Digestive Endoscopy最新文献

{"title":"Accessing the Pancreatobiliary System via Lumen-Apposing Metal Stents: A State-of-the-Art Review of Endoscopic Ultrasound-Directed Interventions","authors":"Giuseppe Vanella,&nbsp;Michiel Bronswijk,&nbsp;Enrique Pérez-Cuadrado-Robles,&nbsp;Roy L. J. van Wanrooij,&nbsp;Prabhleen Chahal,&nbsp;Edoardo Forti,&nbsp;Camilla Gallo,&nbsp;Marco Spadaccini,&nbsp;Alessandro Fugazza,&nbsp;Mouen Khashab,&nbsp;Amrita Sethi,&nbsp;Amy Tyberg,&nbsp;Manuel Perez-Miranda,&nbsp;Massimiliano Mutignani,&nbsp;Rastislav Kunda,&nbsp;Michel Kahaleh,&nbsp;Schalk Van der Merwe,&nbsp;Paolo Giorgio Arcidiacono","doi":"10.1111/den.70098","DOIUrl":"10.1111/den.70098","url":null,"abstract":"<p>The growing number of bariatric and oncologic gastrointestinal and hepatopancreatobiliary surgeries has fueled the increased need for biliary interventions in patients with surgically altered anatomy (SAA), where standard endoscopic retrograde cholangiopancreatography (ERCP) is often unfeasible. Traditional alternative methods, such as enteroscopy- or laparoscopy-assisted ERCP, are associated with technical and logistical limitations. Endoscopic ultrasound (EUS)-directed ERCP uses lumen-apposing metal stents (LAMS) to create temporary anastomoses between adjacent lumens, thus restoring access for standard ERCP. These procedures include EUS-directed transgastric (EDGE), transenteric (EDEE), transduodenal (EDDE), and transcholedochal/transcystic (EDCE) ERCP. This review provides an evidence-based analysis of the available techniques and comparative outcomes, with a particular focus on technical and strategic aspects including: (1) how to create an EUS-guided anastomosis across different surgical scenarios; (2) how to perform a through-the-LAMS ERCP, including endoscope and accessory selection, ERCP timing and LAMS fixation; and (3) how to manage the fistula after completion of therapy, including timing of LAMS removal and fistula closure. An algorithm is proposed to guide the endoscopist through the complex decision-making inherent to pancreatobiliary interventions in SAA.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 2","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108683","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":"Screw Spike Method With a Drill Dilator for Severe Biliary Stricture","authors":"Yuki Kawaji,&nbsp;Masahiro Itonaga,&nbsp;Masayuki Kitano","doi":"10.1111/den.70111","DOIUrl":"10.1111/den.70111","url":null,"abstract":"<p>Malignant biliary obstruction sometimes becomes highly stenotic, making guidewire passage difficult. A drill dilator (Tornus ES, Asahi Intec Co. Ltd.) is a newly developed dilation device (Figure 1). Due to its rotational advancement, it can pass through highly stenosed areas [<span>1-3</span>]. We developed a new technique to penetrate strictures using the drill dilator without a guidewire, named “screw spike method,” and present a case for whom this method proved effective for severe biliary stenosis.</p><p>The patient was an 82-year-old male. Following endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) for lower bile duct obstruction and duodenal stenting for duodenal obstruction due to pancreatic cancer, re-intervention was performed for acute cholangitis caused by occlusion of the EUS-HGS stent (self-expandable metal stent [SEMS]). After removal of the EUS-HGS stent, a catheter was inserted from the EUS-HGS route into the bile duct. Cholangiography showed a stricture at the distal end of the bile duct and papilla. Duodenal invasion caused by pancreatic cancer extended across the papilla (Figure 2a). We planned to place a SEMS in the stricture using the antegrade technique. We attempted to pass through the stricture using a guidewire, but this was impossible due to severe stenosis. Without a guidewire, the drill dilator was advanced toward the stricture (Figure 2b,c). To avoid extraluminal advancement, the forward direction was determined using fluoroscopy, pre-procedural CT, and previous cholangiographic findings. With rotational maneuvers, the drill dilator successfully traversed the stricture at the distal end of the bile duct and passed into the duodenum like “a screw spike” (Figure 2c,d). The drill dilator was advanced under continuous fluoroscopic monitoring. After passage, correct intraluminal positioning was confirmed by guidewire advancement into the duodenum and contrast injection before SEMS deployment. Subsequently, an SEMS was placed at the stricture using the antegrade technique (Figure 2e). Thus, the screw spike method is highly effective for severe strictures.