Digestive Endoscopy最新文献

{"title":"Usefulness of detective flow imaging endoscopic ultrasound for pancreatic neuroendocrine tumors difficult to detect with other imaging modalities","authors":"Takaoki Hayakawa,&nbsp;Eisuke Iwasaki,&nbsp;Takanori Kanai","doi":"10.1111/den.14979","DOIUrl":"10.1111/den.14979","url":null,"abstract":"<p>Recently, detective flow imaging endoscopic ultrasound (DFI-EUS), which can visualize microvascular blood flow, has been developed and integrated into an ultrasound observation system (ARIETTA 850; Fujifilm Healthcare, Tokyo, Japan). DFI-EUS is characterized by its ease of application in routine observations, offering the advantage of minimal patient discomfort and eliminating the need for drug administration, unlike contrast-enhanced EUS. However, the usefulness of DFI-EUS for pancreatic neuroendocrine tumor (pNET) has rarely been reported.</p><p>A 43-year-old woman with a history of hypoglycemic attacks visited our hospital. Dynamic computed tomography (CT) and magnetic resonance imaging (MRI), performed for further investigation, showed no abnormalities (Fig. 1a). However, based on the results of a glucose load test and selective arterial calcium injection test, an insulinoma located in the tail of the pancreas was suspected. EUS was conducted to identify the tumor's location and determine the extent of resection for surgery. The tumor could not be detected by B-mode or conventional color Doppler EUS (eFlow-EUS) (Fig. 1b), but only DFI-EUS could visualize the tumor location by depicting blood vessels wrapping around the tumor from the periphery, allowing visualization of a small 8.9 mm tumor in the tail of the pancreas (Fig. 2). Surgery was performed later, and the diagnosis of insulinoma was confirmed (Video S1).</p><p>Although there has been a previous report of a pNET case observed using both B-mode EUS and DFI-EUS,<span>¹</span> this is the first reported case in which the tumor was detectable only with DFI-EUS. It has been reported that pNETs are characterized by their hypervascularity,<span>^{2, 3}</span> and by visualizing this feature with DFI-EUS, we were able to identify its location. When a pNET is clinically suspected but not detectable by other imaging modalities, DFI-EUS may be valuable for detecting the tumor.</p><p>Author E.I. serves as an Editor of <i>Digestive</i> <i>Endoscopy</i>. The other author declares no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"553-554"},"PeriodicalIF":5.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14979","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808746","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 treatment for pancreatic fluid collections: Is active intervention always the optimal option?","authors":"Masaki Kuwatani","doi":"10.1111/den.14969","DOIUrl":"10.1111/den.14969","url":null,"abstract":"&lt;p&gt;Good patient vitality and activity levels at the first visit positively affect clinical decision-making, particularly in the selection of diagnostic work-ups and treatments across various medical fields. Several indicators of patient vitality, such as frailty (measured by the “Frailty Risk Score”),&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; sarcopenia (assessed using the psoas muscle mass index/area/density), and comorbidity index,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; have been reported in recent literature and are closely associated with disease prognosis. Gilbert &lt;i&gt;et al&lt;/i&gt;. reported that among 202,718 patients, those with the highest Hospital Frailty Risk Scores had significantly increased odds of 30-day mortality (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.68–1.75), prolonged hospital stays (OR 6.03, 95% CI 5.92–6.10), and 30-day readmissions (OR 1.48, 95% CI 1.46–1.50) in older patients in acute care settings.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Furthermore, Farooq &lt;i&gt;et al&lt;/i&gt;. found that frailty in adult patients with acute pancreatitis was associated with higher rates of local complications, such as pseudocyst and walled-off necrosis, and systemic complications including acute respiratory distress syndrome and sepsis, based on a large national database of the United States.