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Original Articles
A stepwise cannulation strategy for conservative endoscopists: the clinical impact of transpancreatic precut after pancreatic stenting in a retrospective study from Taiwan
Wei-Chih Su, Chia-Chi Wang, Tsung-Hsien Hsiao, Hung-Da Chen, Tzu-Hsiang Kung, Chih-Hsiang Chen, Jiann-Hwa Chen
Clin Endosc 2026;59(1):132-141.   Published online January 12, 2026
DOI: https://doi.org/10.5946/ce.2025.241
AbstractAbstract PDFPubReaderePub
Background
/Aims: Pancreatic stenting reduces post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and aids in cannulation in difficult cases. However, conservative endoscopists may stop at this step, resulting in suboptimal outcomes. This study assessed the efficacy of transpancreatic precut sphincterotomy (TPS) as a rescue procedure following pancreatic stenting.
Methods
Between March 2013 and November 2018, 82 patients underwent pancreatic stenting at our institution prior to successful biliary cannulation. TPS was introduced in April 2016, and patients were divided into Before TPS and After TPS groups. The outcomes included cannulation success, PEP incidence, and predictors of TPS conversion.
Results
There were 43 and 39 patients in the Before TPS and After TPS groups, respectively. Twenty-two patients (56.4%) underwent conversion to TPS in the After TPS group. The After TPS group had a higher bile duct cannulation rate (89.7% vs. 72.1%) than the Before TPS group, but this difference was not statistically significant (p=0.054). Multivariate analysis showed that age >50 years (odds ratio [OR], 0.181; p=0.021) and being in the After TPS group (OR, 0.712; p=0.039) were independently associated with reduced PEP risk. Haraldsson Type 2 and Type 4 papillae carried a relatively high TPS conversion rate.
Conclusions
A stepwise cannulation strategy that incorporates TPS after pancreatic stenting minimizes the need for advanced techniques and improves PEP outcomes.
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Feasibility of pancreatic duct stent placement before endoscopic submucosal dissection for superficial duodenal neoplasms adjacent to the papilla
Ryosuke Kobayashi, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Masafumi Nishio, Chiko Sato, Haruo Miwa, Kazuya Sugimori, Shin Maeda
Clin Endosc 2026;59(1):89-95.   Published online December 31, 2025
DOI: https://doi.org/10.5946/ce.2025.197
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging and is associated with a risk of adverse events, particularly when lesions are located near the major papilla. Pancreatic duct (PD) stent may reduce the risk of post-ESD pancreatitis; however, no standard strategy has been established. This study aimed to evaluate the effectiveness and safety of PD stent placement combined with ESD for SNADETs near the major papilla.
Methods
This was a retrospective study of duodenal ESD after prophylactic PD stent placement in patients with SNADET near the major papilla at a university hospital between March 2014 and September 2023.
Results
Four lesions were located within 5 mm of the major papilla, and seven within 5 to 10 mm. The median interval between stent placement and ESD was 2 days. The en bloc and R0 resection rates were 100% and 90.9%, respectively. No stent migration occurred during ESD, and all mucosal defects were completely closed using endoscopic clips. Delayed bleeding and post-ESD pancreatitis were observed in one and two cases, respectively.
Conclusions
PD stent placement combined with ESD is an effective treatment strategy for SNADETs near the major papilla. However, the risk of post-ESD pancreatitis remains, indicating the need for further preventive strategies.

Citations

Citations to this article as recorded by  
  • Reducing post-endoscopic submucosal dissection pancreatitis in periampullary duodenal lesions: the role of prophylactic pancreatic duct stenting
    Ari Fahrial Syam
    Clinical Endoscopy.2026; 59(1): 70.     CrossRef
  • 550 View
  • 46 Download
  • 1 Web of Science
  • 1 Crossref
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Review
Endoscopic strategy and covered self-expandable metal stents for malignant hilar biliary obstruction
Tae Hoon Lee, Jong Ho Moon, Sang-Heum Park
Received September 19, 2025  Accepted October 16, 2025  Published online December 3, 2025  
DOI: https://doi.org/10.5946/ce.2025.343    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
Malignant hilar biliary obstruction (MHO), most commonly caused by cholangiocarcinoma, is an aggressive condition with a poor prognosis. Because most patients with MHO are unsuitable for primary surgical resection at presentation because of advanced age or comorbidities, palliative biliary drainage is essential to relieve obstructive jaundice and improve the quality of life. Endoscopic drainage has become the preferred palliative approach, with the choice between plastic and metal stents depending on subsequent therapeutic plans, such as systemic chemotherapy or local ablative therapies. Among biliary stents, self-expandable metal stents (SEMSs) are widely used, typically in their uncovered form. However, unlike plastic stents, uncovered SEMSs cannot be removed once deployed, and endoscopic revision is technically challenging. To improve stent patency and facilitate removability, covered SEMSs (CSEMSs) were developed, and are now commonly used in distal malignant biliary obstruction. Nevertheless, in advanced MHO, the primary use of CSEMSs remains controversial. This review summarizes recent endoscopic strategies for advanced MHO, the evolution of CSEMSs, their clinical outcomes, current limitations, and future directions.
  • 751 View
  • 97 Download
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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.
  • 1,182 View
  • 49 Download
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Efficacy of primary endoscopic ultrasound-guided biliary drainage with the placement of multiple plastic stents in the management of hepaticojejunostomy stricture: a retrospective, single-center study in Japan
Mako Ushio, Toshio Fujisawa, Ko Tomishima, Yusuke Takasaki, Shigeto Ishii, Koichi Ito, Akinori Suzuki, Daisuke Namima, Sho Takahashi, Taito Fukuma, Hiroto Ota, Daishi Kabemura, Muneo Ikemura, Ippei Ikoma, Yasuhisa Jimbo, Haruka Hagiwara, Yusuke Yamaguchi, Takumi Okuaki, Shin Arii, Hiroyuki Isayama
Clin Endosc 2025;58(6):909-917.   Published online November 6, 2025
DOI: https://doi.org/10.5946/ce.2025.006
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Hepaticojejunostomy strictures (HJSS), recurrent cholangitis, and jaundice are major complications of surgical hepaticojejunostomy. Previously, HJSS was managed using percutaneous procedures and balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography. However, endoscopic ultrasound-biliary drainage (EUS-BD) was recently reported to be an effective salvage procedure. EUS-BD as a primary drainage method using a trans-endosonographically created route (trans-ESCR) has not been previously evaluated.
Methods
We enrolled consecutive patients who underwent EUS-BD for HJSS at the Juntendo University Hospital between March 2017 and December 2022. After ESCR maturation, multiple plastic stents were placed for 1 year with or without cholangioscopic evaluation. We evaluated the technical and clinical success rates, stent removal, HJSS recurrence, and related adverse events.
Results
Thirty-seven patients required EUS-guided hepaticogastrostomy/hepaticojejunostomy (n=36/1). The technical and clinical success rates were 94.6% and 100.0%, respectively, and 17% of patients experienced adverse events. Cholangioscopy via ESCR was performed in 19 patients to evaluate the strictures and manage concomitant stones. The success rate of stent removal after multiple stent placements for more than 1 year was 83%.
Conclusions
Primary EUS-BD and trans-ESCR are feasible and effective in the management of HJSS. Further prospective studies are needed to confirm the results of this pilot study.
  • 1,237 View
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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
  • 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
  • 2,877 View
  • 93 Download
  • 1 Web of Science
  • 3 Crossref
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Review
Self-expandable metal vs. plastic stents for preoperative biliary drainage in patients receiving neoadjuvant chemotherapy
Takashi Tamura, Reiko Ashida, Yuki Kawaji, Masahiro Itonaga, Yasunobu Yamashita, Masayuki Kitano
Clin Endosc 2025;58(6):817-825.   Published online July 30, 2025
DOI: https://doi.org/10.5946/ce.2025.045
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Neoadjuvant chemotherapy (NAC) improves the rate of curative resection and overall prognosis in patients with resectable or borderline resectable pancreatic cancer. The treatment period from the initiation of NAC to surgery typically ranges from 2 to 6 months. In cases of malignant biliary obstruction caused by pancreatic cancer, maintaining preoperative biliary drainage (PBD) until surgery is essential to continue NAC. Minimizing adverse events related to endoscopic biliary drainage and avoiding perioperative adverse events are crucial. Plastic stents (PSs) are commonly used for PBD; however, the extended duration of PBD required for NAC increases the risk of recurrent biliary obstruction (RBO), potentially leading to discontinuation of NAC. Therefore, preventing RBO during PBD in patients with pancreatic cancer receiving NAC is important. The placement of self-expandable metal stents (SEMSs) for PBD significantly reduces the rate of RBO compared with PS placement. Although SEMS placement may increase the risk of pancreatitis or cholecystitis, its effect on postoperative outcomes is comparable to that of PS placement. Given their lower rate of RBO, SEMSs are considered more suitable than PSs for PBD in patients with pancreatic cancer receiving NAC.
  • 3,144 View
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Original Article
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
Clin Endosc 2025;58(5):738-743.   Published online July 7, 2025
DOI: https://doi.org/10.5946/ce.2024.317
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Self-expanding metal stents (SEMS) are used to manage colonic obstruction for palliative decompression or as a bridge to curative surgery and are typically placed under fluoroscopic guidance. This study aimed to quantify the radiation exposure associated with colonic stenting for obstructing colorectal cancer (CRC) and compare it with established diagnostic reference levels (DRLs) for similar fluoroscopy-guided procedures. Secondary outcomes included procedural success rates, stent patency, stoma rates, and complications.
Methods
This retrospective observational study was conducted at a single district general hospital and included all the patients who underwent colonic stenting for CRC between March 2016 and February 2021. Radiation exposure was measured using the kerma-area product (KAP) in µGy*m² and fluoroscopy time in minutes, obtained from existing electronic patient records.
Results
Fifty-two stenting procedures were performed in 47 patients. Median KAP was 1,373.7 (interquartile range [IQR], 584.4–3,185.2) µGy*m², and fluoroscopy time was 8.9 (IQR, 4.4–12.6) minutes. Technical and clinical success was achieved in 86.5% of the cases. In palliative cases, 88.9% of patients maintained stent patency until death. The complications included perforation (5.8%) and stent migration (3.9%). Laparoscopic surgery was performed in 70% of curative cases.
Conclusions
Radiation exposure during colonic stenting is within acceptable ranges and comparable to that of other fluoroscopy-guided procedures. These findings support the listing of colonic stenting in future National DRLs in the United Kingdom.
  • 2,079 View
  • 118 Download
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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.
  • 2,779 View
  • 155 Download
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Review
Role of fully covered metal stents in the management of chronic pancreatitis
Younghun Jeon, Hoonsub So, Sung Jo Bang
Clin Endosc 2025;58(5):646-652.   Published online May 8, 2025
DOI: https://doi.org/10.5946/ce.2024.349
AbstractAbstract PDFPubReaderePub
Chronic pancreatitis (CP), a progressive inflammatory disease that results in irreversible pancreatic damage, is often complicated by ductal strictures and debilitating pain. Fully covered self-expandable metal stents (FCSEMS) have emerged as significant innovations in the endoscopic management of refractory pancreatic duct strictures. This review synthesizes recent evidence highlighting the benefits and limitations of FCSEMS, such as superior patency, reduced need for reinterventions, and effective symptom relief compared to traditional plastic stents, alongside risks, such as stent migration and de novo strictures. A comparison with plastic stents and an algorithm for pancreatic duct stricture management are provided. Regional variations in clinical guidelines from the United States, Europe, Japan, and Korea reflect diverse approaches to integrating FCSEMS into practice. Emerging innovations in stent technology are promising for improving CP management outcomes.
  • 2,610 View
  • 224 Download
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Original Article
Fabrication and mechanical testing of polydioxanone hook cross biodegradable self-expandable enteric stent: impact of fabrication density and mechanical properties of the stent
Tanyaporn Chantarojanasiri, Juthamas Ratanavaraporn, Saran Keeratihattayakorn
Clin Endosc 2025;58(4):586-594.   Published online April 28, 2025
DOI: https://doi.org/10.5946/ce.2024.252
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: The mechanical properties of biodegradable stent when fabricated using different number of pins per row of fabrication has been limited. We compared the radial compressive force of polydioxanone (PDO) stent that was fabricated in hook and cross manner, using 13, 17 and 19 pins per row and measure the radial compressive force and ex vivo deployment.
Methods
The PDO stents fabricated by the in-house aluminum mandrel were tested for radial force using plate compression until the stent achieved 50% strain. The relationship between compression force and %strain was calculated. Ex vivo testing of stent expansion against short segment stricture was performed in a pig small intestine compared between PDO hook cross PDO stent and braided metallic stent.
Results
The stent shortening of 16.40%, 31.20% and 19.24% was observed in 13-, 17- and 19-pin-per-row, respectively. The maximum force to achieve 50% strain were 0.503, 1.168 and 1.008 N for 13, 17 and 19 pins per row, respectively. The stent fabricated using hook and cross pattern demonstrated higher conformability to anatomical stricture when compared with braided stent.
Conclusions
PDO stent fabricated using 17 pins per row demonstrated highest radial force when compared with 13 and 19 pins per row.
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Systematic Review and Meta-analysis
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
  • 3,447 View
  • 181 Download
  • 4 Web of Science
  • 4 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
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  • 4 Web of Science
  • 4 Crossref
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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