</p><p>Yuki Kawaji conceived the study, acquired images, and drafted the manuscript. Masahiro Itonaga and Masayuki Kitano contributed to the data interpretation, literature review, and critical revision of the manuscript.</p><p>The authors have nothing to report.</p><p>Author M.K. is the Editor-in-Chief of <i>Digestive Endoscopy</i>. Other authors declare no conflicts of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 2","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108811","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":"Spider-Man in WONderland: Bending Biopsy Forceps to Facilitate Endoscopic Necrosectomy","authors":"Tsuyoshi Hamada,&nbsp;Tomotaka Saito,&nbsp;Mitsuhiro Fujishiro","doi":"10.1111/den.70110","DOIUrl":"10.1111/den.70110","url":null,"abstract":"<p>Endoscopic ultrasound (EUS)-guided transluminal drainage is currently the preferred first-line approach for symptomatic walled-off necrosis (WON) of the pancreas [<span>1, 2</span>]. Lumen-apposing metal stents (LAMSs) create a stable conduit for direct endoscopic necrosectomy, resulting in the improved overall outcomes [<span>3, 4</span>]. However, owing to the limited maneuverability of devices through forward-viewing endoscopes, it can be challenging to access necrotic contents located in the peripheral field of view. Here, we present a case in which this difficulty was successfully overcome using biopsy forceps modified to be bendable by attaching a long thread to the cup (Video S1).</p><p>A 27-year-old man with severe necrotizing pancreatitis was referred to our institution. On the 51st day of hospitalization, EUS-guided drainage was performed using an LAMS with electrocautery-enhanced delivery (Hot AXIOS; Boston Scientific, Marlborough, MA, USA) for infected WON extending to the pelvic cavity (Figure 1). During a subsequent necrosectomy session, it was difficult to grasp the necrotic contents located in the peripheral field of the endoscopic view. To overcome this, we attached a long 4-0 silk thread to one cup of the biopsy forceps (Radial Jaw 4P; Boston Scientific) and successfully accessed the necrosis by bending the forceps through traction on the thread passed via the working channel (Figure 2). The detached necrotic contents were then removed using the forceps and a snare. In total, 22 necrosectomy sessions were performed without adverse events related to this new technique, resulting in a resolution of the WON.</p><p>Radial Jaw is one of the most widely used series of biopsy forceps and features holes in each cup that allows the attachment of a long thread [<span>5</span>]. This “spider's thread” technique may improve the accessibility of devices during direct endoscopic necrosectomy.</p><p>Tsuyoshi Hamada and Tomotaka Saito: conceptualization and design of the work. Tsuyoshi Hamada: literature search and drafting of the manuscript. Tomotaka Saito and Mitsuhiro Fujishiro: editing and critical revision of the manuscript for important intellectual contents. Tsuyoshi Hamada and Mitsuhiro Fujishiro: supervision. All authors: Approval of the final version of the manuscript.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 2","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12864174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108754","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 Hepaticocolonostomy Through the Reconstructed Colon","authors":"Nao Otsuka,&nbsp;Ryunosuke Hakuta,&nbsp;Yousuke Nakai","doi":"10.1111/den.70109","DOIUrl":"10.1111/den.70109","url":null,"abstract":"<p>Endoscopic ultrasound (EUS)-guided hepaticogastrostomy is a widely accepted procedure for biliary drainage, especially in patients with inaccessible papilla [<span>1</span>]. Recently, the feasibility of EUS-guided hepaticojejunostomy (EUS-HJS) has also been reported in post-gastrectomy patients [<span>2-4</span>]. Herein, we report the first case of EUS-guided hepaticocolonostomy (EUS-HCS) through the reconstructed colon.