VideoGIE最新文献

{"title":"Endoscopic salvage for afferent loop syndrome: the antegrade lumen-apposing metal stent technique","authors":"Nicholas Ken Jin Ang MBBS (UM),&nbsp;Jie Qi Lim FRCS, MBChB (Edin), ChM (Edin), MSc (Edin), PgCert (Edin), MRCSEd, FRCSEd, MFSTEd, DRCOG,&nbsp;Tiffany Jian Ying Lye MBBS (S’pore), MRCS (Edin), M.Med (Surg), FRCS (Edin),&nbsp;Damien Meng Yew Tan MBBS (S'pore), MRCP (UK), FAMS,&nbsp;Chin Hong Lim BMedSc (Ireland), MB BCh BAO (Ireland), MRCS (Ireland), M Med (Surg), FRCS (Edin)","doi":"10.1016/j.vgie.2026.01.007","DOIUrl":"10.1016/j.vgie.2026.01.007","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Afferent loop syndrome (ALS) is a rare postgastrectomy condition with biliopancreatic limb obstruction. Revision surgery carries high morbidity in patients with hostile anatomy. We aimed to demonstrate the feasibility of a double-scope, antegrade EUS-guided lumen-apposing metal stent (LAMS) enteroenterostomy as an endoscopic alternative in the management of complex ALS.</div></div><div><h3>Methods</h3><div>A patient with extensive prior gastric surgery presented with ALS. With a double-scope antegrade technique, a pediatric gastroscope (GIF-XP190 N; Olympus, Tokyo, Japan) was used to cannulate the afferent limb to place a guidewire, and a linear echoendoscope (GF-UCT180; Fujifilm, Tokyo, Japan) was advanced into the blind loop. The pediatric gastroscope was reintroduced into the efferent limb, which was water-distended to approximately 3 cm in diameter to achieve sonographic apposition. Under combined EUS and fluoroscopic guidance, a 15- × 15-mm electrocautery-enhanced LAMS (Boston Scientific, Marlborough, Mass, USA) was deployed to create an enteroenterostomy.</div></div><div><h3>Results</h3><div>Postdeployment contrast confirmed optimal position and immediate patency without leak. Symptoms resolved rapidly; the patient resumed a diet within days and gained weight. Abdominal radiography showed progressive LAMS expansion without adverse events.</div></div><div><h3>Conclusions</h3><div>Double-scope antegrade EUS-guided LAMS placement safely decompressed the afferent limb in our patient, restoring enteral flow and avoiding high-morbidity reoperation. This technique merits consideration within multidisciplinary care and warrants larger comparative studies to define long-term outcomes.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"11 7","pages":"Pages 298-303"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postlobectomy bronchoesophageal fistula treated with endoscopic helical tacking system and anchor-pronged clip","authors":"Margherita Costanza Maregatti MD,&nbsp;Ivana Bravi MD, PhD,&nbsp;Piera Alessia Galtieri MD,&nbsp;Mariangela Giunta MD,&nbsp;Pietro Soru MD,&nbsp;Davide Ravizza MD,&nbsp;Cristina Maria Concetta Trovato MD,&nbsp;Giuseppe De Roberto MD","doi":"10.1016/j.vgie.2026.02.004","DOIUrl":"10.1016/j.vgie.2026.02.004","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Postsurgical bronchoesophageal fistulas represent challenging adverse events (AEs). We report a case of a postsurgical bronchoesophageal fistula endoscopically treated.</div></div><div><h3>Methods</h3><div>A 50-year-old woman underwent a robot-assisted right upper lobectomy and lymphadenectomy for moderately differentiated acinar lung adenocarcinoma (staging: pT1a; pN0). Six weeks later, a CT imaging raised suspicion of a bronchoesophageal fistula, which was confirmed by a contrast-enhanced x-ray examination, upper endoscopy (7-mm fistula), and bronchoscopy. After multidisciplinary discussion, endoscopic closure of the fistula was attempted using a helical tacking system deployed in a <em>Z</em>-shape to approximate the fibrotic fistula edges and an anchor-pronged clip to enhance tissue grasping to achieve definitive closure of the fistula.