Digestive Endoscopy最新文献

{"title":"Endoscopic submucosal dissection for duodenal tumors including papilla: Is it feasible?","authors":"Osamu Dohi, Naoto Iwai, Naohisa Yoshida","doi":"10.1111/den.14991","DOIUrl":"10.1111/den.14991","url":null,"abstract":"<p>In recent years, the incidence of superficial nonampullary duodenal epithelial tumors (SNADETs) detected using upper gastrointestinal endoscopy has increased in asymptomatic individuals. Most SNADETs are adenomas or intramucosal adenocarcinomas for which minimally invasive endoscopic treatment is often the preferred therapeutic approach, underscoring its growing significance. However, SNADETs are less prevalent than other gastrointestinal neoplasms such as those of the esophagus, stomach, and colorectum, and endoscopic diagnostic and therapeutic modalities for these tumors remain in the developmental stage.</p><p>Endoscopic submucosal dissection (ESD) is recommended when en-bloc resection is difficult to achieve using reliable endoscopic mucosal resection (EMR) or underwater EMR (UEMR). This technique is frequently selected for SNADETs of >2 cm in size, those with scars, or those with anatomically curved locations because the en-bloc resection and R0 resection rates of ESD are higher than those of cold snare polypectomy, EMR, and UEMR.<span><sup>1</sup></span> Although duodenal ESD has been reported to have an extremely high incidence of adverse events in the past,<span><sup>2</sup></span> improvements in various resection techniques and devices, such as the water pressure method, pocket-creation method, and ESD using scissors-type forceps, have made it possible to reduce intraoperative adverse events.<span><sup>3-5</sup></span> With regard to delayed adverse events, reliable wound closure up to 3 days after endoscopic resection is important to prevent adverse events because wound closure after resection reduces the risk of delayed adverse events,<span><sup>1</sup></span> and delayed perforation occurs within 3 days after endoscopic treatments.<span><sup>6</sup></span></p><p>In this issue of <i>Digestive Endoscopy</i>, Yahagi <i>et al</i>.<span><sup>7</sup></span> conducted a retrospective cohort study of patients who underwent ESD for duodenal tumors including the papilla (ESDIP). This technique was primarily introduced for the treatment of lesions of >20 mm in size and cases with laterally spreading morphology, in which it is difficult to achieve en-bloc resection by endoscopic papillectomy (EP). The en-bloc resection rate of ESDIP is extremely high and the R0 resection rate is relatively low (96% and 46%, respectively). Furthermore, the rate of perioperative adverse events was high (intraoperative perforation, 15%; postprocedural bleeding, 19%; and post-ESDIP pancreatitis, 25%). The findings indicated that while ESDIP had a high likelihood of achieving en-bloc resection, there is a risk of perioperative adverse events.</p><p>ESDIP presents a significant technical challenge, and is associated with a high risk of complications. Although Yahagi <i>et al</i>. performed the entire ESDIP procedure using water pressure method,<span><sup>3</sup></span> which decreases intraprocedural perforation during duodenal ESD, the high rate of intraoper","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"411-412"},"PeriodicalIF":5.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14991","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985394","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":"Remimazolam: Promising sedative for upper gastrointestinal endoscopy","authors":"Daisuke Yamaguchi,&nbsp;Motohiro Esaki","doi":"10.1111/den.14995","DOIUrl":"10.1111/den.14995","url":null,"abstract":"<p>The demand for sedation during endoscopy has been obviously increasing, as it allows endoscopists to perform endoscopic examinations safely while providing patients with a greater sense of relief and satisfaction.<span>¹</span></p><p>Sedatives commonly used during endoscopy include midazolam, diazepam, flunitrazepam, dexmedetomidine, and propofol, each with its advantages and disadvantages. The choice of sedatives depends upon the specific needs of each facility.<span>²</span> In Japan, midazolam is the most frequently used sedative during endoscopy. However, patients sedated with midazolam require extended recovery time due to its long half-life and prolonged sedative effects after the procedure.<span>^{2, 3}</span> The need for a recovery room thus limits the use of sedatives in clinical practice.</p><p>Remimazolam is a newly developed ultra-short-acting benzodiazepine. It has been approved by the U.S. Food and Drug Administration (FDA) and is used as a sedative during gastrointestinal endoscopy, while it is not yet covered by the Japanese insurance system. A recent meta-analysis comparing remimazolam with midazolam for sedative gastrointestinal endoscopy showed a higher procedural success, lower need for rescue medication, shorter total recall and delayed recall, and reduced adverse events.