Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to t...Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.展开更多
BACKGROUND Odontogenic maxillary sinusitis,often triggered by dental issues like periapical periodontitis,significantly contributes to chronic sinusitis,mainly affecting adults around 50 years old,emphasizing the need...BACKGROUND Odontogenic maxillary sinusitis,often triggered by dental issues like periapical periodontitis,significantly contributes to chronic sinusitis,mainly affecting adults around 50 years old,emphasizing the need for a multidisciplinary diagnostic and treatment approach.AIM To investigate the therapeutic effect and clinical value of root canal therapy combined with nasal endoscopic surgery compared with simple root canal the-rapy in the treatment of severe odontogenic maxillary sinusitis caused by peria-pical periodontitis.METHODS The clinical data,diagnosis,and treatment of 200 patients with severe odonto-genic maxillary sinusitis caused by periapical periodontitis from October 2020 to October 2021 were analyzed retrospectively.Among them,63 patients were treated with simple root canal therapy as the control group,and 137 patients were treated with root canal therapy combined with nasal endoscopic surgery as the observation group.The therapeutic effect,Lund-Kennedy endoscopic score,paranasal sinus Lund-Mackay score,complication rate,recurrence rate,and patient satisfaction were compared between the two groups.RESULTS First,we compared the effective rates:23 cases were cured,22 were improved,and 8 were ineffective in the control group,yielding a total effective rate of 84.90%.Meanwhile,97 cases were cured,34 improved,and 6 were ineffective in the observation group,resulting in a total effective rate of 95.62%.The observation group had a higher total effective rate compared with the control group(P<0.05).Second,we compared the Lund–Kennedy endoscopic score.Before treatment,no significant difference(P>0.05)was observed in this score between the two groups.After treatment,the Lund–Kennedy endoscopic score decreased in both groups.The Lund–Kennedy endoscopic score of the observation group at 3 and 6 mo after treatment was lower compared to that of the control group(P<0.05).Third,we compared the Lund–Mackay score of paranasal sinuses.Before treatment,there was no significant difference in this score between the two groups(P>0.05).After treatment,the Lund–Mackay scores of paranasal sinuses decreased in both groups.The Lund–Mackay scores of paranasal sinuses in the observation group at 3 and 6 mo after treatment were lower compared to those of the control group(P<0.05).Fourth,we compared the incidence and recurrence rate of complications.Three months after treatment,no significant difference was found in the incidence and recurrence rate of complications between the observation group(6.56%)and the control group(9.52%)(P>0.05).However,6 mo after treatment,the incidence and recurrence rate of complications in the observation group(2.91%)was significantly higher compared to that of the control group(12.69%)(P<0.05).Fifth,we compared patient satisfaction.Six months after treatment,the patient satisfaction of the observation group(93.43%)was significantly better than that of the control group(84.12%)(P<0.05).CONCLUSION Root canal therapy combined with nasal endoscopic surgery has a good therapeutic effect on severe odontogenic maxillary sinusitis caused by periapical periodontitis,and it can reduce the injury of maxillary sinus mucosa and bone,and significantly reduce the incidence of complications and recurrence rate.Meanwhile,it has high patient satisfaction and remarkable therapeutic effect,which is suggested to be popularized and applied in clinic.展开更多
Background:Biliary stent placement during endoscopic retrograde cholangiopancreatography(ERCP)is important for drainage in common bile duct(CBD)strictures,while the stent length is associated with many stent-related c...Background:Biliary stent placement during endoscopic retrograde cholangiopancreatography(ERCP)is important for drainage in common bile duct(CBD)strictures,while the stent length is associated with many stent-related complications.We aimed to develop an artificial intelligence(AI)model for stent length selection during ERCP.Methods:Images of the patients who underwent ERCP and were diagnosed with CBD strictures were collected.Training involved identifying and delineating the duodenoscope,CBD and guidewire,calculating the pixel distance of the target guidewire and determining the required biliary stent length based on the diameter of the duodenoscope.The performance of the model,accuracy for length calculation and the assistance for endoscopists were validated using the testing set.Results:A total of 794 images from 431 patients were included and data augmentation was conducted.The mean intersection over union(mIoU)for duodenoscope,CBD and guidewire were 90.46%,84.79%and 84.64%,respectively.The accuracy in identifying the strictures was 97.58%(121/124).The accuracy for stent length calculation achieved 85.95%(104/121)with an error margin of±1 cm.The mean absolute error(MAE)and mean relative error(MRE)of the AI model was 0.81 cm and 0.13,respectively.The AI model could reduce approximately 202 mGycm^(2)of the radiation exposure for each patient.It significantly improved both MAE and MRE for less experienced endoscopists(P=0.01 and P=0.02,respectively).Conclusions:The AI model could accurately identify duodenoscope,CBD and guidewire,enabling accurate strictures identification and stent length selection.展开更多
BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidec...BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches(TAA)are the two most commonly used remote approaches.No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.AIM To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.METHODS We searched PubMed MEDLINE,Google Scholar,and Cochrane Library from the date of the first published article up to August 2025.The term used were transoral thyroidectomy vestibular approach,trans areolar thyroidectomy,scarless thyroidectomy,remote thyroidectomy,infections,postoperative,inflammation,dysphagia,and swallowing difficulties.We identified 130 studies,of them,30 full texts were screened and only six studies were included in the final meta-analysis.RESULTS Postoperative infections were not different between the two approaches,odd ratio=1.33,95%confidence interval:0.50-3.53,theχ2 was 1.92 and the P-value for overall effect of 0.57.Similarly,transient swallowing difficulty was not different between the two forms of surgery,with odd ratio=0.91,95%confidence interval:0.35-2.40;theχ2 was 1.32,and the P-value for overall effect of 0.85.CONCLUSION No significant statistical differences were evident between trans-oral endoscopic Mirghani H.Infections and swallowing difficulty in scarless thyroidectomy WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties.Further longer randomized trials are needed.展开更多
BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides dire...BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides direct visual observation with diagnostic and therapeutic capabilities.AIM To assess the efficacy and feasibility of EDAT and compare them with those of ERAT in uncomplicated appendicitis.METHODS In this retrospective cohort study,patients diagnosed with uncomplicated appendicitis and treated with ERAT or EDAT between January 2021 and November 2024 were reviewed.The primary outcome was intervention success.Secondary outcomes were guidewire use,stent placement,hospitalization duration,recurrence,and endoscopic direct-view features.Outcomes were compared between groups via appropriate statistical tests.RESULTS Of 170 patients,136 underwent EDAT and 34 ERAT.EDAT showed higher intervention success than ERAT(99.3%vs 82.4%,P<0.001),with less guidewire assistance and fewer stent placements(both P<0.001).Hospital stay was shorter with EDAT(P=0.039).The overall cumulative recurrence rates at 1 year were 10%in EDAT and 24%in ERAT;in the appendicolith subgroup,the recurrence rates were 5%and 14%in EDAT and ERAT,respectively.Findings were consistent in the propensity score-matched(PSM)cohort.CONCLUSION EDAT was demonstrated to be a more effective and feasible approach than ERAT,with a lower overall cumulative recurrence risk and within the appendicolith subgroup.Consistent results after PSM further supported the robustness of these findings.展开更多
