Digestive Endoscopy最新文献

{"title":"Afferent loop syndrome following pancreatic head cancer surgery treated with metal stent placement using a short-type single-balloon enteroscope","authors":"Noriyuki Hirakawa,&nbsp;Katsuya Kitamura,&nbsp;Takao Itoi","doi":"10.1111/den.14936","DOIUrl":"10.1111/den.14936","url":null,"abstract":"<p>Afferent loop syndrome is a rare complication that occurs following reconstructive intestinal tract surgery as a result of postoperative adhesions or peritoneal dissemination due to recurrence. Obstruction of the afferent loop can be fatal, and often requires surgical treatment. However, patients who develop afferent loop syndrome due to recurrence of malignancy are often in poor general health, making surgery invasive.<span>¹</span> With the development of balloon-assisted enteroscopy, there have been reports of these patients being treated endoscopically.<span>^2-5</span></p><p>The patient was a 74-year-old woman who underwent subtotal stomach-preserving pancreaticoduodenectomy for pancreatic head cancer. She was found to have multiple liver metastases on contrast-enhanced computed tomography (CT) 3 years after surgery. While receiving chemotherapy for recurrence of pancreatic head cancer, she presented with fever and abdominal pain. Contrast-enhanced CT led to a diagnosis of afferent loop syndrome caused by peritoneal dissemination. Conservative treatment was unsuccessful (Fig. 1a). Therefore, we decided to treat the afferent loop syndrome by drainage using a short-type single-balloon enteroscope (s-SBE) with a working channel diameter of 3.2 mm (SIF-H290S; Olympus Medical, Tokyo, Japan). We advanced the s-SBE and identified the stenotic area in the afferent loop. We traversed the stenosis with a catheter and guidewire, advancing the guidewire into the dilated bowel (Fig. 1b). In view of elevated inflammatory markers, a nasobiliary drainage tube was placed in the afferent loop (Fig. 2a). When the patient's condition improved, we placed a metal stent at the stricture site using the s-SBE. The s-SBE was advanced to the site of the stricture via the nasobiliary drainage tube. A 22 mm × 15 cm duodenal metal stent with a caliber of 3.0 mm (uncovered Niti-S stent; Taewoong Medical, Seoul, South Korea) was placed in the stenotic area, and patency was confirmed with contrast medium (Fig. 2b, Video S1). There were no postprocedural complications.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"202-203"},"PeriodicalIF":5.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14936","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482276","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":"Treatment outcomes and esophageal cancer incidence by disease type in achalasia patients undergoing peroral endoscopic myotomy: Retrospective study","authors":"Akio Shiwaku,&nbsp;Hironari Shiwaku,&nbsp;Hiroki Okada,&nbsp;Hiroshi Kusaba,&nbsp;Suguru Hasegawa","doi":"10.1111/den.14928","DOIUrl":"10.1111/den.14928","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This retrospective study aimed to compare treatment outcomes and postoperative courses, including the incidence of esophageal cancer (EC), according to disease types, in 450 achalasia patients who underwent peroral endoscopic myotomy (POEM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from consecutive POEM procedures performed from September 2011 to January 2023 at a single institution were reviewed. Achalasia was classified into straight (St), sigmoid (S1), and advanced sigmoid (S2) types using esophagography findings. Regarding efficacy, POEM was considered successful if the Eckardt score was ≤3. A statistical examination of the incidence and trend of EC occurrence across the disease type of achalasia was conducted using propensity score matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 450 patients, 349 were diagnosed with St, 80 with S1, and 21 with S2. POEM efficacy was 97.9% at 1 year and 94.2% at 2 years postprocedure, with no statistical difference between disease types. Using propensity score matching, the incidence of EC in each disease type was as follows: St, 1% (1/98); S1, 2.5% (2/77); S2, 10% (2/18). While no statistical significance was observed between St (1.0%: 1/98) and all sigmoid types (4.0%, 4/95; <i>P</i> = 0.3686). However, a trend test revealed a tendency for EC to occur more frequently in the order of S2, S1, and St type with a statistically significant difference (<i>P</i> = 0.0413).