Clinical Endoscopy

Systematic Review and Meta-Analysis

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

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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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Clinical Outcomes and Complications of Endoscopic Biliary Stenting for Malignant Distal Biliary Obstruction in Pancreatic Cancer: A Systematic Review
Nurken Abdiyev, Nurlan Jaxymbayev, Melis Maira, Medet Rakhmetov, Almas Ismailov, Abdykadyrov Mazhit, Yerlan Abdirashev, Berik Dzhumabekov
Journal of Clinical Medicine.2026; 15(8): 3126. CrossRef

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Original Articles

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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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
Clinical Endoscopy.2026; 59(2): 245. CrossRef
Endoscopic Submucosal Dissection for Gastric Neoplasia: Scoping Review with ☸️SAIMSARA

SAIMSARA Journal.2026;[Epub] CrossRef
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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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

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/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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Review

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

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