Digestive Endoscopy最新文献

{"title":"WEO Newsletter: Travel Report: The Maghreb","authors":"Purnima Bhat","doi":"10.1111/den.70020","DOIUrl":"https://doi.org/10.1111/den.70020","url":null,"abstract":"<p>WEO have successfully launched training centres throughout Sub-Saharan Africa, mostly in English-speaking countries. In 2023, a visit to Senegal resulted in establishment of our first francophone centre and highlighted the need for training in this region. Regional endoscopy training in Africa has been provided by groups from Egypt and South Africa, providing a model for continent-based training that are both socially and environmentally sustainable. With the aim of investigating both the need for training and the capabilities for provision of training in North Africa, we evaluated current state of endoscopy in the Maghreb: Morocco, Algeria, Tunis.</p><p>Morocco is a Mediterranean kingdom in north-west Africa, that gained its independence from the French in 1956. While the political capital is Rabat, the economic capital is the coastal city of Casablanca. The most populated city of Morocco, Casablanca is home to 3.2 million people.</p><p>There are several hundred endoscopists in Morocco, who offer standard diagnostic and therapeutic endoscopy, with ERCP available in most public hospitals and EUS in some. To increase health and sciences education and healthcare services in the country, Mohammed VI Foundation for sciences and health was created by the king. It is a non-profit semi-public foundation managing universities in Casablanca, Rabat and Dakhla and multiple healthcare facilities. The Foundation has a strong orientation toward collaboration with African countries.</p><p>Bordering Morocco to the east, Algeria is a modern country with an increasingly relaxed border policy that reflects its growing peaceful development. It took a little work to get an entry visa and a couple of hours in immigration to enter the country, but it was worth it. The initial connection came from Dr. Mohammed Omar, Chair of the WEO Middle East Committee who knew Dr. Imad Bougedouma. Just to prove that the world is a tiny place, I discovered over coffee that Imad had spent a week in Oslo for training and is known to Prof Aabakken, President of WEO, who has an Algerian sand painting in his office as proof.</p><p>An ex-colony of France, Algeria won its independence after a long and bloody war in 1962, but plunged into a decade-long destructive civil war until 2002. The last twenty-three years of peace has resulted in increasing social development including universal health care, universal education and a rapidly developing middle class.</p><p>GI training in Algeria is confined to the public hospital system alone and starts immediately after internship, continuing for four years with the final year focussed on endoscopy. There are three training public hospitals in Algiers, and only a few key hospitals around the country additionally. With the largest land mass of any country in Africa, Algeria has a significant shortage of proceduralists compounded by distance. For new skills acquisition, a shortage of trainers and centres is apparent. The medical system is two-tiered ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 9","pages":"1019-1023"},"PeriodicalIF":4.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WEO Newsletter: The Impact of Artificial Intelligence on Management of Inflammatory Bowel Disease: An Expert Commentary","authors":"","doi":"10.1111/den.15072","DOIUrl":"https://doi.org/10.1111/den.15072","url":null,"abstract":"&lt;p&gt;By Nayantara Coelho-Prabhu, MD FACG AGAF FASGE, Mayo Clinic Rochester&lt;/p&gt;&lt;p&gt;The complexity of IBD, including both Crohn's disease (CD) and ulcerative colitis (UC), lies in its heterogeneity in presentation, unpredictable disease course, and varying responses to therapy. Current approaches rely on a combination of clinical indices, imaging, endoscopy, histology, and biomarkers—many of which are subjective and variably interpreted. This subjectivity results in difficulties with establishing standards of care, and often is the root cause of complications. Also, there is an increasing focus on achieving healing in IBD across all aspects of the disease including clinical, radiologic, endoscopic and histologic (STRIDE-II). To achieve this, we must establish standardization across these targets. These challenges present a fertile ground for AI applications aimed at improving accuracy, efficiency, and personalization in IBD management.