Digestive Endoscopy最新文献

{"title":"Peroral endoscopic tumor resection for an esophageal leiomyoma using a novel therapeutic thin endoscope","authors":"Haruna Horikawa,&nbsp;Osamu Dohi,&nbsp;Naoto Iwai","doi":"10.1111/den.14985","DOIUrl":"10.1111/den.14985","url":null,"abstract":"<p>Peroral endoscopic tumor resection (POET) is a less invasive treatment for esophageal subepithelial tumors (SET)<span>^1-3</span>; however, it is challenging to approach SETs in narrow submucosal tunnels. Herein, we report a case of POET using a novel thin endoscope for an esophageal leiomyoma. A 45-year-old man with moderate dysphagia was referred to our hospital for further examination of a SET in the abdominal esophagus (Fig. 1a). Endoscopic ultrasonography revealed a 30 mm tumor in the second and the third layers, originating from the fourth layer (Fig. 1b). Pathological analysis of fine-needle aspiration specimens identified leiomyoma. POET was performed using a thin therapeutic endoscope with a 7.9 mm diameter (EG-840TP; Fujifilm, Tokyo, Japan) under general anesthesia (Video S1). A 2 cm longitudinal mucosal incision was made using ProKnife (Boston Scientific, Tokyo, Japan) on the proximal side (Fig. 1c). Subsequently, a submucosal tunnel was created from the mucosal entrance to the tumor (Fig. 1d). To avoid injury to the tumor, this endoscope was important to precisely identify the tumor edge in a narrow submucosal space. Clutch Cutter (Fujifilm) and a clip with a thread for traction were used to dissect the muscularis propria, which was continuous with the tumor. We achieved en-bloc enucleation (Fig. 1e). The lesion was removed using an endoscopic net after widening the mucosal entrance (Fig. 1f). We then sutured the mucosal entrance using the reopenable clip-over-the-line method<span>⁴</span> (Fig. 1g). The patient had slight cutaneous emphysema immediately after the procedure but was discharged on postoperative day 5 with a good clinical course. The final pathology was leiomyoma with negative margins (Fig. 1h–k). This thin endoscope has an accessory channel of the same size as that of the conventional endoscope. Therefore, it minimizes the submucosal tunnel using conventional endoscopic devices (Fig. 2). Thus, this thin endoscope may facilitate POET for esophageal leiomyoma treatments.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"555-557"},"PeriodicalIF":5.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14985","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900761","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":"Position statement of the World Endoscopy Organization: Role of endoscopy in screening, diagnosis, and treatment of esophageal superficial squamous neoplasiaia","authors":"Cesare Hassan,&nbsp;Giulio Antonelli,&nbsp;Philip Wai-yan Chiu,&nbsp;Fabian Emura,&nbsp;Kenichi Goda,&nbsp;Prasad G. Iyer,&nbsp;Sameer Al Awadhi,&nbsp;Abed Al Lehibi,&nbsp;Vitor Arantes,&nbsp;Herbert Burgos,&nbsp;Cecilio L. Cerisoli,&nbsp;Sanford Dawsey,&nbsp;Peter Draganov,&nbsp;David Fleischer,&nbsp;Fernando Fluxá,&nbsp;Nicolas Gonzalez,&nbsp;Haruhiro Inoue,&nbsp;Sneha John,&nbsp;Sergey Kashin,&nbsp;Mouen Khashab,&nbsp;Gwang Ha Kim,&nbsp;Shivangi Kothari,&nbsp;Yeong Yeh Lee,&nbsp;Saowanee Ngamruengphong,&nbsp;Jose Maria Remes-Troche,&nbsp;Ala I. Sharara,&nbsp;Yuto Shimamura,&nbsp;Mahachai Varocha,&nbsp;Guido Villa-Gomez,&nbsp;Kenneth K. Wang,&nbsp;Wen-Lun Wang,&nbsp;Hon-Chi Yip,&nbsp;Prateek Sharma","doi":"10.1111/den.14967","DOIUrl":"10.1111/den.14967","url":null,"abstract":"<p>Esophageal