Digestive Endoscopy最新文献

{"title":"Advancements in endoscopic therapy for colonic diverticular bleeding and tips from public health viewpoints","authors":"Naoki Ishii, Noriatsu Imamura","doi":"10.1111/den.14883","DOIUrl":"10.1111/den.14883","url":null,"abstract":"<p>Kobayashi <i>et al</i>. conducted a retrospective evaluation of the effectiveness and adverse events associated with endoscopic detachable snare ligation (EDSL) for colonic diverticular bleeding (CDB) and identified risk factors for recurrent bleeding following EDSL.<span><sup>1</sup></span> Rebleeding events were analyzed as time-to-event data and compared between the complete and incomplete ligation groups.<span><sup>1</sup></span> The study discusses advancements in endoscopic therapies for CDB.</p><p>Endoscopic therapy has emerged as a widely employed approach in treating CDB, as highlighted by Jensen <i>et al</i>.<span><sup>2</sup></span> Among 17 CDB cases exhibiting stigmata of recent hemorrhage (SRH) such as active bleeding, nonbleeding visible vessels, and adherent clots treated with medical intervention, nine experienced additional bleeding postcolonoscopy and six required hemicolectomy. Conversely, of the 10 CDB patients with SRH treated endoscopically using epinephrine injection and bipolar coagulation, none experienced recurrent bleeding or required surgery. Endoscopic therapies demonstrated superiority over medical treatments in preventing recurrent bleeding and consequent colectomy in a historical cohort.<span><sup>2</sup></span> Hence, SRH management in CDB warrants an endoscopic approach.</p><p>However, due to the absence of muscular layers in most colonic diverticula and the presence of approximately half of the bleeding vessels at the diverticular dome in CDB,<span><sup>3</sup></span> coagulation therapy poses a risk of perforation when applied to diverticular vessels. Clipping presents immediate mechanical hemostasis and theoretically inflicts lesser damage to colonic tissues compared to coagulation therapy, rendering it the preferred initial endoscopic therapy. Nonetheless, deploying hemoclips on vessels at the dome and treating CDB cases with a small orifice pose challenges. Hence, indirect clipping in a zipper fashion is selected for such cases. However, this technique may not adequately occlude the underlying artery, particularly in the ascending location.<span><sup>4</sup></span> Thus, more effective endoscopic treatments are imperative for managing CDB.</p><p>Endoscopic band ligation (EBL) was pioneered by Witte in 2000.<span><sup>5</sup></span> However, the O-band is involved in deeper portions of the colonic wall, which could lead to perforation. Akimaru <i>et al</i>. applied band ligation to the colon of pigs.<span><sup>6</sup></span> Perforation did not occur for 2 weeks after ligation, and histopathological examination revealed interruption of the mucosal layer and replacement of the muscularis propria with granulation tissue at the ligated sites. Complications such as perforation or penetration did not occur in a case series of EBL, which was considered safe for the management of CDB.<span><sup>7</sup></span> EBL can achieve successful immediate hemostasis, even at the dome location or for massive bleeding in th","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1367-1368"},"PeriodicalIF":5.0,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14883","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790192","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":"Reinsertion of a removed self-expandable metal stent through an endosonographically created route after hepaticojejunostomy for multiple cholangioscopy-guided procedures","authors":"Saburo Matsubara,&nbsp;Kentaro Suda,&nbsp;Sumiko Nagoshi","doi":"10.1111/den.14899","DOIUrl":"10.1111/den.14899","url":null,"abstract":"<p>In recent years, antegrade treatment via an endosonographically created route (ESCR) for choledocholithiasis in patients with surgically altered anatomy (SAA) has emerged.<span>^{1, 2}</span> A self-expandable metal stent (SEMS) can form thicker ESCR to facilitate cholangioscopy-guided electrohydraulic lithotripsy (EHL).<span>³</span> If repeat EHL is required, another SEMS should be placed to maintain ESCR, but at a cost. Herein, we present a method for reinserting a removed SEMS.