DEN open最新文献

{"title":"Clinical Outcomes of Rubber-clip-assisted Versus Conventional Colorectal Endoscopic Submucosal Dissection: A Retrospective Study","authors":"Kohei Uyama,&nbsp;Hiroyoshi Iwagami,&nbsp;Takuji Akamatsu,&nbsp;Riki Sakano,&nbsp;Tomoya Kitada,&nbsp;Masayuki Shimoyama,&nbsp;Tomoko Terashita,&nbsp;Yasuki Nakatani,&nbsp;Yoshito Uenoyama,&nbsp;Yukitaka Yamashita","doi":"10.1002/deo2.70415","DOIUrl":"10.1002/deo2.70415","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Adequate traction is essential for safe and efficient colorectal endoscopic submucosal dissection (ESD), but gravitational traction is often insufficient in certain situations. Several traction techniques are reportedly effective. We use the rubber-clip method (RCM), which is a simple and inexpensive technique that combines a standard clip with a rubber band to allow directional traction adjustment. This study was performed to evaluate the clinical outcomes of RCM-assisted colorectal ESD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among 551 colorectal ESD procedures performed between January 2014 and October 2025, 452 patients were eligible for inclusion. Propensity score matching using seven covariates yielded 56 RCM and 56 non-RCM cases. The primary endpoint was procedure time, and the secondary endpoints were perforation, bleeding, en bloc resection, and pathological complete resection. Additionally, all procedures were classified as long-duration (≥120 min) or short-duration (&lt;120 min) to identify independent risk factors for prolonged procedures, including intraoperative variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After matching, the RCM group showed a significantly shorter procedure time than the non-RCM group (66.8 vs. 90.7 min, respectively; <i>p</i> = 0.024) and a lower perforation rate (0.0 % vs. 10.7%, respectively; <i>p</i> = 0.027). In the multivariate analysis, absence of traction, non-expert endoscopist, moderate-to-severe fibrosis, large lesion size, and poor maneuverability were independent risk factors for prolonged procedures, with absence of traction showing the strongest association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The RCM shortened procedure time and reduced perforation risk. Given its low cost, simplicity, and ability to adjust traction direction, the RCM may represent an effective traction method for colorectal ESD.</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":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042700","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":"Virtual Chromoendoscopy Enhancing Visualization of Parasite Anatomical Landmarks: A Case Report","authors":"Andrés Eduardo Guevara-Zavala,&nbsp;Sofía Mariño-Velasco,&nbsp;Jordan Bayne,&nbsp;Joel Omar Jaquez-Quintana,&nbsp;Héctor J. Maldonado-Garza,&nbsp;José Alberto González-González","doi":"10.1002/deo2.70438","DOIUrl":"10.1002/deo2.70438","url":null,"abstract":"<p>Cestodes are parasitic flatworms transmitted through fecal-oral transmission. Some patients may present with nonspecific gastrointestinal symptoms. Endoscopic identification of intestinal helminths is uncommon and may pose a diagnostic challenge. We describe the endoscopic findings of intestinal cestodiasis and highlight the role of advanced endoscopic imaging techniques in its in vivo recognition. We report the case of a patient with no significant medical history who presented with recent-onset intermittent gastrointestinal symptoms, including abdominal distension and bloating. Laboratory tests and computed tomography enterography showed no abnormalities. Using magnification and virtual chromoendoscopy, detailed visualization of a parasite attached to the terminal ileal mucosa was achieved. Colonoscopy revealed a thin helminth adherent to the terminal ileal mucosa. Virtual chromoendoscopy enhanced visualization of characteristic anatomical structures. This case highlights the diagnostic value of advanced endoscopic imaging techniques and underscores their usefulness for recognizing uncommon intestinal infections during routine colonoscopy.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042656","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 Hemostasis With Direct Clipping Using a Tapered-Tip Hood and Slim Endoscope for Colonic Diverticular Bleeding Refractory to Endoscopic Band Ligation: A Case Report","authors":"Hirotake Kusumoto,&nbsp;Toru Kuwano,&nbsp;Yu Horikawa,&nbsp;Yukihiro Okada,&nbsp;Mayumi Iguchi,&nbsp;Yukiko Baba,&nbsp;Hideyuki Kishita,&nbsp;Koichiro Tsukasa,&nbsp;Shunji Shimaoka","doi":"10.1002/deo2.70439","DOIUrl":"10.1002/deo2.70439","url":null,"abstract":"<p>Endoscopic band ligation (EBL) is performed for hemostasis in patients with colonic diverticular bleeding (CDB) due to its low rebleeding rate. However, suction and ligation are not successful in some cases. We describe the case of a 93-year-old woman with CDB in whom EBL failed. Because of tissue rigidity, the sigmoid diverticulum could not be adequately suctioned into the ligation device, which resulted in band detachment and subsequent rebleeding. A slim endoscope fitted with a calibrated, small-caliber-tip, transparent hood enabled visualization of the bleeding point within the diverticulum. Complete hemostasis was then achieved by direct clipping using a reopenable clip. This case suggests that direct clipping using a tapered-tip hood with a slim endoscope can be a useful rescue technique after unsuccessful EBL.