DEN open最新文献

{"title":"Assessing the effectiveness of texture and color enhancement imaging versus white-light endoscopy in detecting gastrointestinal lesions: A systematic review and meta-analysis","authors":"Muhammad Shahzil,&nbsp;Talha Bin Kashif,&nbsp;Zainab Jamil,&nbsp;Muhammad Ali Khaqan,&nbsp;Luqman Munir,&nbsp;Zunaira Amjad,&nbsp;Muhammad Saad Faisal,&nbsp;Ammad Javaid Chaudhary,&nbsp;Hassam Ali,&nbsp;Shahryar Khan,&nbsp;Ikponmwosa Enofe","doi":"10.1002/deo2.70128","DOIUrl":"https://doi.org/10.1002/deo2.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Gastrointestinal cancers account for 26% of cancer incidence and 35% of cancer-related deaths globally. Early detection is crucial but often limited by white light endoscopy (WLE), which misses subtle lesions. Texture and color enhancement imaging (TXI), introduced in 2020, enhances texture, brightness, and color, addressing WLE's limitations. This meta-analysis evaluates TXI's effectiveness compared to WLE in gastrointestinal lesion lesion detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis were conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of CENTRAL, PubMed, Embase, and Web of Science identified randomized controlled trials and observational studies comparing TXI with WLE. Outcomes included lesion detection rates, color differentiation, and visibility scores. The risk of bias was assessed using the Cochrane ROB 2.0 tool and Newcastle-Ottawa tools, and evidence certainty was evaluated using Grading of Recommendations Assessment, Development, and Evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen studies with 16,634 participants were included. TXI significantly improved color differentiation (mean difference: 3.31, 95% confidence interval [CI]: 2.49–4.13), visibility scores (mean difference: 0.50, 95% CI: 0.36–0.64), and lesion detection rates (odds ratio [OR]: 1.84, 95% CI: 1.52–2.22) compared to WLE. Subgroup analyses confirmed TXI's advantages across pharyngeal, esophageal, gastric, and colorectal lesions. TXI also enhanced adenoma detection rates (OR: 1.66, 95% CI: 1.31–2.12) and mean adenoma detection per procedure (mean difference: 0.48, 95% CI: 0.25–0.70).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>TXI improves gastriontestinal lesion lesion detection by enhancing visualization and color differentiation, addressing key limitations of WLE. These findings support its integration into routine endoscopy, with further research needed to compare TXI with other modalities and explore its potential in real-time lesion detection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892955","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":"“Cat scratch colon” causing cecal perforation as a rare complication due to barotrauma during colonoscopy: A case report and literature review","authors":"Hitoshi Hara,&nbsp;Yashuhide Muto,&nbsp;Tomoki Kido,&nbsp;Ryohei Miyata,&nbsp;Moe Tokuda,&nbsp;Tomohiro Maesono,&nbsp;Takahiro Ajihara,&nbsp;Takuma Naritomi,&nbsp;Michio Itabashi","doi":"10.1002/deo2.70125","DOIUrl":"https://doi.org/10.1002/deo2.70125","url":null,"abstract":"<p>“Cat scratch colon” (CSC), characterized by spontaneous bright-red linear markings or mucosal laceration with bleeding due to air insufflation barotrauma, is a rare complication during colonoscopy. These mucosal lacerations can present as superficial tears that do not generally have clinical repercussions or as deeper tears that damage the muscularis and cause perforation. CSC occurs in the colon with submucosal stiffening disease, such as collagenous colitis; however, in cases unrelated to these diseases, CSC appears in the cecum or ascending colon for anatomical reasons. Herein, we report a case of CSC that caused cecal perforation. A 79-year-old woman underwent a colonoscopy for anal bleeding. Although insertion of the colonoscope was easy, as soon as the cecum expanded with air insufflation, the cecal mucosa was torn, and bleeding occurred. The endoscopist determined these findings as shallow mucosal tears and inactive bleeding, and a colonoscopy was completed. She visited our hospital 2 days after colonoscopy with a complaint of abdominal pain that appeared in the morning after colonoscopy. Computed tomography revealed inflammation around the cecum, with free air. Emergency surgery was performed to diagnose an iatrogenic colonic perforation caused by colonoscopy. During surgery, a necrotic area was found in the cecal wall, requiring ileocecal resection. The resected specimen showed cecal mucosal tears with necrosis, which were pathologically consistent with cecal rupture resulting from mucosal laceration. The postoperative course was uneventful. When CSC is encountered along with endoscopic findings of deep mucosal tears in the colon, the possibility of perforation after colonoscopy should be considered.