DEN open最新文献

{"title":"Somatic Mosaic AXIN2-associated Colonic Polyposis Predominantly Involving the Proximal Colon: A Case Report","authors":"Takashi Murakami,&nbsp;Masami Arai,&nbsp;Hidetaka Eguchi,&nbsp;Yuka Hirasawa,&nbsp;Wataru Hata,&nbsp;Yudai Otsuki,&nbsp;Tomonori Yamauchi,&nbsp;Eiji Kamba,&nbsp;Takashi Yao,&nbsp;Akihito Nagahara","doi":"10.1002/deo2.70409","DOIUrl":"10.1002/deo2.70409","url":null,"abstract":"<p>Colonic adenomatous polyposis is most commonly caused by germline pathogenic variants in the <i>APC</i> gene; however, recent genetic studies have identified patients without <i>APC</i> mutations. <i>AXIN2</i>-associated colonic polyposis is a rare condition related to dysregulation of the Wnt/β-catenin signaling pathway. Most reported cases have involved germline <i>AXIN2</i> variants, whereas somatic mosaic <i>AXIN2</i> alterations remain poorly documented. We report a rare case of somatic mosaic <i>AXIN2</i>-associated colonic polyposis predominantly involving the proximal colon. A 77-year-old asymptomatic man was referred for colonoscopic surveillance after previous polypectomy. Colonoscopy revealed multiple adenomatous polyps from the cecum to the proximal ascending colon, with some lesions up to 10 mm in size, while only a few small polyps were observed in the transverse and descending colon and none in the sigmoid colon or rectum. The patient underwent intensive endoscopic management, including endoscopic submucosal dissection for extensive adenomatous mucosa in the cecum, followed by repeated endoscopic resections and close surveillance. Histopathological examination confirmed low-grade tubular adenomas. Because of multiple adenomas, genetic testing was performed after genetic counseling. No pathogenic variants were detected in peripheral blood. Analysis of independently resected colonic polyps consistently identified the same heterozygous frameshift mutation in <i>AXIN2</i> with loss of heterozygosity, whereas no <i>AXIN2</i> abnormalities were detected in normal colonic mucosa, leading to a definitive diagnosis of somatic mosaic <i>AXIN2</i>-associated colonic polyposis. This case highlights a previously unreported mechanism of <i>AXIN2</i>-driven colonic polyposis through somatic mosaicism and suggests that intensive endoscopic treatment with close surveillance may be an effective management strategy in selected patients.</p>","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/PMC13504014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820753","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":"Preoperative Diagnosis of the Bile Duct Traumatic Neuroma by Endoscopic Ultrasound-guided Tissue Acquisition: A Case Report","authors":"Kiyohiro Saito,&nbsp;Shunya Oi,&nbsp;Erina Yoshida,&nbsp;Eri Tanaka,&nbsp;Mai Noujima,&nbsp;Noriaki Yamashita,&nbsp;Shuhei Shintani,&nbsp;Atsushi Nishida,&nbsp;Takuji Iwashita","doi":"10.1002/deo2.70406","DOIUrl":"https://doi.org/10.1002/deo2.70406","url":null,"abstract":"<p>Traumatic neuroma of the cystic duct stump is a rare benign lesion that may mimic biliary malignancy, making preoperative diagnosis challenging. We report a case of an enhancing lesion at the cystic duct stump after cholecystectomy that was diagnosed by endoscopic ultrasound-guided tissue acquisition (EUS-TA). Imaging studies revealed an 8-mm enhancing nodule at the cystic duct stump, and endoscopic retrograde cholangiopancreatography showed a unilateral filling defect at the corresponding site. Peroral cholangioscopy demonstrated smooth mucosa without irregular vessels, suggesting a submucosal lesion rather than mucosal malignancy. EUS revealed a well-demarcated, homogeneous hypoechoic mass immediately distal to the origin of the remnant cystic duct. EUS-TA using a 22-gauge needle enabled TA from the lesion. Histopathological examination showed proliferation of spindle-shaped cells with wavy nuclei, and immunohistochemical staining was positive for S-100 protein, confirming the diagnosis of traumatic neuroma. No procedure-related adverse events occurred, and unnecessary surgical resection was avoided. EUS-TA may facilitate preoperative diagnosis of cystic duct stump traumatic neuroma and help guide appropriate management.