DEN open最新文献

{"title":"Update on Sedation for Upper Gastrointestinal Endoscopy in Japan: Current Evidence on Remimazolam","authors":"Ryoji Ichijima,&nbsp;Masahiro Toyama,&nbsp;Taiki Shishido,&nbsp;Yuki Koyo,&nbsp;Takehiro Yoshii,&nbsp;Reona Kawamura,&nbsp;Tsubasa Ishikawa,&nbsp;Yasuhiko Mizuguchi,&nbsp;Naoya Toyoshima,&nbsp;Hiroyuki Takamaru,&nbsp;Masayoshi Yamada,&nbsp;Masau Sekiguchi,&nbsp;Seiichiro Abe,&nbsp;Yutaka Saito","doi":"10.1002/deo2.70402","DOIUrl":"https://doi.org/10.1002/deo2.70402","url":null,"abstract":"<p>Sedation is an essential component of upper gastrointestinal endoscopy because it reduces patient discomfort and anxiety while improving patient acceptance and procedural quality. In Japan, benzodiazepines such as midazolam and opioid analgesics have long been widely used in routine clinical practice; however, many of these agents historically lacked formal insurance approval for sedation during gastrointestinal endoscopy. Propofol is also a useful sedative because of its rapid onset and recovery, but its use in Japan has been limited because of concerns regarding respiratory and cardiovascular depression and the need for management by anesthesia-trained personnel. Against this background, the approval of remimazolam for sedation during gastrointestinal endoscopy in June 2025 represented a major turning point in Japanese endoscopic sedation practice. Remimazolam is an ultra-short-acting benzodiazepine rapidly metabolized by carboxylesterases and reversible with flumazenil. Japanese phase III trials demonstrated high sedation success rates and rapid recovery during upper gastrointestinal endoscopy, including in elderly patients. Compared with midazolam, remimazolam shortened awakening and ambulation times, whereas compared with propofol, it may cause fewer respiratory and cardiovascular adverse events. This review summarizes the current status of upper gastrointestinal endoscopic sedation in Japan, focusing on the clinical evidence and positioning of the newly approved ultra-short-acting benzodiazepine, remimazolam.</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/deo2.70402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148753649","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 Overtube in Preventing Aspiration Pneumonia During Esophageal Endoscopic Submucosal Dissection","authors":"Masaki Ominami,&nbsp;Shusei Fukunaga,&nbsp;Daiki Kitagawa,&nbsp;Mitsuhiro Kono,&nbsp;Shunsuke Takahashi,&nbsp;Tatsuya Kurokawa,&nbsp;Yoshinori Shimamoto,&nbsp;Yuki Hisaki,&nbsp;Natsumi Maeda,&nbsp;Yuki Ishikawa-Kakiya,&nbsp;Kojiro Tanoue,&nbsp;Akinari Sawada,&nbsp;Yu Nishida,&nbsp;Hirotsugu Maruyama,&nbsp;Yuji Nadatani,&nbsp;Koji Otani,&nbsp;Shuhei Hosomi,&nbsp;Yasuhiro Fujiwara","doi":"10.1002/deo2.70400","DOIUrl":"10.1002/deo2.70400","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Aspiration pneumonia is a potential adverse event of esophageal endoscopic submucosal dissection (ESD). Using an overtube during esophageal ESD may reduce the amount of fluid refluxing into the oral cavity and prevent aspiration pneumonia. This study aimed to clarify the preventive effects of overtubes on aspiration pneumonia during esophageal ESD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between January 2015 and May 2020, 534 consecutive patients underwent esophageal ESD under intravenous anesthesia without endotracheal intubation at our hospital. Using propensity score matching and inverse probability of treatment weighting (IPTW), we retrospectively evaluated the risk factors and incidence of aspiration pneumonia during esophageal ESD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 393 patients who underwent esophageal ESD were enrolled. After matching, 99 matched pairs of patients either had an overtube used during esophageal ESD or did not. The overall incidence of aspiration pneumonia was 15.2%. The incidence of aspiration pneumonia was significantly higher in the non-overtube group than in the overtube group (22.2% vs. 8.1%; <i>p</i> = 0.009). Multivariate logistic regression analysis showed that non-use of an overtube was an independent risk factor for aspiration pneumonia (odds ratio [OR], 4.21; 95% confidence interval [CI], 1.66–10.65; <i>p</i> = 0.002). After adjustment with IPTW, non-use of an overtube also increased the risk of aspiration pneumonia (OR, 3.76; 95% CI, 1.54–9.21; <i>p</i> = 0.004).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Not using an overtube was a risk factor for aspiration pneumonia during esophageal ESD. Therefore, the use of an overtube is recommended to prevent aspiration pneumonia.