Clinical Endoscopy

Advancing colonoscopy training: tailored strategies and simulation-based models for skill mastery: Nilanga Nishad, Malith Nandasena, Andreas Hadjinicolaou, Mo Hameed Thoufeeq; Received January 13, 2025 Accepted March 9, 2025 Published online June 9, 2025; DOI: https://doi.org/10.5946/ce.2025.019 [Epub ahead of print]

Abstract PDF PubReader ePub: Effective endoscopy training begins by assessing the trainee’s experience and identifying their skill level: beginners, learners, independent practitioners, or experts. Beginners focus on basic tasks, such as cecal intubation, while advanced trainees refine efficiency and complex techniques. Training prioritizes conscious competence through deliberate practice, reflection, and verbalizing actions; this enhances mindfulness and procedural expertise. Clear communication, standardized terminology, and constructive feedback ensure safety, confidence, and skill retention. SMART objectives—specific, measurable, achievable, relevant, and timely—help structure sessions for skill development and mastery. Simulation-based models support training at all the levels. Beginners benefit from cost-effective low-fidelity bench models and virtual reality (VR) simulators, which offer realistic tactile feedback and customizable scenarios. Studies have shown that both low- and high-fidelity models can effectively teach basic skills, although VR is preferred for foundational training. Advanced trainees utilize animal-based models for therapeutic interventions, three-dimensional printed models for pathology-specific practice, and hybrid models that combine VR and physical elements for enhanced realism. Augmented reality and haptic feedback systems refine advanced skills, but face developmental and cost challenges. Mentored live patient models excel in real-world decision-making, but raise ethical concerns. Training is tailored to individual needs, and competency-based training ensures mastery at each stage, from beginners to advanced practitioners.

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Clinical significance of computer-aided quality assessment systems in colonoscopy: a comprehensive review: Wai Phyo Lwin, Katsuro Ichimasa, Shin-Ei Kudo, Yuta Kouyama, Taishi Okumura, Yasuharu Maeda, Yutaro Ide, Khay Guan Yeoh, Masashi Misawa; Received January 17, 2025 Accepted February 10, 2025 Published online May 27, 2025; DOI: https://doi.org/10.5946/ce.2025.022 [Epub ahead of print]

Abstract PDF PubReader ePub: Colonoscopy is the primary tool for colorectal cancer screening. High-quality colonoscopy is crucial for the detection of precancerous adenomas; however, the adenoma detection rate varies depending on the skill and experience of the endoscopist. Computer-aided quality assessment (CAQ) uses artificial intelligence (AI) technology to evaluate the quality of colonoscopy examinations. It plays an important role in reducing variations in examination quality and obtaining high-quality colonoscopic images. In this review, we focus specifically on the speedometer, effective withdrawal time, fold examination quality, bowel preparation quality assessment, and cecal intubation with CAQ systems and discuss the role and effectiveness of these systems. CAQ systems are expected to contribute to increase in adenoma detection rates, improvement in endoscopist skills, and standardization of examination quality. However, challenges such as variability in AI performance across different clinical settings and potential overreliance on automated prompts remain key limitations.

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Digital platforms, virtual reality, and augmented reality in gastrointestinal endoscopy training: Wilfredo Pagani, Tavia Buysse, Kulwinder S. Dua; Received December 30, 2024 Accepted February 26, 2025 Published online May 23, 2025; DOI: https://doi.org/10.5946/ce.2024.354 [Epub ahead of print]

Abstract PDF PubReader ePub: Remote training in procedural tasks has experienced robust growth in recent years, spurred by the coronavirus disease 2019 pandemic to meet the need for basic and continued skills development, including in gastrointestinal endoscopy. Remote endoscopy training offers learners the opportunity for skill acquisition, real-time feedback, and access to experts from around the world, and gives mentors the ability to educate trainees without the need to travel themselves. Remote training can be cost-effective but requires reliable technology and continuous assessment to ensure training quality. Ethical and legal issues related to patient safety may also exist. Training using virtual or augmented reality, on the other hand, does not involve patients and, hence, has no patient safety, legal, or ethical issues. Multiple endoscopic scenarios, from basic to advanced, can be practiced multiple times with immediate feedback on performance. These innovations are expected to not only increase individual endoscopy skills but also expand access to specialized care in remote areas, either in the same country or in underserved regions of the world. This review describes various techniques in remote endoscopy training with associated advantages and drawbacks and analyzes research outcomes on the effectiveness of remote endoscopy training.

