Digestive Endoscopy最新文献

{"title":"EUS-Guided Gallbladder Drainage in Acute Cholecystitis With Contained Perforation: An International Multicenter Study","authors":"Marco Spadaccini,&nbsp;Gianluca Franchellucci,&nbsp;Francesco Auriemma,&nbsp;Alessandro Fugazza,&nbsp;Andrea Lisotti,&nbsp;Andrea Anderloni,&nbsp;Giuseppe Dell'Anna,&nbsp;Gianfranco Donatelli,&nbsp;Francesco Maria Di Matteo,&nbsp;Serena Stigliano,&nbsp;Edoardo Forti,&nbsp;Massimiliano Mutignani,&nbsp;Abed Al-Lehibi,&nbsp;Emad Aljahdli,&nbsp;Abdulrahmman Alfadda,&nbsp;Ammar Alotaibi,&nbsp;Resheed Alkhiari,&nbsp;Ilaria Tarantino,&nbsp;Cecilia Binda,&nbsp;Il Sang Shin,&nbsp;Jong Ho Moon,&nbsp;Pietro Fusaroli,&nbsp;Carlo Fabbri,&nbsp;Daryl Ramai,&nbsp;Antonio Facciorusso,&nbsp;Cesare Hassan,&nbsp;Alessandro Repici,&nbsp;Benedetto Mangiavillano,&nbsp;EUS International Group","doi":"10.1111/den.70199","DOIUrl":"10.1111/den.70199","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an established alternative for treating acute cholecystitis (AC) in poor surgical candidates. However, management of AC with contained gallbladder perforation (CGP) remains unclear, with percutaneous treatment as the treatment of choice due to safety concerns regarding EUS-GBD. This study aimed to assess the feasibility and safety of EUS-GBD with Lumen apposing metal stent (LAMS) in patients with AC complicated by CGP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective, international, multicenter study across 10 tertiary referral centers. The primary outcome was safety, assessed by the occurrence of adverse events (AE), which were reported according to the AGREE classification. Secondary outcomes included clinical success, defined as resolution of symptoms with accompanying objective improvement in biochemical and/or radiologic findings of cholecystitis within 3 days of the procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2020 and 2024, a total of 57 patients were included. AEs occurred in seven patients (12.3%), evaluated as grades II, III, and V in 2, 4, and 1 patients, respectively. The only intra-procedural AE was misdeployment of the distal flange of the LAMS, which was successfully managed endoscopically. Post-procedural AEs comprised four bleeding events, one perforation, and one liver abscess, the latter resulting in patient death. Clinical success was observed in 52 of 54 evaluable patients (96%) with a resolution of the peri-cholecystic collection documented in 94.4% of patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study supports the feasibility and safety of EUS-GBD for the treatment of acute cholecystitis with CGP in poor surgical candidates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354902","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":"Toward Tailored EUS-Guided Gallbladder Drainage in the Era of Lumen-Apposing Metal Stent","authors":"Shuntaro Mukai,&nbsp;Takao Itoi","doi":"10.1111/den.70216","DOIUrl":"10.1111/den.70216","url":null,"abstract":"&lt;p&gt;Laparoscopic cholecystectomy remains the standard treatment for acute cholecystitis. However, gallbladder drainage is recommended for patients considered to be at high surgical risk because of poor general condition, advanced age, comorbidities, or underlying malignancy. Percutaneous transhepatic gallbladder drainage (PTGBD) has long been regarded as the standard drainage technique because of its high technical and clinical success rates. In recent years, however, endoscopic internal drainage, including endoscopic transpapillary gallbladder drainage (ETGBD) and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), has become increasingly widespread [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The first case of EUS-GBD using double-pigtail plastic stent (DPPS) was reported in 2007, and EUS-GBD using fully covered metal stents (FCMS) began to appear after 2011 [&lt;span&gt;2, 3&lt;/span&gt;]. Although these early approaches established the feasibility of transmural gallbladder drainage, stent placement was technically demanding and was associated with concerns regarding migration, maldeployment, and bile leakage. The introduction of lumen-apposing metal stent (LAMS) represented a major advance. Since the first report of EUS-GBD using LAMS in 2012, technical success and safety have improved substantially [&lt;span&gt;4&lt;/span&gt;]. In particular, electrocautery-enhanced one-step LAMS delivery systems have simplified the procedure and have become a preferred option for EUS-GBD in many expert centers [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Recent multicenter data from the United States using electrocautery-enhanced LAMS showed excellent outcomes, with a technical success rate of 99.1%, clinical success rate of 97.2%, and procedure-related adverse event rate of only 