Surinder Singh Rana MD, D.M, FAMS, AGAF, FASGE, Master ISG, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India
Dr. Surinder Rana is a Professor of Gastroenterology at the Post Graduate Institute of Medical Education and Research, which is a premier Medical Education Institute in India. Dr. Rana has over 500 publications in peer-reviewed journals. He is a well-known researcher, endoscopist and educator who is involved in several international and national educational conferences and endoscopy workshops.
WEO 通讯编辑：Nalini M Guda MD, MASGE, AGAF, FACG, FJGESSurinder Singh Rana MD, D.M, FAMS, AGAF, FASGE, Master ISG, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India Surinder Rana 博士是印度首屈一指的医学教育学院--研究生医学教育与研究所（PGIMER）的胃肠病学教授。拉纳博士在同行评审期刊上发表了 500 多篇论文。他是一位著名的研究员、内镜医师和教育家，参与了多个国际和国内教育会议及内镜研讨会。
{"title":"WEO Newsletter: Evaluation and Endoscopic Management of Disconnected Pancreatic Duct Syndrome","authors":"","doi":"10.1111/den.14960","DOIUrl":"10.1111/den.14960","url":null,"abstract":"<p>WEO Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES</p><p>Surinder Singh Rana MD, D.M, FAMS, AGAF, FASGE, Master ISG, Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India</p><p>Dr. Surinder Rana is a Professor of Gastroenterology at the Post Graduate Institute of Medical Education and Research, which is a premier Medical Education Institute in India. Dr. Rana has over 500 publications in peer-reviewed journals. He is a well-known researcher, endoscopist and educator who is involved in several international and national educational conferences and endoscopy workshops.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1292-1294"},"PeriodicalIF":5.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14960","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607718","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>Endoscopic bile duct stenting has been the first-line treatment for bile duct obstruction, regardless of resectability or benign/malignant status,<span><sup>1-3</sup></span> although the criteria for evaluating the outcome of bile duct stents have not been adequately explored. For example, since the definition of stent occlusion varied across different articles, a meta-analysis of bile duct stent outcomes was summarized as stent dysfunction in terms of results. Furthermore, while stent occlusion due to tumor invasion was the main stent dysfunction in the case of inserted plastic stents or uncovered self-expandable metallic stents (SEMS), the advent of covered SEMS has made it necessary to consider stent migration or dislocation as a stent dysfunction.<span><sup>4, 5</sup></span> In this context, a need existed for common definitions regarding procedure-related early outcomes for stents, outcomes of stents during follow-up, and adverse events. Previous TOKYO criteria defined terms associated with the technical and clinical success of biliary stenting, recurrent biliary obstruction (RBO) and related factors, and adverse events.<span><sup>6</sup></span> Technical success was defined as the ability of the stent to adequately bypass the planned bile duct stenosis site, and clinical success was defined as a normal or 50% reduction in total bilirubin levels within 14 days of stent placement. In addition, RBO was defined as an outcome measure, including occlusion or deviation, used to assess the duration of stent function from the date of stent placement. An important aspect of RBO was that it focused on symptoms rather than stent patency alone. The time of symptom recurrence due to stent occlusion or deviation was specified as the time of onset of RBO, and this time point was to be used for assessment. The causes of obstruction of the RBO, such as internal growths associated with tumor growth, tumor growths on the edge of the stent, biliary debris or food residues, the direction of stent dislocation or migration (intrahepatic bile duct or duodenal papillary side), and whether pancreatitis or cholecystitis was present, were to be described separately. In addition, items on survival and contingencies other than RBOs have been created and described uniformly to provide an overall clinical picture from the results of clinical studies.</p><p>The progress of biliary drainage over the past decade has been so rapid that it has become increasingly difficult to cover it in the previous TOKYO criteria. For example, balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) for cases with altered anatomy has become widely used.<span><sup>7</sup></span> In ERCP for patients with altered anatomy, the rate of reach to the bile duct orifice should be included in the assessment of technical success.<span><sup>8</sup></span> Endoscopic ultrasound-biliary drainage (EUS-BD) is also widely recognized as a common procedure. It does not bypass the bil
{"title":"New milestone for clinical research about biliary drainage","authors":"Atsushi Kanno, Hironori Yamamoto","doi":"10.1111/den.14934","DOIUrl":"10.1111/den.14934","url":null,"abstract":"<p>Endoscopic bile duct stenting has been the first-line treatment for bile duct obstruction, regardless of resectability or benign/malignant status,<span><sup>1-3</sup></span> although the criteria for evaluating the outcome of bile duct stents have not been adequately explored. For example, since the definition of stent occlusion varied across different articles, a meta-analysis of bile duct stent outcomes was summarized as stent dysfunction in terms of results. Furthermore, while stent occlusion due to tumor invasion was the main stent dysfunction in the case of inserted plastic stents or uncovered self-expandable metallic stents (SEMS), the advent of covered SEMS has made it necessary to consider stent migration or dislocation as a stent dysfunction.