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{"title":"Time to Confirmed Completion of Bowel Preparation as a Preprocedural Indicator of Colonoscope Insertion Difficulty: A Prospective Observational Study","authors":"Kazuki Horiuchi,&nbsp;Yusuke Ishibashi,&nbsp;Hiroki Ueda","doi":"10.1002/deo2.70375","DOIUrl":"10.1002/deo2.70375","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Runway time, defined as the interval between completion of polyethylene glycol ingestion and the start of colonoscopy, has been studied as a determinant of bowel cleansing quality. However, whether the bowel preparation course itself is associated with colonoscope insertion difficulty remains unclear. We aimed to examine the associations of bowel preparation course indicators with cecal intubation time (CIT) and loop formation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this single-center prospective observational study, we enrolled consecutive patients undergoing unsedated colonoscopy and prospectively recorded four bowel preparation course indicators: time to first bowel movement, time to confirmed completion of bowel preparation, total number of bowel movements, and estimated stool volume. Multivariable linear regression analysis was performed using log-transformed CIT as the dependent variable and adjusting for age, sex, body mass index (BMI), and endoscopist. Associations with loop formation were examined using multivariable logistic regression analysis adjusted for age, BMI, and endoscopist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 185 patients were included. Among the four indicators, only the time to confirmed completion of bowel preparation was associated with insertion difficulty. In multivariable linear regression analysis, each 30-min increase in time to confirmed completion of bowel preparation was associated with longer CIT (exp(β), 1.139; 95% confidence interval [CI], 1.065–1.219). In multivariable logistic regression analysis, it was also associated with loop formation (odds ratio, 1.624; 95% CI, 1.129–2.360, per 30-min increase).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Time to confirmed completion of bowel preparation may serve as a simple preprocedural indicator of colonoscope insertion difficulty.</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":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407502","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 Stratification for Rebleeding in Obscure Gastrointestinal Bleeding After Comprehensive Gastrointestinal Evaluation","authors":"Sachiyo Onishi,&nbsp;Kiichi Otani,&nbsp;Naoya Masuda,&nbsp;Hiroki Taniguchi,&nbsp;Kentaro Kojima,&nbsp;Jun Takada,&nbsp;Masaya Kubota,&nbsp;Takashi Ibuka,&nbsp;Masahito Shimizu","doi":"10.1002/deo2.70378","DOIUrl":"10.1002/deo2.70378","url":null,"abstract":"<p><b>Background and Aim</b>: Obscure gastrointestinal bleeding (OGIB) is defined as bleeding of unknown origin after comprehensive upper, lower, and small-bowel evaluations. However, the incidence and predictors of rebleeding after negative comprehensive gastrointestinal evaluation remain unclear. We aimed to identify predictors of rebleeding and develop a simple risk stratification score for OGIB.</p><p><b>Methods</b>: We retrospectively analyzed 226 patients diagnosed with OGIB between 2009 and 2024. The primary outcome was rebleeding during follow-up. Independent predictors were identified using multivariable Cox proportional hazards analysis. A risk score was constructed from regression coefficients and evaluated using receiver operating characteristic analysis and Kaplan–Meier curves.</p><p><b>Results</b>: Among 226 patients, 87 (38.5%) had overt OGIB and 139 (61.5%) had occult OGIB. Rebleeding occurred in 30 (13.2%) patients. Multivariable analysis identified liver cirrhosis (<i>β</i> = 0.59, <i>p</i> &lt; 0.01), overt OGIB (<i>β</i> = 0.69, <i>p</i> &lt; 0.01), and aspirin use (<i>β</i> = 0.51, <i>p</i> = 0.02) as independent predictors. Each factor was assigned one point, yielding a 0–3 point score. The score showed modest discriminative ability (area under the curve = 0.68). Rebleeding rates increased progressively with increasing scores (5.6%, 17.5%, 27.3%, and 100% for scores 0, 1, 2, and 3, respectively) and were significantly higher in the high-risk group (<i>p</i> &lt; 0.01).