Gastrointestinal tumors require personalized treatment strategies due to their heterogeneity and complexity.Multimodal artificial intelligence(AI)addresses this challenge by integrating diverse data sources-including ...Gastrointestinal tumors require personalized treatment strategies due to their heterogeneity and complexity.Multimodal artificial intelligence(AI)addresses this challenge by integrating diverse data sources-including computed tomography(CT),magnetic resonance imaging(MRI),endoscopic imaging,and genomic profiles-to enable intelligent decision-making for individualized therapy.This approach leverages AI algorithms to fuse imaging,endoscopic,and omics data,facilitating comprehensive characterization of tumor biology,prediction of treatment response,and optimization of therapeutic strategies.By combining CT and MRI for structural assessment,endoscopic data for real-time visual inspection,and genomic information for molecular profiling,multimodal AI enhances the accuracy of patient stratification and treatment personalization.The clinical implementation of this technology demonstrates potential for improving patient outcomes,advancing precision oncology,and supporting individualized care in gastrointestinal cancers.Ultimately,multimodal AI serves as a transformative tool in oncology,bridging data integration with clinical application to effectively tailor therapies.展开更多
Obesity is a chronic,multifactorial disease closely linked to a spectrum of cardiometabolic disorders,with its global prevalence rising at an alarming rate.In recent years,minimally invasive,safe,and effective endosco...Obesity is a chronic,multifactorial disease closely linked to a spectrum of cardiometabolic disorders,with its global prevalence rising at an alarming rate.In recent years,minimally invasive,safe,and effective endoscopic bariatric therapies have gained significant attention as alternatives to conventional surgical interventions.This review provides a comprehensive overview of various endoscopic weight-loss procedures,evaluating their advantages and limitations in comparison to surgical approaches to assist clinicians in optimizing patientspecific treatment strategies.Endoscopic bariatric therapies,including intragastric balloons,duodenal-jejunal bypass sleeves,endoscopic sleeve gastroplasty,gastric remodeling procedures,and interventions aimed at delaying gastric emptying are systematically reviewed.The efficacy,safety profiles,and clinical applicability are all synthesized.Endoscopic bariatric therapies exhibit distinct advantages and limitations,with varying indications and contraindications.As part of a multidisciplinary approach to obesity management,these procedures should be integrated with lifestyle modifications and nutritional counseling to maximize therapeutic benefits.Future research should focus on the long-term efficacy,safety,and patient-reported outcomes to refine clinical practice and optimize the role of endoscopic interventions in obesity treatment.展开更多
BACKGROUND Gastric antral vascular ectasia(GAVE)accounts for up to 4%of nonvariceal upper gastrointestinal bleeding.Argon plasma coagulation and radiofrequency ablation have been primary treatment modalities for patie...BACKGROUND Gastric antral vascular ectasia(GAVE)accounts for up to 4%of nonvariceal upper gastrointestinal bleeding.Argon plasma coagulation and radiofrequency ablation have been primary treatment modalities for patients with linear and punctate subtypes,with a newer trend of utilization of endoscopic band ligation(EBL).This study evaluates the outcomes of patients undergoing treatment for nodular GAVE.We hypothesize that patients treated initially with EBL will achieve higher rates of clinical remission with fewer endoscopic treatments and a shorter treatment interval.AIM To investigate the effects of EBL as an initial treatment therapy on outcomes associated with nodular GAVE.METHODS A total of 37 patients at a tertiary medical center with nodular GAVE were included in this retrospective study.The study population was divided between those treated initially with EBL(initial EBL)and initial endoscopic thermal therapy.Pretreatment and post-treatment hemoglobin values,the model for end-stage liver disease scores,hospitalization rates,and other outcomes.Additionally,endoscopic treatment modality type and frequency were recorded,including radiofrequency ablation,argon plasma coagulation,and EBL.Continuous variables were compared using a t-test,while categorical variables were compared using Fisher’s exact.RESULTS Linear regression analysis displayed a positive relationship between the time interval from initial therapeutic esophagogastroduodenoscopy to first EBL treatment and overall treatment interval(t=7.39,P<0.001),as well as between the number of endoscopic treatments(t=8.09,P<0.001).Hemoglobin levels increased in both the initial EBL group(8.7 vs 11.4,P<0.001)and the initial endoscopic thermal therapy group(8.6 vs 10.4,P=0.042).Clinical remission rates were higher in the initial EBL group(90%vs 69%P=0.041),with a non-significant trend of higher endoscopic remission rates(57.1%vs 37.5%,P=0.270).CONCLUSION The observed trend favoring EBL,combined with its association with improved clinical remission and reduced treatment burden,supports its consideration as a preferred initial treatment approach.展开更多
BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficult...BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficulty of surgery.The use of ERAT in appendicitis remains contentious,prompting the presentation of this case report.CASE SUMMARY We report the case of a 43-year-old female patient presenting with intermittent right lower abdominal pain for one day.The patient had undergone ERAT six months previously.Examination revealed stent impaction in the appendix,leading to exacerbated inflammation.Subsequently,a solo single-incision laparo-scopic appendectomy(SSLA)was performed.The ERAT-related complications increased surgical difficulty and prolonged the operation time.Post-SSLA,the patient was hospitalized for one day and showed favorable recovery upon follow-up.CONCLUSION This case highlights the risks of ERAT.Thorough preoperative assessment,proper stent placement during surgery and regular postoperative follow-up are crucial in preventing complications,as their occurrence can increase surgical difficulty.Compared to ERAT,SSLA remains more widely used in clinical practice.Both techniques require further clinical data and research to optimize their application.展开更多
Gastric variceal(GV)bleeding remains a life-threatening complication of portal hypertension,with ongoing debate regarding the optimal endoscopic therapy.Conventional endoscopic cyanoacrylate injection(ECI)is effective...Gastric variceal(GV)bleeding remains a life-threatening complication of portal hypertension,with ongoing debate regarding the optimal endoscopic therapy.Conventional endoscopic cyanoacrylate injection(ECI)is effective but limited by the risk of ectopic embolism,particularly in the presence of gastrorenal shunts.Clip-assisted ECI(clip-ECI)has emerged as a novel modification designed to reduce embolic risk while maintaining hemostatic efficacy.We appraised the recent study by Xiong et al,which compared clip-ECI with endoscopic ultrasoundguided coil and cyanoacrylate injection in 108 propensity-matched patients with cardiofundal varices and shunts.Both techniques demonstrated comparable efficacy,with obliteration rates exceeding 90%and similar one-year rebleeding rates.Importantly,no embolic events were reported.These findings are consistent with prior studies,including multicenter cohorts and a recent randomized controlled trial,which highlight clip-ECI as a safe,effective,and efficient technique,with advantages of shorter procedure times,fewer sessions,and lower costs.While endoscopic ultrasound(EUS)-guided therapy offers precision in expert hands,clip-ECI provides a practical,accessible alternative,particularly in resource-limited settings.Larger prospective studies with standardized definitions and cost-effectiveness analyses are needed to refine treatment algorithms.Clip-ECI represents a promising“flow-control assisted”strategy and a real-world alternative to EUS-based therapies for GV.展开更多
