Clinical Endoscopy

Touch imprint cytology for rapid on-site evaluation in endoscopic ultrasound-guided tissue acquisition of pancreatic tumors: diagnostic performance and practical value—a single-center retrospective observational study from Japan: Motoyasu Kan, Sodai Uchida, Taiga Sudo, Kouki Yokozuka, Yoshiki Nakaya, Akinori Abe, Hiroki Kurosaki, Yoshiki Ogane, Kazuki Watabe, Miho Sakai, Yu Sekine, Mayu Ouchi, Masayuki Yokoyama, Hiroshi Ohyama, Jun Kato; Received August 1, 2025 Accepted October 29, 2025 Published online January 29, 2026; DOI: https://doi.org/10.5946/ce.2025.264 [Epub ahead of print]

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Among various specimen preparation techniques for rapid on-site evaluation (ROSE), touch imprint cytology (TIC) is widely used; however, its utility for pancreatic lesions has not been fully validated. This study aimed to evaluate the diagnostic performance of TIC-based ROSE during endoscopic ultrasound-guided tissue acquisition (EUS-TA) for pancreatic lesions.
Methods
This retrospective study included 385 patients who underwent EUS-TA for pancreatic lesions at a single center. ROSE using TIC was performed in 370 cases (96.1%). Diagnostic concordance between TIC-based ROSE and histology, as well as diagnostic accuracy relative to the final diagnosis, were assessed. The diagnostic performance of TIC was compared with that of spray cytology (SC) and instrument rinse cytology (IRC). Multivariate analysis was conducted to identify factors associated with discordance between TIC-based ROSE and histology.
Results
The concordance rate between TIC-based ROSE and histology was 85.1% (κ=0.575). For the final diagnosis, TIC-based ROSE demonstrated a sensitivity of 92.3%, specificity of 96.9%, and accuracy of 92.7%, showing superior diagnostic performance within the same workflow compared with SC and IRC. Smaller lesion size and the use of a 25-gauge needle were identified as independent factors for discordance.
Conclusions
TIC is a reliable ROSE technique in EUS-TA for pancreatic lesions, providing high diagnostic accuracy and a low inadequacy rate.

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Endoscopic findings are associated with histologic types of primary small intestinal lymphoma: a retrospective study in Japan: Masafumi Kitamura, Mio Sakaguchi, Hirotsugu Sakamoto, Satoshi Shinozaki, Manabu Nagayama, Tomonori Yano, Yusuke Ono, Takuma Kobayashi, Kunihiko Oguro, Shoko Miyahara, Masahiro Okada, Katsuyuki Nakazawa, Keijiro Sunada, Noriyoshi Fukushima, Hironori Yamamoto; Received July 23, 2025 Accepted October 11, 2025 Published online January 29, 2026; DOI: https://doi.org/10.5946/ce.2025.239 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Although endoscopic diagnosis of primary small intestinal lymphoma (PSIL) is important, the association between endoscopic findings and histologic types remains unclear. This study aimed to evaluate the diagnostic accuracy of endoscopic classifications and biopsies in PSIL.
Methods
We retrospectively reviewed 100 lesions from 49 patients with PSIL who underwent double-balloon enteroscopy between 2005 and 2020. Endoscopic findings were classified into six macroscopic types: polypoid, ulcerative, multiple nodules, diffuse, concentric stenosis, or unclassified.
Results
Of the 100 lesions, 47 were multiple nodules, 32 were ulcerative, 8 were polypoid, 7 were diffuse, 4 were concentric stenosis, and 2 were unclassified. Diffuse large B-cell lymphoma (DLBCL) was mainly ulcerative (72%) or polypoid (75%), whereas follicular lymphoma appeared as multiple nodules (98%) or concentric stenosis (100%) (p<0.001, Cramér’s V=0.41). The ulcerative type was associated with DLBCL (sensitivity, 0.74; specificity, 0.87), and multiple-nodule type were associated with follicular lymphoma (sensitivity, 0.75; specificity, 0.97). The overall diagnostic yield of the biopsy was 95%. Interobserver agreement was substantial (κ=0.69; agreement, 78%).
Conclusions
Endoscopic findings were significantly associated with histologic types. Endoscopic findings and biopsies provide a high diagnostic yield, supporting their central role in the diagnostic management of PSIL.

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A stepwise cannulation strategy for conservative endoscopists: the clinical impact of transpancreatic precut after pancreatic stenting in a retrospective study from Taiwan: Wei-Chih Su, Chia-Chi Wang, Tsung-Hsien Hsiao, Hung-Da Chen, Tzu-Hsiang Kung, Chih-Hsiang Chen, Jiann-Hwa Chen; Clin Endosc 2026;59(1):132-141. Published online January 12, 2026; DOI: https://doi.org/10.5946/ce.2025.241

Abstract PDF PubReader ePub: Background
/Aims: Pancreatic stenting reduces post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and aids in cannulation in difficult cases. However, conservative endoscopists may stop at this step, resulting in suboptimal outcomes. This study assessed the efficacy of transpancreatic precut sphincterotomy (TPS) as a rescue procedure following pancreatic stenting.
Methods
Between March 2013 and November 2018, 82 patients underwent pancreatic stenting at our institution prior to successful biliary cannulation. TPS was introduced in April 2016, and patients were divided into Before TPS and After TPS groups. The outcomes included cannulation success, PEP incidence, and predictors of TPS conversion.
Results
There were 43 and 39 patients in the Before TPS and After TPS groups, respectively. Twenty-two patients (56.4%) underwent conversion to TPS in the After TPS group. The After TPS group had a higher bile duct cannulation rate (89.7% vs. 72.1%) than the Before TPS group, but this difference was not statistically significant (p=0.054). Multivariate analysis showed that age >50 years (odds ratio [OR], 0.181; p=0.021) and being in the After TPS group (OR, 0.712; p=0.039) were independently associated with reduced PEP risk. Haraldsson Type 2 and Type 4 papillae carried a relatively high TPS conversion rate.
Conclusions
A stepwise cannulation strategy that incorporates TPS after pancreatic stenting minimizes the need for advanced techniques and improves PEP outcomes.

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Impact of body mass index on the outcomes of endoscopic retrograde cholangiopancreatography: a systematic review and network meta-analysis: Erfan Arabpour, Sina Khoshdel, Mehdi Azizmohammad Looha, Amir Sadeghi, Mohammad Abdehagh; Received July 31, 2025 Accepted October 14, 2025 Published online January 9, 2026; DOI: https://doi.org/10.5946/ce.2025.255 [Epub ahead of print]

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Obesity is an increasing health concern worldwide, and an elevated body mass index (BMI) may influence the outcomes of endoscopic retrograde cholangiopancreatography (ERCP). This systematic review and network meta-analysis aimed to investigate the association between BMI and ERCP outcomes.
Methods
A systematic search was performed using PubMed, Scopus, and Web of Science to identify relevant studies that reported clinical outcomes of ERCP in different BMI groups. Patients were categorized into five BMI-based following groups: underweight (BMI<18.5 kg/m²), normal weight (18.5 kg/m²≤BMI<25 kg/m²), overweight (25 kg/m²≤BMI<30 kg/m²), obesity (30 kg/m²≤BMI<40 kg/m²), and morbid obesity (40 kg/m²≤BMI).
Results
Among 3,001 unique citations, seven were included in the study. Meta-analysis revealed that obesity was not associated with an increased risk of post-ERCP pancreatitis (PEP) (odds ratio, 1.33; 95% confidence interval, 0.62–2.87). In the network analysis, none of the five BMI groups had a significantly higher risk of PEP than that of the other groups (p>0.05). Moreover, the BMI groups had similar rates of difficult cannulation, successful cannulation, complete stone extraction, and procedural success.
Conclusions
ERCP success and adverse events were similar among different BMI groups. Neither an elevated nor a low BMI was associated with an increased risk of PEP. Further large-scale prospective studies are required to validate these findings.

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Clinical efficacy of endoscopic resection for subepithelial tumors in the esophagogastric junction and gastric cardia: an observational study: Sang Jin Park, Min A Yang, Jae Sun Song, Won Dong Lee, Myoung Jin Ju, Jin Woong Cho; Received July 8, 2025 Accepted August 25, 2025 Published online January 7, 2026; DOI: https://doi.org/10.5946/ce.2025.219 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Gastric subepithelial tumors (SETs) located near the esophagogastric junction (EGJ) are difficult to treat surgically and endoscopically. This study aimed to evaluate the effectiveness and safety of endoscopic resection of SETs growing from the muscularis propria located in the EGJ and gastric cardia.
Methods
This study included 26 consecutive patients who underwent endoscopic resection of 27 gastric SETs between November 2012 and May 2023.
Results
Of the 27 gastric SETs, 3 and 24 were located in the EGJ and gastric cardia, respectively. The mean tumor size, operative time, and duration of hospitalization were 21 (6–52) mm, 35.4 (9–65) minutes, and 4.2 (3–7) days, respectively. Endoscopic resection of the SETs achieved an en bloc resection rate of 100% (27/27) and a complete resection rate of 88.9% (24/27). Pathological examination confirmed four gastrointestinal stromal tumors and 23 leiomyomas. No bleeding, peritonitis, or abdominal infection occurred after the endoscopic resections. Residual lesions were identified in three patients (11.1%). No recurrence was observed during follow-up (range, 3–24 months).
Conclusions
SETs in the EGJ and gastric cardia can be resected effectively, even if they originate from the muscularis propria layer.

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Endoscopic ultrasound-guided strain and shear wave elastography for pancreatic and liver diseases: Raymond S.Y. Tang, Ting Ting Chan; Received August 2, 2025 Accepted August 13, 2025 Published online January 5, 2026; DOI: https://doi.org/10.5946/ce.2025.258 [Epub ahead of print]

Abstract PDF PubReader ePub: Endoscopic ultrasound (EUS)-guided elastography is an advanced imaging technique designed to improve assessment of lesion characteristics and disease diagnosis. It allows real-time assessment of tissue stiffness and is currently available in the form of strain elastography (SE) and shear wave elastography (SWE). While EUS-guided SE has high sensitivity for diagnosing malignant solid pancreatic lesions, its specificity remains modest. SWE is a novel technology currently available on the EUS platform. Promising data have been reported on the utility of EUS-guided SWE in various diseases of the pancreas and liver. This review aims to discuss the applications of EUS-guided SE and SWE in pancreatic and liver diseases.

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Feasibility of pancreatic duct stent placement before endoscopic submucosal dissection for superficial duodenal neoplasms adjacent to the papilla: Ryosuke Kobayashi, Kingo Hirasawa, Yuichiro Ozeki, Atsushi Sawada, Masafumi Nishio, Chiko Sato, Haruo Miwa, Kazuya Sugimori, Shin Maeda; Clin Endosc 2026;59(1):89-95. Published online December 31, 2025; DOI: https://doi.org/10.5946/ce.2025.197

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging and is associated with a risk of adverse events, particularly when lesions are located near the major papilla. Pancreatic duct (PD) stent may reduce the risk of post-ESD pancreatitis; however, no standard strategy has been established. This study aimed to evaluate the effectiveness and safety of PD stent placement combined with ESD for SNADETs near the major papilla.
Methods
This was a retrospective study of duodenal ESD after prophylactic PD stent placement in patients with SNADET near the major papilla at a university hospital between March 2014 and September 2023.
Results
Four lesions were located within 5 mm of the major papilla, and seven within 5 to 10 mm. The median interval between stent placement and ESD was 2 days. The en bloc and R0 resection rates were 100% and 90.9%, respectively. No stent migration occurred during ESD, and all mucosal defects were completely closed using endoscopic clips. Delayed bleeding and post-ESD pancreatitis were observed in one and two cases, respectively.
Conclusions
PD stent placement combined with ESD is an effective treatment strategy for SNADETs near the major papilla. However, the risk of post-ESD pancreatitis remains, indicating the need for further preventive strategies.