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; It is widely acknowledged that frailty and comorbidity are interrelated in the progression of many diseases. For instance, during the COVID-19 pandemic, all measures of frailty and comorbidity were associated with higher COVID-19 mortality risk, even after adjusting for age and sex, according to data from the UK Biobank, which included 2812 COVID-19 inpatients.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Furthermore, in an emergency department study of two Dutch hospitals, older adults with polypharmacy resulting from comorbidities and frailty had an increased risk of mortality (OR 2.62 and 3.92, 95% CI 1.39–4.93 and 1.95–7.90 for excessive polypharmacy).&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; This association is not surprising, as scoring systems for both frailty and comorbidity often include overlapping factors such as cognitive function and mobility.&lt;span&gt;&lt;sup&gt;1, 2, 5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Pancreatic fluid collections (PFCs), such as pseudocysts, walled-off necrosis, or postoperative pancreatic fistulas, can develop after acute pancreatitis or pancreatic resection. In some cases, these complications are refractory and potentially fatal despite multidisciplinary approaches. The treatment strategy for PFCs depends on the patient's condition, which is often influenced by the severity and number of comorbidities, as well as the characteristics of the PFC itself. To date, no studies have investigated the impact of comorbidity accumulation on the clinical outcomes of minimally invasive endoscopic ultrasound (EUS)-guided treatments for PFCs. However, Hamada &lt;i&gt;et al&lt;/i&gt;. demonstrated that the Charlson Comorbidity Index (CCI), a measure of comorbidity burden, was significantly associated with in-hospital morta","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"426-427"},"PeriodicalIF":5.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14969","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808744","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 issues for prediction and prevention of postendoscopic retrograde cholangiopancreatography pancreatitis","authors":"Hironari Kato,&nbsp;Takeshi Tomoda,&nbsp;Akihiro Matsumi,&nbsp;Kazuyuki Matsumoto","doi":"10.1111/den.14966","DOIUrl":"10.1111/den.14966","url":null,"abstract":"<p>Acute pancreatitis, which sometimes results in mortality, is a significant complication of endoscopic retrograde cholangiopancreatography (ERCP). Many studies have been conducted to predict and prevent post-ERCP pancreatitis (PEP), and meta-analyses have been reported that summarized these studies. However, many issues remain unresolved. Many risk factors for PEP have been reported, and it is rare for patients undergoing ERCP to have only one risk factor. The use of artificial intelligence may be important for analyzing complex and diverse risk factors. It is desirable to develop an alternative test for pancreatic enzymes that can predict the onset of PEP within 1 h after ERCP. The effectiveness of low-dose nonsteroidal anti-inflammatory drugs (NSAIDs) are controversial. Nitrate and tacrolimus are considered medications that have additional effects on NSAIDs and may be used for the prevention of PEP. Pancreatic stent placement with deliberate placement of the guidewire into the pancreatic duct may be more effective in preventing PEP. A comparison between transpancreatic sphincterotomy with deliberate guidewire placement into the pancreatic duct and needle-knife precut sphincterotomy is necessary. Early precutting is thought to be effective for the prevention of PEP, and the effectiveness of primary precut has been reported. However, the optimal timing of precut for the prevention of PEP has not been sufficiently discussed. Further research on prediction and prevention must be conducted to eliminate the mortality caused by PEP.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"362-372"},"PeriodicalIF":5.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14966","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781941","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":"Utilizing a novel highly rotatable and dual-action sphincterotome for precise cannulation and endoscopic sphincterotomy in surgically altered anatomy","authors":"Haruka Toyonaga,&nbsp;Takuya Takayama,&nbsp;Masaaki Shimatani","doi":"10.1111/den.14970","DOIUrl":"10.1111/den.14970","url":null,"abstract":"<p>Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) has become increasingly common in the management of pancreatobiliary diseases in patients with surgically altered anatomy.