Clinical Endoscopy

Korean guidelines for postpolypectomy colonoscopic surveillance: 2022 revised edition: Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo Young Cho, Moon Sung Lee, Oh Young Lee, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases; Clin Endosc 2022;55(6):703-725. Published online October 13, 2022; DOI: https://doi.org/10.5946/ce.2022.136

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Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for the management of advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: (1) adenoma ≥10 mm in size; (2) 3 to 5 (or more) adenomas; (3) tubulovillous or villous adenoma; (4) adenoma containing high-grade dysplasia; (5) traditional serrated adenoma; (6) sessile serrated lesion (SSL) containing any grade of dysplasia; (7) serrated polyp of at least 10 mm in size; and (8) 3 to 5 (or more) SSLs. More studies are needed to fully comprehend the patients most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

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Association between Atherosclerosis and High-Risk Colorectal Adenomas based on Cardio-Ankle Vascular Index and Ankle-Brachial Index
Jung Ho Lee, Hyunseok Cho, Sang Hoon Lee, Sung Joon Lee, Chang Don Kang, Dae Hee Choi, Jin Myung Park, Seung-Joo Nam, Tae Suk Kim, Ji Hyun Kim, Sung Chul Park
The Korean Journal of Gastroenterology.2024; 83(4): 143. CrossRef
A survey of current practices in post-polypectomy surveillance in Korea
Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Eun Ran Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoo
Intestinal Research.2024; 22(2): 186. CrossRef
Approaches and considerations in the endoscopic treatment of T1 colorectal cancer
Yunho Jung
The Korean Journal of Internal Medicine.2024; 39(4): 563. CrossRef
Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revision
Su Young Kim
The Korean Journal of Medicine.2023; 98(3): 102. CrossRef
Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
Clinical Endoscopy.2023; 56(5): 553. CrossRef
Understanding colorectal polyps to prevent colorectal cancer
Dong-Hoon Yang
Journal of the Korean Medical Association.2023; 66(11): 626. CrossRef
Classification and endoscopic diagnosis of colorectal polyps
Ji Hyun Kim, Sung Chul Park
Journal of the Korean Medical Association.2023; 66(11): 633. CrossRef
Endoscopic treatment of colorectal polyps and early colorectal cancer
Yunho Jung
Journal of the Korean Medical Association.2023; 66(11): 642. 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

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Recent advances in surveillance colonoscopy for dysplasia in inflammatory bowel disease: Soo-Young Na, Won Moon; Clin Endosc 2022;55(6):726-735. Published online November 18, 2022; DOI: https://doi.org/10.5946/ce.2022.132

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Inflammatory bowel disease (IBD) has a global presence with rapidly increasing incidence and prevalence. Patients with IBD including those with ulcerative colitis and Crohn’s disease have a higher risk of developing colorectal cancer (CRC) compared to the general population. Risk factors for CRC in patients with IBD include long disease duration, extensive colitis, primary sclerosing cholangitis, family history of CRC, stricture, and prior dysplasia. Surveillance colonoscopy for CRC in patients with IBD should be tailored to individualized risk factors and requires careful monitoring every year to every five years. The current surveillance techniques are based on several guidelines. Chromoendoscopy with targeted biopsy is being recommended increasingly, and high-definition colonoscopy is gradually replacing standard-definition colonoscopy. However, it remains unclear whether chromoendoscopy, virtual chromoendoscopy, or white-light endoscopy has better efficiency when a high-definition scope is used. With the development of new endoscopic instruments and techniques, the paradigm of surveillance strategy has gradually changed. In this review, we discuss cutting-edge surveillance colonoscopy in patients with IBD including a review of literature.

