Background: Anorectal stricture is a challenging complication of Crohn’s disease (CD). Endoscopic needle-knife stricturotomy (NKSt) has emerged as a minimally invasive treatment option, but its long-term outcomes and factors influencing recurrence remain underexplored. Objectives: This study aimed to prospectively evaluate the long-term efficacy, safety, and risk factors for recurrence after NKSt for primary high-grade anorectal strictures in CD. Design: Single-center prospective cohort study. Methods: Between October 2020 and September 2023, 54 consecutive CD patients with primary high-grade anorectal strictures undergoing NKSt were enrolled. The primary endpoint was stricture recurrence requiring re-intervention. Risk factors were analyzed using univariable and multivariable Cox proportional hazards regression. Recurrence-free survival was estimated with the Kaplan-Meier method. A restricted cubic spline model within the Cox framework was employed to explore the nonlinear relationship between stricture length and recurrence. Results: The median follow-up was 24 months (interquartile range (IQR): 6–43). Immediate technical success was achieved in all patients (100%), and 38 patients (70.4%) reported symptomatic improvement at 3 months. Recurrence occurred in 20 patients (37.0%). Multivariable analysis identified stricture length (hazard ratio (HR) 1.184 per cm increase, 95% confidence interval (CI): 1.015–1.380; p = 0.032), the presence of an ostomy (HR 3.901, 95% CI: 1.406–10.823; p = 0.009), and concurrent biologic therapy (HR 0.177, 95% CI: 0.057–0.546; p = 0.003) as independent predictors of recurrence. In univariable analysis, NKSt combined with bleomycin injection was associated with a lower recurrence risk compared to NKSt alone ( p = 0.027). Conclusion: NKSt is an effective and safe treatment for primary high-grade anorectal strictures in CD, although recurrence is common. Stricture length, ostomy status, and the use of biologic agents are independent predictors of recurrence, while concomitant bleomycin injection may reduce recurrence risk. These findings can inform individualized treatment strategies and highlight the need for validation in larger, multicenter trials.
Background: Colon capsule endoscopy (CCE) is a minimally invasive alternative to colonoscopy, but its diagnostic performance depends entirely on adequate mucosal cleansing (adequate cleansing rate, ACR) and complete colonic transit (completion rate, CR). These requirements impose stringent preparation demands. Existing systematic reviews (SRs) show substantial heterogeneity in recommendations. Objectives: To identify optimal CCE preparation strategies. Design: Umbrella review (overview of SRs). Methods: A comprehensive literature search was conducted through November 2025 for SRs and meta-analyses (MAs) assessing CCE bowel preparation regimens. Methodological quality was assessed using AMSTAR2, and primary study overlap was quantified using the Corrected Covered Area (CCA). Outcomes included ACR and CR, stratified by preparation components. Results: Fourteen SRs (11 MAs) encompassing 102 primary studies (moderate overlap, CCA 8.59%) were included. Pooled ACR (72.5%–76.8%) and CR (79.8%–83.0%) remained below colonoscopy benchmarks. In inflammatory bowel disease, ACR varied widely (49%–98.5%) with no superior regimen. In the general population, low-volume polyethylene glycol (PEG <4 L) yielded higher ACR (77.5%) than high-volume PEG (72.9%). Sodium phosphate (NaP) boosters outperformed PEG specifically for CR, with NaP + Gastrografin achieving the highest CR (93.1%). Castor oil improved excretion (OR 0.17 of incomplete CCE transit, 95% CI 0.09–0.32), and routine prokinetics improved CR compared with no use (OR 1.86, 95% CI 1.13–3.05). Low-fiber diets provided better cleansing than clear liquids (ACR 78.5% vs 70.0%). Conclusion: Current CCE bowel preparation regimens demonstrate variable performance relative to targets, with no single intervention demonstrating unequivocal superiority over others in pairwise comparisons. Evidence supports optimizing performance via low-volume PEG, NaP or Gastrografin-based boosters, routine prokinetics, and a low-fiber diet. A universal regimen is unlikely to suit all patients, highlighting the need for personalized protocols. Standardized cleansing scores and AI-assisted assessment are critical to improving reproducibility and cost-effectiveness.
