Digestive Endoscopy最新文献

{"title":"Feasibility of endoscopic submucosal dissection including papilla (with video)","authors":"Naohisa Yahagi,&nbsp;Yusaku Takatori,&nbsp;Motoki Sasaki,&nbsp;Yuri Imura,&nbsp;Shoma Murata,&nbsp;Tsubasa Sato,&nbsp;Daisuke Minezaki,&nbsp;Takaoki Hayakawa,&nbsp;Yuki Nakajima,&nbsp;Haruka Okada,&nbsp;Hinako Sakurai,&nbsp;Anna Tojo,&nbsp;Kentaro Iwata,&nbsp;Kurato Miyazaki,&nbsp;Atsuto Kayashima,&nbsp;Teppei Masunaga,&nbsp;Mari Mizutani,&nbsp;Teppei Akimoto,&nbsp;Takashi Seino,&nbsp;Shintaro Kawasaki,&nbsp;Masayasu Horibe,&nbsp;Seichiro Fukuhara,&nbsp;Noriko Matsuura,&nbsp;Tomohisa Sujino,&nbsp;Atsushi Nakayama,&nbsp;Kaoru Takabayashi,&nbsp;Eisuke Iwasaki,&nbsp;Motohiko Kato","doi":"10.1111/den.14942","DOIUrl":"10.1111/den.14942","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic papillectomy (EP) is a low-invasive treatment for duodenal tumors including papilla. The limit of lesion size and local recurrence have been issues in EP. We developed endoscopic submucosal dissection (ESD) for the duodenal tumors including papilla (ESDIP: ESD including papilla) to overcome the problems. The aim of this study was to evaluate the feasibility of ESDIP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included the patients who underwent ESDIP from August 2010 to January 2024 in this study. We evaluated the retrospective characteristics of patients and lesions, clinical results of ESDIP and of endoscopic retrograde cholangiopancreatography (ERCP) as prevention for delayed adverse events, and pathological findings. We also calculated the cumulative recurrence rate and overall survival rate at 12 months after ESDIP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-four patients were included in this study. The mean lesion size was 39 mm. The third-quarter cases revealed a less than half-circumferential lesion, and the one case with a full-circumferential lesion. Resection was accomplished in 96% (<i>n</i> = 52), and also the en-bloc resection rate was 96%. Of the cases in accomplished resection, 98% of patients were intubated with a pancreaticobiliary drainage tube by ERCP. Intraprocedural perforation occurred in eight cases. Delayed bleeding occurred in 10 cases. Delayed perforation was seen only in one case. The incidence of post-ERCP pancreatitis was 25%. Cumulative local recurrence rate and the overall survival rate were 15% and 96%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ESDIP may be feasible for duodenal tumors including papilla, and is a potential alternative option to avoid pancreaticoduodenectomy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"402-410"},"PeriodicalIF":5.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570461","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":"Complete endoscopic debridement combined with partial gastric wall resection successfully treated refractory esophago-gastric anastomotic fistula","authors":"Yajuan Li,&nbsp;Jiyu Zhang,&nbsp;Bingrong Liu","doi":"10.1111/den.14944","DOIUrl":"10.1111/den.14944","url":null,"abstract":"<p>A 59-year-old man presented with an esophagogastric anastomotic fistula following Ivor Lewis esophageal cancer resection. The Interventional Radiology Department treats patients with the new “three-tube” method, which involves the fluoroscopically guided transnasal placement of a sinus drainage tube, a nasogastric decompression tube, and a nasojejunal nutritional tube. However, after 6 months of treatment, his chest pain and fever had not improved, he was unable to eat orally, and pus was still coming out of the sinus drainage tube. Upper gastrointestinal radiography showed a fistula still present (Fig. 1a).</p><p>After he was transferred to our department, we decided to perform further treatment. Endoscopy showed plenty of pus in the upper gastrointestinal tract. After cleaning it up, we saw a large anastomotic fistula. Swollen mucosa covered the fistula and interfered with drainage, which was removed with a snare (Fig. 1b,c). A large amount of dense necrotic tissue in the fistula was removed by a hook knife (Fig. 1d,e). The gastric wall between fistula and gastric lumen was removed with a hook knife and a snare in order to open the fistula for adequate drainage (Fig. 1f). During the operation, coagulation forceps were used to stop the bleeding (Video S1). We placed a tube into the fistula, rinsed daily with 8000 mL of saline, a nasogastric tube for negative pressure drainage, and a nasojejunal tube for feeding. Two days later, endoscopy showed no pus in the fistula, and all tubes were removed. He was started on an oral liquid diet, and discharged.