DEN open最新文献

{"title":"Endoscopic Retrograde Cholangiopancreatography-guided Biliary Drainage with Duckbill-type Anti-reflux Metal Stent versus Endoscopic Ultrasound-guided Hepaticogastrostomy for Malignant Distal Biliary Obstruction in Pancreatic Cancer with Duodenal Invasion","authors":"Tsuyoshi Takeda,&nbsp;Takashi Sasaki,&nbsp;Tatsuki Hirai,&nbsp;Yoichiro Sato,&nbsp;Yuri Maegawa,&nbsp;Takafumi Mie,&nbsp;Takaaki Furukawa,&nbsp;Yukari Suzuki,&nbsp;Takeshi Okamoto,&nbsp;Masato Ozaka,&nbsp;Naoki Sasahira","doi":"10.1002/deo2.70154","DOIUrl":"https://doi.org/10.1002/deo2.70154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Duodenal invasion is a risk factor for early recurrent biliary obstruction (RBO) due to the increased risk of duodenobiliary reflux. Transpapillary biliary drainage using anti-reflux metal stents (ARMS) and endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) are two different strategies for this condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed unresectable pancreatic cancer (PC) patients with duodenal invasion who underwent either transpapillary biliary drainage using duckbill-type ARMS (D-ARMS) or EUS-HGS for malignant distal biliary obstruction (MDBO). Technical and clinical success, causes of RBO, non-RBO adverse events (AEs), time to RBO (TRBO), and endoscopic reintervention (ERI) were compared between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-four patients were included (D-ARMS: 22, EUS-HGS: 22). Technical and clinical success rates, and non-RBO AE rates (9.1% vs. 36.4%, <i>p</i> = 0.069) were not significantly different between groups. Common causes of RBO were biliary debris/stones in the D-ARMS group and hyperplasia in the EUS-HGS group. Overall RBO rates (33.3% vs. 45.0%, <i>p</i> = 0.53), median TRBO (246 vs. 222 days, <i>p</i> = 0.98), and outcomes after ERI were comparable between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Transpapillary biliary drainage using D-ARMS may be a viable option in managing MDBO with duodenal invasion, especially for non-high-volume centers, when both procedures are technically feasible.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70154","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232393","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":"Pancreatic Neuroendocrine Tumor Leading to a Diagnosis of Multiple Endocrine Neoplasia Type 1","authors":"Noriyuki Hirakawa,&nbsp;Katsuya Kitamura,&nbsp;Kei Yamamoto,&nbsp;Kenichi Tadokoro,&nbsp;Yasunosuke Akita,&nbsp;Jun Uemura,&nbsp;Fumito Yamanishi,&nbsp;Masakazu Abe,&nbsp;Munehide Nakatsugawa,&nbsp;Takao Itoi","doi":"10.1002/deo2.70160","DOIUrl":"https://doi.org/10.1002/deo2.70160","url":null,"abstract":"<p>Pancreatic neuroendocrine neoplasms are rare but occasionally encountered. They are generally highly vascularized solid tumors, often round in shape with clear boundaries, defined contours, and a homogeneous internal structure. However, they can also present with atypical features, such as cystic degeneration, hemorrhage, calcification, and fibrosis, making diagnosis difficult in some cases. They are also known as comorbidities of multiple endocrine neoplasia type 1 (MEN1). This report describes a case in which endoscopic ultrasound (EUS) led to a diagnosis of MEN1. A 50-year-old man was referred to our hospital for examination of a mass in the pancreatic body. An EUS-guided fine-needle biopsy was performed, and a histological diagnosis of neuroendocrine tumor (NET) was made. In addition, the NET was also identified in the duodenum. Serum calcium and parathyroid hormone levels were elevated. Examination of the parathyroid and pituitary glands revealed concurrent hyperparathyroidism and a pituitary adenoma, confirming the diagnosis of MEN1, including a NET in the duodenum.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232394","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":"Impact of Non-Anesthesiologist-Administered Propofol Sedation for Outpatient Endoscopy in the Healthcare System","authors":"Francesco Vito Mandarino,&nbsp;Giorgia Gribaudo,&nbsp;Noemi Salmeri,&nbsp;Lorella Fanti,&nbsp;Alberto Barchi,&nbsp;Luca Massimino,&nbsp;Ernesto Fasulo,&nbsp;Giuseppe Dell'Anna,&nbsp;Francesco Azzolini,&nbsp;Edi Viale,&nbsp;Edoardo Vespa,&nbsp;Lorenzo Quario,&nbsp;Antonio Facciorusso,&nbsp;Lorenzo Fuccio,&nbsp;Lorenzo Giovanni Mantovani,&nbsp;Paolo Angelo Cortesi,&nbsp;Silvio Danese","doi":"10.1002/deo2.70151","DOIUrl":"https://doi.org/10.1002/deo2.70151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Non-anesthesiologist-administered propofol (NAAP) sedation for outpatient endoscopy has proven to be safe. However, implementing NAAP in Western countries faces challenges, and propofol-based sedation is still largely administered by anesthetists. For low-risk patients, anesthesiologist-administered propofol (AAP) could represent an avoidable waste of healthcare resources.