DEN open最新文献

{"title":"Efficacy and Safety of Multihole Partially Covered Self-Expandable Metal Stents for Distal Malignant Biliary Obstruction: A Single-Center Retrospective Study","authors":"Kengo Matsumoto,&nbsp;Kazuhide Iwasa,&nbsp;Asuka Watanabe,&nbsp;Hiroki Takiyama,&nbsp;Satoru Okabe,&nbsp;Naoto Osugi,&nbsp;Dai Nakamatsu,&nbsp;Masashi Yamamoto,&nbsp;Shiro Hayashi,&nbsp;Koji Fukui,&nbsp;Tsutomu Nishida","doi":"10.1002/deo2.70168","DOIUrl":"https://doi.org/10.1002/deo2.70168","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Covered self-expandable metal stents (SEMS) are the standard for managing unresectable distal malignant biliary obstruction (DMBO), as they prolong the time to recurrent biliary obstruction (TRBO). However, fully covered SEMS (FCSEMS) increases the risk of cholecystitis and pancreatitis. This exploratory study evaluated a novel multihole partially covered SEMS (MHSEMS) designed to reduce these risks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The clinical data of 26 DMBO patients treated with MHSEMSs were retrospectively compared with those of 63 patients treated with FCSEMSs between April 2018 and October 2024. The outcomes included clinical success, early complications, and recurrent biliary obstruction (RBO).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The baseline characteristics, including age (median 78 years), sex distribution (55.2% vs. 57.7% male), BMI (20.5 vs. 19.8), tumor size (27 mm vs. 30 mm), and stricture length (20 mm vs. 19.5 mm), were comparable between the groups. Procedural factors, including initial papillary cannulation (34.9% vs. 26.9%) and pancreatography (12.9% vs. 15.4%), were also similar in terms of incidence. Early complications were less common in the MHSEMS group (7.7% vs. 23.8%), with no cases of cholecystitis observed. Fewer early complications were observed with MHSEMS, suggesting potential clinical benefits. The RBO rates (7.7% vs. 15.9%, <i>p</i> = 0.28) and median TRBO (151 vs. 141.5 days, <i>p</i> = 0.87) were also comparable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although the differences in outcomes were not statistically significant, the incidence of early complications was lower, especially for cholecystitis, with the MHSEMS in the management of DMBO. Larger prospective studies are needed to confirm these preliminary findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339531","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":"Endoscopic Ultrasound-guided Drainage With Lumen-apposing Metal Stent versus Plastic Stent for the Treatment of Pancreatic Pseudocyst: A Systematic Review and Meta-analysis","authors":"André Orsini Ardengh,&nbsp;Thiago Arantes de Carvalho Visconti,&nbsp;Marcelo Klotz Dall'Agnol,&nbsp;Ygor Rocha Fernandes,&nbsp;Matheus de Oliveira Veras,&nbsp;Evellin Souza Valentim dos Santos,&nbsp;Marcos Eduardo Lera do Santos,&nbsp;Sergio Eiji Matuguma,&nbsp;José Celso Ardengh,&nbsp;Wanderley Marques Bernardo,&nbsp;Eduardo Guimarães Hourneaux de Moura","doi":"10.1002/deo2.70165","DOIUrl":"https://doi.org/10.1002/deo2.70165","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pancreatic pseudocyst (PP), following acute or chronic pancreatitis, may become symptomatic or persist beyond 6–8 weeks, requiring drainage. Endoscopic ultrasonography-guided drainage (EUS-D) is the preferred method, using double pigtail plastic stents (DPPS) or self-expandable metallic stents (SEMS), such as lumen-apposing metal stents (LAMS). This meta-analysis compares DPPS and LAMS in EUS-D for PP, focusing on technical success, clinical success, adverse events (AEs), recurrence, and procedure time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A search strategy was conducted in MEDLINE, Embase, Lilacs, and Cochrane databases according to PRISMA guidelines. Random-effect models were used for statistical analysis based on intention-to-treat. Heterogeneity was assessed using the I² test. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies—of Exposures tool. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation Tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten studies were included: one prospective cohort and nine retrospective cohorts, conducted between 2014 and 2024. A total of 502 patients with PP were treated with EUS-D. The clinical success rate was higher using LAMS (Risk ratio [RR] = 1.05; 95% confidence interval [CI]: 1.01; 1.09; I² = 0%), with shorter procedure time (Mean difference = -16.30; 95% CI: -27.65; -4.94; I² = 86%) compared to DPPS. No statistical difference was observed for early and late AEs, recurrence, or technical success.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study demonstrated that LAMS has a higher clinical success rate and a shorter procedure time compared to DPPS. There is no difference in terms of early and late AEs, recurrence, and technical success.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339532","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":"Artificial Intelligence-assisted Endoscopy and Examiner Confidence: A Study on Human–Artificial Intelligence Interaction in Barrett's Esophagus (With Video)","authors":"David Roser,&nbsp;Michael Meinikheim,&nbsp;Anna Muzalyova,&nbsp;Robert Mendel,&nbsp;Christoph Palm,&nbsp;Andreas Probst,&nbsp;Sandra Nagl,&nbsp;Markus W. Scheppach,&nbsp;Christoph Römmele,&nbsp;Elisabeth Schnoy,&nbsp;Nasim Parsa,&nbsp;Michael F. Byrne,&nbsp;Helmut Messmann,&nbsp;Alanna Ebigbo","doi":"10.1002/deo2.70150","DOIUrl":"https://doi.org/10.1002/deo2.70150","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Despite high stand-alone performance, studies demonstrate that artificial intelligence (AI)-supported endoscopic diagnostics often fall short in clinical applications due to human-AI interaction factors. This video-based trial on Barrett's esophagus aimed to investigate how examiner behavior, their levels of confidence, and system usability influence the diagnostic outcomes of AI-assisted endoscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The present analysis employed data from a multicenter randomized controlled tandem video trial involving 22 endoscopists with varying degrees of expertise. Participants were tasked with evaluating a set of 96 endoscopic videos of Barrett's esophagus in two distinct rounds, with and without AI assistance. Diagnostic confidence levels were recorded, and decision changes were categorized according to the AI prediction. Additional surveys assessed user experience and system usability ratings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AI assistance significantly increased examiner confidence levels (<i>p</i> &lt; 0.001) and accuracy. Withdrawing AI assistance decreased confidence (<i>p</i> &lt; 0.001), but not accuracy. Experts consistently reported higher confidence than non-experts (<i>p</i> &lt; 0.001), regardless of performance. Despite improved confidence, correct AI guidance was disregarded in 16% of all cases, and 9% of initially correct diagnoses were changed to incorrect ones. Overreliance on AI, algorithm aversion, and uncertainty in AI predictions were identified as key factors influencing outcomes. The System Usability Scale questionnaire scores indicated good to excellent usability, with non-experts scoring 73.5 and experts 85.6.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings highlight the pivotal function of examiner behavior in AI-assisted endoscopy. To fully realize the benefits of AI, implementing explainable AI, improving user interfaces, and providing targeted training are essential. Addressing these factors could enhance diagnostic accuracy and confidence in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144323483","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":"Management Strategies for Refractory Esophageal Varices","authors":"Keita Maki,&nbsp;Hiroaki Haga,&nbsp;Yoshiyuki Ueno","doi":"10.1002/deo2.70155","DOIUrl":"https://doi.org/10.1002/deo2.70155","url":null,"abstract":"<p>Refractory esophageal varices that are difficult to control or unresponsive to endoscopic treatment remain a major clinical challenge in the management of portal hypertension. This review provides a comprehensive overview of treatment strategies for these cases, along with a comparative analysis of the American Association for the Study of Liver Diseases, Baveno VII, and Japanese clinical practice guidelines. Treatment approaches are classified into four domains: endoscopic therapy, interventional radiology (IVR), surgical procedures, and