Digestive Endoscopy最新文献

{"title":"Over-the-scope clip closure with dual thin grasping forceps after gastric endoscopic submucosal dissection","authors":"Ryo Sasaki,&nbsp;Takuto Hikichi,&nbsp;Takumi Yanagita","doi":"10.1111/den.14897","DOIUrl":"10.1111/den.14897","url":null,"abstract":"<p>Postoperative bleeding and perforation are common complications of gastric endoscopic submucosal dissection (ESD),<span>¹</span> and closure is a topic. However, closures are often complicated.<span>^{2, 3}</span> Nishiyama <i>et al</i>.<span>⁴</span> described the use of novel thin grasping forceps for over-the-scope clip (OTSC) closure after endoscopic full-thickness resection. The grasping forceps (TechGrasper; Micro-Tech, Nanjing, China) offers two main advantages. The forceps' small diameter does not interfere with suction applied before the OTSC deployment, and the strong grasping power ensures reliable staple application to the muscle layer. Here, we report the first case of successful ulcer closure after gastric ESD using TechGrasper-assisted OTSC.</p><p>A 78-year-old man with lung adenocarcinoma underwent esophagogastroduodenoscopy for preoperative screening, which revealed a 30 mm gastric cancer. Although the patient was a candidate for ESD, lung resection was prioritized because of advanced-stage lung cancer (pT2aN2M0, pStage IIIA). Postoperative adjuvant chemotherapy including regimens associated with increased risk of perforation and thrombocytopenia was recommended. Therefore, before chemotherapy initiation, the patient underwent TechGrasper-assisted OTSC closure of the post-ESD ulcer, which measured 50 × 34 mm in diameter (Fig. 1a,b).<span>⁵</span> Briefly, immediately after ESD, an OTSC (Ovesco Endoscopy GmbH, Tuebingen, Germany) was attached to the tip of a two channel endoscope (GIF-2TQ260M; Olympus Co., Tokyo, Japan). After grasping the edge of the post-ESD ulcer, the TechGraspers were pulled into the cap of the OTSC, which was then released with sufficient suction (Fig. 1c,d). The endoscopist pulled and adjusted one pair of forceps, and the assistant pulled the other pair of forceps. Four OTSCs were successfully applied to the post-ESD ulcer (Fig. 2a and Video S1). The patient underwent adjuvant chemotherapy 4 weeks after ESD, without subsequent adverse events (Fig. 2b–d). The present case illustrates the utility of TechGrasper-assisted OTSC as a simple technique to promote effective wound healing following gastric ESD.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1181-1182"},"PeriodicalIF":5.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14897","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972398","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 ultrasonography for microvascular imaging without contrast enhancement in the differential diagnosis of pancreatic lesions","authors":"Yasunobu Yamashita,&nbsp;Hirofumi Yamazaki,&nbsp;Akiya Nakahata,&nbsp;Toshio Shimokawa,&nbsp;Takaaki Tamura,&nbsp;Yuki Kawaji,&nbsp;Takashi Tamura,&nbsp;Keiichi Hatamaru,&nbsp;Masahiro Itonaga,&nbsp;Reiko Ashida,&nbsp;Masayuki Kitano","doi":"10.1111/den.14889","DOIUrl":"10.1111/den.14889","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Detective flow imaging endoscopic ultrasonography (DFI-EUS) is a recent imaging modality developed for detecting fine vessels without the need for ultrasound contrast agents. The aim of the present study was to evaluate the utility of DFI-EUS for solid pancreatic lesions and to compare the diagnostic ability for pancreatic cancer (PC) between DFI-EUS, directional power Doppler (eFLOW) EUS, and contrast-enhanced harmonic (CH)-EUS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with a pancreatic lesion who underwent DFI-EUS, eFLOW-EUS, and CH-EUS between March 2019 and November 2023 were retrospectively enrolled. Final diagnoses were confirmed by pathologic examination of EUS-guided tissue acquisition and/or resected specimens. Lesions were categorized into the three patterns of poor, mild, and rich vascularity on DFI-EUS and eFLOW-EUS, and hypo-, iso-, and hypervascular on CH-EUS. PC was defined as a poor pattern on DFI-EUS and eFLOW-EUS, and a hypovascular pattern on CH-EUS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final diagnoses of 90 examined tumors were PC (<i>n</i> = 57), inflammatory mass (<i>n</i> = 6), autoimmune pancreatitis (<i>n</i> = 13), neuroendocrine tumor (<i>n</i> = 9), and others (<i>n</i> = 5). The sensitivity, specificity, and accuracy for diagnosis of PC were 93%, 82%, and 88%, respectively, on DFI-EUS, 97%, 42%, and 77% on eFLOW-EUS, and 95%, 89%, and 92% on CH-EUS. The accuracy of DFI-EUS was significantly superior to eFLOW-EUS (<i>P</i> = 0.005), but no significant difference was found between DFI-EUS and CH-EUS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DFI-EUS is more sensitive for depicting vasculature than eFLOW-EUS, and has higher diagnostic sensitivity for PC. Evaluation of vascularity on DFI-EUS is useful for the differential diagnosis of pancreatic lesions without the need for intravenous contrast agent.