Digestive Endoscopy最新文献

{"title":"Lariat hooking method as an easy and quick preparation of clip-and-thread technique for endoscopic submucosal dissection","authors":"Satoshi Ono,&nbsp;Chinari Tanaka,&nbsp;Kazushi Fukagawa","doi":"10.1111/den.14913","DOIUrl":"10.1111/den.14913","url":null,"abstract":"<p>Endoscopic submucosal dissection (ESD) for neoplastic lesions of the gastrointestinal tract is widely accepted as a minimally invasive treatment. Against this backdrop, the effectiveness of countertraction in ESD has been reported for difficult cases, and among various devices, the threaded clip technique is frequently used as a simple and inexpensive method.<span>^1-3</span> However, ligating threads is a very detailed process and sometimes requires time and effort. In this report we describe an easy and quick way, the lariat hooking method (LHM), to ligate thread to the clip (Video S1). LHM requires only a reopenable clip with some gap between the arms (StellaClip; HOYA, Tokyo, Japan) and a thread tied in the lariat style. To attach the thread to the clip, insert the clip into the lariat, open the clip, hook the proximal thread between the arms of the clip, and close the clip lightly (Fig. 1). After these procedures, grasp the edge of the lesion using the clip tied to the thread and release the clip as usual. The advantage of this method is not only its simplicity, but also the reliability that the thread is firmly ligated directly to the main body of the clip, not the clip arm. When a thread is ligated to the arm of a clip as a conventional method, the traction force to pull the thread is transmitted to only one arm of the clip, resulting in the clip acting in the direction of opening, sometimes causing the clip to come off. However, LHM applies traction force in the same direction as the direction of the clip, allowing the lesion to be tensioned more consistently (Fig. 2). Thus, LHM is considered to be an effective method to prepare the clip-and-thread in a short time and at the same time to perform ESD with stable countertraction.</p><p>Authors received samples of re-openable clips from HOYA Corp. C.T. is employed by HOYA Corp.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1382-1383"},"PeriodicalIF":5.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14913","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115606","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":"Risk-scoring system predicting need for hospital-specific interventional care after peroral endoscopic myotomy","authors":"Hirofumi Abe,&nbsp;Shinwa Tanaka,&nbsp;Hiroya Sakaguchi,&nbsp;Chise Ueda,&nbsp;Hitomi Hori,&nbsp;Tatsuya Nakai,&nbsp;Tetsuya Yoshizaki,&nbsp;Fumiaki Kawara,&nbsp;Takashi Toyonaga,&nbsp;Masato Kinoshita,&nbsp;Satoshi Urakami,&nbsp;Shinya Hoki,&nbsp;Hiroshi Tanabe,&nbsp;Yuzo Kodama","doi":"10.1111/den.14909","DOIUrl":"10.1111/den.14909","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Early identification of patients needing hospital-specific interventional care (HIC) following endoscopic treatment is valuable for optimizing postoperative hospital stays. We aimed to develop and validate a risk-scoring system for predicting HIC in patients who underwent peroral endoscopic myotomy (POEM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included patients with esophageal motility disorders who underwent POEM at our hospital between April 2015 and March 2023. HIC was defined as any of the following situations: fasting for gastrointestinal rest to manage adverse events (AEs); intravenous administration of medications such as antibiotics and blood transfusion; endoscopic, radiologic, and surgical interventions; intensive care unit management; or other life-threatening events. A risk-scoring system for predicting HIC after postoperative day (POD) 1 was developed using multivariable logistic regression and was internally validated using bootstrapping and decision curve analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 589 patients, 50 (8.5%) experienced HIC after POD1. Risk scores were assigned for four factors as follows: age (0 points for &lt;70 years, 1 point for 70–79 years, 2 points for ≥80 years), preoperative prognostic nutritional index (0 points for &gt;45, 1 point for 40–45, 4 points for &lt;40), postoperative surgical site AEs on second-look endoscopy (7 points), and postoperative pneumonia on chest radiography (6 points). The discriminative ability (concordance statistics, 0.85; 95% confidence interval, 0.78–0.91) and calibration (slope 1.00; 0.74–1.28) were satisfactory. The decision curve analysis demonstrated its clinical usefulness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This risk-scoring system can predict the HIC after POD1 and provide useful information for determining discharge.