&lt;/p&gt;&lt;p&gt;Endoscopic assessment remains central to IBD diagnosis and monitoring. However, the qualitative nature of inflammation scoring and interobserver variability in all scoring systems such as the Mayo Endoscopic Score or SES-CD has long plagued clinical and research settings. This has been the impetus to develop automated scoring systems that aim to standardize these scores. The first iteration of these models used still images to train convoluted neural networks (CNNs) and then reported on their successful scoring of test data still images. These systems utilized expert scoring as the gold standard, and they were found to have excellent performance in distinguishing Mayo 0-1 from Mayo 2-3 scores, similar to human experts. The next step was that CNNs were trained to read video segments, obtained from pharmaceutical randomized trials that had captured video segments, scored by central readers. Because the earlier systems were compared to human gold standard, which has low interoperator agreement, the next step in this evolution was to consider disease outcome as a measure of validity. Again, clinical trial videos were used and the CNNs were trained to report a cumulative disease score that was correlated with outcomes with more meaningful results. The goal is to be able to predict responders from non-responders. AI can detect subtle visual features on endoscopy, which can be harnessed to make histologic inference without the need for biopsy. Such predictive CNNs have been developed using white light images as well as enhanced imaging techniques including endocytoscopy, narrow band imaging (vascular patterns) and I-scan. These can predict relapse rates based on real-time endoscope imaging with great accuracy. In capsule enteroscopy, AI has been developed to accurately identify and quantify small bowel ulcerations, and significantly reduce capsule reading time, for both trainees and experts. These recent AI-driven computer vision tools have demonstrated the ability to automatically segment mucosal features, detect ulcera","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 7","pages":"807-809"},"PeriodicalIF":5.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144598393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Size matters: Establishing a cut-off for rectal neuroendocrine neoplasm to predict recurrence and standardize surveillance guidelines","authors":"Seijong Kim,&nbsp;Eun Ran Kim,&nbsp;Sung Noh Hong,&nbsp;Dong Kyung Chang,&nbsp;Young-Ho Kim,&nbsp;Jung Kyong Shin,&nbsp;Yoonah Park,&nbsp;Jung Wook Huh,&nbsp;Hee Cheol Kim,&nbsp;Seong Hyeon Yun,&nbsp;Woo Yong Lee,&nbsp;Yong Beom Cho","doi":"10.1111/den.15056","DOIUrl":"10.1111/den.15056","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to identify risk factors for recurrence of rectal neuroendocrine neoplasms, establish a cut-off size for recurrence prediction, and standardize surveillance guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study analyzed patients diagnosed with rectal neuroendocrine neoplasm at Samsung Medical Center from January 2007 to July 2021. Tumors were classified according to World Health Organization and European Neuroendocrine Tumor Society guidelines. The primary outcome was to determine the ideal cut-off size for predicting recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1011 patients (median follow-up: 58 months) were included: 967 with grade (G) I neuroendocrine tumor (NET), 35 with GII NET, and 9 with neuroendocrine carcinoma. Disease-free and overall survival were significantly better in GI NET than in GII and neuroendocrine carcinoma. For NET G1 patients undergoing endoscopic resection, a 0.7 cm cut-off (area under the curve = 0.94) showed 100% sensitivity, 79% specificity, and no recurrence. In contrast, for lymphovascular invasion (LVI)-positive, lymph node–negative NET G1 patients undergoing transanal endoscopic microsurgery/transanal excision or radical resection, an optimal cut-off of 1.5 cm (area under the curve = 0.92) was identified. NET G2 had a 22.9% lymph node metastasis rate, with recurrence risk increasing with size.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>For NET G1 tumors ≤0.7 cm without LVI following endoscopic resection, routine surveillance may not be necessary due to the minimal risk of recurrence. Similarly, for LVI-positive, lymph node–negative NET G1 tumors that underwent surgical resection, surveillance may not be required if the tumor is ≤1.5 cm. Additionally, NET G2 tumors require regular follow-up regardless of size to ensure favorable oncologic outcomes. These findings contribute to a risk-based approach for surveillance, optimizing follow-up strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 9","pages":"962-971"},"PeriodicalIF":4.