{"title":"Removal of intrahepatic duct stones using grasping forceps in a patient with surgically altered anatomy","authors":"Yi-Jun Liao, Chia-Chia Lu, Wan-Tzu Lin","doi":"10.1111/den.15014","DOIUrl":"10.1111/den.15014","url":null,"abstract":"<p>Watch a video of this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 7","pages":"802-804"},"PeriodicalIF":5.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560284","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":"Delayed bleeding after endoscopic sphincterotomy in patients receiving anticoagulants","authors":"Mitsushige Sugimoto, Masaki Murata, Kento Shionoya, Takayoshi Tsuchiya, Takao Itoi","doi":"10.1111/den.15016","DOIUrl":"10.1111/den.15016","url":null,"abstract":"<p>Delayed bleeding after endoscopic sphincterotomy (EST) constitutes a significant adverse event, occurring in ~0.5–5% of patients. The number of patients receiving anticoagulants to prevent cardiovascular and cerebrovascular disease has increased with the aging society worldwide; however, anticoagulants (direct oral anticoagulants [DOACs] and warfarin) are one of the most major risk factors for postprocedure bleeding. This review investigated post-EST bleeding in anticoagulant users, focusing on risk factors, clinical guidelines, pharmacological characteristics, and the future of post-EST bleeding. Several clinical guidelines for antithrombotic drug users have been established to prevent postprocedure bleeding; nevertheless, the risk of bleeding is believed to be several times higher than for nondrug users, regardless of clinical guideline compliance. The major problem in this field is that patients who experience delayed bleeding are often receiving multiple antithrombotic drugs, and no parameters that can accurately monitor the anticoagulant effect of DOACs have been identified. Therefore, identifying patients with a generally high-risk of postprocedure bleeding is crucial. Recently, the plasma level and antifactor Xa activity of factor Xa inhibitors have been investigated in relation to the risk of major bleeding in users. Similar to the prothrombin time-international normalized ratio for warfarin, plasma levels, and antifactor Xa activity may be useful parameters for monitoring the anticoagulant effect and identifying DOAC users at higher risk of postprocedure bleeding, including post-EST bleeding. Future studies should stratify the risk of post-EST delayed bleeding based on a scoring system to prevent this complication.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 7","pages":"733-746"},"PeriodicalIF":5.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560257","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":"Guidelines for endoscopic diagnosis and treatment of inflammatory bowel diseases","authors":"Takayuki Matsumoto, Tadakazu Hisamatsu, Motohiro Esaki, Teppei Omori, Hirotake Sakuraba, Shinichiro Shinzaki, Ken Sugimoto, Kento Takenaka, Makoto Naganuma, Shigeki Bamba, Takashi Hisabe, Sakiko Hiraoka, Mikihiro Fujiya, Minoru Matsuura, Shunichi Yanai, Kenji Watanabe, Haruhiko Ogata, Akira Andoh, Hiroshi Nakase, Kazuo Ohtsuka, Fumihito Hirai, Mitsuhiro Fujishiro, Yoshinori Igarashi, Shinji Tanaka","doi":"10.1111/den.15002","DOIUrl":"10.1111/den.15002","url":null,"abstract":"<p>In recent years, we have seen a considerable increase in the number of patients with inflammatory bowel diseases of unknown etiology, including both Crohn's disease and ulcerative colitis. Inflammatory bowel diseases can cause intestinal lesions throughout the gastrointestinal tract, necessitating gastrointestinal endoscopy for examining all relevant aspects, especially lesion characteristics, for differential diagnosis and histological diagnosis, to select the appropriate treatment options, determine treatment effectiveness, etc. Specific guidelines are necessary to ensure that endoscopy can be performed in a safe and more tailored and efficient manner, especially since gastrointestinal endoscopy, including enteroscopy, is a common procedure worldwide, including in Japan. Within this context, the Japan Gastroenterological Endoscopy Society has formulated the “Guidelines for the Endoscopic Diagnosis and Treatment of Inflammatory Bowel Diseases” to provide detailed guidelines regarding esophagogastroduodenoscopy, enteroscopy, and colonoscopy procedures for definitive diagnosis, as well as determination of treatment effectiveness in clinical cases of inflammatory bowel diseases.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"319-351"},"PeriodicalIF":5.