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"247-256"},"PeriodicalIF":5.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115607","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":"Endoscopic ultrasound-guided rendezvous techniques for difficult biliary cannulation: Technical review","authors":"Takuji Iwashita,&nbsp;Shinya Uemura,&nbsp;Ryuichi Tezuka,&nbsp;Akihiko Senju,&nbsp;Shota Iwata,&nbsp;Yosuke Ohashi,&nbsp;Masahito Shimizu","doi":"10.1111/den.14908","DOIUrl":"10.1111/den.14908","url":null,"abstract":"<p>Endoscopic retrograde cholangiopancreatography (ERCP) is the standard procedure for the diagnosis and treatment of biliary diseases. However, selective biliary cannulation, the essential first step in ERCP, can sometimes fail due to anatomical variations or technical limitations. In these cases, the endoscopic ultrasound-guided rendezvous technique (EUS-RV) offers a valuable salvage option. Nevertheless, it is crucial to be aware of potential adverse events associated with bile duct puncture. To optimize the success rate and safety of EUS-RV, understanding the basic techniques, technical tips for each procedural step, and troubleshooting strategies for potential difficulties is essential. This review article summarizes the clinical outcomes and technical considerations of EUS-RV, including a comprehensive analysis of the current evidence.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"68-76"},"PeriodicalIF":5.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14908","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082799","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 hand suturing has the potential to reduce bleeding after gastric endoscopic submucosal dissection in patients on antithrombotic agents: Multicenter phase II study","authors":"Osamu Goto,&nbsp;Yoshinori Morita,&nbsp;Hiroshi Takayama,&nbsp;Kingo Hirasawa,&nbsp;Chiko Sato,&nbsp;Tsuneo Oyama,&nbsp;Akiko Takahashi,&nbsp;Seiichiro Abe,&nbsp;Yutaka Saito,&nbsp;Hiroyuki Ono,&nbsp;Noboru Kawata,&nbsp;Toshiaki Otsuka,&nbsp;Katsuhiko Iwakiri","doi":"10.1111/den.14911","DOIUrl":"10.1111/den.14911","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The risk of postoperative bleeding is high after gastric endoscopic submucosal dissection (ESD) in patients continuously treated with antithrombotic agents (ATAs). The effectiveness of endoscopic hand suturing (EHS) on bleeding after gastric ESD was investigated in patients at high risk of delayed bleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with neoplasms ≤2 cm who underwent gastric ESD and continued to receive perioperative ATAs were enrolled in this multicenter phase II study. The mucosal defect was closed with EHS after removing the lesion. Postoperative bleeding rate was assessed for 3–4 postoperative weeks as a primary outcome measure. The technical success of EHS and adverse events were also assessed. Based on expected and threshold postoperative bleeding rates of 10% and 25%, respectively, we aimed to include 48 patients in the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 49 patients were enrolled in the study, and 43 patients were finally registered as the per-protocol set. The postoperative bleeding rate was 7.0% (3/43 patients; the upper limit of one-sided 95% confidence interval [CI], 17.1% and 97.5% CI, 19.1%). The upper limits of the CI were below the threshold value (25%), and the postoperative bleeding rate was below the expected value (10%). The technical EHS success rate, closure maintenance rate on postoperative day 3, and postoperative subclinical bleeding rate were 100%, 83%, and 2%, respectively. No severe adverse events related to EHS were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Endoscopic hand suturing may prevent postoperative bleeding in patients undergoing gastric ESD while being treated continuously with ATAs (UMIN000038140).</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"266-274"},"PeriodicalIF":5.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082798","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":"Impact of self-expanding metal stents on long-term survival outcomes as a bridge to surgery in patients with colon cancer obstruction: Current state and future prospects","authors":"Hao-Yu Zhang,&nbsp;Zhen-Jun Wang,&nbsp;Jia-Gang Han","doi":"10.1111/den.14905","DOIUrl":"10.1111/den.14905","url":null,"abstract":"<p>Since self-expanding metal stents (SEMS) were first introduced in acute colon cancer obstruction, the increased rate of primary anastomosis and improved quality of life following SEMS placement have been clearly shown. However, it was demonstrated that SEMS are associated with higher recurrence rates. Although several trials have shown that overall and disease-free survival in patients following SEMS placement is similar with patients undergoing emergency surgery, obstruction and a high incidence of recurrence imposed many concerns. The optimal time interval from SEMS to surgery is still a matter of debate. Some studies have recommended a time interval of ~2 weeks between SEMS insertion and elective surgery. A prolonged interval of time from SEMS insertion to elective surgery and the administration of neoadjuvant chemotherapy (NAC) has been proposed. SEMS-NAC might have advantages for improving the surgical and long-term survival outcomes of patients with acute colon cancer obstruction, which is an optional approach in the management of acute colon cancer obstruction.