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883930","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":"Olmesartan-induced gastritis with no lower gastrointestinal symptoms: A case report","authors":"Satoshi Kosaka,&nbsp;Miki Kamiyama,&nbsp;Masahiro Ochi","doi":"10.1002/deo2.70124","DOIUrl":"https://doi.org/10.1002/deo2.70124","url":null,"abstract":"<p>A 74-year-old man with decreased appetite, weight, and heartburn was referred to our hospital. His medications included olmesartan. Esophagogastroduodenoscopy (EGD) revealed antral-dominant erosive gastritis and nodular mucosa. A gastric biopsy revealed inflammatory cell infiltration. The serum anti-<i>Helicobacter pylori</i> immunoglobulin G antibody test result was negative. Famotidine was ineffective in relieving his symptoms, and esomeprazole failed to prevent overt gastric bleeding, which required endoscopic hemostasis. The working diagnosis was drug-induced gastritis, particularly olmesartan-induced gastritis. His appetite loss started to improve within a week of olmesartan withdrawal. The erosions healed on EGD 2 months later. Over the next 10 months, he remained in his usual state until olmesartan was inadvertently administered. Subsequent EGD revealed a mild gastritis relapse. We diagnosed olmesartan-induced gastritis and discontinued olmesartan treatment. Mucosal healing was confirmed by EGD 1 year later. Olmesartan is known to cause angiotensin II receptor blocker-induced enteropathy. Although angiotensin II receptor blocker-induced enteropathy affects the stomach, angiotensin II receptor blocker-induced gastritis without lower gastrointestinal symptoms is rare. The characteristic endoscopic appearance may provide a clue to the correct diagnosis.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883926","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":"Rectal metastasis from lung cancer diagnosed by endoscopic ultrasound-guided fine needle biopsy: A case report","authors":"Shinji Mukawa,&nbsp;Yudai Koya,&nbsp;Tomoyuki Murakami,&nbsp;Koichiro Miyagawa,&nbsp;Yuki Maruno,&nbsp;Koki Yamaguchi,&nbsp;Shun Hanada,&nbsp;Shinji Oe,&nbsp;Masaru Harada","doi":"10.1002/deo2.70127","DOIUrl":"https://doi.org/10.1002/deo2.70127","url":null,"abstract":"<p>A 73-year-old man visited our hospital due to hyperintestinal peristalsis and diarrhea. He had been undergoing regular annual checkups for dust lung disease. Contrast-enhanced computed tomography scan showed edematous thickening of the rectal wall with contrast effect. A colonoscopy revealed a submucosal tumor-like protrusion in the Rb lesion of the rectum without neoplastic epithelial changes. Forceps biopsies of the overlying mucosa were non-diagnostic; however, endoscopic ultrasound-guided fine needle biopsy revealed that the specimen was poorly differentiated non-small cell invasive carcinoma. Then, we performed a chest computed tomography and a newly detected mass lesion in the upper lobe of the right lung. Based on immunohistochemical analysis and image findings, the patient was diagnosed with rectal metastasis from lung cancer. Subsequently, sputum cytology confirmed the diagnosis of lung adenocarcinoma. Rectal submucosal tumor-like protrusions are occasionally encountered. When a non-exposed rectal tumor is identified, it is important to differentiate metastatic diseases, consider endoscopic ultrasound-guided fine needle biopsy, and make a definitive diagnosis through detailed immunohistochemical evaluation and systemic imaging surveillance.