</div></div><div><h3>Results</h3><div>The procedure was well tolerated, and 4 weeks later, both upper endoscopy and x-ray esophageal transit demonstrated fistula closure. At 10-month follow-up, the patient was asymptomatic, and the fistula was persistently closed.</div></div><div><h3>Conclusions</h3><div>Combined endoscopic management with a helical tacking system and anchor-pronged clip successfully resolved this AE, highlighting a minimally invasive therapeutic option for such challenging cases.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"11 7","pages":"Pages 269-271"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of an injection needle in treating complete obstruction of the pancreaticojejunal anastomosis","authors":"Kensuke Yokoyama MD, PhD,&nbsp;Atsushi Kanno MD, PhD,&nbsp;Tomonori Yano MD, PhD","doi":"10.1016/j.vgie.2026.02.007","DOIUrl":"10.1016/j.vgie.2026.02.007","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Stenosis at pancreaticojejunal (PJ) anastomosis is a recognized adverse event after pancreaticoduodenectomy. Although double-balloon endoscopic retrograde cholangiopancreatography (DB-ERCP) can be used for management, this procedure is often technically challenging.</div></div><div><h3>Methods</h3><div>We describe a case in which complete obstruction of PJ anastomosis was successfully treated by identifying the anastomosis with contrast injection through a standard injection needle.</div></div><div><h3>Results</h3><div>Pancreatography was performed by puncturing the area suspected to be the anastomosis with a 25-gauge injection needle. After pancreatography, the anastomosis was dilated using a balloon catheter, and endoscopic nasopancreatic duct drainage was placed. No adverse events occurred.</div></div><div><h3>Conclusions</h3><div>After DB-ERCP, pancreatic duct dilatation improved. Pancreatography and treatment of PJ anastomotic obstruction can be performed safely by puncturing the anastomotic site with an injection needle.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"11 7","pages":"Pages 283-285"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cinch-modified reopenable clip over-the-line method for mucosal defect closure","authors":"Chih-Hsien Wang MD, MS,&nbsp;Ting-Hsu Liu MD, MS,&nbsp;Ming-Lun Han MD, PhD","doi":"10.1016/j.vgie.2026.02.006","DOIUrl":"10.1016/j.vgie.2026.02.006","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Endoscopic mucosal defect closure is essential to prevent adverse events after advanced endoscopic resection. The reopenable clip over-the-line method (ROLM) is effective for large defects but remains technically demanding, particularly during suture fixation and cutting. We present a simplified modification using an endoscopic cinch device.</div></div><div><h3>Methods</h3><div>The cinch-modified ROLM (C-ROLM) incorporates an endoscopic cinch device to simultaneously fix and cut the suture line in a single step. After sequential approximation of mucosal defect edges using a reopenable hemostatic clip threaded with a surgical suture, the cinch device is advanced over the suture, tension is adjusted, and the cinch is deployed to secure closure.</div></div><div><h3>Results</h3><div>C-ROLM was successfully applied to close a 3-cm colonic mucosal defect after endoscopic submucosal dissection in a 78-year-old woman. Complete closure was achieved in 16.5 minutes without technical difficulty or adverse events.</div></div><div><h3>Conclusions</h3><div>C-ROLM simplifies the most technically challenging steps of ROLM and may facilitate efficient closure of large mucosal defects, potentially reducing postprocedural adverse events.