</p><p><b>Conclusion</b>: Rebleeding remained clinically relevant despite comprehensive gastrointestinal evaluation. The proposed risk score provides a simple and practical tool for identifying patients at increased risk of rebleeding and may support risk-adapted follow-up after a negative comprehensive gastrointestinal evaluation.</p><p><b>Trial Registration</b>: N/A.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440449","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":"Adverse Pathological Features and Worse Prognosis in Rectal Cancer Compared With Colon Cancer in T1 and T2 Stages","authors":"Shunto Iwasaki,&nbsp;Shin-ei Kudo,&nbsp;Yuta Kouyama,&nbsp;Katsuro Ichimasa,&nbsp;Shigenori Semba,&nbsp;Yuriko Morita,&nbsp;Yuki Takashina,&nbsp;Tomotaka Takizawa,&nbsp;Yu Nimura,&nbsp;Taishi Okumura,&nbsp;Kenta Nakahara,&nbsp;Yasuharu Maeda,&nbsp;Noriyuki Ogata,&nbsp;Takemasa Hayashi,&nbsp;Naruhiko Sawada,&nbsp;Toshiyuki Baba,&nbsp;Tetsuo Nemoto,&nbsp;Masashi Misawa","doi":"10.1002/deo2.70371","DOIUrl":"10.1002/deo2.70371","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Emerging endoscopic techniques are expanding opportunities for minimally invasive therapy in early colorectal cancers (CRCs). Data regarding the clinicopathological features and outcomes of colon versus rectal cancers in Tis, T1, and T2 stages remain limited. This study evaluates and compares these two entities to clarify their oncologic differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed patients with pTis-T2 CRCs treated by endoscopic or surgical resection at a single Japanese center between 2001 and 2022. Tumor location was classified as rectum (Ra, Rb) or colon (cecum to RS). Clinical variables (sex and age), pathological features (tumor size, differentiation, lymphatic invasion [Ly], vascular invasion [V], and tumor budding), and recurrence and metastasis rates were compared according to tumor location.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The proportion of rectal cancer rose with invasion depth, from 16.2% (271/1673) in Tis to 18.5% (248/1337) in T1 and 26.4% (178/675) in T2 (<i>p</i> &lt; 0.01). Compared with T1 colon cancer, T1 rectal cancer showed higher rates of Ly1-2 (35.1% vs. 27.4%), V1-2 (37.9% vs. 24.6%), and recurrence (4.4% vs. 0.6%) (all <i>p</i> &lt; 0.05). Similarly, T2 rectal cancer showed higher V1-2 (68.5% vs. 54.1%) and recurrence rates (13.5% vs. 5.0%) compared with colon cancer (all <i>p</i> &lt; 0.05). No significant differences were observed in lymph node or distant metastasis at either T1 or T2 stages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rectal cancers demonstrate more aggressive features and higher recurrence rates than colon cancers. Consequently, these patients require more stringent therapeutic approaches and rigorous postoperative surveillance, even in early stages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>Umin Clinical Trials Registry, UMIN 000042622.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13334210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Colorectal Endoscopic Full-Thickness Resection Using the Full-Thickness Resection Device: A Multicenter Study","authors":"Vicki McGarrigle,&nbsp;Yuto Shimamura,&nbsp;Leonardo Zorron Cheng Tao Pu,&nbsp;Marios Efthymiou,&nbsp;Rhys Vaughan,&nbsp;Cameron Schauer,&nbsp;Anurag Sekra,&nbsp;Erin Horsfall,&nbsp;Alexandra Simpson,&nbsp;Rajvinder Singh,&nbsp;Nicholas Wan,&nbsp;Milan Bassan,&nbsp;Martin Harb,&nbsp;Ben Terkasher,&nbsp;Frank Weilert,&nbsp;Saurabh Gupta,&nbsp;Kwang Chien Yee,&nbsp;Rajan Patel,&nbsp;Ibrahim Hassan,&nbsp;Byron Theron,&nbsp;Sujievvan Chandran","doi":"10.1002/deo2.70365","DOIUrl":"https://doi.org/10.1002/deo2.70365","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endoscopic full-thickness resection (EFTR) using the full-thickness resection device (FTRD) is an emerging technique for the management of complex colorectal lesions and early colorectal cancers. Although EFTR offers a minimally invasive alternative to surgery, data on efficacy, safety, and predictors of adverse events (AEs) remain limited. This study evaluated outcomes of colorectal EFTR using FTRD and identified patient- and lesion-related factors associated with AEs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter retrospective study included patients who underwent colorectal EFTR with FTRD across 13 centers in Australia and New Zealand. Patient demographics, lesion characteristics, procedural outcomes, R0 resection rates, and AEs were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 170 EFTR procedures were