<span>^{1, 2}</span> In cases of Billroth II or Roux-en-Y reconstruction where the duodenal papilla is preserved, papillary interventions are essential for both diagnostic evaluations or treatments. However, performing precise cannulation and endoscopic sphincterotomy (EST) during BE-ERCP can be challenging.<span>³</span> One reason for this difficulty is that the endoscope's angulation required for directly facing the papilla often causes the sphincterotome's tip and blade to orient away from the desired direction, typically opposite of the oral protrusion (Fig. 1a,b). While various sphincterotomes have been reported to be useful,<span>^{4, 5}</span> the optimal device and technique remain unclear. Recently, a novel highly rotatable and dual-action sphincterotome (ENGETSU; KANEKA Medix Co., Osaka, Japan) has become available, offering the potential to change the incision direction freely to switch between push and pull modes with rotation, thereby enabling precise cannulation and EST (Fig. 1c,d; Video S1).</p><p>A 68-year-old man with a history of total gastrectomy followed by Roux-en-Y reconstruction presented with choledocholithiasis. BE-ERCP with short-type double balloon enteroscope (EI-580BT; Fujifilm Co., Tokyo, Japan) was performed to access the papilla. Upon inserting the sphincterotome, the curvature of the endoscope tip caused the blade to be directed opposite the side of the oral protrusion. By utilizing the rotational capability and alternating between push and pull modes, the catheter tip was successfully cannulated and the blade was directed towards the oral protrusion, allowing for precise incision (Fig. 2). Endoscopic papillary large-balloon dilatation was added after EST and the stones were successfully removed without adverse events. The novel sphincterotome enabled efficient cannulation and EST, demonstrating the device's utility not only in cases with normal anatomy using side-viewing duodenoscopes, but also in surgically altered anatomy with balloon-assisted endoscopy.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"440-442"},"PeriodicalIF":5.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14970","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781896","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 gastrojejunostomy: Novel double catheter technique with video","authors":"Pankaj Gupta,&nbsp;Vikas Singla,&nbsp;Pankaj Singh","doi":"10.1111/den.14973","DOIUrl":"10.1111/den.14973","url":null,"abstract":"<p>Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) can provide durable treatment for gastric outlet obstruction.<span>¹</span> Technical challenges have limited widespread adoption of the procedure.<span>²</span> Various techniques such as nasojejunal tube or dedicated balloon-assisted technique have been explained in the literature.<span>³</span> The commonly used technique of nasojejunal catheter-assisted GJ has the limitation of difficulty in correct identification of the desired loop. Multiple small bowel and even colonic loop may get distended with infusion of fluid, and may lead to erroneous puncture of the distal small bowel or colonic loop. We attempted to overcome this difficulty by placing two catheters simultaneously in the jejunum. One catheter placed near the duodenojejunal (DJ) flexure is used to infuse saline for jejunal loop distension and another catheter placed distally acts as a guide to identify the correct proximal jejunal loop. A 64-year-old man with advanced gastric cancer-causing pyloric obstruction underwent EUS-GJ (Video S1). The procedure was performed under general anesthesia with endotracheal intubation in the supine position. Gastroscope (HQ 190; Olympus, Tokyo, Japan) could be negotiated across the pyloric growth and guidewire (Visiglide, G-240-2544S; Olympus) was placed in the jejunum and a catheter (nasobiliary drain, 7F; Devon, Bangalore, India) was placed with the tip at ~50 cm from the DJ flexure. Another guidewire was passed and the catheter was placed with the tip near the DJ flexure, under fluoroscopic guidance (Fig. 1). Linear echoendoscope (GF UCT 180, ME-2 premium plus processer; Olympus) was introduced. Glucagon injection was used for bowel relaxation and a methylene blue-stained normal saline was infused through the proximal catheter and jejunal loop where the distal catheter was identified. A lumen-apposing metal stent (Hot AXIOS Stent and Delivery System, 20 mm ×10 mm; Boston Scientific, Marlborough, MA, USA) was deployed with the freehand puncture technique (Fig. 2). Immediate release of methylene blue-stained fluid through the deployed stent was identified, confirming the position of stent in the bowel lumen. The present technique may overcome the difficulty in identification of the correct bowel loop during EUS-guided gastrojejunostomy.