Is it necessary to stop glucagon-like peptide-1 receptor agonists prior to endoscopic procedure? A retrospective study

BACKGROUND Glucagon-like peptide-1 receptor agonists(GLP-1 RA)are effective in diabetes and obesity,reducing hyperglycemia by increasing insulin release and delaying gastric emptying.However,they can cause gastroparesis,raising concerns about aspiration during procedures.Recent guidelines advise discontinuing GLP-1 RA before surgery to reduce the risk of pulmonary aspiration.AIM To evaluate the effect of GLP-1 RAs on gastric residual contents during endosco-pic procedures.METHODS A retrospective chart review at BronxCare Health System,New York,from January 2019 to October 2023,assessed gastric residue and aspiration in GLP-1 RA patients undergoing endoscopic procedures.Two groups were compared based on dietary status before the procedure.Data included demographics,symptoms of gastroparesis,opiate use,hemoglobin A1c,GLP-1 agonist indication,endo-scopic details,and aspiration occurrence.IBM SPSS was used for analysis,cal-culating means,standard deviations,and applying Pearson’s chi-square and t-tests for associations,with P<0.05 as being significant.RESULTS During the study,306 patients were included,with 41.2%on a clear liquid/low residue diet and 58.8%on a regular diet before endoscopy.Most patients(63.1%)were male,with a mean age of 60±12 years.The majority(85.6%)were on GLP-1 RAs for diabetes,and 10.1%reported digestive symptoms before endoscopy.Among those on a clear liquid diet,1.5%had residual food at endoscopy compared to 10%on a regular diet,which was statistically significant(P=0.03).Out of 31 patients with digestive symptoms,13%had residual food,all from the regular diet group(P=0.130).No complications were reported during or after the procedures.CONCLUSION The study reflects a significant rise in GLP-1 RA use for diabetes and obesity.A 24-hour liquid diet seems safe for endoscopic procedures without aspiration.Patients with upper gastrointestinal symptoms might have a higher residual food risk,though not statistically significant.Further research is needed to assess risks based on diabetes duration,gastroparesis,and GLP-1 RA dosing,aiming to minimize interruptions in therapy during procedures.

Highlight of Endoscopic procedures developed in Japan

Endoscopic submucosal dissection （ESD） invented in Japan, plays an important role in the treatment of early gastrointestinal cancer （EGC） and dysplasia. Endoscopic procedures are now widely spreading around the world. ESD has the advantage that en bloc resection as well as pathological view can be achieved when compared with conventional endoscopic mucosal resection （1）.

Individual flexible endoscopic procedure for treatment of obstruction of fourth ventricle outlet

Objective To summarize the indication,method and effect of individual flexible endoscopic procedure for treatment of obstruction of fourth ventricle outlet. Methods The clinical data of 32 cases of obstruction of fourth ventricle outlet treated by individual flexible endoscopic

Endoscopic treatment for acute appendicitis with coexistent acute pancreatitis: Two case reports

BACKGROUND Appendectomy is the procedure of choice for the treatment of acute appendicitis.However,surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis(AP).Endoscopic retrograde appendicitis treatment(ERAT)may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.CASE SUMMARY We report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy.One patient had moderately severe AP due to hyperlipidemia,while the other patient had a gallstone induced by moderately severe AP.Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP.Therefore,the alternative and minimally invasive ERAT was considered.After written informed consent was collected from the patients,the ERAT procedure was performed.Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.CONCLUSION ERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.

Sino-nasal outcome Test-22 and Lund–Mackay CT score to select endoscopic sinus surgery in chronic rhinosinusitis

Objectives:Chronic rhinosinusitis is one of the common diseases that cause morbidity and affects a person's quality of life.We tried to provide a more appropriate and effective approach to selecting patients for endoscopic sinus surgery.Methods:The study population is chronic rhinosinusitis children referred to the ear,nose,and throat clinic of two general hospitals in Tehran,Iran,who have previously undergone sufficient drug treatment and have not recovered.The Lund–Mackay score is calculated by examining the computed tomography(CT)scan.The Sino-nasal Outcome Test-22(SNOT-22)questionnaire was provided to the patients before the operation,after the operation,and 3 and 6 months later in the clinic.Results:Before the operation,the most SNOT-22 score people were in the range of 40–59 points.The SNOT-22 score before the operation is significantly different from 3 and 6 months after the operation.The highest frequency of Lund–Mackay CT(LMCT)scan score was in the range of 18–23 points.The LMCT scan score did not show any significant relationship with the SNOT-22 score before surgery,3 months,and 6 months after surgery.Sensitivity to aspirin had a significant relationship with SNOT-22 scores and the history of asthma and nasal polyps had a significant relationship with the preoperative LMCT scan score.Conclusions:The LMCT scan scoring system cannot be a good measure of chronic rhinosinusitis severity or the prognosis of patients after surgery.The SNOT-22 questionnaire can be used as a predictive tool to help the doctor and the patient in deciding to operate and the possibility of obtaining a relative recovery.