<span>⁴</span> Since remimazolam has pharmacokinetically a shorter half-life than midazolam, it can be expected to reduce both the time to alertness and the time spent in the recovery room.<span>^{3, 4}</span></p><p>Propofol, another commonly used sedative for endoscopy, has the advantage of a narrower range of sedation and anesthesia than midazolam and results in a better awakening quality. However, its primary side-effects, including respiratory and circulatory depression, are often problematic. The Japan Gastroenterological Endoscopy Society's guidelines for sedation (second edition) state that propofol may be used by nonanesthesiologists if they have undergone sedation training and only for patients with American Society of Anesthesiologists-Physical Status (ASA-PS) classification I or II.<span>²</span></p><p>The study by Lee <i>et al</i>.<span>⁵</span> was a randomized controlled trial (RCT) that compared the effects of remimazolam and propofol on oxygen reserve during upper gastrointestinal endoscopy. For this purpose, the study used the oxygen reserve index (ORi) to investigate whether a sedative dose of remimazolam maintains better oxygenation than propofol in a state of mild hyperoxia, as experienced by patients during upper gastrointestinal endoscopy. The ORi is a respiratory parameter that reflects venous blood oxygen saturation and is useful for evaluating oxygenation status in a mild hyperoxic state with a PaO₂ of 100–200 mmHg, which cannot be adequately evaluated using conventional pulse oximetry.<span>⁵</span> This study found a significantly higher","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"400-401"},"PeriodicalIF":5.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14995","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985408","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":"Adverse events of 20–22G second-generation endoscopic ultrasound-guided fine-needle biopsy needles for solid lesions in the upper gastrointestinal tract and adjacent organs: Systematic review and meta-analysis","authors":"Cheng-ye Pan,&nbsp;Shi-min Wang,&nbsp;Dong-hao Cai,&nbsp;Jia-yi Ma,&nbsp;Shi-yu Li,&nbsp;Yibin Guo,&nbsp;Sun Jing,&nbsp;Jin Zhendong,&nbsp;Kaixuan Wang","doi":"10.1111/den.14972","DOIUrl":"10.1111/den.14972","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Previous research has conducted meta-analyses on the diagnostic accuracy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). However, studies on adverse events (AEs) have been limited and sporadic and have included a highly diverse group of patients (with upper and lower gastrointestinal tract issues) and needles of varying sizes (19-22-25G). The purpose of this systematic review and meta-analysis was to determine the incidence of AEs related to the utilization of 20–22G second-generation EUS-FNB needles subsequent to puncture of the upper gastrointestinal tract and adjacent organs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched the PubMed, Embase, and SCIE databases from January 1, 2010, to December 31, 2023. The primary outcome was percentage of summary AEs. Subgroup analyses were based on needle type, needle size, and lesion site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 99 studies were included in the analysis, with 9303 patients. The overall AE rate for 20–22G second generation EUS-FNB needles in upper gastrointestinal EUS-FNB was 1.8% (166/9303), with bleeding being the most common AE at 44.0%. The percentages of pancreatitis, abdominal pain, and other AEs were 24.1%, 21.1%, and 10.8%, respectively. Patients undergoing hepatic EUS-FNB had the highest incidence of AEs at 14.0%, followed by submucosal lesions at 3.2% and pancreatic lesions at 2.6%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EUS-FNB is a safe procedure with a relatively low risk of upper gastrointestinal AEs (1.8%) and no associated deaths. Postoperative bleeding and pancreatitis are the most common complications of EUS-FNB. Most AEs are mild and self-limiting in severity, and serious complications are very rare.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"490-500"},"PeriodicalIF":5.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959739","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":"WEO Newsletter: Towards a Green Endoscopy","authors":"","doi":"10.1111/den.14987","DOIUrl":"10.1111/den.14987","url":null,"abstract":"<p>Cesare Hassan^1,2 Maddalena Menini¹ and Alessandro Repici^1,2</p><p>¹IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy and ²Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy</p><p><i>Correspondence:</i> Cesare Hassan, <i>Humanitas Research Hospital and University</i>, Via Manzoni 56, 20089 Rozzano (Milano) Italy, Tel: +39 (0)282247385, Fax: +390282242595, Email: <span>[email protected]</span></p><p>When we think of endoscopy, we think of innovation, advanced techniques, patient safety, and more. But have we ever stopped to reflect on the environmental price of these accomplishments? Could our practices be harmful to the planet's health?</p><p>To put the issue into perspective, healthcare contributes between 1% and 5% of global environmental impacts, depending on the metric considered, and surpasses 5% in certain national contexts.