Digestive Endoscopy最新文献

{"title":"Snare-assisted clipping method for closure of mucosal incision of gastric peroral endoscopic myotomy","authors":"Niroshan Muwanwella","doi":"10.1111/den.14930","DOIUrl":"10.1111/den.14930","url":null,"abstract":"<p>Gastric peroral endoscopic myotomy (G-POEM) is an emerging treatment modality for gastroparesis. This technique involves mucosal incision, submucosal tunneling, and pyloric myotomy followed by closure of the mucosal incision.</p><p>There are multiple closure methods described in the literature, including through-the-scope (TTS) clips,<span>¹</span> over-the-scope clips, and endoscopic suturing.<span>²</span> TTS clips are the easiest and most economical of the above methods. However, mucosal closure after G-POEM with TTS clips can by difficult due to the thicker gastric mucosa and widening of the mucosal entry site, resulting in difficulty of apposition of mucosal edges.</p><p>Clip and snare traction is well described in the literature to assist endoscopic submucosal dissection.<span>³</span> An internal traction method has been previously described for full-thickness mucosal defect closure.<span>⁴</span></p><p>I describe an adaptation of the above methods to assist clip deployment for mucosal closure.</p><p>Once the myotomy is complete, the scope is withdrawn and a snare is attached to the end of the scope by closing the snare over the distal attachment cap. Then the scope is reinserted and a TTS clip is closed just distal to the distal edge of the mucosal incision. Prior to full deployment of the clip, the snare is opened to disengage from the scope and closed over the stem of the clip.</p><p>The snare is then used to apply gentle traction to pull the mucosa upwards, creating a mucosal “tent.” The next clip is then deployed, closing the mucosal edges together. Another clip is then introduced through the channel and is used to transfer the snare to the stem of the last deployed clip. This process is repeated until the mucosal incision is completely closed. In this case, the final clip is deployed without the assistance of the snare.</p><p>This case illustrates a novel method of gastric mucosal incision closure using inexpensive, widely available devices.</p><p>Author declares no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Review Board: N/A.</p><p>Informed consent: Informed consent was obtained from the patient to publish deidentified endoscopic images and videos.</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":"36 12","pages":"1388"},"PeriodicalIF":5.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14930","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333703","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":"Comorbidity burden and outcomes of endoscopic ultrasound-guided treatment of pancreatic fluid collections: Multicenter study with nationwide data-based validation","authors":"Tsuyoshi Hamada,&nbsp;Atsuhiro Masuda,&nbsp;Nobuaki Michihata,&nbsp;Tomotaka Saito,&nbsp;Masahiro Tsujimae,&nbsp;Mamoru Takenaka,&nbsp;Shunsuke Omoto,&nbsp;Takuji Iwashita,&nbsp;Shinya Uemura,&nbsp;Shogo Ota,&nbsp;Hideyuki Shiomi,&nbsp;Toshio Fujisawa,&nbsp;Sho Takahashi,&nbsp;Saburo Matsubara,&nbsp;Kentaro Suda,&nbsp;Hiroki Matsui,&nbsp;Akinori Maruta,&nbsp;Kensaku Yoshida,&nbsp;Keisuke Iwata,&nbsp;Mitsuru Okuno,&nbsp;Nobuhiko Hayashi,&nbsp;Tsuyoshi Mukai,&nbsp;Kiyohide Fushimi,&nbsp;Ichiro Yasuda,&nbsp;Hiroyuki Isayama,&nbsp;Hideo Yasunaga,&nbsp;Yousuke Nakai,&nbsp;the WONDERFUL study group in Japan and collaborators","doi":"10.1111/den.14924","DOIUrl":"10.1111/den.14924","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The appropriate holistic management is mandatory for successful endoscopic ultrasound (EUS)-guided treatment of pancreatic fluid collections (PFCs). However, comorbidity status has not been fully examined in relation to clinical outcomes of this treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a multi-institutional cohort of 406 patients receiving EUS-guided treatment of PFCs in 2010–2020, we examined the associations of Charlson Comorbidity Index (CCI) with in-hospital mortality and other clinical outcomes. Multivariable logistic regression analysis was conducted with adjustment for potential confounders. The findings were validated using a Japanese nationwide inpatient database including 4053 patients treated at 486 hospitals in 2010–2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the clinical