</p><p>Surveillance endoscopy after 1, 4, and 7 months (Fig. 2a–c) showed a good healing process. Then 17 months later, endoscopy and computed tomography showed complete healing of the fistula (Fig. 2d,e), and a weight gain of 9 kg during follow-up.</p><p>Overall, anastomotic fistula is a refractory disease, this case demonstrates that this method is safe and valid and deserves to be promoted.</p><p>Authors declare no conflict of interest for this article.</p><p>This work was supported by grants from Zhongyuan Talent Program (ZYYCYU202012113).</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 for the publication of their information and imaging.</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":"302-303"},"PeriodicalIF":5.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14944","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570452","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":"Self-assembling peptides for successful hemostasis in advanced gastric cancer","authors":"Shusei Fukunaga,&nbsp;Akinobu Nakata,&nbsp;Yasuhiro Fujiwara","doi":"10.1111/den.14954","DOIUrl":"10.1111/den.14954","url":null,"abstract":"<p>Endoscopic hemostasis of bleeding from advanced gastric cancer is difficult because of the multiple sources and fragile tissues. Palliative radiotherapy, although effective, takes time to be effective.<span>^{1, 2}</span></p><p>The endoscopic application of a self-assembling peptide (SAP; PuraStat; 3-D Matrix, Tokyo, Japan) has been reported as a bridge to radiotherapy.<span>³</span> However, maintaining the visual field through air inflation is difficult because of blood pooling and wall stiffness.</p><p>Gel immersion endoscopy allows visualization under conditions of poor visibility.<span>^{4, 5}</span> However, it is unknown whether SAP coating is possible under gel immersion conditions.</p><p>Here, we demonstrate the application of SAP under gel immersion by a phantom experiment and report successful hemostasis of tumor bleeding by SAP application under gel immersion called the “gel under gel” technique (Video S1).</p><p>We modeled a hemorrhage by injecting simulated blood from a tube in an acrylic aquarium (Fig. 1a,b). We used an irrigation valve (BioShield irrigator; STERIS, Mentor, OH, USA) to simultaneously inject a transparent gel (Viscoclear; Otsuka Pharmaceutical Factory, Tokushima, Japan) and applied the SAP to the hemorrhage site using a dedicated catheter (Fig. 1c). By extruding the SAP with an indigo carmine solution instead of air, the end of the SAP use could be determined without bubbling. The gels did not mix, and the gel-forming SAP remained at the bleeding point after the surrounding gel was removed.</p><p>A 53-year-old man with advanced gastric cancer presented with severe anemia. Esophagogastroduodenoscopy revealed multiple bleeding points (Fig. 2a). The bleeding points were clearly identified by transparent gel injection. Hemostasis was achieved by applying the SAP using a catheter during gel immersion (Fig. 2b). The gel-forming SAP remained attached to the tumor surface, and complete hemostasis was achieved (Fig. 2c).</p><p>Self-assembling peptide application under gel immersion may be useful for achieving hemostasis in bleeding tumors by maintaining a clear visual field.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"432-433"},"PeriodicalIF":5.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14954","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549306","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":"Tip-in gel immersion endoscopic mucosal resection with partial submucosal injection for a superficial nonampullary duodenal epithelial tumor on the duodenal angulus","authors":"Tomohiro Shimada,&nbsp;Yoshihide Kanno,&nbsp;Kei Ito","doi":"10.1111/den.14939","DOIUrl":"10.1111/den.14939","url":null,"abstract":"<p>Superficial nonampullary duodenal epithelial tumors (SNADETs) located on the inner side of the duodenal angulus are challenging to visualize and snare due to the intestinal flexure.<span>¹</span> Here, we report a case where gel immersion endoscopic mucosal resection (EMR), supplemented with partial submucosal injection (PI) on the lesion's anal side only for better lesion visualization,<span>¹</span> and tip-in EMR,<span>¹</span> which is the snare tip is inserted into the submucosa and fixed, appeared beneficial for a SNADET located on the duodenal angulus (Figs 1,2; Video S1).