Digestive Endoscopy最新文献

{"title":"Visualizing Paneth Cell Metaplasia: A Novel Approach to UC Endoscopic Cancer Surveillance","authors":"Hirotake Sakuraba","doi":"10.1111/den.70234","DOIUrl":"10.1111/den.70234","url":null,"abstract":"<p>Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by diffuse inflammation extending from the rectum to the proximal colon. Chronic, persistent inflammation of the mucosa increases the risk of cancer development in UC patients. While remarkable advances in medical treatment have reduced the number of surgical cases due to refractory against medical treatments in recent years, the proportion of surgeries performed for cancer development has increased [<span>1</span>]. Endoscopic care, such as disease monitoring and endoscopic submucosal dissection, has become an increasingly important component of the comprehensive management of UC [<span>2</span>], particularly, surveillance for UC-associated neoplasia (UCAN) remains a significant challenge in current endoscopic practice. Despite the widespread adoption of technologies such as high-definition endoscopy, chromoendoscopy, and image-enhanced endoscopy (IEE), the detection and precise diagnosis of early-stage UCAN remains challenging [<span>3</span>]. The primary reason for this lies in the biological characteristics of UC-associated carcinogenesis. Specifically, UCAN develops against a background of chronically inflamed and remodeled mucosa, often presenting as flat lesions with indistinct borders, making detection difficult, even for endoscopy experts [<span>4</span>].</p><p>In this issue of <i>Digestive Endoscopy</i>, Tomioka et al. [<span>5</span>] reported on the ultra-low concentration crystal violet staining method, crystal violet staining for colitis-associated neoplasia (CV-SCAN), developed to endoscopically visualize Paneth cell metaplasia (PCM). This study represents an attempt to endoscopically capture the “precancerous mucosal field” beyond the detection of individual neoplastic lesions, which aligns well with the current understanding of UCAN pathogenesis. The value of this research lies not in prompting immediate clinical implementation but in expanding the concept of endoscopic surveillance.</p><p>UCAN arises through a dysplasia–carcinoma sequence with distinct molecular mechanisms from sporadic colorectal cancer through continuous inflammation. UCAN follows a molecularly distinct pathway, leading to poorly differentiated adenocarcinoma, and often arises within a multifocal precancerous mucosal background, making early detection critically important. In addition, early molecular alterations, such as p53 abnormalities, can occur even in endoscopically normal mucosa. Therefore, the diagnosis of early lesions in UCAN relies on the immunohistochemical evaluation of markers such as p53 and Ki-67.</p><p>Paneth cells are occasionally found in the cecum and proximal colon. However, the presence of Paneth cells in the distal colon is common in UC, indicating a long history of inflammation [<span>6</span>]. PCM has been noted as an indicator of mucosal remodeling due to chronic inflammation, associated with disease duration and cancer risk [<span>7</span>]; however","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439132","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":"Impact of Stent Type on Surgical Outcomes in Pancreatic Cancer Patients Undergoing Preoperative Biliary Drainage","authors":"Takashi Tamura,&nbsp;Tomoaki Matsumori,&nbsp;Yoshihiro Nishikawa,&nbsp;Koh Kitagawa,&nbsp;Minako Nagai,&nbsp;Atsushi Shimizu,&nbsp;Ippei Matsumoto,&nbsp;Atsuhiro Masuda,&nbsp;Arata Sakai,&nbsp;Takuo Yamai,&nbsp;Akira Tomokuni,&nbsp;Tsukasa Ikeura,&nbsp;Takashi Ito,&nbsp;Toshifumi Doi,&nbsp;Hayato Miyake,&nbsp;Hirotsugu Maruyama,&nbsp;Yuki Ishikawa-Kakiya,&nbsp;Takeshi Ogura,&nbsp;Saori Ueno,&nbsp;Hideyuki Shiomi,&nbsp;Akiko Tsujimoto,&nbsp;Shuhei Shintani,&nbsp;Tetsuya Ikeda,&nbsp;Yoshito Uenoyama,&nbsp;Tomoya Emori,&nbsp;Masaaki Shimatani,&nbsp;Keisuke Hanada,&nbsp;Masayuki Kitano,&nbsp;Mamoru Takenaka","doi":"10.1111/den.70229","DOIUrl":"10.1111/den.70229","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Metal (MS) or plastic stents (PS) are placed for preoperative biliary drainage (PBD) in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing neoadjuvant chemotherapy (NAC) or chemoradiotherapy (NACRT). This multicentre retrospective study compared