Digestive Endoscopy最新文献

{"title":"Development and Crossover Evaluation of an Artificial Intelligence-Assisted System for Solid Pancreatic Lesion Detection and Pancreatic Parenchyma Recognition in Endoscopic Ultrasonography (With Video)","authors":"Toshio Fujisawa,&nbsp;Takamichi Kuwahara,&nbsp;Tatsuya Sato,&nbsp;Yusuke Takasaki,&nbsp;Nozomi Okuno,&nbsp;Ryunosuke Hakuta,&nbsp;Ko Tomishima,&nbsp;Shin Haba,&nbsp;Naminatsu Takahara,&nbsp;Yukiko Ito,&nbsp;Yousuke Nakai,&nbsp;Kazuo Hara,&nbsp;Hiroyuki Isayama","doi":"10.1111/den.70282","DOIUrl":"10.1111/den.70282","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Study Aims</h3>\u0000 \u0000 <p>Pancreatobiliary endoscopic ultrasonography (EUS) is technically demanding, and supervised training opportunities are limited. We developed an artificial intelligence (AI) overlay system for detecting solid pancreatic lesions (SPL) and recognizing pancreatic parenchyma (PP) and evaluated its effect on reader performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Across six centers, two deep learning-based models were trained using expert-annotated EUS frames. We then conducted a randomized, two-sequence, two-period crossover reader study in which eight endosonographers (five novices and three experts) interpreted image sets with and without AI assistance. The primary endpoint was superiority of sensitivity for SPL detection among novices; key secondary endpoints included specificity and PP recognition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 118 patients, 120 SPL-positive/negative image sets and 160 PP-positive/negative image sets were constructed. Among novices, AI assistance improved SPL detection sensitivity (88.7% vs. 76.8%, <i>p</i> &lt; 0.001) and accuracy (86.4% vs. 78.7%), while specificity met the predefined noninferiority criterion (84.2% vs. 80.5%, <i>p</i> &lt; 0.001). For PP recognition, sensitivity increased numerically (86.3% vs. 83.3%) but did not meet the predefined superiority criterion (<i>p</i> = 0.095); specificity met the noninferiority criterion (87.8% vs. 81.0%), and accuracy increased from 82.1% to 87.0%. Among experts, sensitivity was maintained for both tasks, whereas specificity increased with AI assistance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI assistance improved SPL detection among novice endosonographers. For PP recognition, sensitivity increased without reaching statistical superiority, whereas specificity met the predefined noninferiority criterion. These findings support a potential adjunctive role for AI in EUS interpretation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70282","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921292","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":"Diagnostic Performance and Reproducibility of Chromoendoscopic Classification (FOCUS Classification: Flat-Type Dysplasia Optical Assessment by Chromoendoscopy in Ulcerative ColitiS) for Flat-Type Dysplasia in Ulcerative Colitis–Associated Neoplasia","authors":"Kaoru Takabayashi,&nbsp;Shoma Murata,&nbsp;Motoki Sasaki,&nbsp;Kurato Miyazaki,&nbsp;Teppei Masunaga,&nbsp;Kumiko Kirita,&nbsp;Mari Mizutani,&nbsp;Yusuke Yoshimatsu,&nbsp;Yusaku Takatori,&nbsp;Teppei Akimoto,&nbsp;Hiroki Kiyohara,&nbsp;Shinya Sugimoto,&nbsp;Shintaro Kawasaki,&nbsp;Yohei Mikami,&nbsp;Noriko Matsuura,&nbsp;Atsushi Nakayama,&nbsp;Tomohisa Sujino,&nbsp;Yasuhiro Ito,&nbsp;Kazuhiro Yamanoi,&nbsp;Shigeki Sekine,&nbsp;Yasushi Iwao,&nbsp;Naohisa Yahagi,&nbsp;Takanori Kanai,&nbsp;Motohiko Kato","doi":"10.1111/den.70280","DOIUrl":"10.1111/den.70280","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Ulcerative colitis-associated neoplasia (UCAN) often presents as flat-type dysplasia that is difficult to characterize endoscopically. We developed a FOCUS (Flat-type dysplasia Optical assessment by Chromoendoscopy in Ulcerative colitiS) classification and evaluated its diagnostic performance and reproducibility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective study included 33 UCAN lesions from 26 patients. Prospectively recorded FOCUS classifications at 230 biopsy sites were compared with histopathology. Chromoendoscopic patterns were categorized as Type I (“suggestive of non-dysplasia,”), Type II (“suggestive of dysplasia with low confidence”), or Type III (“suggestive of dysplasia with high confidence”). Diagnostic performance was assessed using two prespecified thresholds: Types II/III versus Type I and Type III versus Types I/II. Eight endoscopists independently classified all images; interobserver and intraobserver agreement were assessed using Fleiss' and Cohen's <i>κ</i>, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The dysplasia-bearing rate increased stepwise from Type I to Type III (Type I 15.5%, Type II 58.3%, Type III 81.8%). Using the primary threshold, sensitivity was 82.0%, and specificity 75.4% (positive likelihood ratio 3.33; negative likelihood ratio 0.24). Interobserver agreement for the three-category classification was moderate to substantial (Fleiss' <i>κ</i> 0.629; 95% CI 0.545–0.712), and median intraobserver agreement was substantial (Cohen's <i>κ</i> 0.738).