Digestive Endoscopy最新文献

{"title":"Multimodal AI in Endoscopy: Bridging Innovation and Implementation Challenges","authors":"Zekai Yu","doi":"10.1111/den.70052","DOIUrl":"10.1111/den.70052","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380015","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":"Advances in Endoscopic Ultrasonography Technology for Measurement of Tissue Elasticity","authors":"Yasunobu Yamashita,&nbsp;Masayuki Kitano","doi":"10.1111/den.70055","DOIUrl":"10.1111/den.70055","url":null,"abstract":"<div>\u0000 \u0000 <p>Endoscopic ultrasonography (EUS) is an efficient and reliable diagnostic modality for digestive diseases due to its high spatial resolution. Therefore, conventional EUS is useful to detect early pancreatic lesions. Moreover, EUS is an important imaging modality to detect early morphologic changes in chronic pancreatitis (CP). An EUS-based method is used to diagnose CP worldwide. Moreover, conventional EUS is an important method for the diagnosis of early-stage CP. However, diagnosis using conventional EUS is operator-dependent, and an approach that allows more objective diagnosis is needed. In this regard, EUS technology for measurement of tissue elasticity facilitates diagnosis. There are different methods such as strain elastography, shear-wave elastography, and measurement of optimal ultrasound speed. Strain elastography is useful for differential diagnosis of solid pancreatic lesions, malignant lymph nodes, CP, and gastrointestinal subepithelial lesions. Shear-wave elastography is useful for diagnosis of CP and liver cirrhosis. Measurement of optimal ultrasound speed is useful for diagnosis of CP. A strong advantage of EUS is its ability to evaluate elasticity noninvasively. This review describes the methods and their usefulness in various diseases.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380044","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":"Artificial Intelligence in Digestive Endoscopy Training—The Past, Present, and Future","authors":"Jacky C. L. Ho,&nbsp;Zhouyao Qian,&nbsp;Louis H. S. Lau,&nbsp;Hon-Chi Yip,&nbsp;Philip W. Y. Chiu","doi":"10.1111/den.70047","DOIUrl":"10.1111/den.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Artificial intelligence (AI) is reshaping gastrointestinal endoscopy, yet its role in training remains unexplored. This narrative review summarizes current evidence on AI-assisted endoscopy training, addresses potential drawbacks, and envisions future directions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This narrative review was performed via a systematic MEDLINE search (including articles from inception to January 2025), with search terms covering ‘AI’, ‘endoscopy,’ and ‘training.’ Studies were excluded if they were reviews, letters, editorials or comments; focused solely on model development; lacked a training component; or were limited to simple comparisons between the performance of endoscopists and AI systems. After screening 1443 records, 27 articles were included in this review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AI demonstrates potential in enhancing the training of various types of endoscopy (including luminal, hepatobiliary, capsule, and therapeutic endoscopy) by improving quality metrics, enhancing lesion detection, and guiding anatomical landmark recognition, yet the current applications are mainly task-based. Future AI must evolve to provide comprehensive training and personalized performance tracking to endoscopists of different levels of experience. Further studies are needed to assess objective educational outcomes and cost-effectiveness. Key concerns for AI adoption, including deskilling, over-reliance, ethical considerations, and practicality, should be addressed through structured implementation, quality assurance, and regulatory framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, AI can augment endoscopy training by improving skill acquisition and procedural quality, yet significant gaps remain. More research is needed to support its widespread integration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373312","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":"Artificial Intelligence and Its Impact on the Quality of Endoscopy Reports","authors":"Masau Sekiguchi,&nbsp;Yasuhiko Mizuguchi,&nbsp;Ryosuke Kawagoe,&nbsp;Yutaka Saito","doi":"10.1111/den.70057","DOIUrl":"10.1111/den.70057","url":null,"abstract":"<div>\u0000 \u0000 <p>Endoscopy plays a crucial role in reducing the incidence and mortality of gastrointestinal cancers. Ensuring high procedural quality is essential to maximize its effectiveness, and comprehensive endoscopy reports documenting quality-related findings are indispensable. However, generating these reports requires endoscopists to perform