Clinical Endoscopy

Surveillance for metachronous cancers after endoscopic resection of esophageal squamous cell carcinoma: Ryu Ishihara; Clin Endosc 2024;57(5):559-570. Published online May 10, 2024; DOI: https://doi.org/10.5946/ce.2023.263

Abstract PDF PubReader ePub: The literature pertaining to surveillance following treatment for esophageal squamous cell carcinoma (SCC) was reviewed and summarized, encompassing the current status and future perspectives. Analysis of the standardized mortality and incidence ratios for these cancers indicates an elevated risk of cancer in the oral cavity, pharynx, larynx, and lungs among patients with esophageal SCC compared to the general population. To enhance the efficacy of surveillance for these metachronous cancers, risk stratification is needed. Various factors, including multiple Lugol-voiding lesions, multiple foci of dilated vascular areas, young age, and high mean corpuscular volume, have been identified as predictors of metachronous SCCs. Current practice involves stratifying the risk of metachronous esophageal and head/neck SCCs based on the presence of multiple Lugol-voiding lesions. Endoscopic surveillance, scheduled 6–12 months post-endoscopic resection, has demonstrated effectiveness, with over 90% of metachronous esophageal SCCs treatable through minimally invasive modalities. Narrow-band imaging emerges as the preferred surveillance method for esophageal and head/neck SCC based on comparative studies of various imaging techniques. Innovative approaches, such as artificial intelligence-assisted detection systems and radiofrequency ablation of high-risk background mucosa, may improve outcomes in patients following endoscopic resection.

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Endoscopic stenting for malignant gastric outlet obstruction: focusing on comparison of endoscopic stenting and surgical gastrojejunostomy: Sun Gyo Lim, Chan Gyoo Kim; Clin Endosc 2024;57(5):571-580. Published online February 23, 2024; DOI: https://doi.org/10.5946/ce.2023.160

Abstract PDF PubReader ePub: Malignant gastric outlet obstruction (GOO) is a condition characterized by blockage or narrowing where the stomach empties its contents into the small intestine due to primary malignant tumors or metastatic diseases. This condition leads to various symptoms such as nausea, vomiting, abdominal pain, and weight loss. To manage malignant GOO, different treatment options have been employed, including surgical gastrojejunostomy (SGJ), gastroduodenal stenting (GDS) using self-expandable metallic stent (SEMS), and endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ). This review focuses on comparing the clinical outcomes of endoscopic stenting (GDS and EUS-GJ) with SGJ for malignant GOO. Studies have shown that GDS with SEMS provides comparable clinical outcomes and safety for the palliation of obstructive symptoms. The choice between covered and uncovered SEMS remains controversial, as different studies have reported varying results. EUS-GJ, performed via endoscopic ultrasound guidance, has shown promising efficacy and safety in managing malignant GOO, but further studies are needed to establish it as the primary treatment option. Comparative analyses suggest that GDS has higher recurrence and reintervention rates compared to EUS-GJ and SGJ, with similar overall procedural complications. However, bleeding rates were lower with GDS than with SGJ. Randomized controlled trials are required to determine the optimal treatment approach for malignant GOO.

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Painless colonoscopy: fact or fiction?: Pieter Sinonquel, Alexander Jans, Raf Bisschops; Clin Endosc 2024;57(5):581-587. Published online June 27, 2024; DOI: https://doi.org/10.5946/ce.2024.001

Abstract PDF PubReader ePub: Although colonoscopy is a routinely performed procedure, it is not devoid of challenges, such as the potential for perforation and considerable patient discomfort, leading to patients postponing the procedure with several healthcare risks. This review delves into preprocedural and procedural solutions, and emerging technologies aimed at addressing the drawbacks of colonoscopies. Insufflation and sedation techniques, together with various other methods, have been explored to increase patient satisfaction, and thereby, the quality of endoscopy. Recent advances in this field include the prevention of loop formation, encompassing the use of variable-stiffness endoscopes, computer-guided scopes, magnetic endoscopic imaging, robotics, and capsule endoscopy. An autonomous endoscope that relies on self-propulsion to completely avoid looping is a potentially groundbreaking technology for the next generation of endoscopes. Nevertheless, critical techniques need to be refined to ensure the development of effective and efficient endoscopes.

