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Gastrointestinal Endoscopy: Clinical Advances in Diagnosis and Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 4383

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Special Issue Editors

Prof. Dr. Tadateru Maehata

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Guest Editor

Department of Internal Medicine, Division of Gastroenterology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
Interests: endoscopic submucosal dissection; endoscopic imaging; colorectal cancer

Dr. Joao Santos-Antunes

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Guest Editor

1. Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal
2. Gastroenterology Department, Centro Hospitalar S. João, 4200-319 Porto, Portugal
Interests: gastric premalignant lesions; esophageal cancer; colorectal cancer; therapeutic endoscopy

Dr. Mariana Figueiredo Ferreira

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Guest Editor Assistant

Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), 1070 Bruxelles, Belgium
Interests: gastrointestinal oncology; therapeutic endoscopy; endoscopic submucosal dissection

Special Issue Information

Dear Colleagues,

Endoscopy is of the utmost importance in the diagnosis and treatment of gastrointestinal lesions. In recent decades, the appearance of new technologies and better imaging, together with the development of training programs, allow for the earlier detection of gastrointestinal lesions and provide opportunities for minimally invasive endoscopic treatment. In fact, endoscopic resection is the mainstay treatment for premalignant and early malignant lesions of the gastrointestinal tract. There is now solid evidence about the efficacy and safety of techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for the treatment of epithelial neoplasia along the gastrointestinal tract, as well as other techniques, such as full-thickness resection (EFTR), endoscopic intermuscular or subserosal dissection (EID/ ESSD), which expand our endoscopic armory for the management of these lesions. In addition, the use of endoscopy in the treatment of subepithelial lesions is already established, using the techniques previously mentioned or other variants such as submucosal tunneling endoscopic resection (STER).

Besides its use in the digestive tract, endoscopy is extremely important for the diagnosis and treatment of hepatobiliopancreatic conditions. Its role in the evaluation of the pancreas and biliary ducts and in the management of cystic and solid pancreatic lesions, as well as in hepatobiliary pathology, is well established, and it is been applied with increasing complexity and efficacy.

In this Special Issue, we welcome any original research, technical notes or review articles in the field of diagnostic or therapeutic gastrointestinal endoscopy.

Prof. Dr. Tadateru Maehata
Dr. Joao Santos-Antunes
Guest Editors

Dr. Mariana Figueiredo Ferreira
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

diagnostic endoscopy
therapeutic endoscopy
gastrointestinal neoplasia
endoscopic mucosal resection
endoscopic submucosal dissection
early cancer
subepithelial lesions

Published Papers (5 papers)

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14 pages, 1191 KiB

Open AccessArticle

Does Portal Hypertension Increase the Risk of Helicobacter pylori Infection and Pre-Malignant Gastric Lesions?

by Rui Gaspar, Pedro Cardoso, Tiago Ribeiro, Marco Silva and Guilherme Macedo

J. Clin. Med. 2024, 13(6), 1768; https://doi.org/10.3390/jcm13061768 - 19 Mar 2024

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Abstract

Background and Aims: The presence of portal hypertension in cirrhotic patients is a major prognostic factor associated with the development of severe complications and increased mortality. The gold standard for diagnosing portal hypertension is the hepatic venous pressure gradient. More recently, spleen stiffness has emerged as a new and non-invasive diagnostic tool, and has already been included in the last Baveno VII guidelines. The exact prevalence of Helicobacter pylori infection, pre-malignant lesions and their relation to portal hypertension have never been described. The aim of our study was to evaluate the relationship between the presence of portal hypertension assessed via liver and spleen elastography and Helicobacter pylori infection and pre-malignant gastric lesions. Methods: An observational study was conducted, including consecutive patients admitted from December 2020 to December 2022. All patients underwent upper endoscopy and were also subjected to liver and spleen elastography (using the new probe of 100 Hz) by the same blinded operator in a tertiary center. Results: We included 155 cirrhotic patients, with a mean age of 64.1 years (±8.8), and 81.3% were male. The most common etiology was alcoholic liver disease (72.9%). The median value of liver stiffness measurement was 24.4 kPa [3.1–75.0], and the spleen stiffness measurement was 49.1 kPa [12.8–100.0]. Akin to endoscopic findings, 50.3% presented esophageal varices, 5.2% gastric atrophy, 11.6% gastric metaplasia, and 32.9% portal hypertension gastropathy. Regarding histologic findings, we found that 34.8% presented H. pylori infection, 35.5% gastric atrophy (OLGA 1—58.2%) and 38.7% gastric metaplasia (OLGIM 1—63.3%). Liver stiffness and spleen stiffness measurements were associated with the presence of portal hypertensive gastropathy (p < 0.01), but not with H. pylori infection or pre-malignant gastric lesions. Conclusions: Although present in almost one third of cirrhotic patients, H. pylori infection and pre-malignant gastric lesions are not associated with liver stiffness and spleen stiffness measurements. On the other hand, we found an association between liver stiffness and spleen stiffness measurements and portal hypertensive gastropathy. Full article