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"192-198"},"PeriodicalIF":5.0,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918233","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":"Dental floss clip traction-assisted endoscopic ultrasound-guided hepaticogastrostomy for transluminal intrahepatic bile duct stone fragmentation and removal","authors":"Jia-Yi Ma,&nbsp;Zhen-Dong Jin,&nbsp;Kai-Xuan Wang","doi":"10.1111/den.14901","DOIUrl":"10.1111/den.14901","url":null,"abstract":"<p>A 62-year-old man who had undergone Roux-en-Y hepaticojejunostomy because of choledochal cyst presented with jaundice. Magnetic resonance cholangiopancreatography revealed obstructive stones in left intrahepatic duct (Fig. 1).</p><p>Double-ballon enteroscope-assisted endoscopic retrograde cholangiopancreatography was initially attempted but failed to reach anastomosis. Endoscopic ultrasound-guided hepaticogastrostomy (HGS) was alternatively performed (Fig. 2a). Cholangiography confirmed multiple intrahepatic bile duct stones and a 2 cm length anastomotic stricture. After dilatation of the stomach wall and anastomotic stricture, a 10 × 80 mm fully covered self-expanding metal stent (FCSEMS) was deployed.</p><p>One week later when the FCSEMS was assumed to be fully expanded (Fig. 2b), transluminal stone removal was attempted. With the concern of stent migration during stone removal, a clip and dental floss was used for FCSEMS traction and fixation (Fig. 2c). SpyGlass-guided laser lithotripsy and stone extraction was performed through the endoscopic ultrasound-guided HGS route (Fig. 2d). A coaxial double-pigtail plastic stent was inserted through the FCSEMS to function as an anchor. No postoperative adverse event was observed. Jaundice was rapidly relieved (Video S1).</p><p>Removal of left intrahepatic duct stones via the HGS route has been described in sporadic cases.<span>¹</span> Three highlights of this case are specifically introduced as follows. First, given that the stone's size exceeded the width of intrahepatic bile duct and the diameter of metal stent when it was not fully expanded, adequate stone removal cannot be accomplished in a single session. An HGS route must first be established. Lithotripsy was then carried out. Second, to decrease the risk of stent migration during accessory devices pass-by, we borrowed the method of dental floss traction applied in endoscopic submucosal dissection.<span>²</span> Last, anastomotic stenosis is difficult to alleviate from a single dilation. With the help of the HGS route, double-ballon enteroscope-assisted endoscopic retrograde cholangiopancreatography can be easily performed by rendezvous technique in the subsequent session and the transgastric stent can be removed thereby.</p><p>Authors declare no conflict of interest for this article.</p><p>This study was supported by the National Natural Science Foundation of China (Grant No. 82070663 [J.Y.M.]) and Specific Research Fund of The Innovation Platform for Academicians of Hainan Province (Grant No. YSPTZX202029 [K.X.W.]).</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1284-1285"},"PeriodicalIF":5.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14901","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908526","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":"Outcomes of noncurative endoscopic submucosal dissection for T1 colorectal cancer: Prospective, multicenter, cohort study in Japan","authors":"Shigetsugu Tsuji,&nbsp;Hisashi Doyama,&nbsp;Nozomu Kobayashi,&nbsp;Ken Ohata,&nbsp;Yoji Takeuchi,&nbsp;Akiko Chino,&nbsp;Hiroyuki Takamaru,&nbsp;Yosuke Tsuji,&nbsp;Kinichi Hotta,&nbsp;Keita Harada,&nbsp;Hiroaki Ikematsu,&nbsp;Toshio Uraoka,&nbsp;Takashi Murakami,&nbsp;Atsushi Katagiri,&nbsp;Shinichiro Hori,&nbsp;Tomoki Michida,&nbsp;Takuto Suzuki,&nbsp;Masakatsu Fukuzawa,&nbsp;Shinsuke Kiriyama,&nbsp;Kazutoshi Fukase,&nbsp;Yoshitaka Murakami,&nbsp;Hideki