Digestive Endoscopy最新文献

{"title":"Closure method to prevent leakages from perforations using multiple over-the-scope clips in an over-the-line method","authors":"Makoto Kobayashi,&nbsp;Tatsuma Nomura,&nbsp;Motoyoshi Yano","doi":"10.1111/den.14984","DOIUrl":"10.1111/den.14984","url":null,"abstract":"<p>An over-the-scope clip (OTSC; Ovesco Endoscopy GmbH, Tuebingen, Germany) is a very useful device for the closure of perforations.<span>¹</span> However, when multiple OTSCs are used in sequence for large perforations, the outer projections of the OTSCs create gaps. A reopenable clip-over-the-line method uses multiple clips. However, by pulling a thread, the gaps between clips are reduced.<span>^{2, 3}</span> We have attempted to close perforations using multiple OTSCs in an over-the-line method (MOLM) (Figs 1, 2).</p><p>Two OTSCs were used for the closure of an artificial perforation in a resected porcine stomach. First, nylon thread was passed through the gap, between the first OTSC and hood, and ligated to the OTSC. Second, the first OTSC was attached to an endoscope with the thread facing inward and closure was undertaken from the edge of the perforation. Third, after the second OTSC was attached to the endoscope, the thread tied to the first OTSC was withdrawn from the endoscope tip into the working channel. The endoscope was inserted into the stomach. Finally, the thread was pulled until the two OTSCs came together and the remaining perforation was closed. Excess thread was cut by a Loop Cutter (Olympus, Tokyo, Japan) and the procedure was terminated. Observation by endoscopy from inside the lumen showed complete closure. Further pressure was then applied using water in the stomach but no leakage was observed. Even a 3 cm diameter defect could be closed in the same way from the edge with four OTSCs and a Twin Grasper (Ovesco Endoscopy GmbH) (Video S1).</p><p>By using a MOLM, it is possible to eliminate gaps between OTSCs and to provide strong and leak-free closures of large perforations.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"558-559"},"PeriodicalIF":5.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14984","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017406","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":"Multicenter prospective feasibility study on compliance, safety, and acceptance of small bowel and colon capsule endoscopy in the out-of-clinic setting in Japan","authors":"Naoki Ohmiya,&nbsp;Akihiro Araki,&nbsp;Akiyoshi Tsuboi,&nbsp;Keiko Nakamura,&nbsp;Kyoko Ito,&nbsp;Naoki Hotta,&nbsp;Yasuo Kakugawa,&nbsp;Shiro Oka,&nbsp;Yutaka Saito,&nbsp;Tomohiro Kato,&nbsp;Shinji Tanaka","doi":"10.1111/den.14981","DOIUrl":"10.1111/den.14981","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to determine the compliance, safety, and acceptance of colon capsule endoscopy (CCE) and small bowel capsule endoscopy (SBCE) in an out-of-clinic setting remotely supported by medical staff.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 30 examinees (24 with CCE and six with SBCE) who had not undergone CE at six gastroenterological centers. All examinees were provided with instructions on equipment and bowel preparations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CCE was performed at home (<i>n</i> = 16) or at the workplace (<i>n</i> = 8). Compliance with data-recorder alerts was 100% for bowel preparation and 79% for equipment operation. Total capsule colonoscopy was achieved in 83.3%. The overall adequate endoscopic cleansing rate was 83.3%, and abnormalities, including colorectal polyps, were detected in 37.5%. CCE malfunction, such as the inability to automatically detect the small bowel mucosa occurred in one (4.2%). One experienced mild abdominal pain that required no treatment. Inquiries were present from half of the examinees. The proportions of examinees who desired and refused CCE at the next examination were 67% and 4%, respectively. SBCE was performed at home (<i>n</i> = 4) or at the workplace (<i>n</i> = 2). Compliance with the procedures was 100%. Whole small bowel images were recorded for all examinees. The overall adequate endoscopic clearness rate was 100%. One abnormality was detected. Inquiries were present from half of the examinees. There were no adverse events or malfunctions. The proportion of examinees who reported “quite easy” and “fairly easy” was 66%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CCE and SBCE with all procedures in the out-of-clinic setting supported by remote consultations were feasible. A multicenter prospective study of the safety and acceptance of capsule endoscopy examinations at home (HomeCam-J study) (jRCTs042220163).</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 6","pages":"680-694"},"PeriodicalIF":5.