squamous cell carcinoma (ESCC) remains a significant global health challenge, being the sixth leading cause of cancer mortality with pronounced geographic variability. The incidence rates range from 125 per 100,000 in northern China to 1–1.5 per 100,000 in the United States, driven by environmental and lifestyle factors such as tobacco and alcohol use, dietary habits, and pollution. Major modifiable risk factors include tobacco and alcohol consumption, with a synergistic risk increase when combined. Nonmodifiable risk factors include previous diagnoses of head and neck squamous cell carcinoma (H&amp;N SCC), achalasia, and prior radiotherapy. Prevention strategies must be tailored to specific regional burdens to efficiently allocate medical and financial resources. Gastrointestinal endoscopy is crucial in reducing ESCC burden through early detection and characterization of neoplastic changes, such as high-grade dysplasia. Early diagnosis significantly improves survival rates, while endoscopic resection of noninvasive dysplasia can prevent ESCC onset, reducing treatment burden for advanced disease. Postresection surveillance can detect high-risk metachronous lesions. Despite these benefits, endoscopic prevention faces challenges, including the lack of high-level evidence supporting its efficacy, opportunity costs, the need for specialized training and techniques, and the requirement for advanced technology investments. This Position Statement from the World Endoscopy Organization (WEO) aims to address these challenges, supplying recommendations for the exploitation of endoscopic resources regarding the possible role of screening, quality, and training for the detection, characterization, resection, and surveillance of ESCC.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"470-489"},"PeriodicalIF":5.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900762","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":"Rituximab-associated colitis mimicking ulcerative colitis","authors":"Yoshihiro Yokoyama,&nbsp;Hiroki Kurumi,&nbsp;Hiroshi Nakase","doi":"10.1111/den.14982","DOIUrl":"10.1111/den.14982","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"295"},"PeriodicalIF":5.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900763","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":"Enhancing visibility in gastric endoscopic dissection: Red dichromatic imaging in managing submucosal fatty tissue","authors":"Kohei Shigeta,&nbsp;Masao Yoshida,&nbsp;Hiroyuki Ono","doi":"10.1111/den.14978","DOIUrl":"10.1111/den.14978","url":null,"abstract":"<p>Submucosal fatty tissue can significantly reduce visibility during endoscopic submucosal dissection (ESD) due to lens cloudiness.<span>¹</span> In colorectal ESD, red dichromatic imaging (RDI) maintains clear visibility in the presence of extensive submucosal fatty tissue.<span>²</span> Despite reports on the effectiveness of RDI in hemostasis during gastric ESD,<span>^{3, 4}</span> evidence and image documentation of its effectiveness in techniques other than endoscopic hemostasis are limited. Therefore, in this video article, we demonstrate the effectiveness of RDI to enhance visibility during gastric ESD.