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883928","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 case of hemobilia caused by a pseudoaneurysm resulting in obstructive cholangitis in a patient who underwent plastic stent placement for pancreatic cancer (with video)","authors":"Yusuke Seyama,&nbsp;Akinori Sugaya,&nbsp;Ken Koyama,&nbsp;Hiroyuki Honda,&nbsp;Hajime Ishibashi,&nbsp;Masaharu Yamaoka,&nbsp;Mitsuharu Ozeki,&nbsp;Mitsuhide Goto,&nbsp;Masahiro Araki,&nbsp;Kenji Amagai","doi":"10.1002/deo2.70130","DOIUrl":"https://doi.org/10.1002/deo2.70130","url":null,"abstract":"<p>Hemobilia, or hemorrhage within the biliary system, is an uncommon cause of stent obstruction associated with bile duct strictures that are rarely observed with plastic stents. Reports of a pseudoaneurysm as a cause of hemobilia after plastic stent placement are also rare. We present a rare case of hemobilia caused by a pseudoaneurysm that resulted in obstructive cholangitis in a patient who underwent plastic stent placement for bile duct invasion caused by pancreatic cancer. A 78-year-old man with a history of stroke who was using antiplatelet therapy presented with obstructive jaundice caused by locally advanced pancreatic cancer and underwent endoscopic plastic stent placement in the bile duct followed by concurrent chemoradiotherapy. Second-line chemotherapy was administered as the disease progressed; however, he experienced obstructive cholangitis and was admitted to our hospital. Hemobilia was identified as the underlying cause; notably, it was not evident during the initial evaluation and was diagnosed during endoscopic stent replacement. Emergency angiography revealed a pseudoaneurysm of the posterior superior pancreaticoduodenal artery, which was successfully treated using coil embolization. Cholangitis and hemobilia resolved, and the patient was discharged without bleeding recurrence.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883925","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 UK single-center pilot experience using a novel robotic inchworm colonoscopy system","authors":"Jabed F. Ahmed,&nbsp;Sergio Coda,&nbsp;Purushothaman Premchand,&nbsp;Saswata Banerjee,&nbsp;Nisha Patel","doi":"10.1002/deo2.70123","DOIUrl":"https://doi.org/10.1002/deo2.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Colonoscopy is the gold standard investigation in the lower gastrointestinal tract. However, 75% of patients can experience pain with moderate sedation. The application of robotic technology aims to overcome difficulties faced including better utilization of rooms for advanced procedures and to achieve a complete colonoscopy in patients restricted by pain and technical challenges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This pilot study, the first at a UK-National Health Service Hospital between January 2023 to August 2024 with one expert endoscopist performing the robotic colonoscopy (RC). Patients with failed previous standard colonoscopy (SC) along with index diagnostic procedures deemed potentially difficult were recruited. Procedures were performed outside the endoscopy unit similar to an outpatient clinical room.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-three patients were recruited (41 men:52 women), mean age of 53.8 years over 20 months. The commonest indications for RC were rectal bleeding (26.9%), failed SC (22.6%), and change in bowel habits (17.2%). Twenty-one patients had failed the previous SC with 14 patients achieving completion with subsequent RC (66% improvement). The average cecal intubation time of 41.07 min with an average total procedure time of 76.48 min. A significant improvement in patient discomfort score was reported (4.71 SC vs. 1.71 RC; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RC provides a significantly more comfortable colonoscopy and has great potential to improve safety in colonoscopy from this early cohort of patients. Direct visualization, biopsy, and polypectomy are still possible with RC. This study has demonstrated a viable alternative to SC. With no sedation it allows procedures to be conducted outside the traditional endoscopy unit such as outpatients. The study highlights a learning curve to reduce cecal intubation time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883927","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 meta-analysis of the effectiveness and safety of endoscopic ultrasound-guided choledochoduodenostomy employing electrocautery-enhanced lumen-apposing metal stents for biliary drainage after failed endoscopic retrograde cholangiopancreatography","authors":"Safiya Ibnawadh,&nbsp;Abdulrahman Alfadda,&nbsp;Abdulrahman Ibnawadh","doi":"10.1002/deo2.70105","DOIUrl":"https://doi.org/10.1002/deo2.