internal medicine-based strategies. In recent years, clinical practice has shifted from traditional surgical interventions and transjugular intrahepatic portosystemic shunt (TIPS) to minimally invasive IVR techniques, such as partial splenic embolization, percutaneous transhepatic obliteration, and transileocolic vein obliteration, often combined with endoscopic methods. In Japan, where TIPS is not routinely performed due to limited availability and lack of insurance coverage, these alternative IVR procedures are more commonly utilized. Differences among regional guidelines highlight the need for adaptable treatment strategies based on local resources and institutional expertise. Effective management of refractory cases requires multidisciplinary collaboration among gastroenterologists, interventional radiologists, and surgeons. This review emphasizes the importance of integrating international evidence with local clinical practice to develop a tailored, team-based approach that improves outcomes in patients with complex variceal disease.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315368","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":"Concurrent Diagnosis of Superficial Esophageal Cancer and Esophageal Achalasia: A Case Report and Literature Review","authors":"Ai Katsumi,&nbsp;Hideki Mori,&nbsp;Noriko Matsuura,&nbsp;Tatsuhiro Masaoka,&nbsp;Yusaku Takatori,&nbsp;Hideomi Tomida,&nbsp;Teppei Akimoto,&nbsp;Hiroko Ando,&nbsp;Motohiko Kato,&nbsp;Takanori Kanai","doi":"10.1002/deo2.70164","DOIUrl":"https://doi.org/10.1002/deo2.70164","url":null,"abstract":"<p>We report a case of a 70-year-old woman with esophageal achalasia and concurrent superficial esophageal squamous cell carcinoma. Three adjacent superficial lesions were resected en bloc by endoscopic submucosal dissection (ESD), with no lymphovascular invasion. Given that the patient's dysphagia was effectively controlled with medication and dietary modifications, peroral endoscopic myotomy (POEM) was deferred following a careful assessment of the risk–benefit balance. As both ESD and POEM involve submucosal intervention, this case highlights the importance of individualized treatment based on symptom severity and lesion characteristics.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300504","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":"Japanese Multi-Institution Study of Success Rates of Wire-Guided Biliary Cannulation During Endoscopic Retrograde Cholangiopancreatography in Relation to Guidewire tip Length (With Video)","authors":"Takeshi Ogura,&nbsp;Yuki Tanisaka,&nbsp;Masanari Sekine,&nbsp;Katsumasa Kobayashi,&nbsp;Hirotsugu Maruyama,&nbsp;Shinji Hirai,&nbsp;Hideyuki Shiomi,&nbsp;Minoru Shigekawa,&nbsp;Masaki Kuwatani,&nbsp;Kenji Ikezawa,&nbsp;Masahiro Itonaga,&nbsp;Mamoru Takenaka,&nbsp;Susumu Hijioka,&nbsp;Tsukasa Ikeura,&nbsp;Shinpei Doi,&nbsp;Nao Fujimori,&nbsp;Kazuya Koizumi,&nbsp;Yousuke Nakai,&nbsp;Tadahisa Inoue,&nbsp;Shuntaro Mukai,&nbsp;Kazuyuki Matsumoto,&nbsp;Ryuki Minami,&nbsp;Koichiro Mandai,&nbsp;Atsuhiro Matsuda,&nbsp;Takuji Iwashita,&nbsp;Hiroki Kawashima,&nbsp;Takao Itoi","doi":"10.1002/deo2.70144","DOIUrl":"https://doi.org/10.1002/deo2.70144","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Wire-guided cannulation (WGC) reportedly increases the successful biliary cannulation rate and reduces the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis. Currently, various types of guidewires are available. However, the effect of the length of flexible-tip guidewires on the success rate of biliary cannulation under WGC and the rate of adverse events, especially post-endoscopic retrograde cholangiopancreatography pancreatitis, is unclear. The aim of this study was to compare the influence of long-tapered and short-tapered tips of a 0.025-inch guidewire on outcomes in primary selective biliary cannulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients who underwent biliary access under endoscopic retrograde cholangiopancreatography guidance using WGC at 27 high-volume centers in Japan were enrolled in this prospective registration study. The primary outcome was the technical success rate of biliary cannulation. The secondary outcomes were the rates of adverse events, biliary cannulation time, and number of guidewire insertions into the pancreatic duct.