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Recent advancement in size measurement during endoscopy: Hye Kyung Jeon, Gwang Ha Kim; Received March 4, 2025 Accepted March 24, 2025 Published online May 23, 2025; DOI: https://doi.org/10.5946/ce.2025.070 [Epub ahead of print]

Abstract PDF PubReader ePub: Accurate lesion size measurement is essential in endoscopic practice as it influences treatment strategies, surveillance decisions, and clinical outcomes, especially in colorectal polyps. Traditional measurement techniques, including visual estimation and biopsy forceps, have significant interobserver variability and procedural inefficiencies. Recent advancements in digital measurement technologies, including virtual scale endoscopy (VSE) and artificial intelligence (AI)-assisted virtual rulers, have addressed these limitations. VSE projects a virtual scale onto endoscopic images, enhancing measurement precision and reducing variability. Several studies have demonstrated its superior accuracy compared with conventional methods; however, limitations such as increased procedure time and operator training requirements persist. AI-assisted virtual rulers utilize deep learning algorithms to automate lesion size estimation, significantly improving reproducibility and diagnostic reliability. Although these technologies offer promising improvements, challenges remain, including real-time integration, standardization, and regulatory approval. Future research should focus on refining AI models, expanding validation studies, and optimizing their usability in routine practice. A hybrid approach that combines AI automation with real-time digital tools may enhance the precision and efficiency of endoscopic lesion assessment, ultimately improving patient outcomes.

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Computer-aided diagnosis of colorectal polyps: assisted or autonomous?: Yuichi Mori, Cesare Hassan; Received December 23, 2024 Accepted January 11, 2025 Published online May 22, 2025; DOI: https://doi.org/10.5946/ce.2024.338 [Epub ahead of print]

Abstract PDF PubReader ePub: Computer-aided diagnosis (CADx) in colonoscopy aims to improve the accuracy of diagnosing small polyps; however, its integration into clinical practice remains challenging. Human-artificial intelligence (AI) collaboration, which is expected to enhance optical diagnosis, has shown limited success in clinical trials, with studies indicating no significant improvement in human-only performance. Conversely, autonomous CADx systems that operate independently of clinicians have demonstrated superior diagnostic accuracy in some studies, suggesting their potential for efficiency, consistency, and standardization in healthcare. However, the adoption of autonomous AI raises ethical, legal, and practical concerns such as accountability for errors, loss of clinical context, and clinician or patient distrust. The decision between using CADx as an assistant or as an autonomous system may depend on the clinical scenario. Autonomous systems can standardize routine screening for low-risk patients, whereas assistive systems may complement expertise in complex cases. Regardless of the model used, robust regulatory frameworks and clinician training are essential to ensure safety and maintain trust. Balancing the strengths of AI with the critical role of human judgment is the key to optimizing outcomes and navigating the complex implications of integrating CADx technologies into colonoscopy practice.

