DEN open最新文献

{"title":"Prevalence and Clinical Significance of Gastric-Type Mucosal Lesions in Non-Ampullary Duodenal Epithelial Tumors Based on Mucin Phenotype","authors":"Kazuya Ohno,&nbsp;Eiji Nakatani,&nbsp;Takafumi Kurokami,&nbsp;Asami Kawai,&nbsp;Masanori Matsuda,&nbsp;Yuichi Masui,&nbsp;Tatsunori Satoh,&nbsp;Taiyo Hirata,&nbsp;Shodai Takeda,&nbsp;Yoshihiro Uehara,&nbsp;Kodai Baba,&nbsp;Yuka Ozaki,&nbsp;Tomoki Hikichi,&nbsp;Haruna Takahashi,&nbsp;Koki Sakaguchi,&nbsp;Kazuhito Honda,&nbsp;Tomomi Maeda,&nbsp;Moeri Hotta,&nbsp;Naofumi Nakamura,&nbsp;Makoto Suzuki,&nbsp;Ken Haruma","doi":"10.1002/deo2.70443","DOIUrl":"https://doi.org/10.1002/deo2.70443","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Non-ampullary duodenal epithelial tumors differ in clinicopathological features according to mucin phenotype. Gastric-type tumors have distinct biological features; however, their associated mucosal background remains unclear. In this study, gastric foveolar metaplasia, gastric heterotopia, and Brunner's gland hyperplasia were collectively referred to as gastric-type mucosal lesions (G-MLs). We aimed to assess their prevalence and associations with mucin phenotype and clinicopathological factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed the data of 130 patients with 130 resected non-ampullary duodenal epithelial tumors at a single center. Tumors were classified according to mucin phenotype. The prevalence of concomitant G-MLs and associated factors was evaluated. Exploratory Firth-penalized logistic regression analysis was used to assess the association between gastric-type tumors and G-ML presence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Concomitant G-MLs were identified in 44 patients (33.8%). Their prevalence was higher in gastric-type tumors (13/16; 81.3%) than in gastric–intestinal-type tumors (10/37; 27.0%) and intestinal-type tumors (21/77; 27.3%). G-MLs were associated with mild endoscopic gastric mucosal atrophy and smoking status and were inversely associated with current <i>Helicobacter pylori</i> infection. In the exploratory fully adjusted model, gastric-type tumors remained positively associated with the presence of G-MLs (adjusted odds ratio, 7.00; 95% confidence interval, 1.98–30.95; <i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>G-MLs were present in approximately one-third of patients and were most frequent in gastric-type tumors. These findings indicate an association between G-MLs and gastric-type tumors; however, the cross-sectional design does not allow inference of a biological relationship.</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":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70443","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149258825","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":"Environmental Impact of Conventional Versus Underwater Endoscopic Mucosal Resection for Colorectal Lesions: A Procedure-Based Life Cycle Assessment With Pooled Effectiveness Estimates","authors":"Giulio Calabrese,&nbsp;Frederic Moll,&nbsp;João A. Cunha Neves,&nbsp;Livio Bonacci,&nbsp;Emanuele Sinagra,&nbsp;Fabiana Castiglione,&nbsp;Marcello Maida,&nbsp;Eduardo Albéniz-Arbizu,&nbsp;Mathieu Pioche,&nbsp;Sandro Sferrazza","doi":"10.1002/deo2.70457","DOIUrl":"https://doi.org/10.1002/deo2.70457","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The environmental impact of endoscopic techniques remains poorly defined. We compared procedure-related environmental outcomes between conventional endoscopic mucosal resection (EMR) and underwater EMR (U-EMR) for colorectal lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective pilot procedure-based life cycle assessment of the resection phase, 10–25-mm colorectal lesions underwent EMR or U-EMR across three endoscopy units. Outcomes included global warming potential (GWP, kg CO₂-equivalent/procedure), waste, life-cycle water consumption, fossil resource scarcity, and terrestrial acidification. Exploratory GWP per en bloc resection was estimated using pooled randomized-trial and pilot-cohort data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-nine procedures were included: 23 EMR and 26 U-EMR. <i>En bloc</i> resection was achieved in 56.5% of EMR and 69.2% of U-EMR, and R0 resection in 52.2% and 69.2%. Mean GWP was significantly lower with U-EMR than EMR (1.92 ± 0.54 vs. 2.42 ± 0.50 kg CO₂-eq; <i>p =</i> 0.002), corresponding to a reduction of 0.50 kg CO₂-eq per procedure and 50 kg CO₂-eq per 100 procedures. U-EMR was associated with lower waste generation (324.0 ± 78.3 vs. 407.3 ± 72.0 g; <i>p</i> &lt; 0.001), water consumption (0.56 ± 0.17 vs. 0.77 ± 0.20 m³; <i>p</i> &lt; 0.001), fossil resource scarcity (0.33 ± 0.10 vs. 0.40 ± 0.09 kg oil-eq; <i>p =</i> 0.007), and terrestrial acidification (0.0052 ± 0.0018 vs. 0.0068 ± 0.0018 kg SO₂-eq; <i>p =</i> 