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Review
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]
AbstractAbstract PDFPubReaderePub
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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Systematic Review and Meta-analysis
Outcomes associated with bilateral plastic versus metal stents for palliation in malignant hilar biliary obstruction: an updated meta-analysis from the United States
Raveena S. Boodram, Shyam Vedantam, Sunil Amin, Sean Bhalla, Jodie A. Barkin, Mahmoud Mahfouz, Shria Kumar
Clin Endosc 2026;59(2):223-233.   Published online March 9, 2026
DOI: https://doi.org/10.5946/ce.2025.149
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic methods are favorable for palliation of malignant hilar biliary obstruction (MHBO) given its minimally invasive nature. This meta-analysis aimed to evaluate outcomes related to bilateral plastic stents (PS) versus bilateral metal stents (MS) in MHBO palliation.
Methods
Databases were searched through November 2023. Only studies that directly compared bilateral PS and bilateral MS in MHBO were included. The primary outcome was clinical success. Secondary outcomes included technical success, adverse events, postprocedural cholangitis, recurrent biliary obstruction, endoscopic reintervention, and conversion to percutaneous drainage. Mantel-Haenszel pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Statistical heterogeneity was assessed using the I2 statistic and publication bias was assessed using funnel plots.
Results
One randomized controlled trial and three retrospective cohort studies involving 420 patients were included. Bilateral MS had non-significant superior clinical success, lower rates of reintervention, and lower rates of adverse events, including postprocedural cholangitis. There was no difference in technical success or need for external drainage. Bilateral PS had increased odds of recurrent biliary obstruction (pooled OR, 1.79; 95% CI, 1.15-2.81; p=0.01).
Conclusions
The selection of bilateral PS or MS for MHBO palliation should remain an individualized decision.
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Original Articles
Efficacy of double half-pigtail plastic stents for endoscopic biliary drainage of acute calculous cholangitis
Toshitaka Sakai, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Kento Hosokawa, Hidehito Sumiya, Jun Horaguchi, Masaya Oikawa, Takashi Tsuchiya, Yutaka Noda, Kei Ito
Clin Endosc 2025;58(6):898-908.   Published online November 11, 2025
DOI: https://doi.org/10.5946/ce.2025.134
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Plastic stent placement is required when biliary stones cannot be completely removed during the initial endoscopic retrograde cholangiopancreatography (ERCP). Although double half-pigtail plastic stents (DHPs) help prevent stent migration, their clinical utility has not yet been evaluated.
Methods
We retrospectively reviewed data from 221 patients who underwent DHP placement for acute calculous cholangitis (ACC) between January 2015 and March 2024. Patient without complete stone removal during initial ERCP were included. Clinical success, adverse events, recurrent biliary obstruction (RBO), and time to RBO (TRBO) were compared in 21 patients treated with straight plastic stents (STs) under similar conditions.
Results
Clinical success was achieved in 99% of patients in the DHP group and 95% of the ST group (p=0.13). Adverse event rates were comparable between groups. During follow-up, the DHP group had significantly lower stent occlusion (2% vs. 20%, p<0.01) and migration rates (4% vs. 15%, p=0.02), leading to a lower RBO rate (5% vs. 35%, p<0.01). The median TRBO was significantly longer in the DHP group (585 vs. 247 days, p<0.01).
Conclusions
DHPs had comparable efficacy to STs, with significantly fewer stent-related adverse events. This may be a potential option for biliary drainage in ACC.
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Efficacy of multi-hole self‑expandable metallic stents versus partially covered self‑expandable metallic stents in patients with malignant distal biliary obstruction caused by unresectable pancreatic cancer: a retrospective comparative cohort study in Japan
Shohei Asada, Koh Kitagawa, Fumimasa Tomooka, Jun-ichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Kosuke Kaji, Akira Mitoro, Hitoshi Yoshiji
Clin Endosc 2025;58(5):744-756.   Published online August 26, 2025
DOI: https://doi.org/10.5946/ce.2024.340
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: This study aimed to compare the stent patency between the novel multi-hole self-expandable metallic stent (MH-SEMS) and conventional partially covered SEMS (PC-SEMS) for malignant distal biliary obstruction (MDBO) in patients with pancreatic carcinoma.
Methods
This retrospective study compared stent patency between patients with MH-SEMS (n=43) and those with PC-SEMS (n=94). Secondary outcomes were overall survival (OS), incidence of recurrent biliary obstruction (RBO), causes of RBO, and adverse events (AEs).
Results
The median time to RBO did not differ significantly between the MH-SEMS and PC-SEMS groups (318 vs. 460 days, p=0.17). Furthermore, the two groups did not differ significantly in terms of OS and incidence rate of AEs, including RBO and cholecystitis. RBO caused by tumor ingrowth was slightly more common in the MH-SEMS group (p=0.089). The MH-SEMS group had a slightly lower 12-month non-obstruction rate than the PC-SEMS group (33.9% vs. 60.9%). In the MH-SEMS group, stent removal was successful in all seven patients in whom it was attempted.
Conclusions
The clinical outcomes of MH-SEMS and PC-SEMS were similar in patients with MDBO caused by pancreatic carcinoma were similar.

Citations

Citations to this article as recorded by  
  • Multi-Hole Self-Expandable Metallic Stent for Malignant Distal Biliary Obstruction: A Literature Review
    Koh Kitagawa, Shohei Asada, Jun-ichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Akira Mitoro, Hitoshi Yoshiji
    Journal of Clinical Medicine.2026; 15(4): 1410.     CrossRef
  • Efficacy of fully covered self-expanding metal stents removal versus stent-in-stent techniques in recurrent malignant distal biliary obstruction
    See Young Lee, Sung Ill Jang, Eui Joo Kim, Dong Ki Lee, Seoyeon Cho, Yeseul Seong, Jung Hyun Jo, Chan Min Jung, In Rae Cho, Woo Hyun Paik, Ji Kon Ryu, Hyun Seok Lee, Sang Hyub Lee, Jae Hee Cho
    Scientific Reports.2026;[Epub]     CrossRef
  • Advancements in stent strategies for malignant distal biliary obstruction: defining the clinical role of multi-hole self-expandable metal stents
    Sung Yong Han
    Clinical Endoscopy.2025; 58(5): 698.     CrossRef
  • Endoscopic biliary drainage with multi-hole self-expandable metallic stent during neoadjuvant chemoradiotherapy in pancreatic cancer
    Shohei Asada, Koh Kitagawa, Junichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Kosuke Kaji, Akira Mitoro, Minako Nagai, Hitoshi Yoshiji, Masayuki Sho
    World Journal of Gastrointestinal Endoscopy.2025;[Epub]     CrossRef
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Systematic Review and Meta-Analysis
Endoscopic ultrasound-guided biliary drainage versus endoscopic retrograde cholangiopancreatography biliary drainage in the palliative management of malignant distal biliary obstruction: an updated systematic review and meta-analysis of randomized controlled trials
Spyros Peppas, Advait Suvarnakar, Bara A. Abujaber, Nadera Altork, Amer Arman, Sayel Alzraikat, Akram I. Ahmad, Camille Boustani, Won Kyoo Cho
Clin Endosc 2025;58(3):386-397.   Published online May 9, 2025
DOI: https://doi.org/10.5946/ce.2024.155
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Evidence suggests comparable outcomes between endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in the biliary drainage of malignant distal biliary obstruction (MDBO). We conducted an updated systematic review and meta-analysis comparing the EUS with ERCP in the management of MDBO.
Methods
We performed a literature search using the Medline, Embase and Cochrane databases, including randomized controlled trials comparing EUS and ERCP in patients with MDBO. Meta-analysis was performed using the random-effects model using the STATA ver. 17.0 software.
Results
Both procedures were comparable in technical (risk ratio [RR], 1.01; 95% confidence interval [CI], 0.78–1.30) and clinical (RR, 1.10; 95% CI, 0.85–1.41) success. No difference was identified in total adverse events (RR, 0.75; 95% CI, 0.42–1.35), acute cholangitis (RR, 0.84; 95% CI, 0.43–1.62), stent patency (RR, 1.13; 95% CI, 0.87–1.46) and mean stent patency time (mean difference, –0.01; 95% CI: –0.21 to 0.19). ERCP was associated with a higher risk of procedure-related pancreatitis (RR, 0.17; 95% CI, 0.04–0.68) and statistically non-significant higher risk for reintervention (RR, 0.61; 95% CI, 0.37–1.01).
Conclusions
Although EUS and ERCP were comparable in terms of efficacy and safety, ERCP was associated with a higher risk of procedure-related pancreatitis and reintervention, with the latter finding not reaching statistical significance.
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Review
Endoscopic ultrasound-guided gastroenterostomy, with focus on technique and practical tips
Chi-Ying Yang, Wen-Hsin Huang, Hsing-Hung Cheng
Clin Endosc 2025;58(2):201-217.   Published online March 4, 2025
DOI: https://doi.org/10.5946/ce.2024.206
AbstractAbstract PDFPubReaderePub
Gastric outlet obstruction (GOO) is a condition characterized by a mechanical obstruction of the stomach or duodenum, caused by either benign or malignant disease. Traditionally, surgical gastrojejunostomy (SGJ) has been the standard treatment for malignant GOO and endoscopic stenting (ES) offers a less invasive option, but it often requires repeat interventions. Recently, endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE), an innovative technique, has been applied as an alternative to SGJ and ES for GOO patients. Direct EUS-GE, device-associated EUS-GE, and EUS-guided double balloon-occluded gastrojejunostomy bypass are the most commonly used techniques with reported technical success rates ranging from 80% to 100%, and clinical success rates between 68% and 100%. Adverse event (AE) rates range from 0% to 28.2% and the stent misdeployment is the most common while other AEs include abdominal pain, bleeding, infection, peritonitis, bowel perforation, gastric leakage, and stent migration. It is clear that EUS-GE may achieve a similar clinical success to SGJ with fewer AEs and a shorter hospital stay. Compared to ES, EUS-GE showed higher clinical success, fewer stent obstructions, and lower reintervention rates.

Citations

Citations to this article as recorded by  
  • Is It Time to Replace the Duodenal Self-Expandable Metal Stent with Endoscopic Ultrasonography-Guided Gastroenterostomy for Malignant Gastric Outlet Obstruction in Patients with Pancreatic Cancer?
    Hsiao-Sheng Lu, Kuei-Chuan Lee, Ming-Chih Hou
    Gut and Liver.2026; 20(1): 37.     CrossRef
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Systematic Review and Meta-analysises
Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials
Yousaf Zafar, Hafsa Azam, Muhammad Abdullah Bin Azhar, Fabeeha Shaheen, Syed Sarmad Javaid, Laila Manzoor, Muaaz Masood, Rajesh Krishnamoorthi
Clin Endosc 2025;58(4):533-543.   Published online February 24, 2025
DOI: https://doi.org/10.5946/ce.2024.183
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Malignant biliary obstruction is a major clinical challenge. We assessed the efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) compared with that of endoscopic retrograde cholangiopancreatography biliary drainage (ERCP-BD) or percutaneous transhepatic biliary drainage (PTBD).
Methods
We searched for randomized controlled trials comparing EUS-BD with ERCP or PTBD in treating malignant biliary obstruction. Using random-effects models, we synthesized risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). A subgroup analysis was performed using a comparator (ERCP or PTBD).
Results
EUS-BD significantly reduced the risk of stent dysfunction (RR, 0.46; 95% CI, 0.33–0.64), with consistent results in subgroup analysis for ERCP (RR, 0.54; 95% CI, 0.35–0.84) and PTBD (RR, 0.37; 95% CI, 0.22–0.61). It also lowered the risk of post-procedure pancreatitis (RR, 0.24; 95% CI, 0.07–0.83) and reduced tumor ingrowth or overgrowth risk (RR, 0.27; 95% CI, 0.11–0.65), even when compared to ERCP alone (RR, 0.28; 95% CI, 0.11–0.70). EUS-BD demonstrated a lower risk of adverse events compared to PTBD (RR, 0.37; 95% CI, 0.14–0.97) and reduced length of hospital stay (WMD, –1.03; 95% CI, –1.53 to –0.53) when compared to ERCP.
Conclusions
EUS-BD outperformed ERCP-BD and PTBD in reducing stent dysfunction, postprocedural pancreatitis, and tumor ingrowth or overgrowth.

