Clinical Endoscopy

Optimal endoscopic drainage strategy for unresectable malignant hilar biliary obstruction: Itaru Naitoh, Tadahisa Inoue; Clin Endosc 2023;56(2):135-142. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2022.150

Endoscopic biliary drainage strategies for managing unresectable malignant hilar biliary obstruction differ in terms of stent type, drainage area, and deployment method. However, the optimal endoscopic drainage strategy remains unclear. Uncovered self-expandable metal stents (SEMS) are the preferred type because of their higher functional success rate, longer time to recurrent biliary obstruction (RBO), and fewer cases of reintervention than plastic stents (PS). Other PS subtypes and covered SEMS, which feature a longer time to RBO than PS, can be removed during reintervention for RBO. Bilateral SEMS placement is associated with a longer time to RBO and a longer survival time than unilateral SEMS placement. Unilateral drainage is acceptable if a drainage volume of greater than 50% of the total liver volume can be achieved. In terms of deployment method, no differences were observed in clinical outcomes between side-by-side (SBS) and stent-in-stent deployment. Simultaneous SBS boasts a shorter procedure time and higher technical success rate than sequential SBS. This review of previous studies aimed to clarify the optimal endoscopic biliary drainage strategy for unresectable malignant hilar biliary obstruction.

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Comparison of unilateral and bilateral intraductal plastic stent placement for unresectable malignant hilar biliary obstruction: A propensity score‐matched cohort analysis
Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yuhei Iwasa, Shinya Uemura, Kensaku Yoshida, Akinori Maruta, Takuji Iwashita, Ichiro Yasuda, Masahito Shimizu
Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(4): 284. CrossRef
Preoperative endoscopic biliary drainage by metal versus plastic stents for resectable perihilar cholangiocarcinoma
David M. de Jong, Timothy M. Gilbert, Lynn E. Nooijen, Eva Braunwarth, Marijana Ninkovic, Florian Primavesi, Hassan Z. Malik, Nick Stern, Richard Sturgess, Joris I. Erdmann, Rogier P. Voermans, Marco J. Bruno, Bas Groot Koerkamp, Lydi M.J.W. van Driel
Gastrointestinal Endoscopy.2024; 99(4): 566. CrossRef
TOKYO criteria 2024 for the assessment of clinical outcomes of endoscopic biliary drainage
Hiroyuki Isayama, Tsuyoshi Hamada, Toshio Fujisawa, Mitsuharu Fukasawa, Kazuo Hara, Atsushi Irisawa, Shigeto Ishii, Ken Ito, Takao Itoi, Yoshihide Kanno, Akio Katanuma, Hironari Kato, Hiroshi Kawakami, Hirofumi Kawamoto, Masayuki Kitano, Hirofumi Kogure,
Digestive Endoscopy.2024;[Epub] CrossRef
Trisectoral Metal Stenting Using Combined Stent-by-Stent and Stent-in-Stent Method for Malignant Hilar Biliary Obstruction: A Prospective Pilot Study
Tadahisa Inoue, Rena Kitano, Mayu Ibusuki, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
Digestive Diseases and Sciences.2024;[Epub] CrossRef
Research progress on biliary stents

Progress in Medical Devices.2023;[Epub] CrossRef

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Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction: Partha Pal, Sundeep Lakhtakia; Clin Endosc 2023;56(2):143-154. Published online February 17, 2023; DOI: https://doi.org/10.5946/ce.2022.198