multi-institutional cohort, CCI was positively associated with the risk of in-hospital mortality (<i>P</i>_trend &lt; 0.001). Compared to patients with CCI = 0, patients with CCI of 1–2, 3–5, and ≥6 had adjusted odds ratios (95% confidence intervals) of 0.76 (0.22–2.54), 5.39 (1.74–16.7), and 8.77 (2.36–32.6), respectively. In the nationwide validation cohort, a similar positive association was observed; the corresponding odds ratios (95% confidence interval) were 1.21 (0.90–1.64), 1.52 (0.92–2.49), and 4.84 (2.63–8.88), respectively (<i>P</i>_trend &lt; 0.001). The association of higher CCI with longer length of stay was observed in the nationwide cohort (<i>P</i>_trend &lt; 0.001), but not in the clinical cohort (<i>P</i>_trend = 0.18). CCI was not associated with the risk of procedure-related adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher levels of CCI were associated with a higher risk of in-hospital mortality among patients receiving EUS-guided treatment of PFCs, suggesting the potential of CCI in stratifying the periprocedural mortality risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial registration</h3>\u0000 \u0000 <p>The research based on the clinical data from the WONDERFUL cohort was registered with UMIN-CTR (registration number UMIN000044130).</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"413-425"},"PeriodicalIF":5.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14924","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic ultrasound-guided vascular interventions","authors":"Atsushi Irisawa,&nbsp;Kazunori Nagashima,&nbsp;Akira Yamamiya,&nbsp;Yoko Abe,&nbsp;Takumi Maki,&nbsp;Ken Kashima,&nbsp;Yasuhito Kunogi,&nbsp;Koh Fukushi,&nbsp;Fumi Sakuma,&nbsp;Yasunori Inaba,&nbsp;Keiichi Tominaga","doi":"10.1111/den.14925","DOIUrl":"10.1111/den.14925","url":null,"abstract":"<p>With the recent development of interventional endoscopic ultrasound (EUS), EUS-guided vascular interventions have seen increased clinical and research focus. This modality can be used to diagnose portal hypertension and treat portal hypertension-related gastrointestinal varices and refractory gastrointestinal hemorrhage, including pseudoaneurysm. The vascular embolic materials used for treatment include tissue adhesives (cyanoacrylates), sclerosants, thrombin, and vascular embolic coils, all of which are associated with favorable results. The feasibility of EUS-guided procedures, including portal vein stenting and portosystemic shunt formation conventionally performed percutaneously and transvenously, has also been demonstrated, albeit in animal studies. As EUS-guided vascular intervention is a technique that may receive significant attention in the future, we provide a thorough review of the current evidence for its use.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"85-92"},"PeriodicalIF":5.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14925","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333702","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":"Phase concept: Novel dynamic endoscopic assessment of intramural antireflux mechanisms (with video)","authors":"Haruhiro Inoue,&nbsp;Mayo Tanabe,&nbsp;Yuto Shimamura,&nbsp;Kazuki Yamamoto,&nbsp;Yohei Nishikawa,&nbsp;Kei Ushikubo,&nbsp;Miyuki Iwasaki,&nbsp;Hidenori Tanaka,&nbsp;Ippei Tanaka,&nbsp;Kaori Owada,&nbsp;Satoshi Abiko,&nbsp;Manabu Onimaru,&nbsp;Stefan Seewald","doi":"10.1111/den.14922","DOIUrl":"10.1111/den.14922","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The gastroesophageal junction (GEJ) consists of various anatomical components that together form a barrier to prevent reflux of gastric content. This study introduces a novel phase concept to dynamically evaluate the antireflux barrier (ARB) during endoscopy and analyzes its functionality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed previously the recorded endoscopic videos of subjects who underwent the endoscopic pressure study integrated system (EPSIS) from February to April 2024 for indications other than gastroesophageal reflux disease symptoms. This device was used as an auxiliary tool to measure intragastric pressure (IGP) during endoscopy with a retroflex view. The ARB dynamic was divided into three phases: Phase I (gastric phase), Phase II (lower esophageal sphincter phase), and Phase III (esophageal clearance phase). We evaluated the morphological changes in the ARB during insufflation using EPSIS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age of the 30 subjects was 58 years (interquartile range [IQR] 46.5–68.8), including 20 men and 10 women. Endoscopic findings and IGPs were recorded during the three phases. In Phase I, at low IGP (median 6.75 mmHg), the gastroesophageal flap valve and longitudinal folds were observed in 80% of cases. In Phase II, at moderate IGP (median 11.8 mmHg), the scope holding sign was observed in 86.7%. In Phase III, at high IGP (median 19 mmHg) inducing belching, peristalsis was observed in 80% of cases with median recovery time of 5 s.