3.7% [&lt;span&gt;6&lt;/span&gt;]. These results clearly demonstrate the clinical value of LAMS for EUS-GBD. In addition, an international multicenter randomized controlled trial comparing EUS-GBD with PTGBD in very high-risk surgical patients with acute cholecystitis reported that EUS-GBD was associated with lower rates of adverse events, 30-day reintervention, and recurrent cholecystitis, as well as less postprocedural pain [&lt;span&gt;7&lt;/span&gt;]. A meta-analysis comparing EUS-GBD with ETGBD also showed higher technical and clinical success rates with EUS-GBD [&lt;span&gt;8&lt;/span&gt;]. Although the overall adverse event rate did not differ significantly between the two approaches, recurrent cholecystitis was less frequent after EUS-GBD. Furthermore, a network meta-analysis by Podboy et al. highlighted the limitations of each drainage strategy: PTGBD is associated with a higher need for reintervention and unplanned hospitalization, whereas ETGBD remains technically challenging, with success rates of approximately 80%–90% even when various technical modifications are used [&lt;span&gt;9&lt;/span&gt;]. These findings suggest that EUS-GBD is particularly suitable for patients who are unlikely to undergo cholecystectomy after gallbladder drainage because of poor general condition","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70216","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354940","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":"Development and Evaluation of an Ergonomically Optimized Scope-Holder for Flexible Endoscopy (With Video)","authors":"Shinnosuke Nagano,&nbsp;Kota Momose,&nbsp;Yuji Ishii,&nbsp;Shuhei Yamaguchi,&nbsp;Shigeto Nakai,&nbsp;Takaomi Hagi,&nbsp;Kotaro Yamashita,&nbsp;Takuro Saito,&nbsp;Koji Tanaka,&nbsp;Tomoki Makino,&nbsp;Tsuyoshi Takahashi,&nbsp;Yukinori Kurokawa,&nbsp;Hidetoshi Eguchi,&nbsp;Yuichiro Doki,&nbsp;Kiyokazu Nakajima","doi":"10.1111/den.70209","DOIUrl":"10.1111/den.70209","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Growing endoscopy demand has increased physical workload and injury risk among endoscopists, while current ergonomic solutions remain limited. We developed a newly motion-optimized endoscope-holding device (scope-holder) designed to reduce muscular burden, allowing each operator to adjust the scope position according to individual preference. This study assessed its ergonomic impacts in a simulated setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical endoscopists and nonmedical participants without any medical background were recruited to collect data. Each participant performed a simulated endoscopic marking task with and without the scope-holder. We compared the procedure time of the task, evaluated muscle efforts in the upper arm, forearm, and shoulder using wireless electromyography, as well as mental workload using NASA-TLX across the two settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 26 participants, including 17 clinical endoscopists and 9 nonmedical participants, were enrolled. In the overall cohort, the scope-holder assisted group significantly reduced activation of biceps brachii (<i>p</i> &lt; 0.001), trapezius (<i>p</i> &lt; 0.001), flexor carpi ulnaris (<i>p</i> = 0.049) muscles and NASA-TLX scores (<i>p</i> = 0.003). Additionally, the assisted group achieved a shorter procedure time (<i>p</i> = 0.018) compared with the non-assisted group. Subgroup analysis showed reduced muscle load in both clinical endoscopists and nonmedical participants (<i>p</i> &lt; 0.05), with additional improvements in mental workload (<i>p</i> = 0.004) and the procedure time (<i>p</i> = 0.027) observed only in nonmedical participants, whereas clinical endoscopists showed no significant difference in mental workload (<i>p</i> = 0.299) and procedure time (<i>p</i> = 0.229).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our newly developed scope-holder, designed to accommodate the operator's natural scope motion, effectively reduced physical and mental workload. It offers a practical solution to improve ergonomics in endoscopic clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70209","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354919","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":"Methodology Assessment of Endoscopic Ultrasound Radiofrequency Ablation (EUS-RFA) for Pancreatic Neoplasms: Results From an International Survey","authors":"Andrea Lisotti,&nbsp;Matteo Tacelli,&nbsp;Stefano Francesco Crinò,&nbsp;Graziella Masciangelo,&nbsp;Pietro Fusaroli,&nbsp;Marc Barthet,&nbsp;Nirav Thosani,&nbsp;Maria Cristina Conti Bellocchi,&nbsp;Sarah Leblanc,&nbsp;Tawfik Khoury,&nbsp;Paolo Giorgio Arcidiacono,&nbsp;Antonio Facciorusso,&nbsp;Fabrice Caillol,&nbsp;Marc Giovannini,&nbsp;Lorenzo Fuccio,&nbsp;Jayanta Samanta,&nbsp;Anthony Y. B. Teoh,&nbsp;Takeshi Ogura,&nbsp;Roald Flesland Havre,&nbsp;Somashekar G. Krishna,&nbsp;Bojan Kovacevic,&nbsp;Vinay Dhir,&nbsp;Peter Vilmann,&nbsp;Sundeep Lakhtakia,&nbsp;Bertrand Napoléon,&nbsp;Khanh Do-Cong Pham","doi":"10.1111/den.70212","DOIUrl":"10.1111/den.70212","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is increasingly used; however, clinical application remains unstandardized. We assessed real-world practice among international users.