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Advanced Therapeutic Endoscopy
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Advanced Therapeutic Endoscopy

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: closed (29 February 2020)

Special Issue Editor

Prof. Dr. Michel Kahaleh

E-Mail Website
Guest Editor
Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
Interests: cancer therapy; gastric cancer; gastrointestinal endoscopy; acute pancreatitis; endoscopic retrograde cholangiopancreatography; radiofrequency ablation; photodynamic therapy (pdt); confocal microscopy; stents; pancreas

Special Issue Information

Dear Colleagues,

The last decade has seen a unique rise in advanced endoscopy, with the advent of novel techniques and devices that have permitted novel procedures that were formerly impossible. Whether in therapeutic endoscopy, endoscopic ultrasonography, third space endoscopy, or endobariatric endoscopy, the limits of what can be achieved endoscopically are being advanced on a daily basis. It is now clear that in the near future, many procedures that are currently performed by surgery or interventional radiology will be performed endoscopically. A variety of minimally invasive procedures are and will be performed totally internally without external scars. This Special Issue will summarize the current state of those techniques and will offer a glimpse into the future of advanced endoscopy.

Prof. Dr. Michel Kahaleh
Guest Editor

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

  • minimally invasive
  • therapeutic endoscopy
  • third space endoscopy
  • therapeutic EUS
  • endobariatic

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (7 papers)