Citations

Citations to this article as recorded by  
  • Reply
    Joan B. Gornals, Albert Sumalla-Garcia, Carme Loras
    Clinical Gastroenterology and Hepatology.2026; 24(4): 1203.     CrossRef
  • Biliary Drainage in Altered Anatomy: A Comprehensive Literature Review
    Rishi Chowdhary, Jorge D. Machicado, Veeral M. Oza
    Journal of Digestive Endoscopy.2026;[Epub]     CrossRef
  • A Time-Based and Clinical Status Stratified Protocol for Major Bile Duct Injury After Cholecystectomy: Retrospective, Single-Center Outcomes From a Resource-Limited Setting
    Ahmed Ateik, Saif A Ghabisha, Lamia Abdulmughni, Fares Awn
    Cureus.2026;[Epub]     CrossRef
  • Biliary Drainage During Neoadjuvant Chemotherapy in Pancreatic Cancer: Evidence and Practical Recommendations
    Tadahisa Inoue, Masanao Nakamura, Kiyoaki Ito
    Cancers.2026; 18(3): 467.     CrossRef
  • Endoscopic Ultrasound-Guided Versus Percutaneous Transhepatic Biliary Drainage After Failed Endoscopic Retrograde Cholangiopancreatography in Malignant Biliary Obstruction: A Single-Center Retrospective Cohort
    Wojciech Ciesielski, Łukasz Durko, Ludomir Stefańczyk, Adam Dobek, Anna Bulicz, Amelia Wojnicka, Zuzanna Sosnowska, Agata Grochowska, Janusz Strzelczyk, Piotr Hogendorf, Adam Durczyński, Tomasz Klimczak
    Cancers.2026; 18(5): 783.     CrossRef
  • Role of Endoscopy in Malignant Biliary Obstruction
    Ishaan Vohra, Burraq Imran, Zubair Khan, Muhammad Hasan
    Diagnostics.2026; 16(5): 721.     CrossRef
  • 7,064 View
  • 415 Download
  • 5 Web of Science
  • 6 Crossref
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Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis
Sheza Malik, Priyadarshini Loganathan, Hajra Khan, Abul Hasan Shadali, Pradeep Yarra, Saurabh Chandan, Babu P. Mohan, Douglas G. Adler, Shivangi Kothari
Clin Endosc 2025;58(2):240-252.   Published online February 3, 2025
DOI: https://doi.org/10.5946/ce.2024.120
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction.
Methods
A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed.
Results
We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%–90.1%; I2=68%) and 91.6% (95% CI, 89.7%–93.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41–0.63; I2=70%; p<0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37–0.72; I2=10%; p<0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively.
Conclusions
SEMS as a BTS demonstrated a higher success rate, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption.

Citations

Citations to this article as recorded by  
  • Successful Colonic Stenting Across the Ileocecal Valve With Severe Malignant Stenosis Using Ultra‐thin Scope and Single‐balloon Overtube
    Takato Maeda, Norihiro Hanabata, Shohei Igarashi, Masayoshi Ko, Koji Shimaya, Hiroshi Numao, Masaki Munakata, Hirotake Sakuraba
    DEN Open.2026;[Epub]     CrossRef
  • Nationwide Analysis of Right-Sided Colonic Stenting: Rarely Used but Reduces Stoma Creation Significantly
    Khalid Ahmed, Ahmed Dirweesh, Zachary D. Leslie, Yasmin Ali, Nabeel Azeem, Eric Wise, Cyrus Jahansouz, Martin Freeman, Stuart K. Amateau
    Techniques and Innovations in Gastrointestinal Endoscopy.2026; 28(1): 250952.     CrossRef
  • Minimally invasive, maximum impact: advances in the application of colonic stents
    Filippos Koutroumpakis, Emmanuel Coronel
    Current Opinion in Gastroenterology.2026; 42(1): 19.     CrossRef
  • Embracing minimally invasive approaches to colorectal cancer resection
    Nan Zun Teo, James Weiquan Li, James Chi Yung Ngu, Tiing Leong Ang
    Singapore Medical Journal.2025; 66(Suppl 1): S38.     CrossRef
  • 4,255 View
  • 192 Download
  • 4 Web of Science
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Original Article
Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage in hypervascular hepatocellular carcinoma: a retrospective study from Japan
Kenneth Tachi, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Ahmed Mohammed Sadek, Hossam El-Din Shaaban Mahmoud Ibrahim, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto
Clin Endosc 2025;58(3):448-456.   Published online November 11, 2024
DOI: https://doi.org/10.5946/ce.2024.079
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC.
Methods
This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023.
Results
A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours.
Conclusions
EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.
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Review
Endoscopic biliary drainage for distal bile duct obstruction due to pancreatic cancer
Masahiro Itonaga, Masayuki Kitano
Clin Endosc 2025;58(1):40-52.   Published online September 26, 2024
DOI: https://doi.org/10.5946/ce.2023.294
AbstractAbstract PDFPubReaderePub
Approximately 60% of pancreatic cancers occur in the pancreatic head and may present as obstructive jaundice due to bile duct invasion. Obstructive jaundice often leads to poor general conditions and acute cholangitis, interfering with surgery and chemotherapy and requiring biliary drainage. The first choice of treatment for biliary drainage is the endoscopic transpapillary approach. In unresectable tumors, self-expandable metal stents (SEMSs) are most commonly used and are classified into uncovered and covered SEMSs. Recently, antireflux metal stents and large- or small-diameter SEMSs have become commercially available, and their usefulness has been reported. Plastic stents are infrequently used in patients with resectable biliary obstruction; however, owing to the recent trend in preoperative chemotherapy, SEMSs are frequently used because of the long time to recurrent biliary obstruction. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is often performed in patients who are not eligible for the transpapillary approach, and favorable outcomes have been reported. Different EUS-BD techniques and specialized stents have been developed and can be safely used in high-volume centers. The indications for EUS-BD are expected to further expand in the future.

Citations

Citations to this article as recorded by  
  • Comparative Evaluation of Percutaneous Transhepatic Biliary Drainage and Endoscopic Ultrasound‐Guided Biliary Drainage for Preoperative Management of Malignant Distal Bile Duct Obstruction After Failed ERCP: A Multicenter Retrospective Analysis
    Masahiro Itonaga, Mamoru Takenaka, Hideyuki Shiomi, Koh Kitagawa, Shuhei Shintani, Hirotsugu Maruyama, Ryota Sagami, Tsukasa Ikeura, Takeshi Ogura, Yusuke Ishida, Koichiro Mandai, Satoshi Sugimori, Yoshiki Imamura, Atsuhiro Masuda, Kenji Ikezawa, Atsushi
    Digestive Endoscopy.2026;[Epub]     CrossRef
  • Adverse Events of EUS‐Guided Biliary Drainage for Malignant Biliary Obstruction: A Large Multicenter Study
    Masahiro Itonaga, Takeshi Ogura, Mamoru Takenaka, Kazuyuki Matsumoto, Hideyuki Shiomi, Shuhei Shintani, Hideki Kamada, Taro Yamashita, Koichiro Mandai, Masanori Asada, Hajime Imai, Kotaro Takeshita, Tsukasa Ikeura, Nao Fujimori, Makiko Kinoshita, Kenji Ik
    Journal of Hepato-Biliary-Pancreatic Sciences.2026; 33(3): 228.     CrossRef
  • Mechanistic insights into pancreatic cancer progression from circadian rhythm disruption and gut microbiota dysbiosis (Review)
    Yang Liu, Yongfeng Li, Heng Ma, Shichang Deng, Chao Cheng
    International Journal of Molecular Medicine.2026; 57(3): 1.     CrossRef
  • Partially covered or uncovered metal stent efficacy in malignant unresectable distal biliary obstruction (METARSI): Randomized multicenter trial
    Silvia Cocca, Flavia Pigò, Helga Bertani, Roberta Rea, Giuseppina Pontillo, Michele Campigotto, Giuseppe Grande, Salvatore Russo, Margherita Marocchi, Marinella Lupo, Gian Maria Prati, Giovanni Aragona, Raffaele Manta, Carmelo Barbera, Fabio Monica, Franc
    Endoscopy International Open.2026;[Epub]     CrossRef
  • Comparison of approaches: multiple plastic versus single plastic biliary stenting
    E.N. Solodinina, N.S. Politov
    Russian Journal of Evidence-Based Gastroenterology.2026; 15(1): 37.     CrossRef
  • Balloon Enteroscopy‐Assisted ERCP Versus Endoscopic Ultrasound‐Guided Biliary Drainage for Unresectable Malignant Biliary Obstruction in Patients With Surgically Altered Anatomy: A Multicenter Prospective Registration Study
    Masahiro Itonaga, Mamoru Takenaka, Kenji Ikezawa, Tsukasa Ikeura, Masaaki Shimatani, Masanori Asada, Nao Fujimori, Ryota Sagami, Takeshi Ogura, Hajime Imai, Kazuyuki Matsumoto, Shuhei Shintani, Hideyuki Shiomi, Keiichi Hatamaru, Kosuke Minaga, Ryoji Takad
    Digestive Endoscopy.2025; 37(11): 1179.     CrossRef
  • Advances in Endoscopic Management of Distal Biliary Stricture: Integrating Clinical Evidence into Patient-Specific Decision-Making
    Reiko Yamada, Tetsuro Miwata, Yoshifumi Nakamura, Kenji Nose, Takamitsu Tanaka, Hirono Owa, Minako Urata, Yasuaki Shimada, Hayato Nakagawa
    Cancers.2025; 17(16): 2644.     CrossRef
  • Successful conversion of percutaneous transhepatic gallbladder drainage to endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting for a malignant distal biliary obstruction due to invasive intraductal papillary mucinous carcinom
    Taiji Yoshimoto, Takeshi Takajo, Hiroshi Takihara, Ryuichi Yamamoto
    Journal of Medical Case Reports.2025;[Epub]     CrossRef
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Original Articles
Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea
Hyundam Gu, Suyoung Lee, Sol Kim, Hye-Lim Jang, Da-Woon Choi, Kyu Seok Kim, Yu Ri Shin, Dae Young Cheung, Bo-In Lee, Jin Il Kim, Han Hee Lee
Clin Endosc 2024;57(6):790-797.   Published online September 23, 2024
DOI: https://doi.org/10.5946/ce.2024.110
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Colonic stenting plays a vital role in the management of acute malignant colonic obstruction. The increasing use of self-expandable metal stents (SEMS) and the diverse challenges posed by colonic obstruction at various locations underscore the importance of effective training for colonic stent placement.
Methods
All the components of the simulator were manufactured using silicone molding techniques in conjunction with three-dimensional (3D) printing. 3D images sourced from computed tomography scans and colonoscopy images were converted into a stereolithography format. Acrylonitrile butadiene styrene copolymers have been used in fused deposition modeling to produce moldings.
Results
The simulator replicated the large intestine from the rectum to the cecum, mimicking the texture and shape of the human colon. It enables training for colonoscopy insertion, cecum intubation, loop reduction, and stenting within stenotic areas. Interchangeable stenotic modules for four sites (rectum, sigmoid colon, descending colon, and ascending colon) were easily assembled for training. These modules integrate tumor contours and blood vessel structures with a translucent center, allowing real-time visualization during stenting. Successful and repeatable demonstrations of stent insertion and expansion using the reusable SEMS were consistently achieved.
Conclusions
This innovative simulator offers a secure colonic stenting practice across various locations, potentially enhancing clinical outcomes by improving operator proficiency during actual procedures.

Citations

Citations to this article as recorded by  
  • 3D Printing in Gastroenterology
    Jack T. Gardner, Steve P. Bensen
    Journal of Clinical Gastroenterology.2026; 60(1): 28.     CrossRef
  • Novel minimally invasive strategies for achieving source control in intra-abdominal infections
    Clayton Wyland, Desmond Zeng, Robert G. Sawyer
    Current Opinion in Critical Care.2025; 31(2): 228.     CrossRef
  • Comments on ‘Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea’
    Dae Jin Jung, Gwang Ha Kim
    Clinical Endoscopy.2025; 58(2): 334.     CrossRef
  • Three-Dimensional-Printed Gastrointestinal Tract Models for Surgical Planning and Medical Education: A Systematic Review
    Jing Lei, Lisa B. G. Tee, Krish Ragunath, Zhonghua Sun
    Applied Sciences.2025; 15(13): 7384.     CrossRef
  • 6,949 View
  • 216 Download
  • 4 Web of Science
  • 4 Crossref
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Endoscopic ultrasound-guided hepaticogastrostomy and endoscopic retrograde cholangiopancreatography-guided biliary drainage for distal malignant biliary obstruction due to pancreatic cancer with asymptomatic duodenal invasion: a retrospective, single-center study in Japan
Naminatsu Takahara, Yousuke Nakai, Kensaku Noguchi, Tatsunori Suzuki, Tatsuya Sato, Ryunosuke Hakuta, Kazunaga Ishigaki, Tomotaka Saito, Tsuyoshi Hamada, Mitsuhiro Fujishiro
Clin Endosc 2025;58(1):134-143.   Published online August 23, 2024
DOI: https://doi.org/10.5946/ce.2024.031
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Duodenal invasion (DI) is a risk factor for early recurrent biliary obstruction (RBO) in endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) may reduce early RBO in cases of asymptomatic DI, even when ERCP is possible.
Methods
We enrolled 56 patients with pancreatic cancer and asymptomatic DI who underwent EUS-HGS (n=25) or ERCP-BD (n=31). Technical and clinical success, early (<3 months) and overall RBO rates, time to RBO (TRBO), and adverse events were compared between the EUS-HGS and ERCP-BD groups. Risk factors for early RBO were also evaluated.
Results
Baseline characteristics were similar between the groups. Both procedures demonstrated 100% technical and clinical success rates, with a similar incidence of adverse events (48% vs. 39%, p=0.59). While the median TRBO was comparable (5.7 vs. 8.8 months, p=0.60), EUS-HGS was associated with a lower incidence of early RBO compared to ERCP-BD (8% vs. 29%, p=0.09). The major causes of early RBO in ERCP-BD were sludge and food impaction, rarely occurring in EUS-HGS. EUS-HGS was potentially reduced early RBO (odds ratio, 0.32; p=0.07).
Conclusions
EUS-HGS can be a viable option for treating pancreatic cancer with asymptomatic DI.