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Current status and trends of green endoscopy: Kihyun Ryu, Won Jae Yoon, Sang Hoon Kim, Da Hee Park, Jin Hwa Park, Ki Bae Bang, Tae Joo Jeon, Da Hyun Jung, Young Sin Cho; Received December 16, 2024 Accepted January 21, 2025 Published online May 21, 2025; DOI: https://doi.org/10.5946/ce.2024.332 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: The increasing global emphasis on sustainability has extended its influence to the field of medicine, including endoscopy. Green endoscopy aims to minimize the environmental footprint of endoscopic practices while maintaining high standards of patient care. This review examines the current status of green endoscopy, focusing on its environmental impact, strategies for waste reduction, and adoption of sustainable practices. The key topics include the environmental challenges posed by single-use devices, the role of sterilization and recycling, and innovations in energy-efficient endoscopic equipment. Furthermore, we highlight policy recommendations and actionable strategies for healthcare systems to transition toward green practices. By integrating these approaches, the field of endoscopy can meaningfully contribute to global sustainability efforts without compromising clinical outcomes.

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Future of image enhanced endoscopy of esophageal adenocarcinoma: Kerem Parlar, Mert Cakir, Ozlem Ozer, Prateek Sharma; Received December 6, 2024 Accepted December 31, 2024 Published online May 20, 2025; DOI: https://doi.org/10.5946/ce.2024.324 [Epub ahead of print]

Abstract PDF PubReader ePub: Barrett’s esophagus is a premalignant precursor lesion of esophageal adenocarcinoma that affects approximately 1% of the population worldwide. Esophageal adenocarcinoma has a high mortality rate with a five-year survival of 15% to 20%. Early detection of Barrett's esophagus and dysplasia via endoscopy is crucial for preventing its progression to esophageal adenocarcinoma. New imaging techniques, such as image-enhanced endoscopy, have simplified the identification of Barrett’s esophagus, dysplasia, and esophageal adenocarcinoma. Narrow-band imaging, blue-light imaging, and i-Scan are the prominent image-enhanced endoscopic techniques used to detect neoplasia. In Barrett’s screening and surveillance, key aspects such as the screening population, tools, and intervals need to be clearly defined and standardized for future guidelines to improve the detection of precursor lesions and reduce the incidence of esophageal adenocarcinoma. Making image-enhanced endoscopy less subjective and enhancing the quality measures during endoscopy are crucial steps. Examples of quality measures include cleaning the esophagus before endoscopy and allowing sufficient time for inspection. Artificial intelligence systems can aid the early identification of lesions and reduce subjectivity.

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Role of fully covered metal stents in the management of chronic pancreatitis: Younghun Jeon, Hoonsub So, Sung Jo Bang; Received December 26, 2024 Accepted February 13, 2025 Published online May 8, 2025; DOI: https://doi.org/10.5946/ce.2024.349 [Epub ahead of print]

Abstract PDF PubReader ePub: Chronic pancreatitis (CP), a progressive inflammatory disease that results in irreversible pancreatic damage, is often complicated by ductal strictures and debilitating pain. Fully covered self-expandable metal stents (FCSEMS) have emerged as significant innovations in the endoscopic management of refractory pancreatic duct strictures. This review synthesizes recent evidence highlighting the benefits and limitations of FCSEMS, such as superior patency, reduced need for reinterventions, and effective symptom relief compared to traditional plastic stents, alongside risks, such as stent migration and de novo strictures. A comparison with plastic stents and an algorithm for pancreatic duct stricture management are provided. Regional variations in clinical guidelines from the United States, Europe, Japan, and Korea reflect diverse approaches to integrating FCSEMS into practice. Emerging innovations in stent technology are promising for improving CP management outcomes.

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How to improve the quality of upper gastrointestinal diagnostic endoscopy?: Mário Dinis-Ribeiro, Miguel Areia; Received December 23, 2024 Accepted January 24, 2025 Published online April 8, 2025; DOI: https://doi.org/10.5946/ce.2024.339 [Epub ahead of print]

