have received training on ethics,but there is still considerable room for improvement in their ethical awareness.Different learning pathways may affect the mastery of ethical principles, and understanding of ethical principles is more easily achieved through hospital ethics institutions.CONCLUSIONTo address the ethical issues in gastrointestinal endoscopy technology, it is necessary to enhance the humanisticeducation of gastrointestinal endoscopy practitioners, incorporate ethical standards into the technology assessmentprocess, and establish a patient-centered diagnostic and treatment model to improve the ethical awareness of practitionersand achieve a balance between technology and ethics.展开更多
BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector compu...BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.展开更多
Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucos...Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.展开更多
In this letter,we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions duri...In this letter,we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions during capsule endoscopy(CE).CE was first presented in 2000 and was approved by the Food and Drug Administration in 2001.The indications of CE overlap with those of regular diagnostic endoscopy.However,in clinical practice,CE is usually used to detect lesions in areas inaccessible to standard endoscopies or in cases of bleeding that might be missed during conventional endoscopy.Since the emergence of CE,many physiological and technical challenges have been faced and addressed.In this letter,we summarize the current challenges and briefly mention the proposed methods to overcome these challenges to answer a central question:Do we still need CE?展开更多
Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation ...Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation strategies,risk assessment,and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient’s comorbidities and procedural requirements.Within this landscape,the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion,demonstrating significantly reduced hypotension,faster induction,and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates.These findings align with broader recommendations from both European and American societies advo-cating sedation regimens that preserve stable circulation.Etomidate’s favorable hemodynamic profile,coupled with propofol’s reliability,suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography,interventional endoscopic ultrasound,and endoscopic submucosal dissection,where deeper or more sustained sedation is often required.Remimazolam,a novel short-acting benzodiazepine,has similarly been associated with reduced cardiovascular depression and faster recovery,partic-ularly in high-risk populations,although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited.Further investig-ations into these sedation strategies in higher-risk cohorts,as well as complex the-rapeutic endoscopy,will likely inform more nuanced,patient-specific protocols aimed at maximizing both safety and procedural efficiency.展开更多
Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies,allowing the non-invasive study of the entire mucosa.This has led,together with new technical advances,to the cr...Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies,allowing the non-invasive study of the entire mucosa.This has led,together with new technical advances,to the creation of two new models(PillCam ESO and PillCam Colon)for the study of esophageal and colonic diseases.These two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts,because traditional endoscopy is often unpleasant and uncomfortable for the patient,can be painful,often requires moderate or deep sedation and is not without complications(hemorrhage,perforation,etc.).PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps,and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening,even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional colonoscopy.This article discusses the advantages of capsule endoscopy over conventional endoscopy,its current application possibilities and indications in routine clinical practice.In the various sections of the work,we assess the application of endoscopic capsule in different sections of the digestive tract(esophagus,stomach,and colon)and finally the potential role of panendoscopy with PillCam Colon.展开更多
The field of gastroenterology has experienced revolutionary advances over the past years,as flexible endoscopes have become widely accessible.In addition to enabling faster,less invasive,and more affordable treatment,...The field of gastroenterology has experienced revolutionary advances over the past years,as flexible endoscopes have become widely accessible.In addition to enabling faster,less invasive,and more affordable treatment,flexible endoscopes have greatly improved the detection and endoscopic screening of malignancies and prevented many cancer-related deaths.The development and clinical application of new diagnostic endoscopic technologies,such as magnification endoscopy,narrow-band imaging,endoscopic ultrasound with biopsy,and more recently,artificial intelligence enhanced technologies,have made the recognition and detection of various neoplasms and sub-epithelial tumors more possible.This review demonstrates the latest advancements in endoscopic procedures,techniques,and devices applied in the diagnosis and management of gastrointestinal cancer.展开更多
Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeuti...Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeutic advantages across a broad spectrum of diseases.This review examines its role in diagnosing and managing common pediatric GI conditions,emphasizing notable advancements in techniques,clinical use,and future directions.We conducted a detailed literature survey using PubMed,Scopus,and Google Scholar,and English-language articles were reviewed.This review process included the latest articles,guidelines,and conference papers on pediatric and adult upper GI endoscopy.An upper GI endoscopy is imperative in diagnosing many pediatric GI diseases as it enables visualization of the gut mucosa,obtaining mucosal biopsies from suspicious areas or lesions for histological assessment,and selecting an effective management and follow-up plan.New advancements,including high-resolution endoscopy,narrow-band imaging,and confocal laser endomicroscopy,have revolutionized pediatric endoscopy by improving precision and reducing the need for invasive interventions.Furthermore,recent therapeutic developments in the field,such as endoscopic submucosal dissection and endoscopic mucosal resection,are now being utilized to treat preneoplastic lesions or refractory esophageal strictures.However,despite its usefulness,performing this procedure in children is challenging for various reasons,including the need for sedation,anesthesia,and smaller instrument sizes,the unavailability of trained staff,lack of training facilities,and the absence of dedicated endoscopy suites for children.In conclusion,pediatric upper GI endoscopy plays a pivotal role in pediatric gastroenterology,offering both therapeutic and diagnostic benefits.Progress in the field leads to the development of novel techniques that improve overall patient care,such as artificial intelligence in pattern recognition,which enhances lesion detection,predicts premalignant or pre-inflammatory areas,and minimizes investigator-related errors.Additionally,refining protocols and guidelines is essential to improve the safety,efficacy,and precision of upper GI endoscopy,ensuring the best possible care for children.展开更多
We read the recent minireview by Ding et al.This review provided a structured introduction to the applications of artificial intelligence(AI)in gastrointestinal endoscopy while emphasizing the technical solutions for ...We read the recent minireview by Ding et al.This review provided a structured introduction to the applications of artificial intelligence(AI)in gastrointestinal endoscopy while emphasizing the technical solutions for imaging hurdles.However,we identified some areas that were lacking analytical depth.Specifically,the review oversimplified machine learning and deep learning models(e.g.,generative adversarial networks misclassification)and failed to deeply analyze the explanations for missed tumor rates and the critical role of data quality/bias.In this article,we stress that the potential of AI extends beyond diagnostics and highlight its emerging and crucial role in endoscopist training,skill development,and proficiency enhancement.We conclude that future AI adoption depends on robust multicenter trials and the implementation of AI-assisted educational platforms.展开更多
In the last 50 years,gastrointestinal endoscopy has evolved rapidly with increasing indications of use for both diagnostic and therapeutic modalities.However,it has also contributed to a significant carbon footprint a...In the last 50 years,gastrointestinal endoscopy has evolved rapidly with increasing indications of use for both diagnostic and therapeutic modalities.However,it has also contributed to a significant carbon footprint and healthcarerelated climate change.Endoscopy is a high-volume specialty in the United States,with an estimated>22 million endoscopies performed annually.Therefore,it has also,unfortunately,become the third-highest generator of healthcare-related waste,with an estimated annual emission of 85768 metric tons of carbon dioxide.It is estimated that a single endoscopy session may generate more than 2 kg of waste.At the level of physicians,administrators,industry,and humanity,reducing healthcare-related waste has become one of the significant challenges currently faced.The ultimate professional goal should be to raise awareness,educate,start initiatives to reduce medical waste and perform research to make endoscopy more sustainable.These applications will lead to the establishment and promotion of environmentally friendly practices with standardized metrics to reduce the carbon footprint of gastrointestinal endoscopy.展开更多
Lumbar interbody fusion is essential for treating degenerative lumbar diseases.The disadvantages of open surgery have led to the evolution of minimally invasive spine surgery,including endoscopic techniques such as un...Lumbar interbody fusion is essential for treating degenerative lumbar diseases.The disadvantages of open surgery have led to the evolution of minimally invasive spine surgery,including endoscopic techniques such as unilateral biportal endoscopy(UBE).Leveraging arthroscopic principles,UBE offers superior visualization and flexibility and expands from decompression to fusion(UBE fusion).However,achieving robust UBE fusion presents challenges,such as suboptimal arthrodesis rates and implant-related complications,requiring more than surgical skill alone.Optimizing UBE fusion critically depends on the effective integration of advanced biomaterials with the surgical technique.This minireview assessed recent advances in UBE,focusing on the development of novel biomaterials,such