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Wei MT, Friedland S, Hwang JH. The Current Landscape of Endoscopic Submucosal Training in the United States. Curr Gastroenterol Rep 2025; 27:4. [PMID: 39509015 DOI: 10.1007/s11894-024-00950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2024] [Indexed: 11/15/2024]
Abstract
PURPOSE OF REVIEW Endoscopic submucosal dissection (ESD) has been found to increase en bloc and R0 resection as well as decrease risk of recurrence. However, despite literature supporting the benefits of endoscopic submucosal dissection, adoption of ESD in the United States has been challenging, driven by factors including requirement for specialized training as well as limitations in training availability. RECENT FINDINGS Many devices have been developed to improve ease and therefore adoption for the procedure, with advancements in stability, resection as well as closure of the mucosal defect following resection. While the Japanese model of training in ESD centers around the Master-Apprentice model, this is scarce in the United States. Most US endoscopists therefore must follow other paths to learn and become proficient at ESD. There has been a rapid expansion in literature on ESD, fellowship programs, opportunities for case observation, and significant evolution in ex vivo training models that can assist an endoscopist in receiving training in ESD. Currently, there are three main ways of learning to perform ESD in the United States: 1. Third space endoscopy fellowship; 2. Master-apprentice model; 3. Utilization of live courses and proctored procedures. ESD is the optimal method to ensure en bloc resection of large mucosal neoplasms of the gastrointestinal tract. While several barriers hinder adoption of ESD in the United States, there has been significant development both in procedural and training aspects. Further research and discussions are needed to determine criteria for credentialing and proficiency in ESD.
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Affiliation(s)
- Mike T Wei
- Stanford University, Stanford, CA, United States.
| | - Shai Friedland
- Stanford University, Stanford, CA, United States
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Joo Ha Hwang
- Stanford University, Stanford, CA, United States
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2
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Laabidi S, Aboubecrine H, Souissi S, Gouiaa D, Labidi A, Ben Mustapha N, Haddad A, Sebai A, Serghini M, Fekih M, Jaziri H, Boubaker J. Colonic strictures in Crohn's disease: a non-surgical survival. Future Sci OA 2025; 11:2455911. [PMID: 39862140 PMCID: PMC11776860 DOI: 10.1080/20565623.2025.2455911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 12/13/2024] [Indexed: 01/27/2025] Open
Abstract
BACKGROUND Colonic stenosis in Crohn's disease (CD) is uncommon, and data on surgery-free survival are limited. This study aimed to determine surgery-free survival rates and identify associated factors. PATIENTS AND METHODS A retrospective study was conducted from 2003 to 2022, including patients with CD complicated by colonic stenosis. Patients with uncertain diagnoses or follow-up periods of less than six months were excluded. RESULTS Fifty-six patients were included (median age 44 years [range 14-65], male-to-female ratio = 0.93). Surgery-free survival rates were 58.9% at 6 months, 43.7% at 2 years, and 31.7% at 5 years, with an average surgery-free survival of 46.7 months. Univariate analysis showed that joint manifestations (p = 0.01), corticosteroids (p = 0.02), anti-TNF alpha (p = 0.02), salicylates (p = 0.02), and azathioprine (p = 0.01) increased surgery-free survival. Complications such as collections or internal fistulas (p = 0.03), parietal ulceration on imaging (p = 0.01), and acute intestinal obstruction (p = 0.01) were associated with reduced surgery-free survival. In multivariate analysis, biologic therapy was the only independent protective factor against surgery (p = 0.001, OR = 0.19). CONCLUSION The early introduction of biologic therapy is crucial for increasing surgery-free survival in patients with colonic stenosis in CD, given the limited effectiveness of conventional treatments.
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Affiliation(s)
- Sarra Laabidi
- Gastroenterology Department, La Rabta Hospital, Tunis, Tunisia
| | | | - Salma Souissi
- Gastroenterology Department, La Rabta Hospital, Tunis, Tunisia
| | - Donia Gouiaa
- Gastroenterology Department, La Rabta Hospital, Tunis, Tunisia
| | - Asma Labidi
- Gastroenterology Department, La Rabta Hospital, Tunis, Tunisia
| | | | - Anis Haddad
- Surgery Department “A”, La Rabta Hospital, Tunis, Tunisia
| | - Amine Sebai
- Surgery Department “A”, La Rabta Hospital, Tunis, Tunisia
| | - Meriem Serghini
- Gastroenterology Department, La Rabta Hospital, Tunis, Tunisia
| | - Monia Fekih
- Gastroenterology Department, Sahloul Hospital, Sousse, Tunisia
| | - Hanene Jaziri
- Gastroenterology Department, Sahloul Hospital, Sousse, Tunisia
| | - Jalel Boubaker
- Gastroenterology Department, La Rabta Hospital, Tunis, Tunisia
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3
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Hayat M, Xiao Y, Arain MA, Yang D. Endoscopic Gallbladder Drainage EUS LAMS vs. ERCP Trans-papillary Drainage. Curr Gastroenterol Rep 2025; 27:5. [PMID: 39549140 DOI: 10.1007/s11894-024-00948-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2024] [Indexed: 11/18/2024]
Abstract
PURPOSE OF REVIEW In this review, we discuss the role of endoscopic gallbladder drainage for acute cholecystitis in non-surgical candidates, describe technical aspects, clinical outcomes, and elaborate on considerations when determining which approach to adopt for a given patient. RECENT FINDINGS Cholecystectomy remains the criterion standard for management of acute cholecystitis in patients who can safely undergo surgery. For non-surgical candidates, percutaneous cholecystostomy (PTC-GBD) has been the traditional strategy to drain and decompress the gallbladder. Advances in endoscopy have further expanded the nonsurgical interventions and approaches to cholecystitis. Both endoscopic transpapillary gallbladder drainage (ET-GBD) and endoscopic ultrasound guided gallbladder drainage (EUS-GBD) have become acceptable alternatives to PTC-GBD, with growing literature supporting their efficacy, safety and improved patient quality of life when compared to a percutaneous approach. Choosing the appropriate endoscopic technique for gallbladder drainage should be tailored to each patient, keeping in view the specific clinical scenarios, endoscopist preference and following a multi-disciplinary approach.