performed. The mean patient age was 67 years (standard deviation [SD] 13.7), and 57% were male. Mean procedure time was 51 min (SD 28.5). The most common indication was non-lifting lesions (36%). Technical success was achieved in 89% of cases. Adenocarcinoma was confirmed on histopathology in 23% of lesions, with an R0 resection rate of 79%. Recurrence occurred in 7.4% of cases during a median follow-up of 5 months (interquartile range [IQR] 8.5). Early and delayed AEs occurred in 4.1% and 12.9%, respectively, including post-procedural bleeding (<i>n </i>= 11), perforation (<i>n </i>= 5), and post-polypectomy syndrome (<i>n</i> = 2). Among 41 procedures involving appendiceal orifice lesions, appendicitis developed in 17% (<i>n</i> = 7). AEs were significantly associated with female sex (64% vs. 40%, <i>p</i> = 0.03) and appendiceal orifice lesions (46% vs. 21%, <i>p </i>= 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Colorectal EFTR using FTRD is effective for the resection of complex colorectal lesions. Careful patient selection and risk stratification are essential to optimize outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes After Failed Endoscopic Detorsion for Sigmoid Volvulus: A Single-Center Retrospective Cohort Study","authors":"Hidehiro Kamezaki,&nbsp;Arisa Kato,&nbsp;Nana Yamada,&nbsp;Terunao Iwanaga,&nbsp;Takafumi Sakuma,&nbsp;Koji Takahashi,&nbsp;Junichi Senoo,&nbsp;Sadahisa Ogasawara,&nbsp;Tomoaki Matsumura,&nbsp;Jun Kato","doi":"10.1002/deo2.70368","DOIUrl":"10.1002/deo2.70368","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic detorsion is the first-line treatment for sigmoid volvulus (SV); however, detorsion is not always successful. We evaluated clinical outcomes after failed endoscopic detorsion and assessed recurrence in patients who achieved clinical success after decompression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective cohort study included 47 patients with first-episode SV, of whom 43 underwent endoscopic management. Baseline characteristics and short-term outcomes were compared between successful and failed detorsion groups. Among patients with clinical success, the in-hospital course and 1-year cumulative recurrence were compared between the successful detorsion and successful decompression groups. Cumulative recurrence was evaluated using the Kaplan–Meier method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Successful detorsion was achieved in 21 of 43 patients (48.8%). Among 22 patients with failed detorsion, 17 achieved clinical success after decompression, whereas five had clinical failure, including four who underwent emergency surgery and one who died the following day. The overall clinical success rate was 88.4% (38/43). Failed detorsion was associated with lower room-air oxygen saturation and higher lactate levels. Clinical success was less frequent in the failed detorsion group (77.3% vs. 100%, <i>p</i> = 0.065), and hospital stay was longer (median 13 vs. 7 days, <i>p</i> = 0.071). Among patients with clinical success, time to resumption of oral intake was shorter in the successful detorsion group (median 1.5 vs. 3 days, <i>p</i> = 0.004), whereas the 1-year cumulative recurrence rate was numerically higher but not statistically significant (79.6 vs. 51.3%, log-rank <i>p</i> = 0.087).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>After assessing the need for emergency surgery, decompression alone may not always require immediate repeat detorsion in selected patients who improve clinically.</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":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371487","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 Additional Treatment for Residual Cases After Endoscopic Papillectomy of Duodenal Ampullary Tumors","authors":"Yusuke Kurita,&nbsp;Keiki Nagai,&nbsp;Noriki Kasuga,&nbsp;Kensuke Kubota,&nbsp;Yuji Fujita,&nbsp;Yusuke Sekino,&nbsp;Hiroki Uechi,&nbsp;Yuji Koyama,&nbsp;Shintaro Tsujikawa,&nbsp;Shota Matsumoto,&nbsp;Shigeki Tamura,&nbsp;Yu Honda,&nbsp;Shin Yagi,&nbsp;Takeshi Iizuka,&nbsp;Sho Hasegawa,&nbsp;Takamitsu Sato,&nbsp;Kunihiro Hosono,&nbsp;Noritoshi Kobayashi,&nbsp;Yuki Honma,&nbsp;Ryusei Matsuyama,&nbsp;Jotaro Harada,&nbsp;Masato Yoneda,&nbsp;Satoshi Fujii,&nbsp;Itaru Endo,&nbsp;Atsushi Nakajima","doi":"10.1002/deo2.70374","DOIUrl":"10.1002/deo2.70374","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>This study aimed to assess the prognosis and