Clinical Endoscopy

Original Articles

The feasibility and safety of trans-colorectal endoscopic ultrasound-guided fine-needle aspiration: a retrospective study of Japan: Takashi Kondo, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Yoshitaro Yamamoto, Minako Urata, Keigo Oshiro, Tomoki Ogata, Ren Kuwabara, Indria Melianti, Yousik Myung, Adwoa Afrakoma Agyei-Nkansah; Clin Endosc 2025;58(6):890-897. Published online November 27, 2025; DOI: https://doi.org/10.5946/ce.2025.042

Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective diagnostic technique; however, few studies have evaluated the efficacy of trans-colorectal EUS-FNA. This study assessed the feasibility of trans-colorectal EUS-FNA.
Methods
We retrospectively analyzed 76 consecutive patients who underwent trans-colorectal EUS-FNA for pelvic lesions between January 2013 and September 2023.
Results
A total of 76 pelvic lesions were identified. The median number of EUS-FNA punctures was 3 (1–8). The median lesion size was 18.9 (8.2–100.0) mm. The success rate was 98.7% (75/76), with no reported adverse events. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA were 94.3% (50/53), 100% (22/22), 100% (50/50), 88.0% (22/25), and 96.0% (72/75), respectively. Malignancy was initially suspected in 65 patients before EUS-FNA; however, 25 patients showed benign results. Of these, three were later reexamined and diagnosed with malignancy, three underwent surgery and were found to have benign pathology, and 19 avoided unnecessary surgery.
Conclusions
Trans-colorectal EUS-FNA is a safe and effective diagnostic procedure.

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EUS characteristics and tissue acquisition strategies for lower gastrointestinal subepithelial lesions: Current evidence and future directions
Yu-Shiuan Liang, Li-Chun Chang, Ping-Huei Tseng
Journal of the Formosan Medical Association.2026;[Epub] CrossRef

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Primary endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage prior to pancreatoduodenectomy: a retrospective study in Japan: Nozomi Okuno, Kazuo Hara, Seiji Natsume, Masataka Okuno, Shin Haba, Tomonari Asano, Takamichi Kuwahara, Hiroki Koda, Yasuhiro Shimizu; Clin Endosc 2025;58(4):604-611. Published online February 11, 2025; DOI: https://doi.org/10.5946/ce.2024.218

Graphical Abstract Abstract PDF

Background
/Aims: Malignant lesions of the pancreatic head can cause obstructive jaundice requiring biliary drainage. However, the effect of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and metal stents on surgical resection remains controversial. This study aimed to investigate the efficacy of primary endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) performed prior to pancreatoduodenectomy, excluding patients with biliary duct cancer.
Methods
We retrospectively analyzed consecutive patients who underwent pancreatoduodenectomy at our institution between January 2019 and December 2022. The patients were divided into three groups: without biliary drainage (n=130), endoscopic biliary stenting (EBS) (n=57), and primary EUS-HGS (n=20).
Results
The positivity rate of the intraoperative bile juice culture was significantly higher in the EBS group (p<0.001). No significant difference was observed among the groups in terms of postoperative adverse events (Clavien-Dindo grade 3 or higher, p=0.784) or the positive rate of peritoneal lavage cytology (p=0.984). Seven patients in the EBS group (12.3%) experienced early adverse events related to biliary drainage (post-ERCP pancreatitis, n=3; acute cholecystitis, n=3; bile duct perforation, n=1), whereas none in the EUS-HGS group experienced adverse events.
Conclusions
Primary EUS-HGS is technically feasible as a preoperative procedure and has no short-term postoperative disadvantages.

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Changing the Flow: How EUS‐Guided Drainage is Reshaping the Management of Distal Malignant Biliary Obstruction
Jeska A. Fritzsche, Inge de Vries, Jeanin E. van Hooft, Rogier P. Voermans, Roy L. J. van Wanrooij
United European Gastroenterology Journal.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
Assessment of endoscopic ultrasound-guided hepaticogastrostomy as a feasible option for preoperative biliary drainage before pancreaticoduodenectomy
Mamoru Takenaka, Masatoshi Kudo
Clinical Endoscopy.2025; 58(4): 549. CrossRef
Prospective, multicentre trial on preoperative biliary drainage by endoscopic ultrasound-guided hepaticogastrostomy for resectable/borderline resectable pancreatic cancer with biliary obstruction: the PROLOGUE study – a study protocol
Shin Yagi, Susumu Hijioka, Yoshikuni Nagashio, Shota Harai, Daiki Agarie, Daiki Yamashige, Kohei Okamoto, Souma Fukuda, Masaru Kuwada, Yasuhiro Komori, Yusuke Kurita, Sho Hasegawa, Kensuke Kubota, Yusuke Ishida, Jun Ushio, Kotaro Takeshita, Kohei Yoshino,
BMJ Open.2025; 15(10): e106543. CrossRef
Advances in EUS-Guided Biliary Drainage for the Management of Pancreatic Cancer
Thomas Lambin, Sarah Leblanc, Bertrand Napoléon
Cancers.2025; 17(21): 3428. CrossRef
Primary Endoscopic Ultrasound-Guided Biliary Drainage for Malignant Biliary Obstruction
Yousuke Nakai, Ryunosuke Hakuta, Ryota Nakabayashi, Yutaka Shimamatsu, Nao Otsuka, Yukiko Takayama
The Korean Journal of Pancreas and Biliary Tract.2025; 30(4): 159. CrossRef

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Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage in hypervascular hepatocellular carcinoma: a retrospective study from Japan: Kenneth Tachi, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Ahmed Mohammed Sadek, Hossam El-Din Shaaban Mahmoud Ibrahim, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto; Clin Endosc 2025;58(3):448-456. Published online November 11, 2024; DOI: https://doi.org/10.5946/ce.2024.079

Graphical Abstract Abstract PDF: Background
/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC.
Methods
This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023.
Results
A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours.
Conclusions
EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.

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Safety and efficacy of trans-afferent loop endoscopic ultrasound-guided pancreaticojejunostomy for post pancreaticoduodenectomy anastomotic stricture using the forward-viewing echoendoscope: a retrospective study from Japan: Ahmed Sadek, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto, Kenneth Tachi; Clin Endosc 2025;58(2):311-319. Published online August 26, 2024; DOI: https://doi.org/10.5946/ce.2024.089

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Endoscopic ultrasound (EUS)-guided pancreatic duct drainage is a well-established procedure for managing pancreaticojejunostomy anastomotic strictures (PJAS) post-Whipple surgery. In this study, we examined the effectiveness and safety of EUS-guided pancreaticojejunostomy (EUS-PJS).
Methods
This retrospective, single-arm study was performed at Aichi Cancer Center Hospital on 10 patients who underwent EUS-guided pancreaticojejunostomy through the afferent jejunal loop using a forward-viewing echoendoscope when endoscopic retrograde pancreatography failed. Our primary endpoint was technical success rate, defined as successful stent insertion. The secondary endpoints were early and late adverse events.
Results
A total of 10 patients underwent EUS-PJS between February 2019 and October 2023. The technical success rate was 100%. The median procedure time was 23.5 minutes. No remarkable early or late adverse events related to the procedure, except for fever, occurred in two patients. The median follow-up duration was 9.5 months, and the median number of stent exchanges was two. A stent-free state was achieved in three patients.
Conclusions
EUS-PJS for PJAS management after pancreaticoduodenectomy appears to be an effective and safe procedure with the potential advantages of fewer reinterventions and the creation of a permanent drainage fistula.

