Search

Objectives: Endoscopic hand suturing (EHS) is a novel technique for closing a mucosal defect after endoscopic submucosal dissection (ESD). We investigated the technical feasibility of colorectal EHS using a modified flexible through‐the‐scope needle holder. Methods: This was a prospective multicenter study conducted at two referral centers between June 2022 and April 2023. This study included colorectal neoplasms 20–50 mm in size located in the sigmoid colon or rectum. A modified flexible through‐the‐scope needle holder, with an increased jaw width to facilitate needle grasping, was used for colorectal EHS. The primary end‐points were sustained closure rate on second‐look endoscopy (SLE) performed on postoperative days 3–4 and suturing time for colorectal EHS. Secondary end‐points included complete closure rate and delayed adverse events. Results: We enrolled 20 colorectal neoplasms in 20 patients, including four patients receiving antithrombotic agents. The tumor location was as follows: lower rectum (n = 8), upper rectum (n = 2), rectosigmoid colon (n = 4), and sigmoid colon (n = 6), and the median mucosal defect size was 37 mm (range, 21–65 mm). The complete closure rate was 90% (18/20 [95% confidence interval (CI) 68.3–98.8%]), and the median suturing time was 49 min (range, 23–92 min [95% CI 35–68 min]). Sustained closure rate on SLE was 85% (17/20 [95% CI 62.1–96.8%]). No delayed adverse events were observed. Conclusion: EHS demonstrated a high sustained closure rate. Given the long suturing time and technical difficulty, EHS should be reserved for cases with a high risk of delayed adverse events. [ABSTRACT FROM AUTHOR]

Objectives: The usefulness of computer‐aided detection systems (CADe) for colonoscopy has been increasingly reported. In many countries, however, data on the cost‐effectiveness of their use are lacking; consequently, CADe for colonoscopy has not been covered by health insurance. We aimed to evaluate the cost‐effectiveness of colonoscopy using CADe in Japan. Methods: We conducted a simulation model analysis using Japanese data to examine the cost‐effectiveness of colonoscopy with and without CADe for a population aged 40–74 years who received colorectal cancer (CRC) screening with a fecal immunochemical test (FIT). The rates of receiving FIT screening and colonoscopy following a positive FIT were set as 40% and 70%, respectively. The sensitivities of FIT for advanced adenomas and CRC Dukes' A–D were 26.5% and 52.8–78.3%, respectively. CADe colonoscopy was judged to be cost‐effective when its incremental cost‐effectiveness ratio (ICER) was below JPY 5,000,000 per quality‐adjusted life‐years (QALYs) gained. Results: Compared to conventional colonoscopy, CADe colonoscopy showed a higher QALY (20.4098 vs. 20.4088) and lower CRC incidence (2373 vs. 2415 per 100,000) and mortality (561 vs. 569 per 100,000). When the CADe cost was set at JPY 1000–6000, the ICER per QALY gained for CADe colonoscopy was lower than JPY 5,000,000 (JPY 796,328–4,971,274). The CADe cost threshold at which the ICER for CADe colonoscopy exceeded JPY 5,000,000 was JPY 6040. Conclusions: Computer‐aided detection systems for colonoscopy has the potential to be cost‐effective when the CADe cost is up to JPY 6000. These results suggest that the insurance reimbursement of CADe for colonoscopy is reasonable. [ABSTRACT FROM AUTHOR]

Background and Aim Methods Results Conclusions Colorectal endoscopic submucosal dissection is a technically demanding procedure with a steep learning curve. In Japan, the National Cancer Center Hospital allows overseas doctors to participate in hands‐on training. We aimed to assess the colorectal endoscopic submucosal dissection performance and learning curve of an endoscopist who participated in hands‐on training.In this retrospective analysis using a prospectively collected database, 100 consecutive superficial colorectal tumors from 100 patients treated with endoscopic submucosal dissection by a colorectal surgeon between January 2020 and May 2024 were included. The cases were grouped into three learning periods: phase I (the initial 30 cases under local expert supervision before training in Japan), phase II (the middle 30 cases), and phase III (the last 40 cases). The primary outcome was resection speed.The median resection speed was 5, 11.7, and 13.2 cm2/h in phases I, II, and III, respectively. In matched data, the resection speeds in phases II and III were higher than that in phase I (P = 0.02 and P < 0.001, respectively). En bloc and R0 resection rates were 99% and 95%, respectively. The en bloc resection, R0 resection, and complication rates were not different between phases. Cumulative sum analysis of the resection speed revealed that proficiency was achieved after 36 cases.An endoscopist who underwent a tutored approach and hands‐on training in Japan achieved the proficiency benchmarks for colorectal endoscopic submucosal dissection after 36 cases. However, the endoscopist's extensive experience before training may contribute to excellent outcomes. [ABSTRACT FROM AUTHOR]