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Reducing post-endoscopic submucosal dissection pancreatitis in periampullary duodenal lesions: the role of prophylactic pancreatic duct stenting
Ari Fahrial Syam
Clinical Endoscopy.2026; 59(1): 70. CrossRef

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Endoscopic ultrasound-guided plugged liver biopsy using a fine-needle biopsy needle and coils in patients with deranged coagulation parameters: proof of concept study for feasibility and safety from India: Biswa Ranjan Patra, Shubham Gupta, Yash Kallurwar, Chetan Saner, Sidharth Harindranath, Ankita Singh, Arun Vaidya, Michael Kuruthukulangara, Jitendra Yadav, Gaurav Lodha, Souradeep Pal, Akash Shukla; Received June 11, 2025 Accepted September 7, 2025 Published online December 23, 2025; DOI: https://doi.org/10.5946/ce.2025.188 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Endoscopic ultrasound (EUS)-guided liver biopsy in patients with coagulopathy remains unexplored mainly because of the lack of effective hemostatic techniques in the event of post-biopsy bleeding. This study evaluated the feasibility and safety of a novel technique, EUS-guided plugged liver biopsy (EUS-PLB), which incorporates coil embolization for tract hemostasis.
Methods
In a pilot study, 20 patients with coagulopathy (platelets 20,000–50,000/μL or international normalized ratio 1.5–2.5) underwent EUS-PLB using a modified heparinized wet suction technique. Hemostasis was achieved via real-time EUS-guided deployment of 1 to 2 coils (35-5-3) into the needle tract. Outcomes included technical and clinical success, sample adequacy, and adverse events.
Results
Coil placement was technically successful in all patients. Persistent needle-tract bleeding occurred in five cases and was effectively controlled. The clinical success rate for preventing significant bleeding (early or delayed) was 100%. Adequate biopsy samples were obtained in 18/20 patients (90%), with a mean total specimen length of 3.34±0.88 cm and median complete portal tracts of 18 (range, 6–25). Histological diagnosis was possible in 95% of cases. One patient experienced a mild adverse event (5%).
Conclusions
This novel EUS-PLB technique with coil embolization may offer a safe and effective biopsy solution for patients with coagulopathy and warrants further investigation.

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Depth of noninjecting resection using bipolar soft coagulation mode for 6 to 9 mm colorectal polyps: a retrospective study in Japan: Yoshifumi Watanabe, Mitsuo Tokuhara, Hidetoshi Nakata, Hiroko Nakahira, Ikuko Torii, Yasumasa Sumitomo; Clin Endosc 2026;59(1):115-123. Published online December 18, 2025; DOI: https://doi.org/10.5946/ce.2025.100

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Endoscopic resection of colorectal polyps reduces mortality from colorectal cancer. We report here a novel resection method, known as noninjecting resection using bipolar soft coagulation mode (NIRBS), and assess its feasibility. This study aimed to compare the resection depth achieved with NIRBS to those achieved with cold snare polypectomy (CSP) and conventional endoscopic mucosal resection (CEMR).
Methods
Patients with 6 to 9 mm colorectal polyps underwent endoscopic resection at Hoshigaoka Medical Center between October 2023 and January 2024. We analyzed the thickness of resected submucosal tissue following the use of NIRBS, CSP, and CEMR.
Results
We identified 95 polyps, including adenomas and serrated lesions. The proportions of specimens containing submucosal tissue were 21.4%, 100.0%, and 97.9% in CSP, CEMR, and NIRBS, respectively. The median submucosal tissue thickness for CEMR and NIRBS was 1,167 and 1,125 µm, respectively, which was significantly greater than 0 µm for CSP. For NIRBS, the median thickness was 1,140 and 1,017 µm for the expert and non-expert endoscopists, respectively.
Conclusions
The depth of submucosal resection with NIRBS exceeded 1,000 μm regardless of endoscopist experience. NIRBS can be a useful resection method for patients with colorectal polyps, including those with non-submucosally invasive carcinomas.

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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

Graphical Abstract Abstract PDF PubReader ePub: 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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Efficacy of double half-pigtail plastic stents for endoscopic biliary drainage of acute calculous cholangitis: Toshitaka Sakai, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Kento Hosokawa, Hidehito Sumiya, Jun Horaguchi, Masaya Oikawa, Takashi Tsuchiya, Yutaka Noda, Kei Ito; Clin Endosc 2025;58(6):898-908. Published online November 11, 2025; DOI: https://doi.org/10.5946/ce.2025.134

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Plastic stent placement is required when biliary stones cannot be completely removed during the initial endoscopic retrograde cholangiopancreatography (ERCP). Although double half-pigtail plastic stents (DHPs) help prevent stent migration, their clinical utility has not yet been evaluated.
Methods
We retrospectively reviewed data from 221 patients who underwent DHP placement for acute calculous cholangitis (ACC) between January 2015 and March 2024. Patient without complete stone removal during initial ERCP were included. Clinical success, adverse events, recurrent biliary obstruction (RBO), and time to RBO (TRBO) were compared in 21 patients treated with straight plastic stents (STs) under similar conditions.
Results
Clinical success was achieved in 99% of patients in the DHP group and 95% of the ST group (p=0.13). Adverse event rates were comparable between groups. During follow-up, the DHP group had significantly lower stent occlusion (2% vs. 20%, p<0.01) and migration rates (4% vs. 15%, p=0.02), leading to a lower RBO rate (5% vs. 35%, p<0.01). The median TRBO was significantly longer in the DHP group (585 vs. 247 days, p<0.01).
Conclusions
DHPs had comparable efficacy to STs, with significantly fewer stent-related adverse events. This may be a potential option for biliary drainage in ACC.

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Effect of double-layered suturing for mucosal defect closure after colorectal endoscopic submucosal dissection on postoperative adverse events: a propensity score-matched retrospective study in Japan: Kyohei Nishino, Hiroki Fujita, Takahiro Yuge, Masanori Hongo, Naoko Mori, Kazumi Shimamoto, Yu Kobayashi, Takashi Toyonaga, Hiromitsu Ban; Clin Endosc 2025;58(6):881-889. Published online November 6, 2025; DOI: https://doi.org/10.5946/ce.2025.053

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Prophylactic closure of mucosal defects after colorectal endoscopic submucosal dissection (ESD) can reduce the incidence of postoperative adverse events. However, data on this notion are limited. This study retrospectively evaluated the effect of closure using a double-layered suturing technique on postoperative adverse events.
Methods
A total of 370 lesions in 317 patients who underwent colorectal ESD were included in this analysis. Patients with 197 lesions that were completely closed were then assigned to the closure group. Patients with 173 lesions, including 55 that were partially closed and 118 that were not closed, were assigned to the non-closure group. Propensity score matching was performed, and 136 lesions were selected for each group.
Results
The closure group had a significantly lower overall incidence rate of postoperative adverse events, including delayed bleeding, delayed perforation, and post-ESD electrocoagulation syndrome, than the non-closure group (2.2% vs. 9.6%, p=0.018). The closure group had a significantly lower incidence of abdominal pain on the day after ESD than the non-closure group (2.9% vs. 11.0%, p=0.015).
Conclusions
Prophylactic closure of mucosal defects after colorectal ESD using a double-layered suturing technique could prevent postoperative adverse events and abdominal pain on the day after ESD.

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Colorectal endoscopic submucosal dissection defect closure: promising but still evolving
Yunho Jung
Clinical Endoscopy.2025; 58(6): 856. CrossRef

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Efficacy of primary endoscopic ultrasound-guided biliary drainage with the placement of multiple plastic stents in the management of hepaticojejunostomy stricture: a retrospective, single-center study in Japan: Mako Ushio, Toshio Fujisawa, Ko Tomishima, Yusuke Takasaki, Shigeto Ishii, Koichi Ito, Akinori Suzuki, Daisuke Namima, Sho Takahashi, Taito Fukuma, Hiroto Ota, Daishi Kabemura, Muneo Ikemura, Ippei Ikoma, Yasuhisa Jimbo, Haruka Hagiwara, Yusuke Yamaguchi, Takumi Okuaki, Shin Arii, Hiroyuki Isayama; Clin Endosc 2025;58(6):909-917. Published online November 6, 2025; DOI: https://doi.org/10.5946/ce.2025.006

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Hepaticojejunostomy strictures (HJSS), recurrent cholangitis, and jaundice are major complications of surgical hepaticojejunostomy. Previously, HJSS was managed using percutaneous procedures and balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography. However, endoscopic ultrasound-biliary drainage (EUS-BD) was recently reported to be an effective salvage procedure. EUS-BD as a primary drainage method using a trans-endosonographically created route (trans-ESCR) has not been previously evaluated.
Methods
We enrolled consecutive patients who underwent EUS-BD for HJSS at the Juntendo University Hospital between March 2017 and December 2022. After ESCR maturation, multiple plastic stents were placed for 1 year with or without cholangioscopic evaluation. We evaluated the technical and clinical success rates, stent removal, HJSS recurrence, and related adverse events.
Results
Thirty-seven patients required EUS-guided hepaticogastrostomy/hepaticojejunostomy (n=36/1). The technical and clinical success rates were 94.6% and 100.0%, respectively, and 17% of patients experienced adverse events. Cholangioscopy via ESCR was performed in 19 patients to evaluate the strictures and manage concomitant stones. The success rate of stent removal after multiple stent placements for more than 1 year was 83%.
Conclusions
Primary EUS-BD and trans-ESCR are feasible and effective in the management of HJSS. Further prospective studies are needed to confirm the results of this pilot study.

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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

Graphical Abstract Abstract PDF PubReader ePub

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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Safety and efficacy of primary precut techniques for biliary cannulation: a systematic review and meta-analysis: Eugene Annor, Nneoma Ubah, Dhaval Save, Ishaan Vohra, Ritu Raj Singh, Dushyant Singh Dahiya, Bhanu Siva Mohan Pinnam, Harishankar Gopakumar; Clin Endosc 2026;59(1):58-66. Published online October 10, 2025; DOI: https://doi.org/10.5946/ce.2025.110

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Biliary cannulation is a critical component of endoscopic retrograde cholangiopancreatography (ERCP). When standard methods fail, needle-knife precut sphincterotomy (NKPS) is commonly employed. This systematic review and meta-analysis evaluated the safety and efficacy of using NKPS as a primary technique.
Methods
Electronic databases were searched for studies published between January 2000 and November 2024 that assessed outcomes of primary precut techniques. “Primary precut” was defined as needle-knife sphincterotomy performed as the initial approach without any prior standard cannulation attempts. Pooled proportions were calculated using random-effects models, and heterogeneity was assessed using the Q-test and the I² statistic.
Results
The mean patient age was 57.95 years (standard deviation [SD], 7.59), and 53.23% were female. The cannulation success rate was 96.50% (95% confidence interval [CI], 94.90–97.60) with no heterogeneity (Q, 7.10; df, 8; I²=0%; p=0.935). The rates of adverse events were as follows: post-ERCP pancreatitis, 1.90% (95% CI, 1.20–3.10; I²=0; p =0.942); bleeding, 2.60% (95% CI, 1.70–4.00, I²=0; p=0.725); cholangitis, 1.50% (95% CI, 0.60–3.60; I²=45.27; p=0.067); and perforation, 0.90% (95% CI, 0.40–1.90; I²=0; p=0.948). The overall adverse event rate was 9.70% (95% CI, 5.70–16.10; I²=83.39; p<0.001).
Conclusions
Primary precut sphincterotomy appears to be an effective and safe technique for biliary cannulation in ERCP. These findings support its consideration as a viable first-line approach in appropriate clinical settings.

