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Successful removal of a buried lumen-apposing metal stent without complications using pancreatic drainage and a hemostatic agent
Yuki Fujii, Kazuyuki Matsumoto, Motoyuki Otsuka
Clin Endosc 2025;58(3):476-477.   Published online February 27, 2025
DOI: https://doi.org/10.5946/ce.2024.233
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Original Articles
Short-term outcome of endoscopic submucosal dissection using a clutch cutter for subepithelial lesions within the esophagogastric submucosa: a Japanese prospective observational study
Kazuya Akahoshi, Kazuki Inamura, Kazuaki Akahoshi, Shigeki Osada, Shinichi Tamura, Yoshihiro Oishi, Masafumi Oya, Hidenobu Koga
Clin Endosc 2025;58(2):278-284.   Published online October 10, 2024
DOI: https://doi.org/10.5946/ce.2024.094
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: The efficacy and safety of endoscopic submucosal dissection using a clutch cutter (ESD-CC) for subepithelial lesions within the esophagogastric submucosa (SELEGSM) has not been investigated. This study aimed to assess the efficacy and safety of ESD-CC for the treatment of SELEGSM.
Methods
This prospective study included 15 consecutive patients with 18 SELEGSMs diagnosed by endoscopic ultrasonography. The primary outcomes were short-term outcomes including en bloc resection rate, R0 resection rate, procedure time, and complication rate. The secondary outcome was final histological diagnosis.
Results
Among the participants, 18 lesions were identified: 12 in the stomach (nine patients) and six in the esophagus (six patients). The en bloc resection rate was 94.4% (17/18). The R0 resection rate was 88.9% (16/18). The median operating time was 39 min, and no instances of perforation or bleeding were observed. The final diagnoses of SELEGSM included six neuroendocrine tumors (33.3%), six granular cell tumors (33.3%), two ectopic pancreases (11.1%), one inflammatory fibroid polyp (5.6%), one leiomyoma (5.6%), one lipoma (5.6%), and one leiomyosarcoma (5.6%).
Conclusions
ESD-CC appears to be a technically efficient and safe approach for SELEGSM resection, suggesting its potential as a valuable treatment option.

Citations

Citations to this article as recorded by  
  • Advancements in endoscopic resection of subepithelial tumors: toward safer, recurrence-free techniques
    Won Shik Kim, Moon Kyung Joo
    Clinical Endoscopy.2025; 58(2): 256.     CrossRef
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Ex vivo cholangioscopy in liver grafts: a novel technique to assess the biliary tree during organ preservation and machine perfusion: a experimental non-clinical study
Mark Ly, Ngee-Soon Lau, Joanna Huang, Hayden Ly, Kasper Ewenson, Nicole Mestrovic, Paul Yousif, Ken Liu, Avik Majumdar, Geoffrey McCaughan, Michael Crawford, Carlo Pulitano
Clin Endosc 2025;58(2):303-310.   Published online March 4, 2025
DOI: https://doi.org/10.5946/ce.2024.099
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Biliary complications are a leading cause of morbidity after liver transplantation, but can be reduced using real-time assessment of the biliary tree. This study described a novel technique for performing ex vivo cholangioscopy during cold static storage and normothermic machine perfusion (NMP) to assess the biliary tree before liver transplantation.
Methods
Human donor livers, which were considered unsuitable for transplantation, were perfused at 36ºC using a modified commercial ex vivo perfusion system. Ex vivo cholangioscopy was performed using a SpyGlass Discover system. Cholangioscopy was performed during cold static storage and after 12 hours in NMP. Bile duct biopsies and confocal microscopy were performed.
Results
Ex vivo cholangioscopy was performed on eight grafts. During cold static storage, luminal debris was visualized throughout the biliary tree. After 12 hours of reperfusion, the bile ducts appeared hyperemic, heterogeneous, and mottled. Confocal microscopy confirmed perfusion of biliary microvasculature.
Conclusions
We describe the first use of ex vivo cholangioscopy to assess the biliary tree before liver transplantation. This real-time technique can be used to assess biliary trees during cold static storage and NMP. In addition, cholangioscopy-based interventions can be used to better assess intrahepatic bile ducts.
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Safety and efficacy of trans-afferent loop endoscopic ultrasound-guided pancreaticojejunostomy for post pancreaticoduodenectomy anastomotic stricture using the forward-viewing echoendoscope: a retrospective study from Japan
Ahmed Sadek, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto, Kenneth Tachi
Clin Endosc 2025;58(2):311-319.   Published online August 26, 2024
DOI: https://doi.org/10.5946/ce.2024.089
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided pancreatic duct drainage is a well-established procedure for managing pancreaticojejunostomy anastomotic strictures (PJAS) post-Whipple surgery. In this study, we examined the effectiveness and safety of EUS-guided pancreaticojejunostomy (EUS-PJS).
Methods
This retrospective, single-arm study was performed at Aichi Cancer Center Hospital on 10 patients who underwent EUS-guided pancreaticojejunostomy through the afferent jejunal loop using a forward-viewing echoendoscope when endoscopic retrograde pancreatography failed. Our primary endpoint was technical success rate, defined as successful stent insertion. The secondary endpoints were early and late adverse events.
Results
A total of 10 patients underwent EUS-PJS between February 2019 and October 2023. The technical success rate was 100%. The median procedure time was 23.5 minutes. No remarkable early or late adverse events related to the procedure, except for fever, occurred in two patients. The median follow-up duration was 9.5 months, and the median number of stent exchanges was two. A stent-free state was achieved in three patients.
Conclusions
EUS-PJS for PJAS management after pancreaticoduodenectomy appears to be an effective and safe procedure with the potential advantages of fewer reinterventions and the creation of a permanent drainage fistula.