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538095","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 clearance of painless pancreatic stones with endotherapy prevents the progression of pancreatic parenchyma atrophy in patients with chronic pancreatitis: Multicenter cohort study","authors":"Tsukasa Ikeura, Ayaka Takaori, Kazuhiro Kikuta, Ken Ito, Tetsuya Takikawa, Takaaki Eguchi, Tadahisa Inoue, Yasuki Hori, Kenji Nakamura, Mamoru Takenaka, Yoshio Sogame, Tadayuki Takagi, Nao Fujimori, Satoshi Yamamoto, Akira Nakamura, Toshitaka Sakai, Arata Sakai, Takashi Tamura, Tomotaka Saito, Koichi Fujita, Atsushi Kanno, Kunihiro Hosono, Keisuke Iwata, Atsushi Irisawa, Kazuhisa Okamoto, Masaki Kuwatani, Makoto Naganuma, Atsushi Masamune, Yoshifumi Takeyama, Japan Pancreatitis Study Group for CP","doi":"10.1111/den.14998","DOIUrl":"10.1111/den.14998","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This retrospective multicenter study aimed to clarify the clinical impact of endotherapy for painless pancreatic duct (PD) stones compared with that in patients who received conservative treatment without endotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 268 patients suffering from chronic pancreatitis with painless PD stones (145 with endotherapy and 123 without endotherapy) and evaluated the impact of endotherapy for painless PD stones on clinical and radiological outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>When conservative treatment without endotherapy was set as a reference, complete clearance of the targeted PD stones decreased the relative risk for atrophy of pancreatic parenchyma after inclusion (hazard ratio [HR] 0.42; 95% confidence interval [CI] 0.21–0.84). Incomplete clearance of the targeted PD stones was identified as a risk factor for new-onset or worsening of diabetes (HR 2.08; 95% CI 1.10–3.91) and inducement of pain attack (HR 4.03; 95% CI 1.45–11.19), although complete clearance was not correlated with these outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In chronic pancreatitis patients with painless PD stones, endotherapy with complete stone clearance allows the maintenance of pancreatic parenchymal volume. However, if complete clearance fails, endotherapy could lead to aggravation of glucose tolerance and pain attacks during follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 6","pages":"638-650"},"PeriodicalIF":5.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517618","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":"Case of refractory esophagotracheobronchial fistula successfully closed with a dumbbell-shaped polyglycolic acid sheet","authors":"Hikaru Kakimoto, Maki Matsui, Satoshi Ono","doi":"10.1111/den.15007","DOIUrl":"10.1111/den.15007","url":null,"abstract":"<p>Watch a video of this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 7","pages":"805-806"},"PeriodicalIF":5.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517607","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":"Response to “Side-by-side placement of fully covered metal stents versus 7F plastic stents in malignant hilar biliary obstruction”","authors":"Yavuz Emre Parlar","doi":"10.1111/den.15011","DOIUrl":"10.1111/den.15011","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"429"},"PeriodicalIF":5.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494943","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":"Virtual-reality endoscopic navigation system in mediastinal natural orifice transluminal endoscopic surgery (with video)","authors":"Masaya Uesato, Senri Umetsu, Akira Nakano, Mayuko Kinoshita, Toshiya Nakaguchi, Hisahiro Matsubara","doi":"10.1111/den.15001","DOIUrl":"10.1111/den.15001","url":null,"abstract":"<p>The approaches to mediastinal surgery are open thoracic, thoracoscopic, and mediastinoscopy. However, using natural orifice transluminal endoscopic surgery (NOTES) would be minimally invasive if the mediastinum is reached via the esophagus. One disadvantage of NOTES was no information outside the wall. We focused on the electromagnetic tracking solution. The sensor position in the space created by the magnetic field generator can be determined. We performed a computed tomography (CT) of a pig before constructing the target mediastinal organs in 3D. The pig was placed in the magnetic field space, and the endoscope with the sensor was subsequently inserted orally and synchronized with the 3D image. By simultaneously viewing the actual and the virtual endoscopic image in 3D, the mediastinum can be visualized through the esophagus. We determined six points in advance in the 3D images, and the esophageal lumen closest to the esophagus from the points was marked with a clip under the endoscope. The CT scans showed that the mean error between the clip position and the closest point from the target point to the esophagus was 4.7 mm across three trials. We named this system the virtual-reality endoscopic navigation system (VENaS). VENaS can help determine the shortest distance to the point away from the esophagus and the 3D relation with the surrounding organs during esophageal endoscopy, and also displays gravity direction and an overhead view, thereby making it easy to approach areas with tumors or malformations in the mediastinum and increasing the realism of mediastinal NOTES.