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Endoscopic full-thickness resection of upper gastrointestinal tract: a review on closure techniques: Siew Fung Hau, Shannon Melissa Chan; Received February 4, 2025 Accepted May 22, 2025 Published online September 29, 2025; DOI: https://doi.org/10.5946/ce.2025.037 [Epub ahead of print]

Abstract PDF PubReader ePub

Endoscopic full-thickness resection has become more and more popular. One of the most important parts of this procedure is the closure of these full-thickness defects. Apart from conventional through-the-scope (TTS) clips, several different methods and devices have emerged as safe and efficacious in recent years. New clips include the anchor pronged TTS clips, dual-action tissue clips, and over-the-scope-clips. There are also new line or loop-assisted closure methods such as clip loop method, reopenable clip over line method, loop 9 method, and the internal-traction-assisted suspended closure method. New devices include the helical tacking system and endoscopic suturing device. This review article will discuss in details the usage of these different methods and available literature on comparison between the different closure methods.

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Technische Fortschritte in der endoskopischen Resektion
Sandra Nagl, Johannes Wießner, Katharina Beyer, Helmut Messmann
Die Innere Medizin.2026; 67(1): 11. CrossRef

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Endoscopic full-thickness resection for the treatment of gastric gastrointestinal stromal tumors: Bao-Hui Song, Jiashaer Bahetinuer, Yun-Shi Zhong, Hon Chi Yip, Ping-Hong Zhou, Ming-Yan Cai; Clin Endosc 2026;59(1):9-20. Published online August 28, 2025; DOI: https://doi.org/10.5946/ce.2025.001

Abstract PDF PubReader ePub: Endoscopic full-thickness resection (EFTR) is a minimally invasive technique that is increasingly used for gastrointestinal stromal tumors (GISTs) originating from the muscularis propria. Despite its advantages over conventional surgery, such as complete tumor resection and faster recovery, EFTR faces challenges related to its efficacy, safety, and feasibility, particularly in gastric GISTs. By summarizing the literature published over the past decade, this review provides a comprehensive overview of the clinical outcomes of EFTR and the evolution of defect closure devices.

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Comparative efficacy and safety of supine versus prone positioning in endoscopic retrograde cholangiopancreatography: a systematic review and meta-analysis: Fariha Hasan, Muhammad Shahzil, Ayesha Liaquat, Taha Bin Arif, Muhammad Yafaa Naveed Chaudhary, Eugene Annor, Dushyant Singh Dahiya, Jay Patel, Rohini Maddigunta, Avneet Singh, Alexander Garcia, Babu P. Mohan, Rachel Frank, Adib Chaaya; Clin Endosc 2025;58(6):843-853. Published online August 26, 2025; DOI: https://doi.org/10.5946/ce.2025.072

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is conventionally performed in the prone position (PP). Recent studies have shown that the supine position (SP) is an effective alternative, with comparable success rates. We conducted a meta-analysis to directly compare the safety and efficacy of the two ERCP positions.
Methods
In line with Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed through a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library. Statistical analyses were performed using RevMan, with results considered significant at p<0.05 and reported as odds ratios (ORs) and mean differences (MDs).
Results
Eleven studies (24,285 patients) were included in the final analysis. Procedural success was significantly higher in the PP (OR, 0.52; 95% confidence interval [CI], 0.36–0.75; p<0.0004) than the SP. However, no significant difference was observed in procedure times (MD, 0.22; 95% CI, –7.07 to 7.50; p=0.95), number of cardiopulmonary complications (OR, 1.08; 95% CI, 0.47–2.48; p=0.86), or post-ERCP pancreatitis (OR, 1.12; 95% CI, 0.52–2.42; p=0.31) between the two groups.
Conclusions
The PP demonstrates superior ERCP success compared to the SP, without prolonging procedure time or increasing the risk of adverse events. However, given the comparable procedure times, incidence of adverse events, and increased comfort for both patients and anesthesiologists, the SP may be a suitable alternative for a select group of patients in whom the PP is not feasible, such as those with morbid obesity or recent abdominal surgery.

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Efficacy and safety of endoscopic submucosal dissection versus endoscopic papillectomy for managing laterally spreading duodenal papillary tumors: Yuki Kano, Ken Ohata, Toshifumi Iida, Susumu Banjoya, Tomoya Kimura, Koichi Furuta, Shinya Nagae, Yohei Ito, Hiroshi Yamazaki, Nao Takeuchi, Shunya Takayanagi, Yoshiaki Kimoto, Yuji Koyama, Seitaro Tsujino, Takashi Sakuno, Kohei Ono, Yohei Minato, Yuji Fujita, Eiji Sakai, Hideyuki Chiba; Clin Endosc 2025;58(5):712-721. Published online August 26, 2025; DOI: https://doi.org/10.5946/ce.2025.066

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aim: Endoscopic submucosal dissection (ESD) can be performed to treat laterally spreading duodenal papillary tumors (LSPTs). However, no studies have been conducted on the outcomes of ESDs for LSPTs.
Methods
We retrospectively compared 47 patients who underwent endoscopic papillectomies (EPs) for papillary tumors (PTs) between June 2007 and July 2023 (EP group) and eight patients who underwent ESDs for LSPTs between February 2022 and July 2023 (ESD group). In the subgroup analysis, five patients who underwent EPs for LSPTs were compared with eight patients who underwent ESDs for LSPTs.
Results
Procedure times and tumor diameters were significantly greater in the ESD group than in the EP group. The positive or unclear vertical margin (VM1/X) rate was significantly higher in the ESD group. Additional therapies were administered for patients with VM1/X in the ESD group, and no local recurrence was observed. No delayed adverse events occurred in the ESD group; however, delayed bleeding and perforation occurred in the EP group. In the subgroup analysis, the en bloc resection rate was significantly higher in the ESD group than in the EP group. The VM1/X rate did not differ significantly between groups.
Conclusions
We suggest that ESD is both feasible and safe for LSPTs.

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Reducing post-endoscopic submucosal dissection pancreatitis in periampullary duodenal lesions: the role of prophylactic pancreatic duct stenting
Ari Fahrial Syam
Clinical Endoscopy.2026; 59(1): 70. CrossRef

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85 Download
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Efficacy of multi-hole self‑expandable metallic stents versus partially covered self‑expandable metallic stents in patients with malignant distal biliary obstruction caused by unresectable pancreatic cancer: a retrospective comparative cohort study in Japan: Shohei Asada, Koh Kitagawa, Fumimasa Tomooka, Jun-ichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Kosuke Kaji, Akira Mitoro, Hitoshi Yoshiji; Clin Endosc 2025;58(5):744-756. Published online August 26, 2025; DOI: https://doi.org/10.5946/ce.2024.340

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: This study aimed to compare the stent patency between the novel multi-hole self-expandable metallic stent (MH-SEMS) and conventional partially covered SEMS (PC-SEMS) for malignant distal biliary obstruction (MDBO) in patients with pancreatic carcinoma.
Methods
This retrospective study compared stent patency between patients with MH-SEMS (n=43) and those with PC-SEMS (n=94). Secondary outcomes were overall survival (OS), incidence of recurrent biliary obstruction (RBO), causes of RBO, and adverse events (AEs).
Results
The median time to RBO did not differ significantly between the MH-SEMS and PC-SEMS groups (318 vs. 460 days, p=0.17). Furthermore, the two groups did not differ significantly in terms of OS and incidence rate of AEs, including RBO and cholecystitis. RBO caused by tumor ingrowth was slightly more common in the MH-SEMS group (p=0.089). The MH-SEMS group had a slightly lower 12-month non-obstruction rate than the PC-SEMS group (33.9% vs. 60.9%). In the MH-SEMS group, stent removal was successful in all seven patients in whom it was attempted.
Conclusions
The clinical outcomes of MH-SEMS and PC-SEMS were similar in patients with MDBO caused by pancreatic carcinoma were similar.

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Advancements in stent strategies for malignant distal biliary obstruction: defining the clinical role of multi-hole self-expandable metal stents
Sung Yong Han
Clinical Endoscopy.2025; 58(5): 698. CrossRef
Endoscopic biliary drainage with multi-hole self-expandable metallic stent during neoadjuvant chemoradiotherapy in pancreatic cancer
Shohei Asada, Koh Kitagawa, Junichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Kosuke Kaji, Akira Mitoro, Minako Nagai, Hitoshi Yoshiji, Masayuki Sho
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef

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Long-term outcome of grade 1 rectal neuroendocrine tumor ≤1 cm after incomplete endoscopic resection: Jong Sun Park, Hye Lynn Jeon, Bumhee Park, Jong Hoon Park, Gil Ho Lee, Sun Gyo Lim, Sung Jae Shin, Kee Myung Lee, Choong-Kyun Noh; Clin Endosc 2025;58(6):871-880. Published online July 22, 2025; DOI: https://doi.org/10.5946/ce.2025.043

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Surveillance strategies for small grade 1 rectal neuroendocrine tumors (G1 rNETs) after incomplete endoscopic resection (ER) remain controversial. We evaluated the long-term outcomes of patients with G1 rNET ≤1 cm after ER who did and did not undergo complete resection.
Methods
We retrospectively evaluated 441 patients with G1 rNETs measuring ≤1 cm after ER between 2011 and 2022. Patients were divided into complete and incomplete resection groups according to histopathological evaluation. Logistic regression analysis identified the risk factors for incomplete resection after ER.
Results
The mean follow-up intervals were 38.6 and 45.7 months in all patients and the incomplete resection group, respectively. No recurrences were observed during the follow-up period. The mean lesion size was 5.5 mm and the complete resection rate was 80.5% (n=355). In the logistic regression analysis, lesion size 5.1 to 10 mm (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.245–4.203; p=0.008), multiple lesions (OR, 8.3; 95% CI, 1.247–54.774; p=0.029), and retroflexion view during the procedure (OR, 4.0; 95% CI, 1.668–9.615; p=0.002) were independent risk factors for incomplete resection.
Conclusions
The prognosis of G1 rNET ≤1 cm after ER was very good, regardless of the histopathological results.

