Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"title":"International Survey Assessing Gender Disparities in Advanced Therapeutic Endoscopy","authors":"Katarzyna M. Pawlak ,&nbsp;Kareem Khalaf ,&nbsp;Erin Brennand ,&nbsp;Andrei Voiosu ,&nbsp;Theodor Voiosu ,&nbsp;Giulio Antonelli ,&nbsp;Sharan B. Malipatil ,&nbsp;Caleb Na ,&nbsp;Ahmed H. Mokhtar ,&nbsp;Balqis Alabdulkarim ,&nbsp;Maryam Mahjoob ,&nbsp;Arjun Kundra ,&nbsp;Jeanin van Hooft ,&nbsp;Uzma Siddiqui ,&nbsp;Roberta Maselli ,&nbsp;Jeffrey D. Mosko ,&nbsp;Jennifer Telford ,&nbsp;Nauzer Forbes ,&nbsp;Natalia Causada Calo","doi":"10.1016/j.tige.2025.250917","DOIUrl":"10.1016/j.tige.2025.250917","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Underrepresentation of women in advanced therapeutic endoscopy is a multifactorial issue. We aim to evaluate the concerns about fluoroscopy use across genders and assess its impact on the representation of women in advanced therapeutic endoscopy.</div></div><div><h3>METHODS</h3><div>An international survey was distributed in August of 2023 to endoscopic retrograde cholangiopancreatography (ERCP)–performing physicians. The primary outcome was the frequency of concerns related to fluoroscopy exposure. Secondary outcomes included the reasons or implication of these concerns. Subgroup analyses were performed across gender.</div></div><div><h3>RESULTS</h3><div>ERCP-performing physicians revealed a gender disparity in therapeutic endoscopy, with 72.8% male respondents and 27.2% female respondents. Most participants were staff (67.6%), predominantly men (70.6%). The average age was 38.2 years, with a median institutional ERCP volume of 550 cases. Awareness of fluoroscopy safety standards was 56.1%, but only 51.6% received formal training. Concerns about radiation included cancer risk (73.4%) and fertility (43.9%). Usage of protective equipment was inadequate: thyroid dosimeters (21.9% always used), pelvic dosimeters (13.1%), and leaded goggles (8.4%). Female respondents specifically noted delayed family planning (27.6%) and fear of working while pregnant (40.4%), whereas male respondents focused on general health risks. Additionally, 68.4% of institutions recorded fluoroscopy time, but only 56.1% reported dosimeter use.</div></div><div><h3>CONCLUSION</h3><div>Gender disparities in fluoroscopy exposure concerns warrant the need for improved training and safety standards to foster equity in therapeutic endoscopy. Addressing these issues through targeted education and policy changes will not only enhance awareness of radiation risks but also promote a more inclusive environment for both male and female practitioners.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 2","pages":"Article 250917"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Band Ligation With Sclerotherapy Versus Milligan–Morgan Hemorrhoidectomy for the Treatment of Mixed Hemorrhoids","authors":"Minghua Ai ,&nbsp;Weizheng Wang ,&nbsp;Jie Li ,&nbsp;Xiaoping Tan ,&nbsp;Qing Zhang","doi":"10.1016/j.tige.2025.250914","DOIUrl":"10.1016/j.tige.2025.250914","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>To compare the clinical efficacy of endoscopic band ligation with sclerotherapy (EBS) with that of Milligan–Morgan hemorrhoidectomy (MMH) in the treatment of mixed hemorrhoids.</div></div><div><h3>METHODS</h3><div>This study was a retrospective, single-center investigation conducted at the First Hospital of Yangtze University. From September 2022 to March 2023, 46 patients who underwent EBS for mixed hemorrhoids were selected in an observation group, whereas 32 patients who underwent MMH for mixed hemorrhoids were allocated to a control group. Surgical-related parameters and adverse events were compared between the 2 groups, and the relationship between the number of endoscopic bands used and pain levels was analyzed.