Citations

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  • Endoscopic Retrograde Cholangiopancreatography‐guided Biliary Drainage with Duckbill‐type Anti‐reflux Metal Stent versus Endoscopic Ultrasound‐guided Hepaticogastrostomy for Malignant Distal Biliary Obstruction in Pancreatic Cancer with Duodenal Invasion
    Tsuyoshi Takeda, Takashi Sasaki, Tatsuki Hirai, Yoichiro Sato, Yuri Maegawa, Takafumi Mie, Takaaki Furukawa, Yukari Suzuki, Takeshi Okamoto, Masato Ozaka, Naoki Sasahira
    DEN Open.2026;[Epub]     CrossRef
  • Impact of Peri‐Procedural Antibiotics on Post‐ERCP Infectious Adverse Events With Distal Malignant Biliary Obstruction
    Tatsunori Satoh, Haruna Takahashi, Eiji Nakatani, Yosuke Kobayashi, Fumitaka Niiya, Junichi Kaneko, Kazuma Ishikawa, Kenta Ito, Tetsushi Azami, Jun Noda, Shinya Kawaguchi
    Journal of Gastroenterology and Hepatology.2026; 41(2): 696.     CrossRef
  • Endoscopic Ultrasound‐Guided Hepaticogastrostomy With Plastic Stents in Comparison to Transpapillary Drainage With Metallic Stents for Unresectable Malignant Distal Biliary Obstructions
    Hidehito Sumiya, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Kento Hosokawa, Shun Nozaki, Kei Ito
    DEN Open.2026;[Epub]     CrossRef
  • Biliary drainage in pancreatic cancer with duodenal invasion: which route is the best?
    Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek
    Clinical Endoscopy.2025; 58(1): 82.     CrossRef
  • EUS-Guided Gallbladder Drainage of Inoperable Malignant Distal Biliary Obstruction by Lumen-Apposing Metal Stent: Systematic Review and Meta-Analysis
    Tawfik Khoury, Moaad Farraj, Wisam Sbeit, Pietro Fusaroli, Giovanni Barbara, Cecilia Binda, Carlo Fabbri, Maamoun Basheer, Sarah Leblanc, Fabien Fumex, Rodica Gincul, Anthony Yuen Bun Teoh, Jérémie Jacques, Bertrand Napoléon, Andrea Lisotti
    Cancers.2025; 17(12): 1983.     CrossRef
  • Primary Endoscopic Ultrasound-Guided Biliary Drainage for Malignant Biliary Obstruction
    Yousuke Nakai, Ryunosuke Hakuta, Ryota Nakabayashi, Yutaka Shimamatsu, Nao Otsuka, Yukiko Takayama
    The Korean Journal of Pancreas and Biliary Tract.2025; 30(4): 159.     CrossRef
  • 5,115 View
  • 364 Download
  • 6 Web of Science
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Hepatobiliary scintigraphy of bile excretion after endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction: a retrospective study in Japan
Masanori Yamada, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Toshitaka Fukui
Clin Endosc 2024;57(6):798-806.   Published online August 20, 2024
DOI: https://doi.org/10.5946/ce.2023.291
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Hepatobiliary scintigraphy (HBS) is used to evaluate bile excretion. This study aimed to evaluate biliary excretion during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using HBS.
Methods
We retrospectively evaluated 78 consecutive patients with malignant extrahepatic biliary obstruction, who underwent HBS after EUS-HGS between April 2015 and July 2022. The peak time and decay rate were scored with 0, 1, or 2 points based on thresholds of 20 and 35 minutes, and 10% and 50%, respectively. A total score of 4 or 3 was considered indicative of good bile excretion, whereas scores of 2, 1, or 0 indicated poor bile excretion.
Results
The good and poor bile excretion groups included 40 and 38 cases, respectively. The group with good bile excretion had a significantly longer time to recurrent biliary obstruction compared to the poor bile excretion group (not reached vs. 124 days, p=0.026). Multivariate analysis identified the site of obstruction as a significant factor influencing good bile excretion (odds ratio, 3.39; 95% confidence interval, 1.01–11.4, p=0.049), with superior bile excretion observed in cases involving upper biliary obstruction compared to middle or lower biliary obstruction.
Conclusions
In patients with malignant biliary obstruction who underwent HGS, the site of obstruction is significantly associated with stent patency.
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Potential of 6-mm-diameter fully covered self-expandable metal stents for unresectable malignant distal biliary obstruction: a propensity score-matched study
Daiki Yamashige, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Soma Fukuda, Shin Yagi, Kohei Okamoto, Hidenobu Hara, Yuya Hagiwara, Daiki Agarie, Tetsuro Takasaki, Akihiro Ohba, Shunsuke Kondo, Chigusa Morizane, Hideki Ueno, Miyuki Sone, Yutaka Saito, Takuji Okusaka
Clin Endosc 2025;58(1):121-133.   Published online July 29, 2024
DOI: https://doi.org/10.5946/ce.2024.044
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: To date, only thinner-diameter metal stents have been evaluated for unresectable malignant distal biliary obstruction (UR-MDBO). This study investigated the outcomes and optimal cohorts for a 6-mm-diameter fully covered self-expandable metal stent (FCSEMS) compared with those for a 10-mm-diameter FCSEMS.
Methods
This single-center retrospective cohort study included patients who underwent initial transpapillary metal stenting for UR-MDBO. Propensity score matching (1:1) analysis was performed.
Results
Of 133/68 patients who underwent 6-mm/10-mm-diameter FCSEMS deployment, 59 in each group were selected. The median time to recurrent biliary obstruction was not significantly different between the groups (p=0.46). In contrast, use of the 6-mm-diameter FCSEMS resulted in a significantly reduced incidence of stent-related adverse events (AEs) (p=0.016), especially cholecystitis (p=0.032), and patients aged <70 years were particularly affected by this significant reduction. Among the patients in the end-stage cohort who were unable to continue chemotherapy after FCSEMS deployment, the free rate of stent-related events, including recurrent biliary obstruction and stent-related AEs, was significantly higher in the 6-mm group (p=0.027).
Conclusions
For UR-MDBO, a 6-mm-diameter FCSEMS can be an optimal and safe option in the younger cohort with a relatively high risk of AEs and in the end-stage cohort requiring safer drainage without interference from stent-related events during times of poor prognosis.

Citations

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  • Biliary Drainage During Neoadjuvant Chemotherapy in Pancreatic Cancer: Evidence and Practical Recommendations
    Tadahisa Inoue, Masanao Nakamura, Kiyoaki Ito
    Cancers.2026; 18(3): 467.     CrossRef
  • Comparative study on the application of fully covered self-expanding metal stents in benign and malignant strictures of the distal bile duct
    Ziyan Wang, Fei Xu, Weigang Shu, Xinyan Zhu, Feng Zhu
    Therapeutic Advances in Gastroenterology.2026;[Epub]     CrossRef
  • From dogma to individualized care: the potential of 6-mm fully covered self-expandable metal stent in unresectable malignant distal biliary obstruction
    Hyung Ku Chon
    Clinical Endoscopy.2025; 58(4): 630.     CrossRef
  • Advancements in stent strategies for malignant distal biliary obstruction: defining the clinical role of multi-hole self-expandable metal stents
    Sung Yong Han
    Clinical Endoscopy.2025; 58(5): 698.     CrossRef
  • 5,598 View
  • 310 Download
  • 4 Web of Science
  • 4 Crossref
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Efficacy of hemostasis by gastroduodenal covered metal stent placement for hemorrhagic duodenal stenosis due to pancreatobiliary cancer invasion: a retrospective study
Yasunari Sakamoto, Taku Sakamoto, Akihiro Ohba, Mitsuhito Sasaki, Shunsuke Kondo, Chigusa Morizane, Hideki Ueno, Yutaka Saito, Yasuaki Arai, Takuji Okusaka
Clin Endosc 2024;57(5):628-636.   Published online June 14, 2024
DOI: https://doi.org/10.5946/ce.2023.155
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Advanced pancreatic and biliary tract cancers can invade the duodenum and cause duodenal hemorrhagic stenosis. This study aimed to evaluate the efficacy of covered self-expandable metal stents in the treatment of cancer-related duodenal hemorrhage with stenosis.
Methods
Between January 2014 and December 2016, metal stents were placed in 51 patients with duodenal stenosis. Among these patients, a self-expandable covered metal stent was endoscopically placed in 10 patients with hemorrhagic duodenal stenosis caused by pancreatobiliary cancer progression. We retrospectively analyzed the therapeutic efficacy of the stents by evaluating the technical and clinical success rates based on successful stent placement, degree of oral intake, hemostasis, stent patency, and overall survival.
Results
The technical and clinical success rates were 100%. All 10 patients achieved a gastric outlet obstruction scoring system score of three within two weeks after the procedure and had no recurrence of melena. The median stent patency duration and overall survival after stent placement were 52 days (range, 20–220 days) and 66.5 days (range, 31–220 days), respectively.
Conclusions
Endoscopic placement of a covered metal stent for hemorrhagic duodenal stenosis associated with pancreatic or biliary tract cancer resulted in duodenal hemostasis, recanalization, and improved quality of life.

Citations

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  • Clinical significance of peritoneal lavage cytology in duodenal cancer
    Yuya Miura, Katsuhisa Ohgi, Ryo Ashida, Yoshiyasu Kato, Shimpei Otsuka, Hideyuki Dei, Katsuhiko Uesaka, Teiichi Sugiura
    Surgery.2025; 181: 109256.     CrossRef
  • Clinical effect of percutaneous hepatic puncture biliary drainage combined with metal stent implantation in the treatment of malignant obstructive jaundice
    Shoulin Zhang, Shaopeng Huang, Zheng Xing, Youwen Song, Fujian Yuan
    BMC Surgery.2025;[Epub]     CrossRef
  • 5,532 View
  • 277 Download
  • 2 Web of Science
  • 2 Crossref
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Outcomes of partially covered self-expandable metal stents with different uncovered lengths in endoscopic ultrasound-guided hepaticogastrostomy: a Japanese retrospective study
Takeshi Okamoto, Takashi Sasaki, Tsuyoshi Takeda, Tatsuki Hirai, Takahiro Ishitsuka, Manabu Yamada, Hiroki Nakagawa, Takafumi Mie, Takaaki Furukawa, Akiyoshi Kasuga, Masato Ozaka, Naoki Sasahira
Clin Endosc 2024;57(4):515-526.   Published online May 10, 2024
DOI: https://doi.org/10.5946/ce.2023.142
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO).
Methods
Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared.
Results
Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS.
Conclusions
No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

Citations

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  • Migration of covered expandable metal stents after endoscopic ultrasound-guided hepaticogastrostomy: stent covering versus stent design?
    Todd H. Baron
    Clinical Endoscopy.2024; 57(4): 471.     CrossRef
  • 5,707 View
  • 233 Download
  • 1 Web of Science
  • 1 Crossref
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Reviews
Colon stenting as a bridge to surgery in obstructive colorectal cancer management
Dong Hyun Kim, Han Hee Lee
Clin Endosc 2024;57(4):424-433.   Published online March 8, 2024
DOI: https://doi.org/10.5946/ce.2023.138
AbstractAbstract PDFPubReaderePub
Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.

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    Sankha Bhattacharya, Dilpreet Singh
    Journal of Macromolecular Science, Part B.2026; 65(4): 694.     CrossRef
  • Nationwide Analysis of Right-Sided Colonic Stenting: Rarely Used but Reduces Stoma Creation Significantly
    Khalid Ahmed, Ahmed Dirweesh, Zachary D. Leslie, Yasmin Ali, Nabeel Azeem, Eric Wise, Cyrus Jahansouz, Martin Freeman, Stuart K. Amateau
    Techniques and Innovations in Gastrointestinal Endoscopy.2026; 28(1): 250952.     CrossRef
  • Safety and Efficacy of Colonic Stenting as a Bridge to Surgery: A Retrospective Study
    Mariam Asad, Muhammad Fahd Shah, Irfan Ul Islam Nasir, Amer Rehman Farooqi, Muhammad Waqas
    Cureus.2026;[Epub]     CrossRef
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    Simbarashe Chinyowa, Grant Murewanhema, Leolin Katsidzira, Jennifer Moodley, Mike Chirenje, Godfrey Muguti
    BMJ Open.2026; 16(1): e110931.     CrossRef
  • Predictors of perforation following colorectal stenting in patients with acute intestinal obstruction
    K.I. Seurko, A.N. Kosenkov, E.V. Stolyarchuk, K.I. Seurko, S.A. Grashchenko, D.A. Stribunov
    Pirogov Russian Journal of Surgery.2026; (3): 33.     CrossRef
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    Dalmacito A. Cordero Jr
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    Deniz Öçal, Mehmet Torun
    Turkish Journal of Colorectal Disease.2026;[Epub]     CrossRef
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    Abdel Latif Khalifa Elnaim, Salma Salah Hassan Mohamed Ali, Rawah Suliman Mohamed Ahmed, Ismail Sagap
    Scientific Reports.2026;[Epub]     CrossRef
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    Chloe Lahoud, Toni Habib, Michel Al Achkar, Tyler Grantham, Nissar Ahmed
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  • Optimal Timing of Surgery After Insertion of Self‐Expandable Metallic Stent to Obstructive Colorectal Neoplasm as a Bridge to Surgery
    Dong Hyun Kim, Hyun Lim, Jung‐Wook Kim, Yunho Jung, Hyun‐Soo Kim, Ki‐Hyun Kim, Jin Won Kim, Young‐Eun Joo, Bo‐In Lee, Han Hee Lee
    Journal of Gastroenterology and Hepatology.2025; 40(7): 1809.     CrossRef
  • Beyond the Block: A Comprehensive Review of Colon Stenting in Obstructive Colorectal Cancer – A New Era of Management
    Tahir I. Khan, Pooja N. Kotla, Anuradha K. Jaiswal, Ankit H. Merai
    Indian Journal of Colo-Rectal Surgery.2025; 8(2): 41.     CrossRef
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    Neng-Wei Wong, Salman Ahmed Abdul Jabbar, James Chi-Yong Ngu, Nan-Zun Teo
    World Journal of Clinical Oncology.2025;[Epub]     CrossRef
  • Colonic stenting for colorectal cancer: stoma avoidance with acceptable radiation exposure
    Christopher Robert Smith, Michael Adesida, Gibran Timothy Yusuf, Hesham Soliman, Mintimer Negametzyanov, Efthymios Ypsilantis
    Clinical Endoscopy.2025; 58(5): 738.     CrossRef
  • Global Use and Outcomes of Endoscopic Stenting in Acute Malignant Left-Sided Colonic Obstruction: A Secondary Analysis of APOLLO, An International, Prospective Cohort Study