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Prognostic Factors in Neuroendocrine Neoplasms of the Rectum
Frederike Butz, Charlotte Friederike Müller-Debus, Flora Georgina Ecseri, Gianna Sophia Mani, Elif Akgündüz, Agata Dukaczewska, Peter Richard Steinhagen, Uli Fehrenbach, Catarina A. Kunze, Henning Jann, Johann Pratschke, Eva Maria Dobrindt, Martina T. Mog
Cancers.2025; 17(17): 2841. CrossRef

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1 Crossref

Efficacy of additional tissue sections for diminutive colorectal adenomas pathologically diagnosed as normal mucosa: a retrospective, cross-sectional study in Japan: Tsuyoshi Ishii, Toshihiro Nishizawa, Hidenobu Watanabe, Masaya Sano, Ai Fujimoto, Yoshiyuki Takahashi, Ryo Shimizu, Hirotoshi Ebinuma, Takahisa Matsuda, Osamu Toyoshima; Clin Endosc 2025;58(4):577-585. Published online July 7, 2025; DOI: https://doi.org/10.5946/ce.2024.265

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Endoscopists occasionally encounter discrepancies between endoscopic and pathological diagnoses after colorectal polypectomies. This study aimed to evaluate the efficacy of additional sections for diagnostic discrepancies.
Methods
We examined polyps endoscopically diagnosed as adenomas or suspected adenomas that were resected and pathologically diagnosed as adenomas or normal mucosa. Adenomas pathologically diagnosed with initial sections were categorized as the “adenoma by initial section” group. Based on the re-diagnosis with additional sectioning, they were assigned to the “adenoma by additional section” or “normal mucosa by both sections” groups.
Results
In the initial pathological diagnosis of 993 lesions, 850 were diagnosed as adenomas and 143 as normal mucosa. Additional sections corrected the pathological diagnoses in 23.8% (34/143) of cases. The rate of high confidence was significantly higher in the “adenoma by additional section” group than in the “normal mucosa by both sections” group (64.7% vs. 38.5%, p<0.01). Lesions in the “adenoma by additional section” group were significantly smaller than those in the “adenoma by initial section” group (2.7 vs. 3.8 mm, p<0.05).
Conclusions
Diminutive adenomas can cause discrepancies between endoscopic and pathological diagnoses. Additional sections may help revise the pathological diagnoses, particularly for lesions with high confidence.

2,353 View
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1 Web of Science

True natural orifice transluminal endoscopic surgery-transgastric cholecystectomy and beyond: Pingting Gao, Jia Yu, Mingyan Cai, Lili Ma, Quanlin Li, Pinghong Zhou; Clin Endosc 2025;58(4):518-524. Published online July 4, 2025; DOI: https://doi.org/10.5946/ce.2024.352

Abstract PDF PubReader ePub

Natural orifice transluminal endoscopic surgery (NOTES) represents a revolutionary advancement in minimally invasive surgery, eliminating the need for external incisions and offering faster recovery and improved aesthetics. Endoscopic transgastric cholecystectomy (ETGC), a NOTES-based procedure, stands out for its potential to revolutionize gallbladder removal by offering a truly scarless alternative to traditional laparoscopic cholecystectomy (LC). This review explores the historical development of cholecystectomy, evolution of NOTES, and emergence of ETGC as a feasible alternative to LC. We highlight the technical refinements that have enabled ETGC, including innovations in full-thickness resection and suturing techniques, and discuss challenges such as visibility, orientation, and wound closure. Finally, we examine the role of robotic platforms in enhancing precision and expanding clinical applications by positioning ETGC as a transformative technique in the era of minimally invasive surgery.

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Comparison of Early Results of Aesthetic Focused Bikini-Line Sleeve Gastrectomy and Standard Laparoscopic Sleeve Gastrectomy
Tuna Bilecik, Halit Eren Taşkın, Mani Habibi
Obesity Surgery.2026;[Epub] CrossRef

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Pre-endoscopy erythromycin versus metoclopramide for upper gastrointestinal bleeding: a systematic review and network meta-analysis: Ravi Teja Pasam, Kanwal Bains, Srilekha Chava, Babu P. Mohan; Clin Endosc 2025;58(6):831-842. Published online July 4, 2025; DOI: https://doi.org/10.5946/ce.2024.351

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Given the limited head-to-head trials comparing the outcomes of pre-endoscopy erythromycin and metoclopramide for upper gastrointestinal bleeding (UGIB), a network meta-analysis (NMA) and component NMA were conducted.
Methods
A comprehensive review of the Medline, Embase, and Cochrane databases was conducted for randomized controlled trials comparing pre-endoscopy erythromycin or metoclopramide for UGIB with or without gastric lavage (GL) to placebo and/or GL. The primary outcome was the adequate visualization of the mucosa. The secondary outcomes were endoscopy visualization score, endoscopy duration, diagnosis established at initial endoscopy, second-look endoscopy, blood transfusions, mortality, and duration of hospitalization.
Results
A total of 16 studies (1,447 patients) were included. No significant differences were observed between erythromycin and metoclopramide in all the outcomes, but erythromycin had significantly better outcomes than the control group in terms of endoscopic visualization score (standardized mean difference, 0.58; 95% confidence interval [CI], 0.26–0.91), adequate mucosal visualization (risk ratio, 1.55; 95% CI, 1.18–2.04), second-look endoscopy, transfusion requirements, and duration of hospitalization. Component network meta-analysis revealed that erythromycin, but not metoclopramide or GL, provided significantly better endoscopic visualization than the placebo.
Conclusions
Erythromycin should be considered before UGIB endoscopy. The current data do not support the use of metoclopramide or GL.

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Endoscopic approach to indeterminate biliary strictures: Yousuke Nakai, Ryunosuke Hakuta, Yutaka Shimamatsu, Nao Otsuka, Yukiko Takayama; Clin Endosc 2026;59(1):40-48. Published online July 1, 2025; DOI: https://doi.org/10.5946/ce.2025.052

Abstract PDF PubReader ePub: Diagnosis of biliary strictures remains challenging because of the low sensitivity of conventional transpapillary sampling using endoscopic retrograde cholangiopancreatography. New devices and tips have been developed to increase the diagnostic yield of conventional transpapillary sampling. However, additional endoscopic procedures are often necessary for indeterminate biliary strictures. Two major approaches for indeterminate biliary strictures are endoscopic ultrasonography-guided sampling and peroral cholangioscopy (POCS)-guided biopsy. The selection of modalities should be considered based on the stricture location. Although endoscopic ultrasound is the preferred approach for distal biliary strictures, POCS is preferred for perihilar biliary strictures. Endoscopic ultrasonography-guided sampling is highly sensitive in cases with a mass, but the sensitivity of POCS-guided biopsies is unsatisfactory, and discrepancy with the visual diagnosis of POCS is common. Whether these advanced techniques should be performed as the initial procedure or as a rescue after a failed diagnosis by conventional transpapillary sampling needs to be clarified in terms of diagnostic yield and cost-effectiveness.

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Natural orifice transluminal endoscopic surgery: history and current development: Zaheer Nabi, D. Nageshwar Reddy; Clin Endosc 2026;59(1):21-32. Published online July 1, 2025; DOI: https://doi.org/10.5946/ce.2025.009

Abstract PDF PubReader ePub: Natural orifice transluminal endoscopic surgery (NOTES) represents an innovative advancement in minimally invasive surgery, utilizing natural body orifices to access the peritoneal cavity to minimize surgical trauma, reduce postoperative pain, and avoid visible scars. Since its inception, NOTES has faced challenges such as technical complexity and securing safe access closure, which initially limited its widespread adoption. However, advancements in endoscopic techniques and technology, closure devices, and hybrid approaches may revitalize its clinical utility. Hybrid NOTES, particularly transvaginal techniques, has demonstrated significant benefits, including reduced postoperative pain, faster recovery, and improved cosmesis, without compromising safety or efficacy. Innovations such as flexible endoscopic platforms, robotic assistance, and novel suturing techniques address previous limitations and enable broader applications across various gastrointestinal indications. Comparative studies have shown comparable outcomes between NOTES and traditional laparoscopy, with specific advantages in terms of patient comfort and recovery time. As technology evolves, NOTES continues to expand its clinical indications, and its future holds promise with the integration of robotics and artificial intelligence. Further research and structured training programs are crucial to overcome existing barriers and ensure safe and effective implementation in diverse clinical settings.

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A new hemostatic device for gastric endoscopic submucosal dissection: a prospective randomized controlled trial comparing Coajet and Hemograsper in Korea: Sang Un Kim, Seong Woo Jeon; Clin Endosc 2025;58(4):552-560. Published online June 4, 2025; DOI: https://doi.org/10.5946/ce.2024.295

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Gastric endoscopic submucosal dissection (ESD) is often accompanied by bleeding. Coajet, a new device containing an injection needle, has been found to be useful in achieving hemostasis through monopolar contact. This study aimed to evaluate the efficacy and safety of this new hemostatic device by comparing it to hemostatic forceps (Hemograsper).
Methods
This prospective, randomized, single-center study enrolled consecutive patients scheduled to undergo gastric ESD from February 2022 to January 2023. The Hemograsper group (HG) underwent hemostasis using the conventional method, whereas the Coajet group (CG) used this new tool for lesion marking, submucosal injection in the initial stage of ESD, and then for hemostasis.
Results
A total 56 patients were enrolled in this study (HG, 28; CG, 28). No significant differences in age, sex, diagnosis, location, endoscopic size, or morphology were observed between the two groups. No significant difference in total operative time (HG, 16.0±6.9 minutes vs. CG, 12.4±6.7 minutes; p=0.05) and hemostatic time (HG, 186.6±134.5 seconds vs. CG, 130.4±81.5 seconds; p=0.06) were observed between the two groups. No differences in other procedure-related variables, such as complete en-bloc resection rate, length of admission, grade of immediate bleeding, and delayed bleeding within 30 days (HG, n=1 vs. CG, n=1), were noted.
Conclusions
The new hemostatic device, Coajet, showed comparable efficacy to that of conventional hemostatic forceps for bleeding control and the prevention of delayed bleeding in gastric ESD.

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A retrospective study on the comparative use of fine-needle biopsy and aspiration for the diagnosis and classification of malignant lymphoma in Japan: Fumitaka Niiya, Akihiro Nakamura, Yasuo Ueda, Takafumi Ogawa, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Yuichi Takano, Masatsugu Nagahama; Clin Endosc 2025;58(5):757-765. Published online May 27, 2025; DOI: https://doi.org/10.5946/ce.2024.320

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for diagnosing malignant lymphoma (ML). However, the optimal needle type for maximizing the diagnostic yield and tissue quality remains unclear. We compared the diagnostic performance and histological tissue quality between fine-needle biopsy (FNB) and fine-needle aspiration (FNA) needles in EUS-TA for ML.
Methods
This retrospective study included patients who underwent EUS-TA for suspected ML. The diagnostic accuracy, histological sample quality assessed by scoring, and adverse events were compared between the FNB and FNA groups. A subgroup analysis was performed for 22-gauge needles.
Results
FNB demonstrated higher diagnostic accuracy (75%) than FNA (50%) for cytology, with 100% sensitivity for histological diagnosis compared with 78.9% for FNA. The FNB group had significantly higher diagnostic rates for the World Health Organization subclassification of ML (71.4% vs. 31.6%, p=0.037). Additionally, FNB obtained superior histological quality, with 71.4% of samples scoring 5 compared with 41.2% in the FNA group. Adverse events were minimal in both groups.
Conclusions
EUS-FNB showed better diagnostic performance and histological tissue quality than EUS-FNA for ML, particularly in obtaining adequate samples for histological evaluation and subclassification. Therefore, EUS-FNB can be safely performed. Future research with larger sample sizes and genetic testing is warranted.