</p><p>A 74-year-old man underwent gastric ESD with a therapeutic gastroscope (GIF-H290T; Olympus, Tokyo, Japan). During the circumferential mucosal incision, extensive submucosal fatty tissue was observed. Even after submucosal injection of indigo carmine, the yellow tone of submucosal fatty tissue remained conspicuous under white light imaging (WLI), and the trimming line was obscured. Conversely, RDI suppressed the yellow tone of fatty tissue and emphasized the blue tone of indigo carmine, which allowed for safe trimming. In submucosal dissection, RDI also improved visibility by reducing lens cloudiness, and the submucosal layer was clearly visible (Fig. 1). We achieved en bloc resection without adverse events (Video S1). Pathological examination revealed that all lesions were intramucosal well-differentiated adenocarcinomas with rich adipose tissue in the submucosal layer. As reported previously, RDI can improve the visibility of the submucosal layer during ESD.<span>⁵</span> RDI reduces the yellow tone of submucosal fatty tissue and they are depicted as the white tone (Fig. 2a–c). Moreover, because RDI does not emit light at shorter wavelengths, it can penetrate greater depths than WLI. Therefore, RDI enhances the blue tone of indigo carmine. Furthermore, the endoscopic appearance with WLI is blurrier because of light scattering than with RDI. (Fig. 2d). In summary, RDI enabled obtaining clear visual fields during gastric ESD with extensive submucosal fatty tissue.</p><p>Author M.Y. is Associate Editor of <i>Digestive Endoscopy</i>. The other authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"550-552"},"PeriodicalIF":5.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14978","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831145","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":"Tribute to our reviewers","authors":"","doi":"10.1111/den.14932","DOIUrl":"https://doi.org/10.1111/den.14932","url":null,"abstract":"&lt;p&gt;It is our greatest pleasure to recognize the many individuals who have provided their valuable time and expertise to support Digestive Endoscopy. The Editorial Board wishes to acknowledge with particular gratitude the following Reviewers who have reviewed papers during the period of July 2023 to June 2024.&lt;/p&gt;&lt;p&gt;Nobutsugu Abe&lt;/p&gt;&lt;p&gt;Seiichiro Abe&lt;/p&gt;&lt;p&gt;Omer Ahmad&lt;/p&gt;&lt;p&gt;Yoichi Akazawa&lt;/p&gt;&lt;p&gt;Teppei Akimoto&lt;/p&gt;&lt;p&gt;Hadrien Alric&lt;/p&gt;&lt;p&gt;Tomonori Aoki&lt;/p&gt;&lt;p&gt;Taiki Aoyama&lt;/p&gt;&lt;p&gt;Livia Archibugi&lt;/p&gt;&lt;p&gt;Reiko Ashida&lt;/p&gt;&lt;p&gt;Hiroshi Ashizawa&lt;/p&gt;&lt;p&gt;Shigeki Bamba&lt;/p&gt;&lt;p&gt;Amol Bapaye&lt;/p&gt;&lt;p&gt;Robert Bechara&lt;/p&gt;&lt;p&gt;Alexandre Bestetti&lt;/p&gt;&lt;p&gt;Ivo Boskoski&lt;/p&gt;&lt;p&gt;Shannon Chan&lt;/p&gt;&lt;p&gt;Li-Chun Chang&lt;/p&gt;&lt;p&gt;Hideyuki Chiba&lt;/p&gt;&lt;p&gt;Cheng-Tang Chiu&lt;/p&gt;&lt;p&gt;Jae Hee Cho&lt;/p&gt;&lt;p&gt;Chu-Kuang Chou&lt;/p&gt;&lt;p&gt;Maria Cristina Conti Bellocchi&lt;/p&gt;&lt;p&gt;Stefano Francesco Crinó&lt;/p&gt;&lt;p&gt;Anjan Dhar&lt;/p&gt;&lt;p&gt;Akira Dobashi&lt;/p&gt;&lt;p&gt;Osamu Dohi&lt;/p&gt;&lt;p&gt;Shinpei Doi&lt;/p&gt;&lt;p&gt;Mitsuru Esaki&lt;/p&gt;&lt;p&gt;Hiroyuki Eto&lt;/p&gt;&lt;p&gt;Antonio Facciorusso&lt;/p&gt;&lt;p&gt;Nao Fujimori&lt;/p&gt;&lt;p&gt;Ai Fujimoto&lt;/p&gt;&lt;p&gt;Toshio Fujisawa&lt;/p&gt;&lt;p&gt;Koichi Fujita&lt;/p&gt;&lt;p&gt;Yusuke Fujiyoshi&lt;/p&gt;&lt;p&gt;Mitsuharu Fukasawa&lt;/p&gt;&lt;p&gt;Nobuhiko Fukuba&lt;/p&gt;&lt;p&gt;Sho Fukuda&lt;/p&gt;&lt;p&gt;Shusei Fukunaga&lt;/p&gt;&lt;p&gt;Kohei Funasaka&lt;/p&gt;&lt;p&gt;Yasuaki Furue&lt;/p&gt;&lt;p&gt;Hiroto Furuhashi&lt;/p&gt;&lt;p&gt;Joan Gornals&lt;/p&gt;&lt;p&gt;Osamu Goto&lt;/p&gt;&lt;p&gt;Wan-Jie Gu&lt;/p&gt;&lt;p&gt;Saurabh Gupta&lt;/p&gt;&lt;p&gt;Shin