Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to t...Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.展开更多
This article comments on the article by Du et al,who conducted a randomized controlled trial aiming at evaluating the effectiveness of a novel spray flushing system in cleaning flexible endoscopes while minimizing dam...This article comments on the article by Du et al,who conducted a randomized controlled trial aiming at evaluating the effectiveness of a novel spray flushing system in cleaning flexible endoscopes while minimizing damage to the working channels.We share our perspective on the importance of improving endoscope reprocessing methods.The findings highlight the spray flushing system's capacity to improve cleaning efficacy while minimizing damage,suggesting that it might be important in enhancing endoscope reprocessing procedures.展开更多
Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside ...Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside improvements in resection methods.Recent innovations,such as endoscopic hand suturing and new through-the-scope clips and systems,are transforming the field.Along with new devices,the combined methods of closure are developed.Embracing these new techniques can lead to enhanced recovery and reduced complications,marking an important milestone in medical practice.In fact,the European Society of GI Endoscopy recommends against routine closure of the ESD defect,except in duodenal ESD;however,endoscopic closure is strongly advised for immediate perforations.Furthermore,the American Gastroenterology Association provides a detailed expert review on managing perforations in the upper and lower GI tract based on endoscopic closure techniques.On the other hand,the most common postprocedural complications following ESD are delayed bleeding,delayed perforation,and stricture formation.According to recent literature,properly managing the post-ESD defect may reduce the risk of these complications.This review aims to explore novel approaches for managing post-ESD defects and intraprocedural complications to enhance safety and improve long-term outcomes.展开更多
Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal tract and arise from the interstitial cells of Cajal.They predominantly affect individuals between 50 and 70 years o...Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal tract and arise from the interstitial cells of Cajal.They predominantly affect individuals between 50 and 70 years of age and often carry malignant potential despite being frequently asymptomatic.The stomach and small intestine are the most common locations,while involvement of the esophagus,colon,or rectum is relatively rare.GISTs are often discovered incidentally during endoscopic or radiologic evaluations,and the diagnosis is confirmed through tissue biopsy and immunohistochemical staining,particularly for KIT(CD117),DOG1,and PDGFRA.In the past decade,laparoscopic resection has been considered the standard treatment for localized GISTs smaller than 5 cm.However,recent advances in endoscopic technology have led to a growing role for endoscopic resection as a safe and effective treatment option for selected nonmetastatic GISTs.Endoscopic techniques such as endoscopic submucosal dissection,endoscopic submucosal excavation,submucosal tunneling endoscopic resection,and endoscopic full-thickness resection have demonstrated favorable outcomes,including high complete resection(R0)rates,shorter hospital stays,and quicker recovery compared to traditional surgery.The selection of an appropriate resection method depends on tumor size,location,depth of invasion,and proximity to vital structures.Endoscopic ultrasound has become an essential tool for preprocedural assessment,providing detailed information on tumor characteristics and helping to guide management decisions.While endoscopic resection is a promising minimally invasive approach,it should be performed by skilled endoscopists with appropriate training due to the technical complexity and risk of complications such as bleeding or perforation.This review summarizes recent developments in endoscopic resection of GISTs,with a focus on indications,procedural safety,clinical outcomes,and recommendations for optimal patient selection and procedural planning.展开更多
Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucos...Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.展开更多
BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidec...BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches(TAA)are the two most commonly used remote approaches.No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.AIM To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.METHODS We searched PubMed MEDLINE,Google Scholar,and Cochrane Library from the date of the first published article up to August 2025.The term used were transoral thyroidectomy vestibular approach,trans areolar thyroidectomy,scarless thyroidectomy,remote thyroidectomy,infections,postoperative,inflammation,dysphagia,and swallowing difficulties.We identified 130 studies,of them,30 full texts were screened and only six studies were included in the final meta-analysis.RESULTS Postoperative infections were not different between the two approaches,odd ratio=1.33,95%confidence interval:0.50-3.53,theχ2 was 1.92 and the P-value for overall effect of 0.57.Similarly,transient swallowing difficulty was not different between the two forms of surgery,with odd ratio=0.91,95%confidence interval:0.35-2.40;theχ2 was 1.32,and the P-value for overall effect of 0.85.CONCLUSION No significant statistical differences were evident between trans-oral endoscopic Mirghani H.Infections and swallowing difficulty in scarless thyroidectomy WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties.Further longer randomized trials are needed.展开更多