0.003). Findings were consistent across scenario and uncertainty analyses. In the meta-analysis-based model, GWP per en bloc resection was lower with U-EMR than EMR (2.59 vs. 3.51 kg CO₂-eq), corresponding to a 26.3% relative reduction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>U-EMR was associated with lower procedure-related environmental burden than conventional EMR, persisting after normalization for en bloc resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>No. 165/26</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70457","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149258830","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":"Quantification of Medical Waste and Incineration-Related CO2 Emissions Associated With Gastrointestinal Endoscopy at Two Facilities in Japan: A Preliminary Observational Study","authors":"Ryosuke Kawanishi,&nbsp;Atsushi Imagawa,&nbsp;Naoya Tada,&nbsp;Noriko Nishiyama,&nbsp;Haruo Oba,&nbsp;Hideki Kobara","doi":"10.1002/deo2.70455","DOIUrl":"https://doi.org/10.1002/deo2.70455","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Sustainable development oals in gastrointestinal endoscopy (GIE), referred to as “green endoscopy,” have been a research focus in Western countries. However, the environmental burden of GIE in Japan is poorly understood. We quantify medical waste and estimate GIE-derived incineration-related CO₂ emissions in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a dual-center observational study, we report waste from esophagogastroduodenoscopy (EGD), colonoscopy (CS), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic submucosal dissection (ESD) from June 2024 to January 2025. We classify waste as infectious/non-infectious, combustible/non-combustible, liquid, or sharps. We record the per-procedure waste and the procedure time, estimate CO₂ emissions from the combustion of the measured waste mass using combustion equations for cellulose and polyethylene, and calculate per-minute emissions and annual totals. Sensitivity analyses are performed for changes in the anticipated waste composition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Estimated per-procedure CO₂ emissions are 949, 1178, 5834, and 4780 g for EGD, CS, ESD, and ERCP, respectively. Aggregate per-minute emissions are 168, 165, 89, and 75 g/min for ERCP, EGD, CS, and ESD, respectively. Annual institutional emissions total approximately 5800 kg. Estimated emissions are 64%–69% and 123%–134% of the base composition scenario values in the lower- and higher-emission composition scenarios, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ESD had the highest per-procedure emissions, and ERCP and EGD had the highest per-minute emissions. These results provide preliminary baseline data on incineration-derived CO₂ emissions as a foundation for promoting “green endoscopy.”</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70455","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149258260","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 Management of a Completely Disconnected Bile Leak After Hepatectomy Using Endoscopic Ultrasound-Guided Transluminal Drainage of a Biloma: A Case Report","authors":"Tatsuki Tanaka,&nbsp;Kohsaku Ohnishi,&nbsp;Hiroshi Yukimoto,&nbsp;Akino Okamoto,&nbsp;Takafumi Tanimoto,&nbsp;Soichiro Mori,&nbsp;Motohiro Hirao,&nbsp;Masanori Tsujie,&nbsp;Atsushi Hosui,&nbsp;Naoki Hiramatsu","doi":"10.1002/deo2.70459","DOIUrl":"https://doi.org/10.1002/deo2.70459","url":null,"abstract":"<p>Post-hepatectomy bile leak is a common postoperative complication. It usually resolves spontaneously but may be refractory. In cases of completely disconnected bile ducts, endoscopic retrograde cholangiopancreatography (ERCP)–guided drainage is often technically difficult, and invasive additional procedures may be required. We report a completely disconnected bile leak after hepatectomy successfully treated with endoscopic ultrasound-guided transluminal drainage (EUS-TD) after unsuccessful EUS-guided biliary drainage (EUS-BD). A 78-year-old woman underwent anterior sectionectomy for recurrent hepatocellular carcinoma and developed persistent bile leakage. ERCP showed complete disruption of the right posterior sectoral bile duct, and guidewire passage was impossible. EUS-BD failed because of the nondilated bile duct; therefore, the bile leak-associated infected biloma was drained through an endoscopically created route under EUS guidance. The infected biloma showed significant shrinkage, and the patient was discharged without complications. EUS-TD may represent an alternative therapeutic option for completely disconnected bile leaks when EUS-BD is technically difficult.