<p>Although 55 years have passed since endoscopic retrograde cholangiopancreatography (ERCP) was first reported in 1968,<span><sup>1</sup></span> post-ERCP pancreatitis (PEP) remains a major clinical challenge. A systematic review of 108 randomized controlled trials conducted between 1977 and 2012 revealed a 9.7% incidence of PEP among 13,296 patients in the control group.<span><sup>2</sup></span> Further, a prospective multicenter observational study involving 3739 cases reported a PEP incidence of 6.9%.<span><sup>3</sup></span> Notably, several studies have documented an increasing trend in PEP incidence over time. An analysis of 1.22 million hospitalizations in the United States from 2011 to 2017 showed rising hospitalization and fatality rates associated with PEP.<span><sup>4</sup></span> This trend may be attributed to the development and increased use of new therapeutic devices such as metal stents and cholangioscopes over the past 55 years. Meanwhile, there has been significant progress in understanding and preventing PEP, with studies identifying predictive factors and preventive strategies for PEP. Unlike 55 years ago, clinicians can now assess patient-related and procedure-related risk factors for PEP before ERCP and consider appropriate preventive measures. However, effective prediction and prevention require a comprehensive understanding of the latest advancements.</p><p>In this issue of <i>Digestive Endoscopy</i>, Kato <i>et al</i>. present an in-depth review titled “Current status and issues for prediction and prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis.”<span><sup>5</sup></span> This article explores the latest prediction models, scoring systems, and newly identified patient factors. The following is a summary of changes and enduring aspects regarding PEP over the past 55 years.</p><p>In the early days of ERCP, knowledge about the risk factors for PEP was limited. There was no awareness that groups, such as young women, were at higher risk of developing PEP. Today, extensive research has identified various risk factors, often broadly categorized as patient-related factors (e.g. younger age or female sex) and procedure-related factors (e.g. difficult cannulation, repeated pancreatic duct instrumentation, or pancreatic duct guidewire placement). In recent years, anatomical factors such as large pancreatic parenchymal volume, high pancreatic fat content, and specific duodenal papilla morphology have been reported as risk factors for PEP.</p><p>As also emphasized by Kato <i>et al</i>.,<sup>5</sup> it is rare for patients undergoing ERCP to possess only a single risk factor, and several studies have reported the prediction of PEP using a prediction model and scoring system. In addition, artificial intelligence has been reported to be a helpful option for dealing with the increasingly complex risk factors of PEP in an integrated manner. The development of PEP prediction models has been reported, with fu
{"title":"What has changed and remained the same in the past 55 years regarding the prediction and prevention of postendoscopic retrograde cholangiopancreatography pancreatitis?","authors":"Mamoru Takenaka, Masatoshi Kudo","doi":"10.1111/den.15025","DOIUrl":"10.1111/den.15025","url":null,"abstract":"<p>Although 55 years have passed since endoscopic retrograde cholangiopancreatography (ERCP) was first reported in 1968,<span><sup>1</sup></span> post-ERCP pancreatitis (PEP) remains a major clinical challenge. A systematic review of 108 randomized controlled trials conducted between 1977 and 2012 revealed a 9.7% incidence of PEP among 13,296 patients in the control group.<span><sup>2</sup></span> Further, a prospective multicenter observational study involving 3739 cases reported a PEP incidence of 6.9%.<span><sup>3</sup></span> Notably, several studies have documented an increasing trend in PEP incidence over time. An analysis of 1.22 million hospitalizations in the United States from 2011 to 2017 showed rising hospitalization and fatality rates associated with PEP.<span><sup>4</sup></span> This trend may be attributed to the development and increased use of new therapeutic devices such as metal stents and cholangioscopes over the past 55 years. Meanwhile, there has been significant progress in understanding and preventing PEP, with studies identifying predictive factors and preventive strategies for PEP. Unlike 55 years ago, clinicians can now assess patient-related and procedure-related risk factors for PEP before ERCP and consider appropriate preventive measures. However, effective prediction and prevention require a comprehensive understanding of the latest advancements.</p><p>In this issue of <i>Digestive Endoscopy</i>, Kato <i>et al</i>. present an in-depth review titled “Current status and issues for prediction and prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis.”<span><sup>5</sup></span> This article explores the latest prediction models, scoring systems, and newly identified patient factors. The following is a summary of changes and enduring aspects regarding PEP over the past 55 years.