Transient global amnesia (TGA) after esophagogastroduodenoscopy (EGD) has been described only in case reports. Because sudden-onset amnesia can mimic stroke and other acute central nervous system disorders, TGA requires careful differentiation in the acute setting, and clinicians need to be familiar with this condition. We estimated its incidence after screening EGD and identified associated risk factors in a large single-center cohort.
Methods
We retrospectively reviewed 420,979 screening EGDs at a single health checkup center (April 2005–March 2025). All EGDs were performed without sedation, using topical pharyngeal anesthesia only. TGA cases were ascertained from the endoscopy adverse-event registry and confirmed. For analyses, three non-TGA controls per TGA case (1:3 ratio) were randomly selected from examinees undergoing EGD on the same calendar date, using same-day matching. Odds ratios (ORs) were estimated using conditional logistic regression.
Results
TGA occurred in 64 episodes in 63 individuals of 420,979 examinations (0.0152%). In route-specific analyses from April 2008, the transoral route carried a higher risk than the transnasal route (Fisher's exact test p = 0.013). In multivariable matched models, older age (odds ratio [OR] 2.32 per 10-year increase; 95% confidence interval [CI], 1.38–3.92), female sex (14.6; 4.82–43.9), transoral insertion (10.2; 1.88–55.4), and treated dyslipidemia (2.84; 1.20–6.73) were statistically associated. EGD time and endoscopist experience were not associated.
Conclusions:
The incidence of post-EGD TGA was very low at 15.2 per 100,000 examinations (0.0152%). Older age, female sex, transoral insertion, and treated dyslipidemia were independently associated with post-EGD TGA. A transnasal approach might be a potential risk-reduction strategy.
{"title":"Transient Global Amnesia After Screening Esophagogastroduodenoscopy: Incidence and Risk Factors in a 20-Year Single-Center Cohort","authors":"Miyuki Kobayashi, Ichiro Takayama, Masahiko Ohtaka, Yasuaki Ishida, Yu Hihara, Mika Miura, Kenji Hosoda, Yuichi Hirose, Kazuhiko Takaso, Yoshioki Yoda, Fumikazu Kobayashi, Hiroshi Yokomichi, Nobuyuki Enomoto","doi":"10.1002/deo2.70298","DOIUrl":"10.1002/deo2.70298","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Transient global amnesia (TGA) after esophagogastroduodenoscopy (EGD) has been described only in case reports. Because sudden-onset amnesia can mimic stroke and other acute central nervous system disorders, TGA requires careful differentiation in the acute setting, and clinicians need to be familiar with this condition. We estimated its incidence after screening EGD and identified associated risk factors in a large single-center cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 420,979 screening EGDs at a single health checkup center (April 2005–March 2025). All EGDs were performed without sedation, using topical pharyngeal anesthesia only. TGA cases were ascertained from the endoscopy adverse-event registry and confirmed. For analyses, three non-TGA controls per TGA case (1:3 ratio) were randomly selected from examinees undergoing EGD on the same calendar date, using same-day matching. Odds ratios (ORs) were estimated using conditional logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>TGA occurred in 64 episodes in 63 individuals of 420,979 examinations (0.0152%). In route-specific analyses from April 2008, the transoral route carried a higher risk than the transnasal route (Fisher's exact test <i>p</i> = 0.013). In multivariable matched models, older age (odds ratio [OR] 2.32 per 10-year increase; 95% confidence interval [CI], 1.38–3.92), female sex (14.6; 4.82–43.9), transoral insertion (10.2; 1.88–55.4), and treated dyslipidemia (2.84; 1.20–6.73) were statistically associated. EGD time and endoscopist experience were not associated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions:</h3>\u0000 \u0000 <p>The incidence of post-EGD TGA was very low at 15.2 per 100,000 examinations (0.0152%). Older age, female sex, transoral insertion, and treated dyslipidemia were independently associated with post-EGD TGA. A transnasal approach might be a potential risk-reduction strategy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a rare case of a BRAF V600E-mutated laterally spreading tumor, granular type (LST-G), with a neuroendocrine carcinoma (NEC) component in a patient with stage IV colorectal cancer. The patient presented with multiple lymph nodes and liver metastases. Following systemic chemotherapy, significant regression of both the primary lesion and metastases was achieved, enabling successful conversion surgery. Postoperative pathological analysis post-surgery revealed only well-differentiated tubular adenocarcinoma, with complete disappearance of the NEC component. Molecular testing confirmed the persistence of the BRAF V600E mutation. The patient remains recurrence-free two years after surgery. This case highlights the potential for conversion surgery in stage IV BRAF-mutated colorectal cancer with NEC.