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Research

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10 pages, 718 KiB  
Article
Oxygenation before Endoscopic Sedation Reduces the Hypoxic Event during Endoscopy in Elderly Patients: A Randomized Controlled Trial
by Hyunil Kim, Jeong Nam Hyun, Kyong Joo Lee, Hyun-Soo Kim and Hong Jun Park
J. Clin. Med. 2020, 9(10), 3282; https://doi.org/10.3390/jcm9103282 - 13 Oct 2020
Cited by 11 | Viewed by 2158
Abstract
Background: Sedation endoscopy increases patient and examiner satisfaction but involves complications. The most serious complication is hypoxia, the risk factors for which are old age, obesity, and American Society of Anesthesiologists physical status of 3 or greater. However, clear evidence of oxygenation during [...] Read more.
Background: Sedation endoscopy increases patient and examiner satisfaction but involves complications. The most serious complication is hypoxia, the risk factors for which are old age, obesity, and American Society of Anesthesiologists physical status of 3 or greater. However, clear evidence of oxygenation during sedation endoscopy for elderly people is lacking in US, European, and Korean guidelines. Method: This study was conducted for 1 year starting in August 2018 to evaluate whether pre-oxygenation use 1 min before sedation endoscopy could reduce the incidence of hypoxia in patients older than 65 years of age. A total of 70 patients were divided into the non-oxygenated group (n = 35; control group) and oxygen-treated group (n = 35; experimental group) during endoscopy. Result: The incidence of hypoxia was 28 (80%) in the control group versus 0 (0%) in the pre-oxygenated group. Factors related to hypoxia in the non-oxygenated group were a relatively high dose of midazolam and concomitant injection with narcotic analgesics such as pethidine. Conclusion: The incidence of hypoxia during sedation endoscopy is high in patients over 65 years, but oxygenation during endoscopic sedation in elderly people can significantly reduce the incidence of intraprocedural hypoxic events. Full article
(This article belongs to the Special Issue Advanced Therapeutic Endoscopy)
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11 pages, 537 KiB  
Article
Balloon-Assisted Colonoscopy after Incomplete Conventional Colonoscopy—Experience from Two European Centres with A Comprehensive Review of the Literature
by Robertson Alexander R, Koulaouzidis Anastasios, Yung Diana E, Fraser Christopher, Nemeth Artur, Trimble Kenneth, Toth Ervin, Plevris John N and Wurm Johansson Gabriele
J. Clin. Med. 2020, 9(9), 2981; https://doi.org/10.3390/jcm9092981 - 15 Sep 2020
Cited by 2 | Viewed by 2497
Abstract
Background: Conventional colonoscopy (CC) allows access for colonic investigation and intervention; in the small group in whom CC is unsuccessful alternative imaging is often sufficient. There remains a subset, however, requiring full colonic visualisation or intervention. Balloon-assisted colonoscopy (BAC) gives a further option [...] Read more.
Background: Conventional colonoscopy (CC) allows access for colonic investigation and intervention; in the small group in whom CC is unsuccessful alternative imaging is often sufficient. There remains a subset, however, requiring full colonic visualisation or intervention. Balloon-assisted colonoscopy (BAC) gives a further option when access is difficult. Aims: This study aims to present the experience with BAC of two European tertiary referral centres. Methods: Procedures were carried out under local protocol over 15-years (2006–2020). Markers of procedural quality such as caecal intubation, complications and comfort were retrospectively compiled and analysed. Published evidence was summarised for comparison. Results: 122 procedures were undertaken, with polyps the most frequent indication and 90.2% having at least one previously incomplete CC. Features associated with difficult colonoscopy were common, including intraabdominal surgery (32.0%). 92.6% reached the caecum; completion was higher (96.3%) in those failing CC due to discomfort and lower in those failing due to anatomical difficulties (90.7%) or previous surgery (84.6%). Mean time to the caecum was 20.9 minutes and mean midazolam and fentanyl doses were 2.6 mg and 49.9 µg with low discomfort scores. Conclusion(s): Balloon-assisted colonoscopy is successful in >90% of patients, is well-tolerated, and is safe. Full article
(This article belongs to the Special Issue Advanced Therapeutic Endoscopy)
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13 pages, 2301 KiB  
Article
Efficacy and Safety of a Novel Submucosal Injection Solution for Resection of Gastrointestinal Lesions
by Cristina Moles-Aranda, Raquel González-Pérez, Francisco Javier Gallego-Rojo, Olga Martínez-Augustin, Beatriz Clares-Naveros, Fermín Sánchez de Medina and José Antonio Morales-Molina
J. Clin. Med. 2020, 9(4), 1162; https://doi.org/10.3390/jcm9041162 - 18 Apr 2020
Cited by 3 | Viewed by 3516
Abstract
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are minimally invasive and efficient techniques for the removal of gastrointestinal (GI) mucosal polyps. In both techniques, submucosal injection solutions are necessary for complete effectiveness and safety during the intervention to be obtained. The [...] Read more.
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are minimally invasive and efficient techniques for the removal of gastrointestinal (GI) mucosal polyps. In both techniques, submucosal injection solutions are necessary for complete effectiveness and safety during the intervention to be obtained. The main objective of this study was to evaluate the efficacy and safety of a new sterile submucosal injection solution for EMR/ESD used within a clinical protocol in patients with intestinal polyps. We carried out a prospective study between 2016 and 2017 with patients who attended the Endoscopy Consultation—Digestive Department of Primary Hospital. Patients were selected for EMR/ESD after the application of clinical protocols. Thirty-six patients were selected (≥ 66 years with comorbidities and risk factors). Lesions were located mainly in the colon. Our solution presented an intestinal lift ≥ 60 min in EMR/ESD and a high expansion of tissue, optimum viscosity, and subsequent complete resorption. The genes S100A9 and TP53 presented an expression increase in the distal regions. TP53 and PCNA were the only genes whose expression was increased in polyp specimens vs. the surrounding tissue at the mRNA level. In EMR/ESD, our solution presented a prolonged effect at the intestinal level during all times of the intervention. Thus, our solution seems be an effective and safe alternative in cases of flat lesions in both techniques. Full article
