Digestive Endoscopy最新文献

{"title":"Submucosal Lidocaine Injection in Colonic Endoscopic Submucosal Dissection: A Single-Center, Double-Blind, Randomized Controlled Trial","authors":"Tomoya Ueda,&nbsp;Takashi Kanesaka,&nbsp;Yoshiaki Ando,&nbsp;Yasuhiro Tani,&nbsp;Gentaro Tanabe,&nbsp;Yuta Fujimoto,&nbsp;Noriaki Ito,&nbsp;Nobutoshi Tsukuda,&nbsp;Kazuki Matsuyama,&nbsp;Muneshin Morita,&nbsp;Minoru Kato,&nbsp;Shunsuke Yoshii,&nbsp;Satoki Shichijo,&nbsp;Sachiko Yamamoto,&nbsp;Koji Higashino,&nbsp;Noriya Uedo,&nbsp;Tomoki Michida,&nbsp;Ryu Ishihara,&nbsp;Hiroshi Seno","doi":"10.1111/den.70272","DOIUrl":"https://doi.org/10.1111/den.70272","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Colonic spasm is one of the major technical challenges encountered during colonic endoscopic submucosal dissection (ESD), impairing visualization of the dissection plane and scope maneuverability. Submucosal lidocaine injection may help to overcome this challenge. This study aimed to evaluate the efficacy and safety of submucosal lidocaine injection during colonic ESD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this single-center, double-blind, randomized controlled trial, 110 patients scheduled for colonic ESD were randomly assigned to the lidocaine or control group. In the lidocaine group, 1% lidocaine with 0.6% sodium alginate was used for submucosal injection; in the control group, saline with 0.6% sodium alginate was used. The primary outcome was procedure time. Secondary outcomes included <i>en bloc</i> and R0 resection rates, incidence of severe spasms, number of antispasmodic administrations, operator satisfaction, and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median procedure time was numerically shorter in the lidocaine group but did not reach statistical significance (67.5 vs. 78.0 min, <i>p</i> = 0.114). The <i>en bloc</i> and R0 resection rates were 100% and 84.6% in the lidocaine group, and 96.3% and 81.5% in the control group, respectively. Severe spasms occurred less frequently in the lidocaine group (34.6% vs. 74.1%), with fewer antispasmodic administrations (median, 1 vs. 2) and higher operator satisfaction scores (median, 4.0 vs. 2.5). No increase in adverse events was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Submucosal lidocaine injection did not significantly shorten procedure time, although it may serve as a useful adjunct for preventing colonic spasms during ESD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>The study was registered in the Japan Registry of Clinical Trials (jRCT1051230189)</p>\u0000 </section>\u0000 </div>","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":"148849305","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":"Real-Time Assessment of Endoscopic Ultrasound-Guided Ethanol Injection for Pancreatic Neuroendocrine Neoplasm Using Superb Microvascular Imaging","authors":"Tadahisa Inoue,&nbsp;Masato Yano,&nbsp;Kiyoaki Ito","doi":"10.1111/den.70270","DOIUrl":"https://doi.org/10.1111/den.70270","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":"148849066","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":"Submucosal Tunneling Endoscopic Resection of a Pelvic Reactive Nodular Fibrous Pseudotumor Through Rectum","authors":"Zihan Li,&nbsp;Xiwei Ding,&nbsp;Lei Wang","doi":"10.1111/den.70263","DOIUrl":"https://doi.org/10.1111/den.70263","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 9","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849339","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":"Deus Sine Machina: Which Intelligence, for Whom","authors":"Eisuke Iwasaki,&nbsp;Aya Kawanishi,&nbsp;Fateh Bazerbachi","doi":"10.1111/den.70265","DOIUrl":"10.1111/den.70265","url":null,"abstract":"&lt;p&gt;Artificial intelligence (AI) has advanced rapidly in gastrointestinal endoscopy. In colonoscopy, computer-aided detection raises adenoma detection across many trials [&lt;span&gt;1&lt;/span&gt;], and AI is extending to lesion characterization, quality control, documentation, and education [&lt;span&gt;2&lt;/span&gt;]. In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Coelho-Prabhu et al. present the World Endoscopy Organization's (WEO) response to the World Health Organization's Global Initiative on AI for Health, a welcome insistence that AI be judged from the standpoint of global equity rather than the frontier of the high-resource world alone [&lt;span&gt;3&lt;/span&gt;]. The WEO is right that, even as AI must escape the preserve of the affluent world, its naïve export may widen rather than narrow disparities. We carry the argument one step further, toward the question the statement raises but leaves implicit: not whether AI can be made to work in low- and middle-income countries, but which AI, for which disease, and for which unmet need.&lt;/p&gt;&lt;p&gt;That AI tends to refine advanced systems rather than reach those most in need is not peculiar to AI; it is the latest form of a structural feature of biomedical innovation, the 10/90 gap, in which scarcely a tenth of research spending is directed at the diseases responsible for the great majority of the world's suffering. AI threatens not merely to inherit this gap but to widen it, for its returns accrue where data and infrastructure already exist, concentrating its gains where capability is already greatest.