</div></div><div><h3>RESULTS</h3><div>The observation group demonstrated significantly shorter surgical and hospitalization durations than the control group (<em>P &lt;</em> 0.05). Furthermore, the 2 groups showed decreased postoperative visual analog scale scores, with the observation group exhibiting consistently lower scores at 24 hours, 48 hours, and 1 week postoperatively (<em>P &lt;</em> 0.05). Additionally, visual analog scale scores in the observation group at 4 hour postsurgery were correlated with the number of endoscopic ligation bands applied (<em>R</em>² = 0.1253; <em>P</em> = 0.0158). No significant differences in postoperative anal swelling, overall efficacy, or patient satisfaction were observed between the 2 groups (all <em>P &gt;</em> 0.05). However, the observation group experienced significantly less intraoperative (0% vs 84.4%; <em>P</em> = 0.000) and postoperative bleeding (6.5% vs 34.4%; <em>P</em> = 0.002) and a lower postoperative infection rate (0% vs 9.4%; <em>P</em> = 0.034) than the control group.</div></div><div><h3>CONCLUSION</h3><div>EBS provides clinical efficacy comparable with that of MMH in the treatment of mixed hemorrhoids. Moreover, the EBS approach is a potentially less invasive and shorter surgical procedure with relatively reduced hospitalization time, lower complication risk, and faster recovery.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 2","pages":"Article 250914"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143687023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Assessment of Large Colorectal Lesions","authors":"Naoto Tamai,&nbsp;Kazuki Sumiyama","doi":"10.1016/j.tige.2025.250931","DOIUrl":"10.1016/j.tige.2025.250931","url":null,"abstract":"<div><div>Endoscopic submucosal dissection (ESD) has emerged as an important therapeutic strategy for colorectal lesions that cannot be resected en bloc using endoscopic mucosal resection or underwater endoscopic mucosal resection, enabling en bloc resection with precise histopathologic evaluation. However, the determination of appropriate indications for ESD of large colorectal lesions remains a significant challenge. This article aimed to provide a comprehensive summary of the indications for colorectal ESD and the role of endoscopic evaluation in formulating optimal treatment strategies. Colorectal lesions with deep submucosal invasion are often associated with extensive submucosal fibrosis, presenting considerable technical difficulties during ESD. Performing ESD on such lesions has been linked to an increased additional surgical intervention and a heightened risk of procedure-related complications. Therefore, thorough preoperative assessment of the lesion is essential to ensure an appropriate treatment strategy while minimizing unnecessary risks. Accurate evaluation of colorectal lesions through white-light imaging, advanced imaging modalities such as narrow-band imaging, and chromoendoscopy are critical for assessing lesion characteristics. Furthermore, the application of artificial intelligence in lesion characterization has shown potential as a supportive tool in facilitating clinical decision-making regarding the indications for ESD. Artificial intelligence may assist endoscopists by enhancing the accuracy of lesion assessment and contributing to improved treatment planning. A comprehensive understanding of the morphologic and pathologic features of large colorectal lesions is vital to identify patients who would benefit most from ESD, while minimizing the risk of complications. This review highlights the necessity of meticulous endoscopic evaluation to enable appropriate lesion selection, ensuring the safe and effective application of ESD for large colorectal lesions and ultimately contributing to improved patient outcomes.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 4","pages":"Article 250931"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traction-Assisted Endoscopic Submucosal Dissection of Colonic Lesions: A North American Experience","authors":"Farid Abushamat,&nbsp;Fares Ayoub,&nbsp;Mai A. Khalaf,&nbsp;Tara Keihanian,&nbsp;Salmaan Jawaid,&nbsp;Mohamed O. Othman","doi":"10.1016/j.tige.2024.250900","DOIUrl":"10.1016/j.tige.2024.250900","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Traction-assisted endoscopic submucosal dissection (TA-ESD) is a proposed technique to improve the efficiency of endoscopic submucosal dissection (ESD). Multiple studies primarily from Asian centers yielded mixed results in terms of procedure time, en bloc resection rate, and R0 resection rate of TA-ESD in comparison with those of conventional endoscopic submucosal dissection (C-ESD). We performed the first comparison of TA-ESD with C-ESD at a high-volume North American center.