(This article belongs to the Special Issue Gastrointestinal Endoscopy: Clinical Advances in Diagnosis and Treatment)

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10 pages, 209 KiB

Open AccessArticle

Safety of Duodenal Endoscopic Submucosal Dissection for Superficial Non-Ampullary Duodenal Epithelial Tumor: A Single-Center Study in the United States

by Mako Koseki, Makoto Nishimura, Tarek Nammour, Kana Chin, Sayaka Nagao, Jacques C. Beauvais and Mark A. Schattner

J. Clin. Med. 2024, 13(1), 143; https://doi.org/10.3390/jcm13010143 - 27 Dec 2023

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Abstract

Endoscopic submucosal dissection (ESD) of superficial non—ampullary duodenal epithelial tumors (SNADETs) is associated with a high rate of en bloc resection and low rate of recurrence. However, in the United States, SNADETs are predominantly managed using endoscopic mucosal resection (EMR) or surgery because the feasibility and safety of duodenal ESD have not yet been established. In this study, we analyzed the outcomes of duodenal ESD for SNADETs. This single—center retrospective study reviewed the data of patients who underwent ESD for SNADETs between June 2018 and August 2023. Baseline patient characteristics, histopathology of the resected lesions, adverse events, and recurrence rates were evaluated. The primary outcome measures were en bloc resection, complications, and recurrence rate. Thirty ESD procedures were performed on 24 patients. All 30 lesions were adenomas, with no cancerous lesions. The en bloc resection rate and R0 resection rates were both 53%. There were no cases of procedure-associated perforation. Post-ESD bleeding was observed in six cases. No ESD—related mortality was observed. The recurrence rate was 14% in 1 year follow up, and 28% the during all follow-up period. ESD is a safe option for SNADET in the United States; however further comparative studies are necessary to determine the optimal procedure for North American populations. Full article

(This article belongs to the Special Issue Gastrointestinal Endoscopy: Clinical Advances in Diagnosis and Treatment)

12 pages, 1734 KiB

Open AccessArticle

Effectiveness and Safety of Endoscopic Submucosal Dissection for Colorectal Neoplasm in Patients with High Charlson Comorbidity Index Score: A HASID Multicenter Study

by Dong-Hyun Kim, Yong-Wook Jung, Byung-Chul Jin, Hyung-Hoon Oh, Hyo-Yeop Song, Seong-Jung Kim, Dae-Seong Myung, Sang-Wook Kim, Jun Lee, Geom-Seog Seo, Young-Eun Joo and Hyun-Soo Kim

J. Clin. Med. 2023, 12(19), 6255; https://doi.org/10.3390/jcm12196255 - 28 Sep 2023

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Abstract

Endoscopic submucosal dissection (ESD) is an effective method for removing early colorectal lesions. However, research on the safety and efficacy of ESD in patients with various underlying conditions remains limited. This study retrospectively examined ESD outcomes in colorectal neoplasm patients from five tertiary medical centers. The Charlson Comorbidity Index (CCI) and age-adjusted CCI (ACCI) were analyzed, and the differences in complete resection and complication rates were analyzed. The CCI, ACCI, and complication rates tended to gradually increase proportionally, and the complication resection rate increased from CCI 2 to ACCI 4 as the starting point, followed by a decreasing trend. Of these, 140 patients (9.7%) had a CCI score of 3 or higher. The high CCI group was older (70.6% vs. 64.7%, p < 0.01) and had a higher proportion of men (70.7% vs. 58.7%, p < 0.01) than the low CCI group. The high CCI group had a higher incidence of cancer than the low CCI group (77.9% vs. 65.2%, p < 0.01). The en bloc resection rate (90.0% vs. 89.3%, p = 0.79) and complete resection rate (75.7% vs. 81.2%, p = 0.12) were not significantly different between the two groups. Colorectal ESD can be safely and effectively performed in patients with various underlying medical conditions. Full article

(This article belongs to the Special Issue Gastrointestinal Endoscopy: Clinical Advances in Diagnosis and Treatment)

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9 pages, 399 KiB

Open AccessArticle

Risk of Residual Neoplasia after a Local-Risk Resection of Colorectal Lesions by Endoscopic Submucosal Dissection: A Multinational Study

by João Santos-Antunes, Mathieu Pioche, Felipe Ramos-Zabala, Paolo Cecinato, Francisco Gallego, Pedro Barreiro, André Mascarenhas, Sandro Sferrazza, Frieder Berr, Andrej Wagner, Arnaud Lemmers, Mariana Figueiredo Ferreira, Eduardo Albéniz, Hugo Uchima, Ricardo Küttner-Magalhães, Carlos Fernandes, Rui Morais, Sunil Gupta, Daniel Martinho-Dias, Isabel Faria-Ramos, Margarida Marques, Michael J. Bourke and Guilherme Macedo Show full author list Hide full author list