&lt;/p&gt;&lt;p&gt;It helps to distinguish two margins on which AI can operate. In the high-resource setting it works on the intensive margin, refining a capability that already exists, such as lifting adenoma detection from good to better. In much of the world the relevant margin is extensive: the capability does not exist at all, and to deploy there is not to refine a service but to create one. An algorithm that improves adenoma detection where no colonoscopy exists refines a service the population has never had; the prior task is not refinement but provision, of a basic and lifesaving capability that is wholly absent. The mismatch is twofold, for endoscopic AI has been built largely around the conditions that dominate high-income practice, colorectal cancer, Barrett's esophagus, inflammatory bowel disease, rather than the esophageal and gastric cancers and the hepatitis-B and schistosomal cirrhosis that carry the heaviest burden where resources are thinnest.&lt;/p&gt;&lt;p&gt;Therefore, our most refined tools, ported identically, would be misplaced twice over: the wrong margin, and the wrong disease.&lt;/p&gt;&lt;p&gt;The point is concrete. Take endoscopic retrograde cholangiopancreatography (ERCP) for ascending cholangitis: it addresses a lethal condition, yet across much of sub-Saharan Africa this capability is scarce or absent. In a survey of physicians across four eastern African countries, of 87 who responded, 63 performed endoscopy, but only six performed ERCP an","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13500932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809314","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":"The Impact of Artificial Intelligence-Assisted Endoscopy on the Detection of Upper Gastrointestinal Neoplasms: A Systematic Review and Meta-Analyses","authors":"Mingru Liu,&nbsp;Mingjun Ma,&nbsp;Di Zhang,&nbsp;Yunqing Zeng,&nbsp;Xiao Liang,&nbsp;Jiaoyang Lu","doi":"10.1111/den.70268","DOIUrl":"https://doi.org/10.1111/den.70268","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Early detection of upper gastrointestinal (UGI) neoplasms is challenging because of their subtle endoscopic features. Artificial intelligence (AI) has improved endoscopic imaging and lesion recognition. This meta-analysis aimed to assess the effectiveness of AI-assisted real-time esophagogastroduodenoscopy (EGD) for detecting UGI neoplasms based on evidence from randomized controlled trials (RCTs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, EMBASE, and Cochrane Library were searched for RCTs comparing AI-assisted EGD with conventional EGD up to April 11, 2026. Risk ratios (RRs) were calculated for the neoplasm detection rate (DR), and incidence rate ratios (IRRs) were pooled for lesions per endoscopy (LPE). Subgroup analyses were conducted according to AI system and pathological types. Random-effects models with Hartung–Knapp adjustment were applied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten RCTs involving 87,721 participants were included. Compared with conventional EGD, AI-assisted EGD significantly improved neoplasm DRs in the esophagus (RR = 1.47, 95% confidence interval [CI] 1.13–1.90, <i>p</i> = 0.012) and stomach (RR = 1.47, 95% CI 1.02–2.13, <i>p</i> = 0.043). In subgroup analyses, computer-assisted detection (CADe) was associated with increased LPE of esophageal neoplasms (IRR = 1.62, 95% CI 1.08–2.45, <i>p</i> = 0.033). AI-assisted EGD also increased the LPEs of gastric cancer (IRR = 1.45, 95% CI 1.09–1.92, <i>p</i> = 0.022) and low-grade intraepithelial neoplasia (IRR = 1.39, 95% CI 1.13–1.70, <i>p</i> = 0.012).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI-assisted real-time EGD was associated with improved detection of UGI neoplasms and may support endoscopists in routine clinical practice. Further studies are required to evaluate the effectiveness of different AI systems across pathological subtypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>PROSPERO; CRD420251158943</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148785162","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":"Long-Pulse Endoscopic Laser Lithotripsy for Right Intrahepatic Bile Duct Stones via an Endoscopic Ultrasound–Guided Created Route","authors":"Ritsuko Oishi,&nbsp;Haruo Miwa,&nbsp;Shin Maeda","doi":"10.1111/den.70264","DOIUrl":"https://doi.org/10.1111/den.70264","url":null,"abstract":"<p>Removal of intrahepatic bile duct (IHBD) stones via endoscopic ultrasound–guided created route (ESCR) has been reported as an effective treatment option in patients with surgically altered anatomy [<span>1, 2</span>]. However, extraction of stones located in the right IHBD remains technically challenging. Endoscopic laser lithotripsy (LL) using a Holmium:YAG laser (LithoEVO; EDAP TMS, Lyon, France) can be performed in either short- or long-pulse modes. In particular, the long-pulse mode delivers laser energy over a longer duration, resulting in finer stone fragmentation [<span>3</span>]. This approach may reduce the need for technically demanding stone extraction maneuvers and facilitate spontaneous clearance of stone fragments through the hepaticojejunostomy anastomosis (Figure 1). Herein, we report complete removal of right IHBD stones using long-pulse LL via ESCR (Video 1).