Digestive Endoscopy最新文献

{"title":"Metal stent versus plastic stent in endoscopic ultrasound-guided hepaticogastrostomy for unresectable malignant biliary obstruction: Large single-center retrospective comparative study","authors":"Daiki Yamashige,&nbsp;Susumu Hijioka,&nbsp;Yoshikuni Nagashio,&nbsp;Yuta Maruki,&nbsp;Yasuhiro Komori,&nbsp;Masaru Kuwada,&nbsp;Soma Fukuda,&nbsp;Shin Yagi,&nbsp;Kohei Okamoto,&nbsp;Daiki Agarie,&nbsp;Mark Chatto,&nbsp;Chigusa Morizane,&nbsp;Hideki Ueno,&nbsp;Shunsuke Sugawara,&nbsp;Miyuki Sone,&nbsp;Yutaka Saito,&nbsp;Takuji Okusaka","doi":"10.1111/den.14956","DOIUrl":"10.1111/den.14956","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Whether metal stents (MS) or plastic stents (PS) yield better outcomes for malignant biliary obstruction in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is controversial. We aimed to compare outcomes of initial EUS-HGS performed with MS or PS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method<b>s</b></h3>\u0000 \u0000 <p>In this single-center retrospective study, we included patients (MS/PS groups: <i>n</i> = 151/72) with unresectable malignant biliary obstruction and performed multivariable analysis. The landmark date was defined as day 100 and used to evaluate the time to recurrent biliary obstruction (TRBO).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The clinical success rate was similar in both groups. The mean total bilirubin percentage decrease at week 2 was significantly higher in the MS group than in the PS group (−45.1% vs. −23.7%, <i>P</i> = 0.016). Median TRBO was significantly different between the MS and PS groups (183 and 92 days, respectively; <i>P</i> = 0.017). TRBO within 100 days was comparable in both groups but was significantly shorter only after 100 days in the PS group (adjusted hazard ratio 12.8, <i>P</i> &lt; 0.001). Adverse events were significantly more common in the MS group (23.8% vs. 9.7%, <i>P</i> = 0.012), although they occurred relatively frequently even with PS in the cholangitis subgroup (<i>P</i>_interaction = 0.034). After endoscopic re-intervention, TRBO tended to be longer with revision PS (hazard ratio 0.40, <i>P</i> = 0.47).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although MS provided early improvement of jaundice and long stent patency, PS provided a better safety profile and comparable stent patency until 100 days. PS might also be an adequate and optimal palliation method in EUS-HGS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"117-129"},"PeriodicalIF":5.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633886","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":"Site of puncture in endoscopic ultrasound-guided fine needle biopsy: Does it change diagnostic outcome?","authors":"Chandramauli Mishra,&nbsp;Suprabhat Giri","doi":"10.1111/den.14965","DOIUrl":"10.1111/den.14965","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"200"},"PeriodicalIF":5.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633890","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":"Successful diagnosis of small gastrointestinal stromal tumor using modified mucosal incision-assisted biopsy with a cold snare","authors":"Yoshitaka Ando,&nbsp;Toshiyuki Sakurai,&nbsp;Masayuki Saruta","doi":"10.1111/den.14955","DOIUrl":"10.1111/den.14955","url":null,"abstract":"<p>Gastric subepithelial lesions (G-SELs), including malignant conditions like gastrointestinal stromal tumors (GISTs), require biopsy for diagnosis.<span>¹</span> The European Society of Gastrointestinal Endoscopy guidelines recommend mucosal incision-assisted biopsy (MIAB) as the first choice for small SELs (≤20 mm),<span>²</span> despite its association with complications such as postoperative bleeding and perforation.<span>³</span> In 2020, Zimmer and Eltze<span>⁴</span> presented a modified MIAB using a cold snare to expose G-SELs. Modified MIAB allows for more reliable tissue sampling than boring biopsy by exposing a larger area of the tumor, but it can increase immediate bleeding due to the absence of electrocautery. Despite this, it avoids thermal damage to tissue samples, reduces the risk of delayed complications, and usually avoids hospitalization. However, to our knowledge, only one retrospective study has reported on this method, limited to benign conditions.<span>⁵</span> Here, we report the first case of small GIST successfully diagnosed using modified MIAB (Video S1).