Digestive Endoscopy最新文献

{"title":"EUS-Guided Versus Percutaneous Transhepatic Drainage of Liver Abscesses: A Multicenter Endohepatology Study in Western Japan (EPIC-LA Study)","authors":"Takeshi Ogura,&nbsp;Taira Kuroda,&nbsp;Takanori Matsuura,&nbsp;Jun Kitadai,&nbsp;Koh Kitagawa,&nbsp;Masahiro Itonaga,&nbsp;Kotaro Takeshita,&nbsp;Tomoaki Matsumori,&nbsp;Tomoya Emori,&nbsp;Mamoru Takenaka,&nbsp;Hajime Imai,&nbsp;Koichiro Mandai,&nbsp;Shuhei Shintani,&nbsp;Nao Fujimori,&nbsp;Hideyuki Shiomi,&nbsp;Masanori Asada,&nbsp;Ryota Sagami,&nbsp;Hirotsugu Maruyama,&nbsp;Tsukasa Ikeura,&nbsp;Masaaki Shimatani,&nbsp;Hidefumi Nishikiori,&nbsp;Kazuyuki Matsumoto,&nbsp;Masahito Kokubu,&nbsp;Hideki Kamada,&nbsp;Yusuke Ishida,&nbsp;Akitoshi Hakoda,&nbsp;Masayuki Kitano","doi":"10.1111/den.70067","DOIUrl":"10.1111/den.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Percutaneous transhepatic liver abscess drainage (PTAD) and endoscopic ultrasound-guided liver abscess drainage (EUS-LAD) have several limitations. Recently, because of technical improvements in echoendoscope maneuvers, EUS-guided access for the right hepatic lobe has been reported. The aim of this multicenter, retrospective study was to compare clinical outcomes of PTAD and EUS-LAD including the right hepatic lobe in West Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This retrospective, multicenter study included consecutive patients with liver abscesses between January 2019 and November 2024. The primary outcome in this study was the clinical success rate compared between EUS-LAD and PTAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the study period, 1012 consecutive patients developed liver abscesses. Of them, 734 patients were excluded, 43 underwent EUS-LAD and 235 patients underwent PTAD. After propensity score-matched analysis, the clinical success rate was significantly higher in the EUS-LAD group (97.7%, 42/43) than in the PTAD group (79.1%, 34/43) (<i>p</i> = 0.007). After a propensity score-matched analysis, 25 patients were included in each group. The clinical success rate was significantly higher in the EUS-LAD group (100%, 25/25) than in the PTAD group (84%, 21/25) (<i>p</i> = 0.037). Adverse events were also significantly higher in the PTAD group (16%, 5/25) than in the EUS-LAD group (<i>p</i> = 0.025). In addition, the median length of hospital stay was significantly shorter in the EUS-LAD group (15 days) than in the PTAD group (22 days) (<i>p</i> = 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EUS-LAD using a metal stent might be one of the options, but further randomized, controlled trials are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642968","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":"Therapy for cT1N0M0 Local Failure After Chemoradiotherapy: Evolution of ESD and PDT as Organ-Preserving Strategies","authors":"Yuichiro Ikebuchi,&nbsp;Hajime Isomoto","doi":"10.1111/den.70065","DOIUrl":"10.1111/den.70065","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589968","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":"Prevention of Delayed Bleeding in Endoscopic Papillectomy","authors":"Hiroki Kawashima","doi":"10.1111/den.70066","DOIUrl":"10.1111/den.70066","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544295","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":"Long-Term Outcomes Following Endoscopic Papillectomy for Ampullary Neuroendocrine Tumors","authors":"Yoonchan Lee,&nbsp;Dongwook Oh,&nbsp;Seung-Mo Hong,&nbsp;Sung Hyun Cho,&nbsp;Gunn Huh,&nbsp;Tae Jun Song,&nbsp;Dong-Wan Seo","doi":"10.1111/den.70064","DOIUrl":"10.1111/den.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The role of endoscopic papillectomy (EP) for ampullary neuroendocrine tumors (Amp-NETs) remains uncertain due to concerns regarding lymph node (LN) metastasis and recurrence. This study evaluated the long-term outcomes of EP for Amp-NETs, focusing on recurrence and procedural safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with histologically confirmed Amp-NETs who underwent EP at a single tertiary center between 2004 and 2018 were retrospectively reviewed. Inclusion criteria were tumor size &lt; 3 cm and absence of radiologic evidence of LN or distant metastasis. Outcomes assessed included recurrence, procedure-related adverse events, and recurrence-free survival (RFS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-four patients were included. En bloc resection was achieved in 33 patients (97.1%), while complete resection was achieved in 19 patients (55.9%). Over a median follow-up of 68.5 months, recurrence occurred in three patients (9.1%). All recurrences occurred exclusively in patients with positive resection margins (20%, 3/15), whereas no recurrence was observed in margin-negative patients (0%, 0/19). Early adverse events occurred in 13 patients (38.2%; bleeding <i>n</i> = 12, pancreatitis <i>n</i> = 3), while late adverse events developed in 4 patients (11.8%; papillary stricture), all of which were managed successfully with endoscopic treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EP is a safe and effective option for small, well-differentiated Amp-NETs without radiologic evidence of LN metastasis. Although the incomplete resection rate is concerning, the absence of recurrence in margin-negative patients supports EP as a viable treatment option in carefully selected cases. Patients with positive margins warrant close surveillance and consideration of additional surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544125","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":"Computer-Aided Diagnosis of Colorectal Polyps: Clinical Usefulness and Limitations","authors":"Kenneth Weicong Lin,&nbsp;Kwong Ming Fock,&nbsp;James Weiquan Li","doi":"10.1111/den.70056","DOIUrl":"10.1111/den.70056","url":null,"abstract":"<div>\u0000 \u0000 <p>Computer-aided diagnosis (CADx) systems have emerged as promising tools to support real-time optical characterization of colorectal polyps during colonoscopy. This narrative review critically evaluates their clinical utility and limitations, focusing on two key strategies: “resect and discard” and “leave in situ.” While CADx offers potential benefits, such as cost reduction, increased diagnostic consistency, and support for nonexpert endoscopists, its performance in clinical settings remains variable and often below established thresholds by societies like ESGE and ASGE. Key metrics such as positive predictive value, negative predictive value, sensitivity, and specificity fluctuate widely across studies and CADx platforms, influenced by system training data, disease prevalence, and human–AI interactions. Importantly, trust and explainability issues hinder adoption, with studies revealing underutilization of accurate CADx predictions due to clinician skepticism. Additionally, CADx systems struggle to reliably differentiate sessile serrated lesions from hyperplastic polyps, partly due to limitations in histopathological ground truth and data set representation. Cost-effectiveness analyses show promise, but practical implementation is challenged by equipment, regulatory, and training costs. Finally, emerging applications of CADx in predicting invasion depth in colorectal cancer show potential but require more robust validation. Overall, while CADx technologies may enhance diagnostic confidence and aid decision-making, especially for less experienced endoscopists, their widespread clinical integration depends on addressing human–AI interaction challenges, improving system transparency, and refining models to include underrepresented lesion types.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544205","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":"Tumor Ingrowth Through Covered Multihole SEMS: A Rare but Important Event","authors":"Kengo Matsumoto,&nbsp;Masashi Yamamoto,&nbsp;Tsutomu Nishida","doi":"10.1111/den.70058","DOIUrl":"10.1111/den.70058","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WEO Newsletter: Green Endoscopy: The Time to Act is Now","authors":"","doi":"10.1111/den.70059","DOIUrl":"https://doi.org/10.1111/den.70059","url":null,"abstract":"&lt;p&gt;WEO Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES&lt;/p&gt;&lt;p&gt;Gregory P. Capelli, DO, MBA; Nalini M. Guda, MD, FACG, FJGES,AGAF, MASGE&lt;/p&gt;&lt;p&gt;Healthcare is a significant source of greenhouse gas emissions and waste. In the United States alone, healthcare is responsible for approximately 8.5% of national greenhouse gas output, with operating rooms and procedure-heavy specialties contributing disproportionately. Globally health care sector contributes to 4–5% of greenhouse gas emissions which is larger than the airline industry.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Endoscopic practice is both essential for patient care and resource-intensive, relying heavily on single-use consumables, high-energy reprocessing, and patient travel to specialized centers. As global attention shifts to sustainability, it is increasingly clear that gastrointestinal endoscopy practices have the responsibility to become more sustainable. Furthermore, reducing waste and optimizing energy use may produce meaningful cost savings as well.&lt;/p&gt;&lt;p&gt;Several studies have been conducted in the recent past that have attempted to quantify the environmental impact of routine endoscopic procedures. In a 2025 prospective study from India, investigators measured the carbon footprint of nearly 3900 procedures and found a mean emission of 38 kg CO₂e per case. Strikingly, over 83% of these emissions were attributed to patient travel, while the procedural component—supplies, energy, and reprocessing—accounted for only 6.5 kg CO₂e per procedure.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Other audits from Europe and North America corroborate that energy use, HVAC (Heating, Ventilation and Airconditioning) demands, and patient transportation are the primary sources of greenhouse gas emissions attributable to endoscopy. Meanwhile, disposable supplies and reprocessing remain secondary contributors.