Digestive Endoscopy最新文献

Not All Endoscopic Submucosal Dissections Are Created Equal: Rethinking Bleeding Risk Stratification During Antiplatelet Therapy 并非所有的内镜下粘膜夹层都是平等的：重新思考抗血小板治疗期间出血风险分层。

IF 3.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy

Pub Date : 2026-10-11 DOI: 10.1111/den.70311

Antonio Capogreco, Francesco Minini

<p>Endoscopic submucosal dissection (ESD) has revolutionized the management of superficial gastrointestinal neoplasia by providing organ-preserving treatment with excellent oncological outcomes. At the same time, the aging of the population and the increasing prevalence of cardiovascular disease have led to a growing number of patients undergoing ESD while receiving antiplatelet therapy. Consequently, endoscopists are increasingly confronted with one of the most challenging aspects of therapeutic endoscopy: balancing the risk of post-procedural bleeding against the potentially serious consequences of thromboembolic events.</p><p>Current international guidelines provide an invaluable framework by classifying ESD among high-risk endoscopic procedures and recommending peri-procedural management of antithrombotic therapy accordingly [<span>1, 2</span>]. These recommendations have undoubtedly improved patient safety and standardized clinical practice. Nevertheless, guideline classifications inevitably represent a simplification of a far more heterogeneous clinical reality. While guidelines classify procedures, clinicians ultimately treat individual patients. Bridging these two perspectives remains one of the greatest challenges in contemporary therapeutic endoscopy.</p><p>Perhaps the question is no longer simply how antiplatelet therapy should be managed during ESD, but whether all ESD procedures truly share the same intrinsic bleeding risk.</p><p>In this issue of <i>Digestive Endoscopy</i>, Hirai et al. [<span>3</span>] report the largest multicenter experience to date evaluating peri-procedural antiplatelet management in patients undergoing ESD for esophageal squamous cell carcinoma. Importantly, this study does not attempt to demonstrate the superiority of one antiplatelet strategy over another. Rather, it provides carefully collected real-world data in an area where evidence has long remained remarkably limited.</p><p>The authors observed low rates of delayed bleeding irrespective of whether thienopyridine therapy was managed according to guideline-based discontinuation or continued throughout the peri-procedural period. Owing to the retrospective design and the very limited number of bleeding events, these findings cannot be interpreted as evidence supporting continued therapy, nor do they justify changes in current recommendations. Instead, they should be viewed as an important contribution to an evolving clinical discussion [<span>3</span>].</p><p>Indeed, the greatest value of this study may not reside in the absolute bleeding rate itself, but in the clinical question that naturally emerges from these observations.</p><p>Are all ESD procedures really equal? Therapeutic endoscopy has traditionally approached ESD as a single procedural entity when considering peri-procedural bleeding risk. Such an approach is understandable and has facilitated the development of practical recommendations. However, accumulating evidence suggests that delayed bleed

内镜下粘膜剥离术（ESD）通过提供器官保留治疗和良好的肿瘤预后，彻底改变了浅表胃肠道肿瘤的治疗。同时，随着人口老龄化和心血管疾病患病率的上升，越来越多的患者在接受抗血小板治疗的同时发生ESD。因此，内窥镜医师越来越多地面临治疗性内窥镜最具挑战性的方面之一：平衡手术后出血的风险与血栓栓塞事件的潜在严重后果。目前的国际指南提供了一个宝贵的框架，将ESD分类为高危内镜手术，并建议相应的术中抗血栓治疗管理[1,2]。这些建议无疑提高了患者的安全性和标准化的临床实践。尽管如此，指南分类不可避免地代表了对远为多样化的临床现实的简化。虽然指南对治疗方法进行了分类，但临床医生最终治疗的是个体患者。连接这两个观点仍然是当代治疗内窥镜最大的挑战之一。也许问题不再是在ESD过程中如何进行抗血小板治疗，而是所有ESD过程是否真的具有相同的内在出血风险。在本期的《消化道内窥镜》杂志上，Hirai等人报道了迄今为止最大的多中心经验，评估了食管鳞状细胞癌行ESD患者的围手术期抗血小板管理。重要的是，这项研究并没有试图证明一种抗血小板策略优于另一种。相反，它提供了精心收集的真实世界数据，而长期以来证据仍然非常有限。作者观察到迟发性出血的发生率很低，无论噻吩吡啶治疗是根据指南停药还是在围手术期继续治疗。由于回顾性设计和出血事件数量非常有限，这些发现不能被解释为支持继续治疗的证据，也不能证明改变目前的建议是合理的。相反，它们应该被视为对不断发展的临床讨论的重要贡献。事实上，这项研究的最大价值可能不在于绝对出血率本身，而在于从这些观察中自然出现的临床问题。所有的ESD程序都是一样的吗？在考虑术中出血风险时，治疗性内窥镜传统上将ESD视为单一的手术实体。这种做法是可以理解的，并促进了实际建议的制定。然而，越来越多的证据表明，ESD后的延迟出血并不是均匀分布在胃肠道中。以往的研究一致报道了鳞状细胞癌食管ESD后延迟出血的发生率非常低，目前的多中心研究进一步证实了在接受抗血小板治疗的患者中这一观察结果[4-6]。这种区别值得仔细考虑。事实上，一些预测模型和系统综述表明，ESD后出血风险取决于多个患者和手术相关因素的相互作用，而不是手术本身[7,8]。风险分层很少由单一变量决定。相反，它反映了患者特征、血栓栓塞负担、手术复杂性、操作人员专业知识和受累器官的生物学特征之间的相互作用。因此，将所有ESD手术视为具有相同的出血风险，可能是对日益复杂的临床情况的过度简化。重要的是，这一概念不应被解释为对现行指导方针的挑战。相反，它反映了循证医学的自然演变。指南必须依赖于给定时间内可获得的最佳证据，而临床研究逐渐确定了可能适合更精细分层的情况。本研究的另一个特别有趣的方面是，它涵盖了多个日本专家中心的当代实践。相当比例的患者在不中断抗血小板治疗的情况下接受了食管ESD，这表明在精心选择的临床方案中已经出现了个体化决策。未来的研究应该超越简单地询问抗血小板治疗是否可以在ESD期间继续。一个更根本的问题可能是，不同的ESD程序是否应该有不同的程序风险分层模型。器官特异性证据，以及患者相关的血栓栓塞风险和手术复杂性，可能最终允许更个性化的围手术期抗血小板管理方法。平井及其同事的研究并没有重新定义当前的临床实践，也不是为了这样做而设计的。然而，它成功地挑战了一个基本没有受到质疑的假设：所有ESD手术都必须被视为具有相同的内在出血风险。器官特异性出血风险是否最终会影响围手术期抗血小板治疗仍未得到解答。然而，目前的研究为解决这个问题提供了重要的一步，并提醒我们，治疗性内窥镜的未来可能不仅取决于改进手术技术，还取决于改进手术风险本身的定义。Antonio Capogreco：概念化；写作——审阅和编辑。Francesco Minini：概念化；写作-原稿和编辑。两位作者都批准了手稿的最终版本，并同意对工作的各个方面负责。作者没有什么可报告的。作者声明无利益冲突。这篇文章链接到Hirai等人。要查看本文，请访问https://doi.org/10.1111/den.70206.Data分享不适用于本文，因为在当前研究期间没有生成或分析数据集。

