Digestive Endoscopy最新文献

{"title":"Corrigendum to “Consensus statements on endoscopic ultrasound-guided tissue acquisition. Guidelines from the Asian Endoscopic Ultrasound group”","authors":"","doi":"10.1111/den.14959","DOIUrl":"10.1111/den.14959","url":null,"abstract":"<p>Chong CC, Pittayanon R, Pausawasdi N, <i>et al</i>. Consensus statements on endoscopic ultrasound-guided tissue acquisition. Guidelines from the Asian Endoscopic Ultrasound Group. <i>Dig Endosc</i> 2024; <b>36</b>: 871–83.</p><p>In the FUNDING INFORMATION section, the project number is wrong. The correct one should be as follows:</p><p>“THIS PROJECT IS supported by the Health and Medical Research Fund (HMRF08190406).”</p><p>The authors apologize for this error and any inconvenience it may have caused.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 6","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14959","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549305","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":"Tip-in gel immersion endoscopic mucosal resection with partial submucosal injection for a superficial nonampullary duodenal epithelial tumor on the duodenal angulus","authors":"Tomohiro Shimada,&nbsp;Yoshihide Kanno,&nbsp;Kei Ito","doi":"10.1111/den.14939","DOIUrl":"10.1111/den.14939","url":null,"abstract":"<p>Superficial nonampullary duodenal epithelial tumors (SNADETs) located on the inner side of the duodenal angulus are challenging to visualize and snare due to the intestinal flexure.<span>¹</span> Here, we report a case where gel immersion endoscopic mucosal resection (EMR), supplemented with partial submucosal injection (PI) on the lesion's anal side only for better lesion visualization,<span>¹</span> and tip-in EMR,<span>¹</span> which is the snare tip is inserted into the submucosa and fixed, appeared beneficial for a SNADET located on the duodenal angulus (Figs 1,2; Video S1).</p><p>The patient was a 44-year-old woman with a 20 mm flat elevated lesion with the protruded component on the lesion's anal side located on the inner side of the inferior duodenal angulus. The visibility of the lesion's anal border was obscured by its protruded component and location, making it difficult to fix the snare tip position with underwater EMR. Thus, after filling the duodenum with a gel product (VISCOCLEAR; Otsuka Pharmaceuticals Factory, Tokyo, Japan), 8 mL of 0.4% sodium hyaluronate (MucoUp; Boston Scientific, Tokyo, Japan) with indigo carmine was partially injected on the lesion's anal side only, and the snare (SD-16U-1; Olympus, Tokyo, Japan) was deployed at the tip and fixed in the submucosa by tip-in at the same site. In this state, by pulling out the scope while opening the snare, and then strangulating, the lesion was resected en bloc using an electrosurgical unit (VIO300D; ERBE Electromedizin, Tuebingen, Germany; settings Endocut Q: effect, 2; duration, 2; interval, 2; forced coagulation, effect, 2; power, 20 W) without shifting the snare tip.</p><p>Although other resection methods may be considered for laterally spreading SNADETs much larger than 20 mm,<span>³</span> the combination of PI and the tip-in technique may enable simpler and more effective endoscopic resection, even for relatively large SNADETs (~20 mm) with poor visibility located on the inner side of the duodenal angulus.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"209-210"},"PeriodicalIF":5.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14939","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523765","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":"Water pressure method endoscopic submucosal dissection with clip traction for early gastric cancer with submucosal fibrosis","authors":"Ryosuke Ikeda,&nbsp;Hiroaki Kaneko,&nbsp;Shin Maeda","doi":"10.1111/den.14949","DOIUrl":"10.1111/den.14949","url":null,"abstract":"<p>Endoscopic submucosal dissection (ESD) is widely performed; however, difficult cases remain, and submucosal fibrosis is a risk factor for difficulty.<span>¹</span> Recently, the effectiveness of the clip traction and water pressure method (WPM) has been reported<span>^{2, 3}</span>; gastric ESD using WPM has also been reported.<span>^{4, 5}</span> We report a case of early gastric cancer with severe fibrosis that was successfully treated with WPM combined with clip traction (Video S1).</p><p>An 82-year-old man who had undergone curative resection of early gastric cancer on the anterior wall of the angulus 4 years ago was referred to our hospital with metachronous cancer adjacent to the ESD scar (Fig. 1a). ESD was performed under conscious sedation. A mucosal incision was performed using a dual knife and insulated-tip knife-2 (Olympus Medical Systems, Co., Tokyo, Japan); however, the anal side, which straddled the ESD scar, was poorly injected (Fig. 1b). After the mucosal incision, submucosal dissection was initiated from the anal side. However, severe fibrosis prevented sufficient formation of the mucosal flap, causing difficulty in visualizing the submucosal layer. Therefore, a small-caliber tip transparent hood (DH-28CR; Fujifilm, Tokyo, Japan) was attached and converted to underwater conditions. WPM temporarily visualized the submucosal layer; however, it was difficult to maintain (Fig. 2a,b). Hence, a clip (EZ clip, HX-610-090; Olympus Medical Systems, Co.) with a thread was attached to the mucosal flap adjacent to severe fibrosis because the fibrotic area had not sufficiently formed the mucosal flap for attaching the clip, allowing a clear view of the submucosal layer (Fig. 2c,d). We dissected the fibrotic submucosal layer and performed a curative en bloc resection with a negative margin.