Digestive Endoscopy最新文献

{"title":"Dental floss with rubber band-formed pulley traction facilitating endoscopic full-thickness resection of gastric submucosal tumor in gastric fundus","authors":"Biao Fu,&nbsp;Zhi-qiang Du,&nbsp;Wei-hui Liu","doi":"10.1111/den.14819","DOIUrl":"10.1111/den.14819","url":null,"abstract":"<p>Endoscopic full-thickness resection (EFTR) is crucial in managing gastrointestinal submucosal tumors (GISTs).<span>¹</span> Different traction methods have enhanced the safety and efficacy of EFTR,<span>^{2, 3}</span> such as floss-assisted traction, which is widely used in endoscopic submucosal dissection and EFTR.<span>^{4, 5}</span> However, these methods usually provide one-way traction and inconsistent force, making it challenging to address specific tumor locations. Therefore, we developed an innovative pulley traction technique successfully applied to EFTR of a GIST in the gastric fundus (Video S1).</p><p>A patient with a 20 mm × 15 mm GIST in gastric fundus was referred for EFTR (Fig. 1a). Initially, a clip linked with dental floss was used to bring a rubber band into the stomach (Fig. 1b). On releasing the rubber band, the clip was secured to the oral mucosal edge of the tumor. A second clip was used to anchor the rubber band to the normal mucosa on the opposite side of the tumor (Fig. 1c). As the pulley traction consistently lifted the tumor, we incised the mucosa and exposed the tumor without use of a transparent cap or submucosal injection (Fig. 1d). With sufficient traction force of the pulley device, the tumor was safely excavated with complete capsule. Because the defect was transformed to be linear by the pulley traction, it was easily closed using clips (Fig. 1e). Finally, the pulley device was removed from the normal mucosa and the lesion was extracted (Fig. 1f).</p><p>Dental floss with rubber band-assisted pulley traction delivers continuous multidirectional traction in difficult locations, thus promoting safe and effective EFTR of GISTs. This method ensures a clear surgical field, prevents hemorrhage, avoids tissue damage, reduces the risk of tumor spillage, provides easy closure of the surgical defect, minimizes tumor resection time, facilitates suturing, and minimizes the likelihood of intra-abdominal infection.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 7","pages":"857-858"},"PeriodicalIF":5.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14819","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141158898","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":"Endoscopic muscularis dissection with over-the-scope clip: Novel resection technique for duodenal neuroendocrine tumors","authors":"Yohei Ogata,&nbsp;Waku Hatta,&nbsp;Atsushi Masamune","doi":"10.1111/den.14833","DOIUrl":"10.1111/den.14833","url":null,"abstract":"<p>Duodenal neuroendocrine tumors (dNETs) easily invade the deep submucosa, resulting in a low R0 resection rate (50%) with conventional endoscopic mucosal resection.<span>¹</span> Endoscopic resection has recently seen the utilization of the over-the-scope clip (OTSC). Endoscopic muscularis resection with OTSC (EMRO) facilitated muscularis resection without perforation<span>²</span> and achieved a high R0 resection rate (92.9%) for dNETs.<span>³</span> Nevertheless, electricity can flow toward the OTSC in employing a monopolar snare when the area constricted by the OTSC is smaller than that of the closed snare,<span>^3-5</span> leading to coagulation damage to the duodenal mucosa and ultimately resulting in EMRO failure.</p><p>Here we present the case of an 80-year-old man with cT1 dNET located on the anterior wall of the bulb (Fig. 1), which was not successfully resected by EMRO but could be resected completely through endoscopic muscularis dissection with OTSC (EMDO) (Video S1). We decided to perform EMRO, deploying the OTSC during the process (Fig. 1). The lesion was ensnared above the OTSC without contact, and Endocut electrocoagulation (VIO300D; Erbe Elektromedizin, Tübingen, Germany) was employed. However, electricity flowed toward the OTSC, resulting in mild coagulation damage to the duodenal mucosa and rendering snare resection impossible. Therefore, we switched to an endoscopic dissection technique, named EMDO. The dissection proceeded above the OTSC, utilizing the ORISE ProKnife (Boston Scientific, Watertown, MA, USA). Endocut mode was primarily employed for mucosal incision and muscularis dissection, resulting in the resection of the lesion without any adverse events. The histopathological findings revealed a dNET confined to the deep submucosa with negative resection margins, confirming successful muscularis resection (Fig. 2).