Citations

Citations to this article as recorded by  
  • Transanastomotic Forward-Viewing EUS-Guided Pancreatic Duct Drainage via Afferent Loop for Pancreaticojejunostomy Anastomotic Stricture After Pancreaticoduodenectomy
    Tadahisa Inoue, Rena Kitano, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
    Digestive Diseases and Sciences.2025; 70(1): 413.     CrossRef
  • Management of Pancreaticojejunostomy Strictures: A New Perspective with Forward-Viewing EUS
    Radhika Chavan
    Digestive Diseases and Sciences.2025; 70(5): 1740.     CrossRef
  • Transforming endoscopic approaches to post-pancreaticoduodenectomy anastomotic strictures: beyond the surface
    Yu-Ting Kuo
    Clinical Endoscopy.2025; 58(2): 259.     CrossRef
  • Forward-viewing echoendoscope-guided pancreaticojejunostomy for post-pancreaticoduodenectomy stricture
    Toru Kaneko, Mitsuhiro Kida, Takahiro Kurosu, Yutaro Saito, Shiori Koyama, Tomohiro Betto, Chika Kusano
    Endoscopy.2025; 57(S 01): E384.     CrossRef
  • 2,562 View
  • 347 Download
  • 2 Web of Science
  • 4 Crossref
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Videos of Issue
One-session endoscopic ultrasound-guided cholecystoduodenostomy for treatment of a high-surgical risk patient with symptomatic cholelithiasis of remnant gallbladder
Oscar Víctor Hernández Mondragón, Enrique Murcio-Pérez, José Martín Hernández Márquez
Clin Endosc 2025;58(2):322-323.   Published online February 17, 2025
DOI: https://doi.org/10.5946/ce.2024.185
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  • 859 View
  • 113 Download
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Endoscopic removal of a deteriorated fully-covered self-expandable metal stent using an endoscopic retrograde cholangiopancreatography guide sheath
Tsuyoshi Suda, Kosuke Satomura, Miyabi Miura, Kiichiro Kaji, Kuniaki Arai, Shuichi Terasaki
Clin Endosc 2025;58(1):147-148.   Published online November 5, 2024
DOI: https://doi.org/10.5946/ce.2024.170
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  • 1,200 View
  • 98 Download
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Brief Report
Modified submucosal tunneling by blunt dissection for peroral endoscopic myotomy
Yusuke Hashimoto, Kuniyo Gomi, Bruno De Souza Ribeiro
Clin Endosc 2025;58(1):149-152.   Published online August 27, 2024
DOI: https://doi.org/10.5946/ce.2024.011
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  • 1,541 View
  • 162 Download
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An enigmatic enteroscopic image in a patient with upper gastrointestinal bleeding
Tommaso Pessarelli, Beatrice Marinoni, Anna Maria Ierardi, Gian Eugenio Tontini
Clin Endosc 2025;58(1):158-160.   Published online September 26, 2024
DOI: https://doi.org/10.5946/ce.2024.138
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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  
  • 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
  • 3,096 View
  • 193 Download
  • 2 Web of Science
  • 2 Crossref
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Hepatobiliary scintigraphy of bile excretion after endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction: a retrospective study in Japan
Masanori Yamada, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Toshitaka Fukui
Clin Endosc 2024;57(6):798-806.   Published online August 20, 2024
DOI: https://doi.org/10.5946/ce.2023.291
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Hepatobiliary scintigraphy (HBS) is used to evaluate bile excretion. This study aimed to evaluate biliary excretion during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using HBS.
Methods
We retrospectively evaluated 78 consecutive patients with malignant extrahepatic biliary obstruction, who underwent HBS after EUS-HGS between April 2015 and July 2022. The peak time and decay rate were scored with 0, 1, or 2 points based on thresholds of 20 and 35 minutes, and 10% and 50%, respectively. A total score of 4 or 3 was considered indicative of good bile excretion, whereas scores of 2, 1, or 0 indicated poor bile excretion.
Results
The good and poor bile excretion groups included 40 and 38 cases, respectively. The group with good bile excretion had a significantly longer time to recurrent biliary obstruction compared to the poor bile excretion group (not reached vs. 124 days, p=0.026). Multivariate analysis identified the site of obstruction as a significant factor influencing good bile excretion (odds ratio, 3.39; 95% confidence interval, 1.01–11.4, p=0.049), with superior bile excretion observed in cases involving upper biliary obstruction compared to middle or lower biliary obstruction.
Conclusions
In patients with malignant biliary obstruction who underwent HGS, the site of obstruction is significantly associated with stent patency.
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Videos of Issue
Successful iatrogenic duodenal perforation treatment with endoscopic hand suturing
Michał Spychalski, Michał Łabęcki, Matylda Sobczak, Agnieszka Nawrocka-Kunecka, Przemysław Piotr Kasprzyk
Clin Endosc 2024;57(6):832-833.   Published online July 24, 2024
DOI: https://doi.org/10.5946/ce.2024.117
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Gel immersion endoscopic mucosal resection for a grade 1 rectal neuroendocrine tumor (carcinoid)
Natsuko Saito, Takeshi Yamashina, Masaaki Shimatani
Clin Endosc 2024;57(6):834-835.   Published online September 6, 2024
DOI: https://doi.org/10.5946/ce.2024.064
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Original Articles
Puncture angle on an endoscopic ultrasound image is independently associated with unsuccessful guidewire manipulation of endoscopic ultrasound-guided hepaticogastrostomy: a retrospective study in Japan
Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Kazuhide Matsumoto, Masatoshi Murakami, Katsuhito Teramatsu, Keijiro Ueda, Masayuki Hijioka, Akira Aso, Yoshihiro Ogawa
Clin Endosc 2024;57(5):656-665.   Published online July 26, 2024
DOI: https://doi.org/10.5946/ce.2023.244
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is performed globally, the procedure remains challenging. Guidewire manipulation is the most difficult step, and there are few reports on the factors associated with unsuccessful guidewire manipulation. This study aimed to assess the significance of the puncture angle on EUS images and identify the most effective guidewire rescue method for patients with unsuccessful guidewire manipulation.
Methods
We retrospectively enrolled 115 patients who underwent EUS-HGS between May 2016 and April 2022 at two centers. The puncture angle between the needle and the intrahepatic bile duct was measured through EUS movie records.
Results
Guidewire manipulation was unsuccessful in 28 patients. Receiver operating characteristic (ROC) curves identified an optimal puncture angle cutoff value of 85° (cutoff value, 85°; area under the ROC curve, 0.826; sensitivity, 85.7%; specificity, 81.6%). Multivariate analysis demonstrated that a puncture angle <85° was a significant risk factor for unsuccessful guidewire manipulation (odds ratio, 19.8; 95% confidence interval, 6.42–61.5; p<0.001). Among the 28 unsuccessful cases, 24 patients (85.7%) achieved successful guidewire manipulation using various rescue methods.
Conclusions
The puncture angle observed on EUS is crucial for guidewire manipulation. A puncture angle of <85° was associated with unsuccessful guidewire manipulation.

