Clinical Endoscopy

Self-expandable metal stent versus transjugular intrahepatic portosystemic shunt in refractory post-endoscopic variceal ligation ulcer bleeding: a retrospective cohort analysis of efficacy, safety, and quality-of-life outcomes from a tertiary care center in India: Varun Mehta, Manjeet Kumar Goyal, Yogesh Kumar Gupta, Abhinav Gupta, Manisha Khubber, Ashita Rukmini Vuthaluru, Ajit Sood; Received October 21, 2025 Accepted January 30, 2026 Published online August 13, 2026; DOI: https://doi.org/10.5946/ce.2025.393 [Epub ahead of print]

Graphical Abstract Abstract PDF: Background
/Aims: Post-endoscopic variceal ligation ulcer bleeding (PEBU) is a rare but life-threatening complication in cirrhosis, often refractory to standard therapy. While transjugular intrahepatic portosystemic shunt (TIPS) is effective, its complexity and risk of hepatic encephalopathy limit its use. Self-expandable metal stent (SEMS) offers a minimally invasive alternative, but comparative data are limited. This study evaluated SEMS versus TIPS in refractory PEBU.
Methods
In this retrospective cohort study, 30 cirrhotic patients with refractory PEBU at a tertiary Indian center were treated with either SEMS (n=15) or TIPS (n=15). The primary endpoint was hemostasis within 72 hours without rebleeding within 5 days. Secondary outcomes included 12-week rebleeding, mortality, complications, and quality of life (Patient-Reported Outcomes Measurement Information System [PROMIS]-10).
Results
Baseline characteristics were comparable. Immediate hemostasis was achieved in 100% (SEMS) and 93.3% (TIPS) (p=0.31). Rebleeding rates were similar (13.3%). SEMS showed lower mortality (6.7% vs. 20%) and less hepatic encephalopathy (20% vs. 46.7%). SEMS showed superior PROMIS-10 scores (13.93±4.33 vs.10.07±4.57, p<0.001) and shorter intensive care unit stay (2 vs. 5 days, p=0.002). Stent migration occurred in 20%.
Conclusions
SEMS provides outcomes comparable to TIPS with fewer complications and easier applicability, supporting its use in resource-limited settings.

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Undifferentiated-type early gastric cancer: from margin demarcation to complete resection: Satoru Mizutani, Seiichiro Abe, Yutaka Saito; Received February 17, 2026 Accepted May 8, 2026 Published online August 10, 2026; DOI: https://doi.org/10.5946/ce.2026.062 [Epub ahead of print]

Abstract PDF: Gastric cancer remains a major global health burden, particularly in Asia, where widespread implementation of endoscopic screening has increased the detection of early gastric cancer (EGC). With advances in endoscopic techniques, endoscopic resection (ER), especially endoscopic submucosal dissection, has become the standard treatment for EGC with a negligible risk of lymph node metastasis (LNM). Undifferentiated-type EGC (UD-EGC) is associated with a higher risk of LNM than differentiated-type EGC. However, favorable long-term outcomes can be achieved with curative resection. Despite this, accurate endoscopic detection, characterization, and delineation of UD-EGC remain a challenge because of their subtle morphology and unique growth pattern. Image-enhanced endoscopy, particularly magnifying endoscopy with narrow-band imaging, plays an important role in diagnosis and assessment of the lateral extent of the lesion. In Japan, accumulating evidence, including prospective multicenter trials, has led to the classification of intramucosal UD-EGC ≤2 cm without ulceration, as an absolute indication for ER in the latest clinical guidelines. Short and long-term outcomes after curative ER for UD-EGC are comparable to those after surgical resection. This review summarizes the current literature on the diagnosis and endoscopic management of UD-EGC, providing a comparative overview of differences in endoscopic treatment recommendations among international guidelines.

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Role of functional endoscopy: Ippei Tanaka, Haruhiro Inoue; Received March 14, 2026 Accepted May 19, 2026 Published online July 30, 2026; DOI: https://doi.org/10.5946/ce.2026.111 [Epub ahead of print]

Abstract PDF: Endoscopy has evolved to include the assessment of gastrointestinal function, an approach known as functional endoscopy. In this review, we summarize the current evidence on the endoscopic pressure-integrated system (EPSIS) as a representative modality in this field. Initial studies demonstrated the diagnostic utility of the EPSIS for gastroesophageal reflux disease by revealing significant associations between EPSIS parameters and 24-hour pH monitoring, as well as endoscopic findings such as erosive esophagitis and Barrett’s esophagus. The usefulness of the EPSIS was also demonstrated in diagnosing achalasia and in the evaluation of treatment efficacy following antireflux mucosal interventions and peroral endoscopic myotomy. Dynamic changes in the gastric cardia during EPSIS were observed as the intragastric pressure increased. These changes were categorized into three sequential phases, referred to as the phase concept. In healthy individuals, all three phases function appropriately, whereas in patients with acid reflux, dysfunction is observed in one or more phases. Despite these promising findings, several aspects of the EPSIS remain to be clarified, and most previous studies have been conducted at a single center. Future multicenter prospective studies are warranted to accumulate robust evidence and further establish the clinical utility of the EPSIS.

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Translating artificial intelligence into clinical practice for gastrointestinal endoscopy: current applications and future perspectives: Hyeong Ho Jo, Jin Ho Choi, Joo Seong Kim, Seung-Joo Nam, Do Hoon Kim, Woo Hyun Paik, Jung Ho Bae, Seung Wook Hong, Chang Seok Bang, Da Hyun Jung, Seong Ji Choi, Hyunsoo Chung, The Research Group for Artificial Intelligence, Korean Society for Gastrointestinal Endoscopy; Received November 13, 2025 Accepted February 28, 2026 Published online July 30, 2026; DOI: https://doi.org/10.5946/ce.2025.419 [Epub ahead of print]

Abstract PDF: Artificial intelligence (AI) has emerged as a transformative tool in gastrointestinal (GI) endoscopy, addressing challenges in detection, diagnosis, and decision-making. In upper GI endoscopy, AI supports blind spot monitoring, Helicobacter pylori diagnosis, and the identification of premalignant and malignant lesions, with high accuracy and reduced miss rates. In lower GI endoscopy, computer-aided detection improves adenoma detection, whereas computer-aided diagnosis supports “resect-and-discard” and “diagnose-and-leave” strategies. However, real-world benefits remain modest, with concerns regarding overdetection and variable performance across lesion types and colon segments. In inflammatory bowel disease, AI standardizes endoscopic and histologic scoring, reduces interobserver variability, and accelerates capsule endoscopy interpretation, including high diagnostic accuracy for Crohn’s disease. Pancreatobiliary applications, including endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and cholangioscopy, demonstrate strong performance in differentiating pancreatic masses and biliary strictures and in predicting postprocedural complications. Despite expert-level performance across multiple domains, most studies remain single-center or retrospective, and explainability, workflow integration, medicolegal responsibility, and cost-effectiveness continue to limit adoption. Emerging solutions, including explainable AI and AI-generated common data model-compatible reports, may bridge these gaps. With rigorous multicenter validation and real-world implementation, AI can evolve from an experimental adjunct into a core component of routine endoscopic practice.

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Laparoscopic and endoscopic cooperative surgery: current status and clinical applications: Jeong Seop Moon; Received January 1, 2026 Accepted March 1, 2026 Published online June 2, 2026; DOI: https://doi.org/10.5946/ce.2026.009 [Epub ahead of print]

Abstract PDF

Recent advances have been made in minimally invasive treatments for benign tumors, borderline malignant tumors, and early gastric cancer (EGC). Laparoscopic and endoscopic cooperative surgery (LECS) combines laparoscopic and endoscopic approaches performed simultaneously, thereby maximizing the advantages of each modality while overcoming the individual limitations. Consequently, LECS enables precise tumor localization, complete resection with minimal margins, a reduced recovery time, and improved clinical outcomes. The primary indications for LECS include the resection of gastrointestinal stromal tumors and various benign submucosal tumors, and its application has recently been extended to select EGC cases. In South Korea, the Ministry of Health and Welfare has approved LECS as a new medical technology for gastrointestinal tumors in 2024. Several LECS techniques have been developed, including classical LECS, inverted LECS, laparoscopy-assisted endoscopic full-thickness resection, non-exposed endoscopic wall-inversion surgery, a combination of laparoscopic and endoscopic approaches for neoplasia with a non-exposure technique, and closed LECS. Above all, close cooperation between laparoscopic and endoscopic teams is essential for the successful performance of LECS procedures.

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Case Report: Laparoscopic-endoscopic cooperative full-thickness resection for recurrent transverse colon cancer after rectal cancer surgery: a case report with video
Zikai Zhou, Qingbin Wu, Wenjian Meng
Frontiers in Oncology.2026;[Epub] CrossRef

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Current perspectives on combining endoscopy and minimally invasive surgery for upper gastrointestinal tumors: Eriko Koizumi, Osamu Goto; Received December 28, 2025 Accepted March 3, 2026 Published online May 22, 2026; DOI: https://doi.org/10.5946/ce.2025.472 [Epub ahead of print]

Abstract PDF: Recent advances in endoscopy have expanded the therapeutic spectrum of minimally invasive gastrointestinal surgery. Several modified procedures have been developed to reduce the risk of bacterial contamination and tumor cell dissemination associated with intentional perforation in classical laparoscopic and endoscopic cooperative surgery (LECS), including inverted LECS and non-exposed approaches. Long-term outcomes of these procedures for gastric lesions have recently been reported, supporting their favorable safety and efficacy. Moreover, the incorporation of sentinel lymph node navigation into non-exposed techniques represents a promising strategy for function-preserving gastric cancer surgery, and recent phase III trials have begun to evaluate its clinical value and long-term outcomes. Additionally, endoscopic full-thickness resection has recently been gaining wider acceptance in Japan and is facilitated by staged strategies that integrate endoscopic resection with single-port placement. Combined endoscopic procedures have been applied to the pharynx, esophagus, and duodenum with excellent short-term outcomes; nonetheless, long-term data remain limited. Ongoing innovations and multicenter studies may refine indications, standardize techniques, and validate safety and efficacy. Overall, the integration of endoscopy and surgery is likely to become increasingly critical in achieving both oncological curability and organ preservation in the management of gastrointestinal tumors.

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The cutting-edge evolution of artificial intelligence-assisted capsule endoscopy: Dong Jun Oh, Yun Jeong Lim; Received November 12, 2025 Accepted January 20, 2026 Published online May 4, 2026; DOI: https://doi.org/10.5946/ce.2025.418 [Epub ahead of print]

Abstract PDF: Since its introduction in 2000, capsule endoscopy (CE) has transformed gastrointestinal (GI) diagnostics by enabling noninvasive visualization of the entire GI tract using a swallowable capsule. However, CE still has several limitations, including long reading times, inter-reader variability, and missed lesions due to poor image quality or incomplete examinations. Recent advances in artificial intelligence (AI) have significantly improved CE interpretation. Deep-learning models, particularly convolutional neural networks, can detect small-bowel lesions with accuracy comparable to that of expert endoscopists, while greatly reducing reading time. AI algorithms can also provide objective assessments of small-bowel cleanliness. Transformer-based models can further enhance video-level analysis by recognizing global patterns and sequential relationships among CE images. In addition, foundation models demonstrate high adaptability and robust performance across different CE systems and a wide range of lesion types. Future AI-assisted CE reading is expected to integrate real-time image analysis, autonomous capsule movement, and multimodal sensing technologies to create an intelligent diagnostic platform. Ultimately, AI is transforming CE into an efficient, reliable, and data-driven diagnostic tool suitable for diverse clinical settings. Furthermore, AI-assisted CE is extending its clinical utility beyond small-bowel lesion detection to the comprehensive evaluation of the stomach and colon.

