Digestive Endoscopy最新文献

{"title":"Not All Endoscopic Submucosal Dissections Are Created Equal: Rethinking Bleeding Risk Stratification During Antiplatelet Therapy","authors":"Antonio Capogreco, Francesco Minini","doi":"10.1111/den.70311","DOIUrl":"10.1111/den.70311","url":null,"abstract":"<p>Endoscopic submucosal dissection (ESD) has revolutionized the management of superficial gastrointestinal neoplasia by providing organ-preserving treatment with excellent oncological outcomes. At the same time, the aging of the population and the increasing prevalence of cardiovascular disease have led to a growing number of patients undergoing ESD while receiving antiplatelet therapy. Consequently, endoscopists are increasingly confronted with one of the most challenging aspects of therapeutic endoscopy: balancing the risk of post-procedural bleeding against the potentially serious consequences of thromboembolic events.</p><p>Current international guidelines provide an invaluable framework by classifying ESD among high-risk endoscopic procedures and recommending peri-procedural management of antithrombotic therapy accordingly [<span>1, 2</span>]. These recommendations have undoubtedly improved patient safety and standardized clinical practice. Nevertheless, guideline classifications inevitably represent a simplification of a far more heterogeneous clinical reality. While guidelines classify procedures, clinicians ultimately treat individual patients. Bridging these two perspectives remains one of the greatest challenges in contemporary therapeutic endoscopy.</p><p>Perhaps the question is no longer simply how antiplatelet therapy should be managed during ESD, but whether all ESD procedures truly share the same intrinsic bleeding risk.</p><p>In this issue of <i>Digestive Endoscopy</i>, Hirai et al. [<span>3</span>] report the largest multicenter experience to date evaluating peri-procedural antiplatelet management in patients undergoing ESD for esophageal squamous cell carcinoma. Importantly, this study does not attempt to demonstrate the superiority of one antiplatelet strategy over another. Rather, it provides carefully collected real-world data in an area where evidence has long remained remarkably limited.</p><p>The authors observed low rates of delayed bleeding irrespective of whether thienopyridine therapy was managed according to guideline-based discontinuation or continued throughout the peri-procedural period. Owing to the retrospective design and the very limited number of bleeding events, these findings cannot be interpreted as evidence supporting continued therapy, nor do they justify changes in current recommendations. Instead, they should be viewed as an important contribution to an evolving clinical discussion [<span>3</span>].</p><p>Indeed, the greatest value of this study may not reside in the absolute bleeding rate itself, but in the clinical question that naturally emerges from these observations.</p><p>Are all ESD procedures really equal? Therapeutic endoscopy has traditionally approached ESD as a single procedural entity when considering peri-procedural bleeding risk. Such an approach is understandable and has facilitated the development of practical recommendations. However, accumulating evidence suggests that delayed bleed","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167791","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":"Rethinking Endoscopic Resection in Light of Sarcopenia","authors":"Hironori Tanaka, Taro Iwatsubo, Hiroki Nishikawa","doi":"10.1111/den.70301","DOIUrl":"10.1111/den.70301","url":null,"abstract":"<p>Endoscopic resection (ER), including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection, has become the standard organ-preserving treatment for early gastrointestinal neoplasms. Owing to its minimally invasive nature, organ preservation, and favorable local control, the indications for ER have expanded, particularly among older patients who may not be suitable candidates for radical surgery. However, as the population ages, patient selection has become increasingly complex. Thus, the key question that endoscopists face is no longer whether a lesion can be technically resected but whether the patient is likely to derive meaningful clinical benefit, considering systemic health, physical function, and overall physiological reserve. Moreover, chronological age alone is an insufficient guide while making such decisions. Consequently, the focus has shifted from achieving technical success to maximizing patient benefit.