<span>¹</span></p><p>Digestive endoscopy is far from blameless as it is a resource-demanding activity with a substantial but insufficiently evaluated environmental footprint.<span>²</span> Endoscopy is believed to be the third-largest producer of waste within the healthcare sector.<span>³</span></p><p>From the gallons of water and kilowatts of energy used in scope reprocessing to the mountains of single-use plastics discarded daily, our practices are leaving a footprint that can no longer be ignored.</p><p>A single reusable endoscope, over its lifecycle, emits several kilograms of CO2 for every procedure it undergoes—an unsettling irony for a tool designed to save lives. And while single-use devices are often marketed as convenient and hygienic, they create a staggering amount of non-biodegradable waste.</p><p>As endoscopists, we pride ourselves on our ability to solve complex problems, yet we seem reluctant to address one staring us in the face: the unsustainable environmental impact of our work. One could argue that environmentally friendly practices should focus on other sectors rather than healthcare, as patient safety – and healthcare quality - must always come first. Similarly, it could be argued that healthcare workers should direct their attention to advancing care rather than worrying about “recycling waste.”</p><p>However, these views are outdated. What could be more urgent than securing our survival on this planet? And is it truly the case that green endoscopy initiatives would compromise the quality of care? Often, energy-intensive and environmentally harmful practices arise not from necessity but from a lack of awareness—or simple negligence and inattention.</p><p>It's easy to dismiss these issues as beyond our control, but that mindset is part of the problem. The encouraging news is that practical, sustainable solutions are within reach. Leading societies in Gastrointestinal Endoscopy emphasize sustainability ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"132-134"},"PeriodicalIF":5.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14987","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959754","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":"Traction-assisted endoscopic ultrasound-guided fine-needle biopsy using the clip-with-thread method for small gastric subepithelial lesions: Randomized controlled trial (with video)","authors":"Yosuke Minoda,&nbsp;Yusuke Suzuki,&nbsp;Haruei Ogino,&nbsp;Shuzaburo Nagatomo,&nbsp;Xiaopeng Bai,&nbsp;Mitsuru Esaki,&nbsp;Masafumi Wada,&nbsp;Yoshimasa Tanaka,&nbsp;Yoshitaka Hata,&nbsp;Nao Fujimori,&nbsp;Shinya Umekita,&nbsp;Daisuke Tsurumaru,&nbsp;Mitsuhiko Ota,&nbsp;Eiji Oki,&nbsp;Eikichi Ihara,&nbsp;Yoshihiro Ogawa","doi":"10.1111/den.14977","DOIUrl":"10.1111/den.14977","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is the gold standard for diagnosing gastric subepithelial lesions (SELs), but diagnosing lesions smaller than 20 mm remains challenging. We developed traction-assisted EUS-FNB (TA-EUS-FNB) using the clip-with-thread method to enhance diagnostic accuracy by stabilizing the lesion and providing counter-traction for easier needle access. This study evaluates the effectiveness of TA-EUS-FNB in diagnosing small gastric SELs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective, randomized, controlled cross-over trial (August 2019–November 2022), 30 patients with gastric SELs &lt;20 mm were randomized to undergo TA-EUS-FNB or conventional EUS-FNB. Each patient underwent four punctures, two per method. The primary end-point was the adequate tissue sampling rate for both techniques. Secondary end-points included diagnostic yield and performance (sensitivity and specificity) in distinguishing gastrointestinal stromal tumors (GISTs) from non-GISTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean tumor size was 15.0 mm, with diagnoses comprising GISTs (<i>n</i> = 15, 50%), leiomyomas (<i>n</i> = 8, 26.7%), schwannomas (<i>n</i> = 2, 6.7%), aberrant pancreas (<i>n</i> = 3, 10%), and inflammation (<i>n</i> = 2, 6.7%). TA-EUS-FNB demonstrated a significantly higher adequate-tissue sampling rate (90% vs. 66.7%, <i>P</i> = 0.035) and diagnostic yield (86.7% vs. 63.3%, <i>P</i> = 0.037) than conventional EUS-FNB. Sensitivity (86.7%, 95% confidence interval [CI] 62.1–96.3% vs. 66.7%, 95% CI 41.7–84.8%; <i>P</i> = 0.20) and specificity (100%, 95% CI 79.6–100% vs. 100%, 95% CI 79.6–100%) were comparable between the methods. No adverse events were observed in the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>TA-EUS-FNB demonstrated superior tissue sampling rates and diagnostic yield for SELs &lt;20 mm compared to conventional EUS-FNB, making it a viable option. Controlling lesion mobility is essential for successful EUS-FNB in small SELs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"512-520"},"PeriodicalIF":5.