<span><sup>4, 5</sup></span> In this context, a need existed for common definitions regarding procedure-related early outcomes for stents, outcomes of stents during follow-up, and adverse events. Previous TOKYO criteria defined terms associated with the technical and clinical success of biliary stenting, recurrent biliary obstruction (RBO) and related factors, and adverse events.<span><sup>6</sup></span> Technical success was defined as the ability of the stent to adequately bypass the planned bile duct stenosis site, and clinical success was defined as a normal or 50% reduction in total bilirubin levels within 14 days of stent placement. In addition, RBO was defined as an outcome measure, including occlusion or deviation, used to assess the duration of stent function from the date of stent placement. An important aspect of RBO was that it focused on symptoms rather than stent patency alone. The time of symptom recurrence due to stent occlusion or deviation was specified as the time of onset of RBO, and this time point was to be used for assessment. The causes of obstruction of the RBO, such as internal growths associated with tumor growth, tumor growths on the edge of the stent, biliary debris or food residues, the direction of stent dislocation or migration (intrahepatic bile duct or duodenal papillary side), and whether pancreatitis or cholecystitis was present, were to be described separately. In addition, items on survival and contingencies other than RBOs have been created and described uniformly to provide an overall clinical picture from the results of clinical studies.</p><p>The progress of biliary drainage over the past decade has been so rapid that it has become increasingly difficult to cover it in the previous TOKYO criteria. For example, balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) for cases with altered anatomy has become widely used.<span><sup>7</sup></span> In ERCP for patients with altered anatomy, the rate of reach to the bile duct orifice should be included in the assessment of technical success.<span><sup>8</sup></span> Endoscopic ultrasound-biliary drainage (EUS-BD) is also widely recognized as a common procedure. It does not bypass the bil","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1211-1212"},"PeriodicalIF":5.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14934","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482278","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 Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES</p><p><b>Dr. Sridhar Sundaram</b></p><p><b>MD, DM, FISG</b></p><p>Present Designation:</p><p>Professor (Gastroenterology), Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai</p><p>Consultant- GI Disease Management Group, Tata Memorial Hospital, Mumbai</p><p>Governing Council Member – Indian Society of Gastroenterology</p><p>Member – ESGE Diversity and Equity Working Group</p><p>Managing Editor – Indian Journal of Gastroenterology</p><p>Member – India EUS Club</p><p>Primary areas of interest: Therapeutic Endoscopic Ultrasound, Endoscopic Resection techniques for early GI cancer</p><p>Abdominal pain due to perineural invasion is one of the most debilitating symptoms associated with pancreaticobiliary cancers. In addition, pain remains one of the most complex symptoms associated with chronic pancreatitis needing intervention (<span>1</span>). Pain from upper abdominal viscera is transmitted via the afferent pathway to the celiac plexus leading into the spinal cord at the T12-L2 level. The efferents from the celiac plexus consists mainly of sympathetic fibres of a network of interconnected para-aortic ganglia, including those at the level of the celiac axis, superior mesenteric artery origin and also renal artery. In addition, parasympathetic efferents of the celiac plexus come from the vagus nerve (<span>2</span>). Traditionally celiac plexus block was performed as an intraoperative ablative procedure. Subsequently fluoroscopy guided celiac plexus interventions were performed. Endoscopic Ultrasound guided celiac plexus block (CPB) was first described in 1996 and has now become the standard of care (<span>3</span>).</p><p>Chronic pancreatitis patients with pain not responding to conventional measures like pancreatic enzyme replacement, antioxidants, non-narcotic and narcotic medications may be candidates who may benefit in short term from CPB. However, the caveat remains that block provides temporary relief and may be an adjunct to other modalities. Celiac plexus neurolysis (CPN) is recommended only in the setting of inoperable pancreatic cancer. In cases of operable pancreatic cancer, neurolysis may lead to scarring the operative field, thereby making surgery technically more challenging. Most patients who do not respond to conventional opioids or require significantly higher doses with adverse events are candidates to consider CPN (<span>4</span>).</p><p>CPB is typically for patients with pain not responding to analgesics and can be repeated at 3–6 months intervals. As pain becomes chronic, response to CPB is likely to be lesser, considering formation of neural feedback loops with cerebral pain conditioning. In patients with pancreatic cancer, pain responds better earlier in the course of disease to CPN. As disease progresses and pain persists, the neural pathways become less responsive and efficacy of CPN reduce