Citations to this article as recorded by  
  • Biliary Drainage During Neoadjuvant Chemotherapy in Pancreatic Cancer: Evidence and Practical Recommendations
    Tadahisa Inoue, Masanao Nakamura, Kiyoaki Ito
    Cancers.2026; 18(3): 467.     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
  • 4,871 View
  • 298 Download
  • 2 Web of Science
  • 3 Crossref
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Review
Advances in self-expandable metal stents for endoscopic ultrasound-guided interventions
Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia
Clin Endosc 2024;57(5):588-594.   Published online July 9, 2024
DOI: https://doi.org/10.5946/ce.2023.169
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound (EUS)-guided interventions have evolved rapidly in recent years, with dedicated metal stents playing a crucial role in this process. Specifically, the invention of biflanged short metal-covered stents, including lumen-apposing metal stents (LAMS), and modifications in a variety of tubular self-expandable metal stents (SEMS), have led to innovations in EUS-guided interventions. LAMS or non-LAMS stents are commonly used in the EUS-guided drainage of pancreatic fluid collections, especially in cases of walled-off necrosis. Additionally, LAMS is commonly considered for drainage of the EUS-guided gallbladder or dilated common bile duct and EUS-guided gastroenterostomy. Fully or partially covered tubular SEMS with several new designs are being considered for EUS-guided biliary drainage. This review focuses on advances in SEMS for EUS-guided interventions and discusses related research results.

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  • 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
  • Stent-Over-Sponge (SOS) as a Rescue Technique for Leak Post-Bariatric Surgery: Experience From Hôpital du Sacré-Coeur, Canada
    Majed Alanazi, Bandar Ali, Ibrahim Alonazi, Pierre Y Garneau , Denis Ronald, Radu Pescarus
    Cureus.2025;[Epub]     CrossRef
  • Endoscopic ultrasound-guided gastroenterostomy, with focus on technique and practical tips
    Chi-Ying Yang, Wen-Hsin Huang, Hsing-Hung Cheng
    Clinical Endoscopy.2025; 58(2): 201.     CrossRef
  • Endoscopic ultrasound-guided hepaticogastrostomy without tract dilation using a novel ultra-tapered slim-delivery metallic stent
    Ritsuko Oishi, Haruo Miwa, Kazuki Endo, Hiromi Tsuchiya, Yuichi Suzuki, Kazushi Numata, Shin Maeda
    Endoscopy.2025; 57(S 01): E244.     CrossRef
  • The evolving role of endoscopic ultrasound-guided lumen-apposing metal stents in the management of peri-pancreatic fluid collections
    Ashita Rukmini Vuthaluru, Varun Mehta, Omesh Goyal, Prabhav Mehta, Manjeet Kumar Goyal
    Therapeutic Advances in Gastroenterology.2025;[Epub]     CrossRef
  • Comparative outcome of metal versus plastic stents for the management of walled-off pancreatic necrosis – An updated meta-analysis of randomised studies
    Suprabhat Giri, Prasanna Gore, Gaurav Khatana, Chandramauli Mishra, Sridhar Sundaram, Vaishali Bhardwaj
    Journal of Minimal Access Surgery.2025; 21(4): 331.     CrossRef
  • Exploring lumen-apposing metal stents as a novel approach for managing walled-off necrosis in pediatric acute pancreatitis in Indian cohort: a prospective study
    Varun Mehta, Abhinav Abhinav, Yogesh Kumar Gupta, Manisha Khubber, Ajit Sood, Manjeet Kumar Goyal
    Clinical Endoscopy.2025; 58(4): 595.     CrossRef
  • Advances in EUS-Guided Biliary Drainage for the Management of Pancreatic Cancer
    Thomas Lambin, Sarah Leblanc, Bertrand Napoléon
    Cancers.2025; 17(21): 3428.     CrossRef
  • 7,898 View
  • 414 Download
  • 6 Web of Science
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Original Articles
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
  • 5,130 View
  • 274 Download
  • 2 Web of Science
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Prophylactic endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis induced after metallic stent placement for malignant biliary strictures: a retrospective study in Japan
Fumisato Kozakai, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Kei Ito
Clin Endosc 2024;57(5):647-655.   Published online May 17, 2024
DOI: https://doi.org/10.5946/ce.2023.284
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study evaluated the efficacy of prophylactic gallbladder stents (GBS) during SEMS placement.
Methods
Among 158 patients who underwent SEMS placement for malignant biliary strictures between January 2018 and March 2023, 30 patients who attempted to undergo prophylactic GBS placement before SEMS placement were included.
Results
Technical success was achieved in 21 cases (70.0%). The mean diameter of the cystic duct was more significant in the successful cases (6.5 mm vs. 3.7 mm, p<0.05). Adverse events occurred for 7 patients (23.3%: acute pancreatitis in 7; non-obstructive cholangitis in 1; perforation of the cystic duct in 1 with an overlap), all of which improved with conservative treatment. No patients developed AC when the GBS placement was successful, whereas 25 of the 128 patients (19.5%) without a prophylactic GBS developed AC during the median follow-up period of 357 days (p=0.043). In the multivariable analysis, GBS placement was a significant factor in preventing AC (hazard ratio, 0.61; 95% confidence interval, 0.37–0.99; p=0.045).
Conclusions
GBS may contribute to the prevention of AC after SEMS placement for malignant biliary strictures.

