Colonoscopy is a reliable technique for the detection, diagnosis, and treatment of adenomas and early cancer. Image-enhanced endoscopy (IEE) is important for detecting colorectal lesions. Texture and color-enhancement imaging (TXI) has recently emerged as a novel modality for IEE. Thus, TXI operates in two modes: mode 1 (TXI1) enhances the structure, color, and brightness, whereas mode 2 (TXI2) does not. We have previously reported the detection of colorectal adenomas using TXI. We aimed to determine the detection yields of TXI1 and TXI2 using the data from our previous study.
Methods
We retrospectively analyzed the colonoscopy data from three institutions between August 2020 and January 2021. The patients were classified into two groups: TXI1 and TXI2. The mean number of adenomas detected per procedure (MAP), adenoma detection rate (ADR), and flat adenoma detection rate (FDR) were compared between groups.
Results
The evaluations (95% confidence intervals) for the TXI1 versus TXI2 groups were as follows: MAP, 1.5 (1.3–1.7) versus 1.5 (1.3–1.7); ADR, 56.8% (47.3–65.9) versus 59.7% (50.3–68.6); and FDR, 68.6% (59.5–76.9) versus 63.9% (54.6–72.5), with no statistically significant differences between the groups.
Conclusion
The detection rates of colorectal lesions were comparable between the TXI1 and TXI2 groups.
目的：结肠镜检查是一种可靠的检测、诊断和治疗腺瘤和早期癌症的技术。图像增强内窥镜（IEE）对检测结直肠病变很重要。纹理和彩色增强成像（TXI）最近成为IEE的一种新模式。因此，TXI以两种模式工作：模式1 （TXI1）增强结构、颜色和亮度，而模式2 （TXI2）则没有。我们以前报道过使用TXI检测结直肠腺瘤。我们的目的是利用我们之前研究的数据来确定TXI1和TXI2的检出率。方法：回顾性分析2020年8月至2021年1月三家机构的结肠镜检查数据。患者分为TXI1组和TXI2组。比较两组间每次手术平均腺瘤检出率（MAP）、腺瘤检出率（ADR）和扁平腺瘤检出率（FDR）。结果：TXI1组与TXI2组的评价（95%置信区间）如下：MAP， 1.5 (1.3-1.7) vs 1.5 (1.3-1.7)；ADR 56.8% (47.3-65.9) vs 59.7% (50.3-68.6)；FDR为68.6%（59.5-76.9）对63.9%(54.6-72.5)，组间差异无统计学意义。结论：TXI1组与TXI2组结直肠病变检出率具有可比性。
{"title":"Comparison of Detection Yields Between Texture and Color Enhancement Imaging Mode 1 and Mode 2 for Colorectal Lesions: A Post-hoc Analysis of a Multicenter Observational Study","authors":"Kensuke Shinmura, Hiroaki Ikematsu, Taku Sakamoto, Maasa Sasabe, Tatsuro Murano, Yasuhiko Mizuguchi, Hiroyuki Takamaru, Toshiki Futakuchi, Naoto Tamai, Kazuki Sumiyama, Yutaka Saito","doi":"10.1002/deo2.70248","DOIUrl":"10.1002/deo2.70248","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Colonoscopy is a reliable technique for the detection, diagnosis, and treatment of adenomas and early cancer. Image-enhanced endoscopy (IEE) is important for detecting colorectal lesions. Texture and color-enhancement imaging (TXI) has recently emerged as a novel modality for IEE. Thus, TXI operates in two modes: mode 1 (TXI1) enhances the structure, color, and brightness, whereas mode 2 (TXI2) does not. We have previously reported the detection of colorectal adenomas using TXI. We aimed to determine the detection yields of TXI1 and TXI2 using the data from our previous study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed the colonoscopy data from three institutions between August 2020 and January 2021. The patients were classified into two groups: TXI1 and TXI2. The mean number of adenomas detected per procedure (MAP), adenoma detection rate (ADR), and flat adenoma detection rate (FDR) were compared between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The evaluations (95% confidence intervals) for the TXI1 versus TXI2 groups were as follows: MAP, 1.5 (1.3–1.7) versus 1.5 (1.3–1.7); ADR, 56.8% (47.3–65.9) versus 59.7% (50.3–68.6); and FDR, 68.6% (59.5–76.9) versus 63.9% (54.6–72.5), with no statistically significant differences between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The detection rates of colorectal lesions were comparable between the TXI1 and TXI2 groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12817192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021091","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}
Kakeru Otomo, Tadayuki Takagi, Jun Wada, Natsuki Ishizaki, Kana Tamazawa, Kohei Suzuki, Masato Aizawa, Hiroshi Ogawa, Osamu Suzuki, Kazutomo Togashi
Subepithelial lesions (SELs) of the head and neck have a low diagnostic yield with mucosal biopsy and carry a bleeding risk. Among endoscopic ultrasound–tissue acquisition (EUS-TA) techniques, fine-needle biopsy (FNB) provides higher specimen adequacy and diagnostic accuracy than fine-needle aspiration (FNA). A forward-viewing curved linear-array echoendoscope (FV-EUS) is useful for mobile lesions and those in narrow spaces that are difficult to puncture with conventional oblique-viewing EUS (OV-EUS), but FV-EUS–guided EUS-FNB has not been reported for head and neck lesions.
