RESUMO
Introduction: Gastrointestinal cancers account for 26% of cancer incidence and 35% of cancer-related deaths globally. Early detection is crucial but often limited by white light endoscopy (WLE), which misses subtle lesions. Texture and color enhancement imaging (TXI), introduced in 2020, enhances texture, brightness, and color, addressing WLE's limitations. This meta-analysis evaluates TXI's effectiveness compared to WLE in gastrointestinal lesion lesion detection. Methods: A systematic review and meta-analysis were conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of CENTRAL, PubMed, Embase, and Web of Science identified randomized controlled trials and observational studies comparing TXI with WLE. Outcomes included lesion detection rates, color differentiation, and visibility scores. The risk of bias was assessed using the Cochrane ROB 2.0 tool and Newcastle-Ottawa tools, and evidence certainty was evaluated using Grading of Recommendations Assessment, Development, and Evaluation. Results: Seventeen studies with 16,634 participants were included. TXI significantly improved color differentiation (mean difference: 3.31, 95% confidence interval [CI]: 2.49-4.13), visibility scores (mean difference: 0.50, 95% CI: 0.36-0.64), and lesion detection rates (odds ratio [OR]: 1.84, 95% CI: 1.52-2.22) compared to WLE. Subgroup analyses confirmed TXI's advantages across pharyngeal, esophageal, gastric, and colorectal lesions. TXI also enhanced adenoma detection rates (OR: 1.66, 95% CI: 1.31-2.12) and mean adenoma detection per procedure (mean difference: 0.48, 95% CI: 0.25-0.70). Conclusion: TXI improves gastriontestinal lesion lesion detection by enhancing visualization and color differentiation, addressing key limitations of WLE. These findings support its integration into routine endoscopy, with further research needed to compare TXI with other modalities and explore its potential in real-time lesion detection.
RESUMO
Gastric abscess is a rare condition caused by gastric barrier damage. It is easily misdiagnosed in clinical practice as a cancer recurrence or submucosal tumor, especially after surgery or endoscopic submucosal dissection. With a relatively high mortality rate, the cause and clinical characteristics of gastric abscesses are obscure. To date, diagnostic evaluations have mostly included indirect gastroscopy and abdominal computed tomography. A definite diagnosis of gastric abscess is challenging, and unnecessary surgery is sometimes performed. Relatively few applications of endoscopic ultrasound (EUS) have been described. EUS-guided fine needle aspiration for diagnosis and drainage is not commonly used. Therefore, more experiences related to the cause and clinical characteristics of gastric abscesses should be reported. Further recognition of EUS ultrasonographic images and related minimally invasive EUS therapies are urgently needed. Herein, through a literature review of previous cases, we summarized the causes, clinical features, and diagnostic methods for gastric abscess. Moreover, we aimed to gain more experience diagnosing gastric abscesses by EUS for future differentiation and treatment strategies by endoscopy.
RESUMO
Objectives: Esophagogastroduodenoscopy (EGD) is vital for diagnosing and treating upper gastrointestinal symptoms, but patient discomfort and anxiety can affect procedural outcomes. This study aimed to compare the effectiveness of topical analgesics with and without Entonox during EGD in terms of procedural success, patient tolerance, and satisfaction. Methods: A prospective, randomized, double-blinded, controlled trial. Patients were assigned to receive either 10% xylocaine spray in the control group (Group C) or 10% xylocaine spray combined with Entonox (Group E). Procedural success and patient comfort were evaluated using the Bath Gastroscopy Toleration Score and patient comfort scores, with scores of 0 or 1 indicating success. Satisfaction was measured using the numeric rating scale, where scores of 7 or higher indicated high satisfaction. Results: A total of 211 patients underwent EGD successfully (Group C = 106, Group E = 105). Patients in Group E demonstrated a significantly higher proportion of success rate (76.2% vs. 35.9%, p < 0.001), better toleration score (82.9% vs. 75.5%, p = 0.004), and better patient comfort score (86.7% vs. 39.6%, p < 0.001) compared to Group C. Endoscopists and patients in Group E expressed higher satisfaction levels (9 vs. 8, p < 0.01 and 9 vs. 8, p < 0.01). The side effects of Entonox were minimal. Notably, Group E had a lower proportion of high blood pressure and tachycardia during the procedure (p < 0.001). Conclusions: Combining Entonox with topical analgesics significantly improves tolerance, satisfaction, and procedural success during EGD, offering a safe and effective option for managing patient discomfort and anxiety.