</p><p>To our knowledge, this is the first report of EMDO. Muscularis resection was achieved without perforation, similar to the outcomes of EMRO. EMDO could serve as an alternative when EMRO is not feasible due to the flow of electricity toward the OTSC.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 8","pages":"955-956"},"PeriodicalIF":5.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14833","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141158899","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":"Endoscopic hand suturing using a modified through-the-scope needle holder for mucosal closure after colorectal endoscopic submucosal dissection: Prospective multicenter study (with video)","authors":"Takeshi Uozumi,&nbsp;Seiichiro Abe,&nbsp;Yasuhiko Mizuguchi,&nbsp;Masau Sekiguchi,&nbsp;Naoya Toyoshima,&nbsp;Hiroyuki Takamaru,&nbsp;Masayoshi Yamada,&nbsp;Nozomu Kobayashi,&nbsp;Ryo Sadachi,&nbsp;Sayo Ito,&nbsp;Kazunori Takada,&nbsp;Yoshihiro Kishida,&nbsp;Kenichiro Imai,&nbsp;Kinichi Hotta,&nbsp;Hiroyuki Ono,&nbsp;Yutaka Saito","doi":"10.1111/den.14808","DOIUrl":"10.1111/den.14808","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic hand suturing (EHS) is a novel technique for closing a mucosal defect after endoscopic submucosal dissection (ESD). We investigated the technical feasibility of colorectal EHS using a modified flexible through-the-scope needle holder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a prospective multicenter study conducted at two referral centers between June 2022 and April 2023. This study included colorectal neoplasms 20–50 mm in size located in the sigmoid colon or rectum. A modified flexible through-the-scope needle holder, with an increased jaw width to facilitate needle grasping, was used for colorectal EHS. The primary end-points were sustained closure rate on second-look endoscopy (SLE) performed on postoperative days 3–4 and suturing time for colorectal EHS. Secondary end-points included complete closure rate and delayed adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We enrolled 20 colorectal neoplasms in 20 patients, including four patients receiving antithrombotic agents. The tumor location was as follows: lower rectum (<i>n</i> = 8), upper rectum (<i>n</i> = 2), rectosigmoid colon (<i>n</i> = 4), and sigmoid colon (<i>n</i> = 6), and the median mucosal defect size was 37 mm (range, 21–65 mm). The complete closure rate was 90% (18/20 [95% confidence interval (CI) 68.3–98.8%]), and the median suturing time was 49 min (range, 23–92 min [95% CI 35–68 min]). Sustained closure rate on SLE was 85% (17/20 [95% CI 62.1–96.8%]). No delayed adverse events were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EHS demonstrated a high sustained closure rate. Given the long suturing time and technical difficulty, EHS should be reserved for cases with a high risk of delayed adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1245-1252"},"PeriodicalIF":5.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076990","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":"Analysis based on the opportunities for detecting huge numbers of consecutive colorectal cancers would help identify the reality of clinical practices","authors":"Yasushi Oda","doi":"10.1111/den.14816","DOIUrl":"10.1111/den.14816","url":null,"abstract":"&lt;p&gt;The article by Sekiguchi &lt;i&gt;et al&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; shows that there is a reality of opportunities for detecting colorectal cancers (CRCs) by a prospective case study with questionnaires of consecutive CRC patients at multiple hub hospitals for cancer treatment. More than thousands of CRC patients were collected within only 1 year. Huge numbers of CRCs would help the comparisons of backgrounds of detected CRCs, even though they were only case studies, essentially.&lt;/p&gt;&lt;p&gt;This study showed that nonscreening-detected CRC occupied more than 60% of CRCs, which may indicate that CRC screening in Japan does not function well. A US study found that the screening rate reached 71.8% of citizens aged 50–75 in 2021 and was promoted up to 74.4% as a “healthy people 2030 target.”