Ishikawa,&nbsp;Yutaka Saito","doi":"10.1111/den.14878","DOIUrl":"10.1111/den.14878","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study investigated the incidence of lymph node metastasis and long-term outcomes in patients with T1 colorectal cancer where endoscopic submucosal dissection (ESD) resulted in noncurative treatment. It is focused on those with deep submucosal invasion, a factor considered a weak predictor of lymph node metastasis in the absence of other risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This nationwide, multicenter, prospective study conducted a post-hoc analysis of 141 patients with T1 colorectal cancer ≥20 mm where ESD of the lesion resulted in noncurative outcomes, characterized by poor differentiation, deep submucosal invasion (≥1000 μm), lymphovascular invasion, high-grade tumor budding, or positive vertical margins. Clinicopathologic features and patient prognoses focusing on lesion sites and additional surgery requirements were evaluated. Lymph node metastasis incidence in the low-risk T1 group, identified by deep submucosal invasion as the sole high-risk histological feature, was assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Lymph node metastasis occurred in 14% of patients undergoing additional surgery post-noncurative endoscopic submucosal dissection for T1 colorectal cancer. In the low-risk T1 group, in the absence of other risk factors, the frequency was 9.7%. The lymph node metastasis rates in patients with T1 colon and rectal cancers did not differ significantly (14% vs. 16%). Distant recurrence was observed in one patient (2.3%) in the ESD only group and in one (1.0%) in the additional surgery group, both of whom had had rectal cancer removed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The risk of lymph node metastasis or distant occurrence was not negligible, even in the low-risk T1 group. The findings suggest the need for considering additional surgery, particularly for rectal lesions (Clinical Trial Registration: UMIN000010136).</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1369-1379"},"PeriodicalIF":5.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908527","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":"WEO Newsletter: Tips and tricks: Assessment and endoscopic dilation of strictures in inflammatory bowel disease (IBD)","authors":"","doi":"10.1111/den.14902","DOIUrl":"10.1111/den.14902","url":null,"abstract":"&lt;p&gt;Gursimran S. Kochhar, MD, is a gastroenterologist, Division Chief of the Department of Gastroenterology and Hepatology, at Allegheny Health Network, Pittsburgh, Pennsylvania. He specializes in interventional inflammatory bowel disease (IBD) and advanced therapeutic procedures.&lt;/p&gt;&lt;p&gt;Dr. Kochhar completed his training in internal medicine at Cleveland Clinic Foundation, Cleveland, Ohio, where he subsequently received training in nutrition and finished a gastroenterology and hepatology fellowship focused on training in IBD. Dr. Kochhar then completed his advanced endoscopy fellowship at Mayo Clinic, Jacksonville, Florida.&lt;/p&gt;&lt;p&gt;Dr. Kochhar has been at the forefront of managing IBD and its complications with various advanced endoscopic procedures. His innovative research on the endoscopic management of IBD has been successfully published in leading gastroenterology journals, including Gastroenterology, Clinical Gastroenterology and Hepatology, and Gastrointestinal Endoscopy. He has more than 120 publications, including peer-reviewed articles and book chapters. He serves on the Editorial Board of the journal Inflammatory Bowel Diseases. His current research focuses on endoscopic management of IBD complications, artificial intelligence in health care, and newer endoscopic innovations.&lt;/p&gt;&lt;p&gt;Stricture formation is a common complication in Crohn's disease (CD) patients, resulting from the underlying disease process, surgical anastomosis, or strictureplasty. The true incidence of stricturing disease is hard to assess. However, some studies suggest the prevalence of strictures is up to 25% in patients with CD, and over 50% of patients with CD will need at least one surgery in their lifetime.&lt;/p&gt;&lt;p&gt;Endoscopic balloon dilation (EBD), first described by Dr. G.M. Heller in 1988 in a patient with CD,1 is a very important tool in our toolbox to manage strictures in such patients. EBD, if done well, can be very effective in mitigating or delaying surgeries in patients with CD (Fig. 1).