Background: Multiple companies have developed endoscopes with high insertion performance and minimal patient discomfort, but they have not been directly compared. We previously conducted a randomized controlled trial evaluating the diagnostic performance of three different endoscopes and systems for colorectal neoplasms. This post hoc study aimed to compare their insertion performance. Methods: We performed a post hoc analysis of a single-center, randomized, controlled trial (UMIN000032107) that prospectively enrolled who visited Yokohama City University Hospital for endoscopic colorectal neoplasm resection between April 2018 and December 2019. We analyzed three endoscopes: PCF-H290ZI with EVIS LUCERA ELITE (Olympus), EC-L600ZP7 with LASEREO (Fujifilm), and EC-760ZP with ELUXEO (Fujifilm). Insertion-related outcomes, including cecum insertion rate and cecal insertion time (CIT), were compared. All data were evaluated using the Kruskal-Wallis test for three-group comparisons and the Mann-Whitney U test for two-group comparisons. To identify risk factors associated with insert outcome, such as incomplete colonoscopy or prolonged insertion time, we performed logistic regression analysis. Results: A total of 206 patients were analyzed. The cecal insertion rate was 100% for all scopes. Median (interquartile range, 95% confident interval) CITs were 370 (240-514.5, 355.6-487.3) seconds for PCF-H290ZI, 356 (224-551.5, 362.3-493.9) seconds for EC-L600ZP7, and 306 (228-439, 310.7-392.4) seconds for EC-760ZP, with no significant differences (P=0.34). Univariate analysis identified age >= 75 years [odds ratio (OR) 2.40, 95% confidence interval (CI): 1.096-5.275, P=0.03], low body mass index (BMI) (<18.5 kg/m(2); OR 3.57, 95% CI: 1.16-10.97, P=0.005) and high BMI (BMI >= 25 kg/m(2); OR 3.60, 95% CI: 1.49-8.70, P=0.005) were associated with longer CIT, respectively. Conclusions: This study suggests that the insertion performance does not differ among the PCF-H290ZI, EC-L600ZP7, and EC-760ZP when used by expert endoscopists. These findings indicate that scope selection may be based on factors other than insertion ease, such as diagnostic capability or regional availability. Furthermore, recognizing that older age and low BMI are associated with longer insertion times may help clinicians anticipate technical challenges and optimize procedural strategies.
Background: Self-expandable metal stent (SEMS) placement for obstructive colorectal cancer (OCC) is an established treatment option that helps avoid emergency surgery, improves short-term surgical outcomes, and increases primary anastomosis rates. However, recent meta-analyses suggest SEMS placement may increase recurrence following curative surgery, potentially due to mechanical and biomechanical stress on the tumor. Covered SEMS (CSEMS) were developed to suppress tumor ingrowth and reduce bowel injury, but evidence regarding their long-term efficacy and oncological safety remains insufficient. This review systematically analyzes the latest clinical and experimental evidence on CSEMS to clarify clinical utility, challenges, and future research priorities. Methods: We searched PubMed and Google Scholar for peer-reviewed English-language articles published between January 1994 and July 2025. Original studies and review articles related to CSEMS, including those involving OCC, were selected and narratively synthesized. We performed citation searching by screening reference lists and tracking citations of included studies and relevant reviews. We evaluated device variations and structural characteristics; technical and clinical success; complications; tumor ingrowth and overgrowth; surgical impact; macroscopic bowel effects; histopathological changes; biological effects; and long-term outcomes. Methodological limitations and knowledge gaps were explicitly assessed. Because heterogeneous study designs and outcomes precluded a high-quality meta-analysis, we adopted a scoping review approach. Studies reporting uncovered SEMS outcomes were also included for comparison. Results: Forty-eight studies were included. CSEMS showed high technical and clinical success rates, and the previously concerning risk of stent migration declined. Some studies suggested reduced deep venous invasion and bowel injury, but these benefits were not consistent across devices. CSEMS may attenuate bowel injury, and animal models showed no overt ischemia at anastomotic sites, suggesting a potential advantage over conventional SEMS in preserving anti-tumor immunity within the tumor microenvironment (TME). However, mechanical stress, mild hypoxia, and inflammatory responses cannot be completely avoided, and the extent and clinical significance of these effects-particularly regarding long-term oncologic outcomes-remain unclear. Conclusions: CSEMS could be a potential short-term bridge-to-surgery option, particularly for suppressing tumor progression and minimizing bowel injury. Unresolved issues include long-term oncological outcomes, stent migration management, tumor overgrowth, and the mechanisms underlying biological effects.