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Inflammatory bowel disease and primary sclerosing cholangitis: One disease or two?
Kim N. van Munster, Annika Bergquist, Cyriel Y. Ponsioen
Journal of Hepatology.2024; 80(1): 155. CrossRef
Extrachromosomal Circular DNA: An Emerging Potential Biomarker for Inflammatory Bowel Diseases?
Valentina Petito, Federica Di Vincenzo, Lorenza Putignani, Maria T. Abreu, Birgitte Regenberg, Antonio Gasbarrini, Franco Scaldaferri
Genes.2024; 15(4): 414. CrossRef
A Review of Colonoscopy in Intestinal Diseases
Seung Hong, Dong Baek
Diagnostics.2023; 13(7): 1262. CrossRef
Potential Oral Microbial Markers for Differential Diagnosis of Crohn’s Disease and Ulcerative Colitis Using Machine Learning Models
Sang-Bum Kang, Hyeonwoo Kim, Sangsoo Kim, Jiwon Kim, Soo-Kyung Park, Chil-Woo Lee, Kyeong Ok Kim, Geom-Seog Seo, Min Suk Kim, Jae Myung Cha, Ja Seol Koo, Dong-Il Park
Microorganisms.2023; 11(7): 1665. CrossRef
Update on Endoscopic Dysplasia Surveillance in Inflammatory Bowel Disease
Nayantara Coelho-Prabhu, James D. Lewis
American Journal of Gastroenterology.2023;[Epub] CrossRef

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

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

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Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography procedure for choledocholithiasis after sleeve gastrectomy and Roux-en-Y
Reid D. Wasserman, Varun Kesar, Vivek Kesar, Paul Yeaton, Shehriyar Mehershahi
Endoscopy.2024; 56(S 01): E390. CrossRef
A novel endoscopic ultrasound-guided transluminal anchor device
Abhishek Agnihotri, Alexander Schlachterman
Endoscopy.2023; 55(S 01): E775. CrossRef

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Outcomes of thin versus thick-wire snares for cold snare polypectomy: a systematic review and meta-analysis: Suprabhat Giri, Vaneet Jearth, Harish Darak, Sridhar Sundaram; Clin Endosc 2022;55(6):742-750. Published online November 9, 2022; DOI: https://doi.org/10.5946/ce.2022.141

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Background
/Aims: Cold snare polypectomy (CSP) is commonly used for the resection of colorectal polyps ≤10 mm. Data regarding the influence of snare type on CSP effectiveness are conflicting. Hence, this meta-analysis aimed to compare the outcomes and safety of thin- and thick-wire snares for CSP.
Methods
A comprehensive search of the literature published between 2000 and 2021 was performed of various databases for comparative studies evaluating the outcomes of thin- versus thick-wire snares for CSP.
Results
Five studies with data on 1,425 polyps were included in the analysis. The thick-wire snare was comparable to the thin-wire snare with respect to complete histological resection (risk ratio [RR], 1.03; 95% confidence interval [CI], 0.97–1.09), overall bleeding (RR, 0.98; 95% CI, 0.40–2.40), polyp retrieval (RR, 1.01; 95% CI, 0.97–1.04), and involvement of submucosa in the resection specimen (RR, 1.28; 95% CI, 0.72–2.28). There was no publication bias and a small study effect, and the relative effects remained the same in the sensitivity analysis.
Conclusions
CSP using a thin-wire snare has no additional benefit over thick-wire snares in small colorectal polyps. Factors other than snare design may play a role in improving CSP outcomes.

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Factors determining the resection ability of snares in cold snare polypectomy: Construction of an ex vivo model for accurately evaluating resection ability
Ryohei Hirose, Takuma Yoshida, Naohisa Yoshida, Katsuma Yamauchi, Hajime Miyazaki, Naoto Watanabe, Risa Bandou, Ken Inoue, Hiroshi Ikegaya, Takaaki Nakaya, Yoshito Itoh
Digestive Endoscopy.2024; 36(5): 573. CrossRef
Effectiveness and safety of thin vs. thick cold snare polypectomy of small colorectal polyps: Systematic review and meta-analysis
Rishad Khan, Sunil Samnani, Marcus Vaska, Samir C Grover, Catharine M Walsh, Jeffrey Mosko, Michael J Bourke, Steven J Heitman, Nauzer Forbes
Endoscopy International Open.2024; 12(01): E99. 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
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
High‐Performance Dedicated Snares with Tip Attachments can Overcome Current Disadvantages in Cold Snare Polypectomy
Ryohei Hirose, Naohisa Yoshida, Takuma Yoshida, Hiroki Mukai, Katsuma Yamauchi, Hajime Miyazaki, Naoto Watanabe, Risa Bandou, Ken Inoue, Osamu Dohi, Yoshikazu Inagaki, Yutaka Inada, Takaaki Murakami, Akio Yanagisawa, Hiroshi Ikegaya, Takaaki Nakaya, Yoshi
Advanced Materials Technologies.2024;[Epub] 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
Does the wire diameter really determine the outcomes in cold snare polypectomy?
S Giri, S Sundaram
Journal of Gastroenterology and Hepatology.2023; 38(4): 665. CrossRef
Cold resection for colorectal polyps: where we are and where we are going?
Antonio Capogreco, Ludovico Alfarone, Davide Massimi, Alessandro Repici
Expert Review of Gastroenterology & Hepatology.2023; 17(7): 719. CrossRef
Endoscopic treatment of colorectal polyps and early colorectal cancer
Yunho Jung
Journal of the Korean Medical Association.2023; 66(11): 642. CrossRef

