DEN open最新文献

{"title":"Efficacy of Drainage Combining Endoscopic Retrograde Cholangiopancreatography With Endoscopic Ultrasound-guided Biliary Drainage for Difficult-to-Control Cholangitis in Patients With Hilar Cholangiocarcinoma","authors":"Tomoki Ogata,&nbsp;Yusuke Kurita,&nbsp;Takamitsu Sato,&nbsp;Shin Yagi,&nbsp;Yu Honda,&nbsp;Takeshi Iizuka,&nbsp;Sho Hasegawa,&nbsp;Kunihiro Hosono,&nbsp;Noritoshi Kobayashi,&nbsp;Itaru Endo,&nbsp;Kensuke Kubota,&nbsp;Masato Yoneda,&nbsp;Atsushi Nakajima","doi":"10.1002/deo2.70210","DOIUrl":"https://doi.org/10.1002/deo2.70210","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Hilar cholangiocarcinoma often results in repeated early stent dysfunction and difficult-to-control cholangitis after drainage using endoscopic retrograde cholangiopancreatography (ERCP). In this study, we evaluated the effectiveness of additional drainage using endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with hilar cholangiocarcinoma who had difficult-to-control cholangitis after transpapillary drainage with ERCP alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated 20 patients with hilar cholangiocarcinoma who had difficult-to-control cholangitis after transpapillary drainage with ERCP at our hospital between 2017 and 2025 and therefore underwent additional drainage using EUS-BD. We evaluated the time to recurrent biliary obstruction (TRBO) just before and after combined ERCP and EUS-BD in these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The Bismuth classification of stenosis was II in four cases (20.0%), IIIa in five cases (25.0%), IIIb in one case (5.0%), and IV in 10 cases (50.0%). The median (95% confidence interval) TRBO biliary obstruction just before and just after additional drainage with EUS-BD was 16.5 days (7.0–27.0) and 91.0 days (53.0–NR), respectively, and additional drainage with EUS-BD significantly prolonged stent patency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Combining ERCP with EUS-BD for drainage was effective in patients with hilar cholangiocarcinoma who had stent dysfunction due to cholangitis that was difficult to control using transpapillary drainage with ERCP alone.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70210","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146923","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":"Trends in Endoscopist Reporting Rates of Eosinophilic Gastrointestinal Diseases in Japan Evaluated by the Japan Endoscopy Database Project","authors":"Kazuya Miyaguchi,&nbsp;Yoshikazu Tsuzuki,&nbsp;Akiko Shiotani,&nbsp;Kiyohito Tanaka,&nbsp;Hiroyuki Imaeda","doi":"10.1002/deo2.70214","DOIUrl":"https://doi.org/10.1002/deo2.70214","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To examine the annual trends in the occurrence of eosinophilic gastrointestinal disease (EGID) in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study examined data from patients with EGID who underwent endoscopy at 716 facilities between January 2015 and March 2023. Data extracted from the Japanese Endoscopy Database (JED) included endoscopic procedure counts, patient demographics, <i>Helicobacter pylori</i> infection status, comorbidities, and balloon dilatation. Analyses incorporated both confirmed and suspected EGID cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 9,940,870 endoscopic procedures were performed, identifying 9669 cases of EGID. From 2015 to 2023, the Cochran–Armitage trend test showed a significant increase in cases of eosinophilic esophagitis (EoE), eosinophilic gastritis (EoG), and eosinophilic duodenitis (EoD) (<i>p</i> &lt; 0.001). However, no significant trend was observed for eosinophilic enteritis (EoN) or eosinophilic colitis (EoC) (<i>p</i> = 0.136). The number of EoE cases increased, with reporting rates changing from 36 (0.0464%) in 2015 to 3631 (0.176%) in 2022 (<i>p</i> &lt; 0.001). EoG + EoD cases increased from one (0.0013%) to 410 (0.0199%) (<i>p</i> &lt; 0.001), while EoN + EoC cases remained stable (<i>p</i> = 0.136).