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017408","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":"Verification in an animal study of the appropriate settings for a novel radiofrequency generator in radiofrequency ablation therapy for residual intraductal lesions after endoscopic papillectomy (with video)","authors":"Kenjiro Yamamoto,&nbsp;Takao Itoi,&nbsp;Atsushi Sofuni,&nbsp;Takayoshi Tsuchiya,&nbsp;Reina Tanaka,&nbsp;Ryosuke Tonozuka,&nbsp;Kazumasa Nagai,&nbsp;Yukitoshi Matsunami,&nbsp;Hiroyuki Kojima,&nbsp;Hirohito Minami,&nbsp;Noriyuki Hirakawa,&nbsp;Kyoko Asano,&nbsp;Shuntaro Mukai","doi":"10.1111/den.14986","DOIUrl":"10.1111/den.14986","url":null,"abstract":"<p>Endoscopic intraductal radiofrequency ablation (ID-RFA) can curatively treat residual intraductal lesions after endoscopic papillectomy. This study aimed to verify the tissue invasiveness of ID-RFA using a novel RF generator and to explore its appropriate settings in an animal experiment, followed by a small clinical study. Pig liver specimens were ablated using a dedicated RF catheter and two RF generators to investigate structural differences between them and the ablation effects produced under various voltage and power settings. Appropriate settings for the novel generator were sought to provide an ablation effect equivalent to that with the recommended settings for a conventional generator. The ablation effect was also observed at various ablation times in vitro. Then we performed ID-RFA in five patients. Each generator has a different structure, and no novel generator settings are identical to the recommended conventional generator settings. Obtaining adequate ablation requires both sufficient power and sufficient voltage. Based on the validation experiments, we concluded that the appropriate novel generator settings were 125 Vp and 30 W for 30 s. In the clinical study, good tumor ablation was obtained with no recurrence after a single ID-RFA treatment, although the incidence of ductal stricture was relatively high. ID-RFA for residual intraductal lesions may potentially be curative. However, excessive ablation should be avoided. To ensure safe and effective ID-RFA, a thorough understanding of the RF generator specifications is required.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 6","pages":"704-711"},"PeriodicalIF":5.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14986","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017411","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 over-the-wire stent exchange technique with a loop cutter for endoscopic transpapillary gallbladder drainage in a complex anatomical case","authors":"Yasuhiro Kuraishi,&nbsp;Ichitaro Horiuchi,&nbsp;Akira Nakamura","doi":"10.1111/den.14996","DOIUrl":"10.1111/den.14996","url":null,"abstract":"<p>Endoscopic transpapillary gallbladder drainage (ETGBD) is effective for acute cholecystitis in patients contraindicated for emergency cholecystectomy, but poses several challenges, especially during guidewire advancement into the gallbladder.<span>^{1, 2}</span> Stent replacement for recurrent cholecystitis presents similar difficulties. Involving guidewire insertion through the existing stent followed by stent removal while maintaining guidewire access, the over-the-wire stent exchange technique is a viable strategy. We present the successful application of this technique in balloon enteroscopy-assisted ETGBD.</p><p>A 74-year-old man with prior total gastrectomy and Roux-en-Y reconstruction receiving immunosuppressive medications for severe rheumatoid arthritis presented with acute cholecystitis. Imaging revealed multiple gallstones and an anomalous junction of the right hepatic duct and cystic duct (Fig. 1). Given his poor surgical condition, we performed ETGBD using a short-type single-balloon enteroscope. Guidewire insertion under fluoroscopic guidance failed from caudal bifurcation of the cystic duct and limited scope maneuverability, necessitating cholangioscopic guidance for guidewire access. A 5F plastic stent (IYO-stent; Gadelius Medical, Tokyo, Japan) with a proximal spiral structure and a distal pigtail<span>³</span> was placed into the gallbladder. Three months later, recurrent cholecystitis required stent replacement (Fig. 2A–F; Video S1). We opted for the over-the-wire stent exchange technique knowing the guidewire access challenges encountered in the initial procedure. The pigtail configuration complicated guidewire insertion from the stent's distal end. A loop cutter (FS-5L-1; Olympus Medical Systems, Tokyo, Japan) was used to create an opening in the stent body to enable guidewire insertion. The stent was removed over the guidewire with forceps, and a new 5F plastic stent was placed.