Digestive Endoscopy最新文献

{"title":"Beyond EFTR Versus LECS: Toward Risk-Adapted Management of Gastric Submucosal Tumors","authors":"Yoshinori Morita","doi":"10.1111/den.70304","DOIUrl":"10.1111/den.70304","url":null,"abstract":"<p>The management of gastric submucosal tumors (SMTs), particularly gastrointestinal stromal tumors (GISTs), is entering a new phase. Ando et al. provide the first direct comparison of endoscopic full-thickness resection (EFTR) and laparoscopic and endoscopic cooperative surgery (LECS) for gastric SMTs in Japan [<span>1</span>]. This comparison should be viewed against different regional paths of development. LECS is established in Japan, whereas extensive experience with exposed EFTR has accumulated in China [<span>2, 3</span>]. Europe and the United States have pursued a more device-driven path, including non-exposed “close-and-resect” EFTR and full-thickness endoscopic suturing systems [<span>2, 4</span>]. These approaches represent different solutions to the same challenge: achieving oncologically sound and mechanically reliable full-thickness resection while remaining minimally invasive.</p><p>After propensity score matching, 21 patients in each group were compared. Macroscopic complete resection was achieved in all patients, and there was no significant difference in the pathological R0 resection rate (91% for EFTR vs. 100% for LECS). EFTR required a substantially shorter procedure time (93 vs. 161 min) and fewer participating physicians (3 vs. 5), together with less blood loss, a shorter post-treatment hospital stay, and lower procedure-related and total hospitalization costs [<span>1</span>]. However, the study should not be interpreted as showing that EFTR is generally superior to LECS. The study included highly selected lesions 3 cm or smaller without ulceration and excluded extraluminal growth-type lesions, and EFTR was performed at expert centers by endoscopists with extensive endoscopic submucosal dissection (ESD) experience. Furthermore, whereas the EFTR group was treated in 2023–2024, the LECS group dated back to 2008, making temporal differences and residual selection bias unavoidable [<span>1</span>]. Costs were evaluated under different Japanese reimbursement schemes, without direct comparison of actual device costs; the reported cost advantage should therefore be interpreted cautiously.</p><p>The first question, therefore, may not be “EFTR or LECS?” but rather “Does this lesion actually need to be resected?” The updated Asian consensus guidelines recommend, in principle, obtaining a histological diagnosis before deciding on treatment, preferably by endoscopic ultrasonography-guided fine-needle aspiration or biopsy (EUS-FNA/FNB), and allow active surveillance for selected gastric GISTs smaller than 2 cm without apparent high-risk features [<span>5</span>]. Tumor characteristics, procedural risk, and patient preference should also be considered [<span>5</span>]. In clinical practice, patient age and comorbidities also influence whether surveillance or intervention is appropriate. Availability of minimally invasive treatment alone should not determine whether a small gastric SMT is resected. Preoperative EUS, tissue sampling, and ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119228","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 Papillary Large Balloon Dilation for Difficult Bile Duct Stones: A Powerful Tool, but Long-Term Vigilance Is Warranted","authors":"Yuki Tanisaka, Shomei Ryozawa","doi":"10.1111/den.70298","DOIUrl":"10.1111/den.70298","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119395","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":"Anti-Reflux Mucosectomy Intervention and the SECS Criteria","authors":"Marc Barthet","doi":"10.1111/den.70299","DOIUrl":"10.1111/den.70299","url":null,"abstract":"<p>In this <i>Digestive Endoscopy</i> issue, Yamamoto et al. present an article entitled “Efficacy and Safety of Closure-Focused Anti-Reflux Mucoplasty Compared With Conventional ARMS: A Propensity Score-Matched Study” [<span>1</span>]. ARMS and ARMA, which were developed as endoscopic procedures for managing gastro-esophageal reflux disease (GERD) since 12 years and pioneered by Inoue H, were compared to the so-called ARMP and ARMP-V [<span>1, 2</span>]. Before starting any commentaries in this Editorial, we have not to forget that ESGE guidelines about Endoscopic management of motility disorders, stated in 2020 “ESGE recommends against the use of Anti Reflux Mucosectomy (ARMS) in routine clinical practice in the treatment of GERD” [<span>3</span>]. However these ESGE guidelines were provided 6 years ago and it could be postulated that any endoscopic treatment for GERD should be analyzed according to the following criteria: Is it a procedure Simple, Efficient, Cost-effective and Safe, namely SECS criteria?</p><p>Yamamoto et al. included 251 patients in a retrospective study with propensity-score matching. These new techniques or improvement changed the concept of mucosectomy previously performed with EMR, ESD or plasma argon to mucoplasty [<span>1</span>]. With ARMP, a mucosal resection on the gastric side of the lesser curve with complete closure with either prong clips or suturing (which was more demanding) was done. The goal was to eliminate the so-called “dead space” below the esogastric junction. A “derivated procedure” was ARM-V where the authors were adding an uvula-like valve after mucosal resection by ESD to anchor a flap.