DEN open最新文献

{"title":"A Case of Refractory Peptic Ulcer with Choledochoduodenal Fistula Successfully Treated by Biliary Stent Placement Using an Ultrathin Endoscopic Rendezvous Technique: A Case Report.","authors":"Yuki Miyashita, Akinobu Koiwai, Eri Urita, Masazumi Takemoto, Takehito Itoh, Nana Inomata, Morihisa Hirota, Kennichi Satoh","doi":"10.1002/deo2.70338","DOIUrl":"https://doi.org/10.1002/deo2.70338","url":null,"abstract":"<p><p>Choledochoduodenal fistula (CDF) is an abnormal communication between the common bile duct and the duodenum. While gallstones are the primary cause, peptic ulcer-related CDF has become rare due to the widespread antiulcer therapy. Nevertheless, CDF remains clinically relevant as symptoms are often vague and diagnosis is frequently incidental. We report the case of a 79-year-old woman with vomiting, epigastric pain, and back pain due to a refractory duodenal ulcer complicated by CDF. Endoscopic retrograde cholangiopancreatography (ERCP) using a standard duodenoscope was attempted to facilitate fistula closure by biliary stent placement; however, scope passage was prevented by severe duodenal stenosis. Therefore, ERCP was successfully performed using an ultrathin endoscope with a rendezvous technique. A guidewire was advanced through the CDF into the biliary tract and retrieved at the major papilla. Subsequently, a 5-Fr double-pigtail plastic stent was placed in the left intrahepatic bile duct. This approach achieved effective biliary drainage, promoting ulcer healing and complete fistula closure without surgery. The patient was discharged without complications. This case highlights the clinical utility of the ultrathin endoscope-assisted rendezvous ERCP as a minimally invasive option for CDF with duodenal obstruction when conventional ERCP is not feasible.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 ","pages":"e70338"},"PeriodicalIF":1.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13097424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792756","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 Prospective Study Comparing the Diagnostic Ability of Abdominal Ultrasonography with Computed Tomography in Cases Suspected of Retaining the Patency Capsule.","authors":"Tomoharu Matsuura, Satoshi Osawa, Moriya Iwaizumi, Ryota Inoue, Wataru Inui, Tomoyuki Niwa, Kenichi Takahashi, Takatoshi Egami, Keisuke Inagaki, Tomohiro Takebe, Tatsuhiro Ito, Satoru Takahashi, Shunya Onoue, Yusuke Asai, Kiichi Sugiura, Natsuki Ishida, Mihoko Yamade, Yasushi Hamaya, Takanori Yamada, Ken Sugimoto","doi":"10.1002/deo2.70331","DOIUrl":"https://doi.org/10.1002/deo2.70331","url":null,"abstract":"<p><strong>Objectives: </strong>Patency capsule (PC) testing is widely used to assess small-bowel patency before small-bowel capsule endoscopy (SBCE). Although abdominal computed tomography (CT) reliably identifies PC location, routine use is limited by radiation exposure and cost. Abdominal ultrasonography (AUS) is a noninvasive, radiation-free alternative; however, its diagnostic accuracy for PC localization remains unclear.</p><p><strong>Methods: </strong>We conducted a prospective, exploratory, single-center study in patients in whom PC excretion could not be confirmed within the predefined observation period. All patients underwent AUS followed by CT on the same day. The primary endpoint was the sensitivity of AUS for detecting small-bowel PC retention using CT as the reference standard. Secondary endpoints included the PC visualization rate, diagnostic accuracy for small bowel versus colon classification, six-segment agreement between AUS and CT, and SBCE retention after AUS-based assessment.</p><p><strong>Results: </strong>Thirty-four patients were included. AUS visualized the PC in 28 patients (82.4%). All six patients with small-bowel retention on CT were correctly identified as \"small bowel\" by AUS (sensitivity 100%; 95% confidence interval [CI], 61.0-100). Among 28 patients with colonic PC on CT, AUS classified 22 as \"colon,\" yielding a sensitivity of 78.6% (95% CI, 60.5-89.9). Six-segment agreement between AUS and CT was 82.4% overall and 100% among visualized cases. No SBCE retention occurred after AUS-based colonic classification.</p><p><strong>Conclusions: </strong>AUS accurately detected small-bowel PC retention and showed good agreement with CT when visualization was achieved. Although non-visualized findings require cautious interpretation, AUS may serve as a useful first-line imaging modality for evaluating PC location prior to SBCE.