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
Digestive endoscopy is widely performed in clinical practice,including in children,and has revolutionized the diagnosis and treatment of many gastro-intestinal(GI)disorders.Interventional procedures are increasingly u...Digestive endoscopy is widely performed in clinical practice,including in children,and has revolutionized the diagnosis and treatment of many gastro-intestinal(GI)disorders.Interventional procedures are increasingly utilized,particularly for hepatobiliary and pancreatic diseases.However,only a limited number of gastroenterologists are trained and experienced to perform endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in pediatric patients.While GI endoscopic emergencies in children are uncommon,they can be serious.Effective care demands true multidisciplinary teamwork,with close and ongoing collaboration between gastroenterologists,anesthetists,and the pe-diatric team especially in centres where pediatric endoscopy specialists are not available.This mini-review outlines current practices in pediatric digestive endoscopy and explores recent advances in interventional endoscopy compared to adult patients.展开更多
BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence ...BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence exists regarding efficacy,risk,benefit,and cost-effectiveness.AIM To identify the role and effectiveness of SLE in ESD and PUD,associated rebleeding and PUD-related outcomes like mortality,hospital length of stay,need for endoscopic or surgical intervention and blood transfusions.METHODS A systematic review of literature databases PubMed,Cochrane,and Embase was conducted from inception to January 5,2023.Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included.The study was conducted per PRISMA guidelines,and the protocol was registered in PROSPERO(ID CRD42023427555:).RevMan was used to perform meta-analysis,and Mantel-Haenszel Odds ratio(OR)were generated using random effect models.RESULTS A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis,of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding.In ESD,the rates of rebleeding were 7%in the SLE group compared to 4.4%in the non-SLE group with OR 1.65,95%confidence intervals(CI)of 0.96 to 2.85;P=0.07,whereas it was 11%in the SLE group compared to 13%in the non-SLE group with OR 0.895%CI:0.50 to 1.29;P=0.36.The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01,95%CI:-0.22 to 0.25;P=0.91.In SLE vs non-SLE groups with PUD,the OR for Endoscopic intervention was 0.29,95%CI:0.08 to 1.00;P=0.05 while it was OR 2.03,95%CI:0.95 to 4.33;P=0.07,for surgical intervention.The mean difference in the hospital length of stay was-3.57 d between the SLE and no SLE groups in PUD with 95%CI:-7.84 to 0.69;P=0.10,denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE.For mortality between SLE and non-SLE groups in PUD,the OR was 0.88,95%CI:0.45 to 1.72;P=0.70.CONCLUSION SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding.SLE also does not provide any significant improvement in mortality,need for interventions,or blood transfusions in PUD patients.SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.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
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
AIM:To evaluate the feasibility of diagnostic and therapeutic transgastric(TG)peritoneoscopic interventions with a forward-viewing endoscopic ultrasound(FV-EUS).METHODS:This prospective endoscopic experimental study u...AIM:To evaluate the feasibility of diagnostic and therapeutic transgastric(TG)peritoneoscopic interventions with a forward-viewing endoscopic ultrasound(FV-EUS).METHODS:This prospective endoscopic experimental study used an animal model.Combined TG peritoneoscopic interventions and EUS examination of the intraabdominal organs were performed using an FV-EUS on 10 animal models(1 porcine and 9 canine).The procedures carried out include EUS evaluation and endoscopic biopsy of intraperitoneal organs,EUS-guided fine needle aspiration(EUS-FNA),EUS-guided radiofrequency ablation(EUS-RFA),and argon plasma coagulation(APC)for hemostatic control.The animals were kept alive for 7 d,and then necropsy was performed to evaluate results and complications.RESULTS:In all 10 animals,TG peritoneoscopy,followed by endoscopic biopsy for the liver,spleen,abdominal wall,and omentum,was performed successfully.APC helped control minor bleeding.Visualization of intra-abdominal solid organs with real-time EUS was accomplished with ease.Intraperitoneal EUS-FNA was successfully performed on the liver,spleen,and kidney.Similarly,a successful outcome was achieved with EUSRFA of the hepatic parenchyma.No adverse events were recorded during the study.CONCLUSION:Peritoneoscopic natural orifice transluminal endoscopic surgery(NOTES)interventions through FV-EUS were feasible in providing evaluation and performing endoscopic procedures.It promises potential as a platform for future EUS-based NOTES.展开更多