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Rethinking Endoscopic Resection in Light of Sarcopenia 再思考肌少症的内镜切除。

IF 3.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy

Pub Date : 2026-10-11 DOI: 10.1111/den.70301

Hironori Tanaka, Taro Iwatsubo, Hiroki Nishikawa

<p>Endoscopic resection (ER), including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection, has become the standard organ-preserving treatment for early gastrointestinal neoplasms. Owing to its minimally invasive nature, organ preservation, and favorable local control, the indications for ER have expanded, particularly among older patients who may not be suitable candidates for radical surgery. However, as the population ages, patient selection has become increasingly complex. Thus, the key question that endoscopists face is no longer whether a lesion can be technically resected but whether the patient is likely to derive meaningful clinical benefit, considering systemic health, physical function, and overall physiological reserve. Moreover, chronological age alone is an insufficient guide while making such decisions. Consequently, the focus has shifted from achieving technical success to maximizing patient benefit.</p><p>Sarcopenia was first described by Rosenberg in 1989 as the age-related loss of skeletal muscle mass [<span>1</span>]. Recent consensus statements have expanded the concept of sarcopenia beyond reduced muscle mass to encompass muscle strength and the broader framework of muscle health [<span>2, 3</span>]. The revised consensus of the European Working Group on Sarcopenia in Older People 2 identifies low muscle strength as the primary feature of sarcopenia, with low muscle quantity or quality confirming the diagnosis and poor physical performance indicating severe sarcopenia [<span>2</span>]. In contrast, the Asian Working Group for Sarcopenia 2025 Consensus Update defines sarcopenia based on a combination of low muscle mass and low muscle strength, while positioning physical performance as an important clinical outcome indicator [<span>3</span>]. This conceptual shift, which reflects the transition from viewing sarcopenia primarily as a loss of muscle mass to understanding it as a clinical concept characterized by both muscle mass and muscle strength within the broader framework of muscle health, is particularly relevant to older adults undergoing ER for gastrointestinal neoplasms. In these patients, sarcopenia, together with multimorbidity, malnutrition, and frailty, may reflect diminished physiological reserve and greater vulnerability to functional deterioration following treatment, despite the minimally invasive nature of the procedure.</p><p>In this issue of <i>Digestive Endoscopy</i>, Hisada et al. present a timely scoping review of the impact of sarcopenia on patients undergoing ER [<span>4</span>]. Following the PRISMA-ScR framework, the authors systematically mapped the existing evidence on esophageal, gastric, and colorectal ER, identifying 28 studies, the majority of which were retrospective cohorts from East Asia. The reported prevalence of sarcopenia ranged from 13.9% to 72.7%, reflecting differences in target organs, age distribution, and diagnostic criteria.</p><p>The most clinically important f

内镜下切除（ER），包括内镜下粘膜剥离（ESD）和内镜下粘膜切除术，已成为早期胃肠道肿瘤标准的器官保留治疗方法。由于其微创性、器官保存和良好的局部控制，ER的适应症已经扩大，特别是在可能不适合根治性手术的老年患者中。然而，随着人口老龄化，患者选择变得越来越复杂。因此，内窥镜医师面临的关键问题不再是病变能否在技术上切除，而是考虑到全身健康、身体功能和整体生理储备，患者是否可能获得有意义的临床益处。此外，在做出此类决定时，仅凭实际年龄是不够的。因此，重点已从实现技术成功转移到最大化患者利益。1989年，Rosenberg首次将骨骼肌减少症描述为与年龄相关的骨骼肌质量下降。最近的共识声明已经将肌肉减少症的概念从肌肉质量减少扩展到肌肉力量和更广泛的肌肉健康框架[2,3]。欧洲老年人肌肉减少症工作组修订后的共识2将肌肉力量低确定为肌肉减少症的主要特征，肌肉数量或质量低证实了诊断，而身体表现差则表明严重的肌肉减少症[2]。相比之下，亚洲肌少症工作组2025共识更新将肌少症定义为低肌肉质量和低肌肉力量的结合，同时将身体表现定位为重要的临床结果指标[3]。这种观念的转变，反映了从将肌肉减少症主要视为肌肉质量的损失到将其理解为在更广泛的肌肉健康框架内以肌肉质量和肌肉力量为特征的临床概念的转变，与因胃肠道肿瘤接受急诊治疗的老年人特别相关。在这些患者中，肌少症，连同多病、营养不良和虚弱，可能反映了生理储备的减少和治疗后功能恶化的更大脆弱性，尽管手术具有微创性。在本期的《消化道内窥镜》中，Hisada等人及时对肌少症对ER[4]患者的影响进行了范围综述。遵循PRISMA-ScR框架，作者系统地绘制了食管、胃和结直肠ER的现有证据，确定了28项研究，其中大多数是来自东亚的回顾性队列。报告的肌少症患病率从13.9%到72.7%不等，反映了靶器官、年龄分布和诊断标准的差异。这篇综述中最重要的临床发现是，肌肉减少症似乎并没有实质性地损害ER的技术安全性或结果。与手术切除肌肉减少症与术后并发症和其他不良的短期手术结果相关不同，本综述显示，肌肉减少症患者和非肌肉减少症患者的整体切除、治愈性切除、延迟出血和穿孔率大致相当[4-7]。这些发现表明，手术结果更多地受到病变相关因素的影响，如肿瘤大小、位置、纤维化以及手术经验，而不是肌肉减少症本身。因此，当病变适合内镜治疗时，肌少症不应被视为ER的禁忌症。相比之下，这篇综述表明，与手术安全性相比，骨骼肌减少症可能与ER后的全身预后更密切相关。术后肺炎在3项研究中的2项中发生在肌肉减少症患者中更为频繁[4,8,9]，根据不良事件通用术语标准2级及以上的不良事件在4项研究中的3项中更为频繁[4,6,10]，4项研究中的3项延长了住院时间[4,5,7,10]。换句话说，尽管肌肉减少症似乎不会增加ER的技术风险，但它可能会识别出更容易出现全身并发症和延迟恢复的患者。这种区别具有重要的临床意义。急诊室的风险评估应超越技术可行性，纳入患者的生理储备和恢复能力。重要的是，目前的证据还不能确定肌肉减少症是否会影响手术相关并发症后的恢复。可以想象，肌少症反映了生理储备的减少，而不是程序性脆弱性的增加，即使并发症发生率相似，也会导致恢复较慢。本综述还强调了肌肉减少症对长期预后的潜在影响。在几项研究中，肌肉减少症与较差的总生存率相关，而这种关联似乎主要是由非疾病特异性死亡率（如肺炎和其他原发性恶性肿瘤）的增加所驱动的，而不是由疾病特异性死亡bb0引起的。因此，即使在内窥镜室安全地完成了切除手术，并且提供了适当的围手术期病房管理，可治愈的ER也不一定能提高肌肉减少症患者的长期生存率。这一观点强调，在确定ER的适宜性时，不仅需要评估病变的可切除性，还需要评估生理储备、合并症和非癌性死亡的竞争风险。在解释现有证据时，应考虑到几个限制。本综述中纳入的大多数研究是回顾性的，并且仅限于接受ER治疗的患者，不可避免地引入了选择偏倚。骨骼肌减少症、虚弱、表现不佳或预期寿命有限的患者可能被认为不适合在门诊进行急诊治疗，因此在研究入组前被排除在外。因此，肌肉减少症的患病率和临床影响可能被低估了。未来的研究应扩展到接受ER治疗的患者之外，包括所有可能适合ER治疗的病变个体，包括那些因一般情况不佳而推迟治疗的个体。这种方法不仅有助于确定急诊手术是否安全，而且有助于确定患者是否可以从手术中获得临床益处。另一个重要的问题涉及到用于肌肉减少症的诊断标准。目前的文献主要依赖于ct得出的肌肉质量指数；然而，肌肉力量很少被纳入[4]。因此，需要使用更新后的标准进行前瞻性研究，以获得更多有临床意义的证据[2-4]。此类研究还应评估功能结果，包括日常生活活动、出院目的地、康复需求和生活质量，而不是只关注技术可行性或常规不良事件。下一个挑战是确定肌肉减少症的评估应该如何为临床决策提供信息。在一些肌肉减少症患者和非癌症相关性死亡的高竞争风险中，可治愈的ER不一定能改善长期生存。在这种情况下，谨慎的共同决策是必不可少的，将病变可治愈性与生理储备、合并症、预期寿命和患者偏好结合起来。然而，在为肌肉减少症患者选择ER时，围手术期管理应个体化，以促进治疗后的康复。虽然技术上的安全性似乎得到了保护，但系统不良事件和长期住院可能导致功能下降。因此，围手术期策略的目的不仅是实现完全切除，而且要防止并发症，保持活动能力，并促进及时出院。这些策略可能包括营养优化、吞咽和呼吸功能评估、早期活动、主动出院计划以及针对高危病变的个体化手术计划[3,7]。对于因迟发性出血或其他手术相关不良事件的高风险病变而接受急诊治疗的患者，目前尚不清楚肌肉减少症是否需要在标准实践之外采取额外的预防措施，例如在适当情况下预防性关闭。因此，肌少症评估不应仅仅用于将患者排除在急诊之外；相反，它应该帮助定制治疗策略，围手术期护理和术后随访，根据每个病人的生理脆弱性。田中博典和岩田保太郎起草了这篇文章。所有作者都认可了手稿的最终版本。作者没有什么可报告的。作者没有什么可报告的。作者声明无利益冲突。这篇文章与Hisada等人有链接。要查看本文，请访问https://doi.org/10.1111/den.70210.Data分享不适用于本文，因为在当前研究期间没有生成或分析数据集。