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

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Endoscopic Management of Malignant Biliary Obstruction
Woo Hyun Paik, Do Hyun Park
Gastrointestinal Endoscopy Clinics of North America.2024; 34(1): 127. CrossRef
The Lambda stenting technique: a new approach to address EUS-guided biliary drainage–associated adverse events
Hiroki Sato, Hidemasa Kawabata, Mikihiro Fujiya
VideoGIE.2024; 9(2): 107. CrossRef
Comparison of stent patency between EUS-guided hepaticogastrostomy with bridging and endoscopic transpapillary biliary drainage for hilar obstruction
Kotaro Takeshita, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Akihiro Ohba, Yuki Kawasaki, Tetsuro Takasaki, Shin Yagi, Daiki Agarie, Hidenobu Hara, Yuya Hagiwara, Daiki Yamashige, Kohei Okamoto, Soma Fukuda, Masaru Kuwada, Mark Chatto, Shunsuke Kond
Endoscopy International Open.2024; 12(07): E875. CrossRef
Percutaneous transhepatic cholangioscopy combined with endoscopic retrograde cholangiopancreatography for bilateral biliary bridge drainage for malignant biliary obstruction
Gang Tang, Jingyi Zhang, Rui Chen, Jie Zhang, Rongxing Zhou
Endoscopy.2024; 56(S 01): E724. CrossRef

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Role of radiofrequency ablation in advanced malignant hilar biliary obstruction: Mamoru Takenaka, Tae Hoon Lee; Clin Endosc 2023;56(2):155-163. Published online January 16, 2023; DOI: https://doi.org/10.5946/ce.2022.218

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Malignant hilar biliary obstruction (MHO), an aggressive perihilar biliary obstruction caused by cholangiocarcinoma, gallbladder cancer, or other metastatic malignancies, has a poor prognosis. Surgical resection is the only curative treatment for biliary malignancies. However, the majority of patients with MHO cannot undergo surgery on presentation because of an advanced inoperable state or a poor performance state due to old age or comorbid diseases. Therefore, palliative biliary drainage is mandatory to improve symptomatic jaundice and the quality of life. Among the drainage methods, endoscopic biliary drainage is the current standard for palliation of unresectable advanced MHO. In addition, combined with endoscopic drainage, additional local ablation therapies, such as photodynamic therapy or radiofrequency ablation (RFA), have been introduced to prolong stent patency and survival. Currently, RFA is commonly used as palliative therapy, even for advanced MHO. This literature review summarizes recent studies on RFA for advanced MHO.

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Percutaneous endobiliary radiofrequency ablation with stent placement in type IV hilar cholangiocarcinoma: A prospective comparison with stent placement alone
Kun Yung Kim, Chang Jin Yoon, Jae Hwan Lee, Chong-Ho Lee, Jin-Hyeok Hwang, Jaihwan Kim
European Journal of Radiology.2024; 176: 111516. CrossRef
Metastatic Cholangiocarcinoma Presenting as Colonic Obstruction
Yianni Protopapadakis, Kevin Lamm, Joseph Baber
ACG Case Reports Journal.2023; 10(12): e01238. CrossRef
Is endoscopic radiofrequency ablation plus stent placement superior to stent placement alone for the treatment of malignant biliary obstruction? A systematic review and meta-analysis
Chenming Liu, Jiaming Dong, Yuxing Liu, Siyuan Zhang, Ruanchang Chen, Haijun Tang
Journal of International Medical Research.2023;[Epub] CrossRef

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Intraductal ultrasonography for biliary strictures: Young Koog Cheon; Clin Endosc 2023;56(2):164-168. Published online February 17, 2023; DOI: https://doi.org/10.5946/ce.2022.184

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When diagnosing the nature of biliary strictures, it is sometimes difficult to perform non-invasive methods such as ultrasound, spiral computed imaging, magnetic resonance imaging, or endoscopic ultrasonography. Thus, treatment decisions are usually based on biopsy results. However, brush cytology or biopsy, which is widely used for biliary stenosis, has limitations owing to its low sensitivity and negative predictive value for malignancy. Currently, the most accurate method is bile duct tissue biopsy under direct cholangioscopy. On the other hand, intraductal ultrasonography administered under the guidance of a guidewire has the advantages of easy administration and being less invasive, allowing for adequate examination of the biliary tract and surrounding organs. This review discusses the usefulness and drawbacks of intraductal ultrasonography for biliary strictures.