Abstract PDF PubReader ePub: Upper gastrointestinal endoscopy is commonly performed worldwide and is the gold standard for most upper gastrointestinal tract diseases, particularly cancer. This review will use gastric cancer as an example to tackle how providers can improve the quality of endoscopy being delivered to reduce the missing rate, which may reach up to 10% of cases. In brief, endoscopists must consider pre-, intra-, and post-procedural attitudes to achieve this purpose. “Preparing or planning endoscopy,” cancer as a possible diagnosis in all procedures should be thought. Fasting of patients and the use of mucosal cleaning solutions help ensure mucosal cleansing, while planned sedation increases comfort. During endoscopy, taking time for complete inspection and photodocumentation to assure completeness. Importantly, training and knowledge of cancer (superficial) endoscopic features, particularly using advanced imaging technologies, are of paramount importance, as they are regular post-endoscopy audits of practice that positively impact quality. Finally, human-machine interaction through artificial intelligence has been shown to improve photodocumentation, detection, and auditing, and it may well assure a more homogenous service, particularly among low-performing deliverers.

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A systematic review on endoscopic ultrasound in gastric neuroendocrine neoplasms: guidelines outpacing evidence: Matteo Marasco, Gianluca Esposito, Marianna Signoretti, Maria Rinzivillo, Francesco Panzuto; Received December 15, 2024 Accepted March 5, 2025 Published online April 24, 2025; DOI: https://doi.org/10.5946/ce.2024.343 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Gastric neuroendocrine neoplasms (g-NENs), though rare, have shown a rise in incidence due to increased endoscopic screening and improved diagnostic awareness. International guidelines recommend the use of endoscopic ultrasound (EUS) in managing g-NENs to evaluate subepithelial lesion size, depth, and lymph node involvement before endoscopic resection. However, the supporting evidence for EUS’s role in g-NENs is scarce and limited.
Methods
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was conducted on PubMed to identify studies about the role of EUS in g-NENs, including both retrospective and prospective human studies.
Results
A total of 355 studies were considered; however, only seven were included, highlighting EUS’s diagnostic utility in g-NENs, with only 44 specific cases. EUS showed promise in assessing tumor characteristics critical for endoscopic resection. Nevertheless, its diagnostic accuracy remained variable across lesion types, and its impact on clinical decision-making in g-NENs lacked robust evidence. EUS contributed to subepithelial lesion staging but was underrepresented in neuroendocrine tumor-specific studies, creating a knowledge gap.
Conclusions
This review underscores the need for larger multicenter studies to validate EUS’s efficacy and reliability in g-NEN management. Prospective trials are crucial to strengthen guidelines and provide clearer clinical guidance for managing these tumors.

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Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials: Yousaf Zafar, Hafsa Azam, Muhammad Abdullah Bin Azhar, Fabeeha Shaheen, Syed Sarmad Javaid, Laila Manzoor, Muaaz Masood, Rajesh Krishnamoorthi; Received July 3, 2024 Accepted September 24, 2024 Published online February 24, 2025; DOI: https://doi.org/10.5946/ce.2024.183 [Epub ahead of print]

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Malignant biliary obstruction is a major clinical challenge. We assessed the efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) compared with that of endoscopic retrograde cholangiopancreatography biliary drainage (ERCP-BD) or percutaneous transhepatic biliary drainage (PTBD).
Methods
We searched for randomized controlled trials comparing EUS-BD with ERCP or PTBD in treating malignant biliary obstruction. Using random-effects models, we synthesized risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). A subgroup analysis was performed using a comparator (ERCP or PTBD).
Results
EUS-BD significantly reduced the risk of stent dysfunction (RR, 0.46; 95% CI, 0.33–0.64), with consistent results in subgroup analysis for ERCP (RR, 0.54; 95% CI, 0.35–0.84) and PTBD (RR, 0.37; 95% CI, 0.22–0.61). It also lowered the risk of post-procedure pancreatitis (RR, 0.24; 95% CI, 0.07–0.83) and reduced tumor ingrowth or overgrowth risk (RR, 0.27; 95% CI, 0.11–0.65), even when compared to ERCP alone (RR, 0.28; 95% CI, 0.11–0.70). EUS-BD demonstrated a lower risk of adverse events compared to PTBD (RR, 0.37; 95% CI, 0.14–0.97) and reduced length of hospital stay (WMD, –1.03; 95% CI, –1.53 to –0.53) when compared to ERCP.
Conclusions
EUS-BD outperformed ERCP-BD and PTBD in reducing stent dysfunction, postprocedural pancreatitis, and tumor ingrowth or overgrowth.