&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The increase in screening-detected CRC would also be one of the successful indicators of screening projects in the real world. The screening-detected CRCs critically showed less advanced invasions compared with nonscreening-detected CRCs in this article, too.&lt;/p&gt;&lt;p&gt;The other important issue is several types of interval CRC (iCRC). First of all, CRC detected within 1 year after positive fecal immunochemical test (FIT) with noncompliance to colonoscopy showed more advanced features, such as more invasions, metastasis, and more invasive treatment, as well as the tendency with left side by location and male by sex, which were more similar with symptomatic CRC, compared with FIT-iCRC, which is defined as CRC detected after a negative FIT and before the next recommended test is due and 3-year postcolonoscopy CRC (PCCRC-3 yr), which is defined as CRC diagnosed within 3 years after a colonoscopy with no cancer. These findings emphasize that the patients with FIT-positive results should be treated cautiously and quickly, and that the high quality of the colonoscopy procedure should be performed to prevent FIT-iCRC and PCCRC-3 yr.&lt;/p&gt;&lt;p&gt;FIT-iCRC and PCCRC-3 yr showed a nonnegligible proportion of detected CRCs and a higher proportion of &lt;i&gt;BRAF&lt;/i&gt; mutations, which may include different biological features than other types of CRCs. In addition, these findings indicate that serrated lesions and nonpolypoid lesions, such as laterally spreading tumor, are one of the major candidates for interval cancers.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; These lesions would be needed to investigate the nature of progression.&lt;/p&gt;&lt;p&gt;This study collected huge numbers of CRCs, which may confirm generalizability. Fundamentally, the study design was prospective, and also a consecutive case study in major hub cancer treatment hospitals, which may include some bias. The history of previous findings of colonoscopies in addition to intervals and a history of FIT and colonoscopy also may influence the prevalence of interval cancers. Probably, the next step would be to clarify the magnitude of interval cancer in daily practices by using big real-world data, including control data, which would ve","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1152"},"PeriodicalIF":5.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14816","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066242","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":"Current status of endoscopic ultrasound-guided antitumor treatment for pancreatic cancer","authors":"Kazuyuki Matsumoto,&nbsp;Hironari Kato,&nbsp;Koichiro Tsutsumi,&nbsp;Motoyuki Otsuka","doi":"10.1111/den.14815","DOIUrl":"10.1111/den.14815","url":null,"abstract":"<p>Endoscopic ultrasound (EUS) was developed in the 1990s and has significantly transformed pancreatic tumor diagnosis. Subsequently, EUS has rapidly shifted from being a purely diagnostic procedure to being used in a wide range of interventional procedures. Recently, new therapeutic techniques, such as EUS-guided fine needle injection (EUS-FNI) or radiofrequency ablation (RFA), have been developed to deliver various antitumor agents. Despite technological advancements, pancreatic cancer (PC) has a poor prognosis and improvements in treatment outcomes are urgently required. One of the reasons for the limited response to antitumor agents in PC is the abundant desmoplasia and hypovascular nature of the tumor, complicating drug delivery into the tumor. Thus, changing the tumor microenvironment may be important to enhance the effectiveness of chemotherapy, and direct injection of antitumor agents into the tumor under EUS guidance can help overcome treatment challenges in PC. Treatment approaches using the EUS-FNI or RFA technique are expected to further improve the prognosis of PC. Therefore, this study reviewed the existing literature on EUS-guided antitumor therapy, specifically highlighting its application in PC to address the current challenges and to identify potential advancements in the field.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"18-28"},"PeriodicalIF":5.