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Case report: The diagnostic dilemma of indeterminate biliary strictures: report on two cases with a literature review
Chunyan Meng, Jing Wang, Peipei Zhang, Bo Wang
Frontiers in Oncology.2024;[Epub] CrossRef

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Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis: Suprabhat Giri, Shivaraj Afzalpurkar, Sumaswi Angadi, Jijo Varghese, Sridhar Sundaram; Clin Endosc 2023;56(2):169-179. Published online February 15, 2023; DOI: https://doi.org/10.5946/ce.2022.282

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Background
/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)–guided tissue acquisition from pancreatic lesions.
Methods
A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-TA in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis.
Results
Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52–0.90) and strict criteria (OR, 0.58; 95% CI, 0.46–0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76–1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents.
Conclusions
The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.

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Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma
Abhirup Chatterjee, Jimil Shah
Diagnostics.2023; 14(1): 78. CrossRef

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Seeking to understand non-responders to ablative therapy for dysplastic Barrett's esophagus: Bryan G. Sauer; Clin Endosc 2023;56(2):180-182. Published online March 15, 2023; DOI: https://doi.org/10.5946/ce.2023.048

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Endoscopic ultrasound-guided tissue acquisition for personalized treatment in pancreatic adenocarcinoma: Sang Myung Woo; Clin Endosc 2023;56(2):183-184. Published online March 15, 2023; DOI: https://doi.org/10.5946/ce.2023.037

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Oil blotting paper for formalin fixation increases endoscopic ultrasound‐guided tissue acquisition‐collected sample volumes on glass slides
Takuo Yamai, Kenji Ikezawa, Yusuke Seiki, Ko Watsuji, Yasuharu Kawamoto, Takeru Hirao, Kazuma Daiku, Shingo Maeda, Makiko Urabe, Yugo Kai, Ryoji Takada, Kaori Mukai, Tasuku Nakabori, Hiroyuki Uehara, Sayoko Tsuzaki, Ayumi Ryu, Satoshi Tanada, Shigenori Na
Cancer Medicine.2024;[Epub] CrossRef

1,716 View
113 Download
1 Crossref

Standardization of endoscopic ultrasound shear wave elastography: Julio Iglesias-García, J. Enrique Domínguez-Muñoz; Clin Endosc 2023;56(2):185-187. Published online March 15, 2023; DOI: https://doi.org/10.5946/ce.2023.046

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The Role of Endoscopic Ultrasound and Ancillary Techniques in the Diagnosis of Autoimmune Pancreatitis: A Comprehensive Review
Flavio Metelli, Guido Manfredi, Nico Pagano, Elisabetta Buscarini, Stefano Francesco Crinò, Elia Armellini
Diagnostics.2024; 14(12): 1233. CrossRef

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Respiratory complications during recovery from gastrointestinal endoscopies performed by gastroenterologists under moderate sedation: Inna Eidelman Pozin, Amir Zabida, Moshe Nadler, Guy Zahavi, Dina Orkin, Haim Berkenstadt; Clin Endosc 2023;56(2):188-193. Published online January 10, 2023; DOI: https://doi.org/10.5946/ce.2022.033

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Background
/Aims: Data on the incidence of adverse respiratory events during recovery from gastrointestinal endoscopy are limited. The aim of this study was to investigate the incidence of these complications.
Methods
In this retrospective cohort study, data were obtained from the electronic records of 657 consecutive patients, who underwent gastroenterological procedures under sedation.
Results
Pulse oximetry oxygen saturation (SpO2) <90% for <60 seconds occurred in 82 patients (12.5%) and in 11 patients (1.7%), SpO2 of <90% for >60 seconds occurred in 79 patients (12.0%) and in 11 patients (1.7%), and SpO2 <75% occurred in four patients (0.6%) and in no patients during the procedure and recovery period, respectively. No major complications were noted. The occurrence of desaturation during recovery was correlated with desaturation during the procedure (p<0.001). American Society of Anesthesiologists score (odds ratio [OR], 1.867; 95% confidence interval [CI], 1.008–3.458), ischemic heart disease (OR, 1.815; 95% CI, 0.649–5.080), hypertension (OR, 1.289; 95% CI, 0.472–3.516), and diabetes mellitus (OR, 2.406; 95% CI, 0.950–6.095) increased the occurrence of desaturation during recovery.
Conclusions
We found no major complications during recovery after balanced propofol-based sedation administered by a gastroenterologist-nurse team. Patients with the identified risk predictors must be monitored carefully.