outcomes of additional treatment for residual adenocarcinoma and adenoma following endoscopic papillectomy (EP) for ampullary tumors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Of 191 patients who underwent EP, 43 with adenocarcinoma or adenoma and either positive or unknown pathological margins were included. Cases with positive or unknown pathological margins and residuals on endoscopic observation after EP were defined as endoscopic residuals, and cases without endoscopic residuals were defined as pathological residuals. The outcomes between these groups were compared to evaluate additional treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 12 cases of adenocarcinoma were identified, with pathological residuals in 10 cases and endoscopic residuals in two cases. Of the two cases with endoscopic residuals, one underwent additional surgical resection, while the other was observed and subsequently showed disease progression. Among the 10 cases with pathological residual adenocarcinoma, four underwent additional surgery, but no cancer was detected in the resected specimens. The remaining six cases showed no disease progression during the observation period, suggesting that pathological residual adenocarcinoma may have been completely eradicated by EP. Residual adenoma was detected in 31 cases, with pathological residuals in 20 cases and endoscopic residuals in 11 cases. Adenoma recurrence occurred in three cases, all of which were successfully managed with endoscopic treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>If the pathological margin is positive or unknown, additional treatment is necessary for cases with endoscopic residuals after EP. However, in the absence of endoscopic residuals, follow-up observation may be carefully considered in selected cases with caution.</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":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371526","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":"Effectiveness of Simulation-based Training on Emergency Response Knowledge Among Inter-Professional Staff Involved in Gastrointestinal Endoscopic Practice","authors":"Mitsuru Otsuka,&nbsp;Tsunetaka Kato,&nbsp;Takuto Hikichi,&nbsp;Jun Nakamura,&nbsp;Takumi Yanagita,&nbsp;Eisuke Kameoka,&nbsp;Daiki Nemoto,&nbsp;Rei Suzuki,&nbsp;Mitsuru Sugimoto,&nbsp;Hiroyuki Asama,&nbsp;Hiroshi Shimizu,&nbsp;Kento Osawa,&nbsp;Rei Ohira,&nbsp;Keisuke Kudo,&nbsp;Masao Kobayakawa,&nbsp;Hiromasa Ohira","doi":"10.1002/deo2.70372","DOIUrl":"10.1002/deo2.70372","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the effectiveness of simulation-based training in improving emergency response capabilities during endoscopic practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Physicians, nurses, laboratory technologists, and clinical engineers working in the endoscopy department were enrolled. The simulation-based training program employed simulation models and was conducted under the guidance of a certified emergency nurse using predefined scenarios. Knowledge tests were administered before, immediately after, and 1 month after the training. Test scores were compared across time points and among professional groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two participants (14 physicians, seven nurses, and one laboratory technologist) were included. The accuracy rates improved across all items immediately after the training compared with the pre-training outcomes: correct chest compression (<i>p</i> &lt; 0.01), drugs for cardiac arrest (<i>p</i> &lt; 0.01), drugs for anaphylaxis (<i>p</i> = 0.13), indications for defibrillation (<i>p</i> &lt; 0.01), automated external defibrillator (AED) location (<i>p</i> = 0.01), and Code Blue contact number (<i>p</i> &lt; 0.01). However, at 1 month after the training, most items returned to pre-training levels, except for the indications for defibrillation and Code Blue contact number. In the subgroup analysis by profession, when the accuracy rates immediately before and immediately after the training were compared, physicians showed significant improvements in AED location (<i>p</i> = 0.03) and Code Blue contact number (<i>p</i> &lt; 0.01), whereas nurses showed a significant improvement in drugs for cardiac arrest (<i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Simulation-based training is effective in improving emergency response knowledge in gastrointestinal endoscopy. However, repeated or continuous training may be necessary to sustain these gains.