AIM To simplify the diagnostic criteria for superficial esophageal squamous cell carcinoma(SESCC) on Narrow Band Imaging combined with magnifying endoscopy(NBI-ME).METHODS This study was based on the post-hoc analysis...AIM To simplify the diagnostic criteria for superficial esophageal squamous cell carcinoma(SESCC) on Narrow Band Imaging combined with magnifying endoscopy(NBI-ME).METHODS This study was based on the post-hoc analysis of a randomized controlled trial. We performed NBI-ME for 147 patients with present or a history of squamous cell carcinoma in the head and neck, or esophagus between January 2009 and June 2011. Two expert endoscopistsdetected 89 lesions that were suspicious for SESCC lesions, which had been prospectively evaluated for the following 6 NBI-ME findings in real time: "intervascular background coloration"; "proliferation of intrapapillary capillary loops(IPCL)"; and "dilation", "tortuosity", "change in caliber", and "various shapes(VS)" of IPCLs(i.e., Inoue's tetrad criteria). The histologic examination of specimens was defined as the gold standard for diagnosis. A stepwise logistic regression analysis was used to identify candidates for the simplified criteria from among the 6 NBI-ME findings for diagnosing SESCCs. We evaluated diagnostic performance of the simplified criteria compared with that of Inoue's criteria.RESULTS Fifty-four lesions(65%) were histologically diagnosed as SESCCs and the others as low-grade intraepithelial neoplasia or inflammation. In the univariate analysis, proliferation, tortuosity, change in caliber, and VS were significantly associated with SESCC(P < 0.01). The combination of VS and proliferation was statistically extracted from the 6 NBI-ME findings by using the stepwise logistic regression model. We defined the combination of VS and proliferation as simplified dyad criteria for SESCC. The areas under the curve of the simplified dyad criteria and Inoue's tetrad criteria were 0.70 and 0.73, respectively. No significant difference was shown between them. The sensitivity, specificity, and accuracy of diagnosis for SESCC were 77.8%, 57.1%, 69.7% and 51.9%, 80.0%, 62.9% for the simplified dyad criteria and Inoue's tetrad criteria, respectively.CONCLUSION The combination of proliferation and VS may serve as simplified criteria for the diagnosis of SESCC using NBIME.展开更多
Endoscopy has important roles in the management of primary sclerosing cholangitis(PSC),ranging fromnarrowing down the differential diagnoses,screening for complications,determining prognosis and therapy.While the need...Endoscopy has important roles in the management of primary sclerosing cholangitis(PSC),ranging fromnarrowing down the differential diagnoses,screening for complications,determining prognosis and therapy.While the need for a diagnostic endoscopic retrograde cholangiopancreatography(ERCP)may be obviated by a positive magnetic resonance cholangiopancreatography(MRCP),a negative MRCP does not exclude PSC and may therefore necessitate an ERCP,which is traditionally regarded as the gold standard.In this editorial we have not covered the endoscopic management of inflammatory bowel disease in the context of PSC nor of endoscopic surveil ance and treatment of portal hypertension complicating PSC.展开更多
This letter aims to discuss the article,published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2025.Endoscopic retrograde cholangiopan-creatography(ERCP)is widely acknowledged as an effective...This letter aims to discuss the article,published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2025.Endoscopic retrograde cholangiopan-creatography(ERCP)is widely acknowledged as an effective procedure for managing biliary obstruction.However,its use in very elderly patients,partic-ularly centenarians,presents unique challenges related to both safety and efficacy.In this report,we share our experience with three centenarian patients who underwent ERCP for biliary obstruction in our unit.Remarkably,all patients had favorable outcomes,and no significant adverse events were observed.展开更多
BACKGROUND Difficult benign biliary and pancreatic strictures are generally managed by using a Soehendra screw or cystotome.Many previous studies described the techniques without information even of mid-term follow-up...BACKGROUND Difficult benign biliary and pancreatic strictures are generally managed by using a Soehendra screw or cystotome.Many previous studies described the techniques without information even of mid-term follow-up.AIM To confirm the long-term patency of dilated strictures following the application of a cystotome.METHODS Data were collected from analysis of the literature using appropriate key words.Technical success was defined as the ability to traverse the stricture.Clinical success was defined as drainage of biliary or pancreatic strictures and symptoms’resolution.PRISMA criteria were followed to write the present review.RESULTS Three papers were selected following the inclusion criteria.Our case series was added to the review of the literature.Reported technical and clinical success rates were 100%in all the studies and the rate of adverse events was reported from 9.1%to 60%.However,data on follow-up and long-term patency are scant.CONCLUSION The use of a cystotome can be considered an alternative method for dilation of difficult pancreatic and biliary strictures,after the failure of conventional modalities.According to available literature,long-term results are rarely described,and this is still a crucial issue to evaluate the effectiveness of the technique.展开更多
BACKGROUND An 81-year-old patient presented to our center with pancreatic head cancer,obstructive jaundice,and acute cholecystitis.Due to duodenal tumor infiltration,both endoscopic retrograde cholangiopancreatography...BACKGROUND An 81-year-old patient presented to our center with pancreatic head cancer,obstructive jaundice,and acute cholecystitis.Due to duodenal tumor infiltration,both endoscopic retrograde cholangiopancreatography and endoscopic ultrasound(EUS)-guided choledochoduodenostomy were technically challenging.CASE SUMMARY An EUS-guided gallbladder drainage along with an EUS-guided fine needle biopsy were performed,resulting in a diagnosis of pancreatic cancer resolution of jaundice and improvement in acute cholecystitis,all in a safe and effective single endoscopic session.CONCLUSION This case demonstrated the successful use of EUS-guided gallbladder drainage and EUS-guided fine needle biopsy in a patient with pancreatic cancer invading the duodenal wall.展开更多
Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is emerging as a preferred approach for managing malignant gastric outlet obstruction.This technique offers a balance between the durability of surgical gastrojeju...Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is emerging as a preferred approach for managing malignant gastric outlet obstruction.This technique offers a balance between the durability of surgical gastrojejunostomy(SGJ)and the minimally invasive nature of endoscopic methods.Compared to enteral stenting,EUS-GE shows superior outcomes,including higher long-term patency,lower symptom recurrence,and fewer reinterventions.It also demonstrates comparable or better efficacy than SGJ,with faster oral intake,shorter hospital stays,and reduced complications.However,EUS-GE requires specialized expertise,and long-term outcome data remain limited,so further research is needed to refine protocols and optimize patient selection.展开更多
