Tanyaporn Chantarojanasiri

Gastroduodenal intussusception secondary to gastric gastrointestinal stromal tumor

Introduction Esophagogastroduodenoscopy (EGD) requires effective training to ensure technical proficiency. Tip-control simulation models are widely used for trainees; however, the optimal training schedule and standardized quality assessment methods remain unclear. This study aimed at determining the optimal training schedule for tip-control training and at piloting a structured assessment tool for performance evaluation. Methods In all, 73 first-year gastroenterology fellows, including the classes of 2024 and 2025, were included. In 2024, trainees self-selected training schedules, retrospectively categorized as short (15–30 min) or long (>30–60 min) sessions. Based on 2024 results, all trainees in the 2025 validation cohort followed a standardized short-session schedule (15 min, four times per week). Tip-control performance was assessed at weeks 2 and 4 using a structured assessment form and task completion time. Competency was defined as completion time <60 s with satisfactory performance across all domains. Results In 2024, the long-session group demonstrated higher scores at week 2 (2.7 ± 0.5 vs. 2.3 ± 0.3, p = 0.04). By week 4, the short-session group achieved significantly higher scores (3.6 ± 0.5 vs. 2.7 ± 0.5, p < 0.001) and greater improvement (p < 0.001), supporting selection of short-session training for validation. In 2025, trainees using short sessions demonstrated greater improvement (p = 0.01) and a trend toward higher week-4 scores (p = 0.05), despite less total training time. All trainees achieved competency by week 4. Conclusions Short, frequent training sessions improve tip-control skills more effectively and efficiently than longer sessions, supporting distributed practice in endoscopy training.

Biodegradable enteric stents have limited use in benign enteric stricture due to the short degradation time. Silk fibroin (SF) coating on polydioxanone (PDO) has been proposed to extend the degradation rate. PDO stents and yarn were coated with SF solution by using the dip-coating method. Surface properties of the SF-coated PDO yarn were observed by scanning electron microscopy, Fourier transform infrared spectroscopy, and water contact angle analysis. The degradation of the uncoated and 0.5% SF-coated PDO stents were compared at 4, 8, 12, and 16 weeks after incubation. The 0.5% SF-coated PDO stent showed a significant delay in the degradation rate (remaining weight 98.87 and 93.31% at 4 and 8 weeks versus 91.21 and 88.34% in the noncoated stent). After 8 weeks of incubation, the radial compressive force remained in SF-coated stents, while the uncoated stents were destroyed. The bicinchoninic acid assay of the supernatant fluid confirmed an increased amount of dissolved SF in a linear fashion. In conclusion, SF coating on PDO stents using the dip-coating method and fixing with liquid nitrogen could delay the degradation rate of the biodegradable stent and prolong the stent shape retention up to 4 weeks after incubation when compared with an uncoated stent.

Fabrication and mechanical testing of polydioxanone hook cross biodegradable self-expandable enteric stent: impact of fabrication density and mechanical properties of the stent

Objectives: This study aimed to evaluate the disparity in culture results between sterilization and high‐level disinfection (HLD) for duodenoscopes and linear endoscopic ultrasound (EUS), and to assess the effectiveness of different bacterial contamination detection methods.Methods: This is a prospective randomized study, including duodenoscopes and linear EUS with adenosine triphosphate bioluminescence assay values below 200 relative light units after manual cleaning which were randomly assigned to undergo either sterilization or HLD in a 1:1 ratio. Following disinfection, all endoscopes were subjected to adenosine triphosphate bioluminescence assay testing and cultures using both swab and liquid samples from endoscope channels.Results: Totally 752 endoscopes (444 duodenoscopes and 308 linear EUS) were studied. After disinfection, the positive culture rates for the sterilization and HLD groups were 5.9% and 7.2%, respectively (p = 0.460). No significant difference in contamination rates was observed between duodenoscopes and linear EUS (5.9% and 7.5%, respectively; p = 0.379), and no significant association between contamination rates and the presence of biliary stones was seen (7.3% vs. 6.9%; p = 0.613). The detection rate of bacteria from liquid samples taken from endoscope channels was 0.5%, which was significantly lower than the swabbing method (6.0%, p < 0.001).Conclusions: This study found no statistically significant difference in contamination rates between sterilization and HLD methods for gastrointestinal endoscope reprocessing. The type of endoscope and the presence of biliary stones did not influence the positive culture rate. The swabbing method showed significantly higher bacterial detection when compared with liquid samples.

