Clinical Endoscopy

Predictive factors for the necessity of peroral cholangioscopy-guided lithotripsy in the endoscopic treatment of cystic duct confluence stones: a retrospective study in Japan: Kazuaki Miyamoto, Takahisa Ogawa, Shinsuke Koshita, Yoshihide Kanno, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Fumisato Kozakai, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Kei Ito; Received June 22, 2025 Accepted September 23, 2025 Published online January 9, 2026; DOI: https://doi.org/10.5946/ce.2025.195 [Epub ahead of print]

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/Aims: The treatment of cystic duct confluence stones often requires peroral cholangioscopy (POCS)-guided lithotripsy. This study evaluated the efficacy of endoscopic treatment for cystic duct confluence stones and identified predictive factors for the need for POCS-guided lithotripsy.
Methods
This retrospective cohort study included 38 patients with cystic duct confluence stones treated endoscopically between September 2007 and December 2023. The primary outcome was the rate of complete stone removal. Secondary outcomes included the number of sessions, total procedure time, adverse events, and predictive factors for POCS-guided lithotripsy.
Results
The complete stone removal rate was 100%. POCS-guided lithotripsy was required in 50% of the cases. The mean number of sessions needed for stone removal was 2.05. The mean procedure time was 93.9 minutes. The incidence of adverse events was 13%. Multivariate analysis showed that a minor axis length of the stone relative to the distal bile duct diameter greater than 1.2 was an independent predictive factor for requiring POCS-guided lithotripsy.
Conclusions
Endoscopic treatment is highly effective for cystic duct confluence stones. However, POCS-guided lithotripsy was necessary when the minor axis of the stone relative to the distal bile duct diameter exceeded 1.2.

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Incidence and risk factors for recurrence of common bile duct stones in patients undergoing endoscopic extraction without prophylactic biliary stenting and subsequent cholecystectomy: a retrospective study in Japan: Hidehito Sumiya, Takahisa Ogawa, Shinsuke Koshita, Yoshihide Kanno, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Kei Ito; Clin Endosc 2026;59(1):124-131. Published online October 24, 2025; DOI: https://doi.org/10.5946/ce.2025.081

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Background
/Aims: In patients undergoing endoscopic extraction of common bile duct stones (CBDs) and subsequent cholecystectomy, CBDs sometimes recur during the preoperative and perioperative periods. In this study, the incidence and risk factors for CBDs recurrence were investigated.
Methods
A total of 245 patients (mean age: 66 years; 138 men) who underwent cholecystectomy within 180 days of CBDs extraction between October 2017 and June 2023 were included. Recurrence was defined as the detection of the CBDs during the preoperative or perioperative period using imaging modalities such as computed tomography or re-endoscopic retrograde cholangiopancreatography, regardless of the presence of cholangitis.
Results
CBDs recurrence occurred in 4.1% of the patients (10/245). The median time to recurrence was 40 days. Preoperative recurrence was observed in nine patients, and only one patient had postoperative recurrence. Multivariate analysis identified cystic duct stones as the only significant risk factor for CBDs recurrence (hazard ratio, 15.6; 95% confidence interval, 3.7–66; p<0.001).
Conclusions
The risk of CBDs recurrence after endoscopic extraction during the pre and perioperative periods is high in patients with cystic duct stones. Prophylactic biliary stenting may be considered in high-risk patients.

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Balancing surgical timing and risk stratification to prevent recurrent common bile duct stones after bile duct clearance
Sung Bum Kim
Clinical Endoscopy.2026; 59(1): 76. CrossRef

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Predictive factors for the diagnosis of autoimmune pancreatitis using endoscopic ultrasound-guided tissue acquisition: a retrospective study in Japan: Keisuke Yonamine, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Yutaka Noda, Kei Ito; Clin Endosc 2025;58(3):457-464. Published online March 28, 2025; DOI: https://doi.org/10.5946/ce.2024.238