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Because much of the greenhouse emissions are attributable to patient travel, endoscopy units cannot meaningfully reduce their footprint without engaging broader health-system policies and urban transport infrastructure.&lt;/p&gt;&lt;p&gt;It is important to consider that the waste related to endoscopic procedures themselves is substantial. In a single colonoscopy, disposable plastics, gowns, packaging, and accessories can generate 2–3 kg of solid waste.&lt;span&gt;&lt;sup&gt;4, 6&lt;/sup&gt;&lt;/span&gt; Life-cycle assessments consistently demonstrate that reusable endoscopes and accessories generally outperform single-use alternatives in terms of carbon emissions, provided that reprocessing is efficient and infection-control protocols are followed.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; However, the use of single-use duodenoscopes and caps, driven by infection concerns, continues to expand. This balance between sustainability and infection control will be a defining challenge for the next decade of practice.&lt;/p&gt;&lt;p&gt;Considering these concerns, several societies across the world have issued consensus statements and frameworks. Th","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 11","pages":"1254-1256"},"PeriodicalIF":4.7,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450011","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 Removal of Entrapped Grasping Forceps by Over-The-Scope Clip After Duodenal Endoscopic Submucosal Dissection","authors":"Yuya Miyake,&nbsp;Takaaki Yoshikawa,&nbsp;Shujiro Yazumi","doi":"10.1111/den.70063","DOIUrl":"10.1111/den.70063","url":null,"abstract":"<p>A 74-year-old woman was admitted for endoscopic submucosal dissection (ESD) of a superficial non-ampullary duodenal epithelial tumor. Esophagogastroduodenoscopy revealed a 20-mm 0-IIc tumor in the second portion of the duodenum, 5-cm proximal to the major papilla (Figure 1a). Duodenal ESD achieved complete resection without perforation (Figure 1b). After resection, we attempted to suture the entire mucosal defect using an over-the-scope clip (OTSC; 100.31, Ovesco Endoscopy AG, Tübingen, Germany), grasping both sides of the remnant normal tissue with a Twin Grasper (200.44; Ovesco) (Video S1). However, incomplete traction during OTSC deployment resulted in accidental entrapment of the Twin Grasper (Figure 1c). The device could not be retracted into the channel. Therefore, the shaft was cut outside the endoscope with pliers and covered the remaining forceps with a 16-Fr nasogastric tube to prevent mucosal injury (Figure 1d).</p><p>The next day, a bipolar direct current (DC) cutter (remOVE system, Ovesco) was used to remove the device. The OTSC was divided into two fragments by applying direct current pulses at two opposing sites of the clip (Figure 2a,b). The fragments were safely retrieved from the duodenum using forceps (remOVE Grasper) and a distal attachment cap (remOVE SecureCap 12), included in the remOVE system. The remaining mucosal defect was closed with re-openable clips (Mantis Closure Device, M00521421, Boston Scientific, MA; SureClip eco, RO-CD26195, MC Medical, Tokyo, Japan) (Figure 2c). The patient was discharged on Day 8 after ESD without any further complications.</p><p>OTSC with a Twin Grasper is widely used for closure of large mucosal defects [<span>1, 2</span>]. However, if accidental entrapment occurs, retraction is almost impossible. Removal of OTSC with a bipolar cutting device has been reported to be effective and safe in several case series [<span>3, 4</span>]. This case demonstrates the effective and safe troubleshooting of Twin Grasper entrapment by OTSC, highlighting the utility of bipolar cutting devices.</p><p>Conceptualization: Yuya Miyake and Takaaki Yoshikawa. Investigation: Yuya Miyake. Methodology: Takaaki Yoshikawa. Resources: Takaaki Yoshikawa. Supervision: Takaaki Yoshikawa and Shujiro Yazumi. Visualization: Yuya Miyake. Writing – original draft: Yuya Miyake. Writing – review and editing: all authors.</p><p>The patient described in this case report provided informed consent for publication of the clinical information and images.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410916","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":"Submucosal Tunneling Technique With Full-Thickness Muscle Excision for the Management of a Descending Colon Subepithelial Lesion","authors":"Longbin Huang,&nbsp;Silin Huang,&nbsp;Suhuan Liao","doi":"10.1111/den.70061","DOIUrl":"10.1111/den.70061","url":null,"abstract":"<p>Subepithelial lesions (SELs) arising from the colonic muscularis propria are uncommon but clinically significant. With advancements in therapeutic endoscopy, endoscopic resection has become the preferred treatment approach. The submucosal tunneling endoscopic technique has gained increasing adoption owing to its distinct advantages, including an expanded operative space and enhanced visualization [<span>1-3</span>]. We report a case of a descending colon SEL that was successfully managed using the submucosal tunneling technique with complete full-thickness muscular resection.