numerous manual tasks, from evaluating factors necessary for reporting to documenting findings. Additionally, analyzing endoscopy quality based on reports and related data, such as pathological findings, is labor-intensive. These manual processes are prone to inaccuracies. Artificial intelligence (AI) holds promise for improving the efficiency, accuracy, and quality of endoscopy reporting. AI-driven automation of key evaluation tasks before documentation could significantly reduce the reporting burden on endoscopists while enhancing objectivity and overall report quality. Several AI applications have been explored, including real-time identification and labeling of key anatomical landmarks, examination time assessment, and recognition of endoscopic tools. While full automation of evaluation and documentation using AI remains an ideal yet distant goal, solutions such as voice recognition systems have been developed to alleviate the workload. These systems have demonstrated the potential usefulness in shortening reporting time. Evaluating quality indicators based on endoscopy reports is essential, and monitoring and feedback on these indicators are considered beneficial. Several quality indicators require integration with pathological findings and patient characteristics, which traditionally involves manual data processing. Natural language processing is emerging as a promising alternative to reduce this workload. Further advancements in AI-driven evaluation, documentation, and data integration are needed to fully realize its potential in improving endoscopy report quality.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373352","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":"Immediate Endoscopic Necrosectomy for Walled-Off Pancreatic Necrosis: A First-Choice Option?","authors":"Tsuyoshi Hamada,&nbsp;Toshio Fujisawa,&nbsp;Yousuke Nakai,&nbsp;The WONDERFUL Study Group in Japan","doi":"10.1111/den.70062","DOIUrl":"10.1111/den.70062","url":null,"abstract":"&lt;p&gt;Walled-off necrosis (WON) of the pancreas develops as a local complication of acute necrotizing pancreatitis. When symptomatic WON does not respond to conservative management, patients are generally referred to drainage-based interventions. With the increasing popularity and availability of endoscopic ultrasound (EUS)-guided transluminal procedures, endoscopic treatment has become the preferred first-line treatment for symptomatic WON at many centers [&lt;span&gt;1&lt;/span&gt;]. Prior to the clinical implementation of lumen-apposing metal stents (LAMSs), direct endoscopic necrosectomy was reserved for patients who were not amenable to drainage alone (termed “step-up approach”). The step-up approach is expected to avoid unnecessary necrosectomy sessions and associated adverse events. LAMSs provide a stable transmural port that allows for safe and effective necrosectomy following EUS-guided drainage [&lt;span&gt;2&lt;/span&gt;]. Their lumen-apposing design is particularly advantageous in cases of WON located somewhat apart from the gastrointestinal tract. Consequently, in the era of LAMSs, the optimal timing of necrosectomy has become a major topic of debate [&lt;span&gt;3&lt;/span&gt;]. Intuitively, performing necrosectomy during or shortly after the initial drainage (termed “immediate necrosectomy”) may expedite WON resolution and improve clinical outcomes. However, there have been long-standing concerns about the elevated risk of procedure-related adverse events associated with this aggressive approach (e.g., bleeding and peritonitis due to perforation of the WON wall).&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Yuen and colleagues reported a meta-analysis of 15 cohort studies involving a total of 1290 patients, which aimed to compare immediate necrosectomy and the step-up approach in terms of clinical outcomes [&lt;span&gt;4&lt;/span&gt;]. As only one study compared the clinical outcomes of both treatment strategies within the same cohort, the rates of a given outcome were pooled separately for each group. Overall, no statistically significant differences were noted between the groups: the pooled rates or means (95% confidence intervals) for the immediate necrosectomy and step-up approach groups were 90% (83%–94%) vs. 94% (91%–96%), respectively, for clinical success; 16% (10%–24%) vs. 16% (10%–24%), respectively, for adverse events; 0.99 (0.48–1.51) vs. 1.48 (0.80–2.17), respectively, for the number of reinterventions; and 1.24 (0.57–1.92) vs. 0.93 (0.45–1.39), respectively, for the number of additional necrosectomy sessions. These findings support the comparable clinical outcomes between the treatment strategies. In contrast with the abovementioned concerns, immediate necrosectomy appears to be associated with neither an