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Endoscopic Ultrasound as a Diagnostic Tool for the Mediastinum and Thorax
Sara Nikolic, Lucía Guilabert, Giuseppe Vanella, Catalina Vladut, Giuseppe La Mattina, Giuseppe Infantino, Elio D’Amore, Cecilie Siggaard Knoph, Giacomo Emanuele Maria Rizzo
Journal of Clinical Medicine.2025; 14(14): 4836. CrossRef
Refining the diagnostic strategy for malignant lymphoma: advantages of endoscopic ultrasound-guided fine-needle biopsy over aspiration
Kyong Joo Lee, Se Woo Park
Clinical Endoscopy.2025; 58(5): 701. CrossRef

2,619 View
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Peroral cholangioscopy: past, present and future: Yuki Tanisaka, Robert Hawes; Clin Endosc 2025;58(3):360-369. Published online May 19, 2025; DOI: https://doi.org/10.5946/ce.2024.306

Abstract PDF PubReader ePub

Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for the evaluation of biliary strictures and the management of bile duct stones. However, standard ERCP techniques sometimes fail for both indications. In such situations, peroral cholangioscopy (POCS), which allows direct visualization of the bile duct, can play a significant role in diagnosis and treatment. Direct visualization using POCS can help differentiate between malignant and benign conditions and is more accurate in defining the extent of cholangiocarcinoma. Furthermore, POCS enables visually guided biopsies. Certain types of difficult bile duct stones, such as impacted and intrahepatic stones, require POCS for visually guided lithotripsy. Recent advancements in POCS will broaden its applicability and improve its diagnostic utility. In this review, we provide perspectives on the past, present, and future of POCS.

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Research Progress in the Diagnosis and Treatment of Intrahepatic Bile Duct Stones
道文熊
Advances in Clinical Medicine.2025; 15(09): 783. CrossRef
Clinical Application of Ultra‐Slim Peroral Cholangioscopy for a Giant Common Bile Duct Stone: An Initial Experience
Yuta Kanazawa, Kazumasa Nagai, Noriyuki Hirakawa, Reina Tanaka, Ryosuke Tonozuka, Shuntaro Mukai, Yukitoshi Matsunami, Takao Itoi
Journal of Hepato-Biliary-Pancreatic Sciences.2025;[Epub] CrossRef
A novel sheath system to improve target access for preoperative mapping biopsy: A randomized trial to inform surgical planning
Hironori Aoi, Kentaro Yamao, Takuya Ishikawa, Yasuyuki Mizutani, Tadashi Iida, Kota Uetsuki, Yoshihisa Takada, Takeshi Yamamura, Kazuhiro Furukawa, Masanao Nakamura, Hiroki Kawashima
Surgical Endoscopy.2025;[Epub] CrossRef

4,009 View
261 Download
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3 Crossref

Endoscopic ultrasound-guided biliary drainage versus endoscopic retrograde cholangiopancreatography biliary drainage in the palliative management of malignant distal biliary obstruction: an updated systematic review and meta-analysis of randomized controlled trials: Spyros Peppas, Advait Suvarnakar, Bara A. Abujaber, Nadera Altork, Amer Arman, Sayel Alzraikat, Akram I. Ahmad, Camille Boustani, Won Kyoo Cho; Clin Endosc 2025;58(3):386-397. Published online May 9, 2025; DOI: https://doi.org/10.5946/ce.2024.155

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Evidence suggests comparable outcomes between endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in the biliary drainage of malignant distal biliary obstruction (MDBO). We conducted an updated systematic review and meta-analysis comparing the EUS with ERCP in the management of MDBO.
Methods
We performed a literature search using the Medline, Embase and Cochrane databases, including randomized controlled trials comparing EUS and ERCP in patients with MDBO. Meta-analysis was performed using the random-effects model using the STATA ver. 17.0 software.
Results
Both procedures were comparable in technical (risk ratio [RR], 1.01; 95% confidence interval [CI], 0.78–1.30) and clinical (RR, 1.10; 95% CI, 0.85–1.41) success. No difference was identified in total adverse events (RR, 0.75; 95% CI, 0.42–1.35), acute cholangitis (RR, 0.84; 95% CI, 0.43–1.62), stent patency (RR, 1.13; 95% CI, 0.87–1.46) and mean stent patency time (mean difference, –0.01; 95% CI: –0.21 to 0.19). ERCP was associated with a higher risk of procedure-related pancreatitis (RR, 0.17; 95% CI, 0.04–0.68) and statistically non-significant higher risk for reintervention (RR, 0.61; 95% CI, 0.37–1.01).
Conclusions
Although EUS and ERCP were comparable in terms of efficacy and safety, ERCP was associated with a higher risk of procedure-related pancreatitis and reintervention, with the latter finding not reaching statistical significance.

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The comparative study of Stretta radiofrequency and anti-reflux mucosectomy in the management of intractable gastroesophageal reflux disease: a single-center retrospective study from Korea: Ah Young Lee, Ji Woo Choi, Jeong Haeng Heo, Jun Young Chung, Seong Hwan Kim, Joo Young Cho; Clin Endosc 2025;58(3):409-417. Published online May 7, 2025; DOI: https://doi.org/10.5946/ce.2024.163

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Chronic gastroesophageal reflux disease (GERD) requires symptom relief and treatment of associated conditions. In this study, we aimed to compare anti-reflux mucosectomy (ARMS) and Stretta radiofrequency (SRF) for treating patients with chronic GERD who are unresponsive to proton pump inhibitors (PPIs) and to identify the indications for each procedure.
Methods
Data of patients who underwent ARMS or SRF between March 2021 and April 2023 were analyzed. Changes in GERD questionnaire (GERDQ) scores, endoscopic Los Angeles (LA) grade, flap valve grade (FVG) based on Hill’s type, EndoFLIP distensibility index (DI), endoscopic Barrett’s epithelium (BE) resolution rate, and PPI withdrawal rate were compared between the two groups.
Results
Improvements in the GERDQ scores and PPI withdrawal rates were similar between the groups. The ARMS group showed significantly better changes in endoscopic LA grade, FVG, and EndoFLIP DI than the SRF group. The complications were more prevalent in the ARMS group than in the SRF group.
Conclusions
The change in endoscopic LA grade before and after the procedure was significantly higher in the ARMS group than in the SRF group. Significant improvements in endoscopic FVG, BE resolution, and EndoFLIP DI were observed only with the ARMS group.

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Redefining endoscopic management of refractory gastroesophageal reflux disease: the role of Stretta radiofrequency therapy and antireflux mucosectomy
Yuto Shimamura
Clinical Endoscopy.2025; 58(3): 398. CrossRef
Anti-reflux mucosal ablation: A good method for proton pump inhibitor dependent gastroesophageal reflux disease
Jing-yu Zhu, Yi-heng Yao, Ming Qi, Liang Liu
Indian Journal of Gastroenterology.2025;[Epub] CrossRef
Comment on ‘The comparative study of Stretta radiofrequency and anti-reflux mucosectomy in the management of intractable gastroesophageal reflux disease: a single-center retrospective study from Korea’
Yiheng Yao, Guolei Shi, Liang Liu
Clinical Endoscopy.2025; 58(5): 782. CrossRef
Comments on ‘The comparative study of Stretta radiofrequency and anti-reflux mucosectomy in the management of intractable gastroesophageal reflux disease: a single-center retrospective study from Korea’
Gwang Ha Kim
Clinical Endoscopy.2025; 58(6): 948. CrossRef

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A systematic review on endoscopic ultrasound in gastric neuroendocrine neoplasms: guidelines outpacing evidence: Matteo Marasco, Gianluca Esposito, Marianna Signoretti, Maria Rinzivillo, Francesco Panzuto; Clin Endosc 2025;58(4):525-532. Published online April 24, 2025; DOI: https://doi.org/10.5946/ce.2024.343

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Gastric neuroendocrine neoplasms (g-NENs), though rare, have shown a rise in incidence due to increased endoscopic screening and improved diagnostic awareness. International guidelines recommend the use of endoscopic ultrasound (EUS) in managing g-NENs to evaluate subepithelial lesion size, depth, and lymph node involvement before endoscopic resection. However, the supporting evidence for EUS’s role in g-NENs is scarce and limited.
Methods
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was conducted on PubMed to identify studies about the role of EUS in g-NENs, including both retrospective and prospective human studies.
Results
A total of 355 studies were considered; however, only seven studies focusing on EUS’s diagnostic utility in g-NENs were selected, including only 44 patients. EUS showed promise in assessing tumor characteristics critical for endoscopic resection. Nevertheless, its diagnostic accuracy remained variable across lesion types, and its impact on clinical decision-making in g-NENs lacked robust evidence. EUS contributed to subepithelial lesion staging but was underrepresented in neuroendocrine tumor-specific studies, creating a knowledge gap.
Conclusions
This review underscores the need for larger multicenter studies to validate EUS’s efficacy and reliability in g-NEN management. Prospective trials are crucial to strengthen guidelines and provide clearer clinical guidance for managing these tumors.

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Step‐by‐Step Approach to the Incidental Diagnosis of Type I Gastric Neuroendocrine Tumors: Practical Insights
Laura Baldini, Elisabetta Dell'Unto, Maria Rinzivillo, Gianluca Esposito, Francesco Panzuto
JGH Open.2025;[Epub] CrossRef
Differences in Endoscopic Features of Gastric Neuroendocrine Tumor and Neuroendocrine Carcinoma From a Clinicopathological Perspective
Katsunori Matsueda, Noriya Uedo, Masanori Kitamura, Seiji Kawano, Motoyuki Otsuka
JGH Open.2025;[Epub] CrossRef

3,992 View
218 Download
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2 Crossref

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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Utility of underwater endoscopic mucosal resection combined with a protruding anchor by saline injection for superficial non-ampullary duodenal tumors: a retrospective study in Japan: Yoshie Nomoto, Satoshi Shinozaki, Yoshimasa Miura, Hiroyuki Osawa, Yuji Ino, Tomonori Yano, Nikolaos Lazaridis, Hironori Yamamoto; Clin Endosc 2025;58(4):561-568. Published online March 12, 2025; DOI: https://doi.org/10.5946/ce.2024.181

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Background
/Aims: Underwater endoscopic mucosal resection (UEMR) is the standard resection method for superficial non-ampullary duodenal tumors (SNADETs). We developed a novel UEMR technique that creates an anchor by protruding the distal fold with a saline injection (UEMR-A). The aim of this study was to clarify the usefulness of UEMR-A compared to conventional UEMR (UEMR-C).
Methods
This retrospective observational study included patients who underwent UEMR for SNADETs.
Results
A total of 141 patients were included and divided into UEMR-A (n=54) and UEMR-C (n=87) groups. Lesion resection was performed significantly more frequently by an expert endoscopist in the UEMR-C group compared to the UEMR-A group (p<0.001). The procedure time for UEMR-A was significantly shorter than that for UEMR-C (p=0.018), despite the additional time required for submucosal injection. The R0 resection rate was significantly higher in the UEMR-A group than in the UEMR-C group (p=0.004). The horizontal margins were significantly clearer in the UEMR-A group than in the UEMR-C group (p=0.018). Multivariate analysis revealed that the use of UEMR-A was the only significant positive factor for R0 resection.
Conclusions
The UEMR-A technique for SNADETs appears to improve R0 resection rates and reduce procedure times compared to the UEMR-C technique.