</p><p>In the early days of ERCP, knowledge about the risk factors for PEP was limited. There was no awareness that groups, such as young women, were at higher risk of developing PEP. Today, extensive research has identified various risk factors, often broadly categorized as patient-related factors (e.g. younger age or female sex) and procedure-related factors (e.g. difficult cannulation, repeated pancreatic duct instrumentation, or pancreatic duct guidewire placement). In recent years, anatomical factors such as large pancreatic parenchymal volume, high pancreatic fat content, and specific duodenal papilla morphology have been reported as risk factors for PEP.</p><p>As also emphasized by Kato <i>et al</i>.,<sup>5</sup> it is rare for patients undergoing ERCP to possess only a single risk factor, and several studies have reported the prediction of PEP using a prediction model and scoring system. In addition, artificial intelligence has been reported to be a helpful option for dealing with the increasingly complex risk factors of PEP in an integrated manner. The development of PEP prediction models has been reported, with fu","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"373-375"},"PeriodicalIF":5.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>WEO has made significant strides as a global organization for the endoscopists. 2024 was another year of progress and increasing collaborations with other endoscopic societies.</p><p>WEO remains committed to the promotion of quality endoscopic education and practice throughout the world. 2024 was no exception and we have continued to evolve and conduct educational meetings not just in person but virtually and in hybrid formats to ensure we reach out to a wider audience and needs. This also keeps our environmental sustainability goals in mind.</p><p>What is needed today is the democratization of access to GI endoscopy especially to the developing world to improve global health. WEO in its part has expanded its efforts towards training and endoscopy facilitation in developing areas, in South America, in South-East Asia, and extensively in sub-Saharan Africa, building on an increasing number of official WEO training centers across the region. Since the easing of restrictions due to the recent COVID pandemic, this work is now a priority and WEO will increase its efforts towards this goal. WEO is aiming to contribute its part to make endoscopic education and training available to all and in doing so improve health care access and outcomes. As a part of our commitment and to streamline our efforts further WEO has decided to organize ENDO 2026 in Cape Town, South Africa, in conjunction with the South African societies, SAGES, SASES, and ASSA (South African Gastroenterology Society, South African Society of Endoscopic Surgeons, Association of Surgeons of South Africa). It is our hope that all our physician and industry partners will continue to support this initiative.</p><p>What we are as an organization today and how we continue to grow is mostly due to the efforts of several volunteer faculty, members, member societies and of course our industry partners. As the old African quote says “It takes a village to raise a child” WEO as an organization is indebted to the contributions of everyone involved for its growth and mission. Collaboration with sister societies has been our key pillar and WEO will forge stronger bonds with these organizations, individual members and our industry partners. While it is not easy to list all of the WEO activities, some of the key activities are listed below. WEO encourages everyone to contribute their ideas and join forces in creating globally uniform standards, access and delivery of endoscopic care.</p><p>The <i>Promoting Best Standards of Practice Series</i> of educational broadcasts included four webinars organized by the WEO Standards of Practice Committee 2024.</p><p>Video Capsule Endoscopy Network (VCEN) 2024: Launched this year, the program developed by Jean-Francois Rey, featured three webinars from March to October, culminating in the WEO Capsule Endoscopy Global Summit on November 30 in Chongquing, China, with Lars Aabakken as conference president.</p><p>A VCE session and hands-on training was organized at EN
{"title":"WEO Newsletter: WEO Update from Lars Aabakken, MD President of WEO","authors":"","doi":"10.1111/den.15012","DOIUrl":"https://doi.org/10.1111/den.15012","url":null,"abstract":"<p>WEO has made significant strides as a global organization for the endoscopists. 2024 was another year of progress and increasing collaborations with other endoscopic societies.</p><p>WEO remains committed to the promotion of quality endoscopic education and practice throughout the world. 2024 was no exception and we have continued to evolve and conduct educational meetings not just in person but virtually and in hybrid formats to ensure we reach out to a wider audience and needs. This also keeps our environmental sustainability goals in mind.