Background: There is no consensus on the optimal endoscopic drainage strategy for hilar malignant biliary obstruction (HMBO). Objectives: To compare transpapillary plastic stent (PS) plus endoscopic nasobiliary drainage (ENBD) with PSs alone for HMBO, and to evaluate risk factors for cholangitis in the combined strategy group. Design: Retrospective cohort study. Methods: A total of 175 consecutive patients with HMBO (Bismuth type II–IV) who underwent either PS plus ENBD or PSs alone were enrolled. Propensity score matching (1:1) was performed to reduce selection bias. The primary endpoint was successful drainage. Univariate analysis was used to identify risk factors for cholangitis in the PS plus ENBD group. Results: After matching, 74 patients remained in each group, with balanced baseline characteristics. Successful drainage rates were 77.0% in the PS plus ENBD group and 68.9% in the PSs alone group ( p = 0.267). The PSs alone group had significantly higher rates of cholangitis (23.0% vs 10.8%, p = 0.048) and overall adverse events (29.7% vs 12.2%, p = 0.009). No significant differences were observed in biliary patency, reintervention, or survival time between groups. In the PS plus ENBD group, initial drainage was associated with cholangitis (100.0% vs 59.3%, p = 0.011), and median drainage volume was lower in patients who developed cholangitis (85 mL vs 250 mL, p = 0.021). In 19 patients, the nasobiliary catheter was snipped to convert external to internal drainage. Conclusion: Endoscopic biliary stenting combined with ENBD followed by catheter snipping is a safe and effective approach for HMBO. The addition of ENBD was associated with reduced rates of cholangitis and overall adverse events. In this combined strategy, lack of initial drainage and low drainage volume were associated with cholangitis.
Background: Self-expanding metal stents (SEMS) are recommended for the endoscopic palliation of distal malignant biliary obstruction (DMBO). Placement of SEMS during endoscopic retrograde cholangiopancreatography (ERCP) has been associated with an increased risk of post-ERCP pancreatitis (PEP). Objectives: The aim of this study is to evaluate rates of PEP in patients who underwent SEMS placement for pancreatic versus non-pancreatic malignancy. Design: Retrospective Cohort Study. Methods: Patients who underwent SEMS placement for DMBO between June 2017 and May 2021 were identified retrospectively from a procedural billing database. PEP incidence was compared between pancreatic and non-pancreatic DMBO groups and multivariate logistic regression was performed to identify risk factors for PEP. Results: A total of 488 individuals were identified, with 395 (80.9%) cases of DMBO due to pancreatic and 93 (19.1%) due to non-pancreatic malignancy. Stent types included 124 (25.4%) fully covered (FCSEMS) and 364 (74.6%) uncovered metal stents (UCSEMS). The overall rate of PEP in the cohort was 6.3% with no significant difference between pancreatic and non-pancreatic etiologies (6.1% vs 7.5%, p = 0.606). When adjusted for age <50 years old, female sex, and pancreatic stent placement, a non-pancreatic malignancy was not associated with an increased risk of PEP (OR 0.83, 95% CI 0.36–2.15). Conclusion: No statistically significant difference in PEP rates was seen after biliary sphincterotomy and SEMS placement for palliation of DMBO in patients with pancreatic versus non-pancreatic malignancies.
Eosinophilic gastroenteritis (EGE) is a rare, chronic inflammatory condition characterized by symptoms and eosinophilic infiltration of the gastrointestinal tract in the absence of secondary causes of gastrointestinal eosinophilia. The advent of probe-based confocal laser endomicroscopy (pCLE) has introduced the possibility of real-time, in vivo microscopic imaging, enabling dynamic assessment of mucosal architecture and barrier function. We report the case of a 32-year-old woman with an atypical manifestation of mucosal EGE, initially presenting with pseudothrombotic microangiopathy secondary to vitamin B12 deficiency. The diagnostic work-up included standard endoscopy, histopathological examination of biopsy samples, and pCLE imaging. pCLE was performed both at baseline and during follow-up to evaluate disease distribution and monitor therapeutic response. Imaging was conducted using the GastroFlex UHD Confocal Miniprobe connected to the Cellvizio system, with images captured within 10 min of intravenous fluorescein administration, digitally stored, and later reviewed by blinded pCLE experts. Initial assessment revealed marked eosinophilic infiltration in the stomach, terminal ileum, and cecum, with corresponding interstitial leakage and inflammatory cell infiltration observed on pCLE. Increased epithelial permeability was also detected in additional intestinal segments lacking histological involvement. After 5 weeks of corticosteroid therapy, the patient achieved clinical and histological remission, accompanied by normalization or significant improvement in pCLE findings. Interestingly, pCLE continued to reveal subtle barrier dysfunction in regions showing histological recovery, highlighting persistent subclinical mucosal alterations. This case underscores the value of pCLE in identifying early intestinal barrier dysfunction and in monitoring therapeutic response in EGE. The concordance between pCLE imaging, histological findings, and clinical outcomes supports its use as a complementary diagnostic and monitoring tool in EGE management.