{"title":"WEO Newsletter: Tips and Tricks for Endoscopic Ultrasound guided Celiac Plexus interventions","authors":"","doi":"10.1111/den.14935","DOIUrl":"10.1111/den.14935","url":null,"abstract":"<p>WEO Newsletter Editor: Nalini M Guda MD, MASGE, AGAF, FACG, FJGES</p><p><b>Dr. Sridhar Sundaram</b></p><p><b>MD, DM, FISG</b></p><p>Present Designation:</p><p>Professor (Gastroenterology), Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai</p><p>Consultant- GI Disease Management Group, Tata Memorial Hospital, Mumbai</p><p>Governing Council Member – Indian Society of Gastroenterology</p><p>Member – ESGE Diversity and Equity Working Group</p><p>Managing Editor – Indian Journal of Gastroenterology</p><p>Member – India EUS Club</p><p>Primary areas of interest: Therapeutic Endoscopic Ultrasound, Endoscopic Resection techniques for early GI cancer</p><p>Abdominal pain due to perineural invasion is one of the most debilitating symptoms associated with pancreaticobiliary cancers. In addition, pain remains one of the most complex symptoms associated with chronic pancreatitis needing intervention (<span>1</span>). Pain from upper abdominal viscera is transmitted via the afferent pathway to the celiac plexus leading into the spinal cord at the T12-L2 level. The efferents from the celiac plexus consists mainly of sympathetic fibres of a network of interconnected para-aortic ganglia, including those at the level of the celiac axis, superior mesenteric artery origin and also renal artery. In addition, parasympathetic efferents of the celiac plexus come from the vagus nerve (<span>2</span>). Traditionally celiac plexus block was performed as an intraoperative ablative procedure. Subsequently fluoroscopy guided celiac plexus interventions were performed. Endoscopic Ultrasound guided celiac plexus block (CPB) was first described in 1996 and has now become the standard of care (<span>3</span>).</p><p>Chronic pancreatitis patients with pain not responding to conventional measures like pancreatic enzyme replacement, antioxidants, non-narcotic and narcotic medications may be candidates who may benefit in short term from CPB. However, the caveat remains that block provides temporary relief and may be an adjunct to other modalities. Celiac plexus neurolysis (CPN) is recommended only in the setting of inoperable pancreatic cancer. In cases of operable pancreatic cancer, neurolysis may lead to scarring the operative field, thereby making surgery technically more challenging. Most patients who do not respond to conventional opioids or require significantly higher doses with adverse events are candidates to consider CPN (<span>4</span>).</p><p>CPB is typically for patients with pain not responding to analgesics and can be repeated at 3–6 months intervals. As pain becomes chronic, response to CPB is likely to be lesser, considering formation of neural feedback loops with cerebral pain conditioning. In patients with pancreatic cancer, pain responds better earlier in the course of disease to CPN. As disease progresses and pain persists, the neural pathways become less responsive and efficacy of CPN reduce","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 10","pages":"1185-1189"},"PeriodicalIF":5.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14935","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402208","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":"Failed endoscopic ultrasound-guided gallbladder drainage across the duodenal covered metallic stent salvaged by using a forward-viewing linear echoendoscope.","authors":"Tesshin Ban,Yoshimasa Kubota,Takashi Joh","doi":"10.1111/den.14931","DOIUrl":"https://doi.org/10.1111/den.14931","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"16 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256012","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>Professor Hisao Tajiri, WEO and ENDO 2024 President made the following statement:</p><p>“ENDO 2024 had 3200 participants from all over the world despite the current medical strike happening in Korea, and we were able to have an intimate international exchange through many symposia, live demonstrations, hands-on courses, receptions, and so on. Many young doctors from developing countries in Asia also participated in the Congress. I believe that our WEO was instrumental in fulfilling its mission in terms of education for developing countries.</p><p>I sincerely appreciate the strong support of Prof Hoon Jai Chun, ENDO 2024 Congress Co-President and Prof Jong-Jae Park, President of KSGE [Korean Society of Gastrointestinal Endoscopy] and IDEN [International Digestive Endoscopy Network], and many other doctors involved in KSGE.</p><p>And I also thank organizing committee members of ENDO 2024, Dr. Jean-Francois Rey, Chair of the Steering Committee, Drs. Philip Chiu and Jong Ho Moon, Chair and Co-Chair of the Scientific Committee, Dr. Robert Hawes, Treasurer, Dr. Yutaka Saito, WEO Secretary General, colleagues in Japan, and all other organizing committee members including WEO office staff. I would like to express my sincere gratitude to all of them.</p><p>From Seoul, Korea, through the top experts of GI endoscopy, new insights and bright futures were brought to many endoscopists. I believe that the three-day program met the expectations of all gastroenterologists, endoscopists, and nurses who participated in ENDO 2024. The overwhelming response we have received from the participants, faculty, and industry alike is a great testament to the quality of the Congress and its high relevance to continuing education and to medical advancement; the initiation of both of those is part of WEO's mission, as well as maintaining the quality of endoscopic teaching.</p><p>Some highlights of ENDO 2024 included six outstanding live demonstrations and discussions from three international and three of the most advanced Korean centers, 22 hands-on training stations, 8 of WEO's best-established educational courses, 10 joint symposia with our global partners, 5 KSGE-IDEN sessions and 2 young endoscopist forums, 17 sessions presenting the ENDO 2024 best oral abstracts, and 23 innovative industry symposia.</p><p>ENDO 2024 was honored to host several distinguished educational lectures, by Joo Young Cho (Korea), Fabian Emura (Colombia), Ian Gralnek (Israel), and Nageshwar Reddy (India).</p><p>As is traditional at ENDO congresses, the learning track offered well-established WEO courses including the Advanced Diagnosis Endoscopy Course (ADEC), Colorectal Cancer Screening Committee meetings, WEO International School of Endoscopy (WISE) sessions, the Research Forum, Video Capsule Endoscopy (VCE) and High-Q courses. A Women in Endoscopy session was held for the first time, covering gender-related aspects of endoscopy. ENDO 2024 President Hisao Tajiri commemorated this as the last se