</p><p>What is needed today is the democratization of access to GI endoscopy especially to the developing world to improve global health. WEO in its part has expanded its efforts towards training and endoscopy facilitation in developing areas, in South America, in South-East Asia, and extensively in sub-Saharan Africa, building on an increasing number of official WEO training centers across the region. Since the easing of restrictions due to the recent COVID pandemic, this work is now a priority and WEO will increase its efforts towards this goal. WEO is aiming to contribute its part to make endoscopic education and training available to all and in doing so improve health care access and outcomes. As a part of our commitment and to streamline our efforts further WEO has decided to organize ENDO 2026 in Cape Town, South Africa, in conjunction with the South African societies, SAGES, SASES, and ASSA (South African Gastroenterology Society, South African Society of Endoscopic Surgeons, Association of Surgeons of South Africa). It is our hope that all our physician and industry partners will continue to support this initiative.</p><p>What we are as an organization today and how we continue to grow is mostly due to the efforts of several volunteer faculty, members, member societies and of course our industry partners. As the old African quote says “It takes a village to raise a child” WEO as an organization is indebted to the contributions of everyone involved for its growth and mission. Collaboration with sister societies has been our key pillar and WEO will forge stronger bonds with these organizations, individual members and our industry partners. While it is not easy to list all of the WEO activities, some of the key activities are listed below. WEO encourages everyone to contribute their ideas and join forces in creating globally uniform standards, access and delivery of endoscopic care.</p><p>The <i>Promoting Best Standards of Practice Series</i> of educational broadcasts included four webinars organized by the WEO Standards of Practice Committee 2024.</p><p>Video Capsule Endoscopy Network (VCEN) 2024: Launched this year, the program developed by Jean-Francois Rey, featured three webinars from March to October, culminating in the WEO Capsule Endoscopy Global Summit on November 30 in Chongquing, China, with Lars Aabakken as conference president.</p><p>A VCE session and hands-on training was organized at EN","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"311-313"},"PeriodicalIF":5.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In recent years, we have seen a considerable increase in the number of patients with inflammatory bowel diseases of unknown etiology, including both Crohn's disease and ulcerative colitis. Inflammatory bowel diseases can cause intestinal lesions throughout the gastrointestinal tract, necessitating gastrointestinal endoscopy for examining all relevant aspects, especially lesion characteristics, for differential diagnosis and histological diagnosis, to select the appropriate treatment options, determine treatment effectiveness, etc. Specific guidelines are necessary to ensure that endoscopy can be performed in a safe and more tailored and efficient manner, especially since gastrointestinal endoscopy, including enteroscopy, is a common procedure worldwide, including in Japan. Within this context, the Japan Gastroenterological Endoscopy Society has formulated the “Guidelines for the Endoscopic Diagnosis and Treatment of Inflammatory Bowel Diseases” to provide detailed guidelines regarding esophagogastroduodenoscopy, enteroscopy, and colonoscopy procedures for definitive diagnosis, as well as determination of treatment effectiveness in clinical cases of inflammatory bowel diseases.
{"title":"Guidelines for endoscopic diagnosis and treatment of inflammatory bowel diseases","authors":"Takayuki Matsumoto, Tadakazu Hisamatsu, Motohiro Esaki, Teppei Omori, Hirotake Sakuraba, Shinichiro Shinzaki, Ken Sugimoto, Kento Takenaka, Makoto Naganuma, Shigeki Bamba, Takashi Hisabe, Sakiko Hiraoka, Mikihiro Fujiya, Minoru Matsuura, Shunichi Yanai, Kenji Watanabe, Haruhiko Ogata, Akira Andoh, Hiroshi Nakase, Kazuo Ohtsuka, Fumihito Hirai, Mitsuhiro Fujishiro, Yoshinori Igarashi, Shinji Tanaka","doi":"10.1111/den.15002","DOIUrl":"10.1111/den.15002","url":null,"abstract":"<p>In recent years, we have seen a considerable increase in the number of patients with inflammatory bowel diseases of unknown etiology, including both Crohn's disease and ulcerative colitis. Inflammatory bowel diseases can cause intestinal lesions throughout the gastrointestinal tract, necessitating gastrointestinal endoscopy for examining all relevant aspects, especially lesion characteristics, for differential diagnosis and histological diagnosis, to select the appropriate treatment options, determine treatment effectiveness, etc. Specific guidelines are necessary to ensure that endoscopy can be performed in a safe and more tailored and efficient manner, especially since gastrointestinal endoscopy, including enteroscopy, is a common procedure worldwide, including in Japan. Within this context, the Japan Gastroenterological Endoscopy Society has formulated the “Guidelines for the Endoscopic Diagnosis and Treatment of Inflammatory Bowel Diseases” to provide detailed guidelines regarding esophagogastroduodenoscopy, enteroscopy, and colonoscopy procedures for definitive diagnosis, as well as determination of treatment effectiveness in clinical cases of inflammatory bowel diseases.