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A new hemostatic device for gastric endoscopic submucosal dissection: a prospective randomized controlled trial comparing Coajet and Hemograsper in Korea: Sang Un Kim, Seong Woo Jeon; Received November 2, 2024 Accepted December 25, 2024 Published online June 4, 2025; DOI: https://doi.org/10.5946/ce.2024.295 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Gastric endoscopic submucosal dissection (ESD) is often accompanied by bleeding. Coajet, a new device containing an injection needle, has been found to be useful in achieving hemostasis through monopolar contact. This study aimed to evaluate the efficacy and safety of this new hemostatic device by comparing it to hemostatic forceps (Hemograsper).
Methods
This prospective, randomized, single-center study enrolled consecutive patients scheduled to undergo gastric ESD from February 2022 to January 2023. The Hemograsper group (HG) underwent hemostasis using the conventional method, whereas the Coajet group (CG) used this new tool for lesion marking, submucosal injection in the initial stage of ESD, and then for hemostasis.
Results
A total 56 patients were enrolled in this study (HG, 28; CG, 28). No significant differences in age, sex, diagnosis, location, endoscopic size, or morphology were observed between the two groups. No significant difference in total operative time (HG, 16.0±6.9 minutes vs. CG, 12.4±6.7 minutes; p=0.05) and hemostatic time (HG, 186.6±134.5 seconds vs. CG, 130.4±81.5 seconds; p=0.06) were observed between the two groups. No differences in other procedure-related variables, such as complete en-bloc resection rate, length of admission, grade of immediate bleeding, and delayed bleeding within 30 days (HG, n=1 vs. CG, n=1), were noted.
Conclusions
The new hemostatic device, Coajet, showed comparable efficacy to that of conventional hemostatic forceps for bleeding control and the prevention of delayed bleeding in gastric ESD.

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Exploring lumen-apposing metal stents as a novel approach for managing walled-off necrosis in pediatric acute pancreatitis in Indian cohort: a prospective study: Varun Mehta, Abhinav Abhinav, Yogesh Kumar Gupta, Manisha Khubber, Ajit Sood, Manjeet Kumar Goyal; Received December 6, 2024 Accepted January 15, 2025 Published online May 29, 2025; DOI: https://doi.org/10.5946/ce.2024.315 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Walled-off necrosis (WON) is a severe complication of acute pancreatitis in children, with limited evidence on its endoscopic management. This study evaluated the efficacy and safety of endoscopic ultrasonography (EUS)-guided lumen-apposing metal stent (LAMS) placement for WON in pediatric patients.
Methods
This open-label prospective study included pediatric patients aged 5–18 years with WON secondary to acute necrotizing pancreatitis that was managed with EUS-guided LAMS at a tertiary center from January 2021 to July 2023. Clinical success, defined as symptom resolution and WON clearance at 12 weeks, was the primary outcome. Secondary outcomes included technical success, complications, and the need for additional interventions.
Results
Eleven patients (mean age, 15.5±3.1 years) were included. Clinical success was achieved in 90.9% of the patients within 12 weeks, with a 100% technical success rate. Two patients experienced stent occlusions that were managed with saline irrigation; one case required video-assisted retroperitoneal debridement. The mean hospital stay was 5.4±3.3 days. No major adverse events were reported.
Conclusions
EUS-guided LAMS placement is a safe and effective alternative to surgery for pediatric WON, with high clinical and technical success rates and minimal complications. Further multicenter studies are required to validate these findings.