BACKGROUND Biliary anastomotic stricture(BAS)occurs in approximately 14%-20%of patients post-orthotopic liver transplantation(post-OLT).Endoscopic retrograde cholan-giopancreatography(ERCP)using multiple plastic stent...BACKGROUND Biliary anastomotic stricture(BAS)occurs in approximately 14%-20%of patients post-orthotopic liver transplantation(post-OLT).Endoscopic retrograde cholan-giopancreatography(ERCP)using multiple plastic stents(MPSs)or fully covered self-expandable metal stents(cSEMSs)represent the standard treatment for BAS post-OLT.Recently,cSEMSs have emerged as the primary option for managing BAS post-OLT.AIM To compare the resolution and recurrence of BAS rates in these patients.METHODS This retrospective cohort study was conducted in a single tertiary care center(Hospital Israelita Albert Einstein,São Paulo,Brazil).We reported the results of endoscopic therapy in patients with post-OLT BAS between 2012 and 2022.Patients were stratified into two groups according to therapy:(1)MPSs;and(2)cSEMSs.Primary endpoints were to compare stricture resolution and recurrence among the groups.The secondary endpoint was to identify predictive factors for stricture recurrence.RESULTS A total of 104 patients were included.Overall stricture resolution was 101/104(97.1%).Stricture resolution was achieved in 83/84 patients(99%)in the cSEMS group and 18/20 patients(90%)in the MPS group(P=0.094).Failure occurred in 3/104 patients(2.8%).Stricture recurrence occurred in 9/104 patients(8.7%).Kaplan-Meier analysis showed there was no difference in recurrence-free time among the groups(P=0.201).A multivariate analysis identified the number of ERCP procedures(hazard ratio=1.4;95%confidence interval:1.194-1.619;P<0.001)and complications(hazard ratio=2.8;95%confidence interval:1.008-7.724;P=0.048)as predictors of stricture recurrence.CONCLUSION cSEMSs and MPSs were effective and comparable regarding BAS post-OLT resolution and recurrence.The number of ERCP procedures and complications were predictors of stricture recurrence.展开更多
BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening emergency.Endoscopic hemostasis and vascular interventional therapy are two major minimally invasive treatment strategies.Altho...BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening emergency.Endoscopic hemostasis and vascular interventional therapy are two major minimally invasive treatment strategies.Although these modalities are widely used,their comparative efficacy and safety across different patient populations and anatomical sites remain controversial.AIM To evaluate the clinical outcomes and safety of endoscopic hemostasis combined with vascular interventional therapy for NVUGIB.METHODS A systematic search was done on PubMed,EMBASE,Cochrane Library,and Web of Science(from database establishment to April 2025).Randomized controlled trial(RCT)quality was assessed via Cochrane RoB 2.0,and observational studies via the Critical Appraisal Skills Program.RevMan 5.4 was used for quantitative analysis;fixed/random-effects models were chosen through I^(2)-assessed heterogeneity.Publication bias was checked using funnel plots and sensitivity analysis via model switching.RESULTS Twenty-one studies(3 RCTs,12 single-group studies,and 6 retrospective cohort studies)with good quality were included.For single-group data,combined therapy had risk differences of 0.70(clinical success),0.24(mortality),and 0.22(rebleeding;all P<0.00001,I^(2)=0).Moreover,the≥60-year rebleeding risk difference was 0.43.Reintervention was found to differ by approach(Z=3.03,P=0.002,inter-subgroup I^(2)=99%).In the RCT and cohort studies,combined vs standard therapy had similar initial hemostasis(Z=0.04,P=0.97)and mortality(Z=1.56,P=0.12)but lower rebleeding(Z=3.26/P=0.001;Z=2.95/P=0.03).Symmetrical funnel plots and robust sensitivity analysis showed no publication bias.CONCLUSION Combined endoscopic hemostasis and vascular interventional therapy for acute NVUGIB can significantly reduce rebleeding,without differences in mortality.Age and vascular interventional methods may influence the therapeutic efficacy.展开更多
Endoscopic ultrasound(EUS)guided vascular interventions have expanded the reach of therapeutic endoscopy to include vascular pathology previously inaccessible by endoscopists.Gastric variceal bleeding comprises 20%of ...Endoscopic ultrasound(EUS)guided vascular interventions have expanded the reach of therapeutic endoscopy to include vascular pathology previously inaccessible by endoscopists.Gastric variceal bleeding comprises 20%of all variceal bleeding and is associated with high morbidity and mortality.Historically,endoscopic injection of thrombosis-inducing agents such as glue has been used.However,glue injection carries potential risks including systemic embolization,damage to the endoscope,and recurrent bleeding.The introduction of hemostatic coils has revolutionized the endoscopic approach,with EUS-guided coil embolization emerging as an effective and safe modality for the management of gastric varices(GVs).When compared with conventional glue injection,EUSguided embolization is associated with improved visualization,higher efficacy,and better safety profile.Despite its expanding adoption,the standardization of EUS guided embolization remains a challenge.High-quality studies are needed to standardize this promising technique and define its role in clinical practice.In this review,we will discuss the indications,efficacy,techniques,and various approaches for EUS-guided embolization of GVs.展开更多
This study presents a comprehensive overview of post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP),detailing its epidemiology,pathophysiology,prevention,and treatment.PEP is the most common com...This study presents a comprehensive overview of post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP),detailing its epidemiology,pathophysiology,prevention,and treatment.PEP is the most common complication of ERCP,with an incidence of 3%,16%,and above 20%in high-risk patients.Proposed mechanisms include mechanical trauma,pancreatic-duct(PD)hypertension,oxidative stress,and dysbiosis-driven inflammation.Mitochondrial oxidative stress is a central pathological driver:It activates the NLRP3 inflammasome and the STING pathway,perpetuating a deleterious“injury-inflammation"cycle.Risk factors encompass patient characteristics,procedural variables,and operator-related factors.Preventive strategies combine pharmacological and procedural measures.Rectal non-steroidal anti-inflammatory drugs(NSAIDs),such as indomethacin,inhibit prostaglandin synthesis.European guidelines report that NSAIDs reduce the overall incidence of PEP,with odds ratios of 0.24-0.63.Subgroup analyses indicate the greatest benefit in high-risk cohorts,with mixed-risk groups also deriving more benefit than average-risk groups.In high-risk patients,prophylactic PD stenting markedly lowers PEP incidence by alleviating ductal hypertension.Aggressive fluid resuscitation enhances pancreatic perfusion and decreases the frequency of moderate-to-severe PEP.Recent therapeutic advances emphasize targeted interventions.Mitochondria-directed nanomedicines cross the blood-pancreas barrier,scavenge reactive oxygen species,and attenuate inflammatory cascades.A multidisciplinary team(MDT)approach optimizes infection control and manages complications in severe PEP,improving clinical outcomes.Future research should focus on addressing genetic susceptibility,developing novel targeted agents,and integrating artificial intelligence-assisted risk stratification to refine personalized prevention and therapy.This article reviews the epidemiological and pathophysiological foundations of PEP,evaluates evidencebased preventive strategies(e.g.,NSAIDs,pancreatic duct stenting),and discusses emerging approaches such as gene therapy.It also summarizes advances in treating mild and severe PEP,highlights the role of MDT care,identifies current knowledge gaps,and proposes directions for future research,including the discovery of novel biomarkers and the development of personalized preventive and therapeutic strategies.展开更多
BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete cli...BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete clinical response after neoadjuvant treatment,which often translates to pathologic complete response(pCR)as assessed on surgical specimens after curative intent surgery.Endoscopy plays a significant role in assessing treatment response to neoadjuvant therapies.AIM To explore the role of endoscopy in predicting subsequent pCR after neoadjuvant treatment in rectal cancer patients.METHODS An extensive literature review was undertaken to identify the criteria used for assessment of endoscopic response and their ability to predict pCR.RESULTS Fifteen studies were identified through literature review.The most commonly used endoscopic criteria for evaluation included the presence of a flat white scar and the absence of nodularity or telangiectasia.Information on the timing of endoscopic assessment in relation to neoadjuvant treatment protocols were also extracted from the studies.In most studies,the diagnostic accuracy for predicting pCR exceeded 0.8.The main limitations identified were the retrospective design of included studies included and a moderate risk of bias.CONCLUSION Endoscopy can be a key prognostic factor in predicting pCR to neoadjuvant treatment in rectal cancer despite significant limitations in currently available data.展开更多