    Diseases of the Colon & Rectum.2025; 68(12): 1458.     CrossRef
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    Hong-Yu Sun, Zhi-Cha Li, He-Lei Wang
    World Journal of Gastrointestinal Surgery.2025;[Epub]     CrossRef
  • Feasibility and safety of colonic flexural stenting: a comparative analysis
    Osama Zaman, Neil Fisher, Emmanuel Ogbonna, Marvi Shams, Adewale Ayeni, Peter Waterland, John Frost, Akinfemi Akingboye
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  • Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea
    Hyundam Gu, Suyoung Lee, Sol Kim, Hye-Lim Jang, Da-Woon Choi, Kyu Seok Kim, Yu Ri Shin, Dae Young Cheung, Bo-In Lee, Jin Il Kim, Han Hee Lee
    Clinical Endoscopy.2024; 57(6): 790.     CrossRef
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    Pedro Marílio Cardoso, Eduardo Rodrigues-Pinto
    Cancers.2024; 17(1): 87.     CrossRef
  • 28,622 View
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Close layer
Endoscopic stenting for malignant gastric outlet obstruction: focusing on comparison of endoscopic stenting and surgical gastrojejunostomy
Sun Gyo Lim, Chan Gyoo Kim
Clin Endosc 2024;57(5):571-580.   Published online February 23, 2024
DOI: https://doi.org/10.5946/ce.2023.160
AbstractAbstract PDFPubReaderePub
Malignant gastric outlet obstruction (GOO) is a condition characterized by blockage or narrowing where the stomach empties its contents into the small intestine due to primary malignant tumors or metastatic diseases. This condition leads to various symptoms such as nausea, vomiting, abdominal pain, and weight loss. To manage malignant GOO, different treatment options have been employed, including surgical gastrojejunostomy (SGJ), gastroduodenal stenting (GDS) using self-expandable metallic stent (SEMS), and endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ). This review focuses on comparing the clinical outcomes of endoscopic stenting (GDS and EUS-GJ) with SGJ for malignant GOO. Studies have shown that GDS with SEMS provides comparable clinical outcomes and safety for the palliation of obstructive symptoms. The choice between covered and uncovered SEMS remains controversial, as different studies have reported varying results. EUS-GJ, performed via endoscopic ultrasound guidance, has shown promising efficacy and safety in managing malignant GOO, but further studies are needed to establish it as the primary treatment option. Comparative analyses suggest that GDS has higher recurrence and reintervention rates compared to EUS-GJ and SGJ, with similar overall procedural complications. However, bleeding rates were lower with GDS than with SGJ. Randomized controlled trials are required to determine the optimal treatment approach for malignant GOO.

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  • Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer
    Pengfei Wu, Kai Chen, Jin He
    Annals of Gastroenterological Surgery.2025; 9(2): 218.     CrossRef
  • Aortoenteric Fistula Formation From Chronic Erosion of an Axios Gastroduodenal Stent in a Patient With a History of Radiation
    Caleb M Glover, Adam Bowen, Claire Russell, Ali Rida, Alexandra Davies, Edward Cay, John Walling
    Cureus.2025;[Epub]     CrossRef
  • Advances in Surgical Management of Malignant Gastric Outlet Obstruction
    Sang-Ho Jeong, Miyeong Park, Kyung Won Seo, Jae-Seok Min
    Cancers.2025; 17(15): 2567.     CrossRef
  • Maximum stomach area on preoperative CT predicts delayed gastric emptying in palliative gastrojejunostomy
    Jaewook Shin, Joshua T. Cohen, Shriya Perati, Timothy D. Murtha, Rachel E. Beard, Thomas J. Miner
    Surgical Oncology Insight.2025; 2(3): 100172.     CrossRef
  • 10,081 View
  • 467 Download
  • 3 Web of Science
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Original Articles
Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer
Kunio Kataoka, Eizaburo Ohno, Takuya Ishikawa, Kentaro Yamao, Yasuyuki Mizutani, Tadashi Iida, Hideki Takami, Osamu Maeda, Junpei Yamaguchi, Yukihiro Yokoyama, Tomoki Ebata, Yasuhiro Kodera, Hiroki Kawashima
Clin Endosc 2024;57(1):112-121.   Published online July 18, 2023
DOI: https://doi.org/10.5946/ce.2022.278
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting.
Methods
Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO.
Results
A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033).
Conclusions
Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.

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  • AI-based CT assessment of sarcopenia in borderline resectable pancreatic Cancer: A narrative review of clinical and technical perspectives
    William Gehin, Aurélien Lambert, Jean-Emmanuel Bibault
    Computers in Biology and Medicine.2025; 195: 110659.     CrossRef
  • Impact of sarcopenia and changes in skeletal muscle mass on prognosis of patients with pancreatic ductal adenocarcinoma receiving chemotherapy with first-line gemcitabine and nab-paclitaxel: a prospective study
    Tomoya Emori, Masahiro Itonaga, Reiko Ashida, Tomokazu Ishihara, Akiya Nakahata, Yuki Kawaji, Takashi Tamura, Yasunobu Yamashita, Kazuhiro Fukatsu, Masayuki Kitano
    Journal of Gastroenterology.2025; 60(10): 1310.     CrossRef
  • Endeavors to prevent stent malfunction: new insights into the risk factors for recurrent biliary obstruction
    Sung-Jo Bang
    Clinical Endoscopy.2024; 57(1): 56.     CrossRef
  • Skeletal muscle status and survival among patients with advanced biliary tract cancer
    Shinya Takaoka, Tsuyoshi Hamada, Naminatsu Takahara, Kei Saito, Go Endo, Ryunosuke Hakuta, Kota Ishida, Kazunaga Ishigaki, Sachiko Kanai, Kohei Kurihara, Hiroki Oyama, Tomotaka Saito, Tatsuya Sato, Tatsunori Suzuki, Yukari Suzuki, Shuichi Tange, Yurie Tok
    International Journal of Clinical Oncology.2024; 29(3): 297.     CrossRef
  • 5,491 View
  • 166 Download
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Close layer
A novel fully covered metal stent for unresectable malignant distal biliary obstruction: results of a multicenter prospective study
Arata Sakai, Atsuhiro Masuda, Takaaki Eguchi, Keisuke Furumatsu, Takao Iemoto, Shiei Yoshida, Yoshihiro Okabe, Kodai Yamanaka, Ikuya Miki, Saori Kakuyama, Yosuke Yagi, Daisuke Shirasaka, Shinya Kohashi, Takashi Kobayashi, Hideyuki Shiomi, Yuzo Kodama
Clin Endosc 2024;57(3):375-383.   Published online July 10, 2023
DOI: https://doi.org/10.5946/ce.2023.035
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic self-expandable metal stent (SEMS) placement is currently the standard technique for treating unresectable malignant distal biliary obstructions (MDBO). Therefore, covered SEMS with longer stent patency and fewer migrations are required. This study aimed to assess the clinical performance of a novel, fully covered SEMS for unresectable MDBO.
Methods
This was a multicenter single-arm prospective study. The primary outcome was a non-obstruction rate at 6 months. The secondary outcomes were overall survival (OS), recurrent biliary obstruction (RBO), time to RBO (TRBO), technical and clinical success, and adverse events.
Results
A total of 73 patients were enrolled in this study. The non-obstruction rate at 6 months was 61%. The median OS and TRBO were 233 and 216 days, respectively. The technical and clinical success rates were 100% and 97%, respectively. Furthermore, the rate of occurrence of RBO and adverse events was 49% and 21%, respectively. The length of bile duct stenosis (<2.2 cm) was the only significant risk factor for stent migration.
Conclusions
The non-obstruction rate of a novel fully covered SEMS for MDBO is comparable to that reported earlier but shorter than expected. Short bile duct stenosis is a significant risk factor for stent migration.

Citations

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  • Percutaneous metallic stent placement for malignant extrahepatic biliary obstruction: single-center experience in 612 patients
    Jihoon Kim, Dong Il Gwon, Jeongyeon Kim, Eunbyeol Ko, Jin Hyoung Kim, Gi-Young Ko, Hyun-Ki Yoon
    Acta Radiologica.2026; 67(4): 352.     CrossRef
  • The anti‐migration effect of partially covered self‐expandable metal stents for unresectable malignant distal biliary obstruction: A multicenter comparative study
    Shinya Kohashi, Arata Sakai, Keisuke Furumatsu, Takeshi Ezaki, Takao Iemoto, Takeshi Tanaka, Masahiro Tsujimae, Takashi Kobayashi, Atsuhiro Masuda, Yuzo Kodama
    DEN Open.2025;[Epub]     CrossRef
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    Jung Won Chun, Woo Hyun Paik, Sang Myung Woo, Jin Ho Choi, In Rae Cho, Woo Jin Lee, Ji Kon Ryu, Yong-Tae Kim, Sang Hyub Lee
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    Hyung Ku Chon
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Close layer
Endoscopic ultrasound-guided gastrojejunostomy with a direct technique without previous intestinal filling using a tubular fully covered self-expandable metallic stent
Hakan Şentürk, İbrahim Hakkı Köker, Koray Koçhan, Sercan Kiremitçi, Gülseren Seven, Ali Tüzün İnce
Clin Endosc 2024;57(2):209-216.   Published online July 3, 2023
DOI: https://doi.org/10.5946/ce.2023.022
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic ultrasonography-guided gastrojejunostomy is a minimally invasive method for the management of gastric outlet obstruction. Conventionally, a lumen-apposing metal stent (LAMS) is used to create an anastomosis. However, LAMS is expensive and not widely available. In this report, we described a tubular fully covered self-expandable metallic stent (T-FCSEMS) for this purpose.
Methods
Twenty-one patients (15 men [71.4%]; median age, 66 years; range, 40–87 years) were included in this study. A total of 19 malignant (12 pancreatic, 6 gastric, and 1 metastatic rectal cancer) and 2 benign cases were observed. The proximal jejunum was punctured with a 19 G needle. The stomach and jejunum walls were dilated with a 6 F cystotome, and a 20×80 mm polytetrafluoroethylene T-FCSEMS (Hilzo) was deployed. Oral feeding was initiated after 12 to 18 hours and solid foods after 48 hours.
Results
The median procedure time was 33 minutes (range, 23–55 minutes). After two weeks, 19 patients tolerated oral feeding. In patients with malignancy, the median survival time was 118 days (range, 41–194 days). No serious complications or deaths occurred. All patients with malignancy tolerated oral food intake until they expired.
Conclusions
T-FCSEMS is safe and effective. This stent should be considered as an alternative to LAMS for gastric outlet obstruction.

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    Giacomo Emanuele Maria Rizzo, Giuseppe Infantino, Gabriele Rancatore, Dario Quintini, Dario Ligresti, Nicoletta Belluardo, Giuseppe Rizzo, Elio D’amore, Marco Giacchetto, Ilaria Tarantino
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    Katelin DURHAM, Rami EL ABIAD, Mouen KHASHAB
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    Rami G. El Abiad, Mouen A. Khashab
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    Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia
    Clinical Endoscopy.2024; 57(5): 588.     CrossRef
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    Sun Gyo Lim, Chan Gyoo Kim
    Clinical Endoscopy.2024; 57(5): 571.     CrossRef
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Close layer
Systematic Review and Meta-analysis
No difference in outcomes with 15 mm vs. 20 mm lumen-apposing metal stents for endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a meta-analysis
Shyam Vedantam, Rahil Shah, Sean Bhalla, Shria Kumar, Sunil Amin
Clin Endosc 2023;56(3):298-307.   Published online May 22, 2023
DOI: https://doi.org/10.5946/ce.2022.299
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: We compared outcomes between use of 15 vs. 20 mm lumen-apposing metal stents (LAMSs) in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction.
Methods
Databases were queried for studies that used LAMS for EUS-GE to relieve gastric outlet obstruction, and a proportional meta-analysis was performed.
Results
Thirteen studies were included. The 15 mm and 20 mm LAMS had pooled technical success rates of 93.2% (95% confidence interval [CI], 90.5%–95.2%) and 92.1% (95% CI, 68.4%–98.4%), clinical success rates of 88.6% (95% CI, 85.4%–91.1%) and 89.6% (95% CI, 79.0%–95.1%), adverse event rates of 11.4% (95% CI, 8.1%–15.9%) and 14.7% (95% CI, 4.4%–39.1%), and reintervention rates of 10.3% (95% CI, 6.7%–15.4%) and 3.5% (95% CI, 1.6%–7.6%), respectively. Subgroup analysis revealed no significant differences in technical success, clinical success, or adverse event rates. An increased need for reintervention was noted in the 15 mm stent group (pooled odds ratio, 3.59; 95% CI, 1.40–9.18; p=0.008).
Conclusions
No differences were observed in the technical, clinical, or adverse event rates between 15 and 20 mm LAMS use in EUS-GE. An increased need for reintervention is possible when using a 15 mm stent compared to when using a 20 mm stent.