Background: Minimally invasive surgery (MIS) grew rapidly after the wide adoption of laparoscopic surgery, which was followed shortly by the rise of robotic surgery. While laparoscopic practice is grounded in high quality data generated by landmark clinical trials, the data driving robotic-assisted surgery is largely based on retrospective data. Thus, our aim was to compare robotic and laparoscopic trials in modern prospective MIS trial activity. Methods: This was a cross-sectional study of Phase I-IV MIS trials registered on ClinicalTrials.gov (accessed January 1, 2025). We searched the registry using the terms: "laparoscopy", "robotic surgery" and "minimally invasive surgery". MIS trials were grouped into laparoscopy and robotic studies. Trials were then categorized based on the interventions described (treatment, pain control, perioperative complications, technique) and by surgical subspecialty. Descriptive statistics, chi-square and Mann-Whitney U tests were used for analysis. Results: From 153 trials identified, 125 were MIS clinical trials. Laparoscopy was 2.5-fold more represented than robotic surgery in the pipeline (89 vs. 36 trials). Laparoscopic studies were more likely to be randomized (88% vs. 61%, P<0.001) and be conducted in Phase III or IV (72% vs. 28%, P<0.001). MIS trials were largely focused on interventions that address postoperative pain (39%). When evaluated by operative approach, most laparoscopic trials (42%) assessed pain management, while robotic trials (42%) tended to focus on disease treatment. When comparing trials by subspecialties, a greater proportion of laparoscopic trials involved general surgery procedures aimed at gallbladder disease. Meanwhile, otolaryngology (31%) and urology (22%) were the most represented in robotic surgery, with trials generally centered around oropharyngeal and prostate cancer treatment, respectively. Conclusions: Among ongoing prospective MIS studies, laparoscopy-based trials appear to be prioritized over those involving the surgical robot. Research priorities in modern MIS trial activity appear to be directed at pain control measures, which aligns with a growing emphasis on perioperative care pathways like extended recovery after surgery. The rise of robotic trials in certain subspecialties likely reflects technological advancements in oncologic treatment. Trial registries offer insights into the field of MIS and should continue to be evaluated.
Background: Laparoscopic cholecystectomy (LC) is widely accepted as the treatment of choice for symptomatic gallbladder disease and usually leads to favorable postoperative results. Nevertheless, some patients continue to report persistent or recurrent symptoms despite surgery. This study aimed to determine whether pre-operative complaint duration, symptom severity, and endoscopic retrograde cholangiopancreatography (ERCP) are associated with symptom persistence following LC. Methods: This cross-sectional study was carried out at Dr. Soliman Fakeeh Hospital in Jeddah, Saudi Arabia, and included patients who underwent LC between January 2019 and December 2021. We collected information on demographics, pre-operative symptom duration and severity, perioperative interventions, such as ERCP, and post-operative symptoms and patient satisfaction. The patients were grouped into those whose symptoms improved after surgery [designated as having symptoms alleviated (SA)] and those with persistent symptoms [classified as having symptoms persist (SP)]. Statistical analyses included Chi-squared tests, Mann-Whitney U tests, and Spearman's rank correlation to identify the factors associated with ongoing post-operative symptoms. Results: Overall, 220 patients answered the survey. The patients were followed for 30.7 +/- 7.8 months after surgery. Approximately one-fifth of patients (40/220, 18.2%) experienced persistent abdominal pain intensity, emergency room visit, surgery setting, approaches, and ERCP did not show statistically significant differences between the SA and SP groups. The duration of complaints before surgery was significantly shorter in the SA group vs. the SP group (23.7 +/- 18 vs. 45.9 +/- 31 weeks, P=0.050), respectively. After surgery, 18.2% (40/220) had abdominal pain, 1.8% (4/220) had wound infection, 21.8% (48/220) had persistence scar pain, 4.5% (10/220) had biliary stones, 26.8% (59/220) had heartburn, 30.4% (67/220) had diarrhoea, and 5% (11/220) had incisional hernia. A longer symptom duration showed a borderline association with postoperative symptom persistence [rho=-0.132; P=0.050; 95% confidence interval (CI): -0.26 to 0.00], while the post-operative complications were significantly correlated with symptom persistence (rho=-0.198; P=0.003; 95% CI: -0.32 to 0.06). Only 8.6% (19/220) of patients were unhappy with the result of their surgery. Conclusions: One-fifth of patients may continue to report unchanged symptoms following LC, even though diagnostic tools have improved. Factors such as the duration of the complaint and post-operative complications may be associated with symptom persistence following surgery. Pre-operative procedures such as ERCP have no effect on symptom persistence post-cholecystectomy. Better outcomes cannot be achieved without patient counselling and careful selection.
