DEN open最新文献

Eosinophilic esophagitis is a chronic allergic inflammatory disease, and its incidence and prevalence have recently increased. Eosinophilic esophagitis has not become a rare disease; thus, knowledge for diagnosing it is needed in current clinical practice. The adequate management of endoscopic procedures is particularly important for the diagnosis and evaluation of inflammatory activity and therapeutic responses. The therapeutic options for eosinophilic esophagitis include anti-acid drugs such as proton pump inhibitors, potassium-competitive acid blockers, swallowed topical corticosteroids, biologics, and dietary elimination therapies. Moreover, endoscopic esophageal dilation is a therapeutic option for fibrotic strictures due to eosinophilic esophagitis to improve obstructive symptoms, such as dysphagia and food impaction. In this review, we describe the endoscopic characteristics of eosinophilic esophagitis, including an endoscopic reference score and an optimal biopsy protocol to diagnose and evaluate the therapeutic response. We also describe a current therapeutic management of eosinophilic esophagitis.

The management of locally advanced esophageal cancer typically involves esophagectomy; however, postoperative complications, particularly anastomotic stricture, remain prevalent. Anastomotic stricture can severely compromise patients' quality of life by leading to difficulties in food intake. Although endoscopic balloon dilation has become a standard treatment for gastrointestinal strictures, its efficacy is often limited due to the risk of perforation and the potential for recurrent stricture, necessitating multiple interventions. Recent advancements have introduced endoscopic radial incision and cutting methods, which aim to enhance patency by excising scar tissue. We experienced a case resistant to the radial incision and cutting therapy, necessitating further intervention strategies. This report details our experience utilizing a novel technique, endoscopic incisional balloon dilation, which combines endoscopic incisional technique and balloon dilation therapy with anti-scarring medications, in cases of refractory anastomotic strictures following esophageal cancer resection. We present three challenging cases in which endoscopic incisional balloon dilation yielded significant clinical improvements, alongside supportive literature. Our findings suggest that endoscopic incisional balloon dilation is an effective and safer alternative to conventional methods, capable of addressing complex stricture scenarios while potentially enhancing patient outcomes and quality of life.

Stent-induced ductal change is a complication of endoscopic treatment of the main pancreatic duct in chronic pancreatitis. Most previous reports have been based on morphological duct changes observed via pancreatography. Here, we describe a case of stent-induced ductal change in which the course of the mucosal changes was observed through peroral pancreatoscopy with a videoscopy.

The patient presented with chronic alcoholic pancreatitis. Main pancreatic duct stenosis in the pancreatic head was identified and a 10-Fr plastic stent was inserted. Follow-up pancreatography revealed a focally elevated duct change of approximately 4.5 mm at the distal tip of the stent, and peroral pancreatoscopy was performed. The elevated ductal change was identified as a clear villiform-like nodular mucosal change with the spread of pale papillary and granular mucosa. Reassessment after stent removal showed an improvement in the elevated mucosal lesion, with residual discoloration and mucosal retraction suggestive of scarring. The stent may cause irreversible changes, undetectable morphologically by pancreatography, likely underestimating stent-induced ductal change in chronic pancreatitis.

Endoscopic injection sclerotherapy (EIS) is a useful prophylactic hemostatic procedure for esophageal varices. However, injecting sclerosing agents into blood vessels is technically challenging and often ineffective. Gel-immersion EIS (GI-EIS) may facilitate easier intravascular sclerosing agent injection by dilating the varices and enhancing scope stability by maintaining low intra-gastrointestinal pressure. Therefore, we aimed to evaluate the effectiveness and safety of this procedure. This retrospective study included 18 patients (14 men and four women; median age, 70 years; age range, 18–83 years) who underwent GI-EIS at Osaka Medical Pharmaceutical University Hospital between December 1, 2022, and January 30, 2024. Patients who were at least 18 years of age at the time of treatment were included. No patients were excluded from the study. Thirty-four punctures were performed. The donor vessel angiography success rate was 88.2% (30 of 34 punctures). The clinical success rate was 94.4% (17 of 18 patients). Esophageal varices in most patients disappeared or were reduced by 1 month after treatment. Adverse events related to the procedure included fever (three patients) and chest pain (one patient); however, both were resolved with conservative treatment. No respiratory deterioration due to aspiration occurred during the procedure. The results of this study demonstrate that GI-EIS is a safe, clinically feasible, and effective treatment option for prophylactic hemostasis of esophageal varices.