{"title":"Conversion Surgery after Chemotherapy in a Stage IV BRAF V600E-Mutated Laterally Spreading Tumor With Neuroendocrine Component","authors":"Reona Kawamura, Naoya Toyoshima, Masau Sekiguchi, Hiroyuki Takamaru, Masayoshi Yamada, Nozomu Kobayashi, Hidekazu Hirano, Yasuyuki Takamizawa, Taiki Hashimoto, Yutaka Saito","doi":"10.1002/deo2.70283","DOIUrl":"10.1002/deo2.70283","url":null,"abstract":"<p>We report a rare case of a <i>BRAF</i> V600E-mutated laterally spreading tumor, granular type (LST-G), with a neuroendocrine carcinoma (NEC) component in a patient with stage IV colorectal cancer. The patient presented with multiple lymph nodes and liver metastases. Following systemic chemotherapy, significant regression of both the primary lesion and metastases was achieved, enabling successful conversion surgery. Postoperative pathological analysis post-surgery revealed only well-differentiated tubular adenocarcinoma, with complete disappearance of the NEC component. Molecular testing confirmed the persistence of the <i>BRAF</i> V600E mutation. The patient remains recurrence-free two years after surgery. This case highlights the potential for conversion surgery in stage IV <i>BRAF</i>-mutated colorectal cancer with NEC.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The endoscopic system EVIS X1 with improved image quality has been introduced into clinical practice. We examined whether third-generation narrow-band imaging (3G-NBI) is more effective than white-light imaging (WLI) for detecting early gastric cancer (EGC).
Methods
Our study, performed at a single center, had a parallel-group, open-label, two-arm, randomized, controlled design. Patients who had undergone endoscopic submucosal dissection for EGC were randomly assigned to a group undergoing 3G-NBI after initial WLI (initial WLI group) or a group undergoing WLI after initial 3G-NBI (initial 3G-NBI group). The primary endpoint was the EGC detection rate of the two methods. The secondary endpoints were as follows: proportions of EGC detected and missed lesions, positive predictive value (PPV) for EGC diagnosis, and observation time for WLI and 3G-NBI.
Results
The EGC detection rate was 9.0% (17/188) in the initial WLI group and 8.5% (16/188) in the initial 3G-NBI group. The missed lesion rate was 5.6% (1/18) in the initial WLI group and 0% (0/18) in the initial 3G-NBI group. The PPV of the initial WLI group was 42.5% (17/40), whereas that of the secondary 3G-NBI was 25% (1/4). The PPV of the initial 3G-NBI group was 30.2% (16/53). No biopsies were performed during secondary WLI. The examination times were 274 ± 78.2 and 280 ± 82.9 s for WLI and 3G-NBI, respectively.
Conclusions
3G-NBI was not superior to WLI in detecting EGC. This finding is likely due to improved WLI image quality.