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The FOCUS classification provides clinically meaningful risk stratification for flat-type dysplasia in a high-risk UCAN cohort, with acceptable interobserver and intraobserver reproducibility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914513","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":"A Classification of Procedural Complexity in Therapeutic Endoscopic Ultrasound: Rationale and Implications for Practice and Training","authors":"Giuseppe Vanella,&nbsp;Andrea Lisotti,&nbsp;Cecilia Binda,&nbsp;Belen Martinez-Moreno,&nbsp;Giuseppe Marzocca,&nbsp;Daniele Arese,&nbsp;Enrique Perez-Cuadrado-Robles,&nbsp;Henriette Heinrich,&nbsp;Amrita Sethi,&nbsp;Sundeep Lakhtakia,&nbsp;Schalk Van der Merwe,&nbsp;Marc Giovannini,&nbsp;Paolo Giorgio Arcidiacono,&nbsp;the Next Generation EUS Group","doi":"10.1111/den.70279","DOIUrl":"10.1111/den.70279","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Therapeutic endoscopic ultrasound (TEUS) has expanded into a broad procedural platform including access, delivery, measurement, ablation, drainage, and anastomoses. Nevertheless, TEUS lacks a shared procedural complexity classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Within an International initiative of the Next Generation EUS group, a dedicated task force developed a four-level classification, subsequently evaluated through Delphi methodology. The classification considered target stability and size, accessory exchange, adverse event profile, technical standardization, and prerequisite skills. To support and contextualize the consensus output, a targeted narrative review of published evidence was performed, analyzing technical success, clinical success, adverse events, learning curves, and procedural modifiers across major TEUS procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The Delphi-informed classification achieved 92.7% agreement among 106 respondents. Level 1 includes procedures mainly based on endosonographic skills, such as EUS-guided ablation and placement of Lumen Apposing Metal Stents (LAMS) within large fluid collections; Level 2 includes EUS-guided choledochoduodenostomy and gallbladder drainage with LAMS and fluid collection drainage with multistep plastic stenting; Level 3 includes more demanding fluoroscopy-based interventions, such as EUS-guided hepaticogastrostomy, rendezvous, and upper gastrointestinal anastomoses; Level 4 includes procedures with advanced complexity and limited standardization, such as EUS-directed ERCP, pancreatic duct drainage, and small/large bowel anastomoses. This article discusses the rationale, clinical utility, and training implications of this classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This 4-level Delphi-informed classification for TEUS complexity achieved high expert agreement and provides a pragmatic framework to support training pathways, case selection, outcome interpretation, referral, and credentialing processes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908270","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":"Updated Classification of EUS-Guided Gastroenterostomy Misdeployment","authors":"Radhika Chavan,&nbsp;Kalpit Devani,&nbsp;Sridhar Sundaram,&nbsp;Chaiti Gandhi,&nbsp;Sanjay Rajput","doi":"10.1111/den.70285","DOIUrl":"10.1111/den.70285","url":null,"abstract":"<div>\u0000 \u0000 <p>Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is increasingly used for the management of malignant and benign gastric outlet obstruction because of its safety and efficacy. Although lumen-apposing metal stents (LAMS) have improved technical success, misdeployment remains the most common adverse event and has traditionally been associated with the need for surgery. Misdeployment during EUS-GE is classified into four types (Types I–IV) based on stent position and associated defects. Emerging evidence from expert centers suggests that most misdeployments can be recognized early and are amenable for endoscopic salvage using contemporary rescue techniques, including defect closure, bridging stent placement, and natural orifice transluminal endoscopic surgery (NOTES) based approaches. In light of evolving procedural experience and expanding therapeutic options, we propose an updated, strategy-oriented classification of EUS-GE misdeployment. This includes subclassification of Type II and Type III based on guidewire access in the jejunal loop as well as the addition of Type V (complete intraperitoneal) and Type T (through-and-through) misdeployment. This review provides a comprehensive framework integrating misdeployment patterns with practical management strategies with focus on endoscopic rescue procedures. A structured, decision-oriented approach to misdeployment may reduce the need for surgical intervention and improve the safety and outcomes of EUS-GE.