Digestive Endoscopy最新文献

{"title":"EUS-Guided Gastroenterostomy for Malignant Gastric Outlet Obstruction: Morphological Classification to Prevent Stent Misdeployment","authors":"Yu-Ting Kuo,&nbsp;Chi-Ying Yang,&nbsp;Jiann-Hwa Chen,&nbsp;Szu-Chia Liao,&nbsp;Cheng-Lin Hsieh,&nbsp;Chia-Hsien Wu,&nbsp;Meng-Ying Lin,&nbsp;Chen-Shuan Chung,&nbsp;Kuan-Chih Chen,&nbsp;Mu-Hsien Lee,&nbsp;Hsiang-Yao Shih,&nbsp;Jung-Chun Lin,&nbsp;Cheuk-Kay Sun,&nbsp;Ming-Chang Tsai,&nbsp;Hsiu-Po Wang,&nbsp;the Taiwan EUS-GE Study Group (TEGESG)","doi":"10.1111/den.70235","DOIUrl":"https://doi.org/10.1111/den.70235","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Stent misdeployment is the most critical adverse event (AE) during endoscopic ultrasound-guided gastroenterostomy (EUS-GE). This study aimed to identify predictors of misdeployment in EUS-GE for malignant gastric outlet obstruction (mGOO).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter observational study utilized a prospectively maintained registry of consecutive patients undergoing EUS-GE for mGOO at 13 tertiary centers in Taiwan, with mixed retrospective-prospective assessment of fluoroscopic morphology (FM) of the gastrointestinal tract near the ligament of Treitz (four types) and EUS morphology (EM) of the target bowel (three types). The primary outcome was the misdeployment. Multivariable analysis identified predictors of misdeployment and survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between July 2020 and June 2025, 165 patients were enrolled. Technical and clinical success rates were 98.2% and 95.2%, respectively. Overall AE rate and misdeployment rates were 7.3% and 4.8%, respectively. Same-session endoscopic salvage succeeded in 87.5% of misdeployment cases. EM type C (cross-sectional bowel view) carried the highest misdeployment risk (33%) and was the sole independent predictor (adjusted odds ratio 16.9; <i>p</i> = 0.001). FM provided essential complementary risk stratification; FM type II was more common among misdeployment cases (25.0% vs. 3.8%; <i>p</i> = 0.030). Implementation of a stepwise strategy in 2023—prioritizing EM type A/B, avoiding type C, and minimizing stomach–bowel distance—resulted in zero misdeployment. Independent predictors of poor survival included pancreatic cancer, malnutrition, poor performance status, ascites, metastasis, and misdeployment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Stent misdeployment is a significant complication adversely impacting survival. Utilizing integrated EM and FM risk stratification within a stepwise strategy can minimize misdeployment and optimize clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov: NCT07230665</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70235","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467568","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":"Real-Time Endoscopic Visualization of Raynaud-Like Gastric Mucosal Microcirculatory Changes","authors":"Takumi Yanagita,&nbsp;Takuto Hikichi,&nbsp;Jun Nakamura","doi":"10.1111/den.70236","DOIUrl":"https://doi.org/10.1111/den.70236","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467182","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":"Reproducible Topographic Phenotypes and Three-Phase Anatomical Evolution of Gastric Intestinal Metaplasia","authors":"Chu-Po Chou,&nbsp;Chen-Tu Wu,&nbsp;Yih-Leong Chang,&nbsp;Feng-Pai Tsai,&nbsp;Shih-Chi Hu,&nbsp;Tzu-Min Yu,&nbsp;Chan-Yi Lin,&nbsp;Jyh-Ming Liou,&nbsp;Ming-Shiang Wu,&nbsp;Tzu-Chan Hong","doi":"10.1111/den.70238","DOIUrl":"https://doi.org/10.1111/den.70238","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) is used for risk stratification, it remains poorly defined whether gastric intestinal metaplasia (IM) follows reproducible anatomic patterns or has structured evolution. We hypothesized that IM progresses and regresses through ordered topographic states.