</p><p>A 78-year-old man who had undergone surgery for gastric cancer with Billroth II reconstruction and choledochojejunostomy was admitted for IHBD stone removal because of recurrent cholangitis. Although single-balloon enteroscope-assisted endoscopic retrograde cholangiography was attempted, the mechanical lithotripter could not be advanced because of acute angulation of the right IHBD. Endoscopic ultrasound-guided hepaticogastrostomy was then performed. One month later, LL was performed via ESCR using a slim cholangioscope (eyeMax 9-Fr; Micro-Tech, Nanjing, China). The long-pulse mode maintained a stable cholangioscopic view without stone retropulsion, resulting in fine fragmentation (Figure 2). At a second session performed 2 weeks later, cholangiography showed that most right IHBD stones had disappeared, suggesting effective fragmentation by long-pulse LL. The remaining small fragments were removed using a balloon catheter.</p><p>Previous studies have demonstrated the feasibility of LL for difficult biliary stones and antegrade LL via ESCR [<span>4, 5</span>]. To the best of our knowledge, this is the first report of complete removal of right IHBD stones using long-pulse LL via ESCR. The long-pulse mode facilitates effective stone clearance even in a nondilated and anatomically challenging bile duct.</p><p>Haruo Miwa supervised this procedure, and Shin Maeda supervised writing this article.</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 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70264","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784432","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":"Endo-Hepatology: Paradigm Shift in Endosonographic Diagnosis for Liver Disease to Digestive Endoscopy","authors":"Pathipat Durongpongkasem,&nbsp;Amanda H. Lim,&nbsp;Nam Q. Nguyen","doi":"10.1111/den.70261","DOIUrl":"https://doi.org/10.1111/den.70261","url":null,"abstract":"<p>Assessment of liver disease has traditionally relied on a fragmented approach involving cross-sectional imaging, noninvasive fibrosis assessment, liver biopsy, and endoscopy for complications of portal hypertension. Although effective, this strategy often requires multiple procedures and lacks integration. Advances in endoscopic ultrasound (EUS) have led to the emergence of <i>endo-hepatology</i>, an integrated model enabling comprehensive evaluation and management of liver disease within a single endoscopic platform. This review highlights recent advances in endo-hepatology and the expanding diagnostic and therapeutic roles of EUS. High-resolution EUS imaging, enhanced by contrast-enhanced harmonic techniques, improves detection and characterization of focal liver lesions, including early hepatocellular carcinoma and small metastases. EUS-guided liver biopsy is a safe and effective alternative to percutaneous and transjugular approaches, providing high-quality tissue acquisition from both hepatic lobes. EUS-guided shear wave elastography allows accurate fibrosis assessment in patients with obesity or ascites, overcoming limitations of transabdominal techniques. EUS-guided portal pressure gradient measurement offers direct assessment of portal hypertension without radiation or contrast exposure. Therapeutic EUS applications, including coil and glue therapy for gastric varices and emerging locoregional treatments for liver tumors, offer minimally invasive options in selected patients. Collectively, these advances support EUS as a potential “one-stop” modality for liver disease assessment and management. As evidence continues to accumulate, endo-hepatology is likely to assume an increasingly central role in modern hepatology practice.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70261","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784894","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":"Non-Injection Resection Using Bipolar Soft Coagulation Mode for a 28-mm Superficial Non-Ampullary Duodenal Epithelial Tumor","authors":"Mitsuo Tokuhara,&nbsp;Takakazu Komatsu,&nbsp;Yasushi Sano","doi":"10.1111/den.70271","DOIUrl":"https://doi.org/10.1111/den.70271","url":null,"abstract":"<p>Non-injection resection using bipolar soft coagulation mode (NIRBS) [<span>1-3</span>] was performed for a 28-mm superficial non-ampullary duodenal epithelial tumor (SNADET) located in the duodenal second portion (Figure 1). En bloc and R0 resection for this SNADET were achieved in about 3 min without perforation (Figure 2). While underwater endoscopic mucosal resection [<span>4</span>] has been attempted for small SNADETs fewer than 20 mm, it is not recommended for SNADETs larger than 20 mm [<span>5</span>]. Accordingly, a simple endoscopic method that can completely resect SNADETs larger than 20 mm with a low risk of perforation should be developed. NIRBS is a method in which the normal mucosa around the lesion is grasped without injection into the submucosal layer, sufficiently closed, and resected with energization using the bipolar snare (width, 26 mm; length, 62 mm) set in the soft coagulation mode at Effect 3.3 (VIO 3), which