</p><p>A 76-year-old man with a history of total gastrectomy was admitted for obstructive jaundice due to large common bile duct stones (Fig. 1a). First, endoscopic ultrasound-guided hepaticojejunostomy (EUS-HJS) was performed, using an 8 mm partially covered SEMS (Spring Stopper; Taewoong Medical, Seoul, Korea) (Fig. 1b) to prevent focal cholangitis. One week later, the stent was removed through the channel without resistance, suggesting an absence of tissue hyperplasia in the uncovered area due to the short indwelling time. Then a SpyGlass DS II (Boston Scientific, Natick, MA, USA) was inserted through the ESCR and EHL was performed. Since the stones could not be sufficiently crushed after 1 h, we decided to reinsert the stent for the next session. After attaching a looped nylon thread to the tip of the stent (Fig. 2a), a guidewire indwelling in the ESCR was inserted through the tip of the stent. A wire-guided forceps (Histoguide; STERIS, Mentor, OH, USA) (Fig. 2b) was inserted over the guidewire from the end of the stent to grasp the loop (Fig. 2c). The stent was then inserted into the channel with the lid removed, while being stretched and twisted together with the forceps. Following insertion of the stent into the bile duct, the guidewire and forceps were removed (Video S1). The stones were completely removed during the next cholangioscopy-guided EHL.</p><p>Reuse of a single SEMS with this method for multiple cholangioscopy-guided procedures via an ESCR would be cost beneficial.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1183-1184"},"PeriodicalIF":5.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14899","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763074","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 gallbladder drainage for jaundice: Response to Vanella et al.","authors":"Antoine Debourdeau,&nbsp;Diane Lorenzo","doi":"10.1111/den.14886","DOIUrl":"10.1111/den.14886","url":null,"abstract":"<p>We appreciate Vanella <i>et al</i>.'s insightful letter regarding our GALLBLADEUS study.<span>¹</span> They correctly noted that endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) may have appeared as a third-line option. Due to our retrospective data, we lack specific details, but in our center, EUS-GBD is often preferred over endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) after failed endoscopic retrograde cholangiopancreatography, with many patients receiving EUS-GBD as a second-line treatment.</p><p>We fully agree with Vanella's remark that the presence of duodenal stenosis makes the use of EUS-CDS inappropriate. However, the patients included in this study were treated at a time when this information had not yet been published, particularly by the CABRIOLET trial<span>²</span> conducted by our correspondents. The proportion of patients with duodenal stenosis was significant but comparable in both groups (48.7% EUS-CDS vs. 41.5% EUS-GBD). However, despite this, our study still showed that dysfunctions seemed less frequent in the EUS-GBD group.</p><p>Emerging evidence suggests hepaticogastrostomy as a better route for duodenal stenosis,<span>^{2, 3}</span> although it has a longer learning curve compared to EUS-GBD, which is simpler for less-experienced centers. Our study suggests fewer dysfunctions with EUS-GBD vs. EUS-CDS in this context, a finding that needs confirmation from future prospective, comparative studies as suggested by Vanella <i>et al</i>. We agree that biliary drainage far from the tumor warrants comparing EUS-GBD to hepaticogastrostomy. The significant proportion of duodenal stenosis in our study favors EUS-GBD, suggesting fewer dysfunctions, although this needs confirmation by future studies. This question is of interest because EUS-GBD is simpler for less-experienced centers and could be more widely adopted than hepaticogastrostomy. Future prospective studies comparing EUS-CDS, EUS-GBD, and hepaticogastrostomy across various clinical scenarios are essential. We thank Vanella <i>et al</i>. for their valuable input and look forward to further dialogue and research in this evolving field.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"131"},"PeriodicalIF":5.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763073","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 transpapillary drainage through the pancreatic stump for postoperative pancreatic fistula after distal pancreatectomy","authors":"Takafumi Mie,&nbsp;Takashi Sasaki,&nbsp;Naoki Sasahira","doi":"10.1111/den.14894","DOIUrl":"10.1111/den.14894","url":null,"abstract":"<p>Postoperative pancreatic fistula (POPF) is one of the major complications following distal pancreatectomy (DP). With the increasing adoption of laparoscopic and robotic approaches, the rate of clinically relevant POPF is reported as between 18.2–26.7%.<span>^{1, 2}</span> When POPF does not improve with conservative treatment, interventions such as percutaneous drainage (PTD), endoscopic ultrasound-guided transluminal drainage (EUS-TD), and endoscopic transpapillary drainage (ETPD) are employed.<span>^3-5</span> However, PTD and EUS-TD may not always be appropriate due to interfering blood vessels, the distance from the abdominal or gastrointestinal wall to the POPF, or an immature POPF wall. On the other hand, while ETPD may reduce leakage of pancreatic fluid from the main pancreatic duct into the POPF, it may sometimes be ineffective due to indirect drainage of the POPF.