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"11 7","pages":"Pages 307-309"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic endoscopic ultrasound with a novel adaptable endoscopic ultrasound probe and vision system","authors":"Carlos Robles-Medranda MD, FASGE, AGAF,&nbsp;Martha Arevalo-Mora MD,&nbsp;Raquel del Valle MD,&nbsp;Maria Egas-Izquierdo MD,&nbsp;Domenica Cunto MD,&nbsp;Miguel Puga-Tejada MD, MSc, PhD,&nbsp;Jorge Baquerizo-Burgos MD,&nbsp;Daniela Tabacelia MD","doi":"10.1016/j.vgie.2025.11.011","DOIUrl":"10.1016/j.vgie.2025.11.011","url":null,"abstract":"<div><h3>Background and Aims</h3><div>EUS is limited by cost, complexity, and cross-contamination risks. Disposable EUS (DP-EUS) probes may expand accessibility while maintaining diagnostic and therapeutic capabilities. We report the use of a novel DP-EUS for diverse GI procedures.</div></div><div><h3>Methods</h3><div>DP-EUS was used in 3 cases: (1) a 63-year-old male patient with a pancreatic head mass and failed ERCP underwent DP-EUS–guided fine-needle biopsy (FNB) and biliary/gallbladder drainage using a 10- × 60-mm partially covered metallic stent and 6- × 8-mm electrocautery-enhanced lumen-apposing metal stent; (2) a 72-year-old male patient with a 3-cm gastric subepithelial lesion underwent DP-EUS–guided FNB with color Doppler; and (3) a 6-year-old female patient with portal hypertension and varices underwent DP-EUS–guided liver biopsy, feeder vessel puncture, coil placement, cyanoacrylate injection, and esophageal band ligation.</div></div><div><h3>Results</h3><div>Technical success was achieved in all cases. No adverse events were reported at 1-month follow-up. Histopathology confirmed a pancreatic adenocarcinoma and a gastric GI stromal tumor. Complete occlusion of variceal blood flow was achieved in the pediatric case.</div></div><div><h3>Conclusion</h3><div>DP-EUS system enables diagnostic and therapeutic interventions while preserving the endoscope working channel, with image quality approaching that of conventional EUS. It may reduce cross-contamination risk and may expand EUS accessibility. Further studies are needed to assess broader clinical application and long-term outcomes.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"11 7","pages":"Pages 279-282"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of gastropleural fistula with combined endoscopic therapy: endoscopic vacuum therapy and over-the-scope clip","authors":"Gustavo de Carvalho Bertaccini Guriam MD, MSc,&nbsp;Thiago de Castro Mendonça Furtado MD,&nbsp;Rodrigo Chini MD,&nbsp;Eduardo Garcia Pacheco MD, MSc,&nbsp;Arlindo Moi Jr. MD,&nbsp;Gustavo Murad Pinton MD,&nbsp;José Antônio Mansur Mendes MD,&nbsp;Jose Ricardo Cunha Neves Jr. MD,&nbsp;Leticia Pires Dutra","doi":"10.1016/j.vgie.2026.02.009","DOIUrl":"10.1016/j.vgie.2026.02.009","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Gastropleural fistulas (GPFs) are rare pathologic communications between the stomach and the pleural cavity and are associated with high morbidity and limited success with conventional surgical repair. We aimed to describe the successful management of a complex, refractory GPF using a multimodal endoscopic approach.</div></div><div><h3>Methods</h3><div>A 27-year-old man with traumatic diaphragmatic rupture and multiple failed surgical repairs was referred to our tertiary endoscopy center. Endoscopic evaluation confirmed a gastric-to-pleural fistula. A sequential strategy was used: initial endoscopic negative pressure therapy using a modified nasogastric vacuum system, followed by closure with an over-the-scope (OTS) clip.</div></div><div><h3>Results</h3><div>Negative pressure therapy promoted granulation tissue formation and reduction of fistula output. Deployment of an OTS clip achieved complete sealing of the orifice, with no further thoracic drainage. Total endoscopic therapy lasted 28 days. The patient was discharged in good clinical condition. At 6-month follow-up, he remained asymptomatic, with endoscopy confirming a well-healed scar and no recurrence.</div></div><div><h3>Conclusions</h3><div>Multimodal endoscopic therapy combining negative pressure therapy and OTS clip placement represents a safe and minimally invasive option for complex GPFs refractory to surgery. This case highlights the growing role of advanced endoscopic techniques in the management of challenging gastrointestinal fistulas.