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fully-covered metal stent for perihilar biliary strictures after liver transplantation: Highly effective but not a panacea","authors":"Tatsuya Sato,&nbsp;Naminatsu Takahara,&nbsp;Mitsuhiro Fujishiro","doi":"10.1111/den.15054","DOIUrl":"10.1111/den.15054","url":null,"abstract":"&lt;p&gt;In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Park &lt;i&gt;et al&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; reported the long-term outcomes of a fully-covered self-expandable metal stent (FCSEMS) for refractory anastomotic biliary strictures following liver transplantation (LT) compared with plastic stent (PS) treatment. Notably, living-donor LT (LDLT) patients constitute 70–80% of the study cohort, with strictures located in the common hepatic duct or hilum in 75% of cases. The stricture resolution rate was comparable between the two groups (FCSEMS: 96.7% vs. PS: 94.4%, &lt;i&gt;P&lt;/i&gt; = 0.709); however, stricture recurrence was significantly less frequent in the FCSEMS group (17.2% vs. 47.1%, &lt;i&gt;P&lt;/i&gt; = 0.036), with a shorter treatment duration (3.1 months vs. 7.6 months, &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Therefore, the authors emphasized that FCSEMS can be a promising option for post-LT biliary strictures.&lt;/p&gt;&lt;p&gt;Among various etiologies of benign biliary strictures, post-LT biliary anastomotic strictures remain one of the most challenging conditions to manage endoscopically. The difficulties stem from tight and tortuous fibrotic strictures, complex anastomoses, and the immunocompromised status of patients. When treating post-LT patients, endoscopists must consider the type of LT – deceased-donor LT (DDLT), or LDLT – as the anastomosis site differs between DDLT and LDLT. In DDLT, the recipient's common bile duct (CBD) is anastomosed to the donor's CBD, whereas in LDLT, the anastomosis is located at the level of the hepatic ducts or more proximal bile ducts. These anatomical features complicate the endoscopic treatment, especially in LDLT cases, due to the smaller anastomotic diameter and the bile duct bifurcation being closer to the anastomosis site. Given these differences, treatment strategies should be tailored for post-DDLT and post-LDLTbiliary strictures.&lt;/p&gt;&lt;p&gt;Since the introduction of FCSEMS for benign biliary strictures, post-DDLT strictures have been considered suitable indications for FCSEMS placement. In the early 2010s, several randomized controlled trials conducted in Western countries – where DDLT is the predominant LT type – demonstrated that FCSEMS achieved comparable stricture resolution rates with fewer endoscopic retrograde cholangiopancreatography sessions than PS.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; This strategy is relatively simple and technically feasible; thus, FCSEMS has become a new standard treatment. In contrast, post-LDLT perihilar strictures are still primarily managed with “traditional” multiple plastic stents. It remains technically challenging due to the anatomical complexity, and sometimes not effective enough, for stricture resolution. Reports from Eastern Asia, particularly South Korea and Japan, where LDLT comprises ~80–90% of LT cases, highlighted the need for more effective treatment options for this population.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In the current study, the authors provide new insights into the management of perihilar benign biliary ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 9","pages":"948-949"},"PeriodicalIF":4.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the ideal shape of a self-expandable metal stent with no migration or obstruction?","authors":"Masaki Kuwatani","doi":"10.1111/den.15058","DOIUrl":"10.1111/den.15058","url":null,"abstract":"&lt;p&gt;An ideal biliary stent is one that is permanently patent and physically gentle on the bile duct wall. To achieve this, many endoscopists and company researchers have been making efforts, achieving various ingenuities and concepts. Stent patency is primarily damaged by food impaction, sludge formation in the stent, tumor ingrowth/overgrowth, and stent dislocation/migration. Many measures have been applied to overcome these issues, including stenting above the papilla (inside stent), use of a mechanistic valve to prevent duodenal juice/food reflex, use of special materials such as polytetrafluoroethylene and silicon coating for inner smoothing, application of a membrane that covers a metal stent to prevent ingrowth, flared or tapered structure of a metal stent end, and use of multihole membrane covering a metal stent to prevent migration.