</p><p>A bench test confirmed the reproducibility of creating an access hole in the 5F plastic stent using a loop cutter without distortion or collapse (Fig. 2G,H). The over-the-wire stent exchange technique effectively facilitated ETGBD in patients with complex anatomy by enabling guidewire advancement via a loop cutter-created access point in a 5F stent.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 6","pages":"714-716"},"PeriodicalIF":5.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14996","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017409","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 submucosal dissection and photodynamic therapy of residual lesions after radiotherapy for esophageal cancer","authors":"Takuya Doi,&nbsp;Yoichi Yamamoto,&nbsp;Hiroyuki Ono","doi":"10.1111/den.14992","DOIUrl":"10.1111/den.14992","url":null,"abstract":"<p>An 82-year-old man diagnosed with clinical stage I (cT1N0M0, UICC TNM 8th) esophageal squamous cell carcinoma (ESCC) underwent radiotherapy. A circumferential residual lesion was detected, including a nodular component suspected of invading the shallow muscularis propria (MP) and a flat component presumed to be an intramucosal lesion (Fig. 1a–c). Computed tomography (CT) scan revealed no metastasis. We performed photodynamic therapy (PDT) on the nodular component, followed by endoscopic submucosal dissection (ESD) for the remaining flat lesion. PDT using talaporfin with a diode laser was performed in one session, treating three separate areas with 100 J/cm², totaling 300 J (Fig. 1d,e). Eight weeks post-PDT, esophagogastroduodenoscopy (EGD) revealed scarring at the PDT site (Fig. 2a,b). Subsequently, ESD was performed, and en-bloc resection was achieved with no intraprocedural adverse events, despite submucosal fibrosis due to prior PDT and radiotherapy (Fig. 2c,d). Given the near-circumferential resection, steroid therapy was administered to prevent strictures. Although the vertical margin was negative, the horizontal margin near the post-PDT scar was positive histopathologically, possibly due to the burning effects of ESD. Eight weeks post-ESD, EGD showed no residual lesions or stricture; biopsies confirmed no cancer, achieving a complete response (CR) (Fig. 2e,f). Given the post-PDT status and positive horizontal margin, follow-up with EGD and CT was scheduled every 3 months.</p><p>Photodynamic therapy is indicated for lesions involving less than half the circumference that invade the shallow MP<span>^1-3</span>; whereas, salvage ESD is indicated for intramucosal lesions regardless of their circumference. However, a higher recurrence rate is reported in patients undergoing ESD with submucosal invasion and positive vertical margins.<span>⁴</span> Although the lesion was circumferential, the suspected MP-invaded area was limited, whereas the remaining lesion was suspected to be intramucosal. Combining PDT of the MP-invaded area with salvage ESD of the superficial lesion achieved CR. This combination provides a treatment option for residual ESCC with small invasive and large intramucosal areas (Video S1).</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"560-562"},"PeriodicalIF":5.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14992","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017407","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 submucosal dissection for duodenal tumors including papilla: Is it feasible?","authors":"Osamu Dohi,&nbsp;Naoto Iwai,&nbsp;Naohisa Yoshida","doi":"10.1111/den.14991","DOIUrl":"10.1111/den.14991","url":null,"abstract":"&lt;p&gt;In recent years, the incidence of superficial nonampullary duodenal epithelial tumors (SNADETs) detected using upper gastrointestinal endoscopy has increased in asymptomatic individuals. Most SNADETs are adenomas or intramucosal adenocarcinomas for which minimally invasive endoscopic treatment is often the preferred therapeutic approach, underscoring its growing significance. However, SNADETs are less prevalent than other gastrointestinal neoplasms such as those of the esophagus, stomach, and colorectum, and endoscopic diagnostic and therapeutic modalities for these tumors remain in the developmental stage.&lt;/p&gt;&lt;p&gt;Endoscopic submucosal dissection (ESD) is recommended when en-bloc resection is difficult to achieve using reliable endoscopic mucosal resection (EMR) or underwater EMR (UEMR). This technique is frequently selected for SNADETs of &gt;2 cm in size, those with scars, or those with anatomically curved locations because the en-bloc resection and R0 resection rates of ESD are higher than those of cold snare polypectomy, EMR, and UEMR.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Although duodenal ESD has been reported to have an extremely high incidence of adverse events in the past,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; improvements in various resection techniques and devices, such as the water pressure method, pocket-creation method, and ESD using scissors-type forceps, have made it possible to reduce intraoperative adverse events.