</p><p>Sarcopenia was first described by Rosenberg in 1989 as the age-related loss of skeletal muscle mass [<span>1</span>]. Recent consensus statements have expanded the concept of sarcopenia beyond reduced muscle mass to encompass muscle strength and the broader framework of muscle health [<span>2, 3</span>]. The revised consensus of the European Working Group on Sarcopenia in Older People 2 identifies low muscle strength as the primary feature of sarcopenia, with low muscle quantity or quality confirming the diagnosis and poor physical performance indicating severe sarcopenia [<span>2</span>]. In contrast, the Asian Working Group for Sarcopenia 2025 Consensus Update defines sarcopenia based on a combination of low muscle mass and low muscle strength, while positioning physical performance as an important clinical outcome indicator [<span>3</span>]. This conceptual shift, which reflects the transition from viewing sarcopenia primarily as a loss of muscle mass to understanding it as a clinical concept characterized by both muscle mass and muscle strength within the broader framework of muscle health, is particularly relevant to older adults undergoing ER for gastrointestinal neoplasms. In these patients, sarcopenia, together with multimorbidity, malnutrition, and frailty, may reflect diminished physiological reserve and greater vulnerability to functional deterioration following treatment, despite the minimally invasive nature of the procedure.</p><p>In this issue of <i>Digestive Endoscopy</i>, Hisada et al. present a timely scoping review of the impact of sarcopenia on patients undergoing ER [<span>4</span>]. Following the PRISMA-ScR framework, the authors systematically mapped the existing evidence on esophageal, gastric, and colorectal ER, identifying 28 studies, the majority of which were retrospective cohorts from East Asia. The reported prevalence of sarcopenia ranged from 13.9% to 72.7%, reflecting differences in target organs, age distribution, and diagnostic criteria.</p><p>The most clinically important f","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70301","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168078","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":"Combination Steroid Therapy for Stricture Prevention After Extensive Esophageal Endoscopic Submucosal Dissection: Promise and Remaining Questions","authors":"Fumisato Sasaki","doi":"10.1111/den.70306","DOIUrl":"10.1111/den.70306","url":null,"abstract":"<p>Endoscopic submucosal dissection (ESD) for superficial esophageal cancer enables en bloc resection of extensive lesions and accurate histopathological evaluation; however, post-resection strictures are significant adverse events. In particular, in cases where the mucosal defect extends to more than 7/8 of the circumference of the esophagus, the risk of strictures is high even if the defect is noncircumferential, and repeated endoscopic balloon dilation (EBD) may be required. Local triamcinolone injection (LTI) and oral prednisolone administration (OPA) are the primary treatments used to prevent post-ESD esophageal stricture [<span>1</span>].</p><p>The efficacy of LTI has been demonstrated by studies showing that local injection of triamcinolone into post-ESD ulcers reduces the incidence of strictures and the number of EBD procedures [<span>2, 3</span>]. LTI offers the advantage of a single administration immediately following ESD; however, its efficacy and safety may be influenced by the injection site, dosage, injection depth, and the operator's technique.</p><p>In contrast, OPA does not require local injection and has the potential to continuously suppress inflammation and fibrosis throughout wound healing. It has been reported that starting with 30 mg/day of prednisolone and gradually tapering the dose reduces the incidence of strictures and EBD following esophageal ESD [<span>4</span>]. However, systemic adverse events such as hyperglycemia, hypertension, and infections can be a concern with OPA.</p><p>The JCOG1217 multicenter randomized Phase III trial, which directly compared LTI and OPA, evaluated whether OPA monotherapy was superior to LTI monotherapy in preventing strictures after extensive esophageal ESD. At 12 weeks, the stricture-free survival rates were 88.5% and 94.8% in the LTI and OPA groups, respectively; however, no statistical superiority of OPA was demonstrated [<span>5</span>]. Therefore, among patients who have undergone ESD for extensive esophageal lesions, OPA is not considered a definitively superior alternative to LTI.