</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":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714894","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 of Delayed Post-polypectomy Bleeding in Patients With Antithrombotic Therapy","authors":"Rumiko Tsuboi,&nbsp;Satohiro Matsumoto,&nbsp;Makiko Mieno,&nbsp;Shizukiyo Ishikawa,&nbsp;Yurika Imai,&nbsp;Mina Morino,&nbsp;Keita Matsumoto,&nbsp;Yudai Koito,&nbsp;Hitomi Kashima,&nbsp;Takaya Miura,&nbsp;Yuko Takahashi,&nbsp;Takehiro Ishii,&nbsp;Shuhei Yoshikawa,&nbsp;Haruka Otake,&nbsp;Masanari Sekine,&nbsp;Takeshi Uehara,&nbsp;Takeharu Asano,&nbsp;Hiroyuki Miyatani,&nbsp;Hirosato Mashima","doi":"10.1002/deo2.70401","DOIUrl":"10.1002/deo2.70401","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Recent changes in the perioperative management of antithrombotic therapy (ATT), including the discontinuation of routine heparin bridging and the increased use of cold snare polypectomy, may reduce delayed post-polypectomy bleeding (DPPB) rates. However, few recent studies have evaluated these changes. We compared DPPB rates between patients with and without ATT and explored factors associated with bleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of adult patients who underwent endoscopic resection of colorectal polyps ≤15 mm between April 2021 and October 2023. DPPB was defined as hematochezia or a hemoglobin drop ≥2.0 g/dL requiring endoscopic hemostasis. Univariable analyses were performed to identify factors associated with DPPB, and exploratory multivariable analyses were conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2136 patients with 7025 polyps, 523 patients (1874 polyps) were receiving ATT. The DPPB rates per patient (1.91% vs. 0.25%) and per lesion (0.69% vs. 0.08%) were significantly higher in the ATT group (<i>p</i> &lt; 0.001). In univariable analyses, ATT use (odds ratio [OR] 7.84), ≥3 resected lesions (OR 5.13), and hypertension (OR 3.95) were significant risk factors in the per-patient analysis, while ATT use (OR 8.73), lesion size &gt;10 mm (OR 4.51), and clipping (OR 5.20) were significant in the per-lesion analysis. Among ATT types, warfarin users had the highest DPPB rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Colorectal polypectomy in patients receiving ATT is associated with an increased risk of DPPB. Particular caution is warranted in patients receiving warfarin.</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":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Status of Bowel Preparation for Colonoscopy in Japan: A Web-Based Survey of Endoscopists (PRESS Survey)","authors":"Takayuki Matsumoto,&nbsp;Motohiro Esaki,&nbsp;Fumihito Hirai,&nbsp;Minami Umeyama,&nbsp;Takahiro Suzuki,&nbsp;Toshiki Takatsuki,&nbsp;Yusuke Shimada,&nbsp;Akira Oota,&nbsp;Masato Ueno","doi":"10.1002/deo2.70398","DOIUrl":"10.1002/deo2.70398","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The increasing number of patients with colorectal cancer underscores the importance of colonoscopy. Adequate bowel preparation is essential to ensure the quality and safety of colonoscopic examinations; however, data on the current practices in Japan remain limited. This study aimed to clarify the current status of bowel preparation, use of bowel-cleansing agents, and associated challenges among physicians performing colonoscopies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In March 2026, we conducted a nationwide web-based cross-sectional survey of physicians performing colonoscopies in Japan. The survey assessed bowel preparation practices, use of bowel-cleansing agents, constipation, and renal function before colonoscopy. Responses were obtained from 300 physicians who performed at least 10 colonoscopies per month.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Low-volume polyethylene glycol (PEG) plus ascorbate preparations were the most commonly used bowel-cleansing agents, followed by high-volume PEG preparations and magnesium-based agents. Cleansing efficacy and safety were the most highly valued characteristics of bowel-cleansing agents. 64.7% of physicians reported that the perceived frequency of inadequate bowel preparation was &gt;10% among their patients. Although 64.3% of the physicians reported always assessing constipation, only 32.7% reported always evaluating renal function before colonoscopy. Compared with hospital-based physicians, those working in clinics reported a significantly lower proportion of inadequate bowel preparation, but a significantly lower rate of renal function assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although cleansing efficacy and safety are prioritized in bowel preparation for colonoscopy in Japan, physicians perceived inadequate bowel preparation to occur in a substantial proportion of patients. Thus, further optimization of bowel preparation strategies and more consistent assessment of renal function before colonoscopy are needed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>University Hospital Medical Information Network (UMIN000060808).