{"title":"WEO Newsletter: ENDO 2024 was a great success! Thanks to all who participated","authors":"","doi":"10.1111/den.14920","DOIUrl":"https://doi.org/10.1111/den.14920","url":null,"abstract":"<p>Professor Hisao Tajiri, WEO and ENDO 2024 President made the following statement:</p><p>“ENDO 2024 had 3200 participants from all over the world despite the current medical strike happening in Korea, and we were able to have an intimate international exchange through many symposia, live demonstrations, hands-on courses, receptions, and so on. Many young doctors from developing countries in Asia also participated in the Congress. I believe that our WEO was instrumental in fulfilling its mission in terms of education for developing countries.</p><p>I sincerely appreciate the strong support of Prof Hoon Jai Chun, ENDO 2024 Congress Co-President and Prof Jong-Jae Park, President of KSGE [Korean Society of Gastrointestinal Endoscopy] and IDEN [International Digestive Endoscopy Network], and many other doctors involved in KSGE.</p><p>And I also thank organizing committee members of ENDO 2024, Dr. Jean-Francois Rey, Chair of the Steering Committee, Drs. Philip Chiu and Jong Ho Moon, Chair and Co-Chair of the Scientific Committee, Dr. Robert Hawes, Treasurer, Dr. Yutaka Saito, WEO Secretary General, colleagues in Japan, and all other organizing committee members including WEO office staff. I would like to express my sincere gratitude to all of them.</p><p>From Seoul, Korea, through the top experts of GI endoscopy, new insights and bright futures were brought to many endoscopists. I believe that the three-day program met the expectations of all gastroenterologists, endoscopists, and nurses who participated in ENDO 2024. The overwhelming response we have received from the participants, faculty, and industry alike is a great testament to the quality of the Congress and its high relevance to continuing education and to medical advancement; the initiation of both of those is part of WEO's mission, as well as maintaining the quality of endoscopic teaching.</p><p>Some highlights of ENDO 2024 included six outstanding live demonstrations and discussions from three international and three of the most advanced Korean centers, 22 hands-on training stations, 8 of WEO's best-established educational courses, 10 joint symposia with our global partners, 5 KSGE-IDEN sessions and 2 young endoscopist forums, 17 sessions presenting the ENDO 2024 best oral abstracts, and 23 innovative industry symposia.</p><p>ENDO 2024 was honored to host several distinguished educational lectures, by Joo Young Cho (Korea), Fabian Emura (Colombia), Ian Gralnek (Israel), and Nageshwar Reddy (India).</p><p>As is traditional at ENDO congresses, the learning track offered well-established WEO courses including the Advanced Diagnosis Endoscopy Course (ADEC), Colorectal Cancer Screening Committee meetings, WEO International School of Endoscopy (WISE) sessions, the Research Forum, Video Capsule Endoscopy (VCE) and High-Q courses. A Women in Endoscopy session was held for the first time, covering gender-related aspects of endoscopy. ENDO 2024 President Hisao Tajiri commemorated this as the last se","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 9","pages":"1062-1071"},"PeriodicalIF":5.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14920","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231066","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}
Endoscopic ultrasound (EUS)-guided drainage effectively treats difficult transpapillary drainage.1, 2 However, EUS-guided pancreatic duct drainage (EUS-PD) is technically challenging, as repuncture should be avoided to prevent pancreatic fluid leakage; we describe a technique for EUS-PD stent migration that enables us to avoid repuncture (Video S1).3 A 54-year-old woman, who underwent pancreaticoduodenectomy for pancreatic cancer, experienced recurrent cholangitis and pancreatic stones due to anastomotic stenosis. Endoscopic drainage using a single-balloon enteroscope (SIF-H290S; Olympus, Tokyo, Japan) was attempted, but identifying the pancreatic duct orifice was difficult. Therefore, EUS-PD was performed to secure the route for stone removal. A 19G needle (EZ shot 3 plus; Olympus) was used to puncture the dilated pancreatic duct at the tail. The drill dilator (Tornus ES; Olympus) could not pass the stone. A 4 mm dilating balloon (REN TYPE-IT; Kaneka, Osaka, Japan) was used. After adequate dilation, a 7Fr plastic stent (TYPE IT; Gadelius Medical, Tokyo, Japan) was deployed, but its tip failed to cross the stone and anastomosis, so the stent was placed in the main pancreatic duct proximal to the stone.4 Vomiting and fever occurred postprocedure, and radiography revealed stent migration into the esophagus. However, computed tomography revealed the stent tip barely lodged in the pancreatic duct owing to the large flap. Therefore, using a side-viewing duodenoscope (TJF-260 V; Olympus), a guidewire (VisiGlide II; Olympus) was successfully inserted through the stent flap and guided into the jejunum. The stent was removed using forceps (Figs 1, 2). The tract and anastomotic site were sufficiently dilated using a drill dilator, and a 6 mm fully covered self-expandable metal stent (EGIS biliary stent, 6 × 10 mm; SB-Kawsumi, Kanagawa, Japan) was successfully placed. One month later, the stone was successfully removed by the EUS-PD route. A plastic stent has two large flaps at its tip, and even if it migrates, the flap may remain in the pancreas.