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"319-351"},"PeriodicalIF":5.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.15002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Response to “Side-by-side placement of fully covered metal stents versus 7F plastic stents in malignant hilar biliary obstruction”","authors":"Yavuz Emre Parlar","doi":"10.1111/den.15011","DOIUrl":"10.1111/den.15011","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"429"},"PeriodicalIF":5.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Response to: Site of puncture in endoscopic ultrasound-guided fine needle biopsy: Does it change diagnostic outcome?","authors":"Sung Woo Ko, Tae Jun Song","doi":"10.1111/den.14997","DOIUrl":"10.1111/den.14997","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"201"},"PeriodicalIF":5.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In recent years, the incidence of superficial nonampullary duodenal epithelial tumors (SNADETs) detected using upper gastrointestinal endoscopy has increased in asymptomatic individuals. Most SNADETs are adenomas or intramucosal adenocarcinomas for which minimally invasive endoscopic treatment is often the preferred therapeutic approach, underscoring its growing significance. However, SNADETs are less prevalent than other gastrointestinal neoplasms such as those of the esophagus, stomach, and colorectum, and endoscopic diagnostic and therapeutic modalities for these tumors remain in the developmental stage.</p><p>Endoscopic submucosal dissection (ESD) is recommended when en-bloc resection is difficult to achieve using reliable endoscopic mucosal resection (EMR) or underwater EMR (UEMR). This technique is frequently selected for SNADETs of >2 cm in size, those with scars, or those with anatomically curved locations because the en-bloc resection and R0 resection rates of ESD are higher than those of cold snare polypectomy, EMR, and UEMR.<span><sup>1</sup></span> Although duodenal ESD has been reported to have an extremely high incidence of adverse events in the past,<span><sup>2</sup></span> improvements in various resection techniques and devices, such as the water pressure method, pocket-creation method, and ESD using scissors-type forceps, have made it possible to reduce intraoperative adverse events.<span><sup>3-5</sup></span> With regard to delayed adverse events, reliable wound closure up to 3 days after endoscopic resection is important to prevent adverse events because wound closure after resection reduces the risk of delayed adverse events,<span><sup>1</sup></span> and delayed perforation occurs within 3 days after endoscopic treatments.<span><sup>6</sup></span></p><p>In this issue of <i>Digestive Endoscopy</i>, Yahagi <i>et al</i>.<span><sup>7</sup></span> conducted a retrospective cohort study of patients who underwent ESD for duodenal tumors including the papilla (ESDIP). This technique was primarily introduced for the treatment of lesions of >20 mm in size and cases with laterally spreading morphology, in which it is difficult to achieve en-bloc resection by endoscopic papillectomy (EP). The en-bloc resection rate of ESDIP is extremely high and the R0 resection rate is relatively low (96% and 46%, respectively). Furthermore, the rate of perioperative adverse events was high (intraoperative perforation, 15%; postprocedural bleeding, 19%; and post-ESDIP pancreatitis, 25%). The findings indicated that while ESDIP had a high likelihood of achieving en-bloc resection, there is a risk of perioperative adverse events.</p><p>ESDIP presents a significant technical challenge, and is associated with a high risk of complications. Although Yahagi <i>et al</i>. performed the entire ESDIP procedure using water pressure method,<span><sup>3</sup></span> which decreases intraprocedural perforation during duodenal ESD, the high rate of intraoper
{"title":"Endoscopic submucosal dissection for duodenal tumors including papilla: Is it feasible?","authors":"Osamu Dohi, Naoto Iwai, Naohisa Yoshida","doi":"10.1111/den.14991","DOIUrl":"10.1111/den.14991","url":null,"abstract":"<p>In recent years, the incidence of superficial nonampullary duodenal epithelial tumors (SNADETs) detected using upper gastrointestinal endoscopy has increased in asymptomatic individuals. Most SNADETs are adenomas or intramucosal adenocarcinomas for which minimally invasive endoscopic treatment is often the preferred therapeutic approach, underscoring its growing significance. However, SNADETs are less prevalent than other gastrointestinal neoplasms such as those of the esophagus, stomach, and colorectum, and endoscopic diagnostic and therapeutic modalities for these tumors remain in the developmental stage.