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The JED project data showed increasing detection of EoE, EoG, and EoD in Japan, while EoN and/or EoC cases remained stable. These findings are based on reporting rates from individuals undergoing endoscopy, rather than estimates from population-based endoscopist reporting rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70214","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146924","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":"Efficacy and Safety of Gel Immersion Endoscopic Mucosal Resection for Gastric Neoplasms in Patients With Familial Adenomatous Polyposis: A Multicenter Retrospective Study","authors":"Hidenori Kimura,&nbsp;Kohei Shigeta,&nbsp;Yohei Yabuuchi,&nbsp;Yoichi Yamamoto,&nbsp;Soichiro Nagao,&nbsp;Akito Noguchi,&nbsp;Shinya Uematsu,&nbsp;Shuhei Shintani,&nbsp;Hiroto Inoue,&nbsp;Atsushi Nishida,&nbsp;Hiroyuki Ono,&nbsp;Osamu Inatomi","doi":"10.1002/deo2.70209","DOIUrl":"https://doi.org/10.1002/deo2.70209","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Approximately 10%–30% patients with familial adenomatous polyposis (FAP) develop gastric neoplasms (GNs). Although recent reports have suggested the effectiveness of gel-immersion endoscopic mucosal resection (GI-EMR) for FAP-associated GNs, given its simplicity and safety, treatment outcomes for such lesions have not been evaluated. We aimed to investigate the efficacy and safety of GI-EMR compared with endoscopic submucosal dissection (ESD) for GNs in patients with FAP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this multicenter, retrospective study, treatment outcomes of ESD and GI-EMR for GNs measuring ≤20 mm with protruding or flat elevated morphology between April 2011 and November 2024 were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 15 ESD and 12 GI-EMR cases. En bloc and R0 resection rates did not significantly differ between the ESD and GI-EMR groups (100% vs. 100% and 100% vs. 83.3%, <i>p</i> = 0.19, respectively). The procedure time was significantly shorter for GI-EMR than for ESD (2 vs. 47 min, <i>p</i> &lt; 0.001, respectively). Intraprocedural perforation occurred in 6.7% of ESD cases, but was not observed in the GI-EMR group. Neither delayed bleeding nor perforation occurred in any group. During the median follow-up period of 22.3 months, no local recurrence was observed in either group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>GI-EMR may be considered one of the therapeutic options for GNs in patients with FAP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70209","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146388","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":"Effectiveness of Gel-immersion Endoscopic Injection Sclerotherapy Under Texture and Color Enhancement Imaging for Esophageal Varices: A Comparison of Variceal Visibility Under Gel With White Light Imaging","authors":"Tsunetaka Kato,&nbsp;Takuto Hikichi,&nbsp;Jun Nakamura,&nbsp;Minami Hashimoto,&nbsp;Takumi Yanagita,&nbsp;Mitsuru Otsuka,&nbsp;Daiki Nemoto,&nbsp;Rei Suzuki,&nbsp;Mitsuru Sugimoto,&nbsp;Hiroyuki Asama,&nbsp;Kentaro Sato,&nbsp;Hiroshi Shimizu,&nbsp;Kento Osawa,&nbsp;Rei Ohira,&nbsp;Masao Kobayakawa,&nbsp;Hiromasa Ohira","doi":"10.1002/deo2.70201","DOIUrl":"https://doi.org/10.1002/deo2.70201","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Gel-immersion endoscopic injection sclerotherapy (GI-EIS) addresses the technical challenges in intravariceal injection for esophageal varices (EVs). However, gel accumulation may obscure the variceal morphology. Thus, we developed GI-EIS under texture and color enhancement imaging (TXI) and evaluated its effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included EV patients who underwent primary prophylactic intravariceal EIS. Patients were divided into GI-EIS under TXI and conventional EIS groups. Primary outcomes were the success rates of intravariceal sclerosant injection and sclerosant injection into the afferent vessels. Secondary outcomes included the visibility score of EV morphology under TXI compared with white light imaging (WLI) during gel-immersion and luminance gradient across the EVs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 32 patients (16 in each group) were evaluated. The success rate of intravariceal sclerosant injection was comparable between GI-EIS under TXI and conventional EIS (93.8% vs. 87.5%, <i>p</i> = 0.54). However, injection into the afferent vessels was significantly more successful with GI-EIS under TXI (87.5% vs. 43.8%, <i>p</i> &lt; 0.01). The visibility score of the variceal morphology under TXI