Direct retrograde cholangioscopy (DRC) enables high quality video imaging of the bile ducts and allows intraductal treatment with optical control. We evaluated the feasibility, success, and ...complications of a new third-generation prototype cholangioscope.
All consecutive patients from two tertiary endoscopy centers who had undergone DRC with the prototype were included. Indications for DRC were: evaluation of indeterminate strictures, filling defects, and complex bile duct stones. Technical success was investigated in terms of indication and treatment performed. All adverse events were recorded.
DRC with the prototype was performed in 74 patients. Therapeutic interventions included laser or electrohydraulic lithotripsy and stone removal, among others. The papilla was entered in 72/74 patients (97 %). The targeted bile duct segment was reached in 62 /74 patients (84 %), with an anchoring balloon catheter needed in 21/74 (28 %). Mean investigation time was 21 minutes (15 - 27 minutes)
DRC using the prototype is feasible, safe, and attains access to the bile ducts in almost all patients, with less need of an anchoring balloon catheter compared with the standard technique and short investigation and fluoroscopy times.
Endoscopic transmural drainage is usually performed for symptomatic well-encapsulated walled-off necrosis (WON) that usually develops in the delayed phase (> 4 weeks after disease onset) of acute ...necrotising pancreatitis (ANP). Endoscopic drainage is usually not advocated in the early (< 4 weeks after disease onset) stage of illness because of the risk of complications due to an incompletely formed encapsulating wall and poor demarcation of viable from necrotic tissue. However, emerging data from expert tertiary care centres over the last few years shows that the early endoscopic transluminal drainage approach is effective and safe. The development of lumen-apposing metal stents and better accessories for endoscopic necrosectomy has fuelled the expansion of indications of endoscopic drainage of pancreatic necrosis. However, early endoscopic drainage is associated with higher rates of adverse events; therefore, careful patient selection is paramount. This article will review the current indications, techniques and outcomes of early endoscopic transluminal drainage in pancreatic necrotic collections.
AIM To assess the utility and safety of single-operatorcholangiopancreatoscopy （SOCPS） using the SpyGlasssystem in widespread clinical application for biliary andpancreatic diseases.METHODS： This ...study was a prospective case seriesconducted in 20 referral centers in Japan. There were148 patients who underwent SOCPS; 124 for biliarydiseases and 24 for pancreatic diseases. The attemptedinterventions were SOCPS examination, SOCPS-directedtissue sampling, and therapy for stone removal,among others. The main outcomes were related to theprocedure success rate in terms of visualizing the targetlesions, SOCPS-directed adequate tissue sampling, andcomplete stone removal.RESULTS： A total of 148 patients were enrolled for thediagnosis of indeterminate biliary and pancreatic lesionsor treatment of biliary and pancreatic disease. Theoverall procedure success rate of visualizing the targetlesions was 91.2% （135/148）. The overall proceduralsuccess rates of visualizing the target lesions ofdiagnostic SOCPS in the bile duct and pancreatic ductwere 95.5% （84/89） and 88.2% （15/17）, respectively.Diagnosis： the overall adequate tissue for histologicexamination was secured in 81.4% of the 86 patientswho underwent biopsy under SOCPS （bile duct, 60/75,80.0%; pancreatic duct, 10/11, 90.9%）. The accuracyof histologic diagnosis using SOCPS-directed biopsiesin indeterminate bile duct lesions was 70.7% （53/75）.In the pancreatic duct, the accuracy of SOCPS visualimpression of intraductal papillary mucinous neoplasmwas 87.5% （14/16）. Stone therapy： complete biliaryand pancreatic stone clearance combined withSOCPS-directed stone therapy using electrohydrauliclithotripsy or laser lithotripsy was achieved in 74.2%（23/31） and 42.9% （3/7） of the patients, respectively.Others： SOCPS using the SpyGlass system was used incannulation of the cystic duct in two patients and forpassing across the obstructed self-expandable metallicstent for a malignant biliary stricture in two patients.All procedures were successful in both SOCPS-guidedtherapies. The incidence of procedure-related adverseevents was 5.4% （8/148）.CONCLUSION： SOCPS with direct visualization andbiopsy for diagnosis and SOCPS-directed therapy forbiliary and pancreatic diseases can be safely performedwith a high success rate.
