DEN open最新文献

{"title":"Natural History of Duodenal Adenoma: An 11-year Follow-up","authors":"Hikaru Kuribara,&nbsp;Naomi Kakushima,&nbsp;Hiroyuki Hisada,&nbsp;Yosuke Tsuji,&nbsp;Akihiko Ichida,&nbsp;Kiyoshi Hasegawa,&nbsp;Junichi Nawa,&nbsp;Tetsuo Ushiku,&nbsp;Mitsuhiro Fujishiro","doi":"10.1002/deo2.70186","DOIUrl":"https://doi.org/10.1002/deo2.70186","url":null,"abstract":"<p>Early detection and treatment are essential to decrease the mortality rate of duodenal cancer (DC). However, the natural history of DC remains unclear. A 78-year-old woman underwent screening esophagogastroduodenoscopy (EGD) before surgery for advanced colon cancer. A 25 mm-sized flat-elevated lesion was detected in the second portion of the duodenum anal to the Vater's papilla. The biopsy specimen showed a tubular adenoma. The patient recovered well from right hemicolectomy and wished for periodic EGD follow-up for the duodenal adenoma. The duodenal adenoma slowly increased in size, but a biopsy showed a tubular adenoma for 9 years. Ten years after the initial examination, biopsy showed well-differentiated tubular adenocarcinoma, and submucosal invasion was suspected, although she did not wish to undergo surgery. The lesion finally progressed to advanced cancer 11 years later, and pancreatoduodenectomy was performed. The final stage was pT3N1M0, Stage IIIB. In this case, a duodenal adenoma progressed to advanced DC with lymph node metastasis. Early decision-making regarding endoscopic resection is required even in older patients.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869986","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 Human Epidermal Growth Factor Receptor 2-Positive Colon Cancer With Invasive Micropapillary Carcinoma Component","authors":"Masashi Kono,&nbsp;Yoriaki Komeda,&nbsp;Hiroshi Kashida,&nbsp;Satoru Hagiwara,&nbsp;Akihiro Yoshida,&nbsp;Shunsuke Omoto,&nbsp;Mamoru Takenaka,&nbsp;Naoko Tsuji,&nbsp;George Tribonias,&nbsp;Masatoshi Kudo","doi":"10.1002/deo2.70184","DOIUrl":"https://doi.org/10.1002/deo2.70184","url":null,"abstract":"<p>A female patient in her 60s tested positive for the fecal occult blood test while undergoing health screening. Colonoscopy revealed a 15-mm-sized flat elevated lesion with a central depression in the sigmoid colon. Narrow-band imaging magnification revealed a Japan Narrow-Band Imaging Expert Team classification of type 2B, whereas crystal violet staining showed a mild to severely irregular type VI pit pattern. Ultra-magnification imaging revealed an EC3a morphology in the depressed area. Endoscopic ultrasonography revealed partial disruption of the third layer, leading to the diagnosis of T1b (SM) colon cancer. Owing to the intermediate lesion size and since the patient had requested it, an endoscopic submucosal dissection was performed as an initial treatment. Pathological analysis revealed a moderately differentiated tubular adenocarcinoma with an invasive micropapillary carcinoma (IMPC) component, with deep submucosal invasion. Additional surgery was performed, and no recurrence was observed in the following three years. IMPC is known for its high rate of lymph-node metastasis and poor prognosis, as reported for breast, bladder, and lung cancers. IMPC is rare; this report presents a literature review and case details. This case represents the first reported instance of identification of a cancerous IMPC component by magnifying endoscopy at the T1b (SM) depth. Thus, even for intermediate lesions, IMPC should be considered as a differential diagnosis when endoscopic imaging suggests malignancy.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833219","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 Ultrasonography-guided Variceal Therapy as Salvage Treatment for Rebleeding From Duodenal Varices Following Balloon-occluded Retrograde Transvenous Obliteration","authors":"Sakue Masuda,&nbsp;Atsushi Irisawa,&nbsp;Soichiro Nakaya,&nbsp;Jun Kubota,&nbsp;Karen Kimura,&nbsp;Makomo Makazu,&nbsp;Kazuya Koizumi","doi":"10.1002/deo2.70183","DOIUrl":"https://doi.org/10.1002/deo2.70183","url":null,"abstract":"<p>Duodenal varices, though rare, are potentially life-threatening complications of portal hypertension. Management is challenging when