the safety and efficacy of PBD using MS and PS, including surgery-related adverse events (AEs) and other clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study enrolled patients with resectable or borderline resectable PDAC requiring NAC or NACRT who underwent PBD with MS or PS at 17 tertiary care hospitals in Japan between January 2016 and December 2021. Clinical outcomes were retrospectively analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 249 patients who underwent pancreatectomy, 121 underwent PBD with MS and 128 with PS. Because there were significant differences in baseline characteristics between these groups, propensity score matching was performed, resulting in 66 matched pairs. The RBO rate was significantly lower (15.2% vs. 56.1%, <i>p</i> &lt; 0.001); the time to surgery (<i>p</i> = 0.027) and postoperative hospital stay (<i>p</i> = 0.036) were significantly shorter in the MS group. The incidence of postoperative AEs was significantly lower in the MS group (18.2% vs. 34.9%, <i>p</i> = 0.030) than in the PS group. Univariate and multivariate analyses identified the placement of an MS for PBD as an independent protective factor for postoperative AEs (odds rates: 0.35, <i>p</i> = 0.017).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with PDAC undergoing NAC or NACRT, MS placement for PBD was associated with lower rates of postoperative AEs and RBO than PS placement. MS is a more suitable option than PS for PBD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426956","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":"International Consensus Statements on Endoscopic Ultrasound-Guided Biliary Drainage: Results From the 1st JGES International in 2025","authors":"Takuji Iwashita,&nbsp;Shuntaro Mukai,&nbsp;Yousuke Nakai,&nbsp;Shomei Ryozawa,&nbsp;Akio Katanuma,&nbsp;Ichiro Yasuda,&nbsp;Atsushi Irisawa,&nbsp;Sang-Soo Lee,&nbsp;Jong Ho Moon,&nbsp;Hsui-Po Wang,&nbsp;Sundeep Lakhtakia,&nbsp;Marc Giovannini,&nbsp;Todd H. Baron,&nbsp;Takao Itoi","doi":"10.1111/den.70194","DOIUrl":"10.1111/den.70194","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>EUS-guided biliary drainage (EUS-BD) has evolved as an alternative to ERCP-BD for biliary obstruction, but its role as a primary drainage and its terminology have not been standardized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To establish an international consensus on the indications, techniques, and standardized terminology of EUS-BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To address these, an international consensus meeting was held during the 1st JGES International. Fourteen expert endoscopists from six countries participated in a structured Delphi process, reviewing evidence and voting on clinical questions related to EUS-BD indications, techniques, and terminology, particularly for unresectable malignant distal biliary obstruction (MDBO) and for biliary diseases in patients with surgically altered anatomy (SAA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For unresectable MDBO, EUS-BD was recognized as a safe and effective alternative to ERCP-BD, although it is not yet established as a standard first-line approach. It is an established salvage option after failed ERCP and may be considered as an upfront option in selected patients such as those with duodenal obstruction preventing access to the papilla. The choice between choledochoduodenostomy and hepaticogastrostomy varies among countries depending on device availability and expertise. In patients with SAA, EUS-BD showed higher technical success and shorter procedure time than balloon endoscopy–assisted ERCP, though either approach may be selected based on institutional and endoscopist experience. A unified terminology for interventional EUS is also proposed, including the concepts of anastomosis versus drainage and trans-ESCR (endosonographically created route) procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This consensus highlights the need for standardized global terminology and further trials to define the optimal role of EUS-BD for biliary diseases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70194","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426953","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":"Traction-Assisted ERCP for an Intradiverticular Papilla in a Patient With Surgically Altered Anatomy","authors":"Naoki Shiro,&nbsp;Haruka