Clinical Endoscopy

Advanced endoscopic imaging for detection of Barrett’s esophagus: Netanel Zilberstein, Michelle Godbee, Neal A. Mehta, Irving Waxman; Clin Endosc 2024;57(1):1-10. Published online January 5, 2024; DOI: https://doi.org/10.5946/ce.2023.031

Barrett’s esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC), and is caused by chronic gastroesophageal reflux. BE can progress over time from metaplasia to dysplasia, and eventually to EAC. EAC is associated with a poor prognosis, often due to advanced disease at the time of diagnosis. However, if BE is diagnosed early, pharmacologic and endoscopic treatments can prevent progression to EAC. The current standard of care for BE surveillance utilizes the Seattle protocol. Unfortunately, a sizable proportion of early EAC and BE-related high-grade dysplasia (HGD) are missed due to poor adherence to the Seattle protocol and sampling errors. New modalities using artificial intelligence (AI) have been proposed to improve the detection of early EAC and BE-related HGD. This review will focus on AI technology and its application to various endoscopic modalities such as high-definition white light endoscopy, narrow-band imaging, and volumetric laser endomicroscopy.

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Gender disparities and woman-specific trends in Barrett’s esophagus in the United States: An 11-year nationwide population-based study
Karina Fatakhova, Faisal Inayat, Hassam Ali, Pratik Patel, Attiq Ur Rehman, Arslan Afzal, Muhammad Sarfraz, Shiza Sarfraz, Gul Nawaz, Ahtshamullah Chaudhry, Rubaid Dhillon, Arthur Dilibe, Benjamin Glazebnik, Lindsey Jones, Emily Glazer
World Journal of Methodology.2025;[Epub] CrossRef
Advancements in Barrett's esophagus detection: The role of artificial intelligence and its implications
Sara Massironi
World Journal of Gastroenterology.2024; 30(11): 1494. CrossRef
Advanced Esophageal Endoscopy
Kyoungwon Jung, Rebecca M. Haug, Andrew Y. Wang
Gastroenterology Clinics of North America.2024;[Epub] CrossRef

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Application of artificial intelligence for diagnosis of early gastric cancer based on magnifying endoscopy with narrow-band imaging: Yusuke Horiuchi, Toshiaki Hirasawa, Junko Fujisaki; Clin Endosc 2024;57(1):11-17. Published online January 5, 2024; DOI: https://doi.org/10.5946/ce.2023.173

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Although magnifying endoscopy with narrow-band imaging is the standard diagnostic test for gastric cancer, diagnosing gastric cancer using this technology requires considerable skill. Artificial intelligence has superior image recognition, and its usefulness in endoscopic image diagnosis has been reported in many cases. The diagnostic performance (accuracy, sensitivity, and specificity) of artificial intelligence using magnifying endoscopy with narrow band still images and videos for gastric cancer was higher than that of expert endoscopists, suggesting the usefulness of artificial intelligence in diagnosing gastric cancer. Histological diagnosis of gastric cancer using artificial intelligence is also promising. However, previous studies on the use of artificial intelligence to diagnose gastric cancer were small-scale; thus, large-scale studies are necessary to examine whether a high diagnostic performance can be achieved. In addition, the diagnosis of gastric cancer using artificial intelligence has not yet become widespread in clinical practice, and further research is necessary. Therefore, in the future, artificial intelligence must be further developed as an instrument, and its diagnostic performance is expected to improve with the accumulation of numerous cases nationwide.

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Pitfalls in Endoscopic Submucosal Dissection for Early Gastric Cancer with Papillary Adenocarcinoma
Gwang Ha Kim
Gut and Liver.2024; 18(3): 368. CrossRef

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Computer-aided polyp characterization in colonoscopy: sufficient performance or not?: Natalie Halvorsen, Yuichi Mori; Clin Endosc 2024;57(1):18-23. Published online January 5, 2024; DOI: https://doi.org/10.5946/ce.2023.092

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Computer-assisted polyp characterization (computer-aided diagnosis, CADx) facilitates optical diagnosis during colonoscopy. Several studies have demonstrated high sensitivity and specificity of CADx tools in identifying neoplastic changes in colorectal polyps. To implement CADx tools in colonoscopy, there is a need to confirm whether these tools satisfy the threshold levels that are required to introduce optical diagnosis strategies such as “diagnose-and-leave,” “resect-and-discard” or “DISCARD-lite.” In this article, we review the available data from prospective trials regarding the effect of multiple CADx tools and discuss whether they meet these thresholds.