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    Suprabhat Giri, Saroj Kanta Sahu, Gaurav Khatana, Prasanna Gore, Preetam Nath, Bipadabhanjan Mallick, Jimmy Narayan, Aditya Kale, Sridhar Sundaram
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Close layer
Original Article
Evaluation of the mechanical properties of current biliary self-expandable metallic stents: axial and radial force, and axial force zero border
Wataru Yamagata, Toshio Fujisawa, Takashi Sasaki, Rei Ishibashi, Tomotaka Saito, Shuntaro Yoshida, Shizuka No, Kouta Inoue, Yousuke Nakai, Naoki Sasahira, Hiroyuki Isayama
Clin Endosc 2023;56(5):633-649.   Published online April 10, 2023
DOI: https://doi.org/10.5946/ce.2022.201
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Mechanical properties (MPs) and axial and radial force (AF and RF) may influence the efficacy and complications of self-expandable metallic stent (SEMS) placement. We measured the MPs of various SEMSs and examined their influence on the SEMS clinical ability.
Methods
We evaluated the MPs of 29 types of 10-mm SEMSs. RF was measured using a conventional measurement device. AF was measured using the conventional and new methods, and the correlation between the methods was evaluated.
Results
A high correlation in AFs was observed, as measured by the new and conventional manual methods. AF and RF scatterplots divided the SEMSs into three subgroups according to structure: hook-and-cross-type (low AF and RF), cross-type (high AF and low RF), and laser-cut-type (intermediate AF and high RF). The hook-and-cross-type had the largest axial force zero border (>20°), followed by the laser-cut and cross types.
Conclusions
MPs were related to stent structure. Hook-and-cross-type SEMSs had a low AF and high axial force zero border and were considered safest because they caused minimal stress on the biliary wall. However, the increase in RF must be overcome.

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Close layer
Reviews
Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction
Partha Pal, Sundeep Lakhtakia
Clin Endosc 2023;56(2):143-154.   Published online February 17, 2023
DOI: https://doi.org/10.5946/ce.2022.198
AbstractAbstract PDFPubReaderePub
Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

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Close layer
Role of radiofrequency ablation in advanced malignant hilar biliary obstruction
Mamoru Takenaka, Tae Hoon Lee
Clin Endosc 2023;56(2):155-163.   Published online January 16, 2023
DOI: https://doi.org/10.5946/ce.2022.218
AbstractAbstract PDFPubReaderePub
Malignant hilar biliary obstruction (MHO), an aggressive perihilar biliary obstruction caused by cholangiocarcinoma, gallbladder cancer, or other metastatic malignancies, has a poor prognosis. Surgical resection is the only curative treatment for biliary malignancies. However, the majority of patients with MHO cannot undergo surgery on presentation because of an advanced inoperable state or a poor performance state due to old age or comorbid diseases. Therefore, palliative biliary drainage is mandatory to improve symptomatic jaundice and the quality of life. Among the drainage methods, endoscopic biliary drainage is the current standard for palliation of unresectable advanced MHO. In addition, combined with endoscopic drainage, additional local ablation therapies, such as photodynamic therapy or radiofrequency ablation (RFA), have been introduced to prolong stent patency and survival. Currently, RFA is commonly used as palliative therapy, even for advanced MHO. This literature review summarizes recent studies on RFA for advanced MHO.

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Original Article
Endoscopic Stenting for Malignant Biliary Obstruction: Results of a Nationwide Experience
Jeanne Lubbe, Gabriel Sandblom, Urban Arnelo, Eduard Jonas, Lars Enochsson
Clin Endosc 2021;54(5):713-721.   Published online May 31, 2021
DOI: https://doi.org/10.5946/ce.2021.016
AbstractAbstract PDFPubReaderePub
Background
/Aims: Many unanswered questions remain about the treatment of malignant hilar obstruction. We investigated endoscopic stenting for malignant biliary strictures, as reported in a nationwide registry.
Methods
All endoscopic retrograde cholangiopancreatography (ERCP) procedures entered in the Swedish Registry of Gallstone Surgery and ERCP from January 2010 to December 2017 in which stenting was performed for malignant biliary stricture management were included in this study. Patency was estimated by determining the time to reintervention.
Results
Endoscopic stenting was performed for malignant stricture management in 4623 ERCP procedures, of which 1364 (29.5%) were performed for hilar strictures. Of the hilar strictures, 320 (23.5%) were intrahepatic strictures (Bismuth–Corlette III–IV). Adverse events were more common after hilar stenting than after distal stenting (17.2% vs. 12.0%, p<0.0001). The 6-month reintervention rate was 73.4% after hilar stenting compared with 55.9% after distal stenting (p<0.0001). The 6-month reintervention rates for Bismuth–Corlette types I, II, IIIa, IIIb, and IV were 70.4%, 75.6%, 90.0%, 87.5%, and 85.7%, respectively. In multivariate analysis, the risk for reintervention was three times higher after hilar stenting than after distal stenting (hazard ratio 3.47, 95% confidence interval 2.01–6.00, p<0.001).
Conclusions
This study with a relatively large patient cohort undergoing endoscopic stenting confirms that stenting for malignant hilar obstruction has more adverse events and lower patency than stenting for distal malignant obstruction.

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Focused Review Series: Recent Updates on the Role of EUS in Pancreatobiliary Disease
What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy
Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek, Nonthalee Pausawasdi
Clin Endosc 2021;54(3):301-308.   Published online May 28, 2021
DOI: https://doi.org/10.5946/ce.2021.103
AbstractAbstract PDFPubReaderePub
Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BD offers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guided hepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation, tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGS have been developed to improve the technical success rate and reduce complications. This technical review focuses on the essential practical points at each step of EUS-HGS.

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Original Article
Survival Benefit of Intraductal Radiofrequency Ablation for Malignant Biliary Obstruction: A Systematic Review with Meta-Analysis
Byung Hyo Cha, Myoung-Jin Jang, Sang Hyub Lee
Clin Endosc 2021;54(1):100-106.   Published online January 15, 2021
DOI: https://doi.org/10.5946/ce.2020.254
AbstractAbstract PDFPubReaderePub
Background
/Aims: Cholangiocarcinoma (CCA) is a rare but aggressive disease with a poor survival. Recent trials have shown improved survival with intraductal radiofrequency ablation (RFA) therapy. We performed a systematic review with meta-analysis to determine the survival benefit of endoscopic RFA for unresectable extrahepatic CCA with malignant biliary obstruction (MBO).
Methods
A systematic search from 1970 to 2020 was performed in MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials. gov. We selected eligible studies reporting relative risks, hazard ratios (HRs), or odds ratios, adjusted by controlling for confounding factors of survival rate and stent patency duration, among patients with extrahepatic CCA with MBO treated with RFA with stent insertion or stent insertion only.
Results
A total of eight trials (three randomized and five nonrandomized) with a total of 420 patients were included in the metaanalysis. Pooled overall survival analysis favored RFA treatment with stent insertion (HR, 0.47; 95% confidence interval [CI], 0.34– 0.64; I2=47%; p=0.09); however, no significant difference was found in the duration of stent patency between the groups (HR, 0.79; 95% CI, 0.57–1.09; I2=7%; p=0.36).
Conclusions
RFA therapy with stent insertion may confer a survival benefit compared with stent insertion only in patients with CCA and MBO.

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Case Report
Early Lumen-Apposing Metal Stent Dysfunction Complicating Endoscopic Ultrasound-Guided Gastroenterostomy: A Report of Two Cases
Janine B. Kastelijn, Veronique Van der Voort, Alderina Bijlsma, Leon M. G. Moons, Matthijs P. Schwartz, Frank P. Vleggaar
Clin Endosc 2021;54(4):603-607.   Published online January 13, 2021
DOI: https://doi.org/10.5946/ce.2020.201
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasonography-guided gastroenterostomy using a lumen-apposing metal stent has emerged as a novel technique in the palliative treatment of malignant gastric outlet obstruction. Endoscopic ultrasonography-guided gastroenterostomy seems to have the potential to provide long-lasting patency in a minimally invasive manner. Low reintervention rates have been described. We report two cases with early lumen-apposing metal stent dysfunction, compromising patency. One case showed food impaction after three weeks, and hyperplastic tissue overgrowth with a buried distal flange six weeks after stent placement. The latter was successfully treated by argon plasma coagulation, stent removal, and deployment of a larger-diameter lumen-apposing metal stent. The second case showed a narrowed luminal diameter of the stent and jejunal pressure ulcerations after three weeks. The narrowing was successfully treated by balloon dilation. Eight weeks later, hyperplastic tissue overgrowth at the distal flange of the stent and a gastro-colonic fistula were diagnosed, followed by extensive reconstructive surgery.

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Original Article
Cholecystitis after Placement of Covered Self-Expandable Metallic Stents in Patients with Distal Malignant Biliary Obstructions
Masafumi Watanabe, Kosuke Okuwaki, Jun Woo, Mitsuhiro Kida, Hiroshi Imaizumi, Tomohisa Iwai, Hiroshi Yamauchi, Toru Kaneko, Rikiya Hasegawa, Takahiro Kurosu, Naoki Minato, Hiroki Haradome, Wasaburo Koizumi
Clin Endosc 2021;54(4):589-595.   Published online November 17, 2020
DOI: https://doi.org/10.5946/ce.2020.136
AbstractAbstract PDFPubReaderePub
Background
/Aims: Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement.
Methods
We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively.
Results
The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis.
Conclusions
The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.

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    Chawin Lopimpisuth, Shyam Vedantam, Pojsakorn Danpanichkul, Mahmoud Mahfouz, Jordan Orr, Abid Javed, Shria Kumar, Jodie A. Barkin, Sunil Amin, Sean Bhalla
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Focused Review Series: Endoscopic Ultrasound-Guided Therapeutic Intervention: Focus on Technique and Practical Tips
Endoscopic Ultrasonography-Guided Gastroenterostomy Techniques for Treatment of Malignant Gastric Outlet Obstruction
Ryosuke Tonozuka, Takayoshi Tsuchiya, Shuntaro Mukai, Yuichi Nagakawa, Takao Itoi
Clin Endosc 2020;53(5):510-518.   Published online September 23, 2020
DOI: https://doi.org/10.5946/ce.2020.151
AbstractAbstract PDFPubReaderePub
Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient’s quality of life. Recently, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing self-expandable metal stent (LAMS) has been developed as a minimally invasive and durable endoscopic treatment for GOO. There are three types of EUS-GE technique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslim endoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS have shown technical and clinical success rates (regardless of technique and etiology) of 87%–100% and 84%–100%, respectively. Studies comparing EUS-GE and surgical gastrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, with a lower rate of early adverse events in EUS-GE. A comparison of EUS-GE and endoscopic enteral stent placement revealed similar technical success rates, but initial clinical success rate was higher and the rate of stent failure requiring reintervention was lower with EUS-GE.

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Case Report
Endoscopic Self-Expandable Metal Stent Placement for Malignant Afferent Loop Obstruction After Pancreaticoduodenectomy: A Case Series and Review
Arata Sakai, Hideyuki Shiomi, Takao Iemoto, Ryota Nakano, Takuya Ikegawa, Takashi Kobayashi, Atsuhiro Masuda, Yuzo Kodama
Clin Endosc 2020;53(4):491-496.   Published online March 3, 2020
DOI: https://doi.org/10.5946/ce.2019.145
AbstractAbstract PDFPubReaderePub
In this study, we assessed a series of our cases in which endoscopic self-expandable metal stents (SEMSs) were used to treat malignant afferent loop obstruction (ALO) that arose after pancreaticoduodenectomy (PD). We retrospectively examined the records of 7 patients who underwent endoscopic SEMS placement for malignant ALO following PD. Clinical success was achieved in all cases. The median procedure time was 30 min (range, 15–50 min). There were no cases of stent occlusion, and no procedure-related adverse events were encountered. All patients died of their primary disease, and the median overall survival period was 155 days (range, 96–374 days). A re-intervention involving endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting was performed for obstructive jaundice and acute cholangitis in 1 case. In conclusion, endoscopic SEMS placement may be an effective and safe treatment for malignant ALO that arises after PD.

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    Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Takashi Kobayashi, Yasutaka Yamada, Yuzo Kodama
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    Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Takashi Kobayashi, Yasutaka Yamada, Yuzo Kodama
    World Journal of Gastrointestinal Oncology.2021; 13(7): 509.     CrossRef
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    Hideyuki Shiomi, Arata Sakai, Ryota Nakano, Shogo Ota, Takashi Kobayashi, Atsuhiro Masuda, Hiroko Iijima
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Focused Review Series: The Roleses of Endoscopy in the Management of Colonic Obstruction and Perforation
Endoscopic Management of Malignant Colonic Obstruction
Seung Young Seo, Sang Wook Kim
Clin Endosc 2020;53(1):9-17.   Published online January 7, 2020
DOI: https://doi.org/10.5946/ce.2019.051
AbstractAbstract PDFPubReaderePub
Advanced colorectal cancer can cause acute colonic obstruction, which is a life-threatening condition that requires emergency bowel decompression. Malignant colonic obstruction has traditionally been treated using emergency surgery, including primary resection or stoma formation. However, relatively high rates of complications, such as anastomosis site leakage, have been considered as major concerns for emergency surgery. Endoscopic management of malignant colonic obstruction using a self-expandable metal stent (SEMS) was introduced 20 years ago and it has been used as a first-line palliative treatment. However, endoscopic treatment of malignant colonic obstruction using SEMSs as a bridge to surgery remains controversial owing to short-term complications and longterm oncological outcomes. In this review, the current status of and recommendations for endoscopic management using SEMSs for malignant colonic obstruction will be discussed.

