Clinical Endoscopy

Review

Endoscopic retrograde cholangiopancreatography versus endoscopic ultrasound-guided primary biliary drainage for malignant distal biliary obstruction: a review: Shawn Chun Sum Teoh, Anthony Yuen Bun Teoh; Clin Endosc 2026;59(5):726-731. Published online September 14, 2026; DOI: https://doi.org/10.5946/ce.2026.122

Abstract PDF: Approximately 70% of pancreatic cancers arising in the head of the pancreas cause malignant distal biliary obstruction. Therefore, biliary drainage is an important aspect of the management of these patients. Conventionally, the technique for relieving biliary obstruction has been endoscopic retrograde cholangiopancreatography (ERCP). When ERCP cannot provide biliary drainage, such as in cases of failed cannulation, duodenal obstruction, or altered anatomy (e.g., after gastric bypass), endoscopic ultrasound-guided biliary drainage (EUS-BD) has been recommended by the American Society for Gastrointestinal Endoscopy as the preferred technique over percutaneous transhepatic biliary drainage for relieving biliary obstruction. Recently, EUS-BD has been explored as the primary technique for relieving biliary obstruction. The proposed benefits include higher technical success, shorter procedural time, a lower risk of pancreatitis, and longer stent patency. However, the results of randomized controlled studies have been conflicting. Hence, the aim of this article is to review the evidence from randomized controlled trials comparing EUS-BD with ERCP as the primary method of biliary drainage for malignant distal biliary obstruction.

689 View
82 Download

Original Articles

Development and preliminary evaluation of a novel low-cost endoscopic retrograde cholangiopancreatography simulator with electrocautery training capability: a proof-of-concept study from India: Avinash Tiwari, Duncan Khanikar; Clin Endosc 2026;59(5):806-820. Published online August 13, 2026; DOI: https://doi.org/10.5946/ce.2025.438

Graphical Abstract Abstract PDF Supplementary Material: Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) requires extensive training, with around 350–400 supervised cases being required for proficiency. Existing simulators face costs, limited availability, and limited realism. Therefore, we developed and preliminarily evaluated a minimal ERCP training model that incorporated electrocautery capabilities.
Methods
A five-phase development process was employed, including needs assessment, iterative prototyping with material optimization, technical performance testing across 50 training sessions, comparative analysis against existing simulators, and preliminary expert evaluation by eight experienced endoscopists (mean ERCP experience: 12.3±4.2 years). The primary outcomes included verification of functional capability, cost analysis, durability assessment, and expert ratings on 5-point Likert scales for realism and educational value.
Results
The simulator successfully achieved biliary cannulation in 48/50 sessions (96.0%), supported needle knife precut training with functional electrocautery, and demonstrated compatibility with C-arm fluoroscopy, providing adequate contrast visualization. The total material cost per unit was 47.32 United States dollars (USD), compared to 180,000–250,000 USD for commercial virtual reality simulators. The model withstood 50 sessions without structural failure (onion bulb replacement was required every 8.2±1.4 precut attempts). Expert ratings indicated high scores for anatomical realism (4.1±0.6), tactile feedback (3.9±0.7), and educational value (4.4±0.5).
Conclusions
This novel, low-cost ERCP simulator demonstrated technical feasibility and face validity. This proof-of-concept requires formal prospective validation studies to establish construct validity, concurrent validity, and educational effectiveness through trainee learning outcomes before conclusions regarding the impact on clinical training can be drawn. The innovation addresses significant accessibility barriers but represents preliminary evidence that requires formal educational validation.

1,086 View
129 Download

Predicting retention and rethinking removal of pancreatic duct stents with a standardized protocol: a United Statesbased retrospective study: Divyanshoo R. Kohli, Xiang Yu Gao, Wichit Srikureja, Jack Brandabur, Shih-Ting Chiu, Nishant Puri; Clin Endosc 2026;59(5):833-842. Published online August 13, 2026; DOI: https://doi.org/10.5946/ce.2025.327

Graphical Abstract Abstract PDF: Background
/Aims: Pancreatic duct (PD) stent selection impacts migration and retention. We evaluated risk factors for migration versus inappropriate retention of PD stents at a high volume center using a standardized stent management protocol.
Methods
Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) with PD stenting were retrospectively categorized by stent status at 2 weeks post-ERCP. Spontaneous migration was defined as absence of a PD stent on follow-up imaging, while inappropriate retention was defined as persistence of a non-flanged PD stent within the duct. The primary endpoint was PD stent retention at 2 weeks. Secondary endpoints included predictors of inappropriate retention and the need for endoscopic stent removal.
Results
A total of 482 patients underwent ERCP for biliary (n=289), pancreatic (n=181), or dual (n=12) indications. Non-flanged PD stents for biliary vs. pancreatic indications were 74.4% vs. 31.5% (p<0.001). Among 425 patients with follow-up imaging, predictors of PD stent retention included internal flanges (odds ratio [OR], 6.39; 95% confidence interval [CI], 3.29–12.67), pancreatic indication (OR, 2.23; 95%CI, 1.22–4.07), and stent length >3cm (OR, 2.5; 95% CI, 1.23–5.07). Inappropriate retention of non-flanged stents occurred in 29 patients (12.5%), with only 5 (2.2%) requiring endoscopic removal due to mechanical obstruction.
Conclusions
Inappropriate retention of short, narrow caliber, non flanged PD stents is infrequent and rarely requires endoscopic removal.

898 View
127 Download

Reviews

Endobiliary radiofrequency ablation for malignant biliary obstruction: clinical benefits, limitations, and future directions: Tadahisa Inoue, Huapyong Kang, Jae Hee Cho; Clin Endosc 2026;59(5):716-725. Published online July 1, 2026; DOI: https://doi.org/10.5946/ce.2025.475

Abstract PDF: Endobiliary radiofrequency ablation (EB-RFA) is an adjunctive local therapy performed during endoscopic biliary drainage for malignant biliary obstruction. EB-RFA was originally introduced to reduce the intraductal tumor burden and maintain biliary drainage, and has been investigated for its potential survival benefits, especially for patients with extrahepatic cholangiocarcinoma (eCCA). However, the available evidence shows heterogeneity, and recent large trials have reported neutral results. This review summarizes the current evidence regarding the clinical benefits and limitations of EB-RFA, focusing on its effects on survival and stent patency. Existing data suggest that the survival benefit associated with EB-RFA is greater in patients with eCCA without distant metastasis than in those with metastatic disease. Evidence of its efficacy in improving stent patency is inconsistent based on the findings of randomized trials. However, observational studies, particularly those involving uncovered self-expandable metal stents, have reported its benefits. EB-RFA may also be considered for reintervention in cases involving metal stents occluded due to tumor ingrowth; however, clinical success may be suboptimal due to imperfect tissue contact and technical factors. Future studies with standardized protocols and predefined subgroup analyses are required to define optimal candidates and clinically meaningful endpoints, especially in the context of evolving systemic therapy.

1,787 View
193 Download

Palliative endoscopic biliary drainage for malignant hilar biliary obstruction: Shuji Mitsuhashi, Manik Aggarwal, Vinay Chandrasekhara; Clin Endosc 2026;59(5):703-715. Published online March 31, 2026; DOI: https://doi.org/10.5946/ce.2025.395

Abstract PDF: Malignant hilar biliary obstruction (MHBO) is most commonly caused by cholangiocarcinoma or gallbladder cancer and frequently presents with obstructive jaundice, pruritus, and/or cholangitis. These symptoms impair performance status and delay the initiation of chemotherapy, making biliary drainage essential for both palliation and oncologic treatment. Endoscopic transpapillary biliary stenting via endoscopic retrograde cholangiopancreatography is the standard approach for biliary decompression. In patients with unresectable disease, either plastic or self-expandable metal stents may be used. Optimal outcomes are achieved when drainage encompasses more than 50% of functional liver volume, while atrophic segments should be avoided. When transpapillary access is not feasible or unsuccessful, alternative approaches such as percutaneous transhepatic biliary drainage or endoscopic ultrasound-guided biliary drainage may be considered. Adjunctive therapies, including photodynamic therapy and radiofrequency ablation, are being investigated to enhance local tumor control and prolong stent patency. With continued advances in stent technology, imaging modalities, and endoscopic techniques, the management of MHBO is expected to become increasingly individualized and effective.

4,408 View
378 Download

Systematic Review and Meta-analysis

Outcomes associated with bilateral plastic versus metal stents for palliation in malignant hilar biliary obstruction: an updated meta-analysis from the United States: Raveena S. Boodram, Shyam Vedantam, Sunil Amin, Sean Bhalla, Jodie A. Barkin, Mahmoud Mahfouz, Shria Kumar; Clin Endosc 2026;59(2):223-233. Published online March 9, 2026; DOI: https://doi.org/10.5946/ce.2025.149

Graphical Abstract Abstract PDF Supplementary Material: Background
/Aims: Endoscopic methods are favorable for palliation of malignant hilar biliary obstruction (MHBO) given its minimally invasive nature. This meta-analysis aimed to evaluate outcomes related to bilateral plastic stents (PS) versus bilateral metal stents (MS) in MHBO palliation.
Methods
Databases were searched through November 2023. Only studies that directly compared bilateral PS and bilateral MS in MHBO were included. The primary outcome was clinical success. Secondary outcomes included technical success, adverse events, postprocedural cholangitis, recurrent biliary obstruction, endoscopic reintervention, and conversion to percutaneous drainage. Mantel-Haenszel pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Statistical heterogeneity was assessed using the I2 statistic and publication bias was assessed using funnel plots.
Results
One randomized controlled trial and three retrospective cohort studies involving 420 patients were included. Bilateral MS had non-significant superior clinical success, lower rates of reintervention, and lower rates of adverse events, including postprocedural cholangitis. There was no difference in technical success or need for external drainage. Bilateral PS had increased odds of recurrent biliary obstruction (pooled OR, 1.79; 95% CI, 1.15-2.81; p=0.01).
Conclusions
The selection of bilateral PS or MS for MHBO palliation should remain an individualized decision.

2,015 View
72 Download

Original Article

A stepwise cannulation strategy for conservative endoscopists: the clinical impact of transpancreatic precut after pancreatic stenting in a retrospective study from Taiwan: Wei-Chih Su, Chia-Chi Wang, Tsung-Hsien Hsiao, Hung-Da Chen, Tzu-Hsiang Kung, Chih-Hsiang Chen, Jiann-Hwa Chen; Clin Endosc 2026;59(1):132-141. Published online January 12, 2026; DOI: https://doi.org/10.5946/ce.2025.241

Abstract PDF: Background
/Aims: Pancreatic stenting reduces post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and aids in cannulation in difficult cases. However, conservative endoscopists may stop at this step, resulting in suboptimal outcomes. This study assessed the efficacy of transpancreatic precut sphincterotomy (TPS) as a rescue procedure following pancreatic stenting.
Methods
Between March 2013 and November 2018, 82 patients underwent pancreatic stenting at our institution prior to successful biliary cannulation. TPS was introduced in April 2016, and patients were divided into Before TPS and After TPS groups. The outcomes included cannulation success, PEP incidence, and predictors of TPS conversion.
Results
There were 43 and 39 patients in the Before TPS and After TPS groups, respectively. Twenty-two patients (56.4%) underwent conversion to TPS in the After TPS group. The After TPS group had a higher bile duct cannulation rate (89.7% vs. 72.1%) than the Before TPS group, but this difference was not statistically significant (p=0.054). Multivariate analysis showed that age >50 years (odds ratio [OR], 0.181; p=0.021) and being in the After TPS group (OR, 0.712; p=0.039) were independently associated with reduced PEP risk. Haraldsson Type 2 and Type 4 papillae carried a relatively high TPS conversion rate.
Conclusions
A stepwise cannulation strategy that incorporates TPS after pancreatic stenting minimizes the need for advanced techniques and improves PEP outcomes.

2,074 View
68 Download
1 Web of Science

Systematic Review and Meta-analysis

Impact of body mass index on the outcomes of endoscopic retrograde cholangiopancreatography: a systematic review and network meta-analysis: Erfan Arabpour, Sina Khoshdel, Mehdi Azizmohammad Looha, Amir Sadeghi, Mohammad Abdehagh; Clin Endosc 2026;59(3):386-397. Published online January 9, 2026; DOI: https://doi.org/10.5946/ce.2025.255

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Obesity is an increasing health concern worldwide, and an elevated body mass index (BMI) may influence the outcomes of endoscopic retrograde cholangiopancreatography (ERCP). This systematic review and network meta-analysis aimed to investigate the association between BMI and ERCP outcomes.
Methods
A systematic search was performed using PubMed, Scopus, and Web of Science to identify relevant studies that reported clinical outcomes of ERCP in different BMI groups. Patients were categorized into five BMI-based following groups: underweight (BMI<18.5 kg/m²), normal weight (18.5 kg/m²≤BMI<25 kg/m²), overweight (25 kg/m²≤BMI<30 kg/m²), obesity (30 kg/m²≤BMI<40 kg/m²), and morbid obesity (40 kg/m²≤BMI).
Results
Among 3,001 unique citations, seven were included in the study. Meta-analysis revealed that obesity was not associated with an increased risk of post-ERCP pancreatitis (PEP) (odds ratio, 1.33; 95% confidence interval, 0.62–2.87). In the network analysis, none of the five BMI groups had a significantly higher risk of PEP than that of the other groups (p>0.05). Moreover, the BMI groups had similar rates of difficult cannulation, successful cannulation, complete stone extraction, and procedural success.
Conclusions
ERCP success and adverse events were similar among different BMI groups. Neither an elevated nor a low BMI was associated with an increased risk of PEP. Further large-scale prospective studies are required to validate these findings.

Citations

Citations to this article as recorded by

Impacts of obesity on the outcomes of endoscopic retrograde cholangiopancreatography: A propensity score-matched analysis
Erfan Arabpour, Amir Sadeghi, Pardis Ketabi Moghadam, Mohammad Abdehagh, Mohammad Reza Zali
Arab Journal of Gastroenterology.2026; 27(3): 361. CrossRef

2,785 View
176 Download
1 Web of Science
1 Crossref

Original Articles

Feasibility of pancreatic duct stent placement before endoscopic submucosal dissection for superficial duodenal neoplasms adjacent to the papilla: Ryosuke Kobayashi, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Masafumi Nishio, Chiko Sato, Haruo Miwa, Kazuya Sugimori, Shin Maeda; Clin Endosc 2026;59(1):89-95. Published online December 31, 2025; DOI: https://doi.org/10.5946/ce.2025.197

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging and is associated with a risk of adverse events, particularly when lesions are located near the major papilla. Pancreatic duct (PD) stent may reduce the risk of post-ESD pancreatitis; however, no standard strategy has been established. This study aimed to evaluate the effectiveness and safety of PD stent placement combined with ESD for SNADETs near the major papilla.
Methods
This was a retrospective study of duodenal ESD after prophylactic PD stent placement in patients with SNADET near the major papilla at a university hospital between March 2014 and September 2023.
Results
Four lesions were located within 5 mm of the major papilla, and seven within 5 to 10 mm. The median interval between stent placement and ESD was 2 days. The en bloc and R0 resection rates were 100% and 90.9%, respectively. No stent migration occurred during ESD, and all mucosal defects were completely closed using endoscopic clips. Delayed bleeding and post-ESD pancreatitis were observed in one and two cases, respectively.
Conclusions
PD stent placement combined with ESD is an effective treatment strategy for SNADETs near the major papilla. However, the risk of post-ESD pancreatitis remains, indicating the need for further preventive strategies.

Citations

Citations to this article as recorded by

Duodenal Laparoscopy and Endoscopy Cooperative Surgery Combined With Endoscopic Nasopancreatic Drainage and Endoscopic Nasobiliary Drainage for a Duodenal Adenoma Near the Papilla of Vater: A Case Report
Keisuke Manaka, Hiroki Harada, Takuya Wada, Gen Kitahara, Kosuke Okuwaki, Kota Okuno, Shohei Fujita, Tadashi Higuchi, Koshi Kumagai, Naoki Hiki
DEN Open.2027;[Epub] CrossRef
Reducing post-endoscopic submucosal dissection pancreatitis in periampullary duodenal lesions: the role of prophylactic pancreatic duct stenting
Ari Fahrial Syam
Clinical Endoscopy.2026; 59(1): 70. CrossRef
Management of non-ampullary duodenal adenomas
Gaurav B Nigam, Yash Kanani, Amol Bapaye, Pradeep Mundre
Frontline Gastroenterology.2026; 17(e1): e48. CrossRef

2,910 View
91 Download
3 Web of Science
3 Crossref

Efficacy of double half-pigtail plastic stents for endoscopic biliary drainage of acute calculous cholangitis: Toshitaka Sakai, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Kento Hosokawa, Hidehito Sumiya, Jun Horaguchi, Masaya Oikawa, Takashi Tsuchiya, Yutaka Noda, Kei Ito; Clin Endosc 2025;58(6):898-908. Published online November 11, 2025; DOI: https://doi.org/10.5946/ce.2025.134

Graphical Abstract Abstract PDF

Background
/Aims: Plastic stent placement is required when biliary stones cannot be completely removed during the initial endoscopic retrograde cholangiopancreatography (ERCP). Although double half-pigtail plastic stents (DHPs) help prevent stent migration, their clinical utility has not yet been evaluated.
Methods
We retrospectively reviewed data from 221 patients who underwent DHP placement for acute calculous cholangitis (ACC) between January 2015 and March 2024. Patient without complete stone removal during initial ERCP were included. Clinical success, adverse events, recurrent biliary obstruction (RBO), and time to RBO (TRBO) were compared in 21 patients treated with straight plastic stents (STs) under similar conditions.
Results
Clinical success was achieved in 99% of patients in the DHP group and 95% of the ST group (p=0.13). Adverse event rates were comparable between groups. During follow-up, the DHP group had significantly lower stent occlusion (2% vs. 20%, p<0.01) and migration rates (4% vs. 15%, p=0.02), leading to a lower RBO rate (5% vs. 35%, p<0.01). The median TRBO was significantly longer in the DHP group (585 vs. 247 days, p<0.01).
Conclusions
DHPs had comparable efficacy to STs, with significantly fewer stent-related adverse events. This may be a potential option for biliary drainage in ACC.

Citations

Citations to this article as recorded by

Clinical Outcomes of Double Half‐Pigtail Versus Straight Plastic Stents for Endoscopic Biliary Drainage of Malignant Distal Biliary Obstruction
Wataru Yoshioka, Mutsumi Tasaki, Hinata Tasaki, Hikaru Fujimoto, Shuzo Yunotani, Chika Inadomi, Shotaro Noge, Yoshihito Kubotsu, Futa Koga
DEN Open.2027;[Epub] CrossRef

3,600 View
79 Download
1 Web of Science
1 Crossref

Incidence and risk factors for recurrence of common bile duct stones in patients undergoing endoscopic extraction without prophylactic biliary stenting and subsequent cholecystectomy: a retrospective study in Japan: Hidehito Sumiya, Takahisa Ogawa, Shinsuke Koshita, Yoshihide Kanno, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Kei Ito; Clin Endosc 2026;59(1):124-131. Published online October 24, 2025; DOI: https://doi.org/10.5946/ce.2025.081

Graphical Abstract Abstract PDF

Background
/Aims: In patients undergoing endoscopic extraction of common bile duct stones (CBDs) and subsequent cholecystectomy, CBDs sometimes recur during the preoperative and perioperative periods. In this study, the incidence and risk factors for CBDs recurrence were investigated.
Methods
A total of 245 patients (mean age: 66 years; 138 men) who underwent cholecystectomy within 180 days of CBDs extraction between October 2017 and June 2023 were included. Recurrence was defined as the detection of the CBDs during the preoperative or perioperative period using imaging modalities such as computed tomography or re-endoscopic retrograde cholangiopancreatography, regardless of the presence of cholangitis.
Results
CBDs recurrence occurred in 4.1% of the patients (10/245). The median time to recurrence was 40 days. Preoperative recurrence was observed in nine patients, and only one patient had postoperative recurrence. Multivariate analysis identified cystic duct stones as the only significant risk factor for CBDs recurrence (hazard ratio, 15.6; 95% confidence interval, 3.7–66; p<0.001).
Conclusions
The risk of CBDs recurrence after endoscopic extraction during the pre and perioperative periods is high in patients with cystic duct stones. Prophylactic biliary stenting may be considered in high-risk patients.

Citations

Citations to this article as recorded by

Balancing surgical timing and risk stratification to prevent recurrent common bile duct stones after bile duct clearance
Sung Bum Kim
Clinical Endoscopy.2026; 59(1): 76. CrossRef
Biliary Fistula at the Margin of Liver Caused by New Common Bile Duct Stones after Hepatectomy: A Case Report and Literature Review of Bile Leakage after Liver Surgery
勇李
Asian Case Reports in Emergency Medicine.2026; 14(01): 113. CrossRef

4,457 View
192 Download
1 Web of Science
2 Crossref

Systematic Review and Meta-analysises

Safety and efficacy of primary precut techniques for biliary cannulation: a systematic review and meta-analysis: Eugene Annor, Nneoma Ubah, Dhaval Save, Ishaan Vohra, Ritu Raj Singh, Dushyant Singh Dahiya, Bhanu Siva Mohan Pinnam, Harishankar Gopakumar; Clin Endosc 2026;59(1):58-66. Published online October 10, 2025; DOI: https://doi.org/10.5946/ce.2025.110

Graphical Abstract Abstract PDF

Background
/Aims: Biliary cannulation is a critical component of endoscopic retrograde cholangiopancreatography (ERCP). When standard methods fail, needle-knife precut sphincterotomy (NKPS) is commonly employed. This systematic review and meta-analysis evaluated the safety and efficacy of using NKPS as a primary technique.
Methods
Electronic databases were searched for studies published between January 2000 and November 2024 that assessed outcomes of primary precut techniques. “Primary precut” was defined as needle-knife sphincterotomy performed as the initial approach without any prior standard cannulation attempts. Pooled proportions were calculated using random-effects models, and heterogeneity was assessed using the Q-test and the I² statistic.
Results
The mean patient age was 57.95 years (standard deviation [SD], 7.59), and 53.23% were female. The cannulation success rate was 96.50% (95% confidence interval [CI], 94.90–97.60) with no heterogeneity (Q, 7.10; df, 8; I²=0%; p=0.935). The rates of adverse events were as follows: post-ERCP pancreatitis, 1.90% (95% CI, 1.20–3.10; I²=0; p =0.942); bleeding, 2.60% (95% CI, 1.70–4.00, I²=0; p=0.725); cholangitis, 1.50% (95% CI, 0.60–3.60; I²=45.27; p=0.067); and perforation, 0.90% (95% CI, 0.40–1.90; I²=0; p=0.948). The overall adverse event rate was 9.70% (95% CI, 5.70–16.10; I²=83.39; p<0.001).
Conclusions
Primary precut sphincterotomy appears to be an effective and safe technique for biliary cannulation in ERCP. These findings support its consideration as a viable first-line approach in appropriate clinical settings.

Citations

Citations to this article as recorded by

Needle-knife precut techniques as the initial approach for biliary cannulation: is the evidence sufficient?
Erfan Arabpour, Amir Sadeghi
Clinical Endoscopy.2026; 59(3): 483. CrossRef

4,472 View
284 Download
2 Web of Science
1 Crossref

Comparative efficacy and safety of supine versus prone positioning in endoscopic retrograde cholangiopancreatography: a systematic review and meta-analysis: Fariha Hasan, Muhammad Shahzil, Ayesha Liaquat, Taha Bin Arif, Muhammad Yafaa Naveed Chaudhary, Eugene Annor, Dushyant Singh Dahiya, Jay Patel, Rohini Maddigunta, Avneet Singh, Alexander Garcia, Babu P. Mohan, Rachel Frank, Adib Chaaya; Clin Endosc 2025;58(6):843-853. Published online August 26, 2025; DOI: https://doi.org/10.5946/ce.2025.072

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is conventionally performed in the prone position (PP). Recent studies have shown that the supine position (SP) is an effective alternative, with comparable success rates. We conducted a meta-analysis to directly compare the safety and efficacy of the two ERCP positions.
Methods
In line with Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed through a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library. Statistical analyses were performed using RevMan, with results considered significant at p<0.05 and reported as odds ratios (ORs) and mean differences (MDs).
Results
Eleven studies (24,285 patients) were included in the final analysis. Procedural success was significantly higher in the PP (OR, 0.52; 95% confidence interval [CI], 0.36–0.75; p<0.0004) than the SP. However, no significant difference was observed in procedure times (MD, 0.22; 95% CI, –7.07 to 7.50; p=0.95), number of cardiopulmonary complications (OR, 1.08; 95% CI, 0.47–2.48; p=0.86), or post-ERCP pancreatitis (OR, 1.12; 95% CI, 0.52–2.42; p=0.31) between the two groups.
Conclusions
The PP demonstrates superior ERCP success compared to the SP, without prolonging procedure time or increasing the risk of adverse events. However, given the comparable procedure times, incidence of adverse events, and increased comfort for both patients and anesthesiologists, the SP may be a suitable alternative for a select group of patients in whom the PP is not feasible, such as those with morbid obesity or recent abdominal surgery.

Citations

Citations to this article as recorded by

Sedation Safety in Advanced Endoscopy: A Comparative Analysis of ERCP and EUS Procedures
Ali Ümit Eşbah, Serkan Torun
Sağlık Bilimlerinde Değer.2026; 16(3): 520. CrossRef

5,224 View
185 Download
1 Crossref

Original Article

Efficacy of multi-hole self‑expandable metallic stents versus partially covered self‑expandable metallic stents in patients with malignant distal biliary obstruction caused by unresectable pancreatic cancer: a retrospective comparative cohort study in Japan: Shohei Asada, Koh Kitagawa, Fumimasa Tomooka, Jun-ichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Kosuke Kaji, Akira Mitoro, Hitoshi Yoshiji; Clin Endosc 2025;58(5):744-756. Published online August 26, 2025; DOI: https://doi.org/10.5946/ce.2024.340

Graphical Abstract Abstract PDF

Background
/Aims: This study aimed to compare the stent patency between the novel multi-hole self-expandable metallic stent (MH-SEMS) and conventional partially covered SEMS (PC-SEMS) for malignant distal biliary obstruction (MDBO) in patients with pancreatic carcinoma.
Methods
This retrospective study compared stent patency between patients with MH-SEMS (n=43) and those with PC-SEMS (n=94). Secondary outcomes were overall survival (OS), incidence of recurrent biliary obstruction (RBO), causes of RBO, and adverse events (AEs).
Results
The median time to RBO did not differ significantly between the MH-SEMS and PC-SEMS groups (318 vs. 460 days, p=0.17). Furthermore, the two groups did not differ significantly in terms of OS and incidence rate of AEs, including RBO and cholecystitis. RBO caused by tumor ingrowth was slightly more common in the MH-SEMS group (p=0.089). The MH-SEMS group had a slightly lower 12-month non-obstruction rate than the PC-SEMS group (33.9% vs. 60.9%). In the MH-SEMS group, stent removal was successful in all seven patients in whom it was attempted.
Conclusions
The clinical outcomes of MH-SEMS and PC-SEMS were similar in patients with MDBO caused by pancreatic carcinoma were similar.