as functionalized porous,expandable,or double-cage designs,to improve bone regeneration outcomes.These advancements address challenges,like washout of bone graft material and biologics,and utilize growth factors,such as recombinant human bone morphogenetic proteins,while exploring pathway modulation to improve outcomes.We also evaluated clinical optimization strategies involving technical refinements,fluid and hemostasis control,key complication mitigation especially concerning dural tears and hematomas,and technologies such as navigation and robotics.While UBE shows promise particularly for early recovery,its long-term success hinges on these biotechnological advancements.High-quality evidence,especially from randomized controlled trials and longterm studies,is needed to validate integrated strategies and define the optimal role of UBE fusion.展开更多
The challenge of effectively eliminating air during gastrointestinal endoscopy using ultrasound techniques is apparent.This difficulty arises from the intricacies of removing concealed air within the folds of the gast...The challenge of effectively eliminating air during gastrointestinal endoscopy using ultrasound techniques is apparent.This difficulty arises from the intricacies of removing concealed air within the folds of the gastrointestinal tract,resulting in artifacts and compromised visualization.In addition,the overlap of folds with lesions can obscure their depth and size,presenting challenges for an accurate assessment.Conversely,in intricately folded regions of the gastrointestinal tract,such as the stomach,intestine,and colon,insufficient delivery of air or CO_(2) into the cavity impedes luminal expansion,hindering the accurate visualization of lesions concealed within the folds.Although this underscores the requirement for substantial airflow,excessive airflow can hinder visualization of bleeding lesions and other abnormalities.Considering these challenges,an ideal endoscopic device would facilitate the observation of lesions without the requirement for air or CO_(2) delivery whereas,ensuring optimal expansion of the gastrointestinal tract.Recently,transparent gels with specific viscosities have been employed more frequently to address this issue.This review aims to elucidate how these gels address these challenges and provide a solution for enhanced endoscopic visualization.展开更多
BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters ...BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters in surveillance.METHODS Patients aged≥18 due for polyp surveillance were invited for CCE and FIT.Identifying polyps or colorectal cancer resulted in a positive CCE.Significant lesions(≥3 polyps or≥6 mm polyps),incomplete studies and positive FITs(≥225 ng/mL)were referred for endoscopy.CCE and endoscopy results,FIT accuracy and patient preference were assessed.RESULTS From a total of 126 CCEs[mean age 64(31-80),67(53.2%)males),70.6%(89/126)were excreted,86.5%(109/126)had adequate image quality.CCE positivity was 70.6%(89/126),42.9%(54/126)having significant polyps with 63.5%(80/126)referred for endoscopy(19 sigmoidoscopies,61 colonoscopies).CCE reduced endoscopy need by 36.5%(46/126)and 51.6%(65/126)were spared a colonoscopy.CCE positive predictive value was 88.2%(45/51).Significant extracolonic findings were reported in 3.2%(4/126).Patients with positive CCEs were older>65[odds ratio(OR)=2.5,95%confidence interval(CI):1.1517-5.5787,P=0.0159],with personal history of polyps(OR=2.3,95%CI:0.9734-5.4066,P=0.045),with high/intermediate polyp surveillance risk(OR=5.4,95%CI:1.1979-24.3824,P=0.0156).Overall,5/114(4.4%)FITs were positive(range:0-1394 ng/mL,mean:54 ng/mL).Sensitivity(9.6%)and negative predictive values(20.3%)were inadequate.Receiver operating curve analysis gave a sensitivity and specificity of 26.9%and 91.7%,for FIT of 43 ng/mL.Patients preferred CCE 63.3%(76/120),with less impact on daily activities(21.7%vs 93.2%)and time off work(average days 0.9 vs 1.2,P=0.0201).CONCLUSION CCE appears effective in low-risk polyp surveillance.FIT does not appear to be of benefit in surveillance.展开更多
Colon capsule endoscopy(CCE; Pill Cam Colon; Given Imaging; Yoqneam, Israel) is a minimally invasive wireless technique for the visualization of the colon. With the recent introduction of the second generation colon c...Colon capsule endoscopy(CCE; Pill Cam Colon; Given Imaging; Yoqneam, Israel) is a minimally invasive wireless technique for the visualization of the colon. With the recent introduction of the second generation colon capsule the diagnostic accuracy of CCE for polyp detection has significantly improved and preliminary data suggest it may be useful to monitor mucosal inflammation in patients with inflammatory bowel disease. Limitations include the inability to take biopsies and the procedural costs. However, given the potentially higher acceptance within an average risk colorectal cancer(CRC) screening population, its usefulness as a screening tool with regard to CRC prevention should be further evaluated.展开更多
BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion...BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.展开更多
