[Diagnostic Work-up and Evaluation of Nonmalignant Ampullary Neoplasms].

Neoplasms of the ampulla of Vater account for approximately 5% of all gastrointestinal tumors, with increasing incidence due to advancements in diagnostic techniques. Among them, nonmalignant ampullary neoplasms require careful evaluation due to their potential for malignant transformation, yet accurate diagnosis remains challenging due to nonspecific symptoms and ambiguous endoscopic findings. Recent advancements in imaging technologies, including image-enhanced endoscopy, and the application of endoscopic techniques such as endoscopic ultrasound and intraductal ultrasound, have improved the diagnostic accuracy of nonmalignant ampullary neoplasms.

Long-term outcomes of a modified nonflared fully covered self-expandable metal stent for refractory anastomotic biliary strictures after liver transplantation (with video).

Objectives: Although fully covered self-expandable metal stents (FCSEMS) are used for the management of anastomotic biliary stricture (ABS) after liver transplantation (LT), there is concern about long-term adverse events such as recurrence of stricture. We evaluated the long-term efficacy of a modified nonflared FCSEMS (M-FCSEMS) compared to plastic stents (PS) for refractory ABS after LT.

Methods: Consecutive patients who underwent placement of an M-FCSEMS (M-FCSEMS group) or multiple PS (PS group) for refractory ABS after LT were enrolled.

Efficacy of Biliary Brush Cytology With Rapid On-Site Cytological Evaluation for the Detection of Malignant Biliary Strictures.

Background And Aims: Brush cytology is a widely used diagnostic method in conjunction with intraductal biopsies during endoscopic retrograde cholangiopancreatography, but its diagnostic yield remains a limitation. This study evaluated the efficacy of biliary cytology using a newly developed brush device with rapid on-site cytological evaluation (ROSE) for detecting malignant biliary strictures (MBSs).

Methods: In total, 58 patients with suspected intrinsic MBS identified by intraductal ultrasound were enrolled.

Re-intervention Utility After Endoscopic Ultrasound-Guided Hepaticogastrostomy Using a Partially Covered Stent with Anchoring Flange.

Background And Aim: Although long self-expandable metal stent (SEMS) with a sufficient intragastric portion is typically preferred for endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), this design can complicate endoscopic re-intervention for recurrent biliary obstruction (RBO). We evaluated the efficacy and safety of endoscopic re-intervention for RBO through the stent after EUS-HGS using a novel partially covered SEMS with an anchoring flange.

Methods: The partially covered SEMS was designed with a intrahepatic uncovered portion measuring 1.

Impact of temperature-controlled endobiliary radiofrequency ablation for inoperable hilar cholangiocarcinoma: A propensity score-matched analysis.

Endobiliary radiofrequency ablation (RFA) can be an effective palliative treatment, but few studies have evaluated its outcomes for malignant obstruction in the hilar bile duct, which has a thin wall and complex duct-vascular contacts. We evaluated the efficacy and safety of temperature-controlled endobiliary RFA, which can reduce the risk of unintentional thermal injury by maintaining the temperature of the ablation segment, in the treatment of inoperable hilar cholangiocarcinoma (CCA). After propensity score matching, 64 patients with inoperable hilar CCA were categorized to the RFA + stent group (endobiliary RFA with stenting; n=32) or stent-only group (stenting only; n=32).

Comparison of disposable digital single-operator cholangioscopy versus direct peroral cholangioscopy for the diagnosis of intraductal superficial lesions of the bile duct.

Background: Disposable digital single-operator cholangioscopy (D-SOC) and direct peroral cholangioscopy (D-POC) using an ultraslim endoscope are established POC modalities for the diagnosis and treatment of various biliary diseases. We compared the usefulness of D-SOC and D-POC for the diagnosis of intraductal superficial lesions of the bile duct (ISL-Bs).

Methods: 38 consecutive patients with suspected biliary diseases who underwent both D-SOC and D-POC were enrolled.

Usefulness of Direct Peroral Cholangioscopy Using a Multibending Ultraslim Endoscope for the Management of Intrahepatic Bile Duct Lesions (with Videos).

Background/aims: : Peroral cholangioscopy (POC) has been used to assess intrahepatic duct (IHD) lesions but with a limited role. A new multibending (MB) ultraslim endoscope has been designed to improve POC performance. We evaluated the usefulness of POC using the MB ultraslim endoscope for the management of IHD lesions.

Lumen-apposing metal stents for the treatment of pancreatic and peripancreatic fluid collections and bleeding risk: a propensity matched study.

Introduction:  Endoscopic ultrasound (EUS)-guided drainage of symptomatic pancreatic fluid collections (PFCs) using the Hot-Axios device has recently been associated with a significant risk of bleeding. This adverse event (AE) seems to occur less frequently with the use of a different device, the Spaxus stent. The aim of the current study was to compare the rates of bleeding between the two stents.

Preliminary feasibility study of a new partially covered self-expandable metal stent with an anchoring flange for EUS-guided hepaticogastrostomy (with videos).

Background And Aims: EUS-guided hepaticogastrostomy (EUS-HPG) has a risk of serious procedural adverse events (AEs), but few dedicated devices for EUS-HPG are available. We evaluated the feasibility of a new partially covered self-expandable metal stent (PCSEMS) with an anchoring flange for EUS-HPG.

Methods: The feasibility of a stent featuring a proximal radiopaque uncovered portion 1.

Detection and endoscopic classification of intraductal neoplasms of the bile duct by peroral cholangioscopy with narrow-band imaging (with videos).

Background And Aims: Indirect diagnostic modalities are unsatisfactory for detecting intraductal neoplasm of the bile duct (IN-B), which can be detected by peroral cholangioscopy (POC) with narrow-band imaging (NBI). We investigated the POC findings of IN-B and developed a feasible endoscopic classification system.

Methods: Four hundred seventy-one patients who underwent direct POC from April 2008 to July 2020 were enrolled.

EUS-guided biliary drainage with a novel electrocautery-enhanced lumen apposing metal stent as first approach for distal malignant biliary obstruction: a prospective study.

 Endoscopic retrograde cholangiopancreatography (ERCP) represents the gold standard for jaundice palliation in malignant biliary obstruction (MBO) patients. Biliary drainage using electrocautery lumen apposing metal stent (EC-LAMS) is currently a well-established procedure when ERCP fails. We aimed to assess the technical and clinical success of a new EC-LAMS as the first approach to the palliation of malignant jaundice due to MBO in patients unfit for surgery.

Role of ERCP in Malignant Hilar Biliary Obstruction.

Malignant hilar biliary obstruction (MHO), an aggressive perihilar biliary obstruction caused by cholangiocarcinoma, gallbladder cancer, or other metastatic malignancies, has a poor prognosis. Surgical resection is the only curative treatment method for biliary malignancies. However, most of the patients with MHO cannot undergo surgeries on presentation because of an advanced inoperable state or a poor performance state due to old age or comorbid diseases.