RESUMO
Objectives: Anastomotic biliary strictures are a common complication following orthotopic liver transplantation (post-OLT), impacting morbidity and graft survival. This meta-analysis evaluates the efficacy, safety, and cost-effectiveness of covered self-expanding metal stents (cSEMS) versus multiple plastic stents (MPS) for treating post-OLT strictures. Methods: A systematic review was conducted in PubMed, Cochrane Central, Embase, Scholar, and SciELO. We analyzed randomized controlled trials (RCTs) comparing cSEMS and MPS in post-OLT biliary strictures. Outcomes included stricture resolution, recurrence, endoscopic retrograde cholangiopancreatography sessions, adverse events, and cost. Standardized mean differences (SMDs) and risk ratios (RRs) were calculated with 95% confidence intervals (CIs). Cost-effectiveness analysis covered direct and indirect expenses. Results: Five RCTs with 269 patients were analyzed. No significant differences were found between cSEMS and MPS in terms of stricture resolution (RR = 1.01; 95% CI [0.90, 1.13]; p = 0.91), recurrence rates (RR = 2.23; 95% CI [0.74, 6.75]; p = 0.15), adverse events (RR = 0.80; 95% CI [0.41, 1.54]; p = 0.50), stent migration (RR = 1.55; 95% CI [0.69, 3.50]; p = 0.29), number of endoscopic retrograde cholangiopancreatography sessions (SMD = -2.18; 95% CI [-5.28, 0.91]; p = 0.12), number of stents (SMD = -2.33; 95% CI [-22.26, 17.59]; p = 0.38), treatment time (SMD = -1.60; 95% CI [-4.24, 1.05]; p = 0.15), and cost ($10,344 vs. $18,003; p = 0.19). Conclusion: cSEMS and MPS demonstrate similar efficacy and safety for post-OLT biliary strictures. Both strategies are viable, with selection based on cost, anatomy, and institutional resources.
RESUMO
Atypical lipomatous tumor/well-differentiated liposarcoma is a locally aggressive mesenchymal neoplasm composed of adipocytes and stromal cells. Gastric cases are exceedingly rare, and their malignant potential remains unclear. We report a case of a woman in her 60s who was found to have multiple submucosal tumor-like lesions of the stomach. Over time, the tumors increased in size, requiring a laparoscopic partial gastrectomy. Histological examination revealed a tumor composed of both fatty tissue and fibrous stroma with nuclear atypia. Immunohistochemistry showed positivity for CDK4 and MDM2, and fluorescence in situ hybridization confirmed MDM2 amplification, leading to a diagnosis of atypical lipomatous tumor/well-differentiated liposarcoma. This case presented an unusual gastric manifestation, with multiple submucosal tumor-like lesions on endoscopy and exhibiting progressive morphological changes over several years.
RESUMO
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is used when biliary drainage using endoscopic retrograde cholangiopancreatography fails. Recently, it has been adopted as a primary biliary drainage method, and its indications have expanded. Since EUS-BD can cause adverse events (AEs), such as bile leakage and stent migration, which do not occur in endoscopic retrograde cholangiopancreatography, endoscopists need to be well-versed in its management and preventive techniques. EUS-BD includes several procedures, such as EUS-guided choledochoduodenostomy (EUS-CDS), EUS-guided hepaticogastrostomy (EUS-HGS), EUS-guided antegrade stenting (EUS-AS), and EUS-guided rendezvous (EUS-RV). A recent meta-analysis reported that the overall AE rate of EUS-BD was 13.7% (EUS-CDS, 11.9%; EUS-HGS, 15.5%; EUS-AS, 9.9%; and EUS-RV, 8.8%). Among various EUS-BD techniques, EUS-CDS and EUS-HGS are the most frequently reported. Tubular self-expandable metal stents have been traditionally used in EUS-CDS; however, lumen-apposing metal stents have recently gained popularity. A systematic review showed that the rates of early AEs were similar between self-expandable metal stents and lumen-apposing metal stents; however, stent maldeployment was more problematic with lumen-apposing metal stents. Although tubular self-expandable metal stents are used in EUS-HGS, stent maldeployment remains a serious issue, and available devices and technical tips for preventing this AE should be well understood. Furthermore, AEs, such as sepsis, cholangitis, and bleeding, can occur, and strategies to mitigate these risks are essential. In this narrative review, we discussed AEs related to EUS-BD with a focus on management options and strategies for prevention.