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This research consisted of two phases. The first is a retrospective study comparing NAAP and AAP for outpatient endoscopy at a tertiary center, with the primary outcome being the rate of adverse events (AEs). Propensity score matching was performed to balance baseline characteristics between the two groups. The second phase involved a budget impact model to assess the economic impact of using NAAP instead of AAP for low-risk patients, both locally and nationally, between 2023 and 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between May 2019 and November 2021, 2721 patients undergoing esophagogastroduodenoscopies (EGDs; NAAP 2439 and AAP 282) and 2748 colonoscopies (NAAP 2491 and AAP 257) were enrolled. Overall, the AE rates were similar between the cohorts (esophagogastroduodenoscopies: NAAP 1.1% vs. AAP 0.8%, <i>p</i> = 0.81; colonoscopies: NAAP 1.8% vs. AAP 3.5%, <i>p</i> = 0.20). All NAAP-related AEs were minor.</p>\u0000 \u0000 <p>The budget impact model revealed that adopting NAAP instead of AAP would save €124,724,659 and 2223 working days for healthcare professionals for the Italian National Health System (NHS) between 2023 and 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NAAP has a comparable AE rate to AAP for low-risk outpatient endoscopy. Implementing NAAP instead of AAP could save over €100 million and 2000 working days for the Italian NHS between 2023 and 2025. Wider adoption could improve healthcare resource allocation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70151","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220404","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 Management of Complex Duodenal Ulcer Bleeding Using Over-the-Scope Clips: Clinical Insights From a Regional Core Hospital","authors":"Akihiro Maruyama,&nbsp;Hirotaka Takeshima,&nbsp;Hiroshi Nakayabu,&nbsp;Hiroki Kato,&nbsp;Shintaro Tominaga,&nbsp;Makoto Kobayashi","doi":"10.1002/deo2.70153","DOIUrl":"https://doi.org/10.1002/deo2.70153","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Over-the-scope clips (OTSCs) are considered an effective endoscopic tool for managing upper gastrointestinal bleeding, including duodenal ulcers, mostly based on data from high-volume centers with expert endoscopists. This study aimed to evaluate the clinical safety of OTSCs in regional hospital backgrounds and identify the factors associated with unsuccessful hemostasis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective study of 30 patients with duodenal ulcer bleeding who underwent OTSC placement at a regional core hospital in Japan between April 2014 and January 2025. Clinical outcomes, rebleeding rates, complications, and subgroup analyses by ulcer location, Forrest classification, and operator experience were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Primary hemostasis was achieved in 28 of 30 patients (93.3%). Rebleeding occurred in two cases (6.7%) but was successfully managed endoscopically. Both hemostasis failures involved Forrest Ia ulcers on the posterior duodenal wall. Subgroup analysis revealed significantly lower success rates for Forrest Ia (66.7%) and posterior wall lesions (33.3%). No significant differences in outcomes were observed between experienced and less-experienced endoscopists. Postprocedural complications included mild pancreatitis and duodenal stricture, both managed conservatively. OTSC was used as a first-line modality in 10 cases and as salvage therapy in 20, with all failures occurring in the latter.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>OTSC is a safe and effective hemostatic modality for duodenal ulcer bleeding, even in regional hospitals with limited resources and staffing. It is particularly useful when rapid intervention is required and alternative treatments are not readily available. However, anatomical challenges such as posterior wall location and Forrest Ia classification may predict technical failure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220403","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":"Wirsungocele as a Rare Cause of Recurrent Pancreatitis: Etiology and Therapeutic Insights","authors":"Sorano Ichiya,&nbsp;Jun Nakahodo,&nbsp;Shunsuke Imaeda,&nbsp;Ryogo Minami,&nbsp;Fumio Kakizaki,&nbsp;Wataru Ujita,&nbsp;Hiroki Tabata,&nbsp;Kazuro Chiba,&nbsp;Toshiro Iizuka","doi":"10.1002/deo2.70156","DOIUrl":"https://doi.org/10.1002/deo2.70156","url":null,"abstract":"<p>Wirsungocele, a cystic dilation at the end of the main pancreatic duct, is associated with recurrent acute pancreatitis. A 52-year-old man presented to our hospital with recurrent epigastric pain over an 8-month period with a history of multiple medical visits for the same complaint. Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) revealed focal cystic dilatation at the end of the main pancreatic duct; thus, he was diagnosed with Wirsungocele. He underwent endoscopic pancreatic sphincterotomy and 5Fr 4 cm pancreatic duct stent placement; the pancreatic duct stent was removed 1 month later. Magnetic resonance imaging performed 3 months after discharge revealed no cystic dilation, and he has had no recurrence of pancreatitis for at least 6 months. Dysfunction of the sphincter of Oddi, weakening of the pancreatic duct wall, inflammation and recurrent stress, elevated intraductal pressure, and genetic and structural factors are suspected mechanisms behind the pathophysiology of Wirsungocele. Although the etiology of Wirsungocele is not known, its timely identification and treatment are critical to preventing recurrent episodes of pancreatitis. This case demonstrates the diagnostic value of combining MRCP and EUS as well as the therapeutic benefits of endoscopic intervention, including sphincterotomy and stent placement, in managing Wirsungocele-associated recurrent pancreatitis. Given the paucity of reports on recurrent pancreatitis due to the Wirsungocele, we herein report this case and review the literature.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220405","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":"Feasibility of Novel Slim Peroral Cholangiopancreatoscopy for the Diagnosis of Pancreatobiliary Disease","authors":"Haruo Miwa,&nbsp;Kazuya Sugimori,&nbsp;Kuniyasu Irie,&nbsp;Yoshihiro Goda,&nbsp;Kozue Shibasaki,&nbsp;Yugo Ishino,&nbsp;Shotaro Tsunoda,&nbsp;Kazuki Endo,&nbsp;Ritsuko Oishi,&nbsp;Yuichi Suzuki,&nbsp;Hiromi Tsuchiya,&nbsp;Akihiro Funaoka,&nbsp;Hideyuki Anan,&nbsp;Yoshimasa Suzuki,&nbsp;Takashi Kaneko,&nbsp;Manabu Morimoto,&nbsp;Kazushi Numata,&nbsp;Shin Maeda","doi":"10.1002/deo2.70152","DOIUrl":"https://doi.org/10.1002/deo2.70152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the clinical outcomes of peroral cholangiopancreatoscopy (POCPS) using the 9-Fr eyeMAX for the diagnosis of pancreatobiliary diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study enrolled 43 patients who underwent POCPS using the 9-Fr eyeMAX for diagnostic procedures at two tertiary referral centers between May 2023 and November 2024. The primary outcome was the incidence of adverse events following POCPS. Patient backgrounds, procedural details, technical success (successful insertion of the 9-Fr eyeMAX), and adequate tissue sampling were also analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 43 patients, 32 were male, and 11 were female, with a median age of 75 years (range, 46–87 years). Peroral cholangioscopy (POCS) was performed on 30 patients. The final diagnosis in this cohort was an ampullary tumor (<i>n</i> = 2), extrahepatic bile duct cancer (<i>n</i> = 16), gallbladder cancer (<i>n</i> = 3), metastatic liver tumor (<i>n</i> = 1), and benign biliary stricture (<i>n</i> = 8). The adequate tissue sampling rate for the POCS was 86.4%. Adverse events after POCS occurred in two patients (6.7%), including mild pancreatitis (<i>n</i> = 1) and fever (<i>n</i> = 1). Peroral pancreatoscopy (POPS) was performed on 13 patients. The final diagnoses of all patients undergoing POPS were intraductal papillary mucinous neoplasms (IPMN), categorized as branch duct-type IPMN (<i>n</i> = 1), mixed-type IPMN (<i>n</i> = 8), and main duct-type IPMN (<i>n</i> = 4). The technical success rate was 92.3% (12/13). The tissue sampling rate for POPS was 83.6%. No adverse events, such as pancreatitis, were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The 9-Fr eyeMAX facilitates a safe POCPS procedure, achieving a high technical success rate and an adequate tissue sampling rate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144197327","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":"Investigation of the actual implementation of “post-sedation discharge briteria” and “time-out” immediately before procedure in endoscopy: A nationwide survey study in Japan","authors":"Atsushi Imagawa,&nbsp;Motohiko Kato,&nbsp;Junko Koyama,&nbsp;Mitsuhiro Fujishiro","doi":"10.1002/deo2.70149","DOIUrl":"https://doi.org/10.1002/deo2.70149","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Post-sedation discharge