Haba&lt;/p&gt;&lt;p&gt;Ryunosuke Hakuta&lt;/p&gt;&lt;p&gt;Natalie Halvorsen&lt;/p&gt;&lt;p&gt;Tsuyoshi Hamada&lt;/p&gt;&lt;p&gt;Noboru Hanaoka&lt;/p&gt;&lt;p&gt;Kazuo Hara&lt;/p&gt;&lt;p&gt;Keiichi Hashiguchi&lt;/p&gt;&lt;p&gt;Shinichi Hashimoto&lt;/p&gt;&lt;p&gt;Shinichi Hashimoto&lt;/p&gt;&lt;p&gt;Waku Hatta&lt;/p&gt;&lt;p&gt;Junnosuke Hayasaka&lt;/p&gt;&lt;p&gt;Tsuyoshi Hayashi&lt;/p&gt;&lt;p&gt;Reiji Higashi&lt;/p&gt;&lt;p&gt;Susumu Hijioka&lt;/p&gt;&lt;p&gt;Takuto Hikichi&lt;/p&gt;&lt;p&gt;Makoto Hinokuchi&lt;/p&gt;&lt;p&gt;Sakiko Hiraoka&lt;/p&gt;&lt;p&gt;Kingo Hirasawa&lt;/p&gt;&lt;p&gt;Morihisa Hirota&lt;/p&gt;&lt;p&gt;Takashi Hisabe&lt;/p&gt;&lt;p&gt;Keisuke Hori&lt;/p&gt;&lt;p&gt;Masayasu Horibe&lt;/p&gt;&lt;p&gt;Yohei Horikawa&lt;/p&gt;&lt;p&gt;Akira Horiuchi&lt;/p&gt;&lt;p&gt;Yusuke Horiuchi&lt;/p&gt;&lt;p&gt;Naoki Hosoe&lt;/p&gt;&lt;p&gt;Shuhei Hosomi&lt;/p&gt;&lt;p&gt;Shu Hoteya&lt;/p&gt;&lt;p&gt;Wen-Feng Hsu&lt;/p&gt;&lt;p&gt;Bing Hu&lt;/p&gt;&lt;p&gt;Bing Hu&lt;/p&gt;&lt;p&gt;Ryoji Ichijima&lt;/p&gt;&lt;p&gt;Katsuro Ichimasa&lt;/p&gt;&lt;p&gt;Chikamasa Ichita&lt;/p&gt;&lt;p&gt;Noboru Ideno&lt;/p&gt;&lt;p&gt;Julio Iglesias-Garcia&lt;/p&gt;&lt;p&gt;Eikichi Ihara&lt;/p&gt;&lt;p&gt;Toshiro Iizuka&lt;/p&gt;&lt;p&gt;Yuichiro Ikebuchi&lt;/p&gt;&lt;p&gt;Hisatomo Ikehara&lt;/p&gt;&lt;p&gt;Hiroyuki Imaeda&lt;/p&gt;&lt;p&gt;Yutaka Inada&lt;/p&gt;&lt;p&gt;Yoshikazu Inagaki&lt;/p&gt;&lt;p&gt;Kazuya Inoki&lt;/p&gt;&lt;p&gt;Ken Inoue&lt;/p&gt;&lt;p&gt;Tadahisa Inoue&lt;/p&gt;&lt;p&gt;Fumiaki Ishibashi&lt;/p&gt;&lt;p&gt;Kazuyuki Ishida&lt;/p&gt;&lt;p&gt;Natsuki Ishida&lt;/p&gt;&lt;p&gt;Naoki Ishii&lt;/p&gt;&lt;p&gt;Shigeto Ishii&lt;/p&gt;&lt;p&gt;Tatsuya Ishii&lt;/p&gt;&lt;p&gt;Yasutaka Ishii&lt;/p&gt;&lt;p&gt;Takuya Ishikawa&lt;/p&gt;&lt;p&gt;Norihisa Ishimura&lt;/p&gt;&lt;p&gt;Hirotoshi Ishiwatari&lt;/p&gt;&lt;p&gt;Masahiro Itonaga&lt;/p&gt;&lt;p&gt;Hiroyoshi Iwagami&lt;/p&gt;&lt;p&gt;Itaru Iwama&lt;/p&gt;&lt;p&gt;Keisuke Iwata&lt;/p&gt;&lt;p&gt;Mineo Iwatate&lt;/p&gt;&lt;p&gt;Yugo Iwaya&lt;/p&gt;&lt;p&gt;Seok Jeong&lt;/p&gt;&lt;p&gt;Terry Jue&lt;/p&gt;&lt;p&gt;Tomohiro Kadota&lt;/p&gt;&lt;p&gt;Rakesh Kalapala&lt;/p&gt;&lt;p&gt;Tomoari Kamada&lt;/p&gt;&lt;p&gt;Ken Kamata&lt;/p&gt;&lt;p&gt;Shunsuke Kamba&lt;/p&gt;&lt;p&gt;Yu Kamitani&lt;/p&gt;&lt;p&gt;Takashi Kanesaka&lt;/p&gt;&lt;p&gt;Shuji Kanmura&lt;/p&gt;&lt;p&gt;Yoshihide Kanno&lt;/p&gt;&lt;p&gt;Hiromitsu Kanzaki&lt;/p&gt;&lt;p&gt;Hiroshi Kashida&lt;/p&gt;&lt;p&gt;Hironari Kato&lt;/p&gt;&lt;p&gt;Motohiko Kato&lt;/p&gt;&lt;p&gt;Takehiko Katsurada&lt;/p&gt;&lt;p&gt;Koichiro Kawaguchi&lt;/p&gt;&lt;p&gt;Hiroshi Kawakami&lt;/p&gt;&lt;p&gt;Kazumichi Kawakubo&lt;/p&gt;&lt;p&gt;K","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1391-1393"},"PeriodicalIF":5.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14932","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142851283","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: Current state and future development of robotic endoscopy","authors":"","doi":"10.1111/den.14971","DOIUrl":"10.1111/den.14971","url":null,"abstract":"&lt;p&gt;Hon Chi YIP MBChB (CUHK), FRCS(Edin)&lt;sup&gt;1&lt;/sup&gt; and Philip Wai Yan, CHIU MD (CUHK), MBChB (CUHK), FRCS(Edin)&lt;sup&gt;2&lt;/sup&gt;&lt;/p&gt;&lt;p&gt;&lt;sup&gt;1&lt;/sup&gt;Division of Upper GI &amp; Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong and &lt;sup&gt;2&lt;/sup&gt;Multi-Scale Medical Robotics Center, InnoHK&lt;/p&gt;&lt;p&gt;Development of flexible robotic endoscopy has proven to be a much more challenging