Background: Understanding endoscopists’ perspectives and routine practice offers opportunities to improve bowel cleansing for colonoscopy. Objective: To elucidate Italian endoscopists’ perceptions of bowel preparation quality, focusing on defining high-quality cleansing (HQC) and its perceived benefits in clinical practice and for diagnostic outcomes. Design: Nationwide, cross-sectional, web-based survey. Methods: A nationwide, web-based cross-sectional survey was undertaken in Italy between August and September 2024 among gastroenterologists with special interest in endoscopy. Participants were recruited via telephone screening; of 498 gastroenterologists contacted, 150 respondents completed an online questionnaire; analyses were descriptive. Results: The survey results revealed that all respondents (100%) routinely evaluate and document cleansing in the endoscopy report and almost all (99%) used validated scales. The majority (72%) of endoscopists aimed for HQC, which they defined as a segment score of ⩾8–9 on the Boston Bowel Preparation Scale or ‘excellent’ on the Aronchick scale. Almost all (93%) considered HQC important in every colonoscopy regardless of indication. All respondents considered that HQC allows higher identification rates for adenomas and sessile serrated lesions, reduces procedure time, and improves overall clinical efficiency; 99% considered that HQC allows for more appropriate surveillance intervals. On a scale of 1–10 to rate confidence with the diagnostic reliability of the exam (1 = not at all confident, 10 = very confident), the respondents’ levels of confidence improved with high-quality bowel preparation; mean scores were 2.1 with inadequate preparation, 6.6 with good cleansing and 9.2 with high-quality bowel cleansing. Conclusion: The survey revealed that the vast majority of Italian endoscopists consider HQC essential across all clinical indications. The results support the transition from ‘good’ to ‘high-quality’ cleansing as the new standard in clinical colonoscopy practice.
Background: Previous evidence suggests that a short myotomy does not reduce the efficacy of peroral endoscopic myotomy (POEM) or increase intraoperative complications. However, the available studies are still limited and there has been no research in Latin America. Objectives: This study aims to evaluate whether POEM with a short myotomy differs significantly from a long myotomy in terms of efficacy and safety in patients with achalasia. Design/Methods: A retrospective cohort study including patients who underwent POEM for achalasia between 2017 and 2024. Efficacy was assessed according to the Eckardt scale at 6 months and at 1 year of follow-up. Safety was assessed for perioperative adverse events according to the iPOEM classification. Results: A total of 57 patients were included, 44% underwent short myotomy (median esophageal length of 5 cm; interquartile range (IQR) 4–5), and 56% long myotomy (median 11 cm IQR 10–13). 35% had previously undergone surgery for achalasia. The long myotomy group had more frequently minor complications such as emphysema (15.6% vs 0%; p = 0.039), capnoperitoneum (65.6% vs 16.0%, p < 0.001) and required more abdominal punctures (56.2% vs 12.0%, p < 0.001). There was no difference in the incidence of other complications. The probability of symptomatic response, defined as an Eckardt score ⩽ 3 at 12 months, was similar between groups (84.3% vs 88%, p = 0.69). The median operative time for the short myotomy was shorter (median 80 min; IQR 70–95 vs 127.5 min; IQR 102–155 min; p < 0.001). Conclusion: Short myotomy is not inferior to long myotomy in terms of clinical success and long-term reflux disease in the management of patients with achalasia. Furthermore, it offers advantages such as shorter procedure times and potentially lower rates of minor complications, making it the preferred option in most cases.
