DEN open最新文献

{"title":"Endoscopic Closure Combined With the Endoscopic Submucosal Dissection Technique and Over-the-scope Clip for Chronic Aortoesophageal Fistula: A Case Report","authors":"Ryosuke Kawagoe,&nbsp;Toshiaki Narasaka,&nbsp;Takashi Mamiya,&nbsp;Masaaki Nishi,&nbsp;Kiichiro Tsuchiya","doi":"10.1002/deo2.70202","DOIUrl":"https://doi.org/10.1002/deo2.70202","url":null,"abstract":"<p>Aortoesophageal fistula (AEF) is a rare but life-threatening condition. Initial management typically includes thoracic endovascular aortic repair (TEVAR) or aortic graft replacement to achieve hemostasis, followed by esophagectomy with aortic graft replacement and greater omentum wrapping to eliminate the source of infection. We report a case of successful endoscopic closure of a chronic esophageal fistula secondary to AEF. A 63-year-old man presented with hematemesis. He had a history of two ascending aortic replacements and one descending aortic replacement for aortic dissection. Computed tomography revealed a pseudoaneurysm at the graft anastomosis site and perforation into the esophagus. He was diagnosed with AEF and underwent TEVAR for hemostasis. Although the bleeding was stopped, follow-up imaging confirmed a residual fistula. Because of his poor general condition, surgery was contraindicated, and endoscopic closure was attempted. Initial treatment with hemostasis clips was ineffective. A second attempt using polyglycolic acid sheets, fibrin glue, and hemostasis clips with endoscopic submucosal dissection (ESD) achieved closure, but the fistula reopened after 5 months. Finally, the combination of ESD and over-the-scope clip (OTSC) achieved complete and sustained closure. The patient was discharged after 3 months but died 8 months postoperatively owing to idiopathic splenic rupture. This case demonstrates that the combination of ESD and OTSC may be an effective treatment option for chronic esophageal fistulas caused by AEF.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929619","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":"Standardized Approach for Laparoscopic Hemispheric Liver Resection for Segments 7 and 8","authors":"Ryoichi Miyamoto,&nbsp;Masahiro Shiihara,&nbsp;Mitsuru Watanabe,&nbsp;Jiro Shimazaki,&nbsp;Mitsugi Shimoda,&nbsp;Shuji Suzuki","doi":"10.1002/deo2.70203","DOIUrl":"https://doi.org/10.1002/deo2.70203","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We investigated whether the standardized “can-opener method” surgical technique is an adequate surgical procedure for hemispheric hepatectomy in segments 7 and 8.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty-two patients who underwent laparoscopic hemispheric liver resection for segments 7 and 8 using our standardized surgical technique were enrolled. To examine the effect of this standardized surgical procedure on short-term outcomes, patients were classified into two groups based on the timing of the standardization of their procedures (Group A, the first half of the cases, and Group B, the second half of the cases). Short-term outcomes were subsequently compared between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant differences in operation time (465 min vs. 332 min, <i>p</i> = 0.001), intraoperative blood loss volume (645 g vs. 105 g, <i>p</i> = 0.011), postoperative complications (Clavien‒Dindo Grade I and Grade II) (7 vs. 1, <i>p</i> = 0.011), and length of postoperative hospital stay (10 days vs. 7 days, <i>p</i> = 0.001) were detected between the two groups. All patients had negative surgical margins. With respect to postoperative complications, four patients had Grade I complications, such as wound infection and minor pneumonia, and four patients had Grade II complications, such as bile duct infection and intra-abdominal abscess. No patients experienced 90-day mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our standardized surgical technique is an adequate surgical procedure for hemispheric hepatectomy in segments 7 and 8 and is referred to as the “can-opener method”.