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-biliary drainage and choledochoduodenostomy (EUS-CDD) are increasingly being used as alternative procedures for biliary drainage in patients in whom endoscopic retrograde cholangiopancreatography fails. Novel electrocautery-enhanced lumen-apposing metal stents (EC-LAMS) are expected to be widely used for EUS-CDD. We performed a systematic review and meta-analysis to evaluate the technical and clinical success of EUS-CDD using EC-LAMS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a comprehensive search of several databases from inception to May 2022 to search for relevant studies on the effectiveness and safety of endoscopic ultrasound-guided biliary drainage using EC-LAMS. The pooled rates of technical success, clinical success, and early and late adverse events were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten studies with a total of 481 patients were included in this analysis. The overall technical success rate was 94.3%, 95% confidence interval [CI] (91.5%–96.2%), The overall clinical success rate was 94.9%, 95% CI (92%–96.7%). The overall early adverse event rate was 5.1%, 95% CI (3.4%–7.8%), and the overall late adverse event rate was 10.8%, 95% CI (6.6%–17.2%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with biliary obstruction with failed endoscopic retrograde cholangiopancreatography, EUS-CDD using EC-LAMS is a good alternate management option with a high success rate and relatively low adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865862","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":"Complete mucosal healing prevents stricture progression after endoscopic balloon dilation in Crohn's disease","authors":"Jun Owada,&nbsp;Kunihiko Oguro,&nbsp;Tomonori Yano,&nbsp;Yusuke Ono,&nbsp;Takuma Kobayashi,&nbsp;Shoko Miyahara,&nbsp;Hirotsugu Sakamoto,&nbsp;Hironori Yamamoto","doi":"10.1002/deo2.70121","DOIUrl":"https://doi.org/10.1002/deo2.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic balloon dilation (EBD) is an effective treatment for intestinal strictures in Crohn's disease (CD). However, restenosis often occurs and requires repeat EBD or surgery. Previous studies have seldom examined restenosis with respect to stricture diameter, leaving the factors contributing to post-EBD restenosis unclear. Our retrospective study indicated that complete mucosal healing significantly reduces restenosis after EBD in CD-related small intestinal strictures. This prospective study aimed to validate these findings by accurately measuring stricture diameters in patients with CD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-center prospective study of patients with CD and small intestinal strictures. The patients underwent an EBD session between June 2022 and December 2023. Stricture diameters were measured using a calibrated small-caliber-tip transparent hood. Multivariate analysis was performed to identify factors influencing stricture progression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 41 patients (33 men). The number of strictures detected between sessions increased from 159 to 170. The average diameter of all strictures and the narrowest stricture per patient showed slight increases. However, 73% of patients experienced stricture progression. The presence of ulcers between sessions was identified as a significant risk factor for stricture progression (odds ratio 7.59, <i>p</i> = 0.031). Patients achieving complete mucosal healing demonstrated a significant increase in the narrowest stricture diameter (+1.5 mm, <i>p</i> = 0.00089).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Complete mucosal healing is crucial for preventing stricture progression after EBD in patients with CD-related small intestinal strictures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865861","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":"Knife-assisted full-thickness resection guided by the pocket-detection method for posterior deeply invasive rectal cancer: A novel endoscopic approach (with video)","authors":"Maria Eva Argenziano,&nbsp;Andrea Sorge,&nbsp;Anne Hoorens,&nbsp;Michele Montori,&nbsp;Pieter Jan Poortmans,&nbsp;Sander Smeets,&nbsp;Tamas Tornai,&nbsp;Lynn K. Debels,&nbsp;Lobke Desomer,&nbsp;David J. Tate","doi":"10.1002/deo2.70116","DOIUrl":"https://doi.org/10.1002/deo2.70116","url":null,"abstract":"<p>Local full-thickness resection techniques for rectal cancer are limited by lesion size, location, or poor margin delineation. We aimed to evaluate the feasibility of endoscopic knife-assisted full-thickness resection (kFTR) guided by the pocket-detection method (PDM) for deeply invasive rectal cancer.