Background: Colon capsule endoscopy (CCE) was introduced by NHS England at scale during the COVID-19 pandemic to support colorectal diagnostics recovery. However, little was known about the patient experience of CCE. Objective: To explore the experiences of CCE during the NHS England pilot, to better understand what a patient-centered service for the future should look like. Design: A qualitative study to explore the patient and clinician experiences of CCE. Methods: Focus group discussions ( n = 25 participants) and semi-structured interviews ( n = 7), selected purposively on the basis of maximum variation, generated qualitative material exploring patient understanding, preferences and experiences. To place their experiences in context, we conducted asynchronous focus group discussions with clinicians ( n = 16). Analysis was thematic. Results: Most patients valued CCE’s convenience and would repeat it, although for some their experiences would deter them from having the procedure again. Anxieties included fear when swallowing the capsule; concerns about it becoming stuck and/or whether the recording was working; what to do when the capsule was inside them; and worries about the novelty of the treatment. Women expressed greater discomfort, pain and anxieties during bowel preparation and the procedure than men. Participants highlighted the need for a more balanced description of the procedure than indicated in information leaflets and videos. They particularly felt the possibility of further investigations could be better explained. Healthcare professionals may underestimate patient concerns. Conclusion: CCE has the potential to expand colorectal diagnostic capacity but requires patients to be well informed and supported throughout the process. Gender differences in experiences of CCE are notable and could be partially addressed by providing more specific information, consistent with women’s experiences.
Background:Colorectal cancer (CRC) screening programmes commonly use the Faecal immunochemical test (FIT) followed by colonoscopy. When colonoscopy is not feasible, computed tomography colonography (CTC) serves as an alternative. However, CTC has limitations, such as lower sensitivity for smaller polyps and radiation exposure. Colon capsule endoscopy (CCE) is a non-invasive alternative that may improve polyp detection in FIT-positive individuals. Objectives:To evaluate the feasibility of CCE in FIT-positive participants from the Dutch CRC screening programme who are unable or unwilling to undergo colonoscopy. Design:Prospective multicentre, interventional study. Methods:FIT-positive participants ingested the PillCam® Colon 2 capsule. Colonoscopy was recommended if polyp(s) ⩾6 or suspected malignancy were detected. The primary outcome was the per-patient polyp detection rate (PDR) for polyps ⩾6 mm. Results:Of 169 FIT-positive participants unable to undergo colonoscopy, 54.4% were ineligible for CCE due to contraindications. CCE was performed in 13 participants, with a completion rate of 69.2% and adequate bowel preparation in 38.5. A total of 54 polyps were detected, 46.3% of which were ⩾6 mm. The per-patient detection rate for polyps ⩾6 mm was 76.9%. In 84.6% of cases, follow-up colonoscopy was advised. CCE findings matched colonoscopy in 66.7% of cases; in the remaining 33.3%, polyps were found to be < 6 mm during colonoscopy. One participant was diagnosed with a pT4bN0M0 adenocarcinoma after CCE revealed a tumorous obstruction. Conclusion:Despite a high per-patient PDR, this study indicates that CCE is less suitable for FIT-positive individuals unable or unwilling to undergo colonoscopy due to high comorbidity and frequent contraindications. Inadequate bowel preparation, likely due to reduced gastrointestinal motility, further limited feasibility. Given the elevated risk of advanced neoplasia in this population, many still required follow-up colonoscopy. Therefore, CCE may be better suited for lower-risk populations with fewer procedural limitations. Trial registration:Overview of Medical Research in the Netherlands, NL-OMON55511.