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1312-1327"},"PeriodicalIF":5.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074547","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":"Two-devices-in-one-channel method for minor papilla cannulation","authors":"Kiyoaki Ochi,&nbsp;Tsuneyoshi Ogawa,&nbsp;Toru Ueki","doi":"10.1111/den.14907","DOIUrl":"10.1111/den.14907","url":null,"abstract":"<p>Minor papilla cannulation is performed in patients with pancreas divisum and acute recurrent pancreatitis<span>¹</span>; however, it can be a technically challenging procedure.<span>²</span> We demonstrated the two-devices-in-one-channel method for minor papilla cannulation. A 50-year-old man was admitted to our hospital for recurrent pancreatitis. Pancreas divisum was suspected to be the cause of the recurrent pancreatitis. Subsequently, the patient underwent endoscopic treatment, during which a duodenoscope (model TJF 290 V; Olympus, Tokyo, Japan) was advanced to the minor duodenal papilla. We initially attempted wire-guided cannulation; we were unsuccessful because of the small size of the minor papilla, its loose fixation, and susceptibility to respiratory variability (Fig. 1). Therefore, we attempted minor papilla cannulation using the two-devices-in-one-channel method (Video S1). A slim catheter (model PR-110Q; Olympus), loaded with a 0.025 inch guidewire (Radifocus; Terumo, Tokyo, Japan) and small biopsy forceps (Radial Jaw4P; Boston Scientific, Marlborough, MA, USA) were inserted into the same channel of the duodenoscope. The forceps were then used to grasp the anal side of the minor papilla and pull it towards the scope to retract the catheter tip into the minor papilla. Following this procedure, we fixed the minor papilla and aligned the catheter with the pancreatic duct axis. After successful cannulation, sphincterotomy was performed, followed by the placement of a 7F, 5 cm pancreatic stent (Advanix; Boston Scientific). During the wire-guided cannulation, the endoscopist pushed the cannula with force, which can cause the pancreatic duct axis to bend easily if the minor papilla is inadequately fixed. However, using the two-devices-in-one-channel method and pulling the minor papilla toward the scope can help adjust the axis of the catheter to the pancreatic duct as it straightens the bend in the pancreatic duct. This method is, therefore, an effective technique not only for biliary cannulation<span>^{3, 4}</span> but also for minor papilla cannulation.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1290-1291"},"PeriodicalIF":5.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14907","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074548","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":"Response to “Randomized controlled trial of remimazolam compared with placebo in Japanese patients undergoing upper gastrointestinal endoscopy: Phase III investigator-initiated clinical trial”","authors":"Jae Yong Park","doi":"10.1111/den.14912","DOIUrl":"10.1111/den.14912","url":null,"abstract":"<p>In their multicenter randomized trial, Ichijima <i>et al</i>.<span>¹</span> demonstrated that remimazolam achieves significantly better sedation effect during upper gastrointestinal endoscopy than a placebo. However, using a placebo control is questionable, given remimazolam's established efficacy and the typically low placebo effect (&lt;5%). Using widely used sedatives as active comparators would have been more impactful; this limitation of study design reduces the impact of the research findings.</p><p>A recent meta-analysis reported propofol's superiority in terms of time to loss of consciousness and sedation success after the first dose, but with no differences in procedural outcomes.<span>²</span> Remimazolam had a better safety profile, showing lower risks of bradycardia, hypoxemia, and injection site pain. A Chinese study of 384 patients undergoing upper gastrointestinal endoscopy reported that the sedation success rate of remimazolam was noninferior to propofol (97.3% vs. 100%), with shorter time to full awakening and fewer circulatory and respiratory issues.