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70203","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929624","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":"High Score of ELST-Blue in Endoscopic Ultrasonography Strain Elastography May Provide a High Risk Group of Early Chronic Pancreatitis with the Reduction of Apolipoprotein A2-i Index","authors":"Ken Nakamura,&nbsp;Seiji Futagami,&nbsp;Shuhei Agawa,&nbsp;Sakura Higashida,&nbsp;Tomohide Tanabe,&nbsp;Takeshi Onda,&nbsp;Rie Kawawa,&nbsp;Mayu Habiro,&nbsp;Kumiko Kirita,&nbsp;Songyu Sai,&nbsp;Norio Itokawa,&nbsp;Nobue Ueki,&nbsp;Yoshiyuki Watanabe,&nbsp;Ryo Ohta,&nbsp;Nobuhiko Taniai,&nbsp;Kazufumi Honda,&nbsp;Katsuhiko Iwakiri,&nbsp;Masanori Atsukawa","doi":"10.1002/deo2.70191","DOIUrl":"https://doi.org/10.1002/deo2.70191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To evaluate the usefulness of the ELST-blue score to explore its potential application in identifying high-risk groups for early chronic pancreatitis (ECP) through reflecting on pancreatic elasticity and the reduction of pancreatic function, and we tried to demonstrate whether the ELST-blue score was significantly associated with apolipoprotein A2 (apoA2) isoforms in patients with ECP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty-four patients with pancreatic enzyme abnormalities underwent endosonography. We divided two groups, one group was patients with ECP (<i>n</i> = 16) and the other group was patients with non-ECP (<i>n</i> = 28). ELST-blue was defined using the open-source software ‘Image J’. The concentration of apoA2 isoforms was measured using an enzyme-linked immunosorbent assay kit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Epigastric pain tended to be more severe in patients with ECP than in those without ECP. There was a significant difference in the diameter of the main pancreatic duct of more than 2 mm as well as in stranding or hyperechoic foci and lobularity between patients with ECP and non-ECP. The ELST-blue score was significantly higher in patients with ECP than in non-ECP (<i>p</i> = 0.003). Although an intense negative correlation was determined between ELST-blue score and the apoA2-i Index in patients with ECP (r = -0.704, <i>p</i> = 0.002), there was no significant relationship between ELST-blue score and apoA2-I Index in patients with non-ECP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with ECP accompanied by a high score of ELST-blue have to be followed up carefully.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70191","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915236","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":"Electrolyte Depletion Syndrome due to a 28 cm Rectal Villous Tumor: Successful Endoscopic Resection of One of the Largest Tumors Reported to Date—A Case Report","authors":"Toshifumi Iida,&nbsp;Hideyuki Chiba,&nbsp;Ai Hirohata,&nbsp;Akimichi Hayashi,&nbsp;Yu Ebisawa,&nbsp;Jun Arimoto,&nbsp;Hiroki Kuwabara,&nbsp;Michiko Nakaoka,&nbsp;Ken Ohata","doi":"10.1002/deo2.70197","DOIUrl":"https://doi.org/10.1002/deo2.70197","url":null,"abstract":"<p>Electrolyte depletion syndrome (EDS), also known as McKittrick–Wheelock syndrome, is a rare but life-threatening condition caused by secretory diarrhea from colorectal villous tumors, often accompanied by severe electrolyte imbalances and renal dysfunction. Large, circumferential tumors have traditionally been managed with surgical resection, frequently requiring stoma formation. Recently, endoscopic submucosal dissection (ESD) has emerged as a minimally invasive alternative, although its feasibility for large rectal tumors remains limited. We report a case of EDS caused by a giant circumferential rectal villous tumor measuring approximately 28 cm, successfully treated with ESD. A 58-year-old man presented with persistent diarrhea, electrolyte disturbances, and acute kidney injury. Imaging and endoscopy revealed a circumferential villous tumor extending from the anal verge to the rectosigmoid colon, diagnosed as a villous adenoma without malignancy on biopsy. After careful discussion between the departments of gastrointestinal surgery and gastroenterology, ESD under general anesthesia was selected to avoid colectomy and stoma creation. En bloc resection of a 280 × 240 mm tumor was achieved without major complications. Prophylactic steroid injection and systemic steroid administration prevented post-ESD stricture. Histopathology revealed adenocarcinoma with minimal submucosal invasion (800 µm), no lymphovascular invasion, and negative resection margins, indicating curative resection. At 6-month follow-up, no recurrence or stricture was observed. This case highlights the potential of ESD as a definitive and less invasive treatment option for EDS caused by large rectal villous tumors when performed with appropriate therapeutic planning and meticulous postoperative care.