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959753","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":"Tropical sprue differentiated from celiac disease: First case report in Japan","authors":"Shuji Kochi,&nbsp;Yumi Oshiro,&nbsp;Kazufumi Dohmen","doi":"10.1111/den.14988","DOIUrl":"10.1111/den.14988","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"296"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916459","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":"Clinical performance of endoscopic ultrasound-guided tissue acquisition for perivascular soft-tissue cuffing suspected to be extravascular migratory metastases of pancreatic or bile duct cancer (with video)","authors":"Kosuke Maehara,&nbsp;Susumu Hijioka,&nbsp;Yoshikuni Nagashio,&nbsp;Yuta Maruki,&nbsp;Daiki Yamashige,&nbsp;Kohei Okamoto,&nbsp;Daiki Agarie,&nbsp;Shin Yagi,&nbsp;Soma Fukuda,&nbsp;Masaru Kuwada,&nbsp;Yasuhiro Komori,&nbsp;Takehiko Koga,&nbsp;Atsushi Kanno,&nbsp;Tsunao Imamura,&nbsp;Yutaka Saito,&nbsp;Takuji Okusaka","doi":"10.1111/den.14983","DOIUrl":"10.1111/den.14983","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to investigate the diagnostic performance and safety of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for perivascular soft-tissue cuffing (PSTC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective study evaluated patients in whom EUS-TA was performed for PSTC in pancreatic or bile duct cancer lesions between October 2017 and March 2024. PSTC was defined as a perivascular soft-tissue area contiguous with nearby blood vessels from the suspected primary tumor. EUS-TA procedures and outcomes, including technical success, diagnostic performance, adverse events, and comparison with contrast-enhanced computed tomography (CECT), were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1803 patients, 53 underwent EUS-TA for PSTC. The sensitivity, specificity, and accuracy were 92.1%, 100%, and 92.5%, respectively. The technical success rate was 98.1% (52/53). The adverse event rate was 1.9%. EUS-TA for PSTC was significantly superior to CECT for PSTC in terms of diagnostic accuracy. Furthermore, the diagnostic performance and adverse event rates for EUS-TA for PSTC were comparable to those for TA in solid tumors. Shorter puncture lengths were associated with lower accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EUS-TA for PSTC in pancreatic or bile duct cancer demonstrates high diagnostic accuracy and a low rate of adverse events, showing superior diagnostic performance compared to CECT. These findings suggest that EUS-TA for PSTC can be performed safely and is a clinically beneficial procedure. Despite the technical challenges, EUS-TA for PSTC can influence clinical judgment and should be considered in skilled institutions for future patient treatment decisions. Prospective multicenter studies are warranted to further evaluate its efficacy and safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 6","pages":"695-703"},"PeriodicalIF":5.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14983","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900785","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 hemostasis with a self-assembling peptide gel during endoscopic submucosal dissection and cold-snare polypectomy in the duodenum: Prospective exploratory study (with video)","authors":"Mayuko Seya,&nbsp;Osamu Dohi,&nbsp;Hayato Fukui,&nbsp;Naoto Iwai,&nbsp;Tomoko Ochiai,&nbsp;Hiroki Mukai,&nbsp;Katsuma Yamauchi,&nbsp;Hajime Miyazaki,&nbsp;Takeshi Yasuda,&nbsp;Takuma Yoshida,&nbsp;Tsugitaka Ishida,&nbsp;Toshifumi Doi,&nbsp;Ryohei Hirose,&nbsp;Ken Inoue,&nbsp;Naohisa Yoshida,&nbsp;Kazuhiko Uchiyama,&nbsp;Takeshi Ishikawa,&nbsp;Tomohisa Takagi,&nbsp;Hideyuki Konishi,&nbsp;Yoshito Itoh","doi":"10.1111/den.14974","DOIUrl":"10.1111/den.14974","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>A novel self-assembling peptide gel (SAPG) was recently developed for hemostasis during endoscopic resection (ER) as an alternative for electrocoagulation and clip placement. Therefore, this exploratory study aimed to evaluate the hemostatic effect of SAPG on bleeding during ER of the duodenum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with superficial duodenal epithelial tumors who underwent endoscopic submucosal dissection (ESD) or cold-snare polypectomy (CSP) between June 2022 and October 2023 were enrolled in the study. SAPG was used for hemostasis of the intraprocedural bleeding when spontaneous hemostasis was essential for the continuation of ESD or was not achieved within 30 s after CSP. The primary outcome was a successful hemostatic rate using SAPG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the included patients, 15 and 8 underwent ESD and CSP, respectively. Forty-two points of intraoperative bleeding were noted during ESD, of which 39 (92.9%) and 3 (7.1%) were oozing and nonspurting bleedings, respectively. Successful hemostatic rates were 84.6% and 0% in the oozing and nonspurting bleedings, respectively. All nonspurting bleedings were weakened after SAPG use. Of the 70 CSPs, 60 were oozing bleedings (85.7%), which were successfully stopped with SAPG. The median time to hemostasis from SAPG application was 30 s (interquartile range [IQR] 17–40 s) and 25 s (IQR 10–33 s) during ESD and CSP, respectively. No adverse event was observed in any of the cases during the perioperative period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Self-assembling peptide gel has an acceptable effect of successful hemostasis for intraoperative oozing bleeding during duodenal ESD and CSP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"524-531"},"PeriodicalIF":5.