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Latest advancements in endoscopic palliative care for patients with pancreatic cancer: Raquel Gonçalves, Joel Silva, Eduardo Rodrigues-Pinto; Clin Endosc 2026;59(4):497-509. Published online April 28, 2026; DOI: https://doi.org/10.5946/ce.2025.227

Abstract PDF: Pancreatic cancer is a major cause of cancer-related mortality and is frequently diagnosed at advanced stages when surgery is no longer an option. Most patients require palliative care to manage symptoms, such as jaundice, pain, and gastric outlet obstruction (GOO). Therapeutic endoscopic options, including endoscopic ultrasound (EUS)-guided techniques, have become essential for improving quality of life. We conducted a literature review focusing on the current palliative endoscopic therapy options for advanced pancreatic cancer. Malignant biliary obstruction is primarily treated using endoscopic retrograde cholangiopancreatography. However, when this method is complex or unsuccessful, EUS-guided biliary drainage is considered a reliable and safe alternative. Irradiating stents may increase stent patency times and patient survival. EUS-guided gastroenterostomy, if technical expertise is available, is becoming the first option for GOO in patients with longer survival, with enteral stenting being preferred for patients with limited life expectancies or when the EUS option is not available. Although EUS-guided celiac plexus neurolysis and pancreatic duct drainage play a role in pain management, EUS-guided radiofrequency ablation remains under investigation. In conclusion, endoscopic and EUS-guided interventions provide safe, minimally invasive, and highly effective approaches for the palliative care of pancreatic cancer, enhancing patients’ quality of life and minimizing the need for more invasive surgical procedures.

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Echoendoscopic evaluation of the vascular pattern of solid pancreatic lesions as a predictor of neuroendocrine neoplasms: a retrospective study in Mexico: Edgardo Amaya-Fragoso, José Guillermo de la Mora-Levy, Uriel Isaías Martín-Flores; Clin Endosc 2026;59(3):450-458. Published online April 23, 2026; DOI: https://doi.org/10.5946/ce.2025.338

Graphical Abstract Abstract PDF

Background
/Aims: Endoscopic ultrasonography (EUS) is essential for evaluating solid pancreatic lesions (SPL). Pancreatic neuroendocrine neoplasms (pNEN) account for 2% of SPL and typically show hypervascularity. This study aimed to assess whether a specific vascular pattern could predict pNEN.
Methods
Patients who underwent EUS for a SPL and were histologically diagnosed with pNEN were included. Tissues were obtained using endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) and/or surgical resection. Power Doppler was used to assess the vascular patterns. Patients with pNEN were compared to those diagnosed with pancreatic ductal adenocarcinoma during the same period. Group comparisons by size and histological grade were performed using the chi-square test. Logistic regression analysis identified the EUS features associated with pNEN.
Results
Among 125 patients (43 pNEN), a peripheral vascular rim (PVR) was associated with pNEN (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.7–8.5; p=0.03), with 100% specificity. Hypervascularity (OR, 3.8; 95% CI, 1.1–13.4; p=0.03) and pancreatic atrophy (OR, 0.3; 95% CI, 0.1–0.9; p=0.04) were also associated.
Conclusions
PVR demonstrated 100% specificity and 34.9% sensitivity for pNEN diagnosis, serving as a rule-in sign. PVR visualization may aid in differential diagnosis when EUS-FNB is unavailable or inconclusive.

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Peripheral vascular rim on endoscopic ultrasound as a practical rule-in sign for pancreatic neuroendocrine neoplasms
Eunae Cho
Clinical Endoscopy.2026; 59(3): 403. CrossRef

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Impact of real-time artificial intelligence integration on detection of gastric lesions: an exploratory single-center before-and-after study using low-definition routine endoscopy: Hwijun Lee, Huynh Cong Bang, Seokho Cho, Jungmin Ha, Tran Thien Khiem, Le Viet Tung, La Vinh Phuc, Duong Trong Si, Tran The Du, Diem Thi-Ngoc Vo, Vo Nguyen Trung; Clin Endosc 2026;59(3):408-416. Published online April 22, 2026; DOI: https://doi.org/10.5946/ce.2025.272

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Early detection of gastric neoplasia, particularly subcentimeter lesions, using upper gastrointestinal (GI) endoscopy remains challenging. This study evaluated the impact of a real-time artificial intelligence (AI) detection system on the lesion detection rate (LDR) during routine upper GI endoscopy performed using a low-definition platform commonly used in resource-limited settings, with a focus on lesions ≤0.5 cm.
Methods
Diagnostic upper GI endoscopies performed between September 2024 and May 2025 were analyzed. LDRs were compared between the pre- and post-AI periods, including subgroup analyses by lesion size and type.
Results
A total of 2,329 patients were included (1,491 pre-AI, 838 post-AI). After AI implementation, overall LDR per person increased from 1.15±0.45 to 1.20±0.57 (p<0.05). Detection of lesions ≤0.5 cm increased from 18.0% to 19.8% (p<0.05), while detection of larger lesions remained unchanged. The biopsy rate decreased from 13.8% to 8.5% (p<0.05).
Conclusions
Real-time AI modestly improved the detection of diminutive gastric lesions while reducing unnecessary biopsies without compromising malignancy detection, thereby supporting its utility in routine endoscopy under resource-limited conditions.

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Expanding role of artificial intelligence in gastric neoplasms: moving beyond resource limitations
Hannah Lee, Jun-Won Chung, Kyoung Oh Kim, Kwang An Kwon, Jung Ho Kim
Clinical Endoscopy.2026; 59(3): 400. CrossRef

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Palliative endoscopic biliary drainage for malignant hilar biliary obstruction: Shuji Mitsuhashi, Manik Aggarwal, Vinay Chandrasekhara; Received October 26, 2025 Accepted December 11, 2025 Published online March 31, 2026; DOI: https://doi.org/10.5946/ce.2025.395 [Epub ahead of print]

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.

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Underwater endoscopic submucosal dissection in the gastrointestinal tract: technical review and dual-approach endoscopic submucosal dissection: Mitsuru Nagata; Received September 7, 2025 Accepted November 8, 2025 Published online March 17, 2026; DOI: https://doi.org/10.5946/ce.2025.330 [Epub ahead of print]

Abstract PDF: Endoscopic submucosal dissection (ESD) has become an established technique for en bloc resection of superficial gastrointestinal neoplasms. However, conventional ESD (CESD) under gas insufflation remains technically demanding, particularly in gravity-side lesions or in cases with submucosal fibrosis. Underwater ESD (UESD) was developed to overcome these challenges. Complete submergence mitigates gravity-related difficulties, enhances visualization through the natural zoom effect, and facilitates submucosal dissection via buoyancy and water pressure. Retrospective data further suggest that UESD may reduce the risk of post-ESD coagulation syndrome, which is likely attributable to the heat sink effect. UESD can also be integrated with device-assisted traction and pocket creation methods. However, limitations, such as visual field impairment caused by bleeding or bubble formation, remain concerns, and their optimal management requires further investigation. Nevertheless, UESD allows procedural flexibility by switching between UESD and CESD within the same procedure, herein referred to as dual-approach ESD. Despite its routine use in clinical practice, dual-approach ESD has not been clearly distinguished from UESD in most clinical studies, complicating comparisons with CESD. To advance both clinical practice and research, future investigations should clearly differentiate UESD from dual-approach ESD for a more accurate evaluation. Furthermore, appropriate procedural selection requires careful consideration of multiple factors.

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Efficacy of image-enhanced endoscopy for colorectal polyp detection: Reo Kobayashi, Naohisa Yoshida, Ken Inoue; Clin Endosc 2026;59(4):485-496. Published online March 3, 2026; DOI: https://doi.org/10.5946/ce.2025.221

Abstract PDF: Colonoscopy plays a key role in reducing the incidence and mortality of colorectal cancer by detecting precancerous lesions, such as adenomas. Image-enhanced endoscopy (IEE) has been reported to effectively improve lesion detection and characterization in many cases. With the development of new endoscopic instruments, the IEE technology is rapidly advancing, and new endoscopes using light-emitting diode light sources, in addition to xenon and laser light sources, have been introduced, and various types of IEEs are used. Several observational methods have been validated for detecting and preventing missed lesions, such as narrow-band imaging (NBI), blue laser/light imaging (BLI), linked color imaging, and texture and color enhancement imaging, which have been suggested to be more effective than white light observation. The Japan NBI Expert Team classification, a unified classification of NBI magnification developed in Japan, can be used alongside NBI and BLI magnification to evaluate surface and vessel patterns and diagnose lesions. In this review, we describe the usefulness of each IEE with reference to the latest data.

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Time as a marker of quality in diagnostic upper endoscopy: a retrospective study of its association with clinically significant findings: Micheal Tadros, Dharma Ayer, Caesar Ferrari, Kumael Jafri, Sonia Samuel, Dana Gornick, Paul J. Feustel; Clin Endosc 2026;59(3):433-441. Published online February 24, 2026; DOI: https://doi.org/10.5946/ce.2025.342

Graphical Abstract Abstract PDF

Background
/Aims: Procedural duration has been proposed as a marker of esophagogastroduodenoscopy (EGD) quality; however, formal benchmarks remain undefined. This study examined the association between EGD duration and clinically significant findings (CSFs), as well as procedural behaviors contributing to diagnostic yield.
Methods
We conducted a retrospective analysis of 120 first-time diagnostic EGDs performed at a single academic center and categorized procedures as lasting <3, 3 to 6, or >6 minutes. Logistic regression models were used to assess associations among procedure time, quality metrics (photographs, landmarks, biopsies), clinical indications, and CSF detection.
Results
Longer procedures were independently associated with a high rate of CSF detection. Compared with procedures lasting <3 minutes, those lasting >6 minutes had 17.5-fold greater odds of detecting a CSF (p=0.02). Procedures performed for bleeding or “other” indications were independently associated with a high diagnostic yield (p=0.02 and 0.03, respectively). Although increased photo count and landmark documentation correlated with time, neither was independently predictive of CSFs after adjustment. Procedural duration also showed a stepwise increase in the number of biopsies obtained, photographs taken, and landmarks identified.
Conclusions
Longer EGD duration was independently associated with increased CSF detection in a stepwise manner. Procedural time may serve as a practical, unifying measure correlated with multiple performance behaviors reflective of comprehensiveness in diagnostic EGD.

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Seeing more by looking longer: the value of time in diagnostic upper endoscopy
Seung Young Seo
Clinical Endoscopy.2026; 59(3): 398. CrossRef

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Role of image-enhanced endoscopy for the diagnosis of gastric intestinal metaplasia: Sang Pyo Lee, Shin Hee Kim; Clin Endosc 2026;59(4):523-528. Published online February 13, 2026; DOI: https://doi.org/10.5946/ce.2025.260

Abstract PDF: Gastric intestinal metaplasia (IM) is a key precursor lesion in gastric cancer progression, as described by the Correa model. Image-enhanced endoscopy (IEE) with magnifying endoscopy has significantly improved the visualization of the mucosal surfaces and microvascular structures, aiding in the accurate diagnosis of IM. While histological evaluation remains the gold standard, IEE might provide a practical and cost-effective alternative for the risk stratification of gastric IM.