Background and Aim: The APAGE Position Statements aimed to provide guidance to healthcare practitioners on clinical practices aligned with climate sustainability.Methods: A taskforce convened by APAGE proposed provisional statements. Twenty‐two gastroenterologists from the Asian Pacific region participated in online voting and consensus was assessed through an anonymized and iterative Delphi process.Results: There were five sections that addressed the rationale for climate action, the importance of adopting principles of waste management, clinical practice, gastrointestinal endoscopy, and issues related to advocacy and research. Sixteen statements achieved consensus and included the following: 1. APAGE recommends adopting prompt measures to reduce the carbon footprint of clinical practice due to the importance of climate action and its health cobenefits. 5. APAGE recommends adherence to professional clinical guidelines to optimize clinical care delivery in gastroenterology and hepatology to avoid the environmental impact of unnecessary procedures and tests. 8. APAGE recommends an emphasis on health promotion, disease prevention, and appropriate screening and surveillance, when resources are available, to reduce the environmental impact of managing more advanced diseases that require more intensive resources. 12. APAGE recommends that technological advances in endoscopic imaging and artificial intelligence, when available, be used to improve the precision of endoscopic diagnosis to reduce the risk of missed lesions and need for unnecessary biopsies. 13. APAGE recommends against the routine use of single‐use endoscopes.Conclusion: The position statements provide guidance to healthcare practitioners on clinical practices in gastroenterology, hepatology, and endoscopy that promote climate sustainability.

Biliary drainage in pancreatic cancer with duodenal invasion: which route is the best?

Objectives: Choledocholithiasis is the leading cause of biliary pancreatitis and biliary sepsis. Endoscopic retrograde cholangiopancreatography (ERCP) is considered a minimally invasive treatment for choledocholithiasis. However, diagnostic ERCP should be avoided. We conducted a prospective trial in high‐risk choledocholithiasis patients based on the American Society for Gastrointestinal Endoscopy (ASGE) 2019 criteria to investigate the diagnostic accuracy of the current guideline.Methods: This multicenter, prospective cohort study included 240 consecutive patients. The primary outcome was the performance of the criteria in predicting choledocholithiasis. The secondary outcome was a percentage reduction in diagnostic ERCP when endoscopic ultrasound was used in tandem with ERCP in individuals without ascending cholangitis.Results: The overall criteria revealed a positive common bile duct (CBD) stone in 87.1% of patients. Regarding the diagnostic performance of each criterion, ascending cholangitis had a specificity of 67.7% and a positive predictive value (PPV) of 90.2%; total bilirubin >4 mg/dL and dilated CBD had a specificity of 74.2% and a PPV of 55.6%; and CBD stone on ultrasound/cross‐sectional imaging had a specificity of 58.1% and a PPV of 89.2%. Of the 138 patients without ascending cholangitis who met the other two high‐risk criteria and were sent for EUS first, 21 cases (15.2%) were able to avoid a diagnostic ERCP.Conclusions: The current ASGE 2019 criteria yield acceptable choledocholithiasis diagnostic accuracy. Using endoscopic ultrasound to confirm CBD stones before ERCP can help almost half of patients with the specific condition of total bilirubin >4 mg/dL and dilated CBD to avoid diagnostic ERCP.

Background and study aims The Varix Trainer model 1 (VTM1) was created for trainees to safely practice basic endoscope manipulation skills. The VTM1 was tested to see if it could distinguish levels of endoscope manipulation skills (construct validity) and whether training with it could improve these skills faster (content validity). Patients and methods We enrolled 23 novice endoscopists, 18 second-year trainees, and 13 expert endoscopists. They were asked to point with the endoscope tip to 20 numbers in the model as quickly as possible using torque, single-hand small/large wheel manipulation (SHSW), and retroflexion techniques. Their mean times (t20) were compared to determine if the model could distinguish different levels of expertise. Subsequently, 14 novices trained for eight short sessions, and the pre-training and post-training t20 were compared. Nine novice endoscopists received no training and were retested after 4 to 6 weeks (controls). Results Experts had faster t20 than second-year trainees, who were faster than novices, for all three techniques (P < 0.001). After eight sessions, the mean t20 for novices improved from 112 to 66 seconds for torque, 144 to 72 seconds for SHSW, and 108 to 63 seconds for retroflexion, (all P < 0.001). Their t20 were equivalent to second-year trainees. Improvement in t20 was also seen with the control group, but total reduction was less than for the training group. Conclusions The VTM1 distinguished varying levels of expertise for all techniques, suggesting that it is a valid tool for assessing endoscope manipulation skill. A short curriculum improved novices’ manipulation skills faster than traditional practice.