Digestive Endoscopy最新文献

{"title":"Upper gastrointestinal endoscopy in the surgically altered patient","authors":"Purnima Bhat,&nbsp;Arthur John Kaffes,&nbsp;Kristoffer Lassen,&nbsp;Lars Aabakken","doi":"10.1111/den.14823","DOIUrl":"10.1111/den.14823","url":null,"abstract":"<p>As management of upper gastrointestinal malignancies improves, and with popularization of bariatric surgery, endoscopists are likely to meet patients with altered upper gastrointestinal anatomy. Short-term, the surgery can cause complications like bleeding, leaks, and fistulas, and longer-term problems such as intestinal or biliary anastomotic strictures or biliary stones can arise, all necessitating endoscopy. In addition, the usual upper gastrointestinal pathologies can also still occur. These patients pose unique challenges. To proceed, understanding the new layout of the upper gastrointestinal tract is essential. The endoscopist, armed with a clear plan for navigation, can readily diagnose and manage most commonly occurring conditions, such as marginal ulcers and proximal anastomotic strictures with standard endoscopic instruments. With complex reconstructions involving long segments of small bowel, such as Roux-en-Y gastric bypass, utilization of balloon-assisted enteroscopy may be necessary, mandating modification of procedures such as endoscopic retrograde cholangiopancreatography. Successful endoscopic management of patients with altered anatomy will require prior planning and preparation to ensure the appropriate equipment, setting, and skill set is provided.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1077-1093"},"PeriodicalIF":5.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14823","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478119","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":"International consensus on the management of large (≥20 mm) colorectal laterally spreading tumors: World Endoscopy Organization Delphi study","authors":"Roupen Djinbachian,&nbsp;Douglas K. Rex,&nbsp;Han-Mo Chiu,&nbsp;Norio Fukami,&nbsp;Hiroyuki Aihara,&nbsp;Barbara A. J. Bastiaansen,&nbsp;Robert Bechara,&nbsp;Pradeep Bhandari,&nbsp;Amit Bhatt,&nbsp;Michael J. Bourke,&nbsp;Jeong-Sik Byeon,&nbsp;Daniela Cardoso,&nbsp;Akiko Chino,&nbsp;Philip W. Y. Chiu,&nbsp;Evelien Dekker,&nbsp;Peter V. Draganov,&nbsp;Shaimaa Elkholy,&nbsp;Fabian Emura,&nbsp;John Goldblum,&nbsp;Amyn Haji,&nbsp;Shiaw-Hooi Ho,&nbsp;Yunho Jung,&nbsp;Hiroshi Kawachi,&nbsp;Mouen Khashab,&nbsp;Supakij Khomvilai,&nbsp;Eun Ran Kim,&nbsp;Roberta Maselli,&nbsp;Helmut Messmann,&nbsp;Leon Moons,&nbsp;Yuichi Mori,&nbsp;Yukihiro Nakanishi,&nbsp;Saowanee Ngamruengphong,&nbsp;Adolfo Parra-Blanco,&nbsp;María Pellisé,&nbsp;Rafael Castilho Pinto,&nbsp;Mathieu Pioche,&nbsp;Heiko Pohl,&nbsp;Amit Rastogi,&nbsp;Alessandro Repici,&nbsp;Amrita Sethi,&nbsp;Rajvinder Singh,&nbsp;Noriko Suzuki,&nbsp;Shinji Tanaka,&nbsp;Michael Vieth,&nbsp;Hironori Yamamoto,&nbsp;Dong-Hoon Yang,&nbsp;Chizu Yokoi,&nbsp;Yutaka Saito,&nbsp;Daniel von Renteln","doi":"10.1111/den.14826","DOIUrl":"10.1111/den.14826","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>There have been significant advances in the management of large (≥20 mm) laterally spreading tumors (LSTs) or nonpedunculated colorectal polyps; however, there is a lack of clear consensus on the management of these lesions with significant geographic variability especially between Eastern and Western paradigms. We aimed to provide an international consensus to better guide management and attempt to homogenize practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two experts in interventional endoscopy spearheaded an evidence-based Delphi study on behalf of the World Endoscopy Organization Colorectal Cancer Screening Committee. A steering committee comprising six members devised 51 statements, and 43 experts from 18 countries on six continents participated in a three-round voting process. The Grading of Recommendations, Assessment, Development and Evaluations tool was used to assess evidence quality and recommendation strength. Consensus was defined as ≥80% agreement (strongly agree or agree) on a 5-point Likert scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-two statements reached consensus after three rounds of voting. Recommendations included: three statements on training and competency; 10 statements on preresection evaluation, including optical diagnosis, classification, and staging of LSTs; 14 statements on endoscopic resection indications and technique, including statements on en bloc and piecemeal resection decision-making; seven statements on postresection evaluation; and eight statements on postresection care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An international expert consensus based on the current available evidence has been developed to guide the evaluation, resection, and follow-up of LSTs. This may provide guiding principles for the global management of these lesions and standardize current practices.