</p><p>However, in a subgroup analysis of JCOG1217, the 12-week stenosis-free survival rate in cases with a post-ESD mucosal defect extending 7/8 or more of the circumference but less than the full circumference was 75.2% in the LTI group and 92.5% in the OPA group, showing a favorable trend in the OPA group. Although this result was not statistically significant (HR, 0.545; 95% CI, 0.198–1.502) and should be interpreted with caution as an exploratory finding, the number of patients and stricture events available for this subgroup comparison was limited, resulting in low precision as reflected by the wide confidence interval. The JCOG1217 investigators also noted that the reduced overall sample size and statistical power could have contributed to negative subgroup findings [<span>5</span>]. Nevertheless, the numerical difference suggests the need to select treatments based on stricture risk.</p><p>The si","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70306","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172358","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":"Redefining Safety and Versatility in Malignant Colorectal Obstruction: The Clinical Impact of a New Low-Axial-Force Self-Expandable Metallic Stent With a Slim Delivery System","authors":"Hiroyoshi Iwagami","doi":"10.1111/den.70313","DOIUrl":"10.1111/den.70313","url":null,"abstract":"<p>Mizumoto et al. conducted a multicenter prospective study on the safety and efficacy of a new low-axial-force (AF) self-expandable metallic stent (SEMS) with a slim delivery system for malignant colorectal obstruction [<span>1</span>]. Malignant colorectal obstruction is a life-threatening complication that occurs in up to 15%–20% of patients with colorectal cancer [<span>2</span>]. Historically, the management of acute obstruction presented a significant therapeutic challenge. Before the introduction of SEMS, transanal decompression tube placement or emergency surgery served as the primary modalities for bowel decompression. However, transanal ileus tubes were notoriously associated with severe patient discomfort, a marked impairment in quality of life, and demanding, labor-intensive nursing care. Furthermore, these decompression tubes frequently provided inadequate decompression or became displaced, leading to persistent bowel distension and delayed definitive therapy.</p><p>A major paradigm shift occurred in 2012 when colonic SEMS placement became covered by Japan's national health insurance. Colonic stenting revolutionized the management of malignant colorectal obstruction, serving two distinct therapeutic roles: bridge-to-surgery (BTS) for resectable cases and palliative decompression for patients with unresectable or metastatic disease. For BTS, stenting converts an unpredictable emergency procedure into a planned elective surgery. Successful decompression offers four substantial clinical advantages [<span>2-4</span>]. First is physiological stabilization. Avoiding emergency surgery reduces perioperative morbidity and mortality by allowing adequate resuscitation, correction of electrolyte imbalances, and thorough staging. Second is improved surgical feasibility. Bowel decompression minimizes proximal colonic edema, significantly increasing the rate of primary anastomosis while reducing the need for temporary or permanent stoma creation. Third is an improved patient experience. Unlike transanal tubes, SEMS requires no cumbersome flushing protocols, enables rapid resumption of oral nutrition, and allows patients to temporarily return home before definitive resection. Fourth is improved diagnostic access. Decompression of the lumen provides a critical opportunity to evaluate the proximal colon.</p><p>In the palliative setting, meta-analyses comparing SEMS placement with primary emergency surgery have demonstrated lower complication and mortality rates in the stenting group [<span>5</span>]. Furthermore, guidelines from the European Society of Gastrointestinal Endoscopy [<span>2</span>] and the Japanese Society for Cancer of the Colon and Rectum [<span>6</span>] state that stent placement imposes less physical and psychological burden on patients, leading to weak recommendations for both BTS and palliative indications [<span>2, 6</span>].</p><p>The evolution of colonic SEMS over the past decade has been driven by a deeper understanding of st","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139248","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":"Single-Balloon Endoscopy–Assisted Magnetic Compression Anastomosis for Refractory Biliary Anastomotic Stricture After Hepaticojejunostomy","authors":"Kenta Yoshida,&nbsp;Takuto Yamaguchi,&nbsp;Hirotake Sakuraba","doi":"10.1111/den.70300","DOIUrl":"10.1111/den.70300","url":null,"abstract":"<p>A 77-year-old man developed a refractory biliary anastomotic stricture involving the posterior segmental bile duct with bile leakage after left hepatectomy with Roux-en-Y hepaticojejunostomy for perihilar cholangiocarcinoma. Both balloon-assisted endoscopic and percutaneous approaches failed to achieve guidewire passage across the severely obstructed