Citations

Citations to this article as recorded by  
  • Backward leap technique using a novel 0.018-inch guidewire
    Kosuke Takahashi, Eisuke Ozawa, Yasuhiko Nakao, Masanori Fukushima, Hisamitsu Miyaaki, Kazuhiko Nakao
    Endoscopy.2025; 57(S 01): E90.     CrossRef
  • The Role and Appropriate Selection of Guidewires in Biliopancreatic Endoscopy
    Daniele Alfieri, Claudia Delogu, Stefano Mazza, Aurelio Mauro, Erica Bartolotta, Alessandro Cappellini, Davide Scalvini, Francesca Torello Viera, Marco Bardone, Andrea Anderloni
    Medicina.2025; 61(5): 913.     CrossRef
  • 3,255 View
  • 240 Download
  • 2 Web of Science
  • 2 Crossref
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Safety and efficacy of endoscopic ultrasound-guided pancreatic duct drainage using a drill dilator: a retrospective study in Japan
Ahmed Sadek, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto, Kenneth Tachi
Clin Endosc 2024;57(5):666-674.   Published online June 5, 2024
DOI: https://doi.org/10.5946/ce.2023.272
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Dilation of the tract before stent deployment is a challenging step in endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD). In this study, we examined the effectiveness and safety of a novel spiral dilator, Tornus ES (Asahi Intec), for EUS-PDD.
Methods
This was a retrospective, single-arm, observational study at Aichi Cancer Center Hospital. The punctured tract was dilated using a Tornus ES dilator in all EUS-PDD cases. Our primary endpoint was the technical success rate of initial tract dilation. Technical success was defined as successful fistula dilation using a Tornus ES followed by successful stent insertion. Secondary endpoints were procedure times and early adverse events.
Results
A total of 12 patients were included between December 2021 and March 2023. EUS-PDD was performed in 11 patients for post-pancreaticoduodenectomy anastomotic strictures and one patient with pancreatitis with duodenal perforation. The technical success rates of stent insertion and fistula dilation using a Tornus ES dilator was 100%. The median procedure time was 24 minutes. No remarkable adverse events related to the procedure were observed, apart from fever, which occurred in 2 patients.
Conclusions
Tract dilation in EUS-PDD using a Tornus ES is effective and safe.

Citations

Citations to this article as recorded by  
  • Feasibility of endoscopic ultrasound‐guided hepaticogastrostomy using a novel long balloon catheter
    Yuichi Takano, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Fumitaka Niiya, Naotaka Maruoka, Tatsuya Yamagami, Masatsugu Nagahama
    DEN Open.2025;[Epub]     CrossRef
  • Endoscopic ultrasound-guided pancreatic duct drainage: Progress and future outlook
    Si-Yao Wang, Si-Qiao Zhao, Shu-Peng Wang, Yue Zhang, Si-Yu Sun, Sheng Wang
    World Journal of Gastrointestinal Surgery.2025;[Epub]     CrossRef
  • A novel spiral dilator for pancreatic duct drainage: catching two birds with one stone
    Han Taek Jeong, Jimin Han
    Clinical Endoscopy.2024; 57(5): 608.     CrossRef
  • Technical outcomes between a drill dilator and ultra-tapered mechanical dilator during EUS-guided pancreaticogastrostomy: Comparative study
    Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Jun Sakamoto, Jun Matsuno, Yuki Uba, Mitsuki Tomita, Nobuhiro Hattori, Junichi Nakamura, Kimi Bessho, Hiroki Nishikawa
    Endoscopy International Open.2024;[Epub]     CrossRef
  • 4,216 View
  • 324 Download
  • 4 Web of Science
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Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea
Yuri Kim, Ji Yong Ahn, Hwoon-Yong Jung, Seokin Kang, Ho June Song, Kee Don Choi, Do Hoon Kim, Jeong Hoon Lee, Hee Kyong Na, Young Soo Park
Clin Endosc 2024;57(3):350-363.   Published online February 15, 2024
DOI: https://doi.org/10.5946/ce.2023.144
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs.
Methods
Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed.
Results
Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection did not experience recurrence during a median 14-month follow-up period, except for one patient in the ESD group.
Conclusions
cc-EFTR displayed a high R0 resection rate; therefore, it is a safe and effective therapeutic option for small gastric GISTs.

Citations

Citations to this article as recorded by  
  • Advancements in Endoscopic Treatment for Gastric Subepithelial Tumors
    Osamu Goto, Kazutoshi Higuchi, Eriko Koizumi, Katsuhiko Iwakiri
    Gut and Liver.2025; 19(2): 151.     CrossRef
  • Endoscopic resection penetrating the muscularis propria for gastric gastrointestinal stromal tumors: advances and challenges
    Jin Woong Cho
    Clinical Endoscopy.2024; 57(3): 329.     CrossRef
  • 6,518 View
  • 184 Download
  • 2 Web of Science
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Brief Reports
Effective hemostasis under gel immersion endoscopy using inflated balloons on the tip of double balloon endoscope for active bleeding in the small intestine
Shunsuke Horitani, Natsuko Saito, Koki Hosoda, Hironao Matsumoto, Toshiyuki Mitsuyama, Takeshi Yamashina, Masaaki Shimatani, Makoto Naganuma
Clin Endosc 2024;57(3):409-411.   Published online February 8, 2024
DOI: https://doi.org/10.5946/ce.2023.146
PDFSupplementary MaterialPubReaderePub

