Clinical Endoscopy

Systematic Review and Meta-analysises

Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials: Yousaf Zafar, Hafsa Azam, Muhammad Abdullah Bin Azhar, Fabeeha Shaheen, Syed Sarmad Javaid, Laila Manzoor, Muaaz Masood, Rajesh Krishnamoorthi; Clin Endosc 2025;58(4):533-543. Published online February 24, 2025; DOI: https://doi.org/10.5946/ce.2024.183

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Malignant biliary obstruction is a major clinical challenge. We assessed the efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) compared with that of endoscopic retrograde cholangiopancreatography biliary drainage (ERCP-BD) or percutaneous transhepatic biliary drainage (PTBD).
Methods
We searched for randomized controlled trials comparing EUS-BD with ERCP or PTBD in treating malignant biliary obstruction. Using random-effects models, we synthesized risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). A subgroup analysis was performed using a comparator (ERCP or PTBD).
Results
EUS-BD significantly reduced the risk of stent dysfunction (RR, 0.46; 95% CI, 0.33–0.64), with consistent results in subgroup analysis for ERCP (RR, 0.54; 95% CI, 0.35–0.84) and PTBD (RR, 0.37; 95% CI, 0.22–0.61). It also lowered the risk of post-procedure pancreatitis (RR, 0.24; 95% CI, 0.07–0.83) and reduced tumor ingrowth or overgrowth risk (RR, 0.27; 95% CI, 0.11–0.65), even when compared to ERCP alone (RR, 0.28; 95% CI, 0.11–0.70). EUS-BD demonstrated a lower risk of adverse events compared to PTBD (RR, 0.37; 95% CI, 0.14–0.97) and reduced length of hospital stay (WMD, –1.03; 95% CI, –1.53 to –0.53) when compared to ERCP.
Conclusions
EUS-BD outperformed ERCP-BD and PTBD in reducing stent dysfunction, postprocedural pancreatitis, and tumor ingrowth or overgrowth.

Citations

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Joan B. Gornals, Albert Sumalla-Garcia, Carme Loras
Clinical Gastroenterology and Hepatology.2026; 24(4): 1203. CrossRef
Biliary Drainage in Altered Anatomy: A Comprehensive Literature Review
Rishi Chowdhary, Jorge D. Machicado, Veeral M. Oza
Journal of Digestive Endoscopy.2026;[Epub] CrossRef
A Time-Based and Clinical Status Stratified Protocol for Major Bile Duct Injury After Cholecystectomy: Retrospective, Single-Center Outcomes From a Resource-Limited Setting
Ahmed Ateik, Saif A Ghabisha, Lamia Abdulmughni, Fares Awn
Cureus.2026;[Epub] CrossRef
Biliary Drainage During Neoadjuvant Chemotherapy in Pancreatic Cancer: Evidence and Practical Recommendations
Tadahisa Inoue, Masanao Nakamura, Kiyoaki Ito
Cancers.2026; 18(3): 467. CrossRef
Endoscopic Ultrasound-Guided Versus Percutaneous Transhepatic Biliary Drainage After Failed Endoscopic Retrograde Cholangiopancreatography in Malignant Biliary Obstruction: A Single-Center Retrospective Cohort
Wojciech Ciesielski, Łukasz Durko, Ludomir Stefańczyk, Adam Dobek, Anna Bulicz, Amelia Wojnicka, Zuzanna Sosnowska, Agata Grochowska, Janusz Strzelczyk, Piotr Hogendorf, Adam Durczyński, Tomasz Klimczak
Cancers.2026; 18(5): 783. CrossRef
Role of Endoscopy in Malignant Biliary Obstruction
Ishaan Vohra, Burraq Imran, Zubair Khan, Muhammad Hasan
Diagnostics.2026; 16(5): 721. CrossRef
Case Report: Unexpected LAMS obstruction following successful EUS-BD in a patient with pancreatic carcinoma
Xuxia He, Kun He, Qiang Wang
Frontiers in Surgery.2026;[Epub] CrossRef
EUS-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed ERCP in oncological patients: a 10-year retrospective comparison
P Alves, L Lenz, C Clemente, I Kristal, M Beltrami, AD P Gustavo, B Costa Martins, A Safatle-Ribeiro, F Maluf-Filho
Endoscopy.2026; 58(S 03): S634. CrossRef
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Joan B. Gornals, Manuel Perez-Miranda, Carme Loras
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Use of abdominal compression device in colonoscopy: a systematic review and meta-analysis: Yousaf Zafar, Ahmed Mustafa Rashid, Syed Sarmad Javaid, Ahmed Kamal Siddiqi, Adnan Zafar, Arsalan Zafar Iqbal, Jagpal Singh Klair, Rajesh Krishnamoorthi; Clin Endosc 2023;56(4):446-452. Published online May 26, 2023; DOI: https://doi.org/10.5946/ce.2022.304