</p><p>WPM is useful for viewing the fibrotic submucosal layer; however, in this case, the combination of clip traction was more effective in maintaining the resection layer.</p><p>Authors declare no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Reviewer Board: N/A.</p><p>Informed Consent: Informed consent was obtained from the patient in this case report.</p><p>Registry and the Registration No. of the study/trial: N/A.</p><p>Animal Studies: N/A.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"304-305"},"PeriodicalIF":5.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14949","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514060","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 gallbladder drainage using a novel cholangioscope","authors":"Ryosuke Hamamura,&nbsp;Masanori Kobayashi,&nbsp;Ryuichi Okamoto","doi":"10.1111/den.14958","DOIUrl":"10.1111/den.14958","url":null,"abstract":"<p>A 73-year-old man, recently treated with stent-graft insertion for an abdominal aortic aneurysm, developed acute cholecystitis from gallstones in a preshock state (Fig. 1a). Cholecystectomy was deemed high risk, and percutaneous transhepatic gallbladder drainage (PTGBD) was planned but considered unsafe due to Chilaiditi syndrome. Therefore, endoscopic transpapillary gallbladder drainage (ETGBD) was conducted. However, the cystic duct could not be visualized on cholangiography despite meticulous guidewire exploration for ~10 min, failing to identify its bifurcation. We then attempted to locate the cystic duct using a novel cholangioscope with a cytology brush sheath, as previously reported for confirming residual bile duct stones.<span>¹</span> This method utilizes only the reusable complementary metal oxide semiconductor (CMOS) camera unit of an ultrathin cholangioscope (DRES Slim Scope; Japan Lifeline, priced at 300,000 yen for ~10 uses) which is passed through the brush lumen of a double-lumen bile duct cytology brush (CytoMaxII; Cook Japan, Tokyo, Japan) (Fig. 1b,c). By replacing the original sheath, which costs 39,000 yen, with the CytoMaxII priced at 12,000 yen, the cost of using the cholangioscope is reduced to 42,000 yen per procedure. Moreover, this method allows the sheath to function similarly to an endoscopic hood, enabling reliable exploration of the cystic duct bifurcation (Fig. 1d). With this method, it became possible to safely advance the guidewire into the gallbladder, ultimately allowing for the placement of an ETGBD tube (Fig. 1e, Video S1).</p><p>In cases where surgery or PTGBD is not feasible and ETGBD is necessary, inserting a guidewire into the cystic duct is essential but often challenging.<span>^{2, 3}</span> Using peroral cholangioscopy allows for safer and more reliable guidewire insertion compared to relying solely on X-ray images,<span>⁴</span> yet cholangioscopes are expensive and less accessible. Our method balances cost and reliability in challenging ETGBD situations and also holds various other possibilities.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"434-435"},"PeriodicalIF":5.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14958","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514056","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-assisted removal of an intrahepatic bile duct stone","authors":"Saburo Matsubara,&nbsp;Kentaro Suda,&nbsp;Sumiko Nagoshi","doi":"10.1111/den.14937","DOIUrl":"10.1111/den.14937","url":null,"abstract":"<p>A 41-year-old woman with a left hepatic duct stone underwent endoscopic retrograde cholangiography for stone extraction (Fig. 1a). An over-the-wire type 8 wire basket catheter (Medi-Globe GmbH, Rohrdorf, Germany) failed to catch the stone and rather pushed the stone deeper (Fig. 1b). Because several attempts for stone extraction with a sphincterotome or ultrafine balloon catheter (REN; Kaneka Medix, Osaka, Japan) were unsuccessful, endoscopic retrograde cholangiography combined with endoscopic ultrasound was planned instead of cholangioscopy unfit for nondilated ducts. In the second session, the stone in B2 was depicted from the stomach using a curved linear-array echoendoscope (EG-740UT; FUJIFILM, Tokyo, Japan). Following a puncture of B2 with a 22G needle (SonoTip Pro Control; Medi-Globe) and contrast injection (Fig. 2a), a 0.018 inch guidewire was inserted into the common bile duct. After insertion of a double lumen catheter with a 3.6F tip (Uneven Double Lumen Cannula; Piolax Medical Devices, Kanagawa, Japan) into B2 upstream of the stone, pushing the stone by the guidewire or saline through the second lumen of the catheter was attempted without success. Then an endoscopic introducer (EndoSheather; Piolax Medical Devices) composed of a tapered inner catheter and large-bore outer sheath was inserted into the bile duct upstream of the stone. After removal of the guidewire and inner catheter, the stone was successfully moved to the hilum by flushing with saline through the outer sheath (Fig. 2b). Stone removal was finally accomplished after changing the scope to a duodenoscope without adverse events (Fig. 2c; Video S1). Endoscopic removal of intrahepatic bile duct stones is often challenging because of the difficulty of advancing extraction devices beyond the stone.