BACKGROUND Despite growing evidence on endoscopic full thickness resection(EFTR),data on segment-specific outcomes in real-world patients remain limited.AIM To investigate segment-specific outcomes of EFTR using a ful...BACKGROUND Despite growing evidence on endoscopic full thickness resection(EFTR),data on segment-specific outcomes in real-world patients remain limited.AIM To investigate segment-specific outcomes of EFTR using a full-thickness resection device(FTRD)for neoplastic colorectal lesions.METHODS In this multicenter,retrospective study,EFTR was conducted in unselected realworld patients referred to participating German centers after colonoscopy confirmed EFTR eligibility.The primary outcome was histologically complete resection(R0)of the lesion,including segment-specific outcomes and adverse events(AE).Additional efficacy and safety parameters were investigated by colonic topography for up to 30 days.RESULTS The analysis included 102 patients(64 males,38 females)with a median age of 70 years.EFTR via FTRD was technically successful in all patients.The R0 rate was 81.4%,segment-specifically ranging from 85.0%(rectum),84.6%(descending colon),84.0%(ascending colon),83.3%(cecum),and 76.5%(sigmoid colon)to 73.3%(transverse colon).Examination time was longer in proximal parts compared to the rectosigmoid(non-significant).Overall,33 patients(32.4%)experienced AE,including only one major complication(0.98%;perforation of sigmoid colon).Abdominal postsurgical pain(18.6%),hematochezia(9.8%),and hemoglobin decline(7.8%)were the most frequent minor complications.Transverse colon lesions had the numerically highest rate of AE,with 8 of 15 patients(53.3%)affected.CONCLUSION EFTR is efficacious for neoplastic colorectal lesions,though R0 rates vary by location.This may impact patient education,selection of the operator,and consideration of laparoscopy surgery.展开更多
Bariatric and metabolic surgeries have gained extensive popularity and trust due to their documented efficacy and safety in managing not only obesity but also associated comorbidities such as diabetes mellitus, hypert...Bariatric and metabolic surgeries have gained extensive popularity and trust due to their documented efficacy and safety in managing not only obesity but also associated comorbidities such as diabetes mellitus, hypertension, dyslipidemia, sleep apnea, and joint pain. Traditionally, bariatric surgeries have been categorized into hypoabsorptive, restrictive, or hybrid approaches. However, these classifications inadequately reflect the complex anatomical and physiological alterations associated with modern surgical methodologies. This paper explores the evolution of metabolic surgeries, emphasizing the integration of physiological concepts into classic procedures to provide more tailored and effective treatment options for obesity and its comorbidities. Finally, the proposal for a new classification based on current metabolic concepts will facilitate communication among patients, doctors, and healthcare professionals. Additionally, it will enable a more didactic and standardized approach to data collection for conducting studies and publications.展开更多
Gastrointestinal leaks and fistulae are serious, potentially life threateningconditions that may occur with a wide variety of clinical presentations. Leaks aremostly related to post-operative anastomotic defects and a...Gastrointestinal leaks and fistulae are serious, potentially life threateningconditions that may occur with a wide variety of clinical presentations. Leaks aremostly related to post-operative anastomotic defects and are responsible for animportant share of surgical morbidity and mortality. Chronic leaks and longstanding post-operative collections may evolve in a fistula between twoepithelialized structures. Endoscopy has earned a pivotal role in the managementof gastrointestinal defects both as first line and as rescue treatment. Endotherapyis a minimally invasive, effective approach with lower morbidity and mortalitycompared to revisional surgery. Clips and luminal stents are the pioneer ofgastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closuredevices and techniques, such as endoscopic internal drainage, suturing systemand vacuum therapy, has broadened the indications of endoscopy for themanagement of GI wall defect. Although several endoscopic options are currentlyused, a standardized evidence-based algorithm for management of GI defect isnot available. Successful management of gastrointestinal leaks and fistulaerequires a tailored and multidisciplinary approach based on clinical presentation,defect features (size, location and onset time), local expertise and the availabilityof devices. In this review, we analyze different endoscopic approaches, which weselected on the basis of the available literature and our own experience. Then, weevaluate the overall efficacy and procedural-specific strengths and weaknesses ofeach approach.展开更多
BACKGROUND It is widely recognized that endoscopic resection(ER) of superficial nonampullary duodenal epithelial tumors(SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleedi...BACKGROUND It is widely recognized that endoscopic resection(ER) of superficial nonampullary duodenal epithelial tumors(SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleeding and perforation.These adverse events could be more critical than those occurring in other levels of the gastrointestinal tract. Because of the low prevalence of the disease and the high risks of severe adverse events, the curability including short-and long-term outcomes have not been standardized yet.AIM To investigate the curability including short-and long-term outcomes of ER for SNADETs in a large case series.METHODS This retrospective study included cases that underwent ER for SNADETs at our university hospital between March 2004 and July 2017. Short-term outcomes of ER were measured based on en bloc and R0 resection rates as well as adverse events. Long-term outcomes included local recurrence detected on endoscopic surveillance and disease-specific mortality in patients followed up for ≥ 12 mo after ER.RESULTS In the study, 131 patients with 147 SNADETs were analyzed. The 147 ERs consisted of 136 endoscopic mucosal resections(EMRs)(93%) and 11 endoscopic submucosal dissections(ESDs)(7%). The median tumor diameter was 10 mm.The pathology diagnosis was adenocarcinoma(56/147, 38%), high-grade intraepithelial neoplasia(44/147, 30%), or low-grade intraepithelial neoplasia(47/147, 32%). The R0 resection rate was 68%(93/136) in the EMR group and73%(8/11) in the ESD group, respectively. Cap-assisted EMR(known as EMR-C)showed a higher rate of R0 resection compared to the conventional method of EMR using a snare(78% vs 62%, P = 0.06). No adverse event was observed in the EMR group, whereas delayed bleeding, intraoperative perforation, and delayed perforation in 3, 3, and 5 patients occurred in the ESD group, respectively. One patient with perforation required emergency surgery. In the 43 mo median follow-up period, local recurrence was found in four EMR cases and all cases were treated endoscopically. No patient died due to tumor recurrence.CONCLUSION Our findings suggest that ER provides good long-term outcomes in the patients with SNADETs. EMR is likely to become the safe and reliable treatment for small SNADETs.展开更多