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Affiliation(s)
- Maham Hayat
- Center for Interventional Endoscopy, AdventHealth, 601 E Rollins St, Orlando, FL, 32803, USA
| | - Yasi Xiao
- Center for Interventional Endoscopy, AdventHealth, 601 E Rollins St, Orlando, FL, 32803, USA
| | - Mustafa A Arain
- Center for Interventional Endoscopy, AdventHealth, 601 E Rollins St, Orlando, FL, 32803, USA
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, 601 E Rollins St, Orlando, FL, 32803, USA.
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4
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Gu W, Tan JRL, Jin H, Lou Q, Tang C, Cheung KS, Yang J, Zhang X. Balloon catheter-assisted endoscopic resection for papillary adenoma of non-exposed protruded type (with video). DEN OPEN 2025; 5:e408. [PMID: 39011513 PMCID: PMC11249003 DOI: 10.1002/deo2.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/25/2024] [Accepted: 06/30/2024] [Indexed: 07/17/2024]
Abstract
Papillary adenomas, known precursors to papillary adenocarcinoma, warrant close monitoring due to their malignant potential. Historically, surgical resection represented the mainstay of treatment for papillary adenomas with intraductal extension. However, recent advancements in endoscopic techniques have facilitated the adoption of endoscopic papillectomy as a minimally invasive alternative in carefully selected cases. We report a case of an 82-year-old woman with a diagnosis of papillary adenoma exhibiting intraductal extension. This was managed with a novel endoscopic technique, balloon catheter-assisted endoscopic resection. Due to the obscured intraductal component of the papillary mass, a balloon occlusion catheter was deployed within the common bile duct and used as traction to facilitate endoscopic visualization of the mass. Endoscopic resection via papillectomy was subsequently performed. Histopathological examination of the resected specimen revealed a villous adenoma with high-grade dysplasia. Serial endoscopic ultrasound examinations with targeted papillary biopsies were performed to monitor for disease recurrence.
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Affiliation(s)
- Weigang Gu
- Department of GastroenterologyAffiliated Hangzhou First People's HospitalHangzhouChina
| | - Justin Ryan L. Tan
- Department of GastroenterologyAffiliated Hangzhou First People's HospitalHangzhouChina
- Department of GastroenterologyChinese General Hospital and Medical CenterManilaPhilippines
- Department of GastroenterologyMetropolitan Medical CenterManilaPhilippines
| | - Hangbin Jin
- Department of GastroenterologyAffiliated Hangzhou First People's HospitalHangzhouChina
| | - Qifeng Lou
- Department of GastroenterologyAffiliated Hangzhou First People's HospitalHangzhouChina
| | - Chuang Tang
- Department of GastroenterologyAffiliated Hangzhou First People's HospitalHangzhouChina
| | - Ka Shing Cheung
- Department of GastroenterologyAffiliated Hangzhou First People's HospitalHangzhouChina
- Department of MedicineThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
- Queen Mary HospitalHong KongHong Kong
| | - Jianfeng Yang
- Department of GastroenterologyAffiliated Hangzhou First People's HospitalHangzhouChina
| | - Xiaofeng Zhang
- Department of GastroenterologyAffiliated Hangzhou First People's HospitalHangzhouChina
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5
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Ito M, Dobashi A, Tominaga T, Futakuchi T, Tamai N, Suka M, Sumiyama K. The competency of the novel through-the-scope suture device for gastric mucosal defects: In vivo study in a porcine model (with video). DEN OPEN 2025; 5:e70037. [PMID: 39534406 PMCID: PMC11556257 DOI: 10.1002/deo2.70037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 10/19/2024] [Accepted: 10/27/2024] [Indexed: 11/16/2024]
Abstract
Objectives Endoscopic closures of mucosal defects following endoscopic resection can be challenging and time-consuming. The novel through-the-scope suture device has demonstrated acceptable closure times, but its learning curve is still unknown. This study aims to evaluate the number of cases required to achieve competency in this device. Methods Two endoscopists participated; a novice with less than 400 experiences in upper gastrointestinal endoscopy and an expert with over 500 experiences in endoscopic submucosal dissection. Neither endoscopist had previous exposure to the device. In four porcine models, 24 gastric mucosal defects, each 2-4 cm in diameter, were created by endoscopic mucosal resection with ligation. Each endoscopist performed endoscopic closure for 12 mucosal defects with a single through-the-scope suture device per lesion. The primary endpoint was the number of cases needed to reach competency, defined as achieving a procedure time below the average closure time reported in the literature. Secondary endpoints included procedure time, complete closure success rates, and incidence of adverse events. Results The mean defect size was 2.9 (±0.2) cm. Competency was achieved after six cases in the expert and seven cases in the novice. The median closure time was 9.0 (interquartile range [IQR]: 6.0-11.0) min for the expert and 8.0 (IQR: 6.2-9.7) min for the novice (p = 0.862). Complete closure success rates were 75.0% (n = 9) for the expert and 83.3% (n = 10) for the novice. No adverse events were reported. Conclusions A small number of cases were required for both expert and novice endoscopists to reach competency in the novel through-the-scope suture device.