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Advances in self-expandable metal stents for endoscopic ultrasound-guided interventions: Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia; Clin Endosc 2024;57(5):588-594. Published online July 9, 2024; DOI: https://doi.org/10.5946/ce.2023.169

Abstract PDF PubReader ePub: Endoscopic ultrasound (EUS)-guided interventions have evolved rapidly in recent years, with dedicated metal stents playing a crucial role in this process. Specifically, the invention of biflanged short metal-covered stents, including lumen-apposing metal stents (LAMS), and modifications in a variety of tubular self-expandable metal stents (SEMS), have led to innovations in EUS-guided interventions. LAMS or non-LAMS stents are commonly used in the EUS-guided drainage of pancreatic fluid collections, especially in cases of walled-off necrosis. Additionally, LAMS is commonly considered for drainage of the EUS-guided gallbladder or dilated common bile duct and EUS-guided gastroenterostomy. Fully or partially covered tubular SEMS with several new designs are being considered for EUS-guided biliary drainage. This review focuses on advances in SEMS for EUS-guided interventions and discusses related research results.

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Coaxial plastic stent placement within lumen-apposing metal stents for the management of pancreatic fluid collections: a systemic review and meta-analysis: Jad AbiMansour, Veeravich Jaruvongvanich, Saran Velaga, Ryan Law, Andrew C. Storm, Mark Topazian, Michael J. Levy, Ryan Alexander, Eric J. Vargas, Aliana Bofill-Garica, John A. Martin, Bret T. Petersen, Barham K. Abu Dayyeh, Vinay Chandrasekhara; Clin Endosc 2024;57(5):595-603. Published online July 24, 2024; DOI: https://doi.org/10.5946/ce.2023.297

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Coaxial placement of double pigtail plastic stents (DPPS) through lumen-apposing metal stents (LAMSs) is commonly performed to reduce the risk of LAMS obstruction, bleeding, and stent migration when used for the drainage of pancreatic fluid collections (PFCs). A systematic review and meta-analysis were performed to compare the outcomes of LAMS alone and LAMS with coaxial DPPS placement in the management of PFCs.
Methods
A systematic review was conducted to identify studies comparing LAMS and LAMS/DPPS for PFC drainage. Primary outcomes included the rate of clinical success, overall adverse events (AEs), bleeding, infection, occlusion, and stent migration. The pooled effect size was summarized using a random-effects model and compared between LAMS and LAMS/DPPS by calculating odds ratios (ORs).
Results
Nine studies involving 709 patients were identified (338 on LAMS and 371 on LAMS/DPPS). LAMS/DPPS was associated with a reduced risk of stent obstruction (OR, 0.59; p=0.004) and infection (OR, 0.55; p=0.001). No significant differences were observed in clinical success (OR, 0.96; p=0.440), overall AEs (OR, 0.57; p=0.060), bleeding (OR, 0.61; p=0.120), or stent migration (OR, 1.03; p=0.480).
Conclusions
Coaxial DPPS for LAMS drainage of PFCs is associated with a reduced risk of stent occlusion and infection; however, no difference was observed in the overall AE rates or bleeding.

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Never judge a book by its cover: the role of timed barium esophagography in patients with complete symptom relief after peroral endoscopic myotomy: Tae Hee Lee; Clin Endosc 2024;57(5):604-605. Published online August 20, 2024; DOI: https://doi.org/10.5946/ce.2024.111

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Endoscopic hemostatic powder as a salvage treatment for acute gastrointestinal bleeding: Duc Trong Quach; Clin Endosc 2024;57(5):606-607. Published online August 22, 2024; DOI: https://doi.org/10.5946/ce.2024.098

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A novel spiral dilator for pancreatic duct drainage: catching two birds with one stone: Han Taek Jeong, Jimin Han; Clin Endosc 2024;57(5):608-609. Published online September 2, 2024; DOI: https://doi.org/10.5946/ce.2024.201

