DEN open最新文献

{"title":"Pancreatitis-Related Encapsulated Fluid Collections Associated With a Pancreatic Duct Stent Retained for 13 Years in Chronic Alcoholic Pancreatitis: A Case Report","authors":"Koichi Soga,&nbsp;Ou Takagi,&nbsp;Yutarou Koike,&nbsp;Kohei Inaba,&nbsp;Mayumi Yamaguchi,&nbsp;Yugo Tetsuka,&nbsp;Masaru Kuwada,&nbsp;Daiki Nemoto,&nbsp;Ikuhiro Kobori,&nbsp;Katsutoshi Sugimoto","doi":"10.1002/deo2.70427","DOIUrl":"https://doi.org/10.1002/deo2.70427","url":null,"abstract":"<p>Pancreatic duct stenting is an established treatment for ductal decompression in obstructive chronic pancreatitis. However, very long-term stent retention may be associated with late complications, particularly in patients with advanced chronic pancreatitis. A 65-year-old man with chronic alcoholic pancreatitis underwent pancreatic duct stenting for a main pancreatic duct stricture, but follow-up was discontinued, and the stent remained in situ for approximately 13 years. He presented with fever and loss of appetite. Computed tomography showed diffuse pancreatic calcifications and pancreatitis-related encapsulated peripancreatic and pelvic fluid collections. The pelvic collection appeared relatively homogeneous, suggesting a pancreatic fluid leak-associated or pseudocyst-like collection rather than definitive walled-off necrosis. After removal of the retained stent, a new pancreatic duct plastic stent was placed. The collections improved after conservative treatment and stent exchange. This case highlights the need for strict surveillance after pancreatic duct stenting.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148942990","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":"Current Status and Unmet Needs of EUS Education in Japan: A Nationwide Survey Focusing on Screening EUS, EUS-Guided Sampling, and Interventional EUS","authors":"Susumu Hijioka,&nbsp;Ichiro Yasuda,&nbsp;Atsushi Irisawa,&nbsp;Akio Katanuma,&nbsp;Shomei Ryozawa,&nbsp;Masayuki Kitano,&nbsp;Hiroyuki Isayama,&nbsp;Kazuo Hara,&nbsp;Yousuke Nakai,&nbsp;Takuji Iwashita,&nbsp;Daiki Yamashige,&nbsp;Takuji Okusaka,&nbsp;Takao Itoi","doi":"10.1002/deo2.70430","DOIUrl":"https://doi.org/10.1002/deo2.70430","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound (EUS) plays a central role in the management of pancreaticobiliary diseases. However, EUS training in Japan remains highly dependent on the experience and educational capacity of individual institutions and supervisors, and the nationwide status of EUS education has not been comprehensively evaluated. This study investigated the current status and unmet educational needs of EUS training in Japan through a nationwide survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An anonymous nationwide questionnaire was distributed to 120 institutions performing EUS across Japan through the investigators’ professional network. Institutions routinely performing diagnostic and/or therapeutic EUS were invited to participate in the survey. Survey items included institutional characteristics and educational practices related to screening EUS, EUS-guided sampling, and interventional EUS (I-EUS). Data regarding annual procedure volumes, criteria for trainee initiation, training systems, and educational challenges were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 114 institutions participated. Median annual procedure volumes were 510 for screening EUS, 135 for EUS-guided sampling, and 25 for I-EUS. The number of supervising physicians increased with procedural complexity. Most institutions reported that I-EUS was performed by physicians with &gt;10 years of clinical experience. Criteria for trainee initiation varied substantially among institutions, and no standardized educational pathway was identified. Major challenges included limited case volume, concerns regarding adverse events, and a lack of simulation-based training resources. Only three institutions reported permanent access to dedicated phantom models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EUS education in Japan remains largely apprenticeship-based, with considerable interinstitutional variability. Standardized curricula, objective competency assessment, and simulation-based training systems are needed to optimize future EUS education.