Background & Aims Propofol is an effective sedative in advanced endoscopy. However, the incidence of sedation-related complications is unclear. We sought to define the frequency of sedation-related ...adverse events, particularly the rate of airway modifications (AMs), with propofol use during advanced endoscopy. We also evaluated independent predictors of AMs. Methods Patients undergoing sedation with propofol for advanced endoscopic procedures, including endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, and small-bowel enteroscopy, were studied prospectively. Sedative dosing was determined by a certified registered nurse anesthetist with the goal of achieving deep sedation. Sedation-related complications included AMs, hypoxemia (pulse oximetry SpO2 < 90%), hypotension requiring vasopressors, and early procedure termination. AMs were defined as chin lift, modified face mask ventilation, and nasal airway. We performed a regression analysis to compare characteristics of patients requiring AMs (AM+) with those who did not (AM−). Results A total of 799 patients were enrolled over 7 months. Procedures included endoscopic ultrasound (423), endoscopic retrograde cholangiopancreatography (336), and small-bowel enteroscopy (40). A total of 87.2% of patients showed no response to endoscopic intubation. Hypoxemia occurred in 12.8%, hypotension in 0.5%, and premature termination in 0.6% of the patients. No patients required bag-mask ventilation or endotracheal intubation. There were 154 AMs performed in 115 (14.4%) patients, including chin lift (12.1%), modified face mask ventilation (3.6%), and nasal airway (3.5%). Body mass index, male sex, and American Society of Anesthesiologists class of 3 or higher were independent predictors of AMs. Conclusions Propofol can be used safely for advanced endoscopic procedures when administered by a trained professional. Independent predictors of AMs included male sex, American Society of Anesthesiologists class of 3 or higher, and increased body mass index.
Background and Aim
Several experts of direct peroral videocholangioscopy (D‐PVCS) using a conventional ultraslim endoscope have reported its usefulness for the diagnosis and therapy of biliary tract ...diseases. We have additionally developed a dedicated double‐bending D‐PVCS technique for freehand scope insertion. In this study, we developed an ex vivo training model for the freehand double‐bending D‐PVCS technique and compared it with the technique using a conventional ultraslim endoscope.
Methods
The ex vivo model was made for training using a U‐shape insertion pattern. A third prototype endoscope and an ultraslim upper gastrointestinal endoscope were used. Two experts and nine non‐experts performed D‐PVCS using the freehand technique.
Results
The two experts could not advance the tip of the endoscope to the hilar portion using the freehand technique, but they could achieve technical successful insertion to the hilar portion with the third prototype cholangioscope using the freehand technique alone. The non‐experts could not advance the tip of the endoscope to the bile duct using the freehand technique. On the other hand, two (22.2%) non‐experts could advance the tip of the third prototype cholangioscope using the freehand technique before the training conducted by the experts. After the training, all the non‐experts could advance the tip of the third prototype cholangioscope to the hilar portion.
Conclusions
The novel ex vivo model using a third prototype cholangioscope was useful for training in the use of the freehand D‐PVCS technique.
Abstract Background & Aims The recently developed technique of per-oral endoscopic myotomy (POEM) has been shown to be effective for the therapy of esophageal motility disorders. Limited information ...is available about POEM adverse events (AE). Methods POEM was performed with the patients under general anesthesia in 241 patients (58% male, mean age 47.4 ± 16.4 years) during 61 months. Main outcome was the rate of intra- and post-procedural adverse events (AE). Post-procedural checks comprised clinical and laboratory examination, and endoscopy, with further follow-ups being performed at 3, 6 and 12 months, respectively. Results 238 out of 241 procedures (mean procedure time 100.2± 39.5 min) were successfully completed. Reasons for abortion were excessive submucosal fibrosis preventing submucosal tunneling. 3 patients had severe procedural-related adverse events (SAE rate 1.2%); one case of pneumothorax requiring intraprocedural drainage, and two patients with delayed SAE (one ischemic gastric cardia perforation and one hemothorax, both leading to surgery). The overall rate of minor AE was 31.1%, mainly prolonged intraprocedural bleeding (>15 minutes hemostasis) and defects of the mucosa overlying the tunnel; none of them led to clinically relevant signs or symptoms. Patients experiencing any AE had a significant prolonged hospital stay (p=0.037) and a trend toward prolonged procedure time (p=0.094). Neck/upper thoracic emphysema and free abdominal air were noted in 31.5% and 35.7% (95.3% drained), but without relevant sequelae. Conclusions POEM has a low rate of serious adverse events; minor adverse events are more frequent but lack a consistent definition. Therefore, based on our experience and literature analysis, we suggest a classification of AE for POEM.
We present the first clinical results of a new tandem technique for direct peroral cholangioscopy using a standard ultraslim upper gastrointestinal endoscope and a guide probe that was originally ...developed for the non-transendoscopic placement of biliary endoprostheses (guide probe of Kautz; MTW, Wesel, Germany).
Twenty direct peroral cholangioscopy procedures were performed with the new anchor-assisted method using the guide probe of Kautz in a single center and were retrospectively analyzed.