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70197","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915235","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":"Adverse Events of Single Balloon Enteroscopy-assisted Endoscopic Retrograde Cholangiopancreatography in the Elderly: A Propensity Score Matching Analysis","authors":"Hiroki Nakagawa,&nbsp;Tsuyoshi Takeda,&nbsp;Takeshi Okamoto,&nbsp;Takafumi Mie,&nbsp;Takaaki Furukawa,&nbsp;Takashi Sasaki,&nbsp;Masato Ozaka,&nbsp;Takahisa Matsuda,&nbsp;Yoshinori Igarashi,&nbsp;Naoki Sasahira","doi":"10.1002/deo2.70193","DOIUrl":"https://doi.org/10.1002/deo2.70193","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sedation for conventional endoscopic retrograde cholangiopancreatography (ERCP) has been reported to be safe even for elderly patients. However, the safety of sedation for balloon enteroscopy-assisted ERCP (BE-ERCP) has not been well-studied in the elderly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed consecutive patients with surgically altered anatomy who underwent their initial BE-ERCP using midazolam and pethidine at our institution between January 2016 and December 2022. The primary outcome was the rate of cardiopulmonary complications, including hypotension, bradycardia, tachycardia, and hypoxemia. Secondary outcomes included the rates of procedural interruptions, delayed arousal, postprocedural falls, and delirium, dose of sedatives, and rate of ERCP-related adverse events (AEs). Risk factors for cardiopulmonary complications and ERCP-related AEs were also examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 190 patients were included (elderly group: 63; non-elderly group: 127). After propensity score matching, 55 patients were selected for each group. The total dose of midazolam was significantly lower in the elderly group (4 mg vs. 5 mg, <i>p</i> = 0.033). Rates of cardiopulmonary complication (11% vs. 11%, <i>p</i> &gt; 0.999) and ERCP-related AEs (6% vs. 9%, <i>p</i> = 0.716) were not significantly different between the two groups. The total dose of pethidine (&gt; 35 mg) and total procedure time (≥ 51 min) were identified as risk factors for cardiopulmonary complications and ERCP-related AEs, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cardiopulmonary complications and ERCP-related AEs were similar in elderly and non-elderly patients undergoing BE-ERCP. With careful monitoring, sedation during BE-ERCP appeared safe, even for elderly patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70193","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144897287","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 Step-up Approach for Walled-off Necrosis After Acute Pancreatitis","authors":"Shuntaro Mukai,&nbsp;Atsushi Sofuni,&nbsp;Takayoshi Tsuchiya,&nbsp;Reina Tanaka,&nbsp;Ryosuke Tonozuka,&nbsp;Yukitoshi Matsunami,&nbsp;Kazumasa Nagai,&nbsp;Hiroyuki Kojima,&nbsp;Hirohito Minami,&nbsp;Noriyuki Hirakawa,&nbsp;Kyoko Asano,&nbsp;Kento Shionoya,&nbsp;Kazuki Hama,&nbsp;Takao Itoi","doi":"10.1002/deo2.70188","DOIUrl":"https://doi.org/10.1002/deo2.70188","url":null,"abstract":"<p>This review outlines current interventional strategies for treating symptomatic walled-off necrosis (WON) after necrotizing pancreatitis. Mortality from acute pancreatitis has improved, but late mortality, particularly from infected necrosis, remains a challenge. WON requires invasive treatment in cases of infection or symptoms. A step-up approach is recommended, in which minimally invasive drainage is performed first, followed by more invasive treatments if the effect is insufficient. Among these, an endoscopic step-up approach mainly consisting of transmural treatment using endoscopic ultrasound-guided drainage and endoscopic necrosectomy (EN) has been reported with favorable outcomes. The use of lumen-apposing metal stents (LAMSs) has enhanced drainage efficiency and facilitated EN, although bleeding and stent-related adverse events remain concerns. Recent techniques such as multiple transluminal gateways and transcystic drainage have improved outcomes for complex, multilocular WON. With the introduction of the LAMS and additional endoscopic drainage techniques, most cases can be successfully treated with endoscopic therapy alone. However, endoscopic treatment alone has limitations for lesions spreading to the pelvic cavity, and a combination of percutaneous treatment or surgical treatment should be considered.