Liver-directed therapies such as resection,ablation,and embolization offer potentially curative options for patients with primary and metastatic liver tumors as part of multidisciplinary oncology care.However,these tr...Liver-directed therapies such as resection,ablation,and embolization offer potentially curative options for patients with primary and metastatic liver tumors as part of multidisciplinary oncology care.However,these treatments pose significant hepatic decompensation risks,particularly with underlying liver disease and chemotherapy-associated steatohepatitis.Accurate assessment of liver function and portal hypertension(PH)is critical for candidate selection.While Child-Pugh score and model for end-stage liver disease are commonly used,they have substantial limitations.Hepatic venous pressure gradient(HVPG)measurement remains the gold standard for assessing PH but is invasive and not widely available.Endoscopic ultrasound(EUS)guided portal pressure gradient(PPG)measurement has emerged as a promising minimally invasive alternative.EUSPPG demonstrates excellent technical success rates,safety profile,and correlation with HVPG in early studies.By providing direct portal pressure measurement,EUS-PPG offers several advantages over existing methods for prognostication and risk stratification prior to liver-directed therapies,particularly in detecting presinusoidal hypertension.Furthermore,it has potential applications in assessing response to neoadjuvant treatments and guiding adjuvant therapies.However,research is needed to validate its predictive performance and cost-effectiveness in larger prospective cohorts and to establish its accuracy compared to non-invasive assessment of liver function.展开更多
BACKGROUND Esophageal squamous cell carcinoma(ESCC)is often managed with surgery,which is the first-line treatment option for stage I–III lesions.However,definitive chemoradiotherapy(dCRT)is associated with a recurre...BACKGROUND Esophageal squamous cell carcinoma(ESCC)is often managed with surgery,which is the first-line treatment option for stage I–III lesions.However,definitive chemoradiotherapy(dCRT)is associated with a recurrence rate of 30%in stage I ESCC and higher rates in advanced-staged lesions.However,several patients prefer dCRT because their general condition is poor.Salvage therapies,including esophagectomy and endoscopic resection[endoscopic submucosal dissection(ESD)/endoscopic mucosal resection],are important for residual or recurrent tumors that develop after dCRT.Esophagectomy can have curative potential.However,it has high complication and mortality rates.Therefore,ESD is a safer alternative.CASE SUMMARY A Japanese man in his 70s was concurrently diagnosed with right hypopha-ryngeal cancer(T2N1M0,cStage III),left oropharyngeal cancer(T1N0M0,cStage I),and left hard palate cancer(T1N0M0,cStage I).Esophagogastroduodenoscopy(EGD)revealed a 20 mm reddish 0-Is+IIb lesion in the upper thoracic esophagus,with an invasion depth of SM2.The lesion was diagnosed as an esophageal mo-derately differentiated squamous cell carcinoma(T1bN0M0,cStage I).As the pharyngeal cancers were in advanced stages,chemoradiotherapy(docetaxel and cisplatin with a radiation dose of 66 Gy)was prioritized.Post-chemoradiotherapy EGD showed that the lesion had flattened into a 0-IIb lesion,thereby indicating a reduced invasion depth(epi-thelium or lamina propria mucosa).ESD achieved en bloc and histologically confirmed curative resection.At 22 months after ESD,the patient did not present with signs of recurrence.CONCLUSION This case emphasizes that ESD can be successfully utilized as a salvage treatment for ESCC after chemoradio-therapy for otolaryngological cancers.展开更多
BACKGROUND Neoadjuvant therapy(NAT)for pancreatic cancer(PC)is becoming standardized,with neoadjuvant chemoradiotherapy(NACRT)showing proven effectiveness.However,the optimal endoscopic biliary drainage approach durin...BACKGROUND Neoadjuvant therapy(NAT)for pancreatic cancer(PC)is becoming standardized,with neoadjuvant chemoradiotherapy(NACRT)showing proven effectiveness.However,the optimal endoscopic biliary drainage approach during NAT remains controversial.In this single-center retrospective case series,we report the use of a novel multi-hole self-expandable metallic stent(MH-SEMS)for preoperative biliary drainage during NACRT in patients with PC.AIM To assess the feasibility of endoscopic biliary drainage using MH-SEMS during NACRT in patients with malignant distal biliary obstruction secondary to resectable and borderline resectable PC.METHODS We included 14 patients—10 with resectable,2 with borderline resectable,and 2 with unresectable locally advanced disease—who had undergone surgery after biliary drainage using MH-SEMS(diameter:10 mm).Clinical and technical success was achieved in all patients,with a median interval of 105 days between stent placement and surgery.RESULTS A partial response was observed in five patients(35.7%),whereas nine patients(64.3%)exhibited stable disease.Only one patient(7.1%)developed moderate cholangitis from recurrent biliary obstruction caused by sludge 337 days after stent placement during systemic chemotherapy,requiring MH-SEMS replacement.Pathological examination of postoperative specimens revealed tumor shrinkage in many cases,and no stent migration was observed.Adverse events included mild pancreatitis in two patients(14.3%)and moderate pancreatitis in one patient(7.1%),as defined by the Tokyo Criteria 2024.CONCLUSION No cases of cholecystitis,liver abscess,or hemorrhage were reported.No disadvantages in surgical procedures or postoperative complications related to MH-SEMS placement were observed.展开更多
Esophageal carcinoma is a highly lethal cancer associated with high morbidity and mortality. Esophageal squamous cell carcinoma and esophageal adenocarcinoma are the two distinct histological types. There has been sig...Esophageal carcinoma is a highly lethal cancer associated with high morbidity and mortality. Esophageal squamous cell carcinoma and esophageal adenocarcinoma are the two distinct histological types. There has been significant progress in endoscopic diagnosis and treatment of early stages of cancer using resection and ablation techniques, as shown in several trials in the recent past. Earlier detection of esophageal cancer and advances in treatment modalities have lead to improvement in the 5-year survival from 5% to about 20% in the past decade. Endoscopic eradication therapy is the preferred modality of treatment in cancer limited to mucosal layer of the esophagus as there is very low risk of lymph node metastasis, leading to high cure rates, low risk of recurrence and with few adverse effects. The most common adverse events seen are strictures, bleeding and rarely perforation which can be endoscopically managed. In patients with recurrent advanced disease or invasive tumor, esophagectomy with lymph node dissection remains the mainstay of treatment. There is debate on post-endoscopic surveillance with some studies suggesting closer follow up with upper endoscopy every 6 mo for the first 1-2 years and then annually for the 3 years while others recommending the appropriate action only if symptoms or other abnormalities develop. Overall, the field of endoscopic therapy is still evolving and focus should be placed on careful patient selection using a multidisciplinary approach.展开更多
Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy(EIT). A proper delineat...Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy(EIT). A proper delineation of the stricture anatomy is a prerequisite. A host of electrocautery and mechanical devices may be used, the most common being the use of needle knife, either standard or insulated tip. The technique entails radial incision and cutting off of the stenotic rim. Adjunctive therapies, to prevent re-stenosis, such as balloon dilatation, oral or intralesional steroids or argon plasma coagulation can be used. The common strictures where EIT has been successfully used are Schatzki's rings(SR) and anastomotic strictures(AS). Short segment strictures(< 1 cm) have been found to have the best outcome. When compared with routine balloon dilatation, EIT has equivalent results in treatment na?ve cases but better long term outcome in refractory cases. Anecdotal reports of its use in other types of strictures have been noted. Post procedure complications of EIT are mild and comparable to dilatation therapy. As of the current evidence, incisional therapy can be used for management of refractory AS and SR with relatively short stenosis(< 1 cm) with good safety profile and acceptable long term patency.展开更多
文摘Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.