&lt;/p&gt;&lt;p&gt;Endoscopic assessment of strictures is challenging, especially if they are impassable. Hence, we rely heavily on preprocedural imaging. Both computed tomography enterography (CTE) and magnetic resonance enterography (MRE) with contrast are acceptable preprocedural imaging techniques. These give us an idea of the length, number, severity, type of stricture (inflammatory versus fibrotic), presence of prestenotic dilation, and any associated fistula or abscess. All these details help us plan the procedure. Strictures longer than 5–7 cm or with significant prestenotic dilation (&gt;5 cm in the small bowel) tend to be less responsive to EBD treatment. Avoid EBD in patients with an associated fistula or abscess. If there is a lot of inflammation on imaging, optimize medical therapy before performing an EBD.&lt;/p&gt;&lt;p&gt;Although there are not many scenarios where EBD is contraindicated, I recommend not performing it if there is an associated abscess or fistula with the stricture, as t","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 8","pages":"961-964"},"PeriodicalIF":5.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14902","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908528","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 insertion of an ileus tube with attached silk threads as endoscope grasping points","authors":"Yuzo Baba,&nbsp;Masakazu Ueda,&nbsp;Ryo Hashiguchi","doi":"10.1111/den.14900","DOIUrl":"10.1111/den.14900","url":null,"abstract":"<p>Successful ileus tube (I-tube) insertion requires passing the I-tube into the pylorus,<span>^{1, 2}</span> which may be achieved using an endoscope, and then advancing the I-tube through the duodenum. The latter can be difficult because the force pushing the I-tube may not be effectively transmitted to the tip.<span>^{3, 4}</span> Because the duodenum runs through the retroperitoneum like a tunnel and does not stretch, the I-tube can pass smoothly through the duodenum if directly pushed from inside the stomach, ensuring that the tip does not get trapped into the duodenal folds.</p><p>Here, we propose a new I-tube insertion method that involves attaching grasping points by tying silk threads on the I-tube and pushing the I-tube from inside the stomach with an endoscope (Fig. 1). Specifically, we used a 16F closed-end I-tube with a soft atraumatic tip that was designed to avoid getting trapped into the folds. Silk threads were tied on the I-tube at 5 cm intervals to cover 60 cm from the tip. After the I-tube entered the duodenum, it was pushed by using an endoscope (Fig. 2; Video S1).</p><p>A 60-year-old man underwent surgery for an abdominal aortic aneurysm. The patient presented with abdominal distention and was suspected to have a combination of paralytic ileus and adhesive intestinal obstruction. Endoscopic I-tube insertion was performed on the sixth operative day. Insertion to a depth of 60 cm into the pylorus was smoothly completed within 6 min, with the balloon successfully entering the jejunum. The patient was discharged on the 27th postoperative day.</p><p>The body of the designed I-tube showed sufficient stiffness to not require the use of a guidewire, and the I-tube did not retract during endoscope removal. Insertion was performed in 14 cases and was successful in all cases. The proposed use of an I-tube with endoscope grasping points is a promising method for rapid and simple ileus tube insertion.<span>^{2, 5}</span></p><p>Author Y.B. holds a United States Patent on the naso-jejunal medical tubes (Patent No. US10,524,988 B2). The other authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1282-1283"},"PeriodicalIF":5.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14900","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894938","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":"Immediate puncture of a dislocated partially covered self-expandable metal stent in endoscopic ultrasound-guided hepaticogastrostomy for prevention of bile leakage","authors":"Saburo Matsubara,&nbsp;Kentaro Suda,&nbsp;Sumiko Nagoshi","doi":"10.1111/den.14903","DOIUrl":"10.1111/den.14903","url":null,"abstract":"<p>A 69-year-old woman with complex hilar strictures due to unresectable gallbladder cancer was admitted for plastic stents obstruction. Considering duodenal invasion, conversion to endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) with bridging stenting after temporary naso-biliary drainage was planned.