Citations

Citations to this article as recorded by

Clinical Outcomes of Multi‐Hole Covered Self‐Expandable Metal Stents for Malignant Distal Biliary Obstruction: A Retrospective Comparative Study With an Exploratory Evaluation of 6‐mm Devices
Akinobu Koiwai, Yuki Miyashita, Nana Inomata, Takehito Ito, Morihisa Hirota, Kennichi Satoh
DEN Open.2027;[Epub] CrossRef
Multi-Hole Self-Expandable Metallic Stent for Malignant Distal Biliary Obstruction: A Literature Review
Koh Kitagawa, Shohei Asada, Jun-ichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Akira Mitoro, Hitoshi Yoshiji
Journal of Clinical Medicine.2026; 15(4): 1410. CrossRef
Efficacy of fully covered self-expanding metal stents removal versus stent-in-stent techniques in recurrent malignant distal biliary obstruction
See Young Lee, Sung Ill Jang, Eui Joo Kim, Dong Ki Lee, Seoyeon Cho, Yeseul Seong, Jung Hyun Jo, Chan Min Jung, In Rae Cho, Woo Hyun Paik, Ji Kon Ryu, Hyun Seok Lee, Sang Hyub Lee, Jae Hee Cho
Scientific Reports.2026;[Epub] CrossRef
A New Strategy to Prolong Covered Self-Expanding Metal Stent Patency in Distal Malignant Biliary Obstruction
Eui Joo Kim, Yun Nah Lee
The Korean Journal of Pancreas and Biliary Tract.2026; 31(2): 76. CrossRef
Incidence of Cholecystitis after Multihole Fully Covered Metal Stent Placement for Unresectable Malignant Distal Biliary Obstruction: A Prospective Exploratory Study
Junro Ishizaki, Kosuke Okuwaki, Masafumi Watanabe, Hiroki Haradome, Kai Adachi, Akihiro Tamaki, Taro Hanaoka, Daisuke Ogawa, Hiroshi Imaizumi, Mitsuhiro Kida, Chika Kusano
Journal of Digestive Endoscopy.2026;[Epub] CrossRef
Advancements in stent strategies for malignant distal biliary obstruction: defining the clinical role of multi-hole self-expandable metal stents
Sung Yong Han
Clinical Endoscopy.2025; 58(5): 698. CrossRef
Endoscopic biliary drainage with multi-hole self-expandable metallic stent during neoadjuvant chemoradiotherapy in pancreatic cancer
Shohei Asada, Koh Kitagawa, Junichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Kosuke Kaji, Akira Mitoro, Minako Nagai, Hitoshi Yoshiji, Masayuki Sho
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef

5,026 View
162 Download
5 Web of Science
7 Crossref

Reviews

Endoscopic approach to indeterminate biliary strictures: Yousuke Nakai, Ryunosuke Hakuta, Yutaka Shimamatsu, Nao Otsuka, Yukiko Takayama; Clin Endosc 2026;59(1):40-48. Published online July 1, 2025; DOI: https://doi.org/10.5946/ce.2025.052

Abstract PDF

Diagnosis of biliary strictures remains challenging because of the low sensitivity of conventional transpapillary sampling using endoscopic retrograde cholangiopancreatography. New devices and tips have been developed to increase the diagnostic yield of conventional transpapillary sampling. However, additional endoscopic procedures are often necessary for indeterminate biliary strictures. Two major approaches for indeterminate biliary strictures are endoscopic ultrasonography-guided sampling and peroral cholangioscopy (POCS)-guided biopsy. The selection of modalities should be considered based on the stricture location. Although endoscopic ultrasound is the preferred approach for distal biliary strictures, POCS is preferred for perihilar biliary strictures. Endoscopic ultrasonography-guided sampling is highly sensitive in cases with a mass, but the sensitivity of POCS-guided biopsies is unsatisfactory, and discrepancy with the visual diagnosis of POCS is common. Whether these advanced techniques should be performed as the initial procedure or as a rescue after a failed diagnosis by conventional transpapillary sampling needs to be clarified in terms of diagnostic yield and cost-effectiveness.

Citations

Citations to this article as recorded by

Methods improving endoscopic retrograde cholangiopancreatography brush cytology in malignant biliary strictures
Kleoniki Kordeni, Antonios Vezakis, Theodoros Voulgaris, Athina Sotirianakou, Ekaterini Politi, Maria Gazouli
World Journal of Gastroenterology.2026;[Epub] CrossRef
Cholangioscopy-guided ERCP: expanding diagnostic and therapeutic applications
Shengjie Yang, Hongyu Li
Frontiers in Medicine.2026;[Epub] CrossRef

6,635 View
550 Download
3 Web of Science
2 Crossref

Peroral cholangioscopy: past, present and future: Yuki Tanisaka, Robert Hawes; Clin Endosc 2025;58(3):360-369. Published online May 19, 2025; DOI: https://doi.org/10.5946/ce.2024.306

Abstract PDF

Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for the evaluation of biliary strictures and the management of bile duct stones. However, standard ERCP techniques sometimes fail for both indications. In such situations, peroral cholangioscopy (POCS), which allows direct visualization of the bile duct, can play a significant role in diagnosis and treatment. Direct visualization using POCS can help differentiate between malignant and benign conditions and is more accurate in defining the extent of cholangiocarcinoma. Furthermore, POCS enables visually guided biopsies. Certain types of difficult bile duct stones, such as impacted and intrahepatic stones, require POCS for visually guided lithotripsy. Recent advancements in POCS will broaden its applicability and improve its diagnostic utility. In this review, we provide perspectives on the past, present, and future of POCS.

Citations

Citations to this article as recorded by

Clinical Utility and Safety of a Novel Ultraslim Catheter‐Type Peroral Cholangioscope/Pancreatoscope: A Single‐Center Case Series
Hiroyuki Kojima, Shuntaro Mukai, Atsushi Sofuni, Takayoshi Tsuchiya, Reina Tanaka, Ryosuke Tonozuka, Kazumasa Nagai, Yukitoshi Matsunami, Hirohito Minami, Noriyuki Hirakawa, Kyoko Asano, Kento Shionoya, Kazuki Hama, Takao Itoi
DEN Open.2027;[Epub] CrossRef
Clinical Application of Ultra‐Slim Peroral Cholangioscopy for a Giant Common Bile Duct Stone: An Initial Experience
Yuta Kanazawa, Kazumasa Nagai, Noriyuki Hirakawa, Reina Tanaka, Ryosuke Tonozuka, Shuntaro Mukai, Yukitoshi Matsunami, Takao Itoi
Journal of Hepato-Biliary-Pancreatic Sciences.2026;[Epub] CrossRef
A novel sheath system to improve target access for preoperative mapping biopsy: A randomized trial to inform surgical planning
Hironori Aoi, Kentaro Yamao, Takuya Ishikawa, Yasuyuki Mizutani, Tadashi Iida, Kota Uetsuki, Yoshihisa Takada, Takeshi Yamamura, Kazuhiro Furukawa, Masanao Nakamura, Hiroki Kawashima
Surgical Endoscopy.2026; 40(3): 2268. CrossRef
Predictive factors for the necessity of peroral cholangioscopy-guided lithotripsy in the endoscopic treatment of cystic duct confluence stones: a retrospective study in Japan
Kazuaki Miyamoto, Takahisa Ogawa, Shinsuke Koshita, Yoshihide Kanno, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Fumisato Kozakai, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Kei Ito
Clinical Endoscopy.2026; 59(2): 280. CrossRef
Diagnostic Utility of Digital Single-Operator Cholangioscopy for Risk-Enriched Detection and Surveillance of Intraductal Neoplasms of the Bile Duct: SPY-SCREEN Study (with Videos)
Il Sang Shin, Jong Ho Moon, Yun Nah Lee, Jae Woo Park, Jun Chul Chung, Hee Kyung Kim, Tae Hoon Lee, Jae Kook Yang, Young Deok Cho, Sang-Heum Park
Digestive Diseases and Sciences.2026; 71(9): 4163. CrossRef
Endoscopic Technology for Diagnosis of Biliary Stricture with a Focus on Peroral Cholangioscopy: Challenges in Peroral Cholangioscopy-Based Management
Ko Tomishima, Hiroyuki Isayama, Toshio Fujisawa, Yusuke Takasaki, Taito Fukuma, Sho Takahashi, Shigeto Ishii
The Korean Journal of Pancreas and Biliary Tract.2026; 31(2): 42. CrossRef
Holmium Laser Lithotripsy for Pancreatobiliary Stones: Clinical and Regulatory Perspectives after New Technology Approval
Hyung Ku Chon, Se Woo Park
The Korean Journal of Pancreas and Biliary Tract.2026; 31(2): 73. CrossRef
Endoscopic Management of Pancreatobiliary Diseases in Patients with Surgically Altered Anatomy: A Perspective from Single-Balloon Enteroscopy
Yuki Tanisaka, Shomei Ryozawa, Masafumi Mizuide, Akashi Fujita, Suguru Ito, Ryuichi Watanabe, Ryosuke Hamamura, Yoshiki Matsuno
Digestion.2026; : 1. CrossRef
Comparison of EUS-guided treatment and balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography for large bile duct stone removal in patients with surgically altered anatomy: A multicenter study
Ryota Sagami, Kiyoyuki Kobayashi, Makoto Hinokuchi, Kosuke Takahashi, Eisuke Ozawa, Takehiko Koga, Yusuke Ishida, Shotaro Kakehashi, Nao Fujimori, Yasuhisa Hiroshima, Issei Kojima, Hideki Mori, Naosuke Kuraoka, Hidefumi Nishikiori, Kazunari Murakami, Kazu
Endoscopic Ultrasound.2026; 15(3): 191. CrossRef
Cholangioscopy-guided ERCP: expanding diagnostic and therapeutic applications
Shengjie Yang, Hongyu Li
Frontiers in Medicine.2026;[Epub] CrossRef
Feasibility of ex vivo single-operator cholangioscopy in liver grafts
Jimin Han
Clinical Endoscopy.2026; 59(5): 868. CrossRef
Research Progress in the Diagnosis and Treatment of Intrahepatic Bile Duct Stones
道文熊
Advances in Clinical Medicine.2025; 15(09): 783. CrossRef

9,049 View
372 Download
11 Web of Science
12 Crossref

Systematic Review and Meta-Analysis

Endoscopic ultrasound-guided biliary drainage versus endoscopic retrograde cholangiopancreatography biliary drainage in the palliative management of malignant distal biliary obstruction: an updated systematic review and meta-analysis of randomized controlled trials: Spyros Peppas, Advait Suvarnakar, Bara A. Abujaber, Nadera Altork, Amer Arman, Sayel Alzraikat, Akram I. Ahmad, Camille Boustani, Won Kyoo Cho; Clin Endosc 2025;58(3):386-397. Published online May 9, 2025; DOI: https://doi.org/10.5946/ce.2024.155

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Evidence suggests comparable outcomes between endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in the biliary drainage of malignant distal biliary obstruction (MDBO). We conducted an updated systematic review and meta-analysis comparing the EUS with ERCP in the management of MDBO.
Methods
We performed a literature search using the Medline, Embase and Cochrane databases, including randomized controlled trials comparing EUS and ERCP in patients with MDBO. Meta-analysis was performed using the random-effects model using the STATA ver. 17.0 software.
Results
Both procedures were comparable in technical (risk ratio [RR], 1.01; 95% confidence interval [CI], 0.78–1.30) and clinical (RR, 1.10; 95% CI, 0.85–1.41) success. No difference was identified in total adverse events (RR, 0.75; 95% CI, 0.42–1.35), acute cholangitis (RR, 0.84; 95% CI, 0.43–1.62), stent patency (RR, 1.13; 95% CI, 0.87–1.46) and mean stent patency time (mean difference, –0.01; 95% CI: –0.21 to 0.19). ERCP was associated with a higher risk of procedure-related pancreatitis (RR, 0.17; 95% CI, 0.04–0.68) and statistically non-significant higher risk for reintervention (RR, 0.61; 95% CI, 0.37–1.01).
Conclusions
Although EUS and ERCP were comparable in terms of efficacy and safety, ERCP was associated with a higher risk of procedure-related pancreatitis and reintervention, with the latter finding not reaching statistical significance.

Citations

Citations to this article as recorded by

Clinical Outcomes and Complications of Endoscopic Biliary Stenting for Malignant Distal Biliary Obstruction in Pancreatic Cancer: A Systematic Review
Nurken Abdiyev, Nurlan Jaxymbayev, Melis Maira, Medet Rakhmetov, Almas Ismailov, Abdykadyrov Mazhit, Yerlan Abdirashev, Berik Dzhumabekov
Journal of Clinical Medicine.2026; 15(8): 3126. CrossRef
Clinical vulnerability to chemotherapy in cholangiocarcinoma: impact of nutritional status, frailty, and systemic inflammation
Ho Seung Lee, Woo Joo Lee, Jae Min Lee, Han Jo Jeon, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yoon Tae Jeen
Supportive Care in Cancer.2026;[Epub] CrossRef

5,991 View
195 Download
2 Web of Science
2 Crossref

Systematic Review and Meta-analysis

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; Clin Endosc 2025;58(4):533-543. Published online February 24, 2025; DOI: https://doi.org/10.5946/ce.2024.183

Graphical Abstract Abstract PDF Supplementary Material

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.

Citations

Citations to this article as recorded by

Reply
Joan B. Gornals, Albert Sumalla-Garcia, Carme Loras
Clinical Gastroenterology and Hepatology.2026; 24(4): 1203. CrossRef
Biliary Drainage in Altered Anatomy: A Comprehensive Literature Review
Rishi Chowdhary, Jorge D. Machicado, Veeral M. Oza
Journal of Digestive Endoscopy.2026;[Epub] CrossRef
A Time-Based and Clinical Status Stratified Protocol for Major Bile Duct Injury After Cholecystectomy: Retrospective, Single-Center Outcomes From a Resource-Limited Setting
Ahmed Ateik, Saif A Ghabisha, Lamia Abdulmughni, Fares Awn
Cureus.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
Endoscopic Ultrasound-Guided Versus Percutaneous Transhepatic Biliary Drainage After Failed Endoscopic Retrograde Cholangiopancreatography in Malignant Biliary Obstruction: A Single-Center Retrospective Cohort
Wojciech Ciesielski, Łukasz Durko, Ludomir Stefańczyk, Adam Dobek, Anna Bulicz, Amelia Wojnicka, Zuzanna Sosnowska, Agata Grochowska, Janusz Strzelczyk, Piotr Hogendorf, Adam Durczyński, Tomasz Klimczak
Cancers.2026; 18(5): 783. CrossRef
Role of Endoscopy in Malignant Biliary Obstruction
Ishaan Vohra, Burraq Imran, Zubair Khan, Muhammad Hasan
Diagnostics.2026; 16(5): 721. CrossRef
Case Report: Unexpected LAMS obstruction following successful EUS-BD in a patient with pancreatic carcinoma
Xuxia He, Kun He, Qiang Wang
Frontiers in Surgery.2026;[Epub] CrossRef
EUS-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed ERCP in oncological patients: a 10-year retrospective comparison
P Alves, L Lenz, C Clemente, I Kristal, M Beltrami, AD P Gustavo, B Costa Martins, A Safatle-Ribeiro, F Maluf-Filho
Endoscopy.2026; 58(S 03): S634. CrossRef
Endoscopic Ultrasound-Guided Choledochoduodenostomy With Lumen-Apposing Metal Stents: Here to Stay, But All That Glitters Is Not Gold
Joan B. Gornals, Manuel Perez-Miranda, Carme Loras
Gastroenterology.2026; 171(3): 568. CrossRef

10,828 View
467 Download
8 Web of Science
9 Crossref

Original Articles

Endoscopic ultrasound-guided hepaticogastrostomy and endoscopic retrograde cholangiopancreatography-guided biliary drainage for distal malignant biliary obstruction due to pancreatic cancer with asymptomatic duodenal invasion: a retrospective, single-center study in Japan: Naminatsu Takahara, Yousuke Nakai, Kensaku Noguchi, Tatsunori Suzuki, Tatsuya Sato, Ryunosuke Hakuta, Kazunaga Ishigaki, Tomotaka Saito, Tsuyoshi Hamada, Mitsuhiro Fujishiro; Clin Endosc 2025;58(1):134-143. Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.031

Graphical Abstract Abstract PDF

Background
/Aims: Duodenal invasion (DI) is a risk factor for early recurrent biliary obstruction (RBO) in endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) may reduce early RBO in cases of asymptomatic DI, even when ERCP is possible.
Methods
We enrolled 56 patients with pancreatic cancer and asymptomatic DI who underwent EUS-HGS (n=25) or ERCP-BD (n=31). Technical and clinical success, early (<3 months) and overall RBO rates, time to RBO (TRBO), and adverse events were compared between the EUS-HGS and ERCP-BD groups. Risk factors for early RBO were also evaluated.
Results
Baseline characteristics were similar between the groups. Both procedures demonstrated 100% technical and clinical success rates, with a similar incidence of adverse events (48% vs. 39%, p=0.59). While the median TRBO was comparable (5.7 vs. 8.8 months, p=0.60), EUS-HGS was associated with a lower incidence of early RBO compared to ERCP-BD (8% vs. 29%, p=0.09). The major causes of early RBO in ERCP-BD were sludge and food impaction, rarely occurring in EUS-HGS. EUS-HGS was potentially reduced early RBO (odds ratio, 0.32; p=0.07).
Conclusions
EUS-HGS can be a viable option for treating pancreatic cancer with asymptomatic DI.

Citations

Citations to this article as recorded by

Long‐anchoring Stent Method as a Rescue Technique for Early Dysfunction of Covered Self‐Expandable Metal Stents in Distal Malignant Biliary Obstruction: A Retrospective Case Series
Takumi Kinomoto, Yugo Kai, Minoru Shigekawa, Kenji Ikezawa, Takuo Yamai, Hiroki Takiyama, Taku Miyanaga, Takanori Masumoto, Keita Sekiya, Jun Murata, Makiko Urabe, Ryoji Takada, Kaori Mukai, Tasuku Nakabori, Kazuyoshi Ohkawa
DEN Open.2027;[Epub] CrossRef
Endoscopic Retrograde Cholangiopancreatography‐guided Biliary Drainage with Duckbill‐type Anti‐reflux Metal Stent versus Endoscopic Ultrasound‐guided Hepaticogastrostomy for Malignant Distal Biliary Obstruction in Pancreatic Cancer with Duodenal Invasion
Tsuyoshi Takeda, Takashi Sasaki, Tatsuki Hirai, Yoichiro Sato, Yuri Maegawa, Takafumi Mie, Takaaki Furukawa, Yukari Suzuki, Takeshi Okamoto, Masato Ozaka, Naoki Sasahira
DEN Open.2026;[Epub] CrossRef
Impact of Peri‐Procedural Antibiotics on Post‐ERCP Infectious Adverse Events With Distal Malignant Biliary Obstruction
Tatsunori Satoh, Haruna Takahashi, Eiji Nakatani, Yosuke Kobayashi, Fumitaka Niiya, Junichi Kaneko, Kazuma Ishikawa, Kenta Ito, Tetsushi Azami, Jun Noda, Shinya Kawaguchi
Journal of Gastroenterology and Hepatology.2026; 41(2): 696. CrossRef
Endoscopic Ultrasound‐Guided Hepaticogastrostomy With Plastic Stents in Comparison to Transpapillary Drainage With Metallic Stents for Unresectable Malignant Distal Biliary Obstructions
Hidehito Sumiya, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Kento Hosokawa, Shun Nozaki, Kei Ito
DEN Open.2026;[Epub] CrossRef
Update on biliary endoscopy: a comprehensive review
Yukiko Takayama, Yousuke Nakai, Ryunosuke Hakuta, Ryota Nakabayashi, Nao Otsuka, Noriko Ishigaki, Masataka Kikuyama
Expert Review of Gastroenterology & Hepatology.2026; 20(5): 485. CrossRef
Role of Endoscopic Ultrasonography in Management of Pancreaticobiliary Cancers: Recent Trends and Advances
Shivangini Duggal, Mutaz Kalas, Mohamed H. Eldesouki, M. Ammar Kalas, Sherif E. Elhanafi
Cancers.2026; 18(12): 1864. CrossRef
Latest advancements in endoscopic palliative care for patients with pancreatic cancer
Raquel Gonçalves, Joel Silva, Eduardo Rodrigues-Pinto
Clinical Endoscopy.2026; 59(4): 497. CrossRef
Biliary drainage in pancreatic cancer with duodenal invasion: which route is the best?
Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek
Clinical Endoscopy.2025; 58(1): 82. CrossRef
EUS-Guided Gallbladder Drainage of Inoperable Malignant Distal Biliary Obstruction by Lumen-Apposing Metal Stent: Systematic Review and Meta-Analysis
Tawfik Khoury, Moaad Farraj, Wisam Sbeit, Pietro Fusaroli, Giovanni Barbara, Cecilia Binda, Carlo Fabbri, Maamoun Basheer, Sarah Leblanc, Fabien Fumex, Rodica Gincul, Anthony Yuen Bun Teoh, Jérémie Jacques, Bertrand Napoléon, Andrea Lisotti
Cancers.2025; 17(12): 1983. 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

7,100 View
387 Download
11 Web of Science
10 Crossref

Synergistic effect of independent risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis: a multicenter retrospective study in Japan: Hirokazu Saito, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Masayoshi Uehara, Ikuo Matsushita, Tatsuyuki Kakuma, Shunpei Hashigo, Shuji Tada; Clin Endosc 2024;57(4):508-514. Published online April 18, 2024; DOI: https://doi.org/10.5946/ce.2023.203

Graphical Abstract Abstract PDF

Background
/Aims: This study aimed to examine the synergistic effect of independent risk factors on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).
Methods
This multicenter retrospective study included 1,273 patients with native papillae who underwent ERCP for bile duct stones in Japan. Independent PEP risk factors were identified using univariate and multivariate analyses. Significant risk factors for PEP in the multivariate analysis were included in the final analysis to examine the synergistic effect of independent risk factors for PEP.
Results
PEP occurred in 45 of 1,273 patients (3.5%). Three factors including difficult cannulation ≥10 minutes, pancreatic injection, and normal serum bilirubin level were included in the final analysis. The incidences of PEP in patients with zero, one, two, and three factors were 0.5% (2/388), 1.9% (9/465), 6.0% (17/285), and 12.6% (17/135), respectively. With increasing risk factors for PEP, the incidence of PEP significantly increased (1 factor vs. 2 factors, p=0.006; 2 factors vs. 3 factors, p=0.033).
Conclusions
As the number of risk factors for PEP increases, the risk of PEP may not be additive; however, it may multiply. Thus, aggressive prophylaxis for PEP is strongly recommended in patients with multiple risk factors.

Citations

Citations to this article as recorded by

Risk factors and prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis
Pei-Wen Xu, Qian-Qian Xu, Yan Yu, Yan Jiao, Ya-Hui Liu, Lei Yang
World Journal of Gastrointestinal Endoscopy.2026;[Epub] CrossRef
Optimal timing for discontinuation of ERCP in cases of difficult selective biliary cannulation
Han Taek Jeong, Jimin Han
Endoscopy International Open.2025;[Epub] CrossRef
Clinical outcomes of endoscopic retrograde cholangiopancreatography after Billroth II anastomosis: a comparison of gastroscope and duodenoscope
Kang Ho Lee, Gwang Hyo Yim, Jimin Han, Han Taek Jeong
BMC Gastroenterology.2025;[Epub] CrossRef
Prediction model for the occurrence of acute pancreatitis after endoscopic retrograde cholangiopancreatography based on multidimensional indicators
Xun-Xun Cao, Min Sun
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Prevalence and Related Factors of Post-ERCP Pancreatitis in Cholangiocarcinoma Patients: A Retrospective Study in Northeast Thailand
Tanapoom Karntaumporn, Vasin Thanasukarn, Tharatip Srisuk, Vor Luvira, Theerawee Tipwaratorn, Apiwat Jareanrat, Krit Rattanarak, Khanisara Kraphunpongsakul, Natcha Khuntikeo, Jarin Chindaprasirt, Kulyada Eurboonyanun, Prakasit Sa-Ngiamwibool, Watcharin Lo
Journal of Clinical Medicine.2025; 14(20): 7286. CrossRef
Risk factors for acute pancreatitis after endoscopic retrograde cholangiopancreatography: a retrospective single-center study
I.М. Mamontov, D.D. Rjabushhenko, Т.І. Tamm, К.О. Kramarenko, V.V. Nepomniashchyi, A.T. Ustinov
Український радіологічний та онкологічний журнал.2024; 32(3): 287. CrossRef

7,770 View
238 Download
5 Web of Science
6 Crossref

Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla: Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han; Clin Endosc 2024;57(2):226-236. Published online January 26, 2024; DOI: https://doi.org/10.5946/ce.2023.128

Graphical Abstract Abstract PDF

Background
/Aims: This study aimed to compare the safety of the double-guidewire technique (DGT) with that of the conventional single-guidewire technique (SGT) in real-world situations.
Methods
A total of 240 patients with naïve papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Daegu Catholic University Medical Center between January 2021 and December 2021 were included. The primary outcome was the rate of post-ERCP pancreatitis (PEP) in the SGT and DGT groups.
Results
A total of 163 patients (67.9%) belonged to the SGT group, and 77 (32.1%) belonged to the DGT group. The rates of successful biliary cannulation were 95.7% and 83.1% in the SGT and DGT groups, respectively (p=0.002). In the study group, PEP occurred in 14 patients (5.8%). The PEP rates were not significantly different between the SGT and DGT groups (4.3% vs. 9.1%, p=0.150). In the multivariate analysis, the age of <50 years (odds ratio [OR], 9.305; 95% confidence interval [CI], 1.367–63.358; p=0.023) and hyperlipidemia (OR, 7.384; 95% CI, 1.103–49.424; p=0.039) were significant risk factors for PEP in the DGT group.
Conclusions
DGT did not increase the PEP rate in patients with naïve papilla. In addition, the age of <50 years and hyperlipidemia were significant risk factors for PEP in the DGT group.