Citations

Citations to this article as recorded by  
  • Gel immersion in endoscopy: Exploring potential applications
    Hiroki Sato, Hidemasa Kawabata, Mikihiro Fujiya
    World Journal of Gastroenterology.2025;[Epub]     CrossRef
  • 4,381 View
  • 171 Download
  • 1 Web of Science
  • 1 Crossref
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Use of an endoscopic powered debridement device for treatment of post-surgical fatty pancreatic necrosis
Judy Daboul, Shiab Mussad, Anna Cecilia Amaral, Waleed K. Hussain, Peter J. Lee, Samuel Han
Clin Endosc 2024;57(3):412-414.   Published online February 23, 2024
DOI: https://doi.org/10.5946/ce.2023.120
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  • 134 Download
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Original Articles
Endoscopic ultrasound-guided gastrojejunostomy with a direct technique without previous intestinal filling using a tubular fully covered self-expandable metallic stent
Hakan Şentürk, İbrahim Hakkı Köker, Koray Koçhan, Sercan Kiremitçi, Gülseren Seven, Ali Tüzün İnce
Clin Endosc 2024;57(2):209-216.   Published online July 3, 2023
DOI: https://doi.org/10.5946/ce.2023.022
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic ultrasonography-guided gastrojejunostomy is a minimally invasive method for the management of gastric outlet obstruction. Conventionally, a lumen-apposing metal stent (LAMS) is used to create an anastomosis. However, LAMS is expensive and not widely available. In this report, we described a tubular fully covered self-expandable metallic stent (T-FCSEMS) for this purpose.
Methods
Twenty-one patients (15 men [71.4%]; median age, 66 years; range, 40–87 years) were included in this study. A total of 19 malignant (12 pancreatic, 6 gastric, and 1 metastatic rectal cancer) and 2 benign cases were observed. The proximal jejunum was punctured with a 19 G needle. The stomach and jejunum walls were dilated with a 6 F cystotome, and a 20×80 mm polytetrafluoroethylene T-FCSEMS (Hilzo) was deployed. Oral feeding was initiated after 12 to 18 hours and solid foods after 48 hours.
Results
The median procedure time was 33 minutes (range, 23–55 minutes). After two weeks, 19 patients tolerated oral feeding. In patients with malignancy, the median survival time was 118 days (range, 41–194 days). No serious complications or deaths occurred. All patients with malignancy tolerated oral food intake until they expired.
Conclusions
T-FCSEMS is safe and effective. This stent should be considered as an alternative to LAMS for gastric outlet obstruction.

Citations

Citations to this article as recorded by  
  • Tubular fully covered self-expandable metallic stents for endoscopic ultrasound-guided gastrojejunostomy: moving forward or taking a step back?
    Rami G. El Abiad, Mouen A. Khashab
    Clinical Endoscopy.2024; 57(2): 193.     CrossRef
  • 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
    Clinical Endoscopy.2024; 57(5): 588.     CrossRef
  • Endoscopic stenting for malignant gastric outlet obstruction: focusing on comparison of endoscopic stenting and surgical gastrojejunostomy
    Sun Gyo Lim, Chan Gyoo Kim
    Clinical Endoscopy.2024; 57(5): 571.     CrossRef
  • 5,991 View
  • 216 Download
  • 2 Web of Science
  • 3 Crossref
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Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites
Tsukasa Yasuda, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Masanori Yamada, Toshitaka Fukui
Clin Endosc 2024;57(2):246-252.   Published online September 7, 2023
DOI: https://doi.org/10.5946/ce.2023.075
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites.
Methods
Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention.
Results
Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90 %). No endoscopic complications such as bile peritonitis were observed.
Conclusions
In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS.

Citations

Citations to this article as recorded by  
  • Prevention of Adverse Events in Endoscopic Ultrasound‐Guided Biliary Drainage
    Hirotoshi Ishiwatari, Hiroki Sakamoto, Takuya Doi, Masahiro Yamamura
    DEN Open.2026;[Epub]     CrossRef
  • Feasibility and safety of EUS-guided biliary drainage in inexperienced centers: a multicenter study in southwest Japan
    Takehiko Koga, Yusuke Ishida, Shunpei Hashigo, Yuzo Shimokawa, Hirofumi Harima, Kazuhisa Okamoto, Akihisa Ohno, Tsukasa Miyagahara, Toshihiro Fujita, Satoshi Fukuchi, Kosuke Takahashi, Hiroki Taguchi, Norimasa Araki, Yuichiro Ohtsuka, Toshiyuki Uekitani,
    Gastrointestinal Endoscopy.2025; 101(4): 843.     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
  • Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage in hypervascular hepatocellular carcinoma: a retrospective study from Japan
    Kenneth Tachi, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Ahmed Mohammed Sadek, Hossam El-Din Shaaban Mahmoud Ibrahim, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto
    Clinical Endoscopy.2025; 58(3): 448.     CrossRef
  • Management of iatrogenic perforations during endoscopic interventions in the hepato-pancreatico-biliary tract
    Kirsten Boonstra, Rogier P. Voermans, Roy L.J. van Wanrooij
    Best Practice & Research Clinical Gastroenterology.2024; 70: 101890.     CrossRef
  • Is Endoscopic Ultrasound-Guided Hepaticogastrostomy Safe and Effective after Failed Endoscopic Retrograde Cholangiopancreatography?—A Systematic Review and Meta-Analysis
    Saqr Alsakarneh, Mahmoud Y. Madi, Dushyant Singh Dahiya, Fouad Jaber, Yassine Kilani, Mohamed Ahmed, Azizullah Beran, Mohamed Abdallah, Omar Al Ta’ani, Anika Mittal, Laith Numan, Hemant Goyal, Mohammad Bilal, Wissam Kiwan
    Journal of Clinical Medicine.2024; 13(13): 3883.     CrossRef
  • Endoscopic ultrasound-guided antegrade stenting combined with closure of the puncture route using self-assembling peptide solution in a jaundiced patient with ascites
    Hirotsugu Maruyama, Kojiro Tanoue, Tatsuya Kurokawa, Yoshinori Shimamoto, Yuki Ishikawa-Kakiya, Akira Higashimori, Yasuhiro Fujiwara
    Endoscopy.2024; 56(S 01): E953.     CrossRef
  • The Role of Therapeutic Endoscopic Ultrasound in Management of Malignant Double Obstruction (Biliary and Gastric Outlet): A Comprehensive Review with Clinical Scenarios
    Giuseppe Dell’Anna, Rubino Nunziata, Claudia Delogu, Petra Porta, Maria Vittoria Grassini, Jahnvi Dhar, Rukaia Barà, Sarah Bencardino, Jacopo Fanizza, Francesco Vito Mandarino, Ernesto Fasulo, Alberto Barchi, Francesco Azzolini, Guglielmo Albertini Petron
    Journal of Clinical Medicine.2024; 13(24): 7731.     CrossRef
  • 4,400 View
  • 227 Download
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Case Report
Single-pigtail plastic stent made from endoscopic nasobiliary drainage tubes in endoscopic ultrasound-guided gallbladder drainage: a retrospective case series
Koichi Soga
Clin Endosc 2024;57(2):263-267.   Published online April 4, 2023
DOI: https://doi.org/10.5946/ce.2022.213
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Technical failure of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is often attributed to device failure. To rectify this problem, we developed a single-pigtail plastic stent (SPPS) for EUS-GBD. We retrospectively reviewed the cases of four patients who underwent EUS-GBD for acute cholecystitis. To prepare the SPPS, a 7.5-Fr endoscopic nasobiliary drainage tube was cut to an appropriate length. The use of SPPS during EUS-GBD was successful from both technical and clinical standpoints. The SPPS spontaneously detached 57 days after the procedure in patient 4 and 412 days after the procedure in patient 1. Patient 1 developed cholecystitis after 426 days and was managed with antibiotics. The other three patients did not develop any complications after surgery. In conclusion, we designed a new SPPS dedicated to EUS-GBD and established its technical feasibility and clinical effectiveness.