</p><p><strong>Trial registration: </strong>N/A.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 ","pages":"e70331"},"PeriodicalIF":1.5,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792837","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":"Short- and Long-Term Outcomes of Endoscopic Submucosal Dissection for Gastric Lesions in Elderly Patients Aged 80 Years or Older: Focus on Non-Procedure-Related Adverse Events.","authors":"Hideharu Ogiyama, Yoko Murayama, Takuya Iihara, Harune Okuno, Kenji Hanafusa, Toshio Nakayama, Hiroko Fukushima, Hiromi Shimakoshi, Takahiro Amano, Hirotsugu Saiki, Nobuyasu Fukutake, Kunimaro Furuta, Sachiyo Kogita, Hisashi Ishida, Shusaku Tsutsui, Hiroyasu Iishi, Masahide Oshita","doi":"10.1002/deo2.70334","DOIUrl":"https://doi.org/10.1002/deo2.70334","url":null,"abstract":"<p><strong>Objectives: </strong>With an aging society, the proportion of elderly patients undergoing gastric endoscopic submucosal dissection (ESD) is increasing. Although procedure-related adverse events (AEs) are comparable between the elderly and non-elderly patients, data on non-procedure-related AEs remain limited. This study aimed to evaluate the short- and long-term outcomes of gastric ESD in elderly patients, focusing on risk factors for non-procedure-related AEs.</p><p><strong>Methods: </strong>We retrospectively analyzed 941 patients who underwent gastric ESD at two institutions between 2011 and 2024. Patients were stratified into elderly (≥80 years) and non-elderly (<80 years) groups, and short- and long-term outcomes were compared. Procedure-related AEs included delayed bleeding, perforation, and stricture, whereas non-procedure-related AEs included pneumonia and other systemic complications.</p><p><strong>Results: </strong>Procedure-related AE rates were similar between the groups (8.9% vs. 7.1%, <i>p</i> = 0.322), whereas the overall (13.8% vs. 8.3%, <i>p</i> = 0.010) and non-procedure-related AE rates (5.8% vs. 1.4%, <i>p</i> < 0.001) were significantly higher in elderly patients. Univariate analysis showed that Eastern Cooperative Oncology Group performance status (PS) ≥ 2 and Charlson Comorbidity Index (CCI) ≥ 2 were significant risk factors for non-procedure-related AEs among elderly patients. Non-procedure-related AEs were significantly associated with poorer overall survival (OS) (<i>p</i> = 0.013). Multivariate analysis identified systemic factors, including age, albumin level, CCI, and PS, as independent prognostic factors for OS in elderly patients.</p><p><strong>Conclusions: </strong>Assessment of systemic health status, particularly using PS and CCI, is essential for predicting non-procedure-related AEs, and they are useful indices for determining treatment indications in elderly patients undergoing gastric ESD.</p><p><p><b>Trial Registration</b>: Not applicable.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 ","pages":"e70334"},"PeriodicalIF":1.5,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792843","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 Capability of a Novel All-in-One Sphincterotome With High Rotation and a Freely Bendable Blade for Various Endoscopic Retrograde Cholangiopancreatography-Related Procedures.","authors":"Yasuhito Kunogi, Atsushi Irisawa, Akira Yamamiya, Takumi Maki, Koh Fukushi, Ken Kashima, Fumi Sakuma, Shogo Yamamoto, Yasunori Inaba, Ryuichi Maki, Tomoya Sakamoto, Manabu Ishikawa, Ken Ohike, Keiichi Tominaga","doi":"10.1002/deo2.70333","DOIUrl":"https://doi.org/10.1002/deo2.70333","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate the capability of a novel all-in-one sphincterotome in various procedures related to endoscopic retrograde cholangiopancreatography (ERCP), including procedures in patients with surgically altered anatomy.</p><p><strong>Methods: </strong>A total of 108 patients who underwent ERCP using the novel all-in-one sphincterotome (ENGETSU; Kaneka Medix, Tokyo, Japan) between November 2023 and December 2024 were included in this retrospective analysis. We evaluated the success rates of bile duct cannulation and endoscopic sphincterotomy (EST) as well as the incidence of procedure-related adverse events (AEs).