</p><p>An 80-year-old man with total gastrectomy and esophagectomy, with a reconstructed colon via the presternal route (Figure 1a), developed obstructive jaundice. Computed tomography revealed a 23-mm pancreatic head cancer and dilated common bile duct (CBD) and intrahepatic bile ducts (Figure 1b,c). Scope insertion for balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography was supposed to be technically difficult due to complex surgical history, and EUS-HCS was performed through the reconstructed colon (Video S1). An echoendoscope (EG-740UT, FUJIFILM, Tokyo, Japan) was advanced into the reconstructed colon under CO₂ insufflation (Figure 2a) and the dilated bile duct in segment two (B2) was visualized (Figure 2b). The B2 was punctured using a 19-gauge needle. A 0.025-in. guidewire advancement into the CBD was difficult; thus, a cannula was utilized to facilitate safe guidewire manipulation (Figure 2c). The route was dilated with a bougie dilator (MEISSA, Japan Lifeline, Tokyo, Japan), and a 7-Fr single-pigtail plastic stent (Through &amp; Pass, TYPE IT, Gadelius Medical Co Ltd., Tokyo, Japan) was successfully placed from the reconstructed colon into the CBD (Figure 2d,e). The detailed clinical course after EUS-HCS is presented in Video S1.</p><p>This case highlights the feasibility of EUS-HCS from a reconstructed colon. Given the potential risk of infectious adverse events due to the colonic puncture, the puncture site was carefully preplanned to avoid trans-thoracic or mediastinal puncture, and minimal mechanical dilation was performed. Although further studies are required to confirm its safety and long-term outcomes, EUS-HCS may serve as a possible alternative treatment option when conventional approaches are not possible.</p><p>The authors have nothing to report.</p><p>Yousuke Nakai has received a research grant and honoraria from Gadelius Medical Co. Ltd. All other authors declare no competing interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 2","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108813","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":"Integrating Artificial Intelligence Into Endoscopy Education: Evidence, Gaps, and Future Directions","authors":"Weihao Cheng,&nbsp;Shangxuan Li,&nbsp;Zekai Yu","doi":"10.1111/den.70114","DOIUrl":"https://doi.org/10.1111/den.70114","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 2","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146193386","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":"Biliary Skewering Technique With EUS-Guided Hepaticoduodenostomy Achieving Multi-Segmental Right Hepatic Drainage via Direct Stent-to-Stent Connection","authors":"Hiroki Koda,&nbsp;Kazuo Hara,&nbsp;Tomoki Ogata","doi":"10.1111/den.70107","DOIUrl":"10.1111/den.70107","url":null,"abstract":"<p>In malignant hilar biliary obstruction, transpapillary drainage alone is often difficult [<span>1, 2</span>]. Percutaneous transhepatic drainage or additional endoscopic interventions may be required, but external fistula formation can reduce quality of life [<span>3-5</span>]. We report a case in which extensive right hepatic drainage was achieved using the biliary skewering technique combined with endoscopic ultrasound-guided hepaticoduodenostomy (EUS-HDS) (Video S1). A 72-year-old woman with hilar cholangiocarcinoma had separated intrahepatic bile ducts, with the right ducts divided to tertiary branches (Figure 1A,B). Transpapillary stents had been placed into the Segment 2 and Segment 5 branches at a previous hospital; however, drainage remained insufficient, and additional right hepatic drainage was performed under EUS guidance. Using a linear echoendoscope (EG-740UT; FUJIFILM), the Segment 6 and Segment 7 branches were skewered across the liver parenchyma in a single puncture with a 19-gauge needle (EZ Shot 3 Plus; Olympus) (Figure 2A,B). An uncovered self-expandable metal stent (UCSEMS; ZEOSTENT V, 8 mm × 6 cm; ZEON MEDICAL) was deployed from the Segment 7 branch to the Segment 6 