Citations

Citations to this article as recorded by

Immediate double guidewire technique with systematic pancreatic stenting versus standard guidewire-assisted cannulation in patients undergoing ERCP – results from a propensity score matched trial
A Fuso, G Masciangelo, R Arena, P Fusaroli, A Lisotti
Endoscopy.2026; 58(S 03): S28. CrossRef
Biliary cannulation techniques: Optimizing success and minimizing risk
Aryan Jain, Mayur Pabba, Aditya Jain, Savita Madhankumar, Sahib Singh, Saurabh Chandan, Muhammad Khalid Hasan, Mustafa A Arain
World Journal of Gastrointestinal Endoscopy.2026;[Epub] CrossRef

9,439 View
248 Download
3 Web of Science
2 Crossref

Review

Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management: Clement Chun Ho Wu, Samuel Jun Ming Lim, Christopher Jen Lock Khor; Clin Endosc 2023;56(4):433-445. Published online July 17, 2023; DOI: https://doi.org/10.5946/ce.2023.013

Abstract PDF Supplementary Material

Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.

Citations

Citations to this article as recorded by

Global research trends on endoscopic bariatric surgery: bibliometric analysis over past 2 decades
Linjing Li, Kun Zhou, Hang Yin, Rongrong Bi, Lei Wang
Updates in Surgery.2026; 78(3): 1347. CrossRef
Is the Success Rate of Endoscopic Retrograde Cholangiopancreatography (ERCP) ± Sphincterotomy Done for Bile Duct Stones Optimal?
Ciprani Debora, Amar Hoda, Abusharar Majd, Lopes Trisha, Karmarkar Rahi, Almadi Ahmed, Aroori Somaiah
Digestive Diseases and Sciences.2026; 71(2): 672. CrossRef
rs928508 of miR-30c-5p is Associated With the Risk of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis
Yunyun Sun, Xia Li, Liang Chen, Jun Zhang
Pancreas.2026; 55(1): e112. CrossRef
Radiomics analysis based on MRCP for predicting post-ERCP pancreatitis in patients with common bile duct stones
Sheng Chen, Yiyi Jin, Yonghui Wu, Chaotao Tang, Youxiang Chen
Surgical Endoscopy.2026; 40(3): 2447. CrossRef
An interpretable machine learning model for predicting the risk of post-endoscopic retrograde cholangiopancreatography complications in elderly patients with choledocholithiasis
Guanjun Zhang, Ke Meng, Yaqi Zhai, Min Zhu, Yuming Han, Mingyang Li
Saudi Journal of Gastroenterology.2026; 32(3): 228. CrossRef
Nationwide Survey on Endoscopic Papillectomy for Ampullary Adenoma: Current Practices and Variability
Hyung Ku Chon, Ik Hyun Jo, Sungjo Bang, Kihyun Ryu, Dong Wook Lee, Eaum Seok Lee, Yoon Suk Lee, Jonghyun Lee, Huapyong Kang, Tae Joo Jeon, Chang Hwan Park
Gut and Liver.2026; 20(2): 326. CrossRef
Dissolving the problem: Biodegradable stents as a value-driven strategy for post-ERCP pancreatitis prophylaxis in high-risk patients
Clement Wu, Venkata Akshintala
Pancreatology.2026; 26(3): 337. CrossRef
Topical tranexamic acid and sucralfate prevent delayed bleeding after endoscopic sphincterotomy: a randomized controlled trial (with video)
Hsueh-Chien Chiang, Jui-Wen Kang, Wei-Lun Chang, Tzu-Ling Kuo, Chien-Ming Chiang, Juei-Seng Wu, Po-Jun Chen, Chiao-Hsiung Chuang, Chiung-Yu Chen, Xi-Zhang Lin, Meng-Ying Lin
Therapeutic Advances in Gastroenterology.2026;[Epub] CrossRef
Ускладнення лікувальної ендоскопічної ретроградної холангіопанкреатографії у хворих на холедохолітіаз
V. A. Katsal, M. A. Hudz, T. V. Formanchuk, V. V. Balabuieva, V. A. Maliuha, M. V. Kushkova
Reports of Vinnytsia National Medical University.2026; 30(1): 73. CrossRef
Clinical predictive modeling for post-ERCP cholangitis in biliary stricture patients
Bensong Duan, Weixin Ye, Yuping Shi, Suhong Yi, Dadong Wan, Yang Jiang, Liqian Xuan, Jiangfeng Hu
Frontiers in Medicine.2026;[Epub] CrossRef
Role of Prophylactic Aggressive Hydration to Prevent Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Randomized Controlled Trial
Mohammad Omar Yousofzai, Marwah Ijaz, Shaik Taha, M Osama Ghaffar, M Kamran Siddique, Muhammad Irfan Jamil, Jahangeer Ahmed, Ammar Noor, Adeel Ahmed, Tayyaba Arooj Mufti
Cureus.2026;[Epub] CrossRef
Determinants of Acute Kidney Injury After Endoscopic Retrograde Cholangiopancreatography in Patients With Liver Cirrhosis: Retrospective Observational Study
Chieh Wei Chang
JMIR Medical Informatics.2026; 14: e87551. CrossRef
Efficacy and Safety of a Novel Guidewire for Selective Biliary Cannulation: A Multicenter, Prospective Randomized Controlled Study
Eui Joo Kim, Huapyong Kang, Young Heon Han, Yeon Suk Kim, See Young Lee, Sung Ill Jang, Kyong Joo Lee, Dong Hee Koh, Jin Lee, Jae Hee Cho, Se Woo Park
The Korean Journal of Pancreas and Biliary Tract.2026; 31(3): 117. CrossRef
Reducing Post-Endoscopic Sphincterotomy Bleeding: Risk Factor Assessment and Preventive Management
Dong Wook Lee, Sungjo Bang
The Korean Journal of Pancreas and Biliary Tract.2026; 31(3): 107. CrossRef
Advanced and salvage techniques for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography: a randomized trial of outcomes and efficacy
Mohamed Mahmoud Elhoseeny, Omkolsoum Alhaddad, Maha Elsabaawy, Eman Abdelsameea, Ahmed Sallam, Ahmed Khamis, Ahmed Edrees, Amira A.A. Othman
Gastrointestinal Endoscopy.2026;[Epub] CrossRef
Comparison of the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with and without diabetes: a meta-analysis
Fang Jia, Fujing Lv, Shutian Zhang
Surgical Endoscopy.2025; 39(2): 807. CrossRef
Small common bile duct - the risk factor for post-ercp pancreatitis in patients with choledocholithiasis
Ivan Mamontov, Tamara Tamm, Kostiantyn Kramarenko, Dmytro Ryabushchenko, Dmytro Sytnik, Samer Dghaili
Wiadomości Lekarskie.2025; 77(12): 2388. CrossRef
Multidisciplinary Therapeutic Approaches to Pancreatic Cancer According to the Resectability Status
Aurelio Mauro, Carlotta Faverio, Leonardo Brizzi, Stefano Mazza, Davide Scalvini, Daniele Alfieri, Alessandro Cappellini, Fabio Chicco, Carlo Ciccioli, Claudia Delogu, Marco Bardone, Anna Gallotti, Anna Pagani, Francesca Torello Viera, Andrea Anderloni
Journal of Clinical Medicine.2025; 14(4): 1167. CrossRef
Effect of periampullary diverticulum morphology on ERCP cannulation and clinical results
Yavuz Cagir, Muhammed Bahaddin Durak, Cem Simsek, Ilhami Yuksel
Scandinavian Journal of Gastroenterology.2025; 60(4): 292. CrossRef
Delayed bleeding after endoscopic sphincterotomy in patients receiving anticoagulants
Mitsushige Sugimoto, Masaki Murata, Kento Shionoya, Takayoshi Tsuchiya, Takao Itoi
Digestive Endoscopy.2025; 37(7): 733. CrossRef
A Report of a Rare Case of Choledocholithiasis Complicated by Proximal Basket Rod Rupture Requiring Surgical Intervention
Alexandre Gomes
Cureus.2025;[Epub] CrossRef
Development of a Checklist for Evaluating Pancreatobiliary Endoscopy Training Facilities and Educational Programs
Hyung Ku Chon, Sung-Jo Bang, Eaum Seok Lee, Tae Ju Jeon, Chang Hwan Park
The Korean Journal of Pancreas and Biliary Tract.2025; 30(2): 93. CrossRef
Burden and cost of post–endoscopic retrograde cholangiopancreatography pancreatitis among commercially insured people undergoing endoscopic retrograde cholangiopancreatography
Anna Tavakkoli, Kandice A. Kapinos, B. Joseph Elmunzer, Richard S. Kwon, David M. Troendle, Song Zhang, Amit G. Singal
Gastrointestinal Endoscopy.2025; 102(5): 692. CrossRef
Preprocedural score system for post-ERCP pancreatitis risk stratification in patients with billiary obstruction
I.М. Mamontov, D.D. Riabushchenko, Т.І. Tamm, K.О. Kramarenko, S. Dghaili, V.V. Nepomniashchyi
Український радіологічний та онкологічний журнал.2025; 33(1): 9. CrossRef
Prevalence and Characteristics of Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Complications in Patients With Biliopancreatic Disorders: A Retrospective Study
Jose Luis Vallejo Romero, Yazmin Cardenas Ramos, Floricel Olimpia Villegas Amador, Sandra Allison Barrueta Orive, Erick Mauricio Aldana Carbajal, Maria Guadalupe Ramirez Lugo, Karen Andrea Martinez Martinez, Diana Laura Montiel Covarrubias, Luis Eduardo N
Cureus.2025;[Epub] CrossRef
Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Complications: A Systematic Review of Microbial Patterns, Incidence, Risk Factors, and Management Strategies in Contemporary Practice
Anmar Al-Kabban, Fadi M Al-Kabban, Ola Obaid
Cureus.2025;[Epub] CrossRef
A Comprehensive Review of Digestive Endoscopy-Associated Infections: Bacterial Pathogens, Host Susceptibility, and the Impact of Viral Hepatitis
Deniz Günșahin, Vasile Șandru, Gabriel Constantinescu, Mădălina Ilie, Teodor Cabel, Ramona Ștefania Popescu, Bogdan Silviu Ungureanu, Victor Daniel Miron, Gheorghe G. Balan, Diana Cotigă, Bogdan Miutescu, Gülşen Özkaya Şahin, Oana Săndulescu
Microorganisms.2025; 13(9): 2128. CrossRef
Complications and expected imaging findings after endoscopic retrograde cholangiopancreatography
Mehmet Simsar, Yesim Yekta Yuruk, Olgun Sahin, Hilal Sahin
World Journal of Radiology.2025;[Epub] CrossRef
Efficacy and safety of cap-assisted colonoscopy in endoscopic retrograde cholangiopancreatography for patients after Billroth II gastrectomy
Chun-Xiao Hu, Sheng-Yue Zhou, Xiao-Hua Ye
World Chinese Journal of Digestology.2025; 33(9): 707. CrossRef
Efficacy of hydration combined with rectal non-steroidal anti-inflammatory drugs (NSAIDs) versus NSAIDs alone for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis of randomized contr
Huimin Li, Changfeng Miao, Wei Fang, Yuan Deng, Xiong Li, Ting Du, Hongwei Tian
BMC Gastroenterology.2025;[Epub] CrossRef
Comparison of clinical outcomes for single- and double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy
Sung Yong Han, Min Jae Yang, Kyong Joo Lee, Jonghyun Lee, Se Woo Park
World Journal of Gastroenterology.2025;[Epub] CrossRef
Combination use of intravenous ketamine-midazolam as a sedative agent in endoscopic retrograde cholangiopancreatography: a randomized control trial
Rajdave Singh Sadu Singh, Azlanudin Azman, Jegan Thanabalan, Chik Ian, Boo Han Sin, Razman Jarmin, Fahrol Fahmy Jaafar
Scientific Reports.2025;[Epub] CrossRef
Identifying high-risk patients having ERCP as a day surgery with an online prediction platform: Multicohort validation of a machine learning model
Boru Jin, Yi Wang, Xu Zhang, Jinyu Zhao, Wangping He, Kecheng Jin, Zhen Liu, Ruyang Zhong, Yuhu Ma, Chunlu Dong, Yanyan Lin, Xiaoliang Zhu, Kexiang Zhu, Lei Zhang, Ping Yue, Shuyan Li, Jinqiu Yuan, Xun Li, Wenbo Meng
Endoscopy International Open.2025;[Epub] CrossRef
Prevention of post-ERCP complications
Lotfi Triki, Andrea Tringali, Marianna Arvanitakis, Tommaso Schepis
Best Practice & Research Clinical Gastroenterology.2024; 69: 101906. 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
Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla
Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han
Clinical Endoscopy.2024; 57(2): 226. CrossRef
Computed tomography-based prediction of pancreatitis following biliary metal stent placement with the convolutional neural network
Tsuyoshi Hamada, Koichiro Yasaka, Yousuke Nakai, Rintaro Fukuda, Ryunosuke Hakuta, Kazunaga Ishigaki, Sachiko Kanai, Kensaku Noguchi, Hiroki Oyama, Tomotaka Saito, Tatsuya Sato, Tatsunori Suzuki, Naminatsu Takahara, Hiroyuki Isayama, Osamu Abe, Mitsuhiro
Endoscopy International Open.2024; 12(06): E772. 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
Risk factors for acute pancreatitis after endoscopic retrograde cholangiopancreatography: a retrospective single-center study
I.М. Mamontov, D.D. Rjabushhenko, Т.І. Tamm, К.О. Kramarenko, V.V. Nepomniashchyi, A.T. Ustinov
Український радіологічний та онкологічний журнал.2024; 32(3): 287. CrossRef
Could assessment of genetic susceptibility be an effective solution to prevent pancreatitis from occurring after endoscopic retrograde cholangiopancreatography?
Jae Min Lee
The Korean Journal of Internal Medicine.2023; 38(6): 783. CrossRef

24,892 View
726 Download
32 Web of Science
41 Crossref

Original Article

Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture: Takafumi Mie, Takashi Sasaki, Takeshi Okamoto, Tsuyoshi Takeda, Chinatsu Mori, Yuto Yamada, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira; Clin Endosc 2024;57(2):253-262. Published online May 16, 2023; DOI: https://doi.org/10.5946/ce.2022.216

Graphical Abstract Abstract PDF

Background
/Aims: Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS.
Methods
We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy–endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020.
Results
Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01–7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85–6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively.
Conclusions
Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.

Citations

Citations to this article as recorded by

Efficacy and Safety of a 6‐Month Placement of a Fully Covered Self‐Expanding Metal Stent for Refractory or Recurrent Hepaticojejunostomy Anastomotic Stricture via Balloon Enteroscopy‐Assisted Endoscopic Retrograde Cholangiopancreatography
Taro Hanaoka, Kosuke Okuwaki, Masafumi Watanabe, Tomohisa Iwai, Kai Adachi, Akihiro Tamaki, Junro Ishizaki, Yusaku Manabe, Masayoshi Tadehara, Rikiya Hasegawa, Takaaki Matsumoto, Hiroshi Imaizumi, Mitsuhiro Kida, Chika Kusano
DEN Open.2026;[Epub] CrossRef
Successful treatment of a complete obstruction at the hepaticojejunostomy anastomosis using cholangioscopic biopsy forceps inserted via the endoscopic ultrasound-guided hepaticogastrostomy route
Sho Hasegawa, Kunihiro Hosono, Masato Yoneda
Clinical Endoscopy.2026; 59(2): 311. CrossRef
Endoscopic Management of Pancreatobiliary Diseases in Patients with Surgically Altered Anatomy: A Perspective from Single-Balloon Enteroscopy
Yuki Tanisaka, Shomei Ryozawa, Masafumi Mizuide, Akashi Fujita, Suguru Ito, Ryuichi Watanabe, Ryosuke Hamamura, Yoshiki Matsuno
Digestion.2026; : 1. CrossRef
Innovation in the percutaneous management of benign hepaticojejunostomy stricture with multiple lithiasis using SpyGlass Discover and biodegradable stent: a case report
Edison Santiago Borja Villacrés, Jefferson Andrés Carvajal Torres, Santiago Andrés Muñoz-Palomeque
Journal of Surgical Case Reports.2025;[Epub] CrossRef

8,112 View
232 Download
5 Web of Science
4 Crossref

Systematic Review and Meta-analysis

Safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis compared to non-cirrhosis and effect of Child-Pugh score on post-ERCP complications: a systematic review and meta-analysis: Zahid Ijaz Tarar, Umer Farooq, Mustafa Gandhi, Saad Saleem, Ebubekir Daglilar; Clin Endosc 2023;56(5):578-589. Published online May 2, 2023; DOI: https://doi.org/10.5946/ce.2023.027

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: The safety of endoscopic retrograde cholangiopancreatography (ERCP) in hepatic cirrhosis and the impact of Child-Pugh class on post-ERCP complications need to be better studied. We investigated the post-ERCP complication rates in patients with cirrhosis compared with those without cirrhosis.
Methods
We conducted a literature search of relevant databases to identify studies that reported post-ERCP complications in patients with hepatic cirrhosis.
Results
Twenty-four studies comprising 28,201 patients were included. The pooled incidence of post-ERCP complications in cirrhosis was 15.5% (95% confidence interval [CI], 11.8%–19.2%; I2=96.2%), with an individual pooled incidence of pancreatitis 5.1% (95% CI, 3.1%–7.2%; I2=91.5%), bleeding 3.6% (95% CI, 2.8%–4.5%; I2=67.5%), cholangitis 2.9% (95% CI, 1.9%–3.8%; I2=83.4%), and perforation 0.3% (95% CI, 0.1%–0.5%; I2=3.7%). Patients with cirrhosis had a greater risk of post-ERCP complications (risk ratio [RR], 1.41; 95% CI, 1.16–1.71; I2=56.3%). The risk of individual odds of adverse events between cirrhosis and non-cirrhosis was as follows: pancreatitis (RR, 1.25; 95% CI, 1.06–1.48; I2=24.8%), bleeding (RR, 1.94; 95% CI, 1.59–2.37; I2=0%), cholangitis (RR, 1.15; 95% CI, 0.77–1.70; I2=12%), and perforation (RR, 1.20; 95% CI, 0.59–2.43; I2=0%).
Conclusions
Cirrhosis is associated with an increased risk of post-ERCP pancreatitis, bleeding, and cholangitis.

Citations

Citations to this article as recorded by

Quality indicators for endoscopic retrograde cholangiopancreatography
Michelle A. Anderson, Gregory A. Cote, Rajesh N. Keswani, Sarah A. Rodriguez, Uzma D. Siddiqui, B. Joseph Elmunzer
Gastrointestinal Endoscopy.2026; 103(1): 9. CrossRef
Quality Indicators for ERCP
Michelle A. Anderson, Gregory A. Cote, Rajesh N. Keswani, Sarah A. Rodriguez, Uzma D. Siddiqui, B. Joseph Elmunzer
American Journal of Gastroenterology.2026; 121(1): 80. CrossRef
Post‐ERCP Outcomes in Cirrhotic Patients With Thrombocytopenia: A Propensity‐Matched Retrospective Comparative Analysis on TriNetX Health Research Database
Umar Hayat, Azhar Hussain, Hassam Ali, Karan J. Yagnik, Pranav Patel, Ali A. Siddiqui, Sumant Inamdar, Kamran Qureshi, Harshit S. Khara, Bradley Confer, David L. Diehl
JGH Open.2026;[Epub] CrossRef
High-Risk Comorbidities Drive Adverse Inpatient Outcomes After ERCP: A National Analysis and Predictive Model
Zachary D. Leslie, Khalid Ahmed, Yasmin Ali, Eric S. Wise, Nabeel Azeem, Martin Freeman, Stuart K. Amateau, Ahmed Dirweesh
Digestive Diseases and Sciences.2026; 71(10): 4756. CrossRef
Determinants of Acute Kidney Injury After Endoscopic Retrograde Cholangiopancreatography in Patients With Liver Cirrhosis: Retrospective Observational Study
Chieh Wei Chang
JMIR Medical Informatics.2026; 14: e87551. CrossRef
Impact of music intervention on endoscopic retrograde cholangiopancreatography patients’ pain, anxiety, and vital signs: a randomized controlled trial
Emine Çakır, Yeliz Ciğerci, Sezgin Yılmaz
Scientific Reports.2026;[Epub] CrossRef
Post‐ERCP Outcomes in Cirrhotics Patients With Thrombocytopenia: A Propensity‐Matched Retrospective Comparative Analysis
Syeda Aima Zahra Gilani, Mohsin Naseer
Journal of Gastroenterology and Hepatology.2026; 41(9): 3029. CrossRef
Beyond Rebalanced Haemostasis: Haemostatic Phenotypes, Thrombin Generation, and Clinical Risk in Chronic Liver Disease
Sohaib Mukhtar Agouba, Pavla Bradacova, Jan Mikler, Miroslava Drotarova, Kristina Maria Belakova, Monika Brunclikova, Veronika Voskova Gemelova, Jan Stasko, Ingrid Skornova, Tomas Simurda
TH Open.2026;[Epub] CrossRef
Chronic liver disease impacting the severity of acute pancreatitis: a detailed narrative review of the literature
Abdul Basit, Muhammad Ashhad Usman, Syed Muhammad Ali, Abdul Mabood Basil
Frontiers in Gastroenterology.2026;[Epub] CrossRef
Predictive Factors of Post-ERCP Hepatic Decompensation in Patients with Cirrhosis: A Retrospective Case-Control Study
Mohammed Abusuliman, Sanad Dawod, Faisal Nimri, Taher Jamali, Gordon Jacobsen, Muhammad Zarrar Khan, Remy Arwani, Omar Shamaa, Suhaib Alhaj Ali, Spandana Alluri, Rami Youssef, Abdulmalik Saleem, Ahmad Alomari, Muhammad Saad Faisal, Haya Omeish, Muhammad S
Digestive Diseases and Sciences.2025; 70(8): 2852. CrossRef
The Palliation of Unresectable Pancreatic Cancer: Evolution from Surgery to Minimally Invasive Modalities
Muaaz Masood, Shayan Irani, Mehran Fotoohi, Lauren Wancata, Rajesh Krishnamoorthi, Richard A. Kozarek
Journal of Clinical Medicine.2025; 14(14): 4997. CrossRef
Liver cirrhosis may increase the incidence of delayed bleeding and mortality after endoscopic retrograde cholangiopancreatography for common bile duct stones
Linzhen Li, Di Wang, Xiaoping Niu
Frontiers in Medicine.2025;[Epub] CrossRef
Opposition Research: Endoscopic Management of Acute Cholecystitis in Patients with Decompensated Cirrhosis
Muaaz Masood, Sumant Inamdar, Ragesh B Thandassery
Digestive Diseases and Sciences.2025; 70(12): 4032. CrossRef
Chronic thrombocytopenia and outcomes following surgery for metastatic spinal tumors: An analysis of the United States Nationwide Inpatient Sample 2005–2018
Yu-Tse Liu, Ting-Wei Chang, Cheng-Chi Lee, Ching-Chang Chen, Chun-Ting Chen, Mun-Chun Yeap, Yu-Chi Wang
Journal of Orthopaedic Surgery.2025;[Epub] CrossRef
The Impact of Frailty on ERCP-Related Adverse Events: Findings From a National Cohort
Umer Farooq, Zahid Ijaz Tarar, Abdallah El Alayli, Faisal Kamal, Alexander Schlachterman, Anand Kumar, David E. Loren, Thomas E. Kowalski
Techniques and Innovations in Gastrointestinal Endoscopy.2024; 26(2): 138. CrossRef
Applicability of Child-Turcotte-Pugh Score in Anticipating Post-ERCP Adverse Events in Patients With Cirrhosis
Saqr Alsakarneh, Fouad Jaber, Willie Mohammed, Mohammad Almeqdadi, Abdallah Al-Ani, Yassine Kilani, Saeed Abughazaleh, Laith Momani, Muhammad Shah Miran, Hassan Ghoz, John Helzberg, Wendell Clarkston, Mohamed Othman
Journal of Clinical Gastroenterology.2024; 58(6): 554. CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Hyung Ku Chon, Ki-Hyun Kim, Tae Jun Song, Dong-Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyun Chung, Jin Lee, Miyoung Choi
Gut and Liver.2024; 18(4): 564. CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Ki-Hyun Kim, Hyung Ku Chon, Tae Jun Song, Dong Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyung Chung, Jin Lee, Miyoung Choi
The Korean Journal of Gastroenterology.2024; 84(3): 111. CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Ki-Hyun Kim, Hyung Ku Chon, Tae Jun Song, Dong Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyung Chung, Jin Lee, Miyoung Choi
The Korean Journal of Pancreas and Biliary Tract.2024; 29(4): 144. CrossRef
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY FOR THE MANAGEMENT OF CHOLEDOCHOLITHIASIS IN OLDER PATIENTS
Júlia Gardenyes, Pere Roura, Helena Vallverdú-Cartie, Judit Hermoso-Bosch, Cl�udia Roca, Mariona Espaulella, Antoni Casals, Héctor Ivo Marani, Joan Saló, Martín Galdín, Marta Gallach, Carles Leal
Revista Española de Enfermedades Digestivas.2023;[Epub] CrossRef

9,532 View
195 Download
17 Web of Science
20 Crossref

Original Articles

Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography: Yasuhiro Kuraishi, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Masanori Yamada, Nobumasa Mizuno; Clin Endosc 2023;56(4):490-498. Published online April 27, 2023; DOI: https://doi.org/10.5946/ce.2022.130

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and serious complication of endoscopic retrograde cholangiopancreatography. To prevent this event, a unique precutting method, termed opening window fistulotomy, was performed in patients with a large infundibulum as the primary procedure for biliary cannulation, whereby a suprapapillary laid-down H-shaped incision was made without touching the orifice. This study aimed to assess the safety and feasibility of this novel technique.
Methods
One hundred and ten patients were prospectively enrolled in this study. Patients with a papillary roof size ≥10 mm underwent opening window fistulotomy for primary biliary access. In addition, the incidence of complications and success rate of biliary cannulation were evaluated.
Results
The median size of the papillary roof was 6 mm (range, 3–20 mm). Opening window fistulotomy was performed in 30 patients (27.3%), none of whom displayed PEP. Duodenal perforation was recorded in one patient (3.3%), which was resolved by conservative treatment. The cannulation rate was high (96.7%, 29/30 patients). The median duration of biliary access was 8 minutes (range, 3–15 minutes).
Conclusions
Opening window fistulotomy demonstrated its feasibility for primary biliary access by achieving great safety with no PEP complications and a high success rate for biliary cannulation.