文摘BACKGROUND Odontogenic maxillary sinusitis,often triggered by dental issues like periapical periodontitis,significantly contributes to chronic sinusitis,mainly affecting adults around 50 years old,emphasizing the need for a multidisciplinary diagnostic and treatment approach.AIM To investigate the therapeutic effect and clinical value of root canal therapy combined with nasal endoscopic surgery compared with simple root canal the-rapy in the treatment of severe odontogenic maxillary sinusitis caused by peria-pical periodontitis.METHODS The clinical data,diagnosis,and treatment of 200 patients with severe odonto-genic maxillary sinusitis caused by periapical periodontitis from October 2020 to October 2021 were analyzed retrospectively.Among them,63 patients were treated with simple root canal therapy as the control group,and 137 patients were treated with root canal therapy combined with nasal endoscopic surgery as the observation group.The therapeutic effect,Lund-Kennedy endoscopic score,paranasal sinus Lund-Mackay score,complication rate,recurrence rate,and patient satisfaction were compared between the two groups.RESULTS First,we compared the effective rates:23 cases were cured,22 were improved,and 8 were ineffective in the control group,yielding a total effective rate of 84.90%.Meanwhile,97 cases were cured,34 improved,and 6 were ineffective in the observation group,resulting in a total effective rate of 95.62%.The observation group had a higher total effective rate compared with the control group(P<0.05).Second,we compared the Lund–Kennedy endoscopic score.Before treatment,no significant difference(P>0.05)was observed in this score between the two groups.After treatment,the Lund–Kennedy endoscopic score decreased in both groups.The Lund–Kennedy endoscopic score of the observation group at 3 and 6 mo after treatment was lower compared to that of the control group(P<0.05).Third,we compared the Lund–Mackay score of paranasal sinuses.Before treatment,there was no significant difference in this score between the two groups(P>0.05).After treatment,the Lund–Mackay scores of paranasal sinuses decreased in both groups.The Lund–Mackay scores of paranasal sinuses in the observation group at 3 and 6 mo after treatment were lower compared to those of the control group(P<0.05).Fourth,we compared the incidence and recurrence rate of complications.Three months after treatment,no significant difference was found in the incidence and recurrence rate of complications between the observation group(6.56%)and the control group(9.52%)(P>0.05).However,6 mo after treatment,the incidence and recurrence rate of complications in the observation group(2.91%)was significantly higher compared to that of the control group(12.69%)(P<0.05).Fifth,we compared patient satisfaction.Six months after treatment,the patient satisfaction of the observation group(93.43%)was significantly better than that of the control group(84.12%)(P<0.05).CONCLUSION Root canal therapy combined with nasal endoscopic surgery has a good therapeutic effect on severe odontogenic maxillary sinusitis caused by periapical periodontitis,and it can reduce the injury of maxillary sinus mucosa and bone,and significantly reduce the incidence of complications and recurrence rate.Meanwhile,it has high patient satisfaction and remarkable therapeutic effect,which is suggested to be popularized and applied in clinic.
基金supported by grants from the Taishan Scholars Program of Shandong Province(tsqn202312333)the National Natural Science Foundation of China(82470695).
文摘Background:Biliary stent placement during endoscopic retrograde cholangiopancreatography(ERCP)is important for drainage in common bile duct(CBD)strictures,while the stent length is associated with many stent-related complications.We aimed to develop an artificial intelligence(AI)model for stent length selection during ERCP.Methods:Images of the patients who underwent ERCP and were diagnosed with CBD strictures were collected.Training involved identifying and delineating the duodenoscope,CBD and guidewire,calculating the pixel distance of the target guidewire and determining the required biliary stent length based on the diameter of the duodenoscope.The performance of the model,accuracy for length calculation and the assistance for endoscopists were validated using the testing set.Results:A total of 794 images from 431 patients were included and data augmentation was conducted.The mean intersection over union(mIoU)for duodenoscope,CBD and guidewire were 90.46%,84.79%and 84.64%,respectively.The accuracy in identifying the strictures was 97.58%(121/124).The accuracy for stent length calculation achieved 85.95%(104/121)with an error margin of±1 cm.The mean absolute error(MAE)and mean relative error(MRE)of the AI model was 0.81 cm and 0.13,respectively.The AI model could reduce approximately 202 mGycm^(2)of the radiation exposure for each patient.It significantly improved both MAE and MRE for less experienced endoscopists(P=0.01 and P=0.02,respectively).Conclusions:The AI model could accurately identify duodenoscope,CBD and guidewire,enabling accurate strictures identification and stent length selection.
文摘BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches(TAA)are the two most commonly used remote approaches.No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.AIM To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.METHODS We searched PubMed MEDLINE,Google Scholar,and Cochrane Library from the date of the first published article up to August 2025.The term used were transoral thyroidectomy vestibular approach,trans areolar thyroidectomy,scarless thyroidectomy,remote thyroidectomy,infections,postoperative,inflammation,dysphagia,and swallowing difficulties.We identified 130 studies,of them,30 full texts were screened and only six studies were included in the final meta-analysis.RESULTS Postoperative infections were not different between the two approaches,odd ratio=1.33,95%confidence interval:0.50-3.53,theχ2 was 1.92 and the P-value for overall effect of 0.57.Similarly,transient swallowing difficulty was not different between the two forms of surgery,with odd ratio=0.91,95%confidence interval:0.35-2.40;theχ2 was 1.32,and the P-value for overall effect of 0.85.CONCLUSION No significant statistical differences were evident between trans-oral endoscopic Mirghani H.Infections and swallowing difficulty in scarless thyroidectomy WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties.Further longer randomized trials are needed.
基金Supported by Guangdong Province Clinical Teaching Base Teaching Reform Research Project,No.2021JD086.