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042692","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":"Metabolic Improvement and Weight Reduction After Large Endoscopic Submucosal Dissection Including the Papilla for Duodenal Adenoma: A Case Report","authors":"Chi-Chu Lo,&nbsp;Chen-Shuan Chung,&nbsp;Wei-Wei Lee,&nbsp;Chien-Chen Tsai,&nbsp;Kurato Miyazaki,&nbsp;Motohiko Kato","doi":"10.1002/deo2.70433","DOIUrl":"10.1002/deo2.70433","url":null,"abstract":"<p>Endoscopic submucosal dissection (ESD) has become an established therapeutic approach for duodenal adenomas, although it is technically demanding. Duodenal mucosal resurfacing (DMR) is an emerging endoscopic metabolic therapy designed to ablate and regenerate duodenal mucosa. To date, no reports have described ESD including the papilla (ESDIP) producing similar metabolic effects to DMR. A 36-year-old Asian man with an elevated body mass index of 30.16 kg/m² was diagnosed with a large duodenal laterally spreading tumor, measuring 80 × 70 mm in size and extending to the major papilla. Water-pressure method-assisted ESDIP was performed with en bloc resection, and histopathology demonstrated a tubulovillous adenoma with low-grade dysplasia and uninvolved margins. Remarkably, during the 2- and 8-week follow-up periods, the patient exhibited reductions in total body weight of 5.9% and 7.9%, respectively, and a marked improvement in glycemic control, with fasting blood glucose decreasing from 210 to 113 mg/dL despite no changes in lifestyle or medication. These metabolic improvements suggest a possible clinical overlap between extensive duodenal mucosal resection via ESDIP and DMR. However, given the limitations of a single case, these findings warrant cautious interpretation and further study to clarify the underlying mechanisms.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993187","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 Profile of Non-anesthesiologist-administered Propofol During Colorectal Endoscopic Submucosal Dissection: A Single-center Study of 454 Procedures","authors":"Yumi Kishi,&nbsp;Mayo Tanabe,&nbsp;Naoyuki Uragami,&nbsp;Daijiro Shiomi,&nbsp;Mai Fukuda,&nbsp;Miho Kurahashi,&nbsp;Toshiki Hanzawa,&nbsp;Michimasa Yamaguchi,&nbsp;Mikio Muraoka,&nbsp;Hatsuka Nakamura,&nbsp;Rei Miyake,&nbsp;Yukiko Okada,&nbsp;Yoichi Toyoda,&nbsp;Akiko Toshimori,&nbsp;Takayoshi Ito,&nbsp;Noboru Yokoyama,&nbsp;Haruhiro Inoue","doi":"10.1002/deo2.70435","DOIUrl":"10.1002/deo2.70435","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Studies of non-anesthesiologist-administered propofol (NAAP) during colorectal endoscopic submucosal dissection (ESD) are scarce, particularly in the elderly. We evaluated its feasibility across a broad age range and identified factors associated with sedation-related adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 454 consecutive colorectal ESD procedures performed with NAAP in 405 patients at a tertiary center (January 2016–May 2024), stratified by age (&lt;65, 65–74, and ≥75 years). Propofol was given by the endoscopy team as a weight-based induction bolus and a continuous infusion titrated to target depth under multiparameter monitoring. New-onset hypotension, bradycardia, and hypoxemia were compared among groups, with multivariable logistic regression for independent predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean age was 68.2 years; 54.8% of procedures were performed in men. Adverse events were common but all transient: hypotension 14.1%, bradycardia 14.8%, hypoxemia 11.9%, without procedure discontinuation, intubation, anesthesiologist rescue, death, or permanent sequelae. A composite event (33.3%) rose with age (24.7%, 36.1%, and 39.1%; <i>p</i> = 0.018). In multivariable analysis, longer procedure duration, measured as propofol administration time, was independently associated with composite events (adjusted odds ratio [aOR] 1.05 per 10 min; <i>p</i> = 0.011) and bradycardia (aOR 1.07 per 10 min; <i>p</i> = 0.002). Age ≥75 years (vs. &lt;65 years) was independently associated with composite events (aOR 1.85; <i>p</i> = 0.027) and hypoxemia (aOR 2.55; <i>p</i> = 0.021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Propofol-based NAAP allowed colorectal ESD to be completed across all age groups without sedation-related procedure termination or escalation of care. Older age and longer procedure duration were associated with selected sedation-related adverse events, providing clinically relevant information for risk assessment during colorectal ESD.