Citations

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  • Risk Factors for Cholecystitis After Self-expandable Metallic Stent Placement for Malignant Distal Biliary Obstruction
    Hashem Albunni, Azizullah Beran, Nwal Hadaki, Mark A. Gromski, Mohammad Al-Haddad
    Journal of Clinical Gastroenterology.2025;[Epub]     CrossRef
  • Risk factors for infection following particle stent placement in obstructive jaundice patients: A retrospective analysis
    Gang Wang, Rui Qi
    Current Problems in Surgery.2025; 67: 101775.     CrossRef
  • Post-endoscopic retrograde cholangiopancreatography cholecystitis: A review of incidence, risk factors, prevention, and management
    Suprabhat Giri, Shivaraj Afzalpurkar, Prasanna Gore, Gaurav Khatana, Saroj Kanta Sahu, Dibya Lochan Praharaj, Bipadabhanjan Mallick, Preetam Nath, Sridhar Sundaram, Manoj Kumar Sahu
    World Journal of Gastrointestinal Endoscopy.2025;[Epub]     CrossRef
  • Role of Prophylactic Endoscopic Gallbladder Stent Placement for Prevention of Acute Cholecystitis in Patients Receiving Stenting for Malignant Biliary Obstruction: A Meta-Analysis
    Zahid Ijaz Tarar, Mustafa Gandhi, Umer Farooq, AhtshamUllah Chaudhry, Gopala K. Konduri, Ahmad Zain, Zohaib Ahmed, Baltej Singh, Nirav Thosani
    Digestive Diseases and Sciences.2025;[Epub]     CrossRef
  • Technical challenges and safety of prophylactic gallbladder stenting with metallic biliary stenting
    Masood Muhammad Karim, Om Parkash
    Clinical Endoscopy.2024; 57(6): 841.     CrossRef
  • 5,103 View
  • 321 Download
  • 4 Web of Science
  • 5 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
  • 5,269 View
  • 231 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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  • 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
  • Emergency presentation of colorectal cancer in Africa: a scoping review
    Simbarashe Chinyowa, Grant Murewanhema, Leolin Katsidzira, Jennifer Moodley, Mike Chirenje, Godfrey Muguti
    BMJ Open.2026; 16(1): e110931.     CrossRef
  • Chitosan Approaches in Colon Cancer Therapy: Understanding its Macromolecular Interactions and Structure-Property Relationships
    Sankha Bhattacharya, Dilpreet Singh
    Journal of Macromolecular Science, Part B.2025; : 1.     CrossRef
  • A rare case of massive colonic distention secondary to undiagnosed colon adenocarcinoma
    Chloe Lahoud, Toni Habib, Michel Al Achkar, Tyler Grantham, Nissar Ahmed
    Medical Reports.2025; 12: 100207.     CrossRef
  • 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
  • Colon stenting in acute colorectal obstruction caused by tumor. Literature review
    Kh. T. Solijonova, I. A. Semenenko, M. E. Shakhbanov, N. Aliyeva
    Siberian journal of oncology.2025; 24(3): 124.     CrossRef
  • Minimally invasive surgery for colorectal cancer emergencies
    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
  • Current mechanisms and techniques for placement of self-expandable metal stents in acute colonic obstruction
    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
    Updates in Surgery.2025;[Epub]     CrossRef
  • Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea
    Hyundam Gu, Suyoung Lee, Sol Kim, Hye-Lim Jang, Da-Woon Choi, Kyu Seok Kim, Yu Ri Shin, Dae Young Cheung, Bo-In Lee, Jin Il Kim, Han Hee Lee
    Clinical Endoscopy.2024; 57(6): 790.     CrossRef
  • Self-Expandable Metal Stents for Obstructing Colon Cancer and Extracolonic Cancer: A Review of Latest Evidence
    Pedro Marílio Cardoso, Eduardo Rodrigues-Pinto
    Cancers.2024; 17(1): 87.     CrossRef
  • 24,982 View
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  • 13 Web of Science
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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.

Citations

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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
  • 9,177 View
  • 463 Download
  • 3 Web of Science
  • 4 Crossref
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Systematic Review and Meta-analysis
Stricturing Crohn's disease: what is the role of endoscopic stenting? A systematic review
Giorgia Burrelli Scotti, Roberto Lorenzetti, Annalisa Aratari, Antonietta Lamazza, Enrico Fiori, Claudio Papi, Stefano Festa
Clin Endosc 2023;56(6):726-734.   Published online October 24, 2023
DOI: https://doi.org/10.5946/ce.2023.059
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic stenting for stricturing Crohn's disease (CD) is an emerging treatment that achieves more persistent dilatation of the stricture over time than endoscopic balloon dilatation (EBD). We aimed to explore the efficacy and safety of stenting for the treatment of CD strictures.
Methods
A systematic electronic literature search was performed (PROSPERO; no. CRD42022308033). The primary outcomes were technical success, efficacy, complication rate, and the need for further interventions due to reobstruction. The outcomes of partially covered self-expanding metal stents (PCSEMS) with scheduled retrieval after seven days were also analyzed.
Results
Eleven eligible studies were included in the review. Overall, 173 patients with CD were included in this study. Mean percentage of technical success was 95% (range, 80%–100%), short-term efficacy was 100% in all studies, and long-term efficacy was 56% (range, 25%–90%). In patients with a scheduled PCSEMS retrieval, the long-term efficacy was 76% (range, 59%–90%), the mean complication rate was 35% (range, 15%–57%), and the major complication rate was 11% (range, 0%–29%).
Conclusions
Endoscopic stenting with scheduled PCSEMS retrieval may be considered a feasible second-line treatment for short CD strictures to postpone surgery. However, larger head-to-head prospective studies are needed to understand the role of stenting as an alternative or additional treatment to EBD in CD.

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  • Role of Endoscopy in Inflammatory Bowel Disease: What Every Gastroenterologist Should Know
    Gursimran S. Kochhar, Claudia Dziegielewski, Jason N. Schairer, Raymond K. Cross
    American Journal of Gastroenterology.2025; 120(11): 2502.     CrossRef
  • Endoscopic approaches to small bowel strictures
    Katelin DURHAM, Rami EL ABIAD, Mouen KHASHAB
    Minerva Gastroenterology.2025;[Epub]     CrossRef
  • Perioperative Considerations for the Surgical Treatment of Crohn’s Disease with Discussion on Surgical Antibiotics Practices and Impact on the Gut Microbiome
    Shelbi Olson, Lindsay Welton, Cyrus Jahansouz
    Antibiotics.2024; 13(4): 317.     CrossRef
  • 5,859 View
  • 211 Download
  • 3 Web of Science
  • 3 Crossref
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Original Articles
Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer
Iatagan R. Josino, Bruno C. Martins, Andressa A. Machado, Gustavo R. de A. Lima, Martin A. C. Cordero, Amanda A. M. Pombo, Rubens A. A. Sallum, Ulysses Ribeiro Jr, Todd H. Baron, Fauze Maluf-Filho
Clin Endosc 2023;56(6):761-768.   Published online July 25, 2023
DOI: https://doi.org/10.5946/ce.2022.297
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMS-ERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer.
Methods
This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study.
Results
Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15–5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01–4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26–0.85; p=0.01). No difference was observed in overall survival.
Conclusions
The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.

Citations

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  • Efficacy and safety of self-expanding metal stents in advanced esophageal cancer: a 12-year analysis in a referral center
    Bruno Costa Martins, Julia Mayumi Gregorio, Rafael Utimura Sueta, Déborah Marques Centeno, Pastor Joaquín Ortiz Mendieta, Marcelo Simas de Lima, Renata Nobre Moura, Luciano Lenz, Caterina Maria Pia Simioni Pennacchi, Andressa Abnader Machado, Rubens Anton
    Diseases of the Esophagus.2025;[Epub]     CrossRef
  • Clinical Implications of Circulating Tumor Cells in Patients with Esophageal Squamous Cell Carcinoma: Cancer-Draining Blood Versus Peripheral Blood
    Dong Chan Joo, Gwang Ha Kim, Hoseok I, Su Jin Park, Moon Won Lee, Bong Eun Lee
    Cancers.2024; 16(16): 2921.     CrossRef
  • How to reduce fistula formation after self-expandable metallic stent insertion for treating malignant esophageal stricture?
    Kwang Bum Cho
    Clinical Endoscopy.2023; 56(6): 735.     CrossRef
  • 4,570 View
  • 131 Download
  • 3 Web of Science
  • 3 Crossref
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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
  • 5,135 View
  • 164 Download
  • 3 Web of Science
  • 4 Crossref
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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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  • 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
  • Prevention of stent migration of covered self-expandable metal stents in distal malignant biliary obstruction: a review of literature
    Jung Won Chun, Woo Hyun Paik, Sang Myung Woo, Jin Ho Choi, In Rae Cho, Woo Jin Lee, Ji Kon Ryu, Yong-Tae Kim, Sang Hyub Lee
    Gastroenterology Report.2025;[Epub]     CrossRef
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    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
  • 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
  • Understanding mechanical properties of biliary metal stents for wise stent selection
    Seok Jeong
    Clinical Endoscopy.2023; 56(5): 592.     CrossRef
  • 7,276 View
  • 127 Download
  • 5 Web of Science
  • 6 Crossref
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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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  • Role of Endoscopic Ultrasound‐guided Gastroenterostomy for Benign Gastric Outlet Obstruction
    Suprabhat Giri, Saroj Kanta Sahu, Gaurav Khatana, Prasanna Gore, Preetam Nath, Bipadabhanjan Mallick, Jimmy Narayan, Aditya Kale, Sridhar Sundaram
    DEN Open.2026;[Epub]     CrossRef
  • 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
  • Benign biliary stricture caused by transduodenal lumen-apposing metal stent placement for pancreatic acute necrotic collection
    Shuhei Shintani, Takuya Okamoto, Kosuke Hiroe, Hidenori Kimura, Hiroto Inoue, Atsushi Nishida, Osamu Inatomi
    International Journal of Gastrointestinal Intervention.2025; 14(1): 24.     CrossRef
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    Chi-Ying Yang, Wen-Hsin Huang, Hsing-Hung Cheng
    Clinical Endoscopy.2025; 58(2): 201.     CrossRef
  • EUS guided gastrojejunostomy: techniques and outcomes
    Sachin Hosahally Jayanna, Surinder Singh Rana
    Expert Review of Gastroenterology & Hepatology.2025; 19(7): 745.     CrossRef
  • Standardizing Success and Troubleshooting in EUS-Guided Gastroenterostomy
    Giuseppe Vanella, Francesco Frigo, Michiel Bronswijk, Roy L.J. van Wanrooij, Yen-I Chen, Kenneth F. Binmoeller, Manuel Perez-Miranda, Roberto Leone, Prabhleen Chahal, Shannon M. Chan, Manol Jovani, Amy Tyberg, Enrique Pérez-Cuadrado-Robles, Reem Sharaiha,
    Journal of Clinical Gastroenterology.2025;[Epub]     CrossRef
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    Miaomiao Zhang, Jianqi Mao, Jia Ma, Shuqin Xu, Yi Lyu, Xiaopeng Yan
    BMC Gastroenterology.2024;[Epub]     CrossRef
  • Revealing Insights: A Comprehensive Overview of Gastric Outlet Obstruction Management, with Special Emphasis on EUS-Guided Gastroenterostomy
    Dimitrios Ziogas, Thomas Vasilakis, Christina Kapizioni, Eleni Koukoulioti, Georgios Tziatzios, Paraskevas Gkolfakis, Antonio Facciorusso, Ioannis S. Papanikolaou
    Medical Sciences.2024; 12(1): 9.     CrossRef
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    Sridhar Sundaram, Suprabhat Giri, Kenneth Binmoeller
    Indian Journal of Gastroenterology.2024; 43(5): 886.     CrossRef
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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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    Ricardo Rangel de Paula PESSOA, Alexandre Moraes BESTETTI, Victor Lira de OLIVEIRA, Wladimir Campos de ARAUJO, Simone GUARALDI, Rodrigo Roda RODRIGUES SILVA, Francisco Antonio Araujo OLIVEIRA, Maria Sylvia Ierardi RIBEIRO, Fred Olavo Aragão Andrade CARNEI
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    Mihai Rimbaș, Kar Wai Lau, Giulia Tripodi, Gianenrico Rizzatti, Alberto Larghi
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  • 144 Download
  • 10 Web of Science
  • 13 Crossref
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Case Reports
Refractory benign biliary stricture due to chronic pancreatitis in two patients treated using endoscopic ultrasound-guided choledochoduodenostomy fistula creation: case reports
Sho Ishikawa, Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Takafumi Yanaidani
Clin Endosc 2024;57(1):122-127.   Published online May 16, 2023
DOI: https://doi.org/10.5946/ce.2022.149
AbstractAbstract PDFPubReaderePub
Benign biliary stricture (BBS) is a complication of chronic pancreatitis (CP). Despite endoscopic biliary stenting, some patients do not respond to treatment, and they experience recurrent cholangitis. We report two cases of CP with refractory BBS treated using endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) fistula creation. A 50-year-old woman and a 60-year-old man both presented with obstructive jaundice secondary to BBS due to alcoholic CP. They underwent repeated placement of a fully covered self-expandable metal stent for biliary strictures. However, the strictures persisted, causing repeated episodes of cholangitis. Therefore, an EUS-CDS was performed. The stents were eventually removed and the patients became stent-free. These fistulas have remained patent without cholangitis for more than 2.5 years. Fistula creation using EUS-CDS is an effective treatment option for BBS.

