Digestive Endoscopy最新文献

{"title":"“Prediction or Proxy?” Reconsidering Deep Learning-Based Models for Secondary Loss of Response in Crohn's Disease","authors":"Zhihao Lei","doi":"10.1111/den.70154","DOIUrl":"10.1111/den.70154","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147686874","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":"Risk Factors for Metastasis and Prognosis in Non-Curative Resection After Endoscopic Submucosal Dissection for Undifferentiated-Type Early Gastric Cancer in a Nationwide Cohort in Japan","authors":"Kazuo Shiotsuki,&nbsp;Kohei Takizawa,&nbsp;Akifumi Notsu,&nbsp;Waku Hatta,&nbsp;Hirotada Akiho,&nbsp;Masao Yoshida,&nbsp;Yusuke Horiuchi,&nbsp;Takashi Kanesaka,&nbsp;Seiichiro Abe,&nbsp;Masahiro Tajika,&nbsp;Yohei Furumoto,&nbsp;Osamu Dohi,&nbsp;Shinichiro Shinzaki,&nbsp;Junichi Kodaira,&nbsp;Hiroyuki Hisada,&nbsp;Tetsuya Sumiyoshi,&nbsp;Yosuke Toya,&nbsp;Takuya Wada,&nbsp;Jun Nakamura,&nbsp;Michiko Seo,&nbsp;Tomohiro Shimada,&nbsp;Aki Hasebe,&nbsp;Noriya Uedo,&nbsp;Hideki Ishikawa,&nbsp;Takuji Gotoda","doi":"10.1111/den.70148","DOIUrl":"10.1111/den.70148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic submucosal dissection (ESD) is currently the standard treatment for early gastric cancer (EGC) without risk of lymph node metastasis (LNM). However, it is unclear whether the “eCura system,” can be applied to undifferentiated-type EGC after non-curative resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This nationwide, multicenter, retrospective study included consecutive patients that resulted in non-curative resection for undifferentiated-type EGC between January 2011 and March 2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 1049 patients were divided into the additional surgery (<i>n</i> = 716) and the follow-up without additional surgery (<i>n</i> = 333) groups. LNM occurred in 6% of the additional surgery group. Tumor size &gt; 30 mm and lymphatic invasion were independent risk factors for LNM upon multivariate logistic regression analyses. The area under the receiver operating characteristic curve (AUC) for the exploratory scoring system (incorporating these risk factors) for LNM prediction was 0.768 (95% confidence interval [CI]: 0.687–0.848) and that for the eCura system was 0.783 (0.703–0.864; <i>p</i> = 0.464). The eCura system was used to stratify the follow-up without additional surgery group according to risk. Five-year cancer-specific survival differed among the low-, intermediate-, and high-risk groups (99.6%, 96.9%, and 60.6%, respectively; <i>p</i> &lt; 0.001). The hazard ratios for cancer recurrence in the intermediate- and high-risk groups were 6.54 (95% CI: 0.41–104.20) and 98.2 (12.10–798.50), respectively (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lymphatic invasion and a tumor size &gt; 30 mm are associated with the risk of LNM. Our findings support using the eCura system for risk stratification in undifferentiated-type EGC after non-curative resection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647661","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":"Management of ERCP Failure in Malignant Biliary Obstruction: Comparative Effectiveness and Safety of EUS-Guided Gallbladder Drainage Versus Choledocoduodenostomy","authors":"Benedetto Mangiavillano,&nbsp;Gianluca Franchellucci,&nbsp;Francesco Auriemma,&nbsp;Daryl Ramai,&nbsp;Alessandro Fugazza,&nbsp;Marco Spadaccini,&nbsp;Carmelo Barbera,&nbsp;Giuseppe Vanella,&nbsp;Germana De Nucci,&nbsp;Andrew Fuller,&nbsp;Belén Martínez-Moreno,&nbsp;Roberto Di Mitri,&nbsp;Francesco Di Matteo,&nbsp;Carlos Robles Medranda,&nbsp;Andrea Anderloni,&nbsp;Luca De Luca,&nbsp;Anthony Yuen Bun Teoh,&nbsp;Jorge Vargas-Madrigal,&nbsp;Edoardo Forti,&nbsp;Michiel Bronswijk,&nbsp;Santi Mangiafico,&nbsp;Helga Bertani,&nbsp;Sundeep Lakhtakia,&nbsp;Khanh Do-Cong Pham,&nbsp;Stefano Francesco Crinò,&nbsp;Sridhar Sundaram,&nbsp;Alessandro Repici,&nbsp;Antonio Facciorusso,&nbsp;EUS International Group","doi":"10.1111/den.70145","DOIUrl":"10.1111/den.70145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>It is unclear which is the best approach for the drainage of malignant distal biliary obstruction (MDBO) after failed endoscopic retrograde cholangiopancreatography (ERCP). We compared endoscopic ultrasound (EUS)-guided gallbladder drainage (GBD) and EUS-guided choledocoduodenostomy (CDS) with lumen-apposing metal stents (LAMS) as rescue treatment in the case of ERCP failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an international multicenter retrospective observational study at 28 tertiary-care centers. Outcomes were compared using propensity score matching (PSM). Clinical success was the primary outcome, with technical success, adverse event (AE) rate, and overall survival being the secondary outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five