</p><p>The G-SEL in the mid-body lesser curvature originated from the muscularis propria layer, measuring 18.1 mm on endoscopic ultrasound (Fig. 1a,b). The covering mucosa was bluntly resected with a thin-wire snare to a size equal to or at least half of the tumor diameter, and submucosal tissue was extracted several times with biopsy forceps (Fig. 1c,d). Once the G-SEL surface became irregular and adequately exposed, three biopsies were performed using biopsy forceps (Fig. 1e). If the tumor is a high-grade GIST, tumor exposure during open laparoscopic and endoscopic cooperative surgery risks peritoneal dissemination, so mucosal defects were clipped (Fig. 1f). All three biopsy procedures yielded c-kit positive tumor tissue, sufficient for a definitive histological diagnosis (Fig. 2). The procedure took 9 min, without complications.</p><p>This report indicates that modified MIAB with cold snare is effective for the histological diagnosis of GISTs and may be performed more quickly than existing methods.</p><p>Authors declare no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Reviewer Board: This procedure and case report were approved by the Ethics Committee of Atsugi City Hospital.</p><p>Informed Consent: Informed consent was obtained from the patient after verbally explaining the purpose, method, safety considerations, and risks of the procedure.</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 3","pages":"308-310"},"PeriodicalIF":5.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14955","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607717","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: Evaluation and Endoscopic Management of Disconnected Pancreatic Duct Syndrome","authors":"","doi":"10.1111/den.14960","DOIUrl":"10.1111/den.14960","url":null,"abstract":"<p>WEO Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES</p><p>Surinder Singh Rana MD, D.M, FAMS, AGAF, FASGE, Master ISG, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India</p><p>Dr. Surinder Rana is a Professor of Gastroenterology at the Post Graduate Institute of Medical Education and Research, which is a premier Medical Education Institute in India. Dr. Rana has over 500 publications in peer-reviewed journals. He is a well-known researcher, endoscopist and educator who is involved in several international and national educational conferences and endoscopy workshops.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1292-1294"},"PeriodicalIF":5.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14960","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607718","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 closure using SureClip Traction Band for delayed perforation after colorectal endoscopic submucosal dissection","authors":"Reo Kobayashi,&nbsp;Naohisa Yoshida,&nbsp;Ken Inoue","doi":"10.1111/den.14938","DOIUrl":"10.1111/den.14938","url":null,"abstract":"<p>Delayed perforation (DP) is reported to occur in 0.1–0.4% of colorectal endoscopic submucosal dissection (ESD).<span>^{1, 2}</span> DP can be fatal due to peritonitis and most cases of colorectal DP result in surgery. Various endoscopic closures after ESD are reported for preventing DP.<span>^{3, 4}</span> However, few reports showed the success of endoscopic closure for DP.<span>⁵</span> In this report, we present a case of DP closed with SureClip Traction Band (SCTB; Micro-Tech Co., Nanjing, China). The patient was a 61-year-old woman. She took prednisolone 10 mg/day for Wegener's granulomatosis. A polypoid lesion of 25 mm was detected in the transverse colon (Fig. 1a). En bloc resection was performed with ESD. The ESD defect was closed using MANTIS Closure Device (Boston Scientific, Marlborough, MA, USA) and SureClip (Micro-Tech Co.), considering the negative impact of prednisolone for would healing (Fig. 1b,c). However, tight complete closure was not achieved due to difficult operability. On the day after ESD, the patient presented abdominal pain and computed tomography (CT) showed free air (Fig. 1d). Because of the localized peritonitis, we decided to close it endoscopically. Although no perforation was found, we performed additional closure with SureClip (Fig. 1e,f). However, 3 days after ESD, free air increased with CT (Fig. 2a). Endoscopic closure was performed again and contrast medium leakage was observed (Fig. 2b). The ulcer base was hard and previous clips remained, making closure difficult. Normal mucosa at the edge of the ulcer on the anal side was captured with SCTB. Then the band was gripped with SureClip and deployed at the oral side of the ulcer for closing the ESD defect. Finally, complete closure could be performed with additional SCTB and SureClip (Fig. 2c–f, Video S1). The patient was discharged 11 days after ESD.