Clinical Endoscopy

Original Articles

Efficacy of hemostasis by gastroduodenal covered metal stent placement for hemorrhagic duodenal stenosis due to pancreatobiliary cancer invasion: a retrospective study: Yasunari Sakamoto, Taku Sakamoto, Akihiro Ohba, Mitsuhito Sasaki, Shunsuke Kondo, Chigusa Morizane, Hideki Ueno, Yutaka Saito, Yasuaki Arai, Takuji Okusaka; Received June 18, 2023 Accepted January 15, 2024 Published online June 14, 2024; DOI: https://doi.org/10.5946/ce.2023.155 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Advanced pancreatic and biliary tract cancers can invade the duodenum and cause duodenal hemorrhagic stenosis. This study aimed to evaluate the efficacy of covered self-expandable metal stents in the treatment of cancer-related duodenal hemorrhage with stenosis.
Methods
Between January 2014 and December 2016, metal stents were placed in 51 patients with duodenal stenosis. Among these patients, a self-expandable covered metal stent was endoscopically placed in 10 patients with hemorrhagic duodenal stenosis caused by pancreatobiliary cancer progression. We retrospectively analyzed the therapeutic efficacy of the stents by evaluating the technical and clinical success rates based on successful stent placement, degree of oral intake, hemostasis, stent patency, and overall survival.
Results
The technical and clinical success rates were 100%. All 10 patients achieved a Gastric Outlet Obstruction Scoring System score of three within two weeks after the procedure and had no recurrence of melena. The median stent patency duration and overall survival after stent placement were 52 days (range, 20–220 days) and 66.5 days (range, 31–220 days), respectively.
Conclusions
Endoscopic placement of a covered metal stent for hemorrhagic duodenal stenosis associated with pancreatic or biliary tract cancer resulted in duodenal hemostasis, recanalization, and improved quality of life.

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Clinical outcomes of nonvariceal upper gastrointestinal bleeding in nonagenarians and octogenarians: a comparative nationwide analysis: Khaled Elfert, James Love, Esraa Elromisy, Fouad Jaber, Suresh Nayudu, Sammy Ho, Michel Kahaleh; Clin Endosc 2024;57(3):342-349. Published online February 7, 2024; DOI: https://doi.org/10.5946/ce.2023.130

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Nonagenarians will purportedly account for 10% of the United States population by 2050. However, no studies have assessed the outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) in this age group.
Methods
The National Inpatient Sample database between 2016 and 2020 was used to compare the clinical outcomes of NVUGIB in nonagenarians and octogenarians and evaluate predictors of mortality and the use of esophagogastroduodenoscopy (EGD).
Results
Nonagenarians had higher in-hospital mortality than that of octogenarians (4% vs. 3%, p<0.001). EGD utilization (30% vs. 48%, p<0.001) and blood transfusion (27% vs. 40%, p<0.001) was significantly lower in nonagenarians. Multivariate logistic regression analysis revealed that nonagenarians with NVUGIB had higher odds of mortality (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.3–1.7) and lower odds of EGD utilization (OR, 0.86; 95% CI, 0.83–0.89) than those of octogenarians.
Conclusions
Nonagenarians admitted with NVUGIB have a higher mortality risk than that of octogenarians. EGD is used significantly in managing NVUGIB among nonagenarians; however, its utilization is comparatively lower than in octogenarians. More studies are needed to assess predictors of poor outcomes and the indications of EGD in this growing population.

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Novel upper gastrointestinal bleeding sensor capsule: a first human feasibility and safety trial: Lukas Bajer, Marvin Ryou, Christopher C. Thompson, Pavel Drastich; Clin Endosc 2024;57(2):203-208. Published online January 17, 2024; DOI: https://doi.org/10.5946/ce.2023.111

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Upper gastrointestinal bleeding (UGIB) is the most common GI condition requiring hospitalization, and can be diagnosed by direct visualization. The present study aimed to evaluate the safety and feasibility of using the PillSense system (EnteraSense Ltd.), a novel diagnostic tool designed for the rapid in vivo detection of UGIB, in human volunteers.
Methods
In the present study, 10 volunteers swallowed a PillSense capsule, followed by 2 servings of an autologous blood preparation. Participants were monitored for capsule passage, overall tolerability of the procedure, and adverse events.
Results
The procedure was completed per the protocol established in the present study in 9/10 cases. In 9 of the subjects, after capsule ingestion, the device indicated the absence of blood with sensor output values of 1. After the ingestion of the first blood mixture, the sensor outputs of all devices increased from 2.8 to 4, indicating that each camera detected blood. The sensor output remained within that range after the ingestion of the second mixture; however, in one case, the baseline capsule signal was positive, because of a preexisting condition. The passage of the capsule was verified in all patients, and no adverse events were reported.
Conclusions
The first trial of the PillSense system in human subjects demonstrated the feasibility, safety, and tolerability of utilizing this product as a novel, noninvasive, and easy-to-use triage tool for the diagnosis of patients suspected of having UGIB.

Citations

Citations to this article as recorded by

Could a bleeding-sensor device be established as a new paradigm for detecting upper gastrointestinal bleeding before performing endoscopy?
Sun Gyo Lim
Clinical Endoscopy.2024; 57(2): 191. CrossRef

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Reviews

Endoscopic management of postoperative bleeding: Sung Hyeok Ryou, Ki Bae Bang; Clin Endosc 2023;56(6):706-715. Published online November 2, 2023; DOI: https://doi.org/10.5946/ce.2023.028

Abstract PDF PubReader ePub: Postoperative gastrointestinal bleeding is a rare but serious complication that can lead to prolonged hospitalization and significant morbidity and mortality. It can be managed by reoperation, endoscopy, or radiological intervention. Although reoperation carries risks, particularly in critically ill postoperative patients, minimally invasive interventions, such as endoscopy or radiological intervention, confer advantages. Endoscopy allows localization of the bleeding focus and hemostatic management at the same time. Although there have been concerns regarding the potential risk of creating an anastomotic disruption or perforation during early postoperative endoscopy, endoscopic management has become more popular over time. However, there is currently no consensus on the best endoscopic management for postoperative gastrointestinal bleeding because most practices are based on retrospective case series. Furthermore, there is a wide range of individual complexities in anatomical and clinical settings after surgery. This review focused on the safety and effectiveness of endoscopic management in various surgical settings.

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Management of complications related to colorectal endoscopic submucosal dissection: Tae-Geun Gweon, Dong-Hoon Yang; Clin Endosc 2023;56(4):423-432. Published online July 27, 2023; DOI: https://doi.org/10.5946/ce.2023.104

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