J. Clin. Med. 2023, 12(16), 5356; https://doi.org/10.3390/jcm12165356 - 17 Aug 2023

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Abstract

Endoscopic submucosal dissection (ESD) in colorectal lesions is demanding, and a significant rate of non-curative procedures is expected. We aimed to assess the rate of residual lesion after a piecemeal ESD resection, or after an en bloc resection but with positive horizontal margins (local-risk resection—LocRR), for colorectal benign neoplasia. A retrospective multicenter analysis of consecutive colorectal ESDs was performed. Patients with LocRR ESDs for the treatment of benign colorectal lesions with at least one follow-up endoscopy were included. A cohort of en bloc resected lesions, with negative margins, was used as the control. A total of 2255 colorectal ESDs were reviewed; 352 of the ESDs were “non-curative”. Among them, 209 were LocRR: 133 high-grade dysplasia and 76 low-grade dysplasia. Ten cases were excluded due to missing data. A total of 146 consecutive curative resections were retrieved for comparison. Compared to the “curative group”, LocRRs were observed in lengthier procedures, with larger lesions, and in non-granular LSTs. Recurrence was higher in the LocRR group (16/199, 8% vs. 1/146, 0.7%; p = 0.002). However, statistical significance was lost when considering only en bloc resections with positive horizontal margins (p = 0.068). In conclusion, a higher rate of residual lesion was found after a piecemeal ESD resection, but not after an en bloc resection with positive horizontal margins. Full article

(This article belongs to the Special Issue Gastrointestinal Endoscopy: Clinical Advances in Diagnosis and Treatment)

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12 pages, 2950 KiB

Open AccessSystematic Review

Esophageal Stent in Acute Refractory Variceal Bleeding: A Systematic Review and a Meta-Analysis

by Busara Songtanin, Chanaka Kahathuduwa and Kenneth Nugent

J. Clin. Med. 2024, 13(2), 357; https://doi.org/10.3390/jcm13020357 - 9 Jan 2024

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Abstract

Background: Acute esophageal variceal bleeding accounts for up to 70% of upper-gastrointestinal bleeding in cirrhotic patients. About 10–20% of patients with acute variceal bleeding have refractory bleeding that is not controlled by medical or endoscopic therapy, and this condition can be life-threatening. Balloon tamponade is a long-standing therapy which is only effective temporarily and has several complications, while transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation may not be readily available at some centers. The use of self-expandable metal stents (SEMSs) in refractory esophageal variceal bleeding has been studied for effectiveness and adverse events and has been recommended for use as a bridge to a more definitive treatment. Aim: To investigate the effectiveness and safety of SEMSs in managing refractory variceal bleeding. Methods: A systematic search of the MEDLINE, EMBASE, and Cochrane library databases was performed from inception to October 2022 using the following terms: “esophageal stent”, “self-expandable metal stents”, “endoscopic hemostasis”, “refractory esophageal varices”, and “esophageal variceal bleeding”. Studies were included in the meta-analysis if they met the following criteria: (1) patients’ age older than 18 and (2) a study (or case series) that has at least 10 patients in the study. Exclusion criteria included (1) non-English publications, (2) in case of overlapping cohorts, data from the most recent and/or most appropriate comprehensive report were collected. DerSimonian–Laird random-effects meta-analysis was performed using the meta package in R statistical software(version 4.2.2). Results: Twelve studies involving 225 patients with 228 stents were included in the analyses. The mean age and/or median age ranged from 49.4 to 69 years, with a male-to-female ratio of 4.4 to 1. The median follow-up period was 42 days. The mean SEMS dwell time was 9.4 days. The most common cause of acute refractory variceal bleeding in chronic liver disease patients included alcohol use followed by viral hepatitis. The pooled rate of immediate bleeding control was 91% (95% CI 82–95%, I² = 0). The pooled rate of rebleeding was 17% (95% CI 8–32%, I² = 69). The pooled rate of stent ulceration was 7% (95% CI 3–13%, I² = 0), and the pooled rate of stent migration was 18% (95% CI 9–32%, I² = 38). The pooled rate of all-cause mortality was 38% (95% CI 30–47%, I² = 34). Conclusions: SEMSs should be primarily considered as salvage therapy when endoscopic band ligation and sclerotherapy fail and can be used as a bridge to emergent TIPS or definitive therapy, such as liver transplantation. Full article

(This article belongs to the Special Issue Gastrointestinal Endoscopy: Clinical Advances in Diagnosis and Treatment)

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