bluuebunny/crossref_metadata_2025_split huggingface dataset:
Colonoscopy quality across Europe: a report of the European Colonoscopy Quality Investigation (ECQI) Group
Authors: Spada Cristiano , Koulaouzidis Anastasios , Hassan Cesare , Amaro Pedro , Agrawal Anurag , Brink Lene , Fischbach Wolfgang , Hünger Matthias , Jover Rodrigo , Kinnunen Urpo , Ono Akiko , Patai Árpad , Pecere Silvia , Petruzziello Lucio , Riemann Jürgen F. , Amlani Bharat , Staines Harry , Stringer Ann L. , Toth Ervin , Antonelli Giulio , Fuccio Lorenzo 
Published: September 2021

Abstract
Background and study aims The European Colonoscopy Quality Investigation (ECQI) Group comprises expert colonoscopists and investigators with the aim of raising colonoscopy standards. We assessed the levels of monitoring and achievement of European Society of Gastrointestinal Endoscopy (ESGE) performance measures (PMs) across Europe using responses to the ECQI questionnaires.
Methods The questionnaire comprises three forms: institution and practitioner questionnaires are completed once; a procedure questionnaire is completed on multiple occasions for individual total colonoscopies. ESGE PMs were approximated as closely as possible from the data collected via the procedure questionnaire. Procedure data could provide rate of adequate bowel preparation, cecal intubation rate (CIR), withdrawal time, polyp detection rate (PDR), and tattooing resection sites.
Results We evaluated ECQI questionnaire data collected between June 2016 and April 2018, comprising 91 practitioner and 52 institution questionnaires. A total of 6445 completed procedure forms were received.Institution and practitioner responses indicate that routine recording of PMs is not widespread: adenoma detection rate (ADR) is routinely recorded in 29 % of institutions and by 34 % of practitioners; PDR by 42 % and 47 %, CIR by 62 % and 64 %, bowel preparation quality by 56 % and 76 %, respectively.Procedure data showed a rate of adequate bowel preparation of 84.2 %, CIR 73.4 %, PDR 40.5 %, mean withdrawal time 7.8 minutes and 12.2 % of procedures with possible removal of a non-pedunculated lesion ≥ 20 mm reporting tattooing.
Conclusions Our findings clearly show areas in need of quality improvement and the importance of promoting quality monitoring throughout the colonoscopy procedure.
Feasibility study of endoscopic biliary drainage under direct peroral cholangioscopy by using an ultra-slim upper endoscope (with videos)
Authors: Park Jae Keun , Moon Jong Ho , Lee Yun Nah , Jo Seok jung , Choi Moon Han , Lee Tae Hoon , Cha Sang-Woo , Cho Young Deok , Park Sang-Heum 
Published: September 2021

AbstractThe therapeutic utility of peroral cholangioscopy (POC) is limited. Direct POC using an ultra‑slim upper endoscope expands the therapeutic indications because of its larger working channel, of up to 2.2 mm. We evaluated the feasibility of selective biliary drainage using a plastic stent under direct POC. From April 2015 to March 2019, biliary drainage under endoscopic visualization was performed in the same endoscopic session as direct POC without exchanging the duodenoscope. After guidewire insertion through the stricture or stone, a 5 Fr plastic stent and/or nasobiliary drainage catheter was used for biliary drainage. Selective biliary drainage under direct POC was performed in 32 patients, including 17 with difficult bile duct stones. Biliary drainage was performed with a plastic stent in 29 patients, nasobiliary drainage in one, and combined drainage in two patients. The technical success rate for biliary drainage placement under direct POC was 100 % (32/32). No significant procedure-related complications occurred. In conclusion, biliary drainage with a plastic stent or catheter under direct POC using an ultra-slim upper endoscope is feasible and may be useful for lesions obstructing the bile duct.
Cost comparisons of endoscopic and surgical resection of stage T1 rectal cancer
Authors: Arthursson Victoria , Rosén Roberto , Norlin Jenny M. , Gralén Katarina , Toth Ervin , Syk Ingvar , Thorlacius Henrik , Rönnow Carl-Fredrik 
Published: September 2021