task than rigid robotic surgical system. The main hurdles that need to be overcome for such a platform include the requirement of much smaller instruments within the GI lumen, as well as the intuitive movement of these instruments within a tortuous gastrointestinal tract. Existing robotic endoscopic systems could be divided into two main types: completely robotized endoscopic systems and robotic add-on system for existing endoscopic platforms. Among these systems, only a few have successfully reported results of human trials, while the majority of the others still remain at pre-clinical stage.&lt;/p&gt;&lt;p&gt;EndoMaster EASE system is a robotic endoscopic platform that consists of an endoscope mounted to a patient side cart, where two 4 mm robotic instruments (one electrosurgical dissector and one grasper) could be inserted into the target site through the endoscopy channel. The primary endoscopic surgeon controls the robotic instruments from the console unit, with both instruments allowing movement up to 9 Degree of Freedom (DOF). The prototype of the system was first applied in 5 human cases of gastric ESD in 2011 (&lt;span&gt;1&lt;/span&gt;). Following system modification into a fully robotic endoscopic platform, a prospective single arm study was recently reported for 43 patients who underwent colorectal ESD using the system (&lt;span&gt;2&lt;/span&gt;). Technical success was achieved in 86.1% of the patients, with en-bloc resection rate of 94.6% among those with successful procedure. While the results of the trial are encouraging, further questions remain including the need to downsize the system, the cost and benefit when compared with conventional ESD, etc.&lt;/p&gt;&lt;p&gt;EndoQuest Robotics Endoluminal Surgical (ELS) System is another robotic endoscopic platform that has reached the stage of clinical trials. Targeting solely at transanal endoscopic procedure at the sigmoid and rectum, the system consists of a 2.2 cm diameter 4-DOF Steerable Overtube (Previously named as Colubriscope), which allows insertion of one 6 mm flexible endoscope and two 6 mm robotic instruments with 7-DOF.&lt;/p&gt;&lt;p&gt;The system has demonstrated feasibility of partial thickness colorectal resection and suture closure in an ex-vivo animal study (&lt;span&gt;3&lt;/span&gt;). Human clinical trial is currently underway for resection of lesions in sigmoid and rectum, and the results are eagerly awaited.&lt;/p&gt;&lt;p&gt;Flex Robotic System (Medrobotics) utilizes a robotized endoscope with two flexible mechanical arms. The 28 mm diameter flexible robotic endoscope is controlled at the console with a joystick, with two working chan","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1394-1397"},"PeriodicalIF":5.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14971","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820199","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 treatment for pancreatic fluid collections: Is active intervention always the optimal option?","authors":"Masaki Kuwatani","doi":"10.1111/den.14969","DOIUrl":"10.1111/den.14969","url":null,"abstract":"&lt;p&gt;Good patient vitality and activity levels at the first visit positively affect clinical decision-making, particularly in the selection of diagnostic work-ups and treatments across various medical fields. Several indicators of patient vitality, such as frailty (measured by the “Frailty Risk Score”),&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; sarcopenia (assessed using the psoas muscle mass