</p><p>Author N.Y. had a grant from Fujifilm and received a lecture fee from Fujifilm. The other authors have no conflicts of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"206-208"},"PeriodicalIF":5.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14938","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570457","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":"Peroral digital cholangioscopy-assisted removal of a migrated biliary plastic stent using a novel small dilating balloon","authors":"Noriyuki Hirakawa,&nbsp;Shuntaro Mukai,&nbsp;Takao Itoi","doi":"10.1111/den.14950","DOIUrl":"10.1111/den.14950","url":null,"abstract":"<p>Biliary plastic stent (PS) migration is occasionally encountered during endoscopic retrograde cholangiopancreatography-related procedures.<span>¹</span> Several removal techniques for migrated stent have been reported.<span>^2-4</span> However, some cases are challenging even with these techniques. Here, we describe a case of successful peroral digital cholangioscopy-assisted removal of a migrated PS using a novel small dilating balloon.</p><p>The patient was a 74-year-old man who had undergone biliary drainage using a straight-type 7F PS for cholangitis because of a common bile duct stone at a previous hospital (Fig. 1a).</p><p>Stone removal was attempted in our hospital, but fluoroscopy showed that the PS had migrated into the bile duct (Fig. 1b). The stone was pushed toward the liver side and papillary balloon dilation was attempted, but this was difficult because of interference from the PS and stone. Therefore, removal of the migrated PS was attempted, first with grasping forceps under fluoroscopic guidance, but was unsuccessful because of the difficulty of grasping the PS. Removal using a basket was predicted to be difficult because of interference from the stone just above the papilla. Therefore, peroral digital cholangioscopy-assisted removal was attempted next. A digital cholangioscope (Spy DS; Boston Scientific, Natick, MA, USA) was inserted into the bile duct and visualized the migrated PS. Then, a 0.025 inch guidewire was passed through the stent's lumen under direct visualization (Fig. 2a). Subsequently, a novel small dilating balloon (3 mm × 6 cm, REN biliary dilation catheter; Kaneka Medix, Osaka, Japan) was inserted into the stent lumen<span>⁵</span> (Fig. 2b,c, Video S1). By inflating the balloon, crimping the balloon and the PS, and pulling back slowly, the migrated PS was successfully removed through-the-scope without interference from the balloon catheter or stone. The novel dilating balloon is longer than conventional versions, allowing for stronger crimping. Finally, the stone was removed and the procedure was completed.</p><p>Author T.I. received lecture fees from Kaneka Medix and Boston Scientific. The other authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"306-307"},"PeriodicalIF":5.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14950","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570465","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":"Complete endoscopic debridement combined with partial gastric wall resection successfully treated refractory esophago-gastric anastomotic fistula","authors":"Yajuan Li,&nbsp;Jiyu Zhang,&nbsp;Bingrong Liu","doi":"10.1111/den.14944","DOIUrl":"10.1111/den.14944","url":null,"abstract":"<p>A 59-year-old man presented with an esophagogastric anastomotic fistula following Ivor Lewis esophageal cancer resection. The Interventional Radiology Department treats patients with the new “three-tube” method, which involves the fluoroscopically guided transnasal placement of a sinus drainage tube, a nasogastric decompression tube, and a nasojejunal nutritional tube. However, after 6 months of treatment, his chest pain and fever had not improved, he was unable to eat orally, and pus was still coming out of the sinus drainage tube. Upper gastrointestinal radiography showed a fistula still present (Fig. 1a).