hundred twenty-nine patients underwent EUS-guided drainage, of which 136 underwent EUS-GBD, and 393 underwent EUS-CDS. After 1-to-1 PSM, 112 patients per group were selected. EUS-GBD and EUS-CDS had similar technical success (97.3% and 91%; <i>p</i> = 0.08) and clinical success rates (83% and 85.7%; <i>p</i> = 0.17). AE rate was 19.6% in the EUS-GBD group and 12.5% in the EUS-CDS group (<i>p</i> = 0.20), of which 10 (8.9%) and 7 (6.2%) were severe AEs respectively (<i>p</i> = 0.61). Bleeding occurred in seven patients (6.1%) after EUS-GBD and three patients (2.5%) after EUS-CDS, whereas five infectious events were registered after EUS-GBD (4.4%) and four cases (3.5%) after EUS-CDS (<i>p</i> = 0.29). No treatment-related deaths were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with MDBO after failed ERCP, EUS-GBD or EUS-CDS were comparable with similar rates of efficacy and safety. EUS-GBD could represent an easy and safe option in MDBO patients without previous cholecystectomy and with a clear patency of the cystic duct.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635302","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":"Endoscopic Ultrasound-Guided Gallbladder Drainage Using a 19-Gauge Needle and a Modified Slim Metal Stent: A Simplified Approach (With Video)","authors":"Alan Chuncharunee,&nbsp;Kazuo Hara,&nbsp;Shin Haba,&nbsp;Takamichi Kuwahara,&nbsp;Nozomi Okuno,&nbsp;Shimpei Matsumoto,&nbsp;Hiroki Koda,&nbsp;Keigo Oshiro,&nbsp;Yuma Yamazaki","doi":"10.1111/den.70152","DOIUrl":"10.1111/den.70152","url":null,"abstract":"<div>\u0000 \u0000 <p>Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a promising therapeutic option for surgically unfit patients with acute cholecystitis. Data on the use of fully covered self-expandable metal stents (FCSEMSs) in this setting remain limited, especially in the cancer population. We describe a simplified needle-to-stent EUS-GBD technique and report its early clinical outcomes using a 19-gauge Franseen-tip FNB needle and a modified slim FCSEMS. We applied this technique in consecutive patients with acute cholecystitis secondary to malignant biliary obstruction between September 2022 and September 2025. Early outcomes were technical and clinical success, adverse events, and 30-day mortality. Eighteen patients were included. The median gallbladder size was 90 mm, and the wall-to-lumen puncture distance was 15 mm. The first part of the duodenum was the main access route (88.9%). Both technical and clinical success rates were 100%. Over a median follow-up of 6 months, one patient (5.6%) developed recurrent cholecystitis, which was successfully treated endoscopically. No severe adverse event or 30-day mortality occurred. This technique is both feasible and safe.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635320","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":"World Endoscopy Organization Position Statements for Artificial Intelligence in Endoscopic Diagnosis of Gastric Epithelial Neoplasia","authors":"Mitsuhiro Fujishiro,&nbsp;Naomi Kakushima,&nbsp;Seiichiro Abe,&nbsp;Hon Chi Yip,&nbsp;Xuemei Liu,&nbsp;Gwan Ha Kim,&nbsp;Mathieu Pioche,&nbsp;George Adel Cortas,&nbsp;Kazuki Sumiyama,&nbsp;Vitor Nunes Arantes,&nbsp;Fabian Emura,&nbsp;Mário Dinis-Ribeiro","doi":"10.1111/den.70144","DOIUrl":"10.1111/den.70144","url":null,"abstract":"<p>The World Endoscopy Organization (WEO) has prepared position statements for artificial intelligence (AI) in endoscopic diagnosis of gastric epithelial neoplasia as part of activities in the Stomach and Duodenal Diseases Committee. Gastric cancer is still a major cause of cancer death globally, and endoscopy plays a crucial role for early detection and early treatment to improve patients' quality of life as well as to save patients' lives. Artificial intelligence (AI) is an emerging technology to have the potential to increase endoscopic diagnostic yields dramatically, but evidence in clinical use is still insufficient, only from advanced institutions in certain countries. Thus, we developed three, three, and four position statements regarding computer-aided detection, computer-aided diagnosis, and promotion of research, respectively, for better understanding of the present standpoints and future perspectives of AI in endoscopic diagnosis of gastric epithelial neoplasia. AI in the stomach must be helpful to ensure the quality of endoscopy and to increase diagnostic accuracy, but it is still controversial in terms of cost-effectiveness. In addition, it is necessary to develop AI for endoscopic diagnosis of not only gastric epithelial neoplasia but also all kinds of neoplastic lesions and the other alert lesions in the upper gastrointestinal tract in order to apply AI in the entire procedure of esophagogastroduodenoscopy (EGD). Furthermore, developing AI for risk stratification to know the best timing of EGD surveillance is warranted as future agenda.