Per-oral endoscopic myotomy(POEM)represents a natural orifice endoscopic surgery(NOTES)approach to laparoscopy Heller myotomy(LHM).POEM is arguably the most successful clinical application of NOTES.The growth of POEM ...Per-oral endoscopic myotomy(POEM)represents a natural orifice endoscopic surgery(NOTES)approach to laparoscopy Heller myotomy(LHM).POEM is arguably the most successful clinical application of NOTES.The growth of POEM from a single center in 2008 to approximately 60 centers worldwide in 2014 with several thousand procedures having been performed attests to the success of POEM.Initial efficacy,safety and acid reflux data suggest at least equivalence of POEM to LHM,the previous gold standard for achalasia therapy.Adjunctive techniques used in the West include impedance planimetry for real-time intraprocedural luminal assessment and endoscopic suturing for challenging mucosal defect closures during POEM.The impact of POEM extends beyond the realm of esophageal motility disorders as it is rapidly popularizing endoscopic submucosal dissection in the West and spawning offshoots that use the submucosal tunnel technique for a host of new indications ranging from resection of tumors to pyloromyotomy for gastroparesis.展开更多
Digestive endoscopy has been widely used in the diagnosis and treatment of digestive diseases.However,the anatomical complexity of specific lesions increases the difficulty of these operations,resulting in complicatio...Digestive endoscopy has been widely used in the diagnosis and treatment of digestive diseases.However,the anatomical complexity of specific lesions increases the difficulty of these operations,resulting in complications or treatment failure.Although various strategies,such as floss traction and the application of transparent caps,have been explored,their effectiveness remains limited due to individual differences in patients’anatomical characteristics.The multibending(MB)endoscope represents a significant innovation as it is a conventional endoscope with an additional bending section and dual channels.Currently,this technology has been applied in gastroscopy,duodenoscopy and peroral cholangioscopy.The bending part of the endoscope facilitates its passage into difficult-to-reach anatomical regions and improves operating angles,thereby enhancing surgical precision and efficiency while reducing complication rates.Furthermore,the dualchannel design accelerates procedural workflows and increases operational versatility.This innovation is poised to transform endoscopic diagnosis and treatment of digestive system diseases.Since the MB endoscope is relatively new,further research is needed to comprehensively explore its benefits for and potential in endoscopic diagnosis and treatment.The aim of this review is to summarize the current research,indications,and future directions of MB endoscope.展开更多
Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the United States. Due to the aggressive tumor biology and late manifestations of the disease, long-term survival is extremely uncommon ...Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the United States. Due to the aggressive tumor biology and late manifestations of the disease, long-term survival is extremely uncommon and the current 5-year survival rate is 7%. Over the last two decades, endoscopic ultrasound(EUS) has evolved from a diagnostic modality to a minimally invasive therapeutic alternative to radiologic procedures and surgery for pancreatic diseases. EUSguided celiac plexus intervention is a useful adjunct to conventional analgesia for patients with pancreatic cancer. EUS-guided biliary drainage has emerged as a viable option in patients who have failed endoscopic retrograde cholangiopancreatography. Recently, the use of lumen-apposing metal stent to create gastrojejunal anastomosis under EUS and fluoroscopic guidance in patients with malignant gastric outlet obstruction has been reported. On the other hand, anti-tumor therapies delivered by EUS, such as the injection of anti-tumor agents, brachytherapy and ablations are still in the experimental stage without clear survival benefit. In this article, we provide updates on well-established EUS-guided interventions as well as novel techniques relevant to pancreatic cancer.展开更多
Large colorectal lesions(≥3 cm)present a significant therapeutic challenge due to their potential for malignancy and the technical difficulties they encounter.Endoscopic resection techniques,including endoscopic muco...Large colorectal lesions(≥3 cm)present a significant therapeutic challenge due to their potential for malignancy and the technical difficulties they encounter.Endoscopic resection techniques,including endoscopic mucosal resection,endoscopic submucosal dissection,and endoscopic full-thickness resection,have revolutionized the management of these lesions by offering organ-preserving alternatives to surgery with favorable outcomes.We read with great interest and commended Zhu et al for their valuable study on the endoscopic treatment of large colorectal lesions.Zhu et al’s study provides crucial real-world evidence regarding the safety and effectiveness of advanced endoscopic resection techniques in this challenging patient group.These findings support the possibility of achieving high rates of complete resection with acceptable adverse event profiles,reinforcing the role of endoscopic mucosal resection and submucosal dissection in routine practice.This editorial also offers a comprehensive review of the current literature,discusses its clinical implications,explores future directions,and compares endoscopic resection methods with surgical options.Zhu et al’s study findings not only validate the efficacy of advanced endoscopic resection but also signify a paradigm shift from surgical to organ-preserving strategies in colorectal oncology,a transformation that requires deliberate system-wide training and capacity building.展开更多
Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, parti...Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, particularly with the advent ofminimally invasive surgical techniques. Preoperative tattoo marking is commonlyused for tumor localization;however, it poses challenges such as intraperitonealink scattering and difficulty in defining dissection planes in the lower rectum. Toaddress these limitations, a new technology utilizing a near-infrared fluorescenceclip placed preoperatively enables accurate intraoperative tumor localization.Intraoperative colonoscopy offers additional advantages, including real-timetumor localization, colonic irrigation, visualization of the proximal colon inobstructive cases, and assessment of anastomosis following colorectal resection.Notably, intraoperative colonoscopy allows for the immediate detection andmanagement of complications, such as anastomotic bleeding and leakage, potentiallyimproving postoperative outcomes. Furthermore, advances in endoscopicresections, including endoscopic mucosal resection, endoscopic submucosal dissection,hybrid endoscopic submucosal dissection, and combined endoscopiclaparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches areincreasingly applicable beyond conventional colorectal neoplasms and showpromise in managing appendiceal tumors as well.展开更多
The field of gastroenterology has experienced revolutionary advances over the past years,as flexible endoscopes have become widely accessible.In addition to enabling faster,less invasive,and more affordable treatment,...The field of gastroenterology has experienced revolutionary advances over the past years,as flexible endoscopes have become widely accessible.In addition to enabling faster,less invasive,and more affordable treatment,flexible endoscopes have greatly improved the detection and endoscopic screening of malignancies and prevented many cancer-related deaths.The development and clinical application of new diagnostic endoscopic technologies,such as magnification endoscopy,narrow-band imaging,endoscopic ultrasound with biopsy,and more recently,artificial intelligence enhanced technologies,have made the recognition and detection of various neoplasms and sub-epithelial tumors more possible.This review demonstrates the latest advancements in endoscopic procedures,techniques,and devices applied in the diagnosis and management of gastrointestinal cancer.展开更多
The challenge of effectively eliminating air during gastrointestinal endoscopy using ultrasound techniques is apparent.This difficulty arises from the intricacies of removing concealed air within the folds of the gast...The challenge of effectively eliminating air during gastrointestinal endoscopy using ultrasound techniques is apparent.This difficulty arises from the intricacies of removing concealed air within the folds of the gastrointestinal tract,resulting in artifacts and compromised visualization.In addition,the overlap of folds with lesions can obscure their depth and size,presenting challenges for an accurate assessment.Conversely,in intricately folded regions of the gastrointestinal tract,such as the stomach,intestine,and colon,insufficient delivery of air or CO_(2) into the cavity impedes luminal expansion,hindering the accurate visualization of lesions concealed within the folds.Although this underscores the requirement for substantial airflow,excessive airflow can hinder visualization of bleeding lesions and other abnormalities.Considering these challenges,an ideal endoscopic device would facilitate the observation of lesions without the requirement for air or CO_(2) delivery whereas,ensuring optimal expansion of the gastrointestinal tract.Recently,transparent gels with specific viscosities have been employed more frequently to address this issue.This review aims to elucidate how these gels address these challenges and provide a solution for enhanced endoscopic visualization.展开更多
Rectal neuroendocrine tumor(rNET)is an indolent malignancy often detected during colonoscopy screening.The incidence of rNET has increased approximately 10-fold over the past 30 years.Most rNETs detected during screen...Rectal neuroendocrine tumor(rNET)is an indolent malignancy often detected during colonoscopy screening.The incidence of rNET has increased approximately 10-fold over the past 30 years.Most rNETs detected during screening endoscopy are small,measuring<10 mm.Current guidelines recommend endoscopic resection for small,well-differentiated rNET using modified endoscopic submucosal resection(mEMR)or endoscopic submucosal dissection.However,the optimal endoscopic treatment method remains uncertain.This paper summarizes the evidence on mEMR with submucosal stretching,mEMR without submucosal stretching,endoscopic submucosal dissection and endoscopic full-thickness resection.Given that rNETs often exhibit submucosal invasion,achieving adequate resection depth is crucial to ensure histological complete resection.mEMR with submucosal stretching appears favorable due to its high rate of histological complete resection,safety and convenience.Risk factors associated with lymph node and distant metastases are also discussed.A treatment algorithm is proposed to facilitate clinical decision-making.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of H...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.展开更多
BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particu...BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.展开更多
BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantage...BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantages in operative time,extent of trauma,and medical costs.However,increasing lesion diameter significantly elevates the technical difficulty of endoscopic resection.Currently,robust evidence-based evidence regarding the upper size limit for safely and effectively resecting lesions endoscopically remains lacking.AIM To evaluate the efficacy and safety of endoscopic resection for colorectal lesions≥30 mm in diameter.METHODS This retrospective study reviewed data from 102 patients who underwent endoscopic resection for colorectal lesions measuring≥30 mm in diameter at General Hospital of Northern Theater Command between January 2023 and July 2024.RESULTS Among 102 patients who underwent endoscopic resection,99 received endoscopic submucosal dissection and 3 underwent endoscopic full-thickness resection.Four patients(3.9%)required conversion to surgical radical resection postoperatively.All patients exhibited favorable wound healing at the resection sites,and no long-term complications were observed during the 3-month postoperative colonoscopy follow-up.The primary perioperative complication was post-endoscopic submucosal dissection electrocoagulation syndrome(PEECS)(24/102,23.5%).Multivariate analysis identified lesion location in the transverse colon as an independent risk factor for PEECS occurrence(odds ratio=6.734,95%confidence interval:1.623-27.945,P=0.009).CONCLUSION Large colorectal lesion diameter does not constitute an absolute contraindication to endoscopic resection.Experienced endoscopic centers can achieve complete resection with a favorable efficacy and safety profile.Notably,lesion location in the transverse colon is identified as an independent risk factor for PEECS.展开更多
Over the last few years, endoscopic submucosal dissection(ESD) has shown to be effective in the management of early colorectal neoplasms, particularly in Asian countries where the technique was born. In the Western wo...Over the last few years, endoscopic submucosal dissection(ESD) has shown to be effective in the management of early colorectal neoplasms, particularly in Asian countries where the technique was born. In the Western world, its implementation has been slow and laborious. In this paper, the indications for ESD, its learning model, the available methods to predict the presence of deep submucosal invasion before the procedure and the published outcomes from Asia and Europe will be reviewed. Since ESD has several limitations in terms of learning achievement in the West, and completion of the procedure for the first cases is difficult in our part of the world, a short review on colorectal assisted ESD has been included. Finally, other endoscopic and surgical treatment modalities that are in competition with colorectal ESD will be summarized.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duode...Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duodenal diverticulum,ampullary neoplastic infiltration or surgically altered anatomy.In these cases percutaneous biliary drainage(PTBD)is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life.Endoscopic ultrasound-guided biliary drainage(EUS-BD)is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices.A large amount of data is already collected that proves its efficacy,safety and ability to replace PTBD in cases of ERCP failure.It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future.Several EUS-BD techniques are developed EUS-guided transmural stenting,antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy.EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure.The lack of training,absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure,which is related to life-threatening adverse events.Developing training models,dedicated devices and guidelines hopefully will make EUS-BD easier,safer and well accepted in the future.This paper focuses on the technical aspects of the different EUS-BD procedures,available literature data,advantages,negative aspects and the future perspectives of these modalities.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)is the mainstay procedure of choice for management of obstructive biliary disease.While ERCP is widely performed with high success rates,the procedure is not feasibl...Endoscopic retrograde cholangiopancreatography(ERCP)is the mainstay procedure of choice for management of obstructive biliary disease.While ERCP is widely performed with high success rates,the procedure is not feasible in every patient such as cases of non-accessible papilla.In the setting of unsuccessful ERCP,endoscopic ultrasound-guided biliary drainage(EUS-BD)has become a promising alternative to surgical bypass and percutaneous biliary drainage(PTBD).A variety of different forms of EUS-BD have been described,allowing for both intrahepatic and extrahepatic approaches.Recent studies have reported high success rates utilizing EUS-BD for both transpapillary and transluminal drainage,with fewer adverse events when compared to PTBD.Advancements in novel technologies designed specifically for EUS-BD have led to increased success rates as well as improved safety profile for the procedure.The techniques of EUS-BD are yet to be fully standardized and are currently performed by highly trained advanced endoscopists.The aim of our review is to highlight the different EUSguided interventions for achieving biliary drainage and to both assess the progress that has been made in the field as well as consider what the future may hold.展开更多
文摘Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.