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70406","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784688","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":"Evaluation of Computer-aided Detection for Identifying Missed Gastric Cancer After Endoscopic Submucosal Dissection","authors":"Tatsunori Minamide,&nbsp;Tomonori Sato,&nbsp;Seiichiro Sakaguchi,&nbsp;Noboru Kawata,&nbsp;Yuki Maeda,&nbsp;Masao Yoshida,&nbsp;Yoichi Yamamoto,&nbsp;Taishi Okumura,&nbsp;Tetsuya Suwa,&nbsp;Hiroshi Ashizawa,&nbsp;Kohei Shigeta,&nbsp;Haruka Nakamura,&nbsp;Akifumi Notsu,&nbsp;Toshio Uraoka,&nbsp;Hiroyuki Ono","doi":"10.1002/deo2.70357","DOIUrl":"https://doi.org/10.1002/deo2.70357","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Computer-aided detection (CADe) using deep learning is promising for reducing missed gastric cancers (MGCs) and supporting physicians in double-checking endoscopic images. We aimed to evaluate the CADe efficacy for MGCs after endoscopic submucosal dissection (ESD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We collected 2324 endoscopic images, including 60 of MGCs detected during surveillance esophagogastroduodenoscopy within 18 months after initial ESD. The performance of the CADe system, developed for early GC detection using deep learning, was compared with that of 10 endoscopists in a detection study using collected images. Per-lesion sensitivity, per-image detection performance, and diagnostic time were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The per-lesion sensitivity for MGCs was 15.0% (9/60) and 13.8% (83/600) for CADe and endoscopist detection, respectively (<i>p</i> = 0.538). The respective per-image computer-aided and endoscopist performance sensitivity was 11.3% and 10.6% (<i>p</i> = 0.548), specificity 88.5% and 94.8% (<i>p</i> &lt; 0.001), positive predictive value 4.4% and 8.3%, and negative predictive value 95.7% and 96.0%. The per-image CADe time was significantly shorter (0.03 s vs. 2.86 s, <i>p</i> &lt; 0.001). CADe showed higher sensitivity in certain subgroups, although these findings should be interpreted cautiously given the small sample size.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>No significant difference in sensitivity was observed between CADe and endoscopist detection for MGCs after ESD, and the absolute sensitivity remained low. Further improvements are needed before clinical implementation of CADe as a double-checking tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>The authors have confirmed clinical trial registration is not needed for this submission.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70357","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148783990","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":"Underestimation of Subserosal Invasion in Early Gastric Cancer-Like Advanced Gastric Carcinoma With Focal Enteroblastic Differentiation: A Case Report","authors":"Akira Tomioka,&nbsp;Kankei Fujimoto,&nbsp;Kei Sugimoto,&nbsp;Takayuki Yamazaki,&nbsp;Nanoka Chiya,&nbsp;Yumi Mashimo,&nbsp;Tomonori Kawasaki,&nbsp;Tomio Arai,&nbsp;Shomei Ryozawa","doi":"10.1002/deo2.70405","DOIUrl":"https://doi.org/10.1002/deo2.70405","url":null,"abstract":"<p>Early gastric cancer (EGC)-like advanced gastric cancer (AGC) is a rare entity that mimics superficial disease despite deep invasion. We report a case of EGC-like AGC with focal enteroblastic differentiation in which subserosal invasion was underestimated because of its superficially appearing endoscopic features. A subtle submucosal tumor (SMT)-like change was recognized only retrospectively after clinicopathological correlation. Endoscopy revealed a depressed 0-IIc–appearing lesion with fold convergence toward a single point, leading to a diagnosis of UL1; however, no mound-like elevation was observed. Retrospective review identified a subtle SMT-like protrusion on the anterior wall, slightly apart from the main depression. Endoscopic submucosal dissection (ESD) was performed for presumed EGC. During ESD, a whitish cord-like structure extending from the muscularis propria was identified at the corresponding site. The ESD specimen showed submucosal invasion with a positive vertical margin, and additional surgical resection revealed subserosal invasion. Histopathological examination of the surgical specimen demonstrated tubular adenocarcinoma (tub2&gt;por1/tub1) with focal enteroblastic differentiation and subserosal invasion (pT3 [SS]) without lymph node metastasis but with venous invasion (V1c). Immunohistochemistry showed CK7 positivity, CK20 negativity, and partial expression of CDX2, glypican-3, and SALL4, whereas AFP was negative. Clinicopathological correlation showed that the retrospectively recognized SMT-like change corresponded to the deepest invasive component. This case highlights the difficulty of preoperative depth assessment in EGC-like AGC. Careful integration of endoscopic, intraoperative, and clinicopathological findings may help avoid underestimation of tumor depth.