The diagnostic procedure of gastrointestinal endoscopy serves essential functions in handling gastrointestinal disorders. Classic endoscopic approaches encounter multiple problems because they depend on human operators and yield ambiguous results during lesion detection. The development of artificial intelligence systems has risen as an efficient technology to enhance diagnosis precision and procedural efficiency during endoscopic procedures. The objective of this review is to assess how artificial intelligence (AI) technology influences gastrointestinal (GI) endoscopic procedures for both lesion identification and classification, and malignant polyp identification, as well as clinical intervention operations. The research investigates obstacles that exist alongside AI implementation problems in clinical gastroenterological practices and determines forthcoming guidelines. A thorough literature survey was conducted through accessing databases, including PubMed alongside Scopus as well as ScienceDirect, Elsevier, and Springer. Studies after 2019 were evaluated for the AI performance in GI endoscopic examination. The use of AI in endoscopic visual examinations boosts both the diagnostic accuracy of esophagogastroduodenoscopy and colonoscopy lesions and exceeds traditional analysis methods. AI technology enhances predictions of malignant polyp status, which helps doctors make treatment decisions while lowering the number of unnecessary biopsies. Several obstacles, including technical boundaries and biased data, and regulatory obstacles, together with clinical implementation obstacles, still continue to exist. The advancement of artificial intelligence through GI endoscopy has led to an improvement of diagnostic outcomes and treatment efficiency alongside better clinical choice capabilities. AI will implement its complete role in routine clinical practice, but needs research about current challenges and regulatory adjustments, and technological improvements to boost patient outcomes.
Background: Insulinomas are the most common functional pancreatic neuroendocrine tumors (pNETs). Minimally invasive approaches like endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) and ethanol ablation (EUS-EA) are emerging treatment options for small insulinomas (<2 cm). Objectives: To assess the safety, efficacy, and long-term outcomes of EUS-RFA and EUS-EA in treating small pancreatic insulinomas. Design: A retrospective, single-center study of nine patients diagnosed with insulinomas and treated with EUS ablation methods. Methods: Nine lesions (mean size 11 mm; range: 6–19 mm) were treated with EUS-RFA ( n = 7) or EUS-EA ( n = 2). EUS-RFA procedures had a mean ablation time of 31 s (range: 17–69 s), while EUS-EA used a mean ethanol volume of 1.4 ml and 0.5 ml for respective patients. All patients were followed up radiologically with CT and/or EUS for a median of 25 months (range: 6–46 months). Results: All patients had immediate hypoglycemia relief after a single treatment. The median clinical follow-up was 40 months (range: 22–60 months), with all patients remaining asymptomatic. Complete radiologic regression was observed in six patients. Two patients had minor adverse events; no severe complications occurred. Conclusion: EUS-guided ablation (RFA or EA) is a safe and effective treatment for small pancreatic insulinomas, providing symptom relief and radiologic regression. Further studies are needed to evaluate long-term efficacy and recurrence rates.
Background and aims:Endoscopic assessment of the regular arrangement of collecting venules (RAC) is a simple and reliable tool for predicting the absence of Helicobacter pylori (H. pylori) infection in the stomach, particularly in Asian populations. While initial studies in Western countries have yielded similar findings, RAC assessment has not yet been widely adopted in these settings. This study aims to evaluate the diagnostic accuracy of RAC in determining H. pylori status in a non-Asian population. Methods:This prospective, multicenter study was conducted in 12 hospitals across non-Asian countries. Patients with no history of H. pylori infection or eradication were included, regardless of proton pump inhibitor (PPI) use. All participants underwent high-definition upper endoscopy without magnification or virtual chromoendoscopy. Endoscopists were trained using a 20-image test to identify the RAC pattern. H. pylori status was determined by histology and/or immunohistochemistry. Results:A total of 648 patients were included, with an H. pylori infection prevalence of 34.7%. The RAC+ pattern was observed in 31.5% of patients, with no significant differences between those receiving PPI treatment and those who were not (p = 0.55). Absence of pathological endoscopic findings was significantly associated with a RAC+ pattern (p = 0.01). The sensitivity and negative predictive value (NPV) of RAC+ for ruling out H. pylori infection were 0.97 (95% CI: 0.94-0.99), reaching 1.00 when discordant images were reviewed by a blinded expert endoscopist. No significant differences in sensitivity or NPV were found between PPI users and non-users, or between regions with high and low H. pylori prevalence. Conclusion:The presence of the RAC pattern along the minor gastric curvature, as assessed with white-light endoscopy, accurately identifies patients without H. pylori infection in non-Asian countries, regardless of PPI use.