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Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea
Jung Wan Choe, Jong Jin Hyun, Seong-Jin Son, Seung-Hak Lee
Clinical Endoscopy.2024; 57(4): 476. CrossRef

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Bile acid sequestrants in poor healing after endoscopic therapy of Barrett’s esophagus: Lukas Welsch, Andrea May, Tobias Blasberg, Jens Wetzka, Elisa Müller, Myriam Heilani, Mireen Friedrich-Rust, Mate Knabe; Clin Endosc 2023;56(2):194-202. Published online March 9, 2023; DOI: https://doi.org/10.5946/ce.2022.121

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Background
/Aims: Endoscopic therapy for neoplastic Barrett’s esophagus (BE) has become the standard of care over the past two decades. In clinical practice, we regularly encounter patients who fail to achieve complete squamous epithelialization of the esophagus. Although the therapeutic strategies in the individual stages of BE, dysplasia, and esophageal adenocarcinoma are well studied and largely standardized, the problem of inadequate healing after endoscopic therapy is only marginally considered. This study aimed to shed light on the variables influencing inadequate wound healing after endoscopic therapy and the effect of bile acid sequestrants (BAS) on healing.
Methods
Retrospective analysis of endoscopically treated neoplastic BE in a single referral center.
Results
In 12.1% out of 627 patients, insufficient healing was present 8 to 12 weeks after previous endoscopic therapy. The average follow-up duration was 38.8±18.4 months. Complete healing was achieved in 13 patients already after intensifying proton pump inhibitor therapy. Out of 48 patients under BAS, 29 patients (60.4%) showed complete healing. An additional eight patients (16.7%) improved, but only partial healing was achieved. Eleven (22.9%) patients showed no response to BAS augmented therapy.
Conclusions
In cases of insufficient healing even under exhaustion of proton pump inhibitors, treatment with BAS can be an option as an ultimate healing attempt.

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Clinicians should be aware of proton pump inhibitor–related changes in the gastric mucosa
Gwang Ha Kim
Clinical Endoscopy.2024; 57(1): 51. CrossRef
Seeking to understand non-responders to ablative therapy for dysplastic Barrett's esophagus
Bryan G. Sauer
Clinical Endoscopy.2023; 56(2): 180. CrossRef

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Methylene blue chromoendoscopy is more useful in detection of intestinal metaplasia in the stomach than mucosal pit pattern or vessel evaluation and predicts advanced Operative Link on Gastric Intestinal Metaplasia stages: Justyna Wasielica-Berger, Pawel Rogalski, Anna Pryczynicz, Agnieszka Swidnicka-Siergiejko, Andrzej Dabrowski; Clin Endosc 2023;56(2):203-213. Published online March 9, 2023; DOI: https://doi.org/10.5946/ce.2022.087

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Background
/Aims: Intestinal metaplasia (IM) of the stomach is a precancerous condition that is often not visible during conventional endoscopy. Hence, we evaluated the utility of magnification endoscopy and methylene blue (MB) chromoendoscopy to detect IM.
Methods
We estimated the percentage of gastric mucosa surface staining with MB, mucosal pit pattern, and vessel visibility and correlated it with the presence of IM and the percentage of metaplastic cells in histology, similar to the Operative Link on Gastric Intestinal Metaplasia (OLGIM) stage.
Results
IM was found in 25 of 33 (75.8%) patients and in 61 of 135 biopsies (45.2%). IM correlated with positive MB staining (p<0.001) and other than dot pit patterns (p=0.015). MB staining indicated IM with better accuracy than the pit pattern or vessel evaluation (71.7% vs. 60.5% and 49.6%, respectively). At a cut-off point of 16.5% for the MB-stained gastric surface, the sensitivity, specificity, and accuracy of chromoendoscopy in the detection of advanced OLGIM stages were 88.9%, 91.7%, and 90.9%, respectively. The percentage of metaplastic cells detected on histology was the strongest predictor of positive MB staining.
Conclusions
MB chromoendoscopy can serve as a screening method for detecting advanced OLGIM stages. MB mainly stains IM areas with a high concentration of metaplastic cells.