RESUMO
Colorectal cancer (CRC) is a leading cause of cancer-related mortality, highlighting the need for early detection and accurate lesion characterization. Traditional white-light imaging has limitations in detecting lesions, particularly those with flat morphology or minimal color contrast with the surrounding mucosa. It also struggles to distinguish neoplastic from non-neoplastic lesions. These limitations led to the development of image-enhanced endoscopy (IEE). Image-enhanced endoscopy modalities such as narrow-band imaging, blue laser imaging, linked color imaging, and texture and color enhancement imaging enhance mucosal surface and vascular pattern visualization, thereby improving lesion detection and characterization. In contrast, red dichromatic imaging is primarily designed to enhance the visibility of deep blood vessels, making it particularly useful during therapeutic endoscopies, such as identifying bleeding sources and monitoring post-treatment hemostasis. Although IEE enhances lesion detection and characterization, it remains limited in assessing submucosal invasion depth, which is a key factor in treatment decisions. Endoscopic submucosal dissection requires accurate prediction of invasion depth; however, IEE mainly reflects superficial features. Endoscopic ultrasound and artificial intelligence-assisted diagnostics have emerged as complementary techniques for improving depth assessment and lesion classification. Additionally, IEE plays a critical role in detecting ulcerative colitis-associated neoplasia (UCAN), which often presents with a flat morphology and indistinct borders. High-definition chromoendoscopy and IEE modalities enhance detection; however, inflammation-related changes limit diagnostic accuracy. Artificial intelligence and molecular biomarkers may improve UCAN diagnosis. This review examines the role of IEE in lesion detection and treatment selection, its limitations, and complementary techniques such as endoscopic ultrasound and artificial intelligence. We also explored pit pattern diagnosis using crystal violet staining and discussed emerging strategies to refine colorectal cancer screening and management.
RESUMO
Objectives: To propose a novel first-line endoscopic therapy for treating polypoid lesions in solitary rectal ulcer syndrome (P-SRUS), the rarest and most challenging subtype of SRUS, which encompasses various endoscopic findings including mucosal erythema, superficial or deep ulcers, and polypoid lesions. Methods: A prospective, single-arm study was conducted on 56 patients with histologically confirmed SRUS and broad-based polypoid lesions in the rectum and anal canal. These patients were referred to the Department of Motility Disorders of the Lower Gastrointestinal Tract. The lesions were removed using snare-assisted mucosal and fibrosis resection. Patients were monitored for clinical and endoscopic responses at 1, 3, 6, and 12 months post-treatment. Results: The study observed improvement in clinical symptoms, a complete endoscopic response, and the absence of late complications following endoscopic resection. Endoscopic evaluations revealed no recurrence of lesions in the follow-up period. Conclusion: Endoscopic resection using the snare-assisted mucosal and fibrosis resection method appears to be an effective and safe treatment option for polypoid SRUS. (Clinical Trial Registration Number: IRCT20211101052935N2).