was consistently five points in all cases. The luminance gradient was significantly higher under TXI than under WLI (TXI vs. WLI; 0.95 vs. 0.68; <i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>GI-EIS under TXI provided improved visualization of variceal morphology and enhanced success of injection into afferent vessels, suggesting that TXI may optimize the therapeutic performance of GI-EIS for EV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111169","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":"Gastric Foveolar-Type Hyperplastic Polyp of the Duodenum With GNAS and KRAS Mutations: A Potential Precursor to Neoplasia","authors":"Kenji Yamazaki,&nbsp;Ryoji Kushima,&nbsp;Noritaka Ozawa,&nbsp;Haruka Koizumi,&nbsp;Saeka Hayashi,&nbsp;Atsushi Soga,&nbsp;Koji Yamashita,&nbsp;Shogo Shimizu,&nbsp;Masahito Shimizu","doi":"10.1002/deo2.70207","DOIUrl":"10.1002/deo2.70207","url":null,"abstract":"<p>We report a gastric foveolar-type hyperplastic polyp of the duodenum harboring mutations in the <i>GNAS</i> and <i>KRAS</i> genes. The lesion was incidentally detected during a routine upper gastrointestinal endoscopy in a man in his 50s. It appeared as a 10-mm elevated lesion located at the superior duodenal angle. The surrounding mucosa showed no endoscopic evidence of gastric foveolar metaplasia (GFM) or heterotopic gastric mucosa (HGM). Endoscopic mucosal resection was performed as diagnostic treatment. Histopathology showed a diffuse, monotonous proliferation of gastric foveolar-type epithelial cells without cytological dysplasia, and immunohistochemical analysis showed diffuse positivity for MUC5AC. Genetic analysis revealed activating mutations in both the <i>GNAS</i> and <i>KRAS</i> genes. Based on these findings, the final diagnosis was a gastric foveolar-type hyperplastic polyp harboring <i>GNAS</i> and <i>KRAS</i> mutations. Such mutations have also been reported in pyloric gland adenomas and gastric-type duodenal adenocarcinomas. Proximal non-ampullary duodenal epithelial tumors are often linked to a gastric-type mucin phenotype with higher malignant potential. Potential precursor lesions for carcinomas proximal to the ampulla include GFM and HGM. This case supports the hypothesis that some duodenal lesions with the gastric-mucin phenotype may harbor molecular alterations typically associated with neoplastic processes despite their non-neoplastic appearance, suggesting a potential role as precursors to neoplasia.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082894","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":"Underwater Pressure Lumen Expansion: A Novel Method to Overcome Lumen Collapse in Submucosal Endoscopy and Animal Endoscopic Full-thickness Resection Models","authors":"Hironari Shiwaku,&nbsp;Akio Shiwaku,&nbsp;Seiya Sato,&nbsp;Kosuke Yamauchi,&nbsp;Suguru Hasegawa","doi":"10.1002/deo2.70195","DOIUrl":"https://doi.org/10.1002/deo2.70195","url":null,"abstract":"<p>In endoscopic full-thickness resection (EFTR), luminal collapse can occur due to communication between the gastrointestinal lumen and peritoneal cavity, making visualization and procedural continuity difficult. We propose the underwater pressure lumen expansion (UPLE) method, in which hydraulic pressure is applied in a fluid-filled environment to re-expand the collapsed lumen, thereby restoring visualization and allowing continued endoscopic manipulation. The UPLE method was applied during peroral endoscopic tumor resection in a clinical case and in an animal model of EFTR, and its utility was successfully demonstrated.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70195","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145037562","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":"Predictors of Delayed Recovery in Ambulatory Advanced Endoscopic Procedures","authors":"Zoilo K. Suarez,&nbsp;Alexandria Lenyo,&nbsp;Philip M. Frasse,&nbsp;Derek J. Platt,&nbsp;Thomas Hollander,&nbsp;Talwinder Nagi,&nbsp;Michael DeDonno,&nbsp;Vladimir Kushnir,&nbsp;Juan Reyes Genere","doi":"10.1002/deo2.70200","DOIUrl":"https://doi.org/10.1002/deo2.70200","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is a scarcity of data evaluating patient-related outcomes of advanced or complex endoscopy (ACE) through the post-anesthesia recovery course. Yet, gastrointestinal distress following ACE can occur commonly, and this may impact recovery length of stay and the approach to post-anesthesia care. This study aimed to describe post-procedural symptoms in patients undergoing ACE and identify factors that influence recovery time and course.