criteria for outpatient endoscopy and time-out procedures immediately before endoscopic examinations are important for ensuring patient safety. This study used a web-based questionnaire to survey the implementation status and current situation of these practices in Japan in 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A self-administered questionnaire was conducted from December 2023 to January 2024 using Google Forms. Participants were primarily from facilities involved in endoscopy study groups and readers of an endoscopy-specific e-newsletter. Additionally, medical staff from endoscopic centers across Japan were invited to participate in collaboration with the Japan Gastroenterological Endoscopy Technicians Society.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1,495 valid responses (medical staff: 1197 [80%]; doctors: 298) were collected from 1168 facilities, after excluding duplicate responses. Among the participating facilities, 58% were general hospitals, 21% were clinics or health check-up centers, and 9% were university hospitals or national cancer centers. Post-sedation discharge criteria were implemented in 58% of facilities for esophagogastroduodenoscopy and 56% for colonoscopy, with the post-sedation recovery score used as the criterion in about half of these cases. Time-out procedures were implemented in 57% of the facilities for both esophagogastroduodenoscopy and colonoscopy. Items confirmed during time-out in more than half of the facilities included: patient's name, details of antithrombotic drugs, content of examination, drug allergies, underlying disease, date of birth, consent form, age, procedure start time, and patient's identification number.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The implementation rate of post-sedation discharge criteria and time-out procedures was found to be close to 60%, reflecting the real-world situation in Japan in 2024.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148620","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 Gastric Cancer Screening and Future Perspectives","authors":"Chika Kusano,&nbsp;Fumiaki Ishibashi,&nbsp;Chikamasa Ichita,&nbsp;Takuji Gotoda","doi":"10.1002/deo2.70148","DOIUrl":"https://doi.org/10.1002/deo2.70148","url":null,"abstract":"<p>Gastric cancer (GC) remains a major global health concern, particularly in East Asia, Central Asia, and Eastern Europe, where its incidence and mortality rates are high. <i>Helicobacter pylori</i> infection is the primary cause of GC and leads to carcinogenic progression from nonatrophic gastritis to cancer. Although screening programs have been implemented in high-risk countries, such as Japan and South Korea, comprehensive strategies remain limited globally. This study reviewed the status of GC screening worldwide and prevention strategies in regions with different risks. Various GC screening methods have been developed, including <i>H. pylori</i> serology, serum pepsinogen testing, upper gastrointestinal contrast radiography, and endoscopy. Endoscopic screening has shown superior sensitivity and specificity, reducing GC mortality by up to 47% in South Korea and demonstrating higher detection rates than upper gastrointestinal contrast radiography and pepsinogen testing. However, cost-effectiveness remains a challenge, particularly in Western countries where the overall GC prevalence is lower. Risk stratification using a combination of <i>H. pylori</i> serology and pepsinogen testing has been adopted in Japan to optimize screening efficiency. Additionally, <i>H. pylori</i> eradication has been recognized as a cost-effective strategy to reduce the incidence of GC with economic benefits demonstrated in Japan and other high-risk regions. In the United States, targeted screening of high-risk immigrant populations has been suggested to enhance cost-effectiveness. GC screening strategies should consider developing epidemiological trends, cost-effectiveness, and risk-based approaches. Future efforts should focus on expanding targeted screening initiatives to high-risk groups to improve early detection and survival rates.