</p><p>Consecutive posterior-lateral rectal lesions suspected of deep submucosal invasion treated at a tertiary care center from February to October 2024 were retrospectively included. kFTR guided by PDM involved creating a submucosal pocket to detect and isolate the suspected invasive component (muscle-retracting sign), followed by muscularis propria incision and full-thickness resection.</p><p>Technical success, accuracy of detecting deep submucosal invasion, and en-bloc resection rates were 100%. The median procedure time was 141.5 [IQR 123.7–179.5] minutes and the median hospitalization was 1 [IQR 1–7] day. No adverse events occurred. Histopathology showed R1-vertical margin in patient 1 (pT2 adenocarcinoma) and R0 resection in patients 2, 3, and 4 (pT1bsm3) after refinement of the procedure to include a ≥3 mm muscularis propria margin around the suspected invasive component. There was no recurrence at the first endoscopic follow-up of patients 1, 2, and 4. Patient 3 was sent to surgical low anterior resection due to multiple high-risk histological features. The previous kFTR did not impair surgery (no residual rectal carcinoma and 1/17 positive lymph nodes).</p><p>Endoscopic kFTR guided by the PDM may be a feasible organ-preserving treatment for the detection and resection of deeply invasive posterior rectal cancer. Future studies are needed to ascertain whether rectal kFTR could represent a viable alternative to conventional surgical local excision techniques.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861612","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 of palliative stenting in patients with esophageal obstruction attributable to malignancy","authors":"Yasuki Hatayama,&nbsp;Hideaki Ishigami,&nbsp;Hidehiro Kamezaki,&nbsp;Daisuke Murakami,&nbsp;Yukiko Shima,&nbsp;Kentaro Ishikawa,&nbsp;Harutoshi Sugiyama,&nbsp;Takayoshi Nishino,&nbsp;Makoto Arai","doi":"10.1002/deo2.70120","DOIUrl":"https://doi.org/10.1002/deo2.70120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Self-expandable metallic stent (SEMS) placement is useful for patients with poor oral intake caused by esophageal stricture attributable to malignancy. In this study, we examined the usefulness of esophageal SEMS placement as a palliative treatment and evaluated the prognostic factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>Patients who underwent esophageal SEMS placement at three regional base hospitals from December 2007 to June 2023 were included in the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 73 patients, 57 patients who underwent palliative SEMS placement were evaluated after excluding 16 patients in whom postoperative treatment was possible after SEMS placement. Median survival after SEMS placement was 67 days (mean, 96 ± 16 days). Univariate analysis identified age (≤78 years vs. &gt;78 years), performance status (3 or 4 vs. 1 or 2), the cancer location (other sites vs. gastrointestinal cancer), the resumption of oral intake (failure vs. success), and clinical stage (IVA/IVB vs. III) as prognostic factors after SEMS placement. On multivariate analysis, performance status 3 or 4 (odds ratio [OR] = 2.87, 95% confidence interval [CI] = 1.28–6.45), cancers other than gastrointestinal cancer (OR = 3.75, 95% CI = 1.14–12.3), and failure to resume oral intake (OR = 21.3, 95% CI = 3.40–133.0) were significantly associated with poor prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Palliative treatment with SEMS placement was safe, and a high percentage of patients resumed food intake. An inability to resume food intake, poor performance status, and cancer outside the gastrointestinal tract were poor prognostic factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861613","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}