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Biliary stents are first divided into “plastic” and “metal” stents. According to several meta-analyses of stent patency in malignant distal biliary obstruction, metal stents are superior to plastic stents; however, they are more commonly associated with postendoscopic retrograde cholangiopancreatography pancreatitis, an important postoperative complication, due to the large diameter. Metal stents are also classified as covered (CSEMS) and uncovered self-expandable metal stents (USEMS). Each type of metal stent has both advantages and disadvantages: the former tends to dislocate/migrate due to covered surface smoothness preventing tumor ingrowth, whereas the latter tends to be occluded by tumor ingrowth through the mesh gap preventing migration. Although the patencies of CSEMS and USEMS are controversial, the drawbacks of both stents as described should be addressed. CSEMS can be further subclassified into fully covered SEMS (FCSEMS) and partially covered SEMS (PCSEMS); the former was developed later to overcome the drawbacks of PCSEMS, such as tumor ingrowth/overgrowth and difficult removability. Although PCSEMS are generally considered best choice due to the issues associated with FCSEMS and USEMS, in their current form, PCSEMS still have issues, despite its longer patency than FCSEMS, as indicated in a recent meta-analysis (369 days vs. 238 days, d-value = 0.116).&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Several countermeasures have been tested to prevent dislocation/migration of CSEMS. First, the flared structure of both ends of CSEMS showed no stent migration, lower tumor ingrowth, and a longer patency than USEMS with the same flared ends.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; However, the rates of tumor overgrowth and sludge formation, both of which were significant issues, did not significantly differ between the two SEMS groups. Second, CSEMS with a tapered-and-flared structure in the distal end showed no dislocation/migration and sustained biliary decompression with no stent trouble until pancreatoduodenectomy.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; However, long-term outcomes of this novel stent are unclear ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 9","pages":"950-951"},"PeriodicalIF":4.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How often does a mixed type intraductal papillary mucinous neoplasm on imaging indicate pathological involvement of the main pancreatic duct?","authors":"Kosuke Takahashi,&nbsp;Ichiro Yasuda,&nbsp;Toshiki Entani,&nbsp;Iori Motoo,&nbsp;Nobuhiko Hayashi,&nbsp;Takayuki Ando,&nbsp;Haruka Fujinami,&nbsp;Kazuto Tajiri,&nbsp;Johji Imura,&nbsp;Kenichi Hirabayashi,&nbsp;Eisuke Ozawa,&nbsp;Hisamitsu Miyaaki,&nbsp;Kazuhiko Nakao","doi":"10.1111/den.15051","DOIUrl":"10.1111/den.15051","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>A pancreatic cyst &gt;5 mm in diameter that communicates with the dilated main pancreatic duct (MPD) ≥5 mm on imaging is defined as mixed type intraductal papillary mucinous neoplasm (MX-IPMN). However, the frequency of tumor involvement of the MPD in MX-IPMN remains unknown. This study investigated how often MX-IPMNs involve the MPD and whether MPD involvement can be diagnosed by peroral pancreatoscopy (POPS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included patients who underwent POPS for MX-IPMN followed by surgical resection between July 2018 and December 2021. The pathological features of MX-IPMN, including tumor extension to the MPD, were analyzed. Additionally, the diagnostic performance of various imaging modalities in detecting tumor extension to the MPD was evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among a total of 15 patients, 10 (67%) had pathologically confirmed tumor extension to the MPD. In most cases with pathologically confirmed MPD involvement, the main tumor was diagnosed as high-grade dysplasia (60%) or invasive carcinoma (10%). Conversely, low-grade dysplasia was the main lesion in most cases without MPD involvement (low-grade dysplasia 80%; high-grade dysplasia 20%, invasive carcinoma 0%). The diagnostic accuracy, sensitivity, and specificity of POPS with or without biopsy was 93.3%, 90.0%, and 100%, respectively. POPS demonstrated higher accuracy and sensitivity than computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasonography (accuracy: 93.3%, 40%, 60%, and 80%; sensitivity: 93.3%, 10%, 40%, and 70%, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Overall, 67% of MX-IPMNs had pathologically proven MPD involvement. Tumor extension to the MPD is highly suspicious of malignancy, and POPS may be useful for evaluating MPD involvement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 9","pages":"972-980"},"PeriodicalIF":4.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of endoscopic papillectomy should be evaluated not only based on short-term results but also long-term prognosis","authors":"Hiroki Kawashima","doi":"10.1111/den.15044","DOIUrl":"10.1111/den.15044","url":null,"abstract":"&lt;p&gt;Endoscopic papillectomy (EP) for ampullary tumors has become a widely performed treatment as the number of accumulated cases has increased across multiple institutions.