anastomosis, and internal drainage was not possible despite repeated attempts (Figure 1a–c). Therefore, percutaneous transhepatic biliary drainage (PTBD) was required for biliary decompression. Because the length of the obstructed segment was short (approximately 1 cm) and reoperation was considered highly invasive, magnetic compression anastomosis (MCA) was selected as an alternative treatment [<span>1-3</span>]. MCA was performed using a combined percutaneous and endoscopic approach assisted by single-balloon endoscopy. A daughter magnet (samarium-cobalt, 3 × 4 mm) was delivered to the biliary side of the obstruction through a 14-Fr sheath placed via the PTBD tract. The smaller daughter magnet was selected to allow passage through the 14-Fr sheath. Subsequently, a parent magnet (samarium-cobalt, 5 × 6 mm) was delivered to the enteric side of the hepaticojejunostomy using single-balloon endoscopy with an overtube. The two magnets were carefully aligned under fluoroscopic guidance until successful coupling was confirmed (Figure 2a,b; Video 1). Nineteen days after MCA, cholangiography showed contrast flow into the intestinal tract, indicating successful fistula formation (Figure 2c). The coupled magnets were retrieved endoscopically, and internal biliary drainage was achieved without procedure-related adverse events or the need for surgical reintervention (Video 2).</p><p>MCA is not widely available and typically requires institutional approval and multidisciplinary collaboration, including coordination with experienced specialists. However, this case demonstrates that single-balloon endoscopy–assisted MCA may be considered as a potential treatment option for carefully selected patients with severely or completely obstructed biliary anastomotic strictures after hepaticojejunostomy when conventional endoscopic and percutaneous techniques fail [<span>4</span>].</p><p>Dr. Yoshida conceptualized and drafted the manuscript, and performed endoscopic examinations. Dr. Yamaguchi drafted the manuscript. Dr. Sakuraba supervised the study, drafted the manuscript, and made intellectual revisions to the manuscript. All the authors have read and approved the final version of the manuscript.</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p><p>The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70300","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139199","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":"Effect of a Computer-Aided Device on Endoscopists' Biopsy Practice for Gastric Neoplasms: A Secondary Analysis of a Randomized Controlled Trial","authors":"Hongliu Du,&nbsp;Shuzhe Tan,&nbsp;Ziyi Zeng,&nbsp;Xinran Zhang,&nbsp;Zehua Dong,&nbsp;Mei Deng,&nbsp;Jiamin Wang,&nbsp;Xiao Tao,&nbsp;Honggang Yu,&nbsp;Xinyue Wan","doi":"10.1111/den.70302","DOIUrl":"10.1111/den.70302","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endoscopic biopsy is fundamental for diagnosing gastrointestinal lesions, yet the effectiveness of AI assistance on endoscopists' biopsy strategies and efficiency for detecting gastric neoplasms remains unclear. This study aims to investigate this effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study is a secondary analysis of a randomized controlled trial (AI group: <i>n</i> = 13,440; control: <i>n</i> = 12,561) compared AI-assisted versus standard screening. The AI system marked high-risk and low-risk lesions with red and blue boxes, respectively. The AI group was stratified into red-box and non-red-box subgroups. Outcomes included neoplasm biopsy efficiency and proportion of non-biopsied documented lesions. The patient-level correlation between false-positive alerts and biopsy counts was examined. All analyses were based on the pathological results after centralized pathology review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The non-biopsy rate was significantly lower in the red-box group than in the non-red box group and the control group (18.00% vs. 43.26%, 18.00% vs. 45.60%, both <i>p</i> &lt; 0.001), suggesting that lesions were biopsied more frequently in the red-box group. Neoplasm biopsy efficiency was higher in the red-box group (8.19% vs. 0.36%, 8.19% vs. 1.77%, both <i>p</i> &lt; 0.001). In negative binomial regression, red-box classification remained associated with a lower non-biopsy rate (IRR 0.393, 95% CI 0.360–0.429, <i>p</i> &lt; 0.001). False-positive alerts showed a weak inverse correlation with biopsy counts (<i>ρ</i> = −0.182, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Red-box classification was associated with more targeted biopsy sampling, while false-positive prompts were not associated with indiscriminate biopsies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119350","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":"Development