BACKGROUND Foreign body(FB)ingestion is one of the most challenging clinical situations faced by endoscopists.Most esophageal FB impaction emergencies occur in children.It is important to study the epidemiological pro...BACKGROUND Foreign body(FB)ingestion is one of the most challenging clinical situations faced by endoscopists.Most esophageal FB impaction emergencies occur in children.It is important to study the epidemiological profile and endoscopic methods for treating FB impacted in the esophagus of children,as it can help in the development of more effective,safe and personalized preventive and therapeutic strategies.AIM To define the profile of children seeking emergency care due to FB impaction in the esophagus,analyze factors associated with complications,and evaluate the effectiveness of rigid(RE)and flexible endoscopes(FE).METHODS A retrospective cohort study of 166 children with impacted FB in the esophagus who underwent an endoscopy(FE=84 vs RE=82)at the Dr.JoséFrota Institute was performed.The primary outcomes were to assess the efficacy of the endoscopic technique and factors associated with complications.The secondary outcomes were age group,gender,symptoms,length of hospital stay,and location of the FB.RESULTS Boys(66.9%),preschoolers(43.4%),FB>24 hours(62.7%),cervical esophagus(60.8%),coin ingestion(57.2%)and complaints of dysphagia(24.9%)and sialorrhea(23.1%)were the predominant findings.Endoscopy was successful(90.4%)with sedation(89.1%).A total of 97%of patients were discharged from the hospital,while 3%died.The average hospital stay length was 2.6 days.Most patients did not experience complications predominated(64.5%).Esophageal perforations were more frequent after RE(11%vs 4.8%),while FE was more effective(95.2%vs 85.4%).Theχ2 test or Fisher's exact test was used to compare categorical variables.For continuous variables,the Kruskal-Wallis test or analysis of variance was used.Statistical analyses were performed in R®software(version 1.3.1093).CONCLUSION Coins were the most frequent FBs and were mainly lodged in the upper esophagus of preschool boys.Risk factors for complications due to esophageal FB include battery ingestion,delayed removal(>48 hours)and lodging in the thoracic esophagus.FE was generally more effective than RE for removing FBs;both procedures are safe.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
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
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
BACKGROUND This is a retrospective study on endoscopic treatment of cervical spinal radiculopathy(CSR)conducted at a single academic institution.Conventional full-spine endoscopy is performed in a single portal which ...BACKGROUND This is a retrospective study on endoscopic treatment of cervical spinal radiculopathy(CSR)conducted at a single academic institution.Conventional full-spine endoscopy is performed in a single portal which has certain limitations of high technical requirements,steep learning curve,and narrow indications.Although unilateral biportal endoscopy(UBE)technique has a gentle learning curve and is gradually applied to treat CSR,all procedures were performed in the uniportal working channel that potentially increase the surgical risk and time in the treatment of complex cases.It is worthy to delve novel technique for more working channels in the treatment of complex CSR.AIM To propose a hybrid technique(HT)that utilizes spine endoscopy in UBE to treatment of CSR.METHODS A total of 81 patients with single-segment CSR who underwent uniportal endoscopic surgery(UES),UBE,or HT at a single institution between September 2019 and August 2021 were retrospectively studied.Perioperative patient data were compared between the groups.The pre-operative and post-operative images were compared to confirm adequate decompression of the nerve root canal.Patients'visual analogue scale(VAS)scores and neck disability index(NDI)were recorded before surgery,and three days,three months and six months after surgery.RESULTS The UBE and HT groups had a significantly shorter operation duration than the UES group.Data for bleeding and length of hospital stay were significantly higher in the UBE group than in the UES and HT groups.The hospitalization cost was lowest in the UES group and highest in the HT group.Soft tissue edema reaction bands on postoperative day 3 were larger in the UBE and HT groups than in the UES group.Post-operative VAS and NDI scores were significantly lower in all three groups than the pre-operative levels.On post-operative day 3,the VAS score for neck pain was significantly higher in the UBE and HT groups than that in the UES group.However,there were no significant differences in the VAS scores for arm pain or NDI between the three groups.The post-operative 3-month and 6-month neck pain VAS,arm pain VAS,NDI,and modified Macnab success rates did not differ statistically between the three groups.CONCLUSION The HT for CSR treatment has the advantage of double working channels to facilitate decompression and hemostasis,improving the surgical efficiency and clinical outcomes of CSR.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