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Advancement of endoscopic treatment in GI tract
Yoshimasa Miura
Journal of Nihon University Medical Association.2025; 84(3): 119. CrossRef
Evaluation of a modified underwater endoscopic mucosal resection technique for duodenal neoplasms: clinical implications and future directions
Ji Yong Ahn
Clinical Endoscopy.2025; 58(4): 544. CrossRef
Reply to the comments on ‘Utility of underwater endoscopic mucosal resection combined with a protruding anchor by saline injection for superficial non-ampullary duodenal tumors: a retrospective study in Japan'
Hironori Yamamoto, Yoshie Nomoto, Satoshi Shinozaki, Yoshimasa Miura, Hiroyuki Osawa
Clinical Endoscopy.2025; 58(6): 953. CrossRef
A reformative underwater endoscopic mucosal resection technique for superficial non-ampullary duodenal tumors
Yiheng Yao, Guolei Shi, Xingjie Shen, Liang Liu
Clinical Endoscopy.2025; 58(6): 951. CrossRef

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

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

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Biliary Drainage in Altered Anatomy: A Comprehensive Literature Review
Rishi Chowdhary, Jorge D. Machicado, Veeral M. Oza
Journal of Digestive Endoscopy.2026;[Epub] CrossRef
A Time-Based and Clinical Status Stratified Protocol for Major Bile Duct Injury After Cholecystectomy: Retrospective, Single-Center Outcomes From a Resource-Limited Setting
Ahmed Ateik, Saif A Ghabisha, Lamia Abdulmughni, Fares Awn
Cureus.2026;[Epub] CrossRef
Biliary Drainage During Neoadjuvant Chemotherapy in Pancreatic Cancer: Evidence and Practical Recommendations
Tadahisa Inoue, Masanao Nakamura, Kiyoaki Ito
Cancers.2026; 18(3): 467. CrossRef
Reply
Joan B. Gornals, Albert Sumalla-Garcia, Carme Loras
Clinical Gastroenterology and Hepatology.2025;[Epub] CrossRef

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Impact of contrast dye submucosal pre-lifting on cold snare resection of small polyps: an Italian randomized observational trial: Ramona Schiumerini, Paola Baccarini, Adele Fornelli, Davide Allegri, Francesca Lodato, Alessia Gazzola, Pasquale Apolito, Nunzio P. Longo, Anna M. Polifemo, Franca Patrizi, Federica Buonfiglioli, Stefania Ghersi, Marco Bassi, Liza Ceroni, Antonella Ghetti, Giulio Fonti, Vincenzo Cennamo; Clin Endosc 2025;58(2):291-302. Published online February 24, 2025; DOI: https://doi.org/10.5946/ce.2024.113

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Small polyps are the most frequently detected lesions during colonoscopy, with an incomplete resection rate of 6.8% to 15.9%. This study aimed to improve small polyp cold snare resection radicality using submucosal contrast dye pre-lifting (PL+CSP).
Methods
This single-center, prospective, randomized controlled trial compared the standard cold snare polypectomy technique (PL-CSP) with PL+CSP to evaluate endoscopic and histological complete resection rates, adverse events, procedural times, and polyp retrieval failure rates.
Results
In 143 patients consecutively enrolled, 186 small polyps were detected and randomly assigned following a 1:1 ratio to the PL-CSP (n=97, 51.6%) and PL+CSP (n=90, 48.4%) techniques. Endoscopic (p=0.97) and histologic (p=0.23) complete resection rates did not differ significantly even in univariate analysis. The intraprocedural bleeding rate was significantly higher in the PL+CSP group as confirmed by the univariate analysis (35.8% vs. 8.3%, p<0.001). The polyps retrieval failure rates were similar (p=0.83). Procedural time was significantly longer for PL+CSP (median time, 75 vs. 45 seconds; p<0.001), without impacting colonoscopy withdrawal time (p=0.215).
Conclusions
PL+CSP of small polyps did not improve endoscopic and histological complete resection rates and polyp sample retrieval. PL+CSP had higher rates of intraprocedural bleeding and was “time-consuming”.

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In-room cytologic evaluation by trained endosonographer for determination of procedure end in endoscopic ultrasound-guided fine needle biopsy of solid pancreatic lesions: a prospective study in Taiwan: Weng-Fai Wong, Yu-Ting Kuo, Wern-Cherng Cheng, Chia-Tung Shun, Ming-Lun Han, Chieh-Chang Chen, Hsiu-Po Wang; Clin Endosc 2025;58(3):465-473. Published online December 12, 2024; DOI: https://doi.org/10.5946/ce.2024.143

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Background
/Aims: Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is an essential tool for tissue acquisition in solid pancreatic tumors. Rapid on-site evaluation (ROSE) by cytologists ensures diagnostic accuracy. However, the universal application of the ROSE is limited by its availability. Therefore, we aimed to investigate the feasibility of determining the end of the procedure based on the results of in-room cytological evaluation by trained endosonographers (IRCETE).
Methods
A training course focusing on the cytological interpretation of common pancreatic tumors was provided to the three endosonographers. After training, the decision to terminate EUS-FNB was made based on IRCETE results. The diagnostic accuracy, concordance rate of diagnostic categories, and sample adequacy were compared with those determined by board-certified cytologists and macroscopic on-site evaluation (MOSE).
Results
We enrolled 65 patients with solid pancreatic tumors, most of whom were malignant (86.2%). The diagnostic accuracy was 90.8% when the end of the procedure was determined based on IRCETE, compared to 87.7% and 98.5% when determined by MOSE and cytologists, respectively (p=0.060). Based on the cytologists’ results, the accuracy of IRCETE in diagnostic category interpretation was 97.3%.
Conclusions
In the absence of ROSE, IRCETE can serve as a supplementary alternative to MOSE in determining the end of tissue sampling with a high accuracy rate.

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Diagnostic accuracy and sensitivity of the rapid on-site evaluation (ROSE) versus macroscopic on-site evaluation (MOSE) in endoscopic ultrasound (EUS)-guided sampling: a systematic review
Eyad Gadour, Bogdan Miutescu, Sarah Al Ghamdi, Calin Burciu, Hossam Shaaban, Deiana Vuletici, Aymen Almuhaidb, Iulia Ratiu, Emad Aljahdli, Hussein Okasha
Frontline Gastroenterology.2025; 16(6): 489. CrossRef

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255 Download
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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 PubReader ePub: 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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Intragastric botulinum toxin injection for weight loss: current trends, shortcomings and future perspective: Erfan Arabpour, Hadi Golmoradi, Parya Mozafari Komesh Tape, Amir Sadeghi, Mohammad Abdehagh, Pardis Ketabi Moghadam, Mohammad Reza Zali; Clin Endosc 2025;58(1):10-24. Published online November 5, 2024; DOI: https://doi.org/10.5946/ce.2024.153

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The administration of botulinum toxin A (BTA) into the gastric wall has emerged as a novel endoscopic bariatric procedure. Although over 20 years have elapsed since the initial human trial of intragastric BTA injection, considerable debate remains surrounding the safety, efficacy, and procedural instructions of this approach. The current literature exhibits discrepancies in the methodologies employed across studies, including differences in the dosage of BTA administered, injection site, number and depth of injections, post-procedural dietary modifications, and follow-up duration. This study reviewed the state-of-the-art use of BTA for weight loss and focused on the clinical evidence of the therapeutic applications of BTA for obesity. Studies with consistent outcome measures and methodologies are necessary to thoroughly assess the potential effects of BTA on weight management.

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A Retrospective Case Series Study of Illegal Cosmetic Iatrogenic Botulism: Outbreak Analysis and Response Lessons
He Qiu, Jiang Shen, Yali Tang, Qiang Ji, Xiaoqun Lin, Dongmei Wu
Aesthetic Surgery Journal.2025; 45(9): 936. CrossRef
Effects of Intraparietal Gastric Botulinum Toxin-A Injection on Weight Loss: A Retrospective Study of 500 Patients
Ahmet Bekin, Tuncay Sahutoglu, Kadri Atay
Diabetes, Metabolic Syndrome and Obesity.2025; Volume 18: 3771. CrossRef
Advances and future directions in endoscopic bariatric therapies
Yu-Xuan Zhai, Tao Mao, Xiao-Yu Li, Lin-Lin Ren, Zi-Bin Tian
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Clinical Utility of Botulinum Toxin Injections in Children with Gastrointestinal Disorders
Dhiren Patel, Alexandra Wilder, Ashlesha Bagwe, Leonel Rodriguez
Current Gastroenterology Reports.2025;[Epub] CrossRef

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Effectiveness of a novel ex vivo training model for gastric endoscopic submucosal dissection training: a prospective observational study conducted at a single center in Japan: Takahito Toba, Tsuyoshi Ishii, Nobuyuki Sato, Akira Nogami, Aya Hojo, Ryo Shimizu, Ai Fujimoto, Takahisa Matsuda; Clin Endosc 2025;58(1):94-101. Published online November 4, 2024; DOI: https://doi.org/10.5946/ce.2024.108

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Background
/Aims: The efficacy of endoscopic submucosal dissection (ESD) for early-stage gastric cancer is well established. However, its acquisition is challenging owing to its complexity. In Japan, G-Master is a novel ex vivo gastric ESD training model. The effectiveness of training using G-Master is unknown. This study evaluated the efficacy of gastric ESD training using the G-Master to evaluate trainees’ learning curves and performance.
Methods
Four trainees completed 30 ESD training sessions using the G-Master, and procedure time, resection area, resection completion, en-bloc resection requirement, and perforation occurrence were measured. Resection speed was the primary endpoint, and learning curves were evaluated using the Cumulative Sum (CUSUM) method.
Results
All trainees completed the resection and en-bloc resection of the lesion without any intraoperative perforations. The learning curves covered three phases: initial growth, plateau, and late growth. The transition from phase 1 to phase 2 required a median of 10 sessions. Each trainee completed 30 training sessions in approximately 4 months.
Conclusions
Gastric ESD training using the G-Master is a simple, fast, and effective method for pre-ESD training in clinical practice. It is recommended that at least 10 training sessions be conducted.