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Current status of gastrointestinal endoscopy in Thailand: Tanyaporn Chantarojanasiri, Wiriyaporn Ridtitid, Nonthalee Pausawasdi; Received July 13, 2025 Accepted October 26, 2025 Published online December 19, 2025; DOI: https://doi.org/10.5946/ce.2025.230 [Epub ahead of print]

Abstract PDF: The Thai Association for Gastrointestinal Endoscopy (TAGE) has played a pivotal role in advancing gastrointestinal (GI) endoscopy in Thailand through its strategic focus on clinical services, education, and research. Since its establishment in 2005, TAGE has united gastroenterologists and surgeons, helping standardize endoscopic practices across the country. Through national training programs, clinical guideline development, hands-on workshops, and international collaborations, TAGE has elevated the quality and accessibility of endoscopic care. Despite challenges such as workforce shortages and the uneven distribution of services, particularly in rural areas, TAGE continues to address these gaps through outreach training, model development, and regional research initiatives. Society leadership in cholangiocarcinoma management, advanced endoscopy, and educational model innovation reflects its commitment to improving outcomes and establishing Thailand as a regional hub for GI endoscopy.

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Non-variceal upper gastrointestinal bleeding: advances and future directions in management: Waku Hatta, Yohei Ogata, Takashi Chiba, Naotaro Tanno, Makoto Kawabe, Kimiko Kayada, Yutaka Hatayama, Masahiro Saito, Akira Imatani, Tomoyuki Koike, Atsushi Masamune; Clin Endosc 2026;59(4):510-522. Published online December 17, 2025; DOI: https://doi.org/10.5946/ce.2025.202

Abstract PDF: Numerous clinical guidelines have been developed for the management of non-variceal upper gastrointestinal bleeding (NVUGIB), yet significant variations exist among the recommendations. This review summarizes the most recent evidence on NVUGIB management, structured across four key stages: pre-endoscopic management, endoscopic treatment, post-endoscopic care, and the identification and management of refractory bleeding. In the pre-endoscopic phase, several risk-scoring systems have been developed to predict mortality. A restrictive transfusion strategy, with a threshold of 7 to 8 g/dL, is now recommended for most patients. Pre-endoscopic administration of intravenous erythromycin also improves visualization during endoscopy. A wide array of endoscopic hemostasis techniques is available, with the choice of method depending on the underlying cause of bleeding. When endoscopic hemostasis fails, transcatheter arterial embolization (TAE) is generally preferred over surgery as the second-line intervention. Once hemostasis is achieved, high-dose acid suppression is essential, and the risk of rebleeding should be assessed. For patients who experience rebleeding, repeat endoscopic therapy is recommended as the first-line approach. However, determining the optimal timing for TAE remains a challenge. Because of the heterogeneity of clinical presentations, NVUGIB management should be personalized. Further research is needed to establish evidence-based, individualized treatment strategies.

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Advanced endoscopy and artificial intelligence-enabled vascular healing for ulcerative colitis: promising frontiers or mere mirage?: Yasuharu Maeda, Shin-ei Kudo, Takanori Kuroki, Yurie Kawabata, Jun Ohara, Katsuro Ichimasa, Noriyuki Ogata, Kazuo Ohtsuka, Masashi Misawa; Received June 11, 2025 Accepted August 12, 2025 Published online December 15, 2025; DOI: https://doi.org/10.5946/ce.2025.186 [Epub ahead of print]

Abstract PDF

Ulcerative colitis, a chronic inflammatory bowel disease, is characterized by subtle microvascular alterations that play a critical role in disease perpetuation and mucosal injury. Recent advances in image-enhanced endoscopy and ultrahigh-magnification endoscopy have improved the real-time visualization of these vascular changes while highlighting their diagnostic value. Artificial intelligence (AI)-enabled endoscopic systems provide automated, reproducible vascular assessments. Emerging data suggest that AI-based vascular healing correlates with clinical remission and may alter histological scores, enabling the prediction of sustained remission. Despite these promising advances, challenges remain, such as standardizing vascular healing definitions, addressing interobserver variability, and validating AI-driven platforms in real-world settings. Integrating microvascular-targeted therapies and advanced imaging has the potential to transform the management of ulcerative colitis, facilitating sustained remission and improving the quality of life. This review examined the evolving role of microvascular assessment in ulcerative colitis, the potential of AI in refining endoscopic evaluation, and the prospects of incorporating vascular healing as a therapeutic target.

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A Scoping Review of Endoscopic Assessment Considering Disease Extent in Ulcerative Colitis: Insights for the Artificial Intelligence Era
Yasuharu Maeda, Shin-ei Kudo, Takanori Kuroki, Yurie Kawabata, Katsuro Ichimasa, Masashi Misawa, Noriyuki Ogata, Kazuo Ohtsuka
Gut and Liver.2026; 20(4): 511. CrossRef

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Applying small bowel endoscopy in inflammatory bowel disease management: Seong-Jung Kim, Sung Noh Hong; Clin Endosc 2026;59(2):203-210. Published online September 29, 2025; DOI: https://doi.org/10.5946/ce.2025.144

Abstract PDF: Inflammatory bowel disease is classified into Crohn’s disease (CD) and ulcerative colitis. Ulcerative colitis involves only the colon, whereas CD is characterized by small bowel involvement, which is a hallmark feature. However, the small bowel is the final frontier of endoscopic evaluation; therefore, small bowel involvement is considered a significant medical challenge in the diagnosis and treatment of patients with CD. Endoscopic visualization and biopsy sampling of the small bowel are crucial for accurate diagnosis, effective monitoring, and management of complications of CD. Small bowel endoscopy enables the early detection of mucosal lesions, facilitates timely intervention for complications such as strictures or bleeding, and plays a critical role in reducing the need for surgical resection. Moreover, it enables targeted tissue acquisition and objective assessment of disease activity, both of which are crucial for optimal treatment planning and monitoring of therapeutic responses. Given these clinical advantages, small bowel endoscopy has become an indispensable tool in the comprehensive management of CD. This review summarizes the current role and evolving advances in small bowel endoscopy, with particular emphasis on its therapeutic applications—including enteroscopic balloon dilation, endoscopic hemostasis, and foreign body retrieval—and discusses future directions based on recent evidence and expert guidelines.

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Recent technological advances in video capsule endoscopy: a comprehensive review: Minjee Kim, Hyun Joo Jang; Clin Endosc 2026;59(2):182-193. Published online September 29, 2025; DOI: https://doi.org/10.5946/ce.2025.135

Abstract PDF

Video capsule endoscopy (VCE) originally revolutionized gastrointestinal imaging by providing a noninvasive method for evaluating small bowel diseases. Recent technological innovations, including enhanced imaging systems, artificial intelligence (AI), and improved localization, have significantly improved VCE’s diagnostic accuracy, efficiency, and clinical utility. This review aims to summarize and evaluate recent technological advances in VCE, focusing on system comparisons, image enhancement, localization technologies, and AI-assisted lesion detection.

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Pillcam Genius Pilot Experience – An Eruditive Innovative -Time to ditch the belt?
N Nandi, FW D Tai, X Dray, M Keuchel, P Baltes, L Elli, L Scaramella, A Cosenza, R Sidhu
Endoscopy.2026; 58(S 03): S364. CrossRef
Isolated Cavernous Hemangioma of the Hepatic Flexure Mimicking a Colonic Neoplasm: A Case Report
Tya Youssef, Ahmad Karim Mourad, Philippe Attieh, Karam Karam, Jessy Fadel, Mazen Farhat, Elias Fiani, Mona Hallak
Medical Reports.2026; : 100491. CrossRef

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Risk factors for suspected infectious fever after diagnostic upper endoscopy: propofol overdose in a retrospective study from Korea: Sunmin Lee, Jung-Hwan Lee, Jongbeom Shin, Boram Cha, Ji-Taek Hong, Kye Sook Kwon; Clin Endosc 2025;58(5):703-711. Published online September 23, 2025; DOI: https://doi.org/10.5946/ce.2024.348

Graphical Abstract Abstract PDF: Background
/Aims: Propofol is widely used for sedation during upper endoscopy; however, oversedation may increase the risk of complications, including aspiration pneumonia. This study aimed to determine whether propofol overdose is a risk factor for suspected postendoscopic infectious fever (SPIF).
Methods
We retrospectively analyzed 1,474 in-patients who underwent upper endoscopy at Inha University Hospital between October 2021 and October 2022. After excluding 400 patients who received interventional procedures, SPIF was defined as new-onset fever (≥38 °C) within three days post-endoscopy with at least one of the following: intravenous antibiotic initiation, leukocytosis (white blood cell≥10,000/mm³), positive blood or sputum cultures, or pneumonia on chest X-ray. The risk factors assessed included comorbidities, sedative type and dosage, procedure duration, and endoscopist’s experience.
Results
New-onset fever occurred in 40 patients (3.7%), with 20 (1.9%) meeting SPIF criteria. Multivariable analysis showed propofol overdose (>2.2 mg/kg) significantly increased risks of new-onset fever (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00–1.06; p=0.023) and SPIF (OR, 1.04; 95% CI, 1.00–1.04; p=0.034). Dementia (OR, 1.11, p<0.001) and prolonged procedure (>5 minutes; OR, 1.01; p=0.012) were also risk factors for SPIF.
Conclusions
Propofol overdose significantly increases the risk of SPIF. Careful sedation management is essential, especially for patients with dementia or prolonged procedures.

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Percutaneous cholecystolithotomy and lithotripsy for managing acute calculous cholecystitis in non-surgical candidates: a systematic review and meta-analysis: Arsalan Nadeem, Ali Husnain, Aleena Ahmed, Haider Ashfaq, Hamza Ashraf, Zain Ali Nadeem, Khawaja Abdul Rehman, Shahroze Ahmad, Muhammad Rafay Shahzad Cheema; Clin Endosc 2025;58(5):684-695. Published online August 27, 2025; DOI: https://doi.org/10.5946/ce.2024.256

Graphical Abstract Abstract PDF Supplementary Material: Background
/Aims: This study aimed to review and update the evidence regarding the efficacy and safety of percutaneous cholecystolithotomy/lithotripsy (PCCL) for managing acute calculous cholecystitis (ACC) in non-surgical candidates.
Methods
A systematic search of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase was conducted. We included studies focusing on the use of PCCL in patients deemed ineligible for surgery owing to ACC and reporting outcomes such as technical success, stone clearance, recurrence, and length of hospital stay. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results
Meta-analysis of 13 studies showed a technical success rate of 97%, with stone and cholecystitis recurrence in 10% and 1% of cases, respectively. The pooled average length of hospital stay was 2.79 days. Complications included retained stones (3%), duct perforations (6%), catheter displacement (5%), bleeding (4%), and bile leakage (5%). A sensitivity analysis confirmed the robustness of these results.
Conclusions
PCCL demonstrated high efficacy with minimal recurrence and low complication rates in managing ACC in non-surgical candidates. Further randomized controlled trials are necessary to compare its efficacy and safety with standard care approaches, such as cholecystectomy or percutaneous cholecystostomy.

