DEN open最新文献

{"title":"Bethesda Endoscopic Retrograde Cholangiopancreatography Skill Assessment Tool (BESAT)-Based Simulator Training Using a Novel Dry Endoscopic Retrograde Cholangiopancreatography Model Improves Technical Proficiency and Self-Efficacy: A Prospective Study","authors":"Yutaka Hatayama,&nbsp;Takeshi Kanno,&nbsp;Tetsuya Takikawa,&nbsp;Ryotaro Matsumoto,&nbsp;Yutaro Arata,&nbsp;Suguo Suzuki,&nbsp;Kaname Uno,&nbsp;Kazuhiro Kikuta,&nbsp;Tomoyuki Koike,&nbsp;Atsushi Masamune","doi":"10.1002/deo2.70382","DOIUrl":"10.1002/deo2.70382","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic sphincterotomy (EST) is a high-risk procedure with a steep learning curve. We previously developed a novel dry simulator capable of reproducing bleeding after an inappropriate incision. This study aimed to evaluate the effectiveness of a structured educational program using the simulator within the Bethesda Endoscopic retrograde cholangiopancreatography (ERCP) Skill Assessment Tool (BESAT) framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective study implemented a standardized training sequence: (1) preliminary video-based learning; (2) an initial attempt at cannulation, EST, and biliary stone extraction; (3) BESAT-based expert feedback focusing on six key technical tips; (4) a second attempt. The primary outcome was the change in EST success, which is defined by an incision in the 11–12 o'clock direction with appropriate length and no bleeding, before and after feedback. Secondary outcomes were procedure completion, including stone removal within 15 min, and subjective self-assessments of procedural understanding and confidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty gastroenterology trainees were enrolled. The EST success rate increased from 43.3% to 76.7% (<i>p</i> &lt; 0.05). The completion rate of the procedure tended to increase from 46.7% to 70.0% (<i>p</i> = 0.07). Subjective self-confidence improved from a median of 24.0–53.0 after training and remained at 53.5 at 3 months; other self-assessed domains also improved and were sustained. Post-hoc analysis showed that initial EST success was associated with &gt;50 prior ERCP cases (odds ratio = 7.86, 95% confidence interval: 1.31–47.0, <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A structured simulator-based program enables trainees to experience failure and improves simulator-based EST performance with sustained gains in self-efficacy.</p>\u0000 \u0000 <p><b>Trial Registration</b>: The trial was prospectively registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000044823).</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876811","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":"Clinical Utility of Anti-reflux Mucosal Intervention for Refractory Gastroesophageal Reflux Disease in Patients With a Hiatal Hernia","authors":"Masachika Saino,&nbsp;Haruhiro Inoue,&nbsp;Kei Ushikubo,&nbsp;Miyuki Iwasaki,&nbsp;Kazuki Yamamoto,&nbsp;Yohei Nishikawa,&nbsp;Ippei Tanaka,&nbsp;Hidenori Tanaka,&nbsp;Mayo Tanabe,&nbsp;Satoshi Abiko,&nbsp;Boldbaatar Gantuya,&nbsp;Manabu Onimaru,&nbsp;Shiro Oka","doi":"10.1002/deo2.70424","DOIUrl":"10.1002/deo2.70424","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Surgical fundoplication is the standard treatment for refractory gastroesophageal reflux disease (GERD) with large (≥3 cm) hiatal hernias; however, its invasiveness is problematic in older adults and high-risk patients. Anti-reflux mucosal intervention (ARMI) is a less invasive endoscopic alternative; however, patients with large hernias have previously been excluded from studies, limiting available evidence. We assessed the feasibility, short-term clinical outcomes, and safety of ARMI in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed consecutive patients with proton pump inhibitor (PPI)/potassium-competitive acid blocker (P-CAB)-refractory GERD and sliding hiatal hernias ≥3 cm who underwent ARMI (anti-reflux mucosectomy; anti-reflux mucoplasty) between April 2024 and April 2025. GERD-Health-Related Quality of Life (GERD-HRQL), GERD Questionnaire (GerdQ), and Frequency Scale for the Symptoms of GERD (FSSG) scores were compared before ARMI and 3 months afterward. PPI/P-CAB discontinuation and treatment-related adverse events were also assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten patients (mean age 74.3 years; 80% women; hernia size 3–6 cm) were included, all with American Society of Anesthesiologists physical status ≥ II. At 3 months, mean GERD-HRQL scores decreased from 21.1 to 4.6 (<i>p</i> = 0.002), FSSG from 22.6 to 6.2 (<i>p</i> = 0.004), and GerdQ from 10.9 to 4.6 (<i>p</i> = 0.008). PPI/P-CAB was discontinued in seven patients. No clinically significant treatment-related adverse events, including perforation, delayed bleeding, or dysphagia, occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ARMI was technically feasible, showed favorable short-term outcomes in patients with refractory GERD and 3–6-cm hiatal hernias, and may represent a less invasive option for older or high-risk patients.</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":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868293","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":"Comparative Diagnostic Sensitivity of Endoscopic Ultrasound-guided Tissue Acquisition for Hepatocellular Carcinoma Versus Intrahepatic Cholangiocarcinoma","authors":"Yuichi Takano,&nbsp;Naoki Tamai,&nbsp;Jun Noda,&nbsp;Tetsushi Azami,&nbsp;Fumitaka Niiya,&nbsp;Ryo Uyama,&nbsp;Naotaka Maruoka,&nbsp;Tatsuya Yamagami,&nbsp;Akihiro Nakamura,&nbsp;Takafumi Ogawa,&nbsp;Takahiro Umemoto,&nbsp;Masatsugu Nagahama","doi":"10.1002/deo2.70423","DOIUrl":"10.1002/deo2.70423","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Accurate histological differentiation between hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) is essential for selecting appropriate treatment. Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is increasingly used for focal liver lesions; however, comparative data on its diagnostic sensitivity for HCC and ICC remain limited. This study compared the diagnostic sensitivity of EUS-TA for these malignancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective study included patients who underwent EUS-TA for focal liver lesions and were ultimately diagnosed with HCC or ICC between 2016 and 2024. Patients with extrahepatic cholangiocarcinoma were excluded. The primary outcome was overall diagnostic sensitivity. Secondary outcomes were cytological sensitivity and procedure-related adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-five patients were included (HCC, <i>n</i> = 18; ICC, <i>n</i> = 27). Median lesion size was 41 mm. Baseline characteristics were similar, except that fine-needle biopsy needles were used less frequently in HCC than in ICC (16.6% vs. 48.1%, <i>p</i> = 0.032). Overall diagnostic sensitivity was high in both groups but lower in HCC than in ICC (83.3% [95% confidence interval {CI}, 58.6–96.4%] vs. 100% [95% CI, 87.2%–100%], <i>p</i> = 0.029). The difference was more pronounced for cytological sensitivity (22.2% [95% CI, 6.4%–47.6%] vs. 77.8% [95% CI, 57.7%–91.4%], <i>p</i> = 0.0007). No procedure-related adverse events occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EUS-TA demonstrated high diagnostic sensitivity for both HCC and ICC without procedure-related adverse events. However, diagnostic sensitivity, particularly cytological sensitivity, was lower in HCC, consistent with the known pathological characteristics of HCC and the established role of histological evaluation in its diagnosis.</p>\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":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868267","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 Removal of a Toothpick Penetrating the Gastric Wall and Extending Into the Head of the Pancreas: A Case Report and Brief Literature Review","authors":"Ken Nakayama,&nbsp;Takanori Ueda,&nbsp;Noriyuki Isohata,&nbsp;Tadashi Kondo,&nbsp;Yuji Hiraoka,&nbsp;Yoshihiro Tanabe,&nbsp;Hironobu Yamazaki,&nbsp;Keiichiro Yoshikata,&nbsp;Masayoshi Yamamoto,&nbsp;Tatsuya Oda","doi":"10.1002/deo2.70418","DOIUrl":"https://doi.org/10.1002/deo2.70418","url":null,"abstract":"<p>Ingested toothpicks can perforate the gastrointestinal tract and penetrate adjacent organs. Pancreatic involvement is rare, and its management varies between surgical and endoscopic interventions. We report the successful endoscopic removal of a toothpick that penetrated the gastric wall and extended into the head of the pancreas. A 59-year-old man presented with a 5-day history