经鼻内镜筛窦纸板进路眶内手术

目的 探讨经鼻内镜筛窦纸板进路手术治疗眶内各种疾病的可行性并确立临床处理的基本原则。方法 经鼻内镜进路眶内手术 10例 :眶内异物取出术 4例、球后海绵状血管瘤切除术 1例、眶内侵犯或转移的恶性肿瘤切除术 5例。结果 眶内异物取出术 3例成功 ,1例失败 ;球后海绵状血管瘤 1例完整切除 ;鼻咽癌眶内转移 1例手术切除 +放射治疗后随访 4年无复发 ,视力恢复至 0 6 ;其他眶内恶性肿瘤 4例 ,手术后随访 1～ 4年均健在。 10例手术后 1例视力损伤 ,9例均保留原有视力 ,其中 3例失明病例中 2例视力有一定程度的恢复。结论 位于视神经内侧的某些占位性病变可以经鼻内镜筛窦纸板进路完成。

经鼻内镜鞍内肿瘤切除术

目的 总结 5 2例经鼻内镜鞍内肿瘤切除的一些经验以供参考。方法 1996年 9月～2 0 0 1年 2月根据术前病理学分类和影像学分期 ,选择经鼻内镜外科治疗垂体腺瘤患者 49例、鞍内颅咽管瘤患者 2例、鞍内脑膜瘤 1例。结果 除 1例非分泌性腺瘤 (Ⅴ期 )和 1例脑膜瘤仅行大部分切除外 ,其余病例瘤组织均得到了完全切除 ,手术时间为 40～ 180min(平均 90min)。术野清晰、广阔。术后头痛、视力障碍和闭经泌乳等症状改善。血清泌乳素 (prolactin ,PRL)和 (growthhormone ,GH)水平恢复正常。术后随访 3～ 72个月 ,2例垂体瘤和 1例颅咽管瘤复发 ,行相同进路的二次手术 ,复发率为5 8%。本组病例术后有 6例患者出现尿崩 ,仅 1例患者需应用口服抗利尿激素治疗。 1例颅咽管瘤患者术后第 3天出现一次癫痫发作 ,意识不清 ,经治疗后痊愈出院。全部病例均未见颅内出血、视神经损伤、脑脊液鼻漏、脑膜炎及其他垂体功能低下等并发症发生。结论 经鼻内镜鞍内肿瘤切除术安全、简便、微创 。

Esophageal liposarcoma:Well-differentiated rhabdomyomatous type

Rhabdomyomatous well-differentiated esophageal liposarcomas are extremely rare. As of August 2016, only one other such case has been reported in the English-language medical literature. Liposarcomas in general are one of the most common soft tissue neoplasms in adults, but the incidence of primary esophageal liposarcomas is exceptionally low. There have been only 42 reported cases of primary liposarcoma of the esophagus worldwide thus far. These malignancies are harbored within giant fibrovascular polyps, which slowly grow within the esophageal lumen causing obstructing symptoms. We hereby present the case of a 68-year-old male patient who came in with a 2-mo history of worsening intermittent dysphagia, persistent cough, and postprandial retrosternal pain. After an esophagogastroduodenoscopy, a computed tomographic scan, and a diagnostic endoscopy, complete endoscopic resection was performed of the 13 cm &times; 6 cm &times; 2.6 cm fibrovascular polyp. A literature review was done and results are presented herein.

Comment on “Artificial intelligence in gastroenterology: A state-ofthe- art review”

Colon capsule endoscopy(CCE)was introduced nearly two decades ago.Initially,it was limited by poor image quality and short battery time,but due to technical improvements,it has become an equal diagnostic alternative to optical colonoscopy(OC).Hastened by the coronavirus disease 2019 pandemic,CCE has been introduced in clinical practice to relieve overburdened endoscopy units and move investigations to out-patient clinics.A wider adoption of CCE would be bolstered by positive patient experience,as it offers a diagnostic investigation that is not inferior to other modalities.The shortcomings of CCE include its inability to differentiate adenomatous polyps from hyperplastic polyps.Solving this issue would improve the stratification of patients for polyp removal.Artificial intelligence(AI)has shown promising results in polyp detection and characterization to minimize incomplete CCEs and avoid needless examinations.Onboard AI appears to be a needed application to enable near-real-time decision-making in order to diminish patient waiting times and avoid superfluous subsequent OCs.With this letter,we discuss the potential and role of AI in CCE as a diagnostic tool for the large bowel.

The Draf Ⅲ procedure: A review of indications and techniques

The DrafⅢprocedure involves the creation of a common frontal sinus cavity.The most common indication for the DrafⅢprocedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative interventions such as bilateral DrafⅡa procedures.Primary DrafⅢmay be indicated in patients with a high risk of failures such as those with severe polyposis and those with a frontal sinus opening less than 4 mm on computed tomography imaging.Other indications for the DrafⅢinclude access for tumor removal and repair of traumatic fractures of the frontal sinus.The"inside-out"DrafⅢprocedure is the standard approach when the frontal recess anterior-posterior diameter is wide enough for instrument access,usually larger than 4-5 mm.The"outside-in"DrafⅢprocedure can be done when the frontal recess is too narrow to safely accommodate instruments.Regular follow-up with debridement should be done to prevent neo-ostium stenosis.

Endo-anesthesia:a primer

Gastrointestinal(GI)endoscopy has witnessed a Cambrian explosion of techniques,indications,and expanding target populations.GI endoscopy encompasses traditional domains that include preventive measures,palliation,as alternative therapies in patients with prohibitive risks of more invasive procedures,and indicated primary treatments.But,it has expanded to include therapeutic and diagnostic interventional endosonography,luminal endoscopic resection,third space endotherapy,endohepatology,and endobariatrics.The lines between surgery and endoscopy are blurred on many occasions within this paradigm.Moreover,patients with high degrees of co-morbidity and complex physiology require more nuanced peri-endoscopic management.The rising demand for endoscopy services has resulted in the development of endoscopy referral centers that offer these invasive procedures as directly booked referrals for regional and rural patients.This further necessitates specialized programs to ensure appropriate evaluation,risk stratification,and optimization for safe sedation and general anesthesia if needed.This landscape is conducive to the organic evolution of endo-anesthesia to meet the needs of these focused and evolving practices.In this primer,we delineate important aspects of endo-anesthesia care and provide relevant clinical and logistical considerations pertaining to the breadth of procedures.