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148942907","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":"Comparison of Two Partially Covered Metal Stents for Endoscopic Ultrasound-guided Hepaticogastrostomy: A Multi-Center Retrospective Study","authors":"Masahiro Yamamura,&nbsp;Hirotoshi Ishiwatari,&nbsp;Saburo Matsubara,&nbsp;Takeshi Okamoto,&nbsp;Michihiro Ono,&nbsp;Toshinori Okuda,&nbsp;Etsuji Ishida,&nbsp;Kohichi Takada,&nbsp;Kazuma Ishikawa,&nbsp;Naoki Sasahira,&nbsp;Kentaro Suda,&nbsp;Morito Ikeda,&nbsp;Daichi Watanabe,&nbsp;Junya Sato,&nbsp;Hiroki Sakamoto,&nbsp;Akihiro Ohba,&nbsp;Takuya Doi,&nbsp;Akifumi Notsu","doi":"10.1002/deo2.70396","DOIUrl":"https://doi.org/10.1002/deo2.70396","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an alternative biliary drainage method after failed endoscopic retrograde cholangiopancreatography. Nevertheless, it is associated with adverse events (AEs), including peritonitis and stent migration. The influence of metallic stent (MS) design characteristics, including axial force (AF), on the safety and efficacy of EUS-HGS remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter retrospective study included patients with unresectable malignant biliary obstruction who underwent EUS-HGS using either a high-AF MS (Niti-S biliary S-type) or a low-AF MS (EGIS biliary) between January 2019 and December 2022. Propensity score matching was performed in a 1:2 ratio. Outcomes included clinical success, early and late non-recurrent biliary obstruction (non-RBO) AEs, RBO, time to RBO (TRBO), and overall survival (OS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After matching, 27 patients in the high-AF group and 54 in the low-AF group were analyzed. Clinical success, RBO rate, TRBO, OS, and late non-RBO AE rates were similar between groups. However, early non-RBO AEs were more frequent in the high-AF group (37% vs. 13%, <i>p</i> <b>=</b> 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Of the two partially covered MSs evaluated, the EGIS biliary stent demonstrated fewer early non-RBO AEs after EUS-HGS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70396","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148942863","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":"Cold Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors: Current Evidence and Clinical Perspectives","authors":"Yuichiro Mikuriya,&nbsp;Kohei Takizawa,&nbsp;Nobuhisa Minakata,&nbsp;Kazuo Shiotsuki","doi":"10.1002/deo2.70429","DOIUrl":"10.1002/deo2.70429","url":null,"abstract":"<p>Superficial non-ampullary duodenal epithelial tumors (SNADETs) are increasingly treated with endoscopic resection. Although conventional thermal techniques are effective, the thin duodenal wall and distinctive anatomy have driven interest in cold resection techniques that avoid electrocautery-related injury. This narrative review individually appraises cold snare polypectomy (CSP), cold forceps polypectomy (CFP), and cold snare endoscopic mucosal resection (CS-EMR) for duodenal SNADETs. Management of selected small low-grade adenomas should be individualized, with careful surveillance considered as an alternative to immediate resection. When resection is chosen, CSP is the principal cold resection technique for lesions &lt;10 mm that are optically diagnosed as low-grade adenomas using white-light imaging and narrow-band imaging. CSP appears technically feasible and safe for selected small SNADETs. However, its shallow resection depth limits vertical margin assessment. Available follow-up data suggest low recurrence rates, and recurrent lesions are generally small and endoscopically manageable. This review also discusses the importance of pretreatment optical diagnosis, appropriate lesion selection, technical considerations, and structured surveillance after cold resection. CFP may be considered for carefully selected diminutive lesions, although the supporting evidence remains limited. Although CS-EMR can enable resection of larger lesions, substantial recurrence rates and the reported risk of perforation argue against its routine use. Overall, CSP is the principal cold resection technique for selected small low-grade adenomas, whereas CFP and CS-EMR have more limited roles.