Elephant trunks are capable of complex, multimodal deformations, allowing them to perform task‐oriented high‐degree‐of‐freedom (DOF) movements pertinent to the field of soft actuators. Despite recent ...advances, most soft actuators can only achieve one or two deformation modes, limiting their motion range and applications. Inspired by the elephant trunk musculature, a liquid crystal elastomer (LCE)‐based multi‐fiber design strategy is proposed for soft robotic arms in which a discrete number of artificial muscle fibers can be selectively actuated, achieving multimodal deformations and transitions between modes for continuous movements. Through experiments, finite element analysis (FEA), and a theoretical model, the influence of LCE fiber design on the achievable deformations, movements, and reachability of trunk‐inspired robotic arms is studied. Fiber geometry is parametrically investigated for 2‐fiber robotic arms and the tilting and bending of these arms is characterized. A 3‐fiber robotic arm is additionally studied with a simplified fiber arrangement analogous to that of an actual elephant trunk. The remarkably broad range of deformations and the reachability of the arm are discussed, alongside transitions between deformation modes for functional movements. It is anticipated that this design and actuation strategy will serve as a robust method to realize high‐DOF soft actuators for various engineering applications.
These elephant trunk‐inspired soft robotic arms, through the design of their selectively addressable liquid crystal elastomer (LCE) artificial muscle fibers, can achieve multimodal deformations and transitions between deformation modes to generate functional movements much like those of an elephant. It is envisioned that this design strategy can serve as a robust method to realize high‐degree‐of‐freedom actuators for various engineering applications.
The novel use of peroral endoscopic myotomy (POEM) in the treatment of Zenker’s diverticulum (ZD) was recently described in case reports. The aim of this study is to report a multicenter experience ...with the POEM technique in the management of ZD.
This is a multicenter international retrospective study involving 10 centers. The Zenker’s POEM technique was performed using principles of submucosal endoscopy.
Seventy-five patients (73.3 ± 1.2 years, 33 women) were included with a mean Charleson comorbidity index of 4 ± .2. The mean size of ZD was 31.3 ± 1.6 mm (range, 10-89). The overall technical success rate was 97.3% (73/75). There were 2 technical failures because of the inability to locate the septum and failed tunnel creation. Adverse events occurred in 6.7% (5/75): 1 bleed (mild) conservatively managed and 4 perforations (1 severe, 3 moderate). The mean procedure time was 52.4 ± 2.9 minutes, and mean length of hospital stay was 1.8 ± .2 days. Clinical success was achieved in 92% (69/75) with a decrease in mean dysphagia score from 1.96 to .25 (P < .0001). The median length of follow-up was 291.5 days (interquartile range, 103.5-436). At the 12-month follow-up, 1 patient reported symptom recurrence.
Endoscopic management of ZD using the POEM technique is novel and feasible with promising efficacy and safety results. Long-term follow-up is needed to ensure durability of response. In addition, comparative studies with other treatment modalities are warranted.
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The aim of this study is to report a novel, multicenter experience with the diverticular peroral endoscopic myotomy (D-POEM) technique in the management of esophageal diverticula.
This is a ...multicenter, international, retrospective study involving three centers. D-POEM was performed using the principles of submucosal endoscopy.
A total of 11 patients with an esophageal diverticulum (Zenker's 7, mid-esophagus 1, epiphrenic 3) were included. The mean size of the esophageal diverticula was 34.5 mm. The overall technical success rate of D-POEM was 90.9 %, with a mean procedure time of 63.2 minutes. There were no adverse events. Clinical success was achieved in 100 % (10 /10), with a decrease in mean dysphagia score from 2.7 to 0.1 (
< 0.001) during a median follow-up of 145 days (interquartile range 126 - 273).
Endoscopic management of esophageal diverticula using the novel technique of D-POEM appears promising. This first case series on D-POEM suggests that the procedure is feasible, safe, and effective in the management of esophageal diverticula. D-POEM offers the distinct advantage of ensuring a complete septotomy. Larger studies are needed to confirm these intriguing results.
Background and Aims
Propofol sedation for endoscopy may result in a rapid and unpredictable progression from deep sedation to general anesthesia, leading to potential complications. We investigated ...the incidence and predictors of sedation-related adverse events (SAEs) in nonintubated patients who underwent outpatient ERCP procedures with propofol sedation.