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Timed barium esophagography to predict recurrent achalasia after peroral endoscopic myotomy: a retrospective study in Thailand: Tharathorn Suwatthanarak, Chainarong Phalanusitthepa, Chatbadin Thongchuam, Thawatchai Akaraviputh, Vitoon Chinswangwatanakul, Thikhamporn Tawantanakorn, Somchai Leelakusolvong, Monthira Maneerattanaporn, Piyaporn Apisarnthanarak, Jitladda Wasinrat; Clin Endosc 2024;57(5):610-619. Published online June 14, 2024; DOI: https://doi.org/10.5946/ce.2023.236

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Achalasia is a rare esophageal motility disease, for which peroral endoscopic myotomy (POEM) has emerged as a promising treatment option; however, recurrence remains a challenge. Timed barium esophagography (TBE) is a useful diagnostic tool and potential outcome predictor of achalasia. This study aimed to determine predictive tools for recurrence after POEM.
Methods
This retrospective study enrolled achalasia patients who underwent POEM between January 2015 and December 2021. Patients were categorized into two groups using the 1-month post-POEM Eckardt scores and TBE: the discordant group (Eckardt score improved >50%, TBE decreased <50%) and the concordant group (both Eckardt score and TBE improved >50%). Recurrence was defined as a reincrease in the Eckardt score to more than three during follow-up.
Results
Complete medical records were available in 30 patients who underwent POEM. Seventeen patients (56.7%) were classified into the discordant group, while 13 patients (43.3%) were in the concordant group. The overall recurrence rate was 11.9% at 1-year, increasing to 23.8% during the extended follow-up. The discordant group had a 6.87 fold higher recurrence rate than the concordant group (52.9% vs. 7.7%, p=0.017).
Conclusions
These results strongly suggest that combining the Eckardt score with TBE can effectively predict recurrent achalasia after POEM. Patients in the discordant group had an elevated risk.

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Never judge a book by its cover: the role of timed barium esophagography in patients with complete symptom relief after peroral endoscopic myotomy
Tae Hee Lee
Clinical Endoscopy.2024; 57(5): 604. CrossRef

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Current status and clinical outcome of endoscopic hemostatic powder in gastrointestinal bleeding: a retrospective multicenter study: Zie Hae Lim, Seung In Seo, Dae-Seong Myung, Seung Han Kim, Han Hee Lee, Selen Kim, Bo-In Lee; Clin Endosc 2024;57(5):620-627. Published online March 8, 2024; DOI: https://doi.org/10.5946/ce.2023.179

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Few multicenter studies have investigated the efficacy of hemostatic powders in gastrointestinal (GI) bleeding. We aimed to investigate the clinical outcomes of hemostatic powder therapy and the independent factors affecting rebleeding rates.
Methods
We retrospectively recruited patients who underwent a new hemostatic adhesive powder (UI-EWD; Next-Biomedical) treatment for upper and lower GI bleeding between January 1, 2020 and March 1, 2023. We collected patients’ medical records and bleeding lesions. The primary outcomes were clinical and technical success rates, and the secondary outcomes were early, delayed, and refractory bleeding, mortality, and factors affecting early rebleeding rates.
Results
This study enrolled 135 patients (age: 67.7±13.6 years, male: 74.1%) from five hospitals. Indications for UI-EWD were peptic ulcers (51.1%), post-procedure-related bleeding (23.0%), and tumor bleeding (19.3%). The clinical and technical success rates were both 97%. The early, delayed, and refractory rebleeding rates were 19.3%, 11.1%, and 12.8%, respectively. Initially elevated blood urea nitrogen (BUN) levels (p=0.014) and Forrest classification IA or IB compared with IIA or IIB (p=0.036) were factors affecting early rebleeding.
Conclusions
UI-EWD showed high clinical and technical success rates; however, rebleeding after UI-EWD therapy in patients with initially high BUN levels and active bleeding, according to the Forrest classification, should be considered.