BACKGROUND Gastrointestinal endoscopy has been widely used in the diagnosis and treatment of gastrointestinal diseases.A great many of studies on gastrointestinal endoscopy have been done.AIM To analyze the characteri...BACKGROUND Gastrointestinal endoscopy has been widely used in the diagnosis and treatment of gastrointestinal diseases.A great many of studies on gastrointestinal endoscopy have been done.AIM To analyze the characteristics of top 100 cited articles on gastrointestinal endoscopy.METHODS A bibliometric analysis was conducted.The publications and their features were extracted from the Web of Science Core Collection,Science Citation Index-Expanded database.Excel,Web of Science database and SPSS software were used to perform the statistical description and analysis.VOSviewer software and Map-Chart were responsible for the visualizations.RESULTS The top 100 cited articles were published between 1976 and 2022.The guidelines(52%)and clinical trials(37%)are the main article types,and average publication year of the guidelines is much later than that of the clinical trials(2015 vs 1998).Among the clinical trials,diagnostic study(27.0%),cohort study(21.6%),case series(13.5%)and cross-sectional study(10.8%)account for a large proportion.Average citations of different study types and designs of the enrolled studies are of no significant differences.Most of the 100 articles were published by European authors and recorded by the endoscopic journals(65%).Top journals in medicine,such as the Lancet,New England Journal of Medicine and JAMA,also reported studies in this field.The hot spots of involved diseases include neoplasm or cancer-related diseases,inflammatory diseases,obstructive diseases,gastrointestinal hemorrhage and ulcer.Endoscopic surgery,endoscopic therapy and stent placement are frequently studied.CONCLUSION Our research contributes to delineating the field and identifying the characteristics of the most highly cited articles.It is noteworthy that there is a significantly smaller number of clinical trials included compared to guidelines,indicating potential areas for future high-quality clinical trials.展开更多
As the number of diagnostic and therapeutic gastrointestinal endoscopies is increasing, and there is an increase in number of patients taking blood thinners, we are seeing more and more patients on blood thinners prio...As the number of diagnostic and therapeutic gastrointestinal endoscopies is increasing, and there is an increase in number of patients taking blood thinners, we are seeing more and more patients on blood thinners prior to endoscopic procedures. Gastrointestinal bleeding or thromboembolism can occur in this category of patients in the periendoscopic period. To better manage these patients, endoscopists should have a clear concept about the various blood thinners in the market. Patients’ risk of thromboembolism off anticoagulation, and the risk of bleeding from endoscopic procedures should be assessed prior to endoscopy. The endoscopic procedure should be done when it is safe to do it.展开更多
Sedation is the standard of care in gastrointestinal(GI)endoscopy in most institutions.Various protocols are employed to ensure a comfor patient experience and a high procedural success rate.Benzodiazepines combined w...Sedation is the standard of care in gastrointestinal(GI)endoscopy in most institutions.Various protocols are employed to ensure a comfor patient experience and a high procedural success rate.Benzodiazepines combined with opioids are the most commonly used methods.However,these drugs have been associated with numerous adverse effects,including respiratory depression,hypoxia,and hypotension.Cohen et al conducted a study in this issue demonstrating the ability to minimize or eliminate opioid use without compromising procedural success rate or patient comfort.In this editorial,we explore the diverse sedation methods employed in GI procedures,assess the efficacy and safety of the drugs used,and highlight best practices.展开更多
文摘Objectives:One of the most notable challenges in endoscopic procedures is maintaining correct orientation.Mental rotation exercise(MRE)has been suggested as a potential aid for improving orientation.However,there is a lack of research on designing MREs with varying difficultylevels for training purposes.Furthermore,few studies provide solid evidence linking MRE difficultylevels with cognitive load measurements.This study aims to address this gap by investigating the correlation between the MRE difficultylevels and participants’cognitive load,as measured by pupil dilation.Method:We recruited 33 participants to perform MREs on a computer equipped with a screen-mounted eye-tracker.The test consisted of 15 MREs,with the first10 relatively easy(traditional cube)and the next 5 more complex(invented molecule).The participants’eye movements during MREs were recorded.The participants’MRE scores and pupil dilation were obtained and compared between two MRE difficultylevels.Results:The participants who performed traditional cube MREs achieved significantlybetter MRE scores(0.77±0.11 vs.0.58±0.03,p<0.001)and lower pupil dilation(0.27±0.04 pixels vs.0.47±0.09 pixels,p<0.001)than did those who performed the invented molecule MREs.Moreover,there were significant negative correlations(r=0.62,p=0.015)between pupil dilation and MRE scores.Conclusions:The results revealed a significantnegative correlation between MRE scores and pupil dilation.The more challenging MRE questions led to worse MRE scores but increased pupil dilation.The MRE difficultylevels can be evaluated not only by the degrees or dimensions with which the objects were rotated but also by the participants’MRE scores and pupil dilation.The results of this study provide a basis for training orientation skills in endoscopy using MREs.By incorporating MREs with varying difficultylevels,customized training programs can be developed to enhance camera navigation in endoscopic and laparoscopic procedures.