Citations

Citations to this article as recorded by

New bile duct cannulation technique using a fine-needle aspiration needle to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis
Ikuhiro Kobori, Ou Takagi, Haruka Kato, Masaru Kuwada, Koichi Soga, Yasumi Katayama, Masaya Tamano
Endoscopy.2026; 58(S 01): E311. CrossRef
Feasibility of primary precut sphincterotomy in endoscopic retrograde cholangiopancreatography for patients with large oral protrusions of the duodenal papilla; prospective observation study in Japan
Masafumi Watanabe, Kosuke Okuwaki, Mitsuhiro Kida, Hiroshi Imaizumi, Kai Adachi, Akihiro Tamaki, Taro Hanaoka, Chika Kusano
Clinical Endoscopy.2026; 59(2): 273. CrossRef
Comments on ‘Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography’
Masood Muhammad Karim, Adeel Ur Rehman, Faisal Wasim Ismail, Om Parkash
Clinical Endoscopy.2024; 57(2): 280. CrossRef

7,389 View
207 Download
3 Web of Science
3 Crossref

Outcomes of endoscopic retrograde cholangiopancreatography in patients with situs inversus viscerum: Long Le, Nicholas McDonald, Anders Westanmo, Mohammad Bilal, Dharma Sunjaya; Clin Endosc 2023;56(6):790-794. Published online April 26, 2023; DOI: https://doi.org/10.5946/ce.2022.292

Graphical Abstract Abstract PDF

Background
/Aims: Situs inversus viscerum (SIV) is a congenital condition defined by left-to-right transposition of all visceral organs. This anatomical variant has caused technical challenges in endoscopic retrograde cholangiopancreatography (ERCP). Data on ERCP in patients with SIV are limited to case reports of unknown clinical and technical success rates. This study aimed to evaluate the clinical and technical success rates of ERCP in patients with SIV.
Methods
Data from patients with SIV who underwent ERCP were retrospectively reviewed. The data were collected by querying the nationwide Veterans Affairs Health System database for patients diagnosed with SIV who underwent ERCP. Patient demographics and procedural characteristics were collected.
Results
Eight patients with SIV who underwent ERCP were included. Choledocholithiasis was the most common indication for ERCP (62.5%). The technical success rate was 63%. Subsequent ERCP with interventional radiology–assisted rendezvous has increased the technical success rate to 100%. Clinical success was achieved in 63% of cases. Among cases of subsequent rendezvous ERCP after conventional ERCP failure, clinical success was achieved in 100%.
Conclusions
The clinical and technical success rates of ERCP in patients with SIV were both 63%. In patients with SIV in whom ERCP fails, interventional radiology–assisted rendezvous ERCP can be considered.

Citations

Citations to this article as recorded by

Tale of two cases: ERCP in situs inversus totalis
A Ocepek, T Ademović, N Bukovnik
Endoscopy.2026; 58(S 03): S309. CrossRef
Adaptability in the Midst of Anatomical Challenges: A Case of Situs Inversus Totalis in Laparoscopic Cholecystectomy
Christopher Nguyen, David Schutter
Cureus.2024;[Epub] CrossRef

7,799 View
132 Download
1 Web of Science
2 Crossref

Rotatable sphincterotome as a rescue device for endoscopic retrograde cholangiopancreatography cannulation: a single-center experience: Takeshi Okamoto, Takashi Sasaki, Tsuyoshi Takeda, Takafumi Mie, Chinatsu Mori, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira; Clin Endosc 2024;57(1):96-104. Published online April 25, 2023; DOI: https://doi.org/10.5946/ce.2022.248

Graphical Abstract Abstract PDF

Background
/Aims: Selective bile duct or pancreatic duct cannulation remains a significant initial hurdle in endoscopic retrograde cholangiopancreatography (ERCP) despite advances in endoscopy and accessories. This study evaluated our experience with a rotatable sphincterotome in cases of difficult cannulation.
Methods
We retrospectively reviewed ERCP cases using TRUEtome, a rotatable sphincterotome, as a rescue device for cannulation at a cancer institute in Japan from October 2014 to December 2021.
Results
TRUEtome was used in 88 patients. Duodenoscopes were used for 51 patients, while single-balloon enteroscopes (SBE) were used for 37 patients. TRUEtome was used for biliary and pancreatic duct cannulation (84.1%), intrahepatic bile duct selection (12.5%), and strictures of the afferent limb (3.4%). Cannulation success rates were similar in the duodenoscope and SBE groups (86.3% vs. 75.7%, p=0.213). TRUEtome was more commonly used in cases with steep cannulation angles in the duodenoscope group and in cases requiring cannulation in different directions in the SBE group. There were no significant differences in adverse events between the two groups.
Conclusions
The cannulation sphincterotome was useful for difficult cannulations in both unaltered and surgically altered anatomies. It may be an option to consider before high-risk procedures such as precut and endoscopic ultrasound-guided rendezvous techniques.

Citations

Citations to this article as recorded by

Japanese Multi‐Institution Study of Success Rates of Wire‐Guided Biliary Cannulation During Endoscopic Retrograde Cholangiopancreatography in Relation to Guidewire tip Length (JMIT Study) (With Video)
Takeshi Ogura, Yuki Tanisaka, Masanari Sekine, Katsumasa Kobayashi, Hirotsugu Maruyama, Shinji Hirai, Hideyuki Shiomi, Minoru Shigekawa, Masaki Kuwatani, Kenji Ikezawa, Masahiro Itonaga, Mamoru Takenaka, Susumu Hijioka, Tsukasa Ikeura, Shinpei Doi, Nao Fu
DEN Open.2026;[Epub] CrossRef
All‐in‐one sphincterotome with high rotation performance and freely bendable blade for endoscopic sphincterotomy in patients with surgically altered anatomy (a case series with video)
Yasuhito Kunogi, Atsushi Irisawa, Akira Yamamiya, Manabu Ishikawa, Tomoya Sakamoto, Yasunori Inaba, Ken Kashima, Fumi Sakuma, Koh Fukushi, Takumi Maki, Kazunori Nagashima, Yoko Abe, Shuichi Kitada, Akane Yamabe, Keiichi Tominaga
DEN Open.2025;[Epub] CrossRef
Establishing Endoscopic Sphincterotomy in Balloon‐Assisted Endoscopic Retrograde Cholangiopancreatography Using a Novel Rotatable Sphincterotome in Surgically Altered Anatomy: Innovation for Procedural Standardization
Masaaki Shimatani
Digestive Endoscopy.2025; 37(12): 1348. CrossRef
Efficacy and safety of cap-assisted colonoscopy in endoscopic retrograde cholangiopancreatography for patients after Billroth II gastrectomy
Chun-Xiao Hu, Sheng-Yue Zhou, Xiao-Hua Ye
World Chinese Journal of Digestology.2025; 33(9): 707. CrossRef
Balloon-assisted ERCP for bile duct stones in surgically altered anatomy: current techniques, devices, and evolving strategies
Haruka Toyonaga, Makoto Masaki, Arata Oka, Hidetoshi Nakata, Shoji Takayama, Tatsuya Nakagawa, Takuya Takayama, Masahiro Orino, Hironao Matsumoto, Takeshi Yamashina, Masaaki Shimatani
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Non-tip and rotatable sphincterotome for biliary cannulation in patients with Roux-en-Y gastrectomy
Haruo Miwa, Kazuya Sugimori, Kazuki Endo, Ritsuko Oishi, Hiromi Tsuchiya, Takashi Kaneko, Shin Maeda
Endoscopy.2024; 56(S 01): E103. CrossRef
Progress in minimally invasive treatment of biliary pancreatic duct obstruction after digestive tract reconstruction by endoscopic retrograde cholangiopancreatography
Ru-Yi Wang, Zhen Fan
World Chinese Journal of Digestology.2024; 32(7): 490. CrossRef

14,670 View
219 Download
4 Web of Science
7 Crossref

Review

Single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a technical review: Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Rie Shiomi, Takahiro Shin, Kei Sugimoto, Shomei Ryozawa; Clin Endosc 2023;56(6):716-725. Published online April 17, 2023; DOI: https://doi.org/10.5946/ce.2023.023

Abstract PDF Supplementary Material

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is technically challenging. For example, scope insertion, selective cannulation, and intended procedures, such as stone extraction or stent placement, can be difficult. Single-balloon enteroscopy (SBE)-assisted ERCP has been used to effectively and safely address these technical issues in clinical practice. However, the small working channel limits its therapeutic potential. To address this shortcoming, a short-type SBE (short SBE) with a working length of 152 cm and a channel of 3.2 mm diameter has recently been introduced. Short SBE facilitates the use of larger accessories to complete certain procedures, such as stone extraction or self-expandable metallic stent placement. Despite the development in the SBE endoscope, various steps have to be overcome to successfully perform such procedure. To improve success, the challenging factors of each procedure must be identified. At the same time, endoscopists need to be mindful of adverse events, such as perforation, which can arise due to adhesions specific to the surgically altered anatomy. This review discussed technical tips regarding SBE-assisted ERCP in patients with surgically altered anatomy to increase success and reduce the risk of adverse events associated with ERCP.

Citations

Citations to this article as recorded by

Migration of Fish Bones to the Bile Duct Following Hepaticojejunostomy
Kenta Yoshida, Tsuyoshi Hayashi, Kazuki Hama, Ryo Ando, Haruka Toyonaga, Tatsuya Ishii, Toshifumi Kin, Masayo Motoya, Kuniyuki Takahashi, Yuko Omori, Satoshi Ota, Akio Katanuma
DEN Open.2026;[Epub] CrossRef
Colonoscopy-assisted preplacement of guide tube for endoscopic retrograde cholangiopancreatography in patients with complex surgically altered anatomy
Lu Xie, Yangyang Zheng, Qiaoxian He, Lei Lu, Weigang Gu, Zheng Jin, Qifeng Lou, Jianfeng Yang, Xiaofeng Zhang, Hangbin Jin
Surgical Endoscopy.2026; 40(6): 5220. CrossRef
Comparison of EUS-guided treatment and balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography for large bile duct stone removal in patients with surgically altered anatomy: A multicenter study
Ryota Sagami, Kiyoyuki Kobayashi, Makoto Hinokuchi, Kosuke Takahashi, Eisuke Ozawa, Takehiko Koga, Yusuke Ishida, Shotaro Kakehashi, Nao Fujimori, Yasuhisa Hiroshima, Issei Kojima, Hideki Mori, Naosuke Kuraoka, Hidefumi Nishikiori, Kazunari Murakami, Kazu
Endoscopic Ultrasound.2026; 15(3): 191. CrossRef
Clinical outcomes of endoscopic retrograde cholangiopancreatography after Billroth II anastomosis: a comparison of gastroscope and duodenoscope
Kang Ho Lee, Gwang Hyo Yim, Jimin Han, Han Taek Jeong
BMC Gastroenterology.2025;[Epub] CrossRef
Peroral cholangioscopy: past, present and future
Yuki Tanisaka, Robert Hawes
Clinical Endoscopy.2025; 58(3): 360. CrossRef
Efficacy and safety of cap-assisted colonoscopy in endoscopic retrograde cholangiopancreatography for patients after Billroth II gastrectomy
Chun-Xiao Hu, Sheng-Yue Zhou, Xiao-Hua Ye
World Chinese Journal of Digestology.2025; 33(9): 707. CrossRef
Balloon-assisted ERCP for bile duct stones in surgically altered anatomy: current techniques, devices, and evolving strategies
Haruka Toyonaga, Makoto Masaki, Arata Oka, Hidetoshi Nakata, Shoji Takayama, Tatsuya Nakagawa, Takuya Takayama, Masahiro Orino, Hironao Matsumoto, Takeshi Yamashina, Masaaki Shimatani
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Comparison of clinical outcomes for single- and double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy
Sung Yong Han, Min Jae Yang, Kyong Joo Lee, Jonghyun Lee, Se Woo Park
World Journal of Gastroenterology.2025;[Epub] CrossRef
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
Clinical Endoscopy.2025; 58(6): 941. CrossRef
Anatomical Alterations and Endoscopic Strategies After Upper Gastrointestinal Surgery
Byung Chul Jin, Seung Young Seo
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(4): 319. CrossRef
Advanced technical tips and recent insights in ERCP using balloon‐assisted endoscopy
Masaaki Shimatani, Toshiyuki Mitsuyama, Takeshi Yamashina, Masahiro Takeo, Shunsuke Horitani, Natsuko Saito, Hironao Matsumoto, Masahiro Orino, Masataka Kano, Takafumi Yuba, Takuya Takayama, Tatsuya Nakagawa, Shoji Takayama
DEN Open.2024;[Epub] CrossRef
Efficacy of texture and color enhancement imaging for short‐type single‐balloon enteroscopy‐assisted biliary cannulation in patients with Roux‐en‐Y gastrectomy: Multicenter study (with video)
Yuki Tanisaka, Mamoru Takenaka, Masafumi Mizuide, Akashi Fujita, Ryuhei Jinushi, Takahiro Shin, Kei Sugimoto, Ken Kamata, Kosuke Minaga, Shunsuke Omoto, Tomohiro Yamazaki, Shomei Ryozawa
Digestive Endoscopy.2024; 36(9): 1030. CrossRef
Progress in minimally invasive treatment of biliary pancreatic duct obstruction after digestive tract reconstruction by endoscopic retrograde cholangiopancreatography
Ru-Yi Wang, Zhen Fan
World Chinese Journal of Digestology.2024; 32(7): 490. CrossRef
Endoscopic Management of Biliary and Pancreatic Pathologies in Roux-en-Y Gastric Bypass Patients: Development of a Treatment Algorithm Based on 9-Year Experience
Laurent Monino, Lancelot Marique, Yannick Deswysen, Maximilien Thoma, Pierre H. Deprez, Pierre Goffette, Benoit Navez, Tom G. Moreels
Obesity Surgery.2024; 34(10): 3717. CrossRef
Use of short single-balloon enteroscopy in patients with surgically altered anatomy: a single-center experience
Songming Ding, Shanjie Dong, Hengkai Zhu, Yiting Hu, Shusen Zheng, Qiyong Li
Scientific Reports.2024;[Epub] CrossRef
Emergency Laparoscopic Common Bile Duct Exploration for Acute Cholangitis in Cases with Difficulty with an Endoscopic Approach
Naoki Matsumoto, Isao Sato, Yoshihide Chino, Makoto Mizutani, Tomotake Tabata, Tomoyuki Tagi, Shigeyoshi Shimaoka, Takafumi Oe
The Japanese Journal of Gastroenterological Surgery.2024; 57(11): 535. CrossRef
Development and evaluation of artificial organ models for ERCP training in patients with surgically altered anatomies
Kai Koch, Benedikt Duckworth-Mothes, Ulrich Schweizer, Karl-Ernst Grund, Tom G. Moreels, Alfred Königsrainer, Dörte Wichmann
Scientific Reports.2023;[Epub] CrossRef
Simplified single-session EUS-guided transhepatic antegrade stone removal for management of choledocholithiasis in patients with surgically altered anatomy
Tingting Yu, Suning Hou, Haiming Du, Wei Zhang, Jiao Tian, Yankun Hou, Jun Yao, Senlin Hou, Lichao Zhang
Gastroenterology Report.2023;[Epub] CrossRef

9,921 View
434 Download
14 Web of Science
18 Crossref

Original Articles

Medical disputes related to advanced endoscopic procedures with endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the management of pancreas and biliary tract diseases: Yoon Suk Lee, Jae-Young Jang, Jun Yong Bae, Eun Hye Oh, Yehyun Park, Yong Hwan Kwon, Jeong Eun Shin, Jun Kyu Lee, Tae Hee Lee, Chang Nyol Paik; Clin Endosc 2023;56(4):499-509. Published online March 28, 2023; DOI: https://doi.org/10.5946/ce.2022.208

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: This study aimed to evaluate the characteristics of endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasonography (EUS)-related adverse events (AEs) that eventually lead to medical disputes or claims on medical professional liability.
Methods
Medical disputes for ERCP/EUS-related AEs filed in the Korea Medical Dispute Mediation and Arbitration Agency between April 2012 and August 2020 were evaluated using corresponding medical records. AEs were categorized into three sections: procedure-related, sedation-related, and safety-related AEs.
Results
Among a total of 34 cases, procedure-related AEs were 26 (76.5%; 12 duodenal perforations, 7 post-ERCP pancreatitis, 5 bleedings, 2 perforations combined with post-ERCP pancreatitis); sedation-related AEs were 5 (14.7%; 4 cardiac arrests, 1 desaturation), and safety-related AEs were 5 (8.8%; 1 follow-up loss for stent removal, 1 asphyxia, 1 fall). Regarding clinical outcomes, 20 (58.8%) were fatal and eventually succumbed to AEs. For the types of medical institutions, 21 cases (61.8%) occurred at tertiary or academic hospitals, and 13 (38.2%) occurred at community hospitals.
Conclusions
The ERCP/EUS-related AEs filed in Korea Medical Dispute Mediation and Arbitration Agency showed distinct features: duodenal perforation was the most frequent AE, and clinical outcomes were fatal, resulting in at least more than permanent physical impairment.

Citations

Citations to this article as recorded by

Clinically significant post-ERCP bleeding after common bile duct stone removal
Yoon Suk Lee
International Journal of Gastrointestinal Intervention.2026; 15(1): 59. CrossRef
Biliary Stent Placement by Endoscopic Retrograde Cholangiopancreatography: Quality Indicators and Technical Applications
Yoon Suk Lee, Tae Joo Jeon
Gut and Liver.2026; 20(4): 524. CrossRef
Diagnostic Assessment of Endoscopic Ultrasonography–Fine Needle Aspiration Cytology in the Pancreas: A Comparison between Liquid-Based Preparation and Conventional Smear
Jung-Soo Pyo, Dae Hyun Lim, Kyueng-Whan Min, Nae Yu Kim, Il Hwan Oh, Byoung Kwan Son
Medicina.2024; 60(6): 930. CrossRef

6,257 View
155 Download
3 Web of Science
3 Crossref

Role of vitamin C and rectal indomethacin in preventing and alleviating post-endoscopic retrograde cholangiopancreatography pancreatitis: a clinical study: Amir Sadeghi, Rana Jafari-Moghaddam, Sara Ataei, Mahboobe Asadiafrooz, Mohammad Abbasinazari; Clin Endosc 2023;56(2):214-220. Published online March 6, 2023; DOI: https://doi.org/10.5946/ce.2022.165

Graphical Abstract Abstract PDF

Background
/Aims: This study aimed to determine whether vitamin C in addition to indomethacin decreases the occurrence and severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) occurrence and severity.
Methods
This randomized clinical trial included patients undergoing ERCP. The participants were administered either rectal indomethacin (100 mg) plus an injection of vitamin C (500 mg) or rectal indomethacin (100 mg) alone just before ERCP. The primary outcomes were PEP occurrence and severity. The secondary amylase and lipase levels were determined after 24 hours.
Results
A total of 344 patients completed the study. Based on intention-to-treat analysis, the PEP rates were 9.9% for indomethacin plus vitamin C plus indomethacin and 15.7% for indomethacin alone. Regarding the per-protocol analysis, the PEP rates were 9.7% and 15.7% in the combination and indomethacin arms, respectively. There was a remarkable difference between the two arms in PEP occurrence and severity on intention-to-treat and per-protocol analyses (p=0.034 and p=0.031, respectively). The post-ERCP lipase and amylase concentrations were lower in the combination arm than in the indomethacin alone arm (p=0.034 and p=0.029, respectively).
Conclusions
Vitamin C injection in addition to rectal indomethacin reduced PEP occurrence and severity.

Citations

Citations to this article as recorded by

Efficacy of indomethacin for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: A comprehensive meta-analysis of randomized controlled trials
Fu Tian, Zhi-Cheng Huang, Hayat Khizar, Kai Qiu
World Journal of Gastroenterology.2026;[Epub] CrossRef
Efficacy of 2‐Mercaptoethane Sulfonate Sodium (MESNA) in the Prevention of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: A Randomized Open Label Trial
Amir Sadeghi, Hesamoddin Samar, Mohammad Abbasinazari, Parvaneh Mohammadi, Ali Abazarikia, Shadi Ziaie
JGH Open.2025;[Epub] CrossRef
Effect of CoQ10 Addition to Rectal Indomethacin on Clinical Pancreatitis and Related Biomarkers in Post-endoscopic Retrograde Cholangiopancreatography
Saeed Abdi, Roja Qobadighadikolaei, Faezeh Jamali, Maryam Shahrokhi, Farzaneh Dastan, Mohammad Abbasinazari
Journal of Cellular & Molecular Anesthesia.2024;[Epub] CrossRef
Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla
Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han
Clinical Endoscopy.2024; 57(2): 226. CrossRef
Reactive oxygen species and oxidative stress in acute pancreatitis: Pathogenesis and new therapeutic interventions
Chuan-Chao Xia, Hong-Tan Chen, Hao Deng, Yi-Ting Huang, Guo-Qiang Xu
World Journal of Gastroenterology.2024; 30(45): 4771. CrossRef

6,660 View
187 Download
4 Web of Science
5 Crossref

Reviews

Simulator-based training method in gastrointestinal endoscopy training and currently available simulators: Yuri Kim, Jeong Hoon Lee, Gin Hyug Lee, Ga Hee Kim, Gunn Huh, Seung Wook Hong, Hwoon-Yong Jung; Clin Endosc 2023;56(1):1-13. Published online January 6, 2023; DOI: https://doi.org/10.5946/ce.2022.191

Abstract PDF

The apprenticeship-based training method (ABTM) is highly effective for gastrointestinal (GI) endoscopic training. However, the conventional ABTM has significant issues. Although many supplementary training methods (TMs) have been developed and utilized, they cannot entirely replace the ABTM, which remains the major TM strategy. Currently, new TM construction is crucial and necessary due to financial constraints, difficulty of obtaining sufficient training time due to patient safety-related regulations, and catastrophic damage caused by disasters such as the coronavirus disease 2019 pandemic. The simulator-based TM (SBTM) is widely accepted as an alternative to the ABTM, owing to the SBTM’s advantages. Since the 1960s, many GI endoscopy training simulators have been developed and numerous studies have been published on their effectiveness. While previous studies have focused on the simulator’s validity, this review focused on the accessibility of simulators that were introduced by the end of 2021. Although the current SBTM is effective in GI endoscopic education, extensive improvements are needed to replace the ABTM. Incorporating simulator-incorporated TMs into an improved ABTM is an attempt to overcome the incompleteness of the current SBTM. Until a new simulator is developed to replace the ABTM, it is desirable to operate a simulator-integrated and well-coordinated TM that is suitable for each country and institution.