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A retrospective study on the comparative use of fine-needle biopsy and aspiration for the diagnosis and classification of malignant lymphoma in Japan: Fumitaka Niiya, Akihiro Nakamura, Yasuo Ueda, Takafumi Ogawa, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Yuichi Takano, Masatsugu Nagahama; Received November 28, 2024 Accepted February 9, 2025 Published online May 27, 2025; DOI: https://doi.org/10.5946/ce.2024.320 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for diagnosing malignant lymphoma (ML). However, the optimal needle type for maximizing the diagnostic yield and tissue quality remains unclear. We compared the diagnostic performance and histological tissue quality between fine-needle biopsy (FNB) and fine-needle aspiration (FNA) needles in EUS-TA for ML.
Methods
This retrospective study included patients who underwent EUS-TA for suspected ML. The diagnostic accuracy, histological sample quality assessed by scoring, and adverse events were compared between the FNB and FNA groups. A subgroup analysis was performed for 22-gauge needles.
Results
FNB demonstrated higher diagnostic accuracy (75%) than FNA (50%) for cytology, with 100% sensitivity for histological diagnosis compared with 78.9% for FNA. The FNB group had significantly higher diagnostic rates for the World Health Organization subclassification of ML (71.4% vs. 31.6%, p=0.037). Additionally, FNB obtained superior histological quality, with 71.4% of samples scoring 5 compared with 41.2% in the FNA group. Adverse events were minimal in both groups.
Conclusions
EUS-FNB showed better diagnostic performance and histological tissue quality than EUS-FNA for ML, particularly in obtaining adequate samples for histological evaluation and subclassification. Therefore, EUS-FNB can be safely performed. Future research with larger sample sizes and genetic testing is warranted.

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Fabrication and mechanical testing of polydioxanone hook cross biodegradable self-expandable enteric stent: impact of fabrication density and mechanical properties of the stent: Tanyaporn Chantarojanasiri, Juthamas Ratanavaraporn, Saran Keeratihattayakorn; Received September 16, 2024 Accepted November 18, 2024 Published online April 28, 2025; DOI: https://doi.org/10.5946/ce.2024.252 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: The mechanical properties of biodegradable stent when fabricated using different number of pins per row of fabrication has been limited. We compared the radial compressive force of polydioxanone (PDO) stent that was fabricated in hook and cross manner, using 13, 17 and 19 pins per row and measure the radial compressive force and ex vivo deployment.
Methods
The PDO stents fabricated by the in-house aluminum mandrel were tested for radial force using plate compression until the stent achieved 50% strain. The relationship between compression force and %strain was calculated. Ex vivo testing of stent expansion against short segment stricture was performed in a pig small intestine compared between PDO hook cross PDO stent and braided metallic stent.
Results
The stent shortening of 16.40%, 31.20% and 19.24% was observed in 13-, 17- and 19-pin-per-row, respectively. The maximum force to achieve 50% strain were 0.503, 1.168 and 1.008 N for 13, 17 and 19 pins per row, respectively. The stent fabricated using hook and cross pattern demonstrated higher conformability to anatomical stricture when compared with braided stent.
Conclusions
PDO stent fabricated using 17 pins per row demonstrated highest radial force when compared with 13 and 19 pins per row.