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The prediction model of operative link on gastric intestinal metaplasia stage III-IV: A multicenter study
Song Wang, Meng Qian, Min Wu, Shuo Feng, Kaiguang Zhang
Heliyon.2023; 9(11): e21905. CrossRef

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Role of vitamin C and rectal indomethacin in preventing and alleviating post-endoscopic retrograde cholangiopancreatography pancreatitis: a clinical study: Amir Sadeghi, Rana Jafari-Moghaddam, Sara Ataei, Mahboobe Asadiafrooz, Mohammad Abbasinazari; Clin Endosc 2023;56(2):214-220. Published online March 6, 2023; DOI: https://doi.org/10.5946/ce.2022.165

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Background
/Aims: This study aimed to determine whether vitamin C in addition to indomethacin decreases the occurrence and severity of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) occurrence and severity.
Methods
This randomized clinical trial included patients undergoing ERCP. The participants were administered either rectal indomethacin (100 mg) plus an injection of vitamin C (500 mg) or rectal indomethacin (100 mg) alone just before ERCP. The primary outcomes were PEP occurrence and severity. The secondary amylase and lipase levels were determined after 24 hours.
Results
A total of 344 patients completed the study. Based on intention-to-treat analysis, the PEP rates were 9.9% for indomethacin plus vitamin C plus indomethacin and 15.7% for indomethacin alone. Regarding the per-protocol analysis, the PEP rates were 9.7% and 15.7% in the combination and indomethacin arms, respectively. There was a remarkable difference between the two arms in PEP occurrence and severity on intention-to-treat and per-protocol analyses (p=0.034 and p=0.031, respectively). The post-ERCP lipase and amylase concentrations were lower in the combination arm than in the indomethacin alone arm (p=0.034 and p=0.029, respectively).
Conclusions
Vitamin C injection in addition to rectal indomethacin reduced PEP occurrence and severity.

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Effect of CoQ10 Addition to Rectal Indomethacin on Clinical Pancreatitis and Related Biomarkers in Post-endoscopic Retrograde Cholangiopancreatography
Saeed Abdi, Roja Qobadighadikolaei, Faezeh Jamali, Maryam Shahrokhi, Farzaneh Dastan, Mohammad Abbasinazari
Journal of Cellular & Molecular Anesthesia.2024;[Epub] 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

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Clinical utility of endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling of pancreatic cancer: Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Daiki Fumihara, Takafumi Yanaidani; Clin Endosc 2023;56(2):221-228. Published online March 7, 2023; DOI: https://doi.org/10.5946/ce.2022.086

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Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for the diagnosis of pancreatic cancer. The feasibility of comprehensive genomic profiling (CGP) using samples obtained by EUS-TA has been under recent discussion. This study aimed to evaluate the utility of EUS-TA for CGP in a clinical setting.
Methods
CGP was attempted in 178 samples obtained from 151 consecutive patients with pancreatic cancer at the Aichi Cancer Center between October 2019 and September 2021. We evaluated the adequacy of the samples for CGP and determined the factors associated with the adequacy of the samples obtained by EUS-TA retrospectively.
Results
The overall adequacy for CGP was 65.2% (116/178), which was significantly different among the four sampling methods (EUS-TA vs. surgical specimen vs. percutaneous biopsy vs. duodenal biopsy, 56.0% [61/109] vs. 80.4% [41/51] vs. 76.5% [13/17] vs. 100.0% [1/1], respectively; p=0.022). In a univariate analysis, needle gauge/type was associated with adequacy (22 G fine-needle aspiration vs. 22 G fine-needle biopsy [FNB] vs. 19 G-FNB, 33.3% (5/15) vs. 53.5% (23/43) vs. 72.5% (29/40); p=0.022). The sample adequacy of 19 G-FNB for CGP was 72.5% (29/40), and there was no significant difference between 19 G-FNB and surgical specimens (p=0.375).
Conclusions
To obtain adequate samples for CGP with EUS-TA, 19 G-FNB was shown to be the best in clinical practice. However, 19 G-FNB was not still sufficient, so further efforts are required to improve adequacy for CGP.