Abstract
Background and study aims Management of T1 rectal cancer is complex and includes several resection methods, making cost comparisons challenging. The aim of this study was to compare costs of endoscopic and surgical resection and to investigate hypothetical cost scenarios for the treatment of T1 rectal cancer.
Patients and methods Retrospective population-based cost minimization study on prospectively collected data on T1 rectal cancer patients treated using endoscopic submucosal dissection (ESD), transanal endoscopic microsurgery (TEM), open, laparoscopic, or robotic resection, in Skåne County, Sweden (2011–2017). The hypothetical cost scenarios were based on the distribution of high-risk features of lymph node metastases in a national cohort (2009–2017).
Results Eighty-five patients with T1 RC undergoing ESD (n = 16), TEM (n = 17), open (n = 35), laparoscopic (n = 9), and robotic (n = 8) resection were included. ESD had a total 1-year cost of 5165 € and was significantly (P < 0.05) less expensive compared to TEM (14871€), open (21 453 €), laparoscopic (22 488 €) and robotic resection (26 562 €). Risk factors for lymph node metastases were seen in 68 % of 779 cases of T1 rectal cancers included in the national cohort. The hypothetical scenario of performing ESD on all T1 RC had the lowest total 1-year per patient cost compared to all other alternatives.
Conclusions This is the first study analyzing total 1-year costs of endoscopic and surgical methods to resect T1 rectal cancer, which showed that the cost of ESD was significantly lower compared to TEM and surgical resection. In fact, based on hypothetical cost scenarios, ESD is still justifiable from a cost perspective even when all high-risk cases are followed by surgery in accordance to guidelines.
Severe COVID-19 and Retina: Are There Any Retinal Manifestations?
Authors: Gündogan Medine , Kiliç Soner , Göktas Sertan , Vural Esra , Sirem Muhammed Rasit , Ünal Sefa , Celik Ilhami 
Published: September 2021

Abstract
Purpose To investigate whether there are retinal lesions associated with severe COVID-19.
Methods We studied 232 symptomatic subjects aged 18 – 65 years who had severe COVID-19 and had received treatment. The evaluations included ophthalmological examinations, optical
coherence tomography (OCT), imaging modalities with near infrared reflectance (NIR), fundus autofluorescence (FAF), and fundus photography (FP).
Results The mean age of the patients was 49 years, and 67.6% of them were men. There were no findings of microhemorrhage, cotton wool spots (CWS), vitritis, or retinitis in the
examination and imaging.
Conclusions This study indicates that retinal involvement as a complication associated with COVID-19 is questionable, although some reports have demonstrated a relationship that may
occur secondary to existing systemic diseases.
Endoscopic ultrasound-guided fine-needle biopsy in patients with unexplained diffuse gastrointestinal wall thickening
Authors: Chavarría Carlos , García-Alonso Francisco J. , de Benito-Sanz Marina , Mata-Romero Pilar , Madrigal Beatriz , Sanchez-Ocaña Ramon , Diez-Redondo Pilar , Núñez Henar , Perez-Miranda Manuel , de la Serna-Higuera Carlos 
Published: September 2021

Abstract
Background and study aims Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is recommended after non-diagnostic biopsy in gastrointestinal wall thickening, although the performance of currently available FNB needles in this setting is unknown. We aimed to assess the diagnostic accuracy and safety of EUS-FNB and to evaluate the "T" wall staging in malignant pathology.
Patients and methods This was a single center retrospective study that included all consecutive patients undergoing EUS-FNB for diffuse gastrointestinal wall thickening with at least one previous negative conventional endoscopic biopsy between January 2016 and November 2019. EUS-FNB was performed using linear-array echoendoscopes with slow-pull/fanning technique. Tissue acquisition was done with 19- or 22-gauge biopsy needles. Samples were included in formalin without rapid on-site evaluation and submitted for histopathological processing. The final diagnosis was based on conclusive histology or absence of evidence of disease progression after follow-up at least 6 months.
Results Twenty-nine patients (21 men), with a median age of 68 (IQR: 56–77), were included. EUS-FNB was technically feasible and the sample quality was adequate for full histological assessment in all patients (100 %). Sensitivity, specificity, positive and negative predictive values, and overall accuracy for diagnosis of malignancy were 95.5 %, 100 %, 100 %, 83.3 %, and 96.3 %, respectively. In patients with malignant disease, the samples obtained allowed detection of signs of deep layer inﬁltration (“histological staging”) in 17 of 21 cases (81 %). No adverse events were noted.
Conclusions The EUS-FNB technique demonstrated excellent diagnostic performance and safety in the study of unexplained diffuse gastrointestinal wall thickening. Histological staging was obtained in a high percentage of samples.
Over-the-scope clip as first-line therapy for ulcers with high-risk bleeding stigmata is efficient compared to standard endoscopic therapy
Authors: Buddam Avanija , Rao Sirish , Koppala Jahnavi , Rangray Rajani , Abdussalam Abdullah , Mukherjee Sandeep , Chandra Subhash 
Published: September 2021