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The phase concept provides a valuable framework for understanding the antireflux mechanism. Further research is needed to validate these findings in GEJ disorders and explore correlations with other modalities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"257-265"},"PeriodicalIF":5.0,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14922","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302453","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":"Failed endoscopic ultrasound-guided gallbladder drainage across the duodenal covered metallic stent salvaged by using a forward-viewing linear echoendoscope","authors":"Tesshin Ban,&nbsp;Yoshimasa Kubota,&nbsp;Takashi Joh","doi":"10.1111/den.14931","DOIUrl":"10.1111/den.14931","url":null,"abstract":"<p>Endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) has emerged as an alternative to standard percutaneous or transpapillary approaches in fragile patients with acute cholecystitis.<span>^1-3</span> Oblique-viewing linear endoscopic ultrasonography (OV-EUS) is used for biliary intervention. However, forward-viewing linear endoscopic ultrasonography (FV-EUS) is applied in certain settings.<span>^{4, 5}</span> Herein, we report salvaged EUS-GBD by using FV-EUS after failure of OV-EUS.</p><p>An 82-year-old man with clinical stage IV pancreatic cancer presented with severe vomiting and initially underwent implantation of a duodenal bulb-covered metallic stent. One week later, this patient underwent endoscopic ultrasonography-guided choledochoduodenostomy due to acute obstructive suppurative cholangitis without intrahepatic biliary dilation (Video S1). One month later, this patient developed antibiotic-refractory acute cholecystitis, which deteriorated into a pericholecystic abscess (Fig. 1). Prioritizing the internal drainage, we attempted EUS-GBD using OV-EUS (EG-580UT; Fujifilm, Tokyo, Japan). The gallbladder was depicted; however, the scope struggled to maneuver in the duodenal metallic stent, and a 19G lancet puncture needle could not advance from the scope channel into the gallbladder (Fig. 2a, Video S1). The following day, we retried EUS-GBD using FV-EUS (TGF-UC260J; Olympus, Tokyo, Japan), which quickly facilitated the gallbladder visualization, needle puncture, 0.025 inch hydrophilic guidewire advancement, electrocautery dilation (Cysto-Gastro-Sets; Endo-flex, Voerde, Germany), and a double-pigtailed plastic stent deployment (Advanix J, 7F, 7 cm; Boston Scientific, Marlborough, MA, USA) (Fig. 2b,c, Video S1). The clinical course was uneventful.</p><p>The maneuverability of the OV-EUS was limited inside the duodenal bulb stent. We needed to down-angle the scope steeply to depict the gallbladder, which obstructed the puncture needle. In this situation, FV-EUS in the long position easily depicted the gallbladder without an angle maneuver. In addition, all the devices showed excellent pushability and trackability, including the puncture needle, dilator, and gallbladder stent, because the target was located vertically in front of the long-positioned FV-EUS.<span>⁵</span></p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1389-1390"},"PeriodicalIF":5.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14931","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256012","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":"WEO Newsletter: ENDO 2024 was a great success! Thanks to all who participated","authors":"","doi":"10.1111/den.14920","DOIUrl":"https://doi.org/10.1111/den.14920","url":null,"abstract":"&lt;p&gt;Professor Hisao Tajiri, WEO and ENDO 2024 President made the following statement:&lt;/p&gt;&lt;p&gt;“ENDO 2024 had 3200 participants from all over the world despite the current medical strike happening in Korea, and we were able to have an intimate international exchange through many symposia, live demonstrations, hands-on courses, receptions, and so on. Many young doctors from developing countries in Asia also participated in the Congress. I believe that our WEO was instrumental in fulfilling its mission in terms of education for developing countries.