{"title":"Third-Generation Narrow-Band Imaging Versus White-Light Imaging for the Detection of Early Gastric Cancer: A Randomized Controlled Study","authors":"Yukihisa Fujinaga, Hitoshi Mori, Masayoshi Takami, Hiroyuki Masuda, Jun-ichi Hanatani, Satoshi Iwai, Shohei Asada, Akihiko Shibamoto, Yuki Tsuji, Koh Kitagawa, Norihisa Nishimura, Shinya Sato, Kosuke Kaji, Tadashi Namisaki, Akira Mitoro, Hitoshi Yoshiji","doi":"10.1002/deo2.70288","DOIUrl":"10.1002/deo2.70288","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The endoscopic system EVIS X1 with improved image quality has been introduced into clinical practice. We examined whether third-generation narrow-band imaging (3G-NBI) is more effective than white-light imaging (WLI) for detecting early gastric cancer (EGC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Our study, performed at a single center, had a parallel-group, open-label, two-arm, randomized, controlled design. Patients who had undergone endoscopic submucosal dissection for EGC were randomly assigned to a group undergoing 3G-NBI after initial WLI (initial WLI group) or a group undergoing WLI after initial 3G-NBI (initial 3G-NBI group). The primary endpoint was the EGC detection rate of the two methods. The secondary endpoints were as follows: proportions of EGC detected and missed lesions, positive predictive value (PPV) for EGC diagnosis, and observation time for WLI and 3G-NBI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The EGC detection rate was 9.0% (17/188) in the initial WLI group and 8.5% (16/188) in the initial 3G-NBI group. The missed lesion rate was 5.6% (1/18) in the initial WLI group and 0% (0/18) in the initial 3G-NBI group. The PPV of the initial WLI group was 42.5% (17/40), whereas that of the secondary 3G-NBI was 25% (1/4). The PPV of the initial 3G-NBI group was 30.2% (16/53). No biopsies were performed during secondary WLI. The examination times were 274 ± 78.2 and 280 ± 82.9 s for WLI and 3G-NBI, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>3G-NBI was not superior to WLI in detecting EGC. This finding is likely due to improved WLI image quality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Remimazolam is a novel ultra–short-acting benzodiazepine that may offer advantages over conventional sedatives in endoscopic procedures. Evidence for its use in pancreatobiliary endoscopic ultrasonography (EUS) is limited. We compared the efficacy and safety of remimazolam and midazolam in outpatient pancreatobiliary EUS.
Methods
This retrospective study included outpatients undergoing diagnostic pancreatobiliary EUS between July 2024 and July 2025. Patients received either remimazolam (initial 0.2 mg/kg, top-up 0.1 mg/kg [high-risk patients: 0.16 mg/kg, 0.08 mg/kg]) or midazolam. The target sedation depth was Modified Observer's Assessment of Alertness/Sedation ≤3, procedures were performed without supplemental oxygen, and pentazocine was co-administered. The primary outcome was rapid recovery (meeting all criteria: modified Aldrete score ≥6 at 5 min, ≥9 at 30 min, ambulation ≥3 m at 30 min). Secondary outcomes included sedation success (all: EUS completion, without >2 top-ups within 10 min, without rescue sedation, without agitation requiring interruption), recovery time, flumazenil use, and adverse events.
Results
We analyzed 139 patients (remimazolam, n = 75; midazolam, n = 64). Rapid recovery was more frequent with remimazolam (70.7% vs. 25.0%, p < 0.001). Sedation success was higher (92.0% vs. 73.4%, p = 0.005), recovery was shorter (median 34 vs. 55 min, p < 0.001), and flumazenil use was lower (4.0% vs. 45.3%, p < 0.001). Hypoxemia (SpO2 <90% lasting ≥10 s) occurred slightly more often with remimazolam (30.6% vs. 26.6%, p = 0.707), but all episodes were mild and reversible with airway support/oxygen. Hypotension was rare and comparable.
Conclusions
Remimazolam provided faster recovery and higher sedation success than midazolam in outpatient pancreatobiliary EUS. Supplemental oxygen before sedation is a reasonable option to enhance safety.