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Affiliation(s)
- Mamoru Ito
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
| | - Akira Dobashi
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
| | - Takanori Tominaga
- Department of Gastroenterology and HepatologyThe Jikei University School of MedicineTokyoJapan
| | - Toshiki Futakuchi
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
| | - Naoto Tamai
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
| | - Machi Suka
- Department of Public Health and Environmental MedicineThe Jikei University School of MedicineTokyoJapan
| | - Kazuki Sumiyama
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
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6
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Kumagai K, Takada Y, Sugimoto A, Sakagami S, Akioka Y, Mitani R, Oshima A, Kitade M, Oshiro M, Katsuyama S, Ota S, Adachi K, Shimada Y, Hayashi M, Itami A, Itani T. Endoscopic incisional balloon dilation combined with anti-scarring agents for postoperative esophageal anastomotic strictures. DEN OPEN 2025; 5:e70062. [PMID: 39822949 PMCID: PMC11736416 DOI: 10.1002/deo2.70062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 01/02/2025] [Accepted: 01/06/2025] [Indexed: 01/19/2025]
Abstract
The management of locally advanced esophageal cancer typically involves esophagectomy; however, postoperative complications, particularly anastomotic stricture, remain prevalent. Anastomotic stricture can severely compromise patients' quality of life by leading to difficulties in food intake. Although endoscopic balloon dilation has become a standard treatment for gastrointestinal strictures, its efficacy is often limited due to the risk of perforation and the potential for recurrent stricture, necessitating multiple interventions. Recent advancements have introduced endoscopic radial incision and cutting methods, which aim to enhance patency by excising scar tissue. We experienced a case resistant to the radial incision and cutting therapy, necessitating further intervention strategies. This report details our experience utilizing a novel technique, endoscopic incisional balloon dilation, which combines endoscopic incisional technique and balloon dilation therapy with anti-scarring medications, in cases of refractory anastomotic strictures following esophageal cancer resection. We present three challenging cases in which endoscopic incisional balloon dilation yielded significant clinical improvements, alongside supportive literature. Our findings suggest that endoscopic incisional balloon dilation is an effective and safer alternative to conventional methods, capable of addressing complex stricture scenarios while potentially enhancing patient outcomes and quality of life.
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Affiliation(s)
- Ken Kumagai
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Yutaka Takada
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Ayaka Sugimoto
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Shinjiro Sakagami
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Yuri Akioka
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Rie Mitani
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Akihiro Oshima
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Masayuki Kitade
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Manami Oshiro
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Sonoka Katsuyama
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
- Department of GastroenterologyMedical Research Institute KITANO HOSPITAL, PIIF Tazuke‐KofukaiOsakaJapan
| | - Shogo Ota
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Kanna Adachi
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Yukari Shimada
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Motohito Hayashi
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Atsushi Itami
- Department of SurgeryKobe City Nishi‐Kobe Medical CenterHyogoJapan
| | - Toshinao Itani
- Department of GastroenterologyKobe City Nishi‐Kobe Medical CenterHyogoJapan
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7
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Ishihara Y, Ichita C, Jinushi R, Sasaki A. Clinical assessment of computed tomography for detecting ingested blister packs: A single-center retrospective study. DEN OPEN 2025; 5:e406. [PMID: 39011510 PMCID: PMC11248714 DOI: 10.1002/deo2.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/24/2024] [Accepted: 06/30/2024] [Indexed: 07/17/2024]
Abstract
Objectives Blister pack (BP) ingestion poses serious risks, such as gastrointestinal perforation, and accurate localization by computed tomography (CT) is a common practice. However, while it has been reported in vitro that CT visibility varies with the material type of BPs, there have been no reports on this variability in clinical settings. In this study, we investigated the CT detection rates of different BPs in clinical settings. Methods This single-center retrospective study from 2010 to 2022 included patients who underwent endoscopic foreign body removal for BP ingestion. The patients were categorized into two groups for BP components, the polypropylene (PP) and the polyvinyl chloride (PVC)/polyvinylidene chloride (PVDC) groups. The primary outcome was the comparison of CT detection rates between the groups. We also evaluated whether the BPs contained tablets and analyzed their locations. Results This study included 61 patients (15 in the PP group and 46 in the PVC/PVDC group). Detection rates were 97.8% for the PVC/PVDC group compared to 53.3% for the PP group, a significant difference (p < 0.01). No cases of BPs composed solely of PP were detected by CT. Blister packs were most commonly found in the upper thoracic esophagus. Conclusions Even in a clinical setting, the detection rates of PVC and PVDC were higher than that of PP alone. Identifying PP without tablets has proven challenging in clinical. Considering the risk of perforation, these findings suggest that esophagogastroduodenoscopy may be necessary, even if CT detection is negative.