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引用次数: 0

Combination Steroid Therapy for Stricture Prevention After Extensive Esophageal Endoscopic Submucosal Dissection: Promise and Remaining Questions 联合类固醇治疗预防广泛食管内镜粘膜下夹层后狭窄：前景和遗留问题。

IF 3.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy

Pub Date : 2026-10-11 DOI: 10.1111/den.70306

Fumisato Sasaki

<p>Endoscopic submucosal dissection (ESD) for superficial esophageal cancer enables en bloc resection of extensive lesions and accurate histopathological evaluation; however, post-resection strictures are significant adverse events. In particular, in cases where the mucosal defect extends to more than 7/8 of the circumference of the esophagus, the risk of strictures is high even if the defect is noncircumferential, and repeated endoscopic balloon dilation (EBD) may be required. Local triamcinolone injection (LTI) and oral prednisolone administration (OPA) are the primary treatments used to prevent post-ESD esophageal stricture [<span>1</span>].</p><p>The efficacy of LTI has been demonstrated by studies showing that local injection of triamcinolone into post-ESD ulcers reduces the incidence of strictures and the number of EBD procedures [<span>2, 3</span>]. LTI offers the advantage of a single administration immediately following ESD; however, its efficacy and safety may be influenced by the injection site, dosage, injection depth, and the operator's technique.</p><p>In contrast, OPA does not require local injection and has the potential to continuously suppress inflammation and fibrosis throughout wound healing. It has been reported that starting with 30 mg/day of prednisolone and gradually tapering the dose reduces the incidence of strictures and EBD following esophageal ESD [<span>4</span>]. However, systemic adverse events such as hyperglycemia, hypertension, and infections can be a concern with OPA.</p><p>The JCOG1217 multicenter randomized Phase III trial, which directly compared LTI and OPA, evaluated whether OPA monotherapy was superior to LTI monotherapy in preventing strictures after extensive esophageal ESD. At 12 weeks, the stricture-free survival rates were 88.5% and 94.8% in the LTI and OPA groups, respectively; however, no statistical superiority of OPA was demonstrated [<span>5</span>]. Therefore, among patients who have undergone ESD for extensive esophageal lesions, OPA is not considered a definitively superior alternative to LTI.</p><p>However, in a subgroup analysis of JCOG1217, the 12-week stenosis-free survival rate in cases with a post-ESD mucosal defect extending 7/8 or more of the circumference but less than the full circumference was 75.2% in the LTI group and 92.5% in the OPA group, showing a favorable trend in the OPA group. Although this result was not statistically significant (HR, 0.545; 95% CI, 0.198–1.502) and should be interpreted with caution as an exploratory finding, the number of patients and stricture events available for this subgroup comparison was limited, resulting in low precision as reflected by the wide confidence interval. The JCOG1217 investigators also noted that the reduced overall sample size and statistical power could have contributed to negative subgroup findings [<span>5</span>]. Nevertheless, the numerical difference suggests the need to select treatments based on stricture risk.</p><p>The si