雷马唑仑是一种新型超短效苯二氮卓类药物，在内窥镜手术中可能比传统镇静剂更具优势。其在胰胆道超声内镜检查（EUS）中的应用证据有限。我们比较了雷马唑仑和咪达唑仑在门诊胰胆EUS治疗中的疗效和安全性。方法回顾性研究纳入2024年7月至2025年7月期间接受诊断性胰胆EUS的门诊患者。患者接受雷马唑仑（初始0.2 mg/kg，补充0.1 mg/kg[高危患者：0.16 mg/kg, 0.08 mg/kg]）或咪达唑仑。目标镇静深度为修正观察者警觉/镇静评分≤3分，手术过程中不补充氧气，并联合给药戊唑嗪。主要结局是快速恢复（满足所有标准：5分钟时Aldrete评分≥6,30分钟时≥9,30分钟时步行≥3米）。次要结局包括镇静成功（全部：EUS完成，10分钟内无2次补液，无抢救性镇静，无躁动需要中断）、恢复时间、氟马西尼使用和不良事件。结果分析139例患者（雷马唑仑75例；咪达唑仑64例）。雷马唑仑组快速恢复更为频繁（70.7% vs. 25.0%, p < 0.001）。镇静成功率较高（92.0% vs. 73.4%, p = 0.005），恢复时间较短（中位34 vs. 55 min, p < 0.001），氟马西尼使用率较低（4.0% vs. 45.3%, p < 0.001）。低氧血症（SpO2 <；90%持续≥10 s）在雷马唑仑组发生的频率略高（30.6% vs. 26.6%, p = 0.707），但所有发作都是轻微的，在气道支持/氧气下是可逆的。低血压罕见且具有可比性。结论雷马唑仑比咪达唑仑在门诊胰胆EUS治疗中恢复更快，镇静成功率更高。镇静前补充氧气是提高安全性的合理选择。
{"title":"Efficacy and Safety of Remimazolam Compared to Midazolam for Sedation During Endoscopic Ultrasonography: A Single-Center Retrospective Cohort Study","authors":"Haruka Toyonaga, Makoto Masaki, Hajime Yamazaki, Arata Oka, Yoshiki Matsuno, Hidetoshi Nakata, Shoji Takayama, Tatsuya Nakagawa, Takuya Takayama, Masahiro Orino, Hironao Matsumoto, Kimi Sumimoto, Masahiro Takeo, Norimasa Fukata, Takeshi Yamashina, Masaaki Shimatani, Makoto Naganuma","doi":"10.1002/deo2.70267","DOIUrl":"https://doi.org/10.1002/deo2.70267","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Remimazolam is a novel ultra–short-acting benzodiazepine that may offer advantages over conventional sedatives in endoscopic procedures. Evidence for its use in pancreatobiliary endoscopic ultrasonography (EUS) is limited. We compared the efficacy and safety of remimazolam and midazolam in outpatient pancreatobiliary EUS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included outpatients undergoing diagnostic pancreatobiliary EUS between July 2024 and July 2025. Patients received either remimazolam (initial 0.2 mg/kg, top-up 0.1 mg/kg [high-risk patients: 0.16 mg/kg, 0.08 mg/kg]) or midazolam. The target sedation depth was Modified Observer's Assessment of Alertness/Sedation ≤3, procedures were performed without supplemental oxygen, and pentazocine was co-administered. The primary outcome was rapid recovery (meeting all criteria: modified Aldrete score ≥6 at 5 min, ≥9 at 30 min, ambulation ≥3 m at 30 min). Secondary outcomes included sedation success (all: EUS completion, without >2 top-ups within 10 min, without rescue sedation, without agitation requiring interruption), recovery time, flumazenil use, and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed 139 patients (remimazolam, <i>n</i> = 75; midazolam, <i>n</i> = 64). Rapid recovery was more frequent with remimazolam (70.7% vs. 25.0%, <i>p</i> < 0.001). Sedation success was higher (92.0% vs. 73.4%, <i>p</i> = 0.005), recovery was shorter (median 34 vs. 55 min, <i>p</i> < 0.001), and flumazenil use was lower (4.0% vs. 45.3%, <i>p</i> < 0.001). Hypoxemia (SpO<sub>2</sub> <90% lasting ≥10 s) occurred slightly more often with remimazolam (30.6% vs. 26.6%, <i>p</i> = 0.707), but all episodes were mild and reversible with airway support/oxygen. Hypotension was rare and comparable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Remimazolam provided faster recovery and higher sedation success than midazolam in outpatient pancreatobiliary EUS. Supplemental oxygen before sedation is a reasonable option to enhance safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70267","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146129988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is a technically demanding procedure performed predominantly at centers with high expertise. Its feasibility and learning curves in inexperienced centers remain unclear. This study aimed to evaluate the initial clinical outcomes and learning curves of EUS-HGS implemented in inexperienced centers.
Methods
Between September 2018 and December 2020, four tertiary care centers specializing in pancreaticobiliary disease implemented EUS-HGS. The first 20 patients who underwent EUS-HGS at each institution were retrospectively enrolled. The primary outcomes were technical success, procedure time, and serious (moderate-to-severe) adverse events (AEs). A learning curve analysis was conducted using chronological quartiles. Logistic regression was used to identify the predictors of technical failure and serious AEs.
Results
The overall technical success rate was 94% (75/80); serious AEs occurred in 11% (9/80). Procedure time significantly decreased across quartiles, whereas no significant trend was observed for technical success or serious AE rates. The univariate analysis did not identify significant predictors of technical failure, whereas the multivariate analysis identified ascites as an independent predictor of serious AEs.