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; However, due to the anatomical characteristics where both the bile duct and pancreatic duct open, pathological assessment of resected specimens remains challenging, making the evaluation of treatment outcomes difficult. In other gastrointestinal tumors, margin assessment can be conducted based on horizontal and vertical directions alone, whereas in ampullary tumors, margin evaluation in the direction of the bile duct and pancreatic duct is also necessary. Additionally, the generally small size of resected specimens further limits the pathological margin assessment following EP. This contributes to the broad range of reported R0 rates, varying significantly from 47% to 93% in previous reports.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Guidelines for EP have been established in the United States, Europe, and Japan. Of the three guidelines, those of the European Society of Gastrointestinal Endoscopy&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; and the Japanese&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; state that ampullary adenomas without intraductal extension are ideal indications for EP.&lt;/p&gt;&lt;p&gt;Binda &lt;i&gt;et al&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; and The Interventional Endoscopy and Ultrasound group conducted a retrospective study on 430 EP cases to establish a scoring system predicting cases at high risk for incomplete resection (IR) based on preoperative factors. IR was defined as cases where lateral or endoampullary margins were affected by residual tumor post-EP, meaning they were not diagnosed as R0 pathologically. Despite including many cases considered high risk for IR, such as 60 cases (14.0%) of T1 or higher adenocarcinoma, 68 cases (15.8%) of intraductal extension (IDE) smaller than 20 mm, and 83 cases (19.3%) of laterally spreading tumors (LST) larger than 10 mm, the reported IR rate was relatively favorable at 23.6% (99 cases) compared to previous reports. This study introduced the PANETH score, with a common bile duct dilatation (CBD) diameter of 8 mm or more without cholecystectomy or 10 mm or more after cholecystectomy as 1 point, and the presence of IDE and LST as 2 points each, for a total of 3 points or more as significant risk factors for IR. Although adenocarcinoma itself was presumed to be a significant risk factor for IR, it was not included in the multivariate analysis to avoid confounding with the CBD factor. In our experience as well, cases with CBD or elevated biliary enzymes often result in final pathological diagnoses of adenocarcinoma, supporting the validity of this assessment.&lt;/p&gt;&lt;p&gt;In this study, 95 patients required additional surgery or were in a condition necessitating surgery. Additionally, 132 patients experienced recurrence. While there may be some overlap between these groups, the total number exceeds the reported 99 IR cases. This suggests that some cases deemed R0 still requi","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 9","pages":"952-954"},"PeriodicalIF":4.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serious adverse events associated with bowel preparation for colonoscopy in Japan: Systematic review","authors":"Toshihiro Tadano,&nbsp;Koichiro Abe,&nbsp;Seiju Sasaki,&nbsp;Teruhiko Terasawa,&nbsp;Satoyo Hosono,&nbsp;Takafumi Katayama,&nbsp;Keika Hoshi,&nbsp;Tomio Nakayama,&nbsp;Chisato Hamashima","doi":"10.1111/den.15055","DOIUrl":"10.1111/den.15055","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Bowel preparation for colonoscopy can lead to serious adverse events (AEs), raising significant safety concerns in colorectal cancer (CRC) screening. A systematic review of these serious AEs in Japan was performed to explore potential management strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Ovid-MEDLINE and Ichushi databases were searched from inception to March 2024. Domestic studies that reported serious AEs in adults aged 18 years and older who were administered bowel cleansing agents or laxatives for a scheduled colonoscopy, regardless of its purpose, were extracted. Serious AEs were defined as those requiring hospitalization or extended hospital stays. Selected studies were assessed for quality verification using the established checklist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 5049 articles were identified through database searches, and 54 articles were extracted based on selection criteria. Reports of the frequency of serious AEs were based on one case series study, which found 13.9 cases of bowel obstruction and 2.3 cases of bowel perforation per 100,000 colonoscopies. Multiple serious AEs caused by different agents were identified in 78 cases across 54 articles. These AEs were predominantly observed in elderly individuals and those with comorbidities. Though most cases were associated with diagnostic tests for symptomatic patients, some were also observed in primary screening or fecal test-positive individuals. The most common AE was induced by bowel obstruction, primarily in abdominally symptomatic patients, including one fatality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The frequency and characteristics of serious AEs associated with bowel preparation for colonoscopy in Japan were presented. These findings may contribute to managing these AEs, specifically in CRC screening.