内镜下粘膜下剥离术（ESD）治疗浅表性食管癌，可以实现大面积病变的整体切除和准确的组织病理学评估；然而，术后狭窄是重要的不良事件。特别是，当粘膜缺损延伸到食管周长的7/8以上时，即使缺损是非周向的，发生狭窄的风险也很高，可能需要多次内镜下球囊扩张（EBD）。局部注射曲安奈德（LTI）和口服强的松龙（OPA）是预防esd后食管狭窄的主要治疗方法。研究表明，局部注射曲安奈德可减少esd后溃疡狭窄的发生率和EBD手术的次数，从而证明LTI的有效性[2,3]。LTI的优点是在ESD之后立即进行一次管理；然而，其有效性和安全性可能受到注射部位、剂量、注射深度和操作人员技术的影响。相比之下，OPA不需要局部注射，并且在伤口愈合过程中具有持续抑制炎症和纤维化的潜力。据报道，以30毫克/天的泼尼松龙开始并逐渐减少剂量可减少食管ESD bbb后狭窄和EBD的发生率。然而，全身性不良事件，如高血糖、高血压和感染可能是OPA关注的问题。JCOG1217多中心随机III期试验直接比较了LTI和OPA，评估了OPA单药治疗在预防广泛食管ESD后狭窄方面是否优于LTI单药治疗。12周时，LTI组和OPA组无狭窄生存率分别为88.5%和94.8%；然而，OPA并没有统计学上的优越性。因此，在广泛食道病变接受ESD的患者中，OPA并不被认为是绝对优于LTI的选择。然而，在JCOG1217的亚组分析中，esd后粘膜缺损延伸7/8周长或大于7/8周长但小于全周长的病例，12周无狭窄生存率在LTI组为75.2%，OPA组为92.5%，显示出OPA组的有利趋势。虽然该结果没有统计学意义（HR, 0.545; 95% CI, 0.198-1.502），应该谨慎地解释为探索性发现，但该亚组比较的患者和狭窄事件数量有限，导致较低的精度，这反映在较宽的置信区间上。JCOG1217研究人员还指出，减少的总体样本量和统计能力可能导致阴性亚组结果[5]。然而，数值上的差异表明需要根据结构风险来选择治疗方法。Kadota等人的这项研究的意义在于关注了这一高危人群，并比较了LTI单药治疗与LTI + OPA联合治疗。该研究包括68例食管ESD后黏膜缺损延伸7/8或更多的食管周长但小于全周长的患者；回顾性比较LTI单药治疗组42例和联合治疗组26例。LTI单药组和联合治疗组狭窄率分别为42.9%和26.9%，12周无狭窄生存率分别为64.3%和76.9%。虽然差异无统计学意义，但结果表明，在LTI中加入OPA可能会减少狭窄的发生率。LTI和OPA联合使用存在一定程度的生物学原理。虽然LTI在局部和高浓度作用于esd后溃疡，但OPA在整个伤口愈合过程中系统性地抑制炎症和纤维化。因此，在单纯LTI不能充分预防狭窄的高危病例中，结合这两种作用部位和作用时间不同的治疗可能会产生额外的益处。涉及7/8或更多周长的非周长缺陷是一个明显的高危亚群。与不太广泛的非周性缺陷相比，它们有较高的狭窄性风险，但预防性类固醇治疗可能仍有一定疗效。相比之下，先前的研究表明，单独使用类固醇预防可能不足以治疗周围缺陷[7,8]。因此，近周但非周的缺陷占据了中间的临床地位：它们有足够高的风险来证明强化治疗是合理的，但仍然可以接受基于类固醇的预防。这为该亚组的LTI中OPA的添加提供了具体评估的依据。然而，本研究的结果应谨慎解读。首先，这是一项单中心、回顾性研究，治疗不是随机分配的。由于OPA是在研究期间引入的，并且该队列包括由于高龄、糖尿病或高感染风险等因素而未接受OPA的患者，因此我们不能排除与患者选择和治疗时机相关的混杂因素。其次，病例数和狭窄事件数较少，主要终点无统计学差异。因此，本研究并未证明联合治疗的疗效，应视为一项假设生成研究，为前瞻性试验提供基础。此外，需要6次或更多EBD手术的难治性狭窄比例在LTI单独治疗组为16.7%，在联合治疗组为15.4%，两组之间的比率几乎相等。虽然联合治疗可以减少狭窄的发生率，但一旦发生难治性狭窄，它可能无法减轻其严重程度。更广泛地说，预防策略不仅应该从狭窄的发生率和严重程度方面进行评估，还应该从临床相关的多个角度进行评估，包括EBD手术次数、治疗时间、吞咽功能、营养状况和患者报告的结果，这可能会更全面地评估它们对患者的影响。除了这些疗效和患者负担的措施外，强化类固醇治疗的安全性也是一个重要的考虑因素。在联合治疗组中，42.3%的患者出现opa相关不良事件，但均为3级或以下。LTI有壁坏死或穿孔的风险，由于不适当的注射到肌层[9]。然而，OPA与高血糖、高血压和感染等全身性风险相关。在联合治疗中，必须考虑两种治疗的相关风险，根据年龄、糖尿病、感染风险、切除不完全的可能性和需要额外治疗等因素选择患者是很重要的。考虑到JCOG1217研究和本研究，对于预防食管ESD后狭窄的一刀切治疗策略存在局限性。虽然LTI单独可能足以治疗相对狭窄的粘膜缺陷，但其预防作用可能不足以治疗周长7/8或更多的非周长缺陷。因此，在这些高风险病例中，将OPA加入LTI可能会提供额外的好处。然而，这种联合策略的有效性和安全性尚未确定。本研究提出的临床假设目前正在一项正在进行的多中心随机III期试验JCOG2315中进行检验。该试验的结果有望为确定在LTI中添加OPA是否有助于预防广泛食管ESD bb0后的狭窄提供重要信息。Kadota等人的研究表明，对于跨越7/8或更多周长的非周长粘膜缺陷，单纯LTI可能无法提供足够的预防效果，添加OPA是一种可行的治疗选择。虽然结果很有希望，但这种联合疗法还不能作为标准的治疗方法。在这个阶段，在平衡狭窄和类固醇相关不良事件的风险时，应该选择性地考虑这一治疗策略，我们等待通过JCOG2315研究进行前瞻性验证。作者没有什么可报道的。作者声明无利益冲突。本文链接到Kadota等人的论文。要查看本文，请访问https://doi.org/10.1111/den.70208.Data分享不适用于本文，因为在当前研究期间没有生成或分析数据集。

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引用次数: 0

Redefining Safety and Versatility in Malignant Colorectal Obstruction: The Clinical Impact of a New Low-Axial-Force Self-Expandable Metallic Stent With a Slim Delivery System 重新定义恶性结直肠梗阻的安全性和多功能性：一种新型低轴力自膨胀金属支架的临床影响。

IF 3.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy

Pub Date : 2026-10-09 DOI: 10.1111/den.70313

Hiroyoshi Iwagami

<p>Mizumoto et al. conducted a multicenter prospective study on the safety and efficacy of a new low-axial-force (AF) self-expandable metallic stent (SEMS) with a slim delivery system for malignant colorectal obstruction [<span>1</span>]. Malignant colorectal obstruction is a life-threatening complication that occurs in up to 15%–20% of patients with colorectal cancer [<span>2</span>]. Historically, the management of acute obstruction presented a significant therapeutic challenge. Before the introduction of SEMS, transanal decompression tube placement or emergency surgery served as the primary modalities for bowel decompression. However, transanal ileus tubes were notoriously associated with severe patient discomfort, a marked impairment in quality of life, and demanding, labor-intensive nursing care. Furthermore, these decompression tubes frequently provided inadequate decompression or became displaced, leading to persistent bowel distension and delayed definitive therapy.</p><p>A major paradigm shift occurred in 2012 when colonic SEMS placement became covered by Japan's national health insurance. Colonic stenting revolutionized the management of malignant colorectal obstruction, serving two distinct therapeutic roles: bridge-to-surgery (BTS) for resectable cases and palliative decompression for patients with unresectable or metastatic disease. For BTS, stenting converts an unpredictable emergency procedure into a planned elective surgery. Successful decompression offers four substantial clinical advantages [<span>2-4</span>]. First is physiological stabilization. Avoiding emergency surgery reduces perioperative morbidity and mortality by allowing adequate resuscitation, correction of electrolyte imbalances, and thorough staging. Second is improved surgical feasibility. Bowel decompression minimizes proximal colonic edema, significantly increasing the rate of primary anastomosis while reducing the need for temporary or permanent stoma creation. Third is an improved patient experience. Unlike transanal tubes, SEMS requires no cumbersome flushing protocols, enables rapid resumption of oral nutrition, and allows patients to temporarily return home before definitive resection. Fourth is improved diagnostic access. Decompression of the lumen provides a critical opportunity to evaluate the proximal colon.</p><p>In the palliative setting, meta-analyses comparing SEMS placement with primary emergency surgery have demonstrated lower complication and mortality rates in the stenting group [<span>5</span>]. Furthermore, guidelines from the European Society of Gastrointestinal Endoscopy [<span>2</span>] and the Japanese Society for Cancer of the Colon and Rectum [<span>6</span>] state that stent placement imposes less physical and psychological burden on patients, leading to weak recommendations for both BTS and palliative indications [<span>2, 6</span>].</p><p>The evolution of colonic SEMS over the past decade has been driven by a deeper understanding of st