<span>³</span></p><p>Considering the potential expansion of remimazolam use over traditional sedatives like midazolam, it is encouraging that studies targeting Asian populations are increasing, as pharmacodynamics and pharmacokinetics of benzodiazepine might vary by ethnicity or genetic polymorphism.<span>⁴</span> Metabolized by carboxylesterase 1, remimazolam exhibits dose-dependent sedative action and minimal tissue accumulation, largely independent of liver and kidney function. However, recent reports of re-sedation, delayed emergence, and anaphylaxis associated with remimazolam highlight the need for further research on carboxylesterase 1 polymorphism associations.<span>⁵</span></p><p>In conclusion, remimazolam, a new ultra-short-acting benzodiazepine, is notable for its rapid onset, efficacy, and safety, although recent discussions on adverse effects are emerging. Further studies are required to evaluate its efficacy and safety in prolonged sedation for therapeutic endoscopy. Additionally, research on its use in higher risk patients and the benefits of drug combinations with other sedative agents will greatly aid in standardizing its use in endoscopic procedures.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1280"},"PeriodicalIF":5.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14912","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019768","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":"Underwater detection and clipping using a reopenable clip with a long hood for colonic diverticular bleeding","authors":"Kazuya Miyaguchi,&nbsp;Yoshikazu Tsuzuki,&nbsp;Hiroyuki Imaeda","doi":"10.1111/den.14910","DOIUrl":"10.1111/den.14910","url":null,"abstract":"<p>There are multiple treatments available for diverticular hemorrhage.<span>¹</span> Endoscopic identification of stigmata of recent hemorrhage (SRH), especially visible vessels, is important but often difficult.<span>²</span> Exposed vessels are identified by aspirating the diverticulum with a long transparent hood and inverting it. However, some diverticula cannot be visualized inside and are inverted owing to inflammation when the exposed bleeding duct (SRH) is identified. The underwater method improves visibility. Using the opened-it-halfway reopenable clip method<span>³</span> enables hemostasis without inversion.</p><p>The patient, a 77-year-old man, presented with stable vital signs. Computed tomography revealed no obvious sources of bleeding. A colonoscopy (PCF 290TI; Olympus, Tokyo, Japan) with a long hood (MAJ663; Olympus Medical Systems, Tokyo, Japan) (tip protrusion length, 12 mm) was performed using the underwater method to identify the SRH (Fig. 1). Subsequently, we inserted a closed 8 mm SureClip (Micro-Tech, Nanjing, China), opened it halfway, deployed it into the diverticulum (Fig. 2), and performed clipping, successfully achieving hemostasis (Video S1). Other methods do not use a long hood and invert before clipping<span>⁴</span>; however, our method can be used in cases where inversion is impossible. Small diverticula or diverticula that cannot be inverted owing to inflammatory changes can be observed with underwater immersion.<span>⁵</span> When SRH was identified, a clip was inserted using the opened-it-halfway reopenable clip method, and clip hemostasis was performed. Initial avoidance of underwater procedures was due to potential significant bleeding and fecal masses in patients with diverticular hemorrhage. The use of a long hood offers the advantage of enclosing the diverticulum within the hood without a slit, enabling its observation using the magnification effect and fluid force offered by underwater immersion.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1380-1381"},"PeriodicalIF":5.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11638465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019769","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":"Does the timing of bowel preparation change the outcome of bowel cleansing?","authors":"Kinichi Hotta","doi":"10.1111/den.14904","DOIUrl":"10.1111/den.14904","url":null,"abstract":"&lt;p&gt;Bowel preparation is one of the most important quality indicators of colonoscopy, and it has been reported that adenoma detection and the incidence of postcolonoscopy colorectal cancer vary with the degree of bowel cleansing.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Previously, the standard bowel preparation for colonoscopy was a large dose of laxatives taken the day before the examination. Subsequently, it was proven that a portion of the laxative taken on the same day of the examination resulted in better bowel cleansing, better patient acceptability, and improved adenoma detection rate. This led to the recommendation of a split dose in current European Society of Gastrointestinal Endoscopy and the American Society for Gastrointestinal Endoscopy bowel prep guidelines.