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed a prospectively collected database of patients who underwent ambulatory ACE. Procedural-related symptoms, recovery time, dismissal rate, and adverse events (AE) were recorded. Factors associated with extended recovery time were analyzed using multiple regression analysis. Secondary outcomes included unplanned hospitalization rate and AEs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 172 patients were included, with a mean age of 62.77 years (standard deviation 14.176). 64 patients (37.2%) had an extended recovery time. Abdominal pain and nausea were the most common symptoms associated with extended recovery. Female sex, longer procedure duration, and higher post-procedural pain scores at 30 min were significantly associated with extended recovery (<i>p</i> &lt; 0.05). The procedural-related AE rate was 5.8%, and the overall unplanned hospitalization rate was 3.5%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Procedural-related symptoms following ACE are common, and female sex, duration of procedure, and post-procedural pain score at 30 min are predictive of length of stay. These data provide insight into optimizing the approach to post-procedure care in ACE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012618","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 Full-thickness Resection for Gastric Submucosal Tumor: A Technical Analysis Study (With Video)","authors":"Hitoshi Mori,&nbsp;Noriya Uedo,&nbsp;Satoki Shichijo,&nbsp;Muneshin Morita,&nbsp;Yushi Kawakami,&nbsp;Yasuhiro Tani,&nbsp;Hiroyoshi Iwagami,&nbsp;Muneaki Miyake,&nbsp;Taro Iwatsubo,&nbsp;Minoru Kato,&nbsp;Shunsuke Yoshii,&nbsp;Takashi Kanesaka,&nbsp;Koji Higashino,&nbsp;Tomoki Michida,&nbsp;Ryu Ishihara,&nbsp;Naoki Shinno,&nbsp;Hisashi Hara,&nbsp;Yoshitomo Yanagimoto,&nbsp;Kazuyoshi Yamamoto,&nbsp;Takeshi Omori,&nbsp;Hitoshi Yoshiji","doi":"10.1002/deo2.70198","DOIUrl":"https://doi.org/10.1002/deo2.70198","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endoscopic full-thickness resection (EFTR) is an effective treatment method for gastric submucosal tumors (SMTs). We aimed to perform a technical analysis of EFTR in gastric SMT and compare it with the outcome parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Sixty-one gastric SMTs from 60 patients were resected using EFTR. The indication criteria: size, 11–30 mm, connection to the muscularis propria on endoscopic ultrasonography, intraluminal growth type, no ulceration, and histologically evident or clinically suspicious gastrointestinal stromal tumors (GISTs). The following technical improvements were introduced during the study Periods 1–3: routine use of clip-line traction (Periods 1–3); use of a plastic bag retriever (Periods 2–3); adaptation of the reopenable clip over-the-line method (ROLM, Period 3); implementation of no-touch EFTR (Period 3); and elimination of submucosal injection (Period 3).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The endoscopic complete resection rate was 100%, with a similar tumor resection time (median, 50 min) throughout the periods. Specimen damage was less frequent after using the plastic bag retriever in Periods 2 and 3 (<i>p =</i> 0.001). In Period 3, ROLM required longer full-thickness defect closure time (39 min, <i>p =</i> 0.011), but it provided secure closure and shortened the fasting days (<i>p =</i> 0.010). Histological diagnoses included 38 GISTs, 14 leiomyomas, and nine other pathologies. In Period 3, the implementation of no-touch EFTR increased the resected specimen size (33 mm, <i>p</i> = 0.010) and improved the histological complete (R0) resection rate of the GISTs (13/13, 100%, <i>p =</i> 0.017).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Several technical improvements significantly improved the outcomes of EFTR for gastric SMTs, warranting the external validation of this technique.