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Outcomes of POEM are favorable for all disease types. After POEM, it is important not only to monitor the improvement of achalasia symptoms but also to pay attention to the occurrence of EC, especially in patients with sigmoid-type achalasia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"376-390"},"PeriodicalIF":5.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482279","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":"New milestone for clinical research about biliary drainage","authors":"Atsushi Kanno,&nbsp;Hironori Yamamoto","doi":"10.1111/den.14934","DOIUrl":"10.1111/den.14934","url":null,"abstract":"&lt;p&gt;Endoscopic bile duct stenting has been the first-line treatment for bile duct obstruction, regardless of resectability or benign/malignant status,&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt; although the criteria for evaluating the outcome of bile duct stents have not been adequately explored. For example, since the definition of stent occlusion varied across different articles, a meta-analysis of bile duct stent outcomes was summarized as stent dysfunction in terms of results. Furthermore, while stent occlusion due to tumor invasion was the main stent dysfunction in the case of inserted plastic stents or uncovered self-expandable metallic stents (SEMS), the advent of covered SEMS has made it necessary to consider stent migration or dislocation as a stent dysfunction.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; In this context, a need existed for common definitions regarding procedure-related early outcomes for stents, outcomes of stents during follow-up, and adverse events. Previous TOKYO criteria defined terms associated with the technical and clinical success of biliary stenting, recurrent biliary obstruction (RBO) and related factors, and adverse events.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Technical success was defined as the ability of the stent to adequately bypass the planned bile duct stenosis site, and clinical success was defined as a normal or 50% reduction in total bilirubin levels within 14 days of stent placement. In addition, RBO was defined as an outcome measure, including occlusion or deviation, used to assess the duration of stent function from the date of stent placement. An important aspect of RBO was that it focused on symptoms rather than stent patency alone. The time of symptom recurrence due to stent occlusion or deviation was specified as the time of onset of RBO, and this time point was to be used for assessment. The causes of obstruction of the RBO, such as internal growths associated with tumor growth, tumor growths on the edge of the stent, biliary debris or food residues, the direction of stent dislocation or migration (intrahepatic bile duct or duodenal papillary side), and whether pancreatitis or cholecystitis was present, were to be described separately. In addition, items on survival and contingencies other than RBOs have been created and described uniformly to provide an overall clinical picture from the results of clinical studies.&lt;/p&gt;&lt;p&gt;The progress of biliary drainage over the past decade has been so rapid that it has become increasingly difficult to cover it in the previous TOKYO criteria. For example, balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) for cases with altered anatomy has become widely used.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; In ERCP for patients with altered anatomy, the rate of reach to the bile duct orifice should be included in the assessment of technical success.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; Endoscopic ultrasound-biliary drainage (EUS-BD) is also widely recognized as a common procedure. It does not bypass the bil","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1211-1212"},"PeriodicalIF":5.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14934","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482278","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: Tips and Tricks for Endoscopic Ultrasound guided Celiac Plexus interventions","authors":"","doi":"10.1111/den.14935","DOIUrl":"10.1111/den.14935","url":null,"abstract":"&lt;p&gt;WEO Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES&lt;/p&gt;&lt;p&gt;&lt;b&gt;Dr. Sridhar Sundaram&lt;/b&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;MD, DM, FISG&lt;/b&gt;&lt;/p&gt;&lt;p&gt;Present Designation:&lt;/p&gt;&lt;p&gt;Professor (Gastroenterology), Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai&lt;/p&gt;&lt;p&gt;Consultant- GI Disease Management Group, Tata Memorial Hospital, Mumbai&lt;/p&gt;&lt;p&gt;Governing Council