这些瞄准镜具有优越的灵活性和较小的外径，便于通过以前难以导航的狭窄、弯曲或栓系的结肠段。除了急性减压，22mm支架直径和9-Fr输送系统的组合提供了另一个潜在的诊断优势：它可以在特定病例放置后和手术前对支架近端结肠进行内镜可视化。在梗阻性结直肠癌病例中，已知在先前未检查的近端结肠中存在同步病变，特别是约2%-8%的病例中存在同步浸润性癌，约10%的病例中存在晚期同步腺瘤。识别同步性腺瘤可能允许术前内镜切除。发现同步近端癌可以使手术团队修改计划手术的范围或执行确定的一期手术，从而避免了第二次手术的需要。另一方面，SEMS放置后的全结肠镜检查的安全性还没有得到充分的评估。此外，在SEMS放置后立即检测同步近端病变，而不是在术后进行结肠镜检查，是否能改善长期肿瘤预后尚不清楚。因此，尽管SEMS植入后的全结肠镜检查在特定病例中可能具有临床价值，但需要进一步的前瞻性评估以确定其实用性，不仅用于检测同步近端癌，而且还涉及其对手术安全性和肿瘤预后的潜在影响。Mizumoto等人的前瞻性多中心研究提供了令人信服的证据，支持这种具有9-Fr递送系统的新型低af SEMS在实际临床实践中的有效性和安全性。该研究队列的主要临床结果包括以下内容。一是技术和临床疗效高。在BTS和姑息治疗患者中，技术和临床成功率分别为98.4%和95.9%。其次是防弹少年团的安全形象。早期支架相关不良事件发生率为4.5%的BTS患者和8.6%的姑息治疗患者。整体穿孔率为2.1%，BTS组无穿孔。第三是姑息治疗的长期持久性。姑息组1年累计支架通畅率达80.4%[1]。与先前评估结肠支架置入的多中心研究相比[9,10]，这种新的低轴力SEMS在技术和临床成功率上相当，同时显示出更低的穿孔率，更少的早期支架相关不良事件，并改善了支架的长期通畅。目前的日本指南不推荐对需要全身化疗的患者放置支架，因为考虑到穿孔和随后的全身治疗的局限性。然而，最近全身化疗的进展延长了转移性结直肠癌患者的生存期，支架技术也得到了发展，Mizumoto等人报道。鉴于sems后化疗在现实世界的临床实践中是必要的，需要进一步的研究来阐明其安全性，包括支架相关穿孔和其他不良事件的风险。正如作者在局限性部分所承认的，这是一项多中心单臂研究；因此，需要一项随机对照试验来明确确定22mm直径低轴力支架是否比现有设备具有真正的临床优势。然而，这种支架的规格是新颖的。低房颤对于减少梗阻性结直肠癌的并发症至关重要，并且一个纤细的9-Fr传送系统通过扩大兼容内窥镜模型的范围增加了多功能性。这项研究为日常临床实践提供了重要的见解。Mizumoto等人通过证明具有细长输送系统的低轴力支架可以在保持高成功率的同时最大限度地降低穿孔风险，为内镜治疗恶性结直肠梗阻的进步做出了宝贵的贡献。我们衷心感谢Mizumoto等人发表在消化道内窥镜杂志上的这篇优秀文章。原稿由岩上博志（hirooshi Iwagami）撰写。作者没有什么可报道的。作者没有什么可报道的。作者没有什么可报道的。作者声明无利益冲突。这篇文章链接到Mizumoto等人的论文。要查看本文，请访问https://doi.org/10.1111/den.70185.Data分享不适用于本文，因为在当前研究期间没有生成或分析数据集。

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引用次数: 0

Single-Balloon Endoscopy–Assisted Magnetic Compression Anastomosis for Refractory Biliary Anastomotic Stricture After Hepaticojejunostomy 单球囊内镜辅助磁压吻合术治疗肝空肠吻合术后顽固性胆道吻合口狭窄。

IF 3.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy

Pub Date : 2026-10-08 DOI: 10.1111/den.70300

Kenta Yoshida, Takuto Yamaguchi, Hirotake Sakuraba

A 77-year-old man developed a refractory biliary anastomotic stricture involving the posterior segmental bile duct with bile leakage after left hepatectomy with Roux-en-Y hepaticojejunostomy for perihilar cholangiocarcinoma. Both balloon-assisted endoscopic and percutaneous approaches failed to achieve guidewire passage across the severely obstructed anastomosis, and internal drainage was not possible despite repeated attempts (Figure 1a–c). Therefore, percutaneous transhepatic biliary drainage (PTBD) was required for biliary decompression. Because the length of the obstructed segment was short (approximately 1 cm) and reoperation was considered highly invasive, magnetic compression anastomosis (MCA) was selected as an alternative treatment [1-3]. MCA was performed using a combined percutaneous and endoscopic approach assisted by single-balloon endoscopy. A daughter magnet (samarium-cobalt, 3 × 4 mm) was delivered to the biliary side of the obstruction through a 14-Fr sheath placed via the PTBD tract. The smaller daughter magnet was selected to allow passage through the 14-Fr sheath. Subsequently, a parent magnet (samarium-cobalt, 5 × 6 mm) was delivered to the enteric side of the hepaticojejunostomy using single-balloon endoscopy with an overtube. The two magnets were carefully aligned under fluoroscopic guidance until successful coupling was confirmed (Figure 2a,b; Video 1). Nineteen days after MCA, cholangiography showed contrast flow into the intestinal tract, indicating successful fistula formation (Figure 2c). The coupled magnets were retrieved endoscopically, and internal biliary drainage was achieved without procedure-related adverse events or the need for surgical reintervention (Video 2).

MCA is not widely available and typically requires institutional approval and multidisciplinary collaboration, including coordination with experienced specialists. However, this case demonstrates that single-balloon endoscopy–assisted MCA may be considered as a potential treatment option for carefully selected patients with severely or completely obstructed biliary anastomotic strictures after hepaticojejunostomy when conventional endoscopic and percutaneous techniques fail [4].