</p><p>A 59-year-old male was incidentally found to have a SEL in the descending colon, measuring approximately 25 mm in diameter (Figure 1a). Endoscopic ultrasound revealed a hypoechoic lesion originating from the muscularis propria with partial extraluminal extension (Figure 1b). The patient underwent endoscopic resection with tunneling technique (Video S1). Following mucosal incision and submucosal tunnel creation, the whitish tumor was clearly visualized (Figure 2a,b). During the procedure, the tumor was found to be firmly adherent to the muscularis propria layer, with no clear plane for dissection, which necessitated full-thickness muscle resection to achieve complete removal. The resultant linear mucosal defect allowed for effective endoscopic closure (Figure 2c,d). The patient fasted for 24 h and was discharged 4 days postoperatively without complications. The pathological results confirmed a leiomyoma.</p><p>The tunneling technique is a novel approach for SELs originating from the muscularis propria [<span>4</span>]. However, its application in the colon is technically demanding due to the organ's thin-walled structure, tortuous lumen, vigorous peristalsis, and prominent mucosal folds. Full-thickness resection in this setting further complicates luminal insufflation, impairing surgical field exposure and increasing the difficulty of anatomical delineation and precise suturing. The integration of tunneling with full-thickness excision offers distinct advantages, including preserved luminal distension and mucosal integrity, thereby optimizing visualization and suturing efficacy. This case marks the first successful application of this technique for a descending colon SEL, potentially expanding therapeutic options for such lesions.</p><p>Longbin Huang: conceptualization, writing original draft. Silin Huang: design of the work, data curation and visualization. Suhuan Liao: supervision, writing and editing, project administration. Final approval of the version to be published.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395648","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":"Salvage Transpapillary Biliary Drainage Using a Novel Device Delivery System via a PTBD-Guided Rendezvous Technique","authors":"Tomoyuki Tanaka,&nbsp;Yasuhiro Kuraishi,&nbsp;Takaya Oguchi","doi":"10.1111/den.70054","DOIUrl":"10.1111/den.70054","url":null,"abstract":"<p>The EndoSheather (Piolax, Kanagawa, Japan) is a novel device-delivery system composed of a tapered inner catheter and a wide outer sheath [<span>1</span>]. It accommodates instruments up to 1.9 mm in diameter to enable stricture dilation and passage of large-cup biopsy forceps, thereby facilitating mapping biopsies and troubleshooting procedures such as migrated stent retrieval [<span>2, 3</span>]. We herein describe the integration of the EndoSheather into a salvage percutaneous transhepatic biliary drainage-guided rendezvous (PTBD-RV) technique.</p><p>A 70-year-old man with a history of sigmoid colon neuroendocrine tumor resection suffered recurrent cholangitis secondary to malignant hilar bile duct stenosis from liver metastases (Figure 1). Tumor invasion had led to disconnection of the right anterior (Ba), right posterior (Bp) and left hepatic ducts. Plastic stents were placed in each segment, including one inserted into Segment 2 (B2).</p><p>Two years later, cholangitis recurred in Segment 3 (B3). Following unsuccessful transpapillary guidewire access, a PTBD catheter was temporarily placed in B3 for urgent drainage due to severe cholangitis (Figure 1D). Transpapillary drainage was subsequently attempted using PTBD-RV (Figure 2, Video S1).</p><p>The guidewire from the PTBD route failed to traverse the stricture into the duodenum but reached B2. Another guidewire was introduced into B2 via the transpapillary route, and the EndoSheather was advanced over this wire across the stricture. Large-cup biopsy forceps (Radial Jaw 4; Boston Scientific, MA, USA) were delivered through the sheath and grasped the PTBD guidewire in B2. The guidewire was withdrawn through the sheath to establish transpapillary access to B3. The tapered inner catheter enabled stricture traversal, while the wide-lumen sheath facilitated forceps guidance. Plastic stents were successfully placed in B3, B2, Bp, and Ba, completing drainage of all four ducts.</p><p>PTBD-RV is considered a salvage option for failed endoscopic retrograde cholangiopancreatography [<span>4</span>]. This case demonstrates the utility of the EndoSheather for complex malignant biliary strictures and transpapillary drainage [<span>5</span>].</p><p>Tomoyuki Tanaka wrote the manuscript. Yasuhiro Kuraishi co-wrote and reviewed the manuscript. Takaya Oguchi supervised the endoscopy and reviewed the manuscript.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395717","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}