Member – Indian Society of Gastroenterology&lt;/p&gt;&lt;p&gt;Member – ESGE Diversity and Equity Working Group&lt;/p&gt;&lt;p&gt;Managing Editor – Indian Journal of Gastroenterology&lt;/p&gt;&lt;p&gt;Member – India EUS Club&lt;/p&gt;&lt;p&gt;Primary areas of interest: Therapeutic Endoscopic Ultrasound, Endoscopic Resection techniques for early GI cancer&lt;/p&gt;&lt;p&gt;Abdominal pain due to perineural invasion is one of the most debilitating symptoms associated with pancreaticobiliary cancers. In addition, pain remains one of the most complex symptoms associated with chronic pancreatitis needing intervention (&lt;span&gt;1&lt;/span&gt;). Pain from upper abdominal viscera is transmitted via the afferent pathway to the celiac plexus leading into the spinal cord at the T12-L2 level. The efferents from the celiac plexus consists mainly of sympathetic fibres of a network of interconnected para-aortic ganglia, including those at the level of the celiac axis, superior mesenteric artery origin and also renal artery. In addition, parasympathetic efferents of the celiac plexus come from the vagus nerve (&lt;span&gt;2&lt;/span&gt;). Traditionally celiac plexus block was performed as an intraoperative ablative procedure. Subsequently fluoroscopy guided celiac plexus interventions were performed. Endoscopic Ultrasound guided celiac plexus block (CPB) was first described in 1996 and has now become the standard of care (&lt;span&gt;3&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;Chronic pancreatitis patients with pain not responding to conventional measures like pancreatic enzyme replacement, antioxidants, non-narcotic and narcotic medications may be candidates who may benefit in short term from CPB. However, the caveat remains that block provides temporary relief and may be an adjunct to other modalities. Celiac plexus neurolysis (CPN) is recommended only in the setting of inoperable pancreatic cancer. In cases of operable pancreatic cancer, neurolysis may lead to scarring the operative field, thereby making surgery technically more challenging. Most patients who do not respond to conventional opioids or require significantly higher doses with adverse events are candidates to consider CPN (&lt;span&gt;4&lt;/span&gt;).&lt;/p&gt;&lt;p&gt;CPB is typically for patients with pain not responding to analgesics and can be repeated at 3–6 months intervals. As pain becomes chronic, response to CPB is likely to be lesser, considering formation of neural feedback loops with cerebral pain conditioning. In patients with pancreatic cancer, pain responds better earlier in the course of disease to CPN. As disease progresses and pain persists, the neural pathways become less responsive and efficacy of CPN reduce","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1185-1189"},"PeriodicalIF":5.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14935","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402208","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 ability and adverse events of mucosal incision-assisted biopsy for gastric subepithelial tumors: Systematic review and meta-analysis","authors":"Eriko Koizumi,&nbsp;Osamu Goto,&nbsp;Akihisa Matsuda,&nbsp;Toshiaki Otsuka,&nbsp;Yumiko Ishikawa,&nbsp;Shun Nakagome,&nbsp;Masahiro Niikawa,&nbsp;Tsugumi Habu,&nbsp;Keiichiro Yoshikata,&nbsp;Kumiko Kirita,&nbsp;Hiroto Noda,&nbsp;Kazutoshi Higuchi,&nbsp;Takeshi Onda,&nbsp;Jun Omori,&nbsp;Naohiko Akimoto,&nbsp;Hiroshi Yoshida,&nbsp;Katsuhiko Iwakiri","doi":"10.1111/den.14933","DOIUrl":"10.1111/den.14933","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This systematic review and meta-analysis aimed to evaluate the diagnostic ability and examine the efficacy of countermeasures to adverse events of mucosal incision-assisted biopsy (MIAB) for gastric subepithelial tumors (SETs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a literature search and identified 533 relevant articles. Eleven articles, including 339 lesions, were ultimately used in the meta-analysis. The primary end-point was the pathological diagnostic rate of MIAB for gastric SETs, and the secondary end-point was the incidence of adverse events. The efficacy of acid secretion inhibitors in preventing postoperative bleeding and that of local injection before incision to prevent perforation were also examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine studies were conducted in Japan and two in South Korea, of which only two were prospective studies. The pooled pathological diagnostic rate of MIAB for gastric SETs was 87.8% (95% confidence interval [CI] 