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Current status of therapeutic endoscopy in Vietnam: Ky Doan Thai, Binh Thanh Mai, Tung Lam Nguyen, Dung Dang Quy Ho; Clin Endosc 2025;58(6):826-830. Published online August 19, 2025; DOI: https://doi.org/10.5946/ce.2025.041

Abstract PDF

In recent years, the field of gastrointestinal endoscopy has grown significantly in Vietnam. Although Vietnamese gastrointestinal endoscopy still lags behind developed countries, such as Japan and Korea, the advancement throughout the country has been rapid. Current advanced gastrointestinal endoscopy techniques from around the world have been implemented in Vietnam. The number of endoscopists has also significantly increased. These advancements, particularly in interventional endoscopy, have primarily resulted from investments in equipment and tools, strategic personnel training, and international collaborations. Since the establishment of the Vietnamese Federation for Digestive Endoscopy in 2011, numerous international collaborations and training activities have accelerated the development of interventional gastrointestinal endoscopy in Vietnam.

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Impact of a social media-based educational initiative on endoscopic practice in Vietnam: a survey study
Hiroshi Matsunaga, Kouichi Nonaka, Ho Dang Quy Dung, Yoshitsugu Misumi, Yousuke Nakai
Clinical Endoscopy.2026; 59(2): 315. CrossRef
Strengthening upper gastrointestinal endoscopy service in primary healthcare settings in low- and middle-income countries: Proposals from an implementation study in Vietnam
Tomoko Nishioka, Yuta Yokobori, Yuriko Egami, Tien Manh Huynh, Qui Duc Phan, Noriko Fujita, Dang Quy Dung Ho, Duc Trong Quach, Hitoshi Murakami
Global Health & Medicine.2026; 8(2): 90. CrossRef

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Magnetically guided gastric capsule endoscopy: a review and new developments: Jean-Francois Rey; Clin Endosc 2025;58(6):797-807. Published online July 30, 2025; DOI: https://doi.org/10.5946/ce.2025.062

Abstract PDF

Since 2001, capsule endoscopy has been the primary test used to diagnose small-intestinal diseases. However, video capsule endoscopy of the stomach was considered impractical because visualizing the entire stomach was deemed impossible and would require a steerable capsule. Magnetically controlled gastric capsule endoscopy has been increasingly used for the diagnosis of gastric diseases, with significant developments in China. This noninvasive, hygienic, and comfortable method has gained popularity as an alternative to traditional electronic gastroscopy owing to its disposable nature and recent hardware upgrades (resolution, brightness, and field of view). Important steps forward with artificial intelligence and robots allow for the automated detection and characterization of gastric lesions. As it was restricted in China, questions have been raised about its cost-effectiveness worldwide, particularly in countries where early gastric cancer is not a priority. In this paper, I review the initial trials with this innovative capsule and the important technical updates in the last 5 years: robots for capsule guidance and artificial intelligence for the detection and characterization of gastric lesions.

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Hélder Cardoso, Miguel Mascarenhas, Joana Mota, Miguel Martins, Maria João Almeida, Joana Frias, Catarina Cardoso Araújo, Francisco Mendes, Margarida Marques, Patrícia Andrade, Guilherme Macedo
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Rishi Chowdhary, Param Darpan Sheth, Insiya Mohammed Rampurawala, Chitresh Kapadia, Chirag Vohra, Rahul Chowdhary, Kirti Arora, Varna Taranikanti, Ashita Rukmini Vuthaluru, Omesh Goyal, Manjeet Kumar Goyal
Artificial Intelligence in Gastrointestinal Endoscopy.2026;[Epub] CrossRef
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Dongjun Lee, Yonghun Lee, Seungmun Jeon
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Xi Jiang, Chen He, Xiaoou Qiu, Yizhi Chen, Wei Zhou, Zhaoshen Li, Zhuan Liao
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Artificial intelligence technologies in digestive system endoscopy: the state of the problem and prospects (literature review)
E. V. Shlyakhto, E. G. Solonitsyn, D. G. Baranov, B. V. Sigua, I. N. Danilov
Russian surgical journal.2025; 1(2): 8. CrossRef

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Best practice of gastrointestinal endoscopy during Mpox upsurge: an Indonesian Society for Digestive Endoscopy recommendation: Rabbinu Rangga Pribadi, Ahmad Fariz Malvi Zamzam Zein, Raisa Wibowo, Achmad Fauzi, Abdul Aziz Rani, Marcellus Simadibrata, Dadang Makmun, Murdani Abdullah, Ari Fahrial Syam, Muhammad Miftahussurur, Agasjtya Wisjnu Wardhana, Amanda Pitarini Utari, Andi Muhammad Luthfi Parewangi, Arles Arles, Arnelis Arnelis, Bradley Jimmy Waleleng, Bogi Pratomo Wibowo, Fauzi Yusuf, Hasan Maulahela, Hery Djagat Purnomo, I Dewa Nyoman Wibawa, Ignatia Sinta Murti, Indra Marki, Kaka Renaldi, Masrul Lubis, Muhammad Begawan Bestari, Muhammad Firhat Idrus, Pieter Saragih, Putut Bayupurnama, Ruswhandi Ruswhandi, Saskia Aziza Nursyirwan, Suyata Suyata, Titong Sugihartono, Triyanta Yuli Pramana, Virly Nanda Muzellina, Yustar Mulyadi, on behalf of the Indonesian Society for Digestive Endoscopy; Clin Endosc 2025;58(5):662-669. Published online July 30, 2025; DOI: https://doi.org/10.5946/ce.2024.294

Abstract PDF: The emergence of Mpox as a significant zoonotic viral threat presents new challenges in gastrointestinal endoscopy. This article outlines the risk of Mpox transmission during gastrointestinal endoscopy, particularly through respiratory droplets and contact with the mucosal surfaces. Gastrointestinal endoscopy may also facilitate transmission by fomites, as the Mpox virus can persist on medical instruments and surfaces for long periods. Nosocomial Mpox transmission is a significant concern in both endemic and non-endemic regions. This highlights the necessity for enhanced infection control measures in gastrointestinal endoscopy, including pre-endoscopic assessment, proper use of personal protective equipment, and rigorous post-procedural disinfection. Additionally, vaccination of healthcare workers frequently exposed to high-risk situations is emphasized. Ongoing surveillance and monitoring of healthcare workers are key components in minimizing the transmission risk. Although no direct cases of Mpox transmission via gastrointestinal endoscopy have been reported, these recommendations mitigate the potential risks associated with such procedures and necessitate strict adherence to infection control protocols. By adhering to these protocols and adapting to current practices, gastrointestinal endoscopy can be safely performed during the Mpox upsurge, ensuring the protection of both patients and healthcare workers.

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Natural orifice transluminal endoscopic surgery: history and current development: Zaheer Nabi, D. Nageshwar Reddy; Clin Endosc 2026;59(1):21-32. Published online July 1, 2025; DOI: https://doi.org/10.5946/ce.2025.009

Abstract PDF

Natural orifice transluminal endoscopic surgery (NOTES) represents an innovative advancement in minimally invasive surgery, utilizing natural body orifices to access the peritoneal cavity to minimize surgical trauma, reduce postoperative pain, and avoid visible scars. Since its inception, NOTES has faced challenges such as technical complexity and securing safe access closure, which initially limited its widespread adoption. However, advancements in endoscopic techniques and technology, closure devices, and hybrid approaches may revitalize its clinical utility. Hybrid NOTES, particularly transvaginal techniques, has demonstrated significant benefits, including reduced postoperative pain, faster recovery, and improved cosmesis, without compromising safety or efficacy. Innovations such as flexible endoscopic platforms, robotic assistance, and novel suturing techniques address previous limitations and enable broader applications across various gastrointestinal indications. Comparative studies have shown comparable outcomes between NOTES and traditional laparoscopy, with specific advantages in terms of patient comfort and recovery time. As technology evolves, NOTES continues to expand its clinical indications, and its future holds promise with the integration of robotics and artificial intelligence. Further research and structured training programs are crucial to overcome existing barriers and ensure safe and effective implementation in diverse clinical settings.

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Clara G. Kierbel, Matteo Russo
Robotics.2026; 15(7): 118. CrossRef
Dual‐Modal Safety Framework for Robotic‐Assisted Bronchoscopy via Endoscopic Vision and Haptic Feedback
Bodong Fan, Luhao Xie, Lifeng Zhu, Xiaoliang Jin, Jian Lu, Gaojun Teng, Aiguo Song
The International Journal of Medical Robotics and Computer Assisted Surgery.2026;[Epub] CrossRef

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Advancing colonoscopy training: tailored strategies and simulation-based models for skill mastery: Nilanga Nishad, Malith Nandasena, Andreas Hadjinicolaou, Mo Hameed Thoufeeq; Clin Endosc 2025;58(6):808-816. Published online June 9, 2025; DOI: https://doi.org/10.5946/ce.2025.019

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

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A new hemostatic device for gastric endoscopic submucosal dissection: a prospective randomized controlled trial comparing Coajet and Hemograsper in Korea: Sang Un Kim, Seong Woo Jeon; Clin Endosc 2025;58(4):552-560. Published online June 4, 2025; DOI: https://doi.org/10.5946/ce.2024.295

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

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Exploring lumen-apposing metal stents as a novel approach for managing walled-off necrosis in pediatric acute pancreatitis in Indian cohort: a prospective study: Varun Mehta, Abhinav Abhinav, Yogesh Kumar Gupta, Manisha Khubber, Ajit Sood, Manjeet Kumar Goyal; Clin Endosc 2025;58(4):595-603. Published online May 29, 2025; DOI: https://doi.org/10.5946/ce.2024.315

Graphical Abstract Abstract PDF Supplementary Material

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

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The evolving role of endoscopic ultrasound-guided lumen-apposing metal stents in the management of peri-pancreatic fluid collections
Ashita Rukmini Vuthaluru, Varun Mehta, Omesh Goyal, Prabhav Mehta, Manjeet Kumar Goyal
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef

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Recent advancement in size measurement during endoscopy: Hye Kyung Jeon, Gwang Ha Kim; Clin Endosc 2026;59(1):1-8. Published online May 23, 2025; DOI: https://doi.org/10.5946/ce.2025.070

Abstract PDF

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

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Accuracy of Virtual Scale Endoscopy in colorectal polyp size measurement: a Grading of Recommendations Assessment, Development and Evaluation–assessed pairwise and network meta-analysis
Mohamed S. Elgendy, Mohamed Rifai, Amira M. Taha, Islam Rajab, Abdulrahman Maged, Mohamed A. Elgamasy, Hosam I. Taha, Mohamed Abuelazm, Babu P. Mohan, Douglas G. Adler
Gastrointestinal Endoscopy.2026; 103(5): 904. CrossRef
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Elena De Cristofaro, Jean Grimaldi, Diana Giannarelli, Roupen Djinbachian, Jérémie Jacques, Timothée Wallenhorst, Clara Yzet, Louis-Jean Masgnaux, Florian Rostain, Alexandru Lupu, Jérôme Rivory, Mathieu Pioche
Gastrointestinal Endoscopy.2026; 104(3): 436. CrossRef
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Ke Niu, Zeyun Liu, Xue Feng, Heng Li, Naian Xiao, Binghua Su, Qika Lin, Kaize Shi
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Elena De Cristofaro, Jean Grimaldi, Mathieu Pioche
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Masaya Sano, Toshihiro Nishizawa, Osamu Toyoshima, Hidenobu Watanabe, Takuma Hiramatsu, Hiroki Asano, Tomonori Aoki, Keisuke Hata, Hirotoshi Ebinuma, Hidekazu Suzuki
Arab Journal of Gastroenterology.2026;[Epub] CrossRef