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Building Machine Learning Models in Gastrointestinal Endoscopy
Giulio Antonelli, Tom Eelbode, Touka Elsaman, Mrigya Sharma, Raf Bisschops, Cesare Hassan
Gastrointestinal Endoscopy Clinics of North America.2024;[Epub] CrossRef

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Use of artificial intelligence in the management of T1 colorectal cancer: a new tool in the arsenal or is deep learning out of its depth?: James Weiquan Li, Lai Mun Wang, Katsuro Ichimasa, Kenneth Weicong Lin, James Chi-Yong Ngu, Tiing Leong Ang; Clin Endosc 2024;57(1):24-35. Published online September 25, 2023; DOI: https://doi.org/10.5946/ce.2023.036

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The field of artificial intelligence is rapidly evolving, and there has been an interest in its use to predict the risk of lymph node metastasis in T1 colorectal cancer. Accurately predicting lymph node invasion may result in fewer patients undergoing unnecessary surgeries; conversely, inadequate assessments will result in suboptimal oncological outcomes. This narrative review aims to summarize the current literature on deep learning for predicting the probability of lymph node metastasis in T1 colorectal cancer, highlighting areas of potential application and barriers that may limit its generalizability and clinical utility.

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Prediction of Lymph Node Metastasis in T1 Colorectal Cancer Using Artificial Intelligence with Hematoxylin and Eosin-Stained Whole-Slide-Images of Endoscopic and Surgical Resection Specimens
Joo Hye Song, Eun Ran Kim, Yiyu Hong, Insuk Sohn, Soomin Ahn, Seok-Hyung Kim, Kee-Taek Jang
Cancers.2024; 16(10): 1900. 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

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Comparison of scissor-type knife to non-scissor-type knife for endoscopic submucosal dissection: a systematic review and meta-analysis: Harishankar Gopakumar, Ishaan Vohra, Srinivas Reddy Puli, Neil R Sharma; Clin Endosc 2024;57(1):36-47. Published online January 5, 2024; DOI: https://doi.org/10.5946/ce.2023.122

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Background
/Aims: Scissor-type endoscopic submucosal dissection (ST-ESD) knives can reduce the adverse events associated with ESDs. This study aimed to compare ST-ESD and non-scissor-type (NST)-ESD knives.
Methods
We identified ten studies that compared the performance characteristics and safety profiles of ST-ESD and NST-ESD knives. Fixed- and random-effects models were used to calculate the pooled proportions. Heterogeneity was assessed using the I2 test.
Results
On comparing ST-ESD knives to NST-ESD knives, the weighted odds of en bloc resection was 1.61 (95% confidence interval [CI], 0.90–2.90; p=0.14), R0 resection was 1.10 (95% CI, 0.71–1.71; p=0.73), delayed bleeding was 0.40 (95% CI, 0.17–0.90; p=0.03), perforation was 0.35 (95% CI, 0.18–0.70; p<0.01) and ESD self-completion by non-experts was 1.89 (95% CI, 1.20–2.95; p<0.01). There was no heterogeneity, with an I2 score of 0% (95% CI, 0%–54.40%).
Conclusions
The findings of reduced odds of perforation, a trend toward reduced delayed bleeding, and an improvement in the rates of en bloc and R0 resection with ST-ESD knives compared to NST-ESD knives support the use of ST-ESD knives when non-experts perform ESDs or as an adjunct tool for challenging ESD procedures.