Dr. Yoshida conceptualized and drafted the manuscript, and performed endoscopic examinations. Dr. Yamaguchi drafted the manuscript. Dr. Sakuraba supervised the study, drafted the manuscript, and made intellectual revisions to the manuscript. All the authors have read and approved the final version of the manuscript.

The authors have nothing to report.

The authors declare no conflicts of interest.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

一位77岁的男性患者，因肝门周围胆管癌行左肝切除术并Roux-en-Y肝空肠吻合术后，出现难治性胆道吻合口狭窄及后段胆管并胆漏。球囊辅助内镜和经皮入路均未能实现导丝穿过严重阻塞的吻合口，尽管多次尝试，仍无法进行内部引流（图1a-c）。因此，需要经皮经肝胆道引流术（PTBD）进行胆道减压。由于阻塞段的长度较短（约1cm），再手术被认为是高侵入性的，因此选择磁压缩吻合（MCA）作为替代治疗方法[1-3]。MCA采用经皮和内窥镜联合入路，辅以单球囊内窥镜。子磁铁（钐钴，3 × 4 mm）通过经PTBD束放置的14-Fr鞘输送到梗阻的胆道侧。选择较小的子磁铁以允许通过14-Fr护套。随后，使用带上管的单球囊内窥镜将母磁铁（钐钴，5 × 6 mm）递送到肝空肠造口的肠侧。两个磁体在透视引导下仔细对准，直到确认成功耦合（图2a，b；视频1）。MCA术后19天，胆管造影显示造影剂流入肠道，表明成功形成瘘管（图2c）。内镜下取出耦合磁体，实现了胆道内引流，没有手术相关的不良事件或需要手术再干预（视频2）。MCA不能广泛使用，通常需要机构批准和多学科合作，包括与经验丰富的专家协调。然而，本病例表明，当常规内镜和经皮技术失败时，对于经仔细挑选的肝空肠吻合术后胆道吻合口严重或完全梗阻的患者，单球囊内镜辅助MCA可能被认为是一种潜在的治疗选择。吉田构思并起草了手稿，并进行了内窥镜检查。山口博士起草了这份手稿。樱叶博士监督了这项研究，起草了手稿，并对手稿进行了智力上的修改。所有作者都阅读并认可了稿件的最终版本。作者没有什么可报告的。作者没有什么可报告的。作者声明无利益冲突。支持本研究结果的数据可向通讯作者索取。由于隐私或道德限制，这些数据不会公开。

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引用次数: 0

Effect of a Computer-Aided Device on Endoscopists' Biopsy Practice for Gastric Neoplasms: A Secondary Analysis of a Randomized Controlled Trial 计算机辅助设备对内镜医师胃肿瘤活检实践的影响：随机对照试验的二次分析。

IF 3.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy

Pub Date : 2026-10-07 DOI: 10.1111/den.70302

Hongliu Du, Shuzhe Tan, Ziyi Zeng, Xinran Zhang, Zehua Dong, Mei Deng, Jiamin Wang, Xiao Tao, Honggang Yu, Xinyue Wan

Background

Endoscopic biopsy is fundamental for diagnosing gastrointestinal lesions, yet the effectiveness of AI assistance on endoscopists' biopsy strategies and efficiency for detecting gastric neoplasms remains unclear. This study aims to investigate this effectiveness.

Methods

This study is a secondary analysis of a randomized controlled trial (AI group: n = 13,440; control: n = 12,561) compared AI-assisted versus standard screening. The AI system marked high-risk and low-risk lesions with red and blue boxes, respectively. The AI group was stratified into red-box and non-red-box subgroups. Outcomes included neoplasm biopsy efficiency and proportion of non-biopsied documented lesions. The patient-level correlation between false-positive alerts and biopsy counts was examined. All analyses were based on the pathological results after centralized pathology review.

Results

The non-biopsy rate was significantly lower in the red-box group than in the non-red box group and the control group (18.00% vs. 43.26%, 18.00% vs. 45.60%, both p < 0.001), suggesting that lesions were biopsied more frequently in the red-box group. Neoplasm biopsy efficiency was higher in the red-box group (8.19% vs. 0.36%, 8.19% vs. 1.77%, both p < 0.001). In negative binomial regression, red-box classification remained associated with a lower non-biopsy rate (IRR 0.393, 95% CI 0.360–0.429, p < 0.001). False-positive alerts showed a weak inverse correlation with biopsy counts (ρ = −0.182, p < 0.001).

Conclusions

Red-box classification was associated with more targeted biopsy sampling, while false-positive prompts were not associated with indiscriminate biopsies.

背景：内镜活检是诊断胃肠道病变的基础，但人工智能辅助内镜医师活检策略的有效性和检测胃肿瘤的效率尚不清楚。本研究旨在调查这种有效性。方法：本研究是一项随机对照试验（人工智能组：n = 13,440；对照组：n = 12,561）的二次分析，比较人工智能辅助筛查与标准筛查。人工智能系统用红框和蓝框分别标记高风险和低风险病变。人工智能组分为红框组和非红框组。结果包括肿瘤活检的效率和未活检的记录病变的比例。检查假阳性警报与活检计数之间的患者水平相关性。所有分析均基于集中病理复查后的病理结果。结果：红盒组的非活检率明显低于非红盒组和对照组(18.00%比43.26%，18.00%比45.60%，均为p结论：红盒分类与更有针对性的活检取样相关，而假阳性提示与无差别活检无关。

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引用次数: 0

Development of a Multimodal AI Model to Predict the Efficacy of Photodynamic Therapy for Local Residual or Recurrent Lesions Following Chemoradiotherapy or Radiotherapy for Esophageal Cancer 建立多模态AI模型，预测光动力治疗食管癌放化疗或放疗后局部残留或复发病变的疗效。

IF 3.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy

Pub Date : 2026-10-05 DOI: 10.1111/den.70307

Keiichiro Nakajo, Yu Sasagawa, Takuro Tomino, Haruto Hirose, Atsuki Imai, Minami Endo, Hiroki Yamashita, Masataka Yamamoto, Hiroshi Takemura, Tomonori Yano

Objectives

Approximately 12%–40% of patients with esophageal cancer develop local residual or recurrent lesions after chemoradiotherapy (CRT) or radiotherapy (RT). Photodynamic therapy (PDT) is a minimally invasive, organ-preserving alternative; however, therapeutic response is not guaranteed. We developed an artificial intelligence (AI) model to predict PDT efficacy.

Methods

We retrospectively analyzed 177 patients who underwent PDT after CRT/RT at the National Cancer Center Hospital East between August 2006 and December 2024. Clinical data and pre-PDT endoscopic images obtained within 1 month were collected. Local image features extracted via oriented FAST and rotated BRIEF were integrated with clinical information to build a multimodal support vector machine for binary classification. Model performance was evaluated on an independent test set and compared with that of three endoscopists.

Results

The AI model was trained on 145 cases, achieving an accuracy, recall, precision, and F1 score, and area under the receiver operating characteristic curve of 0.813, 0.833, 0.833, 0.833, and 0.897, respectively in the test cohort of 32 cases. The AI model showed numerically higher accuracy, recall, precision, and F1 score than the endoscopists (0.531, 0.636, 0.389, and 0.483, respectively).