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 3335 endoscopies with real-time EGGIM scoring (2022–2025). Topographic coherence was quantified by cosine similarity, while directional severity gradients by Spearman's correlation. Longitudinal trajectories were reconstructed in 486 patients with paired examinations (&gt; 6 months). Score changes were classified as low score-, mid score-, or high score-phase for endoscopic progression or regression, grouping five gastric sites into antrum, transitional zone, and corpus regions. Directionality was tested using paired Wilcoxon signed-rank tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Cross-sectionally, EGGIM score strata displayed highly reproducible topographic patterns (cosine similarity: 0.87–0.99), with a consistent antrum-to-corpus severity gradient (Spearman's ρ: 0.73). These patterns defined three phenotypes: antral-dominant, transitional, and corpus-involving. Longitudinally, endoscopic progression and regression of IM followed a mirrored anatomical pathway across these phenotypes. Antral changes dominated low-score progression and regression (<i>p</i> &lt; 0.001). Mid-score evolution involved parallel antral and transitional zone changes (<i>p</i> &lt; 0.001). High-score regression manifested as corpus score reduction (<i>p</i> &lt; 0.001). High-score progression was infrequent and showed a non-significant trend toward corpus score progression (<i>p</i> = 0.063).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Gastric IM exhibits reproducible topographic phenotypes, and both cross-sectional and longitudinal findings support a three-phase anatomical framework from the antrum through the transitional zone to the corpus.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467183","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":"Risk of Postoperative Bleeding in Esophageal Endoscopic Submucosal Dissection for Squamous Cell Carcinoma in Patients on Antiplatelet Therapy: A Multicenter Retrospective Study in Japan","authors":"Ryosuke Hirai,&nbsp;Yoichi Yamamoto,&nbsp;Takeshi Yasuda,&nbsp;Takumi Yanagita,&nbsp;Taro Iwatsubo,&nbsp;Yasuhiro Tani,&nbsp;Shunsuke Yoshii,&nbsp;Yuhei Sakata,&nbsp;Hiroyoshi Iwagami,&nbsp;Takahito Nozaka,&nbsp;Takeshi Uozumi,&nbsp;Yuichi Masui,&nbsp;Jun Konishi,&nbsp;Kazuo Shiotsuki,&nbsp;Koyo Kido,&nbsp;Yuki Kano,&nbsp;Ken Ohata,&nbsp;Noriko Matsuura,&nbsp;Akira Dobashi,&nbsp;Yusuke Yoda,&nbsp;Saeko Kushida,&nbsp;Yoshinobu Yamamoto,&nbsp;Yuji Urabe,&nbsp;Toshiyuki Yoshio,&nbsp;Seiichiro Abe,&nbsp;Tomohiro Kadota,&nbsp;Kohei Takizawa,&nbsp;Tomonori Yano,&nbsp;Hiroyuki Ono","doi":"10.1111/den.70206","DOIUrl":"10.1111/den.70206","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Postendoscopic submucosal dissection (ESD) bleeding remains a critical concern in patients receiving antithrombotic therapy, yet the risk after esophageal ESD is poorly characterized. This multicenter retrospective study evaluated the incidence of post-ESD bleeding and thromboembolism in patients undergoing esophageal ESD while receiving antiplatelet therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 570 patients with esophageal squamous cell carcinoma treated with ESD while on antiplatelet therapy between 2017 and 2022 at 21 institutions in Japan. Patients were categorized into guideline-based discontinuation or continuation, excluding guideline-deviating discontinuation. The primary endpoint was the rate of post-ESD bleeding among thienopyridine users (monotherapy or dual antiplatelet therapy; DAPT) managed with guideline-based discontinuation. Secondary endpoints included bleeding rates according to antiplatelet regimen and thromboembolism incidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 154, 41, and 375 patients received thienopyridine monotherapy, DAPT, and aspirin monotherapy, respectively. Antiplatelet therapy was continued perioperatively in 32.5%, 31.7%, and 73.1% of these groups. Post-ESD bleeding rates were 2.3% (3/132) and 3.2% (2/63) for guideline-based discontinuation and continuation of thienopyridine users, respectively. Bleeding rates for discontinuation vs. continuation were 0% (0/101) vs. 0.7% (2/274) for aspirin monotherapy, 