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Updated techniques and evidence for endoscopic ultrasound‐guided tissue acquisition from solid pancreatic lesions
Masahiro Itonaga, Reiko Ashida, Masayuki Kitano
DEN Open.2025;[Epub] CrossRef
Tissue acquisition for comprehensive genomic profiling of gallbladder cancer using a forward-viewing echoendoscope in a patient who underwent Roux-en-Y reconstruction
Michihiro Ono, Shutaro Oiwa, Atsushi Uesugi, Seiya Saito, Ryota Yokoyama, Makoto Usami, Tomoyuki Abe, Miri Fujita, Kohichi Takada, Masahiro Maeda
Clinical Journal of Gastroenterology.2024; 17(1): 164. CrossRef
Endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling
Nozomi Okuno, Kazuo Hara
Journal of Medical Ultrasonics.2024; 51(2): 253. CrossRef
Oil blotting paper for formalin fixation increases endoscopic ultrasound‐guided tissue acquisition‐collected sample volumes on glass slides
Takuo Yamai, Kenji Ikezawa, Yusuke Seiki, Ko Watsuji, Yasuharu Kawamoto, Takeru Hirao, Kazuma Daiku, Shingo Maeda, Makiko Urabe, Yugo Kai, Ryoji Takada, Kaori Mukai, Tasuku Nakabori, Hiroyuki Uehara, Sayoko Tsuzaki, Ayumi Ryu, Satoshi Tanada, Shigenori Na
Cancer Medicine.2024;[Epub] CrossRef
Utility of Transpapillary Biopsy and Endoscopic Ultrasound-Guided Tissue Acquisition for Comprehensive Genome Profiling of Unresectable Biliary Tract Cancer
Soma Fukuda, Susumu Hijioka, Yoshikuni Nagashio, Daiki Yamashige, Daiki Agarie, Yuya Hagiwara, Kohei Okamoto, Shin Yagi, Yasuhiro Komori, Masaru Kuwada, Yuta Maruki, Chigusa Morizane, Hideki Ueno, Nobuyoshi Hiraoka, Kiichiro Tsuchiya, Takuji Okusaka
Cancers.2024; 16(16): 2819. CrossRef
Endoscopic ultrasound-guided tissue acquisition for personalized treatment in pancreatic adenocarcinoma
Sang Myung Woo
Clinical Endoscopy.2023; 56(2): 183. CrossRef
Comparison of the novel Franseen needle versus the fine‐needle aspiration needle in endoscopic ultrasound‐guided tissue acquisition for cancer gene panel testing: A propensity score‐matching analysis
Tomotaka Mori, Eisuke Ozawa, Akane Shimakura, Kosuke Takahashi, Satoshi Matsuo, Kazuaki Tajima, Yasuhiko Nakao, Masanori Fukushima, Ryu Sasaki, Satoshi Miuma, Hisamitsu Miyaaki, Shinji Okano, Kazuhiko Nakao
JGH Open.2023; 7(9): 652. CrossRef
Editorial: Endoscopic ultrasound‐guided tissue acquisition in the era of precision medicine
Tiing Leong Ang, James Weiquan Li, Lai Mun Wang
Journal of Gastroenterology and Hepatology.2023; 38(10): 1677. CrossRef

