Digestive Endoscopy最新文献

{"title":"Endoscopic ultrasound-guided vascular interventions","authors":"Atsushi Irisawa,&nbsp;Kazunori Nagashima,&nbsp;Akira Yamamiya,&nbsp;Yoko Abe,&nbsp;Takumi Maki,&nbsp;Ken Kashima,&nbsp;Yasuhito Kunogi,&nbsp;Koh Fukushi,&nbsp;Fumi Sakuma,&nbsp;Yasunori Inaba,&nbsp;Keiichi Tominaga","doi":"10.1111/den.14925","DOIUrl":"10.1111/den.14925","url":null,"abstract":"<p>With the recent development of interventional endoscopic ultrasound (EUS), EUS-guided vascular interventions have seen increased clinical and research focus. This modality can be used to diagnose portal hypertension and treat portal hypertension-related gastrointestinal varices and refractory gastrointestinal hemorrhage, including pseudoaneurysm. The vascular embolic materials used for treatment include tissue adhesives (cyanoacrylates), sclerosants, thrombin, and vascular embolic coils, all of which are associated with favorable results. The feasibility of EUS-guided procedures, including portal vein stenting and portosystemic shunt formation conventionally performed percutaneously and transvenously, has also been demonstrated, albeit in animal studies. As EUS-guided vascular intervention is a technique that may receive significant attention in the future, we provide a thorough review of the current evidence for its use.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"85-92"},"PeriodicalIF":5.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14925","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333702","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":"Failed endoscopic ultrasound-guided gallbladder drainage across the duodenal covered metallic stent salvaged by using a forward-viewing linear echoendoscope","authors":"Tesshin Ban,&nbsp;Yoshimasa Kubota,&nbsp;Takashi Joh","doi":"10.1111/den.14931","DOIUrl":"10.1111/den.14931","url":null,"abstract":"<p>Endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) has emerged as an alternative to standard percutaneous or transpapillary approaches in fragile patients with acute cholecystitis.<span>^1-3</span> Oblique-viewing linear endoscopic ultrasonography (OV-EUS) is used for biliary intervention. However, forward-viewing linear endoscopic ultrasonography (FV-EUS) is applied in certain settings.<span>^{4, 5}</span> Herein, we report salvaged EUS-GBD by using FV-EUS after failure of OV-EUS.</p><p>An 82-year-old man with clinical stage IV pancreatic cancer presented with severe vomiting and initially underwent implantation of a duodenal bulb-covered metallic stent. One week later, this patient underwent endoscopic ultrasonography-guided choledochoduodenostomy due to acute obstructive suppurative cholangitis without intrahepatic biliary dilation (Video S1). One month later, this patient developed antibiotic-refractory acute cholecystitis, which deteriorated into a pericholecystic abscess (Fig. 1). Prioritizing the internal drainage, we attempted EUS-GBD using OV-EUS (EG-580UT; Fujifilm, Tokyo, Japan). The gallbladder was depicted; however, the scope struggled to maneuver in the duodenal metallic stent, and a 19G lancet puncture needle could not advance from the scope channel into the gallbladder (Fig. 2a, Video S1). The following day, we retried EUS-GBD using FV-EUS (TGF-UC260J; Olympus, Tokyo, Japan), which quickly facilitated the gallbladder visualization, needle puncture, 0.025 inch hydrophilic guidewire advancement, electrocautery dilation (Cysto-Gastro-Sets; Endo-flex, Voerde, Germany), and a double-pigtailed plastic stent deployment (Advanix J, 7F, 7 cm; Boston Scientific, Marlborough, MA, USA) (Fig. 2b,c, Video S1). The clinical course was uneventful.</p><p>The maneuverability of the OV-EUS was limited inside the duodenal bulb stent. We needed to down-angle the scope steeply to depict the gallbladder, which obstructed the puncture needle. In this situation, FV-EUS in the long position easily depicted the gallbladder without an angle maneuver. In addition, all the devices showed excellent pushability and trackability, including the puncture needle, dilator, and gallbladder stent, because the target was located vertically in front of the long-positioned FV-EUS.<span>⁵</span></p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1389-1390"},"PeriodicalIF":5.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14931","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256012","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: ENDO 2024 was a great success! Thanks to all who participated","authors":"","doi":"10.1111/den.14920","DOIUrl":"https://doi.org/10.1111/den.14920","url":null,"abstract":"&lt;p&gt;Professor Hisao Tajiri, WEO and ENDO 2024 President made the following statement:&lt;/p&gt;&lt;p&gt;“ENDO 2024 had 3200 participants from all over the world despite the current medical strike happening in Korea, and we were able to have an intimate international exchange through many symposia, live demonstrations, hands-on courses, receptions, and so on. Many young doctors from developing countries in Asia also participated in the Congress. I believe that our WEO was instrumental in fulfilling its mission in terms of education for developing countries.