Citations

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Endoscopic ultrasound-guided recanalization of pancreaticojejunostomy anastomotic stricture using a forward-viewing echoendoscope
Shota Iwata, Takuji Iwashita, Takuya Koizumi, Yosuke Ohashi, Akinori Maruta, Shinya Uemura, Masahito Shimizu
Endoscopy.2026; 58(S 01): E274. CrossRef
Transanastomotic Forward-Viewing EUS-Guided Pancreatic Duct Drainage via Afferent Loop for Pancreaticojejunostomy Anastomotic Stricture After Pancreaticoduodenectomy
Tadahisa Inoue, Rena Kitano, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
Digestive Diseases and Sciences.2025; 70(1): 413. CrossRef
Management of Pancreaticojejunostomy Strictures: A New Perspective with Forward-Viewing EUS
Radhika Chavan
Digestive Diseases and Sciences.2025; 70(5): 1740. CrossRef
Transforming endoscopic approaches to post-pancreaticoduodenectomy anastomotic strictures: beyond the surface
Yu-Ting Kuo
Clinical Endoscopy.2025; 58(2): 259. CrossRef
Forward-viewing echoendoscope-guided pancreaticojejunostomy for post-pancreaticoduodenectomy stricture
Toru Kaneko, Mitsuhiro Kida, Takahiro Kurosu, Yutaro Saito, Shiori Koyama, Tomohiro Betto, Chika Kusano
Endoscopy.2025; 57(S 01): E384. CrossRef
Long-Term Outcomes of EUS-Guided Pancreatic Duct Drainage for the Management of Benign Pancreaticojejunostomy Anastomotic Stricture—A Retrospective Cohort Study
Indria Melianti, Kazuo Hara, Takamichi Kuwahara, Shin Haba, Nozomi Okuno, Shimpei Matsumoto, Hiroki Koda, Keigo Oshiro, Tomoki Ogata
Journal of Clinical Medicine.2025; 14(23): 8439. CrossRef

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Hepatobiliary scintigraphy of bile excretion after endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction: a retrospective study in Japan: Masanori Yamada, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Toshitaka Fukui; Clin Endosc 2024;57(6):798-806. Published online August 20, 2024; DOI: https://doi.org/10.5946/ce.2023.291

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Hepatobiliary scintigraphy (HBS) is used to evaluate bile excretion. This study aimed to evaluate biliary excretion during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using HBS.
Methods
We retrospectively evaluated 78 consecutive patients with malignant extrahepatic biliary obstruction, who underwent HBS after EUS-HGS between April 2015 and July 2022. The peak time and decay rate were scored with 0, 1, or 2 points based on thresholds of 20 and 35 minutes, and 10% and 50%, respectively. A total score of 4 or 3 was considered indicative of good bile excretion, whereas scores of 2, 1, or 0 indicated poor bile excretion.
Results
The good and poor bile excretion groups included 40 and 38 cases, respectively. The group with good bile excretion had a significantly longer time to recurrent biliary obstruction compared to the poor bile excretion group (not reached vs. 124 days, p=0.026). Multivariate analysis identified the site of obstruction as a significant factor influencing good bile excretion (odds ratio, 3.39; 95% confidence interval, 1.01–11.4, p=0.049), with superior bile excretion observed in cases involving upper biliary obstruction compared to middle or lower biliary obstruction.
Conclusions
In patients with malignant biliary obstruction who underwent HGS, the site of obstruction is significantly associated with stent patency.

Citations

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Endoscopic ultrasound-guided transpapillary versus transluminal biliary stenting: randomized comparison of long-term stent patency
Vinay Dhir, Vivek Kumar Singh, Sundeep Lakhtakia, Rajesh Puri, Praveer Rai, Nonthalee Pausawasdi, Ryosuke Tonozuka, Jahangeer Basha, Varayu Prachayakul, Abhishek Kathuria, Pankaj Kumar, Takao Itoi, D. Nageshwar Reddy
Endoscopy.2026; 58(05): 493. CrossRef

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Safety and efficacy of endoscopic ultrasound-guided pancreatic duct drainage using a drill dilator: a retrospective study in Japan: Ahmed Sadek, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto, Kenneth Tachi; Clin Endosc 2024;57(5):666-674. Published online June 5, 2024; DOI: https://doi.org/10.5946/ce.2023.272

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Dilation of the tract before stent deployment is a challenging step in endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD). In this study, we examined the effectiveness and safety of a novel spiral dilator, Tornus ES (Asahi Intec), for EUS-PDD.
Methods
This was a retrospective, single-arm, observational study at Aichi Cancer Center Hospital. The punctured tract was dilated using a Tornus ES dilator in all EUS-PDD cases. Our primary endpoint was the technical success rate of initial tract dilation. Technical success was defined as successful fistula dilation using a Tornus ES followed by successful stent insertion. Secondary endpoints were procedure times and early adverse events.
Results
A total of 12 patients were included between December 2021 and March 2023. EUS-PDD was performed in 11 patients for post-pancreaticoduodenectomy anastomotic strictures and one patient with pancreatitis with duodenal perforation. The technical success rates of stent insertion and fistula dilation using a Tornus ES dilator was 100%. The median procedure time was 24 minutes. No remarkable adverse events related to the procedure were observed, apart from fever, which occurred in 2 patients.
Conclusions
Tract dilation in EUS-PDD using a Tornus ES is effective and safe.

Citations

Citations to this article as recorded by

Use of a screw dilator for pancreaticobiliary disease
Christina S. Gainey, Albert Manudhane, Todd H. Baron
Gastrointestinal Endoscopy.2026; 104(3): 467. CrossRef
Endoscopic ultrasound–guided pancreaticogastrostomy with subsequent pancreatoscopy-guided lithotripsy as a first-line approach for pancreatic head duct stones (with videos)
Tadahisa Inoue, Rena Kitano, Tomoya Kitada, Shun Futagami, Masato Yano, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Masanao Nakamura, Kiyoaki Ito
Gastrointestinal Endoscopy.2026;[Epub] CrossRef
Turning the screw on resistant tracts: lessons from cardiology for pancreaticobiliary endoscopy
Puneet Chhabra
Gastrointestinal Endoscopy.2026; 104(3): 471. CrossRef
Feasibility of endoscopic ultrasound‐guided hepaticogastrostomy using a novel long balloon catheter
Yuichi Takano, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Fumitaka Niiya, Naotaka Maruoka, Tatsuya Yamagami, Masatsugu Nagahama
DEN Open.2025;[Epub] CrossRef
Endoscopic ultrasound-guided pancreatic duct drainage: Progress and future outlook
Si-Yao Wang, Si-Qiao Zhao, Shu-Peng Wang, Yue Zhang, Si-Yu Sun, Sheng Wang
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Removal of the intrahepatically migrated and impacted plastic stent over malignant stricture using drill dilator
Daiki Yamashige, Susumu Hijioka, Yoshikuni Nagashio, Shota Harai, Mark Chatto, Yutaka Saito, Takuji Okusaka
Endoscopy.2025; 57(S 01): E734. CrossRef
Fluoroscopy Time Required for Each Step of Interventional Endoscopic Ultrasonography
Masafumi Watanabe, Kosuke Okuwaki, Mitsuhiro Kida, Hiroshi Imaizumi, Kai Adachi, Akihiro Tamaki, Taro Hanaoka, Daisuke Ogawa, Chika Kusano
Journal of Digestive Endoscopy.2025; 16(03): 136. CrossRef
Balloon-assisted ERCP for bile duct stones in surgically altered anatomy: current techniques, devices, and evolving strategies
Haruka Toyonaga, Makoto Masaki, Arata Oka, Hidetoshi Nakata, Shoji Takayama, Tatsuya Nakagawa, Takuya Takayama, Masahiro Orino, Hironao Matsumoto, Takeshi Yamashina, Masaaki Shimatani
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Long-Term Outcomes of EUS-Guided Pancreatic Duct Drainage for the Management of Benign Pancreaticojejunostomy Anastomotic Stricture—A Retrospective Cohort Study
Indria Melianti, Kazuo Hara, Takamichi Kuwahara, Shin Haba, Nozomi Okuno, Shimpei Matsumoto, Hiroki Koda, Keigo Oshiro, Tomoki Ogata
Journal of Clinical Medicine.2025; 14(23): 8439. CrossRef
A novel spiral dilator for pancreatic duct drainage: catching two birds with one stone
Han Taek Jeong, Jimin Han
Clinical Endoscopy.2024; 57(5): 608. CrossRef
Technical outcomes between a drill dilator and ultra-tapered mechanical dilator during EUS-guided pancreaticogastrostomy: Comparative study
Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Jun Sakamoto, Jun Matsuno, Yuki Uba, Mitsuki Tomita, Nobuhiro Hattori, Junichi Nakamura, Kimi Bessho, Hiroki Nishikawa
Endoscopy International Open.2024;[Epub] CrossRef