</p><p>After he was transferred to our department, we decided to perform further treatment. Endoscopy showed plenty of pus in the upper gastrointestinal tract. After cleaning it up, we saw a large anastomotic fistula. Swollen mucosa covered the fistula and interfered with drainage, which was removed with a snare (Fig. 1b,c). A large amount of dense necrotic tissue in the fistula was removed by a hook knife (Fig. 1d,e). The gastric wall between fistula and gastric lumen was removed with a hook knife and a snare in order to open the fistula for adequate drainage (Fig. 1f). During the operation, coagulation forceps were used to stop the bleeding (Video S1). We placed a tube into the fistula, rinsed daily with 8000 mL of saline, a nasogastric tube for negative pressure drainage, and a nasojejunal tube for feeding. Two days later, endoscopy showed no pus in the fistula, and all tubes were removed. He was started on an oral liquid diet, and discharged.</p><p>Surveillance endoscopy after 1, 4, and 7 months (Fig. 2a–c) showed a good healing process. Then 17 months later, endoscopy and computed tomography showed complete healing of the fistula (Fig. 2d,e), and a weight gain of 9 kg during follow-up.</p><p>Overall, anastomotic fistula is a refractory disease, this case demonstrates that this method is safe and valid and deserves to be promoted.</p><p>Authors declare no conflict of interest for this article.</p><p>This work was supported by grants from Zhongyuan Talent Program (ZYYCYU202012113).</p><p>Approval of the research protocol by an Institutional Reviewer Board: N/A.</p><p>Informed Consent: Informed consent was obtained from the patient for the publication of their information and imaging.</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 3","pages":"302-303"},"PeriodicalIF":5.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14944","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570452","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":"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":"Water pressure method endoscopic submucosal dissection with clip traction for early gastric cancer with submucosal fibrosis","authors":"Ryosuke Ikeda,&nbsp;Hiroaki Kaneko,&nbsp;Shin Maeda","doi":"10.1111/den.14949","DOIUrl":"10.1111/den.14949","url":null,"abstract":"<p>Endoscopic submucosal dissection (ESD) is widely performed; however, difficult cases remain, and submucosal fibrosis is a risk factor for difficulty.<span>¹</span> Recently, the effectiveness of the clip traction and water pressure method (WPM) has been reported<span>^{2, 3}</span>; gastric ESD using WPM has also been reported.<span>^{4, 5}</span> We report a case of early gastric cancer with severe fibrosis that was successfully treated with WPM combined with clip traction (Video S1).</p><p>An 82-year-old man who had undergone curative resection of early gastric cancer on the anterior wall of the angulus 4 years ago was referred to our hospital with metachronous cancer adjacent to the ESD scar (Fig. 1a). ESD was performed under conscious sedation. A mucosal incision was performed using a dual knife and insulated-tip knife-2 (Olympus Medical Systems, Co., Tokyo, Japan); however, the anal side, which straddled the ESD scar, was poorly injected (Fig. 1b). After the mucosal incision, submucosal dissection was initiated from the anal side. However, severe fibrosis prevented sufficient formation of the mucosal flap, causing difficulty in visualizing the submucosal layer. Therefore, a small-caliber tip transparent hood (DH-28CR; Fujifilm, Tokyo, Japan) was attached and converted to underwater conditions. WPM temporarily visualized the submucosal layer; however, it was difficult to maintain (Fig. 2a,b). Hence, a clip (EZ clip, HX-610-090; Olympus Medical Systems, Co.) with a thread was attached to the mucosal flap adjacent to severe fibrosis because the fibrotic area had not sufficiently formed the mucosal flap for attaching the clip, allowing a clear view of the submucosal layer (Fig. 2c,d). We dissected the fibrotic submucosal layer and performed a curative en bloc resection with a negative margin.</p><p>WPM is useful for viewing the fibrotic submucosal layer; however, in this case, the combination of clip traction was more effective in maintaining the resection layer.</p><p>Authors declare no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Reviewer Board: N/A.</p><p>Informed Consent: Informed consent was obtained from the patient in this case report.</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 3","pages":"304-305"},"PeriodicalIF":5.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14949","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514060","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}