&lt;/p&gt;&lt;p&gt;I sincerely appreciate the strong support of Prof Hoon Jai Chun, ENDO 2024 Congress Co-President and Prof Jong-Jae Park, President of KSGE [Korean Society of Gastrointestinal Endoscopy] and IDEN [International Digestive Endoscopy Network], and many other doctors involved in KSGE.&lt;/p&gt;&lt;p&gt;And I also thank organizing committee members of ENDO 2024, Dr. Jean-Francois Rey, Chair of the Steering Committee, Drs. Philip Chiu and Jong Ho Moon, Chair and Co-Chair of the Scientific Committee, Dr. Robert Hawes, Treasurer, Dr. Yutaka Saito, WEO Secretary General, colleagues in Japan, and all other organizing committee members including WEO office staff. I would like to express my sincere gratitude to all of them.&lt;/p&gt;&lt;p&gt;From Seoul, Korea, through the top experts of GI endoscopy, new insights and bright futures were brought to many endoscopists. I believe that the three-day program met the expectations of all gastroenterologists, endoscopists, and nurses who participated in ENDO 2024. The overwhelming response we have received from the participants, faculty, and industry alike is a great testament to the quality of the Congress and its high relevance to continuing education and to medical advancement; the initiation of both of those is part of WEO's mission, as well as maintaining the quality of endoscopic teaching.&lt;/p&gt;&lt;p&gt;Some highlights of ENDO 2024 included six outstanding live demonstrations and discussions from three international and three of the most advanced Korean centers, 22 hands-on training stations, 8 of WEO's best-established educational courses, 10 joint symposia with our global partners, 5 KSGE-IDEN sessions and 2 young endoscopist forums, 17 sessions presenting the ENDO 2024 best oral abstracts, and 23 innovative industry symposia.&lt;/p&gt;&lt;p&gt;ENDO 2024 was honored to host several distinguished educational lectures, by Joo Young Cho (Korea), Fabian Emura (Colombia), Ian Gralnek (Israel), and Nageshwar Reddy (India).&lt;/p&gt;&lt;p&gt;As is traditional at ENDO congresses, the learning track offered well-established WEO courses including the Advanced Diagnosis Endoscopy Course (ADEC), Colorectal Cancer Screening Committee meetings, WEO International School of Endoscopy (WISE) sessions, the Research Forum, Video Capsule Endoscopy (VCE) and High-Q courses. A Women in Endoscopy session was held for the first time, covering gender-related aspects of endoscopy. ENDO 2024 President Hisao Tajiri commemorated this as the last se","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 9","pages":"1062-1071"},"PeriodicalIF":5.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14920","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231066","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":"Troubleshooting the migration of endoscopic ultrasound-guided pancreatic duct drainage stent to avoid repuncture","authors":"Kazuki Hama,&nbsp;Reina Tanaka,&nbsp;Takao Itoi","doi":"10.1111/den.14906","DOIUrl":"10.1111/den.14906","url":null,"abstract":"<p>Endoscopic ultrasound (EUS)-guided drainage effectively treats difficult transpapillary drainage.<span>^{1, 2}</span> However, EUS-guided pancreatic duct drainage (EUS-PD) is technically challenging, as repuncture should be avoided to prevent pancreatic fluid leakage; we describe a technique for EUS-PD stent migration that enables us to avoid repuncture (Video S1).<span>³</span> A 54-year-old woman, who underwent pancreaticoduodenectomy for pancreatic cancer, experienced recurrent cholangitis and pancreatic stones due to anastomotic stenosis. Endoscopic drainage using a single-balloon enteroscope (SIF-H290S; Olympus, Tokyo, Japan) was attempted, but identifying the pancreatic duct orifice was difficult. Therefore, EUS-PD was performed to secure the route for stone removal. A 19G needle (EZ shot 3 plus; Olympus) was used to puncture the dilated pancreatic duct at the tail. The drill dilator (Tornus ES; Olympus) could not pass the stone. A 4 mm dilating balloon (REN TYPE-IT; Kaneka, Osaka, Japan) was used. After adequate dilation, a 7Fr plastic stent (TYPE IT; Gadelius Medical, Tokyo, Japan) was deployed, but its tip failed to cross the stone and anastomosis, so the stent was placed in the main pancreatic duct proximal to the stone.<span>⁴</span> Vomiting and fever occurred postprocedure, and radiography revealed stent migration into the esophagus. However, computed tomography revealed the stent tip barely lodged in the pancreatic duct owing to the large flap. Therefore, using a side-viewing duodenoscope (TJF-260 V; Olympus), a guidewire (VisiGlide II; Olympus) was successfully inserted through the stent flap and guided into the jejunum. The stent was removed using forceps (Figs 1, 2). The tract and anastomotic site were sufficiently dilated using a drill dilator, and a 6 mm fully covered self-expandable metal stent (EGIS biliary stent, 6 × 10 mm; SB-Kawsumi, Kanagawa, Japan) was successfully placed. One month later, the stone was successfully removed by the EUS-PD route. A plastic stent has two large flaps at its tip, and even if it migrates, the flap may remain in the pancreas.