</p><p><strong>Results: </strong>Bile duct cannulation was performed in patients with native papillae, including 30 patients with normal anatomy, three with Billroth I reconstruction, one with Billroth II reconstruction, and six with Roux-en-Y reconstruction. The overall cannulation success rate was 72.5%, with a median cannulation time of 3 min. EST was performed in 65 patients with normal anatomy, three with Billroth I reconstruction, and 13 with Roux-en-Y reconstruction, with an overall success rate of 98.8%. Procedure-related AEs were observed in four patients with post-ERCP pancreatitis, three with post-EST bleeding, and one with cholangitis; all patients recovered and were discharged. Among 14 patients in whom deep biliary cannulation failed when using the conventional ERCP cannula, subsequent use of the novel device during second-line cannulation led to successful cannulation in 13 patients (92.9%).</p><p><strong>Conclusion: </strong>The novel all-in-one sphincterotome demonstrated the capability to perform various ERCP-related procedures, including in patients with surgically altered anatomy.</p><p><strong>Trial registration: </strong>UMIN000058337.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 ","pages":"e70333"},"PeriodicalIF":1.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13088330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725095","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":"Potassium-Competitive Acid Blocker-Associated Gastric Hyperplastic Polyps With Severe Bleeding: A Case Series.","authors":"Kengo Kasuga, Sakuya Katakai, Megumi Shimizu, Ayaki Isshiki, Shingo Ishihara, Hiroomi Ogawa, Xing Hua Ma, Takashige Masuo, Yoji Takeuchi, Toshio Uraoka","doi":"10.1002/deo2.70326","DOIUrl":"https://doi.org/10.1002/deo2.70326","url":null,"abstract":"<p><p>Gastric hyperplastic polyps can cause gastrointestinal bleeding, and their enlargement has been associated with long-term acid-suppressive therapy. Vonoprazan (VPZ), a potassium-competitive acid blocker, provides potent acid suppression and may induce hypergastrinemia, potentially contributing to the growth of hyperplastic polyps. However, clinical information regarding VPZ-associated gastric hyperplastic polyps remains limited. We report three cases of severe bleeding from gastric hyperplastic polyps in patients who were administered VPZ. Case 1 involved a 92-year-old woman who presented with melena and anemia. Endoscopy revealed an 8-cm hyperplastic polyp, and although resection was considered, it was deferred. After switching from VPZ to an H2-receptor antagonist (H2RA), her anemia gradually improved, and the polyp regressed. Case 2 involved a 61-year-old man with hematemesis due to bleeding from multiple hyperplastic polyps. Emergency endoscopic mucosal resection was performed, and markedly elevated serum gastrin levels were noted. Following the replacement of VPZ with an H2RA, the size of the remaining polyps decreased. Case 3 involved a 54-year-old man with anemia and recurrent bleeding from hyperplastic polyps, requiring multiple endoscopic treatments. After VPZ discontinuation and H2RA initiation, the unresected polyps regressed. Two patients were undergoing hemodialysis, which may have exacerbated hypergastrinemia and bleeding. In all three cases, switching from VPZ to an H2RA resulted in the regression of gastric hyperplastic polyps and improvement of anemia. In patients receiving VPZ who develop progressive anemia or bleeding from hyperplastic polyps, discontinuation of VPZ or switching to an H2RA may be effective.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 ","pages":"e70326"},"PeriodicalIF":1.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694294","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":"Enlarging Inflammatory Granulation Tissue After Endoscopic Submucosal Dissection at the Esophageal Inlet During Intensive Stricture Prophylaxis: A Case Report","authors":"Chihiro Tsurita,&nbsp;Naoya Tada,&nbsp;Akira Dobashi,&nbsp;Yukio Nishiya,&nbsp;Kosuke Sasuga,&nbsp;Mamoru Ito,&nbsp;Masato Nagaoka,&nbsp;Masayuki Shimoda,&nbsp;Kazuki Sumiyama","doi":"10.1002/deo2.70328","DOIUrl":"10.1002/deo2.70328","url":null,"abstract":"<p>Surveillance endoscopy in a 47-year-old woman with previous hypopharyngeal chemoradiotherapy and esophageal endoscopic submucosal dissection (ESD) revealed a 12-mm superficial squamous cell carcinoma at the cervical esophagus near the inlet. ESD achieved en bloc resection with a half-circumferential mucosal defect, and histopathology showed pT1a lamina propria mucosae with negative margins. For stricture prophylaxis, triamcinolone was injected into the post-ESD