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In European countries and North America, performing colonoscopy in the morning has been established as a normal endoscopic procedure, starting with the initial day before and high-volume medications, and then moving to a split dose the day before and the same day of the colonoscopy. On the other hand, in Japan and other Asian countries, colonoscopy was mainly performed in the afternoon because upper gastrointestinal endoscopy for gastric cancer screening was widely performed. Since the development of bowel preparation methods, the full dose of laxatives was mainly administered on the morning of the day of colonoscopy because of the time available. Therefore, European guidelines recommend the same day, full-dose bowel preparation for afternoon colonoscopy. A meta-analysis of randomized controlled trials (RCTs) comparing a split-dose and nonsplit-dose regimen showed that the bowel cleansing was best within 3 h from the last dose to the examination, slightly worse at 4–5 h than at 3 h, and worst at &gt;5 h.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; These results were common regardless of the split-dose and nonsplit-dose regimen and the type of laxative. The longer the time between the end of laxative administration and the start of the examination has been shown to decrease the degree of bowel cleansing because of small bowel secretions and segment fecal material in the small bowel. European Society of Gastrointestinal Endoscopy guidelines recommend that laxative administration be completed within 5 h of the start of the examination.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; On the other hand, the American Society for Gastrointestinal Endoscopy guideline recommends that laxatives be administered between 3 and 8 h before the start of the examination, on the same day as the second regimen of a split dose. However, only observational studies have investigated the timing of laxative administration and the start of examination, and there is a lack of evidence from RCTs. In actual practice, there was a wide range in the recommended administration time, and a more reliable and appropriate time was required. In addition, it was necessary to consider the risk of vomiting or aspiration of laxatives remaini","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1355-1356"},"PeriodicalIF":5.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14904","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019767","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":"Recent progress and current status of pancreatobiliary interventional endoscopic ultrasound in children","authors":"Shigeto Ishii,&nbsp;Hiroyuki Isayama,&nbsp;Mitsuyoshi Suzuki,&nbsp;Hiroyuki Koga,&nbsp;Ko Tomishima,&nbsp;Toshio Fujisawa,&nbsp;Toshiaki Shimizu,&nbsp;Atsuyuki Yamataka","doi":"10.1111/den.14893","DOIUrl":"10.1111/den.14893","url":null,"abstract":"<p>In recent years, the usefulness of endoscopic ultrasound (EUS) has been recognized in children. A dedicated pediatric EUS scope has not been developed; in our experience, however, an adult EUS scope can be used. The American Society for Gastrointestinal Endoscopy Technical Committee status assessment report on pediatric endoscopy equipment provides some guidance on the feasibility of EUS according to body size. Careful monitoring is required, keeping in mind potential adverse events such as cervical esophageal perforation and unstable breathing due to tracheal compression. Most devices designed for interventional pancreatobiliary endoscopy are also available for children. Sedation or intubated general anesthesia (GA) is mandatory when performing interventional EUS (I-EUS). I-EUS for children is generally performed using GA in the operating room, but sedation in the endoscopy room is also possible under appropriate monitoring by pediatricians. I-EUS in the operating room is sometimes difficult for endoscopists to perform because of the unsuitable fluoroscopic imaging and the lack of familiar equipment and staff. Compared to GA, sedation in the endoscopy room facilitates easier and quicker repetition of procedures when necessary. Adult pancreatobiliary endoscopists perform most I-EUS procedures in the pediatric population because most pediatric endoscopists have few opportunities to perform EUS-related procedures and thus have difficulty maintaining their skills. To popularize I-EUS techniques for children, it will be necessary to establish a training program for developing pediatric endoscopists.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"53-67"},"PeriodicalIF":5.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14893","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006080","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}