Digestive Endoscopy最新文献

{"title":"Tip-in gel immersion endoscopic mucosal resection with partial submucosal injection for a superficial nonampullary duodenal epithelial tumor on the duodenal angulus","authors":"Tomohiro Shimada,&nbsp;Yoshihide Kanno,&nbsp;Kei Ito","doi":"10.1111/den.14939","DOIUrl":"10.1111/den.14939","url":null,"abstract":"<p>Superficial nonampullary duodenal epithelial tumors (SNADETs) located on the inner side of the duodenal angulus are challenging to visualize and snare due to the intestinal flexure.<span>¹</span> Here, we report a case where gel immersion endoscopic mucosal resection (EMR), supplemented with partial submucosal injection (PI) on the lesion's anal side only for better lesion visualization,<span>¹</span> and tip-in EMR,<span>¹</span> which is the snare tip is inserted into the submucosa and fixed, appeared beneficial for a SNADET located on the duodenal angulus (Figs 1,2; Video S1).</p><p>The patient was a 44-year-old woman with a 20 mm flat elevated lesion with the protruded component on the lesion's anal side located on the inner side of the inferior duodenal angulus. The visibility of the lesion's anal border was obscured by its protruded component and location, making it difficult to fix the snare tip position with underwater EMR. Thus, after filling the duodenum with a gel product (VISCOCLEAR; Otsuka Pharmaceuticals Factory, Tokyo, Japan), 8 mL of 0.4% sodium hyaluronate (MucoUp; Boston Scientific, Tokyo, Japan) with indigo carmine was partially injected on the lesion's anal side only, and the snare (SD-16U-1; Olympus, Tokyo, Japan) was deployed at the tip and fixed in the submucosa by tip-in at the same site. In this state, by pulling out the scope while opening the snare, and then strangulating, the lesion was resected en bloc using an electrosurgical unit (VIO300D; ERBE Electromedizin, Tuebingen, Germany; settings Endocut Q: effect, 2; duration, 2; interval, 2; forced coagulation, effect, 2; power, 20 W) without shifting the snare tip.</p><p>Although other resection methods may be considered for laterally spreading SNADETs much larger than 20 mm,<span>³</span> the combination of PI and the tip-in technique may enable simpler and more effective endoscopic resection, even for relatively large SNADETs (~20 mm) with poor visibility located on the inner side of the duodenal angulus.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"209-210"},"PeriodicalIF":5.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14939","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523765","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 ultrasound-assisted removal of an intrahepatic bile duct stone","authors":"Saburo Matsubara,&nbsp;Kentaro Suda,&nbsp;Sumiko Nagoshi","doi":"10.1111/den.14937","DOIUrl":"10.1111/den.14937","url":null,"abstract":"<p>A 41-year-old woman with a left hepatic duct stone underwent endoscopic retrograde cholangiography for stone extraction (Fig. 1a). An over-the-wire type 8 wire basket catheter (Medi-Globe GmbH, Rohrdorf, Germany) failed to catch the stone and rather pushed the stone deeper (Fig. 1b). Because several attempts for stone extraction with a sphincterotome or ultrafine balloon catheter (REN; Kaneka Medix, Osaka, Japan) were unsuccessful, endoscopic retrograde cholangiography combined with endoscopic ultrasound was planned instead of cholangioscopy unfit for nondilated ducts. In the second session, the stone in B2 was depicted from the stomach using a curved linear-array echoendoscope (EG-740UT; FUJIFILM, Tokyo, Japan). Following a puncture of B2 with a 22G needle (SonoTip Pro Control; Medi-Globe) and contrast injection (Fig. 2a), a 0.018 inch guidewire was inserted into the common bile duct. After insertion of a double lumen catheter with a 3.6F tip (Uneven Double Lumen Cannula; Piolax Medical Devices, Kanagawa, Japan) into B2 upstream of the stone, pushing the stone by the guidewire or saline through the second lumen of the catheter was attempted without success. Then an endoscopic introducer (EndoSheather; Piolax Medical Devices) composed of a tapered inner catheter and large-bore outer sheath was inserted into the bile duct upstream of the stone. After removal of the guidewire and inner catheter, the stone was successfully moved to the hilum by flushing with saline through the outer sheath (Fig. 2b). Stone removal was finally accomplished after changing the scope to a duodenoscope without adverse events (Fig. 2c; Video S1). Endoscopic removal of intrahepatic bile duct stones is often challenging because of the difficulty of advancing extraction devices beyond the stone.<span>¹</span> Although the use of a sphincterotome<span>²</span> or ultrafine balloon catheter<span>³</span> has been reported, they did not work in the present case. This endoscopic ultrasound-assisted procedure for left intrahepatic bile duct stones may be a useful option when transpapillary attempts have failed.