</p><p>The patient was a 44-year-old woman with a 20 mm flat elevated lesion with the protruded component on the lesion's anal side located on the inner side of the inferior duodenal angulus. The visibility of the lesion's anal border was obscured by its protruded component and location, making it difficult to fix the snare tip position with underwater EMR. Thus, after filling the duodenum with a gel product (VISCOCLEAR; Otsuka Pharmaceuticals Factory, Tokyo, Japan), 8 mL of 0.4% sodium hyaluronate (MucoUp; Boston Scientific, Tokyo, Japan) with indigo carmine was partially injected on the lesion's anal side only, and the snare (SD-16U-1; Olympus, Tokyo, Japan) was deployed at the tip and fixed in the submucosa by tip-in at the same site. In this state, by pulling out the scope while opening the snare, and then strangulating, the lesion was resected en bloc using an electrosurgical unit (VIO300D; ERBE Electromedizin, Tuebingen, Germany; settings Endocut Q: effect, 2; duration, 2; interval, 2; forced coagulation, effect, 2; power, 20 W) without shifting the snare tip.</p><p>Although other resection methods may be considered for laterally spreading SNADETs much larger than 20 mm,<span>³</span> the combination of PI and the tip-in technique may enable simpler and more effective endoscopic resection, even for relatively large SNADETs (~20 mm) with poor visibility located on the inner side of the duodenal angulus.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"209-210"},"PeriodicalIF":5.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14939","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523765","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":"Water pressure method endoscopic submucosal dissection with clip traction for early gastric cancer with submucosal fibrosis","authors":"Ryosuke Ikeda,&nbsp;Hiroaki Kaneko,&nbsp;Shin Maeda","doi":"10.1111/den.14949","DOIUrl":"10.1111/den.14949","url":null,"abstract":"<p>Endoscopic submucosal dissection (ESD) is widely performed; however, difficult cases remain, and submucosal fibrosis is a risk factor for difficulty.<span>¹</span> Recently, the effectiveness of the clip traction and water pressure method (WPM) has been reported<span>^{2, 3}</span>; gastric ESD using WPM has also been reported.<span>^{4, 5}</span> We report a case of early gastric cancer with severe fibrosis that was successfully treated with WPM combined with clip traction (Video S1).</p><p>An 82-year-old man who had undergone curative resection of early gastric cancer on the anterior wall of the angulus 4 years ago was referred to our hospital with metachronous cancer adjacent to the ESD scar (Fig. 1a). ESD was performed under conscious sedation. A mucosal incision was performed using a dual knife and insulated-tip knife-2 (Olympus Medical Systems, Co., Tokyo, Japan); however, the anal side, which straddled the ESD scar, was poorly injected (Fig. 1b). After the mucosal incision, submucosal dissection was initiated from the anal side. However, severe fibrosis prevented sufficient formation of the mucosal flap, causing difficulty in visualizing the submucosal layer. Therefore, a small-caliber tip transparent hood (DH-28CR; Fujifilm, Tokyo, Japan) was attached and converted to underwater conditions. WPM temporarily visualized the submucosal layer; however, it was difficult to maintain (Fig. 2a,b). Hence, a clip (EZ clip, HX-610-090; Olympus Medical Systems, Co.) with a thread was attached to the mucosal flap adjacent to severe fibrosis because the fibrotic area had not sufficiently formed the mucosal flap for attaching the clip, allowing a clear view of the submucosal layer (Fig. 2c,d). We dissected the fibrotic submucosal layer and performed a curative en bloc resection with a negative margin.</p><p>WPM is useful for viewing the fibrotic submucosal layer; however, in this case, the combination of clip traction was more effective in maintaining the resection layer.</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 3","pages":"304-305"},"PeriodicalIF":5.