Conclusions

A multimodal AI model integrating clinical data and endoscopic images can accurately predict PDT efficacy after CRT or RT. This approach may help optimize treatment strategies and individualize patient management.

目的：大约12%-40%的食管癌患者在放化疗（CRT）或放疗（RT）后出现局部残留或复发病变。光动力疗法（PDT）是一种微创、保存器官的替代疗法；然而，治疗反应不能保证。我们开发了一个人工智能（AI）模型来预测PDT的疗效。方法：回顾性分析2006年8月至2024年12月在国立癌症中心东医院接受CRT/RT后PDT治疗的177例患者。收集1个月内的临床资料和pdt前的内镜图像。将定向FAST和旋转BRIEF提取的局部图像特征与临床信息相结合，构建多模态支持向量机进行二值分类。在一个独立的测试集上评估模型的性能，并与三位内窥镜医师的性能进行比较。结果：人工智能模型对145例进行了训练，在32例测试队列中，准确率、查全率、精密度、F1评分和受试者工作特征曲线下面积分别为0.813、0.833、0.833、0.897。人工智能模型的准确率、召回率、精密度和F1评分均高于内镜医师（分别为0.531、0.636、0.389和0.483）。结论：结合临床数据和内镜图像的多模态人工智能模型可以准确预测CRT或rt后PDT的疗效，该方法有助于优化治疗策略和个性化患者管理。

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引用次数: 0

EUS Shear Wave Elastography for Assessing Pancreatic Fibrosis: An Exploratory Study of Its Histological Correlation EUS横波弹性成像评估胰腺纤维化：组织学相关性的探索性研究。

IF 3.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy

Pub Date : 2026-10-05 DOI: 10.1111/den.70308

Akiya Nakahata, Yasunobu Yamashita, Fumiyoshi Kojima, Yuto Sugihara, Tomokazu Ishihara, Hiromu Morishita, Takahiro Shishimoto, Yuki Kawaji, Takashi Tamura, Masahiro Itonaga, Reiko Ashida, Shin-Ichi Murata, Keisuke Hanada, Akihiro Takeuchi, Atsushi Shimizu, Manabu Kawai, Masayuki Kitano

Objectives

Endoscopic ultrasound shear wave elastography (EUS-SWE) enables quantitative, noninvasive assessment of tissue elasticity. However, the association between EUS-SWE and pancreatic histology remains unclear. This study aimed to investigate the utility of EUS-SWE for predicting pancreatic fibrosis by comparing it with histological findings of resected specimens.

Methods

Patients who underwent EUS-SWE before pancreatectomy between October 2019 and October 2024 were retrospectively enrolled. SWE was performed near the surgical resection margin, and shear wave velocity (Vs, m/s) was measured. The number of EUS morphological findings according to the Rosemont classification was obtained. Histological findings were assessed using quantitative analysis and grading analysis. The association between EUS-SWE or the number of EUS morphological findings and histological findings, as well as the diagnostic performance of EUS-SWE and EUS morphological findings for predicting histological fibrosis at predefined fibrosis thresholds (≥ 5%, ≥ 10%, ≥ 15%, and ≥ 20%) was evaluated.

Results

Thirty-four patients were included. Vs correlated significantly with quantitative fibrosis (ρ = 0.73, p < 0.001), but not with fatty infiltration and inflammation. The number of EUS morphological findings correlated only with fibrosis grade (ρ = 0.35, p = 0.041). EUS-SWE had higher diagnostic accuracy than EUS morphological findings for predicting histological fibrosis at all thresholds (91.2%, 88.2%, 82.4%, and 88.2% vs. 55.9%, 67.6%, 55.9%, and 50.0%, respectively).

Conclusions

EUS-SWE may serve as a quantitative, noninvasive method for evaluating pancreatic fibrosis.

Trial Registration

UMIN ID: 000058397

目的：内镜超声剪切波弹性成像（EUS-SWE）能够定量、无创地评估组织弹性。然而，EUS-SWE与胰腺组织学之间的关系尚不清楚。本研究旨在通过将EUS-SWE与切除标本的组织学结果进行比较，探讨EUS-SWE在预测胰腺纤维化方面的应用。方法：回顾性纳入2019年10月至2024年10月期间胰切除术前行EUS-SWE的患者。在手术切除边缘附近进行SWE，测量横波速度（Vs, m/s）。根据Rosemont分类获得EUS形态学结果的数量。采用定量分析和分级分析对组织学结果进行评估。评估EUS- swe或EUS形态学结果与组织学结果的数量之间的关系，以及EUS- swe和EUS形态学结果在预先定义的纤维化阈值（≥5%,≥10%，≥15%和≥20%）下预测组织学纤维化的诊断性能。结果：纳入34例患者。Vs与定量纤维化显著相关（ρ = 0.73, p）。结论：EUS-SWE可作为定量、无创评估胰腺纤维化的方法。试用注册：UMIN ID: 000058397。

{"title":"EUS Shear Wave Elastography for Assessing Pancreatic Fibrosis: An Exploratory Study of Its Histological Correlation","authors":"Akiya Nakahata, Yasunobu Yamashita, Fumiyoshi Kojima, Yuto Sugihara, Tomokazu Ishihara, Hiromu Morishita, Takahiro Shishimoto, Yuki Kawaji, Takashi Tamura, Masahiro Itonaga, Reiko Ashida, Shin-Ichi Murata, Keisuke Hanada, Akihiro Takeuchi, Atsushi Shimizu, Manabu Kawai, Masayuki Kitano","doi":"10.1111/den.70308","DOIUrl":"10.1111/den.70308","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound shear wave elastography (EUS-SWE) enables quantitative, noninvasive assessment of tissue elasticity. However, the association between EUS-SWE and pancreatic histology remains unclear. This study aimed to investigate the utility of EUS-SWE for predicting pancreatic fibrosis by comparing it with histological findings of resected specimens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent EUS-SWE before pancreatectomy between October 2019 and October 2024 were retrospectively enrolled. SWE was performed near the surgical resection margin, and shear wave velocity (Vs, m/s) was measured. The number of EUS morphological findings according to the Rosemont classification was obtained. Histological findings were assessed using quantitative analysis and grading analysis. The association between EUS-SWE or the number of EUS morphological findings and histological findings, as well as the diagnostic performance of EUS-SWE and EUS morphological findings for predicting histological fibrosis at predefined fibrosis thresholds (≥ 5%, ≥ 10%, ≥ 15%, and ≥ 20%) was evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-four patients were included. Vs correlated significantly with quantitative fibrosis (<i>ρ</i> = 0.73, <i>p</i> < 0.001), but not with fatty infiltration and inflammation. The number of EUS morphological findings correlated only with fibrosis grade (<i>ρ</i> = 0.35, <i>p</i> = 0.041). EUS-SWE had higher diagnostic accuracy than EUS morphological findings for predicting histological fibrosis at all thresholds (91.2%, 88.2%, 82.4%, and 88.2% vs. 55.9%, 67.6%, 55.9%, and 50.0%, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EUS-SWE may serve as a quantitative, noninvasive method for evaluating pancreatic fibrosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>UMIN ID: 000058397</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 10","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Balloon Enteroscopy-Assisted ERCP and EUS-Guided Biliary Drainage for Malignant Biliary Obstruction in Patients With Surgically Altered Anatomy: A Systematic Review and Meta-Analysis 气囊肠镜辅助ERCP和eus引导胆道引流治疗手术改变解剖结构的恶性胆道梗阻：系统回顾和荟萃分析。

IF 3.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy

Pub Date : 2026-10-04 DOI: 10.1111/den.70309

Masahiro Itonaga, Ke Wan, Tamura Takashi, Yasunobu Yamashita, Reiko Ashida, Masayuki Kitano

Objectives

This systematic review and meta-analysis evaluated the pooled outcomes and comparative evidence of balloon enteroscopy-assisted ERCP (BEA-ERCP) and EUS-guided biliary drainage (EUS-BD) for malignant biliary obstruction (MBO) in patients with surgically altered anatomy (SAA).