Conclusions
EUS-HGS can be feasibly implemented with caution in inexperienced centers, particularly when performed by endoscopists with adequate pancreatobiliary expertise. Additionally, during the implementation phase, procedure time decreased with increasing institutional experience.
{"title":"Clinical Outcomes and Learning Curve of Endoscopic Ultrasound-Guided Hepaticogastrostomy During the Implementation Phase in Inexperienced Centers: A Multicenter Retrospective Study","authors":"Junichi Kaneko, Tatsunori Satoh, Yosuke Kobayashi, Azumi Suzuki, Shinya Kawaguchi","doi":"10.1002/deo2.70291","DOIUrl":"10.1002/deo2.70291","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is a technically demanding procedure performed predominantly at centers with high expertise. Its feasibility and learning curves in inexperienced centers remain unclear. This study aimed to evaluate the initial clinical outcomes and learning curves of EUS-HGS implemented in inexperienced centers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between September 2018 and December 2020, four tertiary care centers specializing in pancreaticobiliary disease implemented EUS-HGS. The first 20 patients who underwent EUS-HGS at each institution were retrospectively enrolled. The primary outcomes were technical success, procedure time, and serious (moderate-to-severe) adverse events (AEs). A learning curve analysis was conducted using chronological quartiles. Logistic regression was used to identify the predictors of technical failure and serious AEs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall technical success rate was 94% (75/80); serious AEs occurred in 11% (9/80). Procedure time significantly decreased across quartiles, whereas no significant trend was observed for technical success or serious AE rates. The univariate analysis did not identify significant predictors of technical failure, whereas the multivariate analysis identified ascites as an independent predictor of serious AEs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EUS-HGS can be feasibly implemented with caution in inexperienced centers, particularly when performed by endoscopists with adequate pancreatobiliary expertise. Additionally, during the implementation phase, procedure time decreased with increasing institutional experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12859524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic disseminated intravascular coagulation (DIC) is a rare complication of an aortic aneurysm (AA), and it may go unnoticed because patients are often asymptomatic. The condition is sometimes first recognized when trauma or an invasive procedure triggers a sudden and severe difficulty in achieving hemostasis. Here, we report a case of chronic DIC that was diagnosed following intractable delayed bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer. The patient underwent two ESD procedures, one in 2021 and another in 2023, and experienced delayed bleeding after both. In 2021, hemostasis was easily achieved, and complication of his hemodialysis was suspected as the cause of subsequent delayed bleeding. However, when hemostasis proved difficult in 2023, chronic DIC caused by an AA was identified as the primary cause of the intractable bleeding. Although the patient had a mildly reduced platelet count before the initial ESD, the presence of chronic DIC went unnoticed. The successful hemostasis during the first procedure obscured the underlying cause of the bleeding and thrombocytopenia. Gastroenterologists should be aware of enhanced-fibrinolytic-type DIC associated with an AA and remain vigilant regarding its high bleeding risk when performing invasive treatments, including endoscopic procedures.