We report a 72-year-old man in whom a lesion at the esophageal inlet was not apparent on initial upper gastrointestinal endoscopy performed with a small-caliber endoscope. Stenosis was subsequently noted at the time of endoscopic submucosal dissection for early gastric cancer. Contrast-enhanced computed tomography showed an approximately 20-mm solid mass on the posterior hypopharyngeal wall. Under general anesthesia with laryngoscopic exposure, an elevated subepithelial lesion without mucosal exposure was observed on the posterior pharyngeal wall. Using FV-EUS with a cap device attached to the scope tip, a 22 × 18 mm hypoechoic subepithelial mass was clearly visualized, and consecutive EUS-FNB was performed with a 22-gauge needle. No complications, including bleeding, occurred. Histopathology and immunohistochemistry demonstrated moderately differentiated squamous cell carcinoma, and the patient was referred for treatment as primary hypopharyngeal cancer. This case illustrates the feasibility and safety of FV-EUS–guided FNB for pharyngeal SELs and suggests a wider role for FV-EUS in head and neck disorders.
{"title":"Forward-Viewing Endoscopic Ultrasound-Guided Fine-Needle Biopsy for a Hypopharyngeal Carcinoma Mimicking a Subepithelial Lesion: A Case Report","authors":"Kakeru Otomo, Tadayuki Takagi, Jun Wada, Natsuki Ishizaki, Kana Tamazawa, Kohei Suzuki, Masato Aizawa, Hiroshi Ogawa, Osamu Suzuki, Kazutomo Togashi","doi":"10.1002/deo2.70275","DOIUrl":"10.1002/deo2.70275","url":null,"abstract":"<p>Subepithelial lesions (SELs) of the head and neck have a low diagnostic yield with mucosal biopsy and carry a bleeding risk. Among endoscopic ultrasound–tissue acquisition (EUS-TA) techniques, fine-needle biopsy (FNB) provides higher specimen adequacy and diagnostic accuracy than fine-needle aspiration (FNA). A forward-viewing curved linear-array echoendoscope (FV-EUS) is useful for mobile lesions and those in narrow spaces that are difficult to puncture with conventional oblique-viewing EUS (OV-EUS), but FV-EUS–guided EUS-FNB has not been reported for head and neck lesions.</p><p>We report a 72-year-old man in whom a lesion at the esophageal inlet was not apparent on initial upper gastrointestinal endoscopy performed with a small-caliber endoscope. Stenosis was subsequently noted at the time of endoscopic submucosal dissection for early gastric cancer. Contrast-enhanced computed tomography showed an approximately 20-mm solid mass on the posterior hypopharyngeal wall. Under general anesthesia with laryngoscopic exposure, an elevated subepithelial lesion without mucosal exposure was observed on the posterior pharyngeal wall. Using FV-EUS with a cap device attached to the scope tip, a 22 × 18 mm hypoechoic subepithelial mass was clearly visualized, and consecutive EUS-FNB was performed with a 22-gauge needle. No complications, including bleeding, occurred. Histopathology and immunohistochemistry demonstrated moderately differentiated squamous cell carcinoma, and the patient was referred for treatment as primary hypopharyngeal cancer. This case illustrates the feasibility and safety of FV-EUS–guided FNB for pharyngeal SELs and suggests a wider role for FV-EUS in head and neck disorders.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021094","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}
A 79-year-old man presented with fever and jaundice. Laboratory tests revealed elevated inflammatory markers and hepatobiliary enzymes. Magnetic resonance imaging revealed a 20 × 16 cm giant hepatic cyst compressing the intrahepatic bile ducts. Emergency endoscopic retrograde cholangiopancreatography revealed intrahepatic bile duct dilatation secondary to cystic compression. An endoscopic nasobiliary drainage tube was inserted. After the cholangitis improved, the tube was replaced with a plastic stent. The patient was discharged but was readmitted 11 days later with recurrent fever and loss of appetite. Computed tomography revealed thickening of the cyst wall and internal debris, consistent with an infected hepatic cyst. Given the patient's poor general condition and presence of compressed vessels and bile ducts along the percutaneous puncture route, endoscopic ultrasound-guided cyst drainage (EUS-CD) with nasocystic drainage was performed. After clinical improvement, surgical fenestration was attempted but aborted due to inflammation and friability with