Citations

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  • Endoscopic ultrasound-guided retrieval of a migrated plastic stent from a pelvic abscess
    Koichi Soga, Yuto Suzuki, Fuki Hayakawa, Takeshi Fujiwara, Yo Fujimoto, Ikuhiro Kobori, Masaya Tamano
    Endoscopy.2024; 56(S 01): E870.     CrossRef
  • Usefulness of inserting a modified single‐pigtail plastic stent into a metallic stent in endoscopic ultrasound-guided gallbladder drainage
    Koichi Soga
    Endoscopy.2023; 55(S 01): E1081.     CrossRef
  • 4,159 View
  • 212 Download
  • 1 Web of Science
  • 2 Crossref
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Video of Issue
A remnant cystic duct presenting as a duodenal subepithelial tumor
Gwang Ha Kim, Dong Chan Joo
Clin Endosc 2024;57(2):268-269.   Published online February 2, 2024
DOI: https://doi.org/10.5946/ce.2023.275
PDFSupplementary MaterialPubReaderePub
  • 3,348 View
  • 237 Download
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Boost Your Learning with Quiz
Nightmare of straight-type plastic stent migration into the peripheral bile duct: what is my savior?
Yun Chae Lee, Shayan Irani, Hyung Ku Chon
Clin Endosc 2024;57(1):134-136.   Published online August 3, 2023
DOI: https://doi.org/10.5946/ce.2023.132
PDFSupplementary MaterialPubReaderePub
  • 2,673 View
  • 133 Download
Close layer
Review
Single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a technical review
Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Rie Shiomi, Takahiro Shin, Kei Sugimoto, Shomei Ryozawa
Clin Endosc 2023;56(6):716-725.   Published online April 17, 2023
DOI: https://doi.org/10.5946/ce.2023.023
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is technically challenging. For example, scope insertion, selective cannulation, and intended procedures, such as stone extraction or stent placement, can be difficult. Single-balloon enteroscopy (SBE)-assisted ERCP has been used to effectively and safely address these technical issues in clinical practice. However, the small working channel limits its therapeutic potential. To address this shortcoming, a short-type SBE (short SBE) with a working length of 152 cm and a channel of 3.2 mm diameter has recently been introduced. Short SBE facilitates the use of larger accessories to complete certain procedures, such as stone extraction or self-expandable metallic stent placement. Despite the development in the SBE endoscope, various steps have to be overcome to successfully perform such procedure. To improve success, the challenging factors of each procedure must be identified. At the same time, endoscopists need to be mindful of adverse events, such as perforation, which can arise due to adhesions specific to the surgically altered anatomy. This review discussed technical tips regarding SBE-assisted ERCP in patients with surgically altered anatomy to increase success and reduce the risk of adverse events associated with ERCP.