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635348","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":"EUS-Guided Hepaticogastrostomy With a Right-to-Left Hepatic Duct Bridging Stent for Refractory Mucin Plug Cholangitis Caused by an Intraductal Papillary Mucinous Neoplasm-Related Pancreatobiliary Fistula","authors":"Kotaro Takeshita,&nbsp;Satoshi Asai,&nbsp;Takeshi Ogura","doi":"10.1111/den.70143","DOIUrl":"10.1111/den.70143","url":null,"abstract":"<p>Pancreaticobiliary fistulas associated with intraductal papillary mucinous neoplasm (IPMN) can cause biliary obstruction, and biliary stenting may fail due to stent occlusion or migration. Alternative strategies, including large-diameter fully covered self-expandable metal stents (FCSEMS), EUS-guided hepaticogastrostomy (EUS-HGS), and surgery, have been reported [<span>1-4</span>].</p><p>A 91-year-old man with IPMN developed refractory mucin plug cholangitis secondary to a pancreaticobiliary fistula (Figure 1a–c). Initial management with transpapillary plastic stenting and nasobiliary drainage, followed by bilateral half-pigtail plastic stents, resulted in early occlusion (Figure 1d,e). Subsequent pancreatobiliary fistula closure using a 10-mm FCSEMS failed because of early stent migration (Figures 1f and 2a). Surgical intervention was contraindicated because of advanced age and poor performance status.</p><p>We therefore planned EUS-HGS with right-to-left hepatic duct bridging (EUS-HGSB) using an FCSEMS. After balloon sweeping of the bile duct to remove mucus, a half-pigtail plastic stent was placed in the right posterior duct to prevent obstruction by the bridging FCSEMS (Figure 2b,c). The segment 3 branch was punctured from the stomach under EUS guidance, and guidewires were advanced into the right anterior duct using a double-guidewire technique. An 8-mm FCSEMS (Hanaro Benefit; Boston Scientific, Tokyo, Japan) was deployed to create the bridging stent, followed by placement of an 8-mm partially covered SEMS (Spring Stopper; Taewoong Medical, Seoul, Korea) to complete the EUS-HGS tract (Figure 2d–f), given the prolonged patency reported for SEMS in EUS-HGS [<span>5</span>]. Despite the risk of peripheral bile duct occlusion, we favored FCSEMS bridging to act as an antireflux barrier against mucin inflow into the intrahepatic ducts, thereby reducing cholangitis recurrence.</p><p>No procedure-related adverse events occurred. Jaundice resolved, and the patient was discharged. No recurrence of cholangitis was observed at the 3-month follow-up. This case suggests that EUS-HGSB using FCSEMS may be an effective option for refractory mucin plug cholangitis caused by IPMN-related biliary fistula (Video 1).</p><p>K.T. designed the study and drafted the manuscript. S.A. and T.O. supervised this study and critically revised the manuscript for important intellectual content.</p><p>The authors have nothing to report.</p><p>This study was approved by the Institutional Review Board of Tane General Hospital (approval no. 2024-43).</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 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624623","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":"Effective Treatment Case of Esophagogastric Varices With a To-and-Fro Flow State Using Convex Ultrasound Endoscopy","authors":"Kazunori Nagashima,&nbsp;Tsunehiro Suzuki,&nbsp;Atsushi Irisawa","doi":"10.1111/den.70142","DOIUrl":"10.1111/den.70142","url":null,"abstract":"<p>Esophagogastric varices often involve connection of blood flow between the esophagus and stomach [<span>1</span>]. Endoscopic injection sclerotherapy (EIS) represents a useful treatment for esophagogastric varices [<span>1-4</span>]. However, with advanced portal hypertension, the left gastric vein (LGV) of main blood supply route is considered to have a period during which a to-and-fro state of flow occurs [<span>4, 5</span>]. We usually evaluate this to-and-fro flow state using color Doppler-enhanced EUS before treating continuous esophagogastric varices. To the best of our knowledge, this report is the first of a video case confirming a to-and-fro flow state of LGV during EIS.