</p><p>We can easily imagine that these improved techniques are clearly more demanding. This is confirmed by an increase of the procedure time from 49.3 mn to 74.6 mn. Moreover, by pooling the ARMS/ARMA results versus ARMP/ARMV results, they found similar postoperative quality of life (QOL) and no significant difference regarding the acid exposure-time (AET 35.1% vs. 45.7%). However, the ARMP/ARMV clearly decreased the rate of adverse events from 25.5% to 5.3%. One could say that the AEs rate in the group of ARMS/ARMA is very high compared to the rate in recent meta-analyses about 13%; the main symptom being dysphagia ranging from 5% to 16% [<span>4-6</span>].</p><p>Despite the authors not finding any difference regarding the efficacy of ARMP/ARMV, they highlight the interest of mini-invasive procedures for managing GERD [<span>1</span>]. GERD is a frequent GI disease with about 40% of patients that are only partial responders to PPI [<span>4, 5, 7</span>]. Therefore, patients with refractory GERD or PPI dependency with side-effects or contraindications could be candidates for these noninvasive procedures that we could call ARMI for anti-reflux mucosal interventions. We could say that regarding endoscopic management of functional disease, the procedures should be in adequacy with the SECS criteria: Simple/Efficient/Cos","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70299","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083065","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-Guided Hepaticogastrostomy With Plastic Stent Versus Metallic Stent for Malignant Biliary Obstruction: A Meta-Analysis","authors":"Hirofumi Yamazaki,&nbsp;Masahiro Itonaga,&nbsp;Ke Wan,&nbsp;Yasunobu Yamashita,&nbsp;Reiko Ashida,&nbsp;Masayuki Kitano","doi":"10.1111/den.70289","DOIUrl":"https://doi.org/10.1111/den.70289","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an alternative procedure for malignant biliary obstruction after failure of endoscopic retrograde cholangiopancreatography. When performing EUS-HGS, either plastic or metal stents are used, but selection often depends on the discretion of the endoscopist. We compared the efficacy and safety of plastic and metal stents during EUS-HGS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a systematic meta-analysis of all relevant articles listed by searching PubMed, Medline, and Web of Science databases. Random-effects or fixed-effects models were used to compare time to recurrent biliary obstruction (TRBO), clinical success rate, adverse event rate, rate of recurrent biliary obstruction, and re-intervention success rate after EUS-HGS with plastic and metal stents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This meta-analysis included six eligible studies. The TRBO of the metal stent group was significantly longer than that of the plastic stent group (hazard ratio 1.83; 95% confidence interval [CI] 1.42–2.36). The total procedure-related adverse event rate of the metal stent group was significantly higher than that of the plastic stent group (odds ratio [OR] 0.48; 95% CI 0.30–0.77). The recurrent biliary obstruction rate of the plastic stent group was significantly higher than that of the metal stent group (OR 1.75; 95% CI 1.06–2.88). No significant difference was found for the clinical success rate or re-intervention success rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this meta-analysis, metal stents showed longer TRBO, lower recurrent biliary obstruction rate, and higher adverse event rate than plastic stents.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068161","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":"Designing Around the Operator: A Kinematics-Informed Scope-Holder for Flexible Endoscopy","authors":"Mayo Tanabe","doi":"10.1111/den.70293","DOIUrl":"10.1111/den.70293","url":null,"abstract":"&lt;p&gt;Nagano et al. [&lt;span&gt;1&lt;/span&gt;] recently reported the development and evaluation of a newly designed endoscope-holding device (scope-holder) intended to reduce the physical burden of flexible endoscopy. Twenty-six participants (17 clinical endoscopists and 9 individuals without a medical background) completed a standardized ex vivo marking task with and without the device in randomized order. In the overall cohort, assistance reduced electromyographic (EMG) activity in the biceps brachii, trapezius, and flexor carpi ulnaris, lowered the National Aeronautics and Space Administration Task Load Index (NASA-TLX), and shortened procedure time. The results are encouraging. What deserves closer attention, however, is not only the magnitude of the effect but also the reasoning that produced the device.