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012616","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":"Utility of the Endoscopic Pressure Study Integrated System in Identifying Silent Gastroesophageal Reflux Disease During Routine Health Check-ups","authors":"Yohei Nishikawa,&nbsp;Haruhiro Inoue,&nbsp;Kazuki Yamamoto,&nbsp;Tomona Sakurai,&nbsp;Yukiko Okada,&nbsp;Kei Ushikubo,&nbsp;Kohei Shigeta,&nbsp;Ippei Tanaka,&nbsp;Satoshi Abiko,&nbsp;Mayo Tanabe,&nbsp;Takayoshi Ito,&nbsp;Noboru Yokoyama,&nbsp;Naoyuki Uragami","doi":"10.1002/deo2.70204","DOIUrl":"https://doi.org/10.1002/deo2.70204","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The endoscopic pressure study integrated system (EPSIS) is a novel functional endoscopic modality that records intragastric pressure (IGP) waveforms during CO₂ insufflation to evaluate lower esophageal sphincter (LES) function and diagnose gastroesophageal reflux disease (GERD). Although previous studies have applied EPSIS to symptomatic patients, its utility in asymptomatic individuals remains unclear. This study aimed to evaluate the diagnostic value of EPSIS in detecting silent GERD—defined as asymptomatic erosive esophagitis—and associated risk factors in individuals undergoing routine health check-ups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 185 participants who underwent esophagogastroduodenoscopy (EGD) and EPSIS as part of routine health check-ups at a single center between November 2024 and March 2025. Participants were classified into erosive and non-erosive groups based on the presence or absence of mucosal breaks (Grade A or higher) according to the Los Angeles classification. Background characteristics, EPSIS parameters, and endoscopic findings were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>EPSIS was safely performed in all participants without adverse events. The erosive esophagitis group showed significantly more flat waveform patterns (39.4% vs. 14.5%, <i>p</i> = 0.002) and lower maximum IGP values (16.7 mmHg vs. 18.3 mmHg, <i>p</i> = 0.008) compared to the non-erosive group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EPSIS enables a safe and objective assessment of LES function and may support the identification of erosive esophagitis in asymptomatic individuals. It may hold promise as a functional diagnostic tool for the detection of silent GERD and may support preventive strategies during routine endoscopy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70204","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012617","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 Rare Case of Immune-related Adverse Events Localized to the Small Intestine","authors":"Ryo Morikawa,&nbsp;Ryosuke Kanaya,&nbsp;Hiromichi Shimizu,&nbsp;Masayoshi Fukuda,&nbsp;Yasuhiro Nemoto,&nbsp;Toshimitsu Fujii,&nbsp;Towako Taguchi,&nbsp;Kurara Yamamoto,&nbsp;Kazuo Ohtsuka,&nbsp;Ryuichi Okamoto","doi":"10.1002/deo2.70187","DOIUrl":"https://doi.org/10.1002/deo2.70187","url":null,"abstract":"<p>Enterocolitis is a common gastrointestinal manifestation of immune-related adverse events (irAEs); however, only a few studies have reported on irAE enteritis with localized active inflammation in the small intestine. Here, we report the case of a 74-year-old man who developed diarrhea, abdominal pain, and oral intake difficulty and was subsequently hospitalized after receiving atezolizumab for pulmonary adenocarcinoma. Computed tomography and enterocolonoscopy revealed active inflammation in the small intestine but not in the colon, leading to the final diagnosis of irAE enteritis. After initiating prednisolone at a dose of 60 mg/day, his symptoms improved rapidly, and a follow-up enterocolonoscopy revealed a marked reduction in inflammation. Being a relatively rare gastrointestinal toxicity, irAE enteritis often goes unrecognized due to diagnostic challenges, but can lead to serious AEs such as perforation. Therefore, even if colonoscopy findings are normal, a thorough examination of the small intestine is essential for patients who develop gastrointestinal symptoms while undergoing immune checkpoint inhibitor therapy. We herein report a rare case of irAE enteritis confirmed through endoscopic and pathological examination, which has not been previously reported.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70187","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012300","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}