1.9% (2/104) vs. 4.0% (2/50) for thienopyridine monotherapy, and 3.6% (1/28) vs. 0% (0/13) for DAPT. Thromboembolism occurred in two patients, both receiving aspirin monotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A substantial number of patients underwent esophageal ESD while continuing antiplatelet therapy. These descriptive findings suggest a need for further evaluation of continued therapy in larger studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457616","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":"Risk Stratification to Optimize Colorectal Cancer Screening: Development and Validation of a Decision-Tree Model for Colonoscopy Prioritization","authors":"María Capilla-Lozano,&nbsp;Carmen Quiñones-Torrelo,&nbsp;Lucas Sebastián-Peris,&nbsp;José Miguel Carot-Sierra,&nbsp;Concepción Gómez-Medina,&nbsp;Inmaculada Lorca,&nbsp;Clara Alfaro-Cervelló,&nbsp;Pilar Aguilar,&nbsp;Susana Castán-Cameo,&nbsp;Silvia Gimeno-Martos,&nbsp;Marta Ponce-Romero,&nbsp;Isabel Pascual-Moreno,&nbsp;Arturo Carratalá-Calvo,&nbsp;Andrés Peña,&nbsp;David Martí-Aguado","doi":"10.1111/den.70224","DOIUrl":"10.1111/den.70224","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Fecal immunochemical test-based colorectal cancer screening is effective; however, colonoscopy demand exceeds endoscopy capacity. Delays in colonoscopy after a positive test reduce screening effectiveness. We developed and validated a decision-tree model to stratify colorectal cancer risk among individuals with a positive test to prioritize colonoscopy for those at highest risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective study including participants with a positive fecal immunochemical test referred for colonoscopy within a Spanish regional population-based screening program (2021–2024). Individuals were randomly assigned to derivation (65%) and validation (35%) cohorts using a stratified random split. Fecal hemoglobin concentration, clinical and laboratory data were collected to develop the decision-tree model. The primary outcomes were colorectal cancer and advanced-stage colorectal cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1773 participants were included. Colorectal cancer was detected in 97 participants (5.5%), including 25 cases (1.5%) with advanced-stage disease. The model stratified participants into low-, intermediate-, high-, and very high-risk groups. A progressive increase in the prevalence of colorectal cancer and advanced-stage disease was observed across risk groups in both cohorts (<i>p</i> &lt; 0.001). The very high-risk group (fecal hemoglobin &gt; 100 μg/g and &gt; 65 years) included 6.7% of participants, with colorectal cancer and advanced-stage prevalence of 21.8% and 7.6%, respectively. Prioritizing colonoscopy for this group yielded a number needed to scope of 4.6 for colorectal cancer and 13.2 for advanced-stage disease, both significantly lower than the current one-size-fits-all strategy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A decision-tree model was developed to stratify the risk of colorectal cancer and optimize endoscopic resources in screening programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70224","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457631","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 Submucosal Dissection Using a Finger-Assist Device","authors":"Mafu Tsunemi,&nbsp;Ippei Matsuzaki,&nbsp;Kiyokazu Nakajima","doi":"10.1111/den.70232","DOIUrl":"10.1111/den.70232","url":null,"abstract":"<p>Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) require precise control of insertion and withdrawal of treatment devices. Using the two-fingers method and the right pinkie maneuver allows the right hand to remain on the endoscope, ensuring a stable operative field [<span>1, 2</span>]. However, treatment devices are thin to pass through the forceps channel and are not ergonomically designed for finger manipulation or the two-fingers method. To address this, devices for simultaneous manipulation of an endoscope and a treatment device, automated device for insertion and transfer, and the “Nelaton Attachment” have been reported to facilitate handling [<span>3-5</span>].