<span>¹</span> After puncturing B2 with a 19 G needle (Fig. 1a), two 0.025 inch guidewires were inserted into B8 and B6 using a double-lumen catheter. Two uncovered self-expandable metal stents (SEMS) were placed in both branches in partially stent-in-stent configuration. Finally, an 8 mm × 12 cm partially covered SEMS (Spring Stopper; Taewoong Medical, Seoul, Korea) with a 15 mm uncovered portion at the distal end was placed in B2 as a transluminal drainage/anastomosis stent (T-DAS). However, the T-DAS was accidentally moved toward the stomach because the tip of the inner catheter was stuck during removal.<span>²</span> Since the uncovered portion was suspected to be exposed to the abdominal cavity (Fig. 1b), there was concern for persistent bile leakage. Coaxial insertion of a fully-covered SEMS (HANAROSTENT Benefit; M.I.Tech, Seoul, Korea) to seal the uncovered portion failed and the guidewire was dislodged. The T-DAS within the liver parenchyma was then punctured with the 19 G needle (Fig. 1c), followed by manipulation of the 0.025 inch guidewire to bring it out of the distal end of the T-DAS into the bile duct (Fig. 1d). The HANAROSTENT Benefit was successfully placed as a second T-DAS after passing through the mesh of the first T-DAS and stopped bile leakage by completely covering the uncovered portion of the first T-DAS in the bile duct (Fig. 2, Video S1). Although computed tomography on the next day showed fluoroscopic markers at the end of the uncovered portion of the first T-DAS were outside of the liver, the clinical course was uneventful. For dislocation of a partially covered SEMS in EUS-HGS, this rescue method could be useful when coaxial fully covered SEMS insertion fails.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1286-1287"},"PeriodicalIF":5.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14903","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876873","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":"Comparison of clinical/histological outcomes according to puncture sites in endoscopic ultrasound-guided fine needle biopsy for large pancreatic masses: Multicenter randomized prospective pilot study","authors":"Sung Woo Ko,&nbsp;Tae Jun Song,&nbsp;Dongwook Oh,&nbsp;Seung Bae Yoon,&nbsp;Chi Hyuk Oh,&nbsp;Jin-Seok Park,&nbsp;Jae Hyuck Chang,&nbsp;Jai Hoon Yoon","doi":"10.1111/den.14885","DOIUrl":"10.1111/den.14885","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>There are no recommendations regarding the optimal puncture site in endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). This multicenter randomized prospective study compared the diagnostic accuracy and histological findings according to the sampling site for pancreatic masses larger than 3 cm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with pancreatic masses larger than 3 cm indicated for EUS-FNB were included in the study. Patients were randomly assigned to two groups for the initial puncture site (central vs. peripheral sampling of the masses). A minimum of four passes were performed, alternating between the center and the periphery. The primary outcome was diagnostic accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 100 patients were equally divided into the central group and the peripheral group. The final diagnosis revealed malignancy in 95 patients (pancreatic cancer [<i>n</i> = 89], neuroendocrine tumor [<i>n</i> = 4], lymphoma [<i>n</i> = 1], metastatic carcinoma [<i>n</i> = 1]), and benign conditions in five patients (chronic pancreatitis [<i>n</i> = 4], autoimmune pancreatitis [<i>n</i> = 1]). There was no significant difference in diagnostic accuracy between the puncture sites. However, combining samples from both areas resulted in higher diagnostic accuracy (97.0%) compared to either area alone, with corresponding values of 88.0% for the center (<i>P</i> = 0.02) and 85.0% for the periphery (<i>P</i> = 0.006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both central sampling and peripheral sampling showed equivalent diagnostic accuracy in detecting malignancy. However, combining samples from both areas generated superior diagnostic yield compared to using either sampling site alone. For pancreatic masses larger than 3 cm, it is advisable to consider sampling from various areas of the masses to maximize the diagnostic yield.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"183-191"},"PeriodicalIF":5.