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Defining the optimal technique for endoscopic ultrasound shear wave elastography: a combined benchtop and animal model study with comparison to transabdominal shear wave elastography: Thomas J. Wang, Marvin Ryou; Clin Endosc 2023;56(2):229-238. Published online February 28, 2023; DOI: https://doi.org/10.5946/ce.2022.135

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Background
/Aims: Shear wave elastography (SWE) is used for liver fibrosis staging based on stiffness measurements. It can be performed using endoscopic ultrasound (EUS) or a transabdominal approach. Transabdominal accuracy can be limited in patients with obesity because of the thick abdomen. Theoretically, EUS-SWE overcomes this limitation by internally assessing the liver. We aimed to define the optimal technique for EUS-SWE for future research and clinical use and compare its accuracy with that of transabdominal SWE.
Methods
Benchtop study: A standardized phantom model was used. The compared variables included the region of interest (ROI) size, depth, and orientation and transducer pressure. Porcine study: Phantom models with varying stiffness values were surgically implanted between the hepatic lobes.
Results
For EUS-SWE, a larger ROI size of 1.5 cm and a smaller ROI depth of 1 cm demonstrated a significantly higher accuracy. For transabdominal SWE, the ROI size was nonadjustable, and the optimal ROI depth ranged from 2 to 4 cm. The transducer pressure and ROI orientation did not significantly affect the accuracy. There were no significant differences in the accuracy between transabdominal SWE and EUS-SWE in the animal model. The variability among the operators was more pronounced for the higher stiffness values. Small lesion measurements were accurate only when the ROI was entirely situated within the lesion.
Conclusions
We defined the optimal viewing windows for EUS-SWE and transabdominal SWE. The accuracy was comparable in the non-obese porcine model. EUS-SWE may have a higher utility for evaluating small lesions than transabdominal SWE.

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Endoscopic Ultrasound-based Shear Wave Elastography for Detection of Advanced Liver Disease
Jad AbiMansour, Jerry Yung-Lun Chin, Jyotroop Kaur, Eric J. Vargas, Barham K. Abu Dayyeh, Ryan Law, Vishal Garimella, Michael J. Levy, Andrew C. Storm, Ross Dierkhising, Alina Allen, Sudhakar Venkatesh, Vinay Chandrasekhara
Journal of Clinical Gastroenterology.2024;[Epub] CrossRef
Response
Divyanshoo R. Kohli, Mohammad Shadab Siddiqui
Gastrointestinal Endoscopy.2024; 100(1): 161. CrossRef
Standardization of endoscopic ultrasound shear wave elastography
Julio Iglesias-García, J. Enrique Domínguez-Muñoz
Clinical Endoscopy.2023; 56(2): 185. CrossRef

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Bronchoesophageal fistula in a patient with Crohn’s disease receiving anti-tumor necrosis factor therapy: Kyunghwan Oh, Kee Don Choi, Hyeong Ryul Kim, Tae Sun Shim, Byong Duk Ye, Suk-Kyun Yang, Sang Hyoung Park; Clin Endosc 2023;56(2):239-244. Published online December 21, 2021; DOI: https://doi.org/10.5946/ce.2021.215

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Tuberculosis is an adverse event in patients with Crohn’s disease receiving anti-tumor necrosis factor (TNF) therapy. However, tuberculosis presenting as a bronchoesophageal fistula (BEF) is rare. We report a case of tuberculosis and BEF in a patient with Crohn’s disease who received anti-TNF therapy. A 33-year-old Korean woman developed fever and cough 2 months after initiation of anti-TNF therapy. And the symptoms persisted for 1 months, so she visited the emergency room. Chest computed tomography was performed upon visiting the emergency room, which showed BEF with aspiration pneumonia. Esophagogastroduodenoscopy with biopsy and endobronchial ultrasound with transbronchial needle aspiration confirmed that the cause of BEF was tuberculosis. Anti-tuberculosis medications were administered, and esophageal stent insertion through endoscopy was performed to manage the BEF. However, the patient’s condition did not improve; therefore, fistulectomy with primary closure was performed. After fistulectomy, the anastomosis site healing was delayed due to severe inflammation, a second esophageal stent and gastrostomy tube were inserted. Nine months after the diagnosis, the fistula disappeared without recurrence, and the esophageal stent and gastrostomy tube were removed.

