Digestive Endoscopy最新文献

{"title":"Usefulness of the right lateral decubitus push method in endoscopic submucosal dissection for upper gastric lesions","authors":"Takuya Matsunaga,&nbsp;Naoyuki Tominaga,&nbsp;Shinichi Ogata","doi":"10.1111/den.14945","DOIUrl":"10.1111/den.14945","url":null,"abstract":"<p>Endoscopic submucosal dissection (ESD) for lesions in the gastric fundus and greater curvature remains challenging owing to difficulties in achieving tangential access with conventional endoscopy, despite the widespread adoption of ESD. Recent reports highlight the need for improved techniques in managing lesions, such as “fundic gland-type gastric cancer” in these regions. Our institution previously introduced the “right lateral decubitus push method” (RPM), wherein the patient is positioned in the right lateral decubitus position, allowing tangential access to the lesion by advancing the endoscope (Fig. 1). This method facilitates a horizontal approach, stabilizes endoscopic operations by increasing the contact area between the endoscope and the gastric wall, and is simple to perform and cost-effective. RPM also permits the use of traction methods<span>¹</span> and multibending endoscopes.<span>²</span> However, the method increases the risk of the gastric contents flooding the esophagogastric junction,<span>³</span> necessitating frequent oral suction or the use of an overtube to prevent aspiration pneumonia.<span>^{4, 5}</span> The feasibility and maneuverability of RPM should be assessed preoperatively in each patient, as the method may not be suitable for all patients. We retrospectively compared the treatment outcomes of 16 cases in which ESD was performed using RPM for lesions from the gastric fundus to the upper greater curvature from January 2010 to December 2020, with 10 cases receiving conventional methods (cESD) (Table 1). Although there were no statistically significant differences in treatment outcomes between the groups, the RPM group showed lower rates of postoperative bleeding and intraoperative perforation, as well as shorter operative times versus the cESD group. Aspiration pneumonia was not observed, likely owing to preventive measures. RPM enabled safe and complete ESD for challenging lesions in the gastric fundus and greater curvature that were difficult to access with conventional left lateral decubitus ESD (Video S1). RPM offers a viable alternative for difficult gastric ESDs, improving accessibility and stability during the procedure.</p><p>Authors declare no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Reviewer Board: This study was performed with the approval of the Saga Medical Centre Koseikan Ethics Committee (Approval number: 21-03-01-02).</p><p>Informed Consent: In this study, informed consent was obtained from patients using the opt-out method..</p><p>Registry and the Registration No. of the study/trial: N/A.</p><p>Animal Studies: N/A.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"300-301"},"PeriodicalIF":5.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14945","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711727","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 gallbladder drainage for acute cholecystitis","authors":"Jacquelyn Chi Ying Fok,&nbsp;Anthony Yuen Bun Teoh,&nbsp;Shannon Melissa Chan","doi":"10.1111/den.14946","DOIUrl":"10.1111/den.14946","url":null,"abstract":"<p>With technological advances in endoscopic ultrasonography, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) was introduced as a treatment option for acute cholecystitis. Recently, new studies have emerged, suggesting that EUS-GBD has a lower adverse event rate and reintervention rate, when compared to percutaneous drainage and endoscopic transpapillary gallbladder drainage. There is growing interest in the different technical aspects of EUS-GBD, such as the puncture approach, choice of stents, and long-term management. There are also cohorts on performing EUS-GBD in potential surgical candidates. This review article gathers the latest evidence on EUS-GBD, including its indications, procedural techniques, choice of equipment, outcomes, postprocedural care, and the controversial extended indications.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"93-102"},"PeriodicalIF":5.