Citations

Citations to this article as recorded by

Effectiveness of Simulation‐based Training on Emergency Response Knowledge Among Inter‐Professional Staff Involved in Gastrointestinal Endoscopic Practice
Mitsuru Otsuka, Tsunetaka Kato, Takuto Hikichi, Jun Nakamura, Takumi Yanagita, Eisuke Kameoka, Daiki Nemoto, Rei Suzuki, Mitsuru Sugimoto, Hiroyuki Asama, Hiroshi Shimizu, Kento Osawa, Rei Ohira, Keisuke Kudo, Masao Kobayakawa, Hiromasa Ohira
DEN Open.2027;[Epub] CrossRef
A Soft-Robotic Biomimetic Benchtop Model for Esophageal Motility Simulation
Seán Kilroy, Neelesh A. Patankar, Walter W. Chan, Giovanni Traverso, Eoin D. O’Cearbhaill
Nature Communications.2026;[Epub] CrossRef
A Pilot Randomized Cross-Over Trial Focused on Colonoscopy Skill Acquisition Using High Fidelity Versus Low Fidelity Simulators in Nigeria
Olusegun Alatise, Alex Doyle, Tajudeen Mohammed, Olujide Arije, Funmilola Wuraola, Oluwaseyi Olanrewaju, Israel Owoade, Matthew O. Bojuwoye, Rivka Kahn, Cristina Olcesse, Jason Esdaille, Sahle Griffith, Gregory Knapp, Richard Spence, Titilayo Ojumu, T. Pe
Journal of Surgical Education.2026; 83(6): 103932. CrossRef
Training in diagnostic and interventional endoscopic ultrasound: a state-of-the-art review
Giulia Palumbo, Gianenrico Rizzatti, Fabrizio Termite, Andrea Tringali, Giulia Tripodi, Ivo Boskoski, Cristiano Spada
Expert Review of Gastroenterology & Hepatology.2026; 20(5): 449. CrossRef
Simulation in Endoscopy
Abraham Z. Cheloff, Seth A. Gross, Suraj Pai, Sheryl A. Pfeil
Gastrointestinal Endoscopy Clinics of North America.2026; 36(3): 537. CrossRef
A Hybrid Sensor-Based Colonoscopy Training System for Real-Time Loop Detection and Force Feedback
Hang-Ling Wu, Isra Elsaadany, Scarlett Miller, Jason Moore
Journal of Medical Devices.2026;[Epub] CrossRef
Programmable Pneumatic Actuator System for a Bioinspired Artificial Colon
Andrew Bickerdike, Bo Tian, Xizheng Fang, Zepeng Wang, Yang Liu, Lucy Adams, Shyam Prasad
Advanced Materials Technologies.2026;[Epub] CrossRef
Face validity of a new mixed-reality simulator for training endoscopic submucosal dissection: a Western pilot study
Henriette Heinrich, Pieter Dewint, Phillipe Leclercq, Jelle Haringsma
iGIE.2026; 5(3): 291. CrossRef
British Society of Gastroenterology/Joint Advisory Group on GI Endoscopy Delphi method of consensus recommendations for standardised upper gastrointestinal bleeding haemostasis courses
Mo Thoufeeq, Syrine Ben Rhouma, Nilanga Nishad, Gaurav B Nigam, Sabina Beg, Aravinth Murugananthan, Sarah Hearnshaw, Sam Murray, Keith Siau, Rebecca Brown, Steve Dixon, Philip Boger, Paul Dunckley, Allan John Morris
Frontline Gastroenterology.2026; : flgastro-2026-103886. CrossRef
Meaningful progress towards a high-fidelity endoscopic submucosal dissection training simulator model
Gin Hyug Lee, So Young Byun
Clinical Endoscopy.2025; 58(1): 77. CrossRef
Effects of a training system that tracks the operator’s gaze pattern during endoscopic submucosal dissection on hemostasis
Takao Tonishi, Fumiaki Ishibashi, Kosuke Okusa, Kentaro Mochida, Sho Suzuki
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Comments on ‘Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea’
Dae Jin Jung, Gwang Ha Kim
Clinical Endoscopy.2025; 58(2): 334. CrossRef
Simulators and training models for diagnostic and therapeutic gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review
Chiara Coluccio, Jérémie Jacques, Istvan Hritz, Ivo Boskoski, Mohamed Abdelrahim, Vincenzo Bove, João A. Cunha Neves, Pieter J. F. de Jonge, Giuseppe Dell’Anna, Gianluca Esposito, Antonio Facciorusso, Rodica Gincul, Paolo Giuffrida, Rakesh Kalapala, Chris
Endoscopy.2025; 57(07): 796. CrossRef
Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part I): European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
Enrique Rodríguez de Santiago, David J. Tate, João Santos-Antunes, Sandra Nagl, Zuzana Vacková, Marcel Tantau, Isis K. Araujo, Eduardo Guimarães Hourneaux de Moura, Pietro Familiari, Helmut Messmann, Alanna Ebigbo, Paul Fockens, Raf Bisschops, Henriette H
Endoscopy.2025; 57(07): 778. CrossRef
Artificial intelligence in simulation-based training for Health Professions Education: Navigating the rabbit hole
Rakhi Negi, Deepti Chopra, Komal Maheshwari, Anushi Mahajan, Dinesh Badyal, Padmini Venkataramani
Medical Journal Armed Forces India.2025; 81(6): 637. CrossRef
Digital platforms, virtual reality, and augmented reality in gastrointestinal endoscopy training
Wilfredo Pagani, Tavia Buysse, Kulwinder S. Dua
Clinical Endoscopy.2025; 58(5): 653. CrossRef
Impact and assessment of training models in interventional endoscopic ultrasound
Bogdan Miutescu, Vinay Dhir
Digestive Endoscopy.2024; 36(1): 59. CrossRef
A Multicenter Survey of Percutaneous Endoscopic Gastrostomy in 2019 at Korean Medical Institutions
Jun Woo Park, Tae Gyun Kim, Kwang Bum Cho, Jeong Seok Kim, Jin Woong Cho, Jung Won Jeon, Sun Gyo Lim, Chan Gyoo Kim, Hong Jun Park, Tae Jun Kim, Eun Sun Kim, Su Jin Jeong, Yong Hwan Kwon
Gut and Liver.2024; 18(1): 77. CrossRef
Exploring Endoscopic Competence in Gastroenterology Training: A Simulation-Based Comparative Analysis of GAGES, DOPS, and ACE Assessment Tools
Faisal Wasim Ismail, Azam Afzal, Rafia Durrani, Rayyan Qureshi, Safia Awan, Michelle R Brown
Advances in Medical Education and Practice.2024; Volume 15: 75. CrossRef
Assemblage of a functional and versatile endoscopy trainer reusing medical waste: Step‐by‐step video tutorial
Riccardo Vasapolli, Jörg Schirra, Christian Schulz
Digestive Endoscopy.2024; 36(5): 634. CrossRef
Navigating the learning landscape: Comprehensive training in third space endoscopy - training, techniques, and practical recommendations
D. Roser, S. Nagl, A. Ebigbo
Best Practice & Research Clinical Gastroenterology.2024; 71: 101918. CrossRef
Systematic review of subjective validation methods for computerized colonoscopy simulators
Adrián Lugilde-López, Manuel Caeiro-Rodríguez, Fernando A. Mikic-Fonte, Martín Llamas-Nistal
Health Informatics Journal.2024;[Epub] CrossRef
Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea
Hyundam Gu, Suyoung Lee, Sol Kim, Hye-Lim Jang, Da-Woon Choi, Kyu Seok Kim, Yu Ri Shin, Dae Young Cheung, Bo-In Lee, Jin Il Kim, Han Hee Lee
Clinical Endoscopy.2024; 57(6): 790. CrossRef
EUS and ERCP training in Europe: Time for simulation, optimization, and standardization
Selma J. Lekkerkerker, Rogier P. Voermans
United European Gastroenterology Journal.2023; 11(5): 407. CrossRef
There is no royal road: a shortcut for endoscopic submucosal dissection training
Seong Woo Jeon
Clinical Endoscopy.2023; 56(5): 590. CrossRef
Enhancing the Quality of Upper Gastrointestinal Endoscopy: Current Indicators and Future Trends
Caesar Ferrari, Micheal Tadros
Gastroenterology Insights.2023; 15(1): 1. CrossRef

13,334 View
373 Download
24 Web of Science
26 Crossref

Optimal endoscopic drainage strategy for unresectable malignant hilar biliary obstruction: Itaru Naitoh, Tadahisa Inoue; Clin Endosc 2023;56(2):135-142. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2022.150

Abstract PDF

Endoscopic biliary drainage strategies for managing unresectable malignant hilar biliary obstruction differ in terms of stent type, drainage area, and deployment method. However, the optimal endoscopic drainage strategy remains unclear. Uncovered self-expandable metal stents (SEMS) are the preferred type because of their higher functional success rate, longer time to recurrent biliary obstruction (RBO), and fewer cases of reintervention than plastic stents (PS). Other PS subtypes and covered SEMS, which feature a longer time to RBO than PS, can be removed during reintervention for RBO. Bilateral SEMS placement is associated with a longer time to RBO and a longer survival time than unilateral SEMS placement. Unilateral drainage is acceptable if a drainage volume of greater than 50% of the total liver volume can be achieved. In terms of deployment method, no differences were observed in clinical outcomes between side-by-side (SBS) and stent-in-stent deployment. Simultaneous SBS boasts a shorter procedure time and higher technical success rate than sequential SBS. This review of previous studies aimed to clarify the optimal endoscopic biliary drainage strategy for unresectable malignant hilar biliary obstruction.

Citations

Citations to this article as recorded by

Safety and Efficacy of Unilateral and Bilateral Stenting for Hilar Biliary Obstruction: An Updated Systematic Review and Meta-Analysis
Yuanzhi Ni, Kamran Ali, Penghao Tang, Khizar Hayat, Zhiwen Cheng, Benfeng Xu, Zhiwen Qin, Wu Zhang
Digestive Diseases and Sciences.2026; 71(2): 437. CrossRef
Clinical utility of suprapapillary plastic stents for lifelong biliary drainage in unresectable malignant hilar biliary obstruction
Hisahiro Uemura, Takashi Kobayashi, Atsuhiro Masuda, Kenta Yamamoto, Kaoruko Kanamaru, Takafumi Tokunaga, Akira Shirohata, Tetsuhisa Ko, Yusuke Yokotani, Yuki Oka, Yosuke Irie, Noriko Juri, Yoshiyuki Harada, Mika Miki, Noriko Inomata, Kae Nagao, Shinya Ko
Gastrointestinal Endoscopy.2026; 103(3): 475. CrossRef
Endoscopic Ultrasound‐Guided Bilateral Stent‐in‐Stent Deployment With Hepaticoenterostomy in patients With Malignant Hilar Biliary Obstruction
Tadahisa Inoue, Rena Kitano, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
Journal of Gastroenterology and Hepatology.2026; 41(3): 971. CrossRef
Self-expandable metal stents versus plastic stents for unresectable malignant hilar biliary obstruction: A systematic review and meta-analysis of reconstructed individual patient data from randomized controlled trials with meta-regression
Mohammad Al Hayek, Mouen Khashab, Marco Spadaccini, Antonio Facciorusso, Ammar Fahaid, Mohamedhen Vall Nounou, Muhammed Elhadi, Alberto Larghi, John J. Vargo, Cesare Hassan, Douglas G. Adler
Digestive and Liver Disease.2026; 58(4): 456. CrossRef
Efficacy of fully covered self-expanding metal stents removal versus stent-in-stent techniques in recurrent malignant distal biliary obstruction
See Young Lee, Sung Ill Jang, Eui Joo Kim, Dong Ki Lee, Seoyeon Cho, Yeseul Seong, Jung Hyun Jo, Chan Min Jung, In Rae Cho, Woo Hyun Paik, Ji Kon Ryu, Hyun Seok Lee, Sang Hyub Lee, Jae Hee Cho
Scientific Reports.2026;[Epub] CrossRef
Outcomes associated with bilateral plastic versus metal stents for palliation in malignant hilar biliary obstruction: an updated meta-analysis from the United States
Raveena S. Boodram, Shyam Vedantam, Sunil Amin, Sean Bhalla, Jodie A. Barkin, Mahmoud Mahfouz, Shria Kumar
Clinical Endoscopy.2026; 59(2): 223. CrossRef
The selection and strategy of stents in endoscopic drainage of unresectable perihilar cholangiocarcinoma: a meta-analysis
Xiaoyi Guo, Jinqi Xing, Haifeng Luo, Di Zhang, Feng Gao, Zihao Dai, Jianfeng Huo, Zhuo Yang, Jiangning Gu
BMC Surgery.2026;[Epub] CrossRef
Application Progress of Biliary Stent in Internal Drainage for Unresectable Hilar Cholangiocarcinoma
曈昕刘
Advances in Clinical Medicine.2026; 16(04): 4301. CrossRef
Biliary stricture management: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Arnaud Lemmers, Andrea Tringali, Sara Teles de Campos, Giuseppe Vanella, Kin Seng Liem, Marianna Arvanitakis, Fabrice Caillol, Christian Gerges, Gavin Johnson, Leena Kylänpää, Enrique Perez-Cuadrado Robles, Maria Chiara Petrone, Mohan Ramchandani, Jeanin
Endoscopy.2026;[Epub] CrossRef
Impact of Sphincterotomy on Suprapapillary Inside Stent Patency in Unresectable Malignant Hilar Biliary Obstruction: A Multicenter Cohort Study
So Nakaji, Kyoyoshi Saito, Emiri Kita, Wataru Yoshioka, Motoyasu Kan, Yusuke Ishida, Rintaro Mikata, Kenichi Tanaka, Toshiyasu Shiratori, Sohei Yoshimura, Hiroshi Ohyama, Toshio Tsuyuguchi, Shigenobu Yoshimura, Yoshiki Nakaya, Naoaki Tsuchiya, Hirokazu Ta
Endoscopy International Open.2026;[Epub] CrossRef
Efficacy and safety of covered self-expandable metal stents for malignant hilar biliary obstruction: systematic review and meta-analysis
Kwang Hyun Chung, Kyong Joo Lee, Abel A. Joseph, Robert J. Huang, Andrew Li, Joo Ha Hwang, Seung Bae Yoon
Gastrointestinal Endoscopy.2025; 101(2): 350. CrossRef
Evaluating safety and efficacy of plastic versus metal stenting in malignant hilar biliary obstruction: a systematic review and meta-analysis of randomized controlled trials
Xinjie Luo, Zhicheng Huang, Kamran Ali, Khizar Hayat
Postgraduate Medical Journal.2025; 101(1195): 447. CrossRef
Direct comparison of simultaneous and sequential endoscopic metallic bilateral stenting in malignant hilar biliary obstruction
Thomas Guilmoteau, Olivier Rouquette, Anthony Buisson, Sébastien Cambier, Armand Abergel, Laurent Poincloux
World Journal of Gastroenterology.2025;[Epub] CrossRef
Prevention of stent migration of covered self-expandable metal stents in distal malignant biliary obstruction: a review of literature
Jung Won Chun, Woo Hyun Paik, Sang Myung Woo, Jin Ho Choi, In Rae Cho, Woo Jin Lee, Ji Kon Ryu, Yong-Tae Kim, Sang Hyub Lee
Gastroenterology Report.2025;[Epub] CrossRef
Feasibility, effectiveness, and safety of simultaneous side-by-side deployment of uncovered self-expandable metal stents for malignant hilar biliary obstruction: a retrospective single-center study
Chengcheng Christine Zhang, Marcus Kantowski, Cyrill Wehling, Patrick Michl, Ronald Koschny, Peter Sauer
BMC Gastroenterology.2025;[Epub] CrossRef
Jaundice-Reducing Efficacy Through Placement of Biliary Plastic Stents During Endoscopic Retrograde Cholangiography in Unresectable Malignant Hilar Biliary Obstructions
Songming Ding, Aili Lu, Shanjie Dong, Hengkai Zhu, Yiting Hu, Shusen Zheng, Qiyong Li
Cureus.2025;[Epub] CrossRef
Intra-stent Radiofrequency Ablation Versus Plastic Stent Placement for Ingrowth Occlusion After Bilateral Metal Stenting in Patients with Malignant Hilar Biliary Obstruction: A Multicenter Propensity Score-Matched Analysis
Tadahisa Inoue, Michihiro Yoshida, Kenta Kachi, Rena Kitano, Mayu Ibusuki, Naoaki Yamada, Fumihiro Okumura, Itaru Naitoh
Digestive Diseases and Sciences.2025; 70(12): 4292. CrossRef
Unique Side‐By‐Side Technique for Malignant Hilar Biliary Obstruction Using Novel Multi‐Hole Self‐Expandable Metallic Stents
Ritsuko Oishi, Haruo Miwa, Shin Maeda
Digestive Endoscopy.2025; 37(12): 1375. CrossRef
Suprapapillary Stent‐By‐Stent Deployment With Slim‐Fully Covered Versus Uncovered Metal Stents for Malignant Hilar Biliary Obstruction: A Multicenter Comparative Study (With Video)
Tadahisa Inoue, Michihiro Yoshida, Naoaki Yamada, Rena Kitano, Tomoya Kitada, Shun Futagami, Kenta Kachi, Fumihiro Okumura, Itaru Naitoh
Digestive Endoscopy.2025; 37(12): 1295. CrossRef
Percutaneous Transhepatic Biliary Intervention for The Management of Malignant Hilar Biliary Obstruction
Quoc Huy Vo, Minh Tuan Le, Dac Hong An Ngo, Ba Khanh Minh Le, Huu Thien Ho, Trong Khoan Le, Thanh Thao Nguyen, Quang Hung Dang, Hoang Huy Le, Trong Binh Le
The Korean Journal of Gastroenterology.2025; 85(4): 517. CrossRef
Endoscopic Stenting for Unresectable Malignant Hilar Biliary Obstruction: Where Do We Stand Today? A Narrative Review
Tadahisa Inoue, Itaru Naitoh, Michihiro Yoshida, Fumihiro Okumura
Current Oncology.2025; 32(11): 608. CrossRef
Which patients with palliative malignant biliary obstruction will benefit most from biliary drainage: Development and validation of a prognostic score
Raphael Olivier, Estelle Antoine, Marie Morvan, Augustin D'Aubigny, Jean Baptiste Nousbaum, Noemie Reboux, Enrique Perez Cuadrado Robles, Lucille Queneherve
Endoscopy International Open.2025;[Epub] CrossRef
Comparison of unilateral and bilateral intraductal plastic stent placement for unresectable malignant hilar biliary obstruction: A propensity score‐matched cohort analysis
Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yuhei Iwasa, Shinya Uemura, Kensaku Yoshida, Akinori Maruta, Takuji Iwashita, Ichiro Yasuda, Masahito Shimizu
Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(4): 284. CrossRef
Preoperative endoscopic biliary drainage by metal versus plastic stents for resectable perihilar cholangiocarcinoma
David M. de Jong, Timothy M. Gilbert, Lynn E. Nooijen, Eva Braunwarth, Marijana Ninkovic, Florian Primavesi, Hassan Z. Malik, Nick Stern, Richard Sturgess, Joris I. Erdmann, Rogier P. Voermans, Marco J. Bruno, Bas Groot Koerkamp, Lydi M.J.W. van Driel
Gastrointestinal Endoscopy.2024; 99(4): 566. CrossRef
TOKYO criteria 2024 for the assessment of clinical outcomes of endoscopic biliary drainage
Hiroyuki Isayama, Tsuyoshi Hamada, Toshio Fujisawa, Mitsuharu Fukasawa, Kazuo Hara, Atsushi Irisawa, Shigeto Ishii, Ken Ito, Takao Itoi, Yoshihide Kanno, Akio Katanuma, Hironari Kato, Hiroshi Kawakami, Hirofumi Kawamoto, Masayuki Kitano, Hirofumi Kogure,
Digestive Endoscopy.2024; 36(11): 1195. CrossRef
Trisectoral Metal Stenting Using Combined Stent-by-Stent and Stent-in-Stent Method for Malignant Hilar Biliary Obstruction: A Prospective Pilot Study
Tadahisa Inoue, Rena Kitano, Mayu Ibusuki, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
Digestive Diseases and Sciences.2024; 69(11): 4283. CrossRef
Suprapapillary trisectoral deployment of slim fully covered metal stents with ultra-stiff high-sliding guidewires for malignant hilar biliary obstruction
Tadahisa Inoue, Rena Kitano, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
Endoscopy.2024; 56(S 01): E996. CrossRef
Research progress on biliary stents
Qi Zhang, Haipo Cui, Yan Zhang, Hexuan Jiang
Progress in Medical Devices.2023;[Epub] CrossRef

9,504 View
469 Download
27 Web of Science
28 Crossref

Original Article

Endoscopic removal of common bile duct stones in nonagenarians: a tertiary center experience: Mustafa Jalal, Amaan Khan, Sijjad Ijaz, Mohammed Gariballa, Yasser El-Sherif, Amer Al-Joudeh; Clin Endosc 2023;56(1):92-99. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2022.020

Abstract PDF

Background
/Aims: There are few studies assessed the efficacy and mortality of endoscopic retrograde cholangiopancreatography (ERCP) for the removal of common bile duct (CBD) stones in the elderly aged ≥90 years. We aimed to assess the safety and efficacy of endoscopic removal of CBD stones in nonagenarians.
Methods
We retrospectively reviewed ERCP reports for CBD stone removal. The endoscopic and therapeutic outcomes were collected. The length of stay (LOS), the total number of adverse events, and mortality rate were compared between groups.
Results
A total of 125 nonagenarians were compared with 1,370 controls (65–89 years old individuals). The mean LOS for nonagenarians was significantly higher than in controls (13.6 days vs. 6.5 days). Completed intended treatment was similar in the nonagenarians and controls (89.8% and 89.5%, respectively). The overall complication rate did not differ between the groups. However, nonagenarians had a higher incidence of post-ERCP pneumonia (3.9%). None of the nonagenarians were readmitted to the hospital within 7 days. Four nonagenarians (3.2%) and 25 (1.8%) controls died within 30 days.
Conclusions
Advanced age alone did not affect the decision to perform the procedure. However, prompt diagnosis and treatment of post-ERCP pneumonia in nonagenarians could improve the outcomes and reduce mortality.

Citations

Citations to this article as recorded by

Holmium Laser Lithotripsy for Pancreatobiliary Stones: Clinical and Regulatory Perspectives after New Technology Approval
Hyung Ku Chon, Se Woo Park
The Korean Journal of Pancreas and Biliary Tract.2026; 31(2): 73. CrossRef
Endoscopic Management of Choledocholithiasis in the Elderly: Balancing Safety and Effectiveness in the Aging Era
Ryunosuke Hakuta, Ryota Nakabayashi, Nao Otsuka, Noriko Ishigaki, Yukiko Takayama, Yousuke Nakai
Digestive Endoscopy.2026;[Epub] CrossRef
Age-related outcomes of digital single-operator cholangio-pancreatoscopy: a single-center retrospective study
Marco Sacco, Federica Mediati, Pietro Palmieri, Stefania Caronna, Chiara Giordanino, Milena Marietti, Chiara Manuli, Mauro Bruno, Silvia Gaia, Claudio Giovanni De Angelis
European Journal of Gastroenterology & Hepatology.2026;[Epub] CrossRef
Risk factors for post‐endoscopic retrograde cholangiopancreatography complications in very elderly patients aged 90 years or older—No additional risk
Daisuke Manabe, Toshihiko Arizumi, Hitoshi Aoyagi, Koichiro Abe, Shinya Kodashima, Yoshinari Asaoka, Takatsugu Yamamoto, Atsushi Tanaka
Geriatrics & Gerontology International.2025; 25(1): 54. CrossRef
Is endoscopic retrograde cholangiopancreatography safe for centenarians?
Filippo Antonini, Durante Donnarumma, Tiziana Buono
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Outcomes of Therapeutic Endoscopic Retrograde Cholangiopancreatography in Elderly Patients (≥80 Years) with Choledocholithiasis: A Comprehensive Meta-Analysis
Liping Wang, Zhihua Chen
Digestive Diseases.2025; 43(6): 718. CrossRef
Efficacy and Safety of Electrohydraulic Lithotripsy Using Peroral Cholangioscopy under Endoscopic Retrograde Cholangiopancreatography Guidance in Older Adults: A Single-Center Retrospective Study
Koji Takahashi, Hiroshi Ohyama, Yuichi Takiguchi, Yu Sekine, Shodai Toyama, Nana Yamada, Chihei Sugihara, Motoyasu Kan, Mayu Ouchi, Hiroki Nagashima, Yotaro Iino, Yuko Kusakabe, Kohichiroh Okitsu, Izumi Ohno, Naoya Kato
Medicina.2023; 59(4): 795. CrossRef

6,306 View
165 Download
7 Web of Science
7 Crossref

Case Report

Portal cavernography during endoscopic retrograde cholangiopancreatography: from bilhemia to hemobilia: Rawad A. Yared, Paraskevas Gkolfakis, Arnaud Lemmers, Vincent Huberty, Thierry Degrez, Jacques Devière, Daniel Blero; Clin Endosc 2023;56(4):521-526. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2021.276

Abstract PDF

Portobiliary fistulas are rare but may lead to life-threatening complications. Biliary plastic stent-induced portobiliary fistulas during endoscopic retrograde cholangiopancreatography have been described. Herein, we present a case of portal cavernography and recurrent hemobilia after endoscopic retrograde cholangiopancreatography in which a portobiliary fistula was detected in a patient with portal biliopathy. This likely indicates a change in clinical presentation (from bilhemia to hemobilia) after biliary drainage that was successfully treated by placement of a fully covered, self-expandable metallic stent.

Citations

Citations to this article as recorded by

Recognition and management of stent malposition in the portal vein during endoscopic retrograde cholangiopancreatography: A case report
Rui Wu, Feng Zhang, Hao Zhu, Ming-Dong Liu, Yu-Zheng Zhuge, Lei Wang, Bin Zhang
World Journal of Gastrointestinal Endoscopy.2024; 16(7): 432. CrossRef

5,694 View
140 Download
1 Web of Science
1 Crossref

Original Article

Pancreatic duct lavage cytology combined with a cell-block method for patients with possible pancreatic ductal adenocarcinomas, including pancreatic carcinoma in situ: Hiroaki Kusunose, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Hideyuki Anan, Kazuki Endo, Haruka Okano, Masaya Oikawa, Takashi Tsuchiya, Takashi Sawai, Yutaka Noda, Kei Ito; Clin Endosc 2023;56(3):353-366. Published online November 16, 2022; DOI: https://doi.org/10.5946/ce.2022.021

Graphical Abstract Abstract PDF

Background
/Aims: This study aimed to clarify the efficacy and safety of pancreatic duct lavage cytology combined with a cell-block method (PLC-CB) for possible pancreatic ductal adenocarcinomas (PDACs).
Methods
This study included 41 patients with suspected PDACs who underwent PLC-CB mainly because they were unfit for undergoing endoscopic ultrasonography-guided fine needle aspiration. A 6-Fr double lumen catheter was mainly used to perform PLC-CB. Final diagnoses were obtained from the findings of resected specimens or clinical outcomes during surveillance after PLC-CB.
Results
Histocytological evaluations using PLC-CB were performed in 87.8% (36/41) of the patients. For 31 of the 36 patients, final diagnoses (invasive PDAC, 12; pancreatic carcinoma in situ, 5; benignancy, 14) were made, and the remaining five patients were excluded due to lack of surveillance periods after PLC-CB. For 31 patients, the sensitivity, specificity, and accuracy of PLC-CB for detecting malignancy were 94.1%, 100%, and 96.8%, respectively. In addition, they were 87.5%, 100%, and 94.1%, respectively, in 17 patients without pancreatic masses detectable using endoscopic ultrasonography. Four patients developed postprocedural pancreatitis, which improved with conservative therapy.
Conclusions
PLC-CB has an excellent ability to detect malignancies in patients with possible PDACs, including pancreatic carcinoma in situ.

Citations

Citations to this article as recorded by

Early diagnosis of pancreatic cancer via pancreatic juice cytology with a cell-block method in a patient with altered anatomy
Yasuo Otsuka, Kosuke Minaga, Akane Hara, Kentaro Yamao, Mamoru Takenaka, Takaaki Chikugo, Masatoshi Kudo
Endoscopy International Open.2024; 12(06): E764. CrossRef
Role of endoscopic retrograde cholangiopancreatography in early diagnosis of pancreatic cancer
Yasutaka ISHII, Masahiro SERIKAWA, Shinya NAKAMURA, Juri IKEMOTO, Shiro OKA
Suizo.2024; 39(4): 247. CrossRef
Cell block created from pancreatic duct lavage is another jigsaw puzzle to diagnose early pancreatic ductal adenocarcinoma
Rungsun Rerknimitr
Clinical Endoscopy.2023; 56(3): 313. CrossRef

6,674 View
243 Download
2 Web of Science
3 Crossref

Reviews

Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography for patients with Roux-en-Y gastric bypass anatomy: technical overview: Hirokazu Honda, Jeffrey D. Mosko, Ryosuke Kobayashi, Andras Fecso, Bong Sik Kim, Schoeman Scott, Gary R. May; Clin Endosc 2022;55(6):736-741. Published online October 5, 2022; DOI: https://doi.org/10.5946/ce.2022.114

Abstract PDF

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass anatomy is a well-documented challenge. Traditionally, this problem has been overcome with adjunctive techniques, such as device-assisted ERCP, including double-balloon or single-balloon enteroscopy and laparoscopy-assisted transgastric ERCP. Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a novel technique that enables access to the ampulla using a duodenoscope without surgical intervention and has shown high clinical and technical success rates in recent studies. However, this approach is technically demanding, necessitating a thorough understanding of the gastrointestinal anatomy as well as high operator experience. In this review, we provide a technical overview of EDGE in parallel with our personal experience at our center and propose a simple algorithm to select patients for its appropriate application. In conjunction, the outcomes of EDGE compared with those of device-assisted and laparoscopy-assisted transgastric ERCP will be discussed.