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Endoscopic Management of Benign Colonic Obstruction and Pseudo-Obstruction
Su Jin Jeong, Jongha Park
Clin Endosc 2020;53(1):18-28.   Published online October 24, 2019
DOI: https://doi.org/10.5946/ce.2019.058
AbstractAbstract PDFPubReaderePub
There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them.

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Review
Review of Simultaneous Double Stenting Using Endoscopic Ultrasound-Guided Biliary Drainage Techniques in Combined Gastric Outlet and Biliary Obstructions
Hao Chi Zhang, Monica Tamil, Keshav Kukreja, Shashideep Singhal
Clin Endosc 2020;53(2):167-175.   Published online August 13, 2019
DOI: https://doi.org/10.5946/ce.2019.050
AbstractAbstract PDFPubReaderePub
Concomitant malignant gastric outlet obstruction and biliary obstruction may occur in patients with advanced cancers affecting these anatomical regions. This scenario presents a unique challenge to the endoscopist in selecting an optimal management approach. We sought to determine the efficacy and safety of endoscopic techniques for treating simultaneous gastric outlet and biliary obstruction (GOBO) with endoscopic ultrasound (EUS) guidance for biliary drainage. An extensive literature search for peer-reviewed published cases yielded 6 unique case series that either focused on or included the use of EUS-guided biliary drainage (EUS-BD) with simultaneous gastroduodenal stenting. In our composite analysis, a total of 51 patients underwent simultaneous biliary drainage through EUS, with an overall reported technical success rate of 100% for both duodenal stenting and biliary drainage. EUS-guided choledochoduodenostomy or EUS-guided hepaticogastrostomy was employed as the initial technique. In 34 cases in which clinical success was ascribed, 100% derived clinical benefit. The common adverse effects of double stenting included cholangitis, stent migration, bleeding, food impaction, and pancreatitis. We conclude that simultaneous double stenting with EUS-BD and gastroduodenal stenting for GOBO is associated with high success rates. It is a feasible and practical alternative to percutaneous biliary drainage or surgery for palliation in patients with associated advanced malignancies.

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    Sachin Hosahally Jayanna, Surinder Singh Rana
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    Woo Hyun Paik, Do Hyun Park
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    Takashi Sasaki, Tsuyoshi Takeda, Yuto Yamada, Takeshi Okamoto, Chinatsu Mori, Takafumi Mie, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
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    Kejie Mao, Binbin Hu, Feng Sun, Kaiming Wan
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  • Efficacy and safety of endoscopic duodenal stent versus endoscopic or surgical gastrojejunostomy to treat malignant gastric outlet obstruction: systematic review and meta-analysis
    Rajesh Krishnamoorthi, Shivanand Bomman, Petros Benias, Richard A. Kozarek, Joyce A. Peetermans, Edmund McMullen, Ornela Gjata, Shayan S. Irani
    Endoscopy International Open.2022; 10(06): E874.     CrossRef
  • 7,470 View
  • 240 Download
  • 6 Web of Science
  • 7 Crossref
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Case Report
Duodenal Stricture due to Necrotizing Pancreatitis following Endoscopic Ultrasound-Guided Ethanol Ablation of a Pancreatic Cyst: A Case Report
Jung Won Chun, Sang Hyub Lee, Jin Ho Choi, Woo Hyun Paik, Ji Kon Ryu, Yong-Tae Kim
Clin Endosc 2019;52(5):510-515.   Published online July 4, 2019
DOI: https://doi.org/10.5946/ce.2018.191
AbstractAbstract PDFPubReaderePub
The frequency of incidental detection of pancreatic cystic lesions (PCLs) is increasing because of the frequent use of cross-sectional imaging. The appropriate treatment for PCLs is challenging, and endoscopic ultrasound-guided ablation for PCLs has been reported in several studies. Although the feasibility and efficacy of this therapeutic modality have been shown, the safety issues associated with the procedure are still a concern. We present a case of a 61-year-old man who underwent ultrasound-guided ethanol ablation for PCL and needed repeated endoscopic balloon dilatation for severe duodenal stricture caused by necrotizing pancreatitis after the cyst ablation therapy.

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    Mengruo Jiang, Lisi Peng, Yuwei Sun, Shiyu Li, Zhaoshen Li, Liqi Sun, Haojie Huang, Jin Zhendong
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Review
Endoscopic Management of Combined Biliary and Duodenal Obstruction
Zaheer Nabi, D. Nageshwar Reddy
Clin Endosc 2019;52(1):40-46.   Published online January 10, 2019
DOI: https://doi.org/10.5946/ce.2018.102
AbstractAbstract PDFPubReaderePub
Combined obstruction of the bile duct and duodenum is a common occurrence in periampullary malignancies. The obstruction of gastric outlet or duodenum can follow, occur simultaneously, or precede biliary obstruction. The prognosis in patients with combined obstruction is particularly poor. Therefore, minimally invasive palliation is preferred in these patients to avoid morbidity associated with surgery. Endoscopic palliation is preferred to surgical bypass due to similar efficacy, less morbidity, and shorter hospital stay. The success of endoscopic palliation depends on the type of bilioduodenal stenosis and the presence of previously placed duodenal metal stents. Biliary cannulation is difficult in type II bilioduodenal strictures where the duodenal stenosis is located at the level of the papilla. Consequentially, technical and clinical success is lower in these patients than in those with type I and III bilioduodenal strictures. However, in cases with failure of endoscopic retrograde cholangiopancreatography, with the introduction of endoscopic ultrasound for biliary drainage, the success of endoscopic bilioduodenal bypass is likely to increase further. The safety and efficacy of endoscopic ultrasound-guided drainage has been documented in multiple studies. With the development of dedicated accessories and standardization of drainage techniques, the role of endoscopic ultrasound is likely to expand further in cases with double obstruction.

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Close layer
Focused Review Series: Expanding Indication: Interventional Endoscopic Management for Pancreaticobiliary Diseases
Endoscopic Ultrasound-Guided Biliary Drainage for Unresectable Hilar Malignant Biliary Obstruction
Yousuke Nakai, Hirofumi Kogure, Hiroyuki Isayama, Kazuhiko Koike
Clin Endosc 2019;52(3):220-225.   Published online November 29, 2018
DOI: https://doi.org/10.5946/ce.2018.094
AbstractAbstract PDFPubReaderePub
Endoscopic transpapillary biliary drainage is the current standard of care for unresectable hilar malignant biliary obstruction (MBO) and bilateral metal stent placement is shown to have longer patency. However, technical and clinical failure is possible and percutaneous transhepatic biliary drainage (PTBD) is sometimes necessary. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly being reported as an alternative rescue procedure to PTBD. EUS-BD has a potential advantage of not traversing the biliary stricture and internal drainage can be completed in a single session. Some approaches to bilateral biliary drainage for hilar MBO under EUS-guidance include a bridging method, hepaticoduodenostomy, and a combination of EUS-BD and transpapillary biliary drainage. The aim of this review is to summarize data on EUS-BD for hilar MBO and to clarify its advantages over the conventional approaches such as endoscopic transpapillary biliary drainage and PTBD.

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    Tsukasa Yasuda, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Masanori Yamada, Toshitaka Fukui
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    Kotaro Takeshita, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Akihiro Ohba, Yuki Kawasaki, Tetsuro Takasaki, Shin Yagi, Daiki Agarie, Hidenobu Hara, Yuya Hagiwara, Daiki Yamashige, Kohei Okamoto, Soma Fukuda, Masaru Kuwada, Mark Chatto, Shunsuke Kond
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    Marcella Pimpinelli, Michael Makar, Michel Kahaleh
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    Mamoru Takenaka, Tae Hoon Lee
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    Shuntaro Mukai, Takao Itoi
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    Hidetoshi Kitamura, Susumu Hijioka, Yoshikuni Nagashio, Shunsuke Sugawara, Satoshi Nara, Miyuki Sone, Minoru Esaki, Yasuaki Arai, Takuji Okusaka, Atsushi Nakajima
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  • Practical Tips for Safe and Successful Endoscopic Ultrasound-Guided Hepaticogastrostomy: A State-of-the-Art Technical Review
    Saburo Matsubara, Keito Nakagawa, Kentaro Suda, Takeshi Otsuka, Masashi Oka, Sumiko Nagoshi
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    Tae Hoon Lee, Jong Ho Moon, Sherman Stuart
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    Hiroki Kawashima, Eizaburo Ohno, Takuya Ishikawa, Yasuyuki Mizutani, Tadashi Iida, Takeshi Yamamura, Naomi Kakushima, Kazuhiro Furukawa, Masanao Nakamura
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  • Combination of ERCP with endoscopic ultrasound-guided hepaticogastrostomy and hepaticoduodenostomy for biliary drainage in malignant hilar biliary obstruction
    Haruka Toyonaga, Tsuyoshi Hayashi, Toshifumi Kin, Kazuki Hama, Kosuke Iwano, Risa Nakamura, Akio Katanuma
    Endoscopy.2022; 54(S 02): E912.     CrossRef
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    Yurie Tokito, Ryunosuke Hakuta, Hirofumi Kogure, Yousuke Nakai, Mitsuhiro Fujishiro
    Progress of Digestive Endoscopy.2022; 100(1): 50.     CrossRef
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    Tatsuya Sato, Yousuke Nakai, Mitsuhiro Fujishiro
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    Se Woo Park
    International Journal of Gastrointestinal Intervention.2022; 11(3): 105.     CrossRef
  • Comparative Study on Nosocomial Biliary Tract Infection Rate Between Biliary Stent Loaded with Radioactive 125I Seeds and Conventional Biliary Stent in the Treatment of Distal Malignant Biliary Obstruction
    Jianli An, Yanchao Dong, Hongtao Niu, Yanguo Li, Xiaoyu Han, Zibo Zou, Jingpeng Wu, Ye Tian, Zhuo Chen
    Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2022; 32(6): 724.     CrossRef
  • ERCP plus endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage for malignant hilar biliary obstruction: a multicenter observational open-label study
    Pradermchai Kongkam, Theerapat Orprayoon, Chaloemphon Boonmee, Passakorn Sodarat, Orathai Seabmuangsai, Chatchawan Wachiramatharuch, Yutthaya Auan-Klin, Khanh Cong Pham, Abbas Ali Tasneem, Stephen J. Kerr, Rommel Romano, Sureeporn Jangsirikul, Wiriyaporn
    Endoscopy.2021; 53(01): 55.     CrossRef
  • Feasibility of EUS-guided hepaticogastrostomy for inoperable malignant hilar biliary strictures
    Jérôme Winkler, Fabrice Caillol, Jean-Philippe Ratone, Erwan Bories, Christian Pesenti, Marc Giovannini
    Endoscopic Ultrasound.2021; 10(1): 51.     CrossRef
  • Combined ERCP and transhepatic endoscopic ultrasound-guided stent placement for biliary drainage in malignant hilar obstruction: not too good to be true
    Manuel Perez-Miranda
    Endoscopy.2021; 53(01): 63.     CrossRef
  • Extrahepatic cholangiocarcinoma: Current status of endoscopic approach and additional therapies
    Alina Ioana Tantau, Alina Mandrutiu, Anamaria Pop, Roxana Delia Zaharie, Dana Crisan, Carmen Monica Preda, Marcel Tantau, Voicu Mercea
    World Journal of Hepatology.2021; 13(2): 166.     CrossRef
  • Efficacy of lumen-apposing metal stents or self-expandable metal stents for endoscopic ultrasound-guided choledochoduodenostomy: a systematic review and meta-analysis
    Arnaldo Amato, Emanuele Sinagra, Ciro Celsa, Marco Enea, Andrea Buda, Filippo Vieceli, Lucia Scaramella, Paul Belletrutti, Alessandro Fugazza, Calogero Cammà, Franco Radaelli, Alessandro Repici, Andrea Anderloni
    Endoscopy.2021; 53(10): 1037.     CrossRef
  • What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy
    Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek, Nonthalee Pausawasdi
    Clinical Endoscopy.2021; 54(3): 301.     CrossRef
  • EUS-guided biliary drainage for malignant hilar biliary obstruction: A concise review
    Sridhar Sundaram, Vinay Dhir
    Endoscopic Ultrasound.2021; 10(3): 154.     CrossRef
  • Proper management of inoperable malignant hilar biliary obstruction: Endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, or percutaneous approach?
    Tae Hoon Lee
    International Journal of Gastrointestinal Intervention.2021; 10(3): 120.     CrossRef
  • A Recent Update on Endoscopic Drainage of Advanced Malignant Hilar Obstruction
    Tae Hoon Lee, Jong Ho Moon, Sang-Heum Park
    The Korean Journal of Gastroenterology.2021; 78(2): 94.     CrossRef
  • Endoscopic Biliary Drainage for Hilar Obstruction: Further Evidence But Still A Long Way To Go
    Yousuke Nakai
    Clinical Endoscopy.2021; 54(5): 629.     CrossRef
  • EUS-guided antegrade metallic stent placement using the stent-in-stent method with a 6-Fr novel slim delivery system in a patient with malignant hilar biliary obstruction
    Shigeyuki Suenaga, Seiji Kaino, Takanori Tsuyama, Yuko Fujimoto, Shogo Amano, Toshiyuki Uekitani, Isao Sakaida
    Endoscopic Ultrasound.2021; 10(5): 387.     CrossRef
  • Retrospective Comparative Study of Side-by-Side and Stent-in-Stent Metal Stent Placement for Hilar Malignant Biliary Obstruction
    Kazunaga Ishigaki, Tsuyoshi Hamada, Yousuke Nakai, Hiroyuki Isayama, Tatsuya Sato, Ryunosuke Hakuta, Kei Saito, Tomotaka Saito, Naminatsu Takahara, Suguru Mizuno, Hirofumi Kogure, Yukiko Ito, Hiroshi Yagioka, Saburo Matsubara, Dai Akiyama, Dai Mohri, Mino
    Digestive Diseases and Sciences.2020; 65(12): 3710.     CrossRef
  • Radiologic Assessment for Endoscopic US-guided Biliary Drainage
    Shunsuke Sugawara, Miyuki Sone, Shinichi Morita, Susumu Hijioka, Yasunari Sakamoto, Masahiko Kusumoto, Yasuaki Arai
    RadioGraphics.2020; 40(3): 667.     CrossRef
  • Endoscopic ultrasound‐guided bilateral biliary drainage through the mesh of the metal stents using a balloon occlusion method
    Kazunari Nakahara, Ryo Morita, Fumio Itoh
    Digestive Endoscopy.2020;[Epub]     CrossRef
  • Simultaneous endoscopic ultrasound-guided hepaticogastrostomy and bridging stenting with partial stent-in-stent method
    Kosuke Maehara, Susumu Hijioka, Yoshikuni Nagashio, Akihiro Ohba, Yuya Kanai, Takuji Okusaka, Yutaka Saito
    Endoscopy.2020; 52(10): E381.     CrossRef
  • Efficacy and safety of EUS biliary drainage in malignant distal and hilar biliary obstruction: A comprehensive review of literature and algorithm
    Stanley Khoo, NhanDuc Tri Do, Pradermchai Kongkam
    Endoscopic Ultrasound.2020; 9(6): 369.     CrossRef
  • Acute biliary interventions
    T.C. See
    Clinical Radiology.2019;[Epub]     CrossRef
  • Endoscopic ultrasound-guided biliary drainage: A change in paradigm?
    En-Ling Leung Ki EL, Bertrand Napoleon
    World Journal of Gastrointestinal Endoscopy.2019; 11(5): 345.     CrossRef
  • Drainage of the right liver using EUS guidance
    Fabrice Caillol, Mathieu Rouy, Christian Pesenti, Jean-Philippe Ratone, Marc Giovannini
    Endoscopic Ultrasound.2019; 8(7): 50.     CrossRef
  • 10,578 View
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Case Reports
Pneumoperitoneum after Endoscopic Duodenal Stent Insertion in a Patient with Percutaneous Transhepatic Biliary Drainage and Biliary Stent: A Case Report
Jinwoo Choi, Min Ji Lee, Hyodeok Lee, Yook Kim, Joung-Ho Han, Seon Mee Park
Clin Endosc 2019;52(3):288-292.   Published online August 29, 2018
DOI: https://doi.org/10.5946/ce.2018.128
AbstractAbstract PDFPubReaderePub
Early removal of a percutaneous transhepatic biliary drainage (PTBD) tube commonly causes pneumoperitoneum. However, we encountered a patient who developed pneumoperitoneum even with an indwelling PTBD tube. An 84-year-old man was admitted with type III combined duodenal and biliary obstruction secondary to metastatic bladder cancer. A biliary stent was placed using a percutaneous approach, and a duodenal stent was placed endoscopically. A large amount of subphrenic free air was detected after the procedures. Laboratory tests indicated intestinal perforation; however, peritoneal signs were absent. The patient was treated conservatively using an indwelling Levin tube. Seven days later, the massive amount of subphrenic free air disappeared. Follow-up tubography revealed unrestricted bile flow into the small intestine, and the PTBD tube was removed. Prolonged endoscopic procedures in patients with a PTBD tract communicating with the gastrointestinal tract can precipitate pneumoperitoneum. Clinicians should be careful to avoid misdiagnosing this condition as intestinal perforation.