AIM: To detect pancreatic neuroendocrine tumors (PNETs) has been varied. This study is undertaken to evaluate the accuracy of endoscopic ultrasound (EUS) in detecting PNETs.METHODS: Only EUS studies confirmed by surge...AIM: To detect pancreatic neuroendocrine tumors (PNETs) has been varied. This study is undertaken to evaluate the accuracy of endoscopic ultrasound (EUS) in detecting PNETs.METHODS: Only EUS studies confirmed by surgery or appropriate follow-up were selected. Articles were searched in Medline, Ovid journals, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Pooling was conducted by both fixed and random effects model). RESULTS: Initial search identified 2610 reference articles, of these 140 relevant articles were selected and reviewed. Data was extracted from 13 studies (n = 456) which met the inclusion criteria. Pooled sensitivity of EUS in detecting a PNETs was 87.2% (95%CI: 82.2-91.2). EUS had a pooled specificity of 98.0% (95%CI: 94.3-99.6). The positive likelihood ratio of EUS was 11.1 (95%CI: 5.34-22.8) and negative likelihood ratio was 0.17 (95%CI: 0.13-0.24). The diagnostic odds ratio, the odds of having anatomic PNETs in positive as compared to negative EUS studies was 94.7 (95%CI: 37.9-236.1). Begg-Mazumdar bias indicator for publication bias gave a Kendall's tau value of 0.31 (P = 0.16), indication no publication bias. The P for χ2 heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION: EUS has excellent sensitivity and specificity to detect PNETs. EUS should be strongly considered for evaluation of PNETs.展开更多
AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip(OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.METHODS: From 02-2009 to 10-2012, 84...AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip(OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.METHODS: From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients(48.8%) presented with severe upper-gastrointestinal(GI) bleeding, 3(3.6%) patients with lower-GI bleeding, 7 patients(8.3%) underwent perforation closure, 18 patients(21.4%) had prevention of secondary perforation, 12 patients(14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection(ESD) and 3 patients(3.6%) had an intervention on a chronic fistula. RESULTS: In 78/84 patients(92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients(89.28%). The overall mortality in the study patients was 11/84(13.1%) and was seen in patients with life threatning upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41(85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases(57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18(100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen(2%).CONCLUSION: This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.展开更多
Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative techniques.Endoscopic ultra...Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative techniques.Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases,together with other imaging tests and clinical data.Elastography can be informative,especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions.However,further studies are necessary to standardize the method,increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses.Moreover,even if promising,elastography still provides little information in the evaluation of benign conditions.展开更多
Esophageal variceal bleeding is a severe complication often associated with portal hypertension,commonly due to liver cirrhosis.Prevention and treatment of this condition are critical for patient outcomes.Preventive s...Esophageal variceal bleeding is a severe complication often associated with portal hypertension,commonly due to liver cirrhosis.Prevention and treatment of this condition are critical for patient outcomes.Preventive strategies focus on reducing portal hypertension to prevent varices from developing or enlarging.Primary prophylaxis involves the use of non-selective beta-blockers,such as propranolol or nadolol,which lower portal pressure by decreasing cardiac output and thereby reducing blood flow to the varices.Endoscopic variceal ligation(EVL)may also be employed as primary prophylaxis to prevent initial bleeding episodes.Once bleeding occurs,immediate treatment is essential.Initial management includes hemodynamic stabilization followed by pharmacological therapy with vasoactive drugs such as octreotide or terlipressin to control bleeding.Endoscopic intervention is the cornerstone of treatment,with techniques such as EVL or sclerotherapy applied to directly manage the bleeding varices.In cases where bleeding is refractory to endoscopic treatment,transjugular intrahepatic portosystemic shunt may be considered to effectively reduce portal pressure.Long-term management after an acute bleeding episode involves secondary prophylaxis using betablockers and repeated EVL sessions to prevent rebleeding,complemented by monitoring and managing liver function to address the underlying disease.In light of new scientific evidence,including the findings of the study by Peng et al,this editorial aims to review available strategies for the prevention and treatment of esophageal varices.展开更多
AIM:To further reduce the risk of bleeding or bile leakage.METHODS:We performed endoscopic ultrasound guided biliary drainage in 6 patients in whom endoscopic retrograde cholangiopancreatography(ERCP) had failed.Bilia...AIM:To further reduce the risk of bleeding or bile leakage.METHODS:We performed endoscopic ultrasound guided biliary drainage in 6 patients in whom endoscopic retrograde cholangiopancreatography(ERCP) had failed.Biliary access of a dilated segment 2 or 3 duct was achieved from the stomach using a 19G needle.After radiologically confirming access a guide wire was placed,a transhepatic tract created using a 6 Fr cystotome followed by balloon dilation of the stricture and antegrade metallic stent placement across the malignant obstruction.This was followed by placement of an endocoil in the transhepatic tract.RESULTS:Dilated segmental ducts were observed in all patients with the linear endoscopic ultrasound scope from the proximal stomach.Transgastric biliary access was obtained using a 19G needle in all patients.Biliary drainage was achieved in all patients.Placement of an endocoil was possible in 5/6 patients.All patients responded to biliary drainage and no complications occurred.CONCLUSION:We show that placing endocoils at the time of endoscopic ultrasound guided biliary stenting is feasible and may reduce the risk of bleeding or bile leakage.展开更多