Citations

Citations to this article as recorded by

Surgical Palliation for Pancreatic Cancer
Adriana C. Gamboa, Rebecca A. Snyder
Surgical Oncology Clinics of North America.2026; 35(1): 167. CrossRef
Biliary Drainage in Altered Anatomy: A Comprehensive Literature Review
Rishi Chowdhary, Jorge D. Machicado, Veeral M. Oza
Journal of Digestive Endoscopy.2026;[Epub] CrossRef
Management of common bile duct stones: surgical versus gastroenterological perspectives
Danylo Yershov, Isabel Pereira, Claire Brown, Darmarajah Veeramootoo, Matthew Browning
Frontline Gastroenterology.2026; : flgastro-2025-103390. CrossRef
Pushed to the EDGE-EUS to the Rescue ; Endoscopic ultrasound-directed trans gastric ERCP (EDGE) in surgically altered anatomy
S Sud, S Koul, G Khatana, R Sud
Endoscopy.2026; 58(S 03): S265. CrossRef
Common Bile Duct Access After Bariatric Surgery: A Narrative Review of Endoscopic Considerations for Treatment of Choledocholithiasis
Anna Booras, Jessica Zaman, Vladimir Davidyuk, Sandra DiBrito
Diagnostics.2026; 16(13): 2042. CrossRef
Clinical utility of single-balloon enteroscopy for malignant small bowel tumors
Jiro Kawashima, Shin-Ei Kudo, Noriyuki Ogata, Yasuharu Maeda, Keisuke Sasabe, Yurie Kawabata, Takanori Kuroki, Yosuke Minegishi, Taishi Okumura, Yuta Kouyama, Tatsuya Sakurai, Kenta Nakahara, Katsuro Ichimasa, Masashi Misawa, Takemasa Hayashi, Naruhiko Sa
Surgical Endoscopy.2026;[Epub] CrossRef
Interventional Endoscopic Ultrasonography: Advances in Application
Haidar Khan, Sharon Slomovich, Neal C. Shah, Frank Gress
Journal of Clinical Medicine.2025; 14(10): 3286. CrossRef
Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE): Techniques, Outcomes and Safety Profiles
Filippo Antonini, Giacomo Emanuele Maria Rizzo, Giuseppe Vanella, Lorenzo Fuccio, Andrea Lisotti, Michiel Bronswijk, Enrique Pérez-Cuadrado-Robles, Cecilia Binda, Stefano Mazza, Andrea Anderloni, Carlo Fabbri, Ilaria Tarantino
Journal of Clinical Medicine.2025; 14(16): 5675. CrossRef
Current status and further directions of endoscopic ultrasound-directed transgastric ERCP and endoscopic ultrasound-directed transenteric ERCP in the management of pancreaticobiliary diseases in surgically altered anatomy: a comprehensive review
Giuseppe Dell’Anna, Angelo Bruni, Jacopo Fanizza, Paolo Biamonte, Sarah Bencardino, Francesco Vito Mandarino, Ernesto Fasulo, Alberto Barchi, Camilla Gallo, Jahnvi Dhar, Jayanta Samanta, Antonio Facciorusso, Ivo Boskoski, Sara Massironi, Vito Annese, Albe
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography procedure for choledocholithiasis after sleeve gastrectomy and Roux-en-Y
Reid D. Wasserman, Varun Kesar, Vivek Kesar, Paul Yeaton, Shehriyar Mehershahi
Endoscopy.2024; 56(S 01): E390. CrossRef
Complications of Post-Roux-en-Y Gastric Bypass: A Case of Excluded Stomach Perforation
C. Ryan Williams, Nathaniel Grabill, Mena Louis, Deepak Dev Vivekanandan, Timothy Stevens
Cureus.2024;[Epub] CrossRef
A novel endoscopic ultrasound-guided transluminal anchor device
Abhishek Agnihotri, Alexander Schlachterman
Endoscopy.2023; 55(S 01): E775. CrossRef

9,305 View
226 Download
9 Web of Science
12 Crossref

Usefulness of the double-guidewire technique for endoscopic procedures in the field of biliary and pancreatic diseases: Mamoru Takenaka, Masatoshi Kudo; Clin Endosc 2022;55(5):605-614. Published online August 23, 2022; DOI: https://doi.org/10.5946/ce.2022.032

Abstract PDF

The double-guidewire method has been increasingly used in endoscopic procedures for biliary and pancreatic diseases in recent years, including endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography-related procedures. In addition, double-lumen catheters with uneven distal and proximal lumen openings have been introduced, making it possible to easily create a double-guidewire situation, and the usefulness of the double-guidewire technique using uneven double-lumen cannulas has been widely reported. Although the advantages of using two guidewires depend on the particular situation and the appropriate use of the two guidewires, deepening the knowledge of the double-guidewire method will contribute greatly to troubleshooting in daily practice. In this review, the usefulness of the double-guidewire technique is discussed with respect to two main areas: selective insertion of guidewires and devices and biliary cannulation.

Citations

Citations to this article as recorded by

Biliary cannulation techniques: Optimizing success and minimizing risk
Aryan Jain, Mayur Pabba, Aditya Jain, Savita Madhankumar, Sahib Singh, Saurabh Chandan, Muhammad Khalid Hasan, Mustafa A Arain
World Journal of Gastrointestinal Endoscopy.2026;[Epub] CrossRef
Surgeon-performed pediatric ERCP at an academic center: 10-year data
M. Carolina Jimenez, Maria J. Donado, Pedro Zapata, Caio M. Barbosa, Stephano Bonitto, David Zhang, Michel Cordies, Robert F. Cubas, R. Joshua Bowles, Jose M. Martinez
Journal of Pediatric Endoscopic Surgery.2026; 8(3): 177. CrossRef
The Role and Appropriate Selection of Guidewires in Biliopancreatic Endoscopy
Daniele Alfieri, Claudia Delogu, Stefano Mazza, Aurelio Mauro, Erica Bartolotta, Alessandro Cappellini, Davide Scalvini, Francesca Torello Viera, Marco Bardone, Andrea Anderloni
Medicina.2025; 61(5): 913. CrossRef
Salvaging hilar access using an uneven double-lumen cannula in endoscopic ultrasound-guided hepaticogastrostomy
Ryosuke Sato, Kazuyuki Matsumoto, Akihiro Matsumi, Kazuya Miyamoto, Yuki Fujii, Daisuke Uchida, Motoyuki Otsuka
Endoscopy.2025; 57(S 01): E1115. CrossRef
Advancements in Research on Challenges in Selective Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography (ERCP)
天雨张
Journal of Clinical Personalized Medicine.2024; 03(01): 100. CrossRef
Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla
Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han
Clinical Endoscopy.2024; 57(2): 226. CrossRef
Dedicated Echoendoscope for Interventional Endoscopic Ultrasound: Comparison with a Conventional Echoendoscope
Toshio Fujisawa, Shigeto Ishii, Yousuke Nakai, Hirofumi Kogure, Ko Tomishima, Yusuke Takasaki, Koichi Ito, Sho Takahashi, Akinori Suzuki, Hiroyuki Isayama
Journal of Clinical Medicine.2024; 13(10): 2840. CrossRef
INTRAOPERATIVE SIGNS OF ACUTE BILIARY PANCREATITIS
S. M. Vasyliuk, O. V. Prudnikov, V. V. Ivanyna, O. S. Tkachuk, N. M. Pavliuk, B. V. Krysa, V. M. Atamaniuk
Kharkiv Surgical School.2022; (4-5): 55. CrossRef

7,429 View
240 Download
5 Web of Science
8 Crossref

Original Articles

Preventive effect of tacrolimus on patients with post-endoscopic retrograde cholangiopancreatography pancreatitis: Harshavardhan Rao B., Paul K. Vincent, Priya Nair, Anoop K. Koshy, Rama P. Venu; Clin Endosc 2022;55(5):665-673. Published online August 2, 2022; DOI: https://doi.org/10.5946/ce.2021.265

Abstract PDF

Background
/Aims: In patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), calcineurin activates zymogen, which results in pancreatitis. In this study, we aimed to determine the efficacy of tacrolimus, a calcineurin inhibitor, in preventing post-ERCP pancreatitis (PEP).
Methods
This was a prospective pilot study in which patients who underwent ERCP received tacrolimus (4 mg in two divided doses); this was the Tac group. A contemporaneous cohort of patients was included as a control group. All patients were followed-up for PEP. PEP was characterized by worsening abdominal pain with an acute onset, elevated pancreatic enzymes, and a duration of hospital stay of more than 48 hours. Serum tacrolimus levels were measured immediately before the procedure in the Tac group.
Results
There were no differences in the baseline characteristics between the Tac group (n=48) and the control group (n=51). Only four out of 48 patients (8.3%) had PEP in the Tac group compared to eight out of 51 patients (15.7%) who had PEP in the control group. The mean trough tacrolimus level in patients who developed PEP was significantly lower (p<0.05).
Conclusions
Oral tacrolimus at a cumulative dose of 4 mg safely prevents PEP. Further randomized controlled studies are warranted to establish the role of tacrolimus in this context.

Citations

Citations to this article as recorded by

Breaking the Calcium Overload Cycle in Acute Pancreatitis: Emerging Pharmacological Strategies
Serge Chooklin, Serhii Chuklin
Digestive Diseases and Sciences.2026; 71(7): 3159. CrossRef
Post-ERCP Pancreatitis: New Insights, Evolving Therapies, and the Road Ahead
Zaheer Nabi, D. Nageshwar Reddy
Visceral Medicine.2026; 42(3): 113. CrossRef
Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis: Novel Mechanisms and Prevention by Drugs
Venkata S. Akshintala, Ibadat S. Boparai, Monique T. Barakat, Sohail Z. Husain
United European Gastroenterology Journal.2025; 13(1): 78. CrossRef
Calcium-directed therapy in acute pancreatitis
S.M. Chooklin, S.S. Chuklin
EMERGENCY MEDICINE.2025; 21(5): 556. CrossRef
Acute pancreatitis: pathogenesis and emerging therapies
Saif Zaman, Fred Gorelick
Journal of Pancreatology.2024; 7(1): 10. CrossRef
Preclinical safety evaluation of calcineurin inhibitors delivered through an intraductal route to prevent post-ERCP pancreatitis demonstrates endocrine and systemic safety
Jianbo Ni, Asna Khalid, Yu-Chu Lin, Monique T. Barakat, Jing Wang, Cheng-Yu Tsai, Pasha Reza Shams Azar, Ying Ding, Judy-April Murayi, Thottala Jayaraman, Ronald Poropatich, Rita Bottino, Li Wen, Georgios I. Papachristou, Gayathri Swaminathan, Mang Yu, So
Pancreatology.2023; 23(4): 333. CrossRef
Could assessment of genetic susceptibility be an effective solution to prevent pancreatitis from occurring after endoscopic retrograde cholangiopancreatography?
Jae Min Lee
The Korean Journal of Internal Medicine.2023; 38(6): 783. CrossRef
Rectal administration of tacrolimus protects against post-ERCP pancreatitis in mice
Yu-Chu Lin, Jianbo Ni, Gayathri Swaminathan, Asna Khalid, Monique T. Barakat, Adam R. Frymoyer, Cheng-Yu Tsai, Ying Ding, Judy-April Murayi, Thottala Jayaraman, Ronald Poropatich, Rita Bottino, Li Wen, Georgios I. Papachristou, Sunil G. Sheth, Mang Yu, So
Pancreatology.2023; 23(7): 777. CrossRef
Tacrolimus for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis: a potential new target of old drug?
Seok Jeong
Clinical Endoscopy.2022; 55(5): 628. CrossRef

6,394 View
164 Download
8 Web of Science
9 Crossref

Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training?: Shyam Vedantam, Sunil Amin, Ben Maher, Saqib Ahmad, Shanil Kadir, Saad Khalid Niaz, Mark Wright, Nadeem Tehami; Clin Endosc 2022;55(3):426-433. Published online February 4, 2022; DOI: https://doi.org/10.5946/ce.2021.239

Abstract PDF Supplementary Material

Background
/Aims: Cholangiogram interpretation is not used as a key performance indicator (KPI) of endoscopic retrograde cholangiopancreatography (ERCP) training, and national societies recommend different minimum numbers per annum to maintain competence. This study aimed to determine the relationship between correct ERCP cholangiogram interpretation and experience.
Methods
One hundred fifty ERCPists were surveyed to appropriately interpret ERCP cholangiographic findings. There were three groups of 50 participants each: “Trainees,” “Consultants group 1” (performed >75 ERCPs per year), and “Consultants group 2” (performed >100 ERCPs per year).
Results
Trainees was inferior to Consultants groups 1 and 2 in identifying all findings except choledocholithiasis outside the intrahepatic duct on the initial or completion/occlusion cholangiogram. Consultants group 1 was inferior to Consultants group 2 in identifying Strasberg type A bile leaks (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.77–0.96), Strasberg type B (OR, 0.84; 95% CI, 0.74–0.95), and Bismuth type 2 hilar strictures (OR, 0.81; 95% CI, 0.69–0.95).
Conclusions
This investigation supports the notion that cholangiogram interpretation improves with increased annual ERCP case volumes. Thus, a higher annual volume of procedures performed may improve the ability to correctly interpret particularly difficult findings. Cholangiogram interpretation, in addition to bile duct cannulation, could be considered as another KPI of ERCP training.

Citations

Citations to this article as recorded by

Multimethod study of Endoscopic Retrograde Cholangio Pancreatography (ERCP) service delivery: stakeholder perspectives on opportunities for quality improvement
Christina Dobson, Simon M Everett, Emily Haworth, Wafaa Ahmed, Kofi W Oppong, Ian D Penman, Beverley Oates, Bettina Kluettgens, Colin Rees, Linda Sharp
Frontline Gastroenterology.2025; : flgastro-2025-103197. CrossRef
UK ERCP sedation practices, patient comfort and endoscopist characteristics: National Endoscopy Database (NED) analysis on behalf of the JAG and BSG
David Beaton, Matt Rutter, Linda Sharp, Kofi W Oppong, Bidour Awadelkarim, Simon M Everett, Vikramjit Mitra
Frontline Gastroenterology.2023; 14(5): 384. CrossRef

9,473 View
274 Download
2 Web of Science
2 Crossref

Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones: Hirokazu Saito, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Haruo Imamura, Ikuo Matsushita, Tatsuyuki Kakuma, Shuji Tada; Clin Endosc 2022;55(2):263-269. Published online November 12, 2021; DOI: https://doi.org/10.5946/ce.2021.153

Abstract PDF

Background
/Aims: Difficult biliary cannulation is an important risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Therefore, this study aimed to identify the factors that predict difficult cannulation for common bile duct stones (CBDS) to reduce the risk for PEP.
Methods
This multicenter retrospective study included 1,406 consecutive patients with native papillae who underwent ERCP for CBDS. Factors predicting difficult cannulation for CBDS were identified using univariate and multivariate analyses.
Results
Univariate analysis showed that six factors significantly predicted difficult cannulation: ERCP performed by non-expert endoscopists, low-volume center, absence of acute cholangitis, normal serum bilirubin, intradiverticular papilla, and type of major duodenal papilla. Multivariate analysis identified ERCP performed by non-expert endoscopists (odds ratio [OR], 2.5; p<0.001), low-volume center (OR, 1.6; p<0.001), intradiverticular papilla (OR, 1.3; p=0.007), normal serum bilirubin (OR, 1.3; p=0.038), and absence of acute cholangitis (OR, 1.3; p=0.049) as factors significantly predicting difficult cannulation for CBDS.
Conclusions
Initial cannulation by an experienced endoscopist, early rescue cannulation, or early takeover by an experienced endoscopist should be considered when performing ERCP for CBDS in the presence of factors predicting difficult cannulation.

Citations

Citations to this article as recorded by

A stepwise cannulation strategy for conservative endoscopists: the clinical impact of transpancreatic precut after pancreatic stenting in a retrospective study from Taiwan
Wei-Chih Su, Chia-Chi Wang, Tsung-Hsien Hsiao, Hung-Da Chen, Tzu-Hsiang Kung, Chih-Hsiang Chen, Jiann-Hwa Chen
Clinical Endoscopy.2026; 59(1): 132. CrossRef
Difficult biliary cannulation among patients with compensated liver cirrhosis: predictors and impact on complications
Mahmoud A. Elkerdawy, Aya Mohammed Mahros, Mohamed H Emara, Mohammed Hussien Ahmed, Ahmed Ebeed, Hassan E Elbatae
Scientific Reports.2026;[Epub] CrossRef
Transpancreatic precut sphincterotomy during ERCP: Learnability and outcomes across operator volumes and experience
Wei-Chih Su, Chih-Hsiang Chen, Chia-Chi Wang, Tsung-Hsien Hsiao, Hung-Da Chen, Tzu-Hsiang Kung, Jiann-Hwa Chen
Endoscopy International Open.2026;[Epub] CrossRef
Technical factors associated with biliary cannulation success after transpancreatic precut sphincterotomy
Wei-Chih Su, Tsung-Hsien Hsiao, Chia-Chi Wang, Hung-Da Chen, Tzu-Hsiang Kung, Chih-Hsiang Chen, Jiann-Hwa Chen
Endoscopy International Open.2026;[Epub] CrossRef
Practical Tips and Strategies to Improve the Success Rate of Selective Bile Duct Cannulation
Tae Joo Jeon
The Korean Journal of Pancreas and Biliary Tract.2026; 31(2): 54. CrossRef
Biliary endoscopic drainage of septic ICU patients deemed emergent (BEDSIDE): a retrospective cohort study (2012–2022)
Vibhu Chittajallu, Abbinaya Elangovan, Yazan Abu Omar, Sagarika Satyavada, Umar Hayat, Catherine Vozzo, Richard C. Wong, John A. Dumot, Brooke Glessing, Gerard A. Isenberg, Ashley L. Faulx, Amitabh Chak
BMC Gastroenterology.2026;[Epub] CrossRef
Development of a Scoring System for Predicting the Difficulty of Bile Duct Cannulation and Selecting the Appropriate Cannulation Method
Taira Kuroda, Hideki Miyata, Kozue Kanemitsu-Okada, Emi Yanagihara, Hironobu Saneto, Taisei Murakami, Hirofumi Izumoto, Kei Onishi, Shogo Kitahata, Tomoe Kawamura, Ryuichiro Iwasaki, Fujimasa Tada, Eiji Tsubouchi, Atsushi Hiraoka, Tomoyuki Ninomiya
Digestive Diseases and Sciences.2025; 70(2): 843. CrossRef
Unsedated emergent ERCP is feasible and efficient for acute cholangitis in old patients over 80 years
Jia-Qi Xu, Yi-Fan Qu, Zhao-Chao Zhang, Shi-Yao Chen, Yun-Shi Zhong, Yi-Qun Zhang, Wei-Feng Chen, Jian-Wei Hu, Ming-Yan Cai, Li-Qing Yao, Quan-Lin Li, Ping-Hong Zhou
Surgical Endoscopy.2025; 39(5): 2847. CrossRef
Difficult biliary cannulation during endoscopic retrograde cholangiopancreatography for distal malignant biliary obstruction caused by pancreatic cancer: An observational study
Jun Noda, Yuichi Takano, Naoki Tamai, Masataka Yamawaki, Tetsushi Azami, Fumitaka Niiya, Naotaka Maruoka, Masatsugu Nagahama
DEN Open.2025;[Epub] CrossRef
Strategies for achieving successful cannulation in endoscopic retrograde cholangiopancreatography: A technical overview
Alaa Ismail, Maya M Abdelwahab, Mubin Ozercan, Osama Elnahas, Ibrahim H Bahcecioglu, Mehmet Yalniz, Ahmed Tawheed
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
A pilot study showcasing the difficulties in endoscopic biliary drainage using uncovered self-expanding metal stents for resectable perihilar cholangiocarcinoma
David M. de Jong, Bas Groot Koerkamp, Wojciech G. Polak, Jeroen de Jonge, Jan N.M. IJzermans, Michael Doukas, Roy S. Dwarkasing, Marco J. Bruno, Lydi M.J.W. van Driel
Scandinavian Journal of Gastroenterology.2025; 60(10): 938. CrossRef
Advancements in Research on Challenges in Selective Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography (ERCP)
天雨张
Journal of Clinical Personalized Medicine.2024; 03(01): 100. CrossRef
The impact of transpancreatic precut sphincterotomy on the quality of ERCP in a low-volume setting
Wei-Chih Su, Chia-Chi Wang, Tsung-Hsien Hsiao, Hung-Da Chen, Jiann-Hwa Chen
Gastrointestinal Endoscopy.2024; 99(5): 747. CrossRef
Morphology of the papilla can predict procedural safety and efficacy of ERCP—a systematic review and meta-analysis
Edina Tari, Endre Botond Gagyi, Anett Rancz, Dániel Sándor Veres, Szilárd Váncsa, Péter Jenő Hegyi, Krisztina Hagymási, Péter Hegyi, Bálint Erőss
Scientific Reports.2024;[Epub] CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Hyung Ku Chon, Ki-Hyun Kim, Tae Jun Song, Dong-Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyun Chung, Jin Lee, Miyoung Choi
Gut and Liver.2024; 18(4): 564. CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Ki-Hyun Kim, Hyung Ku Chon, Tae Jun Song, Dong Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyung Chung, Jin Lee, Miyoung Choi
The Korean Journal of Gastroenterology.2024; 84(3): 111. CrossRef
Quality Indicators of Endoscopic Retrograde Cholangiopancreatography in Korea
Ki-Hyun Kim, Hyung Ku Chon, Tae Jun Song, Dong Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Tae Joo Jeon, Chang Hwan Park, Kwang Bum Cho, Dong Wook Lee, Jin-Seok Park, Seung Bae Yoon, Kwang Hyung Chung, Jin Lee, Miyoung Choi
The Korean Journal of Pancreas and Biliary Tract.2024; 29(4): 144. CrossRef
En face position of the major duodenal papilla using a reopenable clip during endoscopic retrograde cholangiopancreatography
Hirokazu Saito, Akiko Ikebata, Shunpei Hashigo
Digestive Endoscopy.2023;[Epub] CrossRef
Criterios 5-5-2 de canulación biliar y complicaciones post colangiopancreatografía retrógrada endoscópica: Experiencia en un hospital de referencia, Perú
Wilmer Gustavo Quiroga Purizaca, Diego Ricardo Páucar Aguilar, Jackeline Amparo Barrientos Pérez, Isamar Benyi Gutiérrez Córdova, Renato Garrido Acedo, Daniel Andrei Vargas Blácido
Revista de Gastroenterología del Perú.2023; 43(2): e1461. CrossRef
Predictive factors of difficult biliary cannulation: An experience of a tunisian tertiary center
K. Ben Abdallah, L. Hamzaoui, M. Mahmoudi, I. Cherif, A. Ben Mohamed, M. Yakoubi, A. Khsiba, M. Medhioub, M.M. Azouz
Heliyon.2022; 8(12): e12526. CrossRef

9,296 View
355 Download
17 Web of Science
20 Crossref

Endoscopic Interventions for the Early and Remission Phases of Acute Biliary Pancreatitis: What are the More Concrete and Practical Situations for Performing Them?: Sho Hasegawa, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Toshitaka Sakai, Hiroaki Kusunose, Kensuke Kubota, Atsushi Nakajima, Yutaka Noda, Kei Ito; Clin Endosc 2021;54(6):888-898. Published online May 27, 2021; DOI: https://doi.org/10.5946/ce.2020.271

Abstract PDF: Background
/Aims: The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because the severity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI).
Methods
A total of 148 patients with ABP were included to investigate 1) the differences in the rate of worsening cholangitis/pancreatitis between the EEI group and the early conservative management (ECM) group, especially for each severity of cholangitis/pancreatitis, and 2) the diagnostic ability of imaging studies, including endoscopic ultrasound (EUS), to detect common bile duct stones (CBDSs) in the ECM group.
Results
No differences were observed in the rate of worsening cholangitis between the EEI and ECM groups, regardless of the severity of cholangitis and/or the existence of impacted CBDSs. Among patients without impacted CBDSs and moderate/severe cholangitis, worsening pancreatitis was significantly more frequent in the EEI group (18% vs. 4%, p=0.048). In patients in the ECM group, the sensitivity and specificity for detecting CBDSs were 73% and 98%, respectively, for EUS, whereas the values were 13% and 92%, respectively, for magnetic resonance cholangiopancreatography.
Conclusions
EEI should be avoided in the absence of moderate/severe cholangitis and/or impacted CBDSs because of the high rate of worsening pancreatitis. EUS can contribute to the accurate detection of residual CBDSs, for the determination of the need for elective EI.

6,921 View
139 Download

Biliary Self-Expandable Metal Stent Could Be Recommended as a First Treatment Modality for Immediate Refractory Post-Endoscopic Retrograde Cholangiopancreatography Bleeding: Sun Young Moon, Jun Heo, Min Kyu Jung, Chang Min Cho; Clin Endosc 2022;55(1):128-135. Published online May 25, 2021; DOI: https://doi.org/10.5946/ce.2021.057

Abstract PDF

Background
/Aims: Recent reports suggest that the biliary self-expandable metallic stent (SEMS) is highly effective for maintaining hemostasis when endoscopic hemostasis fails in endoscopic retrograde cholangiopancreatography (ERCP)-related bleeding. We compared whether temporary SEMS offers better efficacy than angioembolization for refractory immediate ERCP-related bleeding.
Methods
Patients who underwent SEMS placement or underwent angioembolization for bleeding control in refractory immediate ERCP-related bleeding were included in the retrospective analysis. We evaluated the hemostasis success rate, severity of bleeding, change in hemoglobin levels, amount of transfusion, and delay to the start of hemostasis.
Results
A total of 27 patients with SEMS and 13 patients who underwent angioembolization were enrolled. More transfusions were needed in the angioembolization group (1.0±1.4 units vs. 2.5±2.0 units; p=0.034). SEMS failure was successfully rescued by angioembolization. The partially covered SEMS (n=23, 85.1%) was generally used, and the median stent-indwelling time was 4 days. The mean delay to the start of angioembolization was 95.2±142.9 (range, 9–491) min.
Conclusions
Temporary SEMS had similar results to those of angioembolization (96.3% vs. 92.3%; p=0.588). Immediate SEMS insertion is considered a bridge treatment modality for immediate refractory ERCP-related bleeding. Angioembolization still has a role as rescue therapy when SEMS does not work effectively.