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Knives Out: Does the Choice of Endoscopic Knife Influence the Outcome of Colorectal Endoscopic Submucosal Dissection?
Yunho Jung
Digestive Diseases and Sciences.2024;[Epub] CrossRef

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Long-term efficacy of endoscopic radiofrequency Stretta therapy for patients with refractory gastroesophageal reflux disease: Sung Eun Kim; Clin Endosc 2024;57(1):48-50. Published online January 9, 2024; DOI: https://doi.org/10.5946/ce.2023.269

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Clinicians should be aware of proton pump inhibitor–related changes in the gastric mucosa: Gwang Ha Kim; Clin Endosc 2024;57(1):51-52. Published online January 10, 2024; DOI: https://doi.org/10.5946/ce.2023.188

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Whitish gastric mucosa on upper gastrointestinal endoscopy
Eun Jeong Gong, Chang Seok Bang
Clinical Endoscopy.2024; 57(2): 277. CrossRef

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What method can we choose if rapid on-site evaluation is not available for the endoscopic ultrasound-guided tissue acquisition of upper gastrointestinal subepithelial lesions?: Yu Kyung Cho; Clin Endosc 2024;57(1):53-55. Published online January 26, 2024; DOI: https://doi.org/10.5946/ce.2023.299

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Endeavors to prevent stent malfunction: new insights into the risk factors for recurrent biliary obstruction: Sung-Jo Bang; Clin Endosc 2024;57(1):56-57. Published online January 26, 2024; DOI: https://doi.org/10.5946/ce.2023.274

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Endoscopic radiofrequency Stretta therapy reduces proton pump inhibitor dependency and the need for anti-reflux surgery for refractory gastroesophageal reflux disease: Abraham Joel, Alakh Konjengbam, Yirupaiahgari Viswanath, Georgios Kourounis, Emily Hammond, Helen Frank, Shivani Kuttuva, Simon Mbarushimana, Hena Hidayat, Srivishnu Thulasiraman; Clin Endosc 2024;57(1):58-64. Published online May 2, 2023; DOI: https://doi.org/10.5946/ce.2023.026

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Background
/Aims: Radiofrequency treatment of the gastroesophageal junction using the Stretta procedure for treating gastroesophageal reflux disease (GERD) is observed to improve the symptoms and proton pump inhibitor (PPI) dependence and reduce the need for anti-reflux operations. As one of the largest studies in Europe, we evaluated the clinical outcomes of Stretta in patients with medically refractory GERD.
Methods
A tertiary UK center evaluated all patients with refractory GERD who underwent Stretta between 2014 and 2022. Patients and primary care professionals were contacted to obtain information regarding the initiation of PPI and reintervention after Stretta.
Results
Of the 195 patients (median age, 55 years; 116 women [59.5%]) who underwent Stretta, PPI-free period (PFP) data were available for 144 (73.8%) patients. Overall, 66 patients (45.8%) did not receive PPI after a median follow-up of 55 months. Six patients (3.1%) underwent further interventions. The median PFP after Stretta was 41 months. There was a significant negative correlation between PFP and age (p=0.007), with no differences between sexes (p=0.96). Patients younger than 55 years of age had a longer PFP than their older counterparts (p=0.005). Younger males had a significantly longer PFP than older males (p=0.021). However, this was not observed in the female cohort (p=0.09) or between the younger men and women (p=0.66).
Conclusions
Our findings suggest that Stretta is a safe and feasible option for treating refractory GERD, especially in younger patients. It prevents further anti-reflux interventions in most patients and increases the lead-time to surgery in patients with refractory GERD.

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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
Long-term efficacy of endoscopic radiofrequency Stretta therapy for patients with refractory gastroesophageal reflux disease
Sung Eun Kim
Clinical Endoscopy.2024; 57(1): 48. CrossRef
Chronic cough and refractory chronic cough: An important distinction
Peter V. Dicpinigaitis
Journal of Precision Respiratory Medicine.2023; 6(1): 10. CrossRef