Minimally invasive endoscopic resection techniques are the recommended firstline treatment strategy for the majority of large non-pedunculated colorectal polyps,with endoscopic mucosal resection(EMR)as a predominant r...Minimally invasive endoscopic resection techniques are the recommended firstline treatment strategy for the majority of large non-pedunculated colorectal polyps,with endoscopic mucosal resection(EMR)as a predominant resection modality due to its efficacy,efficiency,safety,and cost-effectiveness.A limitation of EMR is recurrence,which has historically occurred in 15%-20%of lesions.In the past 10 years,a number of effective mitigating strategies have been developed,including margin thermal ablation using snare-tip soft coagulation,argon plasma coagulation(APC),and hybrid-APC,alongside margin marking pre-resection.Moreover,techniques for effective recurrence management have also been developed.Herein,we appraise existing evidence on the frequency of recurrence,reasonings behind recurrence formation,as well as recurrence mitigating strategies and the effectiveness of recurrence management.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
BACKGROUND There is a scarcity of evidence and systematic reviews on endoscopic gastroplasty(EG)compared to other management options for the treatment of obesity.AIM To assess the published meta-analyses through a sys...BACKGROUND There is a scarcity of evidence and systematic reviews on endoscopic gastroplasty(EG)compared to other management options for the treatment of obesity.AIM To assess the published meta-analyses through a systematic review approach and provide further insight into the current status of available evidence through a critical appraisal.METHODS PubMed/MEDLINE,Scopus,Embase and Cochrane Library were searched from inception to November 2022.The meta-analyses that compared the efficacy and safety of EG to other interventions were considered for this overview.The outcomes of interest were total body weight loss(TBWL),excessive weight loss,and average weight loss along with occurrence of adverse effects.Methodological quality,heterogeneity,and limitations were also reviewed.RESULTS A total of six meta-analyses out of 364 records were considered for this review with a major contribution from the United States.Overall methodological quality of included studies were moderate to good.EG treatments were significantly better in terms of TBWL,excessive weight loss,and average weight loss.However,there was no significant difference between endoscopic transoral outlet reduction and full-thickness suturing plus argon plasma mucosal coagulation.Lack of comparative studies and randomized trials,lack of long-term follow-up,reporting bias,selection bias,lack of control groups,and considerable level of heterogeneity were the major limitations in the available evidence.CONCLUSION Though EG was significantly effective for treatment of obesity,there is limited comparative evidence on this topic.High-quality well-controlled evidence is required to strengthen the current evidence base on EG treatment for obesity.展开更多
Gastrointestinal endoscopy is a common examination for digestive system.The stimulation of endoscope often causes cough,nausea and vomiting,increased heart rate and blood pressure,arrhythmia,and even cardiovascular an...Gastrointestinal endoscopy is a common examination for digestive system.The stimulation of endoscope often causes cough,nausea and vomiting,increased heart rate and blood pressure,arrhythmia,and even cardiovascular and cerebrovascular accidents,thus makes people fear of this procedure.Sedation or anesthesia can effectively improve the safety,comfort and quality of gastrointestinal endoscopy.A small dose of opioids is a good adjuvant to sedatives.In this narrative review,we summarized the main roles of opioid analgesics in gastrointestinal endoscopy,including reducing visceral pain,throat irritation and the dose of sedatives.Moreover,the frequently used and novel opioids are reviewed.Classic fentanyl,sufentanil and dezocine are preferable by anesthesiologists.Newly approved oliceridine is promising to render ideal analgesic effects for gastrointestinal endoscopy.Clinical studies on oliceridine in endoscopic procedures are urgently needed.展开更多