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"548-549"},"PeriodicalIF":5.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788023","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":"Usefulness of a novel 11F digital single-operator cholangioscopy through a colonoscope in a patient with surgically altered anatomy","authors":"Takafumi Mie,&nbsp;Tsuyoshi Takeda,&nbsp;Takashi Sasaki","doi":"10.1111/den.14968","DOIUrl":"10.1111/den.14968","url":null,"abstract":"<p>Digital single-operator cholangioscopy (DSOC) is useful for evaluating biliary tract malignancies.<span>¹</span> However, DSOC is challenging in patients with surgically altered anatomy (SAA) due to the small channel diameter of the enteroscope. While DSOC insertion through the overtube is useful,<span>^{2, 3}</span> scope manipulation is challenging. Only small biopsy forceps are available with conventional DSOC, resulting in an insufficient specimen. Recently, a novel 11F DSOC (eyeMAX; Micro-Tech, Nanjing, China; working channel, 1.8 mm; working length, 2190 mm)<span>⁴</span> was developed, allowing use of larger biopsy forceps than conventional DSOC.</p><p>A 65-year-old man, who had undergone extended right hepatectomy for cystadenocarcinoma of the liver and distal gastrectomy with B-II reconstruction for gastric cancer, presented to our hospital for a tumor located at the hepatic hilum. In the initial session, we inserted an endoscopic nasobiliary drainage tube after endoscopic papillary large balloon dilation (REN [13–15 mm]; Kaneka, Osaka, Japan) (Fig. 1). Postendoscopic retrograde cholangiopancreatography pancreatitis and bleeding from the tumor occurred, which were managed conservatively. In the next session, we inserted an 11F eyeMax into the bile duct over a 0.025 inch guidewire (VisiGlide2; Olympus, Tokyo, Japan) through a colonoscope (EC-760R-V/M; working length, 1330 mm; channel diameter, 3.8 mm; Fujifilm, Tokyo, Japan). A tumor with ulceration was visualized at the hepatic hilum with no evidence of tumor extending to B4 bifurcation or lower bile duct. Mapping biopsy (Radial Jaw 4P; cup diameter, 1.8 mm; Boston Scientific, MA, USA) revealed adenocarcinoma at the hepatic hilum and no malignancy at the B4 bifurcation or lower bile duct (Fig. 2). Although the recommended channel diameter of the 11F eyeMax is 4.2 mm, it can be inserted through a colonoscope with a 3.8 mm channel. Insertion of the 11F eyeMax is difficult when the colonoscope is bent, requiring straightening of the colonoscope. This method allows stable DSOC manipulation and sufficient tissue sample collection in patients with SAA.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"438-439"},"PeriodicalIF":5.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14968","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781946","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":"Efficacy of endoscopic radiofrequency ablation for proton pump inhibitor-dependent gastroesophageal reflux disease: Multicenter prospective cohort study","authors":"Yuanxi Jiang,&nbsp;Zhiyu Dong,&nbsp;Ying Chen,&nbsp;Huihui Sun,&nbsp;Junwen Wang,&nbsp;Zhenxiang Wang,&nbsp;Qianqian Meng,&nbsp;Han Lin,&nbsp;Qingwei Zhang,&nbsp;Shengliang Chen,&nbsp;Zhizheng Ge,&nbsp;Luowei Wang,&nbsp;Shuchang Xu","doi":"10.1111/den.14963","DOIUrl":"10.1111/den.14963","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the effects of endoscopic radiofrequency ablation (RFA) on proton pump inhibitor (PPI)-dependent gastroesophageal reflux disease (GERD) in a Chinese population, and to explore the factors associated with favorable efficacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multicenter, single-armed prospective cohort study was conducted. PPI-dependent GERD patients were enrolled and underwent RFA. The primary outcome was improvement of GERD health-related quality of life (GERD-HRQL). Secondary outcomes were symptom improvement, satisfaction, PPI use, and the indicators of 24-h pH-impedance