of fever and epigastric pain. Laboratory tests revealed inflammatory changes, with normal serum amylase and hemoglobin levels. Non-contrast computed tomography (CT) with multiplanar reconstruction (MPR) revealed a linear, slightly hyperattenuating foreign body measuring at least 5 cm, extending from the posterior wall of the lower body of the stomach to the head of the pancreas, with minimal free air, surrounding fat stranding, and no dilation of the main pancreatic duct. Contrast-enhanced CT revealed no major vascular involvement or active extravasation. Esophagogastroduodenoscopy was performed on hospital day 3 with surgical backup. A wooden foreign body protruding from the gastric mucosa was removed with biopsy forceps through an overtube under conscious sedation. The extracted object was a 6.5-cm wooden toothpick. The post-procedural course was uneventful. This case highlights the value of MPR and contrast-enhanced CT in defining a foreign body's trajectory and determining procedural feasibility. Endoscopic removal may be a safe and minimally invasive alternative to surgery in selected cases of pancreatic penetration.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70418","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148848975","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":"Polyglycolic Acid Shield Prevents Repeated Delayed Bleeding After Endoscopic Stricturotomy for Anastomotic Stricture in Crohn's Disease: A Case Report","authors":"Hidezumi Kikuchi,&nbsp;Taka Asari,&nbsp;Tetsuya Tatsuta,&nbsp;Kazuhiro Nagane,&nbsp;Kentaro Hoshi,&nbsp;Shohei Igarashi,&nbsp;Takato Maeda,&nbsp;Yasuhisa Murai,&nbsp;Shinji Ota,&nbsp;Hirotake Sakuraba","doi":"10.1002/deo2.70420","DOIUrl":"10.1002/deo2.70420","url":null,"abstract":"<p>Endoscopic stricturotomy (ES) is a novel approach for treating benign strictures of the lower gastrointestinal tract. However, it is performed at a limited number of facilities, and strategies for preventing complications have not yet been established. We performed ES for ileo-sigmoid anastomosis associated with Crohn's disease (CD). Although endoscopic dilatation was successful, delayed bleeding occurred. Endoscopic hemostasis provided temporary relief, but delayed bleeding recurred nine times within 17 days after ES. Combined hemostatic treatments with vascular forceps soft coagulation, biocompatible synthetic peptide gel, and endoscopic clips failed to stop recurrent bleeding. Infliximab infusion was also unsuccessful. Finally, wound coverage with polyglycolic acid (PGA) sheets prevented rebleeding and avoided abdominal surgery. Here, we report that covering with a PGA sheet and fibrin glue may be useful in preventing recurrent delayed bleeding after ES for anastomosis associated with CD.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842415","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":"Early Gastric Cancer Detected During 15-year Surveillance After Ménétrier Disease Remission and Successfully Treated With Endoscopic Submucosal Dissection: A Case Report","authors":"Takaaki Shamoto,&nbsp;Hideko Yamamoto,&nbsp;Takehito Naito,&nbsp;Masahiro Yamada,&nbsp;Hirotaka Suzuki,&nbsp;Emiko Hida,&nbsp;Takafumi Yamamoto,&nbsp;Yoshifumi Arai,&nbsp;Hiroshi Matsubara","doi":"10.1002/deo2.70389","DOIUrl":"10.1002/deo2.70389","url":null,"abstract":"<p>Ménétrier disease (MD) was diagnosed based on hypoalbuminemia and giant gastric folds extending from the body to the fundus in a woman in her 70s. A serum anti-<i>Helicobacter pylori</i> antibody test and urea breath test yielded negative results. Remission was achieved with steroid therapy, and she was relapse-free with the use of a proton pump inhibitor. Annual esophagogastroduodenoscopy (EGD) was continued for gastric cancer surveillance. Fifteen years after the diagnosis of MD, a type 0-I well-differentiated tubular adenocarcinoma was detected on the posterior wall of the upper gastric body. EGD, computed tomography, and endoscopic ultrasonography revealed no findings suggestive of MD recurrence, and the lesion was considered intramucosal. Endoscopic submucosal dissection resulted in curative en bloc resection. Histopathology revealed no evidence of active MD. The patient remained free of MD relapse and gastric cancer recurrence. MD is characterized by giant gastric folds and protein-losing gastroenteropathy, and it is considered a risk factor for gastric cancer. However, reports of gastric cancer diagnosed at an early stage and treated endoscopically during long-term follow-up after clinical remission induced by medical therapy, as in the present case, are rare. This case highlights the importance of continued endoscopic surveillance for gastric carcinogenesis even after long-term clinical remission of MD.