BACKGROUND Although the majority of gastrointestinal(GI)endoscopies in the United States are now performed with propofol sedation,a substantial minority are performed with midazolam and fentanyl sedation.Despite the u...BACKGROUND Although the majority of gastrointestinal(GI)endoscopies in the United States are now performed with propofol sedation,a substantial minority are performed with midazolam and fentanyl sedation.Despite the ubiquity of conscious sedation with midazolam and fentanyl in the United States,there is scant evidence specifically supporting the superiority of midazolam plus fentanyl over single agent midazolam sedation in GI endoscopy.We hypothesize that single agent sedation with midazolam is noninferior to sedation with midazolam plus fentanyl in GI endoscopy.AIM To investigate whether sedation with midazolam alone is noninferior to sedation with midazolam plus fentanyl in GI endoscopy.METHODS We conducted a randomized,single-blind study to compare the safety and effectiveness of single agent midazolam vs.standard fentanyl/midazolam moderate sedation in 300 outpatients presenting for upper endoscopy and/or colonoscopy at a tertiary care hospital.Primary outcomes were patient satisfaction as measured by the previously validated Procedural Sedation Assessment Survey.Secondary outcomes were procedure quality measures and adverse events.Statistical analysis was performed by a biomedical statistician using theχ^(2) test,Fisher’s exact test,and Welch’s 2-sample t-test.RESULTS There was no difference in patient satisfaction between sedation groups,as measured by a less than 1 point difference between groups in Procedural Sedation Assessment Survey scores for discomfort during the procedure,and for preference for level of sedation with future procedures.There were no differences in adverse events or procedure quality measures.Cecal intubation time was 1 minute longer in the single agent midazolam group,and an average of 2.7 mg more midazolam was administered when fentanyl was not included in the sedation regimen.The recruitment goal of 772 patients was not reached.CONCLUSION It may be possible to minimize or avoid using fentanyl in endoscopist administered moderate sedation for GI endoscopy.We hope these findings spur further work in this under-researched area.展开更多
Endoscopic bariatrics has emerged as a minimally invasive alternative to traditional bariatric procedures.Over the last decade,significant progress in endoscopic techniques and technologies has improved the safety,eff...Endoscopic bariatrics has emerged as a minimally invasive alternative to traditional bariatric procedures.Over the last decade,significant progress in endoscopic techniques and technologies has improved the safety,efficacy,and accessibility of these procedures.Current methods,such as intragastric balloons,endoscopic sleeve gastroplasty,and endoscopic-assisted gastrojejunostomy,have promoted weight loss,improving the metabolic health of obese individuals,with emerging evidence suggesting that their combination with pharmacological agents could further maximize their benefit.Emerging technologies,such as robotic-assisted endoscopic devices,advanced imaging systems,and biodegradable implants,could enhance procedural precision,minimize complications,and provide more personalized treatment options.In contrast,novel approaches such as microbiome modulation and tissue regeneration could have an adjunct role in improving patient outcomes.This review provides a brief overview of the current status of endoscopic bariatrics,highlighting the most common procedures and emerging technologies.It also discusses the challenges and future directions for the field,emphasizing the importance of multidisciplinary collaboration,patient selection,and research priorities to establish the long-term benefit and effectiveness of the available endoscopic bariatric interventions.展开更多
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Digestive endoscopy is widely performed in clinical practice,including in children,and has revolutionized the diagnosis and treatment of many gastro-intestinal(GI)disorders.Interventional procedures are increasingly utilized,particularly for hepatobiliary and pancreatic diseases.However,only a limited number of gastroenterologists are trained and experienced to perform endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in pediatric patients.While GI endoscopic emergencies in children are uncommon,they can be serious.Effective care demands true multidisciplinary teamwork,with close and ongoing collaboration between gastroenterologists,anesthetists,and the pe-diatric team especially in centres where pediatric endoscopy specialists are not available.This mini-review outlines current practices in pediatric digestive endoscopy and explores recent advances in interventional endoscopy compared to adult patients.
