Whether you are navigating the first half of year one of a fellowship or starting the search for your first job after training, staying up to date with new studies is rewarding on multiple levels. Here is a list of the top 10 papers published in the GIE Journal in 2023 that are must-reads for trainees, according to Danny Issa, MD, an assistant professor of medicine at UCLA and a member of the ASGE Membership Engagement Committee.
Rex DK, et al. Characterization of endoscopic features and histology of a distinct mucosal transition zone on the ileocecal valve. GIE 2023;98:400-404.
As you continue to build your skills as a colonoscopist, you will benefit from understanding the transition zone, a mucosal area with a distinct appearance between colonic and ileal mucosae. This article found that the transition zone is also unique histologically, more closely resembling ileal mucosa. Recognizing this zone is critical to avoid confusion with adenomas located on the ileocecal valve. Make sure to view the images and video that accompany the article.
Baltes P, et al. Small-bowel capsule endoscopy in patients with Meckel’s diverticulum: clinical features, diagnostic workup, and findings. A European multicenter I-CARE study. GIE 2023;97:917-926.e3.
This retrospective European study included 69 patients with confirmed Meckel’s diverticulum (MD; age 32, 66% male) from 2001 to 2021. GI bleeding/iron-deficiency anemia was present in all patients. Typical capsule endoscopy findings were double lumen (71%), visible entrance into MD (71%), mucosal webs (43.5%) and bulges (27.5%). Mean percent small-bowel transit time for the first indicative image was 57% of time.
Shiratori Y, et al. Timing of colonoscopy in acute lower GI bleeding: a multicenter retrospective cohort study. GIE 2023;97:89-99.e10.
This study included 6270 patients with acute hematochezia admitted to 49 hospitals in Japan. Early colonoscopy (24 hours) was beneficial in patients with shock index ≥1 as it led to lower risk for surgery or interventional radiology. In patients with performance status ≥3, early colonoscopy improved rebleeding risk.
Desai M, et al. Impact of withdrawal time on adenoma detection rate: results from a prospective multicenter trial. GIE 2023;97:537-543.
This multicenter randomized controlled trial included 1142 subjects who underwent screening (45.9%) or surveillance (53.6%) colonoscopy. Adenoma detection rate (ADR) increased for a withdrawal time of six to 13 minutes, beyond which ADR did not increase. For every one-minute increase in withdrawal time, there were 6% higher odds of detecting an additional adenoma (odds ratio, 1.06; P=.004).
Laszkowska M, et al. Factors associated with detection of hereditary diffuse gastric cancer on endoscopy in germline CDH1 mutations. GIE 2023;98:326-336.e3.
The aim was to assess the sensitivity of detecting signet ring cell carcinoma in this population (which is traditionally low). Ninety-eight patients with CDH1 underwent at least one EGD at Memorial Sloan Kettering Cancer Center between 2006 and 2022. The study found that obtaining ≥40 samples was associated with increased detection of signet cells. Short-term surveillance with endoscopy had favorable outcomes.
Shiratori W, et al. Long-term course of gastric submucosal tumors: growth speed and size-increasing factors. GIE 2023;97:1052-1058.e2.
Gastric submucosal lesions are commonly found during endoscopy. In this study, the percentage and speed of lesion enlargement was investigated. A total of 925 gastric lesions were included between 1994 and 2022. Multivariate analysis revealed that irregular extraluminal borders were an increasing factor (hazard ratio [HR], 3.65), initial tumor size ≤9.5 mm (HR, .23) was a nonincreasing factor and GI mesenchymal tumors with calcification did not increase in size.
Wang H, et al. Cold snare EMR for the removal of large duodenal adenomas. GIE 2023;97:1100-1108.
In this Australian study, 50 duodenal adenomas ≥15 mm were removed via cold snare EMR (CS-EMR) and compared with traditional EMR. Adverse events (16.0%) and technical success (100%) were identical. However, CS-EMR had a significantly lower rate of intraprocedural bleeding (2% vs 37%, P<.001) and late bleeding (4.0% vs 16.7%, P=.036). Recurrence was significantly higher with CS-EMR (24.4% vs 2.3%, P=.002).
Nehme F, et al. Performance and attitudes toward real-time computer-aided polyp detection during colonoscopy in a large tertiary referral center in the United States. GIE 2023;98:100-109.e6.
This retrospective study evaluated computer-aided detection (CADe) effectiveness for polyp detection in the U.S. No statistically significant difference in ADR, median procedure time and withdrawal time was seen while using CADe. In fact, due to a high number of false-positive signals (82.4%) and high level of distraction (58.8%), it prolonged procedure time.
Canakis A, et al. Benefits of EUS-guided gastroenterostomy over surgical gastrojejunostomy in the palliation of malignant gastric outlet obstruction: a large multicenter experience. GIE 2023;98:348-359.e30.
This study set out to compare endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) with surgical GJ in 310 patients over seven years at six different medical centers. Outcomes between the EUS-guided gastroenterostomy (EUS-GE) and laparoscopic surgical approach showed EUS-GE had shorter interval time to initiation/resumption of oral intake (3.49 vs 1.46 days, P<.001), decreased length of stay (9 vs 5.31 days, P<.001) and a lower rate of adverse events (11.9% vs 17.9%, P=.003).
Perisetti A, Sharma P. Tips for improving the identification of neoplastic visible lesions in Barrett’s esophagus. GIE 2023;97:248-250.
Five important tips: (1) clean, (2) inspect (1 min/cm associated with a higher detection rate), (3) virtual chromoendoscopy such as narrow-band imaging and blue laser imaging, (4) education about abnormalities and (5) finally, measure your quality indicator such as neoplasia detection rates.