</p><p>For such cases, we performed ETPD through the pancreatic duct stump (PDS). A 59-year-old man developed POPF with fever and abdominal pain 23 days after DP. Pancreatography from near the PDS was performed to confirm the leakage into the POPF, followed by guidewire insertion into the POPF. An endoscopic nasopancreatic drainage (ENPD) tube was subsequently placed into the POPF. After confirming the shrinkage of POPF in 1–2 weeks, the ENPD tube was replaced with a pancreatic duct stent, without penetrating the PDS (Video S1). The ENPD tube over the PDS enabled direct drainage of the POPF, and the pancreatic duct stent could relieve the intrapancreatic high pressure because of Oddi.<span>⁴</span> The stent was removed a few months later after confirming the absence of POPF recurrence by computed tomography (Fig. 1). This strategy was applied in four cases, with no cases with recurrent POPF (Table 1). This method provides an alternative option for PTD or EUS-TD, especially when the POPF has distance from the abdominal or gastrointestinal wall, or when the POPF wall is immature in the early postoperative period.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1176-1178"},"PeriodicalIF":5.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14894","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763072","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":"Successful treatment of postoperative intrahepatic stones with direct peroral cholangioscopy and mother–baby system cholangioscopy","authors":"Hiroki Uechi,&nbsp;Yuji Fujita,&nbsp;Yuji Koyama","doi":"10.1111/den.14896","DOIUrl":"10.1111/den.14896","url":null,"abstract":"<p>A 73-year-old woman underwent pyloric resection and B-1 reconstruction for gastric cancer followed by duodenal bile duct anastomosis to treat common bile duct stones. The patient was later referred for bile duct dilation examination. Magnetic resonance imaging revealed intrahepatic gallstones in the posterior intrahepatic bile duct. Consequently, endoscopic retrograde cholangiopancreatography was performed.</p><p>Initially, direct peroral cholangioscopy (POCS) with an endoscope equipped with water-jet functionality was used to attempt stone fragmentation via electrohydraulic lithotripsy (EHL). However, this approach failed due to challenging angulation of the bile duct, which obstructed access to the posterior biliary duct. Subsequently, the mother–baby technique was employed using a duodenoscope and cholangioscope (SpyScope; Boston Scientific, Marlborough, MA, USA). However, advancing the SpyScope into the posterior biliary duct was unsuccessful due to the instability of the duodenoscope, which impeded the effective transmission of force and passage beyond the bend.</p><p>To address the need for greater scope stability and rigidity, a colonoscope (CF HQ290ZI, channel diameter 3.7 mm; Olympus Medical Systems, Tokyo, Japan) was introduced through the choledochoduodenal anastomosis, effectively serving as the mother endoscope. This combination of direct POCS and the mother–baby system, referred to as combined-POCS, significantly improved scope stability and enhanced the insertability of the choledochoscope. This rigidity of the colonoscope helped facilitate successful access to the posterior biliary branch (Figs 1,2). Complete stone removal was achieved using stone fragmentation with EHL (Video S1).</p><p>Generally, EHL is effective in treating intrahepatic stones,<span>^{1, 2}</span> but its success is often limited by the devices used in the postoperative intestinal tract.<span>³</span> In this case, the sequential application of various treatment methods led to effective resolution. The therapeutic intervention proceeded without adverse events, demonstrating the efficacy of combined-POCS in the management of postoperative intrahepatic stones.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1179-1180"},"PeriodicalIF":5.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14896","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141763075","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":"Laser lithotripsy with balloon enteroscopy-assisted peroral cholangioscopy for a large common bile duct stone after Billroth II gastrectomy","authors":"Haruo Miwa,&nbsp;Kazuya Sugimori,&nbsp;Shin Maeda","doi":"10.1111/den.14888","DOIUrl":"10.1111/den.14888","url":null,"abstract":"<p>Endoscopic procedures for large common bile duct stones in patients with altered anatomy remain challenging, despite reports on direct peroral cholangioscopy (POCS).<span>^1-4</span> Recently, a novel slim cholangioscope (9F eyeMAX; Micro-Tech, Nanjing, China) facilitated balloon enteroscopy-assisted POCS (BE-POCS).