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14949","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514060","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 transpapillary gallbladder drainage using a novel cholangioscope","authors":"Ryosuke Hamamura,&nbsp;Masanori Kobayashi,&nbsp;Ryuichi Okamoto","doi":"10.1111/den.14958","DOIUrl":"10.1111/den.14958","url":null,"abstract":"<p>A 73-year-old man, recently treated with stent-graft insertion for an abdominal aortic aneurysm, developed acute cholecystitis from gallstones in a preshock state (Fig. 1a). Cholecystectomy was deemed high risk, and percutaneous transhepatic gallbladder drainage (PTGBD) was planned but considered unsafe due to Chilaiditi syndrome. Therefore, endoscopic transpapillary gallbladder drainage (ETGBD) was conducted. However, the cystic duct could not be visualized on cholangiography despite meticulous guidewire exploration for ~10 min, failing to identify its bifurcation. We then attempted to locate the cystic duct using a novel cholangioscope with a cytology brush sheath, as previously reported for confirming residual bile duct stones.<span>¹</span> This method utilizes only the reusable complementary metal oxide semiconductor (CMOS) camera unit of an ultrathin cholangioscope (DRES Slim Scope; Japan Lifeline, priced at 300,000 yen for ~10 uses) which is passed through the brush lumen of a double-lumen bile duct cytology brush (CytoMaxII; Cook Japan, Tokyo, Japan) (Fig. 1b,c). By replacing the original sheath, which costs 39,000 yen, with the CytoMaxII priced at 12,000 yen, the cost of using the cholangioscope is reduced to 42,000 yen per procedure. Moreover, this method allows the sheath to function similarly to an endoscopic hood, enabling reliable exploration of the cystic duct bifurcation (Fig. 1d). With this method, it became possible to safely advance the guidewire into the gallbladder, ultimately allowing for the placement of an ETGBD tube (Fig. 1e, Video S1).</p><p>In cases where surgery or PTGBD is not feasible and ETGBD is necessary, inserting a guidewire into the cystic duct is essential but often challenging.<span>^{2, 3}</span> Using peroral cholangioscopy allows for safer and more reliable guidewire insertion compared to relying solely on X-ray images,<span>⁴</span> yet cholangioscopes are expensive and less accessible. Our method balances cost and reliability in challenging ETGBD situations and also holds various other possibilities.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"434-435"},"PeriodicalIF":5.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14958","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514056","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-assisted removal of an intrahepatic bile duct stone","authors":"Saburo Matsubara,&nbsp;Kentaro Suda,&nbsp;Sumiko Nagoshi","doi":"10.1111/den.14937","DOIUrl":"10.1111/den.14937","url":null,"abstract":"<p>A 41-year-old woman with a left hepatic duct stone underwent endoscopic retrograde cholangiography for stone extraction (Fig. 1a). An over-the-wire type 8 wire basket catheter (Medi-Globe GmbH, Rohrdorf, Germany) failed to catch the stone and rather pushed the stone deeper (Fig. 1b). Because several attempts for stone extraction with a sphincterotome or ultrafine balloon catheter (REN; Kaneka Medix, Osaka, Japan) were unsuccessful, endoscopic retrograde cholangiography combined with endoscopic ultrasound was planned instead of cholangioscopy unfit for nondilated ducts. In the second session, the stone in B2 was depicted from the stomach using a curved linear-array echoendoscope (EG-740UT; FUJIFILM, Tokyo, Japan). Following a puncture of B2 with a 22G needle (SonoTip Pro Control; Medi-Globe) and contrast injection (Fig. 2a), a 0.018 inch guidewire was inserted into the common bile duct. After insertion of a double lumen catheter with a 3.6F tip (Uneven Double Lumen Cannula; Piolax Medical Devices, Kanagawa, Japan) into B2 upstream of the stone, pushing the stone by the guidewire or saline through the second lumen of the catheter was attempted without success. Then an endoscopic introducer (EndoSheather; Piolax Medical Devices) composed of a tapered inner catheter and large-bore outer sheath was inserted into the bile duct upstream of the stone. After removal of the guidewire and inner catheter, the stone was successfully moved to the hilum by flushing with saline through the outer sheath (Fig. 2b). Stone removal was finally accomplished after changing the scope to a duodenoscope without adverse events (Fig. 2c; Video S1). Endoscopic removal of intrahepatic bile duct stones is often challenging because of the difficulty of advancing extraction devices beyond the stone.<span>¹</span> Although the use of a sphincterotome<span>²</span> or ultrafine balloon catheter<span>³</span> has been reported, they did not work in the present case. This endoscopic ultrasound-assisted procedure for left intrahepatic bile duct stones may be a useful option when transpapillary attempts have failed.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"204-205"},"PeriodicalIF":5.