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70459","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149258259","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":"Clinical Outcomes of Partial Injection Underwater Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors (With Video)","authors":"Noboru Misawa,&nbsp;Takuma Higurashi,&nbsp;Yuki Asano,&nbsp;Kojiro Inoue,&nbsp;Hitomi Suzuki,&nbsp;Shigeki Tamura,&nbsp;Takashi Kobayashi,&nbsp;Michihiro Iwaki,&nbsp;Asako Nogami,&nbsp;Sho Hasegawa,&nbsp;Masato Yoneda","doi":"10.1002/deo2.70453","DOIUrl":"10.1002/deo2.70453","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Although endoscopic resection is widely performed for superficial non-ampullary duodenal epithelial tumors (SNADETs), conventional endoscopic mucosal resection (CEMR) may be associated with suboptimal complete resection rates. Partial injection underwater EMR (PI-UEMR) has been proposed to improve the visualization of distal lesion margins and facilitate en bloc resection. We aimed to evaluate the outcomes of PI-UEMR for SNADETs, using CEMR as a historical institutional comparator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center observational cohort study included patients who underwent endoscopic mucosal resection for SNADETs between September 2015 and December 2025. Lesions treated with CEMR or PI-UEMR were analyzed. The primary outcomes were en bloc and R0 resection rates. The secondary outcomes included histological diagnosis and procedure-related adverse events, including intraoperative perforation, delayed perforation, and delayed bleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 77 lesions in 73 patients were analyzed, including 39 treated with CEMR and 38 treated with PI-UEMR. The en bloc resection rates were 90.0% and 97.4% in the CEMR and PI-UEMR groups, respectively. The R0 resection rate was significantly higher in the PI-UEMR group than in the CEMR group (89.4% vs. 69.2%). Histological diagnoses were similar between the groups. No intraoperative perforation occurred in either group. No procedure-related adverse events, including delayed perforation or bleeding, were observed in the PI-UEMR group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While maintaining a favorable safety profile, PI-UEMR was associated with a higher R0 resection rate than CEMR in this study. It may represent an effective endoscopic treatment option for SNADETs, particularly when precise visualization of the distal lesion margins is required.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Trial Registration</b>: University Hospital Medical Information Network: UMIN000060637</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149248012","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":"Prediction Models for Delayed Bleeding After Colorectal Endoscopic Submucosal Dissection: A Systematic Review and Critical Appraisal","authors":"Da Miao,&nbsp;Zhuoer Hou,&nbsp;Yao Ge,&nbsp;Haiou Qi","doi":"10.1002/deo2.70456","DOIUrl":"10.1002/deo2.70456","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although many predictive models have been developed or validated for delayed bleeding after colorectal endoscopic submucosal dissection (ESD), their methodological quality and clinical utility remain uncertain. We systematically reviewed and critically appraised all available predictive models for this outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched five databases through March 2026 for observational studies that developed or validated prediction models or scoring systems for delayed bleeding after colorectal ESD in adults (≥18 years). Two reviewers independently extracted data and assessed risk of bias using PROBAST.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 25,177 records screened, five studies reporting five predictive models were included. The incidence of delayed bleeding ranged from 2.9% to 9.9%. The most commonly used predictors were lesion location and lesion size. Discrimination in derivation cohorts ranged from 0.726 to 0.890, internal validation areas under the curve [AUCs] ranged from 0.739 to 0.870, and the externally validated model achieved an AUC of 0.634. All studies were judged to have a high risk of bias, mainly because of inadequate reporting in the predictor, outcome, and analysis domains, although most had low concerns regarding applicability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This systematic review identified five predictive models for delayed bleeding after colorectal ESD. Lesion location and size were the most frequently reported predictors. Discriminative performance varied across derivation and validation cohorts, with suboptimal external-validation results. All models had a high risk of bias per PROBAST (low concerns regarding applicability); therefore, their findings should be interpreted cautiously.