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Colonoscopy for screening is associated with unpleasant experiences for patients, and abdominal compression devices have been developed to minimize these problems. However, there is a paucity of data supporting the therapeutic benefits of this strategy. This study examined the effects of using an abdominal compression device during colonoscopy on the cecal intubation time (CIT), abdominal compression, patient comfort, and postural changes.
Methods
We searched PubMed and Scopus (from inception to November 2021) for randomized controlled trials that assessed the effects of an abdominal compression device during colonoscopy on CIT, abdominal compression, patient comfort, and postural change. A random-effects meta-analysis was performed. Weighted mean differences (WMDs) and Mantel-Haenszel odds ratios (ORs) were calculated.
Results
Our pooled analysis of seven randomized controlled trials revealed that abdominal compression devices significantly reduced CIT (WMD, –0.76 [–1.49 to –0.03] minutes; p=0.04), abdominal compression (OR, 0.52; 95% confidence interval [CI], 0.28–0.94; p=0.03), and postural changes (OR, 0.46; 95% CI, 0.27–0.78; p=0.004) during colonoscopy. However, our results did not show a significant change in patient comfort (WMD, –0.48; 95% CI, –1.05 to 0.08; p=0.09) when using an abdominal compression device.
Conclusions
Our findings demonstrate that employing an abdominal compression device may reduce CIT, abdominal compression, and postural change but have no impact on patient comfort.

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Optimizing colonoscopy with abdominal compression devices: an updated meta-analysis of randomized controlled trials
Abdallfatah Abdallfatah, Mohamed A. Aldemerdash, Ahmed W. Hageen, Samaa Daoud, Mahmoud Elbaklish, Mohammed Hassan Morsy, Ahmed R. A. Abou-Shanab, Islam Mohamed, Hazem Abosheaishaa
Baylor University Medical Center Proceedings.2026; 39(1): 96. CrossRef
Abdominal binders improve colonoscopy outcomes: a systematic review and meta-analysis of randomized controlled trials with BMI-stratified subgroup analysis
Yu-Kuang Kang, Tien-Yu Huang, Meng-Chuan Lu, Peng-Jen Chen, Po-Feng Huang
Therapeutic Advances in Gastroenterology.2026;[Epub] CrossRef
Evidence-Based Foundations and Training Implementation of Standardized Colonoscope Insertion Protocols
灵灵
Advances in Clinical Medicine.2026; 16(08): 600. CrossRef
Use of an abdominal binder in colonoscopies performed by trainees in gastrointestinal endoscopy: a randomized, double-blind, sham-controlled trial
Antonio Marmolejo, Sinue Cázarez, Carlos J. Mata, Sergio Ayala, Jorge Farell, Nubia A. Ramírez, Carlos A. Navarro Castañeda, Luis García
Surgical Endoscopy.2025; 39(5): 3236. CrossRef
Terminal ileum in screening colonoscopy: routine practice or risk-stratified approach?
Seong-Jung Kim
Clinical Endoscopy.2025; 58(5): 696. CrossRef

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Original Article

Safe implementation of transoral incisionless fundoplication as a new technique in a tertiary care center: Shivanand Bomman, Sofya Malashanka, Adil Ghafoor, David J. Sanders, Shayan Irani, Richard A. Kozarek, Andrew Ross, Michal Hubka, Rajesh Krishnamoorthi; Clin Endosc 2022;55(5):630-636. Published online August 17, 2022; DOI: https://doi.org/10.5946/ce.2022.003

Abstract PDF

Background
/Aims: Transoral incisionless fundoplication (TIF) is an accepted anatomic treatment for gastroesophageal reflux disease in selected patients. In this report, we analyze our institution’s programmatic allocation of resources during the safe implementation of TIF as a new procedure.
Methods
A retrospective analysis of all patients who underwent TIF from January 2020 to February 2021 at our institution was performed. The process of initially allocating the operating room (OR) with overnight admission and postoperative esophagram for added safety, and subsequently transitioning TIF to the endoscopy suite (ES) as an outpatient procedure was described. Patient safety and outcomes were evaluated during transition.
Results
Thirty patients who underwent TIF were identified. The mean age was 51.2±16.0 years. TIF was performed in an OR in nine patients (30%) and 21 (70%) in the ES. All the OR patients were admitted overnight and had routine EG. In contrast, four (19%) from the ES group required clinically-indicated admission and three (14.2%) required esophagram. The mean procedure duration was significantly lower in the ES group (65.7 min vs. 84 min, p=0.02).
Conclusions
A stepwise, resource-efficient process was described that allowed safe initiation of TIF as a new technique and its effective transition to a fully outpatient procedure.

