Clinical Endoscopy

Original Articles

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
Distinguishing the mechanisms of recurrent biliary obstruction among antegrade transpapillary stenting versus hepaticogastrostomy versus choledochoduodenostomy
Rungsun Rerknimitr
Endoscopy.2026; 58(09): 1061. CrossRef
Reply to Prof. Rerknimitr
Vinay Dhir, Vivek Kumar Singh
Endoscopy.2026; 58(09): 1062. 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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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

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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.

Citations

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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
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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
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Vivek Kumar Singh, Vinay Dhir
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Kai Koch, Markus Dollhopf
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Kirsten Boonstra, Rogier P. Voermans, Roy L.J. van Wanrooij
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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
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Hirotsugu Maruyama, Kojiro Tanoue, Tatsuya Kurokawa, Yoshinori Shimamoto, Yuki Ishikawa-Kakiya, Akira Higashimori, Yasuhiro Fujiwara
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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

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Case Report

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.

Citations

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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

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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

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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.

Citations

Citations to this article as recorded by

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
Recent Advances in Endoscopic Ultrasound-Guided Tissue Acquisition
Panotpol Termsinsuk, Nonthalee Pausawasdi
Journal of Digestive Endoscopy.2026; 17(01): 031. 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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5,963 View
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