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(Re-)introduction of TNF antagonists and JAK inhibitors in patients with previous tuberculosis: a systematic review
Thomas Theo Brehm, Maja Reimann, Niklas Köhler, Christoph Lange
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Colorectal carcinoma and chronic inflammatory demyelinating polyneuropathy: is there a possible paraneoplastic association?: Adnan Malik, Faisal Inayat, Muhammad Hassan Naeem Goraya, Gul Nawaz, Ahmad Mehran, Atif Aziz, Saad Saleem; Clin Endosc 2023;56(2):245-251. Published online July 28, 2021; DOI: https://doi.org/10.5946/ce.2021.076

Abstract PDF PubReader ePub: A plethora of paraneoplastic syndromes have been reported as remote effects of colorectal carcinoma (CRC). However, there is a dearth of data pertaining to the association of this cancer with demyelinating neuropathies. Herein, we describe the case of a young woman diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP). Treatment with intravenous immunoglobulins and prednisone did not improve her condition, and her neurological symptoms worsened. Subsequently, she was readmitted with exertional dyspnea, lightheadedness, malaise, and black stools. Colonoscopy revealed a necrotic mass in the ascending colon, which directly invaded the second part of the duodenum. Pathologic results confirmed the diagnosis of locally advanced CRC. Upon surgical resection of the cancer, her CIDP showed dramatic resolution without any additional therapy. Patients with CRC may develop CIDP as a type of paraneoplastic syndrome. Clinicians should remain cognizant of this potential association, as it is of paramount importance for the necessary holistic clinical management.

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Effective endoscopic band ligation for diverticular perforation with a refractory pelvic abscess: Koichi Soga, Atsushi Majima; Clin Endosc 2023;56(2):252-255. Published online February 28, 2023; DOI: https://doi.org/10.5946/ce.2022.171

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Trends in Diverticular Disease Hospitalizations and Racial Disparities in Outcomes Across the United States
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Arab Journal of Gastroenterology.2023; 24(3): 149. CrossRef

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Side-viewing scope insertion using a large-diameter overtube designed for colonoscopy in a patient with a cascade stomach: Hirokazu Saito, Yoshitaka Kadowaki, Atsushi Fujimoto, Kana Ohmoto, Shuji Tada; Clin Endosc 2023;56(2):256-257. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2022.089

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Chronic non-healing gastric ulcer in a patient with poorly controlled diabetes mellitus: Sumitro Kosasih, Pemasiri Upali Telisinghe, Kian Chai Lim, Adli Metussin, Rosmonaliza Asli, Vui Heng Chong; Clin Endosc 2023;56(2):258-260. Published online January 9, 2023; DOI: https://doi.org/10.5946/ce.2022.203

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Comparative Analysis of the Effects of Insulin and Metformin on the Ulcerogenic Action of Indomethacin in Rats with Streptozotocin-Induced Diabetes
N. I. Yarushkina, T. T. Podvigina, O. P. Komkova, O. Yu. Morozova, P. V. Punina, L. P. Filaretova
Journal of Evolutionary Biochemistry and Physiology.2023; 59(6): 2399. CrossRef

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Peroral pancreatoscopy with videoscopy and narrow-band imaging in intraductal papillary mucinous neoplasms with dilatation of the main pancreatic duct: Yui Kishimoto, Naoki Okano, Ken Ito, Kensuke Takuma, Seiichi Hara, Susumu Iwasaki, Kensuke Yoshimoto, Yuto Yamada, Koji Watanabe, Yusuke Kimura, Hiroki Nakagawa, Yoshinori Igarashi; Clin Endosc 2023;56(2):261-261. Published online March 6, 2023; DOI: https://doi.org/10.5946/ce.2021.083.e1; Corrects: Clin Endosc 2022;55(2):270

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