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Meaningful progress towards a high-fidelity endoscopic submucosal dissection training simulator model
Gin Hyug Lee, So Young Byun
Clinical Endoscopy.2025; 58(1): 77. CrossRef
Beyond the scope: unveiling the future of digestive endoscopy through experimental models
Federico Soria Gálvez
Revista Española de Enfermedades Digestivas.2025;[Epub] CrossRef

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Short-term outcome of endoscopic submucosal dissection using a clutch cutter for subepithelial lesions within the esophagogastric submucosa: a Japanese prospective observational study: Kazuya Akahoshi, Kazuki Inamura, Kazuaki Akahoshi, Shigeki Osada, Shinichi Tamura, Yoshihiro Oishi, Masafumi Oya, Hidenobu Koga; Clin Endosc 2025;58(2):278-284. Published online October 10, 2024; DOI: https://doi.org/10.5946/ce.2024.094

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Background
/Aims: The efficacy and safety of endoscopic submucosal dissection using a clutch cutter (ESD-CC) for subepithelial lesions within the esophagogastric submucosa (SELEGSM) has not been investigated. This study aimed to assess the efficacy and safety of ESD-CC for the treatment of SELEGSM.
Methods
This prospective study included 15 consecutive patients with 18 SELEGSMs diagnosed by endoscopic ultrasonography. The primary outcomes were short-term outcomes including en bloc resection rate, R0 resection rate, procedure time, and complication rate. The secondary outcome was final histological diagnosis.
Results
Among the participants, 18 lesions were identified: 12 in the stomach (nine patients) and six in the esophagus (six patients). The en bloc resection rate was 94.4% (17/18). The R0 resection rate was 88.9% (16/18). The median operating time was 39 min, and no instances of perforation or bleeding were observed. The final diagnoses of SELEGSM included six neuroendocrine tumors (33.3%), six granular cell tumors (33.3%), two ectopic pancreases (11.1%), one inflammatory fibroid polyp (5.6%), one leiomyoma (5.6%), one lipoma (5.6%), and one leiomyosarcoma (5.6%).
Conclusions
ESD-CC appears to be a technically efficient and safe approach for SELEGSM resection, suggesting its potential as a valuable treatment option.

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Advancements in endoscopic resection of subepithelial tumors: toward safer, recurrence-free techniques
Won Shik Kim, Moon Kyung Joo
Clinical Endoscopy.2025; 58(2): 256. CrossRef

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2 Web of Science
1 Crossref

Endoscopic biliary drainage for distal bile duct obstruction due to pancreatic cancer: Masahiro Itonaga, Masayuki Kitano; Clin Endosc 2025;58(1):40-52. Published online September 26, 2024; DOI: https://doi.org/10.5946/ce.2023.294

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Approximately 60% of pancreatic cancers occur in the pancreatic head and may present as obstructive jaundice due to bile duct invasion. Obstructive jaundice often leads to poor general conditions and acute cholangitis, interfering with surgery and chemotherapy and requiring biliary drainage. The first choice of treatment for biliary drainage is the endoscopic transpapillary approach. In unresectable tumors, self-expandable metal stents (SEMSs) are most commonly used and are classified into uncovered and covered SEMSs. Recently, antireflux metal stents and large- or small-diameter SEMSs have become commercially available, and their usefulness has been reported. Plastic stents are infrequently used in patients with resectable biliary obstruction; however, owing to the recent trend in preoperative chemotherapy, SEMSs are frequently used because of the long time to recurrent biliary obstruction. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is often performed in patients who are not eligible for the transpapillary approach, and favorable outcomes have been reported. Different EUS-BD techniques and specialized stents have been developed and can be safely used in high-volume centers. The indications for EUS-BD are expected to further expand in the future.

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Comparative Evaluation of Percutaneous Transhepatic Biliary Drainage and Endoscopic Ultrasound‐Guided Biliary Drainage for Preoperative Management of Malignant Distal Bile Duct Obstruction After Failed ERCP: A Multicenter Retrospective Analysis
Masahiro Itonaga, Mamoru Takenaka, Hideyuki Shiomi, Koh Kitagawa, Shuhei Shintani, Hirotsugu Maruyama, Ryota Sagami, Tsukasa Ikeura, Takeshi Ogura, Yusuke Ishida, Koichiro Mandai, Satoshi Sugimori, Yoshiki Imamura, Atsuhiro Masuda, Kenji Ikezawa, Atsushi
Digestive Endoscopy.2026;[Epub] CrossRef
Mechanistic insights into pancreatic cancer progression from circadian rhythm disruption and gut microbiota dysbiosis (Review)
Yang Liu, Yongfeng Li, Heng Ma, Shichang Deng, Chao Cheng
International Journal of Molecular Medicine.2026; 57(3): 1. CrossRef
Balloon Enteroscopy‐Assisted ERCP Versus Endoscopic Ultrasound‐Guided Biliary Drainage for Unresectable Malignant Biliary Obstruction in Patients With Surgically Altered Anatomy: A Multicenter Prospective Registration Study
Masahiro Itonaga, Mamoru Takenaka, Kenji Ikezawa, Tsukasa Ikeura, Masaaki Shimatani, Masanori Asada, Nao Fujimori, Ryota Sagami, Takeshi Ogura, Hajime Imai, Kazuyuki Matsumoto, Shuhei Shintani, Hideyuki Shiomi, Keiichi Hatamaru, Kosuke Minaga, Ryoji Takad
Digestive Endoscopy.2025; 37(11): 1179. CrossRef
Advances in Endoscopic Management of Distal Biliary Stricture: Integrating Clinical Evidence into Patient-Specific Decision-Making
Reiko Yamada, Tetsuro Miwata, Yoshifumi Nakamura, Kenji Nose, Takamitsu Tanaka, Hirono Owa, Minako Urata, Yasuaki Shimada, Hayato Nakagawa
Cancers.2025; 17(16): 2644. CrossRef
Successful conversion of percutaneous transhepatic gallbladder drainage to endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting for a malignant distal biliary obstruction due to invasive intraductal papillary mucinous carcinom
Taiji Yoshimoto, Takeshi Takajo, Hiroshi Takihara, Ryuichi Yamamoto
Journal of Medical Case Reports.2025;[Epub] CrossRef
Adverse Events of EUS‐Guided Biliary Drainage for Malignant Biliary Obstruction: A Large Multicenter Study
Masahiro Itonaga, Takeshi Ogura, Mamoru Takenaka, Kazuyuki Matsumoto, Hideyuki Shiomi, Shuhei Shintani, Hideki Kamada, Taro Yamashita, Koichiro Mandai, Masanori Asada, Hajime Imai, Kotaro Takeshita, Tsukasa Ikeura, Nao Fujimori, Makiko Kinoshita, Kenji Ik
Journal of Hepato-Biliary-Pancreatic Sciences.2025;[Epub] CrossRef

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Cold snare polypectomy versus cold endoscopic mucosal resection for small colorectal polyps: a meta-analysis of randomized controlled trials: Vishali Moond, Priyadarshini Loganathan, Sheza Malik, Dushyant Singh Dahiya, Babu P. Mohan, Daryl Ramai, Michele McGinnis, Deepak Madhu, Mohammad Bilal, Aasma Shaukat, Saurabh Chandan; Clin Endosc 2024;57(6):747-758. Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.081

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Cold snare polypectomy (CSP) is routinely performed for small colorectal polyps (≤10 mm). However, challenges include insufficient resection depth and immediate bleeding, hindering precise pathological evaluation. We aimed to compare the outcomes of cold endoscopic mucosal resection (CEMR) with that of CSP for colorectal polyps ≤10 mm, using data from randomized controlled trials (RCTs).
Methods
Multiple databases were searched in December 2023 for RCTs reporting outcomes of CSP versus CEMR for colorectal polyps ≤10 mm in size. Our primary outcomes were rates of complete and en-bloc resections, while our secondary outcomes were total resection time (seconds) and adverse events, including immediate bleeding, delayed bleeding, and perforation.
Results
The complete resection rates did not significantly differ (CSP, 91.8% vs. CEMR 94.6%), nor did the rates of en-bloc resection (CSP, 98.9% vs. CEMR, 98.3%) or incomplete resection (CSP, 6.7% vs. CEMR, 4.8%). Adverse event rates were similarly insignificant in variance. However, CEMR had a notably longer mean resection time (133.51 vs. 91.30 seconds).
Conclusions
Our meta-analysis of seven RCTs showed that while both CSP and CEMR are equally safe and effective for resecting small (≤10 mm) colorectal polyps, the latter is associated with a longer resection time.

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Endoscopic ultrasound-guided hepaticogastrostomy and endoscopic retrograde cholangiopancreatography-guided biliary drainage for distal malignant biliary obstruction due to pancreatic cancer with asymptomatic duodenal invasion: a retrospective, single-center study in Japan: Naminatsu Takahara, Yousuke Nakai, Kensaku Noguchi, Tatsunori Suzuki, Tatsuya Sato, Ryunosuke Hakuta, Kazunaga Ishigaki, Tomotaka Saito, Tsuyoshi Hamada, Mitsuhiro Fujishiro; Clin Endosc 2025;58(1):134-143. Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.031

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Background
/Aims: Duodenal invasion (DI) is a risk factor for early recurrent biliary obstruction (RBO) in endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) may reduce early RBO in cases of asymptomatic DI, even when ERCP is possible.
Methods
We enrolled 56 patients with pancreatic cancer and asymptomatic DI who underwent EUS-HGS (n=25) or ERCP-BD (n=31). Technical and clinical success, early (<3 months) and overall RBO rates, time to RBO (TRBO), and adverse events were compared between the EUS-HGS and ERCP-BD groups. Risk factors for early RBO were also evaluated.
Results
Baseline characteristics were similar between the groups. Both procedures demonstrated 100% technical and clinical success rates, with a similar incidence of adverse events (48% vs. 39%, p=0.59). While the median TRBO was comparable (5.7 vs. 8.8 months, p=0.60), EUS-HGS was associated with a lower incidence of early RBO compared to ERCP-BD (8% vs. 29%, p=0.09). The major causes of early RBO in ERCP-BD were sludge and food impaction, rarely occurring in EUS-HGS. EUS-HGS was potentially reduced early RBO (odds ratio, 0.32; p=0.07).
Conclusions
EUS-HGS can be a viable option for treating pancreatic cancer with asymptomatic DI.

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Endoscopic Retrograde Cholangiopancreatography‐guided Biliary Drainage with Duckbill‐type Anti‐reflux Metal Stent versus Endoscopic Ultrasound‐guided Hepaticogastrostomy for Malignant Distal Biliary Obstruction in Pancreatic Cancer with Duodenal Invasion
Tsuyoshi Takeda, Takashi Sasaki, Tatsuki Hirai, Yoichiro Sato, Yuri Maegawa, Takafumi Mie, Takaaki Furukawa, Yukari Suzuki, Takeshi Okamoto, Masato Ozaka, Naoki Sasahira
DEN Open.2026;[Epub] CrossRef
Impact of Peri‐Procedural Antibiotics on Post‐ERCP Infectious Adverse Events With Distal Malignant Biliary Obstruction
Tatsunori Satoh, Haruna Takahashi, Eiji Nakatani, Yosuke Kobayashi, Fumitaka Niiya, Junichi Kaneko, Kazuma Ishikawa, Kenta Ito, Tetsushi Azami, Jun Noda, Shinya Kawaguchi
Journal of Gastroenterology and Hepatology.2026; 41(2): 696. CrossRef
Endoscopic Ultrasound‐Guided Hepaticogastrostomy With Plastic Stents in Comparison to Transpapillary Drainage With Metallic Stents for Unresectable Malignant Distal Biliary Obstructions
Hidehito Sumiya, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Kento Hosokawa, Shun Nozaki, Kei Ito
DEN Open.2026;[Epub] CrossRef
Biliary drainage in pancreatic cancer with duodenal invasion: which route is the best?
Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek
Clinical Endoscopy.2025; 58(1): 82. CrossRef
EUS-Guided Gallbladder Drainage of Inoperable Malignant Distal Biliary Obstruction by Lumen-Apposing Metal Stent: Systematic Review and Meta-Analysis
Tawfik Khoury, Moaad Farraj, Wisam Sbeit, Pietro Fusaroli, Giovanni Barbara, Cecilia Binda, Carlo Fabbri, Maamoun Basheer, Sarah Leblanc, Fabien Fumex, Rodica Gincul, Anthony Yuen Bun Teoh, Jérémie Jacques, Bertrand Napoléon, Andrea Lisotti
Cancers.2025; 17(12): 1983. 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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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 PubReader ePub: 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.