Citations

Citations to this article as recorded by  
  • Clinical outcomes of endoscopic retrograde cholangiopancreatography after Billroth II anastomosis: a comparison of gastroscope and duodenoscope
    Kang Ho Lee, Gwang Hyo Yim, Jimin Han, Han Taek Jeong
    BMC Gastroenterology.2025;[Epub]     CrossRef
  • Peroral cholangioscopy: past, present and future
    Yuki Tanisaka, Robert Hawes
    Clinical Endoscopy.2025; 58(3): 360.     CrossRef
  • Advanced technical tips and recent insights in ERCP using balloon‐assisted endoscopy
    Masaaki Shimatani, Toshiyuki Mitsuyama, Takeshi Yamashina, Masahiro Takeo, Shunsuke Horitani, Natsuko Saito, Hironao Matsumoto, Masahiro Orino, Masataka Kano, Takafumi Yuba, Takuya Takayama, Tatsuya Nakagawa, Shoji Takayama
    DEN Open.2024;[Epub]     CrossRef
  • Efficacy of texture and color enhancement imaging for short‐type single‐balloon enteroscopy‐assisted biliary cannulation in patients with Roux‐en‐Y gastrectomy: Multicenter study (with video)
    Yuki Tanisaka, Mamoru Takenaka, Masafumi Mizuide, Akashi Fujita, Ryuhei Jinushi, Takahiro Shin, Kei Sugimoto, Ken Kamata, Kosuke Minaga, Shunsuke Omoto, Tomohiro Yamazaki, Shomei Ryozawa
    Digestive Endoscopy.2024; 36(9): 1030.     CrossRef
  • Progress in minimally invasive treatment of biliary pancreatic duct obstruction after digestive tract reconstruction by endoscopic retrograde cholangiopancreatography
    Ru-Yi Wang, Zhen Fan
    World Chinese Journal of Digestology.2024; 32(7): 490.     CrossRef
  • Endoscopic Management of Biliary and Pancreatic Pathologies in Roux-en-Y Gastric Bypass Patients: Development of a Treatment Algorithm Based on 9-Year Experience
    Laurent Monino, Lancelot Marique, Yannick Deswysen, Maximilien Thoma, Pierre H. Deprez, Pierre Goffette, Benoit Navez, Tom G. Moreels
    Obesity Surgery.2024; 34(10): 3717.     CrossRef
  • Use of short single-balloon enteroscopy in patients with surgically altered anatomy: a single-center experience
    Songming Ding, Shanjie Dong, Hengkai Zhu, Yiting Hu, Shusen Zheng, Qiyong Li
    Scientific Reports.2024;[Epub]     CrossRef
  • Emergency Laparoscopic Common Bile Duct Exploration for Acute Cholangitis in Cases with Difficulty with an Endoscopic Approach
    Naoki Matsumoto, Isao Sato, Yoshihide Chino, Makoto Mizutani, Tomotake Tabata, Tomoyuki Tagi, Shigeyoshi Shimaoka, Takafumi Oe
    The Japanese Journal of Gastroenterological Surgery.2024; 57(11): 535.     CrossRef
  • Development and evaluation of artificial organ models for ERCP training in patients with surgically altered anatomies
    Kai Koch, Benedikt Duckworth-Mothes, Ulrich Schweizer, Karl-Ernst Grund, Tom G. Moreels, Alfred Königsrainer, Dörte Wichmann
    Scientific Reports.2023;[Epub]     CrossRef
  • Simplified single-session EUS-guided transhepatic antegrade stone removal for management of choledocholithiasis in patients with surgically altered anatomy
    Tingting Yu, Suning Hou, Haiming Du, Wei Zhang, Jiao Tian, Yankun Hou, Jun Yao, Senlin Hou, Lichao Zhang
    Gastroenterology Report.2023;[Epub]     CrossRef
  • 4,637 View
  • 391 Download
  • 8 Web of Science
  • 10 Crossref
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Original Articles
Usefulness of the S-O clip for duodenal endoscopic submucosal dissection: a propensity score-matched study
Ippei Tanaka, Dai Hirasawa, Hiroaki Saito, Junichi Akahira, Tomoki Matsuda
Clin Endosc 2023;56(6):769-777.   Published online May 24, 2023
DOI: https://doi.org/10.5946/ce.2022.195
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal tumors (SNADETs) is associated with a high rate of en bloc resection. However, the technique for ESD remains challenging. Recent studies have demonstrated the effectiveness of S-O clips in colonic and gastric ESD. We evaluated the efficacy and safety of duodenal ESD using an S-O clip for SNADETs.
Methods
Consecutive patients who underwent ESD for SNADETs between January 2011 and December 2021 were retrospectively enrolled. Propensity score matching analysis was used to compare patients who underwent duodenal ESD with the S-O clip (S-O group) and those who underwent conventional ESD (control group). Intraoperative perforation rate was the primary outcome, while procedure time and R0 resection rate were the secondary outcomes.
Results
After propensity score matching, 16 pairs were created: 43 and 17 in the S-O and control groups, respectively. The intraoperative perforation rate in the S-O group was significantly lower than that in the control group (p=0.033). A significant difference was observed in the procedure time between the S-O and control groups (39±9 vs. 82±30 minutes, respectively; p=0.003).
Conclusions
The S-O clip reduced the intraoperative perforation rate and procedure time, which may be useful and effective in duodenal ESD.

Citations

Citations to this article as recorded by  
  • A Rare Subepithelial Lesion of the Proximal Colon Evaluated Using Miniprobe Endoscopic Ultrasonography: A Case Report
    Hidetaka Hamamoto, Tomoki Matsuda, Mareyuki Endo
    Cureus.2025;[Epub]     CrossRef
  • A serendipitous application of an elastic traction device in endoscopic submucosal dissection
    Ji Hyun Kim, Seung-Joo Nam, Sung Chul Park
    Journal of Innovative Medical Technology.2025; 3(1): 25.     CrossRef
  • Exploring different techniques for endoscopic submucosal dissection of gastrointestinal lesions: a review of the literature
    Giulio Calabrese, Marcello Maida, Darshan Parekh, Yohei Minato, Alessandro Vitello, Alberto Murino, Rui Morais, Emanuele Sinagra, Daryl Ramai, Ken Ohata, Sandro Sferrazza
    Expert Review of Anticancer Therapy.2025; : 1.     CrossRef
  • A method of “Noninjecting Resection using Bipolar Soft coagulation mode; NIRBS” for superficial non-ampullary duodenal epithelial tumor: a pilot study
    Mitsuo Tokuhara, Yasushi Sano, Yoshifumi Watanabe, Hidetoshi Nakata, Hiroko Nakahira, Shingo Furukawa, Takuya Ohtsu, Naohiro Nakamura, Takashi Ito, Ikuko Torii, Takeshi Yamashina, Masaaki Shimatani, Makoto Naganuma
    BMC Gastroenterology.2024;[Epub]     CrossRef
  • Traction methods for endoscopic submucosal dissection
    Ji Hyun Kim, Sung Chul Park
    Journal of Innovative Medical Technology.2024; 2(2): 47.     CrossRef
  • 3,768 View
  • 130 Download
  • 2 Web of Science
  • 5 Crossref
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Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases
Hayato Yamaguchi, Masakatsu Fukuzawa, Takashi Kawai, Takahiro Muramatsu, Taisuke Matsumoto, Kumiko Uchida, Yohei Koyama, Akira Madarame, Takashi Morise, Shin Kono, Sakiko Naito, Naoyoshi Nagata, Mitsushige Sugimoto, Takao Itoi
Clin Endosc 2023;56(6):778-789.   Published online July 26, 2023
DOI: https://doi.org/10.5946/ce.2022.268
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD).
Methods
We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes.
Results
Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]).
Conclusions
RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.