Primary sclerosing cholangitis(PSC) is a chronic,cholestatic liver condition characterized by inflammation,fibrosis,and destruction of the intra-and extrahepatic bile ducts.The therapeutic endoscopist plays a key role...Primary sclerosing cholangitis(PSC) is a chronic,cholestatic liver condition characterized by inflammation,fibrosis,and destruction of the intra-and extrahepatic bile ducts.The therapeutic endoscopist plays a key role in the diagnosis and management of PSC.In patients presenting with a cholestatic profile,endoscopic retrograde cholangiopancreatography(ERCP) is warranted for a definite diagnosis of PSC.Dominant strictures of the bile duct occur in 36%-57% of PSC patients.Endoscopic balloon dilatation with or without stenting have been employed in the management of dominant strictures.In addition,PSC patients are at increased risk of developing cholangiocarcinoma with a 20% lifetime risk.Brush cytology obtained during ERCP and use of fluorescence in situ hybridization forms the initial diagnostic step in the investigation of patients with dominant biliary strictures.Our review aims to summarize the current evidence supporting the role of a therapeutic endoscopist in the management of PSC patients.展开更多
BACKGROUND Endoscopic mucosal resection(EMR)is an effective and minimally invasive alternative to surgery for large polyps and laterally spreading lesions.Gross morphology and surface characteristics may help predict ...BACKGROUND Endoscopic mucosal resection(EMR)is an effective and minimally invasive alternative to surgery for large polyps and laterally spreading lesions.Gross morphology and surface characteristics may help predict submucosal invasion of the lesion(SMIL)during endoscopic evaluation.This is one of the largest singlecenter studies reporting endoscopic mucosal resection for larger(≥20 mm)colorectal lesions in the United States.AIM To determine the recurrence rate of adenomas and endoscopic features that may predict submucosal invasion of colonic mucosal neoplasia.METHODS This is a retrospective cohort study of all the patients referred for endoscopic mucosal resection for lesions≥20 mm,spanning a period from January 2013 to February 2017.The main outcome measure was identifying features that may predict submucosal invasion of mucosal lesions and predict recurrence of adenomas on follow-up surveillance colonoscopy performed at 4-6 mo.RESULTS A total of 480 patients with 500 lesions were included in the study.The median age was 68(Inter quantile range:14)with 52%males.The most common lesion location was ascending colon(161;32%).Paris classification 0-IIa(Flat elevation of mucosa-316;63.2%);Kudo Pit Pattern IIIs(192;38%)and Granular surface morphology(260;52%)were most prevalent.Submucosal invasion was present in 23(4.6%)out of 500 lesions.The independent risk factors for SMIL were Kudo Pit Pattern IIIL+IV and V(Odds ratio:4.5;P value<0.004)and Paris classification 0-IIc(Odds ratio:18.2;P value<0.01).Out of 500,354 post-endoscopic mucosal resection scars were examined at surveillance colonoscopy.Recurrence was noted in 21.8%(77 cases).CONCLUSION There was overall low prevalence of SMIL in our study.Kudo pit pattern(IIIL+IV and V)and Paris classification 0-IIc were the only factors identified as an independent risk factor for submucosal invasion.The independent risk factor for recurrence was adenoma size(>40 mm).Almost all recurrences(98.8%)were treated endoscopically.展开更多
BACKGROUND About 10%-30%of acute pancreatitis remain idiopathic(IAP)even after clinical and imaging tests,including abdominal ultrasound(US),contrast-enhanced computed tomography(CECT)and magnetic resonance cholangiop...BACKGROUND About 10%-30%of acute pancreatitis remain idiopathic(IAP)even after clinical and imaging tests,including abdominal ultrasound(US),contrast-enhanced computed tomography(CECT)and magnetic resonance cholangiopancreatography(MRCP).This is a relevant issue,as up to 20%of patients with IAP have recurrent episodes and 26%of them develop chronic pancreatitis.Few data are available on the role of EUS in clarifying the etiology of IAP after failure of one or more cross-sectional techniques.AIM To evaluate the diagnostic gain after failure of one or more previous crosssectional exams.METHODS We retrospectively collected data about consecutive patients with AP and at least one negative test between US,CECT and MRCP,who underwent linear EUS between January 2017 and December 2020.We investigated the EUS diagnostic yield and the EUS diagnostic gain over different combinations of these crosssectional imaging techniques for the etiologic diagnosis of AP.Types and frequency of EUS diagnosis were also analyzed,and EUS diagnosis was compared with the clinical parameters.After EUS,patients were followed-up for a median of 31.5 mo to detect cases of pancreatitis recurrence.RESULTS We enrolled 81 patients(63%males,mean age 61±18,23%with previous cholecystectomy,17%with recurrent pancreatitis).Overall EUS diagnostic yield for AP etiological diagnosis was 79%(20%lithiasis,31%acute on chronic pancreatitis,14%pancreatic solid or cystic lesions,5%pancreas divisum,5%autoimmune pancreatitis,5%ductal abnormalities),while 21%remained idiopathic.US,CECT and MRCP,taken alone or in combination,led to AP etiological diagnosis in 16(20%)patients;among the remaining 65 patients,49(75%)obtained a diagnosis at EUS,with an overall EUS diagnostic gain of 61%.Sixty-eight patients had negative US;among them,EUS allowed etiological diagnosis in 59(87%).Sixty-three patients had a negative CECT;among them,47(74%)obtained diagnosis with EUS.Twenty-four had a negative MRCP;among them,20(83%)had EUS diagnosis.Twenty-one had negative CT+MRCP,of which 17(81%)had EUS diagnosis,with a EUS diagnostic gain of 63%.Patients with biliary etiology and without previous cholecystectomy had higher median values of alanine aminotransferase(154 vs 25,P=0.010),aspartate aminotransferase(95 vs 29,P=0.018),direct bilirubin(1.2 vs 0.6,P=0.015),gammaglutamyl transpeptidase(180 vs 48,P=0.006)and alkaline phosphatase(150 vs 72,P=0.015)Chronic pancreatitis diagnosis was more frequent in patients with recurrent pancreatitis at baseline(82%vs 21%,P<0.001).During the follow-up,AP recurred in 3 patients,one of which remained idiopathic.CONCLUSION EUS is a good test to define AP etiology.It showed a 63%diagnostic gain over CECT+MRCP.In suitable patients,EUS should always be performed in cases of IAP.Further prospective studies are needed.展开更多
Commentary on the article written and published by Peng et al,investigating the role of endoscopic ultrasound(EUS)-guided biliary drainage for palliation of malignant biliary obstruction after failed endoscopic retrog...Commentary on the article written and published by Peng et al,investigating the role of endoscopic ultrasound(EUS)-guided biliary drainage for palliation of malignant biliary obstruction after failed endoscopic retrograde cholangiopan-creatography(ERCP).For 40 years endoscopic biliary drainage was synonymous with ERCP,and EUS was used mainly for diagnostic purposes.The advent of therapeutic EUS has revolutionized the field,especially with the development of a novel device such as electrocautery-enhanced lumen-apposing metal stents.Complete biliopancreatic endoscopists with both skills in ERCP and in interven-tional EUS,would be ideally suited to ensure patients the best drainage technique according to each individual situation.展开更多