Abstract
Background and study aims Ulcers with high-risk stigmata have significant rebleeding rates despite standard endoscopic therapy. Data on over-the-scope clip (OTSC) for recurrent bleeding is promising but data on first line therapy is lacking. We report comparative outcomes of OTSC as first-line therapy versus standard endoscopic therapy in ulcers with high-risk stigmata.
Patients and methods Consecutive adults who underwent endoscopic therapy for ulcers with high-risk stigmata between July 2019 to September 2020 were included. Patients were grouped into OTSC or standard therapy based on first-line therapy used on index endoscopy. Outcomes measured included: 1) intra-procedural hemostasis based on endoscopic documentation of adequate hemostasis; 2) 7-day rebleeding (> 2 g/dL drop in hemoglobin, hematochezia or hemorrhagic shock); 3) cost of endoscopic interventions; and 4) procedure duration measured as endoscope insertion to removal time. Cost of tools used during the index endoscopy was included.
Results Sixty-eight patients were included, 47 were in standard therapy and 21 in the OTSC group. Hemostasis was achieved in 95.2 % in the OTSC group compared to 83.0 % in the standard therapy group (P = 0.256, number needed to treat [NNT]: 9). Procedure time was shorter in the OTSC group (23 vs. 16 minutes, P = 0.002). Cost of endoscopic interventions were comparable, P = 0.203. Early rebleeding was less often in OTSC group, two (9.5 %) compared to 10 (21.3 %) in standard therapy group, NNT 9.
Conclusions Use of OTSCs as first-line treatment for ulcers bleed probably improves hemostasis and decreases early rebleeding. Use of OTSC as first-line therapy shortened procedure duration without increasing the cost of endoscopic interventions.
Colon capsule endoscopy in clinical practice: lessons from a national 5-year observational prospective cohort
Authors: Benech Nicolas , Vinet Olivier , Gaudin Jean-Louis , Benamouzig Robert , Dray Xavier , Ponchon Thierry , Galmiche Jean-Paul , Sacher-Huvelin Sylvie , Samaha Elia , Saurin Jean-Christophe ,   On Behalf Of The ONECC Study Group
Published: September 2021

Abstract
Background and study aims Colon capsule endoscopy (CCE) has been proposed as an alternative to colonoscopy for screening patients at average risk of colorectal cancer (CRC). A prospective national cohort was developed to assess relevance of CCE in real-life practice and its short- and long-term impacts on clinical management.
Patients and methods All patients who underwent a CCE in France were prospectively enrolled from January 2011 to May 2016 and reached annually by phone until May 2017. All CCE and colonoscopy reports were systematically collected.
Results During the study period, 689 CCEs were analyzed from 14 medical centers. Median follow-up time was 35 months [IQR: 12–50]. Indication for CCE was mainly for elderly patients (median age: 70 years, IQR: [61–79]) due to anesthetic or colonoscopy contraindication (n = 307; 44.6 %). Only 337 CCEs (48.9 %) were both complete and with adequate bowel preparation. Advanced neoplasia (adenoma with high-grade dysplasia or CRC) was diagnosed following 32 CCEs (4.6 %). Among patients who underwent colonoscopy or therapeutic surgery following CCE, 18.8 % of all advanced neoplasias (6/32) had not been diagnosed by CCE mainly due to technical issues. Performing a colonoscopy in the case of significant polyps or insufficient bowel cleansing or after an incomplete CCE allowed the diagnosis of 96.9 % of all identified advanced neoplasias (31/32).
Conclusions Outside the scope of academic trials, improvement is needed to increase the reliability of CCE as less than half were considered optimal i. e. complete with adequate bowel cleansing. Most of missed colonic advanced neoplasia were due to incomplete CCE with distal neoplasia location.
Evaluation of the ESGE recommendations for COVID-19 pre-endoscopy risk-stratification in a high-volume center in Germany
Authors: Zellmer Stephan , Ebigbo Alanna , Kahn Maria , Muzalyova Anna , Classen Johanna , Grünherz Vivian , Temizel Selin , Dhillon Christine , Messmann Helmut , Römmele Christoph 
Published: September 2021