bleeding around the endosonographically/EUS-guided created route (ESCR). On day 25 after EUS-CD, conversion to internal trans-ESCR drainage was performed using a 7-Fr, 15-cm double-pigtail stent, and the transpapillary stent was removed because bile duct compression had resolved. The infection recurred 22 days later owing to stent occlusion, requiring stent exchange and additional drainage via ESCR. Finally, three plastic stents were placed, and the patient had no further infection recurrence. After infection control with nasocystic drainage using EUS-CD, multiple stent placements via ESCR can provide safe, effective, and durable treatment for giant infected hepatic cysts that are unsuitable for percutaneous drainage or surgery.
{"title":"Successful Stepwise Endoscopic Ultrasound-Guided Cyst Drainage for a Giant Infected Hepatic Cyst: A Case Report","authors":"Kazuki Endo, Haruo Miwa, Shotaro Tsunoda, Akihiro Funaoka, Ritsuko Oishi, Yuichi Suzuki, Yusuke Takeshita, Tomoaki Takahashi, Manabu Morimoto, Shin Maeda","doi":"10.1002/deo2.70286","DOIUrl":"10.1002/deo2.70286","url":null,"abstract":"<p>A 79-year-old man presented with fever and jaundice. Laboratory tests revealed elevated inflammatory markers and hepatobiliary enzymes. Magnetic resonance imaging revealed a 20 × 16 cm giant hepatic cyst compressing the intrahepatic bile ducts. Emergency endoscopic retrograde cholangiopancreatography revealed intrahepatic bile duct dilatation secondary to cystic compression. An endoscopic nasobiliary drainage tube was inserted. After the cholangitis improved, the tube was replaced with a plastic stent. The patient was discharged but was readmitted 11 days later with recurrent fever and loss of appetite. Computed tomography revealed thickening of the cyst wall and internal debris, consistent with an infected hepatic cyst. Given the patient's poor general condition and presence of compressed vessels and bile ducts along the percutaneous puncture route, endoscopic ultrasound-guided cyst drainage (EUS-CD) with nasocystic drainage was performed. After clinical improvement, surgical fenestration was attempted but aborted due to inflammation and friability with bleeding around the endosonographically/EUS-guided created route (ESCR). On day 25 after EUS-CD, conversion to internal trans-ESCR drainage was performed using a 7-Fr, 15-cm double-pigtail stent, and the transpapillary stent was removed because bile duct compression had resolved. The infection recurred 22 days later owing to stent occlusion, requiring stent exchange and additional drainage via ESCR. Finally, three plastic stents were placed, and the patient had no further infection recurrence. After infection control with nasocystic drainage using EUS-CD, multiple stent placements via ESCR can provide safe, effective, and durable treatment for giant infected hepatic cysts that are unsuitable for percutaneous drainage or surgery.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021066","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 case of massive bleeding from proton pump inhibitor (PPI)-induced fundic gland polyps (FGPs) that regressed after switching to a histamine-2 receptor antagonist (H2RA). A 46-year-old man with antiphospholipid syndrome had been receiving warfarin and lansoprazole for 4 years. Esophagogastroduodenoscopy (EGD) revealed multiple enlarged, edematous FGPs compared to those observed 3 years earlier. One month later, the patient presented with melena, anemia, and transient loss of consciousness. Laboratory data revealed anemia and a prolonged prothrombin time/international normalized ratio (PT-INR). Emergency EGD showed refractory oozing from the FGPs caused by insufflation and water jet stimulation. The bleeding was successfully controlled with vitamin K administration. After PT-INR normalization, no further bleeding occurred, and a follow-up EGD 3 days later showed no bleeding recurrence. We considered that PPI therapy might lead to recurrent bleeding from the FGPs and switched therapy to an H2RA. Follow-up EGD at 2 and 6 months revealed gradual and marked regression of the FGPs. This case demonstrates that PPI-induced FGPs can result in massive bleeding, particularly in patients receiving anticoagulant therapy. Furthermore, FGP regression following the switch to H2RA suggests that H2RA therapy may be an alternative treatment when discontinuation of PPI therapy is not feasible.
