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Background

Gastric subepithelial lesions (SELs) measuring <20 mm without high-risk features are typically managed with periodic surveillance, while surgical resection is recommended for gastrointestinal stromal tumors (GISTs) per the Japanese guideline. Recent advancements in endoscopic ultrasound-guided tissue acquisition (EUS-TA) needles have improved tissue collection, but few studies have assessed the utility of EUS-TA for SELs <20 mm. This study aimed to evaluate the usefulness of EUS-TA for gastric SELs <20 mm.

Methods

We retrospectively analyzed patients who underwent EUS-TA for SELs at Tonan Hospital between June 2012 and March 2025. Variables including needle type, number of passes, histological diagnosis, and diagnostic accuracy were compared between SELs <20 and ≥20 mm. Rapid On-Site Evaluation (ROSE) was performed for all specimens.

Results

A total of 163 patients were included: 50 with SELs <20 mm and 113 with SELs ≥20 mm. Median lesion size was 15.5 and 31.7 mm, respectively. The <20 mm group required more passes to obtain adequate samples (2.5 vs. 2.0, p = 0.03). GIST was the most common diagnosis in both groups, with no significant difference (56% vs. 61.9%). Fine needle biopsy did not significantly improve sample adequacy or diagnostic accuracy. Diagnostic accuracy for SELs <20 mm was comparable to that for SELs ≥20 mm (88% vs. 93.8%).

Conclusions

EUS-TA with ROSE for gastric SELs <20 mm yields diagnostic accuracy comparable to that for SELs ≥20 mm. Given the high GIST prevalence in small SELs, EUS-TA may be a valuable diagnostic strategy.

Objectives

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is usually performed for unresectable malignant distal biliary obstruction (MDBO) when endoscopic retrograde cholangiopancreatography-guided biliary stenting with fully covered self-expandable metallic stents (EBS-MSs) fails. We aimed to clarify the clinical outcomes of EUS-HGS with plastic stents (HGS-PSs) compared to EBS-MS.

Methods

We retrospectively reviewed patients who underwent either HGS-PS with or without antegrade stenting using MS (AS-MS) or EBS-MS as initial biliary drainage for unresectable MDBO between January 2017 and July 2024.

Results

A total of 27 patients were included in the HGS-PS group, and 128 patients were included in the EBS-MS group. Median procedure time was significantly shorter for the HGS-PS group (24 vs. 39 min, p < 0.001), and the incidence of adverse events was comparable (22% vs. 32%, p = 0.365). The HGS-PS group had a significantly higher recurrent biliary obstruction (RBO) rate (48% vs. 26%, p = 0.002) and shorter time to RBO (TRBO) (169 vs. 341 days, p = 0.001). After propensity score matching, no significant differences were observed in either the RBO rate or TRBO. Subgroup analyses showed that TRBO was comparable between the HGS-PS with AS-MS and EBS-MS groups (273 vs. 341 days, p = 0.609).

Conclusions

Although TRBO tended to be shorter for HGS-PS compared to EBS-MS, the addition of AS-MS to HGS-PS led to comparable TRBO, suggesting that this combination may be a viable alternative.

Clinical Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.

Background

Endoscopic sleeve gastroplasty is a minimally invasive and effective treatment for obesity, although gastric mucosa folding and subsequent reduced visibility of the gastric lining raise concerns for some patients. This study evaluates the safety and efficacy of a revised peroral endoscopic myo-neurotomy (R-POEM-N) technique using a submucosal approach as an alternative bariatric procedure in a porcine model.

Methods

Twelve pigs underwent either an R-POEM-N procedure (n = 8) or a sham endoscopic procedure (n = 4). Myo-neurotomy was performed at four sites in the R-POEM-N group: two on the greater curvature of the gastric body and two in the antrum. All pigs were fed diets at twice the standard weight-equivalent dose and observed for 8 weeks (8 W) following the procedure. The primary outcome was the proportional change in body weight at 8 W, calculated as the ratio of weight change to baseline weight. Secondary outcomes included changes in serum glucolipid levels, food intake, and the safety and duration of R-POEM-N.

Results

R-POEM-N was successfully completed in all pigs without significant adverse events. The procedure time was 171.3 ± 3.0 min. The proportional change in body weight was significantly lower in the R-POEM-N group compared with the control group (p = 0.017). Food intake in the R-POEM-N group was significantly lower than that in the control group (p < 0.05). Changes in serum glycolipid levels were not significantly different between groups.

Conclusions

R-POEM-N successfully reduced weight gain in pigs, supporting its potential as a novel bariatric intervention with minimal invasiveness.

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure for the management of biliary diseases. Successful biliary cannulation is the first step. Advanced cannulation techniques, such as the double-guidewire technique (DGW), precut techniques, and endoscopic ultrasound (EUS)-guided rendezvous (RV), have been developed to improve cannulation success. However, comprehensive evaluations of a structured cannulation algorithm remain limited.

Aims

To evaluate the status of biliary cannulation and associated adverse events (AEs) using a stepwise cannulation algorithm.

Methods

A retrospective evaluation of 1,000 consecutive patients with a naïve papilla who underwent ERCP for biliary disease was performed between 2012 and 2022. Biliary cannulation was attempted using a stepwise algorithm, beginning with wire-loaded cannulation (WLC), followed by DGW, precut techniques, and EUS-RV. The primary endpoint was overall technical success; secondary endpoints included AEs, incidence of post-ERCP pancreatitis (PEP), and risk factor analysis.

Results

Initial WLC achieved selective biliary cannulation in 69.2% of cases. Salvage techniques achieved high success rates: DGW (74.9%), precut techniques (77.6%), and EUS-RV (97.0%). Overall, the final cannulation success rate was 97.8%. The overall AE rate was 7.5%, with PEP being the most common (6.1%). AEs were significantly more frequent in advanced cannulation techniques than WLC (13.3% vs. 5.2%, p < 0.001). Multivariate analysis identified advanced cannulation techniques, pancreatography, and metallic stent placement as independent factors increasing the risk of PEP.

Conclusion

A structured stepwise approach achieves very high biliary cannulation success in patients with a naïve papilla, though advanced cannulation techniques increase AE risk. Appropriate timing and positioning of EUS-RV may further optimize safety and efficacy in biliary cannulation.

Objectives

Anastomotic biliary stricture (ABS) is a common complication following living donor liver transplantation (LDLT). Although plastic stents (PSs) have traditionally been the standard treatment, fully covered self-expandable metal stents (FCSEMSs) have recently gained attention because of their potential advantages. This study aimed to retrospectively analyze cases of ABS after LDLT that were treated with intraductal FCSEMSs (ID-FCSEMS) at our institution.

Methods

This study included 46 adult patients who developed anastomotic bile duct stricture following LDLT. Twenty patients underwent ID-FCSEMS placement, and 22 patients underwent PS placement. The FCSEMSs were scheduled for removal after 16 weeks.

Results

Placement of FCSEMSs was technically successful in all 20 patients. Early complications included cholangitis in five patients, whereas late complications included one case of stent migration and one case of obstructive cholangitis. Clinical success was achieved in 16 patients. Restenosis occurred in two patients. No significant differences were found between the FCSEMS group and the PS group in terms of reimbursement points (as defined by the Japanese medical fee schedule), number of hospitalizations, and total inpatient days.

Conclusions

ID-FCSEMSs demonstrate a high success rate and favorable long-term outcomes for ABS after LDLT. Although no significant difference in cost reduction is observed, ID-FCSEMSs are a safe and effective therapeutic option for ABS.