balloon-occluded retrograde transvenous obliteration (BRTO) fails to achieve complete obliteration. Endoscopic ultrasonography-guided variceal therapy (EUS-VT) is effective for gastric varices, but reports of duodenal varices remain limited. We present a case of a 71-year-old woman with alcoholic liver cirrhosis and duodenal variceal bleeding. Initial hemostasis was achieved with endoscopic variceal ligation, followed by BRTO. However, rebleeding occurred due to incomplete obliteration caused by dual afferent veins. EUS-VT comprising n-butyl cyanoacrylate was performed as salvage therapy because of ascites and vascular complexity. Despite technical challenges, EUS-VT successfully obliterated the varices. Post-procedural computed tomography showed lipiodol migration into the portal system. No rebleeding or liver dysfunction occurred. Ascites worsened—likely because of BRTO and/or EUS-VT—but was manageable with low-dose diuretics. This case highlights EUS-VT as a feasible option after failed BRTO for duodenal varices. A meticulous technique is essential to preventing glue migration.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833229","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":"Comprehensive Endoscopic Management of Superficial Pharyngeal Cancer – From Detection and Diagnosis to Treatment and Surveillance","authors":"Daisuke Kikuchi,&nbsp;Yugo Suzuki,&nbsp;Satoshi Yamashita,&nbsp;Yorinari Ochiai,&nbsp;Shu Hoteya","doi":"10.1002/deo2.70180","DOIUrl":"https://doi.org/10.1002/deo2.70180","url":null,"abstract":"<p>Traditionally, pharyngeal cancer was detected at an advanced stage, as examinations were usually performed only after symptoms such as pain or dysphagia appeared. Consequently, it was considered a malignancy with a poor prognosis. However, recent advances in image-enhanced endoscopy (IEE) have facilitated the early detection of superficial pharyngeal cancers. The combination of IEE and magnifying endoscopy enables both the detection and detailed characterization of lesions, including assessment of malignancy and invasion depth. Due to the anatomically complex structure of the pharyngolaryngeal region, en bloc resection using snare-based endoscopic mucosal resection has been difficult. However, the development of endoscopic submucosal dissection (ESD) and endoscopic laryngopharyngeal surgery has made en bloc resection technically possible. Successful pharyngeal ESD requires careful planning, including consideration of intubation route, laryngoscope positioning, and choice of devices. Tumor thickness ≥1000 µm and positive lymphovascular invasion are pathological risk factors for lymph node metastasis. However, no consensus exists regarding the need for additional adjuvant chemotherapy. After pharyngeal ESD, close follow-up is essential, focusing on lymph node metastasis and metachronous cancers. Lymph node metastasis may require dissection or radiotherapy, while metachronous lesions can often be treated endoscopically. A multidisciplinary approach is essential for effective management of superficial pharyngeal cancer.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811337","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":"When Endoscopic Sedation is Not an Option: Insights From a Multicenter on-site Survey on Tolerance for Japanese Gastric Cancer Screening","authors":"Kazuya Inoki,&nbsp;Toshiya Chiba,&nbsp;Kazuhiro Miura,&nbsp;Teppei Tagawa,&nbsp;Yutaka Aoyagi,&nbsp;Yoshiaki Takeuchi,&nbsp;Naoya Moriyama,&nbsp;Kensuke Kuraoka,&nbsp;Tadashi Ohara,&nbsp;Yuko Haruhara,&nbsp;Akira Mizuki,&nbsp;Jun Satio,&nbsp;Yoshimi Hagisawa,&nbsp;Naomi Ono,&nbsp;Noboru Takayama,&nbsp;Takeo Onishi,&nbsp;Akira Mishima,&nbsp;Norihiro Suzuki,&nbsp;Kazuo Kikuchi,&nbsp;Atsushi Katagiri,&nbsp;Fuyuhiko Yamamura,&nbsp;Sachiko Ohde,&nbsp;Eisuke Inoue,&nbsp;Takahisa Matsuda,&nbsp;Hitoshi Yoshida","doi":"10.1002/deo2.70179","DOIUrl":"https://doi.org/10.1002/deo2.70179","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Esophagogastroduodenoscopy (EGD) is widely used for gastric cancer (GC) screening in Japan; however, sedation during EGD is not recommended. We aimed to assess the tolerability of unsedated EGD (USEGD) in the Japanese population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants who underwent GC screening in Japanese urban areas between July 2021 and December 2022 were included in this study. We conducted a real-time questionnaire survey on USEGD invasiveness in 16 clinics and hospitals. Participants completed a self-report questionnaire, including a six-point face scale, immediately after undergoing USEGD with an ultrathin endoscope for GC screening, and were placed into the tolerable (T group) or intolerable groups (I group) based on the scores 1–3 and 4–6 on the face scale, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 1021 participants (median age, 59 years; interquartile range, 59–74 years) consisted of 561 men and 437 women, while 23 preferred not to answer. Of the 777 participants who underwent USEGD using an ultrathin endoscope, 135 (17.4%) were categorized into the intolerable (I) group based on severe distress, and 642 (82.6%) into the tolerable (T) group. Multiple logistic regression analysis revealed that older age (odds ratio [OR]: 0.974; <i>p</i> = 0.008) and prior USEGD experience (OR: 0.527; <i>p</i> = 0.006) were associated with higher tolerability. Conversely, females (OR: 2.498; <i>p</i> &lt; 0.001) and first-time EGD experience (OR: 2.202; <i>p</i> = 0.003) were associated with lower tolerability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>USEGD was generally well-tolerated; however, some participants found it intolerable, even with transnasal endoscopy. Supportive measures for these individuals are essential for sustaining effective screening programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144814652","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":"Edoxaban-induced enterocolitis: The first case report demonstrating distinct endoscopic and histological features","authors":"Katsuya Endo,&nbsp;Jun Yamada,&nbsp;Tomofumi Katayama,&nbsp;Yuki Yoshino,&nbsp;Daisuke Fukushi,&nbsp;Akinobu Koiwai,&nbsp;Takayuki Kogure,&nbsp;Morihisa Hirota,&nbsp;Kennichi Satoh","doi":"10.1002/deo2.70142","DOIUrl":"https://doi.org/10.1002/deo2.70142","url":null,"abstract":"<p>Direct oral anticoagulants (DOACs), including edoxaban, are widely used for stroke prevention in atrial fibrillation and venous thromboembolism. While gastrointestinal bleeding and diarrhea are recognized adverse effects, DOAC-induced enterocolitis has not been established as a distinct clinical entity. We report the first case of edoxaban-induced enterocolitis in a 75-year-old woman who developed bloody diarrhea and anorexia five days after starting edoxaban. Ileocolonoscopy revealed scattered redness, ulcers, and erosions in the terminal ileum, with diffuse edema and submucosal bleeding from the transverse colon to the rectum. Histopathology showed villous atrophy, lymphatic dilation, and lymphocyte-predominant infiltration in the ileum, along with crypt atrophy, mucosal edema, and hemorrhages in the colon. These findings were inconsistent with infectious, ischemic, vasculitic, or inflammatory bowel diseases, suggesting a drug-induced etiology. Given the acute onset and unique endoscopic and histopathological findings, edoxaban-induced enterocolitis was suspected. The patient's symptoms resolved three days after discontinuing edoxaban, and a follow-up ileocolonoscopy after 3 months showed complete mucosal healing. In accordance with the clinical course, we ultimately diagnosed this case as edoxaban-induced enteritis. Given the widespread use of DOACs, similar cases may be underrecognized, as unexplained bloody diarrhea in these patients often lacks detailed endoscopic evaluation. Further case reports and studies are needed to establish DOAC-induced enteritis as a distinct clinical entity. This case serves as a critical first step in recognizing DOAC-induced enterocolitis and highlights the need for increased awareness among clinicians.