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Safety and efficacy of novel oblique-viewing scope for B2-endoscopic ultrasound-guided hepaticogastrostomy: Sho Ishikawa, Kazuo Hara, Nozomi Okuno, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Takafumi Yanaidani, Masanori Yamada, Tsukasa Yasuda, Toshitaka Fukui, Teru Kumagi, Yoichi Hiasa; Clin Endosc 2024;57(4):527-533. Published online March 29, 2024; DOI: https://doi.org/10.5946/ce.2023.129

Graphical Abstract Abstract PDF

Background
/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) performed at the intrahepatic bile duct segment 3 (B3) is widely used for biliary drainage. Although performing post-puncture procedures is easier in the intrahepatic bile duct segment 2 (B2) when using a conventional oblique-viewing (OV) EUS scope, this method may cause transesophageal puncture and severe adverse events. We evaluated the safety and efficacy of B2 puncture using a novel OV-EUS scope.
Methods
In this single-center retrospective study, we prospectively enrolled and collected data from 45 patients who consecutively underwent EUS-HGS procedures with a novel OV-EUS scope between September 2021 and December 2022 at our cancer center.
Results
The technical success rates of B2-EUS-HGS and EUS-HGS were 93.3% (42/45) and 97.8% (44/45), respectively. The early adverse event rate was 8.9% (4/45) with no cases of scope changes or transesophageal punctures. The median procedure time was 13 minutes (range, 5–30).
Conclusions
B2-EUS-HGS can be performed safely with the novel EG-740UT (Fujifilm) OV-scope without transesophageal puncture and with a high success rate. B2-EUS-HGS using this novel OV scope may be the preferred strategy for EUS-HGS.

Citations

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Enhanced Endoscope is Associated With Success Rates in B2‐ Endoscopic Ultrasound‐Guided Hepaticogastrostomy
Yoshitaro Yamamoto, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Minako Urata, Takashi Kondo, Keigo Oshiro, Tomoki Ogata, Ren Kuwabara
DEN Open.2026;[Epub] CrossRef
Clinical evaluation of a novel fluoroscopic mode for improving visibility during interventional endoscopic ultrasound (with video)
Naoto Aoyama, Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Jun Sakamoto, Yuki Uba, Mitsuki Tomita, Nobuhiro Hattori, Junichi Nakamura, Kimi Bessho, Takafumi Kanadani, Hiroki Nishikawa
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Scope withdrawal technique to prevent transesophageal puncture during endoscopic ultrasound-guided hepaticogastrostomy
Kazuki Endo, Haruo Miwa, Ritsuko Oishi, Hiromi Tsuchiya, Yuichi Suzuki, Kazushi Numata, Shin Maeda
Endoscopy.2025; 57(S 01): E705. CrossRef
Primary endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage prior to pancreatoduodenectomy: a retrospective study in Japan
Nozomi Okuno, Kazuo Hara, Seiji Natsume, Masataka Okuno, Shin Haba, Tomonari Asano, Takamichi Kuwahara, Hiroki Koda, Yasuhiro Shimizu
Clinical Endoscopy.2025; 58(4): 604. 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

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Review

Forward viewing liner echoendoscopy for therapeutic interventions: Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara; Clin Endosc 2024;57(2):175-180. Published online February 29, 2024; DOI: https://doi.org/10.5946/ce.2023.271

Abstract PDF

Therapeutic endoscopic ultrasonography (EUS) procedures using the forward-viewing convex EUS (FV-EUS) have been reviewed based on the articles reported to date. The earliest reported procedure is the drainage of pancreatic pseudocysts using FV-EUS. However, the study on drainage of pancreatic pseudocysts focused on showing that drainage is possible with FV-EUS rather than leveraging its features. Subsequently, studies describing the characteristics of FV-EUS have been reported. By using FV-EUS in EUS-guided choledochoduodenostomy, double punctures in the gastrointestinal tract can be avoided. In postoperative modified anatomical cases, using the endoscopic function of FV-EUS, procedures such as bile duct drainage from anastomosis, pancreatic duct drainage from the afferent limb, and abscess drainage from the digestive tract have been reported. When a perpendicular puncture to the gastrointestinal tract is required or when there is a need to insert the endoscope deep into the gastrointestinal tract, FV-EUS is considered among the options.

Citations

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Endoscopic Transmural Drainage of Walled-off Necrosis in Difficult Situations Using a Forward-Viewing Echoendoscope
Surinder Singh Rana, Sachin Hosahally Jayanna, Ravi Sharma, Mandeep Kang, Rajesh Gupta
Digestive Diseases and Sciences.2026; 71(7): 2763. CrossRef
Stent misdeployment and factors associated with failure in endoscopic ultrasound-guided choledochoduodenostomy: analysis of the combined datasets from two randomized trials
Yen-I Chen, Clara Long, Anand V. Sahai, Bertrand Napoleon, Gianfranco Donatelli, Rastislav Kunda, Myriam Martel, Shannon M. Chan, Paolo G. Arcidiacono, Eric Lam, Pradermchai Kongkam, Nauzer Forbes, Alberto Larghi, Jeffrey D. Mosko, Schalk Van der Merwe, S
Endoscopy.2025; 57(04): 330. CrossRef
Forward-viewing echoendoscope provides single sessional three biliary drainage routes in a patient with pancreatoduodenectomy
Tesshin Ban, Yoshimasa Kubota, Shun Sasoh, Tomoaki Ando, Takashi Joh
Endoscopy.2025; 57(S 01): E333. CrossRef
Endoscopic ultrasound-guided pancreatic duct drainage: Progress and future outlook
Si-Yao Wang, Si-Qiao Zhao, Shu-Peng Wang, Yue Zhang, Si-Yu Sun, Sheng Wang
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Transcolonic Endoscopic Ultrasound‐Guided Fine‐Needle Aspiration for Pancreatic Head Cancer With Difficult Access From the Upper Gastrointestinal Tract
Indria Melianti, Kazuo Hara, Nozomi Okuno
Digestive Endoscopy.2025; 37(10): 1134. CrossRef
Clinical Outcomes and Predictors of Early Adverse Events in Primary EUS-Guided Choledochoduodenostomy for Malignant Distal Biliary Obstruction
Nozomi Okuno, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Shimpei Matsumoto, Keigo Ooshiro, Tomoki Ogata
Journal of Digestive Endoscopy.2025; 16(04): 185. CrossRef
EUS-guided biliary drainage via the afferent limb using a forward-viewing echoendoscope for managing choledochojejunal anastomotic stricture
Daiki Agarie, Susumu Hijioka, Yoshikuni Nagashio, Daiki Yamashige, Kohei Okamoto, Shin Yagi, Soma Fukuda, Masaru Kuwada, Yasuhiro Komori, Aoi Kita, Shota Harai, Yutaka Saito, Kazuko Yamamoto, Takuji Okusaka
Gastrointestinal Endoscopy.2025; 102(6): 894. CrossRef
Failed endoscopic ultrasound‐guided gallbladder drainage across the duodenal covered metallic stent salvaged by using a forward‐viewing linear echoendoscope
Tesshin Ban, Yoshimasa Kubota, Takashi Joh
Digestive Endoscopy.2024; 36(12): 1389. CrossRef