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754168","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":"First Case Report of Triple Recurrent Cholangitis of “Coildocholithiasis,” Following Hepatic Artery Pseudoaneurysm Embolization","authors":"Shigetoshi Nishihara,&nbsp;Tomohiro Ozawa,&nbsp;Fubuki Abe,&nbsp;Takahiro Ban,&nbsp;Masanori Iidaka,&nbsp;Akihiro Nakayama,&nbsp;Shoko Kato,&nbsp;Shu Oikawa,&nbsp;Atsushi Katagiri,&nbsp;Naomi Kakushima","doi":"10.1002/deo2.70407","DOIUrl":"https://doi.org/10.1002/deo2.70407","url":null,"abstract":"<p>A 72-year-old man developed a hepatic artery pseudoaneurysm (HAP) caused by a liver abscess due to acute cholangitis and choledocholithiasis. He was successfully treated by transcatheter arterial embolization (TAE) with tornado microcoils. Two years later, he developed severe acute cholangitis caused by a biliary stone formed around a coil that had migrated into the common bile duct, termed “Coildocholithiasis.” The stone was removed successfully, while several coils remained in the liver. He subsequently experienced repeated “Coildocholithiasis” and cholangitis, and after the third episode of coil migration, no coil remained in the liver. Since HAP can be fatal if it ruptures, TAE has become a standard treatment for HAP and other arterial aneurysms. Coil migration to other organs is a rare late-onset complication. This is the first report of three consecutive coil migrations in one patient, discussing the mechanisms of migration and whether prophylactic endoscopic removal should be considered once asymptomatic coil migration into the bile duct is identified.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754169","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":"Risk Factors for Peritonitis Associated With Endoscopic Ultrasound-guided Hepaticogastrostomy","authors":"Junya Sato,&nbsp;Hirotoshi Ishiwatari,&nbsp;Hiroki Sakamoto,&nbsp;Takuya Doi,&nbsp;Masahiro Yamamura,&nbsp;Kazunori Takada,&nbsp;Masao Yoshida,&nbsp;Sayo Ito,&nbsp;Noboru Kawata,&nbsp;Kenichiro Imai,&nbsp;Kinichi Hotta,&nbsp;Hiroyuki Ono","doi":"10.1002/deo2.70376","DOIUrl":"https://doi.org/10.1002/deo2.70376","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an alternative therapeutic option for unsuccessful endoscopic retrograde cholangiopancreatography in patients with malignant biliary obstruction. Procedure-related adverse events (AEs), such as bile leakage and peritonitis, can lead to prolonged hospitalization and delay the initiation of chemotherapy for underlying malignancies. This study aimed to identify factors associated with the development of peritonitis following EUS-HGS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients who underwent initial EUS-HGS between July 2016 and November 2022 were retrospectively evaluated. We assessed the preprocedural characteristics (cholangitis and duodenal invasion) and intraprocedural technical factors (small bile duct diameter, short hepatic parenchymal distance at puncture, antegrade stenting, and the use of a plastic stent for HGS). Multivariate logistic regression analysis was conducted to evaluate the factors associated with peritonitis after EUS-HGS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 188 patients were included. The cause of biliary obstruction was malignancy in 96% of the cases, with the majority being pancreatic cancer. The rate of early AEs was 15% and included peritonitis (7%), pancreatitis (3%), cholangitis (3%), cholecystitis (1%), and bleeding (1%). Multivariable logistic regression analysis revealed that the diameter of a punctured bile duct ≤3 mm (odds ratio, 4.0; 95% confidence interval, 1.1–15; <i>p</i> = 0.039) independently increased the risk of peritonitis after EUS-HGS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A punctured bile duct diameter of ≤3 mm was identified as a significant independent risk factor for the development of peritonitis after EUS-HGS.