Citations

Citations to this article as recorded by  
  • Exploring different techniques for endoscopic submucosal dissection of gastrointestinal lesions: a review of the literature
    Giulio Calabrese, Marcello Maida, Darshan Parekh, Yohei Minato, Alessandro Vitello, Alberto Murino, Rui Morais, Emanuele Sinagra, Daryl Ramai, Ken Ohata, Sandro Sferrazza
    Expert Review of Anticancer Therapy.2025; : 1.     CrossRef
  • Planned Hybrid Endoscopic Submucosal Dissection as Alternative for Colorectal Neoplasms: A Propensity Score-Matched Study
    Yu-xin Zhang, Xun Liu, Fang Gu, Shi-gang Ding
    Digestive Diseases and Sciences.2024; 69(3): 949.     CrossRef
  • Understanding hybrid endoscopic submucosal dissection subtleties
    João Paulo de Souza Pontual, Alexandre Moraes Bestetti, Diogo Turiani Hourneaux de Moura
    Clinical Endoscopy.2023; 56(6): 738.     CrossRef
  • 3,765 View
  • 151 Download
  • 3 Web of Science
  • 3 Crossref
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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.
  • 3,235 View
  • 147 Download
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Evaluation of a new method, “non-injection resection using bipolar soft coagulation mode (NIRBS)”, for colonic adenomatous lesions
Mitsuo Tokuhara, Masaaki Shimatani, Kazunari Tominaga, Hiroko Nakahira, Takuya Ohtsu, Katsuyasu Kouda, Makoto Naganuma
Clin Endosc 2023;56(5):623-632.   Published online May 18, 2023
DOI: https://doi.org/10.5946/ce.2022.200
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic resection of all colorectal adenomatous lesions with a low complication rate, simplicity, and negative residuals is challenging. Hence, we developed a new method called “non-injection resection using bipolar soft coagulation mode (NIRBS)” method, adapted for colorectal lesions. In addition, we evaluated the effectiveness of this method.
Methods
We performed NIRBS throughout a 12-month period for all colorectal lesions which snare resection was acceptable without cancerous lesions infiltrating deeper than the submucosal layer.
Results
A total of 746 resected lesions were included in the study, with a 4.5 mm mean size (range, 1–35 mm). The major pathological breakdowns were as follows: 64.3% (480/746) were adenomas, and 5.0% (37/746) were intraepithelial adenocarcinomas (Tis lesions). No residuals were observed in any of the 37 Tis lesions (mean size, 15.3 mm). Adverse events included bleeding (0.4%) but no perforation.
Conclusions
NIRBS allowed the resection of multiple lesions with simplicity because of the non-injection and without perforating due to the minimal burn effect of the bipolar snare set in the soft coagulation mode. Therefore, NIRBS can be used to resect adenomatous lesions easily, including Tis lesions, from small to large lesions without leaving residuals.

Citations

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  • International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Clinical Endoscopy.2024; 57(2): 141.     CrossRef
  • IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    The Korean Journal of Gastroenterology.2024; 83(6): 217.     CrossRef
  • International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Gut and Liver.2024; 18(5): 764.     CrossRef
  • A method of “Noninjecting Resection using Bipolar Soft coagulation mode; NIRBS” for superficial non-ampullary duodenal epithelial tumor: a pilot study
    Mitsuo Tokuhara, Yasushi Sano, Yoshifumi Watanabe, Hidetoshi Nakata, Hiroko Nakahira, Shingo Furukawa, Takuya Ohtsu, Naohiro Nakamura, Takashi Ito, Ikuko Torii, Takeshi Yamashina, Masaaki Shimatani, Makoto Naganuma
    BMC Gastroenterology.2024;[Epub]     CrossRef
  • 3,973 View
  • 118 Download
  • 4 Web of Science
  • 4 Crossref
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Review
Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management
Clement Chun Ho Wu, Samuel Jun Ming Lim, Christopher Jen Lock Khor
Clin Endosc 2023;56(4):433-445.   Published online July 17, 2023
DOI: https://doi.org/10.5946/ce.2023.013
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.

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  • Comparison of the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with and without diabetes: a meta-analysis
    Fang Jia, Fujing Lv, Shutian Zhang
    Surgical Endoscopy.2025; 39(2): 807.     CrossRef
  • Small common bile duct - the risk factor for post-ercp pancreatitis in patients with choledocholithiasis
    Ivan Mamontov, Tamara Tamm, Kostiantyn Kramarenko, Dmytro Ryabushchenko, Dmytro Sytnik, Samer Dghaili
    Wiadomości Lekarskie.2025; 77(12): 2388.     CrossRef
  • Multidisciplinary Therapeutic Approaches to Pancreatic Cancer According to the Resectability Status
    Aurelio Mauro, Carlotta Faverio, Leonardo Brizzi, Stefano Mazza, Davide Scalvini, Daniele Alfieri, Alessandro Cappellini, Fabio Chicco, Carlo Ciccioli, Claudia Delogu, Marco Bardone, Anna Gallotti, Anna Pagani, Francesca Torello Viera, Andrea Anderloni
    Journal of Clinical Medicine.2025; 14(4): 1167.     CrossRef
  • Effect of periampullary diverticulum morphology on ERCP cannulation and clinical results
    Yavuz Cagir, Muhammed Bahaddin Durak, Cem Simsek, Ilhami Yuksel
    Scandinavian Journal of Gastroenterology.2025; 60(4): 292.     CrossRef
  • Delayed bleeding after endoscopic sphincterotomy in patients receiving anticoagulants
    Mitsushige Sugimoto, Masaki Murata, Kento Shionoya, Takayoshi Tsuchiya, Takao Itoi
    Digestive Endoscopy.2025;[Epub]     CrossRef
  • A Report of a Rare Case of Choledocholithiasis Complicated by Proximal Basket Rod Rupture Requiring Surgical Intervention
    Alexandre Gomes
    Cureus.2025;[Epub]     CrossRef
  • Development of a Checklist for Evaluating Pancreatobiliary Endoscopy Training Facilities and Educational Programs
    Hyung Ku Chon, Sung-Jo Bang, Eaum Seok Lee, Tae Ju Jeon, Chang Hwan Park
    The Korean Journal of Pancreas and Biliary Tract.2025; 30(2): 93.     CrossRef
  • Burden and cost of post–endoscopic retrograde cholangiopancreatography pancreatitis among commercially insured people undergoing endoscopic retrograde cholangiopancreatography
    Anna Tavakkoli, Kandice A. Kapinos, B. Joseph Elmunzer, Richard S. Kwon, David M. Troendle, Song Zhang, Amit G. Singal
    Gastrointestinal Endoscopy.2025;[Epub]     CrossRef
  • Preprocedural score system for post-ERCP pancreatitis risk stratification in patients with billiary obstruction
    I.М. Mamontov, D.D. Riabushchenko, Т.І. Tamm, K.О. Kramarenko, S. Dghaili, V.V. Nepomniashchyi
    Український радіологічний та онкологічний журнал.2025; 33(1): 9.     CrossRef
  • Prevention of post-ERCP complications
    Lotfi Triki, Andrea Tringali, Marianna Arvanitakis, Tommaso Schepis
    Best Practice & Research Clinical Gastroenterology.2024; 69: 101906.     CrossRef
  • International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Clinical Endoscopy.2024; 57(2): 141.     CrossRef
  • Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla
    Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han
    Clinical Endoscopy.2024; 57(2): 226.     CrossRef
  • Computed tomography-based prediction of pancreatitis following biliary metal stent placement with the convolutional neural network
    Tsuyoshi Hamada, Koichiro Yasaka, Yousuke Nakai, Rintaro Fukuda, Ryunosuke Hakuta, Kazunaga Ishigaki, Sachiko Kanai, Kensaku Noguchi, Hiroki Oyama, Tomotaka Saito, Tatsuya Sato, Tatsunori Suzuki, Naminatsu Takahara, Hiroyuki Isayama, Osamu Abe, Mitsuhiro
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  • IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    The Korean Journal of Gastroenterology.2024; 83(6): 217.     CrossRef
  • International Digestive Endoscopy Network Consensus on the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy
    Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
    Gut and Liver.2024; 18(5): 764.     CrossRef
  • Risk factors for acute pancreatitis after endoscopic retrograde cholangiopancreatography: a retrospective single-center study
    I.М. Mamontov, D.D. Rjabushhenko, Т.І. Tamm, К.О. Kramarenko, V.V. Nepomniashchyi, A.T. Ustinov
    Український радіологічний та онкологічний журнал.2024; 32(3): 287.     CrossRef
  • Could assessment of genetic susceptibility be an effective solution to prevent pancreatitis from occurring after endoscopic retrograde cholangiopancreatography?
    Jae Min Lee
    The Korean Journal of Internal Medicine.2023; 38(6): 783.     CrossRef
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Original Articles
Utility of narrow-band imaging with or without dual focus magnification in neoplastic prediction of small colorectal polyps: a Vietnamese experience
Tien Manh Huynh, Quang Dinh Le, Nhan Quang Le, Huy Minh Le, Duc Trong Quach
Clin Endosc 2023;56(4):479-489.   Published online May 24, 2023
DOI: https://doi.org/10.5946/ce.2022.212
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Accurate neoplastic prediction can significantly decrease costs associated with pathology and unnecessary colorectal polypectomies. Narrow band imaging (NBI) and dual-focus (DF) mode are promising emerging optical technologies for recognizing neoplastic features of colorectal polyps digitally. This study aimed to clarify the clinical usefulness of NBI with and without DF assistance in the neoplastic prediction of small colorectal polyps (<10 mm).
Methods
This cross-sectional study included 530 small colorectal polyps from 343 consecutive patients who underwent colonoscopy at the University Medical Center from September 2020 to May 2021. Each polyp was endoscopically diagnosed in three successive steps using white-light endoscopy (WLE), NBI, and NBI-DF and retrieved for histopathological assessment. The diagnostic accuracy of each modality was evaluated with reference to histopathology.
Results
There were 295 neoplastic polyps and 235 non-neoplastic polyps. The overall accuracies of WLE, WLE+NBI, and WLE+NBI+NBI-DF in the neoplastic prediction of colorectal polyps were 70.8%, 87.4%, and 90.8%, respectively (p<0.001). The accuracy of WLE+NBI+NBI-DF was significantly higher than that of WLE+NBI in the polyp size ≤5 mm subgroup (87.3% vs. 90.1%, p<0.001).
Conclusions
NBI improved the real-time neoplastic prediction of small colorectal polyps. The DF mode was especially useful in polyps ≤5 mm in size.