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  • Endoscopic Ultrasound-Guided Lumen-Apposing Metal Stent Drainage in Benign Pancreatobiliary and Gastrointestinal Disease: Evolving Techniques and Clinical Outcomes
    Filippo Antonini, Marco Valvano, Edoardo Troncone, Domenico Galasso, Amedeo Montale, Mario Capasso, Matteo Marasco, Benedetto Mangiavillano, Giovanna Del Vecchio Blanco, Mauro Dalla Libera, Antonella Scarcelli, Antonio Facciorusso, Lorenzo Fuccio, Massimi
    Diagnostics.2026; 16(4): 522.     CrossRef
  • Endoscopic ultrasound-guided choledochoduodenojejunostomy via afferent limb: a novel approach for hepaticojejunostomy stricture
    Nozomi Okuno, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Shimpei Matsumoto, Hiroki Koda, Tomoki Ogata
    Endoscopy.2025; 57(S 01): E1407.     CrossRef
  • Forward viewing liner echoendoscopy for therapeutic interventions
    Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara
    Clinical Endoscopy.2024; 57(2): 175.     CrossRef
  • Successful sequential management of traumatic choledochal leak and stenosis in children using ERCP: a case report and literature review
    Cuo Leng, Yu Zou, Zhoujian Yang, Xinhua Zhao
    Frontiers in Medicine.2024;[Epub]     CrossRef
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  • 212 Download
  • 3 Web of Science
  • 4 Crossref
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Gastric cancer presenting with ramucirumab-related gastrocolic fistula successfully managed by colonic stenting: a case report
Hiroki Fukuya, Yoichiro Iboshi, Masafumi Wada, Yorinobu Sumida, Naohiko Harada, Makoto Nakamuta, Hiroyuki Fujii, Eikichi Ihara
Clin Endosc 2023;56(6):812-816.   Published online May 11, 2023
DOI: https://doi.org/10.5946/ce.2022.117
AbstractAbstract PDFPubReaderePub
We report a rare case of gastric cancer presenting with a gastrocolic fistula during ramucirumab and paclitaxel combination therapy that was successfully managed with colonic stenting. A 75-year-old man was admitted to our hospital with the chief complaint of melena. Esophagogastroduodenoscopy revealed a large ulcerated tumor in the lower stomach, judged by laparoscopy as unresectable (sT4bN1M0). After four cycles of first-line chemotherapy with S-1 plus oxaliplatin, the patient showed disease progression, and second-line therapy with ramucirumab and paclitaxel was started. At the end of the third cycle, the patient had gastric antral stenosis, which necessitated the placement of a gastroduodenal stent. When the patient complained of diarrhea 10 days later, esophagogastroduodenoscopy revealed a fistula between the greater curvature of the stomach and the transverse colon. The fistula was covered by double colonic stenting, with a covered metal stent placed within an uncovered metal stent, after which leakage from the stomach to the colon stopped.

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  • Ramucirumab

    Reactions Weekly.2024; 1989(1): 189.     CrossRef
  • Metastatic bladder cancer forming a sigmoidorectal fistula after enfortumab vedotin therapy: a case report
    Shinji Tamada, Daiki Ikarashi, Naoki Yanagawa, Moe Toyoshima, Kenta Takahashi, Tomohiko Matsuura, Shigekatsu Maekawa, Renpei Kato, Mitsugu Kanehira, Ryo Takata, Wataru Obara
    Frontiers in Oncology.2023;[Epub]     CrossRef
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  • 170 Download
  • 1 Web of Science
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Original Articles
The efficacy of a novel integrated outside biliary stent and nasobiliary drainage catheter system for acute cholangitis: a single center pilot study
Naosuke Kuraoka, Tetsuro Ujihara, Hiromi Kasahara, Yuto Suzuki, Shun Sakai, Satoru Hashimoto
Clin Endosc 2023;56(6):795-801.   Published online April 11, 2023
DOI: https://doi.org/10.5946/ce.2022.289
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic biliary drainage is the gold standard treatment for cholangitis. The two methods of biliary drainage are endoscopic biliary stenting and nasobiliary drainage. A novel integrated outside biliary stent and nasobiliary drainage catheter system (UMIDAS NB stent; Olympus Medical Systems) was recently developed. In this study, we evaluated the efficacy of this stent in the treatment of cholangitis caused by common bile duct stones or distal bile duct strictures.
Methods
We conducted a retrospective pilot study by examining the medical records of patients who required endoscopic biliary drainage for cholangitis due to common bile duct stones or distal bile duct strictures, and who were treated with a UMIDAS NB stent, between December 2021 and July 2022.
Results
Records of 54 consecutive patients were reviewed. Technical and clinical success rates were 47/54 (87.0%) and 52/54 (96.3%), respectively. Adverse events were observed in 12 patients, with six patients experiencing pancreatitis as an adverse event, following endoscopic retrograde cholangiopancreatography (ERCP). Regarding late adverse events, five cases of biliary stent migration into the bile duct were observed. Disease-related death occurred in one patient.
Conclusions
The outside-type UMIDAS NB stent is an efficacious new method for biliary drainage and can be applied to many indications.

Citations

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  • Predicting unplanned extubation risk in patients with endoscopic nasobiliary drainage
    Wen-Jing Li, Na Mi, Xi Huang, Chang-Sha Liu, Shu-Ting Zhang, Yu Liao, Yan Yu
    World Journal of Gastrointestinal Surgery.2025;[Epub]     CrossRef
  • Current Perspectives on Endoscopic Nasobiliary Drainage: Optimizing Patient Management and Preventing Complications
    Angelica Toppeta, Mattia Corradi, Beatrice Mantia, Adelaide Randazzo, Mario Schettino, Stefania De Lisi, Stefania Carmagnola, Raffaele Salerno
    Journal of Clinical Medicine.2025; 15(1): 169.     CrossRef
  • 5,650 View
  • 153 Download
  • 2 Web of Science
  • 2 Crossref
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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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    Toshio Fujisawa, Masao Toki, Kei Saito, Yuta Hasegawa, Eisuke Iwasaki, Michihiro Saito, Katsuya Kitamura, Ryosuke Tonozuka, Takao Itoi, Ken Ito, Keiko Kaneko, Naminatsu Takahara, Tadakazu Hisamatsu, Hiroyuki Isayama
    DEN Open.2026;[Epub]     CrossRef
  • Late-onset Rupture of the Intrahepatic Pseudoaneurysm Developed by Endoscopic Ultrasonography-guided Hepaticogastrostomy: A Case Report and Literature Review
    Tesshin Ban, Yoshimasa Kubota, Takuya Takahama, Shun Sasoh, Satoshi Tanida, Makoto Nakamura, Tomoaki Ando, Takashi Joh
    Internal Medicine.2025; 64(2): 217.     CrossRef
  • Endoscopic biliary drainage for distal bile duct obstruction due to pancreatic cancer
    Masahiro Itonaga, Masayuki Kitano
    Clinical Endoscopy.2025; 58(1): 40.     CrossRef
  • Evaluation of the effect of metal stents on dose perturbation in the carbon beam irradiation field
    Yuya Miyasaka, Tetsuya Ishizawa, Yoshihito Nawa, Hikaru Souda, Shohei Kawashiro, Hongbo Chai, Miyu Ishizawa, Hiraku Sato, Takeo Iwai
    Journal of Applied Clinical Medical Physics.2025;[Epub]     CrossRef
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    Dae Sung Ryu, Hyeonseung Lee, Seung Jin Eo, Ji Won Kim, Yuri Kim, Seokin Kang, Jin Hee Noh, Sanghee Lee, Jung-Hoon Park, Kun Na, Do Hoon Kim
    Biomaterials.2025; 320: 123265.     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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    Stuart K. Amateau
    Gastrointestinal Endoscopy.2025; 101(6): 1118.     CrossRef
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    Sakue Masuda, Chikamasa Ichita, Kazuya Koizumi
    World Journal of Gastrointestinal Endoscopy.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
    Gastroenterology Report.2025;[Epub]     CrossRef
  • Effect of Silk-Fibroin-Coated Polydioxanone Biodegradable Enteric Stents on the Degradation Rate
    Tanyaporn Chantarojanasiri, Saran Keeratihattayakorn, Sarinthorn Boonkruepan, Jirasak Jitpibull, Juthamas Ratanavaraporn
    ACS Omega.2025; 10(26): 28243.     CrossRef
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    Tanyaporn Chantarojanasiri, Juthamas Ratanavaraporn, Saran Keeratihattayakorn
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    Jiaywei Tsauo, Yan Fu, Yue Liu, Xiaowu Zhang, He Zhao, Xiao Li
    European Radiology Experimental.2024;[Epub]     CrossRef
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    Hiroki Nakagawa, Tsuyoshi Takeda, Takeshi Okamoto, Takafumi Mie, Akiyoshi Kasuga, Takashi Sasaki, Masato Ozaka, Takahisa Matsuda, Yoshinori Igarashi, Naoki Sasahira
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    Yoshihiro Ueda, Kenji Ikezawa, Tomohiro Sagawa, Masaru Isono, Shingo Ohira, Masayoshi Miyazaki, Ryoji Takada, Takuo Yamai, Kazuyoshi Ohkawa, Teruki Teshima, Koji Konishi
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  • Radial force and wire structure determine the onset of covered self‐expandable metal stent migration in endoscopic ultrasound‐guided hepaticogastrostomy: Measurement of sliding‐resistance force using a porcine model
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    Yuechuan Li, Kunshan Yuan, Chengchen Deng, Hui Tang, Jinxuan Wang, Xiaozhen Dai, Bing Zhang, Ziru Sun, Guiying Ren, Haijun Zhang, Guixue Wang
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  • How to reduce fistula formation after self-expandable metallic stent insertion for treating malignant esophageal stricture?
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Close layer
Covered self-expandable metallic stents versus plastic stents for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction
Taro Shibuki, Kei Okumura, Masanari Sekine, Ikuhiro Kobori, Aki Miyagaki, Yoshihiro Sasaki, Yuichi Takano, Yusuke Hashimoto
Clin Endosc 2023;56(6):802-811.   Published online April 5, 2023
DOI: https://doi.org/10.5946/ce.2022.211
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Covered self-expandable metallic stents (cSEMS) have become popular for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting (EUS-HGS). We compared the time to recurrent biliary obstruction (TRBO), complications, and reintervention rates between EUS-HGS using plastic stent (PS) and cSEMS in patients with unresectable malignancies at multicenter institutions in Japan.
Methods
Patients with unresectable malignant biliary obstruction who underwent EUS-HGS between April 2015 and July 2020 at any of the six participating facilities were enrolled. Primary endpoint: TRBO; secondary endpoints: rate of complications other than recurrent biliary obstruction and technical success rate of reintervention were evaluated.
Results
PS and cSEMS were used for EUS-HGS in 109 and 43 patients, respectively. The TRBO was significantly longer in the cSEMS group than in the PS group (646 vs. 202 days). Multivariate analysis identified two independent factors associated with a favorable TRBO: combined EUS-guided antegrade stenting with EUS-HGS and the use of cSEMS. No significant difference was observed in the rate of complications other than recurrent biliary obstruction between the two groups. The technical success rate of reintervention was 85.7% for PS and 100% for cSEMS (p=0.309).
Conclusions
cSEMS might be a better option for EUS-HGS in patients with unresectable malignancies, given the longer TRBO.