</div></div><div><h3>METHODS</h3><div>This was a retrospective cohort-matched study of all patients who underwent colonic ESD at a single center in the United States by a single operator. The study group were patients who underwent TA-ESD and were matched with a C-ESD case on a 1:1 basis based upon location within the colon, lesion size, and scope stabilization device usage. The baseline characteristics and procedure-related outcomes were compared between the groups.</div></div><div><h3>RESULTS</h3><div>In total, 138 colonic ESD cases were included (69 TA-ESD and 69 C-ESD). There were no significant differences in the baseline characteristics between the groups. Mean procedure time was 91.0 minutes (SD: 32.5) for TA-ESD and 85.4 minutes (SD: 39.3) for C-ESD (<em>P</em> = 0.36). En bloc resection was achieved in 69 (100%) of the TA-ESDs and 67 (97.1%) of the C-ESDs (<em>P</em> = 0.15). R0 resection was achieved in 52 (75.4%) of the TA-ESDs and 48 (69.6%) of the C-ESDs (<em>P</em> = 0.45).</div></div><div><h3>CONCLUSION</h3><div>We did not show a significant difference in procedure time, en bloc resection, R0 resection, or adverse events. Further randomized prospective studies that are sufficiently powered and stratified by operator experience level are needed to further elucidate the utility of the technique.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 1","pages":"Article 250900"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Ultrasound-Guided Pancreatic Fluid Collection Drainage and Pancreatic Ductal Drainage","authors":"Sridhar Sundaram ,&nbsp;Surinder Singh Rana","doi":"10.1016/j.tige.2025.250921","DOIUrl":"10.1016/j.tige.2025.250921","url":null,"abstract":"<div><div>Peripancreatic fluid collections (PFCs) are common complications associated with acute and chronic pancreatitis. Symptomatic PFCs need drainage, and endoscopic ultrasound (EUS) is the current standard of care. Various factors like the size, location, presence of debris in the collection, and general condition of the patient drive the choice of technique for EUS-guided transmural PFC drainage. While plastic stents were initially used, specially designed lumen-apposing and biflanged metal stents have revolutionized therapy for pancreatic necrotic collections. Minimally invasive approach in the form of endoscopic necrosectomy is now established as part of the step-up approach for performing debridement. PFCs are also often associated with disconnected pancreatic duct, which is a difficult situation to manage with evolving evidence. Pancreatic ductal obstruction due to strictures and stones represent indications for endoscopic intervention with stent placement to reduce ductal hypertension. EUS-guided pancreatic duct drainage represents an alternative in patients where endoscopic retrograde cholangiopancreatography fails or is not feasible. Either transmural or transpapillary approaches have been described. In this review, we discuss the role of EUS in drainage of PFCs along with technical tips for the same. We also discuss in detail technical steps and accessories and provide a critical appraisal on evidence for EUS-guided pancreatic duct drainage.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 3","pages":"Article 250921"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Sleeve Gastroplasty Reduces Atherosclerotic Cardiovascular Disease Risk: A Cohort Study Using Pooled Cohort Equations and Predicting Risk of Cardiovascular Disease Events Models","authors":"Ali Lahooti ,&nbsp;Chino Aneke-Nash ,&nbsp;Kate E. Johnson ,&nbsp;Anam Rizvi ,&nbsp;Muhammad U. Baig ,&nbsp;Alpana Shukla ,&nbsp;Carolyn Newberry ,&nbsp;Emily Smith ,&nbsp;Jude M. Sharaiha ,&nbsp;Mark Hanscom ,&nbsp;Kartik Sampath ,&nbsp;David L. Carr-Locke ,&nbsp;SriHari Mahadev ,&nbsp;Sonal Kumar ,&nbsp;Robert Schwartz ,&nbsp;Samuel M. Kim ,&nbsp;Reem Z. Sharaiha","doi":"10.1016/j.tige.2025.250942","DOIUrl":"10.1016/j.tige.2025.250942","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure for obesity, a risk factor for atherosclerotic cardiovascular disease (ASCVD). However, its impact on cardiovascular risk remains underexplored. This study evaluates ESG’s effects on ASCVD risk and obesity-related comorbidities.