(This article belongs to the Special Issue Advanced Therapeutic Endoscopy)
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10 pages, 376 KiB  
Article
Helicobacter pylori Gastritis in Children—The Link between Endoscopy and Histology
by Ana-Maria Teodora Domșa, Raluca Lupușoru, Dan Gheban, Radu Șerban and Cristina Maria Borzan
J. Clin. Med. 2020, 9(3), 784; https://doi.org/10.3390/jcm9030784 - 13 Mar 2020
Cited by 21 | Viewed by 3728
Abstract
Background: The management of Helicobacter pylori (H. pylori) infection raises important challenges, still being the most common chronic infection worldwide in all age groups. In high-prevalence regions, paediatric patients need a specific focus, as the acquisition of the infection takes place [...] Read more.
Background: The management of Helicobacter pylori (H. pylori) infection raises important challenges, still being the most common chronic infection worldwide in all age groups. In high-prevalence regions, paediatric patients need a specific focus, as the acquisition of the infection takes place in childhood. The objective of this study was to analyze the endoscopic and histopathologic changes of the gastric mucosa in H. pylori infected children. Material and Methods: A retrospective study was performed on consecutive paediatric patients, ranging from 0 to 18 years of age, who underwent an upper gastrointestinal endoscopy (UGE) for a period of 5 years, regardless of their symptomatology. Endoscopy reports and histological slides were reviewed and clinical, endoscopic, and histologic data were recorded. Results: A total of 248 patients were included in the study, 82 (33.06%) of them being H. pylori infected. There was no difference in age and symptoms between the infected and noninfected group. A significant association was found between the H. pylori infection and histopathological parameters such as acute and chronic inflammatory infiltrate. The bacterial load influences the intensity of inflammation (p < 0.001). The chronic inflammation was predominant, only 23.2% of the patients displayed acute inflammation (p < 0.0001). The topographic distribution of inflammation was dominated by pangastritis (p = 0.04) with 58.6% of the patients presenting similar degrees of inflammation both in the antrum and corpus. Conclusion: Endoscopic features such as nodularity of the antral mucosa (p < 0.05) along with histological findings as lymphoid follicles (p < 0.05) are suggestive of H. pylori infection. However, the concordance between the endoscopic and histological diagnosis is still far from perfect (Cohen’s k coefficient = 0.42), maintaining the need for an invasive approach in children. Full article
(This article belongs to the Special Issue Advanced Therapeutic Endoscopy)
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10 pages, 1434 KiB  
Article
Endoscopic Ultrasound-Guided Treatment of Gastric Varices Using Coils and Cyanoacrylate Glue Injections: Results after 1 Year of Experience
by Sławomir Kozieł, Katarzyna Pawlak, Łukasz Błaszczyk, Mateusz Jagielski and Anna Wiechowska-Kozłowska
J. Clin. Med. 2019, 8(11), 1786; https://doi.org/10.3390/jcm8111786 - 25 Oct 2019
Cited by 23 | Viewed by 5051
Abstract
Background and Aims: Gastric varices (GVs) occur in 20% of patients with portal hypertension. GVs are associated with a 65% risk of bleeding over the course of 2 years and have a mortality rate of up to 20%. The standard treatment for GVs [...] Read more.
Background and Aims: Gastric varices (GVs) occur in 20% of patients with portal hypertension. GVs are associated with a 65% risk of bleeding over the course of 2 years and have a mortality rate of up to 20%. The standard treatment for GVs is obliteration with cyanoacrylate (CYA). This study presents our experience with combined therapy (vascular coils and CYA) under endoscopic ultrasound (EUS) guidance. Methods: 16 patients (9 male and 7 female) were included into our study. Etiology of portal hypertension included: portal vein thrombosis (PVT) (31.0%), isolated splenic vein thrombosis (SVT) (25.0%), alcoholic cirrhosis (12.5%), hepatitis C cirrhosis (19.0%), and alcoholic cirrhosis with PVT (12.5%). Varices type GOV-2 were diagnosed in 8 patients, type IGV-1 and IGV-2 in 6 and 2 patients, respectively. Indications for treatment were based on endoscopic and endosonographic evaluations of GVs. Inclusion and exclusion criteria were also specified. Technique depended on the size of varices (different size of coils + CYA additionally). The results were based on the achievement of technical success, therapeutic effects, and number of adverse events. Average follow-up period was 327 days. Results: From January to August 2017, 16 patients were treated with EUS-guided obliteration of GVs using vascular coils only or coils with CYA injections. 6 (37.5%) and 10 (62.5%) patients underwent primary and secondary prophylaxis for hemorrhage, respectively. Technical success was achieved in 15 patients (94.0%). Mean numbers of implanted coils and CYA volume during one procedure were 1.7 and 2 mL, respectively. Therapeutic success was achieved in all patients treated with the combination. There were no serious complications such as embolization or death due to the procedure. Three patients (19.0%) had transient abdominal pain and two (12.5%) had transient fever. 1 patient had clinical symptoms of gastrointestinal bleeding. Conclusions: Based on our retrospective research we have concluded, that EUS-guided implantation of intravascular coils combined with cyanoacrylate injections is an effective method of treatment with an acceptable number of complications. Full article
(This article belongs to the Special Issue Advanced Therapeutic Endoscopy)
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Review