of a Multimodal AI Model to Predict the Efficacy of Photodynamic Therapy for Local Residual or Recurrent Lesions Following Chemoradiotherapy or Radiotherapy for Esophageal Cancer","authors":"Keiichiro Nakajo,&nbsp;Yu Sasagawa,&nbsp;Takuro Tomino,&nbsp;Haruto Hirose,&nbsp;Atsuki Imai,&nbsp;Minami Endo,&nbsp;Hiroki Yamashita,&nbsp;Masataka Yamamoto,&nbsp;Hiroshi Takemura,&nbsp;Tomonori Yano","doi":"10.1111/den.70307","DOIUrl":"10.1111/den.70307","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Approximately 12%–40% of patients with esophageal cancer develop local residual or recurrent lesions after chemoradiotherapy (CRT) or radiotherapy (RT). Photodynamic therapy (PDT) is a minimally invasive, organ-preserving alternative; however, therapeutic response is not guaranteed. We developed an artificial intelligence (AI) model to predict PDT efficacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 177 patients who underwent PDT after CRT/RT at the National Cancer Center Hospital East between August 2006 and December 2024. Clinical data and pre-PDT endoscopic images obtained within 1 month were collected. Local image features extracted via oriented FAST and rotated BRIEF were integrated with clinical information to build a multimodal support vector machine for binary classification. Model performance was evaluated on an independent test set and compared with that of three endoscopists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The AI model was trained on 145 cases, achieving an accuracy, recall, precision, and F1 score, and area under the receiver operating characteristic curve of 0.813, 0.833, 0.833, 0.833, and 0.897, respectively in the test cohort of 32 cases. The AI model showed numerically higher accuracy, recall, precision, and F1 score than the endoscopists (0.531, 0.636, 0.389, and 0.483, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A multimodal AI model integrating clinical data and endoscopic images can accurately predict PDT efficacy after CRT or RT. This approach may help optimize treatment strategies and individualize patient management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119234","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":"EUS Shear Wave Elastography for Assessing Pancreatic Fibrosis: An Exploratory Study of Its Histological Correlation","authors":"Akiya Nakahata,&nbsp;Yasunobu Yamashita,&nbsp;Fumiyoshi Kojima,&nbsp;Yuto Sugihara,&nbsp;Tomokazu Ishihara,&nbsp;Hiromu Morishita,&nbsp;Takahiro Shishimoto,&nbsp;Yuki Kawaji,&nbsp;Takashi Tamura,&nbsp;Masahiro Itonaga,&nbsp;Reiko Ashida,&nbsp;Shin-Ichi Murata,&nbsp;Keisuke Hanada,&nbsp;Akihiro Takeuchi,&nbsp;Atsushi Shimizu,&nbsp;Manabu Kawai,&nbsp;Masayuki Kitano","doi":"10.1111/den.70308","DOIUrl":"10.1111/den.70308","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound shear wave elastography (EUS-SWE) enables quantitative, noninvasive assessment of tissue elasticity. However, the association between EUS-SWE and pancreatic histology remains unclear. This study aimed to investigate the utility of EUS-SWE for predicting pancreatic fibrosis by comparing it with histological findings of resected specimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent EUS-SWE before pancreatectomy between October 2019 and October 2024 were retrospectively enrolled. SWE was performed near the surgical resection margin, and shear wave velocity (Vs, m/s) was measured. The number of EUS morphological findings according to the Rosemont classification was obtained. Histological findings were assessed using quantitative analysis and grading analysis. The association between EUS-SWE or the number of EUS morphological findings and histological findings, as well as the diagnostic performance of EUS-SWE and EUS morphological findings for predicting histological fibrosis at predefined fibrosis thresholds (≥ 5%, ≥ 10%, ≥ 15%, and ≥ 20%) was evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-four patients were included. Vs correlated significantly with quantitative fibrosis (<i>ρ</i> = 0.73, <i>p</i> &lt; 0.001), but not with fatty infiltration and inflammation. The number of EUS morphological findings correlated only with fibrosis grade (<i>ρ</i> = 0.35, <i>p</i> = 0.041). EUS-SWE had higher diagnostic accuracy than EUS morphological findings for predicting histological fibrosis at all thresholds (91.2%, 88.2%, 82.4%, and 88.2% vs. 55.9%, 67.6%, 55.9%, and 50.0%, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EUS-SWE may serve as a quantitative, noninvasive method for evaluating pancreatic fibrosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>UMIN ID: 