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Affiliation(s)
- Yo Ishihara
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKanagawaJapan
- Department of Palliative MedicineInternational University of Health and Welfare Narita HospitalChibaJapan
| | - Chikamasa Ichita
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKanagawaJapan
- Department of Health Data ScienceYokohama City UniversityKanagawaJapan
| | - Ryuhei Jinushi
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKanagawaJapan
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
| | - Akiko Sasaki
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKanagawaJapan
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8
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Shinozaki S, Osawa H, Miura Y, Nomoto H, Sakamoto H, Hayashi Y, Yano T, Despott EJ, Yamamoto H. Endoscopic findings and outcomes of gastric mucosal changes relating to potassium-competitive acid blocker and proton pump inhibitor therapy. DEN OPEN 2025; 5:e400. [PMID: 38919514 PMCID: PMC11196240 DOI: 10.1002/deo2.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024]
Abstract
Gastric mucosal changes associated with long-term potassium-competitive acid blocker and proton pump inhibitor (PPI) therapy may raise concern. In contrast to that for PPIs, the evidence concerning the safety of long-term potassium-competitive acid blocker use is scant. Vonoprazan (VPZ) is a representative potassium-competitive acid blocker released in Japan in 2015. In order to shed some comparative light regarding the outcomes of gastric mucosal lesions associated with a long-term acid blockade, we have reviewed six representative gastric mucosal lesions: fundic gland polyps, gastric hyperplastic polyps, multiple white and flat elevated lesions, cobblestone-like gastric mucosal changes, gastric black spots, and stardust gastric mucosal changes. For these mucosal lesions, we have evaluated the association with the type of acid blockade, patient gender, Helicobacter pylori infection status, the degree of gastric atrophy, and serum gastrin levels. There is no concrete evidence to support a significant relationship between VPZ/PPI use and the development of neuroendocrine tumors. Current data also shows that the risk of gastric mucosal changes is similar for long-term VPZ and PPI use. Serum hypergastrinemia is not correlated with the development of some gastric mucosal lesions. Therefore, serum gastrin level is unhelpful for risk estimation and for decision-making relating to the cessation of these drugs in routine clinical practice. Given the confounding potential neoplastic risk relating to H. pylori infection, this should be eradicated before VPZ/PPI therapy is commenced. The evidence to date does not support the cessation of clinically appropriate VPZ/PPI therapy solely because of the presence of these associated gastric mucosal lesions.
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Affiliation(s)
- Satoshi Shinozaki
- Shinozaki Medical ClinicTochigiJapan
- Department of MedicineDivision of GastroenterologyJichi Medical UniversityTochigiJapan
| | - Hiroyuki Osawa
- Department of MedicineDivision of GastroenterologyJichi Medical UniversityTochigiJapan
| | - Yoshimasa Miura
- Department of MedicineDivision of GastroenterologyJichi Medical UniversityTochigiJapan
- Department of MedicineDivision of Gastroenterology and HepatologyNihon University School of MedicineTokyoJapan
| | - Hiroaki Nomoto
- Department of MedicineDivision of GastroenterologyJichi Medical UniversityTochigiJapan
| | - Hirotsugu Sakamoto
- Department of MedicineDivision of GastroenterologyJichi Medical UniversityTochigiJapan
| | - Yoshikazu Hayashi
- Department of MedicineDivision of GastroenterologyJichi Medical UniversityTochigiJapan
| | - Tomonori Yano
- Department of MedicineDivision of GastroenterologyJichi Medical UniversityTochigiJapan
| | - Edward J. Despott
- Royal Free Unit for EndoscopyThe Royal Free Hospital and UCL Institute for Liver and Digestive HealthLondonUK
| | - Hironori Yamamoto
- Department of MedicineDivision of GastroenterologyJichi Medical UniversityTochigiJapan
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9
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Kagemoto K, Okamoto K, Okada Y, sei M, Fujimoto S, Yagi M, Mitsuhashi T, Ueda H, Yoshimoto T, Kashihara T, Kawaguchi T, Kida Y, Mitsui Y, Kawano Y, Sogabe M, Miyamoto H, Sato Y, Muguruma N, Takayama T. Clinicopathological evaluation of the efficacy of endoscopic treatment for sessile serrated lesions comparing endoscopic mucosal resection, cold snare polypectomy, and underwater endoscopic mucosal resection. DEN OPEN 2025; 5:e70051. [PMID: 39758158 PMCID: PMC11695825 DOI: 10.1002/deo2.70051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 11/18/2024] [Accepted: 12/16/2024] [Indexed: 01/07/2025]
Abstract
Objectives Recently, various endoscopic treatments for colorectal polyps have been reported, including cold snare polypectomy (CSP) and underwater endoscopic mucosal resection (UEMR), in addition to EMR. However, a precise treatment strategy for sessile serrated lesions (SSL) has not been established. In this study, we analyzed the clinicopathological features of SSL resected by EMR, CSP, and UEMR to determine the most suitable treatment for SSL. Methods A total of 92 SSL resected via EMR (n = 11), CSP (n = 36), and UEMR (n = 45) were retrospectively enrolled between February 2021 and October 2022. To evaluate pathological findings, we examined SSL samples, which were stretched before formalin fixation and sectioned at 2-mm intervals. Primary outcomes were the R0 resection rate and thickness of submucosal (SM) tissue specimens for each treatment. In addition, we evaluated SSL with dysplasia (SSLD) and the inverted growth pattern which may affect the vertical margin. Results The R0 resection rate significantly differed among the three groups (EMR, 73%; CSP, 42%; UEMR, 87%, p = 0.001). The median thickness of SM tissue resected by CSP (0 µm) was significantly less than that by EMR (362 µm) and UEMR (325 µm; p < 0.001). All four SSLDs were diagnosed endoscopically. Five SSLs with inverted growth patterns were pathologically diagnosed. Of these, two SSLs with inverted growth patterns could not be diagnosed endoscopically. Conclusions UEMR is considered to be a suitable treatment option for SSL. CSP results were pathologically insufficient. Therefore, surveillance to evaluate local recurrence is important, and the results of further multicenter prospective studies should be referred.