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Association between occurrence of multiple white and flat elevated gastric lesions and oral proton pump inhibitor intake: Rino Hasegawa, Kenshi Yao, Takao Kanemitsu, Hisatomi Arima, Takayuki Hirase, Yuuya Hiratsuka, Kazuhiro Takeda, Kentaro Imamura, Kensei Ohtsu, Yoichiro Ono, Masaki Miyaoka, Takashi Hisabe, Toshiharu Ueki, Hiroshi Tanabe, Atsuko Ohta, Satoshi Nimura; Clin Endosc 2024;57(1):65-72. Published online May 9, 2023; DOI: https://doi.org/10.5946/ce.2022.257

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Background
/Aims: Multiple white and flat elevated lesions (MWFL) that develop from the gastric corpus to the fornix may be strongly associated with oral antacid intake. Therefore, this study aimed to determine the association between the occurrence of MWFL and oral proton pump inhibitor (PPI) intake and clarify the endoscopic and clinicopathological characteristics of MWFL.
Methods
The study included 163 patients. The history of oral drug intake was collected, and serum gastrin levels and anti-Helicobacter pylori immunoglobulin G antibody titers were measured. Upper gastrointestinal endoscopy was performed. The primary study endpoint was the association between MWFL and oral PPI intake.
Results
In the univariate analyses, MWFL were observed in 35 (49.3%) of 71 patients who received oral PPIs and 10 (10.9%) of 92 patients who did not receive oral PPIs. The occurrence of MWFL was significantly higher among patients who received PPIs than in those who did not (p<0.001). Moreover, the occurrence of MWFL was significantly higher in patients with hypergastrinemia (p=0.005). In the multivariate analyses, oral PPI intake was the only significant independent factor associated with the presence of MWFL (p=0.001; odds ratio, 5.78; 95% confidence interval, 2.06–16.2).
Conclusions
Our findings suggest that oral PPI intake is associated with the presence of MWFL (UMINCTR 000030144).

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Endoscopic findings and outcomes of gastric mucosal changes relating to potassium‐competitive acid blocker and proton pump inhibitor therapy
Satoshi Shinozaki, Hiroyuki Osawa, Yoshimasa Miura, Hiroaki Nomoto, Hirotsugu Sakamoto, Yoshikazu Hayashi, Tomonori Yano, Edward J. Despott, Hironori Yamamoto
DEN Open.2025;[Epub] CrossRef
Clinicians should be aware of proton pump inhibitor–related changes in the gastric mucosa
Gwang Ha Kim
Clinical Endoscopy.2024; 57(1): 51. CrossRef
Drug-induced mucosal alterations observed during esophagogastroduodenoscopy
Masaya Iwamuro, Seiji Kawano, Motoyuki Otsuka
World Journal of Gastroenterology.2024; 30(16): 2220. CrossRef

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Preclinical study of a novel ingestible bleeding sensor for upper gastrointestinal bleeding: Kimberly F. Schuster, Christopher C. Thompson, Marvin Ryou; Clin Endosc 2024;57(1):73-81. Published online May 31, 2023; DOI: https://doi.org/10.5946/ce.2022.293

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Background
/Aims: Upper gastrointestinal bleeding (UGIB) is a life-threatening condition that necessitates early identification and intervention and is associated with substantial morbidity, mortality, and socioeconomic burden. However, several diagnostic challenges remain regarding risk stratification and the optimal timing of endoscopy. The PillSense System is a noninvasive device developed to detect blood in patients with UGIB in real time. This study aimed to assess the safety and performance characteristics of PillSense using a simulated bleeding model.
Methods
A preclinical study was performed using an in vivo porcine model (14 animals). Fourteen PillSense capsules were endoscopically placed in the stomach and blood was injected into the stomach to simulate bleeding. The safety and sensitivity of blood detection and pill excretion were also investigated.
Results
All the sensors successfully detected the presence or absence of blood. The minimum threshold was 9% blood concentration, with additional detection of increasing concentrations of up to 22.5% blood. All the sensors passed naturally through the gastrointestinal tract.
Conclusions
This study demonstrated the ability of the PillSense System sensor to detect UGIB across a wide range of blood concentrations. This ingestible device detects UGIB in real time and has the potential to be an effective tool to supplement the current standard of care. These favorable results will be further investigated in future clinical studies.