{"title":"Proton Pump Inhibitor-Induced Fundic Gland Polyps With Massive Bleeding Regressed on Alternative Histamine 2 Receptor Antagonist Therapy","authors":"Ryosuke Ikeda, Hiroaki Kaneko, Hiroki Sato, Yuto Matsuoka, Tomomi Hamaguchi, Aya Ikeda, Yoshihiro Goda, Soichiro Sue, Kuniyasu Irie, Shin Maeda","doi":"10.1002/deo2.70273","DOIUrl":"https://doi.org/10.1002/deo2.70273","url":null,"abstract":"<p>We report a case of massive bleeding from proton pump inhibitor (PPI)-induced fundic gland polyps (FGPs) that regressed after switching to a histamine-2 receptor antagonist (H2RA). A 46-year-old man with antiphospholipid syndrome had been receiving warfarin and lansoprazole for 4 years. Esophagogastroduodenoscopy (EGD) revealed multiple enlarged, edematous FGPs compared to those observed 3 years earlier. One month later, the patient presented with melena, anemia, and transient loss of consciousness. Laboratory data revealed anemia and a prolonged prothrombin time/international normalized ratio (PT-INR). Emergency EGD showed refractory oozing from the FGPs caused by insufflation and water jet stimulation. The bleeding was successfully controlled with vitamin K administration. After PT-INR normalization, no further bleeding occurred, and a follow-up EGD 3 days later showed no bleeding recurrence. We considered that PPI therapy might lead to recurrent bleeding from the FGPs and switched therapy to an H2RA. Follow-up EGD at 2 and 6 months revealed gradual and marked regression of the FGPs. This case demonstrates that PPI-induced FGPs can result in massive bleeding, particularly in patients receiving anticoagulant therapy. Furthermore, FGP regression following the switch to H2RA suggests that H2RA therapy may be an alternative treatment when discontinuation of PPI therapy is not feasible.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996639","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}
Mai Fukuda, Masakuni Kobayashi, Miku Maeda, Mamoru Ito, Naoya Tada, Toshiki Futakuchi, Naoto Tamai, Nei Fukasawa, Masayuki Shimoda, Kazuki Sumiyama
Hybrid nerve sheath tumors (HNSTs) are exceedingly rare in the gastrointestinal tract, particularly in the stomach. We describe a case of an enlarging gastric subepithelial lesion (SEL) that was accurately diagnosed and curatively treated by endoscopic full-thickness resection (EFTR). A 50-year-old woman presented with a 10 mm SEL on the posterior wall of the upper gastric curvature. Endoscopic ultrasound (EUS) revealed a low-hypoechoic lesion primarily originating from the third layer with focal, indistinct borders with the muscularis propria. Initial boring biopsy suggested a granular cell tumor based on morphology and SOX10/S100 positivity. Six months later, the lesion had enlarged to 15 mm, and EFTR under general anesthesia with laparoscopic backup was selected to obtain a full-thickness specimen. En bloc resection was successfully achieved, and the defect was completely closed with clips. Histopathological and immunohistochemical examinations revealed biphasic Schwann and perineurial differentiation, confirming a hybrid schwannoma/perineurioma. The postoperative course was uneventful, and no recurrence was observed during the 22-month follow-up. This case highlights the diagnostic value of EFTR for rare neurogenic SELs in which superficial biopsy may be inconclusive.