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Original Articles

Clinical utility of endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling of patients with biliary tract cancer, especially with intrahepatic cholangiocarcinoma: Takafumi Yanaidani, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Nobumasa Mizuno, Sho Ishikawa, Masanori Yamada, Tsukasa Yasuda; Clin Endosc 2024;57(3):384-392. Published online February 15, 2024; DOI: https://doi.org/10.5946/ce.2023.139

Graphical Abstract Abstract PDF

Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a standard diagnostic method for biliary tract cancer (BTC), and samples obtained in this manner may be used for comprehensive genomic profiling (CGP). This study evaluated the utility of EUS-TA for CGP in a clinical setting and determined the factors associated with the adequacy of CGP in patients with BTC.
Methods
CGP was attempted for 105 samples from 94 patients with BTC at the Aichi Cancer Center, Japan, from October 2019 to April 2022.
Results
Overall, 77.1% (81/105) of the samples were adequate for CGP. For 22-G or 19-G fine-needle biopsy (FNB), the sample adequacy was 85.7% (36/42), which was similar to that of surgical specimens (94%, p=0.45). Univariate analysis revealed that 22-G or larger FNB needle usage (86%, p=0.003), the target primary lesions (88%, p=0.015), a target size ≥30 mm (100%, p=0.0013), and number of punctures (90%, p=0.016) were significantly positively associated with CGP sample adequacy.
Conclusions
EUS-TA is useful for CGP tissue sampling in patients with BTC. In particular, the use of 22-G or larger FNB needles may allow for specimen adequacy comparable to that of surgical specimens.

Citations

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Adequacy evaluation of 22‐gauge needle endoscopic ultrasound‐guided tissue acquisition samples and glass slides preparation for successful comprehensive genomic profiling testing: A single institute experience
Tami Nagatani, Yoji Wani, Masahiro Takatani, Soichiro Fushimi, Hirofumi Inoue, Shinichiro Hori, Kyohei Kai, Hideki Yamamoto, Tetsuya Okazaki, Maki Tanioka, Hiroyuki Okada, Akira Hirasawa
DEN Open.2026;[Epub] CrossRef
Recent Advances in Endoscopic Ultrasound-Guided Tissue Acquisition
Panotpol Termsinsuk, Nonthalee Pausawasdi
Journal of Digestive Endoscopy.2026; 17(01): 031. CrossRef
Tissue-preserving sectioning as the tip of comprehensive genomic profiling testing using biliary tract cancer tissue obtained by 22-gauge endoscopic ultrasound tissue acquisition
Yoji Wani, Tami Nagatani, Masahiro Takatani
Clinical Endoscopy.2026; 59(1): 160. CrossRef
Decoding drug resistance and apoptosis in biliary tract cancers using 3D tumor models
Gurpreet Singh Gill, Om Saswat Sahoo, Arnab Nayek, Sajib Kumar Sarkar, Kailash Chand Kurdia, Nidhi Bhardwaj, Chandan J. Das, Saurabh Galodha, Gitanjali Goyal, Subhradip Karmakar, Ruby Dhar
Frontiers in Cell Death.2026;[Epub] CrossRef
A rare case of needle tract seeding following endoscopic ultrasound‐guided tissue acquisition for cholangiocarcinoma
Tatsunori Satoh, Haruna Takahashi, Shinya Kawaguchi
Journal of Hepato-Biliary-Pancreatic Sciences.2025;[Epub] CrossRef
Enhancing comprehensive genome profiling of liver tumors using endoscopic ultrasound-guided fine-needle biopsy
Fumitaka Niiya, Akihiro Nakamura, Yasuo Ueda, Takafumi Ogawa, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Yuichi Takano, Masatsugu Nagahama
Endoscopy International Open.2025;[Epub] CrossRef
Is genomic analysis possible in a tissue acquired via endoscopic ultrasound-guided fine-needle biopsy in cholangiocarcinoma?
Jonghyun Lee, Sung Yong Han
Clinical Endoscopy.2024; 57(3): 332. CrossRef
Utility of Transpapillary Biopsy and Endoscopic Ultrasound-Guided Tissue Acquisition for Comprehensive Genome Profiling of Unresectable Biliary Tract Cancer
Soma Fukuda, Susumu Hijioka, Yoshikuni Nagashio, Daiki Yamashige, Daiki Agarie, Yuya Hagiwara, Kohei Okamoto, Shin Yagi, Yasuhiro Komori, Masaru Kuwada, Yuta Maruki, Chigusa Morizane, Hideki Ueno, Nobuyoshi Hiraoka, Kiichiro Tsuchiya, Takuji Okusaka
Cancers.2024; 16(16): 2819. CrossRef
Endoscopic Ultrasound and Intraductal Ultrasound in the Diagnosis of Biliary Tract Diseases: A Narrative Review
Akiya Nakahata, Yasunobu Yamashita, Masayuki Kitano
Diagnostics.2024; 14(18): 2086. CrossRef

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The role of needle-based confocal laser endomicroscopy in the diagnosis of pancreatic neuroendocrine tumors: Masanori Yamada, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Toshitaka Fukui; Clin Endosc 2024;57(3):393-401. Published online September 12, 2023; DOI: https://doi.org/10.5946/ce.2023.068

Graphical Abstract Abstract PDF

Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a highly accurate method for diagnosing pancreatic neuroendocrine tumors (PNETs); however, some PNETs are difficult to diagnose. Recently, the efficacy of needle-based confocal laser endomicroscopy (nCLE) in diagnosing solid pancreatic masses has been reported. However, the efficacy of nCLE in the diagnosis of PNETs remains unknown and only a small number of cases have been reported. Hence, this study aimed to evaluate the efficacy of nCLE in the diagnosis of PNETs.
Methods
This single-center retrospective study evaluated 30 consecutive patients with suspected PNETs on contrast-enhanced computed tomography, who consented to nCLE combined with EUS-FNA and were diagnosed using EUS-FNA or surgical resection. The diagnostic criteria for PNETs using nCLE were based on the nesting and trabecular and glandular arrangement of tumor cell clusters surrounded by capillary vessels and fibrosis, as reported in previous studies.
Results
The diagnosis using nCLE was classified into three categories: misdiagnosis in three cases (10%), non-diagnostic in six cases (20%), and diagnostic in 21 cases (70%). nCLE was able to diagnose PNET in one of the two cases with inconclusive EUS-FNA.
Conclusions
Although further development of the resolution and optimization of the diagnostic criteria are required, nCLE may constitute a useful diagnostic option in cases of inconclusive EUS-FNA for PNETs.