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70188","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144894270","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 Duodenal Stenting for Malignant Gastric Outlet Obstruction: Insights From a 15-year Single-Center Experience","authors":"Masatoshi Murakami,&nbsp;Nao Fujimori,&nbsp;Akihiko Suenaga,&nbsp;Takahiro Ueda,&nbsp;Shotaro Kakehashi,&nbsp;Akito Furuta,&nbsp;Akihisa Ohno,&nbsp;Kazuhide Matsumoto,&nbsp;Yu Takamatsu,&nbsp;Keijiro Ueda,&nbsp;Yoshihiro Ogawa","doi":"10.1002/deo2.70192","DOIUrl":"https://doi.org/10.1002/deo2.70192","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic duodenal stent (DS) placement has become a primary palliative approach for malignant gastric outlet obstruction (MGOO), offering minimally invasive symptom relief. However, complications and risk factors for stent dysfunction and prognostic indicators of survival are not fully elucidated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 114 patients who underwent initial DS placement for MGOO at Kyushu University Hospital between January 2010 and October 2024. Clinical outcomes, stent patency, and survival predictors were analyzed. The primary endpoint was stent patency; overall survival (OS) was a secondary endpoint.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pancreatic cancer was the most common underlying malignancy (77.2%). Technical and clinical success rates were 99.1% and 84.1%, respectively; the overall clinical success rate reached 91.2% after additional stenting in initially unsuccessful cases. Adverse events occurred in 12.3% of patients. Among 104 patients with overall clinical success, 18 patients (17.3%) experienced stent dysfunction. Median stent patency and OS were 14.8 and 2.8 months, respectively. Pre-existing biliary stricture and stent placement across the pylorus were significantly associated with reduced stent patency. High neutrophil-to-lymphocyte ratio predicted poorer survival, whereas type III stenosis and post-stenting chemotherapy were linked to improved survival. No significant differences in outcomes were observed between early and late treatment periods. Reintervention with DS was safe and effective, and 93.3% of patients maintained GOO control with DS alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Duodenal stenting is a safe and effective palliative intervention for MGOO. Incorporating inflammation-based biomarkers and individualized treatment strategies can help optimize patient selection and improve survival outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70192","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144897351","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 Colonic Stenting Across the Ileocecal Valve With Severe Malignant Stenosis Using Ultra-thin Scope and Single-balloon Overtube","authors":"Takato Maeda,&nbsp;Norihiro Hanabata,&nbsp;Shohei Igarashi,&nbsp;Masayoshi Ko,&nbsp;Koji Shimaya,&nbsp;Hiroshi Numao,&nbsp;Masaki Munakata,&nbsp;Hirotake Sakuraba","doi":"10.1002/deo2.70190","DOIUrl":"https://doi.org/10.1002/deo2.70190","url":null,"abstract":"<p>Self-expanding metallic stents (SEMSs) are an established palliative option for malignant colonic obstruction, including in cases with proximal lesions. However, SEMS placement across the ileocecal valve (ICV) can be technically challenging because of the anatomical curvature and luminal stenosis. Herein, we report a successful case of colonic stenting for a malignant ileocecal obstruction using an ultra-thin scope and a single-balloon overtube. A 72-year-old man with alcoholic cirrhosis and multiple liver metastases presented with malignant ileocecal obstruction. Given his inoperability, palliative SEMS placement was attempted. Colonoscopy showed a circumferential tumor in the ileocecum, with no passage of contrast medium into the ileum. Guidewire insertion across the ICV failed because of the inability to visualize the direction of the ileal lumen. To overcome this, we used a rescue technique with an ultra-thin scope and a single-balloon overtube. After placing the overtube in the ascending colon, the ultra-thin scope was advanced through it to explore the stenotic lumen directly. This allowed safe insertion of the guidewire into the proximal lumen of the stenosis. The ultra-thin scope was withdrawn, and a standard scope was inserted over the guidewire. Finally, a SEMS was deployed across the ICV through the scope. The patient's obstructive symptoms were resolved without complications, and he was discharged 7 days later. This case demonstrates that in cases of malignant ileocecal obstruction where SEMS placement using conventional methods is difficult, a rescue technique using an ultra-thin scope with a single-balloon overtube may be a viable alternative.