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Background: One advantage of endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) is that it is difficult for reflux cholangitis, caused by duodenal pressure increasing due to duodenal obstruction, to occur. In addition, since stent deployment is performed away from the malignant stricture site, longer stent patency than with endoscopic retrograde cholangiopancreatography (ERCP) may be obtained. However, no study has previously compared EUS‐HGS and ERCP for patients without duodenal obstruction or surgically altered anatomy. The aim of the present study was to compare clinical outcomes between EUS‐HGS and ERCP in normal anatomy patients without duodenal obstruction. Method: In the ERCP group, patients who initially underwent biliary drainage were included. In the EUS‐HGS group, patients who underwent EUS‐HGS due to failed biliary cannulation were included. Patients with an inaccessible papilla, such as with surgically altered anatomy or duodenal obstruction, were excluded. Results: A total of 314 patients who underwent ERCP and EUS‐HGS were enrolled in this study. Of the 314 patients, 289 underwent biliary stenting under ERCP guidance, and 25 patients underwent biliary stenting under EUS‐HGS. After propensity score‐matching analysis, the adverse event rate tended to be lower in the EUS‐HGS group than in the ERCP group. Although overall survival was not significantly different between the EUS‐HGS and ERCP groups (p =.228), stent patency was significantly longer in the EUS‐HGS group (median 366.0 days) than in the ERCP group (median 76.5 days). Conclusions: EUS‐HGS had a lower adverse event rate, shorter procedure time, and longer stent patency than ERCP in cases of normal anatomy without duodenal obstruction. [ABSTRACT FROM AUTHOR]

Background and Aim: Tip‐in endoscopic mucosal resection (EMR) has a high en bloc resection rate for large colorectal neoplasms. However, non‐experts' performance in Tip‐in EMR has not been investigated. We investigated whether Tip‐in EMR can be achieved effectively and safely even by non‐experts. Methods: This retrospective study included consecutive patients who underwent Tip‐in EMR for 15–25 mm colorectal nonpedunculated neoplasms at a Japanese tertiary cancer center between January 2014 and December 2020. Baseline characteristics, treatment outcomes, learning curve of non‐experts, and risk factors of failing self‐achieved en bloc resection were analyzed. Results: A total of 597 lesions were analyzed (438 by experts and 159 by non‐experts). The self‐achieved en bloc resection (69.8% vs 88.6%, P < 0.001) and self‐achieved R0 resection (58.3% vs 76.5%, P < 0.001) rates were significantly lower in non‐experts with <10 cases of experience than in experts, but not in non‐experts with >10 cases. Adverse event (P = 0.165) and local recurrence (P = 0.892) rates were not significantly different between experts and non‐experts. Risk factors of failing self‐achieved en bloc resection were non‐polypoid morphology (OR 3.4, 95% CI 1.6–7.3, P = 0.001), lesions with an underlying semilunar fold (OR 3.6, 95% CI 1.6–7.3, P < 0.001), positive non‐lifting sign (OR 3.1, 95% CI 1.2–8.0, P = 0.023), and non‐experts with an experience of ≤10 cases (OR 3.6, 95% CI 2.1–6.3, P < 0.001). Conclusion: The clinical outcomes of Tip‐in EMR for 15–25 mm lesions performed by non‐experts were favorable. [ABSTRACT FROM AUTHOR]

Objectives: For preoperative biliary drainage (PBD) of malignant hilar biliary obstruction (MHBO), current guidelines recommend endoscopic nasobiliary drainage (ENBD) due to the higher risk of cholangitis after endoscopic biliary stenting (EBS) during the waiting period before surgery. However, few studies have supported this finding. Therefore, we aimed to compare the outcomes of preoperative ENBD and EBS in patients with MHBO. Methods: Patients with MHBO who underwent laparotomy for radical surgery after ENBD or EBS were included from retrospectively collected data from 13 centers (January 2014 to December 2018). We performed a 1:1 propensity score matching between the ENBD and EBS groups. These patients were compared for the following: cholangitis and all adverse events (AEs) after endoscopic biliary drainage (EBD) until surgery, time to cholangitis development after EBD, postsurgical AEs, and in‐hospital death after surgery. Results: Of the 414 patients identified, 355 were analyzed in this study (226 for ENBD and 129 for EBS). The matched cohort included 63 patients from each group. The proportion of cholangitis after EBD was similar between the two groups (20.6% vs. 25.4%, P = 0.67), and no significant difference was observed in the time to cholangitis development. The proportions of surgical site infections, bile leaks, and in‐hospital mortality rates were similar between the groups. Conclusion: For PBD of MHBO, the proportion of AEs, including cholangitis, after EBD until surgery was similar when either ENBD or EBS was used. [ABSTRACT FROM AUTHOR]