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 530 patients underwent biliary cannulation for biliary disease with native papilla between April 2021 and December 2023. The technical success rate of biliary cannulation was 86.1% (161/187) in the long-tip group and 84.3% (289/343) in the short-tip group, indicating no significant differences between the two groups. Although the frequency of post-endoscopic retrograde cholangiopancreatography was not significantly different, the successful biliary cannulation rate without guidewire mis-insertion into the main pancreatic duct was significantly higher in the long tip group (64.7%, 121/187) compared with the short tip group (54.2%, 186/343<i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In conclusion, WGC using long-tip guidewires might reduce the risk of guidewire insertion into the main pancreatic duct.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300351","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":"A Case of Perforated Peritonitis Caused by the Migration of a Single-Puncture Gastric Wall Fixation Device Following Percutaneous Endoscopic Gastrostomy","authors":"Yuu Kodama,&nbsp;Yuji Mizokami,&nbsp;Hidemitsu Nishizawa,&nbsp;Gen Maeda,&nbsp;Gen Kimura,&nbsp;Yuzo Toyama,&nbsp;Shingo Asahara,&nbsp;Ryuji Nagahama,&nbsp;Hideki Sunagawa","doi":"10.1002/deo2.70159","DOIUrl":"https://doi.org/10.1002/deo2.70159","url":null,"abstract":"<p>We report an uncommon case of perforated peritonitis resulting from the migration of a single-puncture gastric wall fixation device following percutaneous endoscopic gastrostomy. An 83-year-old male developed acute peritonitis 6 days post-procedure, requiring emergency surgery. One fixation device was found embedded in the abdominal wall, and gastric perforation was identified. To our knowledge, this is the first reported case of peritonitis caused by T-fastener migration outside the gastric wall.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70159","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255893","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":"A Novel Bioabsorbable Covered Stent for Advancing Bile Duct Injury Management: A Preclinical Study in a Porcine Model (With Video)","authors":"Mitsuo Miyazawa,&nbsp;Masayasu Aikawa,&nbsp;Junpei Takashima,&nbsp;Hirotoshi Kobayashi,&nbsp;Takuya Minagawa,&nbsp;Osamu Itano,&nbsp;Shunsuke Ohnishi","doi":"10.1002/deo2.70162","DOIUrl":"https://doi.org/10.1002/deo2.70162","url":null,"abstract":"<p>Self-expandable metallic and plastic stents have been used for biliary tract injuries, but they are not entirely adequate as treatments. This study investigated the potential of our novel self-expandable bioabsorbable covered stent (SEBCS) to treat bile duct injuries. We developed a novel SEBCS by covering a self-expandable bioabsorbable stent with a bioabsorbable tube. Five pigs underwent laparotomy after being placed under general anesthesia. A 5-mm incision was made in the extrahepatic bile duct, followed by the insertion of an SEBCS. Postoperatively, hepatobiliary enzyme levels were measured. At 10 weeks postoperatively, a histological evaluation of the injured area and cholangiogram were performed. The SEBCS was successfully inserted into the extrahepatic bile ducts of all animals. The histological evaluation at 10 weeks postoperatively showed epithelial regeneration with numerous peribiliary glands, including at the injury site. Cholangiography revealed no stenosis in the injured area. Hematological and biochemical analyses revealed mild elevation of biliary enzyme levels on day 10 postoperatively compared with preoperative levels; these levels returned to preoperative values by week 10. This novel SEBCS technique demonstrated the potential to regenerate bile ducts at the site of extrahepatic bile duct injury and may be a promising endoscopic treatment for biliary tract injuries.