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914524","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":"Re: Methodology Assessment of Endoscopic Ultrasound Radiofrequency Ablation (EUS-RFA) for Pancreatic Neoplasms: Results From an International Survey","authors":"Maajid Mohi Ud Din Malik,&nbsp;Rajesh Prasad Jayaswal","doi":"10.1111/den.70281","DOIUrl":"10.1111/den.70281","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908259","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":"Use of a Large-Caliber Endoscopic Sheath to Prevent Device Deflection During EUS-Guided Antegrade Stone Removal","authors":"Kenichi Haneda,&nbsp;Akihisa Kato,&nbsp;Michihiro Yoshida","doi":"10.1111/den.70273","DOIUrl":"10.1111/den.70273","url":null,"abstract":"<p>Endoscopic access to the duodenal papilla can be difficult in patients who have undergone postoperative intestinal reconstruction. EUS-guided antegrade biliary intervention (EUS-AI) via a trans-endosonographically created route (trans-ESCR) is widely accepted as an alternative method for stone removal [<span>1, 2</span>]; however, the tortuosity of the intrahepatic bile duct often causes device deflection. As a result, force transmission is poor, making it difficult to push stones out of the papilla.</p><p>The patient was an 86-year-old woman who had undergone distal gastrectomy and Billroth II reconstruction for gastric cancer. She developed common bile duct stone cholangitis (Figure 1a). Transpapillary biliary drainage using a double balloon was attempted, but reaching the papilla was difficult, so EUS-guided hepaticogastrostomy (EUS-HGS) was performed (Figure 1b). Subsequently, stone removal was attempted antegrade via the trans-ESCR. A 0.035-in. guidewire was guided to the duodenum, and antegrade papillary balloon dilation was performed. The subsequently inserted balloon catheter for stone removal became significantly deflected within the intrahepatic bile duct. Due to this loss of axial force, the catheter was unable to push the stone into the duodenum (Figure 2a, Video 1).</p><p>To solve this problem, we used a large-caliber version of EndoSheather (Piolax Inc., Yokohama, Japan) (Figure 2b) [<span>3-5</span>]. By advancing the sheath over a guidewire into the bile duct, the sheath served as a stable conduit for the balloon catheter. The sheath effectively prevented device deflection and ensured optimal force transmission, allowing the catheter to smoothly pass through the papilla and successfully remove the stone (Figure 2c).</p><p>Therefore, the large-caliber sheath is highly effective for various trans-ESCR treatments, including intrahepatic stones. Once a stone is moved into the distal bile duct, the sheath's function of preventing device bending plays an indispensable role in reliable transpapillary removal. This ensures optimal force transmission regardless of the initial stone location.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p><p>The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908245","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 Radiofrequency Ablation at a Crossroads: From Innovation to Standardization","authors":"Sung Hyun Cho,&nbsp;Dongwook Oh","doi":"10.1111/den.70276","DOIUrl":"10.1111/den.70276","url":null,"abstract":"&lt;p&gt;Endoscopic ultrasound–guided radiofrequency ablation (EUS-RFA) has been increasingly adopted over the past decade for the local treatment of a range of pancreatic tumors, including pancreatic cystic neoplasms, pancreatic neuroendocrine tumors, and pancreatic ductal adenocarcinoma [&lt;span&gt;1-3&lt;/span&gt;]. Prospective studies have demonstrated its feasibility and acceptable safety, and EUS-RFA has recently been incorporated into clinical guidelines as a treatment option for insulinomas in selected high-risk surgical candidates [&lt;span&gt;4&lt;/span&gt;]. Clinical use, however, has continued to expand even as high-quality comparative evidence remains limited. It remains unclear whether endoscopists across different institutions and countries are, in practice, applying similar techniques to similar patients and evaluating outcomes against consistent definitions.