{"title":"Hybrid Nerve Sheath Tumor Detected by Endoscopic Full-Thickness Resection for a Gastric Subepithelial Lesion: A Case Report","authors":"Mai Fukuda, Masakuni Kobayashi, Miku Maeda, Mamoru Ito, Naoya Tada, Toshiki Futakuchi, Naoto Tamai, Nei Fukasawa, Masayuki Shimoda, Kazuki Sumiyama","doi":"10.1002/deo2.70276","DOIUrl":"10.1002/deo2.70276","url":null,"abstract":"<p>Hybrid nerve sheath tumors (HNSTs) are exceedingly rare in the gastrointestinal tract, particularly in the stomach. We describe a case of an enlarging gastric subepithelial lesion (SEL) that was accurately diagnosed and curatively treated by endoscopic full-thickness resection (EFTR). A 50-year-old woman presented with a 10 mm SEL on the posterior wall of the upper gastric curvature. Endoscopic ultrasound (EUS) revealed a low-hypoechoic lesion primarily originating from the third layer with focal, indistinct borders with the muscularis propria. Initial boring biopsy suggested a granular cell tumor based on morphology and SOX10/S100 positivity. Six months later, the lesion had enlarged to 15 mm, and EFTR under general anesthesia with laparoscopic backup was selected to obtain a full-thickness specimen. En bloc resection was successfully achieved, and the defect was completely closed with clips. Histopathological and immunohistochemical examinations revealed biphasic Schwann and perineurial differentiation, confirming a hybrid schwannoma/perineurioma. The postoperative course was uneventful, and no recurrence was observed during the 22-month follow-up. This case highlights the diagnostic value of EFTR for rare neurogenic SELs in which superficial biopsy may be inconclusive.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12797082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971569","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 an ultra-short-acting benzodiazepine recently approved for endoscopic procedures in Japan as a sedative agent. We aimed to compare the efficacy and safety of remimazolam and midazolam for endoscopic retrograde cholangiopancreatography (ERCP)-related procedures.
Methods
ERCP-related procedures performed under sedation with remimazolam (between August 2025 and November 2025) and midazolam (between April 2025 and July 2025) were retrospectively reviewed. The primary outcome was the time from the end of the procedure to patient awakening and readiness for discharge. The secondary outcomes included sedation success throughout the procedure, time from the initial dose to achieving sedation, dosage, rate of antagonist use for awakening, and sedation-related adverse events.
Results
Eighty-eight patients underwent ERCP-related procedures with remimazolam and 86 with midazolam. The median times from the end of the procedure to patient awakening and readiness for discharge with remimazolam and midazolam were 2 min (interquartile range [IQR], 1–3) and 4 min (IQR, 3–5), respectively. Sedation with remimazolam required a shorter time to awaken than sedation with midazolam (p < 0.01). Furthermore, the rate of antagonist use for awakening was significantly lower with remimazolam than with midazolam (p < 0.01). The success rate of sedation, median time from the initial dose to achieving sedation, and rate of sedation-related adverse events were not significantly different between groups (p = 0.49, 0.13, and 0.27, respectively).
Conclusions
Remimazolam demonstrated significantly shorter time to patient awakening, suggesting a safer and more efficient discharge process after ERCP-related procedures.