&lt;/p&gt;&lt;p&gt;I sincerely appreciate the strong support of Prof Hoon Jai Chun, ENDO 2024 Congress Co-President and Prof Jong-Jae Park, President of KSGE [Korean Society of Gastrointestinal Endoscopy] and IDEN [International Digestive Endoscopy Network], and many other doctors involved in KSGE.&lt;/p&gt;&lt;p&gt;And I also thank organizing committee members of ENDO 2024, Dr. Jean-Francois Rey, Chair of the Steering Committee, Drs. Philip Chiu and Jong Ho Moon, Chair and Co-Chair of the Scientific Committee, Dr. Robert Hawes, Treasurer, Dr. Yutaka Saito, WEO Secretary General, colleagues in Japan, and all other organizing committee members including WEO office staff. I would like to express my sincere gratitude to all of them.&lt;/p&gt;&lt;p&gt;From Seoul, Korea, through the top experts of GI endoscopy, new insights and bright futures were brought to many endoscopists. I believe that the three-day program met the expectations of all gastroenterologists, endoscopists, and nurses who participated in ENDO 2024. The overwhelming response we have received from the participants, faculty, and industry alike is a great testament to the quality of the Congress and its high relevance to continuing education and to medical advancement; the initiation of both of those is part of WEO's mission, as well as maintaining the quality of endoscopic teaching.&lt;/p&gt;&lt;p&gt;Some highlights of ENDO 2024 included six outstanding live demonstrations and discussions from three international and three of the most advanced Korean centers, 22 hands-on training stations, 8 of WEO's best-established educational courses, 10 joint symposia with our global partners, 5 KSGE-IDEN sessions and 2 young endoscopist forums, 17 sessions presenting the ENDO 2024 best oral abstracts, and 23 innovative industry symposia.&lt;/p&gt;&lt;p&gt;ENDO 2024 was honored to host several distinguished educational lectures, by Joo Young Cho (Korea), Fabian Emura (Colombia), Ian Gralnek (Israel), and Nageshwar Reddy (India).&lt;/p&gt;&lt;p&gt;As is traditional at ENDO congresses, the learning track offered well-established WEO courses including the Advanced Diagnosis Endoscopy Course (ADEC), Colorectal Cancer Screening Committee meetings, WEO International School of Endoscopy (WISE) sessions, the Research Forum, Video Capsule Endoscopy (VCE) and High-Q courses. A Women in Endoscopy session was held for the first time, covering gender-related aspects of endoscopy. ENDO 2024 President Hisao Tajiri commemorated this as the last se","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 9","pages":"1062-1071"},"PeriodicalIF":5.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14920","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231066","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":"Feasibility and safety of endoscopic full-thickness resection for submucosal tumors in the upper gastrointestinal tract, including predominantly extraluminal submucosal tumors (with video)","authors":"Yingjie Guo,&nbsp;Fan Yin,&nbsp;Xingsi Qi,&nbsp;Peng Zhang,&nbsp;Xueguo Sun,&nbsp;Xueli Ding,&nbsp;Xiaoyu Li,&nbsp;Xue Jing,&nbsp;Yueping Jiang,&nbsp;Zibin Tian,&nbsp;Tao Mao","doi":"10.1111/den.14918","DOIUrl":"10.1111/den.14918","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic full-thickness resection (EFTR) for submucosal tumors (SMTs) has been technically challenging. This retrospective study aimed to evaluate the feasibility, safety, and efficacy of EFTR for upper gastrointestinal (GI) SMTs, including extraluminal lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively investigated 232 patients with SMTs who underwent EFTR from January 2014 to August 2023. Clinicopathologic characteristics, procedure-related parameters, adverse events (AEs), and follow-up outcomes were assessed in all patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The en-bloc resection and en-bloc with R0 resection rates were 98.7% and 96.1%, respectively. The average endoscopic tumor size measured 17.2 ± 8.7 mm, ranging from 6 to 50 mm. The resection time and suture time were 49.0 ± 19.4 min and 22.5 ± 11.6 min, respectively. In all, 39 lesions (16.8%) exhibited predominantly