基金Supported by Japan Society for the Promotion of Science,No.24K11935.
文摘This review comprehensively summarized the potential of artificial intelligence(AI)in the management of esophageal cancer.It highlighted the significance of AI-assisted endoscopy in Japan where endoscopy is central to both screening and diagnosis.For the clinical adaptation of AI,several challenges remain for its effective translation.The establishment of high-quality clinical databases,such as the National Clinical Database and Japan Endoscopy Database in Japan,which covers almost all cases of esophageal cancer,is essential for validating multimodal AI models.This requires rigorous external validation using diverse datasets,including those from different endoscope manufacturers and image qualities.Furthermore,endoscopists’skills significantly affect diagnostic accuracy,suggesting that AI should serve as a supportive tool rather than a replacement.Addressing these challenges,along with country-specific legal and ethical considerations,will facilitate the successful integration of multimodal AI into the management of esophageal cancer,particularly in endoscopic diagnosis,and contribute to improved patient outcomes.Although this review focused on Japan as a case study,the challenges and solutions described are broadly applicable to other high-incidence regions.
文摘BACKGROUND Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases.However,a series of ethical issues have emerged,such as expanding treatment indications,which affect the fair distribution of medical resources.There is limited research on ethical issues in the field of digestive endoscopy.AIM To investigate the level of ethical awareness among gastrointestinal endoscopy practitioners and analyze the ethical issues involved in gastrointestinal endoscopy technology.METHODS A questionnaire survey was performed to collect relevant data(gender,age,degree of education,professional title,personnel category,the level of understanding medical ethical principles,ethics training and its learning pathways)from gastrointestinal endoscopy practitioners at the Second Hospital of Dalian Medical University and Dalian Friendship Hospital,including licensed physicians and nurses(including trainees and graduate students).RESULTS The majority of gastrointestinal endoscopy practitioners have received training on ethics,but there is still considerable room for improvement in their ethical awareness.Different learning pathways may affect the mastery of ethical principles, and understanding of ethical principles is more easily achieved through hospital ethics institutions.CONCLUSIONTo address the ethical issues in gastrointestinal endoscopy technology, it is necessary to enhance the humanisticeducation of gastrointestinal endoscopy practitioners, incorporate ethical standards into the technology assessmentprocess, and establish a patient-centered diagnostic and treatment model to improve the ethical awareness of practitionersand achieve a balance between technology and ethics.
文摘BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.
文摘Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.
文摘In this letter,we comment on a recent article published in the World Journal of Gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions during capsule endoscopy(CE).CE was first presented in 2000 and was approved by the Food and Drug Administration in 2001.The indications of CE overlap with those of regular diagnostic endoscopy.However,in clinical practice,CE is usually used to detect lesions in areas inaccessible to standard endoscopies or in cases of bleeding that might be missed during conventional endoscopy.Since the emergence of CE,many physiological and technical challenges have been faced and addressed.In this letter,we summarize the current challenges and briefly mention the proposed methods to overcome these challenges to answer a central question:Do we still need CE?
文摘Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation strategies,risk assessment,and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient’s comorbidities and procedural requirements.Within this landscape,the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion,demonstrating significantly reduced hypotension,faster induction,and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates.These findings align with broader recommendations from both European and American societies advo-cating sedation regimens that preserve stable circulation.Etomidate’s favorable hemodynamic profile,coupled with propofol’s reliability,suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography,interventional endoscopic ultrasound,and endoscopic submucosal dissection,where deeper or more sustained sedation is often required.Remimazolam,a novel short-acting benzodiazepine,has similarly been associated with reduced cardiovascular depression and faster recovery,partic-ularly in high-risk populations,although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited.Further investig-ations into these sedation strategies in higher-risk cohorts,as well as complex the-rapeutic endoscopy,will likely inform more nuanced,patient-specific protocols aimed at maximizing both safety and procedural efficiency.