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1253-1268"},"PeriodicalIF":5.0,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14826","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461199","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: Second-line strategy with a strict entry selection","authors":"Giuseppe Vanella,&nbsp;Francesco Frigo,&nbsp;Paolo Giorgio Arcidiacono","doi":"10.1111/den.14876","DOIUrl":"10.1111/den.14876","url":null,"abstract":"<p>We extend our sincere congratulations to Debourdeau <i>et al</i>. for their GALLBLADEUS Study,<span>¹</span> a pioneering retrospective comparative analysis of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) versus gallbladder drainage (EUS-GBD) following failed endoscopic retrograde cholangiopancreatography (ERCP) for managing distal malignant biliary obstruction (dMBO).</p><p>While commending the authors for their objective and balanced reporting of results, this letter aims to dissect and underscore critical points to accurately convey the study's conclusions and avoid a superficial interpretation suggesting equivalence between EUS-CDS and EUS-GBD.</p><p>First, the two study arms appear mutually exclusive, as EUS-GBD seemingly acted as a third-line rescue in patients with failed ERCP and anticipated more challenging EUS-CDS (see significantly lower median bile duct diameter). Second, EUS-GBD exhibited a slower reduction in bilirubin levels at 7 and 30 days compared to EUS-CDS, despite similar chemotherapy access. Moreover, the higher rate of adverse events in the EUS-CDS group mainly stems from dysfunction events, occurring in a population where about 50% of patients presented with duodenal stenosis, an increasingly recognized risk factor for EUS-CDS dysfunction,<span>^2-4</span> if not a proper contraindication to EUS-CDS. The study's exclusive focus on transgastric EUS-GBD, likely chosen to avoid the problem of duodenal invasion and mitigate tumor interference, further complicates generalizability. Finally, it is important to remember that EUS-GBD for jaundice inherently relies on a careful assessment of a patent's cystic duct.</p><p>Consequently, while the GALLBLADEUS study implies EUS-GBD as a viable option for selected patients with dMBO where ERCP and EUS-CDS are unfeasible, it falls short of suggesting equivalence between techniques and lots of prerequisites need to be ascertained.</p><p>Notably, EUS-GBD remains untested against EUS-hepaticogastrostomy, which exhibits promising performance, especially in the case of duodenal infiltration.<span>^{3, 5}</span></p><p>The game in the realm of EUS-guided biliary drainage strategies remains open, but our comprehension of the players involved is certainly growing deeper.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"130"},"PeriodicalIF":5.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14876","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461196","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":"Exploring the potential: New chapter in gastrointestinal endoscopy with innovative 3D imaging technology","authors":"Xiaoqing Lin,&nbsp;Ken Ohata,&nbsp;Yohei Minato","doi":"10.1111/den.14866","DOIUrl":"10.1111/den.14866","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 8","pages":"952"},"PeriodicalIF":5.0,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461197","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":"Factors affecting complete stone removal and bile duct stone recurrence in patients with surgically altered anatomy treated by double-balloon endoscopy-assisted endoscopic retrograde cholangiography","authors":"Kensuke Yokoyama,&nbsp;Atsushi Kanno,&nbsp;Akitsugu Tanaka,&nbsp;Yusuke Sakurai,&nbsp;Eriko Ikeda,&nbsp;Kozue Ando,&nbsp;Hiroki Nagai,&nbsp;Tomonori Yano,&nbsp;Hironori Yamamoto","doi":"10.1111/den.14824","DOIUrl":"10.1111/den.14824","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study assessed factors influencing the complete removal and recurrence of bile duct stones in patients with surgically altered anatomy (SAA) undergoing double-balloon endoscopy-assisted endoscopic retrograde cholangiography (DBERC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of 289 patients with SAA treated for biliary stones with DBERC at Jichi Medical University Hospital (January 2007 to December 2022) was conducted. Evaluation of factors impacting complete stone removal was performed in 257 patients with successful bile duct cannulation. Logistic