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140491","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":"Covered Self-Expanding Metal Stents Versus Multiple Plastic Stents in Treating Biliary Strictures Post-Orthotopic Liver Transplantation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Ygor Rocha Fernandes,&nbsp;Thiago Arantes de Carvalho Visconti,&nbsp;Marcelo Klotz Dall'Agnol,&nbsp;André Orsini Ardengh,&nbsp;Matheus de Oliveira Veras,&nbsp;Evellin Souza dos Santos Valentim,&nbsp;Marcos Eduardo Lera dos Santos,&nbsp;Sergio Eiji Matuguma,&nbsp;Wanderley Marques Bernardo,&nbsp;Eduardo Guimarães Hourneaux de Moura","doi":"10.1002/deo2.70143","DOIUrl":"https://doi.org/10.1002/deo2.70143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Anastomotic biliary strictures are a common complication following orthotopic liver transplantation (post-OLT), impacting morbidity and graft survival. This meta-analysis evaluates the efficacy, safety, and cost-effectiveness of covered self-expanding metal stents (cSEMS) versus multiple plastic stents (MPS) for treating post-OLT strictures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted in PubMed, Cochrane Central, Embase, Scholar, and SciELO. We analyzed randomized controlled trials (RCTs) comparing cSEMS and MPS in post-OLT biliary strictures. Outcomes included stricture resolution, recurrence, endoscopic retrograde cholangiopancreatography sessions, adverse events, and cost. Standardized mean differences (SMDs) and risk ratios (RRs) were calculated with 95% confidence intervals (CIs). Cost-effectiveness analysis covered direct and indirect expenses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five RCTs with 269 patients were analyzed. No significant differences were found between cSEMS and MPS in terms of stricture resolution (RR = 1.01; 95% CI [0.90, 1.13]; <i>p =</i> 0.91), recurrence rates (RR = 2.23; 95% CI [0.74, 6.75]; <i>p =</i> 0.15), adverse events (RR = 0.80; 95% CI [0.41, 1.54]; <i>p =</i> 0.50), stent migration (RR = 1.55; 95% CI [0.69, 3.50]; <i>p =</i> 0.29), number of endoscopic retrograde cholangiopancreatography sessions (SMD = −2.18; 95% CI [−5.28, 0.91]; <i>p =</i> 0.12), number of stents (SMD = −2.33; 95% CI [−22.26, 17.59]; <i>p =</i> 0.38), treatment time (SMD = −1.60; 95% CI [−4.24, 1.05]; <i>p =</i> 0.15), and cost ($10,344 vs. $18,003; <i>p =</i> 0.19).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>cSEMS and MPS demonstrate similar efficacy and safety for post-OLT biliary strictures. Both strategies are viable, with selection based on cost, anatomy, and institutional resources.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126051","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":"Visibility Evaluation of Fundic Gland Polyp Associated With Proton Pump Inhibitor in Texture and Color Enhancement Imaging","authors":"Ryota Uchida,&nbsp;Hiroya Ueyama,&nbsp;Tsutomu Takeda,&nbsp;Shunsuke Nakamura,&nbsp;Yasuko Uemura,&nbsp;Tomoyo Iwano,&nbsp;Momoko Yamamoto,&nbsp;Hisanori Utsunomiya,&nbsp;Daiki Abe,&nbsp;Shotaro Oki,&nbsp;Nobuyuki Suzuki,&nbsp;Atsushi Ikeda,&nbsp;Yoichi Akazawa,&nbsp;Kumiko Ueda,&nbsp;Mariko Hojo,&nbsp;Shuko Nojiri,&nbsp;Takashi Yao,&nbsp;Akihito Nagahara","doi":"10.1002/deo2.70147","DOIUrl":"https://doi.org/10.1002/deo2.70147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>A ‘gray color sign’ (GCS) is a new endoscopic feature of fundic gland polyp associated with proton pump inhibitor (PPI-FGP). Here, we compare the ability of texture and color enhancement imaging (TXI) to white light imaging (WLI) with regard to the detection of GCS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective study, 19 consecutive patients with PPI-FGP were enrolled at our hospital from April 2021 to October 2022. Endoscopic images of PPI-FGP using WLI, TXI mode1 (TXI-1), TXI mode2 (TXI-2), and narrow-band imaging (NBI) were collected and compared by 10 endoscopists. Visibility of GCS by each mode (Image enhancement endoscopy) was scored as follows: 5, improved; 4, somewhat improved; 3, equivalent; 2, somewhat decreased; and 1, decreased. The inter-rater reliability (intra-class correlation coefficient, ICC) was also evaluated. The images were objectively evaluated based on <i>L* a* b*</i> color values and the color difference (Δ<i>E</i>*) in the CIE LAB color space system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Improved visibility of GCS compared with WLI was achieved for: TXI-1: 82.6%, TXI-2: 86.9%, and NBI: 0% for all endoscopists. Total visibility scores were: TXI-1, 44.9; TXI-2, 42.9; NBI, 17.4 for all endoscopists. Visibility scores were significantly higher using TXI-1 and TXI-2 compared with NBI (<i>p</i> &lt; 0.01). The inter-rater reliability for TXI-1 and TXI-2 was “excellent” for all endoscopists. The use of Δ<i>E</i>* revealed statistically significant differences between WLI and TXI-1 (<i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TXI is an improvement over WLI for the visualization of GCS, and can be used by both trainee and expert endoscopists with equal efficiency and accuracy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118180","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}