文摘BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides direct visual observation with diagnostic and therapeutic capabilities.AIM To assess the efficacy and feasibility of EDAT and compare them with those of ERAT in uncomplicated appendicitis.METHODS In this retrospective cohort study,patients diagnosed with uncomplicated appendicitis and treated with ERAT or EDAT between January 2021 and November 2024 were reviewed.The primary outcome was intervention success.Secondary outcomes were guidewire use,stent placement,hospitalization duration,recurrence,and endoscopic direct-view features.Outcomes were compared between groups via appropriate statistical tests.RESULTS Of 170 patients,136 underwent EDAT and 34 ERAT.EDAT showed higher intervention success than ERAT(99.3%vs 82.4%,P<0.001),with less guidewire assistance and fewer stent placements(both P<0.001).Hospital stay was shorter with EDAT(P=0.039).The overall cumulative recurrence rates at 1 year were 10%in EDAT and 24%in ERAT;in the appendicolith subgroup,the recurrence rates were 5%and 14%in EDAT and ERAT,respectively.Findings were consistent in the propensity score-matched(PSM)cohort.CONCLUSION EDAT was demonstrated to be a more effective and feasible approach than ERAT,with a lower overall cumulative recurrence risk and within the appendicolith subgroup.Consistent results after PSM further supported the robustness of these findings.
基金Supported by Xuhui District Health Commission,No.SHXH202214.
文摘Gastrointestinal tumors require personalized treatment strategies due to their heterogeneity and complexity.Multimodal artificial intelligence(AI)addresses this challenge by integrating diverse data sources-including computed tomography(CT),magnetic resonance imaging(MRI),endoscopic imaging,and genomic profiles-to enable intelligent decision-making for individualized therapy.This approach leverages AI algorithms to fuse imaging,endoscopic,and omics data,facilitating comprehensive characterization of tumor biology,prediction of treatment response,and optimization of therapeutic strategies.By combining CT and MRI for structural assessment,endoscopic data for real-time visual inspection,and genomic information for molecular profiling,multimodal AI enhances the accuracy of patient stratification and treatment personalization.The clinical implementation of this technology demonstrates potential for improving patient outcomes,advancing precision oncology,and supporting individualized care in gastrointestinal cancers.Ultimately,multimodal AI serves as a transformative tool in oncology,bridging data integration with clinical application to effectively tailor therapies.
基金Supported by National Natural Science Foundation of China,No.81602056 and No.82273393the Young Talents Promotion Project of Shandong Medical Association in 2023,No.2023-GJ-0087.
文摘Obesity is a chronic,multifactorial disease closely linked to a spectrum of cardiometabolic disorders,with its global prevalence rising at an alarming rate.In recent years,minimally invasive,safe,and effective endoscopic bariatric therapies have gained significant attention as alternatives to conventional surgical interventions.This review provides a comprehensive overview of various endoscopic weight-loss procedures,evaluating their advantages and limitations in comparison to surgical approaches to assist clinicians in optimizing patientspecific treatment strategies.Endoscopic bariatric therapies,including intragastric balloons,duodenal-jejunal bypass sleeves,endoscopic sleeve gastroplasty,gastric remodeling procedures,and interventions aimed at delaying gastric emptying are systematically reviewed.The efficacy,safety profiles,and clinical applicability are all synthesized.Endoscopic bariatric therapies exhibit distinct advantages and limitations,with varying indications and contraindications.As part of a multidisciplinary approach to obesity management,these procedures should be integrated with lifestyle modifications and nutritional counseling to maximize therapeutic benefits.Future research should focus on the long-term efficacy,safety,and patient-reported outcomes to refine clinical practice and optimize the role of endoscopic interventions in obesity treatment.
文摘BACKGROUND Gastric antral vascular ectasia(GAVE)accounts for up to 4%of nonvariceal upper gastrointestinal bleeding.Argon plasma coagulation and radiofrequency ablation have been primary treatment modalities for patients with linear and punctate subtypes,with a newer trend of utilization of endoscopic band ligation(EBL).This study evaluates the outcomes of patients undergoing treatment for nodular GAVE.We hypothesize that patients treated initially with EBL will achieve higher rates of clinical remission with fewer endoscopic treatments and a shorter treatment interval.AIM To investigate the effects of EBL as an initial treatment therapy on outcomes associated with nodular GAVE.METHODS A total of 37 patients at a tertiary medical center with nodular GAVE were included in this retrospective study.The study population was divided between those treated initially with EBL(initial EBL)and initial endoscopic thermal therapy.Pretreatment and post-treatment hemoglobin values,the model for end-stage liver disease scores,hospitalization rates,and other outcomes.Additionally,endoscopic treatment modality type and frequency were recorded,including radiofrequency ablation,argon plasma coagulation,and EBL.Continuous variables were compared using a t-test,while categorical variables were compared using Fisher’s exact.RESULTS Linear regression analysis displayed a positive relationship between the time interval from initial therapeutic esophagogastroduodenoscopy to first EBL treatment and overall treatment interval(t=7.39,P<0.001),as well as between the number of endoscopic treatments(t=8.09,P<0.001).Hemoglobin levels increased in both the initial EBL group(8.7 vs 11.4,P<0.001)and the initial endoscopic thermal therapy group(8.6 vs 10.4,P=0.042).Clinical remission rates were higher in the initial EBL group(90%vs 69%P=0.041),with a non-significant trend of higher endoscopic remission rates(57.1%vs 37.5%,P=0.270).CONCLUSION The observed trend favoring EBL,combined with its association with improved clinical remission and reduced treatment burden,supports its consideration as a preferred initial treatment approach.
基金Supported by National Key R and D Program of China-Key Special Project on Diagnostic and Therapeutic Equipment and Biomedical Materials,No.2023YFC2412005。
文摘BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficulty of surgery.The use of ERAT in appendicitis remains contentious,prompting the presentation of this case report.CASE SUMMARY We report the case of a 43-year-old female patient presenting with intermittent right lower abdominal pain for one day.The patient had undergone ERAT six months previously.Examination revealed stent impaction in the appendix,leading to exacerbated inflammation.Subsequently,a solo single-incision laparo-scopic appendectomy(SSLA)was performed.The ERAT-related complications increased surgical difficulty and prolonged the operation time.Post-SSLA,the patient was hospitalized for one day and showed favorable recovery upon follow-up.CONCLUSION This case highlights the risks of ERAT.Thorough preoperative assessment,proper stent placement during surgery and regular postoperative follow-up are crucial in preventing complications,as their occurrence can increase surgical difficulty.Compared to ERAT,SSLA remains more widely used in clinical practice.Both techniques require further clinical data and research to optimize their application.
文摘Gastric variceal(GV)bleeding remains a life-threatening complication of portal hypertension,with ongoing debate regarding the optimal endoscopic therapy.Conventional endoscopic cyanoacrylate injection(ECI)is effective but limited by the risk of ectopic embolism,particularly in the presence of gastrorenal shunts.Clip-assisted ECI(clip-ECI)has emerged as a novel modification designed to reduce embolic risk while maintaining hemostatic efficacy.We appraised the recent study by Xiong et al,which compared clip-ECI with endoscopic ultrasoundguided coil and cyanoacrylate injection in 108 propensity-matched patients with cardiofundal varices and shunts.Both techniques demonstrated comparable efficacy,with obliteration rates exceeding 90%and similar one-year rebleeding rates.Importantly,no embolic events were reported.These findings are consistent with prior studies,including multicenter cohorts and a recent randomized controlled trial,which highlight clip-ECI as a safe,effective,and efficient technique,with advantages of shorter procedure times,fewer sessions,and lower costs.While endoscopic ultrasound(EUS)-guided therapy offers precision in expert hands,clip-ECI provides a practical,accessible alternative,particularly in resource-limited settings.Larger prospective studies with standardized definitions and cost-effectiveness analyses are needed to refine treatment algorithms.Clip-ECI represents a promising“flow-control assisted”strategy and a real-world alternative to EUS-based therapies for GV.