Gastroparesis is a chronic disease of the stomach that causes a delayed gastric emptying,without the presence of a stenosis.For 30 years the authors identified pylorospasm as one of the most important pathophysiologic...Gastroparesis is a chronic disease of the stomach that causes a delayed gastric emptying,without the presence of a stenosis.For 30 years the authors identified pylorospasm as one of the most important pathophysiological mechanisms determining gastroparesis.Studies with EndoFLIP,a device that assesses pyloric distensibility,increased the knowledge about pylorospasm.Based on this data,several pyloric-targeted therapies were developed to treat refractory gastroparesis:Surgical pyloroplasty and endoscopic approach,such as pyloric injection of botulinum and pyloric stenting.Notwithstanding,the success of most of these techniques is still not complete.In 2013,the first human gastric per-oral endoscopic myotomy(GPOEM)was performed.It was inspired by the POEM technique,with a similar dissection method,that allows pyloromyotomy.Therapeutical results of GPOEM are similar to surgical approach in term of clinical success,adverse events and post-surgical pain.In the last 8 years GPOEM has gained the attention of the scientific community,as a minimally invasive technique with high rate of clinical success,quickly prevailing as a promising therapy for gastroparesis.Not surprisingly,in referral centers,its technical success rate is 100%.One of the main goals of recent studies is to identify those patients that will respond better to the therapies targeted on pylorus and to choose the better approach for each patient.展开更多
文摘AIM To simplify the diagnostic criteria for superficial esophageal squamous cell carcinoma(SESCC) on Narrow Band Imaging combined with magnifying endoscopy(NBI-ME).METHODS This study was based on the post-hoc analysis of a randomized controlled trial. We performed NBI-ME for 147 patients with present or a history of squamous cell carcinoma in the head and neck, or esophagus between January 2009 and June 2011. Two expert endoscopistsdetected 89 lesions that were suspicious for SESCC lesions, which had been prospectively evaluated for the following 6 NBI-ME findings in real time: "intervascular background coloration"; "proliferation of intrapapillary capillary loops(IPCL)"; and "dilation", "tortuosity", "change in caliber", and "various shapes(VS)" of IPCLs(i.e., Inoue's tetrad criteria). The histologic examination of specimens was defined as the gold standard for diagnosis. A stepwise logistic regression analysis was used to identify candidates for the simplified criteria from among the 6 NBI-ME findings for diagnosing SESCCs. We evaluated diagnostic performance of the simplified criteria compared with that of Inoue's criteria.RESULTS Fifty-four lesions(65%) were histologically diagnosed as SESCCs and the others as low-grade intraepithelial neoplasia or inflammation. In the univariate analysis, proliferation, tortuosity, change in caliber, and VS were significantly associated with SESCC(P < 0.01). The combination of VS and proliferation was statistically extracted from the 6 NBI-ME findings by using the stepwise logistic regression model. We defined the combination of VS and proliferation as simplified dyad criteria for SESCC. The areas under the curve of the simplified dyad criteria and Inoue's tetrad criteria were 0.70 and 0.73, respectively. No significant difference was shown between them. The sensitivity, specificity, and accuracy of diagnosis for SESCC were 77.8%, 57.1%, 69.7% and 51.9%, 80.0%, 62.9% for the simplified dyad criteria and Inoue's tetrad criteria, respectively.CONCLUSION The combination of proliferation and VS may serve as simplified criteria for the diagnosis of SESCC using NBIME.
文摘Endoscopy has important roles in the management of primary sclerosing cholangitis(PSC),ranging fromnarrowing down the differential diagnoses,screening for complications,determining prognosis and therapy.While the need for a diagnostic endoscopic retrograde cholangiopancreatography(ERCP)may be obviated by a positive magnetic resonance cholangiopancreatography(MRCP),a negative MRCP does not exclude PSC and may therefore necessitate an ERCP,which is traditionally regarded as the gold standard.In this editorial we have not covered the endoscopic management of inflammatory bowel disease in the context of PSC nor of endoscopic surveil ance and treatment of portal hypertension complicating PSC.
文摘This letter aims to discuss the article,published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2025.Endoscopic retrograde cholangiopan-creatography(ERCP)is widely acknowledged as an effective procedure for managing biliary obstruction.However,its use in very elderly patients,partic-ularly centenarians,presents unique challenges related to both safety and efficacy.In this report,we share our experience with three centenarian patients who underwent ERCP for biliary obstruction in our unit.Remarkably,all patients had favorable outcomes,and no significant adverse events were observed.
文摘BACKGROUND Difficult benign biliary and pancreatic strictures are generally managed by using a Soehendra screw or cystotome.Many previous studies described the techniques without information even of mid-term follow-up.AIM To confirm the long-term patency of dilated strictures following the application of a cystotome.METHODS Data were collected from analysis of the literature using appropriate key words.Technical success was defined as the ability to traverse the stricture.Clinical success was defined as drainage of biliary or pancreatic strictures and symptoms’resolution.PRISMA criteria were followed to write the present review.RESULTS Three papers were selected following the inclusion criteria.Our case series was added to the review of the literature.Reported technical and clinical success rates were 100%in all the studies and the rate of adverse events was reported from 9.1%to 60%.However,data on follow-up and long-term patency are scant.CONCLUSION The use of a cystotome can be considered an alternative method for dilation of difficult pancreatic and biliary strictures,after the failure of conventional modalities.According to available literature,long-term results are rarely described,and this is still a crucial issue to evaluate the effectiveness of the technique.
文摘BACKGROUND An 81-year-old patient presented to our center with pancreatic head cancer,obstructive jaundice,and acute cholecystitis.Due to duodenal tumor infiltration,both endoscopic retrograde cholangiopancreatography and endoscopic ultrasound(EUS)-guided choledochoduodenostomy were technically challenging.CASE SUMMARY An EUS-guided gallbladder drainage along with an EUS-guided fine needle biopsy were performed,resulting in a diagnosis of pancreatic cancer resolution of jaundice and improvement in acute cholecystitis,all in a safe and effective single endoscopic session.CONCLUSION This case demonstrated the successful use of EUS-guided gallbladder drainage and EUS-guided fine needle biopsy in a patient with pancreatic cancer invading the duodenal wall.
文摘Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is emerging as a preferred approach for managing malignant gastric outlet obstruction.This technique offers a balance between the durability of surgical gastrojejunostomy(SGJ)and the minimally invasive nature of endoscopic methods.Compared to enteral stenting,EUS-GE shows superior outcomes,including higher long-term patency,lower symptom recurrence,and fewer reinterventions.It also demonstrates comparable or better efficacy than SGJ,with faster oral intake,shorter hospital stays,and reduced complications.However,EUS-GE requires specialized expertise,and long-term outcome data remain limited,so further research is needed to refine protocols and optimize patient selection.