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228966","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":"Feasibility of a Deep-Learning Model for Objective Visualization-Quality Assessment During Cholangioscopy-Guided Lithotripsy: A Proof-of-Concept Study","authors":"Hideki Kamada,&nbsp;Kiyoyuki Kobayashi,&nbsp;Hiroki Yamana,&nbsp;Naoki Fujita,&nbsp;Daisuke Namima,&nbsp;Manabu Yamada,&nbsp;Syunsuke Fujita,&nbsp;Hironobu Suto,&nbsp;Keiichi Okano,&nbsp;Hideki Kobara","doi":"10.1002/deo2.70454","DOIUrl":"10.1002/deo2.70454","url":null,"abstract":"<p>During peroral cholangioscopy-guided electrohydraulic lithotripsy (EHL), stone fragmentation obscures the visual field (the “snowstorm effect”), and visualization quality has been assessed only subjectively. This proof-of-concept study explored the feasibility of a deep-learning method for objectively quantifying visualization quality during EHL and, as an exploratory application, compared viscous gel immersion with saline irrigation. A ResNet-18 model was trained on expert-annotated frames (5-point scale) from three development cases. For independent validation, 120 frames from 12 previously unseen comparison cases were scored by two blinded endoscopists (inter-reader weighted <i>κ</i> = 0.98). The model showed only moderate agreement with their consensus (weighted <i>κ</i> = 0.60; accuracy 70.8%); because the validation sample was enriched for predicted-usable frames, metrics re-weighted to the natural frame distribution gave sensitivity 29.8% and specificity 93.5%, indicating systematic under-detection of usable views. Agreement did not differ systematically between gel and saline frames. The High-Quality View Rate (HQVR) was the proportion of EHL-phase frames scored Good/Excellent. In a patient-level comparison, median HQVR was 22.7% for gel versus 8.4% for saline (exact Mann–Whitney U, <i>p</i> = 0.15, not significant); in post hoc exploratory analyses, a threshold-independent mean predicted score differed (1.65 vs. 1.35, <i>p</i> = 0.005) and the longest continuous usable interval favored gel (median 24.4 vs. 5.2 s). Mild cholangitis occurred in 1/5 gel and 4/7 saline patients. Training such a model is feasible, but it is not yet a validated measurement tool, and the gel-versus-saline signal is hypothesis-generating only. Larger multi-case training and prospective validation are required.</p><p><b>Trial Registration</b>: N/A</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225594","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":"Foot-Pedal Monitoring Camera Improves Pedal Operation During Simulated Therapeutic Endoscopy","authors":"Riku Nakajima,&nbsp;Wataru Sano,&nbsp;Sachiko Shimizu,&nbsp;Daizen Hirata,&nbsp;Mineo Iwatate,&nbsp;Mikio Fujita,&nbsp;Yasushi Sano","doi":"10.1002/deo2.70452","DOIUrl":"https://doi.org/10.1002/deo2.70452","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Therapeutic endoscopic procedures often require the coordinated use of multiple foot pedals, making pedal operation challenging. We developed a foot-pedal monitoring camera system that displays the pedal area on the endoscopic monitor, allowing operators to confirm pedal position without looking away from the procedural field. This study evaluated the effect of the system on foot-pedal operation during simulated therapeutic endoscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center simulation study used a custom-built simulator that displayed one of four commands on a monitor: cutting, coagulation, water jet, or injection. Participants responded by pressing the corresponding foot pedal. Each participant completed three sets of 20 commands under two conditions: with and without camera assistance. The primary outcome was participant-level mean reaction time. Secondary outcomes included participant-level median reaction time, incorrect pedal presses, and gaze shifts toward the foot pedals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen endoscopists from 13 institutions completed all simulation tasks under both study conditions. Camera assistance significantly reduced the mean reaction time compared with the conventional condition (1190.4 ms vs. 1280.8 ms; <i>p</i> = 0.0024). Participant-level median reaction times were also significantly shorter with camera assistance. In addition, camera assistance reduced incorrect pedal presses and gaze shifts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The foot-pedal monitoring camera improved the speed of pedal operation and reduced incorrect pedal presses and gaze shifts during simulated therapeutic endoscopy. Further clinical investigation is needed to determine whether these findings translate into improved pedal operation during actual therapeutic endoscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Trial Registration</b>: University Hospital Medical Information Network: UMIN000060763</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70452","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149205717","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":"Feasibility