文摘BACKGROUND Biliary anastomotic stricture(BAS)occurs in approximately 14%-20%of patients post-orthotopic liver transplantation(post-OLT).Endoscopic retrograde cholan-giopancreatography(ERCP)using multiple plastic stents(MPSs)or fully covered self-expandable metal stents(cSEMSs)represent the standard treatment for BAS post-OLT.Recently,cSEMSs have emerged as the primary option for managing BAS post-OLT.AIM To compare the resolution and recurrence of BAS rates in these patients.METHODS This retrospective cohort study was conducted in a single tertiary care center(Hospital Israelita Albert Einstein,São Paulo,Brazil).We reported the results of endoscopic therapy in patients with post-OLT BAS between 2012 and 2022.Patients were stratified into two groups according to therapy:(1)MPSs;and(2)cSEMSs.Primary endpoints were to compare stricture resolution and recurrence among the groups.The secondary endpoint was to identify predictive factors for stricture recurrence.RESULTS A total of 104 patients were included.Overall stricture resolution was 101/104(97.1%).Stricture resolution was achieved in 83/84 patients(99%)in the cSEMS group and 18/20 patients(90%)in the MPS group(P=0.094).Failure occurred in 3/104 patients(2.8%).Stricture recurrence occurred in 9/104 patients(8.7%).Kaplan-Meier analysis showed there was no difference in recurrence-free time among the groups(P=0.201).A multivariate analysis identified the number of ERCP procedures(hazard ratio=1.4;95%confidence interval:1.194-1.619;P<0.001)and complications(hazard ratio=2.8;95%confidence interval:1.008-7.724;P=0.048)as predictors of stricture recurrence.CONCLUSION cSEMSs and MPSs were effective and comparable regarding BAS post-OLT resolution and recurrence.The number of ERCP procedures and complications were predictors of stricture recurrence.
文摘BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening emergency.Endoscopic hemostasis and vascular interventional therapy are two major minimally invasive treatment strategies.Although these modalities are widely used,their comparative efficacy and safety across different patient populations and anatomical sites remain controversial.AIM To evaluate the clinical outcomes and safety of endoscopic hemostasis combined with vascular interventional therapy for NVUGIB.METHODS A systematic search was done on PubMed,EMBASE,Cochrane Library,and Web of Science(from database establishment to April 2025).Randomized controlled trial(RCT)quality was assessed via Cochrane RoB 2.0,and observational studies via the Critical Appraisal Skills Program.RevMan 5.4 was used for quantitative analysis;fixed/random-effects models were chosen through I^(2)-assessed heterogeneity.Publication bias was checked using funnel plots and sensitivity analysis via model switching.RESULTS Twenty-one studies(3 RCTs,12 single-group studies,and 6 retrospective cohort studies)with good quality were included.For single-group data,combined therapy had risk differences of 0.70(clinical success),0.24(mortality),and 0.22(rebleeding;all P<0.00001,I^(2)=0).Moreover,the≥60-year rebleeding risk difference was 0.43.Reintervention was found to differ by approach(Z=3.03,P=0.002,inter-subgroup I^(2)=99%).In the RCT and cohort studies,combined vs standard therapy had similar initial hemostasis(Z=0.04,P=0.97)and mortality(Z=1.56,P=0.12)but lower rebleeding(Z=3.26/P=0.001;Z=2.95/P=0.03).Symmetrical funnel plots and robust sensitivity analysis showed no publication bias.CONCLUSION Combined endoscopic hemostasis and vascular interventional therapy for acute NVUGIB can significantly reduce rebleeding,without differences in mortality.Age and vascular interventional methods may influence the therapeutic efficacy.
文摘Endoscopic ultrasound(EUS)guided vascular interventions have expanded the reach of therapeutic endoscopy to include vascular pathology previously inaccessible by endoscopists.Gastric variceal bleeding comprises 20%of all variceal bleeding and is associated with high morbidity and mortality.Historically,endoscopic injection of thrombosis-inducing agents such as glue has been used.However,glue injection carries potential risks including systemic embolization,damage to the endoscope,and recurrent bleeding.The introduction of hemostatic coils has revolutionized the endoscopic approach,with EUS-guided coil embolization emerging as an effective and safe modality for the management of gastric varices(GVs).When compared with conventional glue injection,EUSguided embolization is associated with improved visualization,higher efficacy,and better safety profile.Despite its expanding adoption,the standardization of EUS guided embolization remains a challenge.High-quality studies are needed to standardize this promising technique and define its role in clinical practice.In this review,we will discuss the indications,efficacy,techniques,and various approaches for EUS-guided embolization of GVs.
文摘This study presents a comprehensive overview of post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP),detailing its epidemiology,pathophysiology,prevention,and treatment.PEP is the most common complication of ERCP,with an incidence of 3%,16%,and above 20%in high-risk patients.Proposed mechanisms include mechanical trauma,pancreatic-duct(PD)hypertension,oxidative stress,and dysbiosis-driven inflammation.Mitochondrial oxidative stress is a central pathological driver:It activates the NLRP3 inflammasome and the STING pathway,perpetuating a deleterious“injury-inflammation"cycle.Risk factors encompass patient characteristics,procedural variables,and operator-related factors.Preventive strategies combine pharmacological and procedural measures.Rectal non-steroidal anti-inflammatory drugs(NSAIDs),such as indomethacin,inhibit prostaglandin synthesis.European guidelines report that NSAIDs reduce the overall incidence of PEP,with odds ratios of 0.24-0.63.Subgroup analyses indicate the greatest benefit in high-risk cohorts,with mixed-risk groups also deriving more benefit than average-risk groups.In high-risk patients,prophylactic PD stenting markedly lowers PEP incidence by alleviating ductal hypertension.Aggressive fluid resuscitation enhances pancreatic perfusion and decreases the frequency of moderate-to-severe PEP.Recent therapeutic advances emphasize targeted interventions.Mitochondria-directed nanomedicines cross the blood-pancreas barrier,scavenge reactive oxygen species,and attenuate inflammatory cascades.A multidisciplinary team(MDT)approach optimizes infection control and manages complications in severe PEP,improving clinical outcomes.Future research should focus on addressing genetic susceptibility,developing novel targeted agents,and integrating artificial intelligence-assisted risk stratification to refine personalized prevention and therapy.This article reviews the epidemiological and pathophysiological foundations of PEP,evaluates evidencebased preventive strategies(e.g.,NSAIDs,pancreatic duct stenting),and discusses emerging approaches such as gene therapy.It also summarizes advances in treating mild and severe PEP,highlights the role of MDT care,identifies current knowledge gaps,and proposes directions for future research,including the discovery of novel biomarkers and the development of personalized preventive and therapeutic strategies.
文摘BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete clinical response after neoadjuvant treatment,which often translates to pathologic complete response(pCR)as assessed on surgical specimens after curative intent surgery.Endoscopy plays a significant role in assessing treatment response to neoadjuvant therapies.AIM To explore the role of endoscopy in predicting subsequent pCR after neoadjuvant treatment in rectal cancer patients.METHODS An extensive literature review was undertaken to identify the criteria used for assessment of endoscopic response and their ability to predict pCR.RESULTS Fifteen studies were identified through literature review.The most commonly used endoscopic criteria for evaluation included the presence of a flat white scar and the absence of nodularity or telangiectasia.Information on the timing of endoscopic assessment in relation to neoadjuvant treatment protocols were also extracted from the studies.In most studies,the diagnostic accuracy for predicting pCR exceeded 0.8.The main limitations identified were the retrospective design of included studies included and a moderate risk of bias.CONCLUSION Endoscopy can be a key prognostic factor in predicting pCR to neoadjuvant treatment in rectal cancer despite significant limitations in currently available data.