80.2–94.0; <i>I</i>² = 68.7%). The adverse event rate of the pooled population was 0.2% (95% CI 0–1.4; <i>I</i>² = 0%). The acid secretion inhibitors significantly reduced postoperative bleeding (odds ratio 0.06, 95% CI 0.01–0.66, <i>P</i> = 0.02). Perforation occurred in 0% and 2.6% of the local and nonlocal injection cohorts, respectively, and the pathological diagnostic rates were 50% and 66.7%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MIAB is a reliable technique with a favorable diagnostic rate and few adverse events. Acid secretion inhibitors may effectively prevent postoperative bleeding; however, the efficacy of local injection remains unclear. This technique could be an option for tissue sampling in gastric SETs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"236-246"},"PeriodicalIF":5.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382614","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":"Is endoscopic ultrasound-guided gastroenterostomy better than surgical gastrojejunostomy or duodenal stenting?","authors":"Anthony Yuen Bun Teoh,&nbsp;Shannon Melissa Chan,&nbsp;Hon Chi Yip","doi":"10.1111/den.14929","DOIUrl":"10.1111/den.14929","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Gastrojejunostomy is a critical procedure for managing gastric outlet obstruction. While surgical gastrojejunostomy has traditionally been the standard approach, endoscopic ultrasound (EUS)-guided gastroenterostomy has emerged as a promising endoscopic alternative. This comprehensive review aims to explore the development, techniques, outcomes, and comparative effectiveness of EUS-guided gastroenterostomy in comparison to duodenal stenting and surgical gastrojejunostomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search was conducted using electronic databases to identify relevant studies published up to April 2024. The search included keywords related to EUS-guided gastrojejunostomy, surgical gastrojejunostomy, and duodenal stenting. Studies reporting on technical success, clinical success, complications, recurrence rates, quality of life, and long-term outcomes were included for analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The development of EUS-guided gastroenterostomy has evolved significantly over the years, driven by device advancements and improved endoscopic techniques. Comparative studies have shown that the technique offers several advantages, including the ability to create an anastomosis without the need for surgery, reduced invasiveness, shorter hospital stays, and potentially improved patient outcomes as compared to duodenal stenting and surgical gastrojejunostomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided gastroenterostomy represents a promising alternative to surgical gastrojejunostomy and duodenal stenting for the management of gastric outlet obstruction. The technique has evolved significantly, offering a less invasive and more effective treatment option.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"77-84"},"PeriodicalIF":5.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382615","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":"Proposal of classification and terminology of interventional endoscopic ultrasonography/endosonography","authors":"Hiroyuki Isayama,&nbsp;Yousuke Nakai,&nbsp;Koji Matsuda,&nbsp;Yoshihide Kanno,&nbsp;Kazuo Hara,&nbsp;Takeshi Ogura,&nbsp;Nobutsugu Abe,&nbsp;Akio Katanuma,&nbsp;Masayuki Kitano,&nbsp;Ichiro Yasuda,&nbsp;Naoki Okano,&nbsp;Takayoshi Tsuchiya,&nbsp;Naotaka Fujita,&nbsp;Kazuo Inui,&nbsp;Toshiharu Ueki,&nbsp;Atsushi Irisawa,&nbsp;Hiro-o Yamano,&nbsp;The Subcommittee for Terminology of Interventional EUS of Japan Gastroenterological Endoscopy Society","doi":"10.1111/den.14927","DOIUrl":"10.1111/den.14927","url":null,"abstract":"<p>Interventional endoscopic ultrasonography/endosongraphy (I-EUS) procedures have rapidly evolved since their introduction three decades ago; however, the classification and terminology for these procedures remain unstandardized. To address this, the Subcommittee for Terminology of I-EUS in the Japan Gastroenterological Endoscopy Society was established to define classifications and a glossary of I-EUS terms. They categorized I-EUS procedures into five types based on purpose and method: (i) EUS-guided sampling; (ii) EUS-guided through-the-needle examination; (iii) EUS-guided drainage/anastomosis (EUS-D/A); (iv) trans-endosonographically/EUS-guided created route (ESCR) procedures; and (v) EUS-guided delivery. EUS-guided sampling includes tissue acquisition and fluid sampling, classified