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Affiliation(s)
- Kaizo Kagemoto
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Koichi Okamoto
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Yasuyuki Okada
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Motoko sei
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Shota Fujimoto
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Mai Yagi
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Takeshi Mitsuhashi
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Hiroyuki Ueda
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Takanori Yoshimoto
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Takanori Kashihara
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Tomoyuki Kawaguchi
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Yoshifumi Kida
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Yasuhiro Mitsui
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Yutaka Kawano
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Masahiro Sogabe
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Hiroshi Miyamoto
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Yasushi Sato
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
| | - Naoki Muguruma
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
- Department of GastroenterologyTakamatsu Municipal HospitalKagawaJapan
| | - Tetsuji Takayama
- Department of Gastroenterology and OncologyInstitute of Biomedical SciencesTokushima University Graduate SchoolTokushimaJapan
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10
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Tomishima K, Isayama H, Suzuki A, Ishii S, Takahashi S, Fujisawa T. Technical review of endoscopic ultrasound-guided drainage/anastomosis and trans-endosonographically created route procedures for the treatment of pancreatic diseases. DEN OPEN 2025; 5:e393. [PMID: 38854708 PMCID: PMC11157673 DOI: 10.1002/deo2.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/17/2024] [Indexed: 06/11/2024]
Abstract
Endoscopic ultrasound (EUS)-guided pancreatic duct drainage includes two procedures: EUS-guided drainage/anastomosis (EUS-D/A) and trans-papillary drainage with EUS-assisted pancreatic rendezvous. EUS-guided pancreatogastrostomy is the most common EUS-D/A procedure and is recommended as a salvage procedure in cases in which endoscopic retrograde cholangiopancreatography fails or is difficult. However, initial EUS-D/A is performed in patients with surgically altered anatomy at our institution. It is one of the most difficult interventional EUS procedures and has a high incidence of adverse events. The technical difficulties differ according to etiology, and the incidence of adverse events varies between initial EUS-D/A and subsequent trans-endosonographically/EUS-guided created route procedures. Hence, it is important to meticulously prepare a procedure based on the patient's condition and the available devices. The technical difficulties in EUS-D/A include: (1) determination of the puncture point, (2) selection of a puncture needle and guidewire, (3) guidewire manipulation, and (4) dilation of the puncture route and stenting. Proper technical procedures are important to increase the success rate and reduce the incidence and severity of adverse events. The complexity of EUS-D/A is also contingent on the severity of pancreatic fibrosis and stricture. In post-pancreatectomy cases, determination of the puncture site is important for success because of the remnant pancreas. Trans-endosonographically/EUS-guided created route procedures following initial EUS-D/A are also important for achieving the treatment goal. This article focuses on effective strategies for initial EUS-D/A, based on the etiology and condition of the pancreas. We mainly discuss EUS-D/A, including its indications, techniques, and success-enhancing strategies.
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Affiliation(s)
- Ko Tomishima
- Department of GastroenterologyGraduate School of MedicineJuntendo UniversityTokyoJapan
| | - Hiroyuki Isayama
- Department of GastroenterologyGraduate School of MedicineJuntendo UniversityTokyoJapan
| | - Akinori Suzuki
- Department of GastroenterologyGraduate School of MedicineJuntendo UniversityTokyoJapan
| | - Shigeto Ishii
- Department of GastroenterologyGraduate School of MedicineJuntendo UniversityTokyoJapan
| | - Sho Takahashi
- Department of GastroenterologyGraduate School of MedicineJuntendo UniversityTokyoJapan
| | - Toshio Fujisawa
- Department of GastroenterologyGraduate School of MedicineJuntendo UniversityTokyoJapan
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11
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Watanabe T, Murano T, Ikematsu H, Shinmura K, Wakabayashi M, Minakata N, Maasa S, Mitsui T, Yamashita H, Inaba A, Sunakawa H, Nakajo K, Kadota T, Yano T. Impact of advanced endoscopy training on colonoscopy quality and efficiency. DEN OPEN 2025; 5:e70027. [PMID: 39398258 PMCID: PMC11470744 DOI: 10.1002/deo2.70027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 09/17/2024] [Accepted: 09/30/2024] [Indexed: 10/15/2024]
Abstract
Objectives Few reports have detailed improvements in the quality of colonoscopies with continuous training post-fellowship completion. We examined the changes in colonoscopy performance among trainees during our advanced endoscopy training program. Methods Screening or surveillance colonoscopies performed by 11 trainees who participated in our 3-year advanced endoscopy training program between April 2015 and March 2020 were retrospectively analyzed. Quality and efficiency metrics of colonoscopies were evaluated annually. Results Altogether, 297, 385, and 438 colonoscopies were enrolled in the first, second, and third training years, respectively. The mean insertion times were 8.6, 7.6, and 6.9 min in the first, second, and third training years, respectively, with significant improvement from the first to second year (p = 0.03) and from the first to third year (p < 0.01). The adenoma detection rate, proximal adenoma detection rate, and mean number of adenomas per patient exhibited a tendency to improve annually; however, the difference was not significant. Polypectomy efficiency was 10.5%, 11.2%, and 13.0%, with significant improvements from the first to third year (p < 0.01) and from the second to third year (p = 0.02). Insertion time and polypectomy efficiency showed significant improvements, especially among trainees experienced with <500 colonoscopies. Conclusions Through our advanced endoscopy training program, there has been an improvement in the quality and efficiency of colonoscopy for trainees who have completed their fellowships, particularly those with <500 colonoscopies.