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Utility of underwater endoscopic mucosal resection combined with a protruding anchor by saline injection for superficial non-ampullary duodenal tumors: a retrospective study in Japan: Yoshie Nomoto, Satoshi Shinozaki, Yoshimasa Miura, Hiroyuki Osawa, Yuji Ino, Tomonori Yano, Nikolaos Lazaridis, Hironori Yamamoto; Received July 4, 2024 Accepted September 30, 2024 Published online March 12, 2025; DOI: https://doi.org/10.5946/ce.2024.181 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Underwater endoscopic mucosal resection (UEMR) is the standard resection method for superficial non-ampullary duodenal tumors (SNADETs). We developed a novel UEMR technique that creates an anchor by protruding the distal fold with a saline injection (UEMR-A). The aim of this study was to clarify the usefulness of UEMR-A compared to conventional UEMR (UEMR-C).
Methods
This retrospective observational study included patients who underwent UEMR for SNADETs.
Results
A total of 141 patients were included and divided into UEMR-A (n=54) and UEMR-C (n=87) groups. Lesion resection was performed significantly more frequently by an expert endoscopist in the UEMR-C group compared to the UEMR-A group (p<0.001). The procedure time for UEMR-A was significantly shorter than that for UEMR-C (p=0.018), despite the additional time required for submucosal injection. The R0 resection rate was significantly higher in the UEMR-A group than in the UEMR-C group (p=0.004). The horizontal margins were significantly clearer in the UEMR-A group than in the UEMR-C group (p=0.018). Multivariate analysis revealed that the use of UEMR-A was the only significant positive factor for R0 resection.
Conclusions
The UEMR-A technique for SNADETs appears to improve R0 resection rates and reduce procedure times compared to the UEMR-C technique.

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Primary endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage prior to pancreatoduodenectomy: a retrospective study in Japan: Nozomi Okuno, Kazuo Hara, Seiji Natsume, Masataka Okuno, Shin Haba, Tomonari Asano, Takamichi Kuwahara, Hiroki Koda, Yasuhiro Shimizu; Received August 18, 2024 Accepted September 16, 2024 Published online February 11, 2025; DOI: https://doi.org/10.5946/ce.2024.218 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Malignant lesions of the pancreatic head can cause obstructive jaundice requiring biliary drainage. However, the effect of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and metal stents on surgical resection remains controversial. This study aimed to investigate the efficacy of primary endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) performed prior to pancreatoduodenectomy, excluding patients with biliary duct cancer.
Methods
We retrospectively analyzed consecutive patients who underwent pancreatoduodenectomy at our institution between January 2019 and December 2022. The patients were divided into three groups: without biliary drainage (n=130), endoscopic biliary stenting (EBS) (n=57), and primary EUS-HGS (n=20).
Results
The positivity rate of the intraoperative bile juice culture was significantly higher in the EBS group (p<0.001). No significant difference was observed among the groups in terms of postoperative adverse events (Clavien-Dindo grade 3 or higher, p=0.784) or the positive rate of peritoneal lavage cytology (p=0.984). Seven patients in the EBS group (12.3%) experienced early adverse events related to biliary drainage (post-ERCP pancreatitis, n=3; acute cholecystitis, n=3; bile duct perforation, n=1), whereas none in the EUS-HGS group experienced adverse events.
Conclusions
Primary EUS-HGS is technically feasible as a preoperative procedure and has no short-term postoperative disadvantages.

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Successful resection and diagnosis of primary gastric myxoid liposarcoma using endoscopic submucosal dissection: Kimitoshi Kubo, Noriko Kimura; Received December 7, 2024 Accepted December 25, 2024 Published online March 13, 2025; DOI: https://doi.org/10.5946/ce.2024.330 [Epub ahead of print]

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Antireflux mucosectomy for refractory gastroesophageal reflux disease following peroral endoscopic myotomy: Hideomi Tomida, Kazuhiro Tange, Yoshiou Ikeda, Yoichi Hiasa; Received December 20, 2024 Accepted December 27, 2024 Published online March 13, 2025; DOI: https://doi.org/10.5946/ce.2024.344 [Epub ahead of print]

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Successful intubation of the periampullary diverticulum in post-Billroth II method-reconstructed intestinal tract using clip-and-snare method with a pre-looping technique: Makoto Yamamoto, Kunihiro Tsuji, Shigetsugu Tsuji, Shigenori Wakita, Hiroyoshi Nakanishi, Haruhiko Shugo, Naohiro Yoshida, Hisashi Doyama; Received February 23, 2025 Accepted March 22, 2025 Published online June 9, 2025; DOI: https://doi.org/10.5946/ce.2025.060 [Epub ahead of print]