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Endoscopic hemostatic powder as a salvage treatment for acute gastrointestinal bleeding
Duc Trong Quach
Clinical Endoscopy.2024; 57(5): 606. CrossRef

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Efficacy of hemostasis by gastroduodenal covered metal stent placement for hemorrhagic duodenal stenosis due to pancreatobiliary cancer invasion: a retrospective study: Yasunari Sakamoto, Taku Sakamoto, Akihiro Ohba, Mitsuhito Sasaki, Shunsuke Kondo, Chigusa Morizane, Hideki Ueno, Yutaka Saito, Yasuaki Arai, Takuji Okusaka; Clin Endosc 2024;57(5):628-636. Published online June 14, 2024; DOI: https://doi.org/10.5946/ce.2023.155

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Advanced pancreatic and biliary tract cancers can invade the duodenum and cause duodenal hemorrhagic stenosis. This study aimed to evaluate the efficacy of covered self-expandable metal stents in the treatment of cancer-related duodenal hemorrhage with stenosis.
Methods
Between January 2014 and December 2016, metal stents were placed in 51 patients with duodenal stenosis. Among these patients, a self-expandable covered metal stent was endoscopically placed in 10 patients with hemorrhagic duodenal stenosis caused by pancreatobiliary cancer progression. We retrospectively analyzed the therapeutic efficacy of the stents by evaluating the technical and clinical success rates based on successful stent placement, degree of oral intake, hemostasis, stent patency, and overall survival.
Results
The technical and clinical success rates were 100%. All 10 patients achieved a gastric outlet obstruction scoring system score of three within two weeks after the procedure and had no recurrence of melena. The median stent patency duration and overall survival after stent placement were 52 days (range, 20–220 days) and 66.5 days (range, 31–220 days), respectively.
Conclusions
Endoscopic placement of a covered metal stent for hemorrhagic duodenal stenosis associated with pancreatic or biliary tract cancer resulted in duodenal hemostasis, recanalization, and improved quality of life.

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White spots around colorectal tumors are cancer-related findings and may aid endoscopic diagnosis: a prospective study in Japan: Kai Korekawa, Yusuke Shimoyama, Fumiyoshi Fujishima, Hiroshi Nagai, Takeo Naito, Rintaro Moroi, Hisashi Shiga, Yoichi Kakuta, Yoshitaka Kinouchi, Atsushi Masamune; Clin Endosc 2024;57(5):637-646. Published online June 21, 2024; DOI: https://doi.org/10.5946/ce.2024.027

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: During endoscopy, white spots (WS) are sometimes observed around benign or malignant colorectal tumors; however, few reports have investigated WS, and their significance remains unknown. Therefore, we investigated the significance of WS from clinical and pathological viewpoints and evaluated its usefulness in endoscopic diagnosis.
Methods
Clinical data of patients with lesions diagnosed as epithelial tumors from January 1, 2019, to December 31, 2020, were analyzed (n=3,869). We also performed a clinicopathological analysis of adenomas or carcinomas treated with endoscopic resection (n=759). Subsequently, detailed pathological observations of the WS were performed.
Results
The positivity rates for WS were 9.3% (3,869 lesions including advanced cancer and non-adenoma/carcinoma) and 25% (759 lesions limited to adenoma and early carcinoma). Analysis of 759 lesions showed that the WS-positive lesion group had a higher proportion of cancer cases and larger tumor diameters than the WS-negative group. Multiple logistic analysis revealed the following three statistically significant risk factors for carcinogenesis: positive WS, flat lesions, and tumor diameter ≥5 mm. Pathological analysis revealed that WS were macrophages that phagocytosed fat and mucus and were white primarily because of fat.
Conclusions
WS are cancer-related findings and can become a new criterion for endoscopic resection in the future.

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Prophylactic endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis induced after metallic stent placement for malignant biliary strictures: a retrospective study in Japan: Fumisato Kozakai, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Kei Ito; Clin Endosc 2024;57(5):647-655. Published online May 17, 2024; DOI: https://doi.org/10.5946/ce.2023.284

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study evaluated the efficacy of prophylactic gallbladder stents (GBS) during SEMS placement.
Methods
Among 158 patients who underwent SEMS placement for malignant biliary strictures between January 2018 and March 2023, 30 patients who attempted to undergo prophylactic GBS placement before SEMS placement were included.
Results
Technical success was achieved in 21 cases (70.0%). The mean diameter of the cystic duct was more significant in the successful cases (6.5 mm vs. 3.7 mm, p<0.05). Adverse events occurred for 7 patients (23.3%: acute pancreatitis in 7; non-obstructive cholangitis in 1; perforation of the cystic duct in 1 with an overlap), all of which improved with conservative treatment. No patients developed AC when the GBS placement was successful, whereas 25 of the 128 patients (19.5%) without a prophylactic GBS developed AC during the median follow-up period of 357 days (p=0.043). In the multivariable analysis, GBS placement was a significant factor in preventing AC (hazard ratio, 0.61; 95% confidence interval, 0.37–0.99; p=0.045).
Conclusions
GBS may contribute to the prevention of AC after SEMS placement for malignant biliary strictures.