</p><p>Author T.I. received honoraria for his lectures from Olympus and Boston Scientific. The other authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1288-1289"},"PeriodicalIF":5.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14906","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195514","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":"Feasibility and safety of endoscopic full‐thickness resection for submucosal tumors in the upper gastrointestinal tract, including predominantly extraluminal submucosal tumors (with video)","authors":"Yingjie Guo, Fan Yin, Xingsi Qi, Peng Zhang, Xueguo Sun, Xueli Ding, Xiaoyu Li, Xue Jing, Yueping Jiang, Zibin Tian, Tao Mao","doi":"10.1111/den.14918","DOIUrl":"https://doi.org/10.1111/den.14918","url":null,"abstract":"ObjectivesEndoscopic full‐thickness resection (EFTR) for submucosal tumors (SMTs) has been technically challenging. This retrospective study aimed to evaluate the feasibility, safety, and efficacy of EFTR for upper gastrointestinal (GI) SMTs, including extraluminal lesions.MethodsWe retrospectively investigated 232 patients with SMTs who underwent EFTR from January 2014 to August 2023. Clinicopathologic characteristics, procedure‐related parameters, adverse events (AEs), and follow‐up outcomes were assessed in all patients.ResultsThe en‐bloc resection and en‐bloc with R0 resection rates were 98.7% and 96.1%, respectively. The average endoscopic tumor size measured 17.2 ± 8.7 mm, ranging from 6 to 50 mm. The resection time and suture time were 49.0 ± 19.4 min and 22.5 ± 11.6 min, respectively. In all, 39 lesions (16.8%) exhibited predominantly extraluminal growth. Gastrointestinal stromal tumors (GISTs) were the predominant pathology, accounting for 78.4% of the cases. Twenty‐one patients (9.1%) encountered complications, including pneumothorax (1/232, 0.43%), hydrothorax (1/232, 0.43%), localized peritonitis (3/232, 1.29%), and fever (16/232, 6.9%). Although the incidence of postoperative fever was notably higher in the predominantly extraluminal group (7/39, 17.9%) compared to the predominantly intraluminal group (9/193, 4.7%, <jats:italic>P</jats:italic> = 0.008), there were no significant differences in outcomes of the EFTR procedure. No instances of recurrence were observed during the mean follow‐up period of 3.7 ± 2.3 years.ConclusionEFTR was found to be feasible, safe, and effective for resecting upper GI SMTs, including lesions with predominantly extraluminal growth. Further validation in a prospective study is warranted.","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"2 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195510","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":"Endoscopic ultrasound-guided gastrojejunostomy with wire endoscopic simplified technique: Move towards benign indications (with video)","authors":"Jean-Michel Gonzalez,&nbsp;Sohaib Ouazzani,&nbsp;Geoffroy Vanbiervliet,&nbsp;Mohamed Gasmi,&nbsp;Marc Barthet","doi":"10.1111/den.14895","DOIUrl":"10.1111/den.14895","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is an alternative to duodenal stenting and surgical GJ (SGGJ) in malignant gastric outlet obstruction (MGOO). European Society of Gastrointestinal Endoscopy guidelines restricted EUS-GJ for MGOO only, because of misdeployment. The aim was to evaluate its outcomes focusing on benign indications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective study conducted from 2016 to 2023 in a tertiary center. Patients included had malignant or benign GOO indicated for EUS-GJ. Techniques were the direct approach until August 2021, and the wire endoscopic simplified technique (WEST) afterwards. The main objective was to compare outcomes in benign vs. MGOO. Secondary end-points were technical success, adverse events rates, and describing the evolution of techniques and indications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In all, 87 patients were included, 46 men, mean age 66 ± 16.2 years. Indications were malignant in 60.1% and benign in 39.1%. The EUS-GJ technique was direct in 33 patients (37.9%) and WEST in 54 (62.1%). No difference was found in terms of technical, clinical, or adverse events rates. The initial technical success rate was 88.5%. The final technical and clinical success rates were 96.6% and 94.25%, respectively. In the last year, benign exceeded malignant indications (70.4% vs. 29.6%, <i>P</i> &lt; 0.05). Seven misdeployments occurred, six being addressed with the rescue technique. The misdeployment rate was significantly decreased using the WEST approach compared to the direct one: 3.7% vs. 18% (<i>P</i> &lt; 0.05). The severe postoperative adverse events rate was 2.3%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrated similar outcomes of EUS-GJ between benign and MGOO, with a decreasing misdeployment rate (&lt;4%) applying WEST. This represents an additional step towards recommending EUS-GJ in benign indications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"167-175"},"PeriodicalIF":5.