RESUMO
Objectives: This study aimed to evaluate the successful sequencing rate of Foundation One CDx (F1CDx) using small tissue samples obtained with a 22-gauge needle (22G) through endoscopic ultrasound-guided fine needle acquisition (EUS-TA) and to propose guidelines for tissue quantity evaluation criteria and proper slide preparation in clinical practice. Methods: Between June 2019 and April 2024, 119 samples of 22G EUS-TA collected for F1CDx testing at Himeji Red Cross Hospital were retrospectively reviewed. Tissue adequacy was only assessed based on tumor cell percentage (≥20%). The procedure stopped when white tissue fragments reached 20 mm during macroscopic on-site evaluation. The specimens were prepared using both 'tissue preserving sectioning' to retain tissue within formalin-fixed paraffin-embedded blocks and the 'thin sectioning matched needle gauge and tissue length' method with calculation to ensure minimal unstained slides for the 1 mm3 sample volume criterion. Tissue area from HE slides and sample volume were measured, and F1CDx reports were analyzed. Results: Of 119 samples, 108 (90.8%) were suitable for F1CDx. Excluding the cases not submitted for testing, in the 45 cases where F1CDx was done using 22G EUS-TA samples, eight (17.8%) had a sum of tissue area tissue of 25 mm2 or greater in the HE-stained sample. However, all cases met the F1CDx 1 mm3 volume criterion by submitting > 30 unstained slides per sample. As a result, 43 of 45 cases (95.6%) were successfully analyzable. Conclusions: The 22G EUS-TA needle is an effective tool for providing the sufficient tissue volume required for F1CDx.
RESUMO
Objectives: A 'gray color sign' (GCS) is a new endoscopic feature of fundic gland polyp associated with proton pump inhibitor (PPI-FGP). Here, we compare the ability of texture and color enhancement imaging (TXI) to white light imaging (WLI) with regard to the detection of GCS. Methods: In this prospective study, 19 consecutive patients with PPI-FGP were enrolled at our hospital from April 2021 to October 2022. Endoscopic images of PPI-FGP using WLI, TXI mode1 (TXI-1), TXI mode2 (TXI-2), and narrow-band imaging (NBI) were collected and compared by 10 endoscopists. Visibility of GCS by each mode (Image enhancement endoscopy) was scored as follows: 5, improved; 4, somewhat improved; 3, equivalent; 2, somewhat decreased; and 1, decreased. The inter-rater reliability (intra-class correlation coefficient, ICC) was also evaluated. The images were objectively evaluated based on L* a* b* color values and the color difference (ΔE*) in the CIE LAB color space system. Results: Improved visibility of GCS compared with WLI was achieved for: TXI-1: 82.6%, TXI-2: 86.9%, and NBI: 0% for all endoscopists. Total visibility scores were: TXI-1, 44.9; TXI-2, 42.9; NBI, 17.4 for all endoscopists. Visibility scores were significantly higher using TXI-1 and TXI-2 compared with NBI (p < 0.01). The inter-rater reliability for TXI-1 and TXI-2 was "excellent" for all endoscopists. The use of ΔE* revealed statistically significant differences between WLI and TXI-1 (p < 0.01). Conclusions: TXI is an improvement over WLI for the visualization of GCS, and can be used by both trainee and expert endoscopists with equal efficiency and accuracy.
RESUMO
Gastric cancer (GC) remains a major global health concern, particularly in East Asia, Central Asia, and Eastern Europe, where its incidence and mortality rates are high. Helicobacter pylori infection is the primary cause of GC and leads to carcinogenic progression from nonatrophic gastritis to cancer. Although screening programs have been implemented in high-risk countries, such as Japan and South Korea, comprehensive strategies remain limited globally. This study reviewed the status of GC screening worldwide and prevention strategies in regions with different risks. Various GC screening methods have been developed, including H. pylori serology, serum pepsinogen testing, upper gastrointestinal contrast radiography, and endoscopy. Endoscopic screening has shown superior sensitivity and specificity, reducing GC mortality by up to 47% in South Korea and demonstrating higher detection rates than upper gastrointestinal contrast radiography and pepsinogen testing. However, cost-effectiveness remains a challenge, particularly in Western countries where the overall GC prevalence is lower. Risk stratification using a combination of H. pylori serology and pepsinogen testing has been adopted in Japan to optimize screening efficiency. Additionally, H. pylori eradication has been recognized as a cost-effective strategy to reduce the incidence of GC with economic benefits demonstrated in Japan and other high-risk regions. In the United States, targeted screening of high-risk immigrant populations has been suggested to enhance cost-effectiveness. GC screening strategies should consider developing epidemiological trends, cost-effectiveness, and risk-based approaches. Future efforts should focus on expanding targeted screening initiatives to high-risk groups to improve early detection and survival rates.