index/area/density), and comorbidity index,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; have been reported in recent literature and are closely associated with disease prognosis. Gilbert &lt;i&gt;et al&lt;/i&gt;. reported that among 202,718 patients, those with the highest Hospital Frailty Risk Scores had significantly increased odds of 30-day mortality (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.68–1.75), prolonged hospital stays (OR 6.03, 95% CI 5.92–6.10), and 30-day readmissions (OR 1.48, 95% CI 1.46–1.50) in older patients in acute care settings.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Furthermore, Farooq &lt;i&gt;et al&lt;/i&gt;. found that frailty in adult patients with acute pancreatitis was associated with higher rates of local complications, such as pseudocyst and walled-off necrosis, and systemic complications including acute respiratory distress syndrome and sepsis, based on a large national database of the United States.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; It is widely acknowledged that frailty and comorbidity are interrelated in the progression of many diseases. For instance, during the COVID-19 pandemic, all measures of frailty and comorbidity were associated with higher COVID-19 mortality risk, even after adjusting for age and sex, according to data from the UK Biobank, which included 2812 COVID-19 inpatients.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Furthermore, in an emergency department study of two Dutch hospitals, older adults with polypharmacy resulting from comorbidities and frailty had an increased risk of mortality (OR 2.62 and 3.92, 95% CI 1.39–4.93 and 1.95–7.90 for excessive polypharmacy).&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; This association is not surprising, as scoring systems for both frailty and comorbidity often include overlapping factors such as cognitive function and mobility.&lt;span&gt;&lt;sup&gt;1, 2, 5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Pancreatic fluid collections (PFCs), such as pseudocysts, walled-off necrosis, or postoperative pancreatic fistulas, can develop after acute pancreatitis or pancreatic resection. In some cases, these complications are refractory and potentially fatal despite multidisciplinary approaches. The treatment strategy for PFCs depends on the patient's condition, which is often influenced by the severity and number of comorbidities, as well as the characteristics of the PFC itself. To date, no studies have investigated the impact of comorbidity accumulation on the clinical outcomes of minimally invasive endoscopic ultrasound (EUS)-guided treatments for PFCs. However, Hamada &lt;i&gt;et al&lt;/i&gt;. demonstrated that the Charlson Comorbidity Index (CCI), a measure of comorbidity burden, was significantly associated with in-hospital morta","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"426-427"},"PeriodicalIF":5.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14969","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808744","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":"Usefulness of detective flow imaging endoscopic ultrasound for pancreatic neuroendocrine tumors difficult to detect with other imaging modalities","authors":"Takaoki Hayakawa,&nbsp;Eisuke Iwasaki,&nbsp;Takanori Kanai","doi":"10.1111/den.14979","DOIUrl":"10.1111/den.14979","url":null,"abstract":"<p>Recently, detective flow imaging endoscopic ultrasound (DFI-EUS), which can visualize microvascular blood flow, has been developed and integrated into an ultrasound observation system (ARIETTA 850; Fujifilm Healthcare, Tokyo, Japan). DFI-EUS is characterized by its ease of application in routine observations, offering the advantage of minimal patient discomfort and eliminating the need for drug administration, unlike contrast-enhanced EUS. However, the usefulness of DFI-EUS for pancreatic neuroendocrine tumor (pNET) has rarely been reported.