</p><p>We developed a novel reusable assistive device (Finger Assister; CASTEM Co. Ltd., Hiroshima, Japan) within Project ENGINE. The device weighs 6 g, measures 6 cm in length, and has a maximum diameter of 1.5 cm. This device can be easily attached or detached laterally to EMR snares and ESD knives, and features an ergonomic surface adaptable to various finger sizes (Figure 1). Between procedures, the device can be cleaned using a neutral or enzymatic detergent and is compatible with ethanol, sodium hypochlorite, and ortho-phthalaldehyde disinfectants.</p><p>The patient had a 30-mm laterally spreading tumor with fibrosis due to recurrence after ESD in the sigmoid colon. This assist device was attached to an ESD knife (Endosaber Yamashina Seiki Co. Ltd., Shiga, Japan). The device remained stable throughout the procedure, all manipulations were performed with the two-fingers method, and the procedure was safely completed within 30 min (Figure 2, Video 1).</p><p>The pathological diagnosis was superficially serrated adenoma, and the tumor was completely resected. The patient was discharged without adverse events.</p><p>Further studies should evaluate its effects on musculoskeletal disorders, procedural efficiency, and endoscopic training. Nevertheless, its reusable design offers cost and environmental advantages and could contribute to improving endoscopists' performance.</p><p>Mafu Tsunemi made substantial contributions to the conceptualization of the study. Ippei Matsuzaki and Kiyokazu Nakajima contributed substantially to the revision of the manuscript.</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>Informed consent was obtained from the patient.</p><p>The authors declare no conflicts of interest.</p><p>The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439106","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":"Predictors of Biliary Drainage Dysfunction Following EUS-Guided Gallbladder Drainage for Malignant Distal Biliary Obstruction: A Multicenter Retrospective Study","authors":"M. Goudot,&nbsp;D. Lorenzo,&nbsp;L. Caillo,&nbsp;J. Privat,&nbsp;S. Ouazana,&nbsp;S. Leblanc,&nbsp;B. Napoléon,&nbsp;J. Jacques,&nbsp;F. Moryoussef,&nbsp;J. F. Bourgaux,&nbsp;R. Gérard,&nbsp;C. Loras Alastruey,&nbsp;S. Bazaga,&nbsp;J. Daniel,&nbsp;J. Albouys,&nbsp;N. Williet,&nbsp;M. Schaefer,&nbsp;A. Benezech,&nbsp;M. Camus-Duboc,&nbsp;T. Wallenhorst,&nbsp;P. Mayer,&nbsp;J. Gornals,&nbsp;T. Mura,&nbsp;A. Debourdeau","doi":"10.1111/den.70211","DOIUrl":"10.1111/den.70211","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided gallbladder drainage is increasingly used for malignant distal biliary obstruction, yet predictors of drainage dysfunction remain unknown. This study aimed to identify clinical and procedural factors associated with dysfunction, clinical success, and morbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, international, multicenter cohort study included consecutive patients who underwent endoscopic ultrasound-guided gallbladder drainage with electrocautery-enhanced lumen-apposing metal stents for malignant distal biliary obstruction across 17 centers (March 2017–September 2024). The primary endpoint was biliary drainage dysfunction analyzed using Kaplan–Meier estimation and Cox regression. Secondary endpoints included predictors of clinical success and high-grade adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 166 patients were included. Technical and clinical success rates were 98.8% (164/166) and 82.9% (136/164), respectively. Among 146 patients in the survival analysis, 12-month biliary patency was 70.4%. Neither the access route (transgastric 68.5% vs. transduodenal 73.5%, <i>p</i> = 0.50) nor stent diameter (8, 10, or 15 mm; <i>p</i> = 0.82) influenced patency. Ascites was the only independent predictor of dysfunction (HR 2.45 [95% CI 1.17–5.13], <i>p</i> = 0.018). Endoscopic ultrasound-confirmed cystic duct