Clinical Endoscopy

Comparison of bispectral index-guided endoscopic ultrasonography with continuous vs. intermittent infusion of propofol: a retrospective study in Japan: Ayana Okamoto, Ken Kamata, Tomohiro Yamazaki, Shunsuke Omoto, Kosuke Minaga, Mamoru Takenaka, Masatoshi Kudo; Clin Endosc 2024;57(6):814-820. Published online July 24, 2024; DOI: https://doi.org/10.5946/ce.2024.019

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: This study aimed to evaluate the safety and efficacy of continuous propofol infusion for anesthesia during endoscopic ultrasonography (EUS).
Methods
A total of 427 consecutive patients who underwent EUS between May 2018 and February 2019 were enrolled in this study. The patients were divided into two propofol infusion groups: continuous (n=207) and intermittent (n=220). The following parameters were compared: (1) propofol dose, (2) respiratory and circulatory depression, (3) body movement requiring discontinuation of the examination, (4) awakening score, and (5) patient satisfaction.
Results
The median total maintenance dose of propofol was significantly higher in the continuous group than in the intermittent group (160.0 mg vs. 130.0 mg, respectively); however, the reduction in SpO2 was significantly lower in the continuous group (2.9% vs. 13.2%). Body movements occurred less frequently in the continuous group than in the intermittent group (40.1% vs. 49.5%, respectively). The rate of complete awakening was significantly higher in the continuous group than in the intermittent group. Finally, there was a significant difference in the percentage of patients who answered “absolutely yes” when asked about receiving EUS again: 52.7% in the continuous group vs. 34.3% in the intermittent group.
Conclusions
Continuous infusion resulted in stable sedation and reduced propofol-associated risks.

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Drainage for fluid collections post pancreatic surgery and acute pancreatitis: similar but different?: Yousuke Nakai, Saburo Matsubara, Tsuyoshi Mukai, Tsuyoshi Hamada, Takashi Sasaki, Hirotoshi Ishiwatari, Susumu Hijioka, Hideyuki Shiomi, Mamoru Takenaka, Takuji Iwashita, Atsuhiro Masuda, Tomotaka Saito, Hiroyuki Isayama, Ichiro Yasuda, for the WONDERFUL study group in Japan; Clin Endosc 2024;57(6):735-746. Published online May 17, 2024; DOI: https://doi.org/10.5946/ce.2023.254

Postoperative pancreatic fistulas (POPFs) are common adverse events that occur after pancreatic surgery. Endoscopic ultrasonography (EUS)-guided drainage (EUS-D) is a first-line treatment, similar to that for pancreatic fluid collection (PFCs) after acute pancreatitis. However, some POPFs do not develop fluid collections depending on the presence or location of the surgical drain, whereas others develop fluid collections, such as postoperative fluid collections (POPFCs). Although POPFCs are similar to PFCs, the strategy and modality for POPF management need to be modified according to the presence of fluid collections, surgical drains, and surgical type. As discussed for PFCs, the indications, timing, and selection of interventions or stents for EUS-D have not been fully elucidated for POPFs. In this review, we discuss the management of POPFs and POPFCs in comparison with PFCs due to acute pancreatitis and summarize the topics that should be addressed in future studies.