&lt;span&gt;&lt;sup&gt;3-5&lt;/sup&gt;&lt;/span&gt; With regard to delayed adverse events, reliable wound closure up to 3 days after endoscopic resection is important to prevent adverse events because wound closure after resection reduces the risk of delayed adverse events,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; and delayed perforation occurs within 3 days after endoscopic treatments.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Yahagi &lt;i&gt;et al&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; conducted a retrospective cohort study of patients who underwent ESD for duodenal tumors including the papilla (ESDIP). This technique was primarily introduced for the treatment of lesions of &gt;20 mm in size and cases with laterally spreading morphology, in which it is difficult to achieve en-bloc resection by endoscopic papillectomy (EP). The en-bloc resection rate of ESDIP is extremely high and the R0 resection rate is relatively low (96% and 46%, respectively). Furthermore, the rate of perioperative adverse events was high (intraoperative perforation, 15%; postprocedural bleeding, 19%; and post-ESDIP pancreatitis, 25%). The findings indicated that while ESDIP had a high likelihood of achieving en-bloc resection, there is a risk of perioperative adverse events.&lt;/p&gt;&lt;p&gt;ESDIP presents a significant technical challenge, and is associated with a high risk of complications. Although Yahagi &lt;i&gt;et al&lt;/i&gt;. performed the entire ESDIP procedure using water pressure method,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; which decreases intraprocedural perforation during duodenal ESD, the high rate of intraoper","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"411-412"},"PeriodicalIF":5.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14991","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985394","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":"Remimazolam: Promising sedative for upper gastrointestinal endoscopy","authors":"Daisuke Yamaguchi,&nbsp;Motohiro Esaki","doi":"10.1111/den.14995","DOIUrl":"10.1111/den.14995","url":null,"abstract":"&lt;p&gt;The demand for sedation during endoscopy has been obviously increasing, as it allows endoscopists to perform endoscopic examinations safely while providing patients with a greater sense of relief and satisfaction.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Sedatives commonly used during endoscopy include midazolam, diazepam, flunitrazepam, dexmedetomidine, and propofol, each with its advantages and disadvantages. The choice of sedatives depends upon the specific needs of each facility.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In Japan, midazolam is the most frequently used sedative during endoscopy. However, patients sedated with midazolam require extended recovery time due to its long half-life and prolonged sedative effects after the procedure.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; The need for a recovery room thus limits the use of sedatives in clinical practice.&lt;/p&gt;&lt;p&gt;Remimazolam is a newly developed ultra-short-acting benzodiazepine. It has been approved by the U.S. Food and Drug Administration (FDA) and is used as a sedative during gastrointestinal endoscopy, while it is not yet covered by the Japanese insurance system. A recent meta-analysis comparing remimazolam with midazolam for sedative gastrointestinal endoscopy showed a higher procedural success, lower need for rescue medication, shorter total recall and delayed recall, and reduced adverse events.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Since remimazolam has pharmacokinetically a shorter half-life than midazolam, it can be expected to reduce both the time to alertness and the time spent in the recovery room.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Propofol, another commonly used sedative for endoscopy, has the advantage of a narrower range of sedation and anesthesia than midazolam and results in a better awakening quality. However, its primary side-effects, including respiratory and circulatory depression, are often problematic. The Japan Gastroenterological Endoscopy Society's guidelines for sedation (second edition) state that propofol may be used by nonanesthesiologists if they have undergone sedation training and only for patients with American Society of Anesthesiologists-Physical Status (ASA-PS) classification I or II.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The study by Lee &lt;i&gt;et al&lt;/i&gt;.