defect, oral prednisolone was tapered over several months, and prophylactic endoscopic balloon dilation was performed three times at 3–4-week intervals. Three months after ESD, a 10-mm white-coated lesion appeared at the inlet and progressively enlarged. Under intravenous sedation, detailed endoscopic assessments and biopsies were limited by the complex location, and the biopsy suggested neoplastic cells with marked degeneration. Due to progressive odynophagia and poor oral intake, endoscopic re-evaluation under general anesthesia was performed. Using Sato's curved laryngoscope, the lesion was clearly visualized as a semipedunculated mass arising from the post-ESD site and was completely resected for diagnosis and symptom relief. Histopathology revealed inflammatory granulation tissue without malignancy. Symptoms resolved promptly with no recurrence during 6 months of follow-up. This case highlights the development of exuberant granulation tissue at the post-ESD site in the cervical esophagus during intensive stricture prophylaxis. Although this rare finding likely reflects multiple overlapping factors, endoscopic evaluation and treatment were successfully performed while avoiding overtreatment.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694049","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":"Severe Bacteremia Caused by Clostridium butyricum Following Endoscopic Ultrasound-Guided Peripancreatic Fluid Drainage for Walled-off Necrosis: A Case Report","authors":"Koichi Soga,&nbsp;Ou Takagi,&nbsp;Haruka Kato,&nbsp;Hiroki Maeda,&nbsp;Yuki Soma,&nbsp;Masaru Kuwada,&nbsp;Yo Fujimoto,&nbsp;Ryosaku Shirahashi,&nbsp;Ikuhiro Kobori,&nbsp;Masaya Tamano","doi":"10.1002/deo2.70325","DOIUrl":"10.1002/deo2.70325","url":null,"abstract":"<p>We report a rare case of bacteremia caused by <i>Clostridium butyricum</i> following endoscopic ultrasound-guided peripancreatic fluid drainage (EUS-PFD) for walled-off necrosis (WON) in a patient with alcoholic chronic pancreatitis. The patient underwent EUS-PFD using a plastic stent (PS) for WON, initially with a good response. However, dislodgement of the PS resulted in closure and secondary cavity infection. The patient subsequently developed sepsis and multiorgan failure. Blood cultures from arterial and venous sources confirmed <i>C. butyricum</i>, consistent with the patient's oral intake of <i>C. butyricum</i> MIYAIRI 588 (CBM 588). Intensive care, including repeated EUS-PFD and antibiotic administration, led to recovery. Although CBM 588, a <i>C. butyricum agent</i>, remains a valuable probiotic, clinicians must exercise caution when prescribing it to patients with impaired mucosal barriers or those undergoing EUS-guided drainage procedures. Close monitoring of stent placement, drainage efficacy, and individualized assessment of probiotic administration are essential to minimize the risk of systemic infections.</p><p><b>Trial Registration</b>: The authors have confirmed clinical trial registration is not needed for this submission.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13069354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679740","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":"Successful Endoscopic Removal of a Clip-stone Complex Following Laparoscopic Cholecystectomy: A Case Report","authors":"Takahiro Yamada,&nbsp;Masao Toki,&nbsp;Takuya Ishida,&nbsp;Hidenori Shibuta,&nbsp;Tadaaki Ogimoto,&nbsp;Sho Kawamoto,&nbsp;Kazushige Ochiai,&nbsp;Jun Miyoshi,&nbsp;Tadakazu Hisamatsu","doi":"10.1002/deo2.70321","DOIUrl":"10.1002/deo2.70321","url":null,"abstract":"<p>An 84-year-old woman with a history of laparoscopic cholecystectomy for gallbladder stone disease 6 years earlier presented to our outpatient clinic. She was referred to gastroenterology for a thorough examination after blood tests showed liver dysfunction. An abdominal non-contrast computed tomography scan showed a hyperdensity area in the common bile duct with a suspected metallic component, and we diagnosed a clip-stone complex caused by a migrated clip. Laparoscopic cholecystectomy has become the standard of care for cholecystolithiasis, and as the number of operations increases, it is important to keep post-cholecystectomy clip migration in mind as a late postoperative complication. We decided to perform endoscopic retrograde cholangiography to remove the complex stones, and performed a balloon catheter stone removal procedure with endoscopic papillary large balloon dilation (EPLBD). There have been reports of emergency surgery due to stone interference between the clip and catheter when a basket catheter was used to remove stones. We argue that balloon catheter stone removal in combination with EPLBD should be considered for clip-stone complexes.