文摘BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence exists regarding efficacy,risk,benefit,and cost-effectiveness.AIM To identify the role and effectiveness of SLE in ESD and PUD,associated rebleeding and PUD-related outcomes like mortality,hospital length of stay,need for endoscopic or surgical intervention and blood transfusions.METHODS A systematic review of literature databases PubMed,Cochrane,and Embase was conducted from inception to January 5,2023.Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included.The study was conducted per PRISMA guidelines,and the protocol was registered in PROSPERO(ID CRD42023427555:).RevMan was used to perform meta-analysis,and Mantel-Haenszel Odds ratio(OR)were generated using random effect models.RESULTS A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis,of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding.In ESD,the rates of rebleeding were 7%in the SLE group compared to 4.4%in the non-SLE group with OR 1.65,95%confidence intervals(CI)of 0.96 to 2.85;P=0.07,whereas it was 11%in the SLE group compared to 13%in the non-SLE group with OR 0.895%CI:0.50 to 1.29;P=0.36.The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01,95%CI:-0.22 to 0.25;P=0.91.In SLE vs non-SLE groups with PUD,the OR for Endoscopic intervention was 0.29,95%CI:0.08 to 1.00;P=0.05 while it was OR 2.03,95%CI:0.95 to 4.33;P=0.07,for surgical intervention.The mean difference in the hospital length of stay was-3.57 d between the SLE and no SLE groups in PUD with 95%CI:-7.84 to 0.69;P=0.10,denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE.For mortality between SLE and non-SLE groups in PUD,the OR was 0.88,95%CI:0.45 to 1.72;P=0.70.CONCLUSION SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding.SLE also does not provide any significant improvement in mortality,need for interventions,or blood transfusions in PUD patients.SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.
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AIM:To evaluate the feasibility of diagnostic and therapeutic transgastric(TG)peritoneoscopic interventions with a forward-viewing endoscopic ultrasound(FV-EUS).METHODS:This prospective endoscopic experimental study used an animal model.Combined TG peritoneoscopic interventions and EUS examination of the intraabdominal organs were performed using an FV-EUS on 10 animal models(1 porcine and 9 canine).The procedures carried out include EUS evaluation and endoscopic biopsy of intraperitoneal organs,EUS-guided fine needle aspiration(EUS-FNA),EUS-guided radiofrequency ablation(EUS-RFA),and argon plasma coagulation(APC)for hemostatic control.The animals were kept alive for 7 d,and then necropsy was performed to evaluate results and complications.RESULTS:In all 10 animals,TG peritoneoscopy,followed by endoscopic biopsy for the liver,spleen,abdominal wall,and omentum,was performed successfully.APC helped control minor bleeding.Visualization of intra-abdominal solid organs with real-time EUS was accomplished with ease.Intraperitoneal EUS-FNA was successfully performed on the liver,spleen,and kidney.Similarly,a successful outcome was achieved with EUSRFA of the hepatic parenchyma.No adverse events were recorded during the study.CONCLUSION:Peritoneoscopic natural orifice transluminal endoscopic surgery(NOTES)interventions through FV-EUS were feasible in providing evaluation and performing endoscopic procedures.It promises potential as a platform for future EUS-based NOTES.
基金the Institutional Research Ethics Board(number 6.886.384)Brazil platform system(Approval with CAAE number 79007324.1.0000.5047).
文摘BACKGROUND Foreign body(FB)ingestion is one of the most challenging clinical situations faced by endoscopists.Most esophageal FB impaction emergencies occur in children.It is important to study the epidemiological profile and endoscopic methods for treating FB impacted in the esophagus of children,as it can help in the development of more effective,safe and personalized preventive and therapeutic strategies.AIM To define the profile of children seeking emergency care due to FB impaction in the esophagus,analyze factors associated with complications,and evaluate the effectiveness of rigid(RE)and flexible endoscopes(FE).METHODS A retrospective cohort study of 166 children with impacted FB in the esophagus who underwent an endoscopy(FE=84 vs RE=82)at the Dr.JoséFrota Institute was performed.The primary outcomes were to assess the efficacy of the endoscopic technique and factors associated with complications.The secondary outcomes were age group,gender,symptoms,length of hospital stay,and location of the FB.RESULTS Boys(66.9%),preschoolers(43.4%),FB>24 hours(62.7%),cervical esophagus(60.8%),coin ingestion(57.2%)and complaints of dysphagia(24.9%)and sialorrhea(23.1%)were the predominant findings.Endoscopy was successful(90.4%)with sedation(89.1%).A total of 97%of patients were discharged from the hospital,while 3%died.The average hospital stay length was 2.6 days.Most patients did not experience complications predominated(64.5%).Esophageal perforations were more frequent after RE(11%vs 4.8%),while FE was more effective(95.2%vs 85.4%).Theχ2 test or Fisher's exact test was used to compare categorical variables.For continuous variables,the Kruskal-Wallis test or analysis of variance was used.Statistical analyses were performed in R®software(version 1.3.1093).CONCLUSION Coins were the most frequent FBs and were mainly lodged in the upper esophagus of preschool boys.Risk factors for complications due to esophageal FB include battery ingestion,delayed removal(>48 hours)and lodging in the thoracic esophagus.FE was generally more effective than RE for removing FBs;both procedures are safe.