</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714919","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 Novel Biliary Plastic Stent With a Centrally Located Flap: Initial Clinical Experience in Three Cases","authors":"Fumi Sakuma,&nbsp;Atsushi Irisawa,&nbsp;Takumi Maki,&nbsp;Ken Kashima,&nbsp;Yasuhito Kunogi,&nbsp;Koh Fukushi,&nbsp;Shogo Yamamoto,&nbsp;Yasunori Inaba,&nbsp;Ryuichi Maki,&nbsp;Akira Yamamiya","doi":"10.1002/deo2.70399","DOIUrl":"10.1002/deo2.70399","url":null,"abstract":"<p>Endoscopic biliary plastic stent (PS) insertion is standard for maintaining bile flow, but migration and dislodgement persist as important challenges. We developed the cross range flap stent (CRF stent), a 7 Fr, 7 cm straight-type PS. Unlike conventional stents with flaps at both ends, the CRF stent features flaps and flap holes at the intestinal end and the center to improve stability and to prevent migration. This report describes three consecutive early cases for which the CRF stent was used for distal malignant biliary stricture caused by pancreatic cancer, acute cholangitis caused by common bile duct stones, and prevention of cholangitis after endoscopic papillectomy. In all cases, the CRF stent was placed easily using its integrated delivery system. No migration or occlusion was observed during the observation periods. The unique centrally located flap appears to be particularly effective for short obstructions and for various clinical conditions. Further largescale comparative studies must be conducted, but the CRF stent has shown potential to minimize stentrelated adverse events.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714784","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":"Post-Endoscopic Retrograde Cholangiopancreatography Bleeding After Endoscopic Stone Removal in Dialysis Patients: A Multicenter Retrospective Study","authors":"Masaki Nishimura,&nbsp;Haruo Miwa,&nbsp;Takashi Kaneko,&nbsp;Kazuki Endo,&nbsp;Ritsuko Oishi,&nbsp;Yuichi Suzuki,&nbsp;Hiromi Tsuchiya,&nbsp;Yoshimasa Suzuki,&nbsp;Yoshihiro Goda,&nbsp;Akihiro Funaoka,&nbsp;Nobutaka Doba,&nbsp;Kuniyasu Irie,&nbsp;Yuki Miura,&nbsp;Tomohiro Ishii,&nbsp;Masaaki Kondo,&nbsp;Kazuya Sugimori,&nbsp;Shin Maeda","doi":"10.1002/deo2.70395","DOIUrl":"10.1002/deo2.70395","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Post-endoscopic retrograde cholangiopancreatography (post-ERCP) bleeding occurs more frequently in dialysis patients than in non-dialysis patients. This study aimed to identify risk factors for post-ERCP bleeding following stone removal in patients undergoing dialysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter retrospective study enrolled 102 consecutive dialysis patients who underwent endoscopic stone removal at seven institutions between January 2009 and March 2022. Baseline characteristics, procedural details, stone removal outcomes, adverse events (AEs), and risk factors for post-ERCP bleeding were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 102 patients, 65 were men. Median patient age was 77 years (range, 51–91 years). Antithrombotic drugs were administered to 64 patients (63%). Endoscopic sphincterotomy, endoscopic papillary balloon dilation, and endoscopic papillary large balloon dilation were performed in 58 (57%), 20 (20%), and 11 (11%) patients, respectively. AEs occurred in 23 patients (23%), including bleeding in eight patients (8%), acute pancreatitis in nine patients (9%), cholangitis in seven patients (7%), and others in two patients (2%). Multivariate analysis identified intraoperative bleeding and continued aspirin use as independent risk factors for post-ERCP bleeding. Similar associations were observed in subgroup analyses restricted to patients with a naïve papilla.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Intraoperative bleeding and continued aspirin use were associated with post-ERCP bleeding following stone removal in dialysis patients, highlighting the importance of careful periprocedural hemostatic management in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Not applicable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698674","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":"Delayed Argon Plasma Coagulation After Endoscopic Injection Sclerotherapy for Esophageal Varices Reduces Recurrence Risk","authors":"Takumi Yanagita,&nbsp;Takuto Hikichi,&nbsp;Jun Nakamura,&nbsp;Tsunetaka Kato,&nbsp;Minami Hashimoto,&nbsp;Mitsuru Otsuka,&nbsp;Eisuke Kameoka,&nbsp;Rei Suzuki,&nbsp;Mitsuru Sugimoto,&nbsp;Hiroyuki Asama,&nbsp;Hiroshi Shimizu,&nbsp;Kento Osawa,&nbsp;Rei Ohira,&nbsp;Keisuke Kudo,&nbsp;Daiki Nemoto,&nbsp;Masao Kobayakawa,&nbsp;Hiromasa Ohira","doi":"10.1002/deo2.70380","DOIUrl":"10.1002/deo2.70380","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Argon plasma coagulation (APC) is commonly used as consolidation therapy after endoscopic injection sclerotherapy (EIS) for esophageal varices (EVs); however, the optimal timing of APC remains unclear. This study evaluated the association between the EIS–APC