monitoring. A nomogram to predict complete remission was constructed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 66 patients were included. The GERD-HRQL score was significantly reduced at the 3 month (mean difference, 14.7 [12.6–16.9]), 6 month (mean difference, 15.9 [13.8–18.1]), 12 month (mean difference, 16.7 [14.4–18.9]), 24 month (mean difference, 18.4 [16.2–20.1]), 36 month (mean difference, 18.2 [16.3–20.4]), and 48 month follow-up (mean difference, 16.1 [14.2–18.3]), all <i>P</i> &lt; 0.001. The esophageal and extra-esophageal symptom scores were all significantly decreased. The proportion of satisfaction and no PPI use were significantly higher. With regard to the indicators of 24-h pH-impedance monitoring, acid exposure time (AET), and DeMeester score, but not lower esophageal sphincter (LES) pressure, decreased significantly at the 12 month follow-up. A nomogram based on age, body mass index (BMI), baseline AET, and LES pressure was then constructed and showed good discrimination in the prediction of complete remission following RFA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrated that RFA improved life quality as well as symptoms in PPI-dependent GERD patients in a Chinese population. Younger age, higher BMI, lower baseline AET, and higher baseline LES pressure indicate favorable efficacy of RFA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"501-511"},"PeriodicalIF":5.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14963","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781945","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":"Digital single-operator cholangioscopy-guided endoluminal radiofrequency of an intraductal papillary mucinous neoplasia of the bile duct","authors":"Xin Deng,&nbsp;Tong Mou,&nbsp;Qiao Wu","doi":"10.1111/den.14962","DOIUrl":"10.1111/den.14962","url":null,"abstract":"<p>A 77-year-old man with recurrent episodes of abdominal pain was diagnosed with a difficult common bile stone by computed tomography (Fig. 1A). Endoscopic retrograde cholangiopancreatography and digital single-operator cholangioscopy (DSOC) with electrohydraulic lithotripsy cleared the bile duct stones and a small number of papillary neoplasms located at the hilar bile ducts were found incidentally (Fig. 1D). Tissues were collected under direct visualization with biopsy forceps and pathological examination revealed intraductal papillary mucinous neoplasia of the bile duct (IPNB). A novel radiofrequency operation electrode was inserted into the bile duct through DSOC (Fig. 1B). DSOC-guided endoluminal radiofrequency ablation (RFA) was used to destroy the lesions under direct vision (Fig. 1C; Video S1). After RFA, these neoplasms became necrotic (Fig. 1E) and pathological examination revealed charring of the tissues after RFA. No adverse events occurred. Finally, the patient has remained in good health and we plan to continue long-term follow-up.</p><p>IPNB is a relatively rare tumor derived from the biliary epithelium and is known as one of the premalignant lesions in the biliary duct.<span>¹</span> Previous studies have reported endoscopic RFA was one of the local treatment options.<span>^{2, 3}</span> However, traditional RFA is guided by fluoroscopic images and cannot destroy the lesions precisely. To our knowledge, this is the first report that a DSOC-guided endoluminal radiofrequency catheter was used to ablate IPNB. This novel technique could be an accurate and microinvasive treatment method for selected patients with bile duct-related disorders.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"436-437"},"PeriodicalIF":5.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14962","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741585","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 Pressure Study Integrated System: Promising tool for evaluating the esophagogastric junction, but why not use it in the stomach as well?","authors":"Antoine Debourdeau,&nbsp;Jean-Michel Gonzalez,&nbsp;Veronique Vitton","doi":"10.1111/den.14964","DOIUrl":"10.1111/den.14964","url":null,"abstract":"<p>We extend our sincere congratulations to Dr. Nishikawa and his team for their pioneering work on the Endoscopic Pressure Study Integrated System (EPSIS) for the diagnosis of achalasia and gastroesophageal reflux disease.<span>¹</span> This innovative approach holds great promise for advancing our understanding and diagnostic capabilities in esophageal motility disorders.