{"title":"Intractable Delayed Bleeding After Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients With Chronic Disseminated Intravascular Coagulation Caused by Aortic Aneurysm","authors":"Hiroyuki Endo, Waku Hatta, Noriyuki Obara, Kasumi Hishinuma, Tomoyuki Koike, Atsushi Masamune","doi":"10.1002/deo2.70277","DOIUrl":"10.1002/deo2.70277","url":null,"abstract":"<p>Chronic disseminated intravascular coagulation (DIC) is a rare complication of an aortic aneurysm (AA), and it may go unnoticed because patients are often asymptomatic. The condition is sometimes first recognized when trauma or an invasive procedure triggers a sudden and severe difficulty in achieving hemostasis. Here, we report a case of chronic DIC that was diagnosed following intractable delayed bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer. The patient underwent two ESD procedures, one in 2021 and another in 2023, and experienced delayed bleeding after both. In 2021, hemostasis was easily achieved, and complication of his hemodialysis was suspected as the cause of subsequent delayed bleeding. However, when hemostasis proved difficult in 2023, chronic DIC caused by an AA was identified as the primary cause of the intractable bleeding. Although the patient had a mildly reduced platelet count before the initial ESD, the presence of chronic DIC went unnoticed. The successful hemostasis during the first procedure obscured the underlying cause of the bleeding and thrombocytopenia. Gastroenterologists should be aware of enhanced-fibrinolytic-type DIC associated with an AA and remain vigilant regarding its high bleeding risk when performing invasive treatments, including endoscopic procedures.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tetsushi Azami, Yuichi Takano, Go Akihiro, Mako Kitazono, Naoki Tamai, Jun Noda, Fumitaka Niiya, Kazuyuki Miyamoto, Masatsugu Nagahama
Histological biopsy is essential for diagnosing ampullary tumors; however, it can occasionally result in severe adverse events. A 49-year-old male underwent esophagogastroduodenoscopic screening, which revealed an ampulla of Vater with enlargement of the oral protrusion. An endoscopic biopsy was performed; several hours later, the patient developed severe acute pancreatitis requiring hospitalization. The biopsy result was benign, and no gallstones, ductal abnormalities, or other etiologies were identified on endoscopic ultrasonography or magnetic resonance cholangiopancreatography, and the biopsy was considered the most likely trigger. The patient recovered with conservative management and was discharged on day 14. No recurrence has been observed 3 months after discharge. Although acute pancreatitis following biopsy of the ampulla of Vater is extremely rare, it can be fatal. Endoscopists should be aware of this potential risk, carefully assess the necessity of biopsy, and ensure that patients provide informed consent before the procedure.
{"title":"A Case of Severe Acute Pancreatitis Following Endoscopic Biopsy of the Ampulla of Vater: A Rare Adverse Event of Esophagogastroduodenoscopy","authors":"Tetsushi Azami, Yuichi Takano, Go Akihiro, Mako Kitazono, Naoki Tamai, Jun Noda, Fumitaka Niiya, Kazuyuki Miyamoto, Masatsugu Nagahama","doi":"10.1002/deo2.70292","DOIUrl":"10.1002/deo2.70292","url":null,"abstract":"<p>Histological biopsy is essential for diagnosing ampullary tumors; however, it can occasionally result in severe adverse events. A 49-year-old male underwent esophagogastroduodenoscopic screening, which revealed an ampulla of Vater with enlargement of the oral protrusion. An endoscopic biopsy was performed; several hours later, the patient developed severe acute pancreatitis requiring hospitalization. The biopsy result was benign, and no gallstones, ductal abnormalities, or other etiologies were identified on endoscopic ultrasonography or magnetic resonance cholangiopancreatography, and the biopsy was considered the most likely trigger. The patient recovered with conservative management and was discharged on day 14. No recurrence has been observed 3 months after discharge. Although acute pancreatitis following biopsy of the ampulla of Vater is extremely rare, it can be fatal. Endoscopists should be aware of this potential risk, carefully assess the necessity of biopsy, and ensure that patients provide informed consent before the procedure.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12849200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Migration of fish bones into the bile duct is rare, but can cause bile duct stone formation or acute cholangitis. Herein, we examine the characteristics of this phenomenon.
Methods
This single-center, retrospective study enrolled patients with a history of fish bone extraction from the bile duct by an endoscopic procedure at our hospital between June 2016 and November 2023. Patient characteristics, treatment details, and clinical course were assessed from the electronic medical records.
Results
A total of 11 patients were enrolled, including 10 who underwent subtotal stomach-preserving pancreaticoduodenectomy with Child's reconstruction and one who underwent extrahepatic bile duct resection with choledochojejunostomy. The median time between surgery and endoscopic treatment was 84 months (range 12–124). On computed tomography (CT), all fish bones were detected as high-density dots or linear substances in the bile duct. Endoscopic procedures were performed using single-balloon enteroscopy. All fish bones and coexisting biliary stones were successfully removed, with a median duration of 40.5 (range 9–54) minutes. Three cases of mild cholangitis were observed and resolved with conservative treatment. Two patients had recurrence, and all cases were successfully treated endoscopically.
Conclusions
This migration may occur in patients with surgically altered biliary anatomy. Most migrated fish bones can be safely detected by CT, and treated by single-balloon enteroscopy.