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Affiliation(s)
- Takashi Watanabe
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
- Course of Advanced Clinical Research of CancerJuntendo University Graduate School of MedicineTokyoJapan
| | - Tatsuro Murano
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Kensuke Shinmura
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Masashi Wakabayashi
- Biostatistics DivisionCenter for Research Administration and SupportNational Cancer CenterChibaJapan
| | - Nobuhisa Minakata
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Sasabe Maasa
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Tomohiro Mitsui
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Hiroki Yamashita
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Atsushi Inaba
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Hironori Sunakawa
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Keiichiro Nakajo
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Tomohiro Kadota
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Tomonori Yano
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
- Course of Advanced Clinical Research of CancerJuntendo University Graduate School of MedicineTokyoJapan
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12
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Pollack E, Norwood D, Caceres H, Rapaka B, Perry IE, Barlass U, Mitchell R, McCreight J, Peter S, Mulki R, Ahmed A, Kyanam K, Sánchez‐Luna SA. Lumen-apposing metal stents provide early and late clinical benefits for the management of benign gastrointestinal strictures: Is there a role for definitive therapy? DEN OPEN 2025; 5:e70005. [PMID: 39220854 PMCID: PMC11366066 DOI: 10.1002/deo2.70005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/08/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
Objectives This study aimed to characterize the clinical outcomes, safety, and efficacy of lumen-apposing metal stents (LAMS) in treating benign gastrointestinal strictures. Methods A single-center retrospective review of all patients who underwent LAMS placement for benign strictures from June 2017 to July 2023. Primary outcomes were technical success, early clinical success, late clinical success (LCS), and sustained post-LAMS clinical success (SPLCS). Secondary outcomes included stent dwell time, stenosis changes, adverse events, reintervention rates, and symptomatology evaluation. Results Thirty-five patients underwent placement of 42 LAMS (74% female, mean age: 54.2 ± 11.7 years). Anastomotic strictures accounted for 64% of cases (N = 27, 45% at the gastrojejunal anastomosis). The median STD was 91.0 days (interquartile range [IQR]: 55.0-132.0). Technical success was obtained in all cases. Early clinical successand LCS were achieved in 80% of cases overall. SPLCS was achieved in 45% (n = 15) of cases. The overall reintervention rate was 63%, with a median time to reintervention being 50.5 days (IQR: 24-105). adverse events occurred in 28% (n = 12) overall, with a 24% migration rate (n = 10). Follow-up was completed in 83% of cases with a median duration of 629 days (range: 192.0-1297.0). Overall symptom improvement occurred in 79% (n = 27) during indwelling LAMS versus 58% and 56% at 30- and 60-days post-removal, respectively. Conclusions LAMS for benign gastrointestinal strictures are associated with high technical and early clinical success/LCS rates, positive quality-of-life metrics, and a tolerable adverse event rate. Overall, recurrence of symptoms and high reintervention rates post-LAMS removal reinforce the difficulty in managing benign gastrointestinal strictures but also argue for LAMS as a definitive therapy in select cases.
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Affiliation(s)
- Ethan Pollack
- Department of Internal MedicineThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Dalton Norwood
- Department of Internal MedicineUAB Minority Health and Health Equity Research CenterThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Hector Caceres
- Department of Internal MedicineUAB Minority Health and Health Equity Research CenterThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Babusai Rapaka
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Isaac E. Perry
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Usman Barlass
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Rachel Mitchell
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Jessica McCreight
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Shajan Peter
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Ramzi Mulki
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Ali Ahmed
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Kondal Kyanam
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
| | - Sergio A. Sánchez‐Luna
- Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirminghamAlabamaUSA
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13
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Kato T, Hikichi T, Nakamura J, Hashimoto M, Kobashi R, Yanagita T, Takagi T, Suzuki R, Sugimoto M, Asama H, Sato Y, Shioya Y, Kobayakawa M, Ohira H. Visibility of esophageal squamous cell carcinoma under iodine staining on texture and color enhancement imaging. DEN OPEN 2025; 5:e370. [PMID: 38725874 PMCID: PMC11079435 DOI: 10.1002/deo2.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 05/12/2024]
Abstract
Objective Iodine staining on white light imaging (WLI) is the gold standard for detecting and demarcating esophageal squamous cell carcinoma (ESCC). We examined the effects of texture and color enhancement imaging (TXI) on improving the endoscopic visibility of ESCC under iodine staining. Methods Twenty ESCC lesions that underwent endoscopic submucosal dissection were retrospectively included. The color difference between ESCC and the surrounding mucosa (ΔEe) on WLI, TXI, and narrow-band imaging was assessed, and ΔEe under 1% iodine staining on WLI and TXI. Furthermore, the visibility grade determined by endoscopists was evaluated on each imaging. Result The median ΔEe was greater on TXI than on WLI (14.53 vs. 10.71, respectively; p < 0.005). Moreover, the median ΔEe on TXI under iodine staining was greater than the median ΔEe on TXI and narrow-band imaging (39.20 vs. 14.53 vs. 16.42, respectively; p < 0.005 for both). A positive correlation in ΔEe under iodine staining was found between TXI and WLI (correlation coefficient = 0.61, p < 0.01). Moreover, ΔEe under iodine staining on TXI in each lesion was greater than the corresponding ΔEe on WLI. The visibility grade assessed by endoscopists on TXI was also significantly greater than that on WLI under iodine staining (p < 0.01). Conclusions The visibility of ESCC after iodine staining was greater on TXI than on WLI.