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649562","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":"Metal stent versus plastic stent in endoscopic ultrasound-guided hepaticogastrostomy for unresectable malignant biliary obstruction: Large single-center retrospective comparative study","authors":"Daiki Yamashige,&nbsp;Susumu Hijioka,&nbsp;Yoshikuni Nagashio,&nbsp;Yuta Maruki,&nbsp;Yasuhiro Komori,&nbsp;Masaru Kuwada,&nbsp;Soma Fukuda,&nbsp;Shin Yagi,&nbsp;Kohei Okamoto,&nbsp;Daiki Agarie,&nbsp;Mark Chatto,&nbsp;Chigusa Morizane,&nbsp;Hideki Ueno,&nbsp;Shunsuke Sugawara,&nbsp;Miyuki Sone,&nbsp;Yutaka Saito,&nbsp;Takuji Okusaka","doi":"10.1111/den.14956","DOIUrl":"10.1111/den.14956","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Whether metal stents (MS) or plastic stents (PS) yield better outcomes for malignant biliary obstruction in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is controversial. We aimed to compare outcomes of initial EUS-HGS performed with MS or PS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method<b>s</b></h3>\u0000 \u0000 <p>In this single-center retrospective study, we included patients (MS/PS groups: <i>n</i> = 151/72) with unresectable malignant biliary obstruction and performed multivariable analysis. The landmark date was defined as day 100 and used to evaluate the time to recurrent biliary obstruction (TRBO).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The clinical success rate was similar in both groups. The mean total bilirubin percentage decrease at week 2 was significantly higher in the MS group than in the PS group (−45.1% vs. −23.7%, <i>P</i> = 0.016). Median TRBO was significantly different between the MS and PS groups (183 and 92 days, respectively; <i>P</i> = 0.017). TRBO within 100 days was comparable in both groups but was significantly shorter only after 100 days in the PS group (adjusted hazard ratio 12.8, <i>P</i> &lt; 0.001). Adverse events were significantly more common in the MS group (23.8% vs. 9.7%, <i>P</i> = 0.012), although they occurred relatively frequently even with PS in the cholangitis subgroup (<i>P</i>_interaction = 0.034). After endoscopic re-intervention, TRBO tended to be longer with revision PS (hazard ratio 0.40, <i>P</i> = 0.47).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although MS provided early improvement of jaundice and long stent patency, PS provided a better safety profile and comparable stent patency until 100 days. PS might also be an adequate and optimal palliation method in EUS-HGS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"117-129"},"PeriodicalIF":5.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Site of puncture in endoscopic ultrasound-guided fine needle biopsy: Does it change diagnostic outcome?","authors":"Chandramauli Mishra,&nbsp;Suprabhat Giri","doi":"10.1111/den.14965","DOIUrl":"10.1111/den.14965","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"200"},"PeriodicalIF":5.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful diagnosis of small gastrointestinal stromal tumor using modified mucosal incision-assisted biopsy with a cold snare","authors":"Yoshitaka Ando,&nbsp;Toshiyuki Sakurai,&nbsp;Masayuki Saruta","doi":"10.1111/den.14955","DOIUrl":"10.1111/den.14955","url":null,"abstract":"<p>Gastric subepithelial lesions (G-SELs), including malignant conditions like gastrointestinal stromal tumors (GISTs), require biopsy for diagnosis.<span>¹</span> The European Society of Gastrointestinal Endoscopy guidelines recommend mucosal incision-assisted biopsy (MIAB) as the first choice for small SELs (≤20 mm),<span>²</span> despite its association with complications such as postoperative bleeding and perforation.<span>³</span> In 2020, Zimmer and Eltze<span>⁴</span> presented a modified MIAB using a cold snare to expose G-SELs. Modified MIAB allows for more reliable tissue sampling than boring biopsy by exposing a larger area of the tumor, but it can increase immediate bleeding due to the absence of electrocautery. Despite this, it avoids thermal damage to tissue samples, reduces the risk of delayed complications, and usually avoids hospitalization. However, to our knowledge, only one retrospective study has reported on this method, limited to benign conditions.<span>⁵</span> Here, we report the first case of small GIST successfully diagnosed using modified MIAB (Video S1).