文摘Capsule endoscopy is nowadays the diagnostic technique of choice in the study of small bowel pathologies,allowing the non-invasive study of the entire mucosa.This has led,together with new technical advances,to the creation of two new models(PillCam ESO and PillCam Colon)for the study of esophageal and colonic diseases.These two new capsules offer an interesting alternative to conventional endoscopy in the study of the upper and lower digestive tracts,because traditional endoscopy is often unpleasant and uncomfortable for the patient,can be painful,often requires moderate or deep sedation and is not without complications(hemorrhage,perforation,etc.).PillCam Colon is particularly important for its usefulness in the diagnosis of colonic polyps,and is a potentially useful tool in cases of incomplete colonoscopy or in colorectal cancer screening,even more when most patients are reluctant to undergo screening programs due to the said disadvantages of conventional colonoscopy.This article discusses the advantages of capsule endoscopy over conventional endoscopy,its current application possibilities and indications in routine clinical practice.In the various sections of the work,we assess the application of endoscopic capsule in different sections of the digestive tract(esophagus,stomach,and colon)and finally the potential role of panendoscopy with PillCam Colon.
文摘The field of gastroenterology has experienced revolutionary advances over the past years,as flexible endoscopes have become widely accessible.In addition to enabling faster,less invasive,and more affordable treatment,flexible endoscopes have greatly improved the detection and endoscopic screening of malignancies and prevented many cancer-related deaths.The development and clinical application of new diagnostic endoscopic technologies,such as magnification endoscopy,narrow-band imaging,endoscopic ultrasound with biopsy,and more recently,artificial intelligence enhanced technologies,have made the recognition and detection of various neoplasms and sub-epithelial tumors more possible.This review demonstrates the latest advancements in endoscopic procedures,techniques,and devices applied in the diagnosis and management of gastrointestinal cancer.
文摘Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeutic advantages across a broad spectrum of diseases.This review examines its role in diagnosing and managing common pediatric GI conditions,emphasizing notable advancements in techniques,clinical use,and future directions.We conducted a detailed literature survey using PubMed,Scopus,and Google Scholar,and English-language articles were reviewed.This review process included the latest articles,guidelines,and conference papers on pediatric and adult upper GI endoscopy.An upper GI endoscopy is imperative in diagnosing many pediatric GI diseases as it enables visualization of the gut mucosa,obtaining mucosal biopsies from suspicious areas or lesions for histological assessment,and selecting an effective management and follow-up plan.New advancements,including high-resolution endoscopy,narrow-band imaging,and confocal laser endomicroscopy,have revolutionized pediatric endoscopy by improving precision and reducing the need for invasive interventions.Furthermore,recent therapeutic developments in the field,such as endoscopic submucosal dissection and endoscopic mucosal resection,are now being utilized to treat preneoplastic lesions or refractory esophageal strictures.However,despite its usefulness,performing this procedure in children is challenging for various reasons,including the need for sedation,anesthesia,and smaller instrument sizes,the unavailability of trained staff,lack of training facilities,and the absence of dedicated endoscopy suites for children.In conclusion,pediatric upper GI endoscopy plays a pivotal role in pediatric gastroenterology,offering both therapeutic and diagnostic benefits.Progress in the field leads to the development of novel techniques that improve overall patient care,such as artificial intelligence in pattern recognition,which enhances lesion detection,predicts premalignant or pre-inflammatory areas,and minimizes investigator-related errors.Additionally,refining protocols and guidelines is essential to improve the safety,efficacy,and precision of upper GI endoscopy,ensuring the best possible care for children.
文摘We read the recent minireview by Ding et al.This review provided a structured introduction to the applications of artificial intelligence(AI)in gastrointestinal endoscopy while emphasizing the technical solutions for imaging hurdles.However,we identified some areas that were lacking analytical depth.Specifically,the review oversimplified machine learning and deep learning models(e.g.,generative adversarial networks misclassification)and failed to deeply analyze the explanations for missed tumor rates and the critical role of data quality/bias.In this article,we stress that the potential of AI extends beyond diagnostics and highlight its emerging and crucial role in endoscopist training,skill development,and proficiency enhancement.We conclude that future AI adoption depends on robust multicenter trials and the implementation of AI-assisted educational platforms.