and Cox proportional hazards regression models were used to compute the odds ratios (ORs) and hazard ratios (HRs) at 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 257 patients, 139 (54.0%) and 209 (81.3%) achieved initial and complete removal, respectively. Recurrence occurred in 55 (21.4%) patients. Factors associated with initial complete stone removal included cholangitis (<i>P</i> &lt; 0.01, OR 0.48, 95% CI 0.27–0.83), number of stones (<i>P</i> &lt; 0.01, OR 0.31, 95% CI 0.18–0.54), and largest stone diameter (<i>P</i> &lt; 0.01, OR 0.37, 95% CI 0.20–0.67). The size of the largest stone was associated with complete removal (<i>P</i> = 0.01, OR 0.24, 95% CI 0.13–0.76). Recurrence was associated with cholangitis (<i>P</i> = 0.046, HR 0.54, 95% CI 0.29–0.99), congenital biliary dilatation (<i>P</i> = 0.01, HR 2.65, 95% CI 1.21–5.80), and number of stones (<i>P</i> = 0.02, HR 1.96, 95% CI 1.12–3.41).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Successful complete bile stone removal in patients with SAA depends on the stone diameter and number. Stone recurrence is influenced by the number of stones and history of congenital biliary dilatation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1269-1279"},"PeriodicalIF":5.0,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461198","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":"Muscle resection biopsy during peroral endoscopic myotomy in a patient with achalasia","authors":"Shinya Hoki,&nbsp;Hirofumi Abe,&nbsp;Chise Ueda","doi":"10.1111/den.14871","DOIUrl":"10.1111/den.14871","url":null,"abstract":"<p>Esophageal achalasia is an esophageal motility disorder, primarily characterized by degeneration of the esophageal myenteric plexus.<span>¹</span> Although the myenteric plexus is the primary concern during pathogenesis of achalasia,<span>²</span> a method for endoscopically sampling it has not yet been established. We report a novel sampling method—muscle resection biopsy—designed to sample the myenteric plexus while distinguishing between the circular and longitudinal muscle layers during peroral endoscopic myotomy (Video S1). A submucosal tunnel was first created and a small full-thickness muscle incision was made just above the lower esophageal sphincter using a needle-type knife (FlushKnife BTS3.0; FUJIFILM Holdings Corporation, Tokyo, Japan) and laterally extended to both sides, forming a U shape (Fig. 1a). A hemostatic clip (EZclip; Olympus Corporation, Tokyo, Japan), with one arm marked in red, was applied to the shaped muscle layers with the marked arm on the luminal side (Fig. 1b,c). We then excised the remaining muscle layers using a snare (SD-221L-25; Olympus Corporation; Fig. 1d) and collected the resected tissue.</p><p>Peroral endoscopic muscle biopsy using a submucosal tunnel has been recognized as a simple and useful sampling method for evaluating eosinophilic infiltration and fibrosis in the muscle layer.<span>³</span> However, the small size of biopsy samples and tissue damage caused by biopsy forceps make identifying the myenteric plexus and preserving the structures of both the circular and longitudinal muscle layers challenging. Although this method is time-consuming, requires skillful manipulation of an endoknife, and has potential risk of bleeding, it enables the collection of large, undamaged, tissues via biopsy forceps and allows for identification of the myenteric plexus and muscle layers while preserving the microscopic structure of the luminal wall (Fig. 2). Histopathological information obtained by this approach can be useful for assessing the microenvironment underlying the neurodegeneration in combination with immunohistochemical staining results.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 9","pages":"1052-1053"},"PeriodicalIF":5.0,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14871","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141461200","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":"Smartphone application for artificial intelligence-based evaluation of stool state during bowel preparation before colonoscopy","authors":"Atsushi Inaba,&nbsp;Kensuke Shinmura,&nbsp;Hiroki Matsuzaki,&nbsp;Nobuyoshi Takeshita,&nbsp;Masashi Wakabayashi,&nbsp;Hironori Sunakawa,&nbsp;Keiichiro Nakajo,&nbsp;Tatsuro Murano,&nbsp;Tomohiro Kadota,&nbsp;Hiroaki Ikematsu,&nbsp;Tomonori Yano","doi":"10.1111/den.14827","DOIUrl":"10.1111/den.14827","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Colonoscopy (CS) is an important screening method for the early detection and removal of precancerous lesions. The stool state during bowel preparation (BP) should be properly evaluated to perform CS with sufficient quality. This study aimed to