Author T.I. received honoraria for his lectures from Olympus and Boston Scientific. The other authors declare no conflict of interest for this article.
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{"title":"Troubleshooting the migration of endoscopic ultrasound-guided pancreatic duct drainage stent to avoid repuncture","authors":"Kazuki Hama, Reina Tanaka, Takao Itoi","doi":"10.1111/den.14906","DOIUrl":"10.1111/den.14906","url":null,"abstract":"<p>Endoscopic ultrasound (EUS)-guided drainage effectively treats difficult transpapillary drainage.<span><sup>1, 2</sup></span> However, EUS-guided pancreatic duct drainage (EUS-PD) is technically challenging, as repuncture should be avoided to prevent pancreatic fluid leakage; we describe a technique for EUS-PD stent migration that enables us to avoid repuncture (Video S1).<span><sup>3</sup></span> A 54-year-old woman, who underwent pancreaticoduodenectomy for pancreatic cancer, experienced recurrent cholangitis and pancreatic stones due to anastomotic stenosis. Endoscopic drainage using a single-balloon enteroscope (SIF-H290S; Olympus, Tokyo, Japan) was attempted, but identifying the pancreatic duct orifice was difficult. Therefore, EUS-PD was performed to secure the route for stone removal. A 19G needle (EZ shot 3 plus; Olympus) was used to puncture the dilated pancreatic duct at the tail. The drill dilator (Tornus ES; Olympus) could not pass the stone. A 4 mm dilating balloon (REN TYPE-IT; Kaneka, Osaka, Japan) was used. After adequate dilation, a 7Fr plastic stent (TYPE IT; Gadelius Medical, Tokyo, Japan) was deployed, but its tip failed to cross the stone and anastomosis, so the stent was placed in the main pancreatic duct proximal to the stone.<span><sup>4</sup></span> Vomiting and fever occurred postprocedure, and radiography revealed stent migration into the esophagus. However, computed tomography revealed the stent tip barely lodged in the pancreatic duct owing to the large flap. Therefore, using a side-viewing duodenoscope (TJF-260 V; Olympus), a guidewire (VisiGlide II; Olympus) was successfully inserted through the stent flap and guided into the jejunum. The stent was removed using forceps (Figs 1, 2). The tract and anastomotic site were sufficiently dilated using a drill dilator, and a 6 mm fully covered self-expandable metal stent (EGIS biliary stent, 6 × 10 mm; SB-Kawsumi, Kanagawa, Japan) was successfully placed. One month later, the stone was successfully removed by the EUS-PD route. A plastic stent has two large flaps at its tip, and even if it migrates, the flap may remain in the pancreas.</p><p>Author T.I. received honoraria for his lectures from Olympus and Boston Scientific. The other authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1288-1289"},"PeriodicalIF":5.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14906","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195514","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}
Yingjie Guo, Fan Yin, Xingsi Qi, Peng Zhang, Xueguo Sun, Xueli Ding, Xiaoyu Li, Xue Jing, Yueping Jiang, Zibin Tian, Tao Mao
ObjectivesEndoscopic full‐thickness resection (EFTR) for submucosal tumors (SMTs) has been technically challenging. This retrospective study aimed to evaluate the feasibility, safety, and efficacy of EFTR for upper gastrointestinal (GI) SMTs, including extraluminal lesions.MethodsWe retrospectively investigated 232 patients with SMTs who underwent EFTR from January 2014 to August 2023. Clinicopathologic characteristics, procedure‐related parameters, adverse events (AEs), and follow‐up outcomes were assessed in all patients.ResultsThe en‐bloc resection and en‐bloc with R0 resection rates were 98.7% and 96.1%, respectively. The average endoscopic tumor size measured 17.2 ± 8.7 mm, ranging from 6 to 50 mm. The resection time and suture time were 49.0 ± 19.4 min and 22.5 ± 11.6 min, respectively. In all, 39 lesions (16.8%) exhibited predominantly extraluminal growth. Gastrointestinal stromal tumors (GISTs) were the predominant pathology, accounting for 78.4% of the cases. Twenty‐one patients (9.1%) encountered complications, including pneumothorax (1/232, 0.43%), hydrothorax (1/232, 0.43%), localized peritonitis (3/232, 1.29%), and fever (16/232, 6.9%). Although the incidence of postoperative fever was notably higher in the predominantly extraluminal group (7/39, 17.9%) compared to the predominantly intraluminal group (9/193, 4.7%, P = 0.008), there were no significant differences in outcomes of the EFTR procedure. No instances of recurrence were observed during the mean follow‐up period of 3.7 ± 2.3 years.ConclusionEFTR was found to be feasible, safe, and effective for resecting upper GI SMTs, including lesions with predominantly extraluminal growth. Further validation in a prospective study is warranted.