文摘In the last 50 years,gastrointestinal endoscopy has evolved rapidly with increasing indications of use for both diagnostic and therapeutic modalities.However,it has also contributed to a significant carbon footprint and healthcarerelated climate change.Endoscopy is a high-volume specialty in the United States,with an estimated>22 million endoscopies performed annually.Therefore,it has also,unfortunately,become the third-highest generator of healthcare-related waste,with an estimated annual emission of 85768 metric tons of carbon dioxide.It is estimated that a single endoscopy session may generate more than 2 kg of waste.At the level of physicians,administrators,industry,and humanity,reducing healthcare-related waste has become one of the significant challenges currently faced.The ultimate professional goal should be to raise awareness,educate,start initiatives to reduce medical waste and perform research to make endoscopy more sustainable.These applications will lead to the establishment and promotion of environmentally friendly practices with standardized metrics to reduce the carbon footprint of gastrointestinal endoscopy.
基金Supported by Joint Traditional Chinese Medicine Science and Technology Projects of National Demonstration Zones for Comprehensive Traditional Chinese Medicine,No.GZY-KJS-SD-2023-031.
文摘Lumbar interbody fusion is essential for treating degenerative lumbar diseases.The disadvantages of open surgery have led to the evolution of minimally invasive spine surgery,including endoscopic techniques such as unilateral biportal endoscopy(UBE).Leveraging arthroscopic principles,UBE offers superior visualization and flexibility and expands from decompression to fusion(UBE fusion).However,achieving robust UBE fusion presents challenges,such as suboptimal arthrodesis rates and implant-related complications,requiring more than surgical skill alone.Optimizing UBE fusion critically depends on the effective integration of advanced biomaterials with the surgical technique.This minireview assessed recent advances in UBE,focusing on the development of novel biomaterials,such as functionalized porous,expandable,or double-cage designs,to improve bone regeneration outcomes.These advancements address challenges,like washout of bone graft material and biologics,and utilize growth factors,such as recombinant human bone morphogenetic proteins,while exploring pathway modulation to improve outcomes.We also evaluated clinical optimization strategies involving technical refinements,fluid and hemostasis control,key complication mitigation especially concerning dural tears and hematomas,and technologies such as navigation and robotics.While UBE shows promise particularly for early recovery,its long-term success hinges on these biotechnological advancements.High-quality evidence,especially from randomized controlled trials and longterm studies,is needed to validate integrated strategies and define the optimal role of UBE fusion.
文摘The challenge of effectively eliminating air during gastrointestinal endoscopy using ultrasound techniques is apparent.This difficulty arises from the intricacies of removing concealed air within the folds of the gastrointestinal tract,resulting in artifacts and compromised visualization.In addition,the overlap of folds with lesions can obscure their depth and size,presenting challenges for an accurate assessment.Conversely,in intricately folded regions of the gastrointestinal tract,such as the stomach,intestine,and colon,insufficient delivery of air or CO_(2) into the cavity impedes luminal expansion,hindering the accurate visualization of lesions concealed within the folds.Although this underscores the requirement for substantial airflow,excessive airflow can hinder visualization of bleeding lesions and other abnormalities.Considering these challenges,an ideal endoscopic device would facilitate the observation of lesions without the requirement for air or CO_(2) delivery whereas,ensuring optimal expansion of the gastrointestinal tract.Recently,transparent gels with specific viscosities have been employed more frequently to address this issue.This review aims to elucidate how these gels address these challenges and provide a solution for enhanced endoscopic visualization.