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Digital platforms, virtual reality, and augmented reality in gastrointestinal endoscopy training: Wilfredo Pagani, Tavia Buysse, Kulwinder S. Dua; Clin Endosc 2025;58(5):653-661. Published online May 23, 2025; DOI: https://doi.org/10.5946/ce.2024.354

Abstract PDF

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

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Jun-Seong Kim, Kun-Woo Kim, Hyo-Joon Kim, Seong-Yong Moon
Applied Sciences.2026; 16(3): 1325. CrossRef
The SENENDO Volunteer Mission — A Training and Care Delivery Model That Addresses Lacking Digestive Endoscopy Resources in Sub-Saharan Africa
Gabriel Rahmi, Ibrahima Diallo, Mamadou Ngone Gueye, Pape Saliou Mbaye, Alan N. Barkun
Gastroenterology.2026; 170(5): 867. CrossRef
Emerging trends in endoscopy and virtual reality from 1991 to 2024: A bibliometric analysis
Qian Wang, Dahui Zhong, Ying Peng, Xinhong Chen
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Simon M Everett, Amit Maydeo, Duvvur Nageshwar Reddy, Nagesh Kamat, Pradeep Bhandari
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Motion Tracking-Based Dental Posture Training: Heuristic-Based Assessment and a Comparative Feasibility Study
Jun-Seong Kim, Kun-Woo Kim, Hyo-Joon Kim, Seong-Yong Moon
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Samer Al-Dury, Sinan Sharba, Yahya Al Hammada, Noora Alzadjali, Noor Mohammed
Best Practice & Research Clinical Gastroenterology.2026; : 102132. CrossRef

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Current status and trends of green endoscopy: Kihyun Ryu, Won Jae Yoon, Sang Hoon Kim, Da Hee Park, Jin Hwa Park, Ki Bae Bang, Tae Joo Jeon, Da Hyun Jung, Young Sin Cho; Clin Endosc 2025;58(4):493-502. Published online May 21, 2025; DOI: https://doi.org/10.5946/ce.2024.332

Abstract PDF Supplementary Material

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

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Systematic Review: Ultrasound Goes Echo—Decarbonising Inflammatory Bowel Disease Care Through Intestinal Ultrasound
Sara Massironi, Alessandra Zilli, Federica Furfaro, Mariangela Allocca, Laurent Peyrin‐Biroulet, Vipul Jairath, Silvio Danese
Alimentary Pharmacology & Therapeutics.2025; 62(10): 966. CrossRef

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Role of fully covered metal stents in the management of chronic pancreatitis: Younghun Jeon, Hoonsub So, Sung Jo Bang; Clin Endosc 2025;58(5):646-652. Published online May 8, 2025; DOI: https://doi.org/10.5946/ce.2024.349

Abstract PDF

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

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Robotic surgery for benign biliary strictures
Xitao Wang, Jian Tan, Yunfeng Li
Intelligent Surgery.2026; 9: 42. CrossRef

4,704 View
245 Download
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Classification of image-enhanced endoscopy in colon tumors: One-Zoong Kim; Clin Endosc 2025;58(3):337-351. Published online May 8, 2025; DOI: https://doi.org/10.5946/ce.2024.263

Abstract PDF: Colorectal cancer accounts for 10% of global cancer cases in each year, making accurate evaluation and resection crucial. Imaging-enhanced endoscopy helps differentiate between hyperplastic polyps and adenomas, guiding treatment decisions. Colon tumors are classified into benign (e.g., serrated and adenomatous polyps) and malignant (e.g., adenocarcinomas). The Paris classification categorizes superficial neoplastic lesions by morphology, while laterally spreading tumors are classified by size and growth pattern. Effective classification aids in determining resectability and appropriate interventions for colon tumors, ultimately improving patient outcomes. Image-enhanced endoscopy improves colon tumor diagnosis using various techniques like dye, optical, and electronic methods. Kudo’s pit pattern categorizes lesions based on surface morphology using dye, while Sano, Jikei, and Hiroshima classifications focus on vascular patterns using narrow-band imaging (NBI). The NBI International Colorectal Endoscopic (NICE) classification integrates these methods to identify lesions, especially deep submucosal invasive cancers. The Workgroup Serrated Polyps and Polyposis (WASP) classification targets sessile serrated lesions, and the Japan NBI Expert Team (JNET) classification further refines adenoma categorization with low- and high-grade adenoma. The Colorectal Neoplasia Endoscopic Classification to Choose the Treatment (CONECCT) classification consolidates multiple systems for comprehensive assessment, aiding in treatment decisions and potentially applicable to artificial intelligence for diagnostic validation across imaging modalities like linked color imaging, blue light imaging, or i-scan.

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Utility of underwater endoscopic mucosal resection combined with a protruding anchor by saline injection for superficial non-ampullary duodenal tumors: a retrospective study in Japan: Yoshie Nomoto, Satoshi Shinozaki, Yoshimasa Miura, Hiroyuki Osawa, Yuji Ino, Tomonori Yano, Nikolaos Lazaridis, Hironori Yamamoto; Clin Endosc 2025;58(4):561-568. Published online March 12, 2025; DOI: https://doi.org/10.5946/ce.2024.181

Graphical Abstract Abstract PDF

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

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Yoshimasa Miura
Journal of Nihon University Medical Association.2025; 84(3): 119. CrossRef
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Ji Yong Ahn
Clinical Endoscopy.2025; 58(4): 544. CrossRef
Reply to the comments on ‘Utility of underwater endoscopic mucosal resection combined with a protruding anchor by saline injection for superficial non-ampullary duodenal tumors: a retrospective study in Japan'
Hironori Yamamoto, Yoshie Nomoto, Satoshi Shinozaki, Yoshimasa Miura, Hiroyuki Osawa
Clinical Endoscopy.2025; 58(6): 953. CrossRef
A reformative underwater endoscopic mucosal resection technique for superficial non-ampullary duodenal tumors
Yiheng Yao, Guolei Shi, Xingjie Shen, Liang Liu
Clinical Endoscopy.2025; 58(6): 951. CrossRef

5,390 View
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Core curriculum for sedation in gastrointestinal endoscopy with a focus on practice: a proposal from the Korean Society of Gastrointestinal Endoscopy: Hong Sub Lee, Yun Jeong Lim, Jong-Jae Park, Endoscopic Sedation Committee of Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2025;58(2):218-224. Published online March 10, 2025; DOI: https://doi.org/10.5946/ce.2024.215

Abstract PDF

Ideal sedation education for gastrointestinal endoscopy should encompass all medications used in sedation therapy, and facilitate appropriate application in clinical practice by combining theoretical and practical education according to each country’s situation. The educational goals for endoscopic sedation in Korea have already been announced, and theoretical training is regularly conducted by the Korean Society of Gastrointestinal Endoscopy (KSGE). However, no official core curriculum for sedation during gastrointestinal endoscopy exists in Korea. Therefore, a practical curriculum aligned with Korea’s clinical context should be developed. The Endoscopic Sedation Committee of KSGE has identified these challenges and proposed a core curriculum for sedation during endoscopy. Firstly, in terms of theory, it would be beneficial to maintain current education. Secondly, since practical training is still lacking, it would be beneficial to have practical hands-on training. To accomplish this, each simulation center should provide basic practical training such as airway maintenance and advanced teamwork skills. This review presents a detailed curriculum for safe sedation in gastrointestinal endoscopy, developed based on Korea’s specific needs and supported by current literature.

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Risk factors for suspected infectious fever after diagnostic upper endoscopy: propofol overdose in a retrospective study from Korea
Sunmin Lee, Jung-Hwan Lee, Jongbeom Shin, Boram Cha, Ji-Taek Hong, Kye Sook Kwon
Clinical Endoscopy.2025; 58(5): 703. CrossRef

4,740 View
191 Download
1 Web of Science
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Predictors of failure of percutaneous endoscopic gastrostomy tube placement: a retrospective study in a tertiary care center in the USA: Ryan Xin, Cassandra Sanossian, Melissa Fazzari, Brandon Mui, Marouf Hossain, Jennifer Katz; Clin Endosc 2025;58(3):418-424. Published online January 23, 2025; DOI: https://doi.org/10.5946/ce.2024.118

Graphical Abstract Abstract PDF: Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) tube placement is a common procedure used to initiate enteral feeding. To our knowledge, there are no previous studies that analyze predictors of PEG failure. This study aims to identify risk factors for failure of inpatient PEG placement.
Methods
A retrospective chart review was conducted of inpatients in the Montefiore Health System who were scheduled to undergo PEG placement from 2016 to 2020 (n=1,138). Patient, endoscopist, and procedural characteristics were summarized using descriptive statistics, both overall and stratified by whether the PEG was successfully placed.
Results
The overall success rate of PEG placement was 89%. The most common indications included stroke (31%), dementia (27%), and ventilator use (24%). Patient characteristics, including body mass index (BMI) (p=0.16) and indication for PEG placement (p=0.06), were not significantly associated with PEG failure. Instead, endoscopist and procedural characteristics were found to be significant, including type of attending (p<0.001), location of case (p=0.02), and category of anesthesia (p<0.001).
Conclusions
PEG placement remains a highly successful procedure. Endoscopist and procedural characteristics, not patient characteristics, were associated with PEG placement success. Notably, patient BMI and indication for PEG placement could not be used to risk stratify candidates for PEG placement.

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Remimazolam, a novel drug, for safe and effective endoscopic sedation: Jae Min Lee, Yehyun Park, Dong Won Ahn, Jun Kyu Lee, Kwang Hyuck Lee; Clin Endosc 2025;58(3):370-376. Published online January 14, 2025; DOI: https://doi.org/10.5946/ce.2024.026

Abstract PDF

Remimazolam is a novel benzodiazepine with unique pharmacokinetic and pharmacodynamic properties, making it an ideal candidate for sedation during endoscopic procedures. Distinguished by its rapid onset and short duration of action, remimazolam offers a safer and more efficient alternative to traditional sedatives, such as midazolam and propofol, with fewer side effects, such as hypotension, bradycardia, and respiratory depression. This article reviews the characteristics of remimazolam and its practical advantages, including ease of use, quick recovery time, and minimal residual sedation, emphasizing its potential to improve patient safety and procedural efficiency in clinical endoscopy settings.