by needle type into fine needle aspiration and fine needle biopsy. Through-the-needle examinations include imaging, measurements, and biopsies. EUS-D/A includes organ drainage/anastomosis, fluid collection drainage, and digestive tract anastomosis. In the EUS-D/A route, “anastomosis” is used for organ-to-organ procedures, whereas “tract” is for fluid drainage. ESCR is a newly proposed term for procedures via anastomosis or tract, such as endoscopic necrosectomy and EUS-guided antegrade stenting. The term “trans-luminal drainage/anastomosis stent” is used for stents that maintain the ESCR rather than treating strictures. EUS-guided delivery involves the delivery of substances, such as fluids, drugs, medical devices, and energy. This proposed categorization and terminology aimed to clarify I-EUS procedures and will require updates as new techniques and concepts emerge.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"5-17"},"PeriodicalIF":5.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14927","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373690","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":"Current status and future perspectives for endoscopic treatment of local complications in chronic pancreatitis","authors":"Ken Ito,&nbsp;Kensuke Takuma,&nbsp;Naoki Okano,&nbsp;Yuto Yamada,&nbsp;Michihiro Saito,&nbsp;Manabu Watanabe,&nbsp;Yoshinori Igarashi,&nbsp;Takahisa Matsuda","doi":"10.1111/den.14926","DOIUrl":"10.1111/den.14926","url":null,"abstract":"<p>Chronic pancreatitis is a progressive disease characterized by irregular fibrosis, cellular infiltration, and parenchymal loss within the pancreas. Chronic pancreatitis treatment includes lifestyle modifications based on disease etiology, dietary adjustments appropriate for each stage and condition, drug therapy, endoscopic treatments, and surgical treatments. Although surgical treatments of symptomatic chronic pancreatitis provide good pain relief, endoscopic therapies are recommended as the first-line treatment because they are minimally invasive. In recent years, endoscopic therapy has emerged as an alternative treatment method to surgery for managing local complications in patients with chronic pancreatitis. For pancreatic stone removal, a combination of extracorporeal shock wave lithotripsy and endoscopic extraction is used. For refractory pancreatic duct stones, intracorporeal fragmentation techniques, such as pancreatoscopy-guided electrohydraulic lithotripsy and laser lithotripsy, offer additional options. Interventional endoscopic ultrasound has become the primary treatment modality for pancreatic pseudocysts, except in the absence of disconnected pancreatic duct syndrome. This review focuses on the current status of endoscopic therapies for common local complications of chronic pancreatitis, including updated information in the past few years.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"219-235"},"PeriodicalIF":5.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14926","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373679","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":"Snare-assisted clipping method for closure of mucosal incision of gastric peroral endoscopic myotomy","authors":"Niroshan Muwanwella","doi":"10.1111/den.14930","DOIUrl":"10.1111/den.14930","url":null,"abstract":"<p>Gastric peroral endoscopic myotomy (G-POEM) is an emerging treatment modality for gastroparesis. This technique involves mucosal incision, submucosal tunneling, and pyloric myotomy followed by closure of the mucosal incision.</p><p>There are multiple closure methods described in the literature, including through-the-scope (TTS) clips,<span>¹</span> over-the-scope clips, and endoscopic suturing.<span>²</span> TTS clips are the easiest and most economical of the above methods. However, mucosal closure after G-POEM with TTS clips can by difficult due to the thicker gastric mucosa and widening of the mucosal entry site, resulting in difficulty of apposition of mucosal edges.</p><p>Clip and snare traction is well described in the literature to assist endoscopic submucosal dissection.<span>³</span> An internal traction method has been previously described for full-thickness mucosal defect closure.<span>⁴</span></p><p>I describe an adaptation of the above methods to assist clip deployment for mucosal closure.</p><p>Once the myotomy is complete, the scope is withdrawn and a snare is attached to the end of the scope by closing the snare over the distal attachment cap. Then the scope is reinserted and a TTS clip is closed just distal to the distal edge of the mucosal incision. Prior to full deployment of the clip, the snare is opened to disengage from the scope and closed over the stem of the clip.