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Miniaturized Capsule System Toward Real‐Time Electrochemical Detection of H2S in the Gastrointestinal Tract
Justin M. Stine, Katie L. Ruland, Luke A. Beardslee, Joshua A. Levy, Hossein Abianeh, Santiago Botasini, Pankaj J. Pasricha, Reza Ghodssi
Advanced Healthcare Materials.2024;[Epub] CrossRef

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Efficacy of an assistive guide tube for improved endoscopic access to gastrointestinal lesions: an in vivo study in a porcine model: Dong Seok Lee, Jeong-Sik Byeon, Sang Gyun Kim, Ji Won Kim, Kook Lae Lee, Ji Bong Jeong, Yong Jin Jung, Hyoun Woo Kang; Clin Endosc 2024;57(1):82-88. Published online April 18, 2023; DOI: https://doi.org/10.5946/ce.2022.161

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Guide tube-assisted endoscopy for procedures that require repeated endoscopic access is safer and more effective than conventional endoscopy. However, its effectiveness has not been confirmed in animal studies. We assessed the usefulness of guide tube-assisted endoscopic procedures in an in vivo porcine model.
Methods
Five different guide tube-assisted endoscopic procedures were performed by experienced endoscopists on a pig weighing 32 kg. To evaluate the efficacy of these procedures, we compared the endoscopic approach time when a guide tube was used to that when it was not. Additional endoscopic procedures using a guide tube were performed, including multiple foreign body extractions, multiple polypectomies, and multiple submucosal dissections. To evaluate safety, we compared the insertion force into the proximal esophagus between the guide tube and conventional overtube methods.
Results
Using the endoscopic approach with a guide tube required a shorter average approach time to reach the three target lesions than when using the endoscopic approach without a guide tube (p<0.001). Compared to the conventional overtube method, the guide tube method produced a lower average resistance during insertion into the upper esophagus (p<0.001).
Conclusions
Guide tube-assisted endoscopic procedures are effective and safe for repeated endoscopic access in an in vivo porcine model.

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Stereomicroscopic on-site evaluation in endoscopic ultrasound-guided tissue acquisition of upper gastrointestinal subepithelial lesions: Seigo Nakatani, Kosuke Okuwaki, Masafumi Watanabe, Hiroshi Imaizumi, Tomohisa Iwai, Takaaki Matsumoto, Rikiya Hasegawa, Hironori Masutani, Takahiro Kurosu, Akihiro Tamaki, Junro Ishizaki, Ayana Ishizaki, Mitsuhiro Kida, Chika Kusano; Clin Endosc 2024;57(1):89-95. Published online April 18, 2023; DOI: https://doi.org/10.5946/ce.2022.288

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Background
/Aims: In stereomicroscopic sample isolation processing, the cutoff value (≥4 mm) of stereomicroscopically visible white cores indicates high diagnostic sensitivity. We aimed to evaluate endoscopic ultrasound-guided tissue acquisition (EUS-TA) using a simplified stereomicroscopic on-site evaluation of upper gastrointestinal subepithelial lesions (SELs).
Methods
In this multicenter prospective trial, we performed EUS-TA using a 22-gauge Franseen needle in 34 participants with SELs derived from the upper gastrointestinal muscularis propria, requiring pathological diagnosis. The presence of stereomicroscopically visible white core (SVWC) in each specimen was assessed using stereomicroscopic on-site evaluation. The primary outcome was EUS-TA’s diagnostic sensitivity with stereomicroscopic on-site evaluation based on the SVWC cutoff value (≥4 mm) for malignant upper gastrointestinal SELs.
Results
The total number of punctures was 68; 61 specimens (89.7%) contained stereomicroscopically visible white cores ≥4 mm in size. The final diagnoses were gastrointestinal stromal tumor, leiomyoma, and schwannoma in 76.5%, 14.7%, and 8.8% of the cases, respectively. The sensitivity of EUS-TA with stereomicroscopic on-site evaluation based on the SVWC cutoff value for malignant SELs was 100%. The per-lesion accuracy of histological diagnosis reached the highest level (100%) at the second puncture.
Conclusions
Stereomicroscopic on-site evaluation showed high diagnostic sensitivity and could be a new method for diagnosing upper gastrointestinal SELs using EUS-TA.