Citations

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Recent Advances in Endoscopic Ultrasound for Pancreatic Cystic Lesions
Veeral M. Oza, Anuroop Yekula, Truptesh H. Kothari
Journal of Digestive Endoscopy.2026; 17(02): 081. CrossRef
Endoscopic Ultrasound for the Management of Pancreatic Neuroendocrine Tumors: Diagnosis, Treatment, and Future Perspectives
Angelo Bruni, David Meacci, Roberto Falbo, Marco Fichera, Francesco Poggioli, Riccardo Casadei, Claudio Ricci, Leonardo Henry Eusebi
Journal of Gastroenterology and Hepatology.2026; 41(4): 1173. CrossRef
Recent developments in the diagnosis of pancreatic neuroendocrine neoplasms
Anna Battistella, Matteo Tacelli, Paola Mapelli, Marco Schiavo Lena, Valentina Andreasi, Luana Genova, Francesca Muffatti, Francesco De Cobelli, Stefano Partelli, Massimo Falconi
Expert Review of Gastroenterology & Hepatology.2024; 18(4-5): 155. CrossRef
Advancements and challenges in gastrointestinal imaging
Eun Jeong Gong, Chang Seok Bang
World Journal of Clinical Cases.2024; 12(33): 6591. CrossRef

6,603 View
150 Download
3 Web of Science
4 Crossref

Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites: Tsukasa Yasuda, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Masanori Yamada, Toshitaka Fukui; Clin Endosc 2024;57(2):246-252. Published online September 7, 2023; DOI: https://doi.org/10.5946/ce.2023.075

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites.
Methods
Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention.
Results
Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90 %). No endoscopic complications such as bile peritonitis were observed.
Conclusions
In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS.

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Phase I/II Prospective Study on Endoscopic Ultrasound‐Guided Hepaticogastrostomy as Primary Drainage for Unresectable Malignant Hilar Biliary Obstruction
Tomoki Ogata, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Shimpei Matsumoto, Hiroki Koda, Keigo Oshiro
DEN Open.2027;[Epub] CrossRef
Prevention of Adverse Events in Endoscopic Ultrasound‐Guided Biliary Drainage
Hirotoshi Ishiwatari, Hiroki Sakamoto, Takuya Doi, Masahiro Yamamura
DEN Open.2026;[Epub] CrossRef
Clinical Outcomes and Learning Curve of Endoscopic Ultrasound‐Guided Hepaticogastrostomy During the Implementation Phase in Inexperienced Centers: A Multicenter Retrospective Study
Junichi Kaneko, Tatsunori Satoh, Yosuke Kobayashi, Azumi Suzuki, Shinya Kawaguchi
DEN Open.2026;[Epub] CrossRef
EUS-guided pancreatic duct drainage—technical tips and outcomes: narrative review
Yasunobu Yamashita, Masayuki Kitano
Therapeutic Advances in Gastroenterology.2026;[Epub] CrossRef
Endosonografisch gesteuerte Gallengangsdrainage im chirurgischen Behandlungskonzept
Kai Koch, Markus Dollhopf
Allgemein- und Viszeralchirurgie up2date.2026; 20(02): 177. CrossRef
Unaddressed confounders in endoscopic ultrasound-guided biliary stenting: impact of palliative chemotherapy and patient selection on stent patency
Koji Takahashi
Endoscopy.2026; 58(07): 802. CrossRef
Feasibility and safety of EUS-guided biliary drainage in inexperienced centers: a multicenter study in southwest Japan
Takehiko Koga, Yusuke Ishida, Shunpei Hashigo, Yuzo Shimokawa, Hirofumi Harima, Kazuhisa Okamoto, Akihisa Ohno, Tsukasa Miyagahara, Toshihiro Fujita, Satoshi Fukuchi, Kosuke Takahashi, Hiroki Taguchi, Norimasa Araki, Yuichiro Ohtsuka, Toshiyuki Uekitani,
Gastrointestinal Endoscopy.2025; 101(4): 843. CrossRef
Clinical effect of percutaneous hepatic puncture biliary drainage combined with metal stent implantation in the treatment of malignant obstructive jaundice
Shoulin Zhang, Shaopeng Huang, Zheng Xing, Youwen Song, Fujian Yuan
BMC Surgery.2025;[Epub] CrossRef
Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage in hypervascular hepatocellular carcinoma: a retrospective study from Japan
Kenneth Tachi, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Ahmed Mohammed Sadek, Hossam El-Din Shaaban Mahmoud Ibrahim, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto
Clinical Endoscopy.2025; 58(3): 448. CrossRef
Technical Review on Endoscopic Ultrasound-Guided Hepaticogastrostomy
Vivek Kumar Singh, Vinay Dhir
Journal of Digestive Endoscopy.2025; 16(04): 213. CrossRef
Moderne Ansätze der Gallengangsdrainage: Endosonografisch geführte Techniken im Vergleich
Kai Koch, Markus Dollhopf
Gastroenterologie up2date.2025; 21(03): 221. CrossRef
Management of iatrogenic perforations during endoscopic interventions in the hepato-pancreatico-biliary tract
Kirsten Boonstra, Rogier P. Voermans, Roy L.J. van Wanrooij
Best Practice & Research Clinical Gastroenterology.2024; 70: 101890. CrossRef
Is Endoscopic Ultrasound-Guided Hepaticogastrostomy Safe and Effective after Failed Endoscopic Retrograde Cholangiopancreatography?—A Systematic Review and Meta-Analysis
Saqr Alsakarneh, Mahmoud Y. Madi, Dushyant Singh Dahiya, Fouad Jaber, Yassine Kilani, Mohamed Ahmed, Azizullah Beran, Mohamed Abdallah, Omar Al Ta’ani, Anika Mittal, Laith Numan, Hemant Goyal, Mohammad Bilal, Wissam Kiwan
Journal of Clinical Medicine.2024; 13(13): 3883. CrossRef
Endoscopic ultrasound-guided antegrade stenting combined with closure of the puncture route using self-assembling peptide solution in a jaundiced patient with ascites
Hirotsugu Maruyama, Kojiro Tanoue, Tatsuya Kurokawa, Yoshinori Shimamoto, Yuki Ishikawa-Kakiya, Akira Higashimori, Yasuhiro Fujiwara
Endoscopy.2024; 56(S 01): E953. CrossRef
The Role of Therapeutic Endoscopic Ultrasound in Management of Malignant Double Obstruction (Biliary and Gastric Outlet): A Comprehensive Review with Clinical Scenarios
Giuseppe Dell’Anna, Rubino Nunziata, Claudia Delogu, Petra Porta, Maria Vittoria Grassini, Jahnvi Dhar, Rukaia Barà, Sarah Bencardino, Jacopo Fanizza, Francesco Vito Mandarino, Ernesto Fasulo, Alberto Barchi, Francesco Azzolini, Guglielmo Albertini Petron
Journal of Clinical Medicine.2024; 13(24): 7731. CrossRef

8,944 View
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13 Web of Science
15 Crossref

Case Reports

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

Abstract PDF

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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Endoscopic Ultrasound-Guided Lumen-Apposing Metal Stent Drainage in Benign Pancreatobiliary and Gastrointestinal Disease: Evolving Techniques and Clinical Outcomes
Filippo Antonini, Marco Valvano, Edoardo Troncone, Domenico Galasso, Amedeo Montale, Mario Capasso, Matteo Marasco, Benedetto Mangiavillano, Giovanna Del Vecchio Blanco, Mauro Dalla Libera, Antonella Scarcelli, Antonio Facciorusso, Lorenzo Fuccio, Massimi
Diagnostics.2026; 16(4): 522. CrossRef
Stent-free biliary bypass by endoscopic ultrasound-guided choledochoduodenostomy for benign common hepatic duct stricture
Yuki Uba, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Shimpei Matsumoto, Hiroki Koda
Endoscopy.2026; 58(S 02): E494. CrossRef
Endoscopic ultrasound-guided choledochoduodenojejunostomy via afferent limb: a novel approach for hepaticojejunostomy stricture
Nozomi Okuno, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Shimpei Matsumoto, Hiroki Koda, Tomoki Ogata
Endoscopy.2025; 57(S 01): E1407. CrossRef
Forward viewing liner echoendoscopy for therapeutic interventions
Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara
Clinical Endoscopy.2024; 57(2): 175. CrossRef
Successful sequential management of traumatic choledochal leak and stenosis in children using ERCP: a case report and literature review
Cuo Leng, Yu Zou, Zhoujian Yang, Xinhua Zhao
Frontiers in Medicine.2024;[Epub] CrossRef