<span>¹</span> Although the use of a sphincterotome<span>²</span> or ultrafine balloon catheter<span>³</span> has been reported, they did not work in the present case. This endoscopic ultrasound-assisted procedure for left intrahepatic bile duct stones may be a useful option when transpapillary attempts have failed.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"204-205"},"PeriodicalIF":5.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14937","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514058","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":"Novel technique “short myotomy” during endoscopic submucosal dissection for a diverticulum-associated colonic lesion","authors":"Ryosuke Kobayashi,&nbsp;Kingo Hirasawa,&nbsp;Shin Maeda","doi":"10.1111/den.14941","DOIUrl":"10.1111/den.14941","url":null,"abstract":"<p>While endoscopic submucosal dissection (ESD) for colorectal tumors is widely accepted,<span>^{1, 2}</span> ESD for tumors involving a diverticulum is still challenging and associated with a high risk of perforation due to the absence of the muscularis propria. Additionally, during the procedure there is a risk of damage to the specimen or interruption of ESD, given an insufficient plane in the submucosal layer within the diverticulum. Therefore, we report the tips of ESD including the novel technique named “short myotomy” for a diverticulum-associated lesion to resolve this problem (Video S1, Fig. 1). The lesion was located on the dorsal side of the ascending colon. A procedure was performed with the patient under conscious sedation and using carbon dioxide insufflation. A small-caliber transparent hood (DH-29CR; Fujifilm, Tokyo, Japan) was attached to the tip of an endoscope, and a 1.5 mm Dual knife (KD650Q; Olympus, Tokyo, Japan) was the surgical device used. After completing the circumferential mucosal incision, a submucosal dissection was made. The water pressure technique was applied for dissecting the submucosa with the multiloop device.<span>^{3, 4}</span> When getting into the diverticulum, the dissection plane was narrow between the muscle layers and the specimen (Fig. 2a). Then, the incision of muscle layers in front of the diverticulum was made to create a dissection plane to go below the diverticulum (Fig. 2b,c). This short myotomy enabled the precise excision below the diverticulum (Fig. 2d). The lesion was resected in one piece without specimen damage. The ulcer bed including the diverticulum was completely closed with endoscopic clips. An abdominal computed tomography scan immediately after ESD showed no extraluminal air. The patient was discharged on postoperative day 3. The histopathological diagnosis indicated intramucosal cancer with negative margins. The short myotomy is a novel technique in addition to existing methods, which allows for secure ESD for complete resection and a time-saving procedure.</p><p>Authors declare no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Reviewer Board: This study was approved by the Ethics Committee of Yokohama City University Medical Center.</p><p>Informed Consent: N/A.</p><p>Registry and the Registration No. of the study/trial: N/A.</p><p>Animal Studies: N/A.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"211-213"},"PeriodicalIF":5.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14941","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514059","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":"Elevating standards: Training and quality metrics in interventional endoscopic ultrasound","authors":"Dongwook Oh,&nbsp;Tae Jun Song","doi":"10.1111/den.14947","DOIUrl":"10.1111/den.14947","url":null,"abstract":"&lt;p&gt;In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Miutescu and Dhir present an in-depth review of the training and quality indicators essential for proficiency in interventional endoscopic ultrasound (iEUS).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The transformation of EUS from a diagnostic tool to a therapeutic one necessitates specialized training to ensure efficacy and safety in various interventional procedures.&lt;/p&gt;&lt;p&gt;Performing iEUS procedures requires high technical skill and expertise. Therefore, selecting candidates with the appropriate background and qualities is crucial for advancing the field of iEUS. The selection of candidates should be based on a solid foundation in gastroenterology, demonstrated interest, and prior experience in endoscopic procedures.