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18 pages, 6292 KiB  
Review
Various Endoscopic Techniques for Treatment of Consequences of Acute Necrotizing Pancreatitis: Practical Updates for the Endoscopist
by Mateusz Jagielski, Marian Smoczyński, Jacek Szeliga, Krystian Adrych and Marek Jackowski
J. Clin. Med. 2020, 9(1), 117; https://doi.org/10.3390/jcm9010117 - 1 Jan 2020
Cited by 9 | Viewed by 3435
Abstract
Despite great progress in acute pancreatitis (AP) treatment over the last 30 years, treatment of the consequences of acute necrotizing pancreatitis (ANP) remains controversial. While numerous reports on minimally invasive treatment of the consequences of ANP have been published, several aspects of interventional [...] Read more.
Despite great progress in acute pancreatitis (AP) treatment over the last 30 years, treatment of the consequences of acute necrotizing pancreatitis (ANP) remains controversial. While numerous reports on minimally invasive treatment of the consequences of ANP have been published, several aspects of interventional treatment, particularly endoscopy, are still unclear. In this article, we attempt to discuss these aspects and summarize the current knowledge on endoscopic therapy for pancreatic necrosis. Endotherapy has been shown to be a safe and effective minimally invasive treatment modality in patients with consequences of ANP. The evolution of endoscopic techniques has made endoscopic drainage more effective and reduced the use of other minimally invasive therapies for pancreatic necrosis. Full article
(This article belongs to the Special Issue Advanced Therapeutic Endoscopy)
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8 pages, 1907 KiB  
Review
Effects of Encircled Abdominal Compression Device in Colonoscopy: A Meta-Analysis
by Toshihiro Nishizawa, Hidekazu Suzuki, Hajime Higuchi, Hirotoshi Ebinuma and Osamu Toyoshima
J. Clin. Med. 2020, 9(1), 11; https://doi.org/10.3390/jcm9010011 - 19 Dec 2019
Cited by 11 | Viewed by 3970
Abstract
Background and Aim: The efficacy of encircling abdominal compression devices in colonoscopies is inconsistent. We performed a meta-analysis of randomized controlled trials (RCTs) in which encircling abdominal compression devices were compared with control in colonoscopies. Methods: We systematically searched RCTs published in the [...] Read more.
Background and Aim: The efficacy of encircling abdominal compression devices in colonoscopies is inconsistent. We performed a meta-analysis of randomized controlled trials (RCTs) in which encircling abdominal compression devices were compared with control in colonoscopies. Methods: We systematically searched RCTs published in the Cochrane Library, PubMed, and the Igaku-Chuo-Zasshi database. The data from the eligible RCTs were combined using the random-effects model. The weighted mean differences (WMDs), pooled odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Results: Five RCTs were included in this meta-analysis. Compared to the control group, encircling abdominal compression devices significantly reduced the caecal intubation time (WMD: −1.31, 95% CI: −2.40 to −0.23, p = 0.02). Compared to the control group, encircling abdominal compression devices significantly decreased the frequency of postural change (OR 0.30, 95% CI: 0.22 to 0.41, p < 0.00001). Compared to the control group, the use of encircling abdominal compression devices significantly reduced the need for abdominal compression (OR: 0.35, 95% CI: 0.17 to 0.70, p = 0.003). Conclusions: Encircling abdominal compression devices in colonoscopies was found to reduce the caecal intubation time and the frequency of abdominal compression. Full article
(This article belongs to the Special Issue Advanced Therapeutic Endoscopy)
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