</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":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70376","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754167","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":"Balloon Enteroscopy-assisted Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis in Situs Inversus Totalis With Billroth II Reconstruction: A Case Report and Literature Review","authors":"Shuhei Shintani,&nbsp;Shunya Oi,&nbsp;Kiyohiro Saito,&nbsp;Erina Yoshida,&nbsp;Noriaki Yamashita,&nbsp;Atsushi Nishida,&nbsp;Takuji Iwashita","doi":"10.1002/deo2.70403","DOIUrl":"https://doi.org/10.1002/deo2.70403","url":null,"abstract":"<p>Endoscopic retrograde cholangiopancreatography (ERCP) in patients with situs inversus totalis (SIT) and Billroth II reconstruction is technically challenging because of mirror-image anatomy, altered access to the papilla, and inverted papillary orientation. A 56-year-old man with a history of distal gastrectomy with Billroth II reconstruction for a gastric ulcer 20 years earlier was found to have common bile duct stones on pre-ERCP imaging. ERCP was performed in the prone position, as in conventional ERCP, with the endoscopist standing on the patient's right side. A short-type single-balloon enteroscope was advanced through the afferent limb to the major papilla. Biliary cannulation was achieved using a standard ERCP catheter without positional modification or sphincterotome. Cholangiography confirmed small common bile duct stones. Endoscopic papillary balloon dilation with an 8-mm balloon was performed, followed by stone extraction using a basket catheter. Final cholangiography confirmed complete stone clearance, and no adverse events, including post-ERCP pancreatitis, occurred. This case suggests that favorable alignment between the 7 o'clock working-channel direction and the bile duct axis may allow conventional-position ERCP in selected patients with SIT and Billroth II reconstruction.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753880","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":"Recent Development of Endo-hepatology","authors":"Akira Yamamiya,&nbsp;Atsushi Irisawa,&nbsp;Yasunori Inaba,&nbsp;Rafael Romero-Castro","doi":"10.1002/deo2.70404","DOIUrl":"https://doi.org/10.1002/deo2.70404","url":null,"abstract":"<p>Endo-hepatology is a rapidly evolving field encompassing endoscopic diagnosis and treatment of hepatobiliary diseases, primarily using endoscopic ultrasound (EUS). Since its conceptualization in 2012, the field has expanded dramatically alongside advances in interventional EUS. A landmark 2024 review broadened the concept to include endoscopic management of hepatobiliary diseases using interventional EUS/endoscopic retrograde cholangiopancreatography and advanced imaging technologies. In portal hypertension (PH), diagnostic applications include EUS-based variceal hemodynamic assessment, EUS-guided shear wave elastography, EUS-guided porto-systemic pressure gradient measurement (EUS-PPGM), EUS-guided liver biopsy (EUS-LB), and portal vein sampling. Therapeutic applications include EUS-guided vascular embolization for gastric, esophageal, and ectopic varices; portosystemic shunt obliteration for refractory hepatic encephalopathy; radiofrequency ablation of hepatocellular carcinoma; and emerging procedures such as intrahepatic portosystemic shunt creation and portal vein stenting. EUS-PPGM enables direct, minimally invasive portal pressure measurement and correlates strongly with the hepatic venous pressure gradient (HVPG). It may offer particular advantages in pre-sinusoidal PH, such as porto-sinusoidal vascular disorder, and in conditions with mixed sinusoidal and presinusoidal components, including metabolic dysfunction-associated steatotic liver disease, where HVPG may underestimate portal pressure. The “one-stop” concept integrates portal pressure measurement, LB, liver stiffness assessment, and variceal evaluation and treatment within a single endoscopic session. EUS-guided coil plus cyanoacrylate injection has demonstrated favorable efficacy and safety for gastric varices, while EUS-LB provides diagnostic accuracy comparable to percutaneous biopsy with less post-procedure pain. By integrating diagnostic and therapeutic procedures, endo-hepatology bridges endoscopy and hepatology and may provide comprehensive, minimally invasive, and personalized management of PH and chronic liver disease.