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70142","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758623","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 Transoral Robotic Surgery and Endoscopic Laryngopharyngeal Surgery for Hypopharyngeal and Supraglottic Laryngeal Cancers","authors":"Tsutomu Ueda,&nbsp;Takayuki Taruya,&nbsp;Yuji Urabe,&nbsp;Minoru Hattori,&nbsp;Nobuyuki Chikuie,&nbsp;Yuki Sato,&nbsp;Takayoshi Hattori,&nbsp;Hiroaki Tahara,&nbsp;Takao Hamamoto,&nbsp;Takashi Ishino,&nbsp;Sachio Takeno","doi":"10.1002/deo2.70178","DOIUrl":"https://doi.org/10.1002/deo2.70178","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to compare intraoperative and postoperative outcomes, technical advantages, and limitations of transoral robotic surgery (TORS) using the Da Vinci Xi robotic system and endoscopic laryngopharyngeal surgery (ELPS) for hypopharyngeal and supraglottic laryngeal cancers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective cohort study analyzed preoperative variables, intraoperative data, postoperative complications, and functional outcomes in patients with hypopharyngeal and supraglottic laryngeal cancers who underwent TORS or ELPS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty patients were enrolled (21: TORS; 29: ELPS). Median age at treatment was 73 years (range, 51–87 years). Median resection time was significantly shorter for ELPS (23 min, range 6–124) than for TORS (42 min, range 6–155; <i>p</i> &lt; 0.001). No significant association was observed between surgical approach and postoperative complication incidence. Multivariate analysis identified the presence of subepithelial invasion (<i>p</i> = 0.0089) as an independent predictor of postoperative complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ELPS had a shorter resection time than TORS; however, both approaches showed no significant differences in safety and efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70178","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144725652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Endoscopic Submucosal Dissection for Giant Inflammatory Fibroid Polyp in Terminal Ileum","authors":"Sayuri Watanabe,&nbsp;Yuki Nakajima,&nbsp;Masato Aizawa,&nbsp;Jun Wada,&nbsp;Kakeru Otomo,&nbsp;Goro Shibukawa,&nbsp;Tadayuki Takagi,&nbsp;Kenichi Utano,&nbsp;Osamu Suzuki,&nbsp;Kazutomo Togashi","doi":"10.1002/deo2.70177","DOIUrl":"https://doi.org/10.1002/deo2.70177","url":null,"abstract":"<p>A 55-year-old woman presented with postprandial abdominal pain and diarrhea. Contrast-enhanced abdominal computed tomography revealed a large tumor in the ileocecal region. Colonoscopy demonstrated a pedunculated polyp originating from the terminal ileum, intermittently prolapsing into the cecum with a stalk-like base. Biopsy specimens showed nonspecific inflammatory changes. Initial hot snare polypectomy was unsuccessful due to the polyp's large size and mobility. Therefore, endoscopic submucosal dissection using the underwater pocket-creation method was performed, with the polyp stabilized using a traction device anchored to its apex and the opposite side of the ileocecal valve. This technique enabled safe resection of the lesion from its broad stalk. Although marked submucosal fibrosis was observed beneath the lesion, en bloc resection was successfully completed without perforation in 63 min. Retrieval of the resected specimen via conventional endoscopic methods was unsuccessful due to difficulty passing through the hepatic flexure. Instead, the specimen was retrieved following natural elimination the next day. The resected specimen was a prolate spheroid measuring 62 × 40 × 22 mm. Histopathological examination confirmed an inflammatory fibroid polyp (IFP), consisting of edematous stroma with dense inflammatory cell infiltration. The patient resumed oral intake on postoperative day 2 and had an uneventful recovery. Follow-up colonoscopy at 6 months revealed no residual or recurrent lesion. To our knowledge, this case represents the largest IFP of the small intestine ever resected endoscopically. For a giant, mobile lesion in the terminal ileum, the combination of the pocket-creation method, underwater technique, and lesion anchoring was an effective strategy.