RESUMO
Wirsungocele, a cystic dilation at the end of the main pancreatic duct, is associated with recurrent acute pancreatitis. A 52-year-old man presented to our hospital with recurrent epigastric pain over an 8-month period with a history of multiple medical visits for the same complaint. Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) revealed focal cystic dilatation at the end of the main pancreatic duct; thus, he was diagnosed with Wirsungocele. He underwent endoscopic pancreatic sphincterotomy and 5Fr 4 cm pancreatic duct stent placement; the pancreatic duct stent was removed 1 month later. Magnetic resonance imaging performed 3 months after discharge revealed no cystic dilation, and he has had no recurrence of pancreatitis for at least 6 months. Dysfunction of the sphincter of Oddi, weakening of the pancreatic duct wall, inflammation and recurrent stress, elevated intraductal pressure, and genetic and structural factors are suspected mechanisms behind the pathophysiology of Wirsungocele. Although the etiology of Wirsungocele is not known, its timely identification and treatment are critical to preventing recurrent episodes of pancreatitis. This case demonstrates the diagnostic value of combining MRCP and EUS as well as the therapeutic benefits of endoscopic intervention, including sphincterotomy and stent placement, in managing Wirsungocele-associated recurrent pancreatitis. Given the paucity of reports on recurrent pancreatitis due to the Wirsungocele, we herein report this case and review the literature.
RESUMO
Objectives: Over-the-scope clips (OTSCs) are considered an effective endoscopic tool for managing upper gastrointestinal bleeding, including duodenal ulcers, mostly based on data from high-volume centers with expert endoscopists. This study aimed to evaluate the clinical safety of OTSCs in regional hospital backgrounds and identify the factors associated with unsuccessful hemostasis. Methods: We conducted a retrospective study of 30 patients with duodenal ulcer bleeding who underwent OTSC placement at a regional core hospital in Japan between April 2014 and January 2025. Clinical outcomes, rebleeding rates, complications, and subgroup analyses by ulcer location, Forrest classification, and operator experience were evaluated. Results: Primary hemostasis was achieved in 28 of 30 patients (93.3%). Rebleeding occurred in two cases (6.7%) but was successfully managed endoscopically. Both hemostasis failures involved Forrest Ia ulcers on the posterior duodenal wall. Subgroup analysis revealed significantly lower success rates for Forrest Ia (66.7%) and posterior wall lesions (33.3%). No significant differences in outcomes were observed between experienced and less-experienced endoscopists. Postprocedural complications included mild pancreatitis and duodenal stricture, both managed conservatively. OTSC was used as a first-line modality in 10 cases and as salvage therapy in 20, with all failures occurring in the latter. Conclusion: OTSC is a safe and effective hemostatic modality for duodenal ulcer bleeding, even in regional hospitals with limited resources and staffing. It is particularly useful when rapid intervention is required and alternative treatments are not readily available. However, anatomical challenges such as posterior wall location and Forrest Ia classification may predict technical failure.
RESUMO
Objectives: Post-sedation discharge criteria for outpatient endoscopy and time-out procedures immediately before endoscopic examinations are important for ensuring patient safety. This study used a web-based questionnaire to survey the implementation status and current situation of these practices in Japan in 2024. Methods: A self-administered questionnaire was conducted from December 2023 to January 2024 using Google Forms. Participants were primarily from facilities involved in endoscopy study groups and readers of an endoscopy-specific e-newsletter. Additionally, medical staff from endoscopic centers across Japan were invited to participate in collaboration with the Japan Gastroenterological Endoscopy Technicians Society. Results: A total of 1,495 valid responses (medical staff: 1197 [80%]; doctors: 298) were collected from 1168 facilities, after excluding duplicate responses. Among the participating facilities, 58% were general hospitals, 21% were clinics or health check-up centers, and 9% were university hospitals or national cancer centers. Post-sedation discharge criteria were implemented in 58% of facilities for esophagogastroduodenoscopy and 56% for colonoscopy, with the post-sedation recovery score used as the criterion in about half of these cases. Time-out procedures were implemented in 57% of the facilities for both esophagogastroduodenoscopy and colonoscopy. Items confirmed during time-out in more than half of the facilities included: patient's name, details of antithrombotic drugs, content of examination, drug allergies, underlying disease, date of birth, consent form, age, procedure start time, and patient's identification number. Conclusion: The implementation rate of post-sedation discharge criteria and time-out procedures was found to be close to 60%, reflecting the real-world situation in Japan in 2024.