<span>⁵</span></p><p>An 83-year-old man, after Billroth II gastrectomy, was admitted with a large common bile duct stone. BE-POCS using a Holmium YAG (Ho:YAG) laser was employed for stone removal (Video S1). A balloon enteroscope (SIF-H290S; Olympus, Tokyo, Japan) was inserted into the afferent loop, and cholangiography revealed a large stone (15 mm) in the dilated common bile duct (20 mm). After papillary balloon dilation (15 mm), 9F eyeMAX was smoothly inserted via enteroscopy. A large stone was located in the hepatic hilum. Ho:YAG laser (LithoEVO; EDAP TMS, Lyon, France) lithotripsy effectively crushed the stone core under cholangioscope guidance (Fig. 1). The irrigation ability was sufficient to maintain a clear view because of a separate irrigation channel. A basket catheter (LithoCrush V; Olympus) was used to remove the fragments; however, the largest piece could not be extracted, and mechanical lithotripsy failed. A plastic stent was placed until the second session because of the procedure length (100 min). One month later, the largest fragment was completely crushed using the Ho: YAG laser to prevent basket impaction (Fig. 2). The green color of the laser helped detect the probe tip during the procedure. The fragmented stones were removed using a spiral basket catheter (KANEKA Medics, Tokyo, Japan). Cholangioscopy confirmed no residual stones in the intrahepatic bile ducts. Finally, small fragments were extracted using a microbasket catheter (ABIS, Hyogo, Japan) (60 min).</p><p>This is the first report of laser lithotripsy with BE-POCS for a patient with Billroth II gastrectomy. Ho:YAG laser lithotripsy using a slim cholangioscope is useful for treating difficult stones in patients with altered anatomy.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 9","pages":"1059-1061"},"PeriodicalIF":5.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14888","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749907","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":"Low-cost and reliable method for confirming residual bile duct stones utilizing a novel peroral cholangioscope","authors":"Shun Ishido,&nbsp;Masanori Kobayashi,&nbsp;Ryuichi Okamoto","doi":"10.1111/den.14890","DOIUrl":"10.1111/den.14890","url":null,"abstract":"<p>When performing endoscopic procedures for bile duct stones, confirming the absence of residual stones is crucial. However, during postprocedural cholangiography, the presence of air or debris can pose challenges in assessing residual stones.<span>¹</span> Especially in cases of altered anatomy, pursuing reintervention may not be feasible, even if residual stones are present.<span>^{2, 3}</span> Although peroral cholangioscopes can confirm stone absence,<span>⁴</span> their routine use is impractical because of high costs. Therefore, we developed a novel method using the complementary metal oxide semiconductor (CMOS) camera unit of a new ultrathin cholangioscope (DRES Slim Scope; Japan Lifeline, Tokyo, Japan), allowing for the reliable confirmation of the absence of residual stones at a low cost (Video S1). The CMOS camera unit, with a 1 mm diameter, is priced at 300,000 Japanese yen and can be reused 10 times with proper washing and sterilization (30,000 yen/use).<span>⁵</span> It can be passed through the lumen after removing the brush from the double-lumen biliary cytology brush (CytoMaxII; Cook Japan Inc., Tokyo, Japan) (Fig. 1). Substituting the CytoMaxII sheath priced at 12,000 yen for the original sheath priced at 39,000 yen enables biliary duct observation at 42,000 yen.</p><p>We present an actual case utilizing this method. A 71-year-old woman with a history of pancreaticoduodenectomy developed cholangitis resulting from hepaticojejunostomy anastomotic stricture and bile duct stones. The stricture was dilated with a balloon, and stone removal was performed using a basket and balloon. However, the cholangiography indicated the possible presence of residual stones, although definitive confirmation remained elusive. By using the aforementioned method while irrigating saline solution through the Y-shaped connector, we visualized the bile duct and confirmed the absence of stones (Fig. 2). Given the reduced effort and cost associated with endoscopic nasobiliary drainage tube placement or reintervention, this method proves beneficial for both altered and normal anatomy cases.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1173-1175"},"PeriodicalIF":5.0,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14890","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749908","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":"Fishing for a button battery using a self-made magnetic device","authors":"Takahiro Gonai,&nbsp;Yosuke Toya,&nbsp;Takayuki Matsumoto","doi":"10.1111/den.14880","DOIUrl":"10.1111/den.14880","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 9","pages":"1051"},"PeriodicalIF":5.