Clinical Endoscopy

Outcomes of partially covered self-expandable metal stents with different uncovered lengths in endoscopic ultrasound-guided hepaticogastrostomy: a Japanese retrospective study: Takeshi Okamoto, Takashi Sasaki, Tsuyoshi Takeda, Tatsuki Hirai, Takahiro Ishitsuka, Manabu Yamada, Hiroki Nakagawa, Takafumi Mie, Takaaki Furukawa, Akiyoshi Kasuga, Masato Ozaka, Naoki Sasahira; Clin Endosc 2024;57(4):515-526. Published online May 10, 2024; DOI: https://doi.org/10.5946/ce.2023.142

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Background
/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO).
Methods
Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared.
Results
Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS.
Conclusions
No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

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Migration of covered expandable metal stents after endoscopic ultrasound-guided hepaticogastrostomy: stent covering versus stent design?
Todd H. Baron
Clinical Endoscopy.2024; 57(4): 471. CrossRef

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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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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 2022;55(2):270-278. Published online December 6, 2021; DOI: https://doi.org/10.5946/ce.2021.083; Correction in: Clin Endosc 2023;56(2):261

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Background
/Aims: Endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMNs) is useful in determining whether the lesions are benign or malignant. This study aimed to examine the usefulness of peroral pancreatoscopy (POPS) in determining the prognosis of IPMNs.
Methods
POPS with videoscopy was performed using the mother–baby scope technique. After surgery, computed tomography/magnetic resonance cholangiopancreatography or ultrasonography and blood tests were performed every 6 months during the follow-up.
Results
A total of 39 patients with main pancreatic duct (MPD)–type IPMNs underwent POPS using a videoscope, and the protrusions in the MPD were observed in 36 patients. The sensitivity and specificity of cytology/biopsy performed at the time of POPS were 85% and 87.5%, respectively. Of 19 patients who underwent surgery, 18 (95%) patients had negative surgical margins and 1 (5%) patient had a positive margin.
Conclusions
In IPMNs with dilatation of the MPD, POPS is considered effective if the lesions can be directly observed. The diagnosis of benign and malignant lesions is possible depending on the degree of lesion elevation. However, in some cases, slightly elevated lesions may increase in size during the follow-up or multiple lesions may be simultaneously present; therefore, careful follow-up is necessary.

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Identification of the course of plastic stent‐induced pancreatic duct mucosal change in chronic pancreatitis using peroral pancreatoscopy (with video)
Kensuke Takuma, Naoki Okano, Yusuke Kimura, Koji Watanabe, Hiroki Nakagawa, Kensuke Hoshi, Masashi Miura, Naobumi Tochigi, Yoshinori Igarashi, Takahisa Matsuda
DEN Open.2025;[Epub] CrossRef
Pancreatoscopy in the evaluation and management of pancreatic disorders
Rodrigo Mansilla-Vivar, Eduardo Segovia-Vergara, Vicente Pons-Beltrán
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Pancreatic Cancer Detection in Intraductal Papillary Mucinous Neoplasm (IPMN)—New Insights
Wojciech Pawłowski, Mateusz Stefański, Barbara Włodarczyk, Łukasz Durko, Ewa Małecka-Wojciesko
Cancers.2025; 17(20): 3341. CrossRef
Pancreatoscopy-Guided Endotherapies for Pancreatic Diseases
Yuri Hanada, Raj J. Shah
Gastrointestinal Endoscopy Clinics of North America.2024; 34(3): 417. CrossRef
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
Clinical Endoscopy.2023; 56(2): 261. CrossRef
Predicting Malignancy by Peroral Pancreatoscopy of an Intraductal Papillary Mucinous Neoplasm with a Dilated Main Pancreatic Duct: Is Seeing Enough?
Yun Nah Lee, Jong Ho Moon
Clinical Endoscopy.2022; 55(2): 213. CrossRef

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Efficacy of Hypertonic Saline-Epinephrine Local Injection Around the Anal Side before Endoscopic Papillectomy for Ampullary Tumors: Naoki Okano, Yoshinori Igarashi, Ken Ito, Saori Mizutani, Hiroki Nakagawa, Kouji Watanabe, Yuuto Yamada, Kensuke Yoshimoto, Yuusuke Kimura, Susumu Iwasaki, Kensuke Takuma, Seiichi Hara, Yuui Kishimoto; Clin Endosc 2021;54(5):706-712. Published online March 10, 2021; DOI: https://doi.org/10.5946/ce.2020.208

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Background
/Aims: Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed to investigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for prevention of bleeding.
Methods
We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopic papillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in the simple snaring resection group (Group A) and the HSE injection group (Group B) were compared.
Results
A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7% (96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8% (3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates of positive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively.
Conclusions
HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopic papillectomy for ampullary tumors.

Citations

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Endoscopic papillectomy versus surgical ampullectomy for adenomas and early cancers of the papilla: a retrospective Pancreas2000/European Pancreatic Club analysis
Marcus Hollenbach, Christian Heise, Einas Abou-Ali, Aiste Gulla, Francesco Auriemma, Kevin Soares, Galen Leung, Mark A Schattner, William R Jarnagin, Tiegong Wang, Fabrice Caillol, Marc Giovannini, Yanis Dahel, Thilo Hackert, Woo Hyun Paik, Alessandro Zer
Gut.2025; 74(3): 397. CrossRef
A Novel Clip Device for Safer and Faster Suturing in Endoscopic Papillectomy: A Retrospective Study of 241 Procedures
Kohei Takano, Kentaro Yamao, Takuya Ishikawa, Yoshihisa Takada, Yasuyuki Mizutani, Tadashi Iida, Kota Uetsuki, Takeshi Yamamura, Yoji Ishizu, Kazuhiro Furukawa, Takashi Honda, Masanao Nakamura, Hiroki Kawashima
Journal of Gastroenterology and Hepatology.2025; 40(5): 1238. CrossRef
Endoscopic papillectomy for ampullary lesions of minor papilla
Kien Vu Trung, Christian Heise, Einas Abou-Ali, Francesco Auriemma, Elias Karam, Sophia E. van der Wiel, Marco J. Bruno, Fabrice Caillol, Marc Giovannini, Viliam Masaryk, Uwe Will, Andrea Anderloni, Enrique Pérez-Cuadrado-Robles, Ana Dugic, Benjamin Meier
Gastrointestinal Endoscopy.2024; 99(4): 587. CrossRef
Endoscopic papillectomy for ampullary lesions in patients with familial adenomatous polyposis compared with sporadic lesions: a propensity score-matched cohort
Kien Vu Trung, Einas Abou-Ali, Fabrice Caillol, Woo H. Paik, Bertrand Napoleon, Viliam Masaryk, Sophia E. van der Wiel, Enrique Pérez-Cuadrado-Robles, Nicolas Musquer, Asif Halimi, Kevin Soares, Francois R. Souche, Steffen Seyfried, Maria C. Petrone, Stef
Endoscopy.2023; 55(08): 709. CrossRef
Updates in endoscopic management of ampullary and duodenal adenomas
Pravallika Chadalavada, Tilak Upendra Shah
Current Opinion in Gastroenterology.2023; 39(6): 496. CrossRef
Submucosal Epinephrine Injection Before Endoscopic Papillectomy: Less is More?
Roy L.J. van Wanrooij, Jeanin E. van Hooft
Clinical Endoscopy.2021; 54(5): 627. CrossRef

6,024 View
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