</p><p>Endoscopic submucosal dissection (ESD) is recommended when en-bloc resection is difficult to achieve using reliable endoscopic mucosal resection (EMR) or underwater EMR (UEMR). This technique is frequently selected for SNADETs of >2 cm in size, those with scars, or those with anatomically curved locations because the en-bloc resection and R0 resection rates of ESD are higher than those of cold snare polypectomy, EMR, and UEMR.<span><sup>1</sup></span> Although duodenal ESD has been reported to have an extremely high incidence of adverse events in the past,<span><sup>2</sup></span> improvements in various resection techniques and devices, such as the water pressure method, pocket-creation method, and ESD using scissors-type forceps, have made it possible to reduce intraoperative adverse events.<span><sup>3-5</sup></span> With regard to delayed adverse events, reliable wound closure up to 3 days after endoscopic resection is important to prevent adverse events because wound closure after resection reduces the risk of delayed adverse events,<span><sup>1</sup></span> and delayed perforation occurs within 3 days after endoscopic treatments.<span><sup>6</sup></span></p><p>In this issue of <i>Digestive Endoscopy</i>, Yahagi <i>et al</i>.<span><sup>7</sup></span> conducted a retrospective cohort study of patients who underwent ESD for duodenal tumors including the papilla (ESDIP). This technique was primarily introduced for the treatment of lesions of >20 mm in size and cases with laterally spreading morphology, in which it is difficult to achieve en-bloc resection by endoscopic papillectomy (EP). The en-bloc resection rate of ESDIP is extremely high and the R0 resection rate is relatively low (96% and 46%, respectively). Furthermore, the rate of perioperative adverse events was high (intraoperative perforation, 15%; postprocedural bleeding, 19%; and post-ESDIP pancreatitis, 25%). The findings indicated that while ESDIP had a high likelihood of achieving en-bloc resection, there is a risk of perioperative adverse events.</p><p>ESDIP presents a significant technical challenge, and is associated with a high risk of complications. Although Yahagi <i>et al</i>. performed the entire ESDIP procedure using water pressure method,<span><sup>3</sup></span> which decreases intraprocedural perforation during duodenal ESD, the high rate of intraoper","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"411-412"},"PeriodicalIF":5.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14991","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The demand for sedation during endoscopy has been obviously increasing, as it allows endoscopists to perform endoscopic examinations safely while providing patients with a greater sense of relief and satisfaction.<span><sup>1</sup></span></p><p>Sedatives commonly used during endoscopy include midazolam, diazepam, flunitrazepam, dexmedetomidine, and propofol, each with its advantages and disadvantages. The choice of sedatives depends upon the specific needs of each facility.<span><sup>2</sup></span> In Japan, midazolam is the most frequently used sedative during endoscopy. However, patients sedated with midazolam require extended recovery time due to its long half-life and prolonged sedative effects after the procedure.<span><sup>2, 3</sup></span> The need for a recovery room thus limits the use of sedatives in clinical practice.</p><p>Remimazolam is a newly developed ultra-short-acting benzodiazepine. It has been approved by the U.S. Food and Drug Administration (FDA) and is used as a sedative during gastrointestinal endoscopy, while it is not yet covered by the Japanese insurance system. A recent meta-analysis comparing remimazolam with midazolam for sedative gastrointestinal endoscopy showed a higher procedural success, lower need for rescue medication, shorter total recall and delayed recall, and reduced adverse events.<span><sup>4</sup></span> Since remimazolam has pharmacokinetically a shorter half-life than midazolam, it can be expected to reduce both the time to alertness and the time spent in the recovery room.<span><sup>3, 4</sup></span></p><p>Propofol, another commonly used sedative for endoscopy, has the advantage of a narrower range of sedation and anesthesia than midazolam and results in a better awakening quality. However, its primary side-effects, including respiratory and circulatory depression, are often problematic. The Japan Gastroenterological Endoscopy Society's guidelines for sedation (second edition) state that propofol may be used by nonanesthesiologists if they have undergone sedation training and only for patients with American Society of Anesthesiologists-Physical Status (ASA-PS) classification I or II.<span><sup>2</sup></span></p><p>The study by Lee <i>et al</i>.<span><sup>5</sup></span> was a randomized controlled trial (RCT) that compared the effects of remimazolam and propofol on oxygen reserve during upper gastrointestinal endoscopy. For this purpose, the study used the oxygen reserve index (ORi) to investigate whether a sedative dose of remimazolam maintains better oxygenation than propofol in a state of mild hyperoxia, as experienced by patients during upper gastrointestinal endoscopy. The ORi is a respiratory parameter that reflects venous blood oxygen saturation and is useful for evaluating oxygenation status in a mild hyperoxic state with a PaO<sub>2</sub> of 100–200 mmHg, which cannot be adequately evaluated using conventional pulse oximetry.<span><sup>5</sup></span> This study found a significantly higher