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731678","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":"Training and quality indicators in interventional endoscopic ultrasound","authors":"Bogdan Miutescu,&nbsp;Vinay Dhir","doi":"10.1111/den.14881","DOIUrl":"10.1111/den.14881","url":null,"abstract":"<p>Endoscopic ultrasound (EUS) has transformed the landscape of minimally invasive gastrointestinal procedures, necessitating specialized training for proficiency in interventional EUS (iEUS). This study evaluates the effectiveness of iEUS training, focusing on learning curves, success rates, and the associated risks in various procedures, aiming to recommend practices for standardizing training and ensuring competency. Key metrics such as procedure type, learning curve for proficiency, success rates, and risk of adverse events were analyzed to establish benchmarks for training programs. Proficiency in pancreatic fluid collection drainage was achieved after 20–30 procedures, with a 100% success rate and a complication rate ranging from 1.5 to 80%. Gallbladder drainage required 19 cases to reach an 86% success rate, with adverse events reported in 19% of cases. Choledocoduodenostomy mastery was observed after approximately 100 cases, with postintervention pancreatitis affecting 5.3–6.6% of all cases. Hepaticogastrostomy showed a 93% success rate after 33 cases, with a 24.8% adverse event rate. Hepaticoenterostomy reached 100% success beyond the 40th patient, with a 20% rate of postsurgical strictures. Pancreatic duct drainage achieved 89% technical and 87% clinical success after 27 cases, with 12–15% adverse events. Gastro-enteric anastomosis required 25 cases for proficiency and approximately 40 cases for mastery, with 5.5% immediate and 1% late adverse events. iEUS training outcomes vary significantly across different procedures, highlighting the importance of structured, procedure-specific training programs to achieve proficiency. These findings provide a foundation for developing universal competency benchmarks in iEUS, facilitating consistent and effective training worldwide.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"40-50"},"PeriodicalIF":5.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14881","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635983","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":"“SEMS-in-SEMS” technique for the removal of embedded fully covered self-expandable metal stents in benign pancreatic duct stricture","authors":"Il Sang Shin,&nbsp;Jong Ho Moon,&nbsp;Yun Nah Lee","doi":"10.1111/den.14887","DOIUrl":"10.1111/den.14887","url":null,"abstract":"<p>Fully covered self-expandable metal stents (SEMS) are an alternative treatment option for persistent benign main pancreatic duct stricture (BPS), but their removal can be hampered by fibrosis formation and tissue overgrowth if the indwelling duration exceeds 3 months.<span>¹</span> We present a case in which a fully covered SEMS, which initially could not be removed from the pancreatic duct, was retrieved using a “SEMS-in-SEMS” technique.</p><p>A 69-year-old male patient with a history of symptomatic chronic pancreatitis treated by multiple exchanges of plastic stents presented with abdominal pain. Computed tomography identified refractory BPS at the pancreatic head, and a fully covered SEMS (Bonastent M-intraductal; Standard Sci Tech, Seoul, South Korea) with a diameter of 8 mm and a length of 5 cm was inserted across the stricture. Although stent removal and a follow-up pancreatogram were scheduled at 3 months, the patient arbitrarily delayed visiting the hospital until 7 months after SEMS insertion. During the delayed follow-up endoscopic retrograde cholangiopancreatography, the inserted SEMS could not be removed, likely because it had become embedded in the pancreatic duct wall. Subsequent pancreatogram suggested tissue hyperplasia and overgrowth into the stent. The SEMS-in-SEMS technique was performed by placing a second fully covered SEMS with a diameter of 10 mm and a length of 7 cm, extended by 1 cm at both ends, inside the existing SEMS to compress the hyperplastic tissue and induce its ischemia and necrosis (Fig. 1, Video S1). One month later, an attempt to remove both stents using a rat-tooth forceps succeeded (Fig. 2).</p><p>The placement of a SEMS inside another SEMS can induce pressure necrosis of bile duct hyperplasia, enabling subsequent removal of the embedded biliary stent.<span>^2-4</span> The SEMS-in-SEMS technique, which was documented only in the bile duct interventions, can also be safe and effective for the extraction of embedded SEMS in patients with BPS.</p><p>Authors declare no conflict of interest for this article.</p><p>This work was partly supported by the SoonChunHyang University Research Fund.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1171-1172"},"PeriodicalIF":5.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14887","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635981","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}