{"title":"Migration of Fish Bones to the Bile Duct Following Hepaticojejunostomy","authors":"Kenta Yoshida, Tsuyoshi Hayashi, Kazuki Hama, Ryo Ando, Haruka Toyonaga, Tatsuya Ishii, Toshifumi Kin, Masayo Motoya, Kuniyuki Takahashi, Yuko Omori, Satoshi Ota, Akio Katanuma","doi":"10.1002/deo2.70293","DOIUrl":"10.1002/deo2.70293","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Migration of fish bones into the bile duct is rare, but can cause bile duct stone formation or acute cholangitis. Herein, we examine the characteristics of this phenomenon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective study enrolled patients with a history of fish bone extraction from the bile duct by an endoscopic procedure at our hospital between June 2016 and November 2023. Patient characteristics, treatment details, and clinical course were assessed from the electronic medical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 11 patients were enrolled, including 10 who underwent subtotal stomach-preserving pancreaticoduodenectomy with Child's reconstruction and one who underwent extrahepatic bile duct resection with choledochojejunostomy. The median time between surgery and endoscopic treatment was 84 months (range 12–124). On computed tomography (CT), all fish bones were detected as high-density dots or linear substances in the bile duct. Endoscopic procedures were performed using single-balloon enteroscopy. All fish bones and coexisting biliary stones were successfully removed, with a median duration of 40.5 (range 9–54) minutes. Three cases of mild cholangitis were observed and resolved with conservative treatment. Two patients had recurrence, and all cases were successfully treated endoscopically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This migration may occur in patients with surgically altered biliary anatomy. Most migrated fish bones can be safely detected by CT, and treated by single-balloon enteroscopy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12849206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) in intrahepatic bile duct segment 3 (B3) is widely used for biliary drainage. Post-puncture procedures are easy to perform in intrahepatic bile duct segment 2 (B2), but using a conventional oblique-viewing (OV) scope (GF-UCT260) may result in transesophageal puncture. In this study, we compared the safety and efficacy of B2 puncture using a conventional OV scope, a novel OV scope (EG-740UT), and a forward-viewing (FV) scope (TGF-UC260J).
Methods
This single-center retrospective study investigated 319 consecutive patients in whom B2-EUS-HGS was attempted using an OV or FV between January 2017 and March 2024 at Aichi Cancer Center.
Results
In B2-EUS-HGS, the use of enhanced endoscopes (TGF-UC260J and EG-740UT) resulted in a relatively high technical success rate of 93.6% (205/219) and an overall clinical success rate of 97.1% (199/205). The enhanced endoscope group demonstrated a significantly higher technical success rate (p < 0.001) compared to the conventional endoscope group. No significant differences were observed between the two groups in terms of overall clinical success rate (p = 0.128) and early adverse event rate (p = 0.461).
Conclusions
B2-EUS-HGS using either an FV or novel OV scope showed comparable safety with a high technical and overall clinical success rate. The use of an FV or novel OV scope seems to be a suitable strategy for performing B2-EUS-HGS.
Clinical Trial Registration
Study/trial registration and registration number were not applicable (N/A), as this study was a retrospective analysis using anonymized data.
{"title":"Enhanced Endoscope is Associated With Success Rates in B2- Endoscopic Ultrasound-Guided Hepaticogastrostomy","authors":"Yoshitaro Yamamoto, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Minako Urata, Takashi Kondo, Keigo Oshiro, Tomoki Ogata, Ren Kuwabara","doi":"10.1002/deo2.70279","DOIUrl":"10.1002/deo2.70279","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) in intrahepatic bile duct segment 3 (B3) is widely used for biliary drainage. Post-puncture procedures are easy to perform in intrahepatic bile duct segment 2 (B2), but using a conventional oblique-viewing (OV) scope (GF-UCT260) may result in transesophageal puncture. In this study, we compared the safety and efficacy of B2 puncture using a conventional OV scope, a novel OV scope (EG-740UT), and a forward-viewing (FV) scope (TGF-UC260J).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective study investigated 319 consecutive patients in whom B2-EUS-HGS was attempted using an OV or FV between January 2017 and March 2024 at Aichi Cancer Center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In B2-EUS-HGS, the use of enhanced endoscopes (TGF-UC260J and EG-740UT) resulted in a relatively high technical success rate of 93.6% (205/219) and an overall clinical success rate of 97.1% (199/205). The enhanced endoscope group demonstrated a significantly higher technical success rate (<i>p</i> < 0.001) compared to the conventional endoscope group. No significant differences were observed between the two groups in terms of overall clinical success rate (<i>p</i> = 0.128) and early adverse event rate (<i>p</i> = 0.461).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>B2-EUS-HGS using either an FV or novel OV scope showed comparable safety with a high technical and overall clinical success rate. The use of an FV or novel OV scope seems to be a suitable strategy for performing B2-EUS-HGS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trial Registration</h3>\u0000 \u0000 <p>Study/trial registration and registration number were not applicable (N/A), as this study was a retrospective analysis using anonymized data.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12849196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although Brunner's glands (BGs), located in the submucosa of the duodenum, may be involved by tumor cells of superficial non-ampullary duodenal epithelial tumors (SNADETs), the detailed incidence and histopathological features have not yet been analyzed. This study aimed to clarify the histopathological relationship between SNADETs and BGs.