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900786","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":"Optimal tissue acquisition method for pancreatic mass","authors":"Kwang Hyun Chung,&nbsp;Sang Hyub Lee","doi":"10.1111/den.14976","DOIUrl":"10.1111/den.14976","url":null,"abstract":"<p>Pancreatic masses pose a diagnostic difficulty due to the technical complexities related to tissue acquisition. Endoscopic ultrasound (EUS)-guided tissue acquisition has transformed the field by allowing access to pancreatic lesions through fine-needle and biopsy. However, diagnostic accuracy differs based on tumor characteristics and procedural factors. This narrative review explores the nuances of tissue acquisition methods for pancreatic tumors, including factors such as tumor location, size, histological characteristics, and needle selection. It assesses the efficacy of different needle designs and maneuvers, including suction techniques and needle passes. Moreover, the diverse tissue preparation methods, including cytological smear, cell block, and direct histology, are discussed, highlighting the importance of tailored approaches based on tumor characteristics. Additionally, the roles of macroscopic on-site evaluation and rapid on-site evaluation in optimizing specimen adequacy are investigated. Furthermore, percutaneous ultrasound-guided biopsy is considered an alternative approach, particularly in settings where EUS is impractical. Additionally, the review emphasizes the emerging trend of using tissue for genetic testing and molecular analysis, requiring high-quality sample acquisition. Future directions in tissue acquisition techniques and their integration into clinical practice are discussed, providing promising avenues for pancreatic disease diagnosis and treatment.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 6","pages":"629-637"},"PeriodicalIF":5.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14976","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900760","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":"Peroral endoscopic tumor resection for an esophageal leiomyoma using a novel therapeutic thin endoscope","authors":"Haruna Horikawa,&nbsp;Osamu Dohi,&nbsp;Naoto Iwai","doi":"10.1111/den.14985","DOIUrl":"10.1111/den.14985","url":null,"abstract":"<p>Peroral endoscopic tumor resection (POET) is a less invasive treatment for esophageal subepithelial tumors (SET)<span>^1-3</span>; however, it is challenging to approach SETs in narrow submucosal tunnels. Herein, we report a case of POET using a novel thin endoscope for an esophageal leiomyoma. A 45-year-old man with moderate dysphagia was referred to our hospital for further examination of a SET in the abdominal esophagus (Fig. 1a). Endoscopic ultrasonography revealed a 30 mm tumor in the second and the third layers, originating from the fourth layer (Fig. 1b). Pathological analysis of fine-needle aspiration specimens identified leiomyoma. POET was performed using a thin therapeutic endoscope with a 7.9 mm diameter (EG-840TP; Fujifilm, Tokyo, Japan) under general anesthesia (Video S1). A 2 cm longitudinal mucosal incision was made using ProKnife (Boston Scientific, Tokyo, Japan) on the proximal side (Fig. 1c). Subsequently, a submucosal tunnel was created from the mucosal entrance to the tumor (Fig. 1d). To avoid injury to the tumor, this endoscope was important to precisely identify the tumor edge in a narrow submucosal space. Clutch Cutter (Fujifilm) and a clip with a thread for traction were used to dissect the muscularis propria, which was continuous with the tumor. We achieved en-bloc enucleation (Fig. 1e). The lesion was removed using an endoscopic net after widening the mucosal entrance (Fig. 1f). We then sutured the mucosal entrance using the reopenable clip-over-the-line method<span>⁴</span> (Fig. 1g). The patient had slight cutaneous emphysema immediately after the procedure but was discharged on postoperative day 5 with a good clinical course. The final pathology was leiomyoma with negative margins (Fig. 1h–k). This thin endoscope has an accessory channel of the same size as that of the conventional endoscope. Therefore, it minimizes the submucosal tunnel using conventional endoscopic devices (Fig. 2). Thus, this thin endoscope may facilitate POET for esophageal leiomyoma treatments.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 5","pages":"555-557"},"PeriodicalIF":5.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14985","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900761","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}