has a minimal heat effect. The snare grips the mucosa without slipping because of the decreased mucosal pressure and tension due to non-injection (NI). The snare closes the submucosal layer, sliding just above the muscle layer. The softest submucosal layer is lifted upward by the same force that strangles the mucosal layer toward the center of the snare. The strangled mucosal layers eventually adhere to each other, completely separating the deepest portion of the lesion from the muscular layer. And then, the lesion is resected by energization while closing the snare. Although further clinical validation is required for size and morphological indications of SNADETs, NIRBS might make it possible to perform en bloc and R0 resection for SNADETs larger than 20 mm simply without perforation due to the minimal heat effect of the bipolar snare set in the soft coagulation mode despite NI (Video 1).</p><p><b>Mitsuo Tokuhara:</b> conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, writing original draft, and writing review and editing. <b>Takakazu Komatsu:</b> validation. <b>Yasushi Sano:</b> writing review and editing.</p><p>The authors have nothing to report.</p><p>Guarantor of the Manuscript: Mitsuo Tokuhara.</p><p>The authors declare no conflicts of interest.</p><p>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70271","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784893","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":"Submucosal Injection-Guided Septotomy for Zenker's Diverticulum: Finding the Middle Ground","authors":"Robert Bechara","doi":"10.1111/den.70267","DOIUrl":"https://doi.org/10.1111/den.70267","url":null,"abstract":"&lt;p&gt;Flexible endoscopic treatment has transformed the management of Zenker's diverticulum. Yet the optimal technique remains uncertain. Zenker's diverticulum is structural in appearance but functional in origin; the pouch is a consequence of disordered cricopharyngeal relaxation rather than the disorder itself. Impaired cricopharyngeal relaxation limits upper esophageal sphincter opening, generating elevated hypopharyngeal pressure that drives mucosal and submucosal herniation through Killian's triangle. The diverticulum is therefore the visible manifestation of the disease, but the therapeutic target is the dysfunctional cricopharyngeus. Persistent cricopharyngeal dysfunction and the consequent diverticulum can lead to dysphagia, regurgitation, cough, aspiration, and weight loss. Open surgery and rigid endoscopic septotomy remain appropriate in selected patients; however, flexible endoscopic therapy has become the preferred first-line approach for symptomatic Zenker's diverticulum, supported by favorable clinical success and safety profiles, its feasibility in patients with cervical spine disease or limited neck mobility, and its suitability for the older, medically complex population in whom Zenker's diverticulum commonly occurs [&lt;span&gt;1-3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The field has therefore moved beyond the simple question of whether the septum can be divided endoscopically, toward how to divide it completely, efficiently, safely, and reproducibly, without leaving residual septum or mucosal flap that can sustain symptoms. Conventional flexible endoscopic septotomy (FES) remains an accessible, efficient, and effective option, but its limitations are recognized: incomplete myotomy, limited visualization of the distal septal margin, bleeding, perforation, and recurrence [&lt;span&gt;1&lt;/span&gt;]. Zenker's peroral endoscopic myotomy (Z-POEM) and peroral endoscopic septotomy (POES) were developed to address these shortcomings by bringing the principles of third-space endoscopy to the cricopharyngeal septum, enabling complete exposure and more precise myotomy. However, this precision comes at a cost: the need for third-space expertise and the potential for a residual redundant mucosal flap after myotomy, particularly in larger diverticula [&lt;span&gt;4, 5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Azzolini, Dell'Anna, and colleagues introduce submucosal injection-guided septotomy (SING), a hybrid technique designed to preserve the practicality of FES while incorporating principles from submucosal endoscopy [&lt;span&gt;6&lt;/span&gt;]. The procedure begins with the placement of a nasogastric tube in the esophageal lumen as an orienting landmark. The proximal two-thirds of the septum is then divided using a conventional full-thickness septotomy. In the distal third, bilateral submucosal injection delineates the cricopharyngeal muscle by creating contrast between the stained submucosa and muscle fibers. Selective myotomy is then extended through the septal muscle to the tran","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70267","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784373","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":"Objective Endoscopic Assessment for Prediction of Secondary Loss of Response of Biologics in Crohn's Disease","authors":"Kazuo Ohtsuka","doi":"10.1111/den.70249","DOIUrl":"https://doi.org/10.1111/den.70249","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784371","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}