Clinical Endoscopy

Reviews

Colon stenting as a bridge to surgery in obstructive colorectal cancer management: Dong Hyun Kim, Han Hee Lee; Received May 23, 2023 Accepted July 29, 2023 Published online March 8, 2024; DOI: https://doi.org/10.5946/ce.2023.138 [Epub ahead of print]

Abstract PDF PubReader ePub: Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.

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Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control: Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura; Clin Endosc 2024;57(3):309-316. Published online February 15, 2024; DOI: https://doi.org/10.5946/ce.2023.217

The treatment of obesity and its comorbidities ranges from clinical management involving lifestyle changes and medications to bariatric and metabolic surgery. Various endoscopic bariatric and metabolic therapies recently emerged to address an important therapeutic gap by offering a less invasive alternative to surgery that is more effective than conservative therapies. This article comprehensively reviews the technical aspects, mechanism of action, outcomes, and future perspectives of one of the most promising endoscopic bariatric and metabolic therapies, named duodenojejunal bypass liner. The duodenojejunal bypass liner mimics the mechanism of Roux-en-Y gastric bypass by preventing food contact with the duodenum and proximal jejunum, thereby initiating a series of hormonal changes that lead to delayed gastric emptying and malabsorptive effects. These physiological changes result in significant weight loss and improved metabolic control, leading to better glycemic levels, preventing dyslipidemia and non-alcoholic fatty liver disease, and mitigating cardiovascular risk. However, concern exists regarding the safety profile of this device due to the reported high rates of severe adverse events, particularly liver abscesses. Ongoing technical changes aiming to reduce adverse events are being evaluated in clinical trials and may provide more reliable data to support its routine use in clinical practice.

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Bacteroides and NAFLD: pathophysiology and therapy
Jun Zhang, Jing Zhou, Zheyun He, Hongshan Li
Frontiers in Microbiology.2024;[Epub] CrossRef

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Endoscopic treatment of upper gastrointestinal postsurgical leaks: a narrative review: Renato Medas, Eduardo Rodrigues-Pinto; Clin Endosc 2023;56(6):693-705. Published online July 3, 2023; DOI: https://doi.org/10.5946/ce.2023.043

Abstract PDF PubReader ePub: Upper gastrointestinal postsurgical leaks are life-threatening conditions with high mortality rates and are one of the most feared complications of surgery. Leaks are challenging to manage and often require radiological, endoscopic, or surgical intervention. Steady advancements in interventional endoscopy in recent decades have allowed the development of new endoscopic devices and techniques that provide a more effective and minimally invasive therapeutic option compared to surgery. Since there is no consensus regarding the most appropriate therapeutic approach for managing postsurgical leaks, this review aimed to summarize the best available current data. Our discussion specifically focuses on leak diagnosis, treatment aims, comparative endoscopic technique outcomes, and combined multimodality approach efficacy.

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Original Articles

Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States: Dushyant Singh Dahiya, Abhilash Perisetti, Hemant Goyal, Sumant Inamdar, Amandeep Singh, Rajat Garg, Chin-I Cheng, Mohammad Al-Haddad, Madhusudhan R. Sanaka, Neil Sharma; Clin Endosc 2023;56(3):340-352. Published online April 17, 2023; DOI: https://doi.org/10.5946/ce.2022.166

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States.
Methods
We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared.
Results
From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p=0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management.
Conclusions
Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.

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Navigating Abdominal Volvulus: A Comprehensive Review of Management Strategies
Simran Chauhan, Raju K Shinde, Yashraj Jain
Cureus.2024;[Epub] CrossRef
Incidental Sigmoid Volvulus after a Ground-level Fall: An Unusual Case Report
Ziya Karimov, Elchin Shirinov, Gunay Huseynova, Mirhuseyn Mammadov, Meltem Songür Kodik
Caucasian Medical Journal.2023; 1(3): 36. CrossRef
Colonic Volvulus
Samantha L. Savitch, Calista M. Harbaugh
Clinics in Colon and Rectal Surgery.2023;[Epub] CrossRef

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Efficacy of endoscopy under general anesthesia for the detection of synchronous lesions in oro-hypopharyngeal cancer: Yoichiro Ono, Kenshi Yao, Yasuhiro Takaki, Satoshi Ishikawa, Kentaro Imamura, Akihiro Koga, Kensei Ohtsu, Takao Kanemitsu, Masaki Miyaoka, Takashi Hisabe, Toshiharu Ueki, Atsuko Ota, Hiroshi Tanabe, Seiji Haraoka, Satoshi Nimura, Akinori Iwashita, Susumu Sato, Rumie Wakasaki; Clin Endosc 2023;56(3):315-324. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2022.072

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma.
Methods
This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia.
Results
Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness.
Conclusions
Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.

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Nasopharyngeal examination during transoral upper gastrointestinal endoscopy
Vui Heng Chong
Clinical Endoscopy.2024; 57(1): 137. CrossRef
Endoscopy under general anesthesia for detecting synchronous lesions of head and neck squamous cell carcinoma
Jin Hee Noh, Do Hoon Kim
Clinical Endoscopy.2023; 56(3): 308. CrossRef

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Endoscopic Submucosal Dissection versus Surgery for Undifferentiated-Type Early Gastric Cancer: A Systematic Review and Meta-Analysis: Cheal-Wung Huh, Dae Won Ma, Byung-Wook Kim, Joon Sung Kim, Seung Jae Lee; Clin Endosc 2021;54(2):202-210. Published online February 17, 2021; DOI: https://doi.org/10.5946/ce.2020.121

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