Citations

Citations to this article as recorded by

Hepatobiliary Nontuberculous Mycobacterial Infection Mimicking Malignancy in a Patient with Anti-Interferon-γ Autoantibodies
Mengmeng Zhang, Qiang Wang, Xi Wu, Dong Wu, Aiming Yang
Diagnostics.2026; 16(12): 1774. CrossRef

6,786 View
199 Download
1 Web of Science
1 Crossref

Review

Technical Review of Developments in Endoscopic Ultrasound-Guided Hepaticogastrostomy: Takeshi Ogura, Kazuhide Higuchi; Clin Endosc 2021;54(5):651-659. Published online April 26, 2021; DOI: https://doi.org/10.5946/ce.2021.020-KDDW

Abstract PDF

Endoscopic ultrasound-guided biliary drainage has been developed as an alternative method for biliary drainage. EUS-guided hepaticogastrostomy (EUS-HGS) can be attempted via the trans-gastric route. These procedures are technically complex for two reasons. First, puncture of the intrahepatic bile duct via the trans-gastric route can be more difficult than that by other approaches because of the small diameter of the target site, and guidewire insertion or manipulation is challenging during EUS-HGS. Second, critical adverse events, such as stent migration into the abdominal cavity, could occur because of the greater mobility of the stomach compared to the duodenum. Therefore, endoscopists should be cautious when performing EUS-HGS. An advantage of EUS-HGS is that it can be performed in patients with complications such as duodenal bulb obstruction or surgically altered anatomy. Recent advances in technique and improvements in devices and stents for EUS-HGS have shown promise for improving the technical success rate of EUS-HGS and reducing the rate of adverse events. However, endoscopists should remain aware of the possibility of critical adverse events such as stent migration.

Citations

Citations to this article as recorded by

Prospective evaluation study of EUS-guided hepaticogastrostomy without tract dilation: Comparison to with tract dilation
Mitsuki Tomita, Takeshi Ogura, Akitoshi Hakoda, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Jun Matsuno, Nobuhiro Hattori, Junichi Nakamura, Takafumi Kanadani, Kimi Bessho, Hiroki Nishikawa
Endoscopic Ultrasound.2026;[Epub] CrossRef
Evaluation of time to endosonographic creation route after endoscopic ultrasound-guided hepaticogastrostomy
Yuki Uba, Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Jun Sakamoto, Jun Matsuno, Mitsuki Tomita, Nobuhiro Hattori, Junichi Nakamura, Takafumi Kanadani, Kimi Bessho, Naoto Aoyama, Kouji Kawakami, Ahmad Fikry Aboelezz, Hiroki Nishikawa
Endoscopy International Open.2026;[Epub] CrossRef
Role of Endoscopic Ultrasonography in Management of Pancreaticobiliary Cancers: Recent Trends and Advances
Shivangini Duggal, Mutaz Kalas, Mohamed H. Eldesouki, M. Ammar Kalas, Sherif E. Elhanafi
Cancers.2026; 18(12): 1864. CrossRef
Single-session multi-segment EUS-guided biliary drainage in surgically altered anatomy: Three-route drainage for high-grade hilar obstruction (with video)
Masaki Miyazawa, Shotaro Kawase, Hajime Takatori
Endoscopic Ultrasound.2026; 15(3): 244. CrossRef
Guidewire–bile duct angle as a determinant of stent delivery success in EUS-guided hepaticogastrostomy: a prospective double-lumen dilator cohort with propensity score-matched historical controls
Naoto Aoyama, Takeshi Ogura, Yoshitaro Yamamoto, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Junichi Nakamura, Nobuhiro Hattori, Kimi Bessho, Takafumi Kanadani, Nga Nguyen Trong, Ly Kim Chhun, Ahmad F. Aboelezz, Yi-Jun Liao, Szu-Chia Liao, Hiroki Nishikawa
Therapeutic Advances in Gastroenterology.2026;[Epub] CrossRef
Risk Management in ERCP and Endoscopic Ultrasound
Takashi Tamura, Reiko Ashida, Yuki Kawaji, Masahiro Itonaga, Yasunobu Yamashita, Masayuki Kitano
Digestive Endoscopy.2026;[Epub] CrossRef
Feasibility of endoscopic ultrasound‐guided hepaticogastrostomy using a novel long balloon catheter
Yuichi Takano, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Fumitaka Niiya, Naotaka Maruoka, Tatsuya Yamagami, Masatsugu Nagahama
DEN Open.2025;[Epub] CrossRef
A technique for penetrating the bile duct wall using a guidewire during endoscopic ultrasound-guided hepaticogastrostomy
Takeshi Ogura, Kimi Bessho, Takafumi Kanadani, Nobuhiro Hattori, Hiroki Nishikawa
Endoscopy.2025; 57(S 01): E197. CrossRef
Quality Indicators for EUS
Girish Mishra, Anne Marie Lennon, Nonthalee Pausawasdi, Vanessa M. Shami, Reem Z. Sharaiha, B. Joseph Elmunzer
American Journal of Gastroenterology.2025; 120(5): 973. CrossRef
Quality indicators for EUS
Girish Mishra, Anne Marie Lennon, Nonthalee Pausawasdi, Vanessa M. Shami, Reem Z. Sharaiha, B. Joseph Elmunzer
Gastrointestinal Endoscopy.2025; 101(5): 928. CrossRef
The Role and Appropriate Selection of Guidewires in Biliopancreatic Endoscopy
Daniele Alfieri, Claudia Delogu, Stefano Mazza, Aurelio Mauro, Erica Bartolotta, Alessandro Cappellini, Davide Scalvini, Francesca Torello Viera, Marco Bardone, Andrea Anderloni
Medicina.2025; 61(5): 913. CrossRef
Clinical evaluation of a novel fluoroscopic mode for improving visibility during interventional endoscopic ultrasound (with video)
Naoto Aoyama, Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Jun Sakamoto, Yuki Uba, Mitsuki Tomita, Nobuhiro Hattori, Junichi Nakamura, Kimi Bessho, Takafumi Kanadani, Hiroki Nishikawa
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
A novel approach to facilitate guidewire placement in endoscopic ultrasound-guided biliary drainage
Cancan Zhou, Zheng Wang, Zheng Wu, Hao Sun, Jie Hao
Endoscopy.2025; 57(S 01): E1031. CrossRef
Chinese expert consensus on the clinical practice of EUS-guided biliary drainage (2024, Shanghai)
Kaixuan Wang, Jiayi Ma, Jun Li, Zhaoshen Li, Siyu Sun, Zhendong Jin
Endoscopic Ultrasound.2025; 14(4): 161. CrossRef
Virtual reality cross-sections matched to endoscopic ultrasound for preprocedural simulation of hepaticogastrostomy
Daisuke Namima, Hideki Kamada, Noriko Nishiyama, Naoki Fujita, Hiroki Yamana, Kiyoyuki Kobayashi, Hideki Kobara
Endoscopy.2025; 57(S 01): E1393. CrossRef
Propensity score matching analysis for clinical impact of braided-type versus laser-cut-type covered self-expandable metal stents for endoscopic ultrasound-guided hepaticogastrostomy
Mitsuki Tomita, Takeshi Ogura, Akitoshi Hakoda, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Yoshitaro Yamamoto, Hiroki Nishikawa
Hepatobiliary & Pancreatic Diseases International.2024; 23(2): 181. CrossRef
Usefulness of endoscopic ultrasound‐guided transhepatic biliary drainage with a 22‐gauge fine‐needle aspiration needle and 0.018‐inch guidewire in the procedure's induction phase
Kei Yane, Masahiro Yoshida, Takayuki Imagawa, Kotaro Morita, Hideyuki Ihara, Kota Hanada, Sota Hirokawa, Yusuke Tomita, Takeyoshi Minagawa, Yutaka Okagawa, Tetsuya Sumiyoshi, Michiaki Hirayama, Hitoshi Kondo
DEN Open.2024;[Epub] CrossRef
EUS-guided hepaticogastrostomy versus EUS-guided hepaticogastrostomy with antegrade stent placement in patients with unresectable malignant distal biliary obstruction: a propensity score–matched case-control study
Hirotoshi Ishiwatari, Takeshi Ogura, Susumu Hijioka, Takuji Iwashita, Saburo Matsubara, Kazuma Ishikawa, Fumitaka Niiya, Junya Sato, Atsushi Okuda, Saori Ueno, Yoshikuni Nagashio, Yuta Maruki, Shinya Uemura, Akifumi Notsu
Gastrointestinal Endoscopy.2024; 100(1): 66. CrossRef
Stent Deployment Without Tract Dilation in Endoscopic Ultrasound-Guided Hepaticogastrostomy Using a Novel Partially Covered Metal Stent With a Super-Slim Stent Delivery System: A Case Report
Koji Takahashi, Hiroshi Ohyama, Izumi Ohno, Naoya Kato
Cureus.2024;[Epub] CrossRef
TOKYO criteria 2024 for the assessment of clinical outcomes of endoscopic biliary drainage
Hiroyuki Isayama, Tsuyoshi Hamada, Toshio Fujisawa, Mitsuharu Fukasawa, Kazuo Hara, Atsushi Irisawa, Shigeto Ishii, Ken Ito, Takao Itoi, Yoshihide Kanno, Akio Katanuma, Hironari Kato, Hiroshi Kawakami, Hirofumi Kawamoto, Masayuki Kitano, Hirofumi Kogure,
Digestive Endoscopy.2024; 36(11): 1195. CrossRef
One-step technique for endoscopic ultrasound-guided hepaticogastrostomy using a partially covered metal stent for superficial bile duct access
Takeshi Ogura, Yuki Uba, Nobuhiro Hattori, Kimi Bessho, Hiroki Nishikawa
Endoscopy.2024; 56(S 01): E665. CrossRef
Endoscopic ultrasound-guided hepaticogastrostomy for patients with frequent respiratory fluctuations using a novel hybrid guidewire to prevent guidewire shearing
Takeshi Ogura, Yuki Uba, Nobuhiro Hattori, Jun Matsuno, Hiroki Nishikawa
Endoscopy.2024; 56(S 01): E743. CrossRef
Technique tips for fitting alignment of puncture route during EUS-guided hepaticogastrostomy (with video)
Takeshi Ogura, Kimi Bessho, Nobihiro Hattori, Yuki Uba, Hiroki Nishikawa
Endoscopic Ultrasound.2024; 13(4): 276. CrossRef
Thin Delivery Stents Can Obviate the Need for Additional Fistula Dilatation of Large Diameter in Endoscopic Ultrasound-Guided Hepaticogastrostomy
Tomoki Ogata, Yusuke Kurita, Takamitsu Sato, Shin Yagi, Sho Hasegawa, Kunihiro Hosono, Noritoshi Kobayashi, Itaru Endo, Kensuke Kubota, Atsushi Nakajima
Journal of Clinical Medicine.2024; 13(21): 6328. CrossRef
Hepatobiliary scintigraphy of bile excretion after endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction: a retrospective study in Japan
Masanori Yamada, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Toshitaka Fukui
Clinical Endoscopy.2024; 57(6): 798. CrossRef
Efficacy of a dedicated plastic stent in endoscopic ultrasound-guided hepaticogastrostomy during the learning curve: cumulative multi-center experience
Koh Kitagawa, Akira Mitoro, Ryuki Minami, Shinsaku Nagamatsu, Takahiro Ozutsumi, Yukihisa Fujinaga, Norihisa Nishimura, Yasuhiko Sawada, Tadashi Namisaki, Takemi Akahane, Kosuke Kaji, Fumimasa Tomooka, Shohei Asada, Miki Kaneko, Hitoshi Yoshiji
Scandinavian Journal of Gastroenterology.2023; 58(3): 296. CrossRef
Removal of a small pancreatic stone in thin main pancreatic duct using an ultrafine balloon catheter (with video)
Saburo Matsubara, Keito Nakagawa, Kentaro Suda, Takeshi Otsuka, Masashi Oka, Sumiko Nagoshi
Journal of Hepato-Biliary-Pancreatic Sciences.2023;[Epub] CrossRef
Drainage of Afferent Limb Obstruction via the Trans-gastric-bile Duct Formed after Endoscopic Ultrasound-guided Hepaticogastrostomy in a Patient with Pancreatic Cancer
Masatoshi Mabuchi, Seiji Adachi, Yukari Uno, Hironori Nakamura, Makoto Shimazaki, Shinji Nishiwaki, Iwao Kumazawa, Takuji Iwashita, Masahito Shimizu
Internal Medicine.2023; 62(16): 2355. CrossRef
Clinical feasibility of endoscopic ultrasound‐guided biliary drainage for preoperative management of malignant biliary obstruction (with videos)
Shuntaro Mukai, Takao Itoi, Takayoshi Tsuchiya, Kentaro Ishii, Ryosuke Tonozuka, Yuichi Nagakawa, Shingo Kozono, Chie Takishita, Hiroaki Osakabe, Atsushi Sofuni
Journal of Hepato-Biliary-Pancreatic Sciences.2023; 30(7): 983. CrossRef
A retrospective multicenter study comparing the punctures to B2 and B3 in endoscopic ultrasound–guided hepaticogastrostomy
Masanari Sekine, Yusuke Hashimoto, Taro Shibuki, Kei Okumura, Ikuhiro Kobori, Aki Miyagaki, Yoshihiro Sasaki, Yuichi Takano, Keita Matsumoto, Hirosato Mashima
DEN Open.2023;[Epub] CrossRef
Stent‐in‐stent technique in a case of difficult removal of a EUS‐guided hepaticogastrostomy partially covered metal stent due to mucosal hyperplasia (with video)
Takeshi Ogura, Yuki Uba, Hiroki Nishikawa
Journal of Hepato-Biliary-Pancreatic Sciences.2023; 30(10): 1188. CrossRef
Loop technique for guidewire manipulation during endoscopic ultrasound‐guided hepaticogastrostomy
Haruo Miwa, Kazuya Sugimori, Yuto Matsuoka, Kazuki Endo, Ritsuko Oishi, Masaki Nishimura, Yuichiro Tozuka, Takashi Kaneko, Kazushi Numata, Shin Maeda
JGH Open.2023; 7(5): 358. CrossRef
Drainage Approach for Malignant Biliary Obstruction
Ian Eisenberg, Monica Gaidhane, Michel Kahaleh, Amy Tyberg
Journal of Clinical Gastroenterology.2023; 57(6): 546. CrossRef
Guidewire malposition outside the bile duct during endoscopic ultrasound-guided hepaticogastrostomy
Yoshimitsu Fukasawa, Mitsuharu Fukasawa, Shinichi Takano, Satoshi Kawakami, Hiroshi Hayakawa, Shota Harai, Nobuyuki Enomoto
Endoscopy.2023; 55(S 01): E894. CrossRef
Preloading guidewire method: EUS-guided hepaticogastrostomy
Hirotsugu Maruyama, Yuki Ishikawa-Kakiya, Kojiro Tanoue, Akira Higashimori, Yasuhiro Fujiwara
Arab Journal of Gastroenterology.2023; 24(3): 183. CrossRef
Guidewires in GI endoscopy
Samuel Han, Mohit Girotra, Venkata S. Akshintala, Dennis Chen, Yen-I Chen, Koushik K. Das, Allon Kahn, Girish Mishra, V. Raman Muthusamy, Jorge V. Obando, Frances U. Onyimba, Swati Pawa, Tarun Rustagi, Sonali Sakaria, Guru Trikudanathan, Ryan J. Law
iGIE.2023; 2(3): 386. CrossRef
EUS–guided transhepatic metal stent deployment technique without tract dilation using a 0.018-inch guidewire (with video)
Takeshi Ogura, Jyunichi Kawai, Kyohei Nishiguchi, Yoshitaro Yamamoto, Kazuhide Higuchi
Endoscopic Ultrasound.2023; 12(5): 431. CrossRef
The writing on the wall: self-expandable stents for endoscopic ultrasound-guided hepaticogastrostomy?
Hyung Ku Chon, Shayan Irani, Tae Hyeon Kim
Clinical Endoscopy.2023; 56(6): 741. CrossRef
Rescue technique after endoscopic ultrasound-guided hepaticogastrostomy stent dislocation
Takeshi Ogura, Taro Iwatsubo, Atsushi Okuda, Saori Ueno, Hiroki Nishikawa
Endoscopy.2023; 55(S 01): E1236. CrossRef
Simplified single-session EUS-guided transhepatic antegrade stone removal for management of choledocholithiasis in patients with surgically altered anatomy
Tingting Yu, Suning Hou, Haiming Du, Wei Zhang, Jiao Tian, Yankun Hou, Jun Yao, Senlin Hou, Lichao Zhang
Gastroenterology Report.2023;[Epub] CrossRef
Endoscopic ultrasound-guided hepaticogastrostomy using a novel drill dilator
Masanori Yamada, Kazuo Hara, Shin Haba, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi
Endoscopy.2022; 54(S 02): E856. CrossRef
Successful endoscopic treatment of huge infected biloma and hepatic abscess after endoscopic ultrasound-guided hepaticogastrostomy with brain abscess
Koji Takahashi, Hiroshi Ohyama, Hiroki Nagashima, Yotaro Iino, Yuko Kusakabe, Kohichiroh Okitsu, Izumi Ohno, Yuichi Takiguchi, Naoya Kato
Clinical Journal of Gastroenterology.2022; 15(5): 988. CrossRef
Prevention of Serious Complications during Endoscopic Ultrasound-Guided Biliary Drainage: A Case-Based Technical Review
Surinder Singh Rana, Jimil Shah, Harish Bhujade, Ujjwal Gorsi, Mandeep Kang, Rajesh Gupta
Journal of Digestive Endoscopy.2022; 13(02): 082. CrossRef
Endoscopic salvage therapy after failed biliary cannulation using advanced techniques: A concise review
Yung-Kuan Tsou, Kuang-Tse Pan, Mu Hsien Lee, Cheng-Hui Lin
World Journal of Gastroenterology.2022; 28(29): 3803. CrossRef
Usefulness of the double-guidewire technique for endoscopic procedures in the field of biliary and pancreatic diseases
Mamoru Takenaka, Masatoshi Kudo
Clinical Endoscopy.2022; 55(5): 605. CrossRef
New Stents for Endoscopic Ultrasound-Guided Procedures
Gunn Huh, Tae Jun Song
The Korean Journal of Pancreas and Biliary Tract.2021; 26(4): 248. CrossRef

10,224 View
386 Download
47 Web of Science
46 Crossref

Original Article

Outcomes of Dilation of Recalcitrant Pancreatic Strictures Using a Wire-Guided Cystotome: Sridhar Sundaram, Dhaval Choksi, Aditya Kale, Suprabhat Giri, Biswaranjan Patra, Shobna Bhatia, Akash Shukla; Clin Endosc 2021;54(6):903-908. Published online March 4, 2021; DOI: https://doi.org/10.5946/ce.2020.297

Abstract PDF

Background
/Aims: Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendra stent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreatic strictures with a 6-Fr cystotome.
Methods
A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant to conventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricture with plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae.
Results
Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis, with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and one had a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the most common location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limiting bleeding, whereas another patient developed mild post-ERCP pancreatitis.
Conclusions
The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreatic strictures after the failure of conventional modalities.

Citations

Citations to this article as recorded by

Cystotome Use for Impassable Biliopancreatic Strictures: Efficacy and Safety—Systematic Review and Single Center Case Series
Gabriel Marcellier, Nathaniel Edery, Carlos Pratico, Benedicte Jais, Alain Berson, Frederique Maire, Paul Rivallin, Frederic Prat
Clinical and Translational Gastroenterology.2026; 17(6): e01019. CrossRef
Endoscopic Ultrasound-Guided Pancreatic Duct Drainage Using a Cystotome in a Patient with Post-Whipple Anatomy
Jeong Hoon Kim, Jade Wang, Anam Rizvi, Patrick Magahis, Reem Z. Sharaiha, David Carr-Locke, Kartik Sampath
Endoscopy International Open.2026;[Epub] CrossRef
Does wire-guided cystotome dilation for difficult benign bilio-pancreatic strictures guarantee long-term patency? A narrative mini-review of the literature
Omar Ksissa, Lorenzo Dioscoridi, Edoardo Forti, Francesco Pugliese, Marcello Cintolo, Andrea Palermo, Massimiliano Mutignani
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Fully Covered Self-expandable Metallic Stents for Refractory Benign Pancreatic Duct Strictures: A Systematic Review and Meta-analysis
Gajanan Rodge, Suprabhat Giri, Kailash Kolhe, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram, Aditya Kale
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(5): 529. CrossRef
Treatment of Difficult Pancreatic Duct Strictures Using a Cystotome: A Single-Center Experience
Jonghyun Lee, Dong Uk Kim, Sung Yong Han
The Korean Journal of Pancreas and Biliary Tract.2023; 28(4): 108. CrossRef
Approach to management of pancreatic strictures: the gastroenterologist’s perspective
Vaneet Jearth, Suprabhat Giri, Sridhar Sundaram
Clinical Journal of Gastroenterology.2021; 14(6): 1587. CrossRef

6,805 View
112 Download
5 Web of Science
6 Crossref

Case Report

Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding: Michihiro Yoshida, Tadahisa Inoue, Itaru Naitoh, Kazuki Hayashi, Yasuki Hori, Makoto Natsume, Naoki Atsuta, Hiromi Kataoka; Clin Endosc 2022;55(1):150-155. Published online November 19, 2020; DOI: https://doi.org/10.5946/ce.2020.217

Abstract PDF

We reviewed 7 patients with unsuccessful endoscopic hemostasis using covered self-expandable metal stent (CSEMS) placement for post-endoscopic sphincterotomy (ES) bleeding. ES with a medium incision was performed in 6 and with a large incision in 1 patient. All but 1 of them (86%) showed delayed bleeding, warranting second endoscopic therapies followed by CSEMS placement 1–5 days after the initial ES. Subsequent CSEMS placement did not achieve complete hemostasis in any of the patients. Lateral-side incision lines (3 or 9 o’clock) had more frequent bleeding points (71%) than oral-side incision lines (11–12 o’clock; 29%). Additional endoscopic hemostatic procedures with hemostatic forceps, hypertonic saline epinephrine, or hemoclip achieved excellent hemostasis, resulting in complete hemostasis in all patients. These experiences provide an alert: CSEMS placement is not an ultimate treatment for post-ES bleeding, despite its effectiveness. The lateral-side of the incision line, as well as the oral-most side, should be carefully examined for bleeding points, even after the CSEMS placement.

Citations

Citations to this article as recorded by

Side-by-side plastic stent insertion for refractory post-endoscopic sphincterotomy bleeding after covered metal stent placement
Takehiko Koga, Naoaki Tsuchiya, Yusuke Ishida, Makoto Fukuyama, Keisuke Matsumoto, Yi-Ling Ko, Fumihito Hirai
Endoscopy.2026; 58(S 01): E207. CrossRef
Is routine placement of hemoclips during endoscopic retrograde cholangiopancreatography necessary for preventing delayed bleeding?
Zhen-Wei Ma, Xiao-Jun Gong, Gang Zheng, Fu-Rong Hu, Qiao Zhang, Yong-Jun Chen, Bing Wang
BMC Gastroenterology.2026;[Epub] CrossRef
Complications of Endoscopic Retrograde Cholangiopancreatography
Monique Barakat, Monica Saumoy, Nauzer Forbes, B. Joseph Elmunzer
Gastroenterology.2025; 169(2): 230. CrossRef
Application of a New Hemostatic Clip to Prevent Delayed Bleeding After Endoscopic Sphincterotomy
Jinpei Dong, Qiushi Feng, Guigen Teng, Haixia Niu, Dapeng Bian
Journal of Clinical Gastroenterology.2024; 58(6): 614. CrossRef
Effectiveness and safety of a new clip for delivery using a duodenoscope for bleeding after endoscopic sphincterotomy
Atsushi Yamaguchi, Hiroki Kamada, Shigeaki Semba, Naohiro Kato, Yasuhiro Okuda, Yuji Teraoka, Takeshi Mizumoto, Yuzuru Tamaru, Tsuyoshi Hatakeyama, Hirotaka Kouno, Shigeto Yoshida
Endoscopy International Open.2024; 12(10): E1190. CrossRef
Multiple drugs

Reactions Weekly.2022; 1907(1): 314. CrossRef

7,518 View
210 Download
5 Web of Science
6 Crossref

Original Articles

Cholecystitis after Placement of Covered Self-Expandable Metallic Stents in Patients with Distal Malignant Biliary Obstructions: Masafumi Watanabe, Kosuke Okuwaki, Jun Woo, Mitsuhiro Kida, Hiroshi Imaizumi, Tomohisa Iwai, Hiroshi Yamauchi, Toru Kaneko, Rikiya Hasegawa, Takahiro Kurosu, Naoki Minato, Hiroki Haradome, Wasaburo Koizumi; Clin Endosc 2021;54(4):589-595. Published online November 17, 2020; DOI: https://doi.org/10.5946/ce.2020.136

Abstract PDF

Background
/Aims: Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement.
Methods
We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively.
Results
The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis.
Conclusions
The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.