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14885","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876872","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 reopenable clip with anchor prongs facilitates mucosal defect closure after colorectal endoscopic submucosal dissection: Pilot feasibility study (with video)","authors":"Naoya Tada,&nbsp;Naoto Tamai,&nbsp;Mamoru Ito,&nbsp;Mai Fukuda,&nbsp;Toshiki Futakuchi,&nbsp;Hideka Horiuchi,&nbsp;Masakuni Kobayashi,&nbsp;Kazuki Sumiyama","doi":"10.1111/den.14891","DOIUrl":"10.1111/den.14891","url":null,"abstract":"<p>Closure of mucosal defects following colorectal endoscopic submucosal dissection (C-ESD) is often performed to prevent post-C-ESD adverse events. However, large mucosal defect closure using conventional clips remains technically challenging. Here, we evaluated the feasibility of the novel endoclip with anchor prongs, called the MANTIS Clip (Boston Scientific, Tokyo, Japan), for mucosal defect closure after C-ESD. This high-volume retrospective study was conducted at a single center. From March until December 2023, consecutive patients who underwent post-C-ESD mucosal defect closure using MANTIS Clip to achieve complete closure were enrolled. Patient clinical characteristics and outcomes were evaluated. Closure of the mucosal defect using the MANTIS Clip was attempted following C-ESD in 32 lesions. The median sizes of the resection specimens and the tumors were 32 mm (range, 17–100 mm) and 23.5 mm (range, 5–96 mm), respectively. The lesions were distributed between the cecum, ascending, transverse, descending, sigmoid, and rectum. Complete closure was achieved in 96.9% of cases (31/32). All lesions up to 61 mm in defect size were completely closed. The median closure time was 7.9 (range, 3.3–18.0) min. The median numbers of MANTIS Clip and additional conventional clips were 3 (range, 1–4) and 5 (range, 1–11), respectively. No adverse events associated with closure, post-ESD bleeding, and delayed perforation occurred. MANTIS Clip closure for large post-C-ESD mucosal defects was found to be feasible and reliable with a high complete closure rate and a short procedure time.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1164-1170"},"PeriodicalIF":5.0,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790193","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":"Single-session endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography with a dedicated over-the-scope fixation device: Feasibility study (with video)","authors":"Michiel Bronswijk,&nbsp;Emine Gökce,&nbsp;Pieter Hindryckx,&nbsp;Schalk Van der Merwe","doi":"10.1111/den.14879","DOIUrl":"10.1111/den.14879","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) is proposed as a less invasive alternative to laparoscopy-assisted ERCP. However, postponing ERCP for 1–2 weeks to reduce the risk of lumen-apposing metal stent (LAMS) migration may not be practical in urgent cases such as cholangitis, leading to increased procedural burden. This study aimed to assess the feasibility and safety of a single-session EDGE utilizing a dedicated over-the-scope fixation device.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of prospectively collected data from three referral centers was performed, including consecutive single-session EDGE procedures with the Stentfix device, utilizing only 20 × 10 mm LAMS. The primary outcome was LAMS migration, and key secondary outcomes included adverse events and technical success.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty patients (mean age 59 [standard deviation (SD) ± 11.3] years, 65.0% female) with a predominantly classic Roux-en-Y gastric bypass history (90.0%, mini-bypass 10.0%) underwent ERCP for indications such as common bile duct stones (60.0%), cholangitis (25.0%), or biliary pancreatitis (15.0%). No LAMS migration occurred, and technical success was achieved in 95.0%. Over a median follow-up of 102 days (interquartile range [IQR] 24.8–182), two adverse events were reported (10.0%), comprising postprocedural pain (grade I) and post-ERCP pancreatitis (grade II).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While acknowledging potential contributions from LAMS orientation and stent caliber, our data suggest that utilizing a dedicated over-the-scope stent fixation device may effectively prevent LAMS migration during single-session EDGE without the need for endoscopic suturing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"176-182"},"PeriodicalIF":5.0,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790194","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}