{"title":"Feasibility and safety of endoscopic full‐thickness resection for submucosal tumors in the upper gastrointestinal tract, including predominantly extraluminal submucosal tumors (with video)","authors":"Yingjie Guo, Fan Yin, Xingsi Qi, Peng Zhang, Xueguo Sun, Xueli Ding, Xiaoyu Li, Xue Jing, Yueping Jiang, Zibin Tian, Tao Mao","doi":"10.1111/den.14918","DOIUrl":"https://doi.org/10.1111/den.14918","url":null,"abstract":"ObjectivesEndoscopic full‐thickness resection (EFTR) for submucosal tumors (SMTs) has been technically challenging. This retrospective study aimed to evaluate the feasibility, safety, and efficacy of EFTR for upper gastrointestinal (GI) SMTs, including extraluminal lesions.MethodsWe retrospectively investigated 232 patients with SMTs who underwent EFTR from January 2014 to August 2023. Clinicopathologic characteristics, procedure‐related parameters, adverse events (AEs), and follow‐up outcomes were assessed in all patients.ResultsThe en‐bloc resection and en‐bloc with R0 resection rates were 98.7% and 96.1%, respectively. The average endoscopic tumor size measured 17.2 ± 8.7 mm, ranging from 6 to 50 mm. The resection time and suture time were 49.0 ± 19.4 min and 22.5 ± 11.6 min, respectively. In all, 39 lesions (16.8%) exhibited predominantly extraluminal growth. Gastrointestinal stromal tumors (GISTs) were the predominant pathology, accounting for 78.4% of the cases. Twenty‐one patients (9.1%) encountered complications, including pneumothorax (1/232, 0.43%), hydrothorax (1/232, 0.43%), localized peritonitis (3/232, 1.29%), and fever (16/232, 6.9%). Although the incidence of postoperative fever was notably higher in the predominantly extraluminal group (7/39, 17.9%) compared to the predominantly intraluminal group (9/193, 4.7%, <jats:italic>P</jats:italic> = 0.008), there were no significant differences in outcomes of the EFTR procedure. No instances of recurrence were observed during the mean follow‐up period of 3.7 ± 2.3 years.ConclusionEFTR was found to be feasible, safe, and effective for resecting upper GI SMTs, including lesions with predominantly extraluminal growth. Further validation in a prospective study is warranted.","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"2 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195510","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}
Jean‐Michel Gonzalez, Sohaib Ouazzani, Geoffroy Vanbiervliet, Mohamed Gasmi, Marc Barthet
ObjectivesEndoscopic ultrasound‐guided gastrojejunostomy (EUS‐GJ) is an alternative to duodenal stenting and surgical GJ (SGGJ) in malignant gastric outlet obstruction (MGOO). European Society of Gastrointestinal Endoscopy guidelines restricted EUS‐GJ for MGOO only, because of misdeployment. The aim was to evaluate its outcomes focusing on benign indications.MethodsThis was a retrospective study conducted from 2016 to 2023 in a tertiary center. Patients included had malignant or benign GOO indicated for EUS‐GJ. Techniques were the direct approach until August 2021, and the wire endoscopic simplified technique (WEST) afterwards. The main objective was to compare outcomes in benign vs. MGOO. Secondary end‐points were technical success, adverse events rates, and describing the evolution of techniques and indications.ResultsIn all, 87 patients were included, 46 men, mean age 66 ± 16.2 years. Indications were malignant in 60.1% and benign in 39.1%. The EUS‐GJ technique was direct in 33 patients (37.9%) and WEST in 54 (62.1%). No difference was found in terms of technical, clinical, or adverse events rates. The initial technical success rate was 88.5%. The final technical and clinical success rates were 96.6% and 94.25%, respectively. In the last year, benign exceeded malignant indications (70.4% vs. 29.6%, P < 0.05). Seven misdeployments occurred, six being addressed with the rescue technique. The misdeployment rate was significantly decreased using the WEST approach compared to the direct one: 3.7% vs. 18% (P < 0.05). The severe postoperative adverse events rate was 2.3%.ConclusionThis study demonstrated similar outcomes of EUS‐GJ between benign and MGOO, with a decreasing misdeployment rate (<4%) applying WEST. This represents an additional step towards recommending EUS‐GJ in benign indications.
