Foreword

Thierry Ponchon

Dear colleagues,

in this 6th issue of 2015, we have 22 original papers and 6 editorials, which I’ll briefly summarize here:

• A comparative trial in 1000 patients observed that anterior meatuscopy is superior to the sniff test for selecting the most patent nasal meatus before transnasal upper gastrointestinal endoscopy. Anterior meatuscopy resulted in reduced epistaxis, nasal pain, and nasal discharge.

• Two publications analyzed the results of endoscopic vacuum therapy for esophageal leakage. In the first study, perforations were healed in all cases (10) in within 3 to 7 days. No stenosis and no other complications related to the treatment were observed. In the second publication, also on 10 cases, perforation resolved in 7 patients and one stenosis was observed. An attached editorial discussed this attractive procedure among the different therapeutic options

• A training program was evaluated on ex-vivo and live swine models in order to determine the number of procedures required to master POEM in an animal model. Mastering was defined when finishing the five steps of the procedure without complications : mucosotomy or passage into the mediastinum. Mastery was obtained after 26 cases. The training format could serve as a model.

• An editorial aimed to discuss various definitions of R0 resection and resection curativeness for superficial neoplastic lesions on Barrett’s esophagus.

• A randomized study was performed in 24 pigs to compare the safety of NOTES mediastinoscopy with video-assisted mediastinoscopy (VAM). More intraoperative adverse events were noted with NOTES than VAM (7 vs. 2, P = 0.04). Hemorrhage was the most frequent complication. A complementary editorial discusses these adverse events and the future of NOTES mediastinoscopy.

• An experimental study on pigs (18 procedures) compared “classical” ESD to tunnel ESD in esophagus and stomach. Difference was observed concerning the speed in the esophagus and a better specimen quality at lateral margins was demonstrated by histopathology.

• A 10 year experience results of injection of n-butyl-2-cyanoacrylate to control esophageal variceal ruptures in patients with Child-Pugh (CP) class C cirrhosis was reported by a single Brazilian center. Bleeding within 5 first days was successfully controlled in 75 % of the cases. At 6 weeks, rebleeding and mortality rate (34 vs 85 %) were significantly higher in case of CP 14 – 15 points compared to CP 10-13.

• An analysis of 343 depressed gastric lesions using magnified NBI was conducted to determine which microvessel features is associated to cancer. Variation in microvessel shape was a statistically significant factor.

• A complementary study on the white opaque substance (WOS) in gastric epithelial neoplasia caused by accumulation of lipid droplets observed that WOS might be an indicator of histologic differentiation and mucin phenotype.

• A novel topical hemostatic powder, Endoclot, was used in 21 patients (out of 173) as rescue therapy. Immediate hemostasis was achieved in all cases, with a 30-day rebleeding rate of 4.8 % and a 30-day mortality rate of 19.0 %. These rates were not different from those of the 148 patients initially treated with standard endoscopic hemostatic techniques.

• A long-term assessment (10 years) of direct percutaneous endoscopic jejunostomy for enteral feeding in 83 patients was conducted. The authors have reported a 90 % technical success rate (90 %), a 13 % rate of peri-operative adverse events and an improvement in long-term nutritional support in 90 % of the patients (90 %).

• An evaluation on how the trainees acquired skill and proficiency in performing colonoscopies was conducted by analyzing their wrist motions on a simulator. It was demonstrated that trainees reduce the time spent at the extreme range of wrist motion as they advance through their 10 months of training. An additional editorial elaborates further on the importance of finding the optimal techniques.

• An hypothesis that endoscopists who provide better image documentation of the cecum during their procedures have a higher polyp detection rate (PDR) was verified. The quality of the cecal images obtained at colonoscopy was graded with a scoring system (CIDS). A mean CIDS > 2.0 was found to be an independent predictor of a higher polyp detection rate (P = 0.001). An editorial on the need for cecal image documentation and quality documentation in general is associated.

• An analysis using the datasets from a previous CT colonography study examined the effect of antispasmodic and observed that the use of antispasmodic was associated with a significant relative increase in percentage surface visualization of 2.6 % to 3.9 %, compared with no antispasmodic, which might explain up to half the improvement in adenoma detection seen in clinical studies.

• A randomized experimental study on 12 swine colons with beads sewn to the mucosa was organized to compare conventional colonoscopy and colonoscopy with a new panoramic 360° view device. 94.9 % of pseudolesions were visualized by panoramic colonoscopy compared to 86.8% with regular colonoscopy (P = 0.002).

• A meta-analysis aimed to determine the effect of educational intervention on the quality of bowel preparation before colonoscopy. Nine randomized controlled trials were included in this meta-analysis, representing a total of 2885 patients. It appears that a brief counseling session with patients before colonoscopy ensures better bowel preparation. A related editorial discusses the merits of this procedure.

• An atomical analysis of the blood supply within 11 peducunlated polyps was conducted in order to optimize the snare placement to prevent post-polypectomy hemorrhage. The maximum diameter of the arterial lumen was greater at the base and the ratio of the vessel area to the cross-section area was greater at the apex, thus indicating that the optimal snare placement is in the middle of the stalk

• A positive evaluation of Gastrografin, as a substitute of sodium phosphate, in bowel preparation for colon capsule endoscopy was reported in 29 patients. The capsule excretion rate was 97 % and bowel cleansing level was adequate in 90 % of cases. Gastrografin was well tolerated without side-effects.

• A study on 58 patients validated a device (target sample check illuminator) that detects the target specimen within pancreatic tumor EUS-FNA samples. The agreement rate between the device and histopathology concerning the presence of specimen was 93.7%.

• A study tried to differentiate small GIST and leiomyoma through the analysis of miRNA expression patterns in 16 human cases by a novel sampling method, submucosal tunneling biopsy, providing sufficient size specimen without contamination. Suitable samples were obtained for miRNA analysis and MiR-140 family members were identified as specific biomarkers to distinguish GIST from leiomyoma.

Enjoy reading!

Thierry Ponchon, MD

Editor-in-Chief, Endoscopy International Open