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    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
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    Amira A A Othman
    World Journal of Gastrointestinal Endoscopy.2026;[Epub]     CrossRef
  • Metal stent versus plastic stent in endoscopic ultrasound‐guided hepaticogastrostomy for unresectable malignant biliary obstruction: Large single‐center retrospective comparative study
    Daiki Yamashige, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Yasuhiro Komori, Masaru Kuwada, Soma Fukuda, Shin Yagi, Kohei Okamoto, Daiki Agarie, Mark Chatto, Chigusa Morizane, Hideki Ueno, Shunsuke Sugawara, Miyuki Sone, Yutaka Saito, Takuji Okusaka
    Digestive Endoscopy.2025; 37(1): 117.     CrossRef
  • Impact of self-expandable metal stent deployment site on stent dysfunction during EUS-guided hepaticogastrostomy
    Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Jun Sakamoto, Masanori Yamada, Masahiro Yamamura, Yuki Uba, Mitsuki Tomita, Nobuhiro Hattori, Junichi Nakamura, Kimi Bessho, Hiroki Nishikawa
    Endoscopic Ultrasound.2025; 14(1): 26.     CrossRef
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    Otavio Cosendey Martins, Vanio Antunes, Marcelo Cristalli Pacheco da Costa, Cynthia Florêncio de Mesquita, Tulio L. Correa, Matheus Vanzin Fernandes, Natália Junkes Milioli, Stefano Baraldo
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    Takeshi Ogura, Saori Ueno, Akitoshi Hakoda, Atsushi Okuda, Nobu Nishioka, Jun Sakamoto, Jun Matsuno, Yuki Uba, Mitsuki Tomita, Nobuhiro Hattori, Junichi Nakamura, Kimi Bessho, Taro Iwatsubo, Toshifumi Yamaguchi, Ahmad F. Aboelezz, Hiroki Nishikawa
    United European Gastroenterology Journal.2025; 13(8): 1429.     CrossRef
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    Kaixuan Wang, Jiayi Ma, Jun Li, Zhaoshen Li, Siyu Sun, Zhendong Jin
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    BMJ Open.2025; 15(10): e106543.     CrossRef
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    Mitsuru Sugimoto, Yuki Nakajima, Yutaro Takeda, Yuki Sato, Tadayuki Takagi, Rei Suzuki, Hiroyuki Asama, Hiroshi Shimizu, Kentaro Sato, Rei Ohira, Jun Nakamura, Tsunetaka Kato, Takumi Yanagita, Mitsuru Otsuka, Takuto Hikichi, Hiromasa Ohira
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    Kambiz Kadkhodayan, Shayan Irani
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    Endoscopy International Open.2024; 12(09): E1065.     CrossRef
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    Panagiotis Paraskevopoulos, Mahmoud Obeidat, Dániel Bednárik, Petrana Martinekova, Dániel Sándor Veres, Nándor Faluhelyi, Alexandra Mikó, Péter Mátrai, Péter Hegyi, Bálint Erőss
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    Hyung Ku Chon, Shayan Irani, Tae Hyeon Kim
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    Samuel Han, Georgios I. Papachristou
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Clinical outcomes of permanent stenting with endoscopic ultrasound gallbladder drainage
Eisuke Suzuki, Yuji Fujita, Kunihiro Hosono, Yuji Koyama, Seitaro Tsujino, Takuma Teratani, Atsushi Nakajima, Nobuyuki Matsuhashi
Clin Endosc 2023;56(5):650-657.   Published online April 5, 2023
DOI: https://doi.org/10.5946/ce.2022.190
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound gallbladder drainage (EUS-GBD) is gaining attention as a treatment method for cholecystitis. However, only a few studies have assessed the outcomes of permanent stenting with EUS-GBD. Therefore, we evaluated the clinical outcomes of permanent stenting using EUS-GBD.
Methods
This was a retrospective, single-center cohort study. The criteria for EUS-GBD at our institution are a high risk for surgery, inability to perform surgery owing to poor performance status, and inability to obtain consent for emergency surgery. EUS-GBD was performed using a 7-Fr double-pigtail plastic stent with a dilating device. The primary outcomes were the recurrence-free rate of cholecystitis and the late-stage complication-avoidance rate. Secondary outcomes were technical success, clinical success, and procedural adverse events.
Results
A total of 41 patients were included in the analysis. The median follow-up period was 168 (range, 10–1,238) days. The recurrence-free and late-stage complication-avoidance rates during the follow-up period were 95% (38 cases) and 90% (36 cases), respectively. There were only two cases of cholecystitis recurrence during the study period.
Conclusions
EUS-GBD using double-pigtail plastic stent was safe and effective with few complications, even in the long term, in patients with acute cholecystitis.

Citations

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  • Effectiveness of Preoperative Endoscopic Ultrasonography-guided Gallbladder Drainage for Acute Calculous Cholecystitis
    Atsuki NAGAO, Naoki KOBAYASHI, Daichi JINGU, Marina JIMBA, Jun SAKUMA, Motomu TANAKA, Masahi MOMIYAMA, Kentaro NAKAJIMA, Yuji KOYAMA, Yuji FUJITA, Tamaki NOIE, Shouichi SATO
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    Hyung Ku Chon, Yun Chae Lee, Tae Hyeon Kim, Seung Ok Lee, Seong-Hun Kim
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Systematic Review and Meta-analysis
Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis
Suprabhat Giri, Shivaraj Afzalpurkar, Sumaswi Angadi, Jijo Varghese, Sridhar Sundaram
Clin Endosc 2023;56(2):169-179.   Published online February 15, 2023
DOI: https://doi.org/10.5946/ce.2022.282
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)–guided tissue acquisition from pancreatic lesions.
Methods
A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-TA in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis.
Results
Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52–0.90) and strict criteria (OR, 0.58; 95% CI, 0.46–0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76–1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents.
Conclusions
The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.

Citations

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    Mitali Madhumita Rath, Prajna Anirvan, Jijo Varghese, Tara Prasad Tripathy, Ranjan K Patel, Manas Kumar Panigrahi, Suprabhat Giri
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    Abhirup Chatterjee, Jimil Shah
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Review
Optimal endoscopic drainage strategy for unresectable malignant hilar biliary obstruction
Itaru Naitoh, Tadahisa Inoue
Clin Endosc 2023;56(2):135-142.   Published online January 5, 2023
DOI: https://doi.org/10.5946/ce.2022.150
AbstractAbstract PDFPubReaderePub
Endoscopic biliary drainage strategies for managing unresectable malignant hilar biliary obstruction differ in terms of stent type, drainage area, and deployment method. However, the optimal endoscopic drainage strategy remains unclear. Uncovered self-expandable metal stents (SEMS) are the preferred type because of their higher functional success rate, longer time to recurrent biliary obstruction (RBO), and fewer cases of reintervention than plastic stents (PS). Other PS subtypes and covered SEMS, which feature a longer time to RBO than PS, can be removed during reintervention for RBO. Bilateral SEMS placement is associated with a longer time to RBO and a longer survival time than unilateral SEMS placement. Unilateral drainage is acceptable if a drainage volume of greater than 50% of the total liver volume can be achieved. In terms of deployment method, no differences were observed in clinical outcomes between side-by-side (SBS) and stent-in-stent deployment. Simultaneous SBS boasts a shorter procedure time and higher technical success rate than sequential SBS. This review of previous studies aimed to clarify the optimal endoscopic biliary drainage strategy for unresectable malignant hilar biliary obstruction.