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14895","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195512","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 clipping combined with cyanoacrylate injection vs. transjugular intrahepatic portosystemic shunt in the treatment of isolated gastric variceal bleeding: Randomized controlled trial","authors":"Jing Li, Zhaoyi Chen, Yaxian Kuai, Fumin Zhang, Huixian Li, Derun Kong","doi":"10.1111/den.14916","DOIUrl":"https://doi.org/10.1111/den.14916","url":null,"abstract":"ObjectivesAlthough the incidence of isolated gastric varices type 1 (IGV1) bleeding is low, the condition is highly dangerous and associated with high mortality, making its treatment challenging. We aimed to compare the safety and efficacy of endoscopic clipping combined with cyanoacrylate injection (EC‐CYA) vs. transjugular intrahepatic portosystemic shunt (TIPS) in treating IGV1.MethodsIn a single‐center, randomized controlled trial, patients with IGV1 bleeding were randomly assigned to the EC‐CYA group or TIPS group. The primary end‐points were gastric variceal rebleeding rates and technical success. Secondary end‐points included cumulative nonbleeding rates, mortality, and complications.ResultsA total of 156 patients between January 2019 and April 2023 were selected and randomly assigned to the EC‐CYA group (<jats:italic>n</jats:italic> = 76) and TIPS group (<jats:italic>n</jats:italic> = 80). The technical success rate was 100% for both groups. The rebleeding rates were 14.5% in the EC‐CYA group and 8.8% in the TIPS group, showing no significant difference (<jats:italic>P</jats:italic> = 0.263). Kaplan–Meier analysis revealed that the cumulative nonbleeding rates at 6, 12, 24, and 36 months for the two groups lacked statistical significance (<jats:italic>P</jats:italic> = 0.344). Similarly, cumulative survival rates at 12, 24, and 36 months for the two groups were not statistically significant (<jats:italic>P</jats:italic> = 0.916). The bleeding rates from other causes were 13.2% and 6.3% for the respective groups, showing no significant difference (<jats:italic>P</jats:italic> = 0.144). No instances of ectopic embolism were observed in either group. The incidence of hepatic encephalopathy (HE) in the TIPS group was statistically higher than that in the EC‐CYA group (<jats:italic>P</jats:italic> = 0.001).ConclusionBoth groups are effective in controlling IGV1 bleeding. Notably, EC‐CYA did not result in ectopic embolism, and the incidence of HE was lower than that observed with TIPS.","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"65 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195511","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":"Practical utility of linked color imaging in colonoscopy: Updated literature review","authors":"Fumiaki Ishibashi,&nbsp;Sho Suzuki","doi":"10.1111/den.14915","DOIUrl":"10.1111/den.14915","url":null,"abstract":"<p>The remarkable recent developments in image-enhanced endoscopy (IEE) have significantly contributed to the advancement of diagnostic techniques. Linked color imaging (LCI) is an IEE technique in which color differences are expanded by processing image data to enhance short-wavelength narrow-band light. This feature of LCI causes reddish areas to appear redder and whitish areas to appear whiter. Because most colorectal lesions, such as neoplastic and inflammatory lesions, have a reddish tone, LCI is an effective tool for identifying colorectal lesions by clarifying the redder areas and distinguishing them from the surrounding normal mucosa. To date, eight randomized controlled trials have been conducted to evaluate the effectiveness of LCI in identifying colorectal adenomatous lesions. The results of a meta-analysis integrating these studies demonstrated that LCI was superior to white-light endoscopy for detecting colorectal adenomatous lesions. LCI also improves the detection of serrated lesions by enhancing their whiteness. Furthermore, accumulating evidence suggests that LCI is superior to white-light endoscopy for the diagnosis of the colonic mucosa in patients with ulcerative colitis. In this review, based on a comprehensive search of the current literature since the implementation of LCI, the utility of LCI in the detection and diagnosis of colorectal lesions is discussed. Additionally, the latest data, including attempts to combine artificial intelligence and LCI, are presented.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"147-156"},"PeriodicalIF":5.