interval and clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective cohort study included consecutive patients receiving EIS followed by APC for EVs. Patients were categorized according to APC setting as inpatient or outpatient, which reflected differences in the EIS–APC interval. The primary outcome was cumulative variceal recurrence as analyzed using the Fine–Gray competing risk model. Secondary outcomes included ulcer persistence at the time of APC and procedure-related adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 112 patients, 82 underwent inpatient APC and 30 underwent outpatient APC. The median EIS–APC interval was 7 days and 28 days, respectively (<i>p</i> &lt; 0.001). The cumulative 3-year incidence of variceal recurrence was lower in the outpatient group (13.9% vs. 28.0%; Gray's test, <i>p</i> = 0.039). In the multivariable Fine–Gray model, a longer EIS–APC interval was independently associated with a lower cumulative incidence of recurrence (subdistribution hazard ratio 0.92, 95% CI 0.86–0.99; <i>p</i> = 0.026). Residual post-EIS ulcers at the time of APC were also less frequent in the outpatient group (33.3% vs. 81.7%, <i>p</i> &lt; 0.001), while adverse events were comparable (20.7% vs. 10.0%, <i>p</i> = 0.268).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A longer EIS–APC interval was associated with a lower recurrence rate without an increase in adverse events. Delaying APC until after mucosal healing may optimize EIS treatment outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>N/A (Only approval of the research protocol by an Institutional Review Board of Fukushima Medical University).</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681512","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":"Lidocaine Spray Versus Viscous Lidocaine Solution Plus Lidocaine Spray in Patients Undergoing Non-Sedated Esophagogastroduodenoscopy: A Randomized Controlled Trial","authors":"Natee Faknak,&nbsp;Anuch Singhattha,&nbsp;Thidarat Inpen,&nbsp;Papatsakorn Nopjaroonsri","doi":"10.1002/deo2.70393","DOIUrl":"10.1002/deo2.70393","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Non-sedated esophagogastroduodenoscopy (EGD) is preferred in patients at risk from sedatives. However, achieving effective pharyngeal anesthesia remains a challenge. This study compared lidocaine spray alone with a combination of lidocaine spray and viscous lidocaine solution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, randomized controlled trial was conducted between January 2024 and October 2024 at Sawanpracharak Hospital, Thailand. A total of 250 patients undergoing non-sedated EGD were randomized to receive lidocaine spray alone (S group, <i>n</i> = 125) or lidocaine spray plus viscous lidocaine (S + V group, <i>n</i> = 125). The primary outcome was procedural pain measured using a visual analog scale (VAS, 0–10) immediately after completion of the procedure. Secondary outcomes included patient satisfaction, endoscopist satisfaction, ease of intubation, tolerance, and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline characteristics were comparable between groups. The S + V group reported significantly lower procedural pain than the S group (mean VAS 1.6 ± 1.1 vs. 3.1 ± 1.7; <i>p</i> = 0.01). Patient satisfaction was higher in the S + V group (very satisfied: 23.2% vs. 12.8%; <i>p</i> = 0.016). Ease of intubation was also improved (effortless intubation: 43.2% vs. 29.6%; <i>p</i> = 0.030). Endoscopist satisfaction numerically favored the S + V group but did not reach statistical significance (<i>p</i> = 0.070). No serious adverse events were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Combining lidocaine spray with viscous lidocaine solution significantly reduced procedural discomfort and improved procedural conditions during non-sedated EGD compared with lidocaine spray alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT06185933</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681460","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":"Transpapillary Placement of a Multihole Covered Metal Stent Using a 5.9-Fr Delivery System Through a Forward-viewing Endoscope in Malignant Biliary Obstruction With Type I Duodenal Stenosis","authors":"Kengo Matsumoto,&nbsp;Daisuke Kondo,&nbsp;Satoru Okabe,&nbsp;Naoto Osugi,&nbsp;Akira Doi,&nbsp;Masashi Yamamoto,&nbsp;Shiro Hayashi,&nbsp;Koji Fukui,&nbsp;Tsutomu Nishida","doi":"10.1002/deo2.70392","DOIUrl":"10.1002/deo2.70392","url":null,"abstract":"<p>Concurrent malignant biliary obstruction (MBO) and type I duodenal stenosis represent a technically demanding scenario, as luminal narrowing frequently precludes passage of a standard side-viewing duodenoscope and limits conventional transpapillary drainage. Although endoscopic ultrasound-guided biliary drainage and percutaneous transhepatic biliary drainage are established alternative approaches, transpapillary