</p><p>This video presents a typical case (Video 1). The patient, a 66-year-old female, had primary biliary cholangitis and esophagogastric varices (Figure 1a,b). Contrast-enhanced CT showed the hemodynamics of esophagogastric varices which fed from LGV through the gastric varices to esophageal varices (Figure 1c). Color Doppler-enhanced EUS shows a to-and-fro flow state of varices (Figure 1d,e). Based on the hemodynamics described, we took care to avoid excessive sclerosant injection during EIS. Specifically, we performed injection only from the esophageal varices to the gastric varices. After the esophageal varices were punctured using a 23G needle (EZ shot3 plus; Olympus Corp.), a sclerosant (ethanolamine oleate, EO) was injected from the esophageal varices to the gastric varices (Figure 2a). After needle removal, pressure was applied to the puncture site with a balloon, which was repositioned near the esophagogastric junction to achieve adequate compression. Given the to-and-fro flow state, temporary occlusion of the outflow route may have facilitated preferential flow of the sclerosant into the LGV (Figure 2b).</p><p>In advanced portal hypertension, especially in esophagogastric varices, evaluation of the to-and-fro flow state using color Doppler-enhanced EUS before treatment is important. During EIS in this flow state, sclerosant may preferentially flow toward the portal system; therefore, careful attention is required.</p><p>K.N. and A.I. wrote the manuscript. A.I. and K.N. revised the manuscript and are the article guarantors. T.S. supervised the manuscript.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70142","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624518","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":"An Exploratory Endoscopic Achalasia Phenotype With Visible Squamocolumnar Junction and Distal Esophagogastric Junction Relaxation Failure: Association With Gastroesophageal Reflux Disease After Peroral Endoscopic Myotomy (With Video)","authors":"Kazuya Sumi,&nbsp;Haruhiro Inoue,&nbsp;Yohei Nishikawa,&nbsp;Kazuki Yamamoto,&nbsp;Ippei Tanaka,&nbsp;Mayo Tanabe,&nbsp;Manabu Onimaru,&nbsp;Koji Otsuka,&nbsp;Takayoshi Ito,&nbsp;Noboru Yokoyama","doi":"10.1111/den.70149","DOIUrl":"10.1111/den.70149","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Backgrounds and Aims</h3>\u0000 \u0000 <p>Esophageal achalasia is typically defined by impaired lower esophageal sphincter (LES) relaxation. In rare cases, complete circumferential visibility of the squamocolumnar junction (SCJ) and upper gastric folds (GFs) is seen endoscopically, suggesting functional obstruction may extend to the distal esophagogastric junction rather than being confined to the LES. Such cases appear to be associated with a high risk of gastroesophageal reflux disease (GERD) after peroral endoscopic myotomy (POEM). We clarified the characteristics and significance of this rare endoscopic phenotype.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed the data of 2553 patients who underwent POEM at our center between 2014 and 2023, and selected cases with full SCJ visibility and relaxation failure at the upper border of the GF before POEM. Patients with prior endoscopic or surgical treatments were excluded. Demographic, procedural, and GERD data were analyzed. GERD severity was assessed endoscopically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twelve patients (0.7%) met these criteria. All were male, with a median age and body mass index of 48.5 years and 21.7 kg/m², respectively. None had a hiatal hernia. All had straight-type achalasia without advanced esophageal dilation. Median myotomy lengths were 7.0 (esophageal) and 4.0 (gastric) cm, respectively. Endoscopic esophagitis was observed in 92% and conclusive GERD in 75%, markedly exceeding previous rates. There was no significant difference in GERD incidence between the anterior and posterior myotomy approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These endoscopic findings may represent achalasia with distal relaxation failure and a high risk of conclusive GERD after POEM. Identifying this endoscopic feature is important for procedural planning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13049693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618950","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":"Universal Cold Snare Polypectomy for Small and Diminutive Colonic Polyps—Sustainability Matters","authors":"Anjan Dhar","doi":"10.1111/den.70150","DOIUrl":"10.1111/den.70150","url":null,"abstract":"&lt;p&gt;Gastrointestinal endoscopy continues to be the third highest generator of greenhouse gases (GHGs) amongst medical specialities, after anesthesia and intensive care and every year, over 22,000,000 endoscopies are undertaken in the United States and approximately 1.5 million in the United Kingdom [&lt;span&gt;1, 2&lt;/span&gt;]. A previous study estimated that, on average, just one endoscopic procedure generates approximately 2.1 kg of waste which is roughly the same as the total waste generated by an individual person in the United States in one day [&lt;span&gt;3&lt;/span&gt;]. There are multiple streams of waste generation during an endoscopic procedure which include automated reprocessing of reusable endoscopes, electricity, water, chemicals, consumables and accessories, and computers as well as