文摘BACKGROUND Despite growing evidence on endoscopic full thickness resection(EFTR),data on segment-specific outcomes in real-world patients remain limited.AIM To investigate segment-specific outcomes of EFTR using a full-thickness resection device(FTRD)for neoplastic colorectal lesions.METHODS In this multicenter,retrospective study,EFTR was conducted in unselected realworld patients referred to participating German centers after colonoscopy confirmed EFTR eligibility.The primary outcome was histologically complete resection(R0)of the lesion,including segment-specific outcomes and adverse events(AE).Additional efficacy and safety parameters were investigated by colonic topography for up to 30 days.RESULTS The analysis included 102 patients(64 males,38 females)with a median age of 70 years.EFTR via FTRD was technically successful in all patients.The R0 rate was 81.4%,segment-specifically ranging from 85.0%(rectum),84.6%(descending colon),84.0%(ascending colon),83.3%(cecum),and 76.5%(sigmoid colon)to 73.3%(transverse colon).Examination time was longer in proximal parts compared to the rectosigmoid(non-significant).Overall,33 patients(32.4%)experienced AE,including only one major complication(0.98%;perforation of sigmoid colon).Abdominal postsurgical pain(18.6%),hematochezia(9.8%),and hemoglobin decline(7.8%)were the most frequent minor complications.Transverse colon lesions had the numerically highest rate of AE,with 8 of 15 patients(53.3%)affected.CONCLUSION EFTR is efficacious for neoplastic colorectal lesions,though R0 rates vary by location.This may impact patient education,selection of the operator,and consideration of laparoscopy surgery.
文摘Bariatric and metabolic surgeries have gained extensive popularity and trust due to their documented efficacy and safety in managing not only obesity but also associated comorbidities such as diabetes mellitus, hypertension, dyslipidemia, sleep apnea, and joint pain. Traditionally, bariatric surgeries have been categorized into hypoabsorptive, restrictive, or hybrid approaches. However, these classifications inadequately reflect the complex anatomical and physiological alterations associated with modern surgical methodologies. This paper explores the evolution of metabolic surgeries, emphasizing the integration of physiological concepts into classic procedures to provide more tailored and effective treatment options for obesity and its comorbidities. Finally, the proposal for a new classification based on current metabolic concepts will facilitate communication among patients, doctors, and healthcare professionals. Additionally, it will enable a more didactic and standardized approach to data collection for conducting studies and publications.
文摘Gastrointestinal leaks and fistulae are serious, potentially life threateningconditions that may occur with a wide variety of clinical presentations. Leaks aremostly related to post-operative anastomotic defects and are responsible for animportant share of surgical morbidity and mortality. Chronic leaks and longstanding post-operative collections may evolve in a fistula between twoepithelialized structures. Endoscopy has earned a pivotal role in the managementof gastrointestinal defects both as first line and as rescue treatment. Endotherapyis a minimally invasive, effective approach with lower morbidity and mortalitycompared to revisional surgery. Clips and luminal stents are the pioneer ofgastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closuredevices and techniques, such as endoscopic internal drainage, suturing systemand vacuum therapy, has broadened the indications of endoscopy for themanagement of GI wall defect. Although several endoscopic options are currentlyused, a standardized evidence-based algorithm for management of GI defect isnot available. Successful management of gastrointestinal leaks and fistulaerequires a tailored and multidisciplinary approach based on clinical presentation,defect features (size, location and onset time), local expertise and the availabilityof devices. In this review, we analyze different endoscopic approaches, which weselected on the basis of the available literature and our own experience. Then, weevaluate the overall efficacy and procedural-specific strengths and weaknesses ofeach approach.
文摘BACKGROUND It is widely recognized that endoscopic resection(ER) of superficial nonampullary duodenal epithelial tumors(SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleeding and perforation.These adverse events could be more critical than those occurring in other levels of the gastrointestinal tract. Because of the low prevalence of the disease and the high risks of severe adverse events, the curability including short-and long-term outcomes have not been standardized yet.AIM To investigate the curability including short-and long-term outcomes of ER for SNADETs in a large case series.METHODS This retrospective study included cases that underwent ER for SNADETs at our university hospital between March 2004 and July 2017. Short-term outcomes of ER were measured based on en bloc and R0 resection rates as well as adverse events. Long-term outcomes included local recurrence detected on endoscopic surveillance and disease-specific mortality in patients followed up for ≥ 12 mo after ER.RESULTS In the study, 131 patients with 147 SNADETs were analyzed. The 147 ERs consisted of 136 endoscopic mucosal resections(EMRs)(93%) and 11 endoscopic submucosal dissections(ESDs)(7%). The median tumor diameter was 10 mm.The pathology diagnosis was adenocarcinoma(56/147, 38%), high-grade intraepithelial neoplasia(44/147, 30%), or low-grade intraepithelial neoplasia(47/147, 32%). The R0 resection rate was 68%(93/136) in the EMR group and73%(8/11) in the ESD group, respectively. Cap-assisted EMR(known as EMR-C)showed a higher rate of R0 resection compared to the conventional method of EMR using a snare(78% vs 62%, P = 0.06). No adverse event was observed in the EMR group, whereas delayed bleeding, intraoperative perforation, and delayed perforation in 3, 3, and 5 patients occurred in the ESD group, respectively. One patient with perforation required emergency surgery. In the 43 mo median follow-up period, local recurrence was found in four EMR cases and all cases were treated endoscopically. No patient died due to tumor recurrence.CONCLUSION Our findings suggest that ER provides good long-term outcomes in the patients with SNADETs. EMR is likely to become the safe and reliable treatment for small SNADETs.
文摘AIM: To detect pancreatic neuroendocrine tumors (PNETs) has been varied. This study is undertaken to evaluate the accuracy of endoscopic ultrasound (EUS) in detecting PNETs.METHODS: Only EUS studies confirmed by surgery or appropriate follow-up were selected. Articles were searched in Medline, Ovid journals, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Pooling was conducted by both fixed and random effects model). RESULTS: Initial search identified 2610 reference articles, of these 140 relevant articles were selected and reviewed. Data was extracted from 13 studies (n = 456) which met the inclusion criteria. Pooled sensitivity of EUS in detecting a PNETs was 87.2% (95%CI: 82.2-91.2). EUS had a pooled specificity of 98.0% (95%CI: 94.3-99.6). The positive likelihood ratio of EUS was 11.1 (95%CI: 5.34-22.8) and negative likelihood ratio was 0.17 (95%CI: 0.13-0.24). The diagnostic odds ratio, the odds of having anatomic PNETs in positive as compared to negative EUS studies was 94.7 (95%CI: 37.9-236.1). Begg-Mazumdar bias indicator for publication bias gave a Kendall's tau value of 0.31 (P = 0.16), indication no publication bias. The P for χ2 heterogeneity for all the pooled accuracy estimates was > 0.10. CONCLUSION: EUS has excellent sensitivity and specificity to detect PNETs. EUS should be strongly considered for evaluation of PNETs.