000058397</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119314","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":"Balloon Enteroscopy-Assisted ERCP and EUS-Guided Biliary Drainage for Malignant Biliary Obstruction in Patients With Surgically Altered Anatomy: A Systematic Review and Meta-Analysis","authors":"Masahiro Itonaga,&nbsp;Ke Wan,&nbsp;Tamura Takashi,&nbsp;Yasunobu Yamashita,&nbsp;Reiko Ashida,&nbsp;Masayuki Kitano","doi":"10.1111/den.70309","DOIUrl":"10.1111/den.70309","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This systematic review and meta-analysis evaluated the pooled outcomes and comparative evidence of balloon enteroscopy-assisted ERCP (BEA-ERCP) and EUS-guided biliary drainage (EUS-BD) for malignant biliary obstruction (MBO) in patients with surgically altered anatomy (SAA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Web of Science, and the Cochrane Library were searched up to January 2026. The primary outcome was the pooled technical success rate. Secondary outcomes included the clinical success rate, adverse event rate, recurrent biliary obstruction (RBO) rate, and mean procedure time. Subgroup analyses compared outcomes in studies directly comparing the two procedures. A random-effects model was used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen studies were included, comprising nine studies investigating BEA-ERCP (394 patients) and seven investigating EUS-BD (206 patients), including three comparative studies. Pooled technical and clinical success rates were 75% and 72% for BEA-ERCP and 97% and 92% for EUS-BD, respectively. Pooled adverse event rates were 11% for BEA-ERCP and 17% for EUS-BD, and pooled RBO rates were 26% and 23%, respectively. In subgroup analyses of the three comparative studies, technical success rates (risk ratio [RR], 0.74; 95% confidence interval [CI], 0.67–0.82) and clinical success rates (RR, 0.70; 95% CI, 0.61–0.80) were significantly lower with BEA-ERCP than with EUS-BD, with no significant differences in adverse event rates, RBO rates, or procedural times.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In the three comparative studies, EUS-BD achieved higher technical and clinical success rates than BEA-ERCP for MBO in patients with SAA, with no significant difference in adverse events. These non-randomized findings are preliminary, and large-scale prospective comparative studies are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119265","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":"Experimental Evaluation of Novel Two-Dimensional Endoscopic Ultrasound Shear Wave Elastography: A Phantom-Based Study","authors":"Yasunobu Yamashita,&nbsp;Akiya Nakahata,&nbsp;Hiroki Yamada,&nbsp;Hirofumi Yamazaki,&nbsp;Hiromu Morishita,&nbsp;Tomokazu Ishihara,&nbsp;Yuto Sugihara,&nbsp;Takahiro Shishimoto,&nbsp;Yuki Kawaji,&nbsp;Takashi Tamura,&nbsp;Masahiro Itonaga,&nbsp;Reiko Ashida,&nbsp;Hiroyuki Kojima,&nbsp;Takao Itoi,&nbsp;Masayuki Kitano","doi":"10.1111/den.70303","DOIUrl":"10.1111/den.70303","url":null,"abstract":"<div>\u0000 \u0000 <p>Point shear wave elastography (SWE) can indicate tissue elasticity using absolute values, but it remains difficult to determine which areas are suitable for measurement. Recently, two-dimensional endoscopic ultrasound SWE (2D-EUS-SWE), which allows visual assessment of appropriate measurement locations, has become possible. However, it remains unclear how to set the measurement and color regions of interest (ROIs) appropriately. This study aimed to evaluate the optimal ROI settings for 2D-EUS-SWE under various measurement conditions with phantom. Two types of commercially available elasticity phantoms were used to evaluate 2D-EUS-SWE. The conditions were set for five parameters: measurement ROI size, color ROI size, color ROI depth, degree of probe pressure, and color ROI angle. Measurements were performed 10 times for each setting. In a tumor model, the color ROI was set over or within the tumor. Reproducibility and reliability were then evaluated for each setting. Setting the color ROI at a depth range of 1–3 cm was found to be appropriate. The measurements were possible regardless of the color and measurement ROI sizes. When the color ROI was positioned directly below (0°), tilting it up to 45° had no effect on the measurement. In the tumor model, measurements were possible regardless of the color ROI size. In addition to clarifying the optimal condition settings, the present findings indicate that 2D-EUS-SWE is an accurate and reliable method for performing measurements using EUS. However, this was conducted under phantom conditions, and future clinical evaluation is necessary.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119408","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}