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  • The characteristics of residual pneumoperitoneum after laparoscopic colorectal surgery
    Sotaro Fukuhara, Hiroyuki Egi, Masatoshi Kochi, Wataru Shimizu, Yuji Takakura, Kazuhiro Taguchi, Ikki Nakashima, Yusuke Sumi, Shintaro Akabane, Koki Sato, Hisaaki Yoshinaka, Yoshifumi Teraoka, Minoru Hattori, Hideki Ohdan
    Asian Journal of Endoscopic Surgery.2022; 15(2): 320.     CrossRef
  • 7,570 View
  • 133 Download
  • 1 Web of Science
  • 1 Crossref
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Removal of Esophageal Variceal Bands to Salvage Complete Esophageal Obstruction
Ala’ A Abdel Jalil, Ghassan Hammoud, Jamal A Ibdah, Sami Samiullah
Clin Endosc 2018;51(5):491-494.   Published online August 21, 2018
DOI: https://doi.org/10.5946/ce.2018.011
AbstractAbstract PDFPubReaderePub
Esophageal varices develop in almost half of the patients with cirrhosis, and variceal hemorrhage constitutes an ominous sign with an increased risk of mortality. Variceal banding is considered an effective and mostly safe measure for primary and secondary prophylaxis. Although adverse events related to banding including dysphagia, stricture formation, bleeding, and ligation-induced ulcers have been described, complete esophageal obstruction is rare, with only 10 reported cases in the literature. Among those cases, 6 were managed conservatively; 1 patient had esophageal intraluminal dissection from an attempt to remove the bands using biopsy forceps but ultimately recovered with conservative management. Three patients developed strictures following removal of the bands, requiring repeated sessions of dilation therapy. We report on a patient who developed absolute dysphagia and complete esophageal obstruction after variceal banding. We successfully used the endoloop cutter hook to release the bands intact and restore luminal integrity.

Citations

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  • Esophageal necrosis and obstruction after esophageal variceal banding
    Simran Gupta, Emily Zhou, Jason Ferreira, Arkadiy Finn
    Journal of Brown Hospital Medicine.2022;[Epub]     CrossRef
  • 9,367 View
  • 122 Download
  • 1 Crossref
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Metal Stent Placement in the Afferent Loop Obstructed by Peritoneal Metastases—Experience of Five Cases
Yoshihide Kanno, Tetsuya Ohira, Yoshihiro Harada, Yoshiki Koike, Taku Yamagata, Megumi Tanaka, Tomohiro Shimada, Kei Ito
Clin Endosc 2018;51(3):299-303.   Published online April 18, 2018
DOI: https://doi.org/10.5946/ce.2018.005
AbstractAbstract PDFPubReaderePub
Afferent loop syndrome is often difficult to resolve. Among patients with afferent loop syndrome whose data were extracted from databases, 5 patients in whom metal stent placement was attempted were included and evaluated in this study. The procedure was technically successful without any adverse events in all patients. Metal stent(s) was placed with an endoscope in the through-the-scope manner in 4 patients and via a percutaneous route in 1 patient. Obvious clinical efficacy was observed in all patients. Adverse events related to the procedure and stent occlusion during the follow-up period were not observed. Metal stent placement for malignant obstruction of the afferent loop was found to be safe and feasible.

Citations

Citations to this article as recorded by  
  • Early and late effects of endoscopic interventions in patients with malignant afferent loop syndrome: A single‐center experience and literature review
    Kenjiro Yamamoto, Takao Itoi, Yukitoshi Matsunami, Atsushi Sofuni, Takayoshi Tsuchiya, Shuntaro Mukai, Hiroyuki Kojima, Hirohito Minami, Ryosuke Nakatsubo, Ryosuke Tonozuka
    Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(2): 120.     CrossRef
  • Efficacy of endoscopic ultrasound‐guided gastroenterostomy using self‐expandable metallic stent for afferent loop syndrome: A single‐center retrospective study
    Yuya Hagiwara, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Akihiro Ohba, Yuki Kawasaki, Kotaro Takeshita, Tetsuro Takasaki, Daiki Agarie, Hidenobu Hara, Shin Yagi, Soma Fukuda, Masaru Kuwada, Daiki Yamashige, Kohei Okamoto, Mark Chatto, Shunsuke Kond
    Journal of Gastroenterology and Hepatology.2024; 39(10): 2136.     CrossRef
  • Efficacy and safety of endoscopic stent placement for afferent loop obstruction using a short double‐balloon endoscopy
    Takashi Ito, Masaaki Shimatani, Masataka Masuda, Koh Nakamaru, Toshiyuki Mitsuyama, Norimasa Fukata, Tsukasa Ikeura, Makoto Takaoka, Kazuichi Okazaki, Makoto Naganuma
    DEN Open.2023;[Epub]     CrossRef
  • Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction
    Chinatsu Yonekura, Takashi Sasaki, Takafumi Mie, Takeshi Okamoto, Tsuyoshi Takeda, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
    Journal of Clinical Medicine.2022; 11(21): 6357.     CrossRef
  • Clinical management for malignant afferent loop obstruction
    Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Takashi Kobayashi, Yasutaka Yamada, Yuzo Kodama
    World Journal of Gastrointestinal Oncology.2021; 13(7): 509.     CrossRef
  • Clinical management for malignant afferent loop obstruction
    Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Takashi Kobayashi, Yasutaka Yamada, Yuzo Kodama
    World Journal of Gastrointestinal Oncology.2021; 13(7): 684.     CrossRef
  • Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome
    Hideyuki Shiomi, Arata Sakai, Ryota Nakano, Shogo Ota, Takashi Kobayashi, Atsuhiro Masuda, Hiroko Iijima
    Clinical Endoscopy.2021; 54(6): 810.     CrossRef
  • Usefulness of endoscopic metal stent placement for malignant afferent loop obstruction
    Akihiko Kida, Hidenori Kido, Toshiki Matsuo, Atsuyoshi Mizukami, Masaaki Yano, Fumitaka Arihara, Koichiro Matsuda, Kohei Ogawa, Mitsuru Matsuda, Akito Sakai
    Surgical Endoscopy.2020; 34(5): 2103.     CrossRef
  • Endoscopic Self-Expandable Metal Stent Placement for Malignant Afferent Loop Obstruction After Pancreaticoduodenectomy: A Case Series and Review
    Arata Sakai, Hideyuki Shiomi, Takao Iemoto, Ryota Nakano, Takuya Ikegawa, Takashi Kobayashi, Atsuhiro Masuda, Yuzo Kodama
    Clinical Endoscopy.2020; 53(4): 491.     CrossRef
  • Endoscopic nasogastric tube insertion for treatment of benign afferent loop obstruction after radical gastrectomy for gastric cancer
    Yuning Cao, Xiangheng Kong, Daogui Yang, Senlin Li
    Medicine.2019; 98(28): e16475.     CrossRef
  • Enteral self-expandable metal stent placement for malignant afferent limb syndrome using single-balloon enteroscope: report of five cases
    Kei Yane, Akio Katanuma, Tsuyoshi Hayashi, Kuniyuki Takahashi, Toshifumi Kin, Kazumasa Nagai, Kazunari Tanaka, Naohiro Komatsu, Masato Endo, Yousuke Kobayashi, Yukiko Takigawa, Ran Utsunomiya
    Endoscopy International Open.2018; 06(11): E1330.     CrossRef
  • 7,777 View
  • 112 Download
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Giant Brunner’s Gland Hamartoma of the Duodenal Bulb Presenting with Upper Gastrointestinal Bleeding and Obstruction
Ju Hyoung Lee, Kyeong Min Jo, Tae Oh Kim, Jong Ha Park, Seung Hyun Park, Jae Won Jung, So Chong Hur, Sung Yeun Yang
Clin Endosc 2016;49(6):570-574.   Published online October 13, 2016
DOI: https://doi.org/10.5946/ce.2016.022
AbstractAbstract PDFPubReaderePub
Brunner’s gland hamartomas are small benign lesions that are most commonly found in the bulb of the duodenum. They are very uncommon, and most are found incidentally during upper gastrointestinal series or esophagogastroduodenoscopy. The lesions tend to be asymptomatic, but patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner's gland hamartoma consists of the components of Brunner's gland cells, as well as glandular, adipose and muscle cells. In this study, we report the case of a 30-year-old man who presented with upper gastrointestinal bleeding and obstructive symptoms due to a giant Brunner's gland hamartoma in the duodenal bulb. The hamartoma was successfully removed by endoscopic resection. No significant complications were observed. Microscopically, the lesion was found to be entirely composed of variable Brunner's glands and adipocytes.