</p><p>A 43-year-old woman with a history of hypoglycemic attacks visited our hospital. Dynamic computed tomography (CT) and magnetic resonance imaging (MRI), performed for further investigation, showed no abnormalities (Fig. 1a). However, based on the results of a glucose load test and selective arterial calcium injection test, an insulinoma located in the tail of the pancreas was suspected. EUS was conducted to identify the tumor's location and determine the extent of resection for surgery. The tumor could not be detected by B-mode or conventional color Doppler EUS (eFlow-EUS) (Fig. 1b), but only DFI-EUS could visualize the tumor location by depicting blood vessels wrapping around the tumor from the periphery, allowing visualization of a small 8.9 mm tumor in the tail of the pancreas (Fig. 2). Surgery was performed later, and the diagnosis of insulinoma was confirmed (Video S1).</p><p>Although there has been a previous report of a pNET case observed using both B-mode EUS and DFI-EUS,<span>¹</span> this is the first reported case in which the tumor was detectable only with DFI-EUS. It has been reported that pNETs are characterized by their hypervascularity,<span>^{2, 3}</span> and by visualizing this feature with DFI-EUS, we were able to identify its location. When a pNET is clinically suspected but not detectable by other imaging modalities, DFI-EUS may be valuable for detecting the tumor.</p><p>Author E.I. serves as an Editor of <i>Digestive</i> <i>Endoscopy</i>. The other author declares no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"553-554"},"PeriodicalIF":5.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14979","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808746","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":"Current status and issues for prediction and prevention of postendoscopic retrograde cholangiopancreatography pancreatitis","authors":"Hironari Kato,&nbsp;Takeshi Tomoda,&nbsp;Akihiro Matsumi,&nbsp;Kazuyuki Matsumoto","doi":"10.1111/den.14966","DOIUrl":"10.1111/den.14966","url":null,"abstract":"<p>Acute pancreatitis, which sometimes results in mortality, is a significant complication of endoscopic retrograde cholangiopancreatography (ERCP). Many studies have been conducted to predict and prevent post-ERCP pancreatitis (PEP), and meta-analyses have been reported that summarized these studies. However, many issues remain unresolved. Many risk factors for PEP have been reported, and it is rare for patients undergoing ERCP to have only one risk factor. The use of artificial intelligence may be important for analyzing complex and diverse risk factors. It is desirable to develop an alternative test for pancreatic enzymes that can predict the onset of PEP within 1 h after ERCP. The effectiveness of low-dose nonsteroidal anti-inflammatory drugs (NSAIDs) are controversial. Nitrate and tacrolimus are considered medications that have additional effects on NSAIDs and may be used for the prevention of PEP. Pancreatic stent placement with deliberate placement of the guidewire into the pancreatic duct may be more effective in preventing PEP. A comparison between transpancreatic sphincterotomy with deliberate guidewire placement into the pancreatic duct and needle-knife precut sphincterotomy is necessary. Early precutting is thought to be effective for the prevention of PEP, and the effectiveness of primary precut has been reported. However, the optimal timing of precut for the prevention of PEP has not been sufficiently discussed. Further research on prediction and prevention must be conducted to eliminate the mortality caused by PEP.