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Assessing implementation strategy and learning curve for transoral incisionless fundoplication as a new technique: Muhammad Haseeb, Christopher C. Thompson; Clin Endosc 2022;55(6):751-752. Published online November 8, 2022; DOI: https://doi.org/10.5946/ce.2022.280

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Gastroesophageal reflux disease in children: What’s new right now?
Palittiya Sintusek, Mohamed Mutalib, Nikhil Thapar
World Journal of Gastrointestinal Endoscopy.2023; 15(3): 84. CrossRef
Endoscopic therapy for gastroesophageal reflux disease: where are we, where are we going?
Muhammad Haseeb, Christopher C. Thompson
Current Opinion in Gastroenterology.2023; 39(5): 381. CrossRef

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Need for careful endoscopic evaluation of large gastric neoplasms before endoscopic submucosal dissection: Seung Woo Lee; Clin Endosc 2022;55(6):753-754. Published online November 16, 2022; DOI: https://doi.org/10.5946/ce.2022.266

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Waterjet-assisted endoscopic submucosal dissection in the colorectum: safe and effective?: Sneha John; Clin Endosc 2022;55(6):755-756. Published online November 16, 2022; DOI: https://doi.org/10.5946/ce.2022.271

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How should a therapeutic strategy be constructed for acute cholecystitis after self-expanding metal stent placement for malignant biliary obstruction?: Mamoru Takenaka, Masatoshi Kudo; Clin Endosc 2022;55(6):757-759. Published online November 1, 2022; DOI: https://doi.org/10.5946/ce.2022.275

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Underestimation of endoscopic size in large gastric epithelial neoplasms: Jae Sun Song, Byung Sun Kim, Min A Yang, Young Jae Lee, Gum Mo Jung, Ji Woong Kim, Jin Woong Cho; Clin Endosc 2022;55(6):760-766. Published online May 19, 2022; DOI: https://doi.org/10.5946/ce.2021.269

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Background
/Aims: Endoscopic submucosal dissection (ESD) is an effective method for resecting gastric adenomas and adenocarcinomas. A significant discrepancy was observed between endoscopic and pathological sizes in samples obtained from patients undergoing ESD. This study elucidates the factors affecting size discrepancy after formalin fixation.
Methods
The records of 64 patients with 69 lesions were analyzed, including 50 adenomas and 19 adenocarcinomas. Data on location, gross shape, histology, and size after fixation in formalin were collected.
Results
The mean size of the resected specimen appeared to decrease after formalin fixation (37.5 mm prefixation vs. 35.8 mm postfixation, p<0.05). The mean long axis diameter of the lesions was 20.3±7.9 mm prefixation and 13.4±7.9 mm postfixation. Size differences in lesions smaller than 20 mm were significantly greater than those in lesions larger than 20 mm (7.6±5.6 mm vs. 2.5±5.8 mm, p<0.01). In multivariate analysis, a tumor size of ≥20 mm was found to be an independent factor affecting size postformalin fixation (p<0.05).
Conclusions
The endoscopic size of lesions before ESD may be underestimated in tumors larger than 20 mm in size. Therefore, increased attention must be paid during ESD to avoid instances of incomplete resection.