基金Supported by The“Endo-Verein Erlangen”a registered non-profit training organization+1 种基金BaiersdorfGermany
文摘AIM: To investigate the efficacy and clinical outcome of patients treated with an over-the-scope-clip(OTSC) system for severe gastrointestinal hemorrhage, perforations and fistulas.METHODS: From 02-2009 to 10-2012, 84 patients were treated with 101 OTSC clips. 41 patients(48.8%) presented with severe upper-gastrointestinal(GI) bleeding, 3(3.6%) patients with lower-GI bleeding, 7 patients(8.3%) underwent perforation closure, 18 patients(21.4%) had prevention of secondary perforation, 12 patients(14.3%) had control of secondary bleeding after endoscopic mucosal resection or endoscopic submucosal dissection(ESD) and 3 patients(3.6%) had an intervention on a chronic fistula. RESULTS: In 78/84 patients(92.8%), primary treatment with the OTSC was technically successful. Clinical primary success was achieved in 75/84 patients(89.28%). The overall mortality in the study patients was 11/84(13.1%) and was seen in patients with life threatning upper GI hemorrhage. There was no mortality in any other treatment group. In detail OTSC application lead to a clinical success in 35/41(85.36%) patients with upper GI bleeding and in 3/3 patients with lower GI bleeding. Technical success of perforation closure was 100% while clinical success was seen in 4/7 cases(57.14%) due to attendant circumstances unrelated to the OTSC. Technical and clinic success was achieved in 18/18(100%) patients for the prevention of bleeding or perforation after endoscopic mucosal resection and ESD and in 3/3 cases of fistula closure. Two application-related complications were seen(2%).CONCLUSION: This largest single center experience published so far confirms the value of the OTSC for GI emergencies and complications. Further clinical experience will help to identify optimal indications for its targeted and prophylactic use.
文摘Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative techniques.Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases,together with other imaging tests and clinical data.Elastography can be informative,especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions.However,further studies are necessary to standardize the method,increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses.Moreover,even if promising,elastography still provides little information in the evaluation of benign conditions.
文摘Esophageal variceal bleeding is a severe complication often associated with portal hypertension,commonly due to liver cirrhosis.Prevention and treatment of this condition are critical for patient outcomes.Preventive strategies focus on reducing portal hypertension to prevent varices from developing or enlarging.Primary prophylaxis involves the use of non-selective beta-blockers,such as propranolol or nadolol,which lower portal pressure by decreasing cardiac output and thereby reducing blood flow to the varices.Endoscopic variceal ligation(EVL)may also be employed as primary prophylaxis to prevent initial bleeding episodes.Once bleeding occurs,immediate treatment is essential.Initial management includes hemodynamic stabilization followed by pharmacological therapy with vasoactive drugs such as octreotide or terlipressin to control bleeding.Endoscopic intervention is the cornerstone of treatment,with techniques such as EVL or sclerotherapy applied to directly manage the bleeding varices.In cases where bleeding is refractory to endoscopic treatment,transjugular intrahepatic portosystemic shunt may be considered to effectively reduce portal pressure.Long-term management after an acute bleeding episode involves secondary prophylaxis using betablockers and repeated EVL sessions to prevent rebleeding,complemented by monitoring and managing liver function to address the underlying disease.In light of new scientific evidence,including the findings of the study by Peng et al,this editorial aims to review available strategies for the prevention and treatment of esophageal varices.
文摘AIM:To further reduce the risk of bleeding or bile leakage.METHODS:We performed endoscopic ultrasound guided biliary drainage in 6 patients in whom endoscopic retrograde cholangiopancreatography(ERCP) had failed.Biliary access of a dilated segment 2 or 3 duct was achieved from the stomach using a 19G needle.After radiologically confirming access a guide wire was placed,a transhepatic tract created using a 6 Fr cystotome followed by balloon dilation of the stricture and antegrade metallic stent placement across the malignant obstruction.This was followed by placement of an endocoil in the transhepatic tract.RESULTS:Dilated segmental ducts were observed in all patients with the linear endoscopic ultrasound scope from the proximal stomach.Transgastric biliary access was obtained using a 19G needle in all patients.Biliary drainage was achieved in all patients.Placement of an endocoil was possible in 5/6 patients.All patients responded to biliary drainage and no complications occurred.CONCLUSION:We show that placing endocoils at the time of endoscopic ultrasound guided biliary stenting is feasible and may reduce the risk of bleeding or bile leakage.
基金Research Grants from the Inflammatory Bowel Disease Working Group and the American College of Gastroenterology(to Navaneethan U)
文摘Primary sclerosing cholangitis(PSC) is a chronic,cholestatic liver condition characterized by inflammation,fibrosis,and destruction of the intra-and extrahepatic bile ducts.The therapeutic endoscopist plays a key role in the diagnosis and management of PSC.In patients presenting with a cholestatic profile,endoscopic retrograde cholangiopancreatography(ERCP) is warranted for a definite diagnosis of PSC.Dominant strictures of the bile duct occur in 36%-57% of PSC patients.Endoscopic balloon dilatation with or without stenting have been employed in the management of dominant strictures.In addition,PSC patients are at increased risk of developing cholangiocarcinoma with a 20% lifetime risk.Brush cytology obtained during ERCP and use of fluorescence in situ hybridization forms the initial diagnostic step in the investigation of patients with dominant biliary strictures.Our review aims to summarize the current evidence supporting the role of a therapeutic endoscopist in the management of PSC patients.