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional 70-item survey was conducted. Results are presented descriptively (numbers, percentages).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 91 of 175 invited physicians from Europe (74.4%), North America (13.3%), and Asia (12.2%) completed the survey. EUS-RFA was performed by 94.1% of respondents for insulinoma, with heterogeneous responses for other indications. Most physicians (96.3%) performed EUS-RFA under deep sedation or general anesthesia; marked variability was reported on antibiotic prophylaxis (57.5%), aggressive hydration (52.5%), generator power settings, ablation strategy, or probe selection. Lesions involving or located ≤ 1 mm from the main pancreatic duct were considered high risk by 97.5% and 85.0%, respectively, yet no standardized preventive strategy was identified. Post-procedural management and follow-up were heterogeneous, with a high proportion of responses for definitions of technical success (88.8%), clinical success in insulinoma (92.3%), and disease recurrence (97.5%), with high variability for definitions of partial ablation and post-RFA pancreatitis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite the global expansion of EUS-RFA, clinical practice remains highly heterogeneous and geographically skewed. The lack of standardized methodology and terminology poses significant barriers to generating high-quality evidence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70212","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347435","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":"Refined Endoscopic Septotomy Using a Small-Caliber Endoscope and Optimized Closure for Zenker's Diverticulum","authors":"Yuichiro Ikebuchi,&nbsp;Hiroki Kurumi,&nbsp;Hajime Isomoto","doi":"10.1111/den.70207","DOIUrl":"10.1111/den.70207","url":null,"abstract":"<p>Three technical refinements facilitated effective septotomy and diverticular reduction in Zenker's diverticulum, resulting in a safe procedure and favorable clinical outcome.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347428","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 Colorectal Sessile Serrated Lesions in Elderly Patients","authors":"Daisuke Ohki,&nbsp;Naomi Kakushima,&nbsp;Ryo Nakamura,&nbsp;Eifu So,&nbsp;Hiroyuki Hisada,&nbsp;Dai Kubota,&nbsp;Yuko Miura,&nbsp;Hiroya Mizutani,&nbsp;Chihiro Takeuchi,&nbsp;Seiichi Yakabi,&nbsp;Keiko Niimi,&nbsp;Yosuke Tsuji,&nbsp;Nobutake Yamamichi,&nbsp;Mitsuhiro Fujishiro","doi":"10.1111/den.70214","DOIUrl":"10.1111/den.70214","url":null,"abstract":"<div>\u0000 \u0000 <p>Sessile serrated lesions (SSLs) are established precursor lesions of colorectal cancer arising through the serrated neoplasia pathway and are estimated to account for a substantial proportion of sporadic colorectal cancers. Accumulating evidence has clarified their distinctive endoscopic, histopathological, and molecular characteristics, including frequent BRAF mutations, CpG island methylator phenotype (CIMP), and progression toward microsatellite instability–high carcinoma. Although the natural history of nondysplastic SSLs is generally slow, lesions that acquire dysplasia may demonstrate more rapid neoplastic progression. With increasing global longevity, the management of SSLs in elderly patients has become a clinically important issue. In this population, clinical decision-making is complicated by higher risks of colonoscopy-related adverse events, antithrombotic use, comorbidities, frailty, and reduced tolerance to bowel preparation or sedation. At the same time, the oncologic benefit of endoscopic treatment or continued surveillance may be limited by remaining life expectancy. Current surveillance recommendations for SSLs are gradually becoming more explicit across regions; however, these recommendations are largely extrapolated from studies of conventional adenomas and mixed-age populations, and elderly-specific evidence remains limited. Consequently, the management of elderly patients with colorectal SSLs requires individualized decision-making integrating lesion-related risk, procedural burden, frailty, life expectancy, and the quality of prior colonoscopic examinations. This review summarizes current evidence regarding colorectal SSLs and discusses practical considerations for individualized management in elderly patients, with particular emphasis on balancing oncologic benefit against procedural risk and long-term surveillance burden in an aging society.