&lt;/p&gt;&lt;p&gt;The clinical problem is well established. A recent systematic review and meta-analysis of 30 studies involving 7646 gastrointestinal endoscopists estimated a pooled career-long prevalence of endoscopy-related injury of 62.5%, albeit with marked heterogeneity [&lt;span&gt;2&lt;/span&gt;]. In Japan, a cross-sectional study linked longer monthly exposure to therapeutic procedures, including lower gastrointestinal endoscopic submucosal dissection, with site-specific musculoskeletal symptoms [&lt;span&gt;3&lt;/span&gt;]. Ergonomic endoscopy has since been framed as a multilevel discipline [&lt;span&gt;4&lt;/span&gt;], and the American Society for Gastrointestinal Endoscopy has issued a dedicated guideline on the prevention of endoscopy-related injury [&lt;span&gt;5&lt;/span&gt;]. Behavioral measures such as posture training ask the endoscopist to adapt, whereas workstation optimization and assistive devices seek to reshape the environment or equipment around the operator. For the latter, design choices become consequential.&lt;/p&gt;&lt;p&gt;Support devices are themselves an established idea. An ergonomically designed endoscope holder evaluated using surface EMG in 15 laparoscopic surgeons reduced activity in several upper-limb and trunk muscles [&lt;span&gt;6&lt;/span&gt;], and an endoscope support device tested during simulated colonoscopy reduced load on the left wrist extensors [&lt;span&gt;7&lt;/span&gt;]. These devices were designed primarily to reduce physical load, and in such systems, the available range of motion is necessarily shaped by the supporting mechanism. A recurring trade-off is reduced physical load at the cost of maneuverability, a tolerable compromise for relatively static tasks but a potential limitation in therapeutic endoscopy, where repeated scope repositioning is required. Nagano et al. reversed this sequence in what may be described as a kinematics-informed design, in which the device's permitted motion is derived from measured endoscopist movement rather than assumed. They first quantified how clinical endoscopists actually move, tracking left-hand trajectories during 25 upper gastrointestinal procedures, then defined the device's movement envelope as the observed mean ±2 SD along three axes and engineered ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70293","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018852","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":"Oral Presentation","authors":"","doi":"10.1111/den.70227","DOIUrl":"https://doi.org/10.1111/den.70227","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 S1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70227","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007517","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":"Drill Dilator-Assisted Rescue of Basket Impaction During Endoscopic Extraction of a Common Bile Duct Stone","authors":"Shogo Ota,&nbsp;Takashi Kobayashi,&nbsp;Toshinao Itani","doi":"10.1111/den.70292","DOIUrl":"10.1111/den.70292","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013425","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":"ePoster Presentation","authors":"","doi":"10.1111/den.70226","DOIUrl":"https://doi.org/10.1111/den.70226","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 S1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70226","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007516","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: Histopathology for Endoscopists","authors":"","doi":"10.1111/den.70296","DOIUrl":"https://doi.org/10.1111/den.70296","url":null,"abstract":"&lt;p&gt;WEO DEN Newsletter issue 38–9—September 2026&lt;/p&gt;&lt;p&gt;WEO Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES&lt;/p&gt;&lt;p&gt;\u0000 \u0000 &lt;/p&gt;&lt;p&gt;&lt;b&gt;Histopathology for Endoscopists&lt;/b&gt;.&lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;Case 5. Esophagitis Dissecans Superficialis: What Should an Endoscopist Know?&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;i&gt;Richard S. Kinsey MD&lt;/i&gt;\u0000 &lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;The case&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;A 44-year-old woman was evaluated for long-standing gastroesophageal reflux and dysphagia. Upper endoscopy was performed for further assessment of her symptoms.&lt;/p&gt;&lt;p&gt;Based on these findings, a diagnosis of esophagitis dissecans superficialis (EDS) was made.&lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;What is it?&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;EDS, also called sloughing esophagitis, is an uncommon, benign and typically self-limited desquamating disorder of the squamous epithelium in which a superficial layer of necrotic epithelium detaches from the viable deeper layer. This produces the characteristic two-toned appearance on histology, with intraepithelial splitting, parakeratosis and often minimal inflammation, and strips or sheets of sloughed mucosa at endoscopy. On rare occasions patients cough up or vomit tubular mucosal casts. It is genuinely rare: one Belgian series identified EDS in approximately 0.03% of more than 21,000 upper endoscopies.&lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;Who gets it, and why?