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835680","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":"Apparent Endoscopic Decrease in the Size of a Large Ulcerated Gastric Schwannoma After Helicobacter pylori Eradication Therapy: A Case Report","authors":"Takahito Awatsu,&nbsp;Daisuke Asaoka,&nbsp;Hirofumi Fukushima,&nbsp;Daishi Kabemura,&nbsp;Yusuke Nomoto,&nbsp;Osamu Nomura,&nbsp;Kazunori Kajino,&nbsp;Mariko Hojo,&nbsp;Akihito Nagahara","doi":"10.1002/deo2.70416","DOIUrl":"10.1002/deo2.70416","url":null,"abstract":"<p>Gastric subepithelial lesions (SELs) comprise a heterogeneous group of tumors, among which gastric schwannomas are rare and generally benign. We report a case of a large gastric schwannoma with ulceration and symptomatic anemia that showed an apparent endoscopic decrease in size following <i>Helicobacter pylori</i> eradication.</p><p>An 85-year-old man presented with iron deficiency anemia. Esophagogastroduodenoscopy revealed a large ulcerated SEL in the lower body of the stomach, along with multiple gastric ulcers. Endoscopic ultrasonography demonstrated a 56 mm tumor originating from the fourth layer, raising suspicion for a gastrointestinal stromal tumor. Boring biopsy from the ulcer base enabled a definitive diagnosis of gastric schwannoma based on immunohistochemical findings. Although surgical resection was recommended, the patient declined. After successful <i>H. pylori</i> eradication, follow-up endoscopy at 6 months showed healing of the ulcerative lesion and an apparent endoscopic decrease in the size of the tumor. Although objective post-treatment assessment was unavailable, this case suggests that inflammatory or ulcer-related changes associated with <i>H. pylori</i> infection may influence the endoscopic appearance of gastric SELs.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13510627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835698","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":"Spontaneous Hyperinflation of Intragastric Balloon Presenting as Acute Pancreatitis","authors":"Ong Yan Ling,&nbsp;Rajesh R,&nbsp;Asokkumar Ravishankar","doi":"10.1002/deo2.70414","DOIUrl":"10.1002/deo2.70414","url":null,"abstract":"<p>Obesity is a metabolic disorder with considerable health implications affecting populations worldwide. Intragastric balloon (IGB) placement has gained popularity as a minimally invasive and reversible management option for obesity. Although generally safe, IGBs can sometimes be associated with serious adverse outcomes. We present a case of IGB hyperinflation due to <i>Candida</i> infection, resulting in local compression of the pancreas and causing acute pancreatitis. Urgent endoscopic removal of the balloon led to complete resolution of symptoms. Spontaneous hyperinflation of an IGB due to fungal overgrowth can lead to extrinsic pancreatic compression. Early recognition and timely balloon removal are key to the management of IGB-related acute pancreatitis.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13509404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835625","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":"Clinical Outcomes of Multi-Hole Covered Self-Expandable Metal Stents for Malignant Distal Biliary Obstruction: A Retrospective Comparative Study With an Exploratory Evaluation of 6-mm Devices","authors":"Akinobu Koiwai,&nbsp;Yuki Miyashita,&nbsp;Nana Inomata,&nbsp;Takehito Ito,&nbsp;Morihisa Hirota,&nbsp;Kennichi Satoh","doi":"10.1002/deo2.70411","DOIUrl":"10.1002/deo2.70411","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Covered self-expandable metal stents (CSEMS) are widely used for malignant distal biliary obstruction (MDBO), but cholecystitis, post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), stent migration, and recurrent biliary obstruction (RBO) remain clinically important limitations. Multi-hole