{"title":"Comparison of Remimazolam and Midazolam for Sedation During Endoscopic Retrograde Cholangiopancreatography-Related Procedures","authors":"Yuki Tanisaka, Shomei Ryozawa, Suguru Ito, Masafumi Mizuide, Akashi Fujita, Ryuichi Watanabe, Ryosuke Hamamura, Yoshiki Matsuno","doi":"10.1002/deo2.70281","DOIUrl":"10.1002/deo2.70281","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Remimazolam is an ultra-short-acting benzodiazepine recently approved for endoscopic procedures in Japan as a sedative agent. We aimed to compare the efficacy and safety of remimazolam and midazolam for endoscopic retrograde cholangiopancreatography (ERCP)-related procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ERCP-related procedures performed under sedation with remimazolam (between August 2025 and November 2025) and midazolam (between April 2025 and July 2025) were retrospectively reviewed. The primary outcome was the time from the end of the procedure to patient awakening and readiness for discharge. The secondary outcomes included sedation success throughout the procedure, time from the initial dose to achieving sedation, dosage, rate of antagonist use for awakening, and sedation-related adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-eight patients underwent ERCP-related procedures with remimazolam and 86 with midazolam. The median times from the end of the procedure to patient awakening and readiness for discharge with remimazolam and midazolam were 2 min (interquartile range [IQR], 1–3) and 4 min (IQR, 3–5), respectively. Sedation with remimazolam required a shorter time to awaken than sedation with midazolam (<i>p</i> < 0.01). Furthermore, the rate of antagonist use for awakening was significantly lower with remimazolam than with midazolam (<i>p</i> < 0.01). The success rate of sedation, median time from the initial dose to achieving sedation, and rate of sedation-related adverse events were not significantly different between groups (<i>p</i> = 0.49, 0.13, and 0.27, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Remimazolam demonstrated significantly shorter time to patient awakening, suggesting a safer and more efficient discharge process after ERCP-related procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12796972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971623","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}
Yuki Ikeda, Masahiro Yoshida, Kei Yane, Mayu Shimizu, Keita Seto, Koki Yoshida, Sota Hirokawa, Kotaro Morita, Tetsuya Sumiyoshi, Michiaki Hirayama, Hitoshi Kondo, Kohichi Takada
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.
背景：胃上皮下病变（SELs）测量方法：我们回顾性分析了2012年6月至2025年3月在Tonan医院接受EUS-TA检查的SELs患者。结果：共纳入163例患者，其中50例为SELs （p = 0.03）。GIST是两组中最常见的诊断，无显著差异（56% vs. 61.9%）。细针活检没有显著提高样本充分性或诊断准确性。结论：EUS-TA联合ROSE诊断胃部SELs
{"title":"Diagnostic Value of Endoscopic Ultrasound-Guided Tissue Acquisition With Rapid On-Site Evaluation in Small Gastric Subepithelial Lesions","authors":"Yuki Ikeda, Masahiro Yoshida, Kei Yane, Mayu Shimizu, Keita Seto, Koki Yoshida, Sota Hirokawa, Kotaro Morita, Tetsuya Sumiyoshi, Michiaki Hirayama, Hitoshi Kondo, Kohichi Takada","doi":"10.1002/deo2.70282","DOIUrl":"10.1002/deo2.70282","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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, <i>p</i> = 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%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12797083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971615","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 clips used in laparoscopic cholecystectomy (LC) is rare, but when a clip migrates into the bile duct, it can serve as a nucleus for common bile duct stone formation and trigger acute cholangitis. An elderly woman in her 80s underwent LC for cholecystolithiasis at another hospital in year X. Abdominal computed tomography in year X+1 revealed that two clips had migrated into the bile duct, but this was not noted at the time, and she remained asymptomatic. In year X+5, she underwent bioprosthetic aortic valve replacement for severe aortic regurgitation. In year X+6, she presented to our emergency department with fever and right upper quadrant pain, and she was diagnosed with acute cholangitis. On the day of admission, only drainage was performed, resulting in rapid improvement of the inflammation. On the sixth hospital day, endoscopic sphincterotomy and endoscopic papillary large balloon dilation (EPLBD) were performed, and the stones were completely removed. Infrared analysis of the retrieved stones showed that over 98% consisted of calcium bilirubinate. Even if clip migration occurs relatively early after LC, there may be a time lag of several years before stone formation and symptom onset; EPLBD achieved complete, safe removal without lithotripsy.