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Affiliation(s)
- Tsunetaka Kato
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Takuto Hikichi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Jun Nakamura
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Minami Hashimoto
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Ryoichiro Kobashi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Takumi Yanagita
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Tadayuki Takagi
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Rei Suzuki
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Mitsuru Sugimoto
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Hiroyuki Asama
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Yuki Sato
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Yasuo Shioya
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Masao Kobayakawa
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Medical Research CenterFukushima Medical UniversityFukushimaJapan
| | - Hiromasa Ohira
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
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14
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Khan A, Mushtaq M, Movva G, Sohal A, Yang J. Gastrointestinal disease in end-stage renal disease. World J Nephrol 2025; 14:101917. [DOI: 10.5527/wjn.v14.i1.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/24/2024] [Accepted: 01/03/2025] [Indexed: 01/20/2025] Open
Abstract
When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy (i.e. renal transplant or dialysis), it is called end-stage renal disease (ESRD). Patients with ESRD often experience a range of gastrointestinal (GI) symptoms, with prevalence rates reported as high as 77%-79%. These symptoms and pathologies arise from various factors, including electrolyte imbalance, fluid imbalance, toxin buildup, uremia, medications, dietary and lifestyle restrictions, and the effects of dialysis. GI diseases in patients with renal failure can be further categorized into upper GI, small bowel, and lower GI issues. Common conditions include gastroesophageal reflux disease, nausea and vomiting, dysmotility within the esophagus and stomach, upper GI bleeding, peptic ulcer bleeding, angioectasia, irritable bowel syndrome, mesenteric ischemia, angiodysplasia, diverticular disease, constipation, pancreatitis, and diseases associated with peritoneal dialysis peritonitis and peritoneal stenosis. This review assesses the existing literature on the different GI diseases among individuals with ESRD, shedding light on their pathophysiology and prevalence.
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Affiliation(s)
- Ayesha Khan
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77550, United States
| | - Muhammad Mushtaq
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77550, United States
| | - Giri Movva
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77550, United States
| | - Aalam Sohal
- Gastroenterology and Hepatology, Creighton University School of Medicine, Phoenix, AZ 85012, United States
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX 77555, United States
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15
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Fatakhova K, Inayat F, Ali H, Patel P, Rehman AU, Afzal A, Sarfraz M, Sarfraz S, Nawaz G, Chaudhry A, Dhillon R, Dilibe A, Glazebnik B, Jones L, Glazer E. Gender disparities and woman-specific trends in Barrett’s esophagus in the United States: An 11-year nationwide population-based study. World J Methodol 2025; 15:97512. [DOI: 10.5662/wjm.v15.i1.97512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 09/29/2024] Open
Abstract
BACKGROUND Barrett's esophagus (BE) is a known premalignant precursor to esophageal adenocarcinoma (EAC). The prevalence rates continue to rise in the United States, but many patients who are at risk of EAC are not screened. Current practice guidelines include male gender as a predisposing factor for BE and EAC. The population-based clinical evidence regarding female gender remains limited.
AIM To study comparative trends of gender disparities in patients with BE in the United States.
METHODS A nationwide retrospective study was conducted using the 2009-2019 National Inpatient Sample (NIS) database. Patients with a primary or secondary diagnosis code of BE were identified. The major outcome of interest was determining the gender disparities in patients with BE. Trend analysis for respective outcomes for females was also reported to ascertain any time-based shifts.
RESULTS We identified 1204190 patients with BE for the study period. Among the included patients, 717439 (59.6%) were men and 486751 (40.4%) were women. The mean age was higher in women than in men (67.1 ± 0.4 vs 66.6 ± 0.3 years, P < 0.001). The rate of BE per 100000 total NIS hospitalizations for males increased from 144.6 in 2009 to 213.4 in 2019 (P < 0.001). The rate for females increased from 96.8 in 2009 to 148.7 in 2019 (P < 0.001). There was a higher frequency of obesity among women compared to men (17.4% vs 12.6%, P < 0.001). Obesity prevalence among females increased from 12.3% in 2009 to 21.9% in 2019 (P < 0.001). A lower prevalence of smoking was noted in women than in men (20.8% vs 35.7%, P < 0.001). However, trend analysis showed an increasing prevalence of smoking among women, from 12.9% in 2009 to 30.7% in 2019 (P < 0.001). Additionally, there was a lower prevalence of alcohol abuse, Helicobacter pylori (H. pylori), and diabetes mellitus among females than males (P < 0.001). Trend analysis showed an increasing prevalence of alcohol use disorder and a decreasing prevalence of H. pylori and diabetes mellitus among women (P < 0.001).
CONCLUSION The prevalence of BE among women has steadily increased from 2009 to 2019. The existing knowledge concerning BE development has historically focused on men, but our findings show that the risk in women is not insignificant.