</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":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13322650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371539","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":"Non-visualized Ultrasonography Should Remain Indeterminate in Patency Capsule Localization","authors":"Anastasios Koulaouzidis,&nbsp;Ervin Toth","doi":"10.1002/deo2.70344","DOIUrl":"https://doi.org/10.1002/deo2.70344","url":null,"abstract":"&lt;p&gt;To the Editor:&lt;/p&gt;&lt;p&gt;We read with considerable interest the prospective study by Matsuura et al. [&lt;span&gt;1&lt;/span&gt;] evaluating abdominal ultrasonography (AUS) against computed tomography (CT) for patency capsule (PC) localization before small-bowel (SB) capsule endoscopy. The clinical question is important, and the appeal of a radiation-free first-line strategy is obvious. Nevertheless, we believe the manuscript's central message is more confident than the data justify.&lt;/p&gt;&lt;p&gt;Our concern is the treatment of non-visualized examinations. In the primary binary analysis, AUS findings reported as “colon” and “not visualized” were both counted as test-negative [&lt;span&gt;1&lt;/span&gt;]. This is the pivotal methodological step behind the paper's apparently perfect performance. However, a non-visualized examination is not a true negative result; it is, clinically, an indeterminate one. Indeed, the authors themselves acknowledge that non-visualization does not exclude SB retention and may still require CT [&lt;span&gt;1&lt;/span&gt;]. To convert diagnostic incompleteness into a negative test risks overstating the real-world capability of AUS [&lt;span&gt;2, 3&lt;/span&gt;]. In practical terms, AUS provided definitive localization in 28/34 patients (82.4%), whereas 6/34 (17.6%) remained non-diagnostic and still required CT [&lt;span&gt;1&lt;/span&gt;]. Albeit useful, it does not amount to a definitive stand-alone test. Further restraint is warranted because the reported 100% sensitivity for SB retention rests on only six CT-confirmed events, with a wide 95% confidence interval of 61.0%–100% [&lt;span&gt;1&lt;/span&gt;]. In addition, the AUS operator had access to prior X-ray findings and the estimated PC location before scanning, introducing review bias [&lt;span&gt;2, 3&lt;/span&gt;]. Finally, this was a single-center expert study without interobserver agreement analysis, limiting generalizability [&lt;span&gt;1, 4&lt;/span&gt;]. AUS appears promising as a triage tool, but non-visualized examinations should remain indeterminate, not negative. Multicenter validation with blinded assessment is now needed.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Anastasios Koulaouzidis&lt;/b&gt; conceived the commentary, performed the methodological and clinical appraisal, interpreted the implications for WCE AI validation, and wrote the manuscript. &lt;b&gt;Ervin Toth&lt;/b&gt; contributed to the writing and approved the final version.&lt;/p&gt;&lt;p&gt;The authors have nothing to report.&lt;/p&gt;&lt;p&gt;Anastasios Koulaouzidis and Ervin Toth are or have been Guest editors for MDPI; Anastasios Koulaouzidis and Ervin Toth are Section board members of &lt;i&gt;Diagnostics&lt;/i&gt; and JCM. Anastasios Koulaouzidis is Associate Editor of the &lt;i&gt;Annals of Gastroenterology, Diagnostics&lt;/i&gt; and &lt;i&gt;Therapeutic Advances of Gastrointestinal Endoscopy&lt;/i&gt;. Anastasios Koulaouzidis is the immediate past president of the iCARE group.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Disclosure(s)&lt;/b&gt;: Anastasios Koulaouzidis is a co-founder shareholder of AJM Med-i-caps Ltd and a consultant for Jinshan Science &amp; Technology Ltd. He has also been co-founder and director of iCERV Ltd. ","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70344","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148324725","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 Endoscopic Ultrasound-guided Fine Needle Biopsy With Simplified Macroscopic On-site Evaluation (With Video)","authors":"Kento Shionoya,&nbsp;Ryosuke Tonozuka,&nbsp;Shuntaro Mukai,&nbsp;Yuki Joyama,&nbsp;Takayoshi Tsuchiya,&nbsp;Reina Tanaka,&nbsp;Kenjiro Yamamoto,&nbsp;Kazumasa Nagai,&nbsp;Yukitoshi Matsunami,&nbsp;Hiroyuki Kojima,&nbsp;Hirohito Minami,&nbsp;Noriyuki Hirakawa,&nbsp;Kyoko Asano,&nbsp;Takao