文摘This article comments on the article by Du et al,who conducted a randomized controlled trial aiming at evaluating the effectiveness of a novel spray flushing system in cleaning flexible endoscopes while minimizing damage to the working channels.We share our perspective on the importance of improving endoscope reprocessing methods.The findings highlight the spray flushing system's capacity to improve cleaning efficacy while minimizing damage,suggesting that it might be important in enhancing endoscope reprocessing procedures.
文摘Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside improvements in resection methods.Recent innovations,such as endoscopic hand suturing and new through-the-scope clips and systems,are transforming the field.Along with new devices,the combined methods of closure are developed.Embracing these new techniques can lead to enhanced recovery and reduced complications,marking an important milestone in medical practice.In fact,the European Society of GI Endoscopy recommends against routine closure of the ESD defect,except in duodenal ESD;however,endoscopic closure is strongly advised for immediate perforations.Furthermore,the American Gastroenterology Association provides a detailed expert review on managing perforations in the upper and lower GI tract based on endoscopic closure techniques.On the other hand,the most common postprocedural complications following ESD are delayed bleeding,delayed perforation,and stricture formation.According to recent literature,properly managing the post-ESD defect may reduce the risk of these complications.This review aims to explore novel approaches for managing post-ESD defects and intraprocedural complications to enhance safety and improve long-term outcomes.
文摘Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal tract and arise from the interstitial cells of Cajal.They predominantly affect individuals between 50 and 70 years of age and often carry malignant potential despite being frequently asymptomatic.The stomach and small intestine are the most common locations,while involvement of the esophagus,colon,or rectum is relatively rare.GISTs are often discovered incidentally during endoscopic or radiologic evaluations,and the diagnosis is confirmed through tissue biopsy and immunohistochemical staining,particularly for KIT(CD117),DOG1,and PDGFRA.In the past decade,laparoscopic resection has been considered the standard treatment for localized GISTs smaller than 5 cm.However,recent advances in endoscopic technology have led to a growing role for endoscopic resection as a safe and effective treatment option for selected nonmetastatic GISTs.Endoscopic techniques such as endoscopic submucosal dissection,endoscopic submucosal excavation,submucosal tunneling endoscopic resection,and endoscopic full-thickness resection have demonstrated favorable outcomes,including high complete resection(R0)rates,shorter hospital stays,and quicker recovery compared to traditional surgery.The selection of an appropriate resection method depends on tumor size,location,depth of invasion,and proximity to vital structures.Endoscopic ultrasound has become an essential tool for preprocedural assessment,providing detailed information on tumor characteristics and helping to guide management decisions.While endoscopic resection is a promising minimally invasive approach,it should be performed by skilled endoscopists with appropriate training due to the technical complexity and risk of complications such as bleeding or perforation.This review summarizes recent developments in endoscopic resection of GISTs,with a focus on indications,procedural safety,clinical outcomes,and recommendations for optimal patient selection and procedural planning.
文摘Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.
文摘BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches(TAA)are the two most commonly used remote approaches.No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.AIM To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.METHODS We searched PubMed MEDLINE,Google Scholar,and Cochrane Library from the date of the first published article up to August 2025.The term used were transoral thyroidectomy vestibular approach,trans areolar thyroidectomy,scarless thyroidectomy,remote thyroidectomy,infections,postoperative,inflammation,dysphagia,and swallowing difficulties.We identified 130 studies,of them,30 full texts were screened and only six studies were included in the final meta-analysis.RESULTS Postoperative infections were not different between the two approaches,odd ratio=1.33,95%confidence interval:0.50-3.53,theχ2 was 1.92 and the P-value for overall effect of 0.57.Similarly,transient swallowing difficulty was not different between the two forms of surgery,with odd ratio=0.91,95%confidence interval:0.35-2.40;theχ2 was 1.32,and the P-value for overall effect of 0.85.CONCLUSION No significant statistical differences were evident between trans-oral endoscopic Mirghani H.Infections and swallowing difficulty in scarless thyroidectomy WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties.Further longer randomized trials are needed.