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 9","pages":"905-918"},"PeriodicalIF":4.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trans-anorectal curved linear-array endoscopic ultrasound: Comprehensive pictorial guide (with videos)","authors":"Vikram Bhatia,&nbsp;Rajan Vijayaraghavan,&nbsp;Ananthu Narayan,&nbsp;Suguna Sree Aakula","doi":"10.1111/den.15057","DOIUrl":"10.1111/den.15057","url":null,"abstract":"<p>Interest in using flexible endoscopic ultrasound (EUS) probes for transrectal applications is growing, including tissue sampling and therapeutic procedures. In this review, we describe of the techniques and anatomical considerations for trans-anorectal ultrasound using a flexible, curved linear array EUS probe (CLA-EUS). Orientation with flexible CLA-EUS in the ano-rectum can be challenging; bony structures should be used as the posterior reference and pelvic organs as the anterior reference structures. Key landmarks, including aortic division, iliac vessels and their divisions, and peritoneal reflections and recesses are described. These vascular and anatomical landmarks are essential for N and M staging of rectal cancers. The anatomy and zonal structure of the prostate, along with the appearance of seminal vesicles, ejaculatory ducts, bladder, ureters, uterus, cervix, and ovaries on CLA-EUS, are detailed. Finally, we describe the anatomy and imaging of the anal canal and pelvic floor muscles, emphasizing differences between CLA-EUS and radial EUS imaging techniques.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 9","pages":"919-932"},"PeriodicalIF":4.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grasp-and-lift technique – Novel cold forceps polypectomy technique for a gastric foveolar-type adenoma","authors":"Nobuyuki Suzuki,&nbsp;Hiroya Ueyama,&nbsp;Akihito Nagahara","doi":"10.1111/den.15059","DOIUrl":"10.1111/den.15059","url":null,"abstract":"<p>Endoscopic resection is the treatment of choice for gastric foveolar-type adenomas with a raspberry-like appearance (GFA-R) that are small lesions with a low-grade malignancy potential.<span>^{1, 2}</span> However, an endoscopic treatment strategy for GFA-Rs has not been established, and resection methods vary among endoscopists.<span>^{1, 3, 4}</span> Cold forceps polypectomy (CFP) is a suitable method for resecting small lesions and carries a lower risk compared to endoscopic mucosal resection/endoscopic submucosal dissection (EMR/ESD); however, the en bloc resection rate falls drastically for larger lesions and reaches rates as low as 70% for lesions sized 5 mm.<span>⁵</span> Therefore, a low-risk en bloc resection method is desirable. Here, we describe a “grasp-and-lift technique” as a novel method for GFA-R en bloc resection using CFP. A 34-year-old man underwent endoscopic resection of a 6 mm GFA-R located at the greater curvature of the middle third of the stomach (Fig. 1a). Using large forceps (Radial Jaw 4 Jumbo, Boston Scientific), we grasped the base of the lesion along with the background mucosa while suctioning air (Fig. 1b,c). The lesion was removed carefully by lifting it toward the contralateral wall (Fig. 1d) and retrieving it along with the endoscope without pulling the lesion through the forceps channel to avoid damage (Fig. 1e). Evaluation of the mucosal defect revealed no residual tumor (Fig. 1f), and the pathological examination confirmed curative resection (Fig. 2). Here, we present the grasp-and-lift technique, a novel method in which a 6 mm GFA-R was successfully resected using CFP. This method can potentially remove lesions with a base smaller than the length of the forceps. Compared to traditional CFP techniques, this technique may offer higher en bloc resection rates. Furthermore, it is less time-consuming, more economical, and has a lower risk than EMR/ESD (Video S1).</p><p>Authors declare no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Reviewer Board: This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Juntendo University School of Medicine (approval number: H19-0050).</p><p>Informed Consent: All patients had given their informed consent before treatment for this study.</p><p>Registry and the Registration No. of the study/trial: N/A.</p><p>Animal Studies: N/A.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 9","pages":"1011-1013"},"PeriodicalIF":4.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}