Citations

Citations to this article as recorded by

Practice patterns of transoral incisionless fundoplication: results of the TIF-US survey
Brennan Gioe, Fouad Jaber, Mohammed Ayyad, Fares Ayoub, Wasif Abidi, Kalpesh K. Patel, Olaya Brewer Gutierrez, Brett Parker, Roy Tomas DaVee, Erik Wilson, Nirav Thosani, Wasseem Skef
Surgical Endoscopy.2026; 40(3): 2322. CrossRef
Efficacy of Second-generation transoral incisionless fundoplication (TIF 2.0) for treatment of gastroesophageal reflux disease (GERD) in hill grade (HG) III gastroesophageal junction (GEJ): A systematic review and pooled analysis
Yinglin Gao, Fouad Jaber, Muaaz Masood, Ashwin Rao, Rajesh Krishnamoorthi, Charlie Borzy, John G. Hunter, J.M. Conchillo, Nicole B Bouvy, Bengt Håkanson, Lars Lundell, Ruben Hernaez, Wasseem Skef
Innovative Surgical Trends.2026;[Epub] CrossRef
Gastroesophageal reflux disease in children: What’s new right now?
Palittiya Sintusek, Mohamed Mutalib, Nikhil Thapar
World Journal of Gastrointestinal Endoscopy.2023; 15(3): 84. CrossRef
Assessing implementation strategy and learning curve for transoral incisionless fundoplication as a new technique
Muhammad Haseeb, Christopher C. Thompson
Clinical Endoscopy.2022; 55(6): 751. CrossRef

6,476 View
137 Download
3 Web of Science
4 Crossref

Systematic Review and Meta-Analysis

Contamination Rates in Duodenoscopes Reprocessed Using Enhanced Surveillance and Reprocessing Techniques: A Systematic Review and Meta-Analysis: Shivanand Bomman, Munish Ashat, Navroop Nagra, Mahendran Jayaraj, Shruti Chandra, Richard A Kozarek, Andrew Ross, Rajesh Krishnamoorthi; Clin Endosc 2022;55(1):33-40. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.212

Abstract PDF Supplementary Material

Background
/Aims: Multiple outbreaks of multidrug-resistant organisms have been reported worldwide due to contaminated duodenoscopes. In 2015, the United States Food and Drug Administration recommended the following supplemental enhanced surveillance and reprocessing techniques (ESRT) to improve duodenoscope disinfection: (1) microbiological culture, (2) ethylene oxide sterilization, (3) liquid chemical sterilant processing system, and (4) double high-level disinfection. A systematic review and meta-analysis was performed to assess the impact of ESRT on the contamination rates.
Methods
A thorough and systematic search was performed across several databases and conference proceedings from inception until January 2021, and all studies reporting the effectiveness of various ESRTs were identified. The pooled contamination rates of post-ESRT duodenoscopes were estimated using the random effects model.
Results
A total of seven studies using various ESRTs were incorporated in the analysis, which included a total of 9,084 post-ESRT duodenoscope cultures. The pooled contamination rate of the post-ESRT duodenoscope was 5% (95% confidence interval [CI]: 2.3%–10.8%, inconsistency index [I²]=97.97%). Pooled contamination rates for high-risk organisms were 0.8% (95% CI: 0.2%–2.7%, I²=94.96).
Conclusions
While ESRT may improve the disinfection process, a post-ESRT contamination rate of 5% is not negligible. Ongoing efforts to mitigate the rate of contamination by improving disinfection techniques and innovations in duodenoscope design to improve safety are warranted.

Citations

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Effectiveness of Reprocessing Protocols for Reusable Endoscopes in Operating Rooms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Yanxin Qu, Xiaonan Liu, Dening An, Haimeng Wei, Zhengjun Zhang, Shuai Tao
Bratislava Medical Journal.2026; 127(6): 2114. CrossRef
Recommendations and guidelines for endoscope reprocessing: Current position statement of digestive endoscopic society of Taiwan
Wei-Kuo Chang, Chen-Ling Peng, Yen-Wei Chen, Cheuk-Kay Sun, Chieh-Chang Chen, Tao-Chieh Liu, Yin-Yi Chu, I-Fang Tsai, Chen-Shuan Chung, Hsiao-Fen Lin, Fang-Yu Hsu, Wei-Chen Tai, Hsi-Chang Lee, Hsu-Heng Yen, E-Ming Wang, Shu-Hui Chen, Cheng-Hsin Chu, Ming-
Journal of Microbiology, Immunology and Infection.2024; 57(2): 211. CrossRef
Duodenoscopes With Disposable Elevator Caps—An Incremental Reduction in Infection Risk for Patients
Melinda Wang, Graham M. Snyder
JAMA Internal Medicine.2023; 183(3): 200. CrossRef
Transmission of oral microbiota to the biliary tract during endoscopic retrograde cholangiography
Maria Effenberger, Ramona Al-Zoairy, Ronald Gstir, Ivo Graziadei, Hubert Schwaighofer, Herbert Tilg, Heinz Zoller
BMC Gastroenterology.2023;[Epub] CrossRef
Role of peroral cholangioscopy and pancreatoscopy in the diagnosis and treatment of biliary and pancreatic disease: past, present, and future
Harishankar Gopakumar, Neil R. Sharma
Frontiers in Gastroenterology.2023;[Epub] CrossRef
Performance of single-use duodenoscopes for ERCP: a systematic review and meta-analysis
Harishankar Gopakumar, Ishaan Vohra, Neil R. Sharma, Srinivas R. Puli
iGIE.2022; 1(1): 77. CrossRef

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