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144897409","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":"Prevention of Cholangitis by Spontaneously Dislodging Biliary Stent After an Endoscopic Procedure in Patients With Asymptomatic Bile Duct Stones","authors":"Shinichi Nihei,&nbsp;Sho Hasegawa,&nbsp;Yu Honda,&nbsp;Yuma Yamazaki,&nbsp;Takeshi Iizuka,&nbsp;Yusuke Kurita,&nbsp;Kunihiro Hosono,&nbsp;Masato Yoneda,&nbsp;Kensuke Kubota,&nbsp;Atsushi Nakajima","doi":"10.1002/deo2.70194","DOIUrl":"https://doi.org/10.1002/deo2.70194","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the effectiveness of spontaneously dislodging biliary stent (SDBS) placement in preventing acute cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with asymptomatic bile duct stones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, single-center study included 63 patients (mean age, 73 ± 11 years; 43 men) who underwent ERCP for asymptomatic bile duct stones at our institute between April 2022 and May 2024; they were categorized into the SDBS (33 patients) and non-stent (30 patients) groups. Stone removal was performed in all cases, and complete stone clearance was achieved. Post-procedure cholangitis was diagnosed based on the Tokyo Guidelines 2018. The primary endpoint was post-procedural acute cholangitis on day one. Secondary endpoints included cholangitis-related factors, type of device used, procedure time, and adverse events other than cholangitis. Multivariate analysis was performed to identify factors associated with post-procedure cholangitis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant differences were observed in prior cholecystectomy, bile duct diameter, or the number of stones between the two groups. The overall incidence of post-procedure cholangitis was 17.4%. The incidence was significantly lower in the SDBS group than in the non-stent group (6% vs. 30%; <i>p =</i> 0.01). No significant differences were observed in procedure time, incidence of complications such as post-ERCP pancreatitis, or postoperative hospital stay between the SDBS and non-stent groups. Multivariate analysis identified the absence of an SDBS (odds ratio, 6.09; 95% confidence interval, 1.04–35.6, <i>p =</i> 0.04) as an independent factor associated with post-procedure cholangitis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SDBS placement may be effective in preventing cholangitis after ERCP in asymptomatic patients with bile duct stones.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70194","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891598","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 Complete Response to Zolbetuximab for Advanced Gastric Cancer With Claudin 18.2 Positive: A Case Report","authors":"Akinori Sasaki,&nbsp;Tomohiro Yamaba,&nbsp;Ayu Tachibana,&nbsp;Rika Kimura,&nbsp;Gaku Uchiyama,&nbsp;Tsubasa Yoshioka,&nbsp;Risa Okamoto","doi":"10.1002/deo2.70189","DOIUrl":"https://doi.org/10.1002/deo2.70189","url":null,"abstract":"<p>Recently, zolbetuximab combined with chemotherapy has been approved as a first-line treatment for advanced gastric cancer (GC). However, to date, no endoscopic images demonstrating endoscopic complete response (eCR) to zolbetuximab plus chemotherapy have been reported. Herein, we report the case of an 80-year-old man who presented with epigastric pain and loss of appetite and was diagnosed with undifferentiated GC and peritoneal metastasis. The patient received modified FOLFOX6 plus zolbetuximab because genetic testing revealed HER2-negative and claudin 18.2-positive. He experienced grade 2 nausea, which improved with the administration of antiemetic agents. Computed tomography performed at month 5 showed resolution of peritoneal dissemination. Endoscopic examination during the same period showed the disappearance of the primary gastric tumor with scarring. Biopsy of the scar area revealed only inflammatory cells; therefore, the primary lesion was defined as an eCR. To the best of our knowledge, this is the first report of eCR to zolbetuximab and chemotherapy in a patient with GC and claudin 18.2 positive. This case report suggested that chemotherapy combined with zolbetuximab may offer greater therapeutic benefit than chemotherapy combined with immune checkpoint inhibitors in patients with undifferentiated GC. Further analysis is expected to enable the identification of patients with claudin 18.2-positive GC in whom zolbetuximab treatment is effective.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885344","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}