Clinical Endoscopy

Review

Advances in self-expandable metal stents for endoscopic ultrasound-guided interventions: Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia; Clin Endosc 2024;57(5):588-594. Published online July 9, 2024; DOI: https://doi.org/10.5946/ce.2023.169

Endoscopic ultrasound (EUS)-guided interventions have evolved rapidly in recent years, with dedicated metal stents playing a crucial role in this process. Specifically, the invention of biflanged short metal-covered stents, including lumen-apposing metal stents (LAMS), and modifications in a variety of tubular self-expandable metal stents (SEMS), have led to innovations in EUS-guided interventions. LAMS or non-LAMS stents are commonly used in the EUS-guided drainage of pancreatic fluid collections, especially in cases of walled-off necrosis. Additionally, LAMS is commonly considered for drainage of the EUS-guided gallbladder or dilated common bile duct and EUS-guided gastroenterostomy. Fully or partially covered tubular SEMS with several new designs are being considered for EUS-guided biliary drainage. This review focuses on advances in SEMS for EUS-guided interventions and discusses related research results.

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Gut and Liver.2026; 20(1): 37. CrossRef
Comparative efficacy and safety of bi-flanged metal stents versus lumen-apposing metal stents for endoscopic drainage of pancreatic fluid collections: a systematic review and meta-analysis
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European Journal of Gastroenterology & Hepatology.2026;[Epub] CrossRef
Role of Endoscopic Ultrasonography in Management of Pancreaticobiliary Cancers: Recent Trends and Advances
Shivangini Duggal, Mutaz Kalas, Mohamed H. Eldesouki, M. Ammar Kalas, Sherif E. Elhanafi
Cancers.2026; 18(12): 1864. CrossRef
Stent-Over-Sponge (SOS) as a Rescue Technique for Leak Post-Bariatric Surgery: Experience From Hôpital du Sacré-Coeur, Canada
Majed Alanazi, Bandar Ali, Ibrahim Alonazi, Pierre Y Garneau , Denis Ronald, Radu Pescarus
Cureus.2025;[Epub] CrossRef
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Chi-Ying Yang, Wen-Hsin Huang, Hsing-Hung Cheng
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Endoscopic ultrasound-guided hepaticogastrostomy without tract dilation using a novel ultra-tapered slim-delivery metallic stent
Ritsuko Oishi, Haruo Miwa, Kazuki Endo, Hiromi Tsuchiya, Yuichi Suzuki, Kazushi Numata, Shin Maeda
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The evolving role of endoscopic ultrasound-guided lumen-apposing metal stents in the management of peri-pancreatic fluid collections
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Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Comparative outcome of metal versus plastic stents for the management of walled-off pancreatic necrosis – An updated meta-analysis of randomised studies
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Journal of Minimal Access Surgery.2025; 21(4): 331. CrossRef
Exploring lumen-apposing metal stents as a novel approach for managing walled-off necrosis in pediatric acute pancreatitis in Indian cohort: a prospective study
Varun Mehta, Abhinav Abhinav, Yogesh Kumar Gupta, Manisha Khubber, Ajit Sood, Manjeet Kumar Goyal
Clinical Endoscopy.2025; 58(4): 595. CrossRef
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Thomas Lambin, Sarah Leblanc, Bertrand Napoléon
Cancers.2025; 17(21): 3428. CrossRef

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Original Article

Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study: Younghee Choe, Yu Kyung Cho, Gwang Ha Kim, Jun-Ho Choi, Eun Soo Kim, Ji Hyun Kim, Eun Kwang Choi, Tae Hyeon Kim, Seong-Hun Kim, Do Hoon Kim, The Research Group for Endoscopic Ultrasound in Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2023;56(6):744-753. Published online August 25, 2023; DOI: https://doi.org/10.5946/ce.2023.005

Graphical Abstract Abstract PDF

Background
/Aims: This study aimed to evaluate the prevalence and natural progression of subepithelial lesions (SELs) in the upper gastrointestinal (UGI) tract.
Methods
The medical records of patients with UGI SELs who underwent endoscopic screening at eight university hospitals between January and December 2010 were retrospectively investigated. The follow-up evaluations were performed until December 2016.
Results
UGI SELs were found in 1,044 of the 65,233 participants screened (endoscopic prevalence, 1.60%; the total number of lesions, 1,062; mean age, 55.1±11.2 years; men, 53.6%). The median follow-up period was 48 (range, 8–74) months. SELs were most frequently found in the stomach (63.8%) and had a mean size of 9.9±6.1 mm. Endoscopic ultrasonography (EUS) was performed in 293 patients (28.1%). The most common lesions were leiomyomas, followed by gastrointestinal stromal tumors (GISTs), and ectopic pancreas. The proportions of SELs with malignant potential according to size were 3% (<1 cm), 22% (1–2 cm), 27% (2–3 cm), and 38% (≥3 cm). In gastric SELs larger than 1 cm, resections were performed in 20 patients because of an increase in size, of which 12 were found to be GISTs.
Conclusions
The prevalence of UGI SELs was 1.60%. Further, 23% of gastric SELs ≥1 cm were precancerous lesions, most followed by EUS and clinical decisions without initial pathological confirmation.