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Transcecal endoscopic appendectomy for management of complex appendiceal polyps extending into the appendiceal orifice
Tara Keihanian, Mai A Khalaf, Fuad Zain Aloor, Dina Hani Zamil, Salmaan Jawaid, Mohamed O. Othman
Endoscopy International Open.2024; 12(08): E932. CrossRef

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Comparison between a novel core knife and the conventional IT knife 2 for endoscopic submucosal dissection of gastric mucosal lesions: Myeongsoon Park, Jin Wook Lee, Dong Woo Shin, Jungseok Kim, Yoo Jin Lee, Ju Yup Lee, Kwang Bum Cho; Clin Endosc 2022;55(6):767-774. Published online May 25, 2022; DOI: https://doi.org/10.5946/ce.2022.002

Abstract PDF PubReader ePub: Background
/Aims: Few studies have compared the performances of endoscopic knives. This study aimed to compare the therapeutic outcomes of a novel core knife and the conventional IT knife 2 for endoscopic submucosal dissection (ESD) of gastric mucosal lesions.
Methods
This prospective, non-inferiority trial included patients diagnosed with gastric adenoma or early-stage adenocarcinoma at Keimyung University Dongsan Hospital between June and November 2020. The patients were randomly assigned to either the core knife or the IT knife 2 group. The operators and assistants scored the knives’ grip convenience and cutting abilities.
Results
A total of 39 patients were enrolled (core knife group, 20 patients; IT knife 2 group, 19 patients). There were no significant between-group differences in operator-assessed grip convenience (9.600 vs. 9.526, p=0.753), cutting ability (9.600 vs. 9.105, p=0.158), or assistant-assessed grip convenience (9.500 vs. 9.368, p=0.574).
Conclusions
The core knife achieved therapeutic outcomes that were comparable to those of the IT knife 2 for ESD of gastric mucosal lesions.

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Endoscopic submucosal dissection in colorectal neoplasia performed with a waterjet system-assisted knife: higher en-bloc resection rate than conventional technique: Paolo Cecinato, Matteo Lucarini, Francesco Azzolini, Mariachiara Campanale, Fabio Bassi, Annalisa Cippitelli, Romano Sassatelli; Clin Endosc 2022;55(6):775-783. Published online October 6, 2022; DOI: https://doi.org/10.5946/ce.2022.099

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Background
/Aims: Colorectal endoscopic submucosal dissection (ESD) is burdened by its associated high risk of adverse events and long procedure time. Recently, a waterjet-assisted knife was introduced to simplify and speed up the procedure. The aim of this study was to evaluate the efficacy and safety of waterjet-assisted ESD (WESD) compared to that of the conventional ESD (CESD) technique.
Methods
The charts of 254 consecutive patients who underwent colorectal ESD between January 2014 and February 2021 for colorectal neoplasms were analyzed. The primary outcome was the en-bloc resection rate. Secondary outcomes were complete and curative resection rates, the need to switch to a hybrid ESD, procedure speed, the adverse event rates, and the recurrence rates.
Results
Approximately 174 neoplasias were considered, of which, 123 were removed by WESD and 51 by CESD. The en-bloc resection rate was higher in the WESD group (94.3% vs. 84.3%). Complete resection rates and curative resection rates were similar. The need to switch to a hybrid ESD was greater during CESD (39.2% vs. 13.8%). Procedure speed and adverse event rates were similar. During follow-up, one recurrence occurred after a WESD.
Conclusions
WESD allows a high rate of en-bloc resections and less frequently requires a rescue switch to the hybrid ESD compared to CESD.

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Is there a best choice of equipment for colorectal endoscopic submucosal dissection?
Francesco Cocomazzi, Sonia Carparelli, Nunzia Labarile, Antonio Capogreco, Marco Gentile, Roberta Maselli, Jahnvi Dhar, Jayanta Samanta, Alessandro Repici, Cesare Hassan, Francesco Perri, Antonio Facciorusso
Expert Review of Medical Devices.2024; 21(7): 561. CrossRef
Colorectal Endoscopic Submucosal Dissection: Performance of a Novel Hybrid-Technology Knife in an Animal Trial
Jérémie Jacques, Horst Neuhaus, Markus D. Enderle, Ulrich Biber, Walter Linzenbold, Martin Schenk, Kareem Khalaf, Alessandro Repici
Diagnostics.2023; 13(21): 3347. CrossRef

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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

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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.