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; was a randomized controlled trial (RCT) that compared the effects of remimazolam and propofol on oxygen reserve during upper gastrointestinal endoscopy. For this purpose, the study used the oxygen reserve index (ORi) to investigate whether a sedative dose of remimazolam maintains better oxygenation than propofol in a state of mild hyperoxia, as experienced by patients during upper gastrointestinal endoscopy. The ORi is a respiratory parameter that reflects venous blood oxygen saturation and is useful for evaluating oxygenation status in a mild hyperoxic state with a PaO&lt;sub&gt;2&lt;/sub&gt; of 100–200 mmHg, which cannot be adequately evaluated using conventional pulse oximetry.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; This study found a significantly higher","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"400-401"},"PeriodicalIF":5.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14995","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985408","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":"Adverse events of 20–22G second-generation endoscopic ultrasound-guided fine-needle biopsy needles for solid lesions in the upper gastrointestinal tract and adjacent organs: Systematic review and meta-analysis","authors":"Cheng-ye Pan,&nbsp;Shi-min Wang,&nbsp;Dong-hao Cai,&nbsp;Jia-yi Ma,&nbsp;Shi-yu Li,&nbsp;Yibin Guo,&nbsp;Sun Jing,&nbsp;Jin Zhendong,&nbsp;Kaixuan Wang","doi":"10.1111/den.14972","DOIUrl":"10.1111/den.14972","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Previous research has conducted meta-analyses on the diagnostic accuracy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). However, studies on adverse events (AEs) have been limited and sporadic and have included a highly diverse group of patients (with upper and lower gastrointestinal tract issues) and needles of varying sizes (19-22-25G). The purpose of this systematic review and meta-analysis was to determine the incidence of AEs related to the utilization of 20–22G second-generation EUS-FNB needles subsequent to puncture of the upper gastrointestinal tract and adjacent organs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched the PubMed, Embase, and SCIE databases from January 1, 2010, to December 31, 2023. The primary outcome was percentage of summary AEs. Subgroup analyses were based on needle type, needle size, and lesion site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 99 studies were included in the analysis, with 9303 patients. The overall AE rate for 20–22G second generation EUS-FNB needles in upper gastrointestinal EUS-FNB was 1.8% (166/9303), with bleeding being the most common AE at 44.0%. The percentages of pancreatitis, abdominal pain, and other AEs were 24.1%, 21.1%, and 10.8%, respectively. Patients undergoing hepatic EUS-FNB had the highest incidence of AEs at 14.0%, followed by submucosal lesions at 3.2% and pancreatic lesions at 2.6%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EUS-FNB is a safe procedure with a relatively low risk of upper gastrointestinal AEs (1.8%) and no associated deaths. Postoperative bleeding and pancreatitis are the most common complications of EUS-FNB. Most AEs are mild and self-limiting in severity, and serious complications are very rare.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"490-500"},"PeriodicalIF":5.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959739","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":"WEO Newsletter: Towards a Green Endoscopy","authors":"","doi":"10.1111/den.14987","DOIUrl":"10.1111/den.14987","url":null,"abstract":"&lt;p&gt;Cesare Hassan&lt;sup&gt;1,2&lt;/sup&gt; Maddalena Menini&lt;sup&gt;1&lt;/sup&gt; and Alessandro Repici&lt;sup&gt;1,2&lt;/sup&gt;&lt;/p&gt;&lt;p&gt;&lt;sup&gt;1&lt;/sup&gt;IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy and &lt;sup&gt;2&lt;/sup&gt;Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy&lt;/p&gt;&lt;p&gt;&lt;i&gt;Correspondence:&lt;/i&gt; Cesare Hassan, &lt;i&gt;Humanitas Research Hospital and University&lt;/i&gt;, Via Manzoni 56, 20089 Rozzano (Milano) Italy, Tel: +39 (0)282247385, Fax: +390282242595, Email: &lt;span&gt;[email protected]&lt;/span&gt;&lt;/p&gt;&lt;p&gt;When we think of endoscopy, we think of innovation, advanced techniques, patient safety, and more. But have we ever stopped to reflect on the environmental price of these accomplishments? Could our practices be harmful to the planet's health?&lt;/p&gt;&lt;p&gt;To put the issue into perspective, healthcare contributes between 1% and 5% of global environmental impacts, depending on the metric considered, and surpasses 5% in certain national contexts.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Digestive endoscopy is far from blameless as it is a resource-demanding activity with a substantial but insufficiently evaluated environmental footprint.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Endoscopy is believed to be the third-largest producer of waste within the healthcare sector.