increased risk of adverse events nor a higher number of necrosectomy sessions. The authors concluded that immediate necrosectomy could be considered a viable treatment option, demonstrating safety and effectiveness profiles similar to those of the step-up appro","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373330","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":"Underwater Endoscopic Mucosal Resection With a Bipolar Snare for a Small Non-Ampullary Duodenal Neuroendocrine Tumor (With Video)","authors":"Mamoru Tokunaga,&nbsp;Yoshiyasu Kitagawa,&nbsp;Takuto Suzuki","doi":"10.1111/den.70051","DOIUrl":"10.1111/den.70051","url":null,"abstract":"<p>Endoscopic resection is a treatment option for non-ampullary duodenal neuroendocrine tumors (DNETs) confined to the submucosa, without nodal or distant metastasis, and &lt; 10 mm [<span>1</span>]. However, because the duodenal wall is thin and DNETs arise from the deep mucosa, endoscopic treatment carries risks of incomplete histopathological resection and adverse events (AEs)—notably perforation and bleeding [<span>2</span>]. Underwater endoscopic mucosal resection (UEMR) has recently been reported effective for superficial non-ampullary duodenal epithelial tumors (SNADETs) [<span>3, 4</span>]. Furthermore, Japanese prospective data indicate a favorable safety profile for UEMR in SNADETs [<span>3</span>]; in a multinational comparison, UEMR was associated with fewer AEs than conventional EMR (CEMR) [<span>4</span>]; and CEMR using a bipolar snare has been reported safe [<span>5</span>]. Accordingly, we considered UEMR with a bipolar snare a potentially effective, safety-oriented option for small non-ampullary DNETs. We present a 72-year-old man in whom an 8-mm submucosal DNET was resected by UEMR using a bipolar snare (Video S1). The lesion, on the inferior wall of the duodenal bulb, appeared subepithelial (Figure 1). Forceps biopsy showed a neuroendocrine tumor; endoscopic ultrasonography confirmed submucosal confinement, and computed tomography showed no nodal or distant metastasis. The procedure used a GIF-XZ1200 gastroscope and EVIS X1 system (Olympus, Tokyo, Japan). Resection was completed with a 13-mm bipolar snare (ZEMEX Bipolar Snare S, Zeon Medical Co. Ltd., Tokyo, Japan) and VIO 3 (ERBE Elektromedizin, Tübingen, Germany; Auto Cut mode, Effect 3). Procedure time was 3 min. There were no AEs, and histopathology showed a well-differentiated NET G1 (7 × 4 × 3 mm; pT1, Ly0, V1) with negative lateral and vertical margins (Figure 2). Subsequent distal gastrectomy revealed no residual tumor or nodal metastasis. Although DNET-specific UEMR data are limited, UEMR with a bipolar snare may be a safe and effective resection method for small non-ampullary DNETs, consistent with reports on duodenal adenomas (Video S1).</p><p><b>Mamoru Tokunaga:</b> conceptualization; investigation; procedure; video editing; writing – original draft. <b>Yoshiyasu Kitagawa:</b> procedure; writing – review and editing; supervision. <b>Takuto Suzuki:</b> writing – review and editing; supervision. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work.</p><p>The authors have nothing to report.</p><p>We confirm that informed consent has been obtained from the patient for the publication of their information and imaging data.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356857","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":"Comparative Evaluation of Percutaneous Transhepatic Biliary Drainage and Endoscopic Ultrasound-Guided Biliary Drainage for Preoperative Management of Malignant Distal Bile Duct Obstruction After Failed ERCP: A Multicenter Retrospective Analysis","authors":"Masahiro Itonaga,&nbsp;Mamoru Takenaka,&nbsp;Hideyuki Shiomi,&nbsp;Koh Kitagawa,&nbsp;Shuhei Shintani,&nbsp;Hirotsugu Maruyama,&nbsp;Ryota Sagami,&nbsp;Tsukasa Ikeura,&nbsp;Takeshi Ogura,&nbsp;Yusuke Ishida,&nbsp;Koichiro Mandai,&nbsp;Satoshi Sugimori,&nbsp;Yoshiki Imamura,&nbsp;Atsuhiro Masuda,&nbsp;Kenji Ikezawa,&nbsp;Atsushi Shimizu,&nbsp;Atsushi Nakai,&nbsp;Minako Nagai,&nbsp;Ryota Nakano,&nbsp;Ke Wan,&nbsp;Toshio Shimokawa,&nbsp;Masayuki Kitano","doi":"10.1111/den.70048","DOIUrl":"10.1111/den.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This multicenter retrospective study aimed to compare surgery-related adverse events (AEs) of percutaneous transhepatic biliary drainage (PTBD) with those of endoscopic ultrasound-guided biliary drainage (EUS-BD) for preoperative management of malignant distal bile duct obstruction (MDBO).