develop a smartphone application (app) with an artificial intelligence (AI) model for stool state evaluation during BP and to investigate whether the use of the app could maintain an adequate quality of CS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>First, stool images were collected in our hospital to develop the AI model and were categorized into grade 1 (solid or muddy stools), grade 2 (cloudy watery stools), and grade 3 (clear watery stools). The AI model for stool state evaluation (grades 1–3) was constructed and internally verified using the cross-validation method. Second, a prospective study was conducted on the quality of CS using the app in our hospital. The primary end-point was the proportion of patients who achieved Boston Bowel Preparation Scale (BBPS) ≥6 among those who successfully used the app.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The AI model showed mean accuracy rates of 90.2%, 65.0%, and 89.3 for grades 1, 2, and 3, respectively. The prospective study enrolled 106 patients and revealed that 99.0% (95% confidence interval 95.3–99.9%) of patients achieved a BBPS ≥6.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The proportion of patients with BBPS ≥6 during CS using the developed app exceeded the set expected value. This app could contribute to the performance of high-quality CS in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1338-1346"},"PeriodicalIF":5.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141510844","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":"Comparative clinical feasibility of antireflux mucosectomy and antireflux mucosal ablation in the management of gastroesophageal reflux disease: Retrospective cohort study","authors":"Ah Young Lee,&nbsp;Seong Hwan Kim,&nbsp;Joo Young Cho","doi":"10.1111/den.14832","DOIUrl":"10.1111/den.14832","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>No definitive treatment has been established for refractory gastroesophageal reflux disease (GERD). Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) using argon plasma coagulation are promising methods. However, no study has compared these two. This study compared the efficacy and safety of the two procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter, retrospective, observational study included 274 patients; 96 and 178 patients underwent ARMA and ARMS, respectively. The primary outcome was subjective symptom improvement based on GERD questionnaire (GERDQ) scores. The secondary outcomes included changes in the presence of Barrett's esophagus, Los Angeles grade for reflux esophagitis, flap valve grade, and proton pump inhibitor withdrawal rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The ARMS group had higher baseline GERDQ scores (10.0 vs. 8.0, <i>P</i> &lt; 0.001) and a greater median postprocedure improvement than the ARMA group (4.0 vs. 2.0, <i>P</i> = 0.002), and even after propensity score matching adjustment, these findings remained. ARMS significantly improved reflux esophagitis compared with ARMA, with notable changes in Los Angeles grade (<i>P</i> &lt; 0.001) and flap valve grade scores (<i>P</i> &lt; 0.001). Improvement in Barrett's esophagus was comparable between the groups (<i>P</i> = 0.337), with resolution rates of 94.7% and 77.8% in the ARMS and ARMA groups, respectively. Compared with the ARMA group, the ARMS group experienced higher bleeding rates (<i>P</i> = 0.034), comparable stricture rates (<i>P</i> = 0.957), and more proton pump inhibitor withdrawals (<i>P</i> = 0.008).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both ARMS and ARMA showed improvements in GERDQ scores, endoscopic esophagitis, flap valve grade, and the presence of Barrett's esophagus after the procedures. However, ARMS demonstrated better outcomes than ARMA in terms of both subjective and objective indicators.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1328-1337"},"PeriodicalIF":5.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141530278","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":"Effective use of the two-devices-in-one-channel technique for stent exchange following endoscopic ultrasound-guided hepaticogastrostomy","authors":"Yasuhiro Kuraishi,&nbsp;Ichitaro Horiuchi,&nbsp;Akira Nakamura","doi":"10.1111/den.14875","DOIUrl":"10.1111/den.14875","url":null,"abstract":"<p>Plastic stent (PS) exchange after endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is considered a routine procedure. However, when biliary access through the existing fistula is lost, additional fistuloplasty is required to restore drainage. Guidewire insertion alongside the existing PS before removal is therefore recommended to maintain access and prevent this complication.