文摘Per-oral endoscopic myotomy(POEM)represents a natural orifice endoscopic surgery(NOTES)approach to laparoscopy Heller myotomy(LHM).POEM is arguably the most successful clinical application of NOTES.The growth of POEM from a single center in 2008 to approximately 60 centers worldwide in 2014 with several thousand procedures having been performed attests to the success of POEM.Initial efficacy,safety and acid reflux data suggest at least equivalence of POEM to LHM,the previous gold standard for achalasia therapy.Adjunctive techniques used in the West include impedance planimetry for real-time intraprocedural luminal assessment and endoscopic suturing for challenging mucosal defect closures during POEM.The impact of POEM extends beyond the realm of esophageal motility disorders as it is rapidly popularizing endoscopic submucosal dissection in the West and spawning offshoots that use the submucosal tunnel technique for a host of new indications ranging from resection of tumors to pyloromyotomy for gastroparesis.
基金Supported by the National Natural Science Foundation of China,No.81602056 and No.82273393the Young Talents Promotion Project of Shandong Medical Association in 2023,No.2023_GJ_0087.
文摘Digestive endoscopy has been widely used in the diagnosis and treatment of digestive diseases.However,the anatomical complexity of specific lesions increases the difficulty of these operations,resulting in complications or treatment failure.Although various strategies,such as floss traction and the application of transparent caps,have been explored,their effectiveness remains limited due to individual differences in patients’anatomical characteristics.The multibending(MB)endoscope represents a significant innovation as it is a conventional endoscope with an additional bending section and dual channels.Currently,this technology has been applied in gastroscopy,duodenoscopy and peroral cholangioscopy.The bending part of the endoscope facilitates its passage into difficult-to-reach anatomical regions and improves operating angles,thereby enhancing surgical precision and efficiency while reducing complication rates.Furthermore,the dualchannel design accelerates procedural workflows and increases operational versatility.This innovation is poised to transform endoscopic diagnosis and treatment of digestive system diseases.Since the MB endoscope is relatively new,further research is needed to comprehensively explore its benefits for and potential in endoscopic diagnosis and treatment.The aim of this review is to summarize the current research,indications,and future directions of MB endoscope.
文摘Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the United States. Due to the aggressive tumor biology and late manifestations of the disease, long-term survival is extremely uncommon and the current 5-year survival rate is 7%. Over the last two decades, endoscopic ultrasound(EUS) has evolved from a diagnostic modality to a minimally invasive therapeutic alternative to radiologic procedures and surgery for pancreatic diseases. EUSguided celiac plexus intervention is a useful adjunct to conventional analgesia for patients with pancreatic cancer. EUS-guided biliary drainage has emerged as a viable option in patients who have failed endoscopic retrograde cholangiopancreatography. Recently, the use of lumen-apposing metal stent to create gastrojejunal anastomosis under EUS and fluoroscopic guidance in patients with malignant gastric outlet obstruction has been reported. On the other hand, anti-tumor therapies delivered by EUS, such as the injection of anti-tumor agents, brachytherapy and ablations are still in the experimental stage without clear survival benefit. In this article, we provide updates on well-established EUS-guided interventions as well as novel techniques relevant to pancreatic cancer.
文摘Large colorectal lesions(≥3 cm)present a significant therapeutic challenge due to their potential for malignancy and the technical difficulties they encounter.Endoscopic resection techniques,including endoscopic mucosal resection,endoscopic submucosal dissection,and endoscopic full-thickness resection,have revolutionized the management of these lesions by offering organ-preserving alternatives to surgery with favorable outcomes.We read with great interest and commended Zhu et al for their valuable study on the endoscopic treatment of large colorectal lesions.Zhu et al’s study provides crucial real-world evidence regarding the safety and effectiveness of advanced endoscopic resection techniques in this challenging patient group.These findings support the possibility of achieving high rates of complete resection with acceptable adverse event profiles,reinforcing the role of endoscopic mucosal resection and submucosal dissection in routine practice.This editorial also offers a comprehensive review of the current literature,discusses its clinical implications,explores future directions,and compares endoscopic resection methods with surgical options.Zhu et al’s study findings not only validate the efficacy of advanced endoscopic resection but also signify a paradigm shift from surgical to organ-preserving strategies in colorectal oncology,a transformation that requires deliberate system-wide training and capacity building.
