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Original Articles
- The feasibility and safety of trans-colorectal endoscopic ultrasound-guided fine-needle aspiration: a retrospective study of Japan
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Takashi Kondo
, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Yoshitaro Yamamoto, Minako Urata, Keigo Oshiro, Tomoki Ogata, Ren Kuwabara, Indria Melianti
, Yousik Myung
, Adwoa Afrakoma Agyei-Nkansah
- Clin Endosc 2025;58(6):890-897. Published online November 27, 2025
- DOI: https://doi.org/10.5946/ce.2025.042
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Graphical Abstract
Abstract
PDF - Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective diagnostic technique; however, few studies have evaluated the efficacy of trans-colorectal EUS-FNA. This study assessed the feasibility of trans-colorectal EUS-FNA.
Methods
We retrospectively analyzed 76 consecutive patients who underwent trans-colorectal EUS-FNA for pelvic lesions between January 2013 and September 2023.
Results
A total of 76 pelvic lesions were identified. The median number of EUS-FNA punctures was 3 (1–8). The median lesion size was 18.9 (8.2–100.0) mm. The success rate was 98.7% (75/76), with no reported adverse events. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA were 94.3% (50/53), 100% (22/22), 100% (50/50), 88.0% (22/25), and 96.0% (72/75), respectively. Malignancy was initially suspected in 65 patients before EUS-FNA; however, 25 patients showed benign results. Of these, three were later reexamined and diagnosed with malignancy, three underwent surgery and were found to have benign pathology, and 19 avoided unnecessary surgery.
Conclusions
Trans-colorectal EUS-FNA is a safe and effective diagnostic procedure. -
Citations
Citations to this article as recorded by
- EUS characteristics and tissue acquisition strategies for lower gastrointestinal subepithelial lesions: Current evidence and future directions
Yu-Shiuan Liang, Li-Chun Chang, Ping-Huei Tseng
Journal of the Formosan Medical Association.2026;[Epub] CrossRef
- EUS characteristics and tissue acquisition strategies for lower gastrointestinal subepithelial lesions: Current evidence and future directions
- 1,973 View
- 53 Download
- 1 Crossref
- Primary endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage prior to pancreatoduodenectomy: a retrospective study in Japan
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Nozomi Okuno, Kazuo Hara, Seiji Natsume, Masataka Okuno, Shin Haba, Tomonari Asano, Takamichi Kuwahara, Hiroki Koda, Yasuhiro Shimizu
- Clin Endosc 2025;58(4):604-611. Published online February 11, 2025
- DOI: https://doi.org/10.5946/ce.2024.218
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Graphical Abstract
Abstract
PDF
- 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. -
Citations
Citations to this article as recorded by- Changing the Flow: How EUS‐Guided Drainage is Reshaping the Management of Distal Malignant Biliary Obstruction
Jeska A. Fritzsche, Inge de Vries, Jeanin E. van Hooft, Rogier P. Voermans, Roy L. J. van Wanrooij
United European Gastroenterology Journal.2026;[Epub] CrossRef - Biliary Drainage During Neoadjuvant Chemotherapy in Pancreatic Cancer: Evidence and Practical Recommendations
Tadahisa Inoue, Masanao Nakamura, Kiyoaki Ito
Cancers.2026; 18(3): 467. CrossRef - Assessment of endoscopic ultrasound-guided hepaticogastrostomy as a feasible option for preoperative biliary drainage before pancreaticoduodenectomy
Mamoru Takenaka, Masatoshi Kudo
Clinical Endoscopy.2025; 58(4): 549. CrossRef - Prospective, multicentre trial on preoperative biliary drainage by endoscopic ultrasound-guided hepaticogastrostomy for resectable/borderline resectable pancreatic cancer with biliary obstruction: the PROLOGUE study – a study protocol
Shin Yagi, Susumu Hijioka, Yoshikuni Nagashio, Shota Harai, Daiki Agarie, Daiki Yamashige, Kohei Okamoto, Souma Fukuda, Masaru Kuwada, Yasuhiro Komori, Yusuke Kurita, Sho Hasegawa, Kensuke Kubota, Yusuke Ishida, Jun Ushio, Kotaro Takeshita, Kohei Yoshino,
BMJ Open.2025; 15(10): e106543. CrossRef - Advances in EUS-Guided Biliary Drainage for the Management of Pancreatic Cancer
Thomas Lambin, Sarah Leblanc, Bertrand Napoléon
Cancers.2025; 17(21): 3428. CrossRef - Primary Endoscopic Ultrasound-Guided Biliary Drainage for Malignant Biliary Obstruction
Yousuke Nakai, Ryunosuke Hakuta, Ryota Nakabayashi, Yutaka Shimamatsu, Nao Otsuka, Yukiko Takayama
The Korean Journal of Pancreas and Biliary Tract.2025; 30(4): 159. CrossRef
- Changing the Flow: How EUS‐Guided Drainage is Reshaping the Management of Distal Malignant Biliary Obstruction