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; This foundational expertise is pivotal, as it allows candidates to transition more effectively into the complexities of iEUS.&lt;/p&gt;&lt;p&gt;Acquiring theoretical knowledge is a foundational step in training for iEUS. This phase encompasses a deep understanding of gastrointestinal and adjacent organ anatomy, pathology, and specific EUS techniques.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Trainees should be well-versed in using various echoendoscopes and EUS devices, which is critical for the practical interpretation and execution of procedures. A structured syllabus that includes simulation models and virtual reality enhances this theoretical foundation, enabling trainees to develop the competence needed for advanced EUS procedures. Prior experience in diagnostic EUS and other imaging techniques, like transabdominal ultrasonography, can significantly shorten the learning curve and enhance procedural proficiency.&lt;/p&gt;&lt;p&gt;One of the critical challenges of training iEUS is the lack of standardization in training programs and quality metrics. The variability in training approaches across institutions can lead to inconsistencies in skill levels among practitioners, potentially impacting patient care. To address this, the authors advocate establishing universally accepted training standards and quality indicators. Such standardization would ensure that all practitioners meet the same high standards, leading to consistent and high-quality care globally. The average advanced endoscopy trainee needs a minimum of 225 EUS procedures to achieve core competence, with an ~50% greater number of procedures required in some cases.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; European Society of Gastrointestinal Endoscopy Guidelines recommend a minimum of 250 supervised EUS procedures, including specific numbers for different lesion types, to evaluate competence and key performance measures that should be recorded and evaluated.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; There are several proposed programs to accumulate practical knowledge in iEUS, including conferences, case studies with detailed procedural walkthroughs on various platforms, specialized online courses, World Endoscopy Organization's International School of EUS, and the Educational Program o","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"51-52"},"PeriodicalIF":5.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14947","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482277","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 gallbladder drainage using a novel sphincterotome","authors":"Takuya Ishikawa,&nbsp;Ryohei Kumano,&nbsp;Hiroki Kawashima","doi":"10.1111/den.14943","DOIUrl":"10.1111/den.14943","url":null,"abstract":"<p>Endoscopic transpapillary gallbladder drainage (ETGBD) has been reported as an option for patients for whom percutaneous transhepatic gallbladder drainage (PTGBD) or cholecystectomy is not indicated.<span>¹</span> Compared with PTGBD, ETGBD is expected to have a lower patient burden and a shorter hospital stay because of internal drainage. However, ETGBD is technically challenging, and some cases are difficult to treat. In particular, it has been reported that guidewire or catheter manipulation is difficult when the cystic duct branches are to the caudal side because of steep angulation.<span>²</span> We report a case of successful ETGBD using a novel sphincterotome (ENGETSU; Kaneka Medix Corporation, Osaka, Japan) (Video S1). The patient suffered from recurrent cholecystitis, and ETGBD was planned, but previous cholangiography during PTGBD revealed the cystic duct branching to the caudal side (Fig. 1). The ENGETSU is a newly developed rotatable sphincterotome with a wide range of motion that enables easy control of the tip compared to the conventional sphincterotome, which only has bending ability. A normal straight tip catheter was initially used to access the cystic duct, but it was unsuccessful because of the steep angle between the common bile duct and the cystic duct(Fig. 2a). A novel sphincterotome was then used to adjust the direction toward the cystic duct by bending and rotating the tip (Fig. 2b), and the guidewire was successfully advanced into the gallbladder (Fig. 2c). A 5F plastic stent dedicated for gallbladder drainage (IYO stent; Gadelius Medical K.K., Tokyo, Japan)<span>³</span> was placed (Fig. 2d), and purulent bile was drained immediately after stent placement. In this procedure, the main operator was a trainee, whereas the assistant was an expert, and one assistant could manipulate both the tip of the sphincterotome and guidewire. In conclusion, the novel sphincterotome, with its rotatable tip and wide range of motion, is useful in difficult ETGBD cases in which the cystic duct branches to the caudal side (Figs 1,2).</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"297-299"},"PeriodicalIF":5.