文摘BACKGROUND Endoscopic mucosal resection(EMR)is an effective and minimally invasive alternative to surgery for large polyps and laterally spreading lesions.Gross morphology and surface characteristics may help predict submucosal invasion of the lesion(SMIL)during endoscopic evaluation.This is one of the largest singlecenter studies reporting endoscopic mucosal resection for larger(≥20 mm)colorectal lesions in the United States.AIM To determine the recurrence rate of adenomas and endoscopic features that may predict submucosal invasion of colonic mucosal neoplasia.METHODS This is a retrospective cohort study of all the patients referred for endoscopic mucosal resection for lesions≥20 mm,spanning a period from January 2013 to February 2017.The main outcome measure was identifying features that may predict submucosal invasion of mucosal lesions and predict recurrence of adenomas on follow-up surveillance colonoscopy performed at 4-6 mo.RESULTS A total of 480 patients with 500 lesions were included in the study.The median age was 68(Inter quantile range:14)with 52%males.The most common lesion location was ascending colon(161;32%).Paris classification 0-IIa(Flat elevation of mucosa-316;63.2%);Kudo Pit Pattern IIIs(192;38%)and Granular surface morphology(260;52%)were most prevalent.Submucosal invasion was present in 23(4.6%)out of 500 lesions.The independent risk factors for SMIL were Kudo Pit Pattern IIIL+IV and V(Odds ratio:4.5;P value<0.004)and Paris classification 0-IIc(Odds ratio:18.2;P value<0.01).Out of 500,354 post-endoscopic mucosal resection scars were examined at surveillance colonoscopy.Recurrence was noted in 21.8%(77 cases).CONCLUSION There was overall low prevalence of SMIL in our study.Kudo pit pattern(IIIL+IV and V)and Paris classification 0-IIc were the only factors identified as an independent risk factor for submucosal invasion.The independent risk factor for recurrence was adenoma size(>40 mm).Almost all recurrences(98.8%)were treated endoscopically.
文摘BACKGROUND About 10%-30%of acute pancreatitis remain idiopathic(IAP)even after clinical and imaging tests,including abdominal ultrasound(US),contrast-enhanced computed tomography(CECT)and magnetic resonance cholangiopancreatography(MRCP).This is a relevant issue,as up to 20%of patients with IAP have recurrent episodes and 26%of them develop chronic pancreatitis.Few data are available on the role of EUS in clarifying the etiology of IAP after failure of one or more cross-sectional techniques.AIM To evaluate the diagnostic gain after failure of one or more previous crosssectional exams.METHODS We retrospectively collected data about consecutive patients with AP and at least one negative test between US,CECT and MRCP,who underwent linear EUS between January 2017 and December 2020.We investigated the EUS diagnostic yield and the EUS diagnostic gain over different combinations of these crosssectional imaging techniques for the etiologic diagnosis of AP.Types and frequency of EUS diagnosis were also analyzed,and EUS diagnosis was compared with the clinical parameters.After EUS,patients were followed-up for a median of 31.5 mo to detect cases of pancreatitis recurrence.RESULTS We enrolled 81 patients(63%males,mean age 61±18,23%with previous cholecystectomy,17%with recurrent pancreatitis).Overall EUS diagnostic yield for AP etiological diagnosis was 79%(20%lithiasis,31%acute on chronic pancreatitis,14%pancreatic solid or cystic lesions,5%pancreas divisum,5%autoimmune pancreatitis,5%ductal abnormalities),while 21%remained idiopathic.US,CECT and MRCP,taken alone or in combination,led to AP etiological diagnosis in 16(20%)patients;among the remaining 65 patients,49(75%)obtained a diagnosis at EUS,with an overall EUS diagnostic gain of 61%.Sixty-eight patients had negative US;among them,EUS allowed etiological diagnosis in 59(87%).Sixty-three patients had a negative CECT;among them,47(74%)obtained diagnosis with EUS.Twenty-four had a negative MRCP;among them,20(83%)had EUS diagnosis.Twenty-one had negative CT+MRCP,of which 17(81%)had EUS diagnosis,with a EUS diagnostic gain of 63%.Patients with biliary etiology and without previous cholecystectomy had higher median values of alanine aminotransferase(154 vs 25,P=0.010),aspartate aminotransferase(95 vs 29,P=0.018),direct bilirubin(1.2 vs 0.6,P=0.015),gammaglutamyl transpeptidase(180 vs 48,P=0.006)and alkaline phosphatase(150 vs 72,P=0.015)Chronic pancreatitis diagnosis was more frequent in patients with recurrent pancreatitis at baseline(82%vs 21%,P<0.001).During the follow-up,AP recurred in 3 patients,one of which remained idiopathic.CONCLUSION EUS is a good test to define AP etiology.It showed a 63%diagnostic gain over CECT+MRCP.In suitable patients,EUS should always be performed in cases of IAP.Further prospective studies are needed.
文摘Commentary on the article written and published by Peng et al,investigating the role of endoscopic ultrasound(EUS)-guided biliary drainage for palliation of malignant biliary obstruction after failed endoscopic retrograde cholangiopan-creatography(ERCP).For 40 years endoscopic biliary drainage was synonymous with ERCP,and EUS was used mainly for diagnostic purposes.The advent of therapeutic EUS has revolutionized the field,especially with the development of a novel device such as electrocautery-enhanced lumen-apposing metal stents.Complete biliopancreatic endoscopists with both skills in ERCP and in interven-tional EUS,would be ideally suited to ensure patients the best drainage technique according to each individual situation.
文摘Gastroparesis is a chronic disease of the stomach that causes a delayed gastric emptying,without the presence of a stenosis.For 30 years the authors identified pylorospasm as one of the most important pathophysiological mechanisms determining gastroparesis.Studies with EndoFLIP,a device that assesses pyloric distensibility,increased the knowledge about pylorospasm.Based on this data,several pyloric-targeted therapies were developed to treat refractory gastroparesis:Surgical pyloroplasty and endoscopic approach,such as pyloric injection of botulinum and pyloric stenting.Notwithstanding,the success of most of these techniques is still not complete.In 2013,the first human gastric per-oral endoscopic myotomy(GPOEM)was performed.It was inspired by the POEM technique,with a similar dissection method,that allows pyloromyotomy.Therapeutical results of GPOEM are similar to surgical approach in term of clinical success,adverse events and post-surgical pain.In the last 8 years GPOEM has gained the attention of the scientific community,as a minimally invasive technique with high rate of clinical success,quickly prevailing as a promising therapy for gastroparesis.Not surprisingly,in referral centers,its technical success rate is 100%.One of the main goals of recent studies is to identify those patients that will respond better to the therapies targeted on pylorus and to choose the better approach for each patient.