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"204-205"},"PeriodicalIF":5.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14937","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514058","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 technique “short myotomy” during endoscopic submucosal dissection for a diverticulum-associated colonic lesion","authors":"Ryosuke Kobayashi,&nbsp;Kingo Hirasawa,&nbsp;Shin Maeda","doi":"10.1111/den.14941","DOIUrl":"10.1111/den.14941","url":null,"abstract":"<p>While endoscopic submucosal dissection (ESD) for colorectal tumors is widely accepted,<span>^{1, 2}</span> ESD for tumors involving a diverticulum is still challenging and associated with a high risk of perforation due to the absence of the muscularis propria. Additionally, during the procedure there is a risk of damage to the specimen or interruption of ESD, given an insufficient plane in the submucosal layer within the diverticulum. Therefore, we report the tips of ESD including the novel technique named “short myotomy” for a diverticulum-associated lesion to resolve this problem (Video S1, Fig. 1). The lesion was located on the dorsal side of the ascending colon. A procedure was performed with the patient under conscious sedation and using carbon dioxide insufflation. A small-caliber transparent hood (DH-29CR; Fujifilm, Tokyo, Japan) was attached to the tip of an endoscope, and a 1.5 mm Dual knife (KD650Q; Olympus, Tokyo, Japan) was the surgical device used. After completing the circumferential mucosal incision, a submucosal dissection was made. The water pressure technique was applied for dissecting the submucosa with the multiloop device.<span>^{3, 4}</span> When getting into the diverticulum, the dissection plane was narrow between the muscle layers and the specimen (Fig. 2a). Then, the incision of muscle layers in front of the diverticulum was made to create a dissection plane to go below the diverticulum (Fig. 2b,c). This short myotomy enabled the precise excision below the diverticulum (Fig. 2d). The lesion was resected in one piece without specimen damage. The ulcer bed including the diverticulum was completely closed with endoscopic clips. An abdominal computed tomography scan immediately after ESD showed no extraluminal air. The patient was discharged on postoperative day 3. The histopathological diagnosis indicated intramucosal cancer with negative margins. The short myotomy is a novel technique in addition to existing methods, which allows for secure ESD for complete resection and a time-saving procedure.</p><p>Authors declare no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Reviewer Board: This study was approved by the Ethics Committee of Yokohama City University Medical Center.</p><p>Informed Consent: N/A.</p><p>Registry and the Registration No. of the study/trial: N/A.</p><p>Animal Studies: N/A.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"211-213"},"PeriodicalIF":5.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14941","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514059","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":"Elevating standards: Training and quality metrics in interventional endoscopic ultrasound","authors":"Dongwook Oh,&nbsp;Tae Jun Song","doi":"10.1111/den.14947","DOIUrl":"10.1111/den.14947","url":null,"abstract":"&lt;p&gt;In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Miutescu and Dhir present an in-depth review of the training and quality indicators essential for proficiency in interventional endoscopic ultrasound (iEUS).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The transformation of EUS from a diagnostic tool to a therapeutic one necessitates specialized training to ensure efficacy and safety in various interventional procedures.&lt;/p&gt;&lt;p&gt;Performing iEUS procedures requires high technical skill and expertise. Therefore, selecting candidates with the appropriate background and qualities is crucial for advancing the field of iEUS. The selection of candidates should be based on a solid foundation in gastroenterology, demonstrated interest, and prior experience in endoscopic procedures.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; This foundational expertise is pivotal, as it allows candidates to transition more effectively into the complexities of iEUS.&lt;/p&gt;&lt;p&gt;Acquiring theoretical knowledge is a foundational step in training for iEUS. This phase encompasses a deep understanding of gastrointestinal and adjacent organ anatomy, pathology, and specific EUS techniques.