6,305 View
225 Download
5 Web of Science
5 Crossref

Endoscopic ultrasound-guided hepaticogastrostomy by puncturing both B2 and B3: a single center experience: Moaz Elshair, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Asmaa Bakr, Abdou Elshafei, Mohamed Z. Abu-Amer; Clin Endosc 2024;57(4):542-546. Published online May 3, 2023; DOI: https://doi.org/10.5946/ce.2022.209

Abstract PDF

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) through ducts B2 or B3 is effective in most patients with biliary obstruction, because B2 and B3 commonly join together. However, in some patients, B2 and B3 do not join each other due to invasive hilar tumors; therefore, single-route drainage is insufficient. Here, we investigated the feasibility and efficacy of EUS-HGS through both B2 and B3 simultaneously in seven patients. We decided to perform EUS-HGS through both B2 and B3 to achieve adequate biliary drainage because these two ducts were separate from each other. Here, we report a 100% technical and overall clinical success rate. Early adverse effects were closely monitored. Minimal bleeding was reported in one patient (1/7) and mild peritonitis in one patient (1/7). None of the patients experienced stent dysfunction, fever, or bile leakage after the procedure. EUS-HGS through both B2 and B3 simultaneously is safe, feasible, and effective for biliary drainage in patients with separated ducts.

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A novel technique of B2–B3 single-puncture bridging through liver parenchyma enabling endoscopic ultrasound-guided hepaticogastrostomy for rescue drainage
Hiroki Koda, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Shimpei Matsumoto, Tomoki Ogata
Endoscopy.2025; 57(S 01): E936. CrossRef

5,849 View
235 Download
1 Web of Science
1 Crossref

Original Articles

Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography: Yasuhiro Kuraishi, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Masanori Yamada, Nobumasa Mizuno; Clin Endosc 2023;56(4):490-498. Published online April 27, 2023; DOI: https://doi.org/10.5946/ce.2022.130

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and serious complication of endoscopic retrograde cholangiopancreatography. To prevent this event, a unique precutting method, termed opening window fistulotomy, was performed in patients with a large infundibulum as the primary procedure for biliary cannulation, whereby a suprapapillary laid-down H-shaped incision was made without touching the orifice. This study aimed to assess the safety and feasibility of this novel technique.
Methods
One hundred and ten patients were prospectively enrolled in this study. Patients with a papillary roof size ≥10 mm underwent opening window fistulotomy for primary biliary access. In addition, the incidence of complications and success rate of biliary cannulation were evaluated.
Results
The median size of the papillary roof was 6 mm (range, 3–20 mm). Opening window fistulotomy was performed in 30 patients (27.3%), none of whom displayed PEP. Duodenal perforation was recorded in one patient (3.3%), which was resolved by conservative treatment. The cannulation rate was high (96.7%, 29/30 patients). The median duration of biliary access was 8 minutes (range, 3–15 minutes).
Conclusions
Opening window fistulotomy demonstrated its feasibility for primary biliary access by achieving great safety with no PEP complications and a high success rate for biliary cannulation.

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New bile duct cannulation technique using a fine-needle aspiration needle to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis
Ikuhiro Kobori, Ou Takagi, Haruka Kato, Masaru Kuwada, Koichi Soga, Yasumi Katayama, Masaya Tamano
Endoscopy.2026; 58(S 01): E311. CrossRef
Feasibility of primary precut sphincterotomy in endoscopic retrograde cholangiopancreatography for patients with large oral protrusions of the duodenal papilla; prospective observation study in Japan
Masafumi Watanabe, Kosuke Okuwaki, Mitsuhiro Kida, Hiroshi Imaizumi, Kai Adachi, Akihiro Tamaki, Taro Hanaoka, Chika Kusano
Clinical Endoscopy.2026; 59(2): 273. CrossRef
Comments on ‘Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography’
Masood Muhammad Karim, Adeel Ur Rehman, Faisal Wasim Ismail, Om Parkash
Clinical Endoscopy.2024; 57(2): 280. CrossRef

6,952 View
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3 Web of Science
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Clinical utility of endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling of pancreatic cancer: Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Daiki Fumihara, Takafumi Yanaidani; Clin Endosc 2023;56(2):221-228. Published online March 7, 2023; DOI: https://doi.org/10.5946/ce.2022.086

Abstract PDF

Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for the diagnosis of pancreatic cancer. The feasibility of comprehensive genomic profiling (CGP) using samples obtained by EUS-TA has been under recent discussion. This study aimed to evaluate the utility of EUS-TA for CGP in a clinical setting.
Methods
CGP was attempted in 178 samples obtained from 151 consecutive patients with pancreatic cancer at the Aichi Cancer Center between October 2019 and September 2021. We evaluated the adequacy of the samples for CGP and determined the factors associated with the adequacy of the samples obtained by EUS-TA retrospectively.
Results
The overall adequacy for CGP was 65.2% (116/178), which was significantly different among the four sampling methods (EUS-TA vs. surgical specimen vs. percutaneous biopsy vs. duodenal biopsy, 56.0% [61/109] vs. 80.4% [41/51] vs. 76.5% [13/17] vs. 100.0% [1/1], respectively; p=0.022). In a univariate analysis, needle gauge/type was associated with adequacy (22 G fine-needle aspiration vs. 22 G fine-needle biopsy [FNB] vs. 19 G-FNB, 33.3% (5/15) vs. 53.5% (23/43) vs. 72.5% (29/40); p=0.022). The sample adequacy of 19 G-FNB for CGP was 72.5% (29/40), and there was no significant difference between 19 G-FNB and surgical specimens (p=0.375).
Conclusions
To obtain adequate samples for CGP with EUS-TA, 19 G-FNB was shown to be the best in clinical practice. However, 19 G-FNB was not still sufficient, so further efforts are required to improve adequacy for CGP.