RESUMO
Objectives: To evaluate the clinical outcomes of peroral cholangiopancreatoscopy (POCPS) using the 9-Fr eyeMAX for the diagnosis of pancreatobiliary diseases. Methods: This retrospective study enrolled 43 patients who underwent POCPS using the 9-Fr eyeMAX for diagnostic procedures at two tertiary referral centers between May 2023 and November 2024. The primary outcome was the incidence of adverse events following POCPS. Patient backgrounds, procedural details, technical success (successful insertion of the 9-Fr eyeMAX), and adequate tissue sampling were also analyzed. Results: Of the 43 patients, 32 were male, and 11 were female, with a median age of 75 years (range, 46-87 years). Peroral cholangioscopy (POCS) was performed on 30 patients. The final diagnosis in this cohort was an ampullary tumor (n = 2), extrahepatic bile duct cancer (n = 16), gallbladder cancer (n = 3), metastatic liver tumor (n = 1), and benign biliary stricture (n = 8). The adequate tissue sampling rate for the POCS was 86.4%. Adverse events after POCS occurred in two patients (6.7%), including mild pancreatitis (n = 1) and fever (n = 1). Peroral pancreatoscopy (POPS) was performed on 13 patients. The final diagnoses of all patients undergoing POPS were intraductal papillary mucinous neoplasms (IPMN), categorized as branch duct-type IPMN (n = 1), mixed-type IPMN (n = 8), and main duct-type IPMN (n = 4). The technical success rate was 92.3% (12/13). The tissue sampling rate for POPS was 83.6%. No adverse events, such as pancreatitis, were observed. Conclusions: The 9-Fr eyeMAX facilitates a safe POCPS procedure, achieving a high technical success rate and an adequate tissue sampling rate.
RESUMO
Objectives: Most esophageal cancers in Japan are squamous cell carcinomas; however, there has been some concern regarding a recent increase in Barrett's esophageal adenocarcinoma (BEA). This study aimed to clarify the clinical characteristics and outcomes of patients treated via endoscopic submucosal dissection (ESD) in Kyushu, including changes over time. Methods: This multicenter, retrospective, observational study was conducted among 21 institutes situated in Kyushu. Data from patients who underwent ESD for BEA or esophageal squamous cell carcinoma between January 2010 and December 2023 were extracted from the pathology database and reviewed. Results: The total number of esophageal ESD cases increased from 2299 over the first 7 years to 4009 over the second seven. The incidence of BEA increased from 3.6% (86/2299) over the earlier period to 4.7% (197/4009; p = 0.034) over the latter. We analyzed data from 283 patients (287 lesions). Smaller tumor-sized lesions were detected over the latter period (14.2 ± 11.6 vs. 11.2 ± 9.5 cm2, p = 0.022), significantly reducing treatment times (122.1 ± 81.2 vs. 93.2 ± 53.3 min p < 0.001). The procedure was safe, with low incidence rates, over both the earlier and later periods (respectively), of perforation (0% vs. 1.0%), delayed bleeding (1.2% vs. 2.0%), and pneumonia (4.7% vs. 4.6%). Conclusion: The proportion of esophageal ESD procedures to treat BEA has increased in Japan's Kyushu region. This procedure has a comparable safety profile to similar ESD procedures used to treat other conditions.
RESUMO
Acute cholecystitis is frequently encountered in daily clinical practice, and early cholecystectomy is the standard therapy. In high-risk surgical patients, such as those with advanced age, deteriorated performance status, or underlying diseases, conservative treatment is typically preferred to manage acute cholecystitis. However, in patients with a disease that is refractory to conservative treatment, drainage procedures are necessary to control the infection. At present, there are three basic approaches for gallbladder drainage: percutaneous transhepatic gallbladder drainage, endoscopic transpapillary gallbladder drainage, and endoscopic ultrasound gallbladder drainage. Each of these methods has advantages and disadvantages. Therefore, the appropriate treatment method is determined on a case-by-case basis, and no consistent strategy for gallbladder drainage has been established. This review aimed to summarize the characteristics of each drainage method and compare the clinical outcomes of the three procedures for acute cholecystitis in high-risk surgical patients.
