Clinical Endoscopy最新文献

{"title":"Endoscopic retrograde cholangiopancreatography versus endoscopic ultrasound-guided primary biliary drainage for malignant distal biliary obstruction: a review.","authors":"Shawn Chun Sum Teoh, Anthony Yuen Bun Teoh","doi":"10.5946/ce.2026.122","DOIUrl":"10.5946/ce.2026.122","url":null,"abstract":"<p><p>Approximately 70% of pancreatic cancers arising in the head of the pancreas cause malignant distal biliary obstruction. Therefore, biliary drainage is an important aspect of the management of these patients. Conventionally, the technique for relieving biliary obstruction has been endoscopic retrograde cholangiopancreatography (ERCP). When ERCP cannot provide biliary drainage, such as in cases of failed cannulation, duodenal obstruction, or altered anatomy (e.g., after gastric bypass), endoscopic ultrasound-guided biliary drainage (EUS-BD) has been recommended by the American Society for Gastrointestinal Endoscopy as the preferred technique over percutaneous transhepatic biliary drainage for relieving biliary obstruction. Recently, EUS-BD has been explored as the primary technique for relieving biliary obstruction. The proposed benefits include higher technical success, shorter procedural time, a lower risk of pancreatitis, and longer stent patency. However, the results of randomized controlled studies have been conflicting. Hence, the aim of this article is to review the evidence from randomized controlled trials comparing EUS-BD with ERCP as the primary method of biliary drainage for malignant distal biliary obstruction.</p>","PeriodicalId":10351,"journal":{"name":"Clinical Endoscopy","volume":" ","pages":"726-731"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic ultrasound-guided cyanoacrylate injection for jejunal varices at the hepaticojejunostomy site using a forward-viewing echoendoscope.","authors":"Kosuke Okuwaki, Masafumi Watanabe, Shuichiro Iwasaki, Nobuyuki Nishizawa, Akihiro Tamaki, Chika Kusano","doi":"10.5946/ce.2025.333","DOIUrl":"10.5946/ce.2025.333","url":null,"abstract":"","PeriodicalId":10351,"journal":{"name":"Clinical Endoscopy","volume":" ","pages":"857-858"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and diagnostic performance of heparinized wetsuction and single-pass single-needle actuation endoscopic ultrasound-guided tissue acquisition for subepithelial lesions in Japan: a single-center retrospective study.","authors":"Kotaro Takeshita, Satoshi Asai, Kenji Matsuo, Takumi Sugihara, Kensei Kawasaki, Aoi Koizumi, Sayuri Hashimoto, Kaho Takagi, Yoshihiro Shima, Tomoya Hashimura, Kento Hisamatsu, Yuma Fujita, Yuichiro Hamamoto, Shuta Otachi, Yuki Kano, Eisuke Nakao, Eisuke Akamine, Yoshinobu Hirose","doi":"10.5946/ce.2025.354","DOIUrl":"10.5946/ce.2025.354","url":null,"abstract":"<p><strong>Background: </strong>Heparinized wet suction (HEP) and the single-pass single-needle actuation method (HEP1p1a) are promising for endoscopic ultrasound-guided tissue acquisition (EUS-TA) because they improve specimen quality. However, its applicability in the biopsy of subepithelial lesions (SELs) remains unexamined. Therefore, this study evaluated the clinical utility of EUS-TA using HEP1p1a in SELs.</p><p><strong>Methods: </strong>This study analyzed data of patients who underwent EUS-TA using HEP1p1a between January 2019 and May 2025. The primary outcome was pathological differentiation. Furthermore, clinical data of EUS-TA using HEP1p1a were compared with those using HEP and other than 1p1a; subgroup analysis was performed comparing the clinical outcomes between SELs ≥20 and <20 mm.</p><p><strong>Results: </strong>Thirty-six patients underwent EUS-TA using HEP1p1a (technical success rate: 100%): 24 and 12 patients with lesions ≥20 and <20 mm, respectively. The rates of achieving pathological differentiation, immunohistochemical success, and definitive histologic diagnosis were 94.4%, 89.3%, and 86.1%, respectively; for SELs ≥20 mm, they were 100%, 94.7%, and 95.8%, respectively. Cellularity and maximum length of white sequential specimens were better in patients with lesions ≥20 mm. No adverse events were observed during or after the procedures.</p><p><strong>Conclusions: </strong>High diagnostic performance and specimen quality were demonstrated with EUS-TA using HEP1p1a for SELs, particularly those >20 mm. To acquire high-quality specimens while minimizing blood contamination, EUS-TA with HEP1pla for SELs might be an effective approach.</p>","PeriodicalId":10351,"journal":{"name":"Clinical Endoscopy","volume":" ","pages":"776-786"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in upper gastrointestinal endoscopy: what detection rates cannot tell us.","authors":"Joon Sung Kim","doi":"10.5946/ce.2026.328","DOIUrl":"10.5946/ce.2026.328","url":null,"abstract":"","PeriodicalId":10351,"journal":{"name":"Clinical Endoscopy","volume":" ","pages":"872-873"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare complication of plastic endoscopic retrograde biliary drainage stent placement: bile duct perforation.","authors":"Akinobu Koiwai, Morihisa Hirota, Yuki Miyashita, Nana Inomata, Kennichi Satoh","doi":"10.5946/ce.2025.400","DOIUrl":"10.5946/ce.2025.400","url":null,"abstract":"","PeriodicalId":10351,"journal":{"name":"Clinical Endoscopy","volume":" ","pages":"853-854"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative endoscopic biliary drainage for malignant hilar biliary obstruction.","authors":"Shuji Mitsuhashi, Manik Aggarwal, Vinay Chandrasekhara","doi":"10.5946/ce.2025.395","DOIUrl":"10.5946/ce.2025.395","url":null,"abstract":"<p><p>Malignant hilar biliary obstruction (MHBO) is most commonly caused by cholangiocarcinoma or gallbladder cancer and frequently presents with obstructive jaundice, pruritus, and/or cholangitis. These symptoms impair performance status and delay the initiation of chemotherapy, making