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Evaluation of cryoablation using a prototype cryoablation needle in swine liver: Hyunjoon Son, Jonghyun Lee, Sung Yong Han, Tae In Kim, Dong Uk Kim, Daejin Kim, Gun-Ho Kim; Clin Endosc 2024;57(5):675-682. Published online July 29, 2024; DOI: https://doi.org/10.5946/ce.2024.024

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Pancreatic cancer poses significant challenges due to its tendency for late-stage diagnosis and high mortality rates. Cryoablation, a technique used to treat various types of cancer, has shown potential in enhancing the prognosis of pancreatic cancer when combined with other therapies. However, its implementation is often limited by the need for lengthy procedures and specialized equipment. This study aims to develop a cryoablation needle optimized for endoscopic ultrasonography to simplify its application in treating pancreatic cancer.
Methods
The study involved conducting cryoablation experiments on swine liver tissue. It utilized cryo-needles to evaluate the extent of cell death across various temperatures and durations of cryoablation.
Results
The cryoablation system, which employed liquid carbon dioxide, achieved rapid cooling, reaching temperatures below –60 °C within 30 seconds and maintained the cryoablation process for 200 seconds. These conditions resulted in necrosis of the liver tissue. Notable cellular changes were observed up to 15 mm away from the cryoablation needle.
Conclusions
This experimental study successfully demonstrated the efficacy of using a cryo-needle for cryoablation in swine liver tissue. Further trials involving pancreatic tissue are expected to verify its effectiveness, underscoring the importance of continued research to establish its role as a complementary therapy in pancreatic cancer treatment.

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Puncture angle on an endoscopic ultrasound image is independently associated with unsuccessful guidewire manipulation of endoscopic ultrasound-guided hepaticogastrostomy: a retrospective study in Japan: Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Kazuhide Matsumoto, Masatoshi Murakami, Katsuhito Teramatsu, Keijiro Ueda, Masayuki Hijioka, Akira Aso, Yoshihiro Ogawa; Clin Endosc 2024;57(5):656-665. Published online July 26, 2024; DOI: https://doi.org/10.5946/ce.2023.244

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is performed globally, the procedure remains challenging. Guidewire manipulation is the most difficult step, and there are few reports on the factors associated with unsuccessful guidewire manipulation. This study aimed to assess the significance of the puncture angle on EUS images and identify the most effective guidewire rescue method for patients with unsuccessful guidewire manipulation.
Methods
We retrospectively enrolled 115 patients who underwent EUS-HGS between May 2016 and April 2022 at two centers. The puncture angle between the needle and the intrahepatic bile duct was measured through EUS movie records.
Results
Guidewire manipulation was unsuccessful in 28 patients. Receiver operating characteristic (ROC) curves identified an optimal puncture angle cutoff value of 85° (cutoff value, 85°; area under the ROC curve, 0.826; sensitivity, 85.7%; specificity, 81.6%). Multivariate analysis demonstrated that a puncture angle <85° was a significant risk factor for unsuccessful guidewire manipulation (odds ratio, 19.8; 95% confidence interval, 6.42–61.5; p<0.001). Among the 28 unsuccessful cases, 24 patients (85.7%) achieved successful guidewire manipulation using various rescue methods.
Conclusions
The puncture angle observed on EUS is crucial for guidewire manipulation. A puncture angle of <85° was associated with unsuccessful guidewire manipulation.

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Backward leap technique using a novel 0.018-inch guidewire
Kosuke Takahashi, Eisuke Ozawa, Yasuhiko Nakao, Masanori Fukushima, Hisamitsu Miyaaki, Kazuhiko Nakao
Endoscopy.2025; 57(S 01): E90. CrossRef
The Role and Appropriate Selection of Guidewires in Biliopancreatic Endoscopy
Daniele Alfieri, Claudia Delogu, Stefano Mazza, Aurelio Mauro, Erica Bartolotta, Alessandro Cappellini, Davide Scalvini, Francesca Torello Viera, Marco Bardone, Andrea Anderloni
Medicina.2025; 61(5): 913. CrossRef
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Cirugía Española (English Edition).2025; : 800259. CrossRef

5,654 View
267 Download
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3 Crossref

Comparison of bispectral index-guided endoscopic ultrasonography with continuous vs. intermittent infusion of propofol: a retrospective study in Japan: Ayana Okamoto, Ken Kamata, Tomohiro Yamazaki, Shunsuke Omoto, Kosuke Minaga, Mamoru Takenaka, Masatoshi Kudo; Clin Endosc 2024;57(6):814-820. Published online July 24, 2024; DOI: https://doi.org/10.5946/ce.2024.019

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: This study aimed to evaluate the safety and efficacy of continuous propofol infusion for anesthesia during endoscopic ultrasonography (EUS).
Methods
A total of 427 consecutive patients who underwent EUS between May 2018 and February 2019 were enrolled in this study. The patients were divided into two propofol infusion groups: continuous (n=207) and intermittent (n=220). The following parameters were compared: (1) propofol dose, (2) respiratory and circulatory depression, (3) body movement requiring discontinuation of the examination, (4) awakening score, and (5) patient satisfaction.
Results
The median total maintenance dose of propofol was significantly higher in the continuous group than in the intermittent group (160.0 mg vs. 130.0 mg, respectively); however, the reduction in SpO2 was significantly lower in the continuous group (2.9% vs. 13.2%). Body movements occurred less frequently in the continuous group than in the intermittent group (40.1% vs. 49.5%, respectively). The rate of complete awakening was significantly higher in the continuous group than in the intermittent group. Finally, there was a significant difference in the percentage of patients who answered “absolutely yes” when asked about receiving EUS again: 52.7% in the continuous group vs. 34.3% in the intermittent group.
Conclusions
Continuous infusion resulted in stable sedation and reduced propofol-associated risks.

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Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for pancreatic cystic lesions: current status and future prospects: Clement Chun Ho Wu, Samuel Jun Ming Lim, Damien Meng Yew Tan; Clin Endosc 2024;57(4):434-445. Published online July 8, 2024; DOI: https://doi.org/10.5946/ce.2023.157

Abstract PDF PubReader ePub

Pancreatic cystic lesions (PCLs) have increased in prevalence due to the increased usage and advancements in cross-sectional abdominal imaging. Current diagnostic techniques cannot distinguish between PCLs requiring surgery, close surveillance, or expectant management. This has increased the morbidity and healthcare costs from inappropriately aggressive and conservative management strategies. Endoscopic ultrasound (EUS) needle-based confocal laser endomicroscopy (nCLE) allows for microscopic examination and delineation of the surface epithelium of PCLs. Landmark studies have identified characteristics distinguishing various types of PCLs, confirmed the high diagnostic yield of EUS-nCLE (especially for PCLs with an equivocal diagnosis), and shown that EUS-nCLE helps to change management and reduce healthcare costs. Refining procedure technique and reducing procedure length have improved the safety of EUS-nCLE. The utilization of artificial intelligence and its combination with other EUS-based advanced diagnostic techniques would further improve the results of EUS-based PCL diagnosis. A structured training program and device improvements to allow more complete mapping of the pancreas cyst epithelium will be crucial for the widespread adoption of this promising technology.

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Recent Advances in Endoscopic Ultrasound (EUS) for Pancreatic Cystic Lesions
Veeral M. Oza, Anuroop Yekula, Truptesh H. Kothari
Journal of Digestive Endoscopy.2026;[Epub] CrossRef
Endoscopic techniques for the diagnosis of pancreatic cystic lesions
Sahib Singh, Saurabh Chandan, Rakesh Vinayek, Jahnvi Dhar, Jayanta Samanta, Gabriele Capurso, Ivo Boskoski, Cristiano Spada, Jorge D Machicado, Stefano Francesco Crinò, Antonio Facciorusso
World Journal of Gastroenterology.2025;[Epub] CrossRef
Endoscopic ultrasound through-the-needle biopsy of pancreatic cystic neoplasms: Update on indications, safety profile, and research directions
Joana Mota, Tiago Ribeiro, Maria Cristina Conti Bellocchi, Nicolò De Pretis, Luca Frulloni, Joanne Lopes, Sokol Sina, Jahnvi Dhar, Jayanta Samanta, Guilherme Macedo, Filipe Vilas-Boas, Stefano Francesco Crinò
Best Practice & Research Clinical Gastroenterology.2025; : 102058. CrossRef
Pathognomonic Signs in Pancreatic Cystic Lesions: What Gastroenterologists and Involved Clinicians Need to Know
Alberto Martino, Luca Barresi, Francesco Paolo Zito, Michele Amata, Roberto Fiorentino, Severo Campione, Alessandro Iacobelli, Enrico Crolla, Roberto Di Mitri, Carlo Molino, Marco Di Serafino, Giovanni Lombardi
Gastroenterology Insights.2024; 15(3): 810. CrossRef

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Role of endoscopy in eosinophilic esophagitis: Eun-Jin Yang, Kee Wook Jung; Clin Endosc 2025;58(1):1-9. Published online July 5, 2024; DOI: https://doi.org/10.5946/ce.2024.023

Abstract PDF PubReader ePub

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease involving inflammation of the esophagus. Endoscopy is essential in the diagnosis and treatment of EoE and shows typical findings, including esophageal edema, rings, exudates, furrows, and stenosis. However, studies involving pediatric and adult patients with EoE suggest that even a normally appearing esophagus can be diagnosed as EoE by endoscopic biopsy. Therefore, in patients with suspected EoE, biopsy samples should be obtained from the esophagus regardless of endoscopic appearance. Moreover, follow-up endoscopies with biopsy after therapy initiation are usually recommended to assess response. Although previous reports of endoscopic ultrasonography findings in patients with EoE have shown diffuse thickening of the esophageal wall, including lamina propria, submucosa, and muscularis propria, its role in EoE remains uncertain and requires further investigation. Endoscopic dilation or bougienage is a safe and effective procedure that can be used in combination with medical and/or dietary elimination therapy in patients with esophageal stricture for the management of dysphagia and to prevent its recurrence.

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Ga Hee Kim, Jooyoung Park, Seungju Park, Jeongeun Hwang, Jisup Lim, Kanggil Park, Sunghwan Ji, Kwangbeom Park, Jun-young Seo, Jin Hee Noh, Ji Yong Ahn, Jeong-Sik Byeon, Do Hoon Kim, Namkug Kim
Yonsei Medical Journal.2026; 67(2): 112. CrossRef
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Journal of Clinical Medicine.2025; 14(11): 3756. CrossRef
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