extraluminal growth. Gastrointestinal stromal tumors (GISTs) were the predominant pathology, accounting for 78.4% of the cases. Twenty-one patients (9.1%) encountered complications, including pneumothorax (1/232, 0.43%), hydrothorax (1/232, 0.43%), localized peritonitis (3/232, 1.29%), and fever (16/232, 6.9%). Although the incidence of postoperative fever was notably higher in the predominantly extraluminal group (7/39, 17.9%) compared to the predominantly intraluminal group (9/193, 4.7%, <i>P</i> = 0.008), there were no significant differences in outcomes of the EFTR procedure. No instances of recurrence were observed during the mean follow-up period of 3.7 ± 2.3 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EFTR was found to be feasible, safe, and effective for resecting upper GI SMTs, including lesions with predominantly extraluminal growth. Further validation in a prospective study is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"285-294"},"PeriodicalIF":5.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195510","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 gastrojejunostomy with wire endoscopic simplified technique: Move towards benign indications (with video)","authors":"Jean-Michel Gonzalez,&nbsp;Sohaib Ouazzani,&nbsp;Geoffroy Vanbiervliet,&nbsp;Mohamed Gasmi,&nbsp;Marc Barthet","doi":"10.1111/den.14895","DOIUrl":"10.1111/den.14895","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) is an alternative to duodenal stenting and surgical GJ (SGGJ) in malignant gastric outlet obstruction (MGOO). European Society of Gastrointestinal Endoscopy guidelines restricted EUS-GJ for MGOO only, because of misdeployment. The aim was to evaluate its outcomes focusing on benign indications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective study conducted from 2016 to 2023 in a tertiary center. Patients included had malignant or benign GOO indicated for EUS-GJ. Techniques were the direct approach until August 2021, and the wire endoscopic simplified technique (WEST) afterwards. The main objective was to compare outcomes in benign vs. MGOO. Secondary end-points were technical success, adverse events rates, and describing the evolution of techniques and indications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In all, 87 patients were included, 46 men, mean age 66 ± 16.2 years. Indications were malignant in 60.1% and benign in 39.1%. The EUS-GJ technique was direct in 33 patients (37.9%) and WEST in 54 (62.1%). No difference was found in terms of technical, clinical, or adverse events rates. The initial technical success rate was 88.5%. The final technical and clinical success rates were 96.6% and 94.25%, respectively. In the last year, benign exceeded malignant indications (70.4% vs. 29.6%, <i>P</i> &lt; 0.05). Seven misdeployments occurred, six being addressed with the rescue technique. The misdeployment rate was significantly decreased using the WEST approach compared to the direct one: 3.7% vs. 18% (<i>P</i> &lt; 0.05). The severe postoperative adverse events rate was 2.3%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrated similar outcomes of EUS-GJ between benign and MGOO, with a decreasing misdeployment rate (&lt;4%) applying WEST. This represents an additional step towards recommending EUS-GJ in benign indications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"167-175"},"PeriodicalIF":5.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14895","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195512","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":"Troubleshooting the migration of endoscopic ultrasound-guided pancreatic duct drainage stent to avoid repuncture","authors":"Kazuki Hama,&nbsp;Reina Tanaka,&nbsp;Takao Itoi","doi":"10.1111/den.14906","DOIUrl":"10.1111/den.14906","url":null,"abstract":"<p>Endoscopic ultrasound (EUS)-guided drainage effectively treats difficult transpapillary drainage.<span>^{1, 2}</span> However, EUS-guided pancreatic duct drainage (EUS-PD) is technically challenging, as repuncture should be avoided to prevent pancreatic fluid leakage; we describe a technique for EUS-PD stent migration that enables us to avoid repuncture (Video S1).