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14943","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514057","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":"Afferent loop syndrome following pancreatic head cancer surgery treated with metal stent placement using a short-type single-balloon enteroscope","authors":"Noriyuki Hirakawa,&nbsp;Katsuya Kitamura,&nbsp;Takao Itoi","doi":"10.1111/den.14936","DOIUrl":"10.1111/den.14936","url":null,"abstract":"<p>Afferent loop syndrome is a rare complication that occurs following reconstructive intestinal tract surgery as a result of postoperative adhesions or peritoneal dissemination due to recurrence. Obstruction of the afferent loop can be fatal, and often requires surgical treatment. However, patients who develop afferent loop syndrome due to recurrence of malignancy are often in poor general health, making surgery invasive.<span>¹</span> With the development of balloon-assisted enteroscopy, there have been reports of these patients being treated endoscopically.<span>^2-5</span></p><p>The patient was a 74-year-old woman who underwent subtotal stomach-preserving pancreaticoduodenectomy for pancreatic head cancer. She was found to have multiple liver metastases on contrast-enhanced computed tomography (CT) 3 years after surgery. While receiving chemotherapy for recurrence of pancreatic head cancer, she presented with fever and abdominal pain. Contrast-enhanced CT led to a diagnosis of afferent loop syndrome caused by peritoneal dissemination. Conservative treatment was unsuccessful (Fig. 1a). Therefore, we decided to treat the afferent loop syndrome by drainage using a short-type single-balloon enteroscope (s-SBE) with a working channel diameter of 3.2 mm (SIF-H290S; Olympus Medical, Tokyo, Japan). We advanced the s-SBE and identified the stenotic area in the afferent loop. We traversed the stenosis with a catheter and guidewire, advancing the guidewire into the dilated bowel (Fig. 1b). In view of elevated inflammatory markers, a nasobiliary drainage tube was placed in the afferent loop (Fig. 2a). When the patient's condition improved, we placed a metal stent at the stricture site using the s-SBE. The s-SBE was advanced to the site of the stricture via the nasobiliary drainage tube. A 22 mm × 15 cm duodenal metal stent with a caliber of 3.0 mm (uncovered Niti-S stent; Taewoong Medical, Seoul, South Korea) was placed in the stenotic area, and patency was confirmed with contrast medium (Fig. 2b, Video S1). There were no postprocedural complications.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"202-203"},"PeriodicalIF":5.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14936","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482276","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":"Treatment outcomes and esophageal cancer incidence by disease type in achalasia patients undergoing peroral endoscopic myotomy: Retrospective study","authors":"Akio Shiwaku,&nbsp;Hironari Shiwaku,&nbsp;Hiroki Okada,&nbsp;Hiroshi Kusaba,&nbsp;Suguru Hasegawa","doi":"10.1111/den.14928","DOIUrl":"10.1111/den.14928","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This retrospective study aimed to compare treatment outcomes and postoperative courses, including the incidence of esophageal cancer (EC), according to disease types, in 450 achalasia patients who underwent peroral endoscopic myotomy (POEM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from consecutive POEM procedures performed from September 2011 to January 2023 at a single institution were reviewed. Achalasia was classified into straight (St), sigmoid (S1), and advanced sigmoid (S2) types using esophagography findings. Regarding efficacy, POEM was considered successful if the Eckardt score was ≤3. A statistical examination of the incidence and trend of EC occurrence across the disease type of achalasia was conducted using propensity score matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 450 patients, 349 were diagnosed with St, 80 with S1, and 21 with S2. POEM efficacy was 97.9% at 1 year and 94.2% at 2 years postprocedure, with no statistical difference between disease types. Using propensity score matching, the incidence of EC in each disease type was as follows: St, 1% (1/98); S1, 2.5% (2/77); S2, 10% (2/18). While no statistical significance was observed between St (1.0%: 1/98) and all sigmoid types (4.0%, 4/95; <i>P</i> = 0.3686). However, a trend test revealed a tendency for EC to occur more frequently in the order of S2, S1, and St type with a statistically significant difference (<i>P</i> = 0.0413).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Outcomes of POEM are favorable for all disease types. After POEM, it is important not only to monitor the improvement of achalasia symptoms but also to pay attention to the occurrence of EC, especially in patients with sigmoid-type achalasia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"376-390"},"PeriodicalIF":5.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482279","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}