branch (Figure 2C). A partially covered SEMS (ZEOSTENT HG, 8 mm × 10 cm; ZEON MEDICAL) was then inserted from the Segment 6 branch to the duodenum, with its uncovered portion overlapping the UCSEMS (Figure 2D). Similarly, the separated Segment 5 branches were bridged using a UCSEMS (ZEOSTENT V, 8 mm × 6 cm; ZEON MEDICAL) (Figure 2E–G). A fully covered SEMS (HANAROSTENT Biliary Benefit, 6 mm × 10 cm; Boston Scientific) with manually created distal side holes was placed from the Segment 5 branch to the duodenum as the HDS stent (Figure 2H). This combined approach enabled multi-segmental right hepatic drainage without external fistula formation, resulting in resolution of jaundice and allowing continued chemotherapy in this complex hilar obstruction (Figure 1C–E).</p><p><b>Hiroki Koda:</b> study conception, procedure performance, video editing, data acquisition, and manuscript drafting. <b>Kazuo Hara:</b> supervision, interpretation of findings, and critical manuscript revision. <b>Tomoki Ogata:</b> assistance with endoscopic procedure and data management.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WEO Newsletter: Histopathology for endoscopists","authors":"","doi":"10.1111/den.70099","DOIUrl":"https://doi.org/10.1111/den.70099","url":null,"abstract":"<p>WEO Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146091206","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":"Report on the First WEGECA Meeting: Women Endoscopists for Global Exchange and Career Advancement","authors":"Mayo Tanabe,&nbsp;Reiko Ashida,&nbsp;Akiko Shiotani,&nbsp;Naomi Kakushima,&nbsp;Haruhiro Inoue,&nbsp;Shinji Tanaka","doi":"10.1111/den.70105","DOIUrl":"10.1111/den.70105","url":null,"abstract":"&lt;p&gt;The inaugural WEGECA (Women Endoscopists for Global Exchange and Career Advancement) assembly was held on September 6, 2025, at the Toshi Center Hotel in Tokyo, following the first JGES International main program. This historic event marked the official launch of a new collaborative initiative under the Japanese Gastroenterological Endoscopy Society (JGES), dedicated to promoting gender diversity, leadership, and international collaboration among women in endoscopy.&lt;/p&gt;&lt;p&gt;WEGECA operates as part of the Career Support Committee for Female Endoscopists, which aims to foster mentorship, equity, and career advancement across generations and to strengthen international exchange and collaboration among women in endoscopy. Supported by the JGES Board of Directors and the International Committee, this first meeting symbolized a transformative moment for gender inclusion within Japan's endoscopic community and for global engagement in the field.&lt;/p&gt;&lt;p&gt;The session began with warm words from Dr. Naomi Kakushima, Vice Chair of the Career Support Committee for Female Endoscopists, who spoke on behalf of Chair Prof. Akiko Shiotani. She highlighted the committee's long-standing efforts to establish regional branches nationwide and expressed appreciation for the participants who gathered to celebrate this new milestone. Dr. Kakushima emphasized that WEGECA embodies the shared aspiration to empower women, cultivate mentorship, and expand professional networks that transcend institutional and national boundaries.&lt;/p&gt;&lt;p&gt;A special address by Prof. Shinji Tanaka, President of JGES, reaffirmed the Society's commitment to diversity and equity. He commended the establishment of WEGECA as a necessary and forward-looking initiative that reflects the evolving global landscape of endoscopy. His presence—along with that of other senior leaders—conferred strong institutional endorsement and reinforced the importance of integrating gender equality into the Society's long-term vision.&lt;/p&gt;&lt;p&gt;The invited lectures highlighted the complementary roles of three organizations dedicated to advancing gender equity and international collaboration in endoscopy: WEGECA in Japan, Women in Endoscopy (WIE), a global organization headquartered in the United States, and the Women in Gastroenterology Network Asia Pacific (WIGNAP). Together, these organizations represent regionally rooted yet globally connected networks that share common goals while addressing distinct local and regional needs (Figure 1).