SEMS (MHSEMS) is a novel CSEMS designed to preserve side-branch drainage and reduce migration. We evaluated MHSEMS compared with conventional CSEMS and explored the potential impact of a newly available 6-mm MHSEMS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective single-center study included consecutive patients who underwent initial transpapillary SEMS placement for MDBO between September 2015 and December 2025. Study-I compared MHSEMS versus conventional CSEMS limited to 8–10 mm diameter stents. Study-II included MHSEMS cases only and compared 6-mm versus 8–10 mm MHSEMS. Outcomes included cholecystitis, PEP, RBO, time to RBO (TRBO), and RBO causes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Study-I included 148 patients; median follow-up was 80.5 versus 81.5 days (<i>p</i> = 0.761). Overall cholecystitis was 1/34 versus 23/98 (<i>p</i> = 0.008). MHSEMS was independently protective for cholecystitis (odds ratio [OR] 0.0879; 95% confidence interval [95%CI] 0.0111–0.696), whereas cystic duct involvement increased risk (OR 3.190; 95%CI 1.160–8.720). PEP was 4/36 versus 18/112 (<i>p</i> = 0.595). RBO was 1/36 versus 28/112, including migration in 0 versus 9. TRBO was longer with MHSEMS (log-rank <i>p</i> = 0.023). Study-II included 64 MHSEMS cases; PEP was 1/28 versus 4/36 (<i>p</i> = 0.375), RBO was 1/28 versus 1/36, and no migration occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MHSEMS was associated with fewer cholecystitis events and migration and longer TRBO versus conventional CSEMS. The potential benefit of 6-mm MHSEMS for reducing PEP remains exploratory and requires confirmation in longer prospective studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820634","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 Endoscopic Ultrasound-Guided Biliary Drainage in the Management of Malignant Hilar Biliary Obstruction: A Multicenter Retrospective Cohort Study","authors":"Takuji Iwashita,&nbsp;Kazuki Hayashi,&nbsp;Michihiro Yoshida,&nbsp;Reiko Yamada,&nbsp;Koichiro Matsuda,&nbsp;Shinichi Morita,&nbsp;Tadahisa Inoue,&nbsp;Kazuhiko Shioji,&nbsp;Keisuke Iwata,&nbsp;Akinori Maruta,&nbsp;Nobuhiko Hayashi,&nbsp;Masaaki Yano,&nbsp;Ichiro Yasuda","doi":"10.1002/deo2.70413","DOIUrl":"10.1002/deo2.70413","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Malignant hilar biliary obstruction (MHBO) remains challenging for biliary decompression. Although endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to endoscopic retrograde cholangiopancreatography-guided BD (ERCP-BD), evidence regarding EUS-BD for MHBO is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate the efficacy and safety of EUS-BD for MHBO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter retrospective cohort study included patients with MHBO who underwent EUS-BD at 12 tertiary referral centers between 2012 and 2023. Technical success, clinical success, and procedure-related adverse events (AEs) were assessed. Multivariable analysis was performed to identify factors associated with clinical failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 141 patients were included. EUS-BD was performed as primary drainage in 67 patients (47.5%) and as rescue drainage after prior ERCP-BD in 74 patients (52.5%); in rescue cases, the reported configurations represented only the EUS-BD component. The overall technical success rate was 98.5% (139/141). Clinical success was achieved in 87.1% (121/139). Among patients who achieved clinical success, the median time to recurrent biliary obstruction was 201 days. Procedure-related AE occurred in 15 patients (10.6%). Multivariable analysis identified Bismuth type IV strictures (odds ratio [OR], 5.89; 95% confidence interval [95% CI], 1.72–24.3) and EUS-BD drainage limited to one or two liver segments (OR, 5.11; 95% CI, 1.49–21.2) as factors associated with clinical failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EUS-BD is a highly feasible and relatively safe option for BD of MHBO in both primary and rescue settings. Bismuth type IV strictures and EUS-BD drainage limited to one or two liver segments were associated with clinical failure.</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":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820695","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}