printers. The impact of greenhouse gases on planetary health has prompted national and international endoscopic societies to produce guidelines for the reduction of waste generated during endoscopy as well as the drive toward recycling of consumables and accessories [&lt;span&gt;4, 5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The European Society of Gastrointestinal Endoscopy (ESGE) in its 2024 update to Colorectal polypectomy and endoscopic mucosal resection guideline recommends the resection of all polyps with the exception of diminutive (≤ 5 mm) rectosigmoid polyps that are predicted to be non-adenomatous with high confidence. Furthermore it recommends cold snare polypectomy for the removal of diminutive polyps (≤ 5 mm) including a clear margin of normal tissue (1–2 mm) surrounding the polyp. It also recommends against the use of cold and hot biopsy forceps excision because of its high rate of incomplete resection, and deep thermal injury with the hot biopsy forceps. Small polyps (6–9 mm) should be removed by cold snare polypectomy with a clear margin of tissue (1–2 mm) surrounding the polyp. Hot snare polypectomy for small polyps is not recommended [&lt;span&gt;6&lt;/span&gt;]. The environmental impact of cold snare polypectomy compared with hot snare polypectomy for diminutive and small polyps has not been assessed. Besides the direct greenhouse gas impact of the cold snare compared with the hot snare, other factors such as the indirect greenhouse gas impact of the diathermy generator, and the disposal of the patient plate are expected to make hot snare polypectomy less environmentally friendly. Furthermore, the incidence of adverse events, post polypectomy complications and consequent hospital admissions as well as additional procedures need to be taken into account for a complete Lifecycle assessment of polypectomy. The ESGE-ESGENA Position Statement paper on reducing the environmental footprint of gastrointestinal endoscopy also recommends a rational use of endoscopic accessories during the procedure (Statement 8) and also favors the use of cold snare polypectomy and under water endoscopic mucosal resection in validated indications to reduce the carbon footprint [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this journal, Hao-Yu e","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596460","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":"Advances in Diagnosis and Treatment With Cholangiopancreatoscopy","authors":"Takeshi Ogura,&nbsp;Nga Nguyen Trong,&nbsp;Jayanta Samanta","doi":"10.1111/den.70141","DOIUrl":"10.1111/den.70141","url":null,"abstract":"<p>Endoscopic retrograde cholangiopancreatography (ERCP) remains the standard for diagnosing and treating pancreatobiliary diseases. Although non-invasive imaging modalities have significantly improved, ERCP continues to play an indispensable role in clinical practice. However, ERCP has inherent limitations. Diagnostic challenges persist in cases of indeterminate biliary strictures, and stone extraction can be difficult when stones are large, impacted, or located within anatomically complex regions. To address these limitations, direct visualization of the bile and pancreatic ducts using peroral cholangioscopy (POCS) and peroral pancreatoscopy (POPS) has gained increasing attention. These techniques enable targeted biopsies under direct vision, thereby enhancing diagnostic accuracy for indeterminate strictures. In addition, advanced intraductal lithotripsy modalities, such as electrohydraulic lithotripsy and laser lithotripsy, can be delivered through cholangioscopes, allowing effective fragmentation of stones that are refractory to conventional ERCP-based techniques. Recent advances in digital cholangioscopes have further improved image resolution, maneuverability, and irrigation control, broadening their clinical utility. Despite these technological improvements, POCS and POPS remain technically demanding, and their indications must be carefully selected according to ductal anatomy and the clinical scenario. In particular, the narrow diameter of the main pancreatic duct limits the application of POPS, restricting its use to specific situations, such as intraductal papillary mucinous neoplasms or indeterminate ductal strictures. Overall, the integration of cholangioscopy and intraductal lithotripsy into ERCP practice represents a significant advancement, enabling more precise diagnosis and expanding therapeutic options for complex pancreatobiliary disorders. This narrative review summarizes recent progress in diagnostic and therapeutic applications of cholangiopancreatography in pancreatobiliary disease.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13035437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583082","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}