&lt;/p&gt;&lt;p&gt;Dr. Reiko Ashida (Chair of WEGECA; Wakayama Medical University) delivered the first invited lecture at the inaugural WEGECA Assembly. She outlined the current landscape of female endoscopists in Japan and explained how WEGECA was founded in response to the need for structured mentorship, greater visibility, and international collaboration. Dr. Ashida also highlighted the symbolism of the WEGECA logo—representing harmony, unity, and empowerment—and described the committee's mission to fo","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013465","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":"Enhancing Endoscopy Report Quality Through Next-Generation AI: Complementing Current Systems With Generative Models, Advanced Speech Recognition, and Robust Natural Language Processing","authors":"Enjian Liu,&nbsp;Zekai Yu","doi":"10.1111/den.70104","DOIUrl":"10.1111/den.70104","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992067","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":"Neovaginal Diversion Colitis Successfully Treated With Mesalazine Suppositories: Endoscopic Documentation of Healing","authors":"Shinichiro Kawatoko,&nbsp;Marimo Mori,&nbsp;Junji Umeno","doi":"10.1111/den.70100","DOIUrl":"10.1111/den.70100","url":null,"abstract":"<p>A 41-year-old woman with Mayer–Rokitansky–Küster–Hauser syndrome (type I), a congenital absence of the uterus and upper vagina, underwent sigmoid colon vaginoplasty at age 18 and was followed at our gynecology department. She presented with a 10-month history of intermittent neovaginal bleeding and dyspareunia. A manual neovaginal examination was unremarkable, but persistent symptoms prompted referral to our department (Gastroenterology) for further evaluation. Vaginoscopy (EVIS X1 and GIF-XZ1200, Olympus Corp., Tokyo, Japan) revealed continuous erythema, edema, erosions, and loss of vascular pattern, resembling ulcerative colitis, in the neovaginal sigmoid colon (Figure 1a,b). Biopsy histology showed chronic active colitis with crypt distortion, cryptitis, and goblet cell depletion (Figure 1c,d). Bacterial culture and <i>Treponema pallidum</i> PCR were negative. Colonoscopy showed only minor aphthous erosions confined to the anal verge, with no lesions in the upstream rectum or colon. She had no gastrointestinal symptoms suggestive of ulcerative colitis, such as diarrhea, hematochezia, or abdominal pain. From these findings, she was diagnosed with isolated neovaginal diversion colitis. She was initially treated with intravaginal budesonide foam enemas (2 mg, once daily) for 7 weeks and advised to refrain from vaginal intercourse; however, symptoms persisted. Subsequently, mesalazine vaginal suppositories (1000 mg, once daily) were initiated with the aid of a vaginal prosthesis to facilitate drug delivery to the neovaginal blind end, resulting in marked symptom improvement within 1 week. Follow-up vaginoscopy after 7 weeks demonstrated mucosal normalization, and histology confirmed resolution of inflammation (Figure 2). She resumed vaginal intercourse while continuing mesalazine suppositories, with only occasional trace bleeding and no other symptoms for 13 months. Neovaginal diversion colitis, also called “diversion neovaginitis,” may result from nutritional deprivation (e.g., short-chain fatty acids) [<span>1</span>]. Despite treatments like short-chain fatty acid enemas, mesalazine, or corticosteroids, no standardized treatment has been established [<span>1, 2</span>]. Accurate endoscopic and histological assessment enables effective medical management and preserves sexual function.</p><p>Shinichiro Kawatoko designed the study, managed the patient's care, performed endoscopic evaluations, reviewed histological specimens, and drafted the manuscript. Marimo Mori and Junji Umeno critically reviewed and revised the manuscript for important intellectual content. All authors have read and approved the final version of the manuscript.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12802533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967921","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}