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70177","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688167","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":"Rupture of Life-Threatening Hepatic Artery Pseudoaneurysm After Endoscopic Ultrasonography-guided Hepaticogastrostomy: Successful Management With Emergency Transcatheter Arterial Embolization","authors":"Hiroshi Yukimoto,&nbsp;Akino Okamoto,&nbsp;Kohsaku Ohnishi,&nbsp;Keitaro Masuko,&nbsp;Junping Wang,&nbsp;Kazuya Ogawa,&nbsp;Ken Ueda,&nbsp;Motohiro Hirao,&nbsp;Yasuhiro Nakaya,&nbsp;Atsushi Hosui","doi":"10.1002/deo2.70176","DOIUrl":"https://doi.org/10.1002/deo2.70176","url":null,"abstract":"<p>A 70-year-old male with lung cancer and interstitial pneumonia was diagnosed with ampullary carcinoma, causing obstructive jaundice. After the failure of endoscopic retrograde cholangiopancreatography, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) was performed with a 7-Fr plastic stent (PS) into the B2 bile duct. Three months later, mild bleeding was observed during stent exchange, but was stopped by stent replacement. The patient developed recurrent cholangitis, and 1 month later, when the PS was removed to add supplementary drainage, massive bleeding occurred from the endosonographically created route into the stomach. Contrast-enhanced computed tomography (CECT) revealed a pseudoaneurysm in the A2 branch of the hepatic artery. Emergency angiography confirmed active extravasation, and successful transcatheter arterial embolization with <i>N</i>-butyl-2-cyanoacrylate was performed. The patient recovered without rebleeding but died two weeks later from worsening interstitial pneumonia. A review of publications identified only three previous cases of pseudoaneurysm after EUS-HGS, all of which involved self-expandable metal stents. This case demonstrates that pseudoaneurysms can cause both gastrointestinal bleeding and recurrent cholangitis. Careful evaluation of CECT images is needed before stent manipulation in patients with biliary symptoms after EUS-HGS.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70176","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688135","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":"The Risk of Colonoscopy-related Bleeding in Patients With or Without Continued Treatment With an Antithrombotic Agent","authors":"Emi Nonaka,&nbsp;Ichitaro Horiuchi,&nbsp;Akira Horiuchi,&nbsp;Satoshi Ukai,&nbsp;Noriko Takahata,&nbsp;Kimihiko Oishi","doi":"10.1002/deo2.70175","DOIUrl":"https://doi.org/10.1002/deo2.70175","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We prospectively investigated the risk of colonoscopy-related bleeding in relation to antithrombotic treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective, observational, single-center cohort study (NCT02594813) enrolled consecutive patients who underwent colonoscopy, including the removal of colorectal polyps, regardless of the continuation of antithrombotic treatment. The primary outcome measure was delayed bleeding in the patients who underwent a hot snare polypectomy and/or endoscopic mucosal resection in addition to a cold snare polypectomy (CSP) and required endoscopic treatment ≤2 weeks after the procedure. Secondary outcomes were immediate bleeding and the number of hemostatic clips used during the procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From January 2019 to December 2023 at our institution, 1562 (mean age 75 years) and 15,769 (mean age, 64 years) patients underwent colonoscopy with or without antithrombotic treatment, respectively. Immediate bleeding following the removal of colorectal polyps, regardless of the polypectomy technique, occurred in 173 (33.86%) of the 511 patients with antithrombotic treatment, which was significantly more frequent than in 439 (9.44%) of the 4651 patients without antithrombotic treatment (<i>p</i> &lt; 0.001). On the other hand, there was no significant difference in delayed bleeding after CSP between the two groups (0.41% vs. 0.11%, <i>p</i> = 0.15). However, the incidence of delayed bleeding following polypectomy was significantly higher in patients receiving antithrombotic treatment compared to those without it (seven of 511 [1.37%] vs. 12 of 4651 [0.26%], <i>p</i> = 0.0016).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The risk of delayed bleeding after colonoscopy with removal of colorectal polyps was low despite continuation of antithrombotic therapy. www.clinicaltrials.gov (NCT02594813).</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647573","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}