</p><p>The G-SEL in the mid-body lesser curvature originated from the muscularis propria layer, measuring 18.1 mm on endoscopic ultrasound (Fig. 1a,b). The covering mucosa was bluntly resected with a thin-wire snare to a size equal to or at least half of the tumor diameter, and submucosal tissue was extracted several times with biopsy forceps (Fig. 1c,d). Once the G-SEL surface became irregular and adequately exposed, three biopsies were performed using biopsy forceps (Fig. 1e). If the tumor is a high-grade GIST, tumor exposure during open laparoscopic and endoscopic cooperative surgery risks peritoneal dissemination, so mucosal defects were clipped (Fig. 1f). All three biopsy procedures yielded c-kit positive tumor tissue, sufficient for a definitive histological diagnosis (Fig. 2). The procedure took 9 min, without complications.</p><p>This report indicates that modified MIAB with cold snare is effective for the histological diagnosis of GISTs and may be performed more quickly than existing methods.</p><p>Authors declare no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Reviewer Board: This procedure and case report were approved by the Ethics Committee of Atsugi City Hospital.</p><p>Informed Consent: Informed consent was obtained from the patient after verbally explaining the purpose, method, safety considerations, and risks of the procedure.</p><p>Registry and the Registration No. of the study/trial: N/A.</p><p>Animal Studies: N/A.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"308-310"},"PeriodicalIF":5.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14955","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroendocrine neoplasm of the minor papilla diagnosed with endoscopic ultrasonography-guided fine-needle biopsy and curatively resected by endoscopic papillectomy","authors":"Kento Shionoya,&nbsp;Kenjiro Yamamoto,&nbsp;Takao Itoi","doi":"10.1111/den.14953","DOIUrl":"10.1111/den.14953","url":null,"abstract":"<p>Minor papillary neoplasms are rare and surgical resection is the most reported treatment.<span>¹</span> Moreover, reports of endoscopic resection of neoplasm in the minor papilla are scarce.<span>²</span></p><p>A 47-year-old man with an enlarged minor papilla detected on upper gastrointestinal endoscopy was referred to our institution (Fig. 1a). Duodenoscopy revealed a submucosal epithelial lesion in the minor papilla (Fig. 1b), and endoscopic ultrasonography (EUS) showed an 8 mm hypoechoic neoplasm within the submucosal layer without invasion of the muscularis propria or intraductal extension into the pancreatic duct (Fig. 1c,d). Contrast-enhanced EUS showed that the neoplasm was contrast on isoechoic. Based on EUS-guided fine-needle biopsy (EUS-FNB) with a 22G three-prong asymmetry tip needle (Trident; Micro-Tech Endoscopy, Nanjing, China) using the fanning technique, the lesion was diagnosed as a low-grade (G1) neuroendocrine neoplasm (NEN). Computed tomography and magnetic resonance cholangiopancreatography showed no distant metastases or pancreatic divisum (Fig. 1e,f). The patient declined surgery, so endoscopic papillectomy (EP) was performed. The scope was placed in a semi-push position to position the lesion favorably. A snare was placed on the oral side of the lesion, which was then grasped by pushing the snare inward. During grasping, the scope was placed in a pulled position by stretching. The lesion was resected en bloc in endocut mode. Subsequently, pulsatile bleeding was controlled using hemostatic clips. A pancreatic ductal stent was not placed, as the pancreatic divisum was absent (Video S1). The pathological diagnosis was NEN-G1 without invasion of the muscularis propria or lymphovascular invasion, and the neoplasm was completely resected without any complications (Fig. 2). There was no recurrence within 1 year.</p><p>EUS-FNB can be used to diagnose NEN of the minor papilla. EP can be effective for NEN of the minor papilla and should be considered when the neoplasm is &lt;10 mm without intrinsic muscle layer invasion or lymph node metastasis.<span>³</span></p><p>Authors declare no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Reviewer Board: N/A.</p><p>Informed Consent: Informed consent was obtained from the patient in this case report.</p><p>Registry and the Registration No. of the study/trial: N/A.