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"11 7","pages":"Pages 275-278"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous carbon dioxide flow via a modified 4-way stopcock to prevent hemostatic spray catheter clogging","authors":"Mina Alkomos MD,&nbsp;Dhruv Patel DO,&nbsp;Islam Rajab MD,&nbsp;Yana Cavanagh MD,&nbsp;Walid Baddoura MD","doi":"10.1016/j.vgie.2026.02.003","DOIUrl":"10.1016/j.vgie.2026.02.003","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Clogging of the Hemospray catheter (TC-325 Hemospray; Cook Medical, Bloomington, Ind, USA) is a common technical challenge, particularly when the tip becomes wet during endoscopic procedures, leading to interruption of hemostasis. A prior solution described a modified airflow connection to prevent occlusion. We developed a simplified, reproducible method using commercially available carbon dioxide (CO₂) insufflation devices and tubing, connected via a 4-way stopcock to provide continuous CO₂ flow through the Hemospray catheter.</div></div><div><h3>Methods</h3><div>The assembly incorporated commercially available CO₂ insufflation devices and tubing, a 4-way stopcock, and the standard Hemospray system. Continuous CO₂ flow was maintained throughout the procedure to displace moisture and preserve lumen patency.</div></div><div><h3>Results</h3><div>Continuous CO₂ flow effectively prevented catheter occlusion and maintained uninterrupted spray function even after fluid contact. The demonstration confirmed consistent delivery without clogging.</div></div><div><h3>Conclusions</h3><div>This 4-way stopcock enables continuous CO₂ flow through the Hemospray catheter, preventing clogging in a simple, low-cost, and reproducible manner. The set-up is readily adaptable to existing endoscopic systems and may enhance procedural efficiency and device reliability.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"11 7","pages":"Pages 272-274"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The flushing method: a novel hemostatic technique for endoscopic submucosal dissection in insufflation and saline-immersion conditions","authors":"Ryosuke Ishida MD ,&nbsp;Takashi Toyonaga MD, PhD ,&nbsp;Hiromitsu Ban MD ,&nbsp;Noriko Suzuki MD, PhD ,&nbsp;Douglas Motomura MD ,&nbsp;Hirofumi Abe MD, PhD ,&nbsp;Tetsuya Yoshizaki MD, PhD ,&nbsp;Yuzo Kodama MD, PhD","doi":"10.1016/j.vgie.2025.12.006","DOIUrl":"10.1016/j.vgie.2025.12.006","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Saline-immersion endoscopic submucosal dissection (ESD) offers improved visualization. It may also provide better buoyancy for the tissue to facilitate the dissection. However, achieving reliable hemostasis remains technically challenging. This article presents the “flushing method,” a novel hemostatic technique enabling consistent precoagulation and bleeding control under insufflation and immersion conditions.</div></div><div><h3>Methods</h3><div>The flushing method was developed by connecting an endoscopic irrigation pump (EIP 2; Erbe Elektromedizin GmbH, Tübingen, Germany) to a FlushKnife BT-S (Fujifilm, Tokyo, Japan) via an extension tube. Pressing the foot pedal activates both the electrosurgical unit and the irrigation pump simultaneously, ejecting saline solution from the base of the knife. This can eliminate the vaporization layer generated by high-frequency coagulation while suppressing the electrical discharge. This allows stable and safe coagulation even at higher-power settings.</div></div><div><h3>Results</h3><div>The technique was applied during ESD for a 150-mm circumferential rectal tumor in a 55-year-old woman. A total of 129 vessels (22 branching and 107 penetrating) were precoagulated using forcedCOAG (effect 5.5) with the irrigation pump flushing. Bleeding events (n = 14) were controlled with the knife alone, without hemostatic forceps.