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946515","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 of a colonic endoscopic submucosal dissection training model that simulates respiratory movements","authors":"Hiroki Ueda,&nbsp;Yoshitsugu Misumi,&nbsp;Kouichi Nonaka","doi":"10.1111/den.14818","DOIUrl":"10.1111/den.14818","url":null,"abstract":"<p>Endoscopic submucosal dissection (ESD) is an established endoscopic treatment for esophageal and stomach tumors, as well as colorectal tumors. The cure rate, operation time, and complication rate for colonic ESD have improved with standardization of the procedure.<span>¹</span> However, colonic ESD is technically difficult due to factors such as the thinness of the intestinal wall, maneuverability of the endoscope, physiological bending, peristalsis, respiratory movements, and heartbeat.<span>^{2, 3}</span> Various training models have previously been reported to overcome these difficulties, such as a colonic ESD training model using an animal model<span>⁴</span> and a model that simulates heartbeat using a motor device<span>⁵</span>; however, there are no reports of ESD training models that simulate respiratory movements. In this report, we introduce the first such ESD training model (Video S1). We use an accordion hose, battery-powered toy train, smartphone holder, turntable (20 cm diameter), plastic plate, a three-plate bolt assembly, two springs, two paper cups, an A4-size binder, and versatile training tissue (VTT; Kotobuki Medical, Saitama, Japan). VTT is a simulated mucosal model consisting of a food-quality konjac, which is readily obtainable and poses few hygiene issues. Moving the toy train fixed with a smartphone holder on the turntable automatically rotates the turntable (Fig. 1a). When the turntable and plastic plate are connected with the bolt plate, the plastic plate moves linearly back and forth (Fig. 1b). This model makes a reciprocating linear movement ~10 times per min. Placing the VTT on this plastic plate results in a movement on the monitor that is very similar to the respiratory movements experienced during colonoscopy (Fig. 2). This model enables training on handling respiratory movements, which pose a difficulty in colonic ESD. Two experts and four trainees at our hospital who trained with this model rated this model highly, suggesting that it could be useful as a colonic ESD training model.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 7","pages":"855-856"},"PeriodicalIF":5.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14818","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922638","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":"Endoscopic carbon dioxide insufflation treating malignant colonic intussusception","authors":"Kentaro Mochida,&nbsp;Fumiaki Ishibashi,&nbsp;Sho Suzuki","doi":"10.1111/den.14821","DOIUrl":"10.1111/den.14821","url":null,"abstract":"<p>Intussusception accounts for 1–5% of the causes of intestinal obstruction in adults.<span>¹</span> Surgical resection is a radical treatment for malignant colonic intussusception.<span>²</span> However, emergent endoscopy for assessing colonic obstruction is sometimes needed preoperatively.<span>³</span> Endoscopy can be used to temporally resolve intussusception preoperatively, although a detailed procedure has not been reported. This video reports the use of carbon dioxide (CO₂) insufflation via colonoscopy to repair intussusception due to colorectal cancer.</p><p>A 58-year-old man presented with severe abdominal pain and constipation. Computed tomography (CT) revealed a large mass and a three-layer structure of the sigmoid colon wall with the mesentery wrapped over the rectum, suggesting intussusception of the sigmoid colon (Fig. 1a). No signs of intestinal ischemia or perforation were observed. Colonoscopy was performed without bowel preparations, revealing a large mass overlapping the normal mucosa in the rectum (Fig. 1b). The colonoscope could not access the oral side of the lesion. Insufflation was achieved using CO₂ through the colonoscope. The mass was moved toward the oral side, and the overlapping sigmoid colon wall was gradually released. Type I advanced cancer of the sigmoid colon was observed after intussusception repair (Fig. 2a). Postcolonoscopy CT revealed that the mass moved to the sigmoid colon and the three-layer structure of the colonic wall disappeared (Fig. 2b). Three weeks after colonoscopy, a laparoscopic-assisted sigmoid colon resection was performed, and the final pathological diagnosis was well-differentiated adenocarcinoma of the sigmoid colon (T3, N0, M0, stage IIa) according to the Japanese Classification.