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Trainees should be well-versed in using various echoendoscopes and EUS devices, which is critical for the practical interpretation and execution of procedures. A structured syllabus that includes simulation models and virtual reality enhances this theoretical foundation, enabling trainees to develop the competence needed for advanced EUS procedures. Prior experience in diagnostic EUS and other imaging techniques, like transabdominal ultrasonography, can significantly shorten the learning curve and enhance procedural proficiency.&lt;/p&gt;&lt;p&gt;One of the critical challenges of training iEUS is the lack of standardization in training programs and quality metrics. The variability in training approaches across institutions can lead to inconsistencies in skill levels among practitioners, potentially impacting patient care. To address this, the authors advocate establishing universally accepted training standards and quality indicators. Such standardization would ensure that all practitioners meet the same high standards, leading to consistent and high-quality care globally. The average advanced endoscopy trainee needs a minimum of 225 EUS procedures to achieve core competence, with an ~50% greater number of procedures required in some cases.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; European Society of Gastrointestinal Endoscopy Guidelines recommend a minimum of 250 supervised EUS procedures, including specific numbers for different lesion types, to evaluate competence and key performance measures that should be recorded and evaluated.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; There are several proposed programs to accumulate practical knowledge in iEUS, including conferences, case studies with detailed procedural walkthroughs on various platforms, specialized online courses, World Endoscopy Organization's International School of EUS, and the Educational Program o","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"51-52"},"PeriodicalIF":5.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14947","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482277","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":"Afferent loop syndrome following pancreatic head cancer surgery treated with metal stent placement using a short-type single-balloon enteroscope","authors":"Noriyuki Hirakawa,&nbsp;Katsuya Kitamura,&nbsp;Takao Itoi","doi":"10.1111/den.14936","DOIUrl":"10.1111/den.14936","url":null,"abstract":"<p>Afferent loop syndrome is a rare complication that occurs following reconstructive intestinal tract surgery as a result of postoperative adhesions or peritoneal dissemination due to recurrence. Obstruction of the afferent loop can be fatal, and often requires surgical treatment. However, patients who develop afferent loop syndrome due to recurrence of malignancy are often in poor general health, making surgery invasive.<span>¹</span> With the development of balloon-assisted enteroscopy, there have been reports of these patients being treated endoscopically.<span>^2-5</span></p><p>The patient was a 74-year-old woman who underwent subtotal stomach-preserving pancreaticoduodenectomy for pancreatic head cancer. She was found to have multiple liver metastases on contrast-enhanced computed tomography (CT) 3 years after surgery. While receiving chemotherapy for recurrence of pancreatic head cancer, she presented with fever and abdominal pain. Contrast-enhanced CT led to a diagnosis of afferent loop syndrome caused by peritoneal dissemination. Conservative treatment was unsuccessful (Fig. 1a). Therefore, we decided to treat the afferent loop syndrome by drainage using a short-type single-balloon enteroscope (s-SBE) with a working channel diameter of 3.2 mm (SIF-H290S; Olympus Medical, Tokyo, Japan). We advanced the s-SBE and identified the stenotic area in the afferent loop. We traversed the stenosis with a catheter and guidewire, advancing the guidewire into the dilated bowel (Fig. 1b). In view of elevated inflammatory markers, a nasobiliary drainage tube was placed in the afferent loop (Fig. 2a). When the patient's condition improved, we placed a metal stent at the stricture site using the s-SBE. The s-SBE was advanced to the site of the stricture via the nasobiliary drainage tube. A 22 mm × 15 cm duodenal metal stent with a caliber of 3.0 mm (uncovered Niti-S stent; Taewoong Medical, Seoul, South Korea) was placed in the stenotic area, and patency was confirmed with contrast medium (Fig. 2b, Video S1). There were no postprocedural complications.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"202-203"},"PeriodicalIF":5.