Background:Primary small intestinal lymphoma (PSIL) is a rare malignancy with heterogeneous clinical and pathological features, making accurate diagnosis challenging. Objectives:To investigate the clinical value of double-balloon enteroscopy (DBE) combined with endoscopic ultrasonography (EUS) in the diagnosis of small intestinal lymphoma. Design:Retrospective cohort study. Methods:We retrospectively reviewed 21 patients with pathologically confirmed PSIL who underwent both DBE and EUS at the Department of Small Intestinal Endoscopy, The Sixth Affiliated Hospital of Sun Yat-sen University, between September 2022 and May 2025. Clinical data were collected and analyzed in combination with pathological findings. Results:A total of 21 patients were included (12 males, 9 females; median age of 52 years, range 31-87 years. Subtypes of B-cell lymphomas included diffuse large B-cell lymphoma (n = 5), follicular lymphoma (n = 3), and mucosa-associated lymphoid tissue lymphoma (n = 6). T-cell lymphomas included peripheral T-cell lymphoma (n = 7). Endoscopic findings were classified into five categories (1): hypertrophic type (2), exophytic tumor type (3), follicular/polypoid type (4), ulcerative type, and (5) diffusion type. EUS classification included superficial spreading (38.1%, 8/21), diffuse infiltrative (42.9%, 9/21), and nodular (19.0%, 4/21). Conclusion:DBE combined with EUS provides complementary morphological and structural information for the diagnosis of PSIL, improving clinical recognition and subtype characterization. Future multicenter studies with larger cohorts are warranted to validate these findings and establish standardized diagnostic protocols.
Background: Bile leakage following hepatectomy is a challenging issue that poses difficulties for hepatobiliary surgeons. Endoscopic treatment is the primary method for managing this complication, although its effectiveness is still uncertain. Objectives: The aim of this study was to assess the effectiveness and risk factors of endoscopic treatment for bile leakage after hepatectomy. Design: A retrospective cohort study. Methods: A retrospective study was performed on 15 patients who experienced bile leakage following hepatectomy and were successfully treated with endoscopic retrograde cholangiography (ERCP). The primary focus was to examine how factors like the site of bile leakage, the position of biliary drainage, and late-set leakage impact early clinical success (ECS). Results: Out of the 15 cases, 10 successfully achieved ECS through endoscopic treatment. The highest success rate (80.0%, 4 out of 5) was seen when biliary drainage was performed by bridging, while drainage placed near the leakage site had a success rate of 75.0% (6 out of 8). The best outcomes occurred when bile leakage was located in the tertiary or higher branch bile ducts, with an 83.3% success rate (5 out of 6). Additionally, early-onset leakage had a higher ECS success rate compared to late-onset bile leakage (75.0% (6/8) vs 57.1% (4/7)). Among the 15 cases, 12 involved extensive liver resections of more than two segments, 14 included segments 7 or 8, 11 had received preoperative adjuvant therapy, and 9 had undergone transarterial chemoembolization (TACE). In cases with late-onset bile leakage, 6 out of 7 (85.7%) had undergone TACE. Bile leakage caused by TACE was more likely to be accompanied by bile duct-bronchial fistula, and the healing process took significantly longer. Conclusion: Endoscopic management of bile leakage following liver resection is both safe and effective, making it a preferred first-line treatment. Improved results can be obtained by placing a stent to bridge and drain near the leakage site. Extensive liver resection, resection involving segments 7 or 8 of the liver, and preoperative adjuvant therapies are significant risk factors for bile leakage, particularly TACE, which may lead to bile duct-bronchial fistulas and extended recovery periods.