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"541-547"},"PeriodicalIF":5.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494970","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":"Ergonomic endoscopy – Fundamentals of ergonomics and interventions for endoscopy-related musculoskeletal disorders","authors":"Ippei Matsuzaki, Takeshi Ebara, Yasuki Hori, Shoko Ono, Yousuke Nakai, Kazuki Hayashi, Mafu Tsunemi, Mitsuhiro Fujishiro","doi":"10.1111/den.14999","DOIUrl":"10.1111/den.14999","url":null,"abstract":"<p>Recently, musculoskeletal disorders (MSDs) among endoscopists have attracted considerable attention. MSDs are caused by prolonged static postures, forceful manual exertions, and repetitive twisting maneuvers. Basic knowledge of ergonomics is useful for improving the posture, movements, and work environment of endoscopists, as well as developing equipment to prevent MSDs. This review discusses problematic endoscopic tasks from an ergonomic perspective, issues with MSD definitions, the prevalence of MSDs, local site interpretations, risk factors including working time and environment, and ergonomic evaluations. The evidence highlights the importance of multifaceted strategies for risk avoidance using the Hierarchy of Controls. Additionally, this review summarizes global trends and introduces the Ergonomic Endoscopy 7 Tips for MSD prevention, emphasizing a systems approach through collaboration with various stakeholders. Thus, it may serve as a guide for gastroenterologists and staff engaged in endoscopic procedures for prolonged periods.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 6","pages":"588-600"},"PeriodicalIF":5.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14999","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450282","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}
Jae Woo Park, Jong Ho Moon, Yun Nah Lee, Il Sang Shin, Jun Chul Chung, Jaehong Jeong, Tae Hoon Lee, Jae Kook Yang, Young Deok Cho, Sang-Heum Park
{"title":"Long-term outcomes of a modified nonflared fully covered self-expandable metal stent for refractory anastomotic biliary strictures after liver transplantation (with video)","authors":"Jae Woo Park, Jong Ho Moon, Yun Nah Lee, Il Sang Shin, Jun Chul Chung, Jaehong Jeong, Tae Hoon Lee, Jae Kook Yang, Young Deok Cho, Sang-Heum Park","doi":"10.1111/den.14990","DOIUrl":"10.1111/den.14990","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Although fully covered self-expandable metal stents (FCSEMS) are used for the management of anastomotic biliary stricture (ABS) after liver transplantation (LT), there is concern about long-term adverse events such as recurrence of stricture. We evaluated the long-term efficacy of a modified nonflared FCSEMS (M-FCSEMS) compared to plastic stents (PS) for refractory ABS after LT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients who underwent placement of an M-FCSEMS (M-FCSEMS group) or multiple PS (PS group) for refractory ABS after LT were enrolled. The primary outcome was the stricture recurrence rate, and the secondary outcomes were technical success, clinical success, and the rate of de novo stricture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In both groups, technical success was achieved in all patients. The median stent duration was 3.1 months in the M-FCSEMS group and 7.6 months in the PS group (<i>P</i> < 0.001). Clinical success rates were 96.7% (29/30) for the M-FCSEMS group and 94.4% (17/18) for the PS group (<i>P</i> = 0.709). Stent migration occurred in 10.0% (3/30) of the patients before removal of the stent in the M-FCSEMS group, while 27.8% (5/18) of patients in the PS group showed stent migration (<i>P</i> = 0.110). Stricture recurrence occurred in 17.2% (5/29) in the M-FCSEMS group, compared to 47.1% (8/17) in the PS group (<i>P</i> = 0.036). There were no de novo strictures observed in either cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Modified nonflared FCSEMS is effective for relieving refractory ABS after LT, with a low recurrence rate and the absence of de novo stricture after long-term follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 6","pages":"651-658"},"PeriodicalIF":5.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442799","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}