Methods

PubMed, Web of Science, and the Cochrane Library were searched up to January 2026. The primary outcome was the pooled technical success rate. Secondary outcomes included the clinical success rate, adverse event rate, recurrent biliary obstruction (RBO) rate, and mean procedure time. Subgroup analyses compared outcomes in studies directly comparing the two procedures. A random-effects model was used.

Results

Thirteen studies were included, comprising nine studies investigating BEA-ERCP (394 patients) and seven investigating EUS-BD (206 patients), including three comparative studies. Pooled technical and clinical success rates were 75% and 72% for BEA-ERCP and 97% and 92% for EUS-BD, respectively. Pooled adverse event rates were 11% for BEA-ERCP and 17% for EUS-BD, and pooled RBO rates were 26% and 23%, respectively. In subgroup analyses of the three comparative studies, technical success rates (risk ratio [RR], 0.74; 95% confidence interval [CI], 0.67–0.82) and clinical success rates (RR, 0.70; 95% CI, 0.61–0.80) were significantly lower with BEA-ERCP than with EUS-BD, with no significant differences in adverse event rates, RBO rates, or procedural times.

Conclusion

In the three comparative studies, EUS-BD achieved higher technical and clinical success rates than BEA-ERCP for MBO in patients with SAA, with no significant difference in adverse events. These non-randomized findings are preliminary, and large-scale prospective comparative studies are warranted.

目的：本系统综述和荟萃分析评估了气囊肠镜辅助ERCP （BEA-ERCP）和eus引导胆道引流（EUS-BD）治疗手术解剖改变（SAA）患者恶性胆道梗阻（MBO）的汇总结果和比较证据。方法：检索截至2026年1月的PubMed、Web of Science和Cochrane Library。主要结果是综合技术成功率。次要结局包括临床成功率、不良事件发生率、复发性胆道梗阻（RBO）率和平均手术时间。亚组分析比较了直接比较两种治疗方法的研究结果。采用随机效应模型。结果：纳入13项研究，包括9项BEA-ERCP研究（394例）和7项EUS-BD研究（206例），其中包括3项比较研究。BEA-ERCP的技术和临床成功率分别为75%和72%，EUS-BD的技术和临床成功率分别为97%和92%。BEA-ERCP合并不良事件发生率为11%，EUS-BD合并不良事件发生率为17%，合并RBO发生率分别为26%和23%。在三个比较研究的亚组分析中，BEA-ERCP的技术成功率（风险比[RR]， 0.74； 95%可信区间[CI]， 0.67-0.82）和临床成功率（RR, 0.70; 95% CI, 0.61-0.80）显著低于EUS-BD，在不良事件发生率、RBO率或手术时间方面无显著差异。结论：在三项比较研究中，EUS-BD治疗SAA患者MBO的技术和临床成功率均高于BEA-ERCP，且不良事件无显著差异。这些非随机的发现是初步的，大规模的前瞻性比较研究是必要的。

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引用次数: 0

Experimental Evaluation of Novel Two-Dimensional Endoscopic Ultrasound Shear Wave Elastography: A Phantom-Based Study 新型二维内窥镜超声横波弹性成像的实验评价：基于幻影的研究。

IF 3.6 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive Endoscopy

Pub Date : 2026-10-02 DOI: 10.1111/den.70303

Yasunobu Yamashita, Akiya Nakahata, Hiroki Yamada, Hirofumi Yamazaki, Hiromu Morishita, Tomokazu Ishihara, Yuto Sugihara, Takahiro Shishimoto, Yuki Kawaji, Takashi Tamura, Masahiro Itonaga, Reiko Ashida, Hiroyuki Kojima, Takao Itoi, Masayuki Kitano

Point shear wave elastography (SWE) can indicate tissue elasticity using absolute values, but it remains difficult to determine which areas are suitable for measurement. Recently, two-dimensional endoscopic ultrasound SWE (2D-EUS-SWE), which allows visual assessment of appropriate measurement locations, has become possible. However, it remains unclear how to set the measurement and color regions of interest (ROIs) appropriately. This study aimed to evaluate the optimal ROI settings for 2D-EUS-SWE under various measurement conditions with phantom. Two types of commercially available elasticity phantoms were used to evaluate 2D-EUS-SWE. The conditions were set for five parameters: measurement ROI size, color ROI size, color ROI depth, degree of probe pressure, and color ROI angle. Measurements were performed 10 times for each setting. In a tumor model, the color ROI was set over or within the tumor. Reproducibility and reliability were then evaluated for each setting. Setting the color ROI at a depth range of 1–3 cm was found to be appropriate. The measurements were possible regardless of the color and measurement ROI sizes. When the color ROI was positioned directly below (0°), tilting it up to 45° had no effect on the measurement. In the tumor model, measurements were possible regardless of the color ROI size. In addition to clarifying the optimal condition settings, the present findings indicate that 2D-EUS-SWE is an accurate and reliable method for performing measurements using EUS. However, this was conducted under phantom conditions, and future clinical evaluation is necessary.

点横波弹性图（SWE）可以用绝对值表示组织弹性，但很难确定哪些区域适合测量。最近，二维内窥镜超声SWE （2D-EUS-SWE）已经成为可能，它可以对适当的测量位置进行视觉评估。然而，如何适当地设置感兴趣的测量和颜色区域（roi）仍然是不清楚的。本研究旨在评估2D-EUS-SWE在不同测量条件下的最佳ROI设置。使用两种市售弹性模体来评估2D-EUS-SWE。设置了5个参数的条件：测量ROI大小、颜色ROI大小、颜色ROI深度、探头压力程度、颜色ROI角度。每组测量10次。在肿瘤模型中，颜色ROI设置在肿瘤上或肿瘤内。然后评估每个设置的再现性和可靠性。将颜色ROI设置在1-3厘米的深度范围内是合适的。无论颜色和测量ROI大小，测量都是可能的。当颜色ROI位于正下方（0°）时，将其倾斜至45°对测量没有影响。在肿瘤模型中，无论颜色ROI大小如何，测量都是可能的。除了明确最佳条件设置外，本研究结果表明2D-EUS-SWE是使用EUS进行测量的准确可靠的方法。然而，这是在虚幻条件下进行的，未来的临床评估是必要的。

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引用次数: 0