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Jong Sun Park, Ji Hyun Park, Bumhee Park, Jong Hoon Park, Sun Gyo Lim, Sung Jae Shin, Kee Myung Lee, Sung Soo Ahn, Choong-Kyun Noh, Gil Ho Lee
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Sang Jin Park, Min A Yang, Jae Sun Song, Won Dong Lee, Myoung Jin Ju, Jin Woong Cho
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Louzhe Xu, Shurong Chen, Chunxiao Li, Jingjing Zhou, Xiaohan Shen, Jinghua Wang, Xinjue He, Tianlian Yan, Han Ma, Yizhen Zhang, Lan Li, Shu Bian, Yue Huang, Chao Lu, Yangyang Xiong, Jiang Liu, Qiang Chen, Lina Ye, Qiaona He, Yini Ke, Youming Li, Xinli Mao
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Sung Eun Kim
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Seokin Kang
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Yonghoon Choi, Jae Yong Park, Sung Eun Kim, Jae Myung Park, Joon Sung Kim, Hyunsoo Chung, Seung Han Kim, Chan Hyuk Park, Sang Hoon Kim, Seon-Young Park, Bong Eun Lee, Seung Woo Lee, Ayoung Lee, Jeong Hoon Lee, Da Hyun Jung, Hyeong Ho Jo, In Hyuk Yoo, Byun
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Huiting Lin, Songfeng Chen, Niandi Tan, Qianjun Zhuang, Xingyu Jia, Dianxuan Jiang, Yinglian Xiao, Jinhui Wang
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Masaya Iwamuro, Hiroyuki Okada, Motoyuki Otsuka
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Rapidly Growing Gastrointestinal Stromal Tumor on the Esophagus
Ji Hye Park, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee
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Advancements in Endoscopic Treatment for Gastric Subepithelial Tumors
Osamu Goto, Kazutoshi Higuchi, Eriko Koizumi, Katsuhiko Iwakiri
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Endoscopic mucosal resection of a large duodenal polyp
Ye Rin Chae, Ga Hee Kim
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Jiao Li, Yongfeng Yan, Dandan Jiang, Xiaoxiang Wang, Li Wang, Li Liu, Tao Shu, Zhengkui Zhou, Xiaobin Sun
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Hye Kyung Jeon, Gwang Ha Kim
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Sang Hoon Kim
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Bang Ju Kim, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee, Jung Wook Lee, Kyung Won Seo, Hee-Kyung Chang
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Assessing the utility of three-dimensional imaging for preoperative assessment of gastric subepithelial tumors
Dong Chan Joo, Gwang Ha Kim
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A Case of Esophageal MALT Lymphoma Mimicking a Subepithelial Tumor
Ha Eun Lee, Gwang Ha Kim, Min Ji Kim, Kyung Bin Kim, Dong Chan Joo, Hye Kyung Jeon, Moon Won Lee, Bong Eun Lee
The Korean Journal of Gastroenterology.2024; 83(4): 157. CrossRef
Small gastric subepithelial lesions: A sand in the eye
Tanyaporn Chantarojanasiri, Nikhil Sonthalia, Rashid N. Lui
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Endoscopic treatment of a large Brunner’s gland hamartoma in the duodenum
Ha Eun Lee, Gwang Ha Kim, Kyungbin Kim
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Dong Chan Joo, Gwang Ha Kim, Moon Won Lee, Bong Eun Lee, Ji Woo Kim, Kwang Baek Kim
Journal of Clinical Medicine.2024; 13(13): 3725. 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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Review

Quality indicators of endoscopic ultrasound in the pancreatobiliary system: a brief review of current guidelines: Sung Yong Han, Hyung Ku Chon, Seong-Hun Kim, Sang Hyub Lee, The Research Group for Endoscopic Ultrasound in Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2024;57(2):158-163. Published online June 9, 2023; DOI: https://doi.org/10.5946/ce.2023.064

Abstract PDF

Since its development, the use of endoscopic ultrasonography (EUS) in the pancreas and the biliary tract has become increasingly important. The accuracy of EUS varies depending on the experience of the endoscopist. Hence, quality control measures using appropriate indicators are required to reduce these variations. American Society for Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy have announced the EUS quality indicators. Here, we reviewed the quality indicators of the EUS procedure in the current published guidelines.