</div></div><div><h3>METHODS</h3><div>In this cohort study, 168 adults with obesity (aged 30-79 years; body mass index, ≥30 kg/m² or ≥27 kg/m²; with comorbidities) underwent ESG at a single tertiary care facility from 2013 to 2024. Patients were evaluated at baseline and 12 months after procedure using the Pooled Cohort Equations (PCEs) for patients aged 40-79 years and the Predicting Risk of Cardiovascular Disease Events (PREVENT) equations for those aged 30-79 years. Changes in body weight, glycemic control, blood pressure, lipid profile (total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides), and liver enzymes (alanine aminotransferase) were also analyzed.</div></div><div><h3>RESULTS</h3><div>Of the 168 patients (median age, 48 years; 74% female; body mass index, 36.0 kg/m²), 129 and 159 met inclusion criteria for PCEs and PREVENT equations, respectively. At 12 months, median PCEs ASCVD risk score decreased from 3.3% to 3.0% (21% reduction, <em>P</em> &lt; 0.001), while the PREVENT 10-year cardiovascular disease risk score declined from 3.1% to 2.4% (20% reduction; <em>P</em> &lt; 0.001), with similar reductions in 30-year risk scores and greater improvements in high/intermediate-risk patients and those aged &gt;50 years. Patients achieved a median total body weight loss of 13.5% (IQR, 8.1%-18.6%), with significant metabolic improvements, and &gt;80% experienced diabetes resolution. There was 1 (0.6%) moderate adverse event.</div></div><div><h3>CONCLUSION</h3><div>Adults who underwent ESG showed significant improvements in ASCVD risk and obesity-related comorbidities at 12 months after procedure. These findings suggest that ESG may be an effective intervention for managing obesity and mitigating cardiovascular risk in patients with obesity. ClincialTrials.gov identifier: NCT04494048.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 4","pages":"Article 250942"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover","authors":"","doi":"10.1016/S2590-0307(25)00032-7","DOIUrl":"10.1016/S2590-0307(25)00032-7","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 3","pages":"Article 250937"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144713651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reopenable Clip-Over-the-Line Method for Troubleshooting Iatrogenic Gastrointestinal Perforations","authors":"Takeshi Yasuda,&nbsp;Narutoshi Ando,&nbsp;Tamae Hashimoto,&nbsp;Yoshiaki Kanai,&nbsp;Yoichi Sakamoto,&nbsp;Yuki Endo,&nbsp;Tomohiro Soda,&nbsp;Takako Akazawa,&nbsp;Tsuguhiro Matsumoto,&nbsp;Norihito Yamauchi,&nbsp;Akira Muramatsu,&nbsp;Hiromu Kutsumi","doi":"10.1016/j.tige.2024.250901","DOIUrl":"10.1016/j.tige.2024.250901","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 1","pages":"Article 250901"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy and Safety of Needle-Knife Fistulotomy vs Standard Cannulation: A Practical Randomized Controlled Trial","authors":"Aleksey Novikov ,&nbsp;Shuji Mitsuhashi ,&nbsp;Muhammad Hassaan Bashir ,&nbsp;Mena Bakhit ,&nbsp;Ian Holmes ,&nbsp;Alexander Schlachterman ,&nbsp;Austin Chiang ,&nbsp;David Loren ,&nbsp;Thomas Kowalski","doi":"10.1016/j.tige.2025.250941","DOIUrl":"10.1016/j.tige.2025.250941","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Current literature suggests that needle-knife fistulotomy (NKF) technique should be reserved for expert advanced endoscopists. The aim of this study was to evaluate the efficacy and safety of NKF compared with those of standard cannulation (SC) for primary biliary access performed by advanced endoscopists with a range of experience, including advanced endoscopy trainees.