<span>¹</span> The two-devices-in-one-channel technique is effective for trans-papillary biliary cannulation, particularly in cases involving juxtapapillary diverticulum.<span>^{2, 3}</span> We recently employed this approach in a challenging case of PS exchange post-EUS-HGS.</p><p>A 70-year-old man suffered acute cholangitis from choledochojejunal anastomotic stricture after extended cholecystectomy. Initial biliary drainage using balloon-assisted endoscopy failed because the scope could not reach the anastomosis, and percutaneous trans-hepatic biliary drainage (PTBD) was subsequently performed. To internalize biliary drainage, EUS-HGS was conducted by placing a 7F PS (ThroughPass TYPE IT; Gadelius Medical, Tokyo, Japan) into the left intrahepatic bile duct to remove the PTBD tube (Fig. 1). During the scheduled PS exchange using a duodenoscope (TJF-Q290V; Olympus, Tokyo, Japan), however, guidewire insertion into the bile duct alongside the stent proved challenging. The scope's position was distant from the fistula despite various manipulations, including air aspiration, and the steep downward angle of the PS further complicated guidewire insertion. We employed the two-devices-in-one-channel technique, inserting a tapered catheter (PR-110Q-1; Olympus) loaded with a 0.025 inch guidewire along with small biopsy forceps (FB45Q-1; Olympus) into the same scope channel (Fig. 2). The forceps grasped the proximal PS flange and pulled it towards the scope, allowing the scope to be positioned closer to the fistula and aligning the fistula axis with the catheter. This approach enabled successful guidewire insertion into the bile duct alongside the stent. After removing the existing PS and balloon dilating the anastomosis, a new PS was successfully placed (Video S1). The two-devices-in-one-channel technique demonstrated effectiveness in overcoming a significant challenge associated with PS exchange post-EUS-HGS.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 9","pages":"1056-1058"},"PeriodicalIF":5.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14875","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141510785","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 endoscopic retrieval of migrated biliary plastic stent via hepaticogastrostomy route using uneven double-lumen catheter and stent retriever","authors":"Shingo Hirai,&nbsp;Yoshinobu Okabe,&nbsp;Shinichiro Yoshioka","doi":"10.1111/den.14868","DOIUrl":"10.1111/den.14868","url":null,"abstract":"<p>Our patient was an 80-year-old man with dementia and a history of distal gastrectomy and Roux-en-Y reconstruction after gastric cancer. He developed cholangitis due to common bile duct stones for which transpapillary endoscopic treatment using short single-balloon enteroscopy was unsuccessful. Managing percutaneous transhepatic biliary drainage was difficult; therefore, we chose endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS). A guidewire (0.025 inch GW) tip was advanced into the duodenum via the HGS route, and the straight-type plastic stent (PS) migrated during its antegrade placement. Another antegrade straight-type PS (7F, 10 cm) was placed across the papilla, and a tapered tip and 4-fold-flanged single-pigtail bile duct stent for EUS inferior drainage<span>¹</span> (7F, 14 cm) were placed via the EUS-HGS route, and the cholangitis improved. At the family's request, the migrated PS was followed. Eleven months later, the patient developed acute cholangitis due to the PS obstruction. The obstructed stray PS causing cholangitis was to be retrieved by the HGS route (Video S1).<span>²</span> The GW was placed in the bile duct via the HGS route and the inside stent with thread was removed. Next, we attempted to retrieve the migrated PS using grasping and basket forceps via the same route; however, capturing the PS was extremely difficult (Fig. 1a). After the PS was moved to the papillary side using a balloon catheter, an uneven double-lumen catheter was placed in the bile duct via the HGS route and the GW was successfully inserted into the lumen of the migrated PS through the side hole of the catheter (Fig. 1b). Thereafter, we successfully recovered the PS using a Soehendra stent retriever (Cook Medical, Bloomington, IN) (Fig. 1c). Although it is often difficult to retrieve a migrated stent via the HGS route, the combined use of an uneven catheter and the Soehendra stent retriever<span>³</span> was successful in this case (Fig. 2).</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 8","pages":"959-960"},"PeriodicalIF":5.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14868","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141422081","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}