Abstract
Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) has defined COVID-19 infection prevention and control strategies within the endoscopy unit. These include pre-endoscopic questionnaire-based risk-stratification as well as pre-procedure viral testing. Real-life data on the effectiveness of these measures are presented here.
Patients and methods Data from the outpatient endoscopic unit of the University Hospital Augsburg between July 1, 2020 and December 31, 2020 including the second pandemic wave were reviewed retrospectively. All patients were assessed with a pre-endoscopic risk-stratification questionnaire as well as viral testing using an antigen point-of-care test (Ag-POCT) in conjunction with a standard polymerase chain reaction (PCR) test. Highly elective procedures were postponed. The theoretically expected number of SARS-CoV-2-positive patients was simulated and compared with the actual number. In addition, endoscopy staff was evaluated with a rapid antibody test to determine the number of infections among the personnel.
Results In total, 1029 procedures, 591 questionnaires, 591 Ag-POCTs, and 529 standard PCR tests were performed in 591 patients. 247 procedures in 142 patients were postponed. One Ag-POCT was positive but with a negative PCR test, while one PCR test was positive but with a negative Ag-POCT. This was lower than the theoretically expected number of COVID-19-positive patients (n = 15). One of 43 employees (2.3 %) in the outpatient endoscopy unit was seropositive.
Conclusions Pre-endoscopic risk management including questionnaire-based risk stratification and viral testing seems to be an effective tool in combination with personal protective equipment for SARS-CoV-2 infection prevention and control within the endoscopy unit even in a high-prevalence setting.
Impact of COVID-19 on gastroenterology fellowship training: a multicenter analysis of endoscopy volumes
Authors: Paleti Swathi , Sobani Zain A. , McCarty Thomas R. , Gutta Aditya , Gremida Anas , Shah Raj , Nutalapati Venkat , Bazerbachi Fateh , Jesudoss Randhir , Amin Shreya , Okwara Chinemerem , Kathi Pradeep Reddy , Ahmed Ali , Gessel Luke , Hung Kenneth , Masoud Amir , Yu Jessica , Mony Shruti , Akshintala Venkata , Jamil Laith , Nasereddin Thayer , Kochhar Gursimran , Vyas Neil , Saligram Shreyas , Garg Rajat , Sandhu Dalbir , Benrajab Karim , Konjeti Rajesh , Agnihotri Abhishek , Trivedi Hirsh , Grunwald Matthew , Mayer Ira , Mohanty Arpan , Rustagi Tarun 
Published: September 2021

Abstract
Background and study aims The COVID-19 pandemic has had a profound impact on gastroenterology training programs. We aimed to objectively evaluate procedural training volume and impact of COVID-19 on gastroenterology fellowship programs in the United States.
Methods This was a retrospective, multicenter study. Procedure volume data on upper and lower endoscopies performed by gastroenterology fellows was abstracted directly from the electronic medical record. The study period was stratified into 2 time periods: Study Period 1, SP1 (03/15/2020 to 06/30/2020) and Study Period 2, SP2 (07/01/2020 to 12/15/2020). Procedure volumes during SP1 and SP2 were compared to Historic Period 1 (HP1) (03/15/2019 to 06/30/2019) and Historic Period 2 (HP2) (07/01/2019 to 12/15/2019) as historical reference.
Results Data from 23 gastroenterology fellowship programs (total procedures = 127,958) with a median of 284 fellows (range 273–289; representing 17.8 % of all trainees in the United States) were collected. Compared to HP1, fellows performed 53.6 % less procedures in SP1 (total volume: 28,808 vs 13,378; mean 105.52 ± 71.94 vs 47.61 ± 41.43 per fellow; P < 0.0001). This reduction was significant across all three training years and for both lower and upper endoscopies (P < 0.0001). However, the reduction in volume was more pronounced for lower endoscopy compared to upper endoscopy [59.03 % (95 % CI: 58.2–59.86) vs 48.75 % (95 % CI: 47.96–49.54); P < 0.0001]. The procedure volume in SP2 returned to near baseline of HP2 (total volume: 42,497 vs 43,275; mean 147.05 ± 96.36 vs 150.78 ± 99.67; P = 0.65).
Conclusions Although there was a significant reduction in fellows’ endoscopy volume in the initial stages of the pandemic, adaptive mechanisms have resulted in a return of procedure volume to near baseline without ongoing impact on endoscopy training.
Effects of the First COVID-19 Lockdown on Ophthalmological Patient Care
Authors: Schuh Anna , Kassumeh Stefan , Schmelter Valerie , Demberg Lilian , Siedlecki Jakob , Anschütz Andreas , Kreutzer Thomas , Mayer Wolfgang J. , Kohnen Thomas , Shajari Mehdi , Priglinger Siegfried 
Published: September 2021

