Automated artificial intelligence scoring systems for the endoscopic assessment of ulcerative colitis: How far are we from clinical application?Artificial intelligence (AI) is going to drastically change our approach to diagnostic endoscopy. In contrast to its human counterpart, AI can manage an exceptional amount of data simultaneously, does not get fatigued, and can be highly effective and efficient. In the past couple of years, we have witnessed a literal blossom of AI systems applied to digestive endoscopy. Industries have been leading this first part of AI application, with the launch of real-time automated polyp detection and characterization systems to screening colonoscopy.
Underwater versus conventional EMR for nonpedunculated colorectal lesions: a randomized clinical trialConventional endoscopic mucosal resection (CEMR) is the standard modality for removing nonpedunculated colorectal lesions. Underwater endoscopic mucosal resection (UEMR) has emerged as an alternative method. There are few comparative studies between these techniques, especially evaluating recurrence. Therefore, the purpose of this trial was to compare CEMR and UEMR for the resection of colorectal lesions with respect to efficacy, safety, and recurrence rate.
Development and validation of artificial neural networks model for detection of Barrett’s neoplasia: a multicenter pragmatic nonrandomized trial (with video)The aim of this study was to develop and externally validate a computer-aided detection (CAD) system for the detection and localization of Barrett’s neoplasia and assess its performance compared with that of general endoscopists in a statistically powered multicenter study by using real-time video sequences.
Reduction in mortality after percutaneous endoscopic gastrostomy tube insertion is likely due to careful patient selectionThe insertion of a percutaneous endoscopic gastrostomy (PEG) tube is an invaluable tool to gain long-term nutritional support for patients who cannot meet their nutritional needs for any of several reasons, with a vast volume of data showing that for certain conditions this procedure can improve patient outcomes. Unfortunately, PEG tube insertion has several adverse events, such as aspiration pneumonia, bleeding, infection, leakage, and tube dysfunction or displacement. Minor adverse events can be common and under-reported; more major adverse events arise in approximately 3% of PEG tube insertions.
Diagnostic yield and technical performance of the novel motorized spiral enteroscopy compared with single-balloon enteroscopy in suspected Crohn's disease: a prospective study (with video)Both single-balloon enteroscopy (SBE) and the novel motorized spiral enteroscopy (NMSE) are effective techniques for device-assisted enteroscopy (DAE). To date, no study has prospectively compared both modalities in suspected Crohn’s disease (CD).
Next-generation sequencing mutation analysis on biliary brush cytology for differentiation of benign and malignant strictures in primary sclerosing cholangitisDifferentiation of benign and malignant biliary tract strictures on brush material remains highly challenging but is essential for adequate clinical management of patients with primary sclerosing cholangitis (PSC). In this case-control study, biliary brush cytology samples from PSC patients with cholangiocarcinoma (PSC-CCA) were compared with samples from PSC patients without CCA (PSC-control subjects) using next-generation sequencing (NGS).
Clinical outcomes of endoscopic submucosal dissection for superficial circumferential esophageal squamous cell carcinomaOur aim was to elucidate the clinical outcomes of endoscopic submucosal dissection (ESD) for superficial circumferential esophageal squamous cell carcinoma (cESCC).
Usefulness of a novel computer-aided detection system for colorectal neoplasia: a randomized controlled trialArtificial intelligence–based computer-aid detection (CADe) devices have been recently tested in colonoscopies, increasing the adenoma detection rate (ADR), mainly in Asian populations. However, evidence for the benefit of these devices in the occidental population is still low. We tested a new CADe device, namely, ENDO-AID (OIP-1) (Olympus, Tokyo, Japan), in clinical practice.
Expanding the role of pneumatic dilation for nonachalasia patients: a comparative studyTreatment options for nonachalasia obstructive disorders of the esophagogastric junction (EGJ) are limited. The aim of this study was to assess the treatment efficacy of pneumatic dilation (PD) for the disorders of EGJ outflow obstruction (EGJOO) and postfundoplication EGJ obstruction (PF-EGJO) and to assess attitudes regarding training in PD.
Patient-related adverse events and device failures associated with commercially available enteral or duodenal self-expanding metal stents: an analysis of the MAUDE databaseDuodenal stents are widely used to treat patients with malignant gastric outlet obstruction (MGOO), most commonly from pancreatic cancer. The WallFlex (Boston Scientific, Natick, Mass, USA) and Evolution (Cook Endoscopy, Winston-Salem, NC, USA) duodenal stents are in widespread use for treating MGOO. The objective of this study was to analyze device failures and patient-related adverse events reported to the U.S. Food and Drug Administration (FDA) for these 2 stents.
Closure of large mucosal defects for prevention of strictures after duodenal endoscopic submucosal dissection (with video)Although lesions occupying a large circumference are associated with the risk of post–endoscopic submucosal dissection (ESD) strictures, the corresponding data for duodenal lesions are unknown. We aimed to analyze the incidence of post-ESD strictures after wide-field duodenal ESD.
Novel classification system for walled-off necrosis: a step toward standardized nomenclature and risk-stratification frameworkThe optimal therapeutic approach for walled-off necrosis (WON) is not fully understood, given the lack of a validated classification system. We propose a novel and robust classification system based on radiologic and clinical factors to standardize the nomenclature, provide a framework to guide comparative effectiveness trials, and inform the optimal WON interventional approach.