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What method can we choose if rapid on-site evaluation is not available for the endoscopic ultrasound-guided tissue acquisition of upper gastrointestinal subepithelial lesions?
Yu Kyung Cho
Clinical Endoscopy.2024; 57(1): 53. CrossRef
Endoscopic Ultrasound-Guided Tissue Acquisition Using Fork-Tip Needle for Subepithelial Lesions: A Single-Center Validation Study
Masafumi Watanabe, Kosuke Okuwaki, Tomohisa Iwai, Mitsuhiro Kida, Hiroshi Imaizumi, Kai Adachi, Akihiro Tamaki, Junro Ishizaki, Taro Hanaoka, Chika Kusano
Digestive Diseases and Sciences.2024; 69(7): 2567. CrossRef
Impact of macroscopic on-site evaluation (MOSE) on accuracy of endoscopic ultrasound-guided fine-needle aspiration/biopsy of solid lesions
Hussein Okasha, Ahmed Ebrahim, Ihab Samih, Mohammed Sayed
International Journal of Gastrointestinal Intervention.2024; 13(3): 98. CrossRef
An Esophageal Leiomyoma with Cystic Degeneration Mimicking a Malignant Neoplasm
Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
The Ewha Medical Journal.2023;[Epub] CrossRef

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Rotatable sphincterotome as a rescue device for endoscopic retrograde cholangiopancreatography cannulation: a single-center experience: Takeshi Okamoto, Takashi Sasaki, Tsuyoshi Takeda, Takafumi Mie, Chinatsu Mori, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira; Clin Endosc 2024;57(1):96-104. Published online April 25, 2023; DOI: https://doi.org/10.5946/ce.2022.248

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Background
/Aims: Selective bile duct or pancreatic duct cannulation remains a significant initial hurdle in endoscopic retrograde cholangiopancreatography (ERCP) despite advances in endoscopy and accessories. This study evaluated our experience with a rotatable sphincterotome in cases of difficult cannulation.
Methods
We retrospectively reviewed ERCP cases using TRUEtome, a rotatable sphincterotome, as a rescue device for cannulation at a cancer institute in Japan from October 2014 to December 2021.
Results
TRUEtome was used in 88 patients. Duodenoscopes were used for 51 patients, while single-balloon enteroscopes (SBE) were used for 37 patients. TRUEtome was used for biliary and pancreatic duct cannulation (84.1%), intrahepatic bile duct selection (12.5%), and strictures of the afferent limb (3.4%). Cannulation success rates were similar in the duodenoscope and SBE groups (86.3% vs. 75.7%, p=0.213). TRUEtome was more commonly used in cases with steep cannulation angles in the duodenoscope group and in cases requiring cannulation in different directions in the SBE group. There were no significant differences in adverse events between the two groups.
Conclusions
The cannulation sphincterotome was useful for difficult cannulations in both unaltered and surgically altered anatomies. It may be an option to consider before high-risk procedures such as precut and endoscopic ultrasound-guided rendezvous techniques.

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Non-tip and rotatable sphincterotome for biliary cannulation in patients with Roux-en-Y gastrectomy
Haruo Miwa, Kazuya Sugimori, Kazuki Endo, Ritsuko Oishi, Hiromi Tsuchiya, Takashi Kaneko, Shin Maeda
Endoscopy.2024; 56(S 01): E103. 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

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Increasing trend of endoscopic drainage utilization for the management of pancreatic pseudocyst: insights from a nationwide database: Khaled Elfert, Salomon Chamay, Lamin Dos Santos, Mouhand Mohamed, Azizullah Beran, Fouad Jaber, Hazem Abosheaishaa, Suresh Nayudu, Sammy Ho; Clin Endosc 2024;57(1):105-111. Published online August 4, 2023; DOI: https://doi.org/10.5946/ce.2023.054