{"title":"Remimazolam: Promising sedative for upper gastrointestinal endoscopy","authors":"Daisuke Yamaguchi, Motohiro Esaki","doi":"10.1111/den.14995","DOIUrl":"10.1111/den.14995","url":null,"abstract":"<p>The demand for sedation during endoscopy has been obviously increasing, as it allows endoscopists to perform endoscopic examinations safely while providing patients with a greater sense of relief and satisfaction.<span><sup>1</sup></span></p><p>Sedatives commonly used during endoscopy include midazolam, diazepam, flunitrazepam, dexmedetomidine, and propofol, each with its advantages and disadvantages. The choice of sedatives depends upon the specific needs of each facility.<span><sup>2</sup></span> In Japan, midazolam is the most frequently used sedative during endoscopy. However, patients sedated with midazolam require extended recovery time due to its long half-life and prolonged sedative effects after the procedure.<span><sup>2, 3</sup></span> The need for a recovery room thus limits the use of sedatives in clinical practice.</p><p>Remimazolam is a newly developed ultra-short-acting benzodiazepine. It has been approved by the U.S. Food and Drug Administration (FDA) and is used as a sedative during gastrointestinal endoscopy, while it is not yet covered by the Japanese insurance system. A recent meta-analysis comparing remimazolam with midazolam for sedative gastrointestinal endoscopy showed a higher procedural success, lower need for rescue medication, shorter total recall and delayed recall, and reduced adverse events.<span><sup>4</sup></span> Since remimazolam has pharmacokinetically a shorter half-life than midazolam, it can be expected to reduce both the time to alertness and the time spent in the recovery room.<span><sup>3, 4</sup></span></p><p>Propofol, another commonly used sedative for endoscopy, has the advantage of a narrower range of sedation and anesthesia than midazolam and results in a better awakening quality. However, its primary side-effects, including respiratory and circulatory depression, are often problematic. The Japan Gastroenterological Endoscopy Society's guidelines for sedation (second edition) state that propofol may be used by nonanesthesiologists if they have undergone sedation training and only for patients with American Society of Anesthesiologists-Physical Status (ASA-PS) classification I or II.<span><sup>2</sup></span></p><p>The study by Lee <i>et al</i>.<span><sup>5</sup></span> was a randomized controlled trial (RCT) that compared the effects of remimazolam and propofol on oxygen reserve during upper gastrointestinal endoscopy. For this purpose, the study used the oxygen reserve index (ORi) to investigate whether a sedative dose of remimazolam maintains better oxygenation than propofol in a state of mild hyperoxia, as experienced by patients during upper gastrointestinal endoscopy. The ORi is a respiratory parameter that reflects venous blood oxygen saturation and is useful for evaluating oxygenation status in a mild hyperoxic state with a PaO<sub>2</sub> of 100–200 mmHg, which cannot be adequately evaluated using conventional pulse oximetry.<span><sup>5</sup></span> This study found a significantly higher","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 4","pages":"400-401"},"PeriodicalIF":5.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14995","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Cesare Hassan<sup>1,2</sup> Maddalena Menini<sup>1</sup> and Alessandro Repici<sup>1,2</sup></p><p><sup>1</sup>IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy and <sup>2</sup>Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy</p><p><i>Correspondence:</i> Cesare Hassan, <i>Humanitas Research Hospital and University</i>, Via Manzoni 56, 20089 Rozzano (Milano) Italy, Tel: +39 (0)282247385, Fax: +390282242595, Email: <span>[email protected]</span></p><p>When we think of endoscopy, we think of innovation, advanced techniques, patient safety, and more. But have we ever stopped to reflect on the environmental price of these accomplishments? Could our practices be harmful to the planet's health?</p><p>To put the issue into perspective, healthcare contributes between 1% and 5% of global environmental impacts, depending on the metric considered, and surpasses 5% in certain national contexts.<span><sup>1</sup></span></p><p>Digestive endoscopy is far from blameless as it is a resource-demanding activity with a substantial but insufficiently evaluated environmental footprint.<span><sup>2</sup></span> Endoscopy is believed to be the third-largest producer of waste within the healthcare sector.<span><sup>3</sup></span></p><p>From the gallons of water and kilowatts of energy used in scope reprocessing to the mountains of single-use plastics discarded daily, our practices are leaving a footprint that can no longer be ignored.