Clinical Endoscopy

Systematic Review and Meta-Analysis

Hybrid argon plasma coagulation in Barrett’s esophagus: a systematic review and meta-analysis: Sagar N. Shah, Nabil El Hage Chehade, Amirali Tavangar, Alyssa Choi, Marc Monachese, Kenneth J. Chang, Jason B. Samarasena; Clin Endosc 2023;56(1):38-49. Published online January 30, 2023; DOI: https://doi.org/10.5946/ce.2022.179

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Background
/Aims: Patients with Barrett’s esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC.
Methods
We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett’s esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM.
Results
Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872–0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005–0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007–0.055; I2=0%).
Conclusions
Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

Citations

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Focused Review Series: Application of Artificial Intelligence in GI Endoscopy

Artificial Intelligence in Gastrointestinal Endoscopy: Alexander P. Abadir, Mohammed Fahad Ali, William Karnes, Jason B. Samarasena; Clin Endosc 2020;53(2):132-141. Published online March 30, 2020; DOI: https://doi.org/10.5946/ce.2020.038

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Artificial intelligence (AI) is rapidly integrating into modern technology and clinical practice. Although in its nascency, AI has become a hot topic of investigation for applications in clinical practice. Multiple fields of medicine have embraced the possibility of a future with AI assisting in diagnosis and pathology applications.
In the field of gastroenterology, AI has been studied as a tool to assist in risk stratification, diagnosis, and pathologic identification. Specifically, AI has become of great interest in endoscopy as a technology with substantial potential to revolutionize the practice of a modern gastroenterologist. From cancer screening to automated report generation, AI has touched upon all aspects of modern endoscopy.
Here, we review landmark AI developments in endoscopy. Starting with broad definitions to develop understanding, we will summarize the current state of AI research and its potential applications. With innovation developing rapidly, this article touches upon the remarkable advances in AI-assisted endoscopy since its initial evaluation at the turn of the millennium, and the potential impact these AI models may have on the modern clinical practice. As with any discussion of new technology, its limitations must also be understood to apply clinical AI tools successfully.

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Focused Review Series: Expanding the Indication with Safety Issue of Endoscopic Ultrasound

Endoscopic Ultrasound-Guided Portal Pressure Measurement and Interventions: Jason B. Samarasena, Kenneth J. Chang; Clin Endosc 2018;51(3):222-228. Published online May 31, 2018; DOI: https://doi.org/10.5946/ce.2018.079

Abstract PDF PubReader ePub

A growing number of studies have explored endoscopic ultrasound (EUS)-guided vascular catheterization. Potential clinical applications of EUS-guided portal venous access include angiography, measurement of the portosystemic pressure gradient, EUS-guided transhepatic intrahepatic portosystemic shunt creation and portal vein sampling for the evaluation in gastrointestinal cancer. The following article reviews the different devices and techniques employed in these applications.

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