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Focused Review Series: Recent Updates on the Role of EUS in Pancreatobiliary Disease

Endoscopic Ultrasound–Guided Fiducial Placement for Stereotactic Body Radiation Therapy in Pancreatic Malignancy: Seong-Hun Kim, Eun Ji Shin; Clin Endosc 2021;54(3):314-323. Published online May 28, 2021; DOI: https://doi.org/10.5946/ce.2021.102

Abstract PDF

Stereotactic body radiation therapy (SBRT) is an important treatment option for pancreatic cancer, which is known to be one of the malignancies with the worst prognosis. However, the high radiation doses delivered during SBRT may cause damage to adjacent radiosensitive organs. To minimize such damage, fiducial markers are used for localization during SBRT for pancreatic cancer. The development of endoscopic ultrasound (EUS) has enabled fiducial markers to be inserted into the pancreas using an EUS fine-needle aspiration (FNA) needle, unlike in the past when percutaneous placement was generally performed. For successful EUS-guided fiducial marker placement, it is necessary for the fiducial markers to be loaded within the EUS-FNA needles to have a low probability of complications and a low migration risk, and to be stably observed in SBRT imaging. A systematic review has shown that the technical success rate of EUS-guided fiducial marker placement is 96.27%, whereas the fiducial marker migration and adverse event rates are 4.33% and 4.85%, respectively. Nonetheless, standardized techniques for fiducial marker placement and the characteristics of optimal fiducial markers have not yet been established. This review will introduce the characteristics (e.g., materials and shapes) of fiducial markers used in fiducial marker placement for pancreatic cancer and will discuss conventional techniques along with their success rates, difficulties, and adverse events.

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Application of intrahepatic fiducial markers in carbon ion radiotherapy for pancreatic cancer—Achieving higher precision treatment
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Journal of Applied Clinical Medical Physics.2026;[Epub] CrossRef
EUS-Guided Fiducial Placement For GI Malignancies: A Tertiary Hospital’s 9-Year Experience
C Thanos, D Piskopou, K Tsitsigiannis, N Georgakopoulou, D Ntailianas, M Triantafyllou, N Kalakos, E Georgiou, T Argyropoulos, I Varmpompitis, A Striki, G Michalopoulos, I Karoumpalis
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Techniques and application of EUS guided procedures in the pancreas and liver
Mohamed Elseragy, Jahangeer Basha, Sundeep Lakhtakia, Matthew T Huggett
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Haidar Khan, Sharon Slomovich, Neal C. Shah, Frank Gress
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Fiducial Marker Placement for Gated Radiotherapy Using Real-Time Tumor-Tracking in Pancreatic Cancer: A Comparative Analysis of Transarterial and Percutaneous Approaches
Daisuke Kato, Daisuke Abo, Ryo Morita, Norio Katoh, Naoki Miyamoto, Ryota Yamada, Naoya Kinota, Takaaki Fujii, Kouji Yamasaki, Motoma Kanaya, Hidefumi Aoyama, Kohsuke Kudo
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A Preliminary Controlled Trial of Endoscopic Ultrasound-guided Fiducial Markers to Guide Pancreas Surgery
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Development of devices for interventional endoscopic ultrasound for the management of pancreatobiliary diseases
Masahiro Itonaga, Masayuki Kitano, Reiko Ashida
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Endoscopic Ultrasound-Guided Fiducial Placement for Stereotactic Body Radiation Therapy in Patients with Pancreatic Cancer
Irina M. Cazacu, Ben S. Singh, Rachael M. Martin-Paulpeter, Sam Beddar, Stephen Chun, Emma B. Holliday, Albert C. Koong, Prajnan Das, Eugene J. Koay, Cullen Taniguchi, Joseph M. Herman, Manoop S. Bhutani
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Review

Clinical and Technical Guideline for Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy (KSGE): Moon Jae Chung, Se Woo Park, Seong-Hun Kim, Chang Min Cho, Jun-Ho Choi, Eun Kwang Choi, Tae Hoon Lee, Eunae Cho, Jun Kyu Lee, Tae Jun Song, Jae Min Lee, Jun Hyuk Son, Jin Suk Park, Chi Hyuk Oh, Dong-Ah Park, Jeong-Sik Byeon, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun, Ho Soon Choi, Chan Guk Park, Joo Young Cho; Clin Endosc 2021;54(2):161-181. Published online March 24, 2021; DOI: https://doi.org/10.5946/ce.2021.069

Abstract PDF

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in 8 categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.

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Commentarys

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