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;From the gallons of water and kilowatts of energy used in scope reprocessing to the mountains of single-use plastics discarded daily, our practices are leaving a footprint that can no longer be ignored.&lt;/p&gt;&lt;p&gt;A single reusable endoscope, over its lifecycle, emits several kilograms of CO2 for every procedure it undergoes—an unsettling irony for a tool designed to save lives. And while single-use devices are often marketed as convenient and hygienic, they create a staggering amount of non-biodegradable waste.&lt;/p&gt;&lt;p&gt;As endoscopists, we pride ourselves on our ability to solve complex problems, yet we seem reluctant to address one staring us in the face: the unsustainable environmental impact of our work. One could argue that environmentally friendly practices should focus on other sectors rather than healthcare, as patient safety – and healthcare quality - must always come first. Similarly, it could be argued that healthcare workers should direct their attention to advancing care rather than worrying about “recycling waste.”&lt;/p&gt;&lt;p&gt;However, these views are outdated. What could be more urgent than securing our survival on this planet? And is it truly the case that green endoscopy initiatives would compromise the quality of care? Often, energy-intensive and environmentally harmful practices arise not from necessity but from a lack of awareness—or simple negligence and inattention.&lt;/p&gt;&lt;p&gt;It's easy to dismiss these issues as beyond our control, but that mindset is part of the problem. The encouraging news is that practical, sustainable solutions are within reach. Leading societies in Gastrointestinal Endoscopy emphasize sustainability ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"132-134"},"PeriodicalIF":5.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14987","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959754","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":"Traction-assisted endoscopic ultrasound-guided fine-needle biopsy using the clip-with-thread method for small gastric subepithelial lesions: Randomized controlled trial (with video)","authors":"Yosuke Minoda,&nbsp;Yusuke Suzuki,&nbsp;Haruei Ogino,&nbsp;Shuzaburo Nagatomo,&nbsp;Xiaopeng Bai,&nbsp;Mitsuru Esaki,&nbsp;Masafumi Wada,&nbsp;Yoshimasa Tanaka,&nbsp;Yoshitaka Hata,&nbsp;Nao Fujimori,&nbsp;Shinya Umekita,&nbsp;Daisuke Tsurumaru,&nbsp;Mitsuhiko Ota,&nbsp;Eiji Oki,&nbsp;Eikichi Ihara,&nbsp;Yoshihiro Ogawa","doi":"10.1111/den.14977","DOIUrl":"10.1111/den.14977","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is the gold standard for diagnosing gastric subepithelial lesions (SELs), but diagnosing lesions smaller than 20 mm remains challenging. We developed traction-assisted EUS-FNB (TA-EUS-FNB) using the clip-with-thread method to enhance diagnostic accuracy by stabilizing the lesion and providing counter-traction for easier needle access. This study evaluates the effectiveness of TA-EUS-FNB in diagnosing small gastric SELs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective, randomized, controlled cross-over trial (August 2019–November 2022), 30 patients with gastric SELs &lt;20 mm were randomized to undergo TA-EUS-FNB or conventional EUS-FNB. Each patient underwent four punctures, two per method. The primary end-point was the adequate tissue sampling rate for both techniques. Secondary end-points included diagnostic yield and performance (sensitivity and specificity) in distinguishing gastrointestinal stromal tumors (GISTs) from non-GISTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean tumor size was 15.0 mm, with diagnoses comprising GISTs (<i>n</i> = 15, 50%), leiomyomas (<i>n</i> = 8, 26.7%), schwannomas (<i>n</i> = 2, 6.7%), aberrant pancreas (<i>n</i> = 3, 10%), and inflammation (<i>n</i> = 2, 6.7%). TA-EUS-FNB demonstrated a significantly higher adequate-tissue sampling rate (90% vs. 66.7%, <i>P</i> = 0.035) and diagnostic yield (86.7% vs. 63.3%, <i>P</i> = 0.037) than conventional EUS-FNB. Sensitivity (86.7%, 95% confidence interval [CI] 62.1–96.3% vs. 66.7%, 95% CI 41.7–84.8%; <i>P</i> = 0.20) and specificity (100%, 95% CI 79.6–100% vs. 100%, 95% CI 79.6–100%) were comparable between the methods. No adverse events were observed in the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>TA-EUS-FNB demonstrated superior tissue sampling rates and diagnostic yield for SELs &lt;20 mm compared to conventional EUS-FNB, making it a viable option. Controlling lesion mobility is essential for successful EUS-FNB in small SELs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"512-520"},"PeriodicalIF":5.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959753","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}