- 5,596 View
- 333 Download
- 4 Web of Science
- 6 Crossref
Case Report
- High-Resolution Probe-Based Confocal Laser Endomicroscopy for Diagnosing Biliary Diseases
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Hiroki Koda, Kazuo Hara, Okuno Nozomi, Takamichi Kuwahara, Mizuno Nobumasa, Shin Haba, Miyano Akira, Isomoto Hajime
- Clin Endosc 2021;54(6):924-929. Published online March 15, 2021
- DOI: https://doi.org/10.5946/ce.2020.191
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Abstract
PDF
- Probe-based confocal laser endomicroscopy is an endoscopic technique that enables in vivo histological evaluation using fluorescent pigment. The ability to diagnostically differentiate between benign and malignant biliary disease using the “CholangioFlexTM”, a dedicated biliary device, has been reported. However, the Miami and Paris classifications, used as diagnostic criteria, mainly evaluate findings in the submucosa, and visualizing the epithelium as the main site of lesions remains difficult. To address this problem, we verified the imaging findings and diagnostic ability of three types of probes: CholangioFlexTM, GastroFlexTM, and AlveoFlexTM. With GastroFlexTM, the clear mucosal epithelium was observed, and differential diagnoses as benign/malignant could be made based on epithelial findings. GastroFlexTM may be a good first-choice probe for probe-based confocal laser endomicroscopy of biliary diseases, and a new diagnostic classification based on bile duct epithelial findings may provide useful criteria independent of the Miami or Paris classifications.
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Citations
Citations to this article as recorded by- Challenges and Prospects of Using Novel Nonlinear Effects in Multimode Optical Fibers for Multiphoton Endomicroscopy
Lidiya V. Boldyreva, Denis S. Kharenko, Kirill V. Serebrennikov, Anna A. Evtushenko, Viktor V. Shloma, Daba A. Radnatarov, Alexandr V. Dostovalov, Zhibzema E. Munkueva, Oleg S. Sidelnikov, Igor S. Chekhovskoy, Kirill S. Raspopin, Mikhail D. Gervaziev, Ste
Diagnostics.2026; 16(3): 438. CrossRef - Early detection of biliary adenocarcinoma using probe-based confocal laser endomicroscopy: a case report
Jiangshan Wu
American Journal of Cancer Research.2025; 15(6): 2642. CrossRef - Intraductal papillary neoplasm of the biliary tract with typical clinicopathological, endoscopic features: A case report
Tian-Yuan Gu, Su-Hang Wang, Shu-Ying Yang, Si-Qi Zhao, Min-Jie Chen, Xiao-Ping Li, Zheng-Wei Song, Xiao-Xia Gu, Fei Chen
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef - Cholangioscopy-based convoluted neuronal network vs. confocal laser endomicroscopy in identification of neoplastic biliary strictures
Carlos Robles-Medranda, Jorge Baquerizo-Burgos, Miguel Puga-Tejada, Domenica Cunto, Maria Egas-Izquierdo, Juan Carlos Mendez, Martha Arevalo-Mora, Juan Alcivar Vasquez, Hannah Lukashok, Daniela Tabacelia
Endoscopy International Open.2024; 12(10): E1118. CrossRef - A Comparative Analysis of Artificial Intelligence-based Digital Cholangioscopy and Probe-based Confocal Laser Endomicroscopy for Detecting Malignant Bile Duct Lesions: A single-centre retrospective study
C. Robles-Medranda, J. Baquerizo-Burgos, M. Puga-Tejada, D. Cunto, M. Egas-Izquierdo, M. Arevalo-Mora, J. C. Mendez, J. Alcivar-Vasquez, H. Alvarado-Escobar, H. Pitanga-Lukashok, D. Tabacelia
Endoscopy.2023; 55(S 02): S134. CrossRef
- Challenges and Prospects of Using Novel Nonlinear Effects in Multimode Optical Fibers for Multiphoton Endomicroscopy
- 6,929 View
- 95 Download
- 5 Web of Science
- 5 Crossref
Original Article
- Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in Patients Undergoing Antithrombotic Therapy
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Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Masahiro Tajika, Tsutomu Tanaka, Sachiyo Onishi, Keisaku Yamada, Akira Miyano, Daiki Fumihara, Moaz Elshair
- Clin Endosc 2021;54(4):596-602. Published online February 17, 2021
- DOI: https://doi.org/10.5946/ce.2020.194
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Abstract
PDF
- Background
/Aims: The Japan Gastroenterological Endoscopy Society (JGES) has published guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. These guidelines classify endoscopic ultrasound-guided biliary drainage (EUS-BD) as a high-risk procedure. Nevertheless, the bleeding risk of EUS-BD in patients undergoing antithrombotic therapy is uncertain. Therefore, this study aimed to assess the bleeding risk in patients undergoing antithrombotic therapy.