Citations

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  • A case of primary duodenal Brunner's gland hamartoma that gradually underwent morphological changes over a period of 10 years
    Yusuke Sunada, Hiromichi Yamane, Nobuaki Ochi, Hirohito Kirishi, Takako Saitou, Masafumi Miura, Hidekazu Nakanishi, Hideyo Fujiwara, Nagio Takigawa
    DEN Open.2025;[Epub]     CrossRef
  • Unusual Gastric Tumors & Tumor-like Lesions: a Case Series
    Sumyra Khurshid Qadri, Nissar Hussain Hamdani, Suddhasattwa Sen, Advait Sanjay Sonar, Ajay Mandal, Sanjoy Mandal, Hema Pant, Sanjay De Bakshi
    Indian Journal of Surgical Oncology.2025; 16(6): 1364.     CrossRef
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    Dirin Ukwade, Sana Hussain, Saaed Ali, Brian Boulay
    Clinical Case Reports.2025;[Epub]     CrossRef
  • Rare Etiologies of Upper Gastrointestinal Bleeding: A Narrative Review
    Ion Dina, Maria Nedelcu, Claudia Georgeta Iacobescu, Ion Daniel Baboi, Alice Lavinia Bălăceanu
    Journal of Clinical Medicine.2025; 14(14): 4972.     CrossRef
  • Adenomatous Hyperplasia of Duodenal Brunner's Glands: An Extremely Uncommon Imitation of Malignant Pathology
    Archit Garg, Vikram Jeet Singh Gill, Mehak Bassi, Andrew Korman, Arkady Broder
    Cureus.2025;[Epub]     CrossRef
  • Brunner’s gland hamartomas: Not always benign
    Manar Shmais, Ahmad Mousawi, Fadi Mourad, Ala I. Sharara
    Arab Journal of Gastroenterology.2024; 25(1): 70.     CrossRef
  • The Characteristics and Treatment Outcomes of 71 Duodenal Brunner’s Gland Adenomas with Endoscopic Submucosal Dissection
    Ying Xiang, Jinyan Liu, Nan ya Wang, Dehua Tang, Lei Wang, Ping xiao Zou, Guifang Xu, Qin Huang
    Digestive Diseases.2023; 41(6): 852.     CrossRef
  • Giant brunner gland hamartoma: An unusual cause of upper gastrointestinal bleed
    Bershic Valantine, ManjunathB Venkatapur, Sultan Nawahirsha, SBabu Kumar
    Gastroenterology, Hepatology and Endoscopy Practice.2023; 3(3): 90.     CrossRef
  • A giant Brunner’s gland hamartoma being treated as a pedunculated polyp: a case report
    Lizhi Yi, Zhengyu Cheng, Huarong Qiu, Jianjun Yang, Tao Wang, Ke Liu
    BMC Gastroenterology.2019;[Epub]     CrossRef
  • 12,203 View
  • 186 Download
  • 9 Web of Science
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Long-Term Palliative Effect of Stenting in Gastric Outlet Obstruction Due to Transarterial Chemoembolization with Yttrium-90 in a Patient with Metastatic Neuroendocrine Tumor
Erkan Caglar, Gulen Doğusoy, Levent Kabasakal, Ahmet Dobrucali
Clin Endosc 2016;49(5):479-482.   Published online June 29, 2016
DOI: https://doi.org/10.5946/ce.2015.149
AbstractAbstract PDFPubReaderePub
Internal radioembolization with yttrium-90 is a promising treatment method, predominantly for liver tumors. However, the shifting of yttrium-90-loaded spherules into the arteries and veins that supply the duodenum and stomach, leading to ulceration, hemorrhage, perforation, and outlet obstruction of these organs, is one of the major undesirable consequences of this technique. We report a case of gastric outlet obstruction (GOO) due to antropyloric stenosis with ulceration, edema, and inflammation following transarterial yttrium-90 treatment for a metastatic neuroendocrine tumor in a 58-year-old man. Stenting was used for palliation in this case. GOO improved after stenting and recovery of oral intake was permanent after stent removal.
  • 9,145 View
  • 113 Download
  • 1 Web of Science
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Phlebosclerotic Colitis in a Healthy Young Woman
Jung Kyu Park, Young Ho Sung, Sun Young Cho, Chang Yul Oh, So Hyun An
Clin Endosc 2015;48(5):447-451.   Published online September 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.5.447
AbstractAbstract PDFPubReaderePub

Phlebosclerotic colitis is a rare disease of intestinal ischemia and differentiating it from the typical ischemic colitis. It is caused by venous obstruction due to colonic and mesenteric venous calcification. We report a 36-year-old woman presenting with intermittent abdominal pain. Initial radiologic findings showed multiple tortuous thread-like calcifications in the region of the right side of the colon and transverse colon on plain abdominal radiographs and computed tomography images. In the colonoscopy, edematous dark-bluish colonic mucosa, sclerotic colon wall, and multiple ulcers without clear boundaries were observed from the ascending colon to the transverse colon. In the sigmoid colon only showed the edematous dark-bluish colonic mucosa, sclerotic colon wall. On the basis of these findings, we diagnosed the patient as having phlebosclerotic colitis. We report a rare case of phlebosclerotic colitis in healthy young woman.

Citations

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    Xiao-Tong Hu, Dong Wang
    European Journal of Medical Research.2025;[Epub]     CrossRef
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    Taehong Kim, Jin Lee, Ji Eun Na, Yong Eun Park, Jongha Park, Tae Oh Kim
    The Korean Journal of Gastroenterology.2023; 82(1): 30.     CrossRef
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    Chien‐Neng Kao, Pao‐Ying Lin, Li‐Chun Chang, Wen‐Feng Hsu, Chia‐Hung Tu, Han‐Mo Chiu, Chun‐Chao Chang
    Advances in Digestive Medicine.2020; 7(4): 201.     CrossRef
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    Rishi Philip Mathew, Safwat Girgis, Malcolm Wells, Gavin Low
    Journal of Clinical Imaging Science.2019; 9: 18.     CrossRef
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    Chi‐Su Sun, Jyh‐Jou Chen, Pei‐Lun Lee, Ming‐Jenn Chen, Khin‐Than Win
    Advances in Digestive Medicine.2018; 5(1-2): 63.     CrossRef
  • Phlebosclerotic colitis
    Wenguo Chen, Huatuo Zhu, Hongtan Chen, Guodong Shan, Guoqiang Xu, Lihua Chen, Fei Dong
    Medicine.2018; 97(43): e12824.     CrossRef
  • Exclusive Phlebosclerosis of Submucosal Veins Leading to Ischemic Necrosis and Perforation of the Large Bowel: First European Case
    Sebastian Klein, Denise Buchner, De-hua Chang, Reinhard Büttner, Uta Drebber, Jochen W.U. Fries
    Case Reports in Gastroenterology.2018; 12(1): 137.     CrossRef
  • 12,619 View
  • 136 Download
  • 7 Web of Science
  • 7 Crossref
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Focused Review Series: Updates on Gastrointestinal and Pancreaticobiliary Stentses
Colorectal Stents: Current Status
Jeong-Mi Lee, Jeong-Sik Byeon
Clin Endosc 2015;48(3):194-200.   Published online May 29, 2015
DOI: https://doi.org/10.5946/ce.2015.48.3.194
AbstractAbstract PDFPubReaderePub

A self-expandable metal stent (SEMS) is an effective and safe method for the decompression of colon obstruction. Based on recent evidence, colorectal SEMS is now recommended for the palliation of patients with colonic obstruction from incurable colorectal cancer or extracolonic malignancy and also as a bridge to surgery in those who are a high surgical risk. Prophylactic SEMS insertion in patients with no obstruction symptoms is not recommended. Most colorectal SEMS are inserted endoscopically under fluoroscopic guidance. The technical and clinical success rates of colorectal SEMS are high, and the complication rate is acceptable. Advances in this technology will make the insertion of colorectal SEMS better and may expand the indications of colorectal SEMS in the future.

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    Antònia Crespí-Mir, Juan Manuel Romero-Marcos, Anabel de la Llave-Serralvo, Carlos Dolz-Abadía, José Andrés Cifuentes-Ródenas
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  • 183 Download
  • 26 Web of Science
  • 29 Crossref
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Upper Gastrointestinal Stent Insertion in Malignant and Benign Disorders
Hyoun Woo Kang, Sang Gyun Kim
Clin Endosc 2015;48(3):187-193.   Published online May 29, 2015
DOI: https://doi.org/10.5946/ce.2015.48.3.187
AbstractAbstract PDFPubReaderePub

Upper gastrointestinal (GI) stents are increasingly being used to manage upper GI obstructions. Initially developed for palliative treatment of esophageal cancer, upper GI stents now play an emerging role in benign strictures of the upper GI tract. Because recurrent obstruction and stent-related complications are common, new modifications of stents have been implemented. Self-expandable metal stents (SEMS) have replaced older plastic stents. In addition, newly designed SEMS have been developed to prevent complications. This review provides an overview of the various types, indications, methods, complications, and clinical outcomes of upper GI stents in a number of malignant and benign disorders dividing the esophagus and gastroduodenum.

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  • 13,467 View
  • 194 Download
  • 25 Web of Science
  • 24 Crossref
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Case Report
Endoscopic Diagnosis of Duodenal Stenosis in a 5-Month-Old Male Infant
Maribeth R. Nicholson, Sari A. Acra, Dai H. Chung, Michael J. Rosen
Clin Endosc 2014;47(6):568-570.   Published online November 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.6.568
AbstractAbstract PDFPubReaderePub

Duodenal stenosis and duodenal atresia are well-known gastrointestinal anomalies in patients with Down syndrome. Although duodenal atresia presents early and classically with vomiting in the immediate neonatal period, the presentation of duodenal stenosis can be significantly more subtle and the diagnosis delayed. Here, we describe the case of a 5-month-old male infant with Down syndrome and delayed presentation of high-grade duodenal stenosis diagnosed endoscopically. Pediatric gastroenterologists should include duodenal stenosis in the differential diagnosis of older infants and children with vomiting and should be familiar with the endoscopic appearance of this lesion.

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    Michelle M. Papachrisanthou, Renée L. Davis
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  • 10,420 View
  • 105 Download
  • 8 Web of Science
  • 9 Crossref
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Review
Status and Literature Review of Self-Expandable Metallic Stents for Malignant Colorectal Obstruction
Dae Young Cheung, Yong Kook Lee, Chang Heon Yang
Clin Endosc 2014;47(1):65-73.   Published online January 24, 2014
DOI: https://doi.org/10.5946/ce.2014.47.1.65
AbstractAbstract PDFPubReaderePub

Use of colorectal stents has increased dramatically over the last decades. Colorectal stents offer an alternative way to relieve fatal intestinal obstruction and can take place of emergency surgery, which associated with significant morbidity and mortality and a high incidence of stoma creation, to elective resection. Although there remain a few concerns regarding the use of stents as a bridge to surgical resection, use of self-expandable metallic stents for palliation in patients with unresectable disease has come to be generally accepted. Advantages of colorectal stents include acute restoration of luminal patency and allowance of time for proper staging and surgical optimization, and the well-known disadvantages are procedure-related complications including perforation, migration, and stent failure. General indications, procedures, and clinical outcomes as well as recent evidences regarding the use of colorectal stents will be discussed in this review.

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    Bingqing Ma, Tianxing Ren, Chengjun Cai, Biao Chen, Jinxiang Zhang
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    Malene Broholm, Thea Helene Degett, Sara Furbo, Anne-Marie Kanstrup Fiehn, Mustafa Bulut, Thomas Litman, Jens Ole Eriksen, Jesper T. Troelsen, Lise Mette Rahbek Gjerdrum, Ismail Gögenur
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    Y. Wan, Y.-Q. Zhu, N.-W. Chen, Z.-G. Wang, Y.-S. Cheng, J. Shi
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    F. Iordache, J. C. Bucobo, D. Devlin, K. You, R. Bergamaschi
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    Jung Ho Kim
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  • 10,810 View
  • 81 Download
  • 12 Web of Science
  • 10 Crossref
Close layer
Case Reports
Small Bowel Stent-in-Stent Placement for Malignant Small Bowel Obstruction Using a Balloon-Assisted Overtube Technique
Daniel Popa, Jayapal Ramesh, Shajan Peter, C. Mel Wilcox, Klaus Mönkemüller
Clin Endosc 2014;47(1):108-111.   Published online January 24, 2014
DOI: https://doi.org/10.5946/ce.2014.47.1.108
AbstractAbstract PDFPubReaderePub

Self-expanding metal stents are a useful therapy to palliate malignant and benign luminal gastrointestinal obstruction. Self-expanding metal stents has been widely reported for colonic, esophageal, and gastric obstruction. However, endoscopic delivery and placement to the small bowel is more challenging and difficult. This case illustrates the usefulness and technical advantages of the balloon-overtube and enteroscopy technique for the palliative treatment of neoplastic stenosis affecting the small intestine.

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Repetitive Colonoscopic Decompression as a Bridge Therapy before Surgery in a Pregnant Patient with Chronic Intestinal Pseudo-Obstruction
Joon Sung Kim, Bo-In Lee, Byung-Wook Kim, Hwang Choi, Yun-Seok Lee, Leeso Maeng
Clin Endosc 2013;46(5):591-594.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.591
AbstractAbstract PDFPubReaderePub

Chronic intestinal pseudo-obstruction is a rare clinical syndrome which is characterized by intestinal obstruction without occluding lesions in the intestinal lumen and pregnancy is one of the important aggravating factors. Here, we report a case of a woman with intractable intestinal pseudo-obstruction that was precipitated by pregnancy. She could not make any stool passage for more than 4 weeks until a fetal gestational age of 17 weeks was reached. However, the patient could be maintained by repetitive colonoscopic decompressions and finally total colectomy could be performed successfully at a fetal gestational age of 21 weeks.

Citations

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