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Original Articles
The feasibility of percutaneous transhepatic gallbladder aspiration for acute cholecystitis after self-expandable metallic stent placement for malignant biliary obstruction: a 10-year retrospective analysis in a single center
Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Masayuki Hijioka, Ken Kawabe, Naohiko Harada, Makoto Nakamuta, Takamasa Oono, Yoshihiro Ogawa
Clin Endosc 2022;55(6):784-792.   Published online October 21, 2022
DOI: https://doi.org/10.5946/ce.2021.244
AbstractAbstract PDFPubReaderePub
Background
/Aims: Patients with acute cholecystitis (AC) after metallic stent (MS) placement for malignant biliary obstruction (MBO) have a high surgical risk. We performed percutaneous transhepatic gallbladder aspiration (PTGBA) as the first treatment for AC. We aimed to identify the risk factors for AC after MS placement and the poor response factors of PTGBA.
Methods
We enrolled 401 patients who underwent MS placement for MBO between April 2011 and March 2020. The incidence of AC was 10.7%. Of these 43 patients, 37 underwent PTGBA as the first treatment. The patients’ responses to PTGBA were divided into good and poor response groups.
Results
There were 20 patients in good response group and 17 patients in poor response group. Risk factors for cholecystitis after MS placement included cystic duct obstruction (p<0.001) and covered MS (p<0.001). Cystic duct obstruction (p=0.003) and uncovered MS (p=0.011) demonstrated significantly poor responses to PTGBA. Cystic duct obstruction is a risk factor for cholecystitis and poor response factor for PTGBA, whereas covered MS is a risk factor for cholecystitis and an uncovered MS is a poor response factor of PTGBA for cholecystitis.
Conclusions
The onset and poor response factors of AC after MS placement were different between covered and uncovered MS. PTGBA can be a viable option for AC after MS placement, especially in patients with covered MS.

Citations

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  • Post-endoscopic retrograde cholangiopancreatography cholecystitis: A review of incidence, risk factors, prevention, and management
    Suprabhat Giri, Shivaraj Afzalpurkar, Prasanna Gore, Gaurav Khatana, Saroj Kanta Sahu, Dibya Lochan Praharaj, Bipadabhanjan Mallick, Preetam Nath, Sridhar Sundaram, Manoj Kumar Sahu
    World Journal of Gastrointestinal Endoscopy.2025;[Epub]     CrossRef
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    Sung-Jo Bang
    Clinical Endoscopy.2024; 57(1): 56.     CrossRef
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    Tadahisa Inoue, Rena Kitano, Mayu Ibusuki, Kazumasa Sakamoto, Satoshi Kimoto, Yuji Kobayashi, Yoshio Sumida, Yukiomi Nakade, Kiyoaki Ito, Masashi Yoneda
    Digestive Diseases and Sciences.2023; 68(12): 4449.     CrossRef
  • The writing on the wall: self-expandable stents for endoscopic ultrasound-guided hepaticogastrostomy?
    Hyung Ku Chon, Shayan Irani, Tae Hyeon Kim
    Clinical Endoscopy.2023; 56(6): 741.     CrossRef
  • How should a therapeutic strategy be constructed for acute cholecystitis after self-expanding metal stent placement for malignant biliary obstruction?
    Mamoru Takenaka, Masatoshi Kudo
    Clinical Endoscopy.2022; 55(6): 757.     CrossRef
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  • 136 Download
  • 5 Web of Science
  • 5 Crossref
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A prospective study of fully covered self-expandable metal stents for refractory benign pancreatic duct strictures
Bhavik Bharat Shah, Gajanan Ashokrao Rodge, Usha Goenka, Shivaraj Afzalpurkar, Mahesh Kumar Goenka
Clin Endosc 2022;55(6):793-800.   Published online April 4, 2022
DOI: https://doi.org/10.5946/ce.2021.211
AbstractAbstract PDFPubReaderePub
Background
/Aims: Fully covered self-expanding metal stents (FCSEMSs) are a relatively novel option for treating painful main pancreatic duct refractory strictures in patients with chronic pancreatitis. Herein, we aimed to assess the efficacy, feasibility, and safety of FCSEMSs in this patient group.
Methods
This prospective single-center study included patients who underwent endoscopic retrograde pancreatography with FCSEMS placement. The primary endpoints were the technical and clinical success rates. A reduction in visual analog scale pain score of >50% compared with that before stent placement was defined as clinical success. Secondary endpoints were resolution of pancreatic strictures on fluoroscopy during endoscopic retrograde pancreatography and the development of stent-related adverse events.
Results
Thirty-six patients were included in the analysis. The technical success rate was 100% (n=36) and the clinical success rate was 86.1% (n=31). There was a significant increase in stricture diameter from 1.7 mm to 3.5 mm (p<0.001) after stent removal. The mean visual analog scale pain score showed statistically significant improvement. At 19 months of follow-up, 55.6% of the patients were asymptomatic. Stent migration (16.7%), intolerable abdominal pain (8.3%), development of de novo strictures (8.3%), and mild pancreatitis (2.8%) were the most common adverse events.
Conclusions
FCSEMS placement showed good technical and clinical success rates for achieving pain relief in patients with refractory main pancreatic duct strictures.

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  • Self-expanding metallic stent for refractory pancreatic duct stricture in chronic pancreatitis: A prospective follow-up study
    Praveer Rai, Pankaj Kumar, Ashok Kumar, Sana Asari, Kartik Agarwal, Mayank, Ravi V. Krishna Kishore, Prabhaker Mishra
    Indian Journal of Gastroenterology.2025; 44(6): 854.     CrossRef
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    Huijuan Fan, Nan Li, Xingguang Zhang, Wei Xu, Wencheng Zhang, Yangjuan Ding, Lingjian Li, Taotao Liu, Shihai Xia
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    Anthony M. Rainho, Owen C. Battel, Vanessa M. Shami
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    Younghun Jeon, Hoonsub So, Sung Jo Bang
    Clinical Endoscopy.2025; 58(5): 646.     CrossRef
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    Jing Li, Yanwei Lv, Zheng Chen, Jiulong Zhao, Shige Wang
    Gels.2024; 10(2): 125.     CrossRef
  • Fully Covered Self-expandable Metallic Stents for Refractory Benign Pancreatic Duct Strictures: A Systematic Review and Meta-analysis
    Gajanan Rodge, Suprabhat Giri, Kailash Kolhe, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram, Aditya Kale
    Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(5): 529.     CrossRef
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    Mikael Parhiala, Camilla Nøjgaard, Andreas Bartholdy, Anne Waage, Povilas Ignatavičius, Trond Engjom, Georg Dimcevski, Ingrid Kvåle Nordaas, Evangelos Kalaitzakis, Asbjørn M. Drewes, Amer Hadi, Søren S. Olesen, Jakob L. Poulsen, Johanna Laukkarinen
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    Jin Hui Yi, Zhao Shen Li, Liang Hao Hu
    Journal of Digestive Diseases.2022; 23(12): 675.     CrossRef
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Endoscopic internal drainage with double pigtail stents for upper gastrointestinal anastomotic leaks: suitable for all cases?
Bin Chet Toh, Jingli Chong, Baldwin PM Yeung, Chin Hong Lim, Eugene KW Lim, Weng Hoong Chan, Jeremy TH Tan
Clin Endosc 2022;55(3):401-407.   Published online January 6, 2022
DOI: https://doi.org/10.5946/ce.2021.197
AbstractAbstract PDFPubReaderePub
Background
/Aims: Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population.
Methods
From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion.
Results
Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining 10 patients, nine did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the 1st week and a soft diet in the 2nd week. One patient was allowed clear oral feeds on the 8th day after DPT insertion.
Conclusions
Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.

Citations

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    Jordan Gipe, Alexandra Agathis, SQ Nguyen
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    Ji Yoon Kim, Hyunsoo Chung
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    Muaaz Masood, Donald E. Low, Shanley B. Deal, Richard A. Kozarek
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Focused Review Series: Endoscopic Management of Postoperative Gastrointestinal Complication: What’s New?
Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome
Hideyuki Shiomi, Arata Sakai, Ryota Nakano, Shogo Ota, Takashi Kobayashi, Atsuhiro Masuda, Hiroko Iijima
Clin Endosc 2021;54(6):810-817.   Published online November 15, 2021
DOI: https://doi.org/10.5946/ce.2021.234
AbstractAbstract PDFPubReaderePub
Afferent loop syndrome (ALS) is a mechanical obstruction of the afferent limbs after gastrectomy with gastrojejunostomy reconstruction. Patients with cancer recurrence require immediate and less invasive treatment because of their poor condition. Percutaneous transhepatic/transluminal drainage (PTD) and endoscopic enteral stenting offer reasonable palliative treatment for malignant ALS but are not fully satisfactory in terms of patient quality of life (QoL) and stent patency. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using a lumen-apposing metal stent may address these shortcomings. Clinical data from 11 reports showed that all patients who had undergone EUS-GE had positive technical and clinical outcomes. The adverse event rate was 11.4%, including only mild or moderate abdominal pain, with no severe adverse events. Indirect comparative studies indicated that patients who had undergone EUS-GE had a significantly superior QoL, a higher clinical success rate, and a lower reintervention rate than those who had undergone PTD or endoscopic enteral stenting. Although the evidence is limited, EUS-GE may be considered as a first-line treatment for malignant ALS because it has better clinical outcomes than other less invasive treatments, such as PTD or endoscopic enteral stenting. Further prospective randomized control trials are necessary to establish EUS-GE as a standard treatment for ALS.