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Management of Postoperative Pancreatic Fluid Collection and Role of Endoscopy: A Case Series and Review of the Literature
Chiara Coluccio, Ilaria Tarantino, Maria Chiara Petrone, Edoardo Forti, Stefano Francesco Crinò, Alessandro Fugazza, Roberto Di Mitri, Cecilia Binda, Davide Trama, Arnaldo Amato, Alessandro Redaelli, Germana De Nucci, Fabia Attili, Mario Luciano Brancacci
Diagnostics.2025; 15(10): 1258. CrossRef
Percutaneous mini–invasive interventions in the treatment of peripancreatic fluid accumulation after pancreatic resection
M. V. Kostylev, V. P. Shkarban, V. I. Trachuk, V. O. Shatalo
The Ukrainian Journal of Clinical Surgery.2025; 92(3): 20. 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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Radiation-emitting metallic stent for unresectable Bismuth type III or IV perihilar cholangiocarcinoma: a multicenter randomized trial
Qi Chen, Nai-Jian Ge, Yu-Liang Li, Ming Huang, Wen-Hui Li, Dong Lu, Ning Wei, Peng-Hua Lv, Jian-Fei Tu, Cheng-Jian He, Wu-Jie Wang, Rong Ding, Bo Peng, Xue-Jun Wang, Fu-An Wang, Guang-Yu Zhu, Yong Wang, Li Chen, Jie Min, Jin-He Guo, Gao-Jun Teng, Jian Lu
International Journal of Surgery.2025; 111(1): 706. CrossRef
Surgical Management of Biliary Strictures
Nitin N. Katariya
Digestive Disease Interventions.2025;[Epub] CrossRef
Biliary metallic stent combined with radioactive 125I seeds strands for malignant hilar obstruction
Milan Sigdel, Chengzhi Zhang, Rongna Hou, Mengyao Song, Zhanguo Sun, Dechao Jiao
BMC Cancer.2025;[Epub] CrossRef
Advances in Endoscopic Diagnosis and Treatment of Hilar Cholangiocarcinoma
璐萍邢
Advances in Clinical Medicine.2025; 15(05): 1961. CrossRef
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
Intraductal ablation therapy for malignant biliary obstruction
Qiyu Zhang, Yanchao Dong, Hongtao Niu
Langenbeck's Archives of Surgery.2024;[Epub] 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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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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Usefulness of the double-guidewire technique for endoscopic procedures in the field of biliary and pancreatic diseases: Mamoru Takenaka, Masatoshi Kudo; Clin Endosc 2022;55(5):605-614. Published online August 23, 2022; DOI: https://doi.org/10.5946/ce.2022.032

Abstract PDF PubReader ePub

The double-guidewire method has been increasingly used in endoscopic procedures for biliary and pancreatic diseases in recent years, including endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography-related procedures. In addition, double-lumen catheters with uneven distal and proximal lumen openings have been introduced, making it possible to easily create a double-guidewire situation, and the usefulness of the double-guidewire technique using uneven double-lumen cannulas has been widely reported. Although the advantages of using two guidewires depend on the particular situation and the appropriate use of the two guidewires, deepening the knowledge of the double-guidewire method will contribute greatly to troubleshooting in daily practice. In this review, the usefulness of the double-guidewire technique is discussed with respect to two main areas: selective insertion of guidewires and devices and biliary cannulation.

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天雨张
Journal of Clinical Personalized Medicine.2024; 03(01): 100. 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
Dedicated Echoendoscope for Interventional Endoscopic Ultrasound: Comparison with a Conventional Echoendoscope
Toshio Fujisawa, Shigeto Ishii, Yousuke Nakai, Hirofumi Kogure, Ko Tomishima, Yusuke Takasaki, Koichi Ito, Sho Takahashi, Akinori Suzuki, Hiroyuki Isayama
Journal of Clinical Medicine.2024; 13(10): 2840. CrossRef
INTRAOPERATIVE SIGNS OF ACUTE BILIARY PANCREATITIS
S. M. Vasyliuk, O. V. Prudnikov, V. V. Ivanyna, O. S. Tkachuk, N. M. Pavliuk, B. V. Krysa, V. M. Atamaniuk
Kharkiv Surgical School.2022; (4-5): 55. CrossRef

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Bispectral index-guided propofol sedation during endoscopic ultrasonography: Ayana Okamoto, Ken Kamata, Takeshi Miyata, Tomoe Yoshikawa, Rei Ishikawa, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Yasutaka Chiba, Toshiharu Sakurai, Naoshi Nishida, Masayuki Kitano, Masatoshi Kudo; Clin Endosc 2022;55(4):558-563. Published online July 12, 2022; DOI: https://doi.org/10.5946/ce.2022.001

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Background
/Aims: Bispectral index (BIS) monitors process and display electroencephalographic data are used to assess the depth of anesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS).
Methods
This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was used in 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatory depression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours after leaving the endoscopy room.
Results
The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg; p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in the non-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than in the non-BIS group (8.5% vs. 39.4%; p<0.001).
Conclusions
During EUS examination, BIS monitoring is useful for maintaining a constant depth of anesthesia, especially in patients 75 years of age or older.