biliary drainage essential for both palliation and oncologic treatment. Endoscopic transpapillary biliary stenting via endoscopic retrograde cholangiopancreatography is the standard approach for biliary decompression. In patients with unresectable disease, either plastic or self-expandable metal stents may be used. Optimal outcomes are achieved when drainage encompasses more than 50% of functional liver volume, while atrophic segments should be avoided. When transpapillary access is not feasible or unsuccessful, alternative approaches such as percutaneous transhepatic biliary drainage or endoscopic ultrasound-guided biliary drainage may be considered. Adjunctive therapies, including photodynamic therapy and radiofrequency ablation, are being investigated to enhance local tumor control and prolong stent patency. With continued advances in stent technology, imaging modalities, and endoscopic techniques, the management of MHBO is expected to become increasingly individualized and effective.</p>","PeriodicalId":10351,"journal":{"name":"Clinical Endoscopy","volume":" ","pages":"703-715"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A double-edged sword in the very elderly: to screen or not to screen with colonoscopy?","authors":"Jaeyoung Chun","doi":"10.5946/ce.2026.428","DOIUrl":"10.5946/ce.2026.428","url":null,"abstract":"","PeriodicalId":10351,"journal":{"name":"Clinical Endoscopy","volume":"59 5","pages":"774-775"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced endoscopy and artificial intelligence-enabled vascular healing for ulcerative colitis: promising frontiers or mere mirage?","authors":"Yasuharu Maeda, Shin-Ei Kudo, Takanori Kuroki, Yurie Kawabata, Jun Ohara, Katsuro Ichimasa, Noriyuki Ogata, Kazuo Ohtsuka, Masashi Misawa","doi":"10.5946/ce.2025.186","DOIUrl":"10.5946/ce.2025.186","url":null,"abstract":"<p><p>Ulcerative colitis, a chronic inflammatory bowel disease, is characterized by subtle microvascular alterations that play a critical role in disease perpetuation and mucosal injury. Recent advances in image-enhanced endoscopy and ultrahigh-magnification endoscopy have improved the real-time visualization of these vascular changes while highlighting their diagnostic value. Artificial intelligence (AI)-enabled endoscopic systems provide automated, reproducible vascular assessments. Emerging data suggest that AI-based vascular healing correlates with clinical remission and may alter histological scores, enabling the prediction of sustained remission. Despite these promising advances, challenges remain, such as standardizing vascular healing definitions, addressing interobserver variability, and validating AI-driven platforms in real-world settings. Integrating microvascular-targeted therapies and advanced imaging has the potential to transform the management of ulcerative colitis, facilitating sustained remission and improving the quality of life. This review examined the evolving role of microvascular assessment in ulcerative colitis, the potential of AI in refining endoscopic evaluation, and the prospects of incorporating vascular healing as a therapeutic target.</p>","PeriodicalId":10351,"journal":{"name":"Clinical Endoscopy","volume":" ","pages":"689-702"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior versus posterior peroral endoscopic myotomy: a prospective randomized controlled trial from a Thai tertiary center.","authors":"Tharathorn Suwatthanarak, Siwaree Maneesoi, Chatbadin Thongchuam, Thawatchai Akaraviputh, Vitoon Chinswangwatanakul, Somchai Leelakusolvong, Chainarong Phalanusitthepa","doi":"10.5946/ce.2025.407","DOIUrl":"10.5946/ce.2025.407","url":null,"abstract":"<p><strong>Background: </strong>Achalasia is an esophageal motility disorder. Peroral endoscopic myotomy is widely used for all subtypes; however, randomized head-to-head evidence comparing the anterior and posterior approaches remains limited. We compared efficacy, safety, and reflux outcomes.</p><p><strong>Methods: </strong>We conducted a single-center, single-blind, prospective randomized controlled trial from February 2023 to August 2024. Twenty-eight patients with achalasia types I-III were randomized to anterior or posterior peroral endoscopic myotomy. The primary outcomes were esophageal acid exposure at 3 months (24-hour pH monitoring) and clinical success (Eckardt score ≤3). The secondary outcomes were procedural parameters, complications, timed barium esophagography, manometry, and reflux esophagitis.</p><p><strong>Results: </strong>Baseline characteristics were comparable between the groups. Procedural metrics and complication rates were similar and mild, with no severe adverse events. At 12 months, both groups showed significant symptom relief, reduced Eckardt scores, and decreased lower esophageal sphincter pressure. Posterior myotomy yielded a higher proportion of abnormal DeMeester scores (57.1% vs. 28.6%, p=0.14), although reflux esophagitis remained mild and comparable between the groups.</p><p><strong>Conclusions: </strong>Posterior peroral endoscopic myotomy demonstrated comparable efficacy, safety, and reflux outcomes. The anterior approach improved clearance on timed barium esophagography; however, both approaches achieved durable symptom control with acceptable safety profiles, supporting posterior myotomy as a valid alternative.</p>","PeriodicalId":10351,"journal":{"name":"Clinical Endoscopy","volume":" ","pages":"787-796"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstructive jaundice caused by a giant common hepatic artery aneurysm.","authors":"Akinobu Koiwai, Morihisa Hirota, Yuki Miyashita, Nana Inomata, Kennichi Satoh","doi":"10.5946/ce.2025.306","DOIUrl":"10.5946/ce.2025.306","url":null,"abstract":"","PeriodicalId":10351,"journal":{"name":"Clinical Endoscopy","volume":" ","pages":"851-852"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}