<span>⁴</span></p><p>Although colonic intussusception repair by air insufflation has been reported previously,<span>⁵</span> this is the first report of a video of colonic intussusception repair using CO₂ insufflation using a colonoscope. This procedure is simple, inexpensive, and effective for avoiding emergency surgery. Therefore, CO₂ insufflation using colonoscopy may be an alternative option for repairing malignant colonic intussusceptions.</p><p>Author S.S. is an Associate Editor of <i>Digestive Endoscopy</i>. Author S.S. received a speaker honorarium from FUJIFILM Corporation. The other authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 7","pages":"859-860"},"PeriodicalIF":5.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14821","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917606","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":"Suturing with muscle layer grasping and pulling technique for mucosal defect of colorectal endoscopic submucosal dissection","authors":"Keisaku Yamada,&nbsp;Masahiro Tajika,&nbsp;Yasumasa Niwa","doi":"10.1111/den.14817","DOIUrl":"10.1111/den.14817","url":null,"abstract":"<p>In recent years, several suturing methods have been invented to prevent the adverse event of endoscopic submucosal dissection (ESD) such as delayed bleeding.<span>¹</span></p><p>Furthermore, it is important to close the entire muscle layer without dead space for a strong suture.<span>^{2, 3}</span></p><p>A 67-year-old female patient presented with a 30 mm 0-IIa lesion in the cecum, and underwent ESD (Video S1).</p><p>First, ESD was performed using an ORISE Proknife (Boston Scientific, Marlborough, MA, USA) from the anal side and en bloc resection was completed. After en bloc resection, a mucosal defect of ~5 cm was observed (Fig. 1), and suturing was performed. First, a clip with nylon thread was attached to the middle of the mucosal defect. The thread was then gently pulled to elevate the grasped muscle layers, while suturing it with a reopenable clip (SureClip; MicroTech, Nanjing, China). In this process, the clip was applied to the submucosal layer at the edge of the mucosal defect, not the mucosa, and sutured to the submucosal layer at the opposite edge along with the elevated muscle layer. The other area was sutured in the same way with a clip by pulling the thread. Once the mucosa on both sides has closed to some extent, additional clips were used to suture the mucosa tightly. Finally, the thread was cut and complete suture was possible (Fig. 2).</p><p>This suturing technique allows the mucosal defect to be reduced by clipping the middle region of the muscle layer. In addition, by hooking the clip not to the mucosa but to the submucosa at the edge of the mucosal defect, the clip is less likely to slip, and by pulling the thread to elevate the muscle layer, the middle muscle layer can be sutured together with both sides, eliminating dead space. This suturing technique is useful for mucosal defect of colorectal ESD.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 7","pages":"853-854"},"PeriodicalIF":5.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14817","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900716","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":"Novel clip closure technique for a large mucosal defect with anchor-pronged clips after duodenal endoscopic submucosal dissection","authors":"Kohei Shigeta,&nbsp;Noboru Kawata,&nbsp;Hiroyuki Ono","doi":"10.1111/den.14813","DOIUrl":"10.1111/den.14813","url":null,"abstract":"<p>Duodenal endoscopic submucosal dissection (DESD) has a high incidence of delayed adverse events (AEs).<span>¹</span> However, complete mucosal closure (CMC) can reduce the risk of AEs after DESD.<span>²</span> Conventional clip closure is a common technique,<span>¹</span> but it poses challenges when used for CMC of large defects after DESD. This case shows a simple closure technique using anchor-pronged clips (MANTIS clip; Boston Scientific, Waltham, MA, USA) for CMC after DESD.