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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
Endoscopic Ultrasound-Guided Naso-gallbladder Drainage Using a Dedicated Catheter for Acute Cholecystitis After Transpapillary Metal Stent Placement for Malignant Biliary Obstruction
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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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

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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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Citric Acid Loaded Hydrogel-Coated Stent for Dissolving Pancreatic Duct Calculi
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
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.2023;[Epub] CrossRef
Quality of life after endoscopic procedures for chronic pancreatitis: A multicentre study
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
United European Gastroenterology Journal.2023; 11(9): 884. CrossRef
Pancreatic duct stents
Jin Hui Yi, Zhao Shen Li, Liang Hao Hu
Journal of Digestive Diseases.2022; 23(12): 675. CrossRef

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Is antibiotic prophylaxis necessary after endoscopic ultrasound–guided fine-needle aspiration of pancreatic cysts?: Seifeldin Hakim, Mihajlo Gjeorgjievski, Zubair Khan, Michael E. Cannon, Kevin Yu, Prithvi Patil, Roy Tomas DaVee, Sushovan Guha, Ricardo Badillo, Laith Jamil, Nirav Thosani, Srinivas Ramireddy; Clin Endosc 2022;55(6):801-809. Published online November 10, 2022; DOI: https://doi.org/10.5946/ce.2021.150

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Background
/Aims: Current society guidelines recommend antibiotic prophylaxis for 3 to 5 days after endoscopic ultrasound–guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions (PCLs). The overall quality of the evidence supporting this recommendation is low. In this study, we aimed to assess cyst infection and adverse event rates after EUS-FNA of PCLs among patients treated with or without postprocedural prophylactic antibiotics.
Methods
We retrospectively reviewed all patients who underwent EUS-FNA of PCLs between 2015 and 2019 at two large-volume academic medical centers with different practice patterns of postprocedural antibiotic prophylaxis. Data on patient demographics, cyst characteristics, fine-needle aspiration technique, periprocedural and postprocedural antibiotic prophylaxis, and adverse events were retrospectively extracted.
Results
A total of 470 EUS-FNA procedures were performed by experienced endosonographers for the evaluation of PCLs in 448 patients, 58.7% of whom were women. The mean age was 66.3±12.8 years. The mean cyst size was 25.7±16.9 mm. Postprocedural antibiotics were administered in 274 cases (POSTAB+ group, 58.3%) but not in 196 cases (POSTAB– group, 41.7%). None of the patients in either group developed systemic or localized infection within the 30-day follow-up period. Procedure-related adverse events included mild abdominal pain (8 patients), intra-abdominal hematoma (1 patient), mild pancreatitis (1 patient), and perforation (1 patient). One additional case of pancreatitis was recorded; however, the patient also underwent endoscopic retrograde cholangiopancreatography.
Conclusions
The incidence of infection after EUS-FNA of PCLs is negligible. Routine use of postprocedural antibiotics does not add a significant benefit.

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Risk of Pancreatitis After Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis
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Extracutaneous mastocytoma is a rare benign tumor composed of mature mast cells and is located in tissues other than the skin. We report the case of a 61-year-old male who was diagnosed with extracutaneous mastocytoma via colonoscopic polypectomy and biopsy. To our knowledge, this was the first case of a solitary extracutaneous mastocytoma of the colon. We reported this case and reviewed the literature.

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Peroral endoscopic myotomy versus Heller’s myotomy for achalasia hospitalizations in the United States: what does the future hold?: Dushyant Singh Dahiya, Vinay Jahagirdar, Manesh Kumar Gangwani, Muhammad Aziz, Chin-I Cheng, Sumant Inamdar, Madhusudhan R. Sanaka, Mohammad Al-Haddad; Clin Endosc 2022;55(6):826-828. Published online November 3, 2022; DOI: https://doi.org/10.5946/ce.2022.283

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