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed data from 15 centers in Japan between 2012 and 2021. Patients with MDBO who underwent PTBD or EUS-BD after failed endoscopic retrograde cholangiopancreatography (ERCP) and later underwent pancreaticoduodenectomy (PD) were included. The primary outcome was surgery-related AEs. Secondary outcomes included drainage-related outcomes, surgery-related outcomes, disease-free survival (DFS), and overall survival (OS). Risk factors associated with surgery-related AEs were also evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 2350 patients received biliary drainage before PD. Of the 73 patients in whom ERCP failed, 65 underwent PTBD and 11 underwent EUS-BD. EUS-BD showed a significantly higher internalization rate (100% vs. 28%, <i>p</i> &lt; 0.001), fewer sessions (median 1 vs. 2, <i>p</i> = 0.006), and shorter hospital stay (10 vs. 22 days, <i>p</i> = 0.002). Surgery-related AEs were similar between groups. In the multivariate analysis, age ≥ 71 years and ASA-PS ≥ 2 were identified as significant risk factors for surgery-related AEs, whereas the drainage method was not a significant factor. No significant differences were observed in DFS or OS between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Surgical-related outcomes, DFS, and OS after EUS-BD were comparable to those after PTBD; however, EUS-BD allowed a higher internalization rate, fewer sessions, and a shorter hospital stay, making it the preferred option for preoperative biliary drainage after failed ERCP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350107","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":"A Retrospective Approach to Predict Metastatic Recurrence Risk After Endoscopic Resection for Esophageal Squamous Cell Carcinoma","authors":"Toshiyuki Yoshio","doi":"10.1111/den.70050","DOIUrl":"10.1111/den.70050","url":null,"abstract":"&lt;p&gt;Recent progress in early detection of esophageal squamous cell carcinoma (ESCC) has led to the widespread acceptance of endoscopic submucosal dissection (ESD) as a minimally invasive treatment. Advances in ESD techniques and the implementation of preventive measures for post-ESD strictures—such as local triamcinolone injections—have yielded favorable outcomes [&lt;span&gt;1&lt;/span&gt;], contributing to the expansion of ESD indications to larger and more advanced lesions. We are in the process of expanding complete circumferential resection to larger ESCC [&lt;span&gt;2&lt;/span&gt;]. Treatment strategies are typically determined based on preoperative assessment of invasion depth. When preoperative diagnosis is cT1a-epithelium (EP)/lamina propria mucosae (LPM), endoscopic resection (ER) is generally indicated [&lt;span&gt;1&lt;/span&gt;]. Even in cases diagnosed as cT1a-mascularis mucosae (MM) or cT1b-submucosa (SM) 1, observation following ER is feasible in a substantial proportion of cases [&lt;span&gt;3&lt;/span&gt;], leading to the broad adoption of ESD, which facilitates reliable en-bloc resection for lesions requiring precise histological evaluation. Limitation of preoperative invasion diagnosis is also the reason to facilitate the use of ESD. The diagnostic accuracy of ME-NBI using B2 vessels for cT1a–MM and cT1b–SM1 lesions remains modest (55.7%) [&lt;span&gt;1&lt;/span&gt;], emphasizing the importance of pathological evaluation after ER.&lt;/p&gt;&lt;p&gt;When postoperative pathological assessment reveals pT1a-EP/LPM/MM without lymphovascular invasion (LVI), favorable clinical outcomes have been reported without additional therapy [&lt;span&gt;1, 3-7&lt;/span&gt;]. However, in cases with submucosal invasion or LVI, the risk of metastasis or recurrence is considered high, and additional treatment is generally recommended. Consequently, esophagectomy or chemoradiation therapy (CRT) is commonly performed, both of which have demonstrated favorable clinical outcomes [&lt;span&gt;8&lt;/span&gt;]. Nevertheless, accurate data regarding the rate of metastasis or recurrence in patients who do not receive additional treatment remain lacking.&lt;/p&gt;&lt;p&gt;Treatment strategies have previously been guided by lymph node (LN) metastasis rates based on the depth of invasion diagnosed in surgical pathology specimens and the evaluation of metastasis in dissected LNs during esophagectomy. However, surgical specimens are typically sectioned at 5-mm intervals, whereas ER specimens are processed at 2-mm intervals. This discrepancy in tissue processing leads to a potential underestimation of invasion depth in surgical cases, resulting in an overestimation of metastasis risk. For instance, the reported LN metastasis rate for pT1a-MM lesions in surgical cases was 14.6% (95% CI: 10.0–20.3), whereas ER cases show a considerably lower rate of 5.6% (95% CI: 2.9–9.5) [&lt;span&gt;1&lt;/span&gt;]. These differences have gradually become more apparent, and the metastasis rate based on ER specimens has emerged as a necessary metric for clinical decision-making.