Methods
We conducted a retrospective study of patients who underwent propofol sedation for ERCP procedures. Patients were sedated using propofol in combination with low-dose opiates. Data collected included patient demographics, American Society of Anesthesiologists (ASAs) physical status, and procedure times. SAE includes hypoxia (pulse oximetry <90 %), hypotension (systolic blood pressure <90 mmHg), and conversation to endotracheal intubation. Factors associated with SAEs were examined by univariate analysis and multivariate regression analysis (MVA).
Results
A total of 3041 patients were evaluated. The median BMI was 25.2 kg/m
2
, and the median ASA score was 3. The mean (±SD) duration of the procedures was 59 ± 23 min. Hypoxia requiring airway manipulation occurred in 28 % (
n
= 843) patients and hypotension requiring vasopressors in 0.4 % (
n
= 12). Forty-nine (1.6 %) patients required endotracheal intubation as a result of food in the stomach. Procedures underwent early termination in 8 (0.3 %) cases due to sedation-related hypotension (
n
= 5) and refractory laryngospasm (
n
= 3). Six patients were admitted after the ERCP for aspiration pneumonia as a result of sedation. Patients who developed SAE were older, had a higher mean BMI, and had longer mean procedure durations. On MVA, older age (
p
= 0.003), female sex (
p
= 0.001), BMI (
p
= 0.02), and ASA class ≥3 (
p
= 0.01) independently predicted SAEs.
Conclusions
Propofol can be used safely and effectively as a sedative agent for patients undergoing ERCPs when administered by trained professionals. Age, female sex, BMI, and ASA class ≥3 are independent predictors of SAEs.
Sessile serrated adenomas/polyps (SSA/Ps) have been increasingly studied during the last 10 years. However, their detailed anatomic distribution pattern has not been studied, especially given newer ...(broader) criteria for the diagnosis.
To characterize the anatomic distribution of SSA/P with and without cytologic dysplasia and to assess the demographics of these patients in a nationwide database.
We retrospectively analyzed the database of Miraca Life Sciences Research Institute for a 1-year period. Patients with a diagnosis of SSA/P, SSA/P with low-grade cytologic dysplasia (SSA/P-LGD), SSA/P with high-grade cytologic dysplasia (SSA/P-HGD), or SSA/P with adenocarcinoma (SSA/P-ACA) were retrieved, and patients' age, sex, and specific anatomic location were analyzed.
A total of 11,201 patients were identified, of which 10,646 (95.0%) had SSA/P, 514 (4.6%) had SSA/P-LGD, 39 (0.35%) had SSA/P-HGD, and 2 (0.018%) had SSA/P-ACA. All SSA/Ps and more advanced lesions were significantly more common in the proximal colon-SSA/P (61.2%), SSA/P-LGD (61.2%), SSA/P-HGD (80%), and SSA/P-ACA (100%)-than in either the transverse (18.8%, 17.8%, 10.0%, and 0%, respectively) or the distal (19.9%, 21.0%, 10.0%, and 0%, respectively) colon, P < .001. Sessile serrated adenoma/polyp with cytologic dysplasia was most commonly found in the ascending colon (LGD, 31.6%) and cecum (HGD, 37.5%). Advanced SSA/Ps were disproportionally more common among older women.
Sessile serrated adenomas/polyps with and without cytologic dysplasia and carcinoma are predominantly found in the cecum and ascending colon, whereas there is low prevalence in both the transverse and distal colon. Confirmation of previously published data regarding demographics of advanced lesions among a different cohort and including newer (broader) criteria suggests these criteria are valid.
Biliary papillomatosis is a rare type of papillomatosis. Depending on the location of the disease, radical surgical resection or liver transplants are the treatment of choice. These radical surgical ...options may be unrealistic in patients who are not surgical candidates or who are unwilling to consider surgery.
To evaluate the effectiveness of endoscopic electrocoagulation for the biliary papillomatosis.
In this case series, we report six patients with unresectable biliary papillomatosis who underwent cholangioscopic electrocoagulation using needle knife and their clinic follow up information.
After patients received cholangioscopy with electrocoagulation of the residual biliary papilloma, the daily T-tube drainage volume increased to 200-400ml with improvement in the drainage content and significant relief of clinical symptoms, such as jaundice and abdominal pain.
This method of using electrocoagulation to directly target and destroy tumor tissue is a safe and effective alternative for those with unresectable disease, and this method has shown to enhance T-tube drainage volume and improve patients' overall clinical symptoms.
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