</p><p>Although the authors focused on the esophagogastric junction, we believe EPSIS has broader applications. It could be highly beneficial for studying functional dyspepsia and gastroparesis. The EPSIS device measures gastric pressure, making it a promising tool for assessing gastric body compliance during routine endoscopy.</p><p>Gastric compliance disorders are a significant pathophysiological aspect of functional dyspepsia. Studies have shown reduced gastric compliance in functional dyspepsia, with barostats indicating a rapid increase in gastric pressure with lower balloon volumes. However, measuring this with a gastric barostat is challenging due to the device's limited availability and poor patient tolerance.<span>²</span></p><p>Interestingly, there is a continuum between functional dyspepsia and gastroparesis, with overlapping profiles in 40% of cases.<span>³</span> Although gastric peroral endoscopic myotomy (G-POEM) effectively treats gastroparesis, about 45% of patients face long-term failure, with unclear underlying causes.</p><p>Our recent research indicates that gastric distensibility is significantly reduced in nonresponders to G-POEM, as evidenced by gastric volumetry.<span>⁴</span> Additionally, gastric emptying scintigraphy meal repartition analysis shows poor utilization of the gastric body and fundus as meal storage areas in nonresponders to G-POEM, which may be related to poor relaxation of the gastric body and fundus.<span>⁵</span></p><p>We believe EPSIS, as described in this study,<span>¹</span> could be useful in confirming these indicators in the pretherapeutic assessment of gastroparetic patients. This could help to determine if impaired gastric accommodation predicts G-POEM failure. We look forward to further developments in this field and how EPSIS can be integrated into broader clinical practice.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"199"},"PeriodicalIF":5.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14964","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741586","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 fully versus partially covered metal stents in endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction (with video)","authors":"Sung Hyun Cho,&nbsp;Seong Je Kim,&nbsp;Tae Jun Song,&nbsp;Dongwook Oh,&nbsp;Dong-Wan Seo","doi":"10.1111/den.14952","DOIUrl":"10.1111/den.14952","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using a fully covered metal stent (FCMS) or partially covered metal stent (PCMS) is performed to manage unresectable malignant biliary obstruction (MBO) following unsuccessful endoscopic retrograde cholangiopancreatography. This study aimed to compare FCMS and PCMS for EUS-HGS in patients with MBO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed the EUS database to analyze consecutive patients with MBO who underwent EUS-HGS between November 2017 and March 2023. We performed a 1:1 matching using propensity score matching based on potential confounding factors. Stent patency, technical success, clinical success, adverse events, reintervention, and overall survival were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The technical success rate of EUS-HGS was 92% (123/134). A total of 80 patients with technical success (40 FCMS, 40 PCMS) were selected after propensity score matching. The two groups showed similar rates of clinical success (90% vs. 88%; <i>P</i> = 0.999), early adverse events (15% vs. 20%; <i>P</i> = 0.556), late adverse events (18% vs. 33%; <i>P</i> = 0.121), reintervention (20% vs. 38%; <i>P</i> = 0.084), and median overall survival (4.1 months [95% confidence interval (CI) 2.6–5.5] vs. 3.8 months [95% CI 1.9–5.7]; <i>P</i> = 0.609). During follow-up, the FCMS group showed higher patency rates (85% vs. 60% at 6 months; 76% vs. 43% at 12 months; <i>P</i> = 0.030).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>FCMS and PCMS for EUS-HGS in patients with unresectable MBO showed similar rates of clinical success, as well as early and late adverse events. However, the FCMS group showed a higher cumulative stent patency rate compared to the PCMS group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"532-540"},"PeriodicalIF":5.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14952","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741492","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}