&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Lisotti and colleagues address this question directly, reporting the results of an international survey of experienced endosonographers that found substantial variation in indications, procedural technique, peri-procedural management, follow-up, and outcome assessment [&lt;span&gt;5&lt;/span&gt;]. The survey demonstrates that current EUS-RFA practice has achieved broad agreement for some aspects of the procedure, whereas considerable variability persists in others. Agreement was highest for insulinoma, for which the supporting evidence is most robust, whereas the use of EUS-RFA for pancreatic ductal adenocarcinoma varied markedly by region. This variability in technique persisted even among the most experienced operators, suggesting that it reflects an absence of a standardized protocol rather than an expected learning curve.&lt;/p&gt;&lt;p&gt;One finding with direct implications for patient safety is what the authors describe as a “risk-mitigation gap.” Proximity of the ablation zone to the main pancreatic duct is an established risk factor for adverse events, a relationship previously demonstrated in the French RAFPAN study [&lt;span&gt;6&lt;/span&gt;]. Consistent with this literature, most respondents identified duct-adjacent lesions as high risk; however, no single preventive strategy predominated, with physicians variably modifying power settings, performing prophylactic duct stenting, avoiding ablation altogether, or proceeding without modification. The optimal preventive strategy therefore remains undefined and would be best established through a prospective comparative study rather than further retrospective series.&lt;/p&gt;&lt;p&gt;The definitions used to report outcomes are not yet standardized. Without a shared definition of what constitutes technical success, complete ablation, or disease recurrence, findings from different centers cannot be reliably compared or pooled. This limits the systematic reviews and meta-analyses needed to build a stronger evidence base and support broader clinical adoption of EUS-RFA. The lexicon proposed in this survey may represent its most useful contribution","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876741","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":"Toward Global Harmonization of EUS-Guided Biliary Drainage: A Step Beyond Regional Consensus","authors":"Kosuke Minaga,&nbsp;Masatoshi Kudo","doi":"10.1111/den.70275","DOIUrl":"10.1111/den.70275","url":null,"abstract":"&lt;p&gt;Since its introduction as a rescue option after failed ERCP-guided biliary drainage (ERCP-BD), EUS-guided biliary drainage (EUS-BD) has seen significant advances over the last 20 years. Originally designed for malignant biliary obstructions, EUS-BD has progressively expanded its role toward primary biliary drainage while broadening its indications beyond malignant disease to include benign biliary disorders. Recent positive outcomes from randomized trials on EUS-BD for primary drainage have accelerated its adoption worldwide and increased interest among therapeutic endoscopists. As EUS-BD continues to evolve from rescue therapy to primary drainage and from malignant to benign cases, the importance of establishing international standards for indications, techniques, and terminology has become more apparent.&lt;/p&gt;&lt;p&gt;Against this background, the inaugural international congress of the Japan Gastroenterological Endoscopy Society (JGES International), held in September 2025, hosted a Delphi consensus meeting on EUS-BD [&lt;span&gt;1&lt;/span&gt;]. Fourteen leading experts from six countries gathered to evaluate the current state and prospects of EUS-BD, producing consensus statements on three main areas: (i) EUS-BD as a primary drainage option for unresectable malignant distal biliary obstruction (MDBO); (ii) EUS-BD in patients with surgically altered anatomy (SAA) for biliary conditions; and (iii) the classification and terminology used in interventional EUS. This consensus represents an important milestone because it reflects perspectives from multiple regions and from pioneers and experts who have played leading roles in the development of EUS-BD [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Of the three topics covered by this international consensus meeting, the discussion on primary biliary drainage for unresectable MDBO stands out as its most forward-looking contribution. Historically, expert guidelines from Japan, China, Europe, and the United States have primarily viewed EUS-BD as a rescue option after unsuccessful ERCP-BD or as an alternative to percutaneous biliary drainage [&lt;span&gt;2-5&lt;/span&gt;]. Although these documents laid the technical and clinical groundwork for EUS-BD, they largely avoided endorsing it as a first-line drainage approach.