</p><p>A single reusable endoscope, over its lifecycle, emits several kilograms of CO2 for every procedure it undergoes—an unsettling irony for a tool designed to save lives. And while single-use devices are often marketed as convenient and hygienic, they create a staggering amount of non-biodegradable waste.</p><p>As endoscopists, we pride ourselves on our ability to solve complex problems, yet we seem reluctant to address one staring us in the face: the unsustainable environmental impact of our work. One could argue that environmentally friendly practices should focus on other sectors rather than healthcare, as patient safety – and healthcare quality - must always come first. Similarly, it could be argued that healthcare workers should direct their attention to advancing care rather than worrying about “recycling waste.”</p><p>However, these views are outdated. What could be more urgent than securing our survival on this planet? And is it truly the case that green endoscopy initiatives would compromise the quality of care? Often, energy-intensive and environmentally harmful practices arise not from necessity but from a lack of awareness—or simple negligence and inattention.</p><p>It's easy to dismiss these issues as beyond our control, but that mindset is part of the problem. The encouraging news is that practical, sustainable solutions are within reach. Leading societies in Gastrointestinal Endoscopy emphasize sustainability
{"title":"WEO Newsletter: Towards a Green Endoscopy","authors":"","doi":"10.1111/den.14987","DOIUrl":"10.1111/den.14987","url":null,"abstract":"<p>Cesare Hassan<sup>1,2</sup> Maddalena Menini<sup>1</sup> and Alessandro Repici<sup>1,2</sup></p><p><sup>1</sup>IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy and <sup>2</sup>Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy</p><p><i>Correspondence:</i> Cesare Hassan, <i>Humanitas Research Hospital and University</i>, Via Manzoni 56, 20089 Rozzano (Milano) Italy, Tel: +39 (0)282247385, Fax: +390282242595, Email: <span>[email protected]</span></p><p>When we think of endoscopy, we think of innovation, advanced techniques, patient safety, and more. But have we ever stopped to reflect on the environmental price of these accomplishments? Could our practices be harmful to the planet's health?</p><p>To put the issue into perspective, healthcare contributes between 1% and 5% of global environmental impacts, depending on the metric considered, and surpasses 5% in certain national contexts.<span><sup>1</sup></span></p><p>Digestive endoscopy is far from blameless as it is a resource-demanding activity with a substantial but insufficiently evaluated environmental footprint.<span><sup>2</sup></span> Endoscopy is believed to be the third-largest producer of waste within the healthcare sector.<span><sup>3</sup></span></p><p>From the gallons of water and kilowatts of energy used in scope reprocessing to the mountains of single-use plastics discarded daily, our practices are leaving a footprint that can no longer be ignored.</p><p>A single reusable endoscope, over its lifecycle, emits several kilograms of CO2 for every procedure it undergoes—an unsettling irony for a tool designed to save lives. And while single-use devices are often marketed as convenient and hygienic, they create a staggering amount of non-biodegradable waste.</p><p>As endoscopists, we pride ourselves on our ability to solve complex problems, yet we seem reluctant to address one staring us in the face: the unsustainable environmental impact of our work. One could argue that environmentally friendly practices should focus on other sectors rather than healthcare, as patient safety – and healthcare quality - must always come first. Similarly, it could be argued that healthcare workers should direct their attention to advancing care rather than worrying about “recycling waste.”</p><p>However, these views are outdated. What could be more urgent than securing our survival on this planet? And is it truly the case that green endoscopy initiatives would compromise the quality of care? Often, energy-intensive and environmentally harmful practices arise not from necessity but from a lack of awareness—or simple negligence and inattention.</p><p>It's easy to dismiss these issues as beyond our control, but that mindset is part of the problem. The encouraging news is that practical, sustainable solutions are within reach. Leading societies in Gastrointestinal Endoscopy emphasize sustainability ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"132-134"},"PeriodicalIF":5.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14987","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Tropical sprue differentiated from celiac disease: First case report in Japan","authors":"Shuji Kochi, Yumi Oshiro, Kazufumi Dohmen","doi":"10.1111/den.14988","DOIUrl":"10.1111/den.14988","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"296"},"PeriodicalIF":5.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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