</div></div><div><h3>Conclusions</h3><div>The flushing method is a safe and effective technique for precoagulation and hemostasis during ESD under both insufflation and saline-immersion conditions. Its versatility may broaden the clinical applicability of ESD.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"11 6","pages":"Pages 255-258"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146446","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":"A cost-effective method of mechanical lithotripsy for the successful endoscopic management of Bouveret syndrome","authors":"Kar Wai Lau MD,&nbsp;Michael Ding MD,&nbsp;Imran Tahir MD,&nbsp;Wai Liam Lam MD,&nbsp;Damien Durkin MD,&nbsp;Srisha Hebbar MD,&nbsp;Roderick Prawiradiradja MD","doi":"10.1016/j.vgie.2026.01.002","DOIUrl":"10.1016/j.vgie.2026.01.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>This article describes successful management of Bouveret syndrome with mechanical lithotripsy assembled from cost-effective devices.</div></div><div><h3>Methods</h3><div>Mechanical lithotripsy was performed for a large 4.4-cm gallstone impacted in the duodenal bulb and causing Bouveret syndrome, using biliary “salvage”–type lithotripter devices consisting of a disposable through-the-scope–type lithotripter cable (Conquest TTCL, Cook Medical, Limerick, Ireland), a disposable hot polypectomy snare, and the Soehendra lithotripter handle (Cook Medical).</div></div><div><h3>Results</h3><div>The gallstone impacted in the duodenum was successfully fragmented and retrieved orally, relieving the gastric outlet obstruction. The patient recovered well and was asymptomatic at 15-month follow-up.</div></div><div><h3>Conclusions</h3><div>Endoscopic treatment of Bouveret syndrome is feasible and safe. Procedural costs can be minimized by using accessories that are cost-effective.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"11 6","pages":"Pages 231-233"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146440","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":"Cholangioscopy-guided diagnosis and management of biliary cast syndrome in a nontransplant patient","authors":"Hanying Wang MM ,&nbsp;Renhu Sun MM ,&nbsp;Guangzhong Yuan MM ,&nbsp;Zhenzhen Liu MM ,&nbsp;Xiao Feng MM ,&nbsp;Tingsheng Ling MD ,&nbsp;Dapeng Wu MM","doi":"10.1016/j.vgie.2026.01.004","DOIUrl":"10.1016/j.vgie.2026.01.004","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Biliary cast syndrome (BCS) in nontransplant patients is rare and diagnostically challenging. We demonstrate the role of single-operator cholangioscopy (SOC) in managing BCS in a patient with rheumatoid arthritis (RA) and identifying an occult, high-risk molecular marker.</div></div><div><h3>Methods</h3><div>A 54-year-old woman with RA presented with cholestatic liver dysfunction. After inconclusive imaging in a nondilated common bile duct, she underwent ERCP with SOC for diagnosis, multimodal cast removal, and targeted biopsy of the underlying mucosa.</div></div><div><h3>Results</h3><div>SOC directly visualized a branching biliary cast in a nondilated duct, leading to a definitive diagnosis. The cast was completely extracted using multimodal techniques. Biopsies of the inflamed mucosa revealed reactive atypical hyperplasia with loss of <em>Smad4</em> expression on immunohistochemistry.</div></div><div><h3>Conclusions</h3><div>SOC is indispensable for diagnosing and managing BCS when imaging is inconclusive. This case links systemic inflammation to BCS and highlights the importance of SOC-guided biopsy to detect high-risk molecular changes, such as <em>Smad4</em> loss in reactive hyperplasia, which warrants long-term surveillance.</div></div>","PeriodicalId":55855,"journal":{"name":"VideoGIE","volume":"11 6","pages":"Pages 234-237"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146441","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}