Citations

Citations to this article as recorded by  
  • Advances in Clinical Research on Colorectal Polyps in the Context of Precision Medicine
    绩徽 李
    Asian Case Reports in Emergency Medicine.2025; 13(02): 146.     CrossRef
  • Effectiveness of Dual-Focus Magnification on Confidence Levels in Optical Diagnosis of Small Colorectal Polyps
    Tien M Huynh, Quang D Le, Nhan Q Le , Huy M Le , Duc T Quach
    Cureus.2024;[Epub]     CrossRef
  • Implementing narrow banding imaging with dual focus magnification for histological prediction of small rectosigmoid polyps in Vietnamese setting
    Tien Manh Huynh, Quang Dinh Le, Nhan Quang Le, Huy Minh Le, Duc Trong Quach
    JGH Open.2024;[Epub]     CrossRef
  • The role of narrow-band imaging with or without dual focus in the detection of polyps smaller than 10 mm, especially diminutive polyps
    Jin Hwa Park
    Clinical Endoscopy.2023; 56(4): 455.     CrossRef
  • Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
    Yong Soo Kwon, Su Young Kim
    Journal of the Korean Medical Association.2023; 66(11): 652.     CrossRef
  • 3,912 View
  • 107 Download
  • 4 Web of Science
  • 5 Crossref
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Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography
Yasuhiro Kuraishi, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Masanori Yamada, Nobumasa Mizuno
Clin Endosc 2023;56(4):490-498.   Published online April 27, 2023
DOI: https://doi.org/10.5946/ce.2022.130
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and serious complication of endoscopic retrograde cholangiopancreatography. To prevent this event, a unique precutting method, termed opening window fistulotomy, was performed in patients with a large infundibulum as the primary procedure for biliary cannulation, whereby a suprapapillary laid-down H-shaped incision was made without touching the orifice. This study aimed to assess the safety and feasibility of this novel technique.
Methods
One hundred and ten patients were prospectively enrolled in this study. Patients with a papillary roof size ≥10 mm underwent opening window fistulotomy for primary biliary access. In addition, the incidence of complications and success rate of biliary cannulation were evaluated.
Results
The median size of the papillary roof was 6 mm (range, 3–20 mm). Opening window fistulotomy was performed in 30 patients (27.3%), none of whom displayed PEP. Duodenal perforation was recorded in one patient (3.3%), which was resolved by conservative treatment. The cannulation rate was high (96.7%, 29/30 patients). The median duration of biliary access was 8 minutes (range, 3–15 minutes).
Conclusions
Opening window fistulotomy demonstrated its feasibility for primary biliary access by achieving great safety with no PEP complications and a high success rate for biliary cannulation.

Citations

Citations to this article as recorded by  
  • Comments on ‘Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography’
    Masood Muhammad Karim, Adeel Ur Rehman, Faisal Wasim Ismail, Om Parkash
    Clinical Endoscopy.2024; 57(2): 280.     CrossRef
  • 4,006 View
  • 177 Download
  • 1 Web of Science
  • 1 Crossref
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