Background:The optimal choice between fully covered self-expandable metallic stents (FCSEMSs) and uncovered self-expandable metallic stent (USEMS) for managing inoperable malignant distal biliary obstruction (MDBO) remains debatable. This study aims to compare the efficacy of CSEMS and USEMS in patients with MDBO. Method:A retrospective analysis was conducted with inoperable MDBO between January 2017 to December 2021 who underwent either USEMS or FCSEMS implantations via endoscopic retrograde cholangiopancreatography (ERCP). Primary outcomes were overall survival and stent patency. Secondary outcomes were stent occlusion rates and postoperative complications. Results:This study included 310 patients (235 patients received FCSEMS implantations and 75 received USEMS implantations). Median follow-up duration was 5.2 months. No significant difference was observed in overall survival between the FCSEMS and USEMS groups (167 vs 169 days, p = 0.566). The mean stent patency duration was longer in the FCSEMS group compared to the USEMS group (445 vs 348 days, p = 0.020). There were no significant differences in postoperative complications between the two groups. Multivariate analysis indicated that endoscopic sphincterotomy (EST) (HR = 1.259, 95% CI: 1.167-1.358, p < 0.001), USEMS (HR = 2.277, 95% CI: 1.750-2.963, p < 0.001), stent length (HR = 1.804, 95% CI: 1.662-1.959, p < 0.001), preoperative biliary stent (HR = 1.166, 95% CI: 1.070-1.271, p < 0.001) and non-pancreatic cancer (HR = 1.404, 95% CI: 1.299-1.516, p < 0.001) were independent risk factors for stent occlusion, while BMI ⩾ 24 kg/m2 (HR = 0.600, 95% CI: 0.548-0.657, p < 0.001) was identified as a protective factor. In the subgroup analysis for pancreatic cancer, patients with FCSEMS (n = 109) had an average survival time of 154.14 ± 93.93 days, while those with USEMS (n = 34) had an average survival time of 130.32 ± 57.31 days (p = 0.21). For non-pancreatic cancer, patients with FCSEMS (n = 115) had an average survival time of 194.10 ± 93.40 days, and patients with USEMS (n = 34) had an average survival time of 204.97 ± 93.40 days (p = 0.67). Conclusion:Compared to USEMS, FCSEMS provides a longer stent patency duration for patients with MDBO. However, no significant differences were found in overall survival and postoperative complications in this retrospective study.
Background: Delayed gastrointestinal transit time (TT), frequently observed in diabetes mellitus (DM), may hinder bowel preparation quality and visualization in video capsule endoscopy (VCE). Objectives: The study aim was to compare VCE preparation adequacy and completion rates between patients with and without DM. Design: Retrospective analysis of a prospectively maintained database, including all consecutive VCEs performed in patients aged ⩾35 years. Methods: Patients were divided into two groups based on a DM diagnosis reported at admission and confirmed by medication records. Clinico-demographic characteristics, bowel preparation quality, TTs, and completion rates were compared between the groups. Logistic regression analysis was performed to identify independent risk factors for inadequate bowel preparation. Results: Out of 672 included VCEs, 189 (28.1%) patients had DM and 483 (71.9%) were controls. Completion rates were comparable (DM-98.4% vs controls-99.0%, p = 0.553). Gastric TT was similar (DM-37.5 ± 45.5 vs controls-34.3± 48.6 min, p = 0.420), while small bowel TT was longer (DM-261.8 ± 95.6 vs controls-244.9 ± 98.4 min, p = 0.040). DM patients had higher inadequate preparation rates (31.2% vs controls-23.4%, p = 0.040). In a multivariate analysis adjusted for age and gender, DM was not independently associated with inadequate preparation. However, DM treated with insulin (26.5% of patients with DM) was significantly associated with inadequate bowel preparation (Odds ratio (OR) 2.355, p = 0.006). Glucagon-like peptide-1 receptor agonist usage (11.8% of patients with DM patients) compared to no-DM controls achieved borderline significance as a risk factor for preparation inadequacy (OR 2.148, 95% CI 0.887–5.201, p = 0.090). Conclusion: VCE appears to be feasible in patients with DM, with similar completion rates and gastric TTs despite slightly prolonged small bowel TTs. However, DM treated with insulin is a significant risk factor for inadequate bowel preparation, suggesting the need for a more intensive preparation protocol within this patient group.