Toyonaga,&nbsp;Masaaki Shimatani","doi":"10.1111/den.70231","DOIUrl":"10.1111/den.70231","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426909","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 Submucosal Dissection Including the Minor Papilla for a Duodenal Laterally Spreading Tumor","authors":"Teppei Akimoto,&nbsp;Naohisa Yahagi,&nbsp;Motohiko Kato","doi":"10.1111/den.70218","DOIUrl":"10.1111/den.70218","url":null,"abstract":"&lt;p&gt;Duodenal endoscopic submucosal dissection (ESD) including the major papilla is complex because preservation of the pancreatic and biliary ducts is essential [&lt;span&gt;1&lt;/span&gt;]. In contrast, preservation of the accessory pancreatic duct may not be necessary in patients without pancreatic divisum [&lt;span&gt;2&lt;/span&gt;]. However, resection of the minor papilla in patients with pancreatic divisum carries a risk of severe acute pancreatitis [&lt;span&gt;3&lt;/span&gt;]. Furthermore, because of its small size, the minor papilla is often difficult to identify preoperatively, making it challenging to determine whether resection will be required in large lesions undergoing ESD.&lt;/p&gt;&lt;p&gt;We report the case of a 69-year-old woman with a 50-mm flat elevated lesion involving over half the circumference of the medial wall of the descending duodenum (Figure 1). A side-viewing endoscope showed a normal major papilla, while the minor papilla could not be identified. Magnetic resonance cholangiopancreatography (MRCP) showed a normally fused pancreatic ductal system, with the main pancreatic duct draining into the major papilla, indicating no pancreatic divisum (Video 1).&lt;/p&gt;&lt;p&gt;ESD was performed using the water pressure method [&lt;span&gt;4&lt;/span&gt;] as follows (Figure 2): (1) submucosal injection on the anal side, during which the minor papilla adjacent to the lesion was identified using a high-resolution therapeutic endoscope and the magnification effect of saline immersion and was subsequently included in the resection; (2) semicircumferential incision on the anal side; (3) oral-side injection and circumferential incision; (4) submucosal dissection; (5) identification and transection of the minor papilla; and (6) completion of resection. The mucosal defect was closed using the origami method [&lt;span&gt;5&lt;/span&gt;]. Resection and closure times were 97 and 16 min, respectively. No postoperative adverse events occurred (Video 2).&lt;/p&gt;&lt;p&gt;In this case without pancreatic divisum, ESD with minor papilla resection followed by closure was safely performed. When the minor papilla cannot be visualized during preoperative endoscopy, MRCP may facilitate procedural planning by clarifying pancreatic duct anatomy in selected lesions near the major papilla.&lt;/p&gt;&lt;p&gt;Conceptualization: N.Y. Methodology, writing – review and editing: N.Y. and M.K. Investigation, data curation, writing – original draft: T.A. Supervision and project administration: T.A. All authors have read and approved the final manuscript.&lt;/p&gt;&lt;p&gt;The authors have nothing to report.&lt;/p&gt;&lt;p&gt;T.A., N.Y., and M.K. serve as consultants and have received honoraria as paid speakers and support for meeting attendance; N.Y. receives royalties, and T.A. and M.K. have received research funding from Olympus Corporation. N.Y. and M.K. also serve as consultants and have received honoraria and support for meeting attendance from FUJIFILM Corporation. M.K. has additionally received research funding from the same company. N.Y. and M.K. have received honoraria as paid s","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70218","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426917","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 Full-Thickness Resection for Gastrointestinal Subepithelial and Epithelial Neoplasia: Current Status, Indications, and Technical and Oncological Challenges—A Multispecialty Perspective","authors":"Seiichiro Abe,&nbsp;Kenichiro Imai,&nbsp;Teppei Akimoto,&nbsp;Takashi Kanesaka,&nbsp;Yosuke Minoda,&nbsp;Noriko Nishiyama,&nbsp;Chiko Sato,&nbsp;Akira Ouchi,&nbsp;Hon Chi Yip,&nbsp;Takao Itoi,&nbsp;Mitsuhiro Fujishiro,&nbsp;Yutaka Saito","doi":"10.1111/den.70221","DOIUrl":"10.1111/den.70221","url":null,"abstract":"<p>Endoscopic full-thickness resection (EFTR) has emerged as a minimally invasive treatment for small gastrointestinal subepithelial neoplasms (SETs). In