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347461","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":"How Does Artificial Intelligence-Assisted Endoscopy Impact Upper Gastrointestinal Screening?","authors":"Sho Suzuki","doi":"10.1111/den.70215","DOIUrl":"https://doi.org/10.1111/den.70215","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148324878","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":"Long-Term Outcomes After Endoscopic Papillary Large Balloon Dilation With Endoscopic Sphincterotomy for Difficult Biliary Stones: A Multicenter Retrospective Longitudinal Study","authors":"Aurelio Mauro,&nbsp;Evgenija Lozova,&nbsp;Giuseppe Vanella,&nbsp;Marco Spadaccini,&nbsp;Davide Scalvini,&nbsp;Vincenzo Occhipinti,&nbsp;Germana De Nucci,&nbsp;Cecilia Binda,&nbsp;Andrea Lisotti,&nbsp;Mia Rainio,&nbsp;Giovanni Aragona,&nbsp;Giovanna Venezia,&nbsp;Debora Berretti,&nbsp;Giovanna Del Vecchio Blanco,&nbsp;Federico Desideri,&nbsp;Giuseppe Fierro,&nbsp;Edoardo Forti,&nbsp;Gianluca Franchellucci,&nbsp;Roberto Grassia,&nbsp;Giuseppe Marzocca,&nbsp;Stefano Mazza,&nbsp;Andrea Tenca,&nbsp;Claudio Zulli,&nbsp;Leena Kylänpää,&nbsp;Ilaria Tarantino,&nbsp;Carlo Fabbri,&nbsp;Andrea Anderloni","doi":"10.1111/den.70204","DOIUrl":"https://doi.org/10.1111/den.70204","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Endoscopic papillary large balloon dilation (EPLBD) is currently considered the first-line treatment for difficult biliary stones (DBS). However, EPLBD alters the sphincter of Oddi's function, potentially exposing patients to cholangitis. To date, few data are available on the long-term consequences of EPLBD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Methods</h3>\u0000 \u0000 <p>The aim of this study is to explore the long-term complications of EPLBD with endoscopic sphincterotomy (ES) in terms of cholangitis and biliary recurrence. Adult patients who underwent EPLBD with ES with complete bile duct clearance were included in the study. Primary outcome of the study was the rate of cholangitis; secondary outcome was biliary recurrence after EPLBD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>1221 patients with a median age of 77 years old (IQR 68–84) were included in the study. One hundred and forty-three patients (11.7%) experienced at least one episode of cholangitis with a cumulative 1-, 3-, and 5-year risk of cholangitis of 7.3%, 13.2%, and 15.3%, respectively. Cholangitis was caused by stones recurrence in 71.6% of cases, whereas alithiasic cholangitis was experienced in 22.9% of patients. The estimated 1-, 3-, and 5-year risk of biliary recurrence was 9.7%, 16.7%, and 21.8%, respectively. In multivariate cox regression analysis, ≥ 2 previous ERCPs before EPLBD were independently associated with increased risk of cholangitis and biliary recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cholangitis and biliary recurrence are not an infrequent complication after EPLBD. Biliary stone recurrence may be a consequence of SO dysfunction after EPLBD with ES; further comparative data are needed to evaluate whether EPLBD with ES is directly associated with long-term complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306164","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":"New Horizons in Cholangiopancreatoscopy: Where Are We Heading in 2026?","authors":"Raymond Shing-Yan Tang,&nbsp;Ting Ting Chan","doi":"10.1111/den.70213","DOIUrl":"10.1111/den.70213","url":null,"abstract":"&lt;p&gt;After non-invasive imaging, endoscopic retrograde cholangiopancreatography (ERCP) is the preferred treatment modality over surgery or interventional radiology procedures in many benign or malignant pancreatobiliary diseases [&lt;span&gt;1, 2&lt;/span&gt;]. While conventional ERCP-based techniques for stone extraction, tissue sampling, and stenting of biliary/pancreatic duct strictures are often sufficient in straightforward cases, management of difficult bile duct/pancreatic duct (PD) stones and indeterminate biliary strictures remains challenging in clinical practice [&lt;span&gt;1, 3&lt;/span&gt;]. In such situations, advanced diagnostic and therapeutic procedures by peroral cholangioscopy (POCS) or peroral pancreatoscopy (POPS) would be necessary since POCS and POPS allow tissue acquisition and intraductal lithotripsy under direct visualization [&lt;span&gt;4-6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Ogura T et al. conducted a comprehensive review of recent advances in cholangiopancreatoscopy [&lt;span&gt;7&lt;/span&gt;]. In current clinical practice, cholangiopancreatoscopy can be performed by 1 of the following techniques: (1) two-operator mother-baby