Itoi","doi":"10.1002/deo2.70347","DOIUrl":"https://doi.org/10.1002/deo2.70347","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>With advances in preoperative chemotherapy and comprehensive genomic profiling, endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) has become vital for diagnosing pancreatic and peridigestive tract lesions. However, evidence remains limited regarding the performance of new-generation puncture needles and simplified specimen evaluation methods. This study retrospectively assessed the diagnostic ability and procedural adverse events (AEs) of a new-generation puncture needle for solid pancreatic, subepithelial, and other lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from 1232 consecutive patients who underwent EUS-FNB between August 2016 and November 2023 at a single care center. Specimen processing was performed using the simplified macroscopic on-site evaluation (S-MOSE) method, which does not require additional pathological tests such as rapid on-site evaluation or cytology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall diagnostic accuracy using S-MOSE was 93.7%. Specifically, the diagnostic accuracy for pancreatic cancer was 95.8%. The AE rate was 1.1% (14/1232), including pancreatitis (six), hemorrhage (five), hematoma (two), and pancreatic fistulas (one). The first puncture diagnostic rate was 83.6%, which increased to 92.5% after the second puncture, with only a marginal gain of 1.2% beyond the third puncture. Multivariable analysis identified smaller lesion size and benign pathology as factors associated with lower diagnostic accuracy; conversely, malignant pathology was associated with higher diagnostic accuracy (odds ratio 1.895, <i>p</i> = 0.011).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EUS-FNB with S-MOSE, typically requiring up to two punctures, provides efficient and accurate histopathological diagnosis across diverse lesions while minimizing procedural burden.</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":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70347","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148324818","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":"Initial Experience With Endoscopic Ultrasound-Guided Gallbladder Drainage Using Lumen-apposing Metal Stents in Extremely Elderly and Frail Patients","authors":"Kiyoyuki Kobayashi,&nbsp;Takako Nomura,&nbsp;Maki Ayaki,&nbsp;Tomohiro Ogi,&nbsp;Yudai Sato,&nbsp;Manabu Yamada,&nbsp;Daisuke Namima,&nbsp;Naoki Fujita,&nbsp;Hiroki Yamana,&nbsp;Hideki Kamada,&nbsp;Toshiharu Funaki,&nbsp;Akihiro Kondo,&nbsp;Yasuhisa Ando,&nbsp;Hironobu Suto,&nbsp;Minoru Oshima,&nbsp;Keiichi Okano,&nbsp;Hideki Kobara","doi":"10.1002/deo2.70369","DOIUrl":"10.1002/deo2.70369","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) is a treatment option for acute cholecystitis in high-risk surgical patients. However, data on extremely elderly and frail patients are limited. We report our initial experience with EUS-GBD using electrocautery-enhanced LAMS in this population after reimbursement approval in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed consecutive patients who underwent EUS-GBD using electrocautery-enhanced LAMS for acute cholecystitis at a single center after reimbursement approval in June 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten patients (median age, 90 years; median Clinical Frailty Scale score, 7) underwent EUS-GBD. All procedures were performed via a transduodenal approach using a 10-mm LAMS. Technical success was achieved in all patients. Clinical success was achieved in nine of the 10 patients (90%); one patient with Grade III cholecystitis complicated by severe pneumonia and heart failure died on postoperative day 1 before clinical assessment. The median stent deployment time was 3.5 min, and the median total procedure time was 16 min. Cholecystoscopy through the LAMS using a slim endoscope was feasible when required.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this pilot study, EUS-GBD using electrocautery-enhanced LAMS was technically successful in extremely elderly and frail patients. Although short-term outcomes appeared acceptable in most patients, the single POD1 death underscores the importance of careful patient selection. These preliminary findings require validation in larger studies.</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":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310630","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}