particular, the development of novel closure methods such as clip-line and various endoscopic suturing techniques has enabled the secure closure of any resultant defects. During the Advanced Therapeutic Endoscopy session at the Endoscopic Forum Japan 2025, we summarized the current status of EFTR for SETs and discussed future clinical applications for epithelial neoplasms from oncological and technical perspectives. Although predominantly documented in gastric subepithelial neoplasms, EFTR is also used to treat select esophageal, duodenal, and colorectal SETs. While extensively evaluated for gastric gastrointestinal stromal tumors (GISTs), relatively low R0 resection rates have limited its broader clinical adoption; however, the novel no-touch EFTR technique could overcome this challenge and facilitate the adoption of this procedure for small gastric GISTs. Applying EFTR to epithelial tumors requires strict assessment of oncological clearance, given the risks of lymph node metastasis and peritoneal seeding following full-thickness breaches. At the end of the session, we voted on the appropriateness of EFTR for epithelial neoplasms across different organs, balancing oncological risks against technical feasibility. All nine participants (100%) supported EFTR for rectal lesions, and eight (89%) supported its use for gastric lesions. Future investigations and technical innovations are required to expand the clinical indications for EFTR in epithelial neoplasms.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70221","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426950","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":"Clinical Outcomes of Endoscopic Full-Thickness Resection Versus Laparoscopic and Endoscopic Cooperative Surgery: A Propensity Score-Matched Comparative Study","authors":"Yoshiaki Ando,&nbsp;Noriya Uedo,&nbsp;Kenichiro Furukawa,&nbsp;Atsushi Sawada,&nbsp;Kingo Hirasawa,&nbsp;Atsuko Ohki,&nbsp;Hirohisa Takeuchi,&nbsp;Nobutsugu Abe,&nbsp;Yoshihiro Kuwabara,&nbsp;Kenji Kishimoto,&nbsp;Isao Myashiro,&nbsp;Hiroyuki Ono","doi":"10.1111/den.70225","DOIUrl":"10.1111/den.70225","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic full-thickness resection (EFTR) and laparoscopic and endoscopic cooperative surgery (LECS) are minimally invasive treatments for gastric submucosal tumors (SMTs). Because comparative data of both methods are lacking, we aimed to compare the clinical outcomes between EFTR and LECS for gastric SMT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter study included patients who underwent EFTR or LECS for gastric SMT in four Japanese institutions. A 1:1 propensity score matching (PSM) analysis was performed with a caliper width of 0.2. Covariates included age; sex; body mass index; history of abdominal surgery, cardiovascular disease, or cerebrovascular disease; comorbidities; smoking and drinking habits; antiplatelet and anticoagulant intake; along with tumor location, type, and size.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We enrolled 38 patients treated with EFTR and 59, with LECS. After PSM, 21 patients were selected. The histological R0 resection rate was comparable between EFTR and LECS before (95% vs. 100%) and after (91% vs. 100%) PSM. In the EFTR group, median operation time was shorter (93 min vs. 161 min, <i>p</i> &lt; 0.001), median numbers of attending doctors were fewer (5 vs. 3, <i>p</i> &lt; 0.001), with procedure (¥305,330 vs. ¥434,700, <i>p</i> = 0.017) and total hospitalization costs (¥676,400 vs. ¥861,420) lower than those in the LECS group after PSM. Adverse event rates were low (5% vs. 14%, <i>p</i> = 0.606) in both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EFTR and LECS provide efficacious oncological outcomes for patients with small (≤ 3 cm) intraluminal type gastric SMT. EFTR demonstrated favorable operative efficiency and economic outcomes, suggesting it may be a potentially cost-effective alternative.