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255892","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":"Factors Affecting Clinical Course of Postoperative Bile Leakage and Efficacy of Endoscopic Biliary Drainage: A Multi-Center Retrospective Cohort Study","authors":"Kota Shimojo,&nbsp;Takuji Iwashita,&nbsp;Keisuke Iwata,&nbsp;Yuki Utakata,&nbsp;Kaori Koide,&nbsp;Takuya Koizumi,&nbsp;Yuki Ito,&nbsp;Yosuke Ohashi,&nbsp;Shota Iwata,&nbsp;Akihiko Senju,&nbsp;Ryuichi Tezuka,&nbsp;Hironao Ichikawa,&nbsp;Yuhei Iwasa,&nbsp;Naoki Mita,&nbsp;Mitsuru Okuno,&nbsp;Kensaku Yoshida,&nbsp;Akinori Maruta,&nbsp;Shinya Uemura,&nbsp;Masahiko Kawai,&nbsp;Yoshiyuki Sasaki,&nbsp;Katsutoshi Murase,&nbsp;Nobuhisa Matsuhashi,&nbsp;Masahito Shimizu","doi":"10.1002/deo2.70161","DOIUrl":"https://doi.org/10.1002/deo2.70161","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bile leakage is one of the complications after hepatobiliary surgery, causing intra-abdominal infections, and is sometimes difficult to treat. The purpose of our study was to investigate the factors related to severity and to evaluate the efficacy of endoscopic treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective multicenter cohort study conducted at three tertiary care medical centers. The severity of bile leakage was classified per the International Study Group of Liver Surgery, and Grades B and C (requiring some intervention or reoperation) were considered as severe.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The subjects were 59 patients. The surgical procedures were 31 cholecystectomies, 23 hepatectomies, and five pancreaticoduodenectomies. The severity was Grade A/B/C: 17/40/2. Multivariate logistic regression analysis found that age (unit odds ratio [UOR], 1.09; 95% confidence interval [CI], 1.0–1.19; <i>p</i> = 0.049) and days from surgery to bile leak (UOR, 1.18; 95% CI, 1.04–1.35; <i>p</i> = 0.012) were independent predictors of bile leak severity. Of 40 Grade B biliary leakage patients, 37 patients underwent endoscopic drainage, of which 11 also received intra-abdominal abscess drainage. Eventually, bile leakage was successfully treated in all patients after several endoscopic drainage sessions, and the median drainage period was 18 days (inter-quartile range: 13–35).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In the management of bile leakage after hepatobiliary surgery, elderly patients or patients with late onset of bile leak may be at high risk of severity. Endoscopic biliary drainage is considered a safe and effective treatment for severe patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70161","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255894","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 a One-step Semi-deployment Flushing and Stenting Technique in Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis (With Video)","authors":"Yuki Kawasaki,&nbsp;Jun Ushio,&nbsp;Hisaki Kato,&nbsp;Kazuya Sumi,&nbsp;Yuki Shibata,&nbsp;Norihiro Nomura,&nbsp;Junichi Eguchi,&nbsp;Takayoshi Ito,&nbsp;Haruhiro Inoue","doi":"10.1002/deo2.70163","DOIUrl":"https://doi.org/10.1002/deo2.70163","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic transpapillary gallbladder stenting (EGBS) has demonstrated high technical and clinical success rates in endoscopic transpapillary gallbladder drainage (ETGBD) for acute cholecystitis. The effectiveness of a 5-Fr endoscopic naso-gallbladder drainage (ENGBD) tube for flushing and the internal fistula technique after tube cutting has also been reported. We developed an alternative one-step semi-deployed flushing and stenting technique for EGBS using a 7-Fr pigtail stent that avoids tube resection and evaluated its effectiveness and safety compared with that of endoscopic nasogastric gallbladder drainage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated 30 patients who underwent ETGBD for acute cholecystitis between April 2023 and November 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The technical and clinical success rates of the one-step semi-deployment flushing and stenting techniques were 95.2% (20/21) and 100% (20/20), respectively. No adverse events were reported. The procedure time did not differ significantly from that of ENGBD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EGBS using one-step semi-deployment flushing and stenting is a simple and effective treatment for acute cholecystitis in patients with ETGBD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244220","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}