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Close layer
Original Articles
Laser-cut-type versus braided-type covered self-expandable metallic stents for distal biliary obstruction caused by pancreatic carcinoma: a retrospective comparative cohort study
Koh Kitagawa, Akira Mitoro, Takahiro Ozutsumi, Masanori Furukawa, Yukihisa Fujinaga, Kenichiro Seki, Norihisa Nishimura, Yasuhiko Sawada, Kosuke Kaji, Hideto Kawaratani, Hiroaki Takaya, Kei Moriya, Tadashi Namisaki, Takemi Akahane, Hitoshi Yoshiji
Clin Endosc 2022;55(3):434-442.   Published online October 28, 2021
DOI: https://doi.org/10.5946/ce.2021.161
AbstractAbstract PDFPubReaderePub
Background
/Aims: Covered self-expandable metallic stents (CMSs) are widely used for malignant distal biliary obstructions (MDBOs) caused by pancreatic carcinoma. This study compared the efficacy and safety of the laser-cut-type and braided-type CMSs.
Methods
To palliate MDBOs caused by pancreatic carcinoma, the laser-cut-type CMSs was used from April 2014 to March 2017, and the braided-type CMSs was used from April 2017 to March 2019. The tested self-expandable metallic stents were equipped with different anti-migration systems.
Results
In total, 47 patients received CMSs for MDBOs (24 laser-cut type, 23 braided-type). The time to recurrent biliary obstruction (TRBO) was significantly longer in the braided-type CMSs (p=0.0008), and the median time to stent dysfunction or patient death was 141 and 265 days in the laser-cut-type CMSs and braided-type CMSs, respectively (p=0.0023). Stent migration was the major cause of stent dysfunction in both groups, which occurred in 37.5% of the laser-cut-type CMSs and 13.0% of the braidedtype CMSs. There were no differences in the survival duration between the groups.
Conclusions
The TRBO was significantly longer for the braided-type CMSs with an anti-migration system than for the laser-cuttype. Stent migration tended to be less frequent with the braided-type CMSs than with the laser-cut-type CMSs.

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Endoscopic Management of Anastomotic Leakage after Esophageal Surgery: Ten Year Analysis in a Tertiary University Center
Nader El-Sourani, Sorin Miftode, Maximilian Bockhorn, Alexander Arlt, Christian Meinhardt
Clin Endosc 2022;55(1):58-66.   Published online October 14, 2021
DOI: https://doi.org/10.5946/ce.2021.099
AbstractAbstract PDFPubReaderePub
Background
/Aims: Anastomotic leakage after esophageal surgery remains a feared complication. During the last decade, management of this complication changed from surgical revision to a more conservative and endoscopic approach. However, the treatment remains controversial as the indications for conservative, endoscopic, and surgical approaches remain non-standardized.
Methods
Between 2010 and 2020, all patients who underwent Ivor Lewis esophagectomy for underlying malignancy were included in this study. The data of 28 patients diagnosed with anastomotic leak were further analyzed.
Results
Among 141 patients who underwent resection, 28 (19.9%) developed an anastomotic leak, eight (28.6%) of whom died. Thirteen patients were treated with endoluminal vacuum therapy (EVT), seven patients with self-expanding metal stents (SEMS) four patients with primary surgery, one patient with a hemoclip, and three patients were treated conservatively. EVT achieved closure in 92.3% of the patients with a large defect and no EVT-related complications. SEMS therapy was successful in clinically stable patients with small defect sizes.
Conclusions
EVT can be successfully applied in the treatment of anastomotic leakage in critically ill patients, while SEMS should be limited to clinically stable patients with a small defect size. Surgery is only warranted in patients with sepsis with graft necrosis.

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Systematic Review and Meta-Analysis
Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis
Marina Tucci Gammaro Baldavira Ferreira, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Alberto Machado da Ponte Neto, Galileu Ferreira Ayala Farias, Antônio Afonso de Miranda Neto, Pedro Victor Aniz Gomes de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
Clin Endosc 2021;54(6):833-842.   Published online July 1, 2021
DOI: https://doi.org/10.5946/ce.2021.052
AbstractAbstract PDFPubReaderePub
Background
/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remains challenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment of dominant strictures among PSC patients.
Methods
Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studies published until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate, transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death).
Results
A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (risk difference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I2=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01; I2=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD,-0.34; 95% CI, -0.45 to -0.23; I2=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia were significantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I2=51%).
Conclusions
Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complication rates without significant differences in efficacy.

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Original Articles
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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    Anna Forslund, Erik Haraldsson, Erik Holmberg, Peter Naredi, Magnus Rizell
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    Yousuke Nakai
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Biliary Self-Expandable Metal Stent Could Be Recommended as a First Treatment Modality for Immediate Refractory Post-Endoscopic Retrograde Cholangiopancreatography Bleeding
Sun Young Moon, Jun Heo, Min Kyu Jung, Chang Min Cho
Clin Endosc 2022;55(1):128-135.   Published online May 25, 2021
DOI: https://doi.org/10.5946/ce.2021.057
AbstractAbstract PDFPubReaderePub
Background
/Aims: Recent reports suggest that the biliary self-expandable metallic stent (SEMS) is highly effective for maintaining hemostasis when endoscopic hemostasis fails in endoscopic retrograde cholangiopancreatography (ERCP)-related bleeding. We compared whether temporary SEMS offers better efficacy than angioembolization for refractory immediate ERCP-related bleeding.
Methods
Patients who underwent SEMS placement or underwent angioembolization for bleeding control in refractory immediate ERCP-related bleeding were included in the retrospective analysis. We evaluated the hemostasis success rate, severity of bleeding, change in hemoglobin levels, amount of transfusion, and delay to the start of hemostasis.
Results
A total of 27 patients with SEMS and 13 patients who underwent angioembolization were enrolled. More transfusions were needed in the angioembolization group (1.0±1.4 units vs. 2.5±2.0 units; p=0.034). SEMS failure was successfully rescued by angioembolization. The partially covered SEMS (n=23, 85.1%) was generally used, and the median stent-indwelling time was 4 days. The mean delay to the start of angioembolization was 95.2±142.9 (range, 9–491) min.
Conclusions
Temporary SEMS had similar results to those of angioembolization (96.3% vs. 92.3%; p=0.588). Immediate SEMS insertion is considered a bridge treatment modality for immediate refractory ERCP-related bleeding. Angioembolization still has a role as rescue therapy when SEMS does not work effectively.
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Focused Review Series: Endoscopic Management of Postoperative Gastrointestinal Complication: What’s New?
Endoscopic Management of Staple Line Leak after Bariatric Surgery: Surgeon’s Perspective
Yoona Chung, Dae Geun Park, Yong Jin Kim
Clin Endosc 2021;54(6):805-809.   Published online May 12, 2021
DOI: https://doi.org/10.5946/ce.2020.298
AbstractAbstract PDFPubReaderePub
Laparoscopic sleeve gastrectomy (LSG) has become a standalone primary procedure as a bariatric metabolic surgery since the early 2000s. The overall complication rate of LSG is reported to range from 2% to 15%. Staple line leakage (SLL) remains a major adverse event and occurs in approximately 1–6% of patients. Choosing the optimal treatment modality is a complex process. Clinicians must understand that nutritional support and drainage of fluid collection are essential for initial management. Conservative endoscopic management and sufficient drainage can resolve approximately 70% of SLLs. Endoscopic management of bariatric complications has been rapidly evolving in recent years and can be considered in all patients who are hemodynamically stable. We will review the available endoscopic management techniques, including stent placement (self-expanding stents and bariatric-specific stents), clipping, tissue sealant application, and internal drainage (double-pigtail stents [DPS] placement, endoscopic vacuum therapy, and septotomy). Stent placement remains the mainstream treatment for SLLs. However, healing with stents requires multiple sessions/stents and a long course of recovery. Endoscopic internal drainage is gaining popularity and has the potential to be a superior method. The importance of early intervention and combined endoscopic methods should be recognized.

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    Muaaz Masood, Donald Low, Shanley B. Deal, Richard A. Kozarek
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Original Articles
Outcomes of Dilation of Recalcitrant Pancreatic Strictures Using a Wire-Guided Cystotome
Sridhar Sundaram, Dhaval Choksi, Aditya Kale, Suprabhat Giri, Biswaranjan Patra, Shobna Bhatia, Akash Shukla
Clin Endosc 2021;54(6):903-908.   Published online March 4, 2021
DOI: https://doi.org/10.5946/ce.2020.297
AbstractAbstract PDFPubReaderePub
Background
/Aims: Pancreatic strictures in chronic pancreatitis are treated using endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement. The management of recalcitrant strictures remains a challenge, with the use of a Soehendra stent retriever or a needle knife described in case reports. Here, we discuss our experience with dilation of dominant pancreatic strictures with a 6-Fr cystotome.
Methods
A retrospective review of an endoscopy database was performed to search for patients with pancreatic strictures recalcitrant to conventional methods of dilation in which a cystotome was used. Technical success was defined as the successful dilation of the stricture with plastic stent placement. Functional success was defined as substantial pain relief or resolution of pancreatic fistulae.
Results
Ten patients (mean age, 30.8 years) underwent dilation of a dominant pancreatic stricture secondary to chronic pancreatitis, with a 6-Fr cystotome. Seven patients presented with pain. Three patients had pancreatic fistulae (two had pancreatic ascites and one had a pancreaticopleural fistula). The median stricture length was 10 mm (range, 5–25 mm). The head of the pancreas was the most common location of the stricture (60%). Technical and functional success was achieved in all patients. One patient had self-limiting bleeding, whereas another patient developed mild post-ERCP pancreatitis.
Conclusions
The use of a 6-Fr cystotome (diathermy catheter) can be an alternative method for dilation of recalcitrant pancreatic strictures after the failure of conventional modalities.