文摘BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters in surveillance.METHODS Patients aged≥18 due for polyp surveillance were invited for CCE and FIT.Identifying polyps or colorectal cancer resulted in a positive CCE.Significant lesions(≥3 polyps or≥6 mm polyps),incomplete studies and positive FITs(≥225 ng/mL)were referred for endoscopy.CCE and endoscopy results,FIT accuracy and patient preference were assessed.RESULTS From a total of 126 CCEs[mean age 64(31-80),67(53.2%)males),70.6%(89/126)were excreted,86.5%(109/126)had adequate image quality.CCE positivity was 70.6%(89/126),42.9%(54/126)having significant polyps with 63.5%(80/126)referred for endoscopy(19 sigmoidoscopies,61 colonoscopies).CCE reduced endoscopy need by 36.5%(46/126)and 51.6%(65/126)were spared a colonoscopy.CCE positive predictive value was 88.2%(45/51).Significant extracolonic findings were reported in 3.2%(4/126).Patients with positive CCEs were older>65[odds ratio(OR)=2.5,95%confidence interval(CI):1.1517-5.5787,P=0.0159],with personal history of polyps(OR=2.3,95%CI:0.9734-5.4066,P=0.045),with high/intermediate polyp surveillance risk(OR=5.4,95%CI:1.1979-24.3824,P=0.0156).Overall,5/114(4.4%)FITs were positive(range:0-1394 ng/mL,mean:54 ng/mL).Sensitivity(9.6%)and negative predictive values(20.3%)were inadequate.Receiver operating curve analysis gave a sensitivity and specificity of 26.9%and 91.7%,for FIT of 43 ng/mL.Patients preferred CCE 63.3%(76/120),with less impact on daily activities(21.7%vs 93.2%)and time off work(average days 0.9 vs 1.2,P=0.0201).CONCLUSION CCE appears effective in low-risk polyp surveillance.FIT does not appear to be of benefit in surveillance.
文摘Colon capsule endoscopy(CCE; Pill Cam Colon; Given Imaging; Yoqneam, Israel) is a minimally invasive wireless technique for the visualization of the colon. With the recent introduction of the second generation colon capsule the diagnostic accuracy of CCE for polyp detection has significantly improved and preliminary data suggest it may be useful to monitor mucosal inflammation in patients with inflammatory bowel disease. Limitations include the inability to take biopsies and the procedural costs. However, given the potentially higher acceptance within an average risk colorectal cancer(CRC) screening population, its usefulness as a screening tool with regard to CRC prevention should be further evaluated.
文摘BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.
文摘BACKGROUND Gastrointestinal endoscopy has been widely used in the diagnosis and treatment of gastrointestinal diseases.A great many of studies on gastrointestinal endoscopy have been done.AIM To analyze the characteristics of top 100 cited articles on gastrointestinal endoscopy.METHODS A bibliometric analysis was conducted.The publications and their features were extracted from the Web of Science Core Collection,Science Citation Index-Expanded database.Excel,Web of Science database and SPSS software were used to perform the statistical description and analysis.VOSviewer software and Map-Chart were responsible for the visualizations.RESULTS The top 100 cited articles were published between 1976 and 2022.The guidelines(52%)and clinical trials(37%)are the main article types,and average publication year of the guidelines is much later than that of the clinical trials(2015 vs 1998).Among the clinical trials,diagnostic study(27.0%),cohort study(21.6%),case series(13.5%)and cross-sectional study(10.8%)account for a large proportion.Average citations of different study types and designs of the enrolled studies are of no significant differences.Most of the 100 articles were published by European authors and recorded by the endoscopic journals(65%).Top journals in medicine,such as the Lancet,New England Journal of Medicine and JAMA,also reported studies in this field.The hot spots of involved diseases include neoplasm or cancer-related diseases,inflammatory diseases,obstructive diseases,gastrointestinal hemorrhage and ulcer.Endoscopic surgery,endoscopic therapy and stent placement are frequently studied.CONCLUSION Our research contributes to delineating the field and identifying the characteristics of the most highly cited articles.It is noteworthy that there is a significantly smaller number of clinical trials included compared to guidelines,indicating potential areas for future high-quality clinical trials.
文摘As the number of diagnostic and therapeutic gastrointestinal endoscopies is increasing, and there is an increase in number of patients taking blood thinners, we are seeing more and more patients on blood thinners prior to endoscopic procedures. Gastrointestinal bleeding or thromboembolism can occur in this category of patients in the periendoscopic period. To better manage these patients, endoscopists should have a clear concept about the various blood thinners in the market. Patients’ risk of thromboembolism off anticoagulation, and the risk of bleeding from endoscopic procedures should be assessed prior to endoscopy. The endoscopic procedure should be done when it is safe to do it.
文摘Sedation is the standard of care in gastrointestinal(GI)endoscopy in most institutions.Various protocols are employed to ensure a comfor patient experience and a high procedural success rate.Benzodiazepines combined with opioids are the most commonly used methods.However,these drugs have been associated with numerous adverse effects,including respiratory depression,hypoxia,and hypotension.Cohen et al conducted a study in this issue demonstrating the ability to minimize or eliminate opioid use without compromising procedural success rate or patient comfort.In this editorial,we explore the diverse sedation methods employed in GI procedures,assess the efficacy and safety of the drugs used,and highlight best practices.