and Safety of a Novel Pig-tail Inside Stent for Unresectable Malignant Hilar Biliary Obstruction: A Single-center Case Series (With Video)","authors":"Motoyasu Kan,&nbsp;Daiki Takahashi,&nbsp;Sodai Uchida,&nbsp;Taiga Sudo,&nbsp;Kouki Yokozuka,&nbsp;Yoshiki Nakaya,&nbsp;Akinori Abe,&nbsp;Hiroki Kurosaki,&nbsp;Yoshiki Ogane,&nbsp;Kazuki Watabe,&nbsp;Miho Sakai,&nbsp;Yu Sekine,&nbsp;Mayu Ouchi,&nbsp;Hiroshi Ohyama,&nbsp;Izumi Ohno,&nbsp;Jun Kato","doi":"10.1002/deo2.70451","DOIUrl":"10.1002/deo2.70451","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Inside stents are increasingly used for malignant hilar biliary obstruction because of their prolonged patency and removability. Although reported migration rates vary, migration remains a clinical concern, and deployment in angulated bile ducts can be technically challenging. We evaluated a novel pig-tail type inside stent (X-FLEX ARC type) in unresectable malignant hilar biliary obstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective single-center case series included consecutive patients who underwent X-FLEX ARC type placement between October 2024 and December 2025. Procedural characteristics were evaluated for the 26 deployed ARC-type stents, whereas clinical outcomes were evaluated after the 13 initial drainage procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen patients underwent 21 endoscopic retrograde cholangiopancreatography sessions, during which 26 ARC-type stents were deployed. Deployment into the intended bile duct branch was completed in all selected sessions. The median placement time was 4.0 min, and additional maneuvers were required for five stents (19.2%). Among 13 initial drainage procedures, clinical success was achieved in 11 (84.6%), and no procedure-related adverse events occurred. Recurrent biliary obstruction (RBO) occurred after five procedures (38.5%), with a median time to RBO of 167 days (95% confidence interval, 137–not reached). No ARC-type stent migration was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This preliminary case series provides descriptive information on ARC-type inside stent placement and removability in selected patients with unresectable malignant hilar biliary obstruction. Prospective comparative studies are needed to determine its technical applicability and effects on stent migration and long-term patency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Trial Registration</b>: N/A</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187051","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 Resection Ability of Low-power Pure-cut Hot Snare Polypectomy for Nonpedunculated Colorectal Polyps Smaller Than 10 mm: A Single-center Prospective Study","authors":"Ryo Mizuno,&nbsp;Hidenori Kimura,&nbsp;Ryoji Kushima,&nbsp;Akifumi Notsu,&nbsp;Atsushi Nishida,&nbsp;Osamu Inatomi,&nbsp;Takuji Iwashita","doi":"10.1002/deo2.70450","DOIUrl":"10.1002/deo2.70450","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Small colorectal polyps sometimes include high-grade adenomas or carcinomas that require endoscopic resection with electrocautery. Recent studies have reported the usefulness of low-power pure-cut hot snare polypectomy (LPPC-HSP) as a less invasive technique. However, the actual resection depth of LPPC-HSP has not been fully investigated. Therefore, this study aimed to evaluate the resection ability of LPPC-HSP for small colorectal polyps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this single-arm prospective observational study, patients scheduled to undergo LPPC-HSP for nonpedunculated colorectal polyps smaller than 10 mm were enrolled. The primary outcome was the rate of sufficient vertical R0 resection (SVR0), defined as an R0 resection with a sufficient submucosal layer beneath the whole lesion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 95 patients with 150 lesions were included. The en bloc and R0 resection rates were 100% and 83%, respectively. The SVR0 rate was 76.7% (90% confidence interval: 70.3%–82.2%). All specimens contained the muscularis mucosa, and 132 lesions (88%) contained submucosal tissue. The median maximum submucosal thickness was 1331 µm (interquartile range, 736–2044 µm). No bleeding, perforation, or other serious adverse events were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LPPC-HSP demonstrated acceptable vertical resection capability. LPPC-HSP may be applicable for colorectal polyps smaller than 10 mm with potential malignancy, providing resection depth comparable to that of conventional electrocautery-based methods.</p>\u0000 \u0000 <p><b>Trial Registration</b>: University Hospital Medical Network Clinical Trials Registry: UMIN000054732</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187057","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}