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400123","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":"Competing Mortality Redefines the Net Benefit of Additional Surgery After Endoscopic Resection for T1 Colorectal Cancer in Older Adults","authors":"Katsuro Ichimasa,&nbsp;Shin-ei Kudo,&nbsp;Yuta Kouyama,&nbsp;Taishi Okumura,&nbsp;Yasuharu Maeda,&nbsp;Takemasa Hayashi,&nbsp;Khay Guan Yeoh,&nbsp;Hideyuki Miyachi,&nbsp;Masashi Misawa","doi":"10.1111/den.70222","DOIUrl":"10.1111/den.70222","url":null,"abstract":"<p>The oncologic benefit of additional surgery after endoscopic resection (ER) for the treatment of T1 colorectal cancer (CRC) remains uncertain in older adults, because competing causes of mortality may attenuate the gain in survival. The proportion of patients aged ≥ 80 years has increased steadily, reflecting population aging. For patients with high-risk T1 CRC, the aim of additional bowel resection is to remove occult lymph node metastasis and reduce the risk of recurrence, and long-term studies have shown improvements in T1 CRC-related outcomes. However, age modifies the magnitude of this benefit. Cohort studies of high-risk T1 CRC have shown only small differences in 5-year cancer-specific survival between patients who underwent additional surgery and those who did not. Moreover, most deaths in the nonsurgical group were attributable to causes other than cancer. Data from meta-analyses have further suggested that the survival advantage associated with surgery becomes evident only after 10 years, indicating a substantial delay in its benefits. In contrast, the incidences of perioperative morbidity and short-term mortality increase with age and have immediate effects on prognosis. These findings indicate that the net survival benefit of additional surgery in older patients depends on the balance between the delayed oncologic benefit and the immediate treatment-related risks. Thus, although surgery remains appropriate for selected fit individuals, clinicians should consider the pathologic risk, frailty, comorbidity burden, and competing mortality of individual older patients with pT1 CRC in their decision-making to optimize outcomes.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70222","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383290","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 Management of Choledocholithiasis in the Elderly: Balancing Safety and Effectiveness in the Aging Era","authors":"Ryunosuke Hakuta,&nbsp;Ryota Nakabayashi,&nbsp;Nao Otsuka,&nbsp;Noriko Ishigaki,&nbsp;Yukiko Takayama,&nbsp;Yousuke Nakai","doi":"10.1111/den.70220","DOIUrl":"10.1111/den.70220","url":null,"abstract":"<div>\u0000 \u0000 <p>Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as a first-line treatment for bile duct stones in multiple guidelines. Although ERCP is an established and effective procedure, it is associated with early adverse events, particularly in elderly patients. Older individuals frequently have multiple comorbidities, are often treated with antithrombotic agents, and may have underlying oropharyngeal dysphagia, all of which increase the risk of complications such as bleeding, hypotension, and aspiration pneumonia. In addition, bile duct stones in elderly patients tend to be larger and more numerous, and the high prevalence of periampullary diverticula may limit the extent of endoscopic sphincterotomy, thereby prolonging procedure time and increasing procedural complexity. Recent evidence has also demonstrated an association between frailty and post-ERCP mortality. While definitive stent placement without stone extraction could be a treatment option, it should only be considered in very elderly patients with significant frailty and limited life expectancy since endoscopic stone removal reduces long-term biliary events and subsequent mortality. In patients with concomitant cholangitis, urgent biliary drainage reduces mortality regardless of severity. However, because elderly patients are at increased risk of periprocedural hypotension and aspiration pneumonia, urgent ERCP should be performed with careful monitoring and meticulous supportive management. In summary, treatment decisions should not be based solely on chronological age but should incorporate a comprehensive assessment of overall physical condition, including frailty.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378387","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 Reintervention Using a Slim Multi-Hole Covered Metal Stent After Endoscopic Ultrasound-Guided Hepaticogastrostomy","authors":"Ryo Sugiura,&nbsp;Katsuma Nakajima,&nbsp;Masaki Kuwatani","doi":"10.1111/den.70223","DOIUrl":"10.1111/den.70223","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 7","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378358","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}