system, (2) direct cholangiopancreatoscopy with an ultra-thin gastroscope or a multi-bending ultra-slim scope, or (3) digital single-operator system [&lt;span&gt;8&lt;/span&gt;]. While excellent image quality and the capability of image-enhanced endoscopy (IEE) are the strengths of the mother-baby system using a dedicated baby video cholangiopancreatoscope, the technically demanding nature of the two-operator mother-baby system often precludes wide adoption of this technology and prompts the development of single-operator cholangiopancreatoscopy (SOC) systems [&lt;span&gt;3&lt;/span&gt;]. As technology advances, the relatively easy-to-set-up digital SOC has replaced the legacy fiber optic system and is the most commonly utilized technique of cholangiopancreatoscopy in contemporary clinical practice [&lt;span&gt;1-3, 7&lt;/span&gt;]. Multiple brands of digital SOC systems are now available, with scope outer diameters ranging from 3.1 to 3.9 mm and working channel sizes ranging from 1.2 to 2.0 mm [&lt;span&gt;7&lt;/span&gt;]. Aiming to address the commonly perceived drawback of small specimen size obtained by dedicated forceps used in SOC, a 3.9-mm SOC with a larger 2.0-mm working channel has become available recently, which allows the use of a larger dedicated biopsy forceps and has the potential to further improve the diagnostic yield of SOC-guided tissue acquisition [&lt;span&gt;8&lt;/span&gt;]. By contrast, the slimmer 3.1-mm digital SOC can be advantageous in patients needing POPS-guided lithotripsy of PD stones in a less dilated main PD.&lt;/p&gt;&lt;p&gt;New innovations have further pushed the boundaries of cholangiopancreatoscopy. Recently, a new digital SOC system (Dragonfly, Medtronic, USA) has been recently developed to overcome the limitations of the current digital SOC design, in which a larger catheter outer diameter is necessary to accommodate a larger working channel. W","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 6","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70213","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297253","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":"Impact of Sarcopenia on Elderly Patients Undergoing Endoscopic Resection: Scoping Review","authors":"Hiroyuki Hisada,&nbsp;Hiroki Asano,&nbsp;Yosuke Tsuji,&nbsp;Dai Kubota,&nbsp;Yuko Miura,&nbsp;Hiroya Mizutani,&nbsp;Daisuke Ohki,&nbsp;Chihiro Takeuchi,&nbsp;Seiichi Yakabi,&nbsp;Keiko Niimi,&nbsp;Naomi Kakushima,&nbsp;Nobutake Yamamichi,&nbsp;Mitsuhiro Fujishiro","doi":"10.1111/den.70210","DOIUrl":"https://doi.org/10.1111/den.70210","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Sarcopenia is a recognized risk factor in surgical oncology, yet its clinical significance in patients undergoing endoscopic resection (ER) remains controversial. This scoping review investigated the prevalence of sarcopenia and its association with technical outcomes, systemic complications, and long-term prognosis in patients undergoing ER.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We followed the PRISMA-ScR framework and searched MEDLINE, Cochrane Central, Web of Science, and Ichushi Web up to November 12, 2025. Eligible studies involved patients undergoing ER (endoscopic submucosal dissection or endoscopic mucosal resection) for esophageal, gastric, or colorectal neoplasms, regardless of diagnostic criteria. A narrative synthesis was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-eight studies, predominantly retrospective cohorts from East Asia, were included. Prevalence ranged from 13.9% to 72.7%. Most studies defined sarcopenia by skeletal muscle mass on computed tomography; only one prospective study incorporated muscle strength. Sarcopenia was generally not associated with technical outcomes such as en bloc resection or perforation. However, it was associated with systemic complications: post-procedural pneumonia was more frequent in two of three studies (odds ratio 3.16 in one), moderate-to-severe adverse events (CTCAE ≥ 2) in three of four, and hospital stay was prolonged in all three reporting studies. Sarcopenia was also associated with poor overall survival (hazard ratios 1.7–15.0), driven by non-disease-specific mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Sarcopenia does not compromise the technical safety of ER but is a critical marker for systemic complications and poor prognosis. Current evidence is limited by retrospective designs lacking muscle strength data. Future research should prioritize prospective assessment using multifaceted diagnostic criteria to refine risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 6","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70210","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148282411","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}