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14915","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195513","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":"Modified gel immersion method during endoscopic ultrasonography and injection sclerotherapy for esophageal varices","authors":"Koichi Soga,&nbsp;Ikuhiro Kobori,&nbsp;Masaya Tamano","doi":"10.1111/den.14919","DOIUrl":"10.1111/den.14919","url":null,"abstract":"<p>Ruptured esophageal varices (EVs) lead to life-threatening events. Endoscopic injection sclerotherapy (EIS) can help prevent bleeding. Endoscopic ultrasound (EUS) is essential for evaluating EV hemodynamics to ensure their effective management. The gel immersion method (GIM), which is crucial for accurate diagnosis and management, provides a clear and stable medium in the gastrointestinal system.<span>¹</span> Compared with traditional water immersion techniques, the GIM provides superior image quality and reduces the risk of aspiration and other complications.<span>²</span> A 75-year-old Japanese woman presented with an EV with enlarged and red color signs at risk of bleeding (Fig. 1a). Two consecutive EUS and EIS procedures were performed using the modified GIM (mGIM-EUS/EIS). During esophagoduodenoscopy, after general evaluation of the EV and deaeration of the stomach, gel (Viscoclear; Otsuka Pharmaceutical Factory, Tokushima, Japan) was injected into the esophagus. The EV was identified and the esophageal wall vessels (perforating veins) were penetrated using a 20 MHz ultrasonic mini probe (Fig. 1b) before mGIM-EIS. This method enabled a detailed hemodynamic evaluation of EV, including the assessment of perforating veins, to help estimate the difficulty of EIS.<span>^{2, 3}</span> mGIM-EIS was conducted without interruption. Filling the esophagus with intermittent gel supplementation prevented visual defects due to bleeding and improved procedural safety (Fig. 2a). The gel facilitated precise needle placement, effective delivery, and visualization of sclerosant agents into the varices, using balloon deployment to reduce the risk of aspiration (Fig. 2b–d, Video S1).<span>³</span> The gel was injected through the working channel during the procedure. The absence of air in the esophagus and stomach reduced the patient burden. The gel used can be securely held in the esophagus, enabling mGIM-EUS/EIS procedures to be performed continuously and without stress. This method minimizes the risk of aspiration and ensures accurate and safe management during mGIM-EIS. Therefore, mGIM-EUS/EIS is more effective and safer than previous methods.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1386-1387"},"PeriodicalIF":5.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14919","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156835","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 submucosal dissection with an insulated tip knife using diluted saline","authors":"Akihiro Maruyama,&nbsp;Makoto Kobayashi,&nbsp;Motoyoshi Yano","doi":"10.1111/den.14917","DOIUrl":"10.1111/den.14917","url":null,"abstract":"<p>Owing to buoyancy, underwater endoscopic submucosal dissection (ESD) offers improved visibility of the submucosal layer.<span>¹</span> Previous research has demonstrated the effectiveness and speed of employing an insulated tip (IT) knife for ESD.<span>^{2, 3}</span> However, due to the current flow in the surrounding saline, employing large electrode devices such as an IT knife becomes challenging. Distilled water without electrolytes does not provide effective submucosal dissection. To address this, we utilized diluted saline (1:2 mixture of saline and distilled water) to modulate electrical flow via impedance difference (Fig. 1). We used this solution for underwater ESD, avoiding dimethicone to maintain transparency. Moreover, indigo carmine and undiluted hyaluronic acid were added to the local injection to aid visibility and protect the submucosal hyaluronic acid. There were three male cases and one female case, with three lesions in the stomach and one lesion in the colon. The average age was 79.2 years, the average resection time was 55 min, the average volume of flooding solution used was 1600 mL, and the average diameter of the lesions was 23.5 mm. We used an ITknife2 and ITknife nano (Olympus, Tokyo, Japan). A VIO-300D (Erbe Elektromedizin, Tubingen, Germany) was employed as a high-frequency surgical device. While there was no significant change in lesion elevation when using diluted saline compared to normal saline as the flooding solution, current leakage into the surrounding liquid was reduced, allowing for submucosal dissection. In underwater ESD, suctioning air to maintain a clear view is crucial. The reduction in current leakage into the surrounding flooded solution decreased the bubbles generated during submucosal dissection. Consequently, less effort was required to suction bubbles to maintain a clear view (Video S1). No incidents of postbleeding or perforation were observed. The use of diluted saline has expanded the options for underwater ESD devices.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1384-1385"},"PeriodicalIF":5.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14917","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156836","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}