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Adequacy evaluation of 22‐gauge needle endoscopic ultrasound‐guided tissue acquisition samples and glass slides preparation for successful comprehensive genomic profiling testing: A single institute experience
Tami Nagatani, Yoji Wani, Masahiro Takatani, Soichiro Fushimi, Hirofumi Inoue, Shinichiro Hori, Kyohei Kai, Hideki Yamamoto, Tetsuya Okazaki, Maki Tanioka, Hiroyuki Okada, Akira Hirasawa
DEN Open.2026;[Epub] CrossRef
Impact of tumor necrosis on comprehensive genomic profiling success in pancreatic cancer: a retrospective study
Takuya Doi, Hirotoshi Ishiwatari, Nobuyuki Ohike, Junya Sato, Hiroki Sakamoto, Masahiro Yamamura, Tomoko Norose, Yuko Kakuda, Yoichi Yamamoto, Masao Yoshida, Noboru Kawata, Kazunori Takada, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hiroyuki Ono
Japanese Journal of Clinical Oncology.2026; 56(1): 48. CrossRef
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Panotpol Termsinsuk, Nonthalee Pausawasdi
Journal of Digestive Endoscopy.2026; 17(01): 031. CrossRef
Tissue-preserving sectioning as the tip of comprehensive genomic profiling testing using biliary tract cancer tissue obtained by 22-gauge endoscopic ultrasound tissue acquisition
Yoji Wani, Tami Nagatani, Masahiro Takatani
Clinical Endoscopy.2026; 59(1): 160. CrossRef
Endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling
Nozomi OKUNO, Kazuo HARA
Choonpa Igaku.2026;[Epub] CrossRef
Utility of archived EUS-guided fine-needle biopsy samples for next-generation sequencing in pancreatic adenocarcinoma
Rodrigo Mata, Piero Alberti, David García-Illescas, Susana Aguilar, Florian Castet, Carles Fabregat-Franco, Sharela Vega, Miquel Masachs, Monder Abu-Suboh, Laia Blanco, Roger Bel, Carmela Iglesias, Jordi Temprana Salvador, Maria Teresa Salcedo, Tian Tian,
Endoscopic Ultrasound.2026; 15(3): 225. CrossRef
Updated techniques and evidence for endoscopic ultrasound‐guided tissue acquisition from solid pancreatic lesions
Masahiro Itonaga, Reiko Ashida, Masayuki Kitano
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Sung Woo Ko, Ik Hyun Jo, Seung Bae Yoon
Pancreatology.2025; 25(1): 89. CrossRef
Randomized trial comparing the Franseen needle versus 2 types of sharpened-tip 3-prong needles in EUS-guided tissue acquisition from solid pancreatic lesions
Takuya Ishikawa, Hirotaka Suzuki, Yasuki Hori, Jun Yashika, Hiroki Suhara, Hajime Sumi, Masahiko Ando, Yachiyo Kuwatsuka, Kentaro Yamao, Yasuyuki Mizutani, Tadashi Iida, Kota Uetsuki, Takeshi Yamamura, Kazuhiro Furukawa, Masanao Nakamura, Hiromi Kataoka,
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Akito Fukuda, Takaaki Mizuno, Tatsuya Yoshida, Kuniko Sunami, Takashi Kubo, Takafumi Koyama, Kan Yonemori, Takuji Okusaka, Ken Kato, Yuichiro Ohe, Yasushi Yatabe, Noboru Yamamoto
Japanese Journal of Clinical Oncology.2025; 55(7): 720. CrossRef
Benefits of macroscopic on-site evaluation in endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling
Junya Sato, Hirotoshi Ishiwatari, Kazuma Ishikawa, Hiroki Sakamoto, Takuya Doi, Masahiro Yamamura, Kazunori Takada, Yoichi Yamamoto, Masao Yoshida, Sayo Ito, Noboru Kawata, Kenichiro Imai, Kinichi Hotta, Hiroyuki Ono
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Tissue acquisition for comprehensive genomic profiling of gallbladder cancer using a forward-viewing echoendoscope in a patient who underwent Roux-en-Y reconstruction
Michihiro Ono, Shutaro Oiwa, Atsushi Uesugi, Seiya Saito, Ryota Yokoyama, Makoto Usami, Tomoyuki Abe, Miri Fujita, Kohichi Takada, Masahiro Maeda
Clinical Journal of Gastroenterology.2024; 17(1): 164. CrossRef
Endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling
Nozomi Okuno, Kazuo Hara
Journal of Medical Ultrasonics.2024; 51(2): 253. CrossRef
Oil blotting paper for formalin fixation increases endoscopic ultrasound‐guided tissue acquisition‐collected sample volumes on glass slides
Takuo Yamai, Kenji Ikezawa, Yusuke Seiki, Ko Watsuji, Yasuharu Kawamoto, Takeru Hirao, Kazuma Daiku, Shingo Maeda, Makiko Urabe, Yugo Kai, Ryoji Takada, Kaori Mukai, Tasuku Nakabori, Hiroyuki Uehara, Sayoko Tsuzaki, Ayumi Ryu, Satoshi Tanada, Shigenori Na
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Utility of Transpapillary Biopsy and Endoscopic Ultrasound-Guided Tissue Acquisition for Comprehensive Genome Profiling of Unresectable Biliary Tract Cancer
Soma Fukuda, Susumu Hijioka, Yoshikuni Nagashio, Daiki Yamashige, Daiki Agarie, Yuya Hagiwara, Kohei Okamoto, Shin Yagi, Yasuhiro Komori, Masaru Kuwada, Yuta Maruki, Chigusa Morizane, Hideki Ueno, Nobuyoshi Hiraoka, Kiichiro Tsuchiya, Takuji Okusaka
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Mcl-1 expression is a predictive marker of response to gemcitabine plus nab-paclitaxel for metastatic pancreatic cancer
Makiko Urabe, Kenji Ikezawa, Yusuke Seiki, Ko Watsuji, Yasuharu Kawamoto, Takeru Hirao, Yugo Kai, Ryoji Takada, Takuo Yamai, Kaori Mukai, Tasuku Nakabori, Hiroyuki Uehara, Shigenori Nagata, Kazuyoshi Ohkawa
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Endoscopic Ultrasound-Guided Pancreatic Tissue Sampling: Lesion Assessment, Needles, and Techniques
Jahnvi Dhar, Jayanta Samanta, Zaheer Nabi, Manik Aggarwal, Maria Cristina Conti Bellocchi, Antonio Facciorusso, Luca Frulloni, Stefano Francesco Crinò
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Yundi Pan, Taojing Ran, Xianda Zhang, Xianzheng Qin, Yao Zhang, Chunhua Zhou, Duowu Zou
Endoscopic Ultrasound.2024; 13(6): 366. CrossRef
Endoscopic ultrasound-guided tissue acquisition for personalized treatment in pancreatic adenocarcinoma
Sang Myung Woo
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Tomotaka Mori, Eisuke Ozawa, Akane Shimakura, Kosuke Takahashi, Satoshi Matsuo, Kazuaki Tajima, Yasuhiko Nakao, Masanori Fukushima, Ryu Sasaki, Satoshi Miuma, Hisamitsu Miyaaki, Shinji Okano, Kazuhiko Nakao
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Journal of Gastroenterology and Hepatology.2023; 38(10): 1677. CrossRef

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Utility of forward-view endoscopic ultrasound in fine-needle aspiration in patients with a surgically altered upper gastrointestinal anatomy: Asmaa Bakr, Kazuo Hara, Moaz Elshair, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Daiki Fumihara, Takafumi Yanaidani, Samy Zaky, Hanaa Omar; Clin Endosc 2023;56(3):367-374. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2021.238

Graphical Abstract Abstract PDF

Background
/Aims: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using oblique-view EUS in patients with a surgically altered anatomy (SAA) of the upper gastrointestinal tract is limited because of difficult scope insertion due to the disturbed anatomy. This study aimed to investigate the efficiency of forward-view (FV)-EUS in performing FNA in patients with a SAA.
Methods
We retrospectively investigated 32 patients with a SAA of the upper gastrointestinal tract who visited Aichi Cancer Center Hospital in Nagoya, Japan, between January 2014 and December 2020. We performed-upper gastrointestinal EUS-FNA using FV-EUS combined with fluoroscopic imaging to confirm tumor recurrence or to make a decision before chemotherapy or after a failure of diagnosis by radiology.
Results
We successfully performed EUS-FNA in all studied patients (100% technical success), with the specificity, sensitivity, and accuracy of 100%, 87.5%, and 87.8%, respectively, with no complications.
Conclusions
EUS-FNA using FV-EUS combined with fluoroscopic imaging is an effective and safe technique for tissue acquisition in patients with a SAA.