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Puncture angle on an endoscopic ultrasound image is independently associated with unsuccessful guidewire manipulation of endoscopic ultrasound-guided hepaticogastrostomy: a retrospective study in Japan: Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Kazuhide Matsumoto, Masatoshi Murakami, Katsuhito Teramatsu, Keijiro Ueda, Masayuki Hijioka, Akira Aso, Yoshihiro Ogawa; Clin Endosc 2024;57(5):656-665. Published online July 26, 2024; DOI: https://doi.org/10.5946/ce.2023.244

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is performed globally, the procedure remains challenging. Guidewire manipulation is the most difficult step, and there are few reports on the factors associated with unsuccessful guidewire manipulation. This study aimed to assess the significance of the puncture angle on EUS images and identify the most effective guidewire rescue method for patients with unsuccessful guidewire manipulation.
Methods
We retrospectively enrolled 115 patients who underwent EUS-HGS between May 2016 and April 2022 at two centers. The puncture angle between the needle and the intrahepatic bile duct was measured through EUS movie records.
Results
Guidewire manipulation was unsuccessful in 28 patients. Receiver operating characteristic (ROC) curves identified an optimal puncture angle cutoff value of 85° (cutoff value, 85°; area under the ROC curve, 0.826; sensitivity, 85.7%; specificity, 81.6%). Multivariate analysis demonstrated that a puncture angle <85° was a significant risk factor for unsuccessful guidewire manipulation (odds ratio, 19.8; 95% confidence interval, 6.42–61.5; p<0.001). Among the 28 unsuccessful cases, 24 patients (85.7%) achieved successful guidewire manipulation using various rescue methods.
Conclusions
The puncture angle observed on EUS is crucial for guidewire manipulation. A puncture angle of <85° was associated with unsuccessful guidewire manipulation.

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Safety and efficacy of endoscopic ultrasound-guided pancreatic duct drainage using a drill dilator: a retrospective study in Japan: Ahmed Sadek, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto, Kenneth Tachi; Clin Endosc 2024;57(5):666-674. Published online June 5, 2024; DOI: https://doi.org/10.5946/ce.2023.272

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Background
/Aims: Dilation of the tract before stent deployment is a challenging step in endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD). In this study, we examined the effectiveness and safety of a novel spiral dilator, Tornus ES (Asahi Intec), for EUS-PDD.
Methods
This was a retrospective, single-arm, observational study at Aichi Cancer Center Hospital. The punctured tract was dilated using a Tornus ES dilator in all EUS-PDD cases. Our primary endpoint was the technical success rate of initial tract dilation. Technical success was defined as successful fistula dilation using a Tornus ES followed by successful stent insertion. Secondary endpoints were procedure times and early adverse events.
Results
A total of 12 patients were included between December 2021 and March 2023. EUS-PDD was performed in 11 patients for post-pancreaticoduodenectomy anastomotic strictures and one patient with pancreatitis with duodenal perforation. The technical success rates of stent insertion and fistula dilation using a Tornus ES dilator was 100%. The median procedure time was 24 minutes. No remarkable adverse events related to the procedure were observed, apart from fever, which occurred in 2 patients.
Conclusions
Tract dilation in EUS-PDD using a Tornus ES is effective and safe.