Background and Aim: Computer‐aided detection (CADe) systems can efficiently detect polyps during colonoscopy. However, false‐positive (FP) activation is a major limitation of CADe. We aimed to compare the rate and causes of FP using CADe before and after an update designed to reduce FP. Methods: We analyzed CADe‐assisted colonoscopy videos recorded between July 2022 and October 2022. The number and causes of FPs and excessive time spent by the endoscopist on FP (ET) were compared pre‐ and post‐update using 1:1 propensity score matching. Results: During the study period, 191 colonoscopy videos (94 and 97 in the pre‐ and post‐update groups, respectively) were recorded. Propensity score matching resulted in 146 videos (73 in each group). The mean number of FPs and median ET per colonoscopy were significantly lower in the post‐update group than those in the pre‐update group (4.2 ± 3.7 vs 18.1 ± 11.1; P < 0.001 and 0 vs 16 s; P < 0.001, respectively). Mucosal tags, bubbles, and folds had the strongest association with decreased FP post‐update (pre‐update vs post‐update: 4.3 ± 3.6 vs 0.4 ± 0.8, 0.32 ± 0.70 vs 0.04 ± 0.20, and 8.6 ± 6.7 vs 1.6 ± 1.7, respectively). There was no significant decrease in the true positive rate (post‐update vs pre‐update: 95.0% vs 99.2%; P = 0.09) or the adenoma detection rate (post‐update vs pre‐update: 52.1% vs 49.3%; P = 0.87). Conclusions: The updated CADe can reduce FP without impairing polyp detection. A reduction in FP may help relieve the burden on endoscopists. [ABSTRACT FROM AUTHOR]

Background and Aim: Hot snare polypectomy using blend or coagulation current is widely used; however, it causes deeper tissue heat injury, leading to adverse events. We hypothesized that hot polypectomy using low‐power pure cut current (PureCut, effect 1 10 W) could reduce deeper tissue heat injury. We conducted animal experiments to evaluate the deeper tissue heat injury and conducted a prospective clinical study to examine its cutting ability. Methods: In a porcine rectum, hot polypectomy using Blend current (EndoCut, effect 3 40 W) and low‐power pure cut current was performed. The deepest part of heat destruction and thickness of the non‐burned submucosal layer were evaluated histologically. Based on the results, we performed low‐power pure cut current hot polypectomy for 10–14 mm adenoma. The primary endpoint was complete resection defined as one‐piece resection with negative for adenoma in quadrant biopsies from the defect margin. Results: In experiments, all low‐power pure‐cut resections were limited within the submucosal layer whereas blend current resections coagulated the muscular layer in 13% (3/23). The remaining submucosal layer was thicker in low‐power pure cut current than in blend current resections. In the clinical study, low‐power pure‐cut hot polypectomy removed all 100 enrolled polyps. For 98 pathologically neoplastic polyps, complete resection was achieved in 84 (85.7%, 95% confidence interval, 77–92%). The lower limit of the 95% confidence interval was not more than 15% below the pre‐defined threshold of 86.6%. No severe adverse events occurred. Conclusions: A novel low‐power pure‐cut hot polypectomy may be feasible for adenoma measuring 10–14 mm. (UMIN000037678). [ABSTRACT FROM AUTHOR]

Background and Aim: Optimal tumor samples are crucial for successful analysis using commercially available comprehensive genomic profiling (CACGP). However, samples acquired by endoscopic ultrasound‐guided tissue acquisition (EUS‐TA) are occasionally insufficient, and no consensus on the optimal number of needle passes required for CACGP exists. This study aimed to explore the optimal number of needle passes required for EUS‐TA to procure an ideal sample fulfilling the prerequisite criteria of CACGPs. Methods: Patients who underwent EUS‐TA for solid masses between November 2019 and July 2021 were retrospectively studied. The correlation between the acquisition rate of an ideal sample and the number of needle passes mounted on a microscope slide was evaluated. Additionally, the factors predicting a successful analysis were investigated in patients scheduled for CACGP using EUS‐TA‐obtained samples during the same period. Results: EUS‐TAs using 22‐ and 19‐gauge (G) needles were performed in 336 and 57 patients, respectively. There was a positive correlation between the acquisition rate and the number of passes using a 22‐G needle (38.9%, 45.0%, 83.7%, and 100% for 1, 2, 3, and 4 passes, respectively), while no correlation was found with a 19‐G needle (84.2%, 83.3%, and 85.0% for 1, 2, and 3 passes, respectively). The analysis success rate in patients with scheduled CACGP was significantly higher with ideal samples than with suboptimal samples (94.1% vs 55.0%, P < 0.01). Conclusions: The optimal estimated number of needle passes was 4 and 1–2 for 22‐ and 19‐G needles, respectively. [ABSTRACT FROM AUTHOR]