<span>³</span> A 54-year-old woman, who underwent pancreaticoduodenectomy for pancreatic cancer, experienced recurrent cholangitis and pancreatic stones due to anastomotic stenosis. Endoscopic drainage using a single-balloon enteroscope (SIF-H290S; Olympus, Tokyo, Japan) was attempted, but identifying the pancreatic duct orifice was difficult. Therefore, EUS-PD was performed to secure the route for stone removal. A 19G needle (EZ shot 3 plus; Olympus) was used to puncture the dilated pancreatic duct at the tail. The drill dilator (Tornus ES; Olympus) could not pass the stone. A 4 mm dilating balloon (REN TYPE-IT; Kaneka, Osaka, Japan) was used. After adequate dilation, a 7Fr plastic stent (TYPE IT; Gadelius Medical, Tokyo, Japan) was deployed, but its tip failed to cross the stone and anastomosis, so the stent was placed in the main pancreatic duct proximal to the stone.<span>⁴</span> Vomiting and fever occurred postprocedure, and radiography revealed stent migration into the esophagus. However, computed tomography revealed the stent tip barely lodged in the pancreatic duct owing to the large flap. Therefore, using a side-viewing duodenoscope (TJF-260 V; Olympus), a guidewire (VisiGlide II; Olympus) was successfully inserted through the stent flap and guided into the jejunum. The stent was removed using forceps (Figs 1, 2). The tract and anastomotic site were sufficiently dilated using a drill dilator, and a 6 mm fully covered self-expandable metal stent (EGIS biliary stent, 6 × 10 mm; SB-Kawsumi, Kanagawa, Japan) was successfully placed. One month later, the stone was successfully removed by the EUS-PD route. A plastic stent has two large flaps at its tip, and even if it migrates, the flap may remain in the pancreas.</p><p>Author T.I. received honoraria for his lectures from Olympus and Boston Scientific. The other authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1288-1289"},"PeriodicalIF":5.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14906","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195514","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 clipping combined with cyanoacrylate injection vs. transjugular intrahepatic portosystemic shunt in the treatment of isolated gastric variceal bleeding: Randomized controlled trial","authors":"Jing Li,&nbsp;Zhaoyi Chen,&nbsp;Yaxian Kuai,&nbsp;Fumin Zhang,&nbsp;Huixian Li,&nbsp;Derun Kong","doi":"10.1111/den.14916","DOIUrl":"10.1111/den.14916","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Although the incidence of isolated gastric varices type 1 (IGV1) bleeding is low, the condition is highly dangerous and associated with high mortality, making its treatment challenging. We aimed to compare the safety and efficacy of endoscopic clipping combined with cyanoacrylate injection (EC-CYA) vs. transjugular intrahepatic portosystemic shunt (TIPS) in treating IGV1.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a single-center, randomized controlled trial, patients with IGV1 bleeding were randomly assigned to the EC-CYA group or TIPS group. The primary end-points were gastric variceal rebleeding rates and technical success. Secondary end-points included cumulative nonbleeding rates, mortality, and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 156 patients between January 2019 and April 2023 were selected and randomly assigned to the EC-CYA group (<i>n</i> = 76) and TIPS group (<i>n</i> = 80). The technical success rate was 100% for both groups. The rebleeding rates were 14.5% in the EC-CYA group and 8.8% in the TIPS group, showing no significant difference (<i>P</i> = 0.263). Kaplan–Meier analysis revealed that the cumulative nonbleeding rates at 6, 12, 24, and 36 months for the two groups lacked statistical significance (<i>P</i> = 0.344). Similarly, cumulative survival rates at 12, 24, and 36 months for the two groups were not statistically significant (<i>P</i> = 0.916). The bleeding rates from other causes were 13.2% and 6.3% for the respective groups, showing no significant difference (<i>P</i> = 0.144). No instances of ectopic embolism were observed in either group. The incidence of hepatic encephalopathy (HE) in the TIPS group was statistically higher than that in the EC-CYA group (<i>P</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Both groups are effective in controlling IGV1 bleeding. Notably, EC-CYA did not result in ectopic embolism, and the incidence of HE was lower than that observed with TIPS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"275-284"},"PeriodicalIF":5.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14916","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195511","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}