&lt;/p&gt;&lt;p&gt;What is the ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338197","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 Plastic Stent With an Integrated Delivery System for Endoscopic Transpapillary Gallbladder Stenting: A Preliminary Feasibility Study (With Video)","authors":"Kazunari Nakahara,&nbsp;Takao Itoi,&nbsp;Junya Sato,&nbsp;Yosuke Igarashi,&nbsp;Yusuke Satta,&nbsp;Akihiro Sekine,&nbsp;Haruka Niwa,&nbsp;Yu Matsuda,&nbsp;Shintaro Kamimukai,&nbsp;Shinjiro Kobayashi,&nbsp;Keisuke Tateishi","doi":"10.1111/den.70053","DOIUrl":"10.1111/den.70053","url":null,"abstract":"<div>\u0000 \u0000 <p>A novel plastic stent with an integrated delivery system specifically designed for endoscopic transpapillary gallbladder stenting (EGBS) was developed. The novel stent system comprises a stent body, an inner catheter, and a pushing catheter. The stent and pusher catheter are integrated, thereby making it possible to pull back the stent. Further, it fits the anatomical shape after placement in the gallbladder as it has a curved shape. The current study evaluated the feasibility and outcomes of EGBS using the novel stent. This retrospective study analyzed the clinical data of 24 consecutive patients who underwent EGBS using the novel stent between April 2023 and March 2025. The technical success rate of stent insertion was 95.8%. In the technically successful EGBS cases, the clinical success rate for acute cholecystitis was 94.7%. The early adverse event (AE) rate was 4.2%, with only one patient presenting with Mallory–Weiss syndrome. During a mean follow-up period of 211 days, the late AE rate in the 20 patients with permanent stent placement was 10%. The late AEs included acute pancreatitis (<i>n</i> = 1) and gallbladder perforation (<i>n</i> = 1). Acute pancreatitis improved with stent removal, and gallbladder perforation resolved with additional percutaneous transhepatic gallbladder drainage. There were no cases of recurrent cholecystitis or stent migration during the follow-up period. In conclusion, the newly developed stent is feasible for EGBS and can achieve good clinical outcomes.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338164","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":"Tracheo-Esophageal Fistula Closure Using an “ESD-Flap”","authors":"Amani Beshara,&nbsp;Dorian Carpentier,&nbsp;Arnaud Lemmers","doi":"10.1111/den.70049","DOIUrl":"10.1111/den.70049","url":null,"abstract":"<p>Endoscopic treatment of tracheoesophageal fistulas (TEFs) remains challenging. Conventional techniques, such as stenting, clips, macroclips, and fibrin glue, have shown limited success, with closure rates below 50%. Cardiac septal occluders have shown more promising results, with reported success rates of up to 77.7% [<span>1</span>]. Endoscopic submucosal dissection (ESD)–based flap closure has emerged as a novel approach, demonstrating &gt; 80% success in limited case reports. Variations include (a) total fistulectomy before mechanical closure [<span>2</span>], (b) use of a traction line for flap manipulation [<span>3</span>], (c) closure with endoloop and clips [<span>4</span>], and (d) pedicle or free mucosal flap transplantation [<span>5</span>].</p><p>We treated a 38-year-old male with a history of type C esophageal atresia, early repaired surgically in infancy. His postoperative course had been complicated by esophageal stricture, managed with balloon dilatations. He was referred for evaluation of worsening cough and recurrent respiratory infections. A barium swallow revealed a short tracheobronchial fistula (Figure 1a). Under general anesthesia, we performed an ESD-based closure. Gastroscopy revealed a 5 mm fistula orifice at 20 cm from the dental arches, 2 cm above the esophago-esophageal anastomosis (Figure 1b). Following submucosal lifting with glycerol, a circumferential incision was made 1 cm from the fistula using a 1.5 mm dual knife. An apple-core-shaped flap was created, dissecting close to the muscularis propria, 5 mm from the fistula. Argon plasma coagulation was applied to ablate neoepithelium. The flap was grasped with an endoloop and secured with four clips to ensure healing, two Olympus EZ clips 7 mm and two Lockado 16 mm (Figure 2a,b). No contrast extravasation was observed postprocedure (Figure 2c, Video S1).</p><p>The patient showed rapid clinical improvement, with resolution of cough and aspiration. He received peri and postprocedural antibiotics for 5 days. A 6-week follow-up barium swallow showed no residual fistula (Figure 2d). He remained symptom-free during 2 years of follow-up.</p><p>All authors substantially contributed to the concept and the design of the work, drafting, reviewing, and finally approved the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314121","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}