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Comparative safety and efficacy of remimazolam versus propofol for endoscopic retrograde cholangiopancreatography with the patient under deep sedation: a multicenter randomized controlled trial
Sung Yong Han, Dongwook Oh, Jung Wan Choe, Jong Hyun Lee, Moon Jae Chung, Sung Ill Jang, Se Woo Park, Jin Seok Park, Min Jae Yang, Eui Joo Kim, Jae Hee Cho
Gastrointestinal Endoscopy.2026; 103(6): 1192. CrossRef
Remimazolam Inhibits Neuronal Apoptosis, Inflammation, and Ferroptosis in Cerebral Infarction via Promoting TRIM67‐Mediated Degradation of ACSL4
Gaopeng Xiao, Yongqin Zhang, Ji Yang, Jigang He, Youwu Zhang, Wen Qin, Liuqiong Yu, Ling Wang, Yujin Li, Yuncheng Bai
Journal of Biochemical and Molecular Toxicology.2026;[Epub] CrossRef
Propofol Versus Remimazolam in Gastrointestinal Endoscopy: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials
Ahmed L. Youseif, Ziad W. Elmezayen, Noha Hammad, Ahmed F. Younis, Aya M. Ramadan, Basma M. El-Khalifa, Amr R. Saleh, Karim A. Khalil, Mohamed Nabil Hamouda, Belal hamed, Alaa Ashraf Mohamed, Youssef Narouz, Doaa A. Elmarzouky, Amira A. Albawri, Yara M. H
Digestive Diseases and Sciences.2026; 71(7): 2770. CrossRef
Effects of remimazolam and sevoflurane on postoperative delirium and early cognitive impairment in elderly patients after laparoscopic-assisted gastrointestinal surgery: a randomized clinical trial
Wei Ren, Kai Zheng, Jian Song, Li Zhang, Shenqiang Gao
Frontiers in Medicine.2026;[Epub] CrossRef
Sedation in endoscopy: Current practices and future innovations
Angelo Bruni, Giovanni Barbara, Alessandro Vitello, Giovanni Marasco, Marcello Maida
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
The Mechanism of Action of Remimazolam on GABAA Receptors in Painless Bronchoscopy and Its Clinical Advantages
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Advances in Clinical Medicine.2025; 15(10): 140. CrossRef

16,735 View
573 Download
6 Crossref

Bowel preparation for small bowel capsule endoscopy: standard regimen with 2 L polyethylene glycol versus 1 L polyethylene glycol plus ascorbate: Riccardo Caccia, Alessandro Rimondi, Luca Elli, Matilde Topa, Flaminia Cavallaro, Carmine Gentile, Lucia Scaramella, Nicoletta Nandi, Reena Sidhu, Pinhas Eidler, Maurizio Vecchi, Gian Eugenio Tontini; Clin Endosc 2025;58(2):285-290. Published online January 2, 2025; DOI: https://doi.org/10.5946/ce.2024.097

Graphical Abstract Abstract PDF

Background
/Aims: Optimization of bowel preparation for small bowel capsule endoscopy (SBCE) is debated. Guidelines recommend 2 L of iso-osmolar polyethylene glycol (PEG) to improve SBCE visibility. We compared the efficacy of the standard 2 L PEG solution with a 1 L PEG plus ascorbate (PEG-ASC) preparation, which has already been established for large-bowel preparation.
Methods
Between October 2020 and February 2022, patients undergoing SBCE were assigned to receive 2 L PEG or 1 L PEG-ASC bowel preparation on an even- or odd-day basis. Bowel cleanliness was evaluated using the small bowel mucosal visibility scoring system (SBMVSS).
Results
Following propensity score matching using a random forest method, two comparable populations of patients treated with 2 L PEG (n=74, male 41%, 53±17 years) and 1 L PEG-ASC (n=74, male 42%, 55±21 years) were obtained from the original cohort of 221 consecutive SBCE patients. Our results showed a trend towards more frequent adequate mucosal visibility with 1 L PEG-ASC compared to 2 L PEG (small bowel mucosal visibility ≥2 in all three small bowel tertiles, p=0.07), as per the SBMVSS score. No significant differences were observed in the diagnostic yield (p=1.00), visibility score=9 (p=0.85), SBCE completeness (p=0.33), or adequate mucosal visibility in each tertile (p=0.61, p=0.74, and p=0.70 for the first, second, and third tertiles, respectively).
Conclusions
Our study suggests the non-inferiority of the 1 L PEG-ASC solution over the standard 2 L PEG for SBCE preparation.

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Applying small bowel endoscopy in inflammatory bowel disease management
Seong-Jung Kim, Sung Noh Hong
Clinical Endoscopy.2026; 59(2): 203. CrossRef
Recent technological advances in video capsule endoscopy: a comprehensive review
Minjee Kim, Hyun Joo Jang
Clinical Endoscopy.2026; 59(2): 182. CrossRef
Multidimensional Optimization of Small Bowel Capsule Endoscopy With Transcutaneous Electrical Acustimulation: A Randomized Controlled Trial
Yi Long Liu, Bei Fang Ning, Ya Nan Mao, Yu Hao Song, Kai Ming Wu, Xia Sheng, Kai Ding, Jiande D. Z. Chen, Wei Tan, Wei Fen Xie
Journal of Digestive Diseases.2026;[Epub] CrossRef
Bowel preparation with still water for small bowel capsule endoscopy: Less is more
Ana I Ferreira, Francisca Côrte-Real, Mariana M Souto, Sofia Xavier, José R Pereira, Cátia Arieira, Bruno Rosa, Maria A Duarte, José Cotter
World Journal of Gastrointestinal Endoscopy.2026;[Epub] CrossRef
Optimizing Bowel Preparation in Small Bowel Capsule Endoscopy: It's All About Timing
Vaneet Jearth, Kshitiz Dogra
Journal of Digestive Endoscopy.2025; 16(02): 113. CrossRef

6,105 View
239 Download
5 Web of Science
5 Crossref

Effect of antithrombotic therapies on small bowel bleeding: an European multicenter retrospective study: Lucia Scaramella, Stefania Chetcuti Zammit, Reena Sidhu, Maurizio Vecchi, Gian Eugenio Tontini, Nicoletta Nandi, Matilde Topa, Luca Elli; Clin Endosc 2025;58(1):102-111. Published online December 2, 2024; DOI: https://doi.org/10.5946/ce.2024.073

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Small bowel bleeding (SBB) is the main indication for videocapsule endoscopy (VCE); the diagnostic yield (DY) could be influenced by antithrombotic therapies. We explored the effects of these therapies on SBB.
Methods
Consecutive patients from two centers (Milan, Italy and Sheffield, UK) who underwent VCE between March 2001 and July 2020 were considered. Demographic data, clinical parameters, drug therapy, and technical characteristics of the procedure were collected. VCE findings and DY were evaluated.
Results
In total, 957 patients (1,052 VCEs) underwent VCE for SBB (DY 50.6%, no retention); 27 patients (27 VCEs) received direct oral anticoagulants, 87 (88 VCEs) received other anticoagulants, 115 (135 VCEs) received antiplatelet therapy, 198 (218 VCEs) received monotherapy, and 31 (32 VCEs) received combined therapy. There were no differences in the completion rate, findings, and DYs between each subgroup or between monotherapy and combined therapy. The overt bleeding rate was similar in all groups, even when comparing antithrombotic users versus those not on therapy (p=0.59) or monotherapy versus combined therapy (p=0.34).
Conclusions
VCE is safe and has a high clinical impact on SBB. Antithrombotic therapies did not affect DY or overt bleeding rate and, consequently, can be considered safe in terms of SBB risk.

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Antithrombotic and management of small bowel bleeding – time to throw caution into the wind?
Lucia Scaramella, Agostino Cosenza, Cristina Romero-Mascarell, Luca Elli
Current Opinion in Gastroenterology.2026; 42(3): 146. CrossRef
Recent technological advances in video capsule endoscopy: a comprehensive review
Minjee Kim, Hyun Joo Jang
Clinical Endoscopy.2026; 59(2): 182. CrossRef
Small bowel pathology – diet, pill or buzz?
Reena Sidhu
Current Opinion in Gastroenterology.2026; 42(3): 143. CrossRef
Do all antithrombotic agents have a similar impact on small bowel bleeding?
Chung Hyun Tae, Ki-Nam Shim
Clinical Endoscopy.2025; 58(1): 80. CrossRef

5,958 View
157 Download
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4 Crossref

Endoscopic vacuum therapy for gastrointestinal transmural defects: a literature review: Tan Minh Le, Van Huy Tran, Kyu Sung Chung, Seong Woo Jeon; Clin Endosc 2025;58(2):181-190. Published online November 8, 2024; DOI: https://doi.org/10.5946/ce.2024.150

Abstract PDF

Endoscopic vacuum therapy (EVT) has emerged as a transformative approach for managing gastrointestinal (GI) transmural defects, offering a less invasive and more promising alternative to surgery. Initially developed to address anastomotic leaks after rectal surgery, the application of EVT has expanded to include other locations within the GI tract. This review investigated the principles, indications, procedures, outcomes, challenges, and future perspectives of EVT for the management of GI transmural defects. In conclusion, EVT has demonstrated favorable outcomes in GI defect closure, with reduced complications, shortened hospital stay, and decreased morbidity rates as compared with conventional treatments. Although EVT faces challenges in some specific anatomical locations and in managing severe complications such as major bleeding, ongoing advancements in technology and standardization efforts offer promise for broader indications and better outcomes. Future perspectives include exploring novel EVT devices, refining patient selection criteria and pre-emptive applications, and standardizing procedural protocols.

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Endoscopic vacuum therapy for gastrointestinal transmural defects: clinical outcomes and treatment implications: a retrospective study from Korea
A Reum Choe, Ki-Nam Shim, Ju-Ran Byeon, Yehyun Park, Eun Mi Song, Chung Hyun Tae, Sung-Ae Jung
Ewha Medical Journal.2026; 49(1): e4. CrossRef
Endoskopische Vakuumtherapie bei rektaler Anastomoseninsuffizienz
Asem Abdoh, Ralf Jakobs
Gastroenterologie up2date.2026; 22(01): 17. CrossRef
Endoscopic negative-pressure therapy for anastomotic leaks after upper gastrointestinal surgery: systematic review and meta-analysis
Santiago Alonso Gómez, María Donat Garrido, Carlos Miliani Molina, Sagrario Martínez Cortijo, Elías Rodríguez Cuellar, Eduardo Ferrero Herrero, Javier Dagnesses-Fonseca
Surgical Endoscopy.2026; 40(5): 3666. CrossRef
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A. Vorontsov, D. Krikunov, S. Vasiliev, N. Markina, V. Petukhov
Vrach.2026; : 84. CrossRef
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Anjan Dhar, Vikramjit Mitra, David Leonard, Nasar Aslam, Benjamin Charles Norton, Samer Al-Dury, Noor Mohammed, Vinay Sehgal, Rehan Haidry
Frontline Gastroenterology.2026; : flgastro-2025-103069. CrossRef
Rescue endoscopic vacuum therapy after failed surgical repair of a perforated gastric ulcer
Joana Mota, Joel Ferreira-Silva, Guilherme Macedo, Eduardo Rodrigues-Pinto
Endoscopy.2026; 58(S 04): E794. CrossRef
Endoscopic Vacuum Therapy: When and How to Use It?
Nuno Gonçalves, Inês Marques de Sá
GE - Portuguese Journal of Gastroenterology.2026; 33(1): 499. CrossRef
Closing the gap: endoscopic treatment of esophageal anastomotic leakage—a retrospective cohort study
Myriam W. Heilani, Daniel Teubner, Thomas Haist, Mate Knabe, Patrizia Malkomes, Florian Alexander Michael, Michael Stumpf, Stefan Zeuzem, Wolf Otto Bechstein, Mireen Friedrich-Rust, Georg Dultz
Surgical Endoscopy.2025; 39(9): 5643. CrossRef
Successful Endoscopic Vacuum Therapy for a Postoperative Esophagogastric Fistula Following Sleeve Gastrectomy: A Case Report
Antonio de Jesús González Luna, Marco Antonio Castellanos López, Luis Antonio Velázquez Lozano, Nancy Cristina Vela Moya, Cristina Vanessa Cuevas Calla
Cureus.2025;[Epub] CrossRef
Endoscopic vacuum therapy for esophageal transmural defects
Ji Hyun Kim, Sung Chul Park
Journal of Innovative Medical Technology.2025; 3(2): 45. CrossRef
Successful endoscopic vacuum therapy in diffuse gastric hemorrhage secondary to acute ischemia: a case report
Marcelo Klotz Dall'Agnol, Igor Mendonça Proença, Mateus Pereira Funari, Diogo Turiani Hourneaux de Moura, Fernando da Costa Ferreira Novo, Fauze Maluf-Filho
iGIE.2025;[Epub] CrossRef