文摘Colonoscopy is a cornerstone in the detection and diagnosis of colorectal tumors,playing a critical role in both screening and clinical evaluation. More recently, itsutility has expanded to therapeutic guidance, particularly with the advent ofminimally invasive surgical techniques. Preoperative tattoo marking is commonlyused for tumor localization;however, it poses challenges such as intraperitonealink scattering and difficulty in defining dissection planes in the lower rectum. Toaddress these limitations, a new technology utilizing a near-infrared fluorescenceclip placed preoperatively enables accurate intraoperative tumor localization.Intraoperative colonoscopy offers additional advantages, including real-timetumor localization, colonic irrigation, visualization of the proximal colon inobstructive cases, and assessment of anastomosis following colorectal resection.Notably, intraoperative colonoscopy allows for the immediate detection andmanagement of complications, such as anastomotic bleeding and leakage, potentiallyimproving postoperative outcomes. Furthermore, advances in endoscopicresections, including endoscopic mucosal resection, endoscopic submucosal dissection,hybrid endoscopic submucosal dissection, and combined endoscopiclaparoscopic surgery, have broadened the indications for endoscopic and endoscopy-guided full-thickness resection of colorectal tumors. These approaches areincreasingly applicable beyond conventional colorectal neoplasms and showpromise in managing appendiceal tumors as well.
文摘The field of gastroenterology has experienced revolutionary advances over the past years,as flexible endoscopes have become widely accessible.In addition to enabling faster,less invasive,and more affordable treatment,flexible endoscopes have greatly improved the detection and endoscopic screening of malignancies and prevented many cancer-related deaths.The development and clinical application of new diagnostic endoscopic technologies,such as magnification endoscopy,narrow-band imaging,endoscopic ultrasound with biopsy,and more recently,artificial intelligence enhanced technologies,have made the recognition and detection of various neoplasms and sub-epithelial tumors more possible.This review demonstrates the latest advancements in endoscopic procedures,techniques,and devices applied in the diagnosis and management of gastrointestinal cancer.
文摘The challenge of effectively eliminating air during gastrointestinal endoscopy using ultrasound techniques is apparent.This difficulty arises from the intricacies of removing concealed air within the folds of the gastrointestinal tract,resulting in artifacts and compromised visualization.In addition,the overlap of folds with lesions can obscure their depth and size,presenting challenges for an accurate assessment.Conversely,in intricately folded regions of the gastrointestinal tract,such as the stomach,intestine,and colon,insufficient delivery of air or CO_(2) into the cavity impedes luminal expansion,hindering the accurate visualization of lesions concealed within the folds.Although this underscores the requirement for substantial airflow,excessive airflow can hinder visualization of bleeding lesions and other abnormalities.Considering these challenges,an ideal endoscopic device would facilitate the observation of lesions without the requirement for air or CO_(2) delivery whereas,ensuring optimal expansion of the gastrointestinal tract.Recently,transparent gels with specific viscosities have been employed more frequently to address this issue.This review aims to elucidate how these gels address these challenges and provide a solution for enhanced endoscopic visualization.
基金Supported by Nanchang High-Level Scientific and Technological Innovation Talents‘Double Hundred Plan’Project,China,No.2022-312.
文摘Rectal neuroendocrine tumor(rNET)is an indolent malignancy often detected during colonoscopy screening.The incidence of rNET has increased approximately 10-fold over the past 30 years.Most rNETs detected during screening endoscopy are small,measuring<10 mm.Current guidelines recommend endoscopic resection for small,well-differentiated rNET using modified endoscopic submucosal resection(mEMR)or endoscopic submucosal dissection.However,the optimal endoscopic treatment method remains uncertain.This paper summarizes the evidence on mEMR with submucosal stretching,mEMR without submucosal stretching,endoscopic submucosal dissection and endoscopic full-thickness resection.Given that rNETs often exhibit submucosal invasion,achieving adequate resection depth is crucial to ensure histological complete resection.mEMR with submucosal stretching appears favorable due to its high rate of histological complete resection,safety and convenience.Risk factors associated with lymph node and distant metastases are also discussed.A treatment algorithm is proposed to facilitate clinical decision-making.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.