{"title":"Clip-Centered Common Bile Duct Stones Managed by Endoscopic Sphincterotomy Plus Endoscopic Papillary Large Balloon Dilation Years After Cholecystectomy","authors":"Nobuhiko Fukuba, Erito Ando, Taisuke Ohmachi, Yasuhide Kodama, Masaki Onoe, Kousaku Kawashima, Norihisa Ishimura, Shunji Ishihara","doi":"10.1002/deo2.70280","DOIUrl":"10.1002/deo2.70280","url":null,"abstract":"<p>Migration of clips used in laparoscopic cholecystectomy (LC) is rare, but when a clip migrates into the bile duct, it can serve as a nucleus for common bile duct stone formation and trigger acute cholangitis. An elderly woman in her 80s underwent LC for cholecystolithiasis at another hospital in year X. Abdominal computed tomography in year X+1 revealed that two clips had migrated into the bile duct, but this was not noted at the time, and she remained asymptomatic. In year X+5, she underwent bioprosthetic aortic valve replacement for severe aortic regurgitation. In year X+6, she presented to our emergency department with fever and right upper quadrant pain, and she was diagnosed with acute cholangitis. On the day of admission, only drainage was performed, resulting in rapid improvement of the inflammation. On the sixth hospital day, endoscopic sphincterotomy and endoscopic papillary large balloon dilation (EPLBD) were performed, and the stones were completely removed. Infrared analysis of the retrieved stones showed that over 98% consisted of calcium bilirubinate. Even if clip migration occurs relatively early after LC, there may be a time lag of several years before stone formation and symptom onset; EPLBD achieved complete, safe removal without lithotripsy.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12796956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971588","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 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.
目的：超声内镜引导下肝胃造口术（EUS-HGS）通常用于内镜逆行胆管造影引导下全覆盖自膨胀金属支架（eb - mss）胆道支架置入失败的恶性胆道远端梗阻（MDBO）。我们的目的是澄清EUS-HGS与塑料支架（hgs - ps）的临床结果与EBS-MS的比较。方法：我们回顾性分析了2017年1月至2024年7月期间，采用MS （as -MS）或EBS-MS作为初始胆道引流治疗不可切除MDBO的HGS-PS伴或不伴顺行支架置入的患者。结果：HGS-PS组共纳入27例患者，EBS-MS组共纳入128例患者。HGS-PS组的中位手术时间显著缩短（24分钟vs. 39分钟，p < 0.001），不良事件发生率相当（22% vs. 32%, p = 0.365）。HGS-PS组复发性胆道梗阻（RBO）发生率显著高于对照组（48% vs. 26%, p = 0.002），复发性胆道梗阻（TRBO）时间显著缩短（169天vs. 341天，p = 0.001）。倾向评分匹配后，RBO率和TRBO均无显著差异。亚组分析显示，HGS-PS联合AS-MS组和EBS-MS组的TRBO具有可比性（273天vs. 341天，p = 0.609）。结论：尽管与EBS-MS相比，HGS-PS的TRBO往往更短，但在HGS-PS的基础上添加AS-MS可导致类似的TRBO，这表明该组合可能是一种可行的替代方案。临床试验注册：作者已确认本次提交不需要临床试验注册。
{"title":"Endoscopic Ultrasound-Guided Hepaticogastrostomy With Plastic Stents in Comparison to Transpapillary Drainage With Metallic Stents for Unresectable Malignant Distal Biliary Obstructions","authors":"Hidehito Sumiya, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Kento Hosokawa, Shun Nozaki, Kei Ito","doi":"10.1002/deo2.70263","DOIUrl":"10.1002/deo2.70263","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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, <i>p</i> < 0.001), and the incidence of adverse events was comparable (22% vs. 32%, <i>p</i> = 0.365). The HGS-PS group had a significantly higher recurrent biliary obstruction (RBO) rate (48% vs. 26%, <i>p</i> = 0.002) and shorter time to RBO (TRBO) (169 vs. 341 days, <i>p</i> = 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, <i>p</i> = 0.609).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p>Clinical Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12791027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968241","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 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.
{"title":"Efficacy and Safety of a Revised Gastric Peroral Endoscopic Myo-Neurotomy Procedure for Bariatric Endoscopy in a Porcine Model","authors":"Yasushi Yamasaki, Kenta Hamada, Junki Toyosawa, Akinobu Takaki, Takehiro Tanaka, Hiroyuki Okada, Motoyuki Otsuka","doi":"10.1002/deo2.70230","DOIUrl":"10.1002/deo2.70230","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twelve pigs underwent either an R-POEM-N procedure (<i>n</i> = 8) or a sham endoscopic procedure (<i>n</i> = 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>p</i> = 0.017). Food intake in the R-POEM-N group was significantly lower than that in the control group (<i>p</i> < 0.05). Changes in serum glycolipid levels were not significantly different between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>R-POEM-N successfully reduced weight gain in pigs, supporting its potential as a novel bariatric intervention with minimal invasiveness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12788173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954584","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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