&lt;/p&gt;&lt;p&gt;In contrast, the present international consensus directly addresses several clinically relevant questions surrounding primary EUS-BD for unresectable MDBO [&lt;span&gt;1&lt;/span&gt;]. Although increasing randomized evidence including a recent meta-analysis [&lt;span&gt;6&lt;/span&gt;], shows that primary EUS-BD is noninferior to ERCP-BD, with lower risks of post-procedural pancreatitis, reintervention, and tumor ingrowth/overgrowth, the panel did not deem the two procedures interchangeable as first-line treatments. This cautious approach likely stems from differences in device availability, reimbursement policies, and procedural expertise, as well as a fundamental procedural distinction: ERCP-BD accesses the biliary system via the native papilla, whereas ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868221","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":"Is EUS-Guided Gallbladder Drainage Ready to Take Center Stage in Malignant Distal Biliary Obstruction?","authors":"Hirotoshi Ishiwatari","doi":"10.1111/den.70269","DOIUrl":"10.1111/den.70269","url":null,"abstract":"&lt;p&gt;ERCP-guided biliary stenting has long been the standard treatment for malignant distal biliary obstruction (MDBO), but the development of EUS-guided biliary drainage (EUS-BD) has gradually reshaped this therapeutic landscape. The principal EUS-BD techniques include EUS-guided choledochoduodenostomy (EUS-CDS), in which a stent is placed between the duodenum and the extrahepatic bile duct; EUS-guided hepaticogastrostomy (EUS-HGS), in which a stent is placed between the stomach and the left intrahepatic bile duct (segments II or III); and EUS-guided antegrade stenting, in which a stent is deployed across the biliary stricture in an antegrade fashion [&lt;span&gt;1-4&lt;/span&gt;]. Although these procedures were initially performed using conventional tubular metal or plastic stents, the introduction of lumen-apposing metal stents (LAMSs) has revolutionized EUS-CDS and largely replaced conventional stents for this indication [&lt;span&gt;5, 6&lt;/span&gt;]. EUS-BD was originally established as a rescue technique after failed ERCP, but it is now widely accepted as the preferred approach for patients with surgically altered anatomy or malignant duodenal obstruction, and in experienced centers it is increasingly being adopted as a primary drainage modality for patients with unresectable MDBO and normal gastrointestinal anatomy.&lt;/p&gt;&lt;p&gt;In contrast, EUS-guided gallbladder drainage (EUS-GBD) was originally developed as a minimally invasive treatment for acute cholecystitis in patients who are poor surgical candidates, decompressing the inflamed gallbladder by creating a fistulous tract to the stomach or duodenum [&lt;span&gt;7&lt;/span&gt;]. However, because the gallbladder communicates with the common bile duct through the cystic duct, EUS-GBD can theoretically also provide biliary drainage in patients with MDBO when the cystic duct remains patent. From a technical perspective, EUS-GBD may offer an additional advantage because the gallbladder provides a larger, more accessible puncture target than the bile duct, potentially simplifying the procedure.&lt;/p&gt;&lt;p&gt;Nevertheless, an important concern remains. Unlike EUS-CDS or EUS-HGS, the effectiveness of EUS-GBD depends on adequate biliary drainage through the cystic duct, and tumor involvement of the cystic duct at baseline or subsequent progression may compromise drainage, resulting in primary clinical failure or recurrent biliary obstruction. Whether the technical advantages of EUS-GBD outweigh these anatomical limitations remains an important clinical question, one that the present study by Goudot et al. addresses by identifying factors associated with drainage dysfunction after EUS-GBD for MDBO [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The clinical applicability of EUS-GBD for MDBO has recently been explored in two multicenter retrospective studies comparing EUS-GBD with EUS-CDS [&lt;span&gt;9, 10&lt;/span&gt;]. Both studies used propensity score matching to minimize selection bias and attempted to clarify whether EUS-GBD could achieve outcomes comparable to those of the ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868245","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":"A Novel Elastic Silicone Ring for Traction in ESD: Initial Experience With the Endo-Silicone Loop Band (With Video)","authors":"Yasutoshi Ochiai,&nbsp;Yasumasa Matsuo,&nbsp;Keisuke Tateishi","doi":"10.1111/den.70266","DOIUrl":"https://doi.org/10.1111/den.70266","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849303","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}