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14936","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482276","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":"New milestone for clinical research about biliary drainage","authors":"Atsushi Kanno,&nbsp;Hironori Yamamoto","doi":"10.1111/den.14934","DOIUrl":"10.1111/den.14934","url":null,"abstract":"&lt;p&gt;Endoscopic bile duct stenting has been the first-line treatment for bile duct obstruction, regardless of resectability or benign/malignant status,&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt; although the criteria for evaluating the outcome of bile duct stents have not been adequately explored. For example, since the definition of stent occlusion varied across different articles, a meta-analysis of bile duct stent outcomes was summarized as stent dysfunction in terms of results. Furthermore, while stent occlusion due to tumor invasion was the main stent dysfunction in the case of inserted plastic stents or uncovered self-expandable metallic stents (SEMS), the advent of covered SEMS has made it necessary to consider stent migration or dislocation as a stent dysfunction.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; In this context, a need existed for common definitions regarding procedure-related early outcomes for stents, outcomes of stents during follow-up, and adverse events. Previous TOKYO criteria defined terms associated with the technical and clinical success of biliary stenting, recurrent biliary obstruction (RBO) and related factors, and adverse events.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Technical success was defined as the ability of the stent to adequately bypass the planned bile duct stenosis site, and clinical success was defined as a normal or 50% reduction in total bilirubin levels within 14 days of stent placement. In addition, RBO was defined as an outcome measure, including occlusion or deviation, used to assess the duration of stent function from the date of stent placement. An important aspect of RBO was that it focused on symptoms rather than stent patency alone. The time of symptom recurrence due to stent occlusion or deviation was specified as the time of onset of RBO, and this time point was to be used for assessment. The causes of obstruction of the RBO, such as internal growths associated with tumor growth, tumor growths on the edge of the stent, biliary debris or food residues, the direction of stent dislocation or migration (intrahepatic bile duct or duodenal papillary side), and whether pancreatitis or cholecystitis was present, were to be described separately. In addition, items on survival and contingencies other than RBOs have been created and described uniformly to provide an overall clinical picture from the results of clinical studies.&lt;/p&gt;&lt;p&gt;The progress of biliary drainage over the past decade has been so rapid that it has become increasingly difficult to cover it in the previous TOKYO criteria. For example, balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) for cases with altered anatomy has become widely used.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; In ERCP for patients with altered anatomy, the rate of reach to the bile duct orifice should be included in the assessment of technical success.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; Endoscopic ultrasound-biliary drainage (EUS-BD) is also widely recognized as a common procedure. It does not bypass the bil","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1211-1212"},"PeriodicalIF":5.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14934","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482278","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":"WEO Newsletter: Tips and Tricks for Endoscopic Ultrasound guided Celiac Plexus interventions","authors":"","doi":"10.1111/den.14935","DOIUrl":"10.1111/den.14935","url":null,"abstract":"&lt;p&gt;WEO Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES&lt;/p&gt;&lt;p&gt;&lt;b&gt;Dr. Sridhar Sundaram&lt;/b&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;MD, DM, FISG&lt;/b&gt;&lt;/p&gt;&lt;p&gt;Present Designation:&lt;/p&gt;&lt;p&gt;Professor (Gastroenterology), Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai&lt;/p&gt;&lt;p&gt;Consultant- GI Disease Management Group, Tata Memorial Hospital, Mumbai&lt;/p&gt;&lt;p&gt;Governing Council Member – Indian Society of Gastroenterology&lt;/p&gt;&lt;p&gt;Member – ESGE Diversity and Equity Working Group&lt;/p&gt;&lt;p&gt;Managing Editor – Indian Journal of Gastroenterology&lt;/p&gt;&lt;p&gt;Member – India EUS Club&lt;/p&gt;&lt;p&gt;Primary areas of interest: Therapeutic Endoscopic Ultrasound, Endoscopic Resection techniques for early GI cancer&lt;/p&gt;&lt;p&gt;Abdominal pain due to perineural invasion is one of the most debilitating symptoms associated with pancreaticobiliary cancers. In addition, pain remains one of the most complex symptoms associated with chronic pancreatitis needing intervention (&lt;span&gt;1&lt;/span&gt;). Pain from upper abdominal viscera is transmitted via the afferent pathway to the celiac plexus leading into the spinal cord at the T12-L2 level. The efferents from the celiac plexus consists mainly of sympathetic