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A novel spiral dilator for pancreatic duct drainage: catching two birds with one stone
Han Taek Jeong, Jimin Han
Clinical Endoscopy.2024; 57(5): 608. CrossRef

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Evaluation of cryoablation using a prototype cryoablation needle in swine liver: Hyunjoon Son, Jonghyun Lee, Sung Yong Han, Tae In Kim, Dong Uk Kim, Daejin Kim, Gun-Ho Kim; Clin Endosc 2024;57(5):675-682. Published online July 29, 2024; DOI: https://doi.org/10.5946/ce.2024.024

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Pancreatic cancer poses significant challenges due to its tendency for late-stage diagnosis and high mortality rates. Cryoablation, a technique used to treat various types of cancer, has shown potential in enhancing the prognosis of pancreatic cancer when combined with other therapies. However, its implementation is often limited by the need for lengthy procedures and specialized equipment. This study aims to develop a cryoablation needle optimized for endoscopic ultrasonography to simplify its application in treating pancreatic cancer.
Methods
The study involved conducting cryoablation experiments on swine liver tissue. It utilized cryo-needles to evaluate the extent of cell death across various temperatures and durations of cryoablation.
Results
The cryoablation system, which employed liquid carbon dioxide, achieved rapid cooling, reaching temperatures below –60 °C within 30 seconds and maintained the cryoablation process for 200 seconds. These conditions resulted in necrosis of the liver tissue. Notable cellular changes were observed up to 15 mm away from the cryoablation needle.
Conclusions
This experimental study successfully demonstrated the efficacy of using a cryo-needle for cryoablation in swine liver tissue. Further trials involving pancreatic tissue are expected to verify its effectiveness, underscoring the importance of continued research to establish its role as a complementary therapy in pancreatic cancer treatment.

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A rare case of esophageal mucoepidermoid carcinoma successfully treated via endoscopic submucosal dissection: So Eun Jeun, Kyung Bin Kim, Bong Eun Lee, Gwang Ha Kim, Moon Won Lee, Dong Chan Joo; Clin Endosc 2024;57(5):683-687. Published online June 18, 2024; DOI: https://doi.org/10.5946/ce.2024.051

Abstract PDF PubReader ePub: Esophageal mucoepidermoid carcinoma (EMEC) is a special subtype of esophageal malignancy, accounting for less than 1% of all cases of primary esophageal carcinoma. Pathologically, it consists of a mixture of adenocarcinoma and squamous cell carcinoma with mucin-secreting cells. Special staining for mucicarmine helps to diagnose EMEC. We present a rare case of EMEC successfully treated via endoscopic submucosal dissection (ESD). A 63-year-old man was referred to our tertiary hospital. On esophagogastroduodenoscopy, a 6-mm-sized subtle reddish depressed lesion was identified in the mid-esophagus. Diagnostic ESD was performed with a high suspicion of carcinoma. Histopathologic findings were consistent with EMEC which was confined to the lamina propria without lymphatic invasion. We plan to do a careful follow-up without administering adjuvant chemotherapy or radiotherapy. Due to the small volume of the lesion, establishing a diagnosis was difficult through forceps biopsy alone. However, by using ESD, we could confirm and successfully treat a rare case of early-stage EMEC.

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Usefulness of micro forceps biopsy for cystic degenerated pancreatic neuroendocrine neoplasm: Takuya Doi, Hirotoshi Ishiwatari, Junya Sato, Hiroki Sakamoto; Clin Endosc 2024;57(5):688-689. Published online August 22, 2024; DOI: https://doi.org/10.5946/ce.2024.052

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Long-term surveillance of gastric varices after cyanoacrylate injection in patients with non-cirrhotic portal hypertension: is it worth the effort?: Bernhard Morell, Fritz Ruprecht Murray, Christoph Gubler, Christoph Schlag, Andreas E. Kremer, Ansgar Deibel; Clin Endosc 2024;57(5):690-693. Published online May 17, 2024; DOI: https://doi.org/10.5946/ce.2023.239

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Safety and efficacy of liquid nitrogen spray cryotherapy-assisted balloon dilation for refractory anastomotic strictures: Christopher Adam Bouvette, Ahmad Basel Nasir, James Matthew Reinersman, Amir Rumman; Clin Endosc 2024;57(5):694-696. Published online June 12, 2024; DOI: https://doi.org/10.5946/ce.2024.012

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A rare cause of progressive dysphagia: Jongin Jeon, Sung Eun Kim, Sun-Ju Oh; Clin Endosc 2024;57(5):697-699. Published online August 22, 2024; DOI: https://doi.org/10.5946/ce.2024.121

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