</p><p>A 63-year-old man underwent DESD for a 40 mm flat elevated lesion in the descending duodenum (Fig. 1a). During the DESD, an intraprocedural perforation occurred, which was closed using a conventional clip (SureClip; Micro-tech, Nanjing, China). Then en bloc resection was performed on a 47 × 41 mm specimen (Fig. 1b). After resection, mucosal closure was initiated with the anchor-pronged clips for the approximately half circumferential defect (Fig. 2a,b). We grasped the oral edge of the defect using the anchor-pronged clip, allowing us to bring and grasp the opposite side (Video S1). The anchor-pronged clip closed the center of the defect (Fig. 2c), and CMC was achieved in 11 min using seven additional conventional clips (Fig. 2d). The patient was discharged 6 days later without AEs. Pathological examination revealed the lesion was an intramucosal well-differentiated adenocarcinoma with negative resection margins.</p><p>Although there are various techniques for CMC after DESD,<span>¹</span> some of these methods require technical skills. Anchor-pronged clip closure is a simple technique that enables the closure of larger defects and overcomes the challenges of conventional clips during the closure procedure, such as tissue slippage when grasping the opposite side.<span>^{3, 4}</span> Furthermore, by applying the previously reported technique of anchor-pronged clip to grasp and suture the muscle layer, it may be possible to reduce suture-induced dead space even in the duodenum.<span>⁵</span> Therefore, mucosal closure using anchor-pronged clips is a viable option for CMC of large defects after DESD.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 7","pages":"849-850"},"PeriodicalIF":5.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14813","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873729","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":"Endoscopic recanalization of an occluded Braun anastomosis using an endoscopic injection needle","authors":"Hiromune Katsuda,&nbsp;Masanori Kobayashi,&nbsp;Ryuichi Okamoto","doi":"10.1111/den.14814","DOIUrl":"10.1111/den.14814","url":null,"abstract":"<p>Braun reconstruction is effective in preventing afferent loop syndrome (ALS) after pancreatoduodenectomy.<span>¹</span> Occlusion of a Braun anastomosis can lead to ALS, posing a risk of nonobstructive cholangitis.<span>²</span> In such circumstances, surgical reconstruction is highly invasive, and although endoscopic ultrasonography (EUS)-guided enterostomy offers a less invasive alternative,<span>^{3, 4}</span> challenging cases still exist. We hereby report the safer endoscopic recanalization for an occluded Braun anastomosis using an endoscopic needle (Video S1).</p><p>An 83-year-old man, with a history of pancreaticoduodenectomy and Child's reconstruction, developed recurrent cholangitis. Balloon-assisted enteroscopy showed no stenosis at the choledocojejunostomy site, but revealed complete closure of the Braun anastomosis (Fig. 1). To address the potential cause of recurrent cholangitis, an endoscopic attempt was made to recanalize the Braun anastomosis. We discovered that a 20G endoscopic injection needle (Varixer needle (01941); Top, Tokyo, Japan) designed for endoscopic injection sclerotherapy is compatible with a 0.018 inch guidewire (Fielder 18; Olympus, Tokyo, Japan). This needle has a slenderer outer sheath than the EUS-guided fine-needle aspiration needle. Unlike the latter, the metal needle is limited to the tip (Fig. 2a), enabling flexible adaptation to the steep bending angles of the endoscope (Fig. 2b). We aimed for safe recanalization using a rendezvous method, puncturing from the efferent loop to facilitate dilation from the afferent loop, where applying force was more feasible in this case. Despite the endoscope being deeply angulated, the puncture was easily performed, allowing for the placement of a 0.018 inch guidewire (Fig. 2c). As a result, we were able to grasp the guidewire from the afferent loop side, enabling subsequent fistula dilation and stent placement exceptionally easily (Fig. 2d). This technique can be used for the occluded choledocojejunostomy site<span>⁵</span> and is a valuable method for recanalization of closed intestinal anastomoses.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 7","pages":"851-852"},"PeriodicalIF":5.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14814","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140875061","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}