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Background
/Aims: The factors affecting the detection rate of lymphoplasmacytic sclerosing pancreatitis (LPSP) using endoscopic ultrasound-guided tissue acquisition (EUS-TA) in patients with type 1 autoimmune pancreatitis (AIP) have not been thoroughly studied. Therefore, we conducted a retrospective study to identify the predictive factors for histologically detecting level 1 or 2 LPSP using EUS-TA.
Methods
Fifty patients with AIP were included in this study, and the primary outcome measures were the predictive factors for histologically detecting level 1 or 2 LPSP using EUS-TA.
Results
Multivariate analysis identified the use of fine needle biopsy (FNB) needles as a significant predictive factor for LPSP detection (odds ratio, 15.1; 95% confidence interval, 1.62–141; ¬¬p=0.017). The rate of good-quality specimens (specimen adequacy score ≥4) was significantly higher for the FNB needle group than for the fine needle aspiration (FNA) needle group (97% vs. 56%; p<0.01), and the FNB needle group required significantly fewer needle passes than the FNA needle group (median, 2 vs. 3; p<0.01).
Conclusions
The use of FNB needles was the most important factor for the histological confirmation of LPSP using EUS-TA in patients with type 1 AIP.

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A new era for autoimmune pancreatitis diagnosis: fine-needle biopsy outperforms fine-needle aspiration in endoscopic ultrasound-guided tissue acquisition
Gunn Huh, Tae Jun Song
Clinical Endoscopy.2025; 58(3): 406. CrossRef

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Prophylactic endoscopic transpapillary gallbladder stenting to prevent acute cholecystitis induced after metallic stent placement for malignant biliary strictures: a retrospective study in Japan: Fumisato Kozakai, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Kei Ito; Clin Endosc 2024;57(5):647-655. Published online May 17, 2024; DOI: https://doi.org/10.5946/ce.2023.284

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Background
/Aims: Endoscopic biliary drainage using self-expandable metallic stents (SEMSs) for malignant biliary strictures occasionally induces acute cholecystitis (AC). This study evaluated the efficacy of prophylactic gallbladder stents (GBS) during SEMS placement.
Methods
Among 158 patients who underwent SEMS placement for malignant biliary strictures between January 2018 and March 2023, 30 patients who attempted to undergo prophylactic GBS placement before SEMS placement were included.
Results
Technical success was achieved in 21 cases (70.0%). The mean diameter of the cystic duct was more significant in the successful cases (6.5 mm vs. 3.7 mm, p<0.05). Adverse events occurred for 7 patients (23.3%: acute pancreatitis in 7; non-obstructive cholangitis in 1; perforation of the cystic duct in 1 with an overlap), all of which improved with conservative treatment. No patients developed AC when the GBS placement was successful, whereas 25 of the 128 patients (19.5%) without a prophylactic GBS developed AC during the median follow-up period of 357 days (p=0.043). In the multivariable analysis, GBS placement was a significant factor in preventing AC (hazard ratio, 0.61; 95% confidence interval, 0.37–0.99; p=0.045).
Conclusions
GBS may contribute to the prevention of AC after SEMS placement for malignant biliary strictures.

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Risk Factors for Cholecystitis After Self-expandable Metallic Stent Placement for Malignant Distal Biliary Obstruction
Hashem Albunni, Azizullah Beran, Nwal Hadaki, Mark A. Gromski, Mohammad Al-Haddad
Journal of Clinical Gastroenterology.2025;[Epub] CrossRef
Risk factors for infection following particle stent placement in obstructive jaundice patients: A retrospective analysis
Gang Wang, Rui Qi
Current Problems in Surgery.2025; 67: 101775. CrossRef
Post-endoscopic retrograde cholangiopancreatography cholecystitis: A review of incidence, risk factors, prevention, and management
Suprabhat Giri, Shivaraj Afzalpurkar, Prasanna Gore, Gaurav Khatana, Saroj Kanta Sahu, Dibya Lochan Praharaj, Bipadabhanjan Mallick, Preetam Nath, Sridhar Sundaram, Manoj Kumar Sahu
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Role of Prophylactic Endoscopic Gallbladder Stent Placement for Prevention of Acute Cholecystitis in Patients Receiving Stenting for Malignant Biliary Obstruction: A Meta-Analysis
Zahid Ijaz Tarar, Mustafa Gandhi, Umer Farooq, AhtshamUllah Chaudhry, Gopala K. Konduri, Ahmad Zain, Zohaib Ahmed, Baltej Singh, Nirav Thosani
Digestive Diseases and Sciences.2025;[Epub] CrossRef
Technical challenges and safety of prophylactic gallbladder stenting with metallic biliary stenting
Masood Muhammad Karim, Om Parkash
Clinical Endoscopy.2024; 57(6): 841. CrossRef

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