</p><p>Animal Studies: N/A.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"430-431"},"PeriodicalIF":5.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14953","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607716","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":"Effect of remimazolam on oxygen reserve compared with propofol during upper gastrointestinal endoscopy: Randomized controlled study","authors":"Kyuho Lee,&nbsp;Da Hyun Jung,&nbsp;Sung Jin Lee,&nbsp;Young Chul Yoo,&nbsp;Sung Kwan Shin","doi":"10.1111/den.14948","DOIUrl":"10.1111/den.14948","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Propofol is commonly used for endoscopic sedation. However, it can induce adverse hemodynamic effects. Remimazolam is known to have a fast onset and short duration comparable to that of propofol, but with fewer effects on hemodynamics. We assessed the Oxygen Reserve Index to verify whether a sedative dose of remimazolam would better preserve oxygenation in the mild hyperoxic range than propofol in sedated patients undergoing diagnostic upper gastrointestinal endoscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients scheduled for diagnostic upper gastrointestinal endoscopy were enrolled. Patients were randomly assigned to either the remimazolam or propofol groups and received 0.1 mg/kg remimazolam or 0.5 mg/kg propofol, respectively. Bolus injections of either 0.05 mg/kg remimazolam or 0.25 mg/kg propofol were added if required. The primary outcome was the prevalence of oxygen reserve depletion, defined as the Oxygen Reserve Index decreasing to 0.00, and hypoxia defined as peripheral oxygen saturation falling to &lt;94%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 69 patients, the incidence of oxygen reserve depletion was significantly higher in the propofol group (65.7% vs. 38.2%, <i>P</i> = 0.022). Hypoxia was frequently observed in the propofol group, whereas none was observed in the remimazolam group (11.4% vs. 0%, <i>P</i> = 0.042). Additional sedative injections were frequently required to complete endoscopy in the propofol group. None of the patients in the remimazolam group required airway interventions. Nausea was frequent in the propofol group in the recovery room.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our results indicate that remimazolam is a safe and useful sedative for upper gastrointestinal endoscopy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"391-399"},"PeriodicalIF":5.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14948","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WEO Newsletter: Evaluation and Endoscopic Management of Disconnected Pancreatic Duct Syndrome","authors":"","doi":"10.1111/den.14960","DOIUrl":"10.1111/den.14960","url":null,"abstract":"<p>WEO Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES</p><p>Surinder Singh Rana MD, D.M, FAMS, AGAF, FASGE, Master ISG, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India</p><p>Dr. Surinder Rana is a Professor of Gastroenterology at the Post Graduate Institute of Medical Education and Research, which is a premier Medical Education Institute in India. Dr. Rana has over 500 publications in peer-reviewed journals. He is a well-known researcher, endoscopist and educator who is involved in several international and national educational conferences and endoscopy workshops.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1292-1294"},"PeriodicalIF":5.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14960","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic closure using SureClip Traction Band for delayed perforation after colorectal endoscopic submucosal dissection","authors":"Reo Kobayashi,&nbsp;Naohisa Yoshida,&nbsp;Ken Inoue","doi":"10.1111/den.14938","DOIUrl":"10.1111/den.14938","url":null,"abstract":"<p>Delayed perforation (DP) is reported to occur in 0.1–0.4% of colorectal endoscopic submucosal dissection (ESD).<span>^{1, 2}</span> DP can be fatal due to peritonitis and most cases of colorectal DP result in surgery. Various endoscopic closures after ESD are reported for preventing DP.<span>^{3, 4}</span> However, few reports showed the success of endoscopic closure for DP.