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Affiliation(s)
- Karina Fatakhova
- Division of Gastroenterology and Hepatology, Mather Hospital and Zucker School of Medicine at Hofstra University, Port Jefferson, NY 11777, United States
| | - Faisal Inayat
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
| | - Hassam Ali
- Division of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Pratik Patel
- Division of Gastroenterology and Hepatology, Mather Hospital and Zucker School of Medicine at Hofstra University, Port Jefferson, NY 11777, United States
| | - Attiq Ur Rehman
- Division of Gastroenterology and Hepatology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, United States
| | - Arslan Afzal
- Division of Gastroenterology and Hepatology, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Muhammad Sarfraz
- Division of Gastroenterology and Hepatology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, United States
| | - Shiza Sarfraz
- Department of Internal Medicine, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Gul Nawaz
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
| | - Ahtshamullah Chaudhry
- Department of Internal Medicine, St. Dominic's Hospital, Jackson, MS 39216, United States
| | - Rubaid Dhillon
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
| | - Arthur Dilibe
- Department of Internal Medicine, East Carolina University Brody School of Medicine, Greenville, NC 27834, United States
| | - Benjamin Glazebnik
- Department of Internal Medicine, Mather Hospital and Hofstra University Zucker, School of Medicine, Port Jefferson, NY 11777, United States
| | - Lindsey Jones
- Department of Internal Medicine, Mather Hospital and Hofstra University Zucker, School of Medicine, Port Jefferson, NY 11777, United States
| | - Emily Glazer
- Division of Gastroenterology and Hepatology, Mather Hospital and Zucker School of Medicine at Hofstra University, Port Jefferson, NY 11777, United States
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16
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Sugimoto M, Takagi T, Suzuki R, Asama H, Shimizu H, Sato K, Ohira R, Nakamura J, Takasumi M, Kato T, Yanagita T, Otsuka M, Hikichi T, Ohira H. Selection methods for endoscopic ultrasound‑guided biliary drainage cases that are appropriate for beginners. Exp Ther Med 2025; 29:53. [PMID: 39885912 PMCID: PMC11775763 DOI: 10.3892/etm.2025.12803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 12/18/2024] [Indexed: 02/01/2025] Open
Abstract
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is performed as a second drainage method when endoscopic retrograde cholangiopancreatography-guided biliary drainage fails. There are several severe adverse events in EUS-BD, and avoiding technical failure is desirable. Although EUS-BD is a skilled endoscopic treatment, the appropriate conditions for EUS-BD beginners are not well known. The present study aimed to clarify the appropriate cases for EUS-BD beginners. The present retrospective cohort study included patients with malignant biliary obstruction who underwent EUS-BD, which was performed by beginners between March 2005 and June 2024. Factors associated with successful EUS-BD performed by beginners were evaluated by multivariate logistic regression analysis. The performance of each factor was evaluated via a receiver operating characteristic (ROC) curve. According to multivariate analysis, the diameter of the punctured bile duct was associated with successful EUS-BD performed by beginners (odds ratio, 1.34; 95% CI, 1.03-1.75; P=0.031). The area under the ROC curve for the diameter of the punctured bile duct was 0.79, and the cutoff value was 6.7 mm (71% sensitivity and 81.8% specificity). The diameter of the punctured bile duct might be associated with successful EUS-BD procedures performed by beginners. When a beginner performs EUS-BD, a diameter of the targeted bile duct >6.7 mm might be desirable for successful procedures.
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Affiliation(s)
- Mitsuru Sugimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Rei Suzuki
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Hiroshi Shimizu
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Kentaro Sato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Rei Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Jun Nakamura
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Fukushima 960-1295, Japan
| | - Mika Takasumi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Tsunetaka Kato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Fukushima 960-1295, Japan
| | - Takumi Yanagita
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Fukushima 960-1295, Japan
| | - Mitsuru Otsuka
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Fukushima 960-1295, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Fukushima 960-1295, Japan
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17
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Rana SS, Ancil S. Management of Pancreatic Duct Strictures, Leaks, and Disconnected Pancreatic Duct Syndrome. Gastroenterol Clin North Am 2025; 54:75-95. [PMID: 39880534 DOI: 10.1016/j.gtc.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2025]
Abstract
Pancreatic duct (PD) strictures, leaks, and disconnected ducts are important morphologic consequences of inflammatory disease of the pancreas, resulting in abdominal pain, pancreatic ascites, pancreatic pleural effusion, and external pancreatic fistula. Traditionally, these PD complications were treated surgically, but a better understanding of their pathophysiology, along with advancement in endoscopic interventions, has transformed the therapy from morbid surgical interventions to minimally invasive, safe, and effective endoscopic treatment. This review discusses the current diagnostic and management strategies for PD strictures, leaks, and disconnected pancreatic ducts.
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Affiliation(s)
- Surinder Singh Rana
- Unit III, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India.
| | - Sanish Ancil
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
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18
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Zhang SY, Wang YC, Liu LL, Wang ZH, Guan XM. Efficacy-cost analysis of endoscopic mucosal resection and cold snare polypectomy: A propensity score matching analysis. World J Gastrointest Surg 2025; 17:99510. [DOI: 10.4240/wjgs.v17.i2.99510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 11/21/2024] [Accepted: 12/09/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy (CSP) in terms of polypectomy efficacy and reduced postoperative adverse events, few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection (EMR) for the treatment of intestinal polyps.
AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.
METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023. According to the treatment methods, they were divided into EMR (n = 46) group and CSP (n = 54) group. The baseline data of the two groups were balanced by 1:1 propensity score matching (PSM), and the cost-effectiveness analysis was performed on the two groups after matching. The recurrence rate of the two groups of patients was followed up for 1 year, and they were divided into recurrence group and non-recurrence group according to whether they recurred. Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.
RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM (P < 0.05). Following PSM, the number of polyps and smoking history were well balanced between the EMR and CSP groups. The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group. Concurrently, the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group (P < 0.05). Upon completion of the 1-year follow-up, the rate of recurrence after endoscopic intestinal polypectomy was 38.00%. Multivariate methods revealed that age ≥ 60 years, male sex, number of polyps ≥ 3, and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy (all P < 0.05).
CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps. An age ≥ 60 years, male sex, having a number of polyps ≥ 3, and pathological type of adenoma are independent influencing factors for recurrence.
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