</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":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993215","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":"Disseminated Klebsiella pneumoniae Infection Mimicking Multiple Colonic Subepithelial Lesions: A Case Report","authors":"Yoshiaki Kobayashi,&nbsp;Tadanobu Nagaya,&nbsp;Mai Iwaya,&nbsp;Hiroshi Ikeuchi,&nbsp;Takuma Okamura,&nbsp;Takeshi Uehara,&nbsp;Yugo Iwaya","doi":"10.1002/deo2.70431","DOIUrl":"10.1002/deo2.70431","url":null,"abstract":"<p>We report a rare case of disseminated <i>Klebsiella pneumoniae</i> infection mimicking multiple subepithelial lesion (SEL)-like elevations throughout the colon. A 73-year-old man was referred for the treatment of diarrhea, edema, and anemia. Colonoscopy revealed numerous SEL-like elevations from the cecum to the rectum, raising suspicion for malignant or infiltrative disease. Endoscopic ultrasonography demonstrated thickening centered in the deep mucosa and muscularis mucosae, with possible extension into the submucosa. Histological examination showed inflammatory cell infiltration, and bacterial culture of biopsy material identified <i>K. pneumoniae</i>. Further systemic evaluation revealed pacemaker lead infection, infective endocarditis, and pyogenic spondylitis, indicating disseminated infection. The colonic lesions improved after targeted antimicrobial therapy and device management. This rare case underscores the importance of considering disseminated bacterial infection in diffuse SEL-like colonic elevations, particularly when accompanied by systemic infectious manifestations.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972706","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":"Feature-Based Patterns Associated With Japan NBI Expert Team Type 1 Classification of Serrated Colorectal Lesions: A Post Hoc Decision Tree Analysis","authors":"Taku Sakamoto,&nbsp;Hiroyuki Takamaru,&nbsp;Daizen Hirata,&nbsp;Iwatate Mineo,&nbsp;Yasushi Sano,&nbsp;Hideki Ishikawa,&nbsp;Saito Yutaka,&nbsp;the Japan NBI Expert Team (JNET)","doi":"10.1002/deo2.70428","DOIUrl":"https://doi.org/10.1002/deo2.70428","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Japan NBI Expert Team (JNET) Type 1 classification is used for optical characterization of colorectal lesions with magnifying NBI, but reported Type 1-related findings may differ between readers when assessing serrated lesions. This small-scale post hoc reader-based study explored reported feature-classification patterns associated with JNET Type 1 selection among serrated colorectal lesions and compared them between expert and non-expert endoscopists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed de-identified data from two web-based image-interpretation studies using the same colorectal lesion image dataset. Thirteen histologically confirmed serrated lesions (11 sessile serrated lesions [SSLs] and two hyperplastic polyps [HPs]) assessed by 27 expert and 49 non-expert Japanese endoscopists were included. Simplified JNET responses were dichotomized as Type 1 versus non-Type 1. Classification and regression tree analysis was used to visualize associations between this outcome and predefined features, including Type 1-supportive findings and an anti-Type 1 composite variable. Variability was assessed using entropy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the expert and non-expert core models, the root splits were anti-Type 1 findings and regular dark or white spots, respectively. These root splits were stable in leave-one-reader-out analyses, but the non-expert root split changed to anti-Type 1 findings after excluding unassessable responses. Median entropy was lower among experts than non-experts (0.229 vs. 0.954).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This exploratory post hoc decision tree analysis suggested relatively stable expert-associated feature-classification patterns, whereas non-expert patterns were influenced by the treatment of unassessable responses. These findings reflect exploratory associations in Type 1 assignment, not cognitive decision sequences, SSL–HP differentiation, or a validated diagnostic algorithm.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70428","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148943463","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 Treatment of Walled-Off Necrosis With Complex Quadruple Fistulas Among the Necrotic Cavity, Stomach, Duodenum, and Common Bile Duct","authors":"Shuhei Shibata,&nbsp;Yotaro Iino,&nbsp;Jo Kurosawa,&nbsp;Ken Uchida,&nbsp;Daiki Takahashi,&nbsp;Yuya Yokoyama,&nbsp;Hiroshi Ohyama,&nbsp;Futoshi Hirai,&nbsp;Michikazu Abe,&nbsp;Jun Kato","doi":"10.1002/deo2.70432","DOIUrl":"https://doi.org/10.1002/deo2.70432","url":null,"abstract":"<p>We report an extremely rare case of duodenal bulb perforation caused by a double-pigtail plastic stent placed for walled-off necrosis (WON), coexisting with a biliary fistula to the WON and a choledochoduodenal fistula, all successfully managed with endoscopic treatment alone. A 61-year-old woman developed severe gallstone pancreatitis and underwent endoscopic ultrasound-guided transmural drainage for WON with placement of a lumen-apposing metal stent and a double-pigtail plastic stent. After repeated endoscopic necrosectomy, the metal stent was removed and the plastic stent remained in place. Contrast leakage from the WON into the bile