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Endoscopic ultrasonography-guided vascular intervention for bile duct–jejunal anastomotic variceal bleeding
Takashi Kondo, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Minako Urata, Yoshitaro Yamamoto
Endoscopy.2025; 57(S 01): E335. CrossRef
Role of the EUS in the Treatment of Biliopancreatic Disease in Patients with Surgically Altered Anatomy
Marcello Cintolo, Edoardo Forti, Giulia Bonato, Michele Puricelli, Lorenzo Dioscoridi, Marianna Bravo, Camilla Gallo, Francesco Pugliese, Andrea Palermo, Alessia La Mantia, Massimiliano Mutignani
Diagnostics.2025; 15(21): 2707. CrossRef

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Case Reports

Endoscopic ultrasound-guided portal vein coiling: troubleshooting interventional endoscopic ultrasonography: Shin Haba, Kazuo Hara, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Akira Miyano, Daiki Fumihara, Moaz Elshair; Clin Endosc 2022;55(3):458-462. Published online November 30, 2021; DOI: https://doi.org/10.5946/ce.2021.114

Abstract PDF Supplementary Material

Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) is widely performed not only as an alternative to transpapillary biliary drainage, but also as primary drainage for malignant biliary obstruction. For anatomical reasons, this technique carries an unavoidable risk of mispuncturing intrahepatic vessels. We report a technique for troubleshooting EUS-guided portal vein coiling to prevent bleeding from the intrahepatic portal vein after mispuncture during interventional EUS. EUS-HGS was planned for a 59-year-old male patient with unresectable pancreatic cancer. The dilated bile duct (lumen diameter, 2.8 mm) was punctured with a 19-gauge needle, and a guidewire was inserted. After bougie dilation, the guidewire was found to be inside the intrahepatic portal vein. Embolizing coils were placed to prevent bleeding. Embolization coils were successfully inserted under stabilization of the catheter using a double-lumen cannula with a guidewire. Following these procedures, the patient was asymptomatic. Computed tomography performed the next day revealed no complications.

Citations

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Endoscopic ultrasound-guided glue embolization to prevent hemorrhage after accidental tract formation to the portal venous system during hepaticogastrostomy
Chloë Hanssens, Elisabeth Dhondt, Pieter Hindryckx
Endoscopy.2026; 58(S 01): E318. CrossRef
An unusual case of high gastrointestinal bleeding after Whipple surgery
E Dubois, R Geelen
Acta Gastro Enterologica Belgica.2024; 87(3): 430. CrossRef

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High-Resolution Probe-Based Confocal Laser Endomicroscopy for Diagnosing Biliary Diseases: Hiroki Koda, Kazuo Hara, Okuno Nozomi, Takamichi Kuwahara, Mizuno Nobumasa, Shin Haba, Miyano Akira, Isomoto Hajime; Clin Endosc 2021;54(6):924-929. Published online March 15, 2021; DOI: https://doi.org/10.5946/ce.2020.191

Abstract PDF

Probe-based confocal laser endomicroscopy is an endoscopic technique that enables in vivo histological evaluation using fluorescent pigment. The ability to diagnostically differentiate between benign and malignant biliary disease using the “CholangioFlex^TM”, a dedicated biliary device, has been reported. However, the Miami and Paris classifications, used as diagnostic criteria, mainly evaluate findings in the submucosa, and visualizing the epithelium as the main site of lesions remains difficult. To address this problem, we verified the imaging findings and diagnostic ability of three types of probes: CholangioFlex^TM, GastroFlex^TM, and AlveoFlex^TM. With GastroFlex^TM, the clear mucosal epithelium was observed, and differential diagnoses as benign/malignant could be made based on epithelial findings. GastroFlex^TM may be a good first-choice probe for probe-based confocal laser endomicroscopy of biliary diseases, and a new diagnostic classification based on bile duct epithelial findings may provide useful criteria independent of the Miami or Paris classifications.

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Challenges and Prospects of Using Novel Nonlinear Effects in Multimode Optical Fibers for Multiphoton Endomicroscopy
Lidiya V. Boldyreva, Denis S. Kharenko, Kirill V. Serebrennikov, Anna A. Evtushenko, Viktor V. Shloma, Daba A. Radnatarov, Alexandr V. Dostovalov, Zhibzema E. Munkueva, Oleg S. Sidelnikov, Igor S. Chekhovskoy, Kirill S. Raspopin, Mikhail D. Gervaziev, Ste
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Jiangshan Wu
American Journal of Cancer Research.2025; 15(6): 2642. CrossRef
Intraductal papillary neoplasm of the biliary tract with typical clinicopathological, endoscopic features: A case report
Tian-Yuan Gu, Su-Hang Wang, Shu-Ying Yang, Si-Qi Zhao, Min-Jie Chen, Xiao-Ping Li, Zheng-Wei Song, Xiao-Xia Gu, Fei Chen
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Cholangioscopy-based convoluted neuronal network vs. confocal laser endomicroscopy in identification of neoplastic biliary strictures
Carlos Robles-Medranda, Jorge Baquerizo-Burgos, Miguel Puga-Tejada, Domenica Cunto, Maria Egas-Izquierdo, Juan Carlos Mendez, Martha Arevalo-Mora, Juan Alcivar Vasquez, Hannah Lukashok, Daniela Tabacelia
Endoscopy International Open.2024; 12(10): E1118. CrossRef
A Comparative Analysis of Artificial Intelligence-based Digital Cholangioscopy and Probe-based Confocal Laser Endomicroscopy for Detecting Malignant Bile Duct Lesions: A single-centre retrospective study
C. Robles-Medranda, J. Baquerizo-Burgos, M. Puga-Tejada, D. Cunto, M. Egas-Izquierdo, M. Arevalo-Mora, J. C. Mendez, J. Alcivar-Vasquez, H. Alvarado-Escobar, H. Pitanga-Lukashok, D. Tabacelia
Endoscopy.2023; 55(S 02): S134. CrossRef

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Original Article

Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in Patients Undergoing Antithrombotic Therapy: Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Masahiro Tajika, Tsutomu Tanaka, Sachiyo Onishi, Keisaku Yamada, Akira Miyano, Daiki Fumihara, Moaz Elshair; Clin Endosc 2021;54(4):596-602. Published online February 17, 2021; DOI: https://doi.org/10.5946/ce.2020.194

Abstract PDF

Background
/Aims: The Japan Gastroenterological Endoscopy Society (JGES) has published guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. These guidelines classify endoscopic ultrasound-guided biliary drainage (EUS-BD) as a high-risk procedure. Nevertheless, the bleeding risk of EUS-BD in patients undergoing antithrombotic therapy is uncertain. Therefore, this study aimed to assess the bleeding risk in patients undergoing antithrombotic therapy.
Methods
This single-center retrospective study included 220 consecutive patients who underwent EUS-BD between January 2013 and December 2018. We managed the withdrawal and continuation of antithrombotic agents according to the JGES guidelines. We compared the bleeding event rates among patients who received and those who did not receive antithrombotic agents.
Results
A total of 18 patients (8.1%) received antithrombotic agents and 202 patients (91.8%) did not. Three patients experienced bleeding events, with an overall bleeding event rate of 1.3% (3/220): one patient was in the antithrombotic group (5.5%) and two patients were in the non-antithrombotic group (0.9%) (p=0.10). All cases were moderate. The sole thromboembolic event (0.4%) was a cerebral infarction in a patient in the non-antithrombotic group.
Conclusions
The rate of EUS-BD-related bleeding events was low. Even in patients receiving antithrombotic therapy, the bleeding event rates were not significantly different from those in patients not receiving antithrombotic therapy.

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