patency was independently associated with clinical success (86.7% vs. 69.4%, OR 2.88 [95% CI 1.19–6.96], <i>p</i> = 0.019). The 15-mm stent was associated with fewer high-grade adverse events (14.3% vs. 32.9%, OR 0.31 [95% CI 0.14–0.69], <i>p</i> = 0.004) without affecting patency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this large multicenter series, neither access route nor stent diameter influenced biliary patency. Ascites was the sole independent predictor of dysfunction. A protective signal of 15 mm stents against high-grade morbidity warrants prospective confirmation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439137","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 and Safety of Balloon Endoscopy-Assisted Peroral Cholangiopancreatoscopy (POCPS) Using a Novel 9Fr Cholangioscope in Patients With Surgically Altered Anatomy: A Dual-Center Retrospective Study (With Video)","authors":"Haruka Toyonaga,&nbsp;Yuki Tanisaka,&nbsp;Makoto Masaki,&nbsp;Arata Oka,&nbsp;Akihiro Okita,&nbsp;Fumiya Osaki,&nbsp;Yoshiki Matsuno,&nbsp;Shoji Takayama,&nbsp;Hidetoshi Nakata,&nbsp;Takuya Takayama,&nbsp;Tatsuya Nakagawa,&nbsp;Masahiro Orino,&nbsp;Hironao Matsumoto,&nbsp;Ryosuke Hamamura,&nbsp;Ryuichi Watanabe,&nbsp;Suguru Ito,&nbsp;Akashi Fujita,&nbsp;Masafumi Mizuide,&nbsp;Shomei Ryozawa,&nbsp;Masaaki Shimatani","doi":"10.1111/den.70237","DOIUrl":"10.1111/den.70237","url":null,"abstract":"<div>\u0000 \u0000 <p>Peroral cholangiopancreatoscopy (POCPS) is established for diagnosis and treatment of pancreatobiliary diseases in patients with normal anatomy, but has been difficult to perform in patients with surgically altered anatomy (SAA) because conventional cholangioscope systems cannot pass through the working channel of balloon endoscopes. The novel 9Fr cholangioscope (eyeMAX 9Fr; Micro-Tech) has a 3.2-mm outer diameter, enabling passage through the 3.2-mm working channel of short-type balloon endoscopes and allowing through-the-channel POCPS during balloon endoscopy-assisted ERCP (BE-ERCP) without scope exchange. We retrospectively evaluated 38 consecutive BE-POCPS procedures using the eyeMAX 9Fr in patients with SAA at two tertiary centers in Japan. Indications included biliary stone (<i>n</i> = 31), pancreatobiliary stricture (<i>n</i> = 4), pancreatic stone (<i>n</i> = 1), cystic duct selection (<i>n</i> = 1), and migrated stent retrieval (<i>n</i> = 1). Technical success was achieved in all 38 cases (100%) across five reconstruction types using both single-balloon and double-balloon endoscopes. For lithotripsy (<i>n</i> = 32), stone fragmentation was successful in all cases, with single-session complete stone clearance in 53.1%. For stricture evaluation (<i>n</i> = 4), visual assessment–final diagnosis concordance was 75.0% (3/4) and biopsy adequacy rate was 75% (3/4); biopsy–final diagnosis concordance was 100% among adequate specimens (3/3). Adverse events occurred in three cases (7.9%), including lithotripsy-related bile duct mucosal injury/bleeding (<i>n</i> = 2), and scope-related small bowel perforation (<i>n</i> = 1). BE-POCPS using the eyeMAX 9Fr is a feasible and safe approach enabling direct visualization, targeted biopsy, and lithotripsy in SAA patients without scope exchange.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450832","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":"Unmasking the Distal Esophagogastric Junction—A Novel Endoscopic Esophago-Gastric Junction Phenotype and the Paradigm of Tailored Myotomy in Achalasia","authors":"Amol Bapaye","doi":"10.1111/den.70233","DOIUrl":"10.1111/den.70233","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439154","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":"Short-Type Balloon Dual-Functionable for Both Papillary Large Balloon Dilation and Stone Extraction","authors":"Naoki Fujita,&nbsp;Hideki Kamada,&nbsp;Hideki Kobara","doi":"10.1111/den.70230","DOIUrl":"10.1111/den.70230","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439170","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}