文摘Liver-directed therapies such as resection,ablation,and embolization offer potentially curative options for patients with primary and metastatic liver tumors as part of multidisciplinary oncology care.However,these treatments pose significant hepatic decompensation risks,particularly with underlying liver disease and chemotherapy-associated steatohepatitis.Accurate assessment of liver function and portal hypertension(PH)is critical for candidate selection.While Child-Pugh score and model for end-stage liver disease are commonly used,they have substantial limitations.Hepatic venous pressure gradient(HVPG)measurement remains the gold standard for assessing PH but is invasive and not widely available.Endoscopic ultrasound(EUS)guided portal pressure gradient(PPG)measurement has emerged as a promising minimally invasive alternative.EUSPPG demonstrates excellent technical success rates,safety profile,and correlation with HVPG in early studies.By providing direct portal pressure measurement,EUS-PPG offers several advantages over existing methods for prognostication and risk stratification prior to liver-directed therapies,particularly in detecting presinusoidal hypertension.Furthermore,it has potential applications in assessing response to neoadjuvant treatments and guiding adjuvant therapies.However,research is needed to validate its predictive performance and cost-effectiveness in larger prospective cohorts and to establish its accuracy compared to non-invasive assessment of liver function.
文摘BACKGROUND Esophageal squamous cell carcinoma(ESCC)is often managed with surgery,which is the first-line treatment option for stage I–III lesions.However,definitive chemoradiotherapy(dCRT)is associated with a recurrence rate of 30%in stage I ESCC and higher rates in advanced-staged lesions.However,several patients prefer dCRT because their general condition is poor.Salvage therapies,including esophagectomy and endoscopic resection[endoscopic submucosal dissection(ESD)/endoscopic mucosal resection],are important for residual or recurrent tumors that develop after dCRT.Esophagectomy can have curative potential.However,it has high complication and mortality rates.Therefore,ESD is a safer alternative.CASE SUMMARY A Japanese man in his 70s was concurrently diagnosed with right hypopha-ryngeal cancer(T2N1M0,cStage III),left oropharyngeal cancer(T1N0M0,cStage I),and left hard palate cancer(T1N0M0,cStage I).Esophagogastroduodenoscopy(EGD)revealed a 20 mm reddish 0-Is+IIb lesion in the upper thoracic esophagus,with an invasion depth of SM2.The lesion was diagnosed as an esophageal mo-derately differentiated squamous cell carcinoma(T1bN0M0,cStage I).As the pharyngeal cancers were in advanced stages,chemoradiotherapy(docetaxel and cisplatin with a radiation dose of 66 Gy)was prioritized.Post-chemoradiotherapy EGD showed that the lesion had flattened into a 0-IIb lesion,thereby indicating a reduced invasion depth(epi-thelium or lamina propria mucosa).ESD achieved en bloc and histologically confirmed curative resection.At 22 months after ESD,the patient did not present with signs of recurrence.CONCLUSION This case emphasizes that ESD can be successfully utilized as a salvage treatment for ESCC after chemoradio-therapy for otolaryngological cancers.
文摘BACKGROUND Neoadjuvant therapy(NAT)for pancreatic cancer(PC)is becoming standardized,with neoadjuvant chemoradiotherapy(NACRT)showing proven effectiveness.However,the optimal endoscopic biliary drainage approach during NAT remains controversial.In this single-center retrospective case series,we report the use of a novel multi-hole self-expandable metallic stent(MH-SEMS)for preoperative biliary drainage during NACRT in patients with PC.AIM To assess the feasibility of endoscopic biliary drainage using MH-SEMS during NACRT in patients with malignant distal biliary obstruction secondary to resectable and borderline resectable PC.METHODS We included 14 patients—10 with resectable,2 with borderline resectable,and 2 with unresectable locally advanced disease—who had undergone surgery after biliary drainage using MH-SEMS(diameter:10 mm).Clinical and technical success was achieved in all patients,with a median interval of 105 days between stent placement and surgery.RESULTS A partial response was observed in five patients(35.7%),whereas nine patients(64.3%)exhibited stable disease.Only one patient(7.1%)developed moderate cholangitis from recurrent biliary obstruction caused by sludge 337 days after stent placement during systemic chemotherapy,requiring MH-SEMS replacement.Pathological examination of postoperative specimens revealed tumor shrinkage in many cases,and no stent migration was observed.Adverse events included mild pancreatitis in two patients(14.3%)and moderate pancreatitis in one patient(7.1%),as defined by the Tokyo Criteria 2024.CONCLUSION No cases of cholecystitis,liver abscess,or hemorrhage were reported.No disadvantages in surgical procedures or postoperative complications related to MH-SEMS placement were observed.
文摘Esophageal carcinoma is a highly lethal cancer associated with high morbidity and mortality. Esophageal squamous cell carcinoma and esophageal adenocarcinoma are the two distinct histological types. There has been significant progress in endoscopic diagnosis and treatment of early stages of cancer using resection and ablation techniques, as shown in several trials in the recent past. Earlier detection of esophageal cancer and advances in treatment modalities have lead to improvement in the 5-year survival from 5% to about 20% in the past decade. Endoscopic eradication therapy is the preferred modality of treatment in cancer limited to mucosal layer of the esophagus as there is very low risk of lymph node metastasis, leading to high cure rates, low risk of recurrence and with few adverse effects. The most common adverse events seen are strictures, bleeding and rarely perforation which can be endoscopically managed. In patients with recurrent advanced disease or invasive tumor, esophagectomy with lymph node dissection remains the mainstay of treatment. There is debate on post-endoscopic surveillance with some studies suggesting closer follow up with upper endoscopy every 6 mo for the first 1-2 years and then annually for the 3 years while others recommending the appropriate action only if symptoms or other abnormalities develop. Overall, the field of endoscopic therapy is still evolving and focus should be placed on careful patient selection using a multidisciplinary approach.
文摘Benign esophageal strictures refractory to the conventional balloon or bougie dilatation may be subjected to various adjunctive modes of therapy, one of them being endoscopic incisional therapy(EIT). A proper delineation of the stricture anatomy is a prerequisite. A host of electrocautery and mechanical devices may be used, the most common being the use of needle knife, either standard or insulated tip. The technique entails radial incision and cutting off of the stenotic rim. Adjunctive therapies, to prevent re-stenosis, such as balloon dilatation, oral or intralesional steroids or argon plasma coagulation can be used. The common strictures where EIT has been successfully used are Schatzki's rings(SR) and anastomotic strictures(AS). Short segment strictures(< 1 cm) have been found to have the best outcome. When compared with routine balloon dilatation, EIT has equivalent results in treatment na?ve cases but better long term outcome in refractory cases. Anecdotal reports of its use in other types of strictures have been noted. Post procedure complications of EIT are mild and comparable to dilatation therapy. As of the current evidence, incisional therapy can be used for management of refractory AS and SR with relatively short stenosis(< 1 cm) with good safety profile and acceptable long term patency.