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14937","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514058","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 technique “short myotomy” during endoscopic submucosal dissection for a diverticulum-associated colonic lesion","authors":"Ryosuke Kobayashi,&nbsp;Kingo Hirasawa,&nbsp;Shin Maeda","doi":"10.1111/den.14941","DOIUrl":"10.1111/den.14941","url":null,"abstract":"<p>While endoscopic submucosal dissection (ESD) for colorectal tumors is widely accepted,<span>^{1, 2}</span> ESD for tumors involving a diverticulum is still challenging and associated with a high risk of perforation due to the absence of the muscularis propria. Additionally, during the procedure there is a risk of damage to the specimen or interruption of ESD, given an insufficient plane in the submucosal layer within the diverticulum. Therefore, we report the tips of ESD including the novel technique named “short myotomy” for a diverticulum-associated lesion to resolve this problem (Video S1, Fig. 1). The lesion was located on the dorsal side of the ascending colon. A procedure was performed with the patient under conscious sedation and using carbon dioxide insufflation. A small-caliber transparent hood (DH-29CR; Fujifilm, Tokyo, Japan) was attached to the tip of an endoscope, and a 1.5 mm Dual knife (KD650Q; Olympus, Tokyo, Japan) was the surgical device used. After completing the circumferential mucosal incision, a submucosal dissection was made. The water pressure technique was applied for dissecting the submucosa with the multiloop device.<span>^{3, 4}</span> When getting into the diverticulum, the dissection plane was narrow between the muscle layers and the specimen (Fig. 2a). Then, the incision of muscle layers in front of the diverticulum was made to create a dissection plane to go below the diverticulum (Fig. 2b,c). This short myotomy enabled the precise excision below the diverticulum (Fig. 2d). The lesion was resected in one piece without specimen damage. The ulcer bed including the diverticulum was completely closed with endoscopic clips. An abdominal computed tomography scan immediately after ESD showed no extraluminal air. The patient was discharged on postoperative day 3. The histopathological diagnosis indicated intramucosal cancer with negative margins. The short myotomy is a novel technique in addition to existing methods, which allows for secure ESD for complete resection and a time-saving 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 approved by the Ethics Committee of Yokohama City University Medical Center.</p><p>Informed Consent: N/A.</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 2","pages":"211-213"},"PeriodicalIF":5.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14941","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514059","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":"Elevating standards: Training and quality metrics in interventional endoscopic ultrasound","authors":"Dongwook Oh,&nbsp;Tae Jun Song","doi":"10.1111/den.14947","DOIUrl":"10.1111/den.14947","url":null,"abstract":"&lt;p&gt;In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Miutescu and Dhir present an in-depth review of the training and quality indicators essential for proficiency in interventional endoscopic ultrasound (iEUS).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The transformation of EUS from a diagnostic tool to a therapeutic one necessitates specialized training to ensure efficacy and safety in various interventional procedures.&lt;/p&gt;&lt;p&gt;Performing iEUS procedures requires high technical skill and expertise. Therefore, selecting candidates with the appropriate background and qualities is crucial for advancing the field of iEUS. The selection of candidates should be based on a solid foundation in gastroenterology, demonstrated interest, and prior experience in endoscopic procedures.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; This foundational expertise is pivotal, as it allows candidates to transition more effectively into the complexities of iEUS.&lt;/p&gt;&lt;p&gt;Acquiring theoretical knowledge is a foundational step in training for iEUS. This phase encompasses a deep understanding of gastrointestinal and adjacent organ anatomy, pathology, and specific EUS techniques.