<span>⁵</span> In this report, we present a case of DP closed with SureClip Traction Band (SCTB; Micro-Tech Co., Nanjing, China). The patient was a 61-year-old woman. She took prednisolone 10 mg/day for Wegener's granulomatosis. A polypoid lesion of 25 mm was detected in the transverse colon (Fig. 1a). En bloc resection was performed with ESD. The ESD defect was closed using MANTIS Closure Device (Boston Scientific, Marlborough, MA, USA) and SureClip (Micro-Tech Co.), considering the negative impact of prednisolone for would healing (Fig. 1b,c). However, tight complete closure was not achieved due to difficult operability. On the day after ESD, the patient presented abdominal pain and computed tomography (CT) showed free air (Fig. 1d). Because of the localized peritonitis, we decided to close it endoscopically. Although no perforation was found, we performed additional closure with SureClip (Fig. 1e,f). However, 3 days after ESD, free air increased with CT (Fig. 2a). Endoscopic closure was performed again and contrast medium leakage was observed (Fig. 2b). The ulcer base was hard and previous clips remained, making closure difficult. Normal mucosa at the edge of the ulcer on the anal side was captured with SCTB. Then the band was gripped with SureClip and deployed at the oral side of the ulcer for closing the ESD defect. Finally, complete closure could be performed with additional SCTB and SureClip (Fig. 2c–f, Video S1). The patient was discharged 11 days after ESD.</p><p>Author N.Y. had a grant from Fujifilm and received a lecture fee from Fujifilm. The other authors have no conflicts of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"206-208"},"PeriodicalIF":5.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14938","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peroral digital cholangioscopy-assisted removal of a migrated biliary plastic stent using a novel small dilating balloon","authors":"Noriyuki Hirakawa,&nbsp;Shuntaro Mukai,&nbsp;Takao Itoi","doi":"10.1111/den.14950","DOIUrl":"10.1111/den.14950","url":null,"abstract":"<p>Biliary plastic stent (PS) migration is occasionally encountered during endoscopic retrograde cholangiopancreatography-related procedures.<span>¹</span> Several removal techniques for migrated stent have been reported.<span>^2-4</span> However, some cases are challenging even with these techniques. Here, we describe a case of successful peroral digital cholangioscopy-assisted removal of a migrated PS using a novel small dilating balloon.</p><p>The patient was a 74-year-old man who had undergone biliary drainage using a straight-type 7F PS for cholangitis because of a common bile duct stone at a previous hospital (Fig. 1a).</p><p>Stone removal was attempted in our hospital, but fluoroscopy showed that the PS had migrated into the bile duct (Fig. 1b). The stone was pushed toward the liver side and papillary balloon dilation was attempted, but this was difficult because of interference from the PS and stone. Therefore, removal of the migrated PS was attempted, first with grasping forceps under fluoroscopic guidance, but was unsuccessful because of the difficulty of grasping the PS. Removal using a basket was predicted to be difficult because of interference from the stone just above the papilla. Therefore, peroral digital cholangioscopy-assisted removal was attempted next. A digital cholangioscope (Spy DS; Boston Scientific, Natick, MA, USA) was inserted into the bile duct and visualized the migrated PS. Then, a 0.025 inch guidewire was passed through the stent's lumen under direct visualization (Fig. 2a). Subsequently, a novel small dilating balloon (3 mm × 6 cm, REN biliary dilation catheter; Kaneka Medix, Osaka, Japan) was inserted into the stent lumen<span>⁵</span> (Fig. 2b,c, Video S1). By inflating the balloon, crimping the balloon and the PS, and pulling back slowly, the migrated PS was successfully removed through-the-scope without interference from the balloon catheter or stone. The novel dilating balloon is longer than conventional versions, allowing for stronger crimping. Finally, the stone was removed and the procedure was completed.</p><p>Author T.I. received lecture fees from Kaneka Medix and Boston Scientific. The other authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"306-307"},"PeriodicalIF":5.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14950","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}