Citations

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  • Does wire-guided cystotome dilation for difficult benign bilio-pancreatic strictures guarantee long-term patency? A narrative mini-review of the literature
    Omar Ksissa, Lorenzo Dioscoridi, Edoardo Forti, Francesco Pugliese, Marcello Cintolo, Andrea Palermo, Massimiliano Mutignani
    World Journal of Gastrointestinal Endoscopy.2025;[Epub]     CrossRef
  • Fully Covered Self-expandable Metallic Stents for Refractory Benign Pancreatic Duct Strictures: A Systematic Review and Meta-analysis
    Gajanan Rodge, Suprabhat Giri, Kailash Kolhe, Shivaraj Afzalpurkar, Sidharth Harindranath, Sridhar Sundaram, Aditya Kale
    Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2024; 34(5): 529.     CrossRef
  • Treatment of Difficult Pancreatic Duct Strictures Using a Cystotome: A Single-Center Experience
    Jonghyun Lee, Dong Uk Kim, Sung Yong Han
    The Korean Journal of Pancreas and Biliary Tract.2023; 28(4): 108.     CrossRef
  • Approach to management of pancreatic strictures: the gastroenterologist’s perspective
    Vaneet Jearth, Suprabhat Giri, Sridhar Sundaram
    Clinical Journal of Gastroenterology.2021; 14(6): 1587.     CrossRef
  • 5,547 View
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RWON Study: The Real-World Walled-off Necrosis Study
Ankush Pawar, Ujjwal Sonika, Manish Kumar, Sundeep Saluja, Siddharth Srivastava
Clin Endosc 2021;54(6):909-915.   Published online February 23, 2021
DOI: https://doi.org/10.5946/ce.2020.175
AbstractAbstract PDFPubReaderePub
Background
/Aims: The management of walled-off necrosis (WON) has undergone a paradigm shift from surgical to nonsurgical modalities. Real-world data on the management of symptomatic WON are scarce.
Methods
Prospectively collected data of symptomatic WON cases were retrospectively evaluated. The treatment modalities used were medical management alone, percutaneous catheter drainage (PCD) or endoscopic drainage (ED), or a combination of PCD and ED. We compared clinical outcome among these modalities.
Results
A total of 264 patients were evaluated. The most common indications for drainage were pain and fever. Of the patients, 28% was treated with medical therapy alone, 31% with ED, 37% with PCD, and 4% with a combined approach. Technical success and clinical success were achieved in 93% and 91% of patients in the endoscopic arm and in 90% and 81% patients in the PCD arm, respectively (p=0.0004 for clinical success). Lower rates of complications (7% vs. 22%, p=0.005), readmission (20% vs. 34%, p=0.04), and mortality (4% vs. 19%, p=0.0012), and shorter hospital stay (13 days vs. 19 days, p=0.0018) were observed in the endoscopic group than in the PCD group.
Conclusions
ED of WON is better than PCD and is associated with lower mortality, fewer complications, and shorter hospitalization.

Citations

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  • MANEJO CIRÚRGICO E ENDOSCÓPICO DA WALLED-OFF NECROSIS INFECTADA APÓS PANCREATITE AGUDA NECROSANTE
    Jefferson Rummenigge Nascimento Campos, Waston Gonçalves Ribeiro , João Lucas de Pontes Ribeiro , Anna Isabel Rodrigues Alves, Fabio Gomes Teixeira, Maria Clara Santos Araujo
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    Varun Mehta, Abhinav Abhinav, Yogesh Kumar Gupta, Manisha Khubber, Ajit Sood, Manjeet Kumar Goyal
    Clinical Endoscopy.2025; 58(4): 595.     CrossRef
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    Andrada Seicean, Cristina Pojoga, Voicu Rednic, Claudia Hagiu, Radu Seicean
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    Ji Young Bang, Shyam Varadarajulu
    Clinical Endoscopy.2021; 54(6): 785.     CrossRef
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Case Reports
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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  • International Consensus Recommendations for Safe Use of LAMS for On- and Off-Label Indications Using a Modified Delphi Process
    Sebastian Stefanovic, Douglas G. Adler, Alexander Arlt, Todd H. Baron, Kenneth F. Binmoeller, Michiel Bronswijk, Marco J. Bruno, Jean-Baptiste Chevaux, Stefano Francesco Crinò, Helena Degroote, Pierre H. Deprez, Peter V. Draganov, Pierre Eisendrath, Marc
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    Schalk W. van der Merwe, Roy L. J. van Wanrooij, Michiel Bronswijk, Simon Everett, Sundeep Lakhtakia, Mihai Rimbas, Tomas Hucl, Rastislav Kunda, Abdenor Badaoui, Ryan Law, Paolo G. Arcidiacono, Alberto Larghi, Marc Giovannini, Mouen A. Khashab, Kenneth F.
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Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding
Michihiro Yoshida, Tadahisa Inoue, Itaru Naitoh, Kazuki Hayashi, Yasuki Hori, Makoto Natsume, Naoki Atsuta, Hiromi Kataoka
Clin Endosc 2022;55(1):150-155.   Published online November 19, 2020
DOI: https://doi.org/10.5946/ce.2020.217
AbstractAbstract PDFPubReaderePub
We reviewed 7 patients with unsuccessful endoscopic hemostasis using covered self-expandable metal stent (CSEMS) placement for post-endoscopic sphincterotomy (ES) bleeding. ES with a medium incision was performed in 6 and with a large incision in 1 patient. All but 1 of them (86%) showed delayed bleeding, warranting second endoscopic therapies followed by CSEMS placement 1–5 days after the initial ES. Subsequent CSEMS placement did not achieve complete hemostasis in any of the patients. Lateral-side incision lines (3 or 9 o’clock) had more frequent bleeding points (71%) than oral-side incision lines (11–12 o’clock; 29%). Additional endoscopic hemostatic procedures with hemostatic forceps, hypertonic saline epinephrine, or hemoclip achieved excellent hemostasis, resulting in complete hemostasis in all patients. These experiences provide an alert: CSEMS placement is not an ultimate treatment for post-ES bleeding, despite its effectiveness. The lateral-side of the incision line, as well as the oral-most side, should be carefully examined for bleeding points, even after the CSEMS placement.

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    Monique Barakat, Monica Saumoy, Nauzer Forbes, B. Joseph Elmunzer
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    Jinpei Dong, Qiushi Feng, Guigen Teng, Haixia Niu, Dapeng Bian
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    Atsushi Yamaguchi, Hiroki Kamada, Shigeaki Semba, Naohiro Kato, Yasuhiro Okuda, Yuji Teraoka, Takeshi Mizumoto, Yuzuru Tamaru, Tsuyoshi Hatakeyama, Hirotaka Kouno, Shigeto Yoshida
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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.

Citations

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  • Postprocedural cholecystitis following covered self-expandable metal stent placement in patients with distal malignant biliary obstruction: a systematic review and meta-analysis
    Chawin Lopimpisuth, Shyam Vedantam, Pojsakorn Danpanichkul, Mahmoud Mahfouz, Jordan Orr, Abid Javed, Shria Kumar, Jodie A. Barkin, Sunil Amin, Sean Bhalla
    Gastrointestinal Endoscopy.2026; 103(2): 220.     CrossRef
  • 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
  • Incidence of Cholecystitis After Endoscopic Biliary Drainage Using a Low Axial Force Covered Self‐Expandable Metallic Stent in Patients With Malignant Distal Biliary Obstruction: A Multicenter Prospective Study
    Naoki Minato, Kosuke Okuwaki, Masafumi Watanabe, Jun Woo, Takaaki Matsumoto, Masayoshi Tadehara, Toru Kaneko, Junro Ishizaki, Tomohisa Iwai, Hiroshi Imaizumi, Mitsuhiro Kida, Hiroki Haradome, Chika Kusano
    Journal of Gastroenterology and Hepatology.2025; 40(2): 502.     CrossRef
  • Risk Factors for Cholecystitis After Self-expandable Metallic Stent Placement for Malignant Distal Biliary Obstruction
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Focused Review Series: Endoscopic Ultrasound-Guided Therapeutic Intervention: Focus on Technique and Practical Tips
Endoscopic Ultrasound-Guided Pancreatic Duct Drainage: Techniques and Literature Review of Transmural Stenting
Akira Imoto, Takeshi Ogura, Kazuhide Higuchi
Clin Endosc 2020;53(5):525-534.   Published online September 24, 2020
DOI: https://doi.org/10.5946/ce.2020.173
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) has emerged as an option in patients with failure of retrograde access to the pancreatic duct (PD) because of difficulty in cannulation or surgically altered anatomy. This article provides a comprehensive review of the techniques and outcomes of EUS-PD, especially EUS-guided pancreatic transmural stenting. The clinical data derived from a total of 401 patients were reviewed in which the overall technical and clinical success rates were 339/401 (85%, range 63%–100%) and 328/372 (88%, range 76%–100%), respectively. Short-term adverse events occurred in 25% (102/401) of the cases, which included abdominal pain (n=45), acute pancreatitis (n=17), bleeding (n=10), and issues associated with pancreatic juice leakage such as perigastric or peripancreatic fluid collection (n=9). In conclusion, although EUS-PD remains a challenging procedure with a high risk of adverse events such as pancreatic juice leakage, perforation, and severe acute pancreatitis, the procedure seems to be a promising alternative for PD drainage in patients with altered anatomy or unsuccessful endoscopic retrograde pancreatography.

Citations

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Case Report
Stepwise Algorithmic Approach to Endoscopic Removal of Biliary Partially Covered and Uncovered Self-Expanding Metal Stents
Deepanshu Jain, Assaf Stein, Muhammad K. Hasan
Clin Endosc 2021;54(4):608-612.   Published online September 8, 2020
DOI: https://doi.org/10.5946/ce.2020.189
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Self-expanding metal stents play a crucial role in the management of patients with biliary obstruction. Endoscopic extraction of uncovered metal stents (UCMSs) and partially covered metal stents (PCMSs) could be challenging because of tissue ingrowth. No standardized technique can guarantee universal success. We present our technique and experience of endoscopic extraction of biliary stents in two patients with a UCMS and three patients with a PCMS. Three of the five patients had a previous failed attempt of stent extraction at an outside hospital. Overall, our composite success rate was 80% (4/5). The individual success rate was 100% (3/3) for PCMSs and 50% (1/2) for UCMSs. The stent-in-stent technique, in which a fully covered metal stent is placed through an existing UCMS/PCMS, was used in 60% (3/5) of the cases, with a success rate of 66.7% (2/3). We share our algorithmic approach to each case, with detailed emphasis on the technical aspects of the procedure.

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    Tommaso Schepis, Ivo Boškoski, Andrea Tringali, Guido Costamagna
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  • 108 Download
  • 4 Web of Science
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