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908417","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":"Respiratory Support With Nasal High Flow Reduces Opioid Requirements During Endoscopic Retrograde Cholangiopancreatography","authors":"Tomotaka Mori,&nbsp;Takao Ayuse,&nbsp;Shuntaro Sato,&nbsp;Taiga Ichinomia,&nbsp;Rintaro Yano,&nbsp;Akane Shimakura,&nbsp;Yasuhiko Nakao,&nbsp;Kosuke Takahashi,&nbsp;Masanori Fukushima,&nbsp;Masafumi Haraguchi,&nbsp;Ryu Sasaki,&nbsp;Eisuke Ozawa,&nbsp;Satoshi Miuma,&nbsp;Stanislav Tatkov,&nbsp;Tetsuya Hara,&nbsp;Hisamitsu Miyaaki","doi":"10.1002/deo2.70421","DOIUrl":"10.1002/deo2.70421","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Nasal high flow (NHF) improves oxygenation, reduces the work of breathing, and stabilizes ventilation. In endoscopic retrograde cholangiopancreatography (ERCP) under dexmedetomidine-based sedation, opioids are often required but increase the risk of respiratory depression and delayed recovery. This study tested the hypothesis that NHF therapy, compared with low-flow oxygen (LFO), may reduce opioid requirements during ERCP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This open-label, single-center, randomized controlled trial enrolled patients undergoing ERCP under dexmedetomidine-based sedation. Patients were randomized to NHF or LFO. Sedation used dexmedetomidine, midazolam and pethidine with a standardized protocol. The primary endpoint was total pethidine dose. Secondary endpoints included transcutaneous carbon dioxide (TcCO₂), oxygenation-perfusion parameters, processed electroencephalography (EEG) parameters, sedative doses, and sedation depth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Enrollment ended early at a total of 94 of the planned 118 patients due to slow recruitment (NHF 47, LFO 47). Poisson regression demonstrated reduced opioid requirements with NHF (incidence rate ratio 0.77, 95% confidence interval, 0.62–0.96, <i>p</i> = 0.023). The total pethidine dose was lower in the NHF group (medians 43.75 mg vs. 70.00 mg, <i>p</i> = 0.004). The TcCO₂ and oxygenation-perfusion parameters were comparable between groups. EEG tests showed lower patient state index and electromyographic activity in the NHF group, indicating deeper sedation. No adverse events attributable to interventions were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NHF reduced opioid requirements while maintaining oxygenation, ventilation, and sedation during ERCP. The ability of NHF to provide respiratory support, ensure adequate oxygenation, and allow monitoring of breathing makes it a promising modality during procedural sedation; however, further multi-center studies are needed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>072210047 [jRCTs]</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898722","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":"Long-anchoring Stent Method as a Rescue Technique for Early Dysfunction of Covered Self-Expandable Metal Stents in Distal Malignant Biliary Obstruction: A Retrospective Case Series","authors":"Takumi Kinomoto,&nbsp;Yugo Kai,&nbsp;Minoru Shigekawa,&nbsp;Kenji Ikezawa,&nbsp;Takuo Yamai,&nbsp;Hiroki Takiyama,&nbsp;Taku Miyanaga,&nbsp;Takanori Masumoto,&nbsp;Keita Sekiya,&nbsp;Jun Murata,&nbsp;Makiko Urabe,&nbsp;Ryoji Takada,&nbsp;Kaori Mukai,&nbsp;Tasuku Nakabori,&nbsp;Kazuyoshi Ohkawa","doi":"10.1002/deo2.70394","DOIUrl":"10.1002/deo2.70394","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Covered self-expandable metal stents (SEMS) are widely used for treating distal malignant biliary obstruction (MBO). Severe SEMS angulation can cause stent dysfunction. Placement of a long double-pigtail plastic stent inside the SEMS (the “long-anchoring stent method”) may straighten the angulated SEMS, thereby achieving effective biliary drainage. This study aimed to report the clinical outcomes of this novel method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 15 patients with distal MBO who underwent initial SEMS placement, subsequently experienced clinical failure or early recurrent biliary obstruction (RBO) within 90 days of initial placement, and underwent reintervention with the long-anchoring stent method between April 2020 and March 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median follow-up period was 307 days after the anchoring procedure. For the primary outcome, clinical success was achieved in all 5 patients with initial SEMS clinical failure and in all 15 patients overall. The median angle of the SEMS significantly straightened from 128.3° with the initial SEMS alone to 151.5° after anchoring stent placement (<i>p</i> &lt; 0.001). As an exploratory analysis of the 10 patients with early RBO, the median time to RBO increased from 21 days after initial SEMS placement to 148 days after anchoring procedure. No severe procedure-related adverse events occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The long-anchoring stent method is a simple, safe, and viable strategy for rescuing early dysfunction of covered SEMS, possibly in part through straightening of the SEMS angulation.