基金Supported by National Natural Science Foundation of China,No.82004298Jiangsu Graduate Research and Practice Innovation Program,China,No.KYCX23_2090.
文摘BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.
基金Supported by the Shenyang Science and Technology of Liaoning Province,No.22-321-32-15.
文摘BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantages in operative time,extent of trauma,and medical costs.However,increasing lesion diameter significantly elevates the technical difficulty of endoscopic resection.Currently,robust evidence-based evidence regarding the upper size limit for safely and effectively resecting lesions endoscopically remains lacking.AIM To evaluate the efficacy and safety of endoscopic resection for colorectal lesions≥30 mm in diameter.METHODS This retrospective study reviewed data from 102 patients who underwent endoscopic resection for colorectal lesions measuring≥30 mm in diameter at General Hospital of Northern Theater Command between January 2023 and July 2024.RESULTS Among 102 patients who underwent endoscopic resection,99 received endoscopic submucosal dissection and 3 underwent endoscopic full-thickness resection.Four patients(3.9%)required conversion to surgical radical resection postoperatively.All patients exhibited favorable wound healing at the resection sites,and no long-term complications were observed during the 3-month postoperative colonoscopy follow-up.The primary perioperative complication was post-endoscopic submucosal dissection electrocoagulation syndrome(PEECS)(24/102,23.5%).Multivariate analysis identified lesion location in the transverse colon as an independent risk factor for PEECS occurrence(odds ratio=6.734,95%confidence interval:1.623-27.945,P=0.009).CONCLUSION Large colorectal lesion diameter does not constitute an absolute contraindication to endoscopic resection.Experienced endoscopic centers can achieve complete resection with a favorable efficacy and safety profile.Notably,lesion location in the transverse colon is identified as an independent risk factor for PEECS.
文摘Over the last few years, endoscopic submucosal dissection(ESD) has shown to be effective in the management of early colorectal neoplasms, particularly in Asian countries where the technique was born. In the Western world, its implementation has been slow and laborious. In this paper, the indications for ESD, its learning model, the available methods to predict the presence of deep submucosal invasion before the procedure and the published outcomes from Asia and Europe will be reviewed. Since ESD has several limitations in terms of learning achievement in the West, and completion of the procedure for the first cases is difficult in our part of the world, a short review on colorectal assisted ESD has been included. Finally, other endoscopic and surgical treatment modalities that are in competition with colorectal ESD will be summarized.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duodenal diverticulum,ampullary neoplastic infiltration or surgically altered anatomy.In these cases percutaneous biliary drainage(PTBD)is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life.Endoscopic ultrasound-guided biliary drainage(EUS-BD)is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices.A large amount of data is already collected that proves its efficacy,safety and ability to replace PTBD in cases of ERCP failure.It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future.Several EUS-BD techniques are developed EUS-guided transmural stenting,antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy.EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure.The lack of training,absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure,which is related to life-threatening adverse events.Developing training models,dedicated devices and guidelines hopefully will make EUS-BD easier,safer and well accepted in the future.This paper focuses on the technical aspects of the different EUS-BD procedures,available literature data,advantages,negative aspects and the future perspectives of these modalities.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)is the mainstay procedure of choice for management of obstructive biliary disease.While ERCP is widely performed with high success rates,the procedure is not feasible in every patient such as cases of non-accessible papilla.In the setting of unsuccessful ERCP,endoscopic ultrasound-guided biliary drainage(EUS-BD)has become a promising alternative to surgical bypass and percutaneous biliary drainage(PTBD).A variety of different forms of EUS-BD have been described,allowing for both intrahepatic and extrahepatic approaches.Recent studies have reported high success rates utilizing EUS-BD for both transpapillary and transluminal drainage,with fewer adverse events when compared to PTBD.Advancements in novel technologies designed specifically for EUS-BD have led to increased success rates as well as improved safety profile for the procedure.The techniques of EUS-BD are yet to be fully standardized and are currently performed by highly trained advanced endoscopists.The aim of our review is to highlight the different EUSguided interventions for achieving biliary drainage and to both assess the progress that has been made in the field as well as consider what the future may hold.