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Trainees should be well-versed in using various echoendoscopes and EUS devices, which is critical for the practical interpretation and execution of procedures. A structured syllabus that includes simulation models and virtual reality enhances this theoretical foundation, enabling trainees to develop the competence needed for advanced EUS procedures. Prior experience in diagnostic EUS and other imaging techniques, like transabdominal ultrasonography, can significantly shorten the learning curve and enhance procedural proficiency.&lt;/p&gt;&lt;p&gt;One of the critical challenges of training iEUS is the lack of standardization in training programs and quality metrics. The variability in training approaches across institutions can lead to inconsistencies in skill levels among practitioners, potentially impacting patient care. To address this, the authors advocate establishing universally accepted training standards and quality indicators. Such standardization would ensure that all practitioners meet the same high standards, leading to consistent and high-quality care globally. The average advanced endoscopy trainee needs a minimum of 225 EUS procedures to achieve core competence, with an ~50% greater number of procedures required in some cases.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; European Society of Gastrointestinal Endoscopy Guidelines recommend a minimum of 250 supervised EUS procedures, including specific numbers for different lesion types, to evaluate competence and key performance measures that should be recorded and evaluated.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; There are several proposed programs to accumulate practical knowledge in iEUS, including conferences, case studies with detailed procedural walkthroughs on various platforms, specialized online courses, World Endoscopy Organization's International School of EUS, and the Educational Program o","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"51-52"},"PeriodicalIF":5.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14947","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482277","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 transpapillary gallbladder drainage using a novel sphincterotome","authors":"Takuya Ishikawa,&nbsp;Ryohei Kumano,&nbsp;Hiroki Kawashima","doi":"10.1111/den.14943","DOIUrl":"10.1111/den.14943","url":null,"abstract":"<p>Endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an option for patients for whom percutaneous transhepatic gallbladder drainage (PTGBD) or cholecystectomy is not indicated.<span>¹</span> Compared with PTGBD, ETGBD is expected to have a lower patient burden and a shorter hospital stay because of internal drainage. However, ETGBD is technically challenging, and some cases are difficult to treat. In particular, it has been reported that guidewire or catheter manipulation is difficult when the cystic duct branches are to the caudal side because of steep angulation.<span>²</span> We report a case of successful ETGBD using a novel sphincterotome (ENGETSU; Kaneka Medix Corporation, Osaka, Japan) (Video S1). The patient suffered from recurrent cholecystitis, and ETGBD was planned, but previous cholangiography during PTGBD revealed the cystic duct branching to the caudal side (Fig. 1). The ENGETSU is a newly developed rotatable sphincterotome with a wide range of motion that enables easy control of the tip compared to the conventional sphincterotome, which only has bending ability. A normal straight tip catheter was initially used to access the cystic duct, but it was unsuccessful because of the steep angle between the common bile duct and the cystic duct(Fig. 2a). A novel sphincterotome was then used to adjust the direction toward the cystic duct by bending and rotating the tip (Fig. 2b), and the guidewire was successfully advanced into the gallbladder (Fig. 2c). A 5F plastic stent dedicated for gallbladder drainage (IYO stent; Gadelius Medical K.K., Tokyo, Japan)<span>³</span> was placed (Fig. 2d), and purulent bile was drained immediately after stent placement. In this procedure, the main operator was a trainee, whereas the assistant was an expert, and one assistant could manipulate both the tip of the sphincterotome and guidewire. In conclusion, the novel sphincterotome, with its rotatable tip and wide range of motion, is useful in difficult ETGBD cases in which the cystic duct branches to the caudal side (Figs 1,2).</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"297-299"},"PeriodicalIF":5.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14943","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514057","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}