</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":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889882","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 Angiosarcoma With Multifocal Small-Bowel Involvement Presenting as Suspected Small-Bowel Bleeding","authors":"Mayu Tomita,&nbsp;Takashi Tashiro,&nbsp;Yoshiharu Yamaguchi,&nbsp;Kazunori Adachi,&nbsp;Masahide Ebi,&nbsp;Naotaka Ogasawara,&nbsp;Makoto Sasaki,&nbsp;Akana Hinokimoto,&nbsp;Toyonori Tsuzuki,&nbsp;Masanao Nakamura","doi":"10.1002/deo2.70408","DOIUrl":"10.1002/deo2.70408","url":null,"abstract":"<p>Angiosarcoma is a rare, aggressive vascular malignancy, and gastrointestinal involvement is uncommon. We report disseminated angiosarcoma with multifocal small-bowel involvement presenting as suspected small-bowel bleeding, in which small-bowel capsule endoscopy (SBCE) and double-balloon endoscopy (DBE) were diagnostically useful. A man in his 60s presented with recurrent melena and transfusion-dependent anemia. SBCE showed active jejunal bleeding with multiple ulcerative lesions, and antegrade DBE revealed hemorrhagic tumors with luminal narrowing. Retrograde DBE demonstrated additional ileal and colonic lesions. Computed tomography showed small-bowel stenosis, mesenteric dissemination, bone metastases, and soft-tissue infiltration around an abdominal aortic stent graft. The patient died 7 weeks after transfer. Autopsy confirmed disseminated angiosarcoma involving the small intestine and mesentery, with the greatest tumor burden around the aortic graft, suggesting a possible periaortic origin. This case highlights the complementary roles of SBCE and DBE and provides rare clinicopathological correlation with autopsy findings.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889821","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":"Association of Propofol Versus Midazolam Sedation With Successful Pharyngeal Observation During Upper Gastrointestinal Endoscopy: A Retrospective Study","authors":"Kazuya Sumi,&nbsp;Tomoya Sato,&nbsp;Tomona Sakurai,&nbsp;Kota Uehara,&nbsp;Akira Ishihara,&nbsp;Takayoshi Ito","doi":"10.1002/deo2.70422","DOIUrl":"10.1002/deo2.70422","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Adequate pharyngeal observation during esophagogastroduodenoscopy (EGD) is increasingly recognized as an important component of high-quality upper gastrointestinal endoscopy. However, visualization may be impaired by gag reflexes and patient movement. The current study evaluated the association between sedation strategy and successful pharyngeal observation during routine EGD. Further, whether this association differs according to operator experience was examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective single-center observational study included consecutive sedated EGD procedures performed between April 2024 and March 2025. Successful pharyngeal observation was defined as the successful identification of predefined pharyngeal and hypopharyngeal anatomical landmarks. Multivariate logistic regression analysis was performed to identify factors independently associated with successful pharyngeal observation. Interaction, sensitivity, and propensity score-matched analyses were also conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 444 EGD procedures, including 245 performed under midazolam sedation and 199 under propofol sedation, were analyzed. The propofol group had a significantly higher successful pharyngeal observation rate than the midazolam group (90.0% vs. 79.2%, <i>p</i> = 0.011). In the multivariate analysis, propofol sedation was independently associated with successful pharyngeal observation (odds ratio: 2.18, 95% confidence interval: 1.20–3.96, <i>p</i> = 0.008). Sensitivity analyses excluding biopsy cases and analyses restricted to trainees yielded consistent results. Propensity score-matched analysis also yielded consistent results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Sedation strategy was independently associated with successful pharyngeal observation during routine EGD. Propofol sedation may facilitate a more consistent pharyngeal visualization across operators with varying levels of experience.