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.
基金Supported by the Provincial Natural Science Foundation of Gansu,No.24JRRF008Science and Technology Research Project of Songjiang District,No.2024SJKJGG105+1 种基金National Natural Science Foundation of China,No.82202694Clinical Research Innovation Plan of Shanghai General Hospital,No.CTCCR-2021C10.
文摘BACKGROUND This is a retrospective study on endoscopic treatment of cervical spinal radiculopathy(CSR)conducted at a single academic institution.Conventional full-spine endoscopy is performed in a single portal which has certain limitations of high technical requirements,steep learning curve,and narrow indications.Although unilateral biportal endoscopy(UBE)technique has a gentle learning curve and is gradually applied to treat CSR,all procedures were performed in the uniportal working channel that potentially increase the surgical risk and time in the treatment of complex cases.It is worthy to delve novel technique for more working channels in the treatment of complex CSR.AIM To propose a hybrid technique(HT)that utilizes spine endoscopy in UBE to treatment of CSR.METHODS A total of 81 patients with single-segment CSR who underwent uniportal endoscopic surgery(UES),UBE,or HT at a single institution between September 2019 and August 2021 were retrospectively studied.Perioperative patient data were compared between the groups.The pre-operative and post-operative images were compared to confirm adequate decompression of the nerve root canal.Patients'visual analogue scale(VAS)scores and neck disability index(NDI)were recorded before surgery,and three days,three months and six months after surgery.RESULTS The UBE and HT groups had a significantly shorter operation duration than the UES group.Data for bleeding and length of hospital stay were significantly higher in the UBE group than in the UES and HT groups.The hospitalization cost was lowest in the UES group and highest in the HT group.Soft tissue edema reaction bands on postoperative day 3 were larger in the UBE and HT groups than in the UES group.Post-operative VAS and NDI scores were significantly lower in all three groups than the pre-operative levels.On post-operative day 3,the VAS score for neck pain was significantly higher in the UBE and HT groups than that in the UES group.However,there were no significant differences in the VAS scores for arm pain or NDI between the three groups.The post-operative 3-month and 6-month neck pain VAS,arm pain VAS,NDI,and modified Macnab success rates did not differ statistically between the three groups.CONCLUSION The HT for CSR treatment has the advantage of double working channels to facilitate decompression and hemostasis,improving the surgical efficiency and clinical outcomes of CSR.
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Minimally invasive endoscopic resection techniques are the recommended firstline treatment strategy for the majority of large non-pedunculated colorectal polyps,with endoscopic mucosal resection(EMR)as a predominant resection modality due to its efficacy,efficiency,safety,and cost-effectiveness.A limitation of EMR is recurrence,which has historically occurred in 15%-20%of lesions.In the past 10 years,a number of effective mitigating strategies have been developed,including margin thermal ablation using snare-tip soft coagulation,argon plasma coagulation(APC),and hybrid-APC,alongside margin marking pre-resection.Moreover,techniques for effective recurrence management have also been developed.Herein,we appraise existing evidence on the frequency of recurrence,reasonings behind recurrence formation,as well as recurrence mitigating strategies and the effectiveness of recurrence management.
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.
文摘BACKGROUND There is a scarcity of evidence and systematic reviews on endoscopic gastroplasty(EG)compared to other management options for the treatment of obesity.AIM To assess the published meta-analyses through a systematic review approach and provide further insight into the current status of available evidence through a critical appraisal.METHODS PubMed/MEDLINE,Scopus,Embase and Cochrane Library were searched from inception to November 2022.The meta-analyses that compared the efficacy and safety of EG to other interventions were considered for this overview.The outcomes of interest were total body weight loss(TBWL),excessive weight loss,and average weight loss along with occurrence of adverse effects.Methodological quality,heterogeneity,and limitations were also reviewed.RESULTS A total of six meta-analyses out of 364 records were considered for this review with a major contribution from the United States.Overall methodological quality of included studies were moderate to good.EG treatments were significantly better in terms of TBWL,excessive weight loss,and average weight loss.However,there was no significant difference between endoscopic transoral outlet reduction and full-thickness suturing plus argon plasma mucosal coagulation.Lack of comparative studies and randomized trials,lack of long-term follow-up,reporting bias,selection bias,lack of control groups,and considerable level of heterogeneity were the major limitations in the available evidence.CONCLUSION Though EG was significantly effective for treatment of obesity,there is limited comparative evidence on this topic.High-quality well-controlled evidence is required to strengthen the current evidence base on EG treatment for obesity.