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522 Download
6 Web of Science
11 Crossref

Image-enhanced endoscopy in upper gastrointestinal disease: focusing on texture and color enhancement imaging and red dichromatic imaging: Jae Yong Park; Clin Endosc 2025;58(2):163-180. Published online November 6, 2024; DOI: https://doi.org/10.5946/ce.2024.159

Abstract PDF

Endoscopic examination plays a crucial role in the diagnosis of upper gastrointestinal (UGI) tract diseases. Despite advancements in endoscopic imaging, the detection of subtle early cancers and premalignant lesions using white-light imaging alone remains challenging. This review discusses two novel image-enhanced endoscopy (IEE) techniques–texture and color enhancement imaging (TXI) and red dichromatic imaging (RDI)–and their potential applications in UGI diseases. TXI enhances texture, brightness, and color tone, which improves the visibility of mucosal irregularities and facilitates earlier detection of neoplastic lesions. Studies have suggested that TXI enhances the color differences between lesions and the surrounding mucosa and improves the visibility of the lesion. TXI aids in the diagnosis of various UGI diseases, including early gastric cancer, esophageal cancer, premalignant conditions such as atrophic gastritis and Barrett’s esophagus, and duodenal tumors. RDI utilizes specific wavelengths to enhance the visualization of deep blood vessels or bleeding points, aiding in the rapid and accurate identification of bleeding sources during endoscopic procedures. Although promising, TXI and RDI require further large-scale studies across diverse populations to establish their clinical utility, diagnostic performance, and cost-effectiveness before integration into the guidelines. Standardized training is also required for effective utilization. Overall, these IEE techniques has the potential to improve the diagnosis and management of UGI.

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Abdallfatah Abdallfatah, Ahmed W. Hageen, Samaa Daoud, Hazem Abosheaishaa, Douglas G. Adler
European Journal of Gastroenterology & Hepatology.2026; 38(5): 650. CrossRef
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One-Zoong Kim
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Swetha Kumari T, Vasuki R
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Diagnostics.2025; 15(21): 2781. CrossRef

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7 Web of Science
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Efficacy of endoscopic vacuum therapy in esophageal luminal defects: a systematic review and meta-analysis: Ishaan Vohra, Harishankar Gopakumar, Neil R. Sharma, Srinivas R. Puli; Clin Endosc 2025;58(1):53-62. Published online October 10, 2024; DOI: https://doi.org/10.5946/ce.2023.282

Graphical Abstract Abstract PDF

Background
/Aims: Endoscopic vacuum-assisted closure (EVAC) is a novel technique used to repair esophageal perforation and leaks. Varying data have been reported on the overall success rate of EVAC. We aimed to conduct a meta-analysis of the available data on the clinical success rate of EVAC.
Methods
Electronic databases were searched for publications addressing the efficacy of EVAC in esophageal luminal defects. Pooling was conducted using both fixed and random-effects models. The overall clinical success of EVAC therapy was considered the primary outcome, whereas, overall complication rates, need for adjunct therapy, and mortality were considered secondary outcomes.
Results
In total, 366 patients were included in the study. On pooled analysis, the mean age was 66 years with 68.32% of patients being men. Overall pooled clinical success rate of EVAC therapy was 87.95%. Upon subgroup analysis, the pooled clinical success rate of postsurgical anastomotic leak and transmural esophageal perforation were found to be 86.57% and 88.89%, respectively. The all-cause hospital mortality was 14% and 4.2% in patients with esophageal perforation and EVAC, respectively.
Conclusions
This study demonstrates that EVAC therapy has a high overall clinical success rate, with low mortality. EVAC therapy seems to be a promising procedure with excellent outcomes in patients with luminal esophageal defects.

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Tommaso Pessarelli, Irene Maria Bambina Bergna, Cinzia Boemo, Alberta De Monti, Marta La Milia, Cristina Marfinati Hervoso, Michela Pagliarulo, Alessandra Piagnani, Mauro Zago, Arnaldo Amato
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Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events: Min Kyu Kim, Sung Wook Hwang; Clin Endosc 2024;57(6):725-734. Published online August 29, 2024; DOI: https://doi.org/10.5946/ce.2024.003

Abstract PDF

The use of immune checkpoint inhibitors (ICIs) for the treatment of various malignancies is increasing. Immune-related adverse events can occur after ICI administration, with gastrointestinal adverse events constituting a significant proportion of these events. When ICI-related diarrhea/colitis is suspected, endoscopic evaluation is recommended to differentiate it from other etiologies and assess the severity of colitis. The distribution of intestinal inflammation in ICI-related colitis demonstrates a high frequency of extensive colitis (23–86%). However, isolated right-sided colitis (3–8%) and ileitis (2–16%) are less prevalent. Endoscopic findings vary and predominantly encompass features indicative of inflammatory bowel disease, including aphthae, ulcers, diffuse or patchy erythema, mucosal edema, loss of vascular pattern, and friability. The presence of ulcers and extensive intestinal inflammation are associated with a reduced response to treatment. Microscopic inflammation can be observed even in endoscopically normal mucosa, underscoring the need for biopsies of seemingly normal mucosa. Histological findings present with acute/chronic inflammation and occasionally exhibit characteristics observed in inflammatory bowel disease, microscopic colitis, or ischemic colitis. The first-line therapeutic choice for ICI-related diarrhea/colitis with a common terminology criteria for adverse events grade of 2 or above is corticosteroids, whereas infliximab and vedolizumab are recommended for refractory cases.

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Diego Casas Deza, Cristina Polo Cuadro, Marta Gascón Ruiz, Manuel Barreiro-de Acosta, Míriam Mañosa, Francisco Rodríguez-Moranta, Yamile Zabana, Elena Céspedes Martínez, Ingrid Ordás, José Miranda Bautista, María José García, Irene García de la Filia Moli
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Grigorios Petrousis, Sylwester Szczegielniak, Haider Sabhan, Peter Elbe, Gülden Bilican, Hans Strid, Francesca Bresso, Charlotte Hedin, Stephan L Haas
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CD8+ cell dominance in immune checkpoint inhibitor-induced colitis and its heterogeneity across endoscopic features
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Safety and efficacy of trans-afferent loop endoscopic ultrasound-guided pancreaticojejunostomy for post pancreaticoduodenectomy anastomotic stricture using the forward-viewing echoendoscope: a retrospective study from Japan: Ahmed Sadek, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto, Kenneth Tachi; Clin Endosc 2025;58(2):311-319. Published online August 26, 2024; DOI: https://doi.org/10.5946/ce.2024.089

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Endoscopic ultrasound (EUS)-guided pancreatic duct drainage is a well-established procedure for managing pancreaticojejunostomy anastomotic strictures (PJAS) post-Whipple surgery. In this study, we examined the effectiveness and safety of EUS-guided pancreaticojejunostomy (EUS-PJS).
Methods
This retrospective, single-arm study was performed at Aichi Cancer Center Hospital on 10 patients who underwent EUS-guided pancreaticojejunostomy through the afferent jejunal loop using a forward-viewing echoendoscope when endoscopic retrograde pancreatography failed. Our primary endpoint was technical success rate, defined as successful stent insertion. The secondary endpoints were early and late adverse events.
Results
A total of 10 patients underwent EUS-PJS between February 2019 and October 2023. The technical success rate was 100%. The median procedure time was 23.5 minutes. No remarkable early or late adverse events related to the procedure, except for fever, occurred in two patients. The median follow-up duration was 9.5 months, and the median number of stent exchanges was two. A stent-free state was achieved in three patients.
Conclusions
EUS-PJS for PJAS management after pancreaticoduodenectomy appears to be an effective and safe procedure with the potential advantages of fewer reinterventions and the creation of a permanent drainage fistula.

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Endoscopic ultrasound-guided recanalization of pancreaticojejunostomy anastomotic stricture using a forward-viewing echoendoscope
Shota Iwata, Takuji Iwashita, Takuya Koizumi, Yosuke Ohashi, Akinori Maruta, Shinya Uemura, Masahito Shimizu
Endoscopy.2026; 58(S 01): E274. CrossRef
Transanastomotic Forward-Viewing EUS-Guided Pancreatic Duct Drainage via Afferent Loop for Pancreaticojejunostomy Anastomotic Stricture After Pancreaticoduodenectomy
Tadahisa Inoue, Rena Kitano, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
Digestive Diseases and Sciences.2025; 70(1): 413. CrossRef
Management of Pancreaticojejunostomy Strictures: A New Perspective with Forward-Viewing EUS
Radhika Chavan
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Transforming endoscopic approaches to post-pancreaticoduodenectomy anastomotic strictures: beyond the surface
Yu-Ting Kuo
Clinical Endoscopy.2025; 58(2): 259. CrossRef
Forward-viewing echoendoscope-guided pancreaticojejunostomy for post-pancreaticoduodenectomy stricture
Toru Kaneko, Mitsuhiro Kida, Takahiro Kurosu, Yutaro Saito, Shiori Koyama, Tomohiro Betto, Chika Kusano
Endoscopy.2025; 57(S 01): E384. CrossRef
Long-Term Outcomes of EUS-Guided Pancreatic Duct Drainage for the Management of Benign Pancreaticojejunostomy Anastomotic Stricture—A Retrospective Cohort Study
Indria Melianti, Kazuo Hara, Takamichi Kuwahara, Shin Haba, Nozomi Okuno, Shimpei Matsumoto, Hiroki Koda, Keigo Oshiro, Tomoki Ogata
Journal of Clinical Medicine.2025; 14(23): 8439. CrossRef

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Role of endoscopy in eosinophilic esophagitis: Eun-Jin Yang, Kee Wook Jung; Clin Endosc 2025;58(1):1-9. Published online July 5, 2024; DOI: https://doi.org/10.5946/ce.2024.023

Abstract PDF

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease involving inflammation of the esophagus. Endoscopy is essential in the diagnosis and treatment of EoE and shows typical findings, including esophageal edema, rings, exudates, furrows, and stenosis. However, studies involving pediatric and adult patients with EoE suggest that even a normally appearing esophagus can be diagnosed as EoE by endoscopic biopsy. Therefore, in patients with suspected EoE, biopsy samples should be obtained from the esophagus regardless of endoscopic appearance. Moreover, follow-up endoscopies with biopsy after therapy initiation are usually recommended to assess response. Although previous reports of endoscopic ultrasonography findings in patients with EoE have shown diffuse thickening of the esophageal wall, including lamina propria, submucosa, and muscularis propria, its role in EoE remains uncertain and requires further investigation. Endoscopic dilation or bougienage is a safe and effective procedure that can be used in combination with medical and/or dietary elimination therapy in patients with esophageal stricture for the management of dysphagia and to prevent its recurrence.