Citations

Citations to this article as recorded by

Postprocedural cholecystitis following covered self-expandable metal stent placement in patients with distal malignant biliary obstruction: a systematic review and meta-analysis
Chawin Lopimpisuth, Shyam Vedantam, Pojsakorn Danpanichkul, Mahmoud Mahfouz, Jordan Orr, Abid Javed, Shria Kumar, Jodie A. Barkin, Sunil Amin, Sean Bhalla
Gastrointestinal Endoscopy.2026; 103(2): 220. CrossRef
Role of Prophylactic Endoscopic Gallbladder Stent Placement for Prevention of Acute Cholecystitis in Patients Receiving Stenting for Malignant Biliary Obstruction: A Meta-Analysis
Zahid Ijaz Tarar, Mustafa Gandhi, Umer Farooq, AhtshamUllah Chaudhry, Gopala K. Konduri, Ahmad Zain, Zohaib Ahmed, Baltej Singh, Nirav Thosani
Digestive Diseases and Sciences.2026; 71(4): 1547. CrossRef
Multi-Hole Self-Expandable Metallic Stent for Malignant Distal Biliary Obstruction: A Literature Review
Koh Kitagawa, Shohei Asada, Jun-ichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Akira Mitoro, Hitoshi Yoshiji
Journal of Clinical Medicine.2026; 15(4): 1410. CrossRef
Fully covered metal stents as a risk factor for acute cholecystitis in patients with biliary stricture: a multicenter retrospective study
Tawfik Khoury, Ariel A. Benson, Mor Goldsztein, Nama Mubariki, Adi Nubani, Tomer Greener, Halim Awadie, Mahmud Mahamid, Andrea Lisotti, Wisam Sbeit
European Journal of Gastroenterology & Hepatology.2026; 38(9): 1036. CrossRef
Incidence of Cholecystitis after Multihole Fully Covered Metal Stent Placement for Unresectable Malignant Distal Biliary Obstruction: A Prospective Exploratory Study
Junro Ishizaki, Kosuke Okuwaki, Masafumi Watanabe, Hiroki Haradome, Kai Adachi, Akihiro Tamaki, Taro Hanaoka, Daisuke Ogawa, Hiroshi Imaizumi, Mitsuhiro Kida, Chika Kusano
Journal of Digestive Endoscopy.2026;[Epub] CrossRef
Incidence of Cholecystitis After Endoscopic Biliary Drainage Using a Low Axial Force Covered Self‐Expandable Metallic Stent in Patients With Malignant Distal Biliary Obstruction: A Multicenter Prospective Study
Naoki Minato, Kosuke Okuwaki, Masafumi Watanabe, Jun Woo, Takaaki Matsumoto, Masayoshi Tadehara, Toru Kaneko, Junro Ishizaki, Tomohisa Iwai, Hiroshi Imaizumi, Mitsuhiro Kida, Hiroki Haradome, Chika Kusano
Journal of Gastroenterology and Hepatology.2025; 40(2): 502. CrossRef
Risk Factors for Cholecystitis After Self-expandable Metallic Stent Placement for Malignant Distal Biliary Obstruction
Hashem Albunni, Azizullah Beran, Nwal Hadaki, Mark A. Gromski, Mohammad Al-Haddad
Journal of Clinical Gastroenterology.2025;[Epub] CrossRef
Fully covered metal stents as a risk factor for acute cholecystitis and cholangitis in patients with biliary stricture: A multicenter retrospective study
T Khoury, A Benson, M Moaad Farraj, M Basheer, M Mahamid, A Nubani, T Greener, N Mubariki, H Awadie, A Lisotti, W Sbeit
Endoscopy.2025; 57(S 02): S127. CrossRef
Interventional Endoscopic Ultrasonography: Advances in Application
Haidar Khan, Sharon Slomovich, Neal C. Shah, Frank Gress
Journal of Clinical Medicine.2025; 14(10): 3286. CrossRef
Post-endoscopic retrograde cholangiopancreatography cholecystitis: A review of incidence, risk factors, prevention, and management
Suprabhat Giri, Shivaraj Afzalpurkar, Prasanna Gore, Gaurav Khatana, Saroj Kanta Sahu, Dibya Lochan Praharaj, Bipadabhanjan Mallick, Preetam Nath, Sridhar Sundaram, Manoj Kumar Sahu
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Adverse events of self-expandable metal stent placement for malignant distal biliary obstruction: a large multicenter study
Takashi Tamura, Takuo Yamai, Norimitsu Uza, Tomoaki Yamasaki, Atsuhiro Masuda, Fumimasa Tomooka, Hirotsugu Maruyama, Minoru Shigekawa, Takeshi Ogura, Katsutoshi Kuriyama, Masanori Asada, Hisakazu Matsumoto, Mamoru Takenaka, Koichiro Mandai, Yui Osaki, Ken
Gastrointestinal Endoscopy.2024; 99(1): 61. CrossRef
Fully covered versus partially covered self-expandable metal stents for palliation of distal malignant biliary obstruction: a systematic review and meta-analysis
Giuseppe Vanella, Chiara Coluccio, Alessandro Cucchetti, Roberto Leone, Giuseppe Dell’Anna, Paolo Giuffrida, Carmela Abbatiello, Cecilia Binda, Carlo Fabbri, Paolo Giorgio Arcidiacono
Gastrointestinal Endoscopy.2024; 99(3): 314. CrossRef
Endoscopic Ultrasound–Guided vs Endoscopic Retrograde Cholangiopancreatography–Guided Biliary Drainage as Primary Approach to Malignant Distal Biliary Obstruction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Harishankar Gopakumar, Ritu Raj Singh, Vakya Revanur, Rajanikanth Kandula, Srinivas R. Puli
American Journal of Gastroenterology.2024; 119(8): 1607. CrossRef
Cholecystitis in patients with a fully covered self-expandable metal stent with and without externally anchored plastic stents
José Miguel Jiménez-Gutiérrez, Félix Téllez-Avila
Endoscopy.2024; 56(04): 317. CrossRef
Risk factors and treatment strategies for cholecystitis after metallic stent placement for malignant biliary obstruction: a multicenter retrospective study
Akihiro Matsumi, Hironari Kato, Taiji Ogawa, Toru Ueki, Masaki Wato, Masakuni Fujii, Tatsuya Toyokawa, Ryo Harada, Yuki Ishihara, Masahiro Takatani, Hirofumi Tsugeno, Naoko Yunoki, Takeshi Tomoda, Toshiharu Mitsuhashi, Motoyuki Otsuka
Gastrointestinal Endoscopy.2024; 100(1): 76. CrossRef
Intrahepatic Rupture of Acute Cholecystitis Complicated by Septic Portal Thrombosis
Mena Louis, Nathaniel Grabill, Baraa Mohamed, Firdous Khan, Joe Williams, Nelson A Royall
Cureus.2024;[Epub] CrossRef
Malignant Obstructive Jaundice ERCP Postoperative Complications Risk Factors
威刘
Asian Case Reports in Emergency Medicine.2024; 12(04): 153. CrossRef
Covered versus uncovered double bare self-expandable metal stent for palliation of unresectable extrahepatic malignant biliary obstruction: a randomized controlled multicenter trial
Se Woo Park, Kyong Joo Lee, Moon Jae Chung, Jung Hyun Jo, Hee Seung Lee, Jeong Youp Park, Seung Woo Park, Si Young Song, Huapyong Kang, Eui Joo Kim, Yeon Suk Kim, Jae Hee Cho, Seungmin Bang
Gastrointestinal Endoscopy.2023; 97(1): 132. CrossRef
Risk factors for early and late cholecystitis after covered metal stent placement for distal biliary obstruction
Tatsuya Ishii, Tsuyoshi Hayashi, Hajime Yamazaki, Risa Nakamura, Kosuke Iwano, Ryo Ando, Haruka Toyonaga, Toshifumi Kin, Kuniyuki Takahashi, Akio Katanuma
Journal of Hepato-Biliary-Pancreatic Sciences.2023; 30(10): 1180. CrossRef
Efficacy and complications of inoperable malignant distal biliary obstruction treatment by metallic stents: fully covered or uncovered?
Jiangning Gu, Xiaoyi Guo, Yong Sun, Bin Fan, Haoran Li, Ting Luo, Haifeng Luo, Jiao Liu, Feng Gao, Yuan Gao, Guang Tan, Xiaoming Liu, Zhuo Yang
Gastroenterology Report.2022;[Epub] CrossRef
Endoscopic Management of Pancreatobiliary Malignancies
Dong Wook Lee, Eun Young Kim
Digestive Diseases and Sciences.2022; 67(5): 1635. CrossRef

9,761 View
201 Download
17 Web of Science
21 Crossref

Evaluating the Revised American Society for Gastrointestinal Endoscopy Guidelines for Common Bile Duct Stone Diagnosis: Jake S. Jacob, Michelle E. Lee, Erin Y. Chew, Aaron P. Thrift, Robert J. Sealock; Clin Endosc 2021;54(2):269-274. Published online November 6, 2020; DOI: https://doi.org/10.5946/ce.2020.100

Abstract PDF Supplementary Material

Background
/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification of patients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare it to the previous guidelines.
Methods
We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-risk patients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured the association between individual criteria and choledocholithiasis.
Results
Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmed choledocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detection of choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% had choledocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. The positive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnostic endoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity for choledocholithiasis. Gallstone pancreatitis was not associated with the risk for choledocholithiasis.
Conclusions
The 2019 revision of the ASGE guidelines decreases the utilization of ERCP as a diagnostic modality and offers an improved risk stratification tool.

Citations

Citations to this article as recorded by

Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography for Bile Duct Stones—Avoiding the Avoidable
Stefan Chiriac, Catalin Sfarti, Horia Minea, Sebastian Zenovia, Irina Girleanu, Laura Huiban, Cristina Muzica, Adrian Rotaru, Remus Stafie, Robert Nastasa, Ermina Stratina, Bogdan Mihnea Ciuntu, Raluca Avram, Anca Trifan
Biomedicines.2026; 14(1): 91. CrossRef
Unnecessary ERCPs: Is Spontaneous Stone Passage the Sole Determinant?
Dimitrios I. Ziogas, Theodoros A. Voulgaris, Ance Volkanovska, Aliki Stamou, Georgios Kranidiotis, Gerasimos Stefanidis, Paraskevas Gkolfakis, Ioannis A. Vezakis, Gjorgi Deriban, Meri Trajkovska, Konstantinos Triantafyllou, Antonios Vezakis, Ioannis S. Pa
Medicina.2026; 62(3): 548. CrossRef
Perioperative management based on the enhanced recovery after surgery concept in elderly patients undergoing laparoscopic common bile duct exploration plus laparoscopic cholecystectomy
Long-Xiang Wang, Yan-Hong Jiang, Yong Ding, Hai-Tao Wu
World Journal of Gastrointestinal Surgery.2026;[Epub] CrossRef
Approach to biliary tree clearance in pediatric patients undergoing cholecystectomy: insights from a tertiary hospital
Tal Weiss, Yael Dreznik, Maya Paran, Dragan Kravarusic
Pediatric Surgery International.2025;[Epub] CrossRef
Endoscopic retrograde cholangiopancreatography, endoscopic papillary balloon dilation, and laparoscopic hepatectomy for intra- and extrahepatic bile duct stones
Zhi-Liang Chen, Hong Fu
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Performance of Diagnostic Guidelines in the Evaluation of Choledocholithiasis in Patients With Acute Biliary Presentation: A Systematic Review and Meta‐Analysis
Henry C. K. Kwok, Fransiska R. M. Falconer, Alain C. Vandal, Andrew G. Hill, Andrew D. Maccormick
World Journal of Surgery.2025; 49(8): 2153. CrossRef
Rendimiento diagnóstico de las Guías de la Sociedad Americana de Endoscopia Gastrointestinal 2019 para coledocolitiasis
Diego David de la Peña Castro, Javier del Bosque Cárdenas, Ana Isabel Padilla García
Cirujano General.2025; 47(2): 82. CrossRef
Balancing Endoscopy and Surgery in Choledocholithiasis: A 12-Year Real-World Analysis From a Brazilian Tertiary University Hospital
Otávio B Ceribeli, Philipe F Tafner, Martinho A Gestic, Murillo P Utrini, Francisco Callejas-Neto, Everton Cazzo
Cureus.2025;[Epub] CrossRef
The role of AI models in enhancing choledocholithiasis diagnosis: A systematic review and meta‑analysis
Panagiotis Doukas, Sotirios Doukas, Arkady Broder
Experimental and Therapeutic Medicine.2025; 30(6): 1. CrossRef
Endoscopic ultrasound avoids diagnostic ERCP among the ASGE high-risk group – Experience in an Asian population
Weng-Fai Wong, Yu-Ting Kuo, Ming-Lun Han, Hsiu-Po Wang
Journal of the Formosan Medical Association.2024; 123(3): 374. CrossRef
Rendimiento diagnóstico de la endosonografía biliopancreática en pacientes con riesgo intermedio de coledocolitiasis
Lázaro Antonio Arango Molano, Andrés Sánchez Gil, Claudia Patricia Diaz Tovar, Andrés Valencia Uribe, Christian Germán Ospina Pérez, Pedro Eduardo Cuervo Pico, Rodrigo Alberto Jiménez Gómez
Revista de Gastroenterología del Perú.2024; 44(1): 8. CrossRef
ASGE Predictors for the Diagnosis of Choledocholithiasis: Validation in a Public Hospital of Merida, Yucatan, México
Richard Camilo Aguirre-Sanchez, Abraham Hernan-Herrera-Sanchez, Carlos Enrique Perez-Osorio, Maria Fidelia Cardenas-Marrufo
The International Journal of Gastroenterology and Hepatology Diseases.2024;[Epub] CrossRef
Predictors of Choledocholithiasis in Cholecystectomy Patients and Their Cutoff Values and Prediction Model in Korea in Comparison with the 2019 ASGE Guidelines
Jung Hun Woo, Hwanhyi Cho, Kihyun Ryu, Young Woo Choi, Sanghyuk Lee, Tae Hee Lee, Dae Sung Kim, In Seok Choi, Ju Ik Moon, Seung Jae Lee
Gut and Liver.2024; 18(6): 1060. CrossRef
Demographic Profiles, Etiological Spectrum, and Anatomical Locations of the Post-Hepatic Obstructive Jaundice in Adult Population in Hadhramout Region in Yemen
Sultan Abdulwadoud Alshoabi, Abdulkhaleq Ayedh Binnuhaid, Halah Fuad Muslem, Abdullgabbar M. Hamid, Fahad H. Alhazmi, Faisal A. Alrehily, Abdulaziz A. Qurashi, Osamah M. Abdulaal, Abdullah F. Alshamrani, Awatif M. Omer
Diseases.2024; 12(12): 333. CrossRef
Suspected common bile duct stones: reduction of unnecessary ERCP by pre-procedural imaging and timing of ERCP
Christina J. Sperna Weiland, Evelien C. Verschoor, Alexander C. Poen, Xavier J. M. N. Smeets, Niels G. Venneman, Abha Bhalla, Ben J. M. Witteman, Hester C. Timmerhuis, Devica S. Umans, Jeanin E. van Hooft, Marco J. Bruno, P. Fockens, Robert C. Verdonk, Jo
Surgical Endoscopy.2023; 37(2): 1194. CrossRef
Low Detection Rates of Bile Duct Stones During Endoscopic Treatment for Highly Suspected Bile Duct Stones with No Imaging Evidence of Stones
Hirokazu Saito, Hajime Iwasaki, Hisashi Itoshima, Yoshihiro Kadono, Takashi Shono, Kentaro Kamikawa, Atsushi Urata, Jiro Nasu, Masayoshi Uehara, Ikuo Matsushita, Tatsuyuki Kakuma, Shuji Tada
Digestive Diseases and Sciences.2023; 68(5): 2061. CrossRef
Effect of Frailty on the Management of Suspected Choledocholithiasis
Katherine C. Bergus, Rondi B. Gelbard, Sara Scarlet, Shruthi Srinivas, Brett M. Tracy
The American Surgeon™.2023; 89(7): 3104. CrossRef
Prospective assessment of the accuracy of ASGE and ESGE guidelines for choledocholithiasis
Andy Silva-Santisteban, Ishani Shah, Madhuri Chandnani, Vaibhav Wadhwa, Leo Tsai, Abraham F. Bezuidenhout, Tyler M. Berzin, Douglas Pleskow, Mandeep Sawhney
Endoscopy International Open.2023; 11(06): E599. CrossRef
ERCP findings provide further justification for a “surgery-first” mindset in choledocholithiasis
Gloria Sanin, Gabriel Cambronero, James Patterson, Maggie Bosley, Aravindh Ganapathy, Carl Wescott, Lucas Neff
Surgical Endoscopy.2023; 37(11): 8714. CrossRef
Dynamic changes in liver function tests do not correctly reclassify patients at risk of choledocholithiasis beyond ASGE 2019 criteria
Tatiana Ramírez-Peña, Rómulo Darío Vargas-Rubio, Carlos Ernesto Lombo, Luis Miguel Rodríguez-Hortua, Oscar Mauricio Muñoz-Velandia
Therapeutic Advances in Gastrointestinal Endoscopy.2023;[Epub] CrossRef
National adherence to the ASGE-SAGES guidelines for managing suspected choledocholithiasis: An EAST multicenter study
Brett M. Tracy, Benjamin K. Poulose, Cameron W. Paterson, April E. Mendoza, Apostolos Gaitanidis, Jonathan M. Saxe, Andrew J. Young, Martin D. Zielinski, Carrie A. Sims, Rondi B. Gelbard
Journal of Trauma and Acute Care Surgery.2022; 92(2): 305. CrossRef
Accuracy of SAGES, ASGE, and ESGE criteria in predicting choledocholithiasis
Kinzang Wangchuk, Pongsakorn Srichan
Surgical Endoscopy.2022; 36(10): 7233. CrossRef
Evaluation of the American Society of Gastrointestinal Endoscopy 2019 and the European Society of Gastrointestinal Endoscopy guidelines' performances for choledocholithiasis prediction in clinically suspected patients: A retrospective cohort study
Suppadech Tunruttanakul, Borirak Chareonsil, Kotchakorn Verasmith, Jayanton Patumanond, Chatchai Mingmalairak
JGH Open.2022; 6(6): 434. CrossRef
Test Performance Characteristics of Dynamic Liver Enzyme Trends in the Prediction of Choledocholithiasis
Yang Lei, B. Lethebe, Erin Wishart, Fateh Bazerbachi, B. Elmunzer, Nirav Thosani, James Buxbaum, Yen-I Chen, Sydney Bass, Martin Cole, Christian Turbide, Darren Brenner, Steven Heitman, Rachid Mohamed, Nauzer Forbes
Journal of Clinical Medicine.2022; 11(15): 4575. CrossRef
Criterios ASGE 2010 frente a 2019 para coledocolitiasis en pacientes llevados a colangiopancreatografía retrógrada endoscópica
Ana María Lourido Gamboa, Guillermo Vallejo Vallecilla, Jesús Eduardo Díaz Realpe, Katheryn Daniela Lagos Castro, Juan David Guzmán Sandoval, Angela María Merchán Galvis
Revista colombiana de Gastroenterología.2022; 37(4): 362. CrossRef
Optimal Predictive Criteria for Common Bile Duct Stones: The Search Continues
Yun Nah Lee, Jong Ho Moon
Clinical Endoscopy.2021; 54(2): 147. CrossRef

12,602 View
351 Download
24 Web of Science
26 Crossref

Novel Ablation Therapy Using Endoscopic Irreversible Electroporation in the Bile Duct: A Pilot Animal Study: Kang Won Lee, Jae Min Lee, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Soon Ho Um, Hong Sik Lee, Hoon Jai Chun, Chang Duck Kim, Chi Hyuk Oh, Hong Bae Kim; Clin Endosc 2021;54(3):413-419. Published online October 20, 2020; DOI: https://doi.org/10.5946/ce.2020.126

Abstract PDF

Background
/Aims: Irreversible electroporation (IRE) is a relatively new ablation method. However, the application of IRE ablation in the treatment of biliary disease has not been attempted. A minimally invasive approach using endoscopic retrograde cholangiopancreatography (ERCP) can be a novel therapeutic modality for IRE ablation. In this study, we aimed to investigate the feasibility of endoscopic IRE for the biliary tract using an animal model.
Methods
A new catheter-type electrode was developed for endoscopic IRE ablation of the biliary tract. We performed ERCP and endoscopic IRE ablations in the normal common bile duct of Yorkshire pigs. The experimental setting of IRE was 500 V/cm (50 pulses, 100-µs length). The animals were sacrificed after 24 hr, and the ablated bile duct was examined.
Results
Well-demarcated focal color changes were observed on the mucosa of the common bile duct. The depth of change after IRE was confined to the mucosal and submucosal layers. Apoptotic changes in the bile duct were observed only around the IRE ablation area. Immunohistochemistry assay showed cell death in the bile duct along the electrode.
Conclusions
Endoscopic IRE ablation using ERCP was successfully performed in the common bile duct. It can be a potential option for the treatment of biliary tumors.

Citations

Citations to this article as recorded by

Coaxially Printed Electroablation Catheter for Magnetically Actuated Navigation and Localized Tissue Ablation
Xiaonan Sun, Tong Wu, Fuqian Chen, Qingyu Yu, Binbin Zhang, Lelun Jiang, Yuanxi Zhang
Actuators.2026; 15(6): 289. CrossRef
Balloon‐assisted laser application for endoscopic treatment of biliary stricture
Seonghee Lim, Van Gia Truong, Seok Jeong, Jiho Lee, Byeong‐il Lee, Hyun Wook Kang
Lasers in Surgery and Medicine.2023; 55(10): 912. CrossRef
Biliary complications and efficacy after ablation of peribiliary tumors using irreversible electroporation (IRE) or radiofrequency ablation (RFA)
Somrach Thamtorawat, Rujira Patanawanitkul, Satit Rojwatcharapibarn, Walailak Chaiyasoot, Trongtum Tongdee, Jirawadee Yodying, Sukrit Sorotpinya
International Journal of Hyperthermia.2022; 39(1): 751. CrossRef
Large Animal Models in Pancreas and Biliary Disease
Seok Jeong, Jin-Seok Park, Don Haeng Lee
The Korean Journal of Gastroenterology.2021; 77(3): 99. CrossRef
Comparison of four endoluminal radiofrequency ablation devices and four power generators in an ex vivo bovine liver model
Stephan Rheinheimer, Anna Jacobsen, Philipp Mayer, Hans-Ulrich Kauczor, Andreas Mahnken
World Academy of Sciences Journal.2021;[Epub] CrossRef

9,501 View
208 Download
6 Web of Science
5 Crossref

Case Report

A Case of Congenital Common Bile Duct Web Treated with Balloon Dilation under Endoscopic Retrograde Cholangiopancreatography in a Young Child: Ji Sook Park, Hong Jun Kim, Ji-Hyun Seo, Hee-Shang Youn; Clin Endosc 2021;54(2):285-288. Published online September 10, 2020; DOI: https://doi.org/10.5946/ce.2020.167

Abstract PDF: Web in common bile duct (CBD web) is very rare. It is usually asymptomatic and detected incidentally during surgery for other causes in adults. It can be congenital or acquired, however congenital CBD web is extremely rare. Currently, despite its invasiveness and complications, endoscopic retrograde cholangiopancreatography (ERCP) is considered as a useful diagnostic and therapeutic modality in children with hepatobiliary pancreatic diseases as in adults. Herein we report a case of congenital CBD web presenting with acute pancreatitis and choledocholithiasis in a 4-year-old girl which was diagnosed and treated using balloon dilation under ERCP. After balloon dilation of the web, a common pancreatobiliary channel was observed. To the best of our knowledge, a case of congenital CBD web with pancreatobiliary junctional abnormality treated using ERCP in a child has not been reported to date.

9,681 View
126 Download

Original Article

Outcomes of Endoscopic Management among Patients with Bile Leak of Various Etiologies at a Tertiary Care Center: Suprabhat Giri, Sridhar Sundaram, Harish Darak, Sanjay Kumar, Shobna Bhatia; Clin Endosc 2020;53(6):727-734. Published online August 21, 2020; DOI: https://doi.org/10.5946/ce.2020.017

Abstract PDF

Background
/Aims: Bile leak is a common complication of cholecystectomy, and it is also observed in other conditions such as ruptured liver abscess, hydatid cyst, and trauma. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line management for such conditions. However, studies on the outcomes of endoscopic management for bile leaks with etiologies other than post-cholecystectomy injury are extremely limited.
Methods
We conducted a retrospective review of patients with symptomatic bile leak who were referred to a tertiary care center and who underwent ERCP between April 2016 and April 2019. The primary outcome was complete symptomatic resolution without extravasation of the contrast medium during the second ERCP conducted after 6 weeks.
Results
In total, 71 patients presented with symptomatic bile leak. The etiologies of bile leak were post-cholecystectomy injury in 34 (47.8%), liver abscess in 20 (28.1%), and post-hydatid cyst surgery in 11 (15.4%) patients. All patients were managed with ERCP, sphincterotomy, and stent placement for 6 weeks, except for one who underwent surgery. The primary outcome was achieved in 65 (91.5%) of 71 patients. There was no significant difference in terms of outcome in relation to the interval between the diagnosis of bile leak and ERCP.
Conclusions
Most patients with bile leak can be successfully managed with ERCP even when performed on an elective basis.

Citations

Citations to this article as recorded by

Endoscopic management of bile leaks after subtotal vs total laparoscopic cholecystectomy: A single center comparative analysis
Ashley Gao, Azizullah Beran, Benjamin L. Bick, Nasir Saleem, Mark A. Gromski, Evan L. Fogel, Aditya Gutta, Itegbemie Obaitan, James L. Watkins, Michael G. House, Nicholas J. Zyromski, Ryan J. Ellis, Eugene P. Ceppa, Alexandra M. Roch, Jeffrey J. Easler, S
Journal of Gastrointestinal Surgery.2026; 30(10): 102478. CrossRef
Bile Leak after Liver Hydatid Cysts Surgery: Predictions and Management
Deari Ahmed Ismaeil, Barham M M Salih, Dara Ahmed Mohammed, Hemn Hussain Kaka Ali, Dlshad Hama Saeed Ahmed, Omar Hama Ghalib Hawrami, Wirya Nasih Saber, Aland Sardar Noori, Hardi Mohammed Dhahir
Indian Journal of Surgery.2026;[Epub] CrossRef
Postoperative Bile Leak in Liver Hydatid Cyst: When to Intervene?
Krishna Rao Gurana, Mukteshwar Dasari, Vijay Kumar Sharma, Julie Shah, Abhijit Chandra
Journal of West African College of Surgeons.2025; 15(4): 463. CrossRef
Bile Leak: Is There Optimal Timing for Endoscopy?
Theodoros A. Voulgaris, Ioannis S. Papanikolaou, Dimitrios I. Ziogas, George Tribonias, Aliki Stamou, Aspasia Louta, Konstantinos Iliakopoulos, Ioannis A. Vezakis, Andreas Polydorou, Antonios Vezakis
Medicina.2025; 61(12): 2108. CrossRef
A critical appraisal of the ISGLS definition of biliary leakage after liver resection
Svenja Sliwinski, Jan Heil, Josephine Franz, Hanan El Youzouri, Michael Heise, Wolf O. Bechstein, Andreas A. Schnitzbauer
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
Progress in ERCP Treatment of Biliary Complications in Patients with Hepatic Echinococcosis
燕泽林
Advances in Clinical Medicine.2023; 13(03): 4013. CrossRef
Diagnosis and management of bile leaks after severe liver injury: A Trauma Association of Canada multicenter study
Morgan Schellenberg, Chad G. Ball, Natthida Owattanapanich, Brent Emigh, Patrick B. Murphy, Bradley Moffat, Brett Mador, Andrew Beckett, Jennie Lee, Emilie Joos, Samuel Minor, Matt Strickland, Kenji Inaba
Journal of Trauma and Acute Care Surgery.2022; 93(6): 813. CrossRef
Postoperative bile leakage caused by intrahepatic duct injury during right hemicolectomy
Jaram Lee, Ook Song, Hyeong-Min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Medicine.2021; 100(46): e27877. CrossRef
The Need for a Better-Designed Study of the Outcomes of Endoscopic Management of Bile Leak
Hyung Ku Chon, Eun Ji Shin, Seong-Hun Kim
Clinical Endoscopy.2020; 53(6): 633. CrossRef

11,215 View
207 Download
7 Web of Science
9 Crossref

First
Prev
Page of 2
Next
Last

Search