</p><p>The snare is then used to apply gentle traction to pull the mucosa upwards, creating a mucosal “tent.” The next clip is then deployed, closing the mucosal edges together. Another clip is then introduced through the channel and is used to transfer the snare to the stem of the last deployed clip. This process is repeated until the mucosal incision is completely closed. In this case, the final clip is deployed without the assistance of the snare.</p><p>This case illustrates a novel method of gastric mucosal incision closure using inexpensive, widely available devices.</p><p>Author declares no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Review Board: N/A.</p><p>Informed consent: Informed consent was obtained from the patient to publish deidentified endoscopic images and videos.</p><p>Registry and the registration no. of the study/trial: N/A.</p><p>Animal studies: N/A.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1388"},"PeriodicalIF":5.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14930","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333703","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":"Comorbidity burden and outcomes of endoscopic ultrasound-guided treatment of pancreatic fluid collections: Multicenter study with nationwide data-based validation","authors":"Tsuyoshi Hamada,&nbsp;Atsuhiro Masuda,&nbsp;Nobuaki Michihata,&nbsp;Tomotaka Saito,&nbsp;Masahiro Tsujimae,&nbsp;Mamoru Takenaka,&nbsp;Shunsuke Omoto,&nbsp;Takuji Iwashita,&nbsp;Shinya Uemura,&nbsp;Shogo Ota,&nbsp;Hideyuki Shiomi,&nbsp;Toshio Fujisawa,&nbsp;Sho Takahashi,&nbsp;Saburo Matsubara,&nbsp;Kentaro Suda,&nbsp;Hiroki Matsui,&nbsp;Akinori Maruta,&nbsp;Kensaku Yoshida,&nbsp;Keisuke Iwata,&nbsp;Mitsuru Okuno,&nbsp;Nobuhiko Hayashi,&nbsp;Tsuyoshi Mukai,&nbsp;Kiyohide Fushimi,&nbsp;Ichiro Yasuda,&nbsp;Hiroyuki Isayama,&nbsp;Hideo Yasunaga,&nbsp;Yousuke Nakai,&nbsp;the WONDERFUL study group in Japan and collaborators","doi":"10.1111/den.14924","DOIUrl":"10.1111/den.14924","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The appropriate holistic management is mandatory for successful endoscopic ultrasound (EUS)-guided treatment of pancreatic fluid collections (PFCs). However, comorbidity status has not been fully examined in relation to clinical outcomes of this treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a multi-institutional cohort of 406 patients receiving EUS-guided treatment of PFCs in 2010–2020, we examined the associations of Charlson Comorbidity Index (CCI) with in-hospital mortality and other clinical outcomes. Multivariable logistic regression analysis was conducted with adjustment for potential confounders. The findings were validated using a Japanese nationwide inpatient database including 4053 patients treated at 486 hospitals in 2010–2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the clinical multi-institutional cohort, CCI was positively associated with the risk of in-hospital mortality (<i>P</i>_trend &lt; 0.001). Compared to patients with CCI = 0, patients with CCI of 1–2, 3–5, and ≥6 had adjusted odds ratios (95% confidence intervals) of 0.76 (0.22–2.54), 5.39 (1.74–16.7), and 8.77 (2.36–32.6), respectively. In the nationwide validation cohort, a similar positive association was observed; the corresponding odds ratios (95% confidence interval) were 1.21 (0.90–1.64), 1.52 (0.92–2.49), and 4.84 (2.63–8.88), respectively (<i>P</i>_trend &lt; 0.001). The association of higher CCI with longer length of stay was observed in the nationwide cohort (<i>P</i>_trend &lt; 0.001), but not in the clinical cohort (<i>P</i>_trend = 0.18). CCI was not associated with the risk of procedure-related adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher levels of CCI were associated with a higher risk of in-hospital mortality among patients receiving EUS-guided treatment of PFCs, suggesting the potential of CCI in stratifying the periprocedural mortality risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial registration</h3>\u0000 \u0000 <p>The research based on the clinical data from the WONDERFUL cohort was registered with UMIN-CTR (registration number UMIN000044130).</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"413-425"},"PeriodicalIF":5.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14924","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333701","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}