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Aggressive systemic mastocytosis: unraveling the mystery behind chronic diarrhea: Thanaboon Chaemsupaphan, Pubet Weeranawin, Ronnakorn Kongsakon, Supot Nimanong, Sitanun Preechathaveekid, Archrob Khuhapinant, Wipapat Vicki Chalermwai, Uayporn Kaosombatwattana; Received January 4, 2025 Accepted January 23, 2025 Published online May 13, 2025; DOI: https://doi.org/10.5946/ce.2025.010 [Epub ahead of print]

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Endoscopic luminal restoration in complete esophageal obstruction: antegrade freehand technique: Vikas Pemmada, Nithin Kaidabettu Ramesh, Parvesh Kumar Jain; Received February 11, 2025 Accepted February 20, 2025 Published online May 8, 2025; DOI: https://doi.org/10.5946/ce.2025.044 [Epub ahead of print]

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Endoscopic ultrasound-guided transrectal drainage of deep pelvic abscesses is safe and effective in children: Christopher A. Bouvette, Jalal Gondal, Rachel Davis, Alessandra Landmann, Amir Rumman; Received September 27, 2024 Accepted November 17, 2024 Published online April 3, 2025; DOI: https://doi.org/10.5946/ce.2024.262 [Epub ahead of print]

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Ten-year outcomes of endoscopic stapling system therapy for gastroesophageal reflux disease: Tarek G. Aridi, Gail McNulty, Glen A. Lehman, Mark A. Gromski; Received October 16, 2024 Accepted December 2, 2024 Published online March 24, 2025; DOI: https://doi.org/10.5946/ce.2024.284 [Epub ahead of print]

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From dogma to individualized care: the potential of 6-mm fully covered self-expandable metal stent in unresectable malignant distal biliary obstruction: Hyung Ku Chon; Received February 24, 2025 Accepted April 13, 2025 Published online June 16, 2025; DOI: https://doi.org/10.5946/ce.2025.061 [Epub ahead of print]

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Per-rectal endoscopic myotomy for ultrashort-segment Hirschsprung’s disease in adult patients: Harshal Surendra Mandavdhare, Arvind Sekar, Ritesh Acharya, Rajani Kant Kumar; Received January 2, 2025 Accepted January 31, 2025 Published online May 8, 2025; DOI: https://doi.org/10.5946/ce.2025.002 [Epub ahead of print]

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Exploratory application of endoscopic ultrasound-guided sclerotherapy in right renal cysts: Zhenyun Gong, Jialiang Huang, Wei Wu, Liming Xu, Duanmin Hu, Guilian Cheng; Received January 30, 2025 Accepted February 5, 2025 Published online May 7, 2025; DOI: https://doi.org/10.5946/ce.2025.034 [Epub ahead of print]

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Perforation due to gag reflex during endoscopic submucosal dissection of entire circumferential superficial esophageal cancer: Kumi Itami, Takaaki Yoshikawa, Shujiro Yazumi; Received January 20, 2025 Accepted February 5, 2025 Published online April 25, 2025; DOI: https://doi.org/10.5946/ce.2025.025 [Epub ahead of print]

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Endoscopic cap-assisted mucosal resection of intradiverticular polyp: Lorenzo Del Nero, Massimo Conio; Received December 12, 2024 Accepted February 13, 2025 Published online April 10, 2025; DOI: https://doi.org/10.5946/ce.2024.342 [Epub ahead of print]

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Successful modified double-layered suturing for the defect after gastric endoscopic submucosal dissection (origami method): Teppei Masunaga, Daisuke Minezaki, Yusaku Takatori, Motohiko Kato, Naohisa Yahagi; Received June 19, 2024 Accepted August 1, 2024 Published online February 27, 2025; DOI: https://doi.org/10.5946/ce.2024.167 [Epub ahead of print]

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