duct was detected, and a biliary stent was inadvertently deployed through a choledochoduodenal fistula. Two hundred thirty-seven days after plastic stent placement, endoscopy revealed a duodenal bulb perforation with purulent discharge. The plastic stent was removed, and the gastric fistula was closed using endoscopic hand-suturing. After spontaneous closure of the stent-induced duodenal perforation was confirmed, the biliary stent placed through the choledochoduodenal fistula was removed and a new stent was inserted through the papilla of Vater, resulting in closure of the choledochoduodenal fistula. Complete closure of all fistulas was confirmed 516 days after the initial hospitalization. This case demonstrates that complex fistulas associated with WON can be successfully treated without surgical intervention.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148942883","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":"Intensive Endoscopic Resection for Downstaging of Superficial Non-ampullary Duodenal Epithelial Tumor Burden in Familial Adenomatous Polyposis: A Single-center Retrospective Study on Long-term Clinical Outcome","authors":"Reona Kawamura,&nbsp;Masayoshi Yamada,&nbsp;Hiroyuki Takamaru,&nbsp;Takeshi Nakajima,&nbsp;Seiichiro Abe,&nbsp;Satoru Nonaka,&nbsp;Ichiro Oda,&nbsp;Noriko Tanabe,&nbsp;Makoto Hirata,&nbsp;Yutaka Saito","doi":"10.1002/deo2.70419","DOIUrl":"https://doi.org/10.1002/deo2.70419","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Study Aims</h3>\u0000 \u0000 <p>Familial adenomatous polyposis (FAP) is a genetic condition that increases the risk of developing colorectal polyposis and cancer, as well as superficial non-ampullary duodenal epithelial tumors (SNADETs). In this single-center retrospective study, we investigated the long-term clinical outcomes of intensive endoscopic resection for downstaging the SNADET burden (intensive downstaging polypectomies [IDPs]) in individuals with FAP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Of 56 patients with FAP who underwent endoscopic treatment of SNADETs, 34 underwent IDPs, and 22 underwent conventional treatments, with a median follow-up period of 71 months. IDP was defined as the resection of ≥ 3 lesions in one treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The total number of resected lesions was 495 lesions (9.7 ± 7.5 lesions/treatment [average ± standard deviation]) in the IDP group and 42 (1.4 ± 0.5 lesions/treatment) in the conventional group. No delayed bleeding was observed in the IDP group and one in the conventional group. No perforation was observed in our study. The 5-year incidence rates of high-grade dysplasia, invasive cancer, and cause-specific duodenectomy in the IDP group were 15.6%, 3.6%, and 0%, respectively. Downstaging of the Spigelman stage (SS) was achieved in 50% (17/34) of patients in the IDP group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrated that IDP was safe and effective in downstaging the burden of SNADETs, and no duodenectomy due to SNADETs was required during the available follow-up period in individuals with FAP, even at SS IV.</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":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70419","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148942890","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":"Transpapillary/Transfistular Drainage for Two Refractory Postoperative Right-Lobe Bilomas: A Case Report","authors":"Fumitaka Niiya,&nbsp;Naoki Tamai,&nbsp;Jun Noda,&nbsp;Tetsushi Azami,&nbsp;Yuichi Takano,&nbsp;Masatsugu Nagahama","doi":"10.1002/deo2.70417","DOIUrl":"https://doi.org/10.1002/deo2.70417","url":null,"abstract":"<p>We report a case of two refractory postoperative right-lobe bilomas that were successfully treated with transpapillary/transfistular (TP/TF) drainage. A 57-year-old man developed two bilomas (segments 6 and 7) after repeated hepatectomy for colorectal liver metastases. Initial endoscopic retrograde cholangiopancreatography with endoscopic nasobiliary drainage (ENBD) was performed; however, biloma enlargement was observed despite ENBD placement, prompting a switch to TP/TF drainage. Two 5-Fr pigtail-type ENBD tubes were placed within the biloma cavities, followed by internalization after confirmed biloma regression (B6: from 93 to 38 mm, B7: from 71 to 28 mm). As the leak improved from high-grade to low-grade, the drainage strategy was modified to plastic stent placement in the B7 bile duct, ultimately achieving complete biloma resolution approximately 8 months after TP/TF drainage. Stent-free status has been maintained for 13 months, with a total follow-up of 21 months. This case demonstrates that TP/TF drainage is a feasible and effective option for multiple right-lobe bilomas, particularly when endoscopic ultrasound-guided transmural drainage would require multiple transmural procedures, allowing endoscopic treatment to be completed without percutaneous drainage.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70417","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148942886","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}