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13069353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679078","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":"Primary Anaplastic Lymphoma Kinase-Positive Inflammatory Myofibroblastic Tumor of the Small Bowel Detected by Capsule Endoscopy: A Case Report","authors":"Tomoyuki Niwa,&nbsp;Yasushi Hamaya,&nbsp;Yusuke Asai,&nbsp;Tatsuhiro Ito,&nbsp;Satoru Takahashi,&nbsp;Shunya Onoue,&nbsp;Satoshi Osawa,&nbsp;Mayu Sakata,&nbsp;Hiroya Takeuchi,&nbsp;Ken Sugimoto","doi":"10.1002/deo2.70327","DOIUrl":"10.1002/deo2.70327","url":null,"abstract":"<p>Primary inflammatory myofibroblastic tumor (IMT) of the small intestine is rare, and its endoscopic characteristics remain poorly defined. We report a case of anaplastic lymphoma kinase (ALK)-positive small bowel IMT detected by capsule endoscopy (CE). A 24-year-old woman presented with epigastric pain. Contrast-enhanced computed tomography revealed a 2-cm mass in the small intestine. Double-balloon endoscopy was attempted but failed to reach the lesion. CE demonstrated a submucosal tumor-like protrusion with mild surface erythema and conspicuous whitish villous changes. Laparoscopy-assisted partial resection of the small intestine was performed, and histopathological examination with immunohistochemistry confirmed ALK-positive IMT. The postoperative course was uneventful, and no recurrence was observed during 8 months of follow-up. This case indicates that CE can provide clinically useful information for the evaluation of small bowel submucosal lesions beyond the reach of conventional endoscopy. IMT should be considered in the differential diagnosis of erythematous small bowel tumors in young patients.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13069587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679707","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":"Risk Factors for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Patients With Post-Endoscopic Sphincterotomy Papillae","authors":"Shuhei Shibata,&nbsp;Katsunobu Tawada,&nbsp;Hideyuki Takashiro,&nbsp;Shinichi Tazawa,&nbsp;Masatoshi Usui,&nbsp;Hiromasa Nomoto,&nbsp;Hirofumi Saito","doi":"10.1002/deo2.70322","DOIUrl":"10.1002/deo2.70322","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a well-known complication. While most reported risk factors relate to treatment-naïve papillae, those in patients with post-endoscopic sphincterotomy (post-EST) papillae remain unclear. We aimed to identify risk factors for PEP in patients with a history of EST undergoing ERCP for biliary disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 678 patients with prior EST who underwent ERCP between January 2017 and October 2023. PEP was diagnosed according to established criteria. Logistic regression analyses were performed to identify risk factors. To account for repeated ERCP sessions, additional analyses using cluster-robust standard errors were conducted. Body mass index (BMI) was evaluated as both a continuous variable and according to World Health Organization categories. Prophylactic rectal diclofenac or intravenous nafamostat mesilate was administered at the operator's discretion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age was 75.4 years, and PEP occurred in 4.4%. Multivariate analysis identified female sex (<i>p</i> = 0.016; odds ratio [OR] 2.97), low BMI (<i>p</i> = 0.021; OR 2.94), and prolonged procedure time (<i>p</i> = 0.0048; OR 4.29) as independent risk factors. Operator experience and prophylactic agents were not significantly associated with PEP. In analyses accounting for within-patient correlation, BMI &lt;18.5 kg/m² remained significantly associated with PEP (OR 2.73; <i>p</i> = 0.012), whereas associations with sex and procedure duration were attenuated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Low BMI is a consistent risk factor for PEP in patients with post-EST papillae. The effectiveness of pharmacologic prophylaxis may differ from that in treatment-naïve papillae and warrants prospective evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640759","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}