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Ga Hee Kim, Jooyoung Park, Seungju Park, Jeongeun Hwang, Jisup Lim, Kanggil Park, Sunghwan Ji, Kwangbeom Park, Jun-young Seo, Jin Hee Noh, Ji Yong Ahn, Jeong-Sik Byeon, Do Hoon Kim, Namkug Kim
Yonsei Medical Journal.2026; 67(2): 112. CrossRef
British Society of Gastroenterology and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland guidance on best practice for upper gastrointestinal endoscopy
Shahd A Mohamed, Jeyakumar Apollos, John Anderson, Matthew Banks, Aidan Cahill, James Catton, Matthew Cowan, Benjamin R Disney, Paul Dunckley, Jonathan Fletcher, Andrew Fraser, Joanna Gray, John T Green, Helen Griffiths, Hasan Haboubi, Neil Haslam, Tammy
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Comparison of the efficacy and safety of endoscopic and fluoroscopic balloon dilatation in benign esophageal strictures
Kwangbeom Park, Chang Hoon Oh, Do Hoon Kim, Ji Hoon Shin, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
The Korean Journal of Internal Medicine.2026; 41(3): 462. CrossRef
Esophageal Remodeling in Eosinophilic Esophagitis: Clinical and Functional Implications
Kee Wook Jung
Gut and Liver.2026; 20(3): 341. CrossRef
Eosinophilic esophageal myositis: a comparative study of distinguishing features, diagnostic challenges, and therapeutic insights
Rui Wu, Yunyun Zhang, Wei Zhao, Huaqing Zhu, Hongjiao Wu, Xinyi Lu, Wei Zhang, Xiaoping Zou, Nina Zhang
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M Romero Martínez, A Gómez Gómez, M Muñoz Tornero, M Alajarín Cervera, T Fernández Llamas, C Bógalo Romero, L Madrigal Bayonas, F J Sánchez Roncero, G Calatayud Vidal, F Alberca De Las Parras
Endoscopy.2026; 58(S 03): S661. CrossRef
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Amir Farah, Tarek Assaf, Jawad Hindy, Wisam Abboud, Mostafa Mahamid, Edoardo Vincenzo Savarino, Amir Mari
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Painless colonoscopy: fact or fiction?: Pieter Sinonquel, Alexander Jans, Raf Bisschops; Clin Endosc 2024;57(5):581-587. Published online June 27, 2024; DOI: https://doi.org/10.5946/ce.2024.001

Abstract PDF

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

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Nam Gyun Kim, Shinwoo Park, Dongoh Seo, Sanghun Lee, Hyuk Yoon, Jaihwan Kim, Jee-Hwan Ryu
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Iatrogenic colon perforation: endoscopic management or surgery
Seung Bum Lee
Clinical Endoscopy.2026; 59(1): 33. CrossRef
Etomidate-propofol combination in painless gastrointestinal endoscopy for elderly patients: A comparative study
Ying-Yan Zhang
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Impact of opioid addition on procedural conditions during colonoscopy: a randomized trial comparing propofol-based sedation protocols
David Novotny, Jan Palenik, Tomas Tyll, Nadija Brodyuk, Stepan Suchanek, Michal Sotak
Clinical Endoscopy.2025; 58(5): 722. CrossRef
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Xiaonan Huang, Shan Tian, Lifan Xu, Juhan Chen, Hao Wang, Tingting Mai, Lei Shi, Han Wang, Mengcheng Cai, Fanfu Fang
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Polyp Matching in Colon Capsule Endoscopy: Pioneering CCE-Colonoscopy Integration Towards an AI-Driven Future
Ian Io Lei, Ramesh Arasaradnam, Anastasios Koulaouzidis
Journal of Clinical Medicine.2024; 13(23): 7034. CrossRef

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The evolution and current state of bariatric endoscopy in Western countries: Maria Valeria Matteo, Vincenzo Bove, Valerio Pontecorvi, Loredana Gualtieri, Giorgio Carlino, Cristiano Spada, Ivo Boškoski; Clin Endosc 2024;57(6):711-724. Published online May 24, 2024; DOI: https://doi.org/10.5946/ce.2023.253

Abstract PDF

With the alarmingly increasing prevalence of obesity in the Western world, it has become necessary to provide more acceptable treatment options for patients with obesity. Minimally invasive endoscopic techniques are continuously evolving. Currently, metabolic and bariatric endoscopies encompass several different techniques that can offer significant weight loss and improvement in comorbidities with a favorable safety profile. Restrictive bariatric procedures include the use of intragastric balloons and gastric remodeling techniques with different suturing devices. Several studies have demonstrated the efficacy and safety of these techniques that are widely used in clinical practice. Small intestine-targeted metabolic endoscopy is an intriguing and rapidly evolving field of research, although it is not widespread in routine practice. These techniques include duodenal-jejunal bypass liners, duodenal mucosal resurfacing, and incisionless anastomoses. The aim of this review article is to provide a detailed update on the currently available bariatric endoscopy techniques in Western countries.

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Endoscopy for Metabolic Diseases
Maria Valeria Matteo, Jana Kefah Ibrahim Hussein, Giorgio Carlino, Vincenzo Bove, Valerio Pontecorvi, Loredana Gualtieri, Martina De Siena, Mariachiara Di Vincenzo, Lorenzo Zileri Dal Verme, Daniele Salvi, Clarissa Ferrari, Cristiano Spada, Ivo Boskoski
Journal of Clinical Medicine.2026; 15(8): 2832. CrossRef
Duodenal mucosa resurfacing: the endoscopic silver bullet against metabolic disorders?
Amedeo Lonardo, Ashwani K. Singal
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Intragastric Balloon as a Bridge Before Metabolic and Bariatric Surgery: A Systematic Review and Meta-analysis
Mohammad Kermansaravi, Ali Esparham, Chetan Parmar, Farah A. Husain, Ali Solouki, Mohammad Mahjoubi, Amir Hossein Davarpanah Jazi, Shahab Shahabi Shahmiri
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Yu-Xuan Zhai, Tao Mao, Xiao-Yu Li, Lin-Lin Ren, Zi-Bin Tian
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Upper abdominal pain in a patient with a history of laparoscopic adjustable gastric banding
Jae Yong Park
Clinical Endoscopy.2025; 58(6): 945. CrossRef

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Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea: Jung Wan Choe, Jong Jin Hyun, Seong-Jin Son, Seung-Hak Lee; Clin Endosc 2024;57(4):476-485. Published online April 12, 2024; DOI: https://doi.org/10.5946/ce.2023.198

Graphical Abstract Abstract PDF

Background
/Aims: Sedation has become a standard practice for patients undergoing gastrointestinal (GI) endoscopy. However, considering the serious cardiopulmonary adverse events associated with sedatives, it is important to identify patients at high risk. Machine learning can generate reasonable prediction for a wide range of medical conditions. This study aimed to evaluate the risk factors associated with sedation during GI endoscopy and develop a predictive model for hypoxia during endoscopy under sedation.
Methods
This prospective observational study enrolled 446 patients who underwent sedative endoscopy at the Korea University Ansan Hospital. Clinical data were used as predictor variables to construct predictive models using the random forest method that is a machine learning algorithm.
Results
Seventy-two of the 446 patients (16.1%) experienced life-threatening hypoxia requiring immediate medical intervention. Patients who developed hypoxia had higher body weight, body mass index (BMI), neck circumference, and Mallampati scores. Propofol alone and higher initial and total dose of propofol were significantly associated with hypoxia during sedative endoscopy. Among these variables, high BMI, neck circumference, and Mallampati score were independent risk factors for hypoxia. The area under the receiver operating characteristic curve for the random forest-based predictive model for hypoxia during sedative endoscopy was 0.82 (95% confidence interval, 0.79–0.86) and displayed a moderate discriminatory power.
Conclusions
High BMI, neck circumference, and Mallampati score were independently associated with hypoxia during sedative endoscopy. We constructed a model with acceptable performance for predicting hypoxia during sedative endoscopy.

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Rong Zhao, Zheng Chen, Qingyu Teng, Tao Xu, Qi Li, Helin Gong, Hongjun Ji, Hui Zhang
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Sedation for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Guideline
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Endoscopy.2026;[Epub] CrossRef
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Core curriculum for sedation in gastrointestinal endoscopy with a focus on practice: a proposal from the Korean Society of Gastrointestinal Endoscopy
Hong Sub Lee, Yun Jeong Lim, Jong-Jae Park
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Machine learning-based prediction of respiratory depression during sedation for liposuction
Jin-Woo Kim, Jae Hee Woo, Jaewon Seo, Hajin Kim, Sunho Lee, Younchan Park, Jaehyun Ahn, Seonghun Hong, Hye-Min Jeong, Yuncheol Kang
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Sunmin Lee, Jung-Hwan Lee, Jongbeom Shin, Boram Cha, Ji-Taek Hong, Kye Sook Kwon
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The effects of ciprofol and propofol on hypoxemia during gastrointestinal endoscopy in overweight and obese patients: a randomized controlled trial
Jiaxin Chen, Lifei Lai, Shuhua Zhao, Yingqing Deng, Zhe Zhu, Jingling Tian, Qianqian Zhu
BMC Anesthesiology.2025;[Epub] CrossRef

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Safety and efficacy of novel oblique-viewing scope for B2-endoscopic ultrasound-guided hepaticogastrostomy: Sho Ishikawa, Kazuo Hara, Nozomi Okuno, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Takafumi Yanaidani, Masanori Yamada, Tsukasa Yasuda, Toshitaka Fukui, Teru Kumagi, Yoichi Hiasa; Clin Endosc 2024;57(4):527-533. Published online March 29, 2024; DOI: https://doi.org/10.5946/ce.2023.129

Graphical Abstract Abstract PDF

Background
/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) performed at the intrahepatic bile duct segment 3 (B3) is widely used for biliary drainage. Although performing post-puncture procedures is easier in the intrahepatic bile duct segment 2 (B2) when using a conventional oblique-viewing (OV) EUS scope, this method may cause transesophageal puncture and severe adverse events. We evaluated the safety and efficacy of B2 puncture using a novel OV-EUS scope.
Methods
In this single-center retrospective study, we prospectively enrolled and collected data from 45 patients who consecutively underwent EUS-HGS procedures with a novel OV-EUS scope between September 2021 and December 2022 at our cancer center.
Results
The technical success rates of B2-EUS-HGS and EUS-HGS were 93.3% (42/45) and 97.8% (44/45), respectively. The early adverse event rate was 8.9% (4/45) with no cases of scope changes or transesophageal punctures. The median procedure time was 13 minutes (range, 5–30).
Conclusions
B2-EUS-HGS can be performed safely with the novel EG-740UT (Fujifilm) OV-scope without transesophageal puncture and with a high success rate. B2-EUS-HGS using this novel OV scope may be the preferred strategy for EUS-HGS.

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Scope withdrawal technique to prevent transesophageal puncture during endoscopic ultrasound-guided hepaticogastrostomy
Kazuki Endo, Haruo Miwa, Ritsuko Oishi, Hiromi Tsuchiya, Yuichi Suzuki, Kazushi Numata, Shin Maeda
Endoscopy.2025; 57(S 01): E705. CrossRef
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Nozomi Okuno, Kazuo Hara, Seiji Natsume, Masataka Okuno, Shin Haba, Tomonari Asano, Takamichi Kuwahara, Hiroki Koda, Yasuhiro Shimizu
Clinical Endoscopy.2025; 58(4): 604. CrossRef
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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

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