</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":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889815","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":"Duodenal Laparoscopy and Endoscopy Cooperative Surgery Combined With Endoscopic Nasopancreatic Drainage and Endoscopic Nasobiliary Drainage for a Duodenal Adenoma Near the Papilla of Vater: A Case Report","authors":"Keisuke Manaka,&nbsp;Hiroki Harada,&nbsp;Takuya Wada,&nbsp;Gen Kitahara,&nbsp;Kosuke Okuwaki,&nbsp;Kota Okuno,&nbsp;Shohei Fujita,&nbsp;Tadashi Higuchi,&nbsp;Koshi Kumagai,&nbsp;Naoki Hiki","doi":"10.1002/deo2.70390","DOIUrl":"10.1002/deo2.70390","url":null,"abstract":"<p>Duodenal laparoscopy and endoscopy cooperative surgery (D-LECS) for superficial non-ampullary duodenal tumors has been increasingly performed as a minimally invasive treatment for lesions with a high risk of complications when treated by endoscopy alone. However, for tumors near the papilla of Vater, the optimal treatment strategy has not been established because of the risk of pancreatitis and cholangitis associated with papillary injury. We report a case of duodenal adenoma near the papilla of Vater successfully treated by D-LECS combined with endoscopic nasopancreatic drainage (ENPD) and endoscopic nasobiliary drainage (ENBD). A 70-year-old woman was found to have a 0-IIa adenoma adjacent to the papilla in the descending portion of the duodenum and underwent D-LECS with endoscopic retrograde cholangiopancreatography assistance. After Kocher mobilization, endoscopic en bloc resection was performed. The mucosal defect was closed using endoscopic mucosal closure and reinforced with laparoscopic seromuscular suturing. To prevent postoperative complications, ENPD and ENBD were performed. Pathological examination confirmed negative resection margins, and the patient was discharged with an uneventful postoperative course. ENPD and ENBD after D-LECS were technically feasible without interfering with endoscopic manipulation. This combined approach may be a selective organ-preserving strategy for carefully selected duodenal tumors located near the papilla of Vater.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889812","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 Injection Sclerotherapy With Pre-deflation Ligation for Prolonged Sclerosant Retention in Esophageal Varices: A Case Report","authors":"Noriaki Sugawara,&nbsp;Taro Iwatsubo,&nbsp;Masatoshi Kaizuka,&nbsp;Sayaka Tsuji,&nbsp;Katsutoshi Nishian,&nbsp;Kazuki Takayama,&nbsp;Shun Sasaki,&nbsp;Akitoshi Hakoda,&nbsp;Kazuhiro Ota,&nbsp;Hiroki Nishikawa","doi":"10.1002/deo2.70410","DOIUrl":"10.1002/deo2.70410","url":null,"abstract":"<p>Esophageal varices are a common complication of portal hypertension, and prophylactic endoscopic injection sclerotherapy with ligation (EISL) is an established treatment option. Effective variceal thrombosis requires sufficient intravariceal retention of the sclerosant, because ethanolamine oleate exerts its thrombogenic effect through prolonged contact with the venous endothelium. In conventional EISL, endoscopic variceal ligation (EVL) is performed after balloon deflation, leaving a transient interval during which restored blood flow and an open puncture site may permit washout of the sclerosant and bleeding. We describe EIS with pre-deflation ligation (EISpdL), in which EVL of the puncture site is completed while the endoscope balloon remains inflated, and balloon compression is maintained throughout the retention period. A 59-year-old man with medium-sized esophageal varices with a positive red color sign (F2, RC1) secondary to metabolic dysfunction-associated steatohepatitis underwent EISpdL combined with gel-immersion EIS. The procedure was technically feasible, required no additional skills beyond conventional EISL, and no immediate procedure-related adverse events were observed. Follow-up endoscopy on post-procedure day 7 showed bronze-colored variceal changes indicating thrombosis, and contrast-enhanced computed tomography two months later confirmed obliteration. EISpdL may enable more stable and prolonged sclerosant retention.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889861","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}