fibres of a network of interconnected para-aortic ganglia, including those at the level of the celiac axis, superior mesenteric artery origin and also renal artery. In addition, parasympathetic efferents of the celiac plexus come from the vagus nerve (&lt;span&gt;2&lt;/span&gt;). Traditionally celiac plexus block was performed as an intraoperative ablative procedure. Subsequently fluoroscopy guided celiac plexus interventions were performed. Endoscopic Ultrasound guided celiac plexus block (CPB) was first described in 1996 and has now become the standard of care (&lt;span&gt;3&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Chronic pancreatitis patients with pain not responding to conventional measures like pancreatic enzyme replacement, antioxidants, non-narcotic and narcotic medications may be candidates who may benefit in short term from CPB. However, the caveat remains that block provides temporary relief and may be an adjunct to other modalities. Celiac plexus neurolysis (CPN) is recommended only in the setting of inoperable pancreatic cancer. In cases of operable pancreatic cancer, neurolysis may lead to scarring the operative field, thereby making surgery technically more challenging. Most patients who do not respond to conventional opioids or require significantly higher doses with adverse events are candidates to consider CPN (&lt;span&gt;4&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;CPB is typically for patients with pain not responding to analgesics and can be repeated at 3–6 months intervals. As pain becomes chronic, response to CPB is likely to be lesser, considering formation of neural feedback loops with cerebral pain conditioning. In patients with pancreatic cancer, pain responds better earlier in the course of disease to CPN. As disease progresses and pain persists, the neural pathways become less responsive and efficacy of CPN reduce","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1185-1189"},"PeriodicalIF":5.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14935","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402208","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":"Is endoscopic ultrasound-guided gastroenterostomy better than surgical gastrojejunostomy or duodenal stenting?","authors":"Anthony Yuen Bun Teoh,&nbsp;Shannon Melissa Chan,&nbsp;Hon Chi Yip","doi":"10.1111/den.14929","DOIUrl":"10.1111/den.14929","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Gastrojejunostomy is a critical procedure for managing gastric outlet obstruction. While surgical gastrojejunostomy has traditionally been the standard approach, endoscopic ultrasound (EUS)-guided gastroenterostomy has emerged as a promising endoscopic alternative. This comprehensive review aims to explore the development, techniques, outcomes, and comparative effectiveness of EUS-guided gastroenterostomy in comparison to duodenal stenting and surgical gastrojejunostomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search was conducted using electronic databases to identify relevant studies published up to April 2024. The search included keywords related to EUS-guided gastrojejunostomy, surgical gastrojejunostomy, and duodenal stenting. Studies reporting on technical success, clinical success, complications, recurrence rates, quality of life, and long-term outcomes were included for analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The development of EUS-guided gastroenterostomy has evolved significantly over the years, driven by device advancements and improved endoscopic techniques. Comparative studies have shown that the technique offers several advantages, including the ability to create an anastomosis without the need for surgery, reduced invasiveness, shorter hospital stays, and potentially improved patient outcomes as compared to duodenal stenting and surgical gastrojejunostomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided gastroenterostomy represents a promising alternative to surgical gastrojejunostomy and duodenal stenting for the management of gastric outlet obstruction. The technique has evolved significantly, offering a less invasive and more effective treatment option.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"77-84"},"PeriodicalIF":5.