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"362-372"},"PeriodicalIF":5.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14966","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781941","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":"Utilizing a novel highly rotatable and dual-action sphincterotome for precise cannulation and endoscopic sphincterotomy in surgically altered anatomy","authors":"Haruka Toyonaga,&nbsp;Takuya Takayama,&nbsp;Masaaki Shimatani","doi":"10.1111/den.14970","DOIUrl":"10.1111/den.14970","url":null,"abstract":"<p>Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) has become increasingly common in the management of pancreatobiliary diseases in patients with surgically altered anatomy.<span>^{1, 2}</span> In cases of Billroth II or Roux-en-Y reconstruction where the duodenal papilla is preserved, papillary interventions are essential for both diagnostic evaluations or treatments. However, performing precise cannulation and endoscopic sphincterotomy (EST) during BE-ERCP can be challenging.<span>³</span> One reason for this difficulty is that the endoscope's angulation required for directly facing the papilla often causes the sphincterotome's tip and blade to orient away from the desired direction, typically opposite of the oral protrusion (Fig. 1a,b). While various sphincterotomes have been reported to be useful,<span>^{4, 5}</span> the optimal device and technique remain unclear. Recently, a novel highly rotatable and dual-action sphincterotome (ENGETSU; KANEKA Medix Co., Osaka, Japan) has become available, offering the potential to change the incision direction freely to switch between push and pull modes with rotation, thereby enabling precise cannulation and EST (Fig. 1c,d; Video S1).</p><p>A 68-year-old man with a history of total gastrectomy followed by Roux-en-Y reconstruction presented with choledocholithiasis. BE-ERCP with short-type double balloon enteroscope (EI-580BT; Fujifilm Co., Tokyo, Japan) was performed to access the papilla. Upon inserting the sphincterotome, the curvature of the endoscope tip caused the blade to be directed opposite the side of the oral protrusion. By utilizing the rotational capability and alternating between push and pull modes, the catheter tip was successfully cannulated and the blade was directed towards the oral protrusion, allowing for precise incision (Fig. 2). Endoscopic papillary large-balloon dilatation was added after EST and the stones were successfully removed without adverse events. The novel sphincterotome enabled efficient cannulation and EST, demonstrating the device's utility not only in cases with normal anatomy using side-viewing duodenoscopes, but also in surgically altered anatomy with balloon-assisted endoscopy.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"440-442"},"PeriodicalIF":5.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14970","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781896","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}