Methods
This single-center retrospective study included 220 consecutive patients who underwent EUS-BD between January 2013 and December 2018. We managed the withdrawal and continuation of antithrombotic agents according to the JGES guidelines. We compared the bleeding event rates among patients who received and those who did not receive antithrombotic agents.
Results
A total of 18 patients (8.1%) received antithrombotic agents and 202 patients (91.8%) did not. Three patients experienced bleeding events, with an overall bleeding event rate of 1.3% (3/220): one patient was in the antithrombotic group (5.5%) and two patients were in the non-antithrombotic group (0.9%) (p=0.10). All cases were moderate. The sole thromboembolic event (0.4%) was a cerebral infarction in a patient in the non-antithrombotic group.
Conclusions
The rate of EUS-BD-related bleeding events was low. Even in patients receiving antithrombotic therapy, the bleeding event rates were not significantly different from those in patients not receiving antithrombotic therapy. -
Citations
Citations to this article as recorded by- The New Potential for Using Franseen Needles in Interventional EUS
Nozomi Okuno, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Yoshitaro Yamamoto, Takashi Kondo
Internal Medicine.2024; 63(20): 2723. CrossRef - International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Clinical Endoscopy.2024; 57(2): 141. CrossRef - IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
The Korean Journal of Gastroenterology.2024; 83(6): 217. CrossRef - International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Gut and Liver.2024; 18(5): 764. CrossRef - Novel drill dilator facilitates endoscopic ultrasound‐guided hepaticogastrostomy
Nozomi Okuno, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Masanori Yamada, Toshitaka Fukui
Digestive Endoscopy.2023; 35(3): 389. CrossRef - Response
Takeshi Ogura
Gastrointestinal Endoscopy.2023; 97(6): 1171. CrossRef - Rescue technique for bleeding after placement of plastic stent in EUS–guided hepaticogastrostomy (with videos)
Akihisa Ohno, Nao Fujimori, Noboru Harada
Endoscopic Ultrasound.2023; 12(3): 347. CrossRef - Adverse events with EUS-guided biliary drainage: a systematic review and meta-analysis
Suprabhat Giri, Babu P. Mohan, Vaneet Jearth, Aditya Kale, Sumaswi Angadi, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram
Gastrointestinal Endoscopy.2023; 98(4): 515. CrossRef - Endoscopic Ultrasound-Guided Biliary Interventions in Liver Disease
Shyam Vedantam, Sunil Amin
Clinics in Liver Disease.2022; 26(1): 101. CrossRef - B2 puncture with forward-viewing EUS simplifies EUS-guided hepaticogastrostomy (with video)
Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Masahiro Tajika, Tsutomu Tanaka, Sachiyo Onishi, Keisaku Yamada, Daiki Fumihara, Takafumi Yanaidani, Sho Ishikawa, Masanori Yamada, Tsukasa Yasuda, Moaz Elshair
Endoscopic Ultrasound.2022; 11(4): 319. CrossRef - The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome
Zhengwang Liu, Xiaotang Qiu, Hua Yang, Xiaocui Wu, Wenjing Ye, Xinbing Zheng, Li Yuan
Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef - Clopidogrel
Reactions Weekly.2022; 1936(1): 165. CrossRef
- The New Potential for Using Franseen Needles in Interventional EUS
- 7,910 View
- 142 Download
- 11 Web of Science
- 12 Crossref
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