&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;The exact etiology is unknown and most cases are idiopathic, but contact or pill injury is the most consistent association. Commonly implicated agents include NSAIDs, bisphosphonates, iron tablets, potassium chloride, SSRIs and other psychoactive drugs; polypharmacy and CNS depressants that impair swallowing prolong mucosal contact time. Most series describe older adults, with reported median ages in the sixth to eighth decade and a female predominance in the majority of cohorts. Patients often carry comorbidities such as malignancy, immunosuppression, chronic kidney disease, coronary disease or general debilitation. Less common associations include autoimmune blistering disorders, celiac disease, hot beverages, caustic ingestion, smoking, prior mediastinal radiation and endoscopic trauma.&lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;What it looks like, and what to exclude&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Endoscopically one sees strips or ribbon-like sheets of pearly white sloughed mucosa or pseudomembranes overlying normal-appearing epithelium, characteristically without deep ulceration or friability. Lesions are most often in the distal and mid esophagus and less commonly proximal, as in this patient. The differential includes Candida esophagitis, which is the commonest mimic and may coexist with EDS, herpes simplex and cytomegalovirus esophagitis, lichen planus, and immunobullous disease such as pemphigus vulgaris and mucous membrane pemphigoid. Biopsies are confirmatory, and direct immunofluorescence should be considered when a blistering disorder is suspected. Notably, in ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149047881","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":"Additional Surgery After Endoscopic Resection for T1 Colorectal Cancer in Older Adults: From Oncologic Benefit to Net Clinical Benefit","authors":"Hidenori Tanaka,&nbsp;Shiro Oka","doi":"10.1111/den.70295","DOIUrl":"10.1111/den.70295","url":null,"abstract":"&lt;p&gt;Following the endoscopic resection of pT1 colorectal cancer, additional surgery with lymph node dissection is recommended for patients with pathological features associated with an increased risk of lymph node metastasis (LNM) [&lt;span&gt;1&lt;/span&gt;]. This strategy is supported by substantial evidence showing that established pathological risk factors identify patients at increased oncological risk and that additional surgery is associated with improved long-term outcomes, including disease-specific survival (DSS) and overall survival (OS), in appropriately selected patients [&lt;span&gt;2&lt;/span&gt;]. A recent meta-analysis by Chen et al. demonstrated that surgical resection was associated with improved DSS compared to local resection, although this benefit became more apparent only after prolonged follow-up [&lt;span&gt;3&lt;/span&gt;]. The 5-year DSS rates were similar between the two groups (96.7% vs. 98.3%), whereas a more substantial difference emerged after 10 years (86.9% vs. 97.1%). In contrast, the corresponding differences in OS remained relatively modest (86.3% vs. 94.5% at 5 years and 72.9% vs. 84.4% at 10 years), reflecting the influence of competing mortality. These findings suggest that the oncological benefits of surgery accumulate gradually over time and may not be fully realized in older adults with limited life expectancy and a high risk of competing mortality. In a real-world setting, among patients aged ≥ 80 years with high-risk pT1 colorectal cancer, there was no significant difference in OS between patients managed with endoscopic resection alone and those who underwent additional surgery when treatment was selected based on the patients' overall condition and surgical tolerability [&lt;span&gt;4&lt;/span&gt;]. This raises an important clinical question: How should additional surgery be considered in older adults after endoscopic resection of pT1 colorectal cancer?&lt;/p&gt;&lt;p&gt;Ichimasa et al. made two important contributions to this discussion [&lt;span&gt;5&lt;/span&gt;]. First, they reframed the clinical questions. Rather than asking whether additional surgery is indicated according to pathological criteria alone, they asked whether additional surgery is likely to provide meaningful benefits for an individual older patient. Second, they systematically synthesized the available evidence regarding the potential benefits and harms of additional surgery. Although experienced clinicians have long recognized the importance of considering the patient's overall condition when making treatment decisions, evidence supporting these decisions remains scattered across multiple domains. Ichimasa et al. have provided clinicians with a practical framework for weighing the potential benefits and harms of additional surgery in older adults and identified key areas where further evidence is needed.&lt;/p&gt;&lt;p&gt;In practice, decision-making requires clinicians to balance multiple, often competing factors, including oncological risk, physiological reserve, comorbidities, life expectancy, and patient pre","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013350","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}