{"title":"Endoscopic ultrasound‐guided gastrojejunostomy with wire endoscopic simplified technique: Move towards benign indications (with video)","authors":"Jean‐Michel Gonzalez, Sohaib Ouazzani, Geoffroy Vanbiervliet, Mohamed Gasmi, Marc Barthet","doi":"10.1111/den.14895","DOIUrl":"https://doi.org/10.1111/den.14895","url":null,"abstract":"ObjectivesEndoscopic ultrasound‐guided gastrojejunostomy (EUS‐GJ) is an alternative to duodenal stenting and surgical GJ (SGGJ) in malignant gastric outlet obstruction (MGOO). European Society of Gastrointestinal Endoscopy guidelines restricted EUS‐GJ for MGOO only, because of misdeployment. The aim was to evaluate its outcomes focusing on benign indications.MethodsThis was a retrospective study conducted from 2016 to 2023 in a tertiary center. Patients included had malignant or benign GOO indicated for EUS‐GJ. Techniques were the direct approach until August 2021, and the wire endoscopic simplified technique (WEST) afterwards. The main objective was to compare outcomes in benign vs. MGOO. Secondary end‐points were technical success, adverse events rates, and describing the evolution of techniques and indications.ResultsIn all, 87 patients were included, 46 men, mean age 66 ± 16.2 years. Indications were malignant in 60.1% and benign in 39.1%. The EUS‐GJ technique was direct in 33 patients (37.9%) and WEST in 54 (62.1%). No difference was found in terms of technical, clinical, or adverse events rates. The initial technical success rate was 88.5%. The final technical and clinical success rates were 96.6% and 94.25%, respectively. In the last year, benign exceeded malignant indications (70.4% vs. 29.6%, <jats:italic>P</jats:italic> < 0.05). Seven misdeployments occurred, six being addressed with the rescue technique. The misdeployment rate was significantly decreased using the WEST approach compared to the direct one: 3.7% vs. 18% (<jats:italic>P</jats:italic> < 0.05). The severe postoperative adverse events rate was 2.3%.ConclusionThis study demonstrated similar outcomes of EUS‐GJ between benign and MGOO, with a decreasing misdeployment rate (<4%) applying WEST. This represents an additional step towards recommending EUS‐GJ in benign indications.","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"1 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195512","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}
ObjectivesAlthough the incidence of isolated gastric varices type 1 (IGV1) bleeding is low, the condition is highly dangerous and associated with high mortality, making its treatment challenging. We aimed to compare the safety and efficacy of endoscopic clipping combined with cyanoacrylate injection (EC‐CYA) vs. transjugular intrahepatic portosystemic shunt (TIPS) in treating IGV1.MethodsIn a single‐center, randomized controlled trial, patients with IGV1 bleeding were randomly assigned to the EC‐CYA group or TIPS group. The primary end‐points were gastric variceal rebleeding rates and technical success. Secondary end‐points included cumulative nonbleeding rates, mortality, and complications.ResultsA total of 156 patients between January 2019 and April 2023 were selected and randomly assigned to the EC‐CYA group (n = 76) and TIPS group (n = 80). The technical success rate was 100% for both groups. The rebleeding rates were 14.5% in the EC‐CYA group and 8.8% in the TIPS group, showing no significant difference (P = 0.263). Kaplan–Meier analysis revealed that the cumulative nonbleeding rates at 6, 12, 24, and 36 months for the two groups lacked statistical significance (P = 0.344). Similarly, cumulative survival rates at 12, 24, and 36 months for the two groups were not statistically significant (P = 0.916). The bleeding rates from other causes were 13.2% and 6.3% for the respective groups, showing no significant difference (P = 0.144). No instances of ectopic embolism were observed in either group. The incidence of hepatic encephalopathy (HE) in the TIPS group was statistically higher than that in the EC‐CYA group (P = 0.001).ConclusionBoth groups are effective in controlling IGV1 bleeding. Notably, EC‐CYA did not result in ectopic embolism, and the incidence of HE was lower than that observed with TIPS.