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Background
/Aims: The pancreatic pseudocyst (PP) is a type of fluid collection that typically develops as a delayed complication of acute pancreatitis. Drainage is indicated for symptomatic patients and/or associated complications, such as infection and bleeding. Drainage modalities include percutaneous, endoscopic, laparoscopic, and open drainage. This study aimed to assess trends in the utilization of different drainage modalities for treating PP from 2016 to 2020. The trends in mortality, mean length of hospital stay, and mean hospitalization costs were also assessed.
Methods
The National Inpatient Sample database was used to obtain data. The variables were generated using International Classification of Diseases-10 diagnostic and procedural codes.
Results
Endoscopic drainage was the most commonly used drainage modality in 2018–2020, with an increasing trend over time (385 procedures in 2018 to 515 in 2020; p=0.003). This is associated with a decrease in the use of other drainage modalities. A decrease in the hospitalization cost for PP requiring drainage was also noted (29,318 United States dollar [USD] in 2016 to 18,087 USD in 2020, p<0.001).
Conclusions
Endoscopic drainage is becoming the most commonly used modality for the treatment of PP in hospitals located in the US. This new trend is associated with decreasing hospitalization costs.

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Pancreatic pseudocyst: The past, the present, and the future
Jonathan GA Koo, Matthias Yi Quan Liau, Igor A Kryvoruchko, Tamer AAM Habeeb, Christopher Chia, Vishal G Shelat
World Journal of Gastrointestinal Surgery.2024; 16(7): 1986. CrossRef

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Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer: Kunio Kataoka, Eizaburo Ohno, Takuya Ishikawa, Kentaro Yamao, Yasuyuki Mizutani, Tadashi Iida, Hideki Takami, Osamu Maeda, Junpei Yamaguchi, Yukihiro Yokoyama, Tomoki Ebata, Yasuhiro Kodera, Hiroki Kawashima; Clin Endosc 2024;57(1):112-121. Published online July 18, 2023; DOI: https://doi.org/10.5946/ce.2022.278

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Background
/Aims: Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting.
Methods
Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO.
Results
A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033).
Conclusions
Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.

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Endeavors to prevent stent malfunction: new insights into the risk factors for recurrent biliary obstruction
Sung-Jo Bang
Clinical Endoscopy.2024; 57(1): 56. CrossRef
Skeletal muscle status and survival among patients with advanced biliary tract cancer
Shinya Takaoka, Tsuyoshi Hamada, Naminatsu Takahara, Kei Saito, Go Endo, Ryunosuke Hakuta, Kota Ishida, Kazunaga Ishigaki, Sachiko Kanai, Kohei Kurihara, Hiroki Oyama, Tomotaka Saito, Tatsuya Sato, Tatsunori Suzuki, Yukari Suzuki, Shuichi Tange, Yurie Tok
International Journal of Clinical Oncology.2024; 29(3): 297. CrossRef

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Refractory benign biliary stricture due to chronic pancreatitis in two patients treated using endoscopic ultrasound-guided choledochoduodenostomy fistula creation: case reports: Sho Ishikawa, Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Takafumi Yanaidani; Clin Endosc 2024;57(1):122-127. Published online May 16, 2023; DOI: https://doi.org/10.5946/ce.2022.149

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Benign biliary stricture (BBS) is a complication of chronic pancreatitis (CP). Despite endoscopic biliary stenting, some patients do not respond to treatment, and they experience recurrent cholangitis. We report two cases of CP with refractory BBS treated using endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) fistula creation. A 50-year-old woman and a 60-year-old man both presented with obstructive jaundice secondary to BBS due to alcoholic CP. They underwent repeated placement of a fully covered self-expandable metal stent for biliary strictures. However, the strictures persisted, causing repeated episodes of cholangitis. Therefore, an EUS-CDS was performed. The stents were eventually removed and the patients became stent-free. These fistulas have remained patent without cholangitis for more than 2.5 years. Fistula creation using EUS-CDS is an effective treatment option for BBS.

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Forward viewing liner echoendoscopy for therapeutic interventions
Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara
Clinical Endoscopy.2024; 57(2): 175. CrossRef

2,126 View
158 Download
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