基金Supported by Wu Jieping Foundation,No.320.6750.2024-05-55.
文摘Gastrointestinal endoscopy is a common examination for digestive system.The stimulation of endoscope often causes cough,nausea and vomiting,increased heart rate and blood pressure,arrhythmia,and even cardiovascular and cerebrovascular accidents,thus makes people fear of this procedure.Sedation or anesthesia can effectively improve the safety,comfort and quality of gastrointestinal endoscopy.A small dose of opioids is a good adjuvant to sedatives.In this narrative review,we summarized the main roles of opioid analgesics in gastrointestinal endoscopy,including reducing visceral pain,throat irritation and the dose of sedatives.Moreover,the frequently used and novel opioids are reviewed.Classic fentanyl,sufentanil and dezocine are preferable by anesthesiologists.Newly approved oliceridine is promising to render ideal analgesic effects for gastrointestinal endoscopy.Clinical studies on oliceridine in endoscopic procedures are urgently needed.
文摘BACKGROUND Although the majority of gastrointestinal(GI)endoscopies in the United States are now performed with propofol sedation,a substantial minority are performed with midazolam and fentanyl sedation.Despite the ubiquity of conscious sedation with midazolam and fentanyl in the United States,there is scant evidence specifically supporting the superiority of midazolam plus fentanyl over single agent midazolam sedation in GI endoscopy.We hypothesize that single agent sedation with midazolam is noninferior to sedation with midazolam plus fentanyl in GI endoscopy.AIM To investigate whether sedation with midazolam alone is noninferior to sedation with midazolam plus fentanyl in GI endoscopy.METHODS We conducted a randomized,single-blind study to compare the safety and effectiveness of single agent midazolam vs.standard fentanyl/midazolam moderate sedation in 300 outpatients presenting for upper endoscopy and/or colonoscopy at a tertiary care hospital.Primary outcomes were patient satisfaction as measured by the previously validated Procedural Sedation Assessment Survey.Secondary outcomes were procedure quality measures and adverse events.Statistical analysis was performed by a biomedical statistician using theχ^(2) test,Fisher’s exact test,and Welch’s 2-sample t-test.RESULTS There was no difference in patient satisfaction between sedation groups,as measured by a less than 1 point difference between groups in Procedural Sedation Assessment Survey scores for discomfort during the procedure,and for preference for level of sedation with future procedures.There were no differences in adverse events or procedure quality measures.Cecal intubation time was 1 minute longer in the single agent midazolam group,and an average of 2.7 mg more midazolam was administered when fentanyl was not included in the sedation regimen.The recruitment goal of 772 patients was not reached.CONCLUSION It may be possible to minimize or avoid using fentanyl in endoscopist administered moderate sedation for GI endoscopy.We hope these findings spur further work in this under-researched area.
文摘Endoscopic bariatrics has emerged as a minimally invasive alternative to traditional bariatric procedures.Over the last decade,significant progress in endoscopic techniques and technologies has improved the safety,efficacy,and accessibility of these procedures.Current methods,such as intragastric balloons,endoscopic sleeve gastroplasty,and endoscopic-assisted gastrojejunostomy,have promoted weight loss,improving the metabolic health of obese individuals,with emerging evidence suggesting that their combination with pharmacological agents could further maximize their benefit.Emerging technologies,such as robotic-assisted endoscopic devices,advanced imaging systems,and biodegradable implants,could enhance procedural precision,minimize complications,and provide more personalized treatment options.In contrast,novel approaches such as microbiome modulation and tissue regeneration could have an adjunct role in improving patient outcomes.This review provides a brief overview of the current status of endoscopic bariatrics,highlighting the most common procedures and emerging technologies.It also discusses the challenges and future directions for the field,emphasizing the importance of multidisciplinary collaboration,patient selection,and research priorities to establish the long-term benefit and effectiveness of the available endoscopic bariatric interventions.