Background: Despite the rising global incidence of colorectal cancer (CRC) and increasing pressure on endoscopy services, colon capsule endoscopy (CCE) has seen limited clinical uptake, primarily because of a lack of trust in its diagnostic accuracy. Although multiple systematic reviews and meta-analyses have reported reasonable polyp detection rates, scepticism persists. This meta-review and umbrella meta-analysis aimed to synthesise evidence on CCE’s diagnostic accuracy in polyp and CRC detection, using computed tomography (CT) colonography or colonoscopy as the reference standard. Methods: We conducted a systematic search of EMBASE, MEDLINE and PubMed for systematic reviews, with or without meta-analyses, evaluating the diagnostic accuracy of CCE in detecting polyps and CRC. A qualitative thematic review and synthesis were conducted following PRISMA guidelines. A bivariate generalised linear mixed model (GLMM) with random effects was used for pooled diagnostic accuracy estimates, and meta-regression was performed using restricted maximum likelihood (REML) estimation. Results: Nine systematic reviews (eight with meta-analyses) were included,1–9 comprising 3,472 participants in 28 unique primary studies after removing duplicates. The pooled per-patient diagnostic accuracy for detecting polyps of any size was: sensitivity: 0.79 (95% confidence interval (CI): 0.69–0.86); specificity: 0.77 (95% CI: 0.71–0.82) and area under the curve (AUC): 0.81 (95% CI: 0.47–0.96). For polyps ≥6 mm, the sensitivity, specificity and AUC were 0.80, 0.87 and 0.81, respectively. Detection of polyps ≥10 mm showed a sensitivity of 0.88, specificity of 0.95, and AUC of 0.95.Second-generation CCE (CCE2) demonstrated improved accuracy in any-size polyps: sensitivity: 0.90 (95% CI: 0.79–0.96), specificity: 0.81 (95% CI: 0.70–0.89) and AUC: 0.82 (95% CI: 0.46–0.96). For polyps ≥6 mm, CCE2 achieved AUC 0.92, and for polyps ≥10 mm, AUC 0.94. CCE2 subgroup analysis demonstrated high sensitivity for any polyp size (0.90) and polyps ≥6 mm (0.87), both with low heterogeneity (p>0.05, I² <25%). The pooled CRC detection sensitivity was 0.96 (95% CI: 0.73–1.00) after excluding missed cancers resulting from capsule battery exhaustion before excretion. Conclusion: CCE2 has high diagnostic accuracy for polyp and CRC detection. While technical challenges persist, CCE2 shows promise as a complementary diagnostic tool to help address increasing endoscopy service demands.
Background:Malignant bowel obstruction (MBO) is a frequent and debilitating complication in advanced abdominal cancers, particularly ovarian, colorectal, and gastric malignancies associated with peritoneal carcinomatosis. Surgery is often not feasible, and conventional decompression carries substantial morbidity. Endoscopic ultrasound-guided enterocolostomy (EUS-EC) with lumen-apposing metal stents (LAMS) has emerged as a minimally invasive alternative, but the evidence remains limited. Objectives:To systematically evaluate the feasibility, safety, and clinical outcomes of EUS-EC with LAMS for the palliation of MBO. Design:Systematic review and meta-analysis. Methods:A comprehensive literature search was performed across PubMed, Embase, Cochrane Library, and Web of Science from database inception through August 2025. Studies were eligible for inclusion if they involved patients with MBO undergoing EUS-EC using LAMS. Statistical analysis was performed using a random-effects model with Hartung-Knapp adjustments. Primary outcomes were technical success (defined as successful stent deployment) and clinical success (defined as relief of obstruction and restoration of bowel function). Results:Twenty-three studies (78 patients) were included. Pooled technical and clinical success rates were 96.1% and 88.4%, respectively. The mean hospital stay was 10.6 days, and oral intake resumed after a mean of 3.1 days. Mean post-procedure survival was 91 days, consistent with the advanced disease stage of most included patients. Adverse events were uncommon: diarrhea (6.4%), perforation (3.8%), bleeding (2.5%), and aspiration (1.2%). Stent misdeployment occurred in one cohort (26.6%), but all cases were managed endoscopically without major sequelae. Among 33 deaths reported, most (78.8%) were due to disease progression, with only 6.1% procedure-related. Conclusion:EUS-EC with LAMS demonstrates high technical and clinical success, rapid symptom relief, and low procedure-related morbidity, supporting its potential as an emerging palliative option for carefully selected patients with MBO. Evidence remains limited to small retrospective cohorts and case reports, highlighting the need for prospective comparative trials with patient-centered outcomes.