drainage remains desirable when papillary access is achievable. We report a 66-year-old woman with stage IV pancreatic cancer who presented with obstructive jaundice and tumor-related type I duodenal stenosis (i.e., obstruction proximal to the papilla). A side-viewing duodenoscope failed to traverse the stenosis; however, a standard forward-viewing endoscope (GIF-Q260J) successfully reached the major papilla. Selective biliary cannulation was achieved, and a covered multihole self-expandable metal stent (SEMS) (HANAROSTENT Biliary Multihole Benefit) was deployed across the distal biliary stricture using an ultra-slim 5.9-Fr delivery system compatible with the 3.2-mm working channel. Stent placement was technically successful without adverse events, resulting in prompt resolution of cholangitis and enabling the initiation of second-line chemotherapy. This case highlights a practical and reproducible strategy that expands the therapeutic capability of standard forward-viewing endoscopes. The combination of a slim delivery system and covered multihole SEMS may provide a physiological alternative to non-transpapillary drainage in selected patients with MBO and advanced type I duodenal stenosis.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13429929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671654","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":"Welcome Message From the New Editor-in-Chief of Digestive Endoscopy Open","authors":"Kazuki Sumiyama","doi":"10.1002/deo2.70387","DOIUrl":"https://doi.org/10.1002/deo2.70387","url":null,"abstract":"&lt;p&gt;It is an extraordinary honor and privilege to be appointed as the Editor-in-Chief of DEN Open, the official open-access journal of the Japan Gastroenterological Endoscopy Society (JGES). First and foremost, I would like to express my deepest respect and gratitude to my predecessor, Professor Takao Itoi, the inaugural Editor-in-Chief, for his outstanding leadership and vision in successfully launching and establishing this journal. I am also profoundly grateful to Professor Mitsuhiro Fujishiro, President of JGES; Professor Masayuki Kitano, Editor-in-Chief of our sister journal, Digestive Endoscopy (DEN); and Professor Takayuki Matsumoto, the former Editor-in-Chief of DEN and the advisor of the journal, for providing me with this incredible opportunity to lead the journal into its next chapter.&lt;/p&gt;&lt;p&gt;Despite its short history since its launch in April 2021, DEN Open has already published a wealth of high-quality original articles, clinically informative reviews, insightful editorials, and valuable case series and reports. As an endoscopist, I have witnessed firsthand how rapidly our field evolves and how diverse clinical insights, preserved in digital archives, shape and improve our day-to-day practice. We have been emphasizing the importance of case report contributions that are too often underestimated in publishing nowadays, because we know that documenting rare clinical scenarios could directly help patients suffering from unusual conditions now and in the future. I strongly encourage authors, especially our younger colleagues from around the world, to submit their work and unique clinical experiences to DEN Open, regardless of the study size or levels of evidence. Every clinical case holds the potential to teach us something valuable. We firmly believe that small insights obtained from individual patients can pave the way for major advancements in patient care globally.&lt;/p&gt;&lt;p&gt;To support our contributing authors, the editorial board of DEN Open is dedicated to maintaining an exceptional standard of peer review while deeply respecting your time. Our esteemed board of reviewers and editors ensures that every submission is carefully evaluated and polished to maximize its quality, clarity, and ultimate impact upon publication. We are committed to a rapid decision-making process and swift publication timelines without any unnecessary delays.&lt;/p&gt;&lt;p&gt;Together with our exceptional editorial team, dedicated reviewers, and the steadfast support of JGES, I am fully committed to fostering DEN Open as a dynamic, inclusive, and highly influential platform in our field.&lt;/p&gt;&lt;p&gt;We look forward to receiving your submissions and working together to advance the frontiers of gastroenterological endoscopy.&lt;/p&gt;&lt;p&gt;Kazuki Sumiyama, MD, PhD, FJGES, FASGE&lt;/p&gt;&lt;p&gt;Editor-in-Chief, DEN Open, Professor and Chair, Department of Endoscopy, The Jikei University School of Medicine.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Kazuki Sumiyama&lt;/b&gt;: writing – original draft.&lt;/p&gt;&lt;p&gt;The author has nothing to report.&lt;/","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70387","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148617073","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}