Indications for anchor-assisted cholangioscopy procedures included indeterminate bile duct strictures (n = 14), filling defects that remained after stone extraction (n = 4), and complex stone extractions (n = 2). Biliary access and visualization of the target region were achieved in 18/20 procedures (90 %). The interventional success rate was 85 % (11 /13 interventions). One case of postinterventional cholangitis occurred (5 %), along with one case of minor peri-interventional papillary bleeding (5 %).
The anchor-assisted cholangioscopy technique is feasible and safe for direct cholangioscopy and provides reliable success rates in clinical practice. This technique represents an alternative approach for direct cholangioscopy on a single-operator basis using standard endoscopes.
Abstract
This ESGE Position Statement defines the expected value of artificial intelligence (AI) for the diagnosis and management of gastrointestinal neoplasia within the framework of the performance ...measures already defined by ESGE. This is based on the clinical relevance of the expected task and the preliminary evidence regarding artificial intelligence in artificial or clinical settings.
Main recommendations:
(1) For acceptance of AI in assessment of completeness of upper GI endoscopy, the adequate level of mucosal inspection with AI should be comparable to that assessed by experienced endoscopists. (2) For acceptance of AI in assessment of completeness of upper GI endoscopy, automated recognition and photodocumentation of relevant anatomical landmarks should be obtained in ≥90% of the procedures. (3) For acceptance of AI in the detection of Barrett’s high grade intraepithelial neoplasia or cancer, the AI-assisted detection rate for suspicious lesions for targeted biopsies should be comparable to that of experienced endoscopists with or without advanced imaging techniques. (4) For acceptance of AI in the management of Barrett’s neoplasia, AI-assisted selection of lesions amenable to endoscopic resection should be comparable to that of experienced endoscopists. (5) For acceptance of AI in the diagnosis of gastric precancerous conditions, AI-assisted diagnosis of atrophy and intestinal metaplasia should be comparable to that provided by the established biopsy protocol, including the estimation of extent, and consequent allocation to the correct endoscopic surveillance interval. (6) For acceptance of artificial intelligence for automated lesion detection in small-bowel capsule endoscopy (SBCE), the performance of AI-assisted reading should be comparable to that of experienced endoscopists for lesion detection, without increasing but possibly reducing the reading time of the operator. (7) For acceptance of AI in the detection of colorectal polyps, the AI-assisted adenoma detection rate should be comparable to that of experienced endoscopists. (8) For acceptance of AI optical diagnosis (computer-aided diagnosis CADx) of diminutive polyps (≤5 mm), AI-assisted characterization should match performance standards for implementing resect-and-discard and diagnose-and-leave strategies. (9) For acceptance of AI in the management of polyps ≥ 6 mm, AI-assisted characterization should be comparable to that of experienced endoscopists in selecting lesions amenable to endoscopic resection.
Background
Oesophagogastroduodenoscopy (OGDS) is the most common diagnostic procedure for upper gastrointestinal diseases. It often causes discomfort and anxiety, which are only mitigated by systemic ...sedation. However, sedation poses additional risks of adverse cardiopulmonary events, increased medical costs, and prolonged recovery. Transcutaneous electrical nerve stimulation of acupuncture points (Acu-TENS) is a non-invasive and innovative approach that induces analgesic effect during endoscopy. This trial is the first to be reported in English that explores the potential of Acu-TENS to increase patient tolerance during non-sedated elective diagnostic OGDS.
Methods
A double-blinded randomized controlled trial involving 348 subjects was conducted at a tertiary hospital to evaluate the success rate of OGDS with Acu-TENS. Subjects aged 18–75 years scheduled for their first elective diagnostic OGDS were randomized into the intervention (Acu-TENS) and placebo arms. OGDS success was assessed based on subjects’ satisfaction ratings on a Likert scale and procedure’s technical adequacy. Secondary measures included subjects’ willingness to undergo future OGDS under similar conditions, procedure duration, and the endoscopist’s perceived ease of the procedure.
Results
OGDS success rates were significantly higher with Acu-TENS (77.8%) than with the placebo (68.0%; odds ratio OR 1.64, 95% confidence interval CI 1.01–2.66,
p
= 0.043). Subjects who received Acu-TENS expressed higher willingness for future OGDS (78.9%) than those who received the placebo (68.6%; OR 1.71, 95% CI 1.04–2.79,
p
= 0.031). Procedure duration were significantly shorter in the intervention arm (6.0 min) than in the placebo arm (10.0 min;
p
= 0.002). No adverse effects were reported, and endoscopists perceived similar procedure ease in both arms.
Conclusions
Acu-TENS improved OGDS success and enhanced patients’ experiences during non-sedated OGDS. It demonstrated safety with no side effects and reduced the procedure completion time. It could be used as an adjunct in non-sedated diagnostic OGDS.
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