Soft self-expandable metal stent to treat painful pancreatic duct strictures secondary to chronic pancreatitis: a prospective multicenter trialFully covered self-expandable metal stents (FCSEMSs) may offer a treatment option for pain associated with a dilated pancreatic duct (PD) in chronic pancreatitis (CP), but optimal patient selection and FCSEMS design, efficacy, and safety remain uncertain. We studied an investigational pancreatic FCSEMS for treatment of CP-associated pain.
Incidence and natural history of gastric high-grade dysplasia in patients with familial adenomatous polyposis syndromeFamilial adenomatous polyposis (FAP) is characterized by high risks of colonic and extracolonic tumors. Recent studies have suggested a rising risk for gastric cancer (GC). We sought to define the spectrum of premalignant gastric polyps in FAP, focusing on high-grade dysplasia (HGD).
Covered versus uncovered double bare self-expandable metal stent for palliation of unresectable extrahepatic malignant biliary obstruction: a randomized controlled multicenter trialIn a recent randomized controlled trial, a double bare metal stent (DBS) showed better stent patency than single-layer metal stents. However, clear evidence comparing the efficacy of uncovered (UCDBS) and partially covered (PCDBS) DBSs for distal malignant biliary obstruction (MBO) is lacking. Therefore, we compared the clinical outcomes including stent patency of UCDBSs versus PCDBSs.
Genotype–phenotype correlation of small-intestinal polyps on small-bowel capsule endoscopy in familial adenomatous polyposisIn familial adenomatous polyposis (FAP), neoplastic lesions outside the colon have become increasingly important. The genotype–phenotype correlation has been established for duodenal polyps, and regular screening is recommended. However, this correlation remains unclear for small-intestinal lesions, except for reports on the relationship between their occurrence and Spigelman stage. Here, we used small-bowel capsule endoscopy (SBCE) to investigate the genotype–phenotype correlation of small-intestinal polyps in FAP.
Second-generation distal attachment cuff for adenoma detection in screening colonoscopy: a randomized multicenter studyRandomized studies have demonstrated that a distal attachment cap with rubber side arms, the Endocuff Vision (ECV; Olympus America, Center Valley, Pa, USA), increased colonoscopic adenoma detection rate (ADR) in various mixed patient collectives. This is the first study to evaluate its use in a primary colonoscopic screening program.
Comparative accuracy of endosonographic shear wave elastography and transcutaneous liver stiffness measurement: a pilot studyVibration-controlled transient elastography (VCTE) is a validated test for assessing liver fibrosis but may be unreliable in select patients, including those with morbid obesity. The limitations of VCTE may be overcome by EUS-guided shear wave elastography (EUS-SWE).
Scheduled endoscopic treatment of biliary anastomotic and nonanastomotic strictures after orthotopic liver transplantationBiliary strictures after liver transplantation are associated with significant morbidity and mortality. Although various endoscopic treatment strategies are available, consensus on a particular strategy is lacking. Moreover, the influence of endoscopic therapy on overall survival has not been studied. This retrospective study aimed to evaluate the impact of scheduled endoscopic dilatation of biliary strictures after orthotopic liver transplantation on therapeutic success, adverse events, and survival.
Timing of colonoscopy in acute lower GI bleeding: a multicenter retrospective cohort studyWe aimed to determine the optimal timing of colonoscopy and factors that benefit patients who undergo early colonoscopy for acute lower GI bleeding.
Simple risk score to predict the likelihood of a positive EUS in idiopathic acute pancreatitisWe sought to derive a risk score, DORM65, of known variables to predict the likelihood of a positive EUS in patients with idiopathic acute pancreatitis (IAP).
Long-term rebleeding rate and predictive factors of rebleeding after capsule endoscopy in patients with obscure GI bleedingThe incidence of rebleeding in obscure GI bleeding (OGIB) remains unclear. This study used capsule endoscopy (CE) to determine the long-term rebleeding rate and predictive factors for rebleeding in patients with OGIB.
Environmental and health outcomes of single-use versus reusable duodenoscopesThe large-scale effects of duodenoscopes on the environment and public health have not been quantified. Our aim was to perform an exploratory life cycle assessment comparing environmental and human health effects of single-use duodenoscopes (SDs) and reusable duodenoscopes (RDs).
Comparison of no stent fixation, endoscopic suturing, and a novel over-the-scope clip for stent fixation in preventing migration of fully covered self-expanding metal stents: a retrospective comparative study (with video)Endoscopic suturing and over-the-scope clips (OTSCs) are used to prevent migration of fully covered self-expandable metal stents (FCSEMSs). Recently, a dedicated OTSC was developed for securing FCSEMSs. Our primary aim was to compare the frequency of stent migration without stent fixation versus fixation with suturing or OTSCs, and out secondary aims were to compare clinical success, procedure duration, and adverse events.
Randomized trial comparing general anesthesia with anesthesiologist-administered deep sedation for ERCP in average-risk patientsGeneral anesthesia (GA) or monitored anesthesia care (MAC) is increasingly used to perform ERCP. The definitive choice between the 2 sedative types remains to be established. This study compared outcomes of GA with MAC in ERCP performed in patients at average risk for sedation-related adverse events (SRAEs).