{"title":"Endoscopic clipping combined with cyanoacrylate injection vs. transjugular intrahepatic portosystemic shunt in the treatment of isolated gastric variceal bleeding: Randomized controlled trial","authors":"Jing Li, Zhaoyi Chen, Yaxian Kuai, Fumin Zhang, Huixian Li, Derun Kong","doi":"10.1111/den.14916","DOIUrl":"https://doi.org/10.1111/den.14916","url":null,"abstract":"ObjectivesAlthough the incidence of isolated gastric varices type 1 (IGV1) bleeding is low, the condition is highly dangerous and associated with high mortality, making its treatment challenging. We aimed to compare the safety and efficacy of endoscopic clipping combined with cyanoacrylate injection (EC‐CYA) vs. transjugular intrahepatic portosystemic shunt (TIPS) in treating IGV1.MethodsIn a single‐center, randomized controlled trial, patients with IGV1 bleeding were randomly assigned to the EC‐CYA group or TIPS group. The primary end‐points were gastric variceal rebleeding rates and technical success. Secondary end‐points included cumulative nonbleeding rates, mortality, and complications.ResultsA total of 156 patients between January 2019 and April 2023 were selected and randomly assigned to the EC‐CYA group (<jats:italic>n</jats:italic> = 76) and TIPS group (<jats:italic>n</jats:italic> = 80). The technical success rate was 100% for both groups. The rebleeding rates were 14.5% in the EC‐CYA group and 8.8% in the TIPS group, showing no significant difference (<jats:italic>P</jats:italic> = 0.263). Kaplan–Meier analysis revealed that the cumulative nonbleeding rates at 6, 12, 24, and 36 months for the two groups lacked statistical significance (<jats:italic>P</jats:italic> = 0.344). Similarly, cumulative survival rates at 12, 24, and 36 months for the two groups were not statistically significant (<jats:italic>P</jats:italic> = 0.916). The bleeding rates from other causes were 13.2% and 6.3% for the respective groups, showing no significant difference (<jats:italic>P</jats:italic> = 0.144). No instances of ectopic embolism were observed in either group. The incidence of hepatic encephalopathy (HE) in the TIPS group was statistically higher than that in the EC‐CYA group (<jats:italic>P</jats:italic> = 0.001).ConclusionBoth groups are effective in controlling IGV1 bleeding. Notably, EC‐CYA did not result in ectopic embolism, and the incidence of HE was lower than that observed with TIPS.","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"65 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195511","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}
The remarkable recent developments in image‐enhanced endoscopy (IEE) have significantly contributed to the advancement of diagnostic techniques. Linked color imaging (LCI) is an IEE technique in which color differences are expanded by processing image data to enhance short‐wavelength narrow‐band light. This feature of LCI causes reddish areas to appear redder and whitish areas to appear whiter. Because most colorectal lesions, such as neoplastic and inflammatory lesions, have a reddish tone, LCI is an effective tool for identifying colorectal lesions by clarifying the redder areas and distinguishing them from the surrounding normal mucosa. To date, eight randomized controlled trials have been conducted to evaluate the effectiveness of LCI in identifying colorectal adenomatous lesions. The results of a meta‐analysis integrating these studies demonstrated that LCI was superior to white‐light endoscopy for detecting colorectal adenomatous lesions. LCI also improves the detection of serrated lesions by enhancing their whiteness. Furthermore, accumulating evidence suggests that LCI is superior to white‐light endoscopy for the diagnosis of the colonic mucosa in patients with ulcerative colitis. In this review, based on a comprehensive search of the current literature since the implementation of LCI, the utility of LCI in the detection and diagnosis of colorectal lesions is discussed. Additionally, the latest data, including attempts to combine artificial intelligence and LCI, are presented.
{"title":"Practical utility of linked color imaging in colonoscopy: Updated literature review","authors":"Fumiaki Ishibashi, Sho Suzuki","doi":"10.1111/den.14915","DOIUrl":"https://doi.org/10.1111/den.14915","url":null,"abstract":"The remarkable recent developments in image‐enhanced endoscopy (IEE) have significantly contributed to the advancement of diagnostic techniques. Linked color imaging (LCI) is an IEE technique in which color differences are expanded by processing image data to enhance short‐wavelength narrow‐band light. This feature of LCI causes reddish areas to appear redder and whitish areas to appear whiter. Because most colorectal lesions, such as neoplastic and inflammatory lesions, have a reddish tone, LCI is an effective tool for identifying colorectal lesions by clarifying the redder areas and distinguishing them from the surrounding normal mucosa. To date, eight randomized controlled trials have been conducted to evaluate the effectiveness of LCI in identifying colorectal adenomatous lesions. The results of a meta‐analysis integrating these studies demonstrated that LCI was superior to white‐light endoscopy for detecting colorectal adenomatous lesions. LCI also improves the detection of serrated lesions by enhancing their whiteness. Furthermore, accumulating evidence suggests that LCI is superior to white‐light endoscopy for the diagnosis of the colonic mucosa in patients with ulcerative colitis. In this review, based on a comprehensive search of the current literature since the implementation of LCI, the utility of LCI in the detection and diagnosis of colorectal lesions is discussed. Additionally, the latest data, including attempts to combine artificial intelligence and LCI, are presented.","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"1 1","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142195513","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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