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382615","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":"Proposal of classification and terminology of interventional endoscopic ultrasonography/endosonography","authors":"Hiroyuki Isayama,&nbsp;Yousuke Nakai,&nbsp;Koji Matsuda,&nbsp;Yoshihide Kanno,&nbsp;Kazuo Hara,&nbsp;Takeshi Ogura,&nbsp;Nobutsugu Abe,&nbsp;Akio Katanuma,&nbsp;Masayuki Kitano,&nbsp;Ichiro Yasuda,&nbsp;Naoki Okano,&nbsp;Takayoshi Tsuchiya,&nbsp;Naotaka Fujita,&nbsp;Kazuo Inui,&nbsp;Toshiharu Ueki,&nbsp;Atsushi Irisawa,&nbsp;Hiro-o Yamano,&nbsp;The Subcommittee for Terminology of Interventional EUS of Japan Gastroenterological Endoscopy Society","doi":"10.1111/den.14927","DOIUrl":"10.1111/den.14927","url":null,"abstract":"<p>Interventional endoscopic ultrasonography/endosongraphy (I-EUS) procedures have rapidly evolved since their introduction three decades ago; however, the classification and terminology for these procedures remain unstandardized. To address this, the Subcommittee for Terminology of I-EUS in the Japan Gastroenterological Endoscopy Society was established to define classifications and a glossary of I-EUS terms. They categorized I-EUS procedures into five types based on purpose and method: (i) EUS-guided sampling; (ii) EUS-guided through-the-needle examination; (iii) EUS-guided drainage/anastomosis (EUS-D/A); (iv) trans-endosonographically/EUS-guided created route (ESCR) procedures; and (v) EUS-guided delivery. EUS-guided sampling includes tissue acquisition and fluid sampling, classified by needle type into fine needle aspiration and fine needle biopsy. Through-the-needle examinations include imaging, measurements, and biopsies. EUS-D/A includes organ drainage/anastomosis, fluid collection drainage, and digestive tract anastomosis. In the EUS-D/A route, “anastomosis” is used for organ-to-organ procedures, whereas “tract” is for fluid drainage. ESCR is a newly proposed term for procedures via anastomosis or tract, such as endoscopic necrosectomy and EUS-guided antegrade stenting. The term “trans-luminal drainage/anastomosis stent” is used for stents that maintain the ESCR rather than treating strictures. EUS-guided delivery involves the delivery of substances, such as fluids, drugs, medical devices, and energy. This proposed categorization and terminology aimed to clarify I-EUS procedures and will require updates as new techniques and concepts emerge.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"5-17"},"PeriodicalIF":5.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14927","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373690","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":"Snare-assisted clipping method for closure of mucosal incision of gastric peroral endoscopic myotomy","authors":"Niroshan Muwanwella","doi":"10.1111/den.14930","DOIUrl":"10.1111/den.14930","url":null,"abstract":"<p>Gastric peroral endoscopic myotomy (G-POEM) is an emerging treatment modality for gastroparesis. This technique involves mucosal incision, submucosal tunneling, and pyloric myotomy followed by closure of the mucosal incision.</p><p>There are multiple closure methods described in the literature, including through-the-scope (TTS) clips,<span>¹</span> over-the-scope clips, and endoscopic suturing.<span>²</span> TTS clips are the easiest and most economical of the above methods. However, mucosal closure after G-POEM with TTS clips can by difficult due to the thicker gastric mucosa and widening of the mucosal entry site, resulting in difficulty of apposition of mucosal edges.</p><p>Clip and snare traction is well described in the literature to assist endoscopic submucosal dissection.<span>³</span> An internal traction method has been previously described for full-thickness mucosal defect closure.<span>⁴</span></p><p>I describe an adaptation of the above methods to assist clip deployment for mucosal closure.</p><p>Once the myotomy is complete, the scope is withdrawn and a snare is attached to the end of the scope by closing the snare over the distal attachment cap. Then the scope is reinserted and a TTS clip is closed just distal to the distal edge of the mucosal incision. Prior to full deployment of the clip, the snare is opened to disengage from the scope and closed over the stem of the clip.</p><p>The snare is then used to apply gentle traction to pull the mucosa upwards, creating a mucosal “tent.” The next clip is then deployed, closing the mucosal edges together. Another clip is then introduced through the channel and is used to transfer the snare to the stem of the last deployed clip. This process is repeated until the mucosal incision is completely closed. In this case, the final clip is deployed without the assistance of the snare.</p><p>This case illustrates a novel method of gastric mucosal incision closure using inexpensive, widely available devices.</p><p>Author declares no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Review Board: N/A.</p><p>Informed consent: Informed consent was obtained from the patient to publish deidentified endoscopic images and videos.</p><p>Registry and the registration no. of the study/trial: N/A.</p><p>Animal studies: N/A.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1388"},"PeriodicalIF":5.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14930","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333703","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}