Management of ERCP-related perforation: a large multicenter study.

Background And Aims: Perforation is a rare but serious adverse event associated with endoscopic retrograde cholangiopancreatography (ERCP). There is no consensus to guide clinicians in the management of ERCP-related duodenal perforations, making it difficult to determine whether surgical or endoscopic treatment is optimal. The present study retrospectively evaluated the characteristics and clinical outcomes of patients who experienced ERCP-related duodenal perforations according to the mechanism of injury.

A Possible Contraindication for Endoscopic Ultrasound-Guided Hepaticogastrostomy: A Giant Hiatal Hernia.

We present the case of an 82-year-old female with obstructive jaundice secondary to a malignant distal biliary stricture. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) was performed. The presence of a giant hiatal hernia induced dynamic liver movement during respiration, leading to unstable scope positioning.

Successful Forceps Biopsy of Carcinoma of the Distal Bile Duct Under Direct Visualization Using a Stone Retrieval Balloon Catheter.

We present the case of a 72-year-old woman with elevated hepatobiliary enzymes and a small mass in the distal bile duct near the papilla. Fluoroscopy-guided forceps biopsy initially yielded insufficient tissue. After endoscopic papillary large balloon dilation with sphincterotomy, a stone retrieval balloon was used to expose the tumor to the duodenum.

A Case of Acute Cholecystitis Successfully Treated With Endoscopic Ultrasound-Guided Gallbladder Drainage in a Patient With Osteogenesis Imperfecta.

A 74-year-old man with severe osteogenesis imperfecta (OI) was admitted to our hospital because of repetitive cholecystitis due to a stone in the gallbladder neck. Because he had severe OI-related chest wall deformity and a high risk of complications from bronchial intubation, general anesthesia, and surgery, we performed endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). The postprocedural clinical course was uneventful, and he was discharged in satisfactory condition.

Evaluation of a Novel Easy Loop-Forming Guidewire to Reduce Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis for Serial Pancreatic Juice Aspiration Cytologic Examination: A Propensity Score Matching Analysis.

Objective: This study aimed to investigate whether a novel, easy loop-forming guidewire could reduce post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) in patients undergoing endoscopic nasopancreatic drainage tube placement for serial pancreatic juice aspiration cytologic examination (SPACE).

Methods: We evaluated patients with suspected pancreatic cancer who underwent SPACE at our institution between January 2015 and April 2023 retrospectively. The patients were divided into 2 groups based on the type of guidewire used, namely, easy loop-forming and control groups.

Cystic duct straightening using a fine-gauge balloon dilator for successful endoscopic transpapillary gallbladder stenting.

Endoscopic transpapillary gallbladder stenting is sometimes inhibited by a cystic duct loop, necessitating cystic duct straightening. Mandai and colleagues report a novel technique for straightening the looped cystic duct using a fine-gauge balloon dilator, which is useful during endoscopic gallbladder stenting when the double-guidewire technique fails.

Safety of early oral intake after endoscopic ultrasound-guided hepaticoenterostomy.

Background: Techniques and devices for endoscopic ultrasound (EUS)-guided hepaticoenterostomy (EUS-HES) procedures, including EUS-guided hepaticogastrostomy (EUS-HGS) and EUS-guided hepaticojejunostomy (EUS-HJS), have been developed; however, the optimal timing to begin oral intake after EUS-HES remains unknown. This study aimed to evaluate the safety of early oral intake after EUS-HES.

Methods: We retrospectively investigated patients who underwent EUS-HES (EUS-HGS or EUS-HJS) between March 2015 and March 2022.

Mediastinal Primary Synovial Sarcoma With Postoperative Pericardial Recurrence in a Previously Treated Angiofibroma.

Synovial sarcoma is a malignant soft tissue tumor that often occurs near the limb joints. Here, we report a case of a patient with a synovial sarcoma that occurred in the mediastinum. The initial pathological diagnosis was suspected angiofibroma after surgical resection.

Transferring a naso-gallbladder drainage tube to the mouth for re-examination of a gallbladder lesion.

Conventional gallbladder re-intervention along the naso-gallbladder drainage tube may result in dislocation of the tube during scope insertion or failure of guidewire insertion into the gallbladder. Mandai et al report a simple method for transferring a transpapillary naso-gallbladder drainage tube to the mouth that facilitates reliable re-intervention for gallbladder lesions.

Endoscopic ultrasound-guided treatment for malignant afferent loop obstruction after Roux-en-Y reconstruction.

The usefulness of endoscopic ultrasound (EUS)-guided gastrojejunostomy (EUS-GJ) using a lumen-apposing metal stent (LAMS) has been reported. However, LAMS is not available in many countries and is more expensive than a conventional fully covered self-expandable metal stent (FCSEMS). We treated cases of malignant afferent loop obstruction after Roux-en-Y reconstruction: three patients underwent EUS-guided hepaticoenterostomy (EUS-HES) and one patient underwent EUS-GJ with a conventional biliary FCSEMS, instead of EUS-GJ with a LAMS.

Transpapillary biliary drainage using a long plastic stent: Preventing early stent dysfunction in pancreatic cancer with duodenal invasion.

Highlight Duodenal invasion has been reported to be a risk factor for early biliary stent dysfunction in patients with pancreatic cancer. Mandai and colleagues describe their method of transpapillary biliary drainage using a long plastic stent as a potentially useful treatment option to avoid early stent dysfunction in such patients.

Post-endoscopic retrograde cholangiopancreatography pancreatitis assessed using criteria for acute pancreatitis.

Background And Aim: International consensus on the definition and classification of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) has been reached. However, the diagnosis and severity of PEP are often assessed according to the diagnostic criteria and classification for acute pancreatitis (AP). This study determined the incidence, severity, and risk factors of PEP diagnosed according to the diagnostic criteria and classification for AP in a large cohort.

Fully covered metal stents vs plastic stents for preoperative biliary drainage in patients with resectable pancreatic cancer without neoadjuvant chemotherapy: A multicenter, prospective, randomized controlled trial.

Background/purpose: Whether a fully covered self-expanding metal stent (FCSEMS) or plastic stent (PS) is preferable for preoperative biliary drainage in patients with resectable pancreatic cancer (RPC) is controversial. This study aimed to evaluate the safety and efficacy of drainage with FCSEMS for obstructive jaundice caused by RPC without neoadjuvant chemotherapy.

Methods: Seventy patients with RPC who required preoperative biliary drainage were randomly assigned 1:1 to the FCSEMS or PS group.

Cancer of Unknown Primary With Presumptive Pancreatic Cancer Treated With FOLFIRINOX.

A 52-year-old man was found to have an increase in carbohydrate antigen (CA)19-9. He underwent endoscopic ultrasound/fine needle aspiration (EUS-FNA) of the soft tissue shadow near the pancreas and was diagnosed with adenocarcinoma. The cancer was judged to be of unknown primary.