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Propofol‐alone sedative efficacy in observational biliopancreatic endoscopic ultrasound
Hisaki Kato, Yuki Kawasaki, Kazuya Sumi, Yuki Shibata, Norihiro Nomura, Jun Ushio, Junichi Eguchi, Takayoshi Ito, Haruhiro Inoue
DEN Open.2025;[Epub] CrossRef
General anesthesia and/or deep hypnotic state in propofol-based conscious sedation for endoscopy
Halim Bou Daher, Ali El Mokahal, Mohamad Ali Ibrahim, Rana Yamout, Nour Hochaimi, Chakib Ayoub, Yasser H. Shaib, Ala I. Sharara
iGIE.2024; 3(2): 286. CrossRef
EEG bispectral index sensor guidance improves accuracy and safety of procedural sedation
A. Oh, N. Karim, A. Pitt, S. Hodgetts, D.W. Edwards, D. Mullan, H-U. Laasch
Clinical Radiology.2024; 79(12): e1490. CrossRef
Comparison of bispectral index-guided endoscopic ultrasonography with continuous vs. intermittent infusion of propofol: a retrospective study in Japan
Ayana Okamoto, Ken Kamata, Tomohiro Yamazaki, Shunsuke Omoto, Kosuke Minaga, Mamoru Takenaka, Masatoshi Kudo
Clinical Endoscopy.2024; 57(6): 814. CrossRef
Advances in Analgosedation and Periprocedural Care for Gastrointestinal Endoscopy
Sonja Skiljic, Dino Budrovac, Ana Cicvaric, Nenad Neskovic, Slavica Kvolik
Life.2023; 13(2): 473. CrossRef
Clinical and economic value of bispectral index monitoring for adequate endoscopic sedation
Se Woo Park
Clinical Endoscopy.2022; 55(4): 518. CrossRef
Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report
Jaesang Lee, Hosik Moon, Sungjin Hong, Jinyoung Chon, Hyejin Kwon, Hunwoo Park, Jiyung Lee
Medicina.2022; 59(1): 65. CrossRef

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Endoscopic Ultrasound Fine-Needle Biopsy May Contribute to the Diagnosis of Malignant Lymph Nodes: Mamoru Takenaka, Shunsuke Omoto, Masatoshi Kudo; Clin Endosc 2020;53(5):508-509. Published online September 24, 2020; DOI: https://doi.org/10.5946/ce.2020.199

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The “echo-free space” technique: A safe and reliable method for endoscopic ultrasound scope insertion into the esophagus
Shunsuke Omoto, Mamoru Takenaka, Kota Takashima, Yoriaki Komeda, Masatoshi Kudo
Endoscopy.2024; 56(S 01): E500. CrossRef
The “echo-free space” technique: a safe and reliable method for endoscopic ultrasound scope insertion
Shunsuke Omoto, Mamoru Takenaka, Tomohiro Fukunaga, Kota Takashima, Yoriaki Komeda, Seok Jeong, Masatoshi Kudo
Endoscopy.2023; 55(S 01): E698. CrossRef

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Can Localized Stenosis of the Main Pancreatic Duct be a Predictive Factor for Early Detection of Pancreatic Cancer?: Mamoru Takenaka, Kentaro Yamao, Masatoshi Kudo; Clin Endosc 2019;52(6):523-524. Published online November 29, 2019; DOI: https://doi.org/10.5946/ce.2019.204

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