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753879","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":"Crystal Violet Staining for Colitis-associated Neoplasia-guided Delineation of Ulcerative Colitis-associated Neoplasia for Endoscopic Submucosal Dissection: A Four-case Report","authors":"Akira Tomioka,&nbsp;Nanoka Chiya,&nbsp;Ryota Hokari,&nbsp;Shomei Ryozawa","doi":"10.1002/deo2.70391","DOIUrl":"https://doi.org/10.1002/deo2.70391","url":null,"abstract":"<p>Ulcerative colitis-associated neoplasia (UCAN) is often difficult to delineate because chronic inflammatory changes obscure lesion borders. Accurate assessment of lesion extent is essential for curative endoscopic submucosal dissection (ESD), yet conventional white-light imaging frequently fails to clearly define lateral tumor spread. We report four patients with UCAN in whom crystal violet staining for colitis-associated neoplasia (CV-SCAN) was used to delineate lesion extent before ESD. All patients had ulcerative colitis in clinical remission and underwent surveillance colonoscopy. In these four patients, UCAN was identified as CV–neoplasia (CV-N) areas during CV-SCAN, whereas lesion borders remained indistinct on conventional white-light imaging. After histological confirmation by targeted biopsy, a repeat CV-SCAN was performed to determine lesion extent before ESD. In three patients, the CV-N-positive areas corresponded well with the pathological extent of neoplasia, and en bloc curative resection was achieved. One patient had a positive horizontal margin after the initial ESD. During an additional procedure, residual UCAN was again visualized as a CV-N-positive area and was successfully removed by additional ESD. No procedure-related adverse events or local recurrences were observed during follow-up. These cases suggest that CV-SCAN may facilitate delineation of UCAN before ESD and may help identify residual neoplasia that is difficult to recognize using white-light imaging alone. CV-SCAN should be considered an adjunctive technique that complements conventional endoscopic modalities rather than a standalone approach for lesion delineation.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70391","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753647","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":"Third Space Endoscopic Therapies for Benign Motility Disorders: A Narrative Review","authors":"Sanjana Bhagwat,&nbsp;Amol Bapaye","doi":"10.1002/deo2.70397","DOIUrl":"https://doi.org/10.1002/deo2.70397","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To review the evidence base, evolution, outcomes, adverse events (AEs), and management for third-space endoscopy (TSE) procedures for management of benign motility disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This review examines TSE procedures for motility disorders, reviewing the current available techniques, success, outcomes, and long-term outcomes from the literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Peroral endoscopic myotomy (POEM) for achalasia cardia is now established as first-line therapy, endorsed by the American Society for Gastrointestinal Endoscopy, American College of Gastroenterology, Society of American Gastrointestinal and Endoscopic Surgeons, and international expert bodies, with long-term clinical success exceeding 90% at 7 years. Since 2010, the technique has evolved considerably, with refinements in myotomy length, orientation, and depth, along with intraoperative use of an endoluminal functional lumen imaging probe to optimize outcomes and reduce post-procedure gastroesophageal reflux (GER). The TSE platform has since expanded to spastic esophageal disorders, esophagogastric junction outflow obstruction, Zenker's and epiphrenic diverticula (Z-POEM/D-POEM), refractory gastroparesis (gastric per-oral endoscopic pyloromyotomy), and Hirschsprung's disease. Techniques have also been modified along the way to achieve better results while minimizing AEs. Post-POEM GER, occurring objectively in 40%–55% of patients, remains the principal long-term challenge, and multiple modalities have been explored to address it.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TSE has fundamentally transformed the management of benign gastrointestinal motility disorders, with POEM serving as the paradigm for the shift from surgical to endoscopic treatment. Ongoing technical refinement, GER mitigation strategies, and emerging innovations are poised to further advance the field.</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":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70397","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753646","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}