</div></div><div><h3>METHODS</h3><div>In total, 186 patients were randomly assigned to either NKF or SC as means of primary biliary access and 137 patients were included in the final analysis (clinicaltrials.gov; NCT06694038). The primary outcome was incidence of post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Secondary outcomes were biliary access success, time to biliary access, incidence of bleeding, and incidence of perforation.</div></div><div><h3>RESULTS</h3><div>Of the 137 procedures included in the study, 99 (72.3%) were carried out by advanced endoscopy trainees under supervision, 26 (19.0%) by advanced endoscopists without significant previous NKF experience, and 12 (8.8%) by an experienced advanced endoscopist with expertise in NKF. In the group that was randomized to SC, 6 (8.22%) patients developed pancreatitis vs 5 (7.81%) patients randomized to NKF arm (<em>P</em> = 0.93). Average time to biliary access within 20 minutes was significantly shorter with SC at 268 seconds (95% CI, 198-338 seconds) vs 380 seconds (95% CI, 292-466 seconds; <em>P</em> &lt; 0.05) in the NKF arm.</div></div><div><h3>CONCLUSION</h3><div>NKF is a safe and effective technique for primary biliary access during ERCP performed by advanced endoscopists with a wide range of experience, with post-ERCP pancreatitis equivalent to SC. NKF, in this study, took slightly longer than SC to achieve bile duct access. Use of either or both techniques resulted in a 100% successful bile duct cannulation in patients with favorable anatomy.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 4","pages":"Article 250941"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144865231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Ultrasound-guided Biliary Interventions","authors":"Hiroyuki Isayama,&nbsp;Ko Tomishima,&nbsp;Shigeto Ishii,&nbsp;Yusuke Takasaki,&nbsp;Mako Ushio,&nbsp;Toshio Fujisawa","doi":"10.1016/j.tige.2025.250916","DOIUrl":"10.1016/j.tige.2025.250916","url":null,"abstract":"<div><div>Endosonographic/endoscopic ultrasound–guided biliary drainage/anastomosis (EUS-BD/A) is widely accepted as a salvage procedure when conventional endoscopic retrograde cholangiopancreatography (ERCP) fails or is difficult. Although this procedure carries risks of severe adverse events (AEs), including perforation and bile leakage due to unattached organs, the risk of postprocedural pancreatitis in EUS-BD/A is extremely low. The intrahepatic bile duct approach is more challenging than extrahepatic because it involves penetrating the liver parenchyma. To establish EUS-BD/A as a standard primary biliary drainage procedure, it is essential to confirm its feasibility compared with ERCP, evaluate expanded indications, develop dedicated devices, and establish AE management strategies. EUS-BD/A showed similar technical and clinical success rates and AE rates, with ERCP and incidence of pancreatitis was significantly lower. Expanded indications for EUS-BD/A include primary drainage, preoperative use, pediatric patients, patients with massive ascites, and reintervention for stent occlusion; however, further evidence is required to support these indications. The development of devices to improve technical success and reduce AE rates is critical to establishing this procedure, but current devices remain insufficient for EUS-BD/A. In Japan, dedicated devices for EUS-BD/A include sharp-tip bougie dilators, drill-type dilators, sharp-tip balloon dilators, and covered self-expandable metallic stents with effective anchoring. Reducing the gap between the device and guidewire is particularly important for endosonographic/endoscopic ultrasound–guided hepaticogastrostomy. Management of AEs and the establishment of follow-up strategies are crucial as well. We herein summarize the prevention and management of AEs, including mediastinitis due to esophageal puncture, bile leakage, bleeding, and perforation, and introduce our follow-up strategy. Our ultimate goal is to establish EUS-BD/A as a standard primary biliary drainage procedure. Continuous efforts are necessary to advance various aspects of EUS-BD/A.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"27 2","pages":"Article 250916"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}