RESUMO
Endoscopic submucosal dissection has transformed early-stage gastrointestinal tumor treatment. This series showcases a novel slim gastroscope's efficacy in tackling challenging lesions. Retrospective analysis of 17 patients undergoing endoscopic submucosal dissection using the novel slim gastroscope for pharyngeal, esophageal, gastric, duodenal, and rectal lesions at our tertiary care center between November 2022 and July 2023. The slim scope has an outer diameter of 7.9âmm, an accessory channel diameter of 3.2âmm, and a downward bending angle of 160 degrees. Primary outcomes were en-bloc and R0 resection rate and secondary outcomes were procedure time, adverse events, and specimen/defect size. 100% successful en bloc and R0 resections were achieved with no significant adverse events. The median lesion size was 15 mm (2-40 mm), and the median procedure time was 30 min (5-105 min). Various strategies, including multiple tunnels, pocket creation,â and endoscopic intermuscular dissection, were employed. The novel slim gastroscope is feasible for endoscopic submucosal dissection in many locations including the pharynx and duodenum and in certain complex lesions (large gastric lesions, rectal lesions with deep submucosal invasion, and circumferential esophageal lesions). This warrants further investigation through larger comparative studies to validate its efficacy and safety in a broader patient population.
RESUMO
Background and aims: Endoscopic anti-reflux therapies like anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation have shown efficacy for gastroesophageal reflux disease (GERD) in systematic reviews and meta-analyses. Anti-reflux mucoplasty (ARM-P), a refinement of ARMS, incorporates immediate closure of the resection site to reduce complications. Recently, anti-reflux mucosal valvuloplasty (ARMV), which employs endoscopic submucosal dissection to create a mucosal valve, was introduced but retains ARMS's limitations, requiring extensive incisions (three-quarters to four-fifths circumference). To address these challenges, we developed anti-reflux mucoplasty with valve (ARM-P/V), integrating ARMV's valvuloplasty with ARM-P's closure technique to improve safety and reduce complications. This pilot study evaluates the safety, feasibility, and efficacy of ARM-P/V. Methods: This retrospective study reviewed data from patients undergoing ARM-P/V for proton pump inhibitor (PPI)-refractory or PPI-dependent GERD at Showa University Koto Toyosu Hospital, Tokyo, from April to August 2024. Symptom severity and quality of life were assessed using validated questionnaires (GERD-Health Related Quality of Life Questionnaire [GERD-HRQL], GERD Questionnaire [GerdQ], and Frequency Scale for the Symptoms of GERD [FSSG]), comparing pre- and post-treatment scores. PPI discontinuation rates were also analyzed. Results: Eighteen patients (mean age 55.4 years) underwent ARM-P/V. Within 3 months, 72.2% (13/18) reduced or discontinued PPI use. GERD-HRQL scores improved from 20.3 to 10.9 (p = 0.004), GerdQ from 10.4 to 6.9 (p < 0.001), and FSSG from 24.0 to 13.2 (p < 0.001). No severe complications (Clavien-Dindo Grade ≥3), delayed bleeding or dysphagia requiring balloon dilation were reported. Conclusions: ARM-P/V demonstrates safety, technical feasibility, and short-term efficacy in GERD treatment. As a refinement of ARMV, it offers a promising alternative to current techniques.
RESUMO
Superficial non-ampullary duodenal epithelial tumor is a rare disease, but its frequency has reportedly been increasing in recent years. We report a case of duodenal pyloric gland adenoma with high-grade dysplasia arising from ectopic gastric mucosa. Esophagogastroduodenoscopy detected a 5-mm raised lesion on the anterior surface of the duodenal bulb. The lesion was diagnosed as gastric foveolar metaplasia with biopsy. A second esophagogastroduodenoscopy was performed 13 years later. The nodule showed a two-stage elevation and a biopsy revealed EGM. The lesion was followed up with EGD almost every year, with enlargement observed each time. Endoscopic submucosal dissection was performed. Histopathological examination revealed pyloric gland adenoma with high-grade dysplasia. Ectopic gastric mucosa was observed in the tumor pathologically and transformation of the EGM into a tumor was followed endoscopically over time.