Abstract
Purpose To determine the effect of lockdown on medical care, with the example of ophthalmology.
Methods Patients in a period during the first lockdown were compared to a non-lockdown period, with a total of 12 259 patients included in an observational study. Changes in different areas (elective, emergency, inpatients, surgeries) and eye care subspecialties were compared. Emergency patients were analyzed according to severity and urgency. Patients showing hints requiring treatment for urgent cardiovascular diseases were determined. Differences in patients who would have suffered severe vision loss without treatment were identified and the QALY (quality-adjusted life years) loss was determined accordingly. A model to prioritize patient visits after the end of lockdown or in future lockdown scenarios was developed. Data were collected at the University Eye Hospital LMU Munich and patient files were reviewed individually by ophthalmologists.
Results The average patient number decreased by − 59.4% (p < 0.001), with a significant loss in all areas (elective, emergency, inpatients, surgeries; p < 0.001). There was a decline of − 39.6% for patients at high risk/high severity. Patients with indications of a risk factor of future stroke declined significantly (p = 0.003). QALY loss at the university eye hospital was 171, which was estimated to be 3160 – 24 143 for all of Germany. Working up high losses of outpatients during these 8 weeks of projected lockdown in Germany would take 7 – 23 weeks under normal circumstances, depending on ophthalmologist density. The prioritization model can reduce morbidity by up to 78%.
Conclusion There was marked loss of emergency cases and patients with chronic diseases. Making up for the losses in examinations and treatments will theoretically take weeks to months. To reduce the risk of morbidity, we recommend a prioritization model for rescheduling and future lockdown scenarios.
Itemreduktion zur Verbesserung der Praktikabilität
neonatologischer Schmerzmesssysteme
Authors: Tischler Max , Kappesser Judith , Utsch Boris , Ehrhardt Harald , Hermann Christiane , Zimmer Klaus-Peter , de Laffolie Jan 
Published: September 2021

Zusammenfassung
Hintergrund Trotz über 50 psychometrisch validierter
Beobachtungsverfahren gibt es bisher keinen Konsens über das
praktikabelste Schmerzassessment bei Neugeborenen. Die Items von NFCSshort und
PIPP wurden mit der Schmerzeinschätzung der prozedurbeteiligten
Behandler verglichen und es wurde evaluiert, ob eine Itemreduktion zu Gunsten
der Alltagsanwendung möglich wäre.
Material und Methoden 52 Neugeborene wurden in unserer Beobachtungsstudie
einer klinisch indizierten peripheren Venenpunktion unterzogen. Patient und
Monitordaten wurden standardisiert auf Video aufgezeichnet. Die
Schmerzintensität wurden durch sieben unabhängige Untersucher
mittels NFCSshort und PIPP bewertet und hinsichtlich der Variabilität
zwischen den Untersuchern verglichen.
Ergebnisse Nur vier Items des PIPP (Herzfrequenz,
Augenbrauenvorwölbung, zusammengekniffene Augen, betonte
Nasolabialfalte) wiesen einen signifikanten Zusammenhang mit der
geschätzten Schmerzhaftigkeit der Prozedur auf. Die Items 1
(Gestationsalter), 2 (Wachheitsgrad) und 4 (Sauerstoffsättigung) hatten
bei keinem Untersucher Einfluss auf das Schmerzmessergebnis. Die Auswertung des
NFCSshort zeigte bei zwei Untersuchern für das Item 1
(Vorwölbung der Augenbrauen) und bei einem Untersucher für das
Item 2 (zusammengekniffene Augen) keine Einflüsse auf das
Messergebnis.
Diskussion Die Ergebnisse der Studie legen eine Kürzung des PIPP um
drei Items nahe, da diese keinen Einfluss auf das Schmerzmessergebnis zeigten.
Eine Reduktion des PIPP um das Item Gestationsalter erscheint fraglich, da es in
weiteren Studien als bedeutsames Item bewertet wurde. Ein Verzicht auf das Item
Sauerstoffsättigung geht mit einem geringeren Messaufwand einher. Eine
weitere Kürzung der bereits gekürzten Version (NFCSshort) auf
weniger als fünf Items ist auf Basis unserer Ergebnisse nicht zu
empfehlen.