Methods
We retrospectively analyzed SNADETs that were resected at a single center between 2006 and 2021. Resected specimens were histologically evaluated to determine the presence and/or involvement of SNADET in BGs. The relationship between clinicopathological features and tumor involvement in BGs was also assessed.
Results
In total, 114 lesions were included. Direct connection with BGs was seen in 52.6% of SNADETs, and submucosal BG involvement was observed in 7.0% (95% confidence interval 3.1%–13.4%) of SNADETs. The presence of submucosal BG involvement was significantly associated with 0-IIc morphology, high-grade dysplasia or carcinoma, and the gastric mucinous phenotype. The presence of either a lesion size 10 mm or greater or 0-IIc morphology demonstrated a sensitivity of 100%, a specificity of 34.9%, and a false negative rate of 0% for predicting submucosal BG involvement. Moreover, non-neoplastic BGs were exposed at the vertical margin in 15.1% of endoscopic resection specimens.
Conclusion
SNADETs can have submucosal involvement via BGs, particularly in lesions fulfilling either a size ≥10 mm or a 0-IIc morphology. These pathological findings suggest that vertical resectability may be relevant in their endoscopic management, although further studies are needed to clarify clinical implications.
{"title":"Clinicopathological Features of Superficial Non-Ampullary Duodenal Epithelial Tumors Involving Brunner's Glands","authors":"Kazuki Takayama, Taro Iwatsubo, Mitsuaki Ishida, Shun Sasaki, Akitoshi Hakoda, Noriaki Sugawara, Kazuhiro Ota, Toshihisa Takeuchi, Nao Kawaguchi, Atsushi Tomioka, Ryo Tanaka, Mitsuhiro Asakuma, Sang-Woong Lee, Kazuhide Higuchi, Yoshinobu Hirose, Hiroki Nishikawa","doi":"10.1002/deo2.70284","DOIUrl":"10.1002/deo2.70284","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Although Brunner's glands (BGs), located in the submucosa of the duodenum, may be involved by tumor cells of superficial non-ampullary duodenal epithelial tumors (SNADETs), the detailed incidence and histopathological features have not yet been analyzed. This study aimed to clarify the histopathological relationship between SNADETs and BGs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed SNADETs that were resected at a single center between 2006 and 2021. Resected specimens were histologically evaluated to determine the presence and/or involvement of SNADET in BGs. The relationship between clinicopathological features and tumor involvement in BGs was also assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 114 lesions were included. Direct connection with BGs was seen in 52.6% of SNADETs, and submucosal BG involvement was observed in 7.0% (95% confidence interval 3.1%–13.4%) of SNADETs. The presence of submucosal BG involvement was significantly associated with 0-IIc morphology, high-grade dysplasia or carcinoma, and the gastric mucinous phenotype. The presence of either a lesion size 10 mm or greater or 0-IIc morphology demonstrated a sensitivity of 100%, a specificity of 34.9%, and a false negative rate of 0% for predicting submucosal BG involvement. Moreover, non-neoplastic BGs were exposed at the vertical margin in 15.1% of endoscopic resection specimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SNADETs can have submucosal involvement via BGs, particularly in lesions fulfilling either a size ≥10 mm or a 0-IIc morphology. These pathological findings suggest that vertical resectability may be relevant in their endoscopic management, although further studies are needed to clarify clinical implications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12834701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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