Digestive Endoscopy最新文献

Inside stents [1, 2] placed above the papilla for upper bile duct strictures were useful [3] and equipped with a retrieval thread for stent removal (Figure 1). However, when the distal flap becomes lodged in a biliary branch, stent removal is challenging due to the weak grip of the forceps and slippage of the retrieval thread. We report a useful technique for easy stent retrieval by rotating an 8-wire basket catheter (RASEN2, Kaneka Medix Corporation, Osaka, Japan) and entangling the retrieval thread to the basket catheter for a firm grasp.

The patient was a 76-year-old man with intrahepatic cholangiocarcinoma who had two stents placed 4 months prior to biliary obstruction. Endoscopic retrograde cholangiopancreatography was performed for the stent exchange. The first stent was easily retrieved by grasping the retrieval thread using forceps; however, the distal flap of the second stent was caught on the biliary duct branch, making retrieval difficult. Attempts to grasp the stent using a snare and forceps were unsuccessful. An 8-wire basket catheter was then used and deployed alongside the retrieval thread. The guide wire was placed inside the catheter to prevent tangling. As the catheter was advanced, the retrieval thread was pulled into the side of the stent. While rotating the catheter, we deliberately pressed it against the bile duct to change its angle. The catheter and retrieval threads were easily tangled, allowing the stent to integrate securely and rotate. The retrieval thread was firmly grasped, the flap was released, and the stent was successfully retrieved (Figure 2).

In conclusion, rotating a basket catheter and entangling the retrieval thread make it possible to easily retrieve stents, even in challenging cases, as the retrieval thread and catheter become integrated.

Masafumi Watanabe designed the study, the main conceptual ideas, and the outline. Masafumi Watanabe edited the video and wrote the manuscript with support from Kosuke Okuwaki. Chika Kusano supervised the project. All the authors discussed the results and commented on the manuscript.

The authors have nothing to report.

The authors declare no conflicts of interest.

Endoscopic observation of lesions located at the esophagogastric junction (EGJ) is technically challenging. This difficulty primarily arises from the anatomical narrowness of the EGJ, which makes it difficult to maintain an optimal distance between the endoscope and the target lesion. While some endoscopists employ the water-flooding technique, the rapid flow of water into the stomach prevents stable observation. Moreover, excessive water use increases the risk of aspiration. Gel immersion endoscopy is a useful method for securing a clear visual field during hemostatic procedure [1, 2]. In this report, we further highlight its effectiveness in magnified endoscopic observation.

A 68-year-old man was referred to our hospital for further evaluation of suspected Barrett's esophageal cancer. Upper gastrointestinal endoscopy revealed a reddish, depressed lesion at the 2 o'clock position in the EGJ area (Figure 1a). Magnified endoscopy with narrow-band imaging was performed using the gel immersion technique (Figure 1b), with a transparent hood attached to the distal tip of the endoscope. The gel we used was “VISCOCLEAR” (Otsuka Pharmaceutical Factory, Tokushima, Japan), which was administered through the endoscope using a standard 50 mL syringe. To minimize bubble formation during observation, we slowly pushed the syringe plunger to gently introduce the gel into the esophagus. Thanks to its specific viscosity, the gel remained in the EGJ without flowing into the stomach, allowing for a stable and clear endoscopic view without the need for constant infusion. Moreover, the relatively low intraluminal pressure under the gel permitted gentle contact, minimizing the risk of tissue damage. The time required from gel infusion to the completion of magnified observation was < 2 min. The lesion was endoscopically diagnosed as benign, and a biopsy revealed only inflammatory changes (Group 1).

In conclusion, the gel immersion technique may offer a safe, stable, and effective approach for endoscopic observation of lesions in the EGJ area.

I.T.: investigation and endoscopic procedure, writing – original draft preparation. I.T., Y.N.: conceptualization and methodology. Y.N., H.I.: writing – review and editing. H.I.: supervision and project administration. All authors: approval of final manuscript.

The authors declare no conflicts of interest.

Endoscopic cricopharyngeal myotomy (C-POEM) is an evolving, minimally invasive technique for treating cricopharyngeal dysfunction [1, 2], which may result from conditions such as idiopathic cricopharyngeal bar, Parkinson's Disease, or Inclusion Body Myositis. The procedure is technically challenging due to the confined space of the hypopharynx (Figure 1). Traditionally, C-POEM is performed using a standard gastroscope, which has a 9.9 mm outer diameter and a 2.3 mm working channel. With the addition of a conical distal attachment cap, a mucosal incision of approximately 15 mm is typically required to access the submucosal space, further complicating the procedure in anatomically restricted areas. We present a video case demonstrating the use of a next-generation slim therapeutic gastroscope—the Fujifilm EG-840TP—in a successful C-POEM. This scope introduces several important technical improvements: Slimmer outer diameter: 7.9 mm versus 9.9 mm (standard scope), allowing easier maneuverability in the hypopharynx and proximal esophagus; larger working channel: 3.2 mm versus 2.3 mm, enabling the simultaneous use of instruments and suction; smaller mucosal incision required: A 10 mm mucosal incision is sufficient, even with the distal cap in place; and enhanced tip angulation of 210° upward and 160° downward flexion, improving access and precision in tight anatomical spaces (Figure 2). These design enhancements facilitate safer and more efficient dissection, improve procedural control, and reduce tissue trauma. A conical cap (DH-083ST—FujiFilm, Japan) with a 3.5 mm distal stiff section from the tip of the gastroscope and a 7 mm inner diameter of the distal end was also used for the C-POEM. Our case highlights the feasibility, safety, and therapeutic potential of the EG-840TP in upper esophageal interventions [3, 4], suggesting that it may set a new standard for C-POEM and similar endoscopic procedures in narrow anatomical regions.

Niroshan Muwanwella: conceptualization (lead), resources, writing – original draft (lead). Krish Ragunath: conceptualization (supporting), writing – review and editing.

Approval of the research protocol by an Institutional Reviewer Board: None.

Informed consent: Informed consent obtained from patient to publish de-identified endoscopic images and videos.

Registry and the registration no. of the study/trial: None.

Animal studies: None.

The authors declare no conflicts of interest. Prof Krish Ragunath is an Associate Editor of Digestive Endoscopy.