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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. The primary outcome was ISL-B detection rate, and the secondary outcomes were technical success of POC and POC-guided forceps biopsy sampling (POC-FB), procedure time, visualization quality, and tissue adequacy. Results D-SOC had a higher technical success rate than D-POC but the difference was not statistically significant (100% vs. 92.1%, P = 0.25). D-POC had a marginally higher ISL-B detection rate (34.2% vs. 28.9%, P = 0.68) and significantly higher visualization quality (P = 0.03). The mean (SD) procedure time was significantly shorter with D-SOC (11.00 [1.33] vs. 19.03 [2.95] minutes, P<0.001). The technical success rate of POC-FB and tissue adequacy did not differ between the two techniques (D-SOC vs. D-POC: 81.8% vs. 84.6%, P = 0.69 and 77.8% vs. 90.9%, P = 0.57, respectively). Conclusions Both POC systems were safe and useful for the detection, characterization, and diagnosis of minute ISL-Bs. While D-SOC displayed a shorter procedure time and a tendency for higher technical success rate, D-POC provided superior visualization quality, allowing detailed observation of the surface structure and microvascular patterns. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to evaluate the efficacy and safety of temperature‐controlled intraductal radiofrequency ablation (ID‐RFA) for advanced malignant hilar biliary obstruction (MHBO). Methods: Patients were randomly assigned to RFA group (ID‐RFA and bilateral plastic stent [PS]) or non‐RFA group (bilateral PS) at a 1:1 ratio. Exchange to self‐expanding metal stent (SEMS) was performed after 3 months or when premature PS occlusion occurred. Total event‐free stent patency, overall survival (OS), and adverse events (AEs) were analyzed. Results: A total of 30 patients from three hospitals were enrolled. Stent patency and OS did not differ between the two groups (178 days vs 122 days, P =.154; 230 days vs 144 days, P =.643; respectively). In patients with each stricture length ≥11 mm on both sides, stent patency was longer in the RFA group than in the non‐RFA group (175 days vs 121 days, P =.028). More patients received elective exchange to SEMS without PS occlusion in the RFA group than in the non‐RFA group (69.2% vs 23.1%, P =.018). AE rates did not differ between the two groups. Conclusions: Temperature‐controlled ID‐RFA for advanced MHBO was safe and feasible. It could prevent premature PS occlusion within 3 months. [ABSTRACT FROM AUTHOR]

Background: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS) has rendered endoscopic gallbladder assessment through a stent possible, but an appropriate endoscope is required. We assessed the feasibility of peroral cholecystoscopy (POCC) using a multibending ultraslim endoscope passed through a LAMS after EUS-GBD.Methods: 14 patients with a LAMS for EUS-GBD who consecutively underwent POCC were included. POCC was performed using a multibending endoscope inserted through the LAMS. The primary outcome was the technical success rate, defined as complete endoscopic examination of the gallbladder from the orifice of the cystic duct to the fundus. The types of intervention and adverse events were recorded.Results: 17 POCCs were performed in 14 patients. Of the 17 POCCs, 15 (88.2 %) were technically successful. Narrow-band imaging endoscopy was performed in 12 procedures (70.6 %), and cholecystoscopy-guided target biopsies were obtained in six. Gallstone extraction was performed in two patients. After POCC, all LAMSs remained stable and no adverse events were observed.Conclusions: POCC using a multibending ultraslim endoscope can be effectively and safely performed through a LAMS after EUS-GBD. [ABSTRACT FROM AUTHOR]

Background and Aim: Durable biliary drainage is essential in patients with pancreatic cancer in the era of effective neoadjuvant chemotherapy (NACT). Plastic stent (PS) tends to occlude easily, and current metal stents are designed for nonresectable cancer. We evaluated the efficacy of a modified non‐flared fully covered self‐expandable metal stent (M‐FCSEMS) during the perioperative period in patients with resectable or borderline resectable pancreatic cancer. Methods: Consecutive patients with resectable or borderline resectable pancreatic ductal adenocarcinoma had a 12‐mm M‐FCSEMS (M‐FCSEMS group) or 7‐Fr PS (PS group) placed for biliary decompression before NACT or curative‐intent surgery. The primary outcome was the re‐intervention rate, and secondary outcomes were technical success, stent patency, and adverse events (AEs). Results: Endoscopic stent placement was technically successful in all 60 patients. Twenty‐three patients underwent surgery and 37 NACT before surgery. Re‐intervention was performed in 10.0% (3/30) of patients in the M‐FCSEMS group and 36.7% (11/30) of patients in the PS group (P = 0.030). The stent patency at 180 days was 89.8% (95% confidence interval, 77.3–100.0%) in the M‐FCSEMS group and 30.2% (95% confidence interval, 11.4–80.0%) in the PS group (P < 0.0001). Stent‐related AEs occurred in 10.0% (3/30) in the M‐FCSEMS group and 40.0% (12/30) in the PS group (P = 0.015). Surgery‐related AEs occurred in 10.5% (2/19) and 14.3% (3/21) in the M‐FCSEMS and PS groups (P = 0.549). Conclusions: Modified non‐flared fully covered self‐expandable metal stents are effective and safe for durable biliary drainage in patients with resectable or borderline resectable pancreatic cancer during the perioperative period. [ABSTRACT FROM AUTHOR]

Background and Aim: Endoscopic management of a benign biliary stricture (BBS) on the hilum is complicated and challenging. Although the placement of a fully covered self‐expandable metal stent (FCSEMS) is possible to increase effectiveness, stent migration and stent‐induced adverse events are problematic. We aimed to evaluate the usefulness of a modified short FCSEMS with a long lasso in patients with a difficult perihilar BBS. Methods: Patients with perihilar BBS within 2 cm from the hilar confluence that failed initially with plastic stents were enrolled. A modified short FCSEMS was deployed and then removed 5–6 months later. The primary outcome was clinical success. Other technical success, adverse events, endoscopic success of stent removal, and recurrence of stricture during the follow‐up period were measured. Results: Endoscopic intraductal placement was technically successful in all patients (n = 19). Combined contralateral plastic stent placement was performed in 13 patients (68.4%). The median duration of stent placement was 163 days (range, 138–196 days). Endoscopic stent removal was successful in all patients except one spontaneous distal migration. Stricture resolution without de novo focal stricture occurrence was 100%. Endoscopic stone removal after stricture improvement was successful in all 13 patients with bile duct stones above the stricture. During a follow‐up period (median 635 days) after stent removal, only one recurrence developed. Conclusions: Temporary placement of a modified intraductal short FCSEMS with or without a contralateral plastic stent improved perihilar BBS in patients that primarily failed by plastic stents. Combined biliary stones were also successfully removed after stricture resolution. [ABSTRACT FROM AUTHOR]

Background and Aim: Endoscopic post‐papillectomy bleeding occurs in 3% to 20% of the cases, and delayed bleeding is also problematic. However, there is no consensus on how to reduce delayed post‐papillectomy bleeding. The aim of this study was to evaluate the efficacy of prophylactic argon plasma coagulation (APC) to minimize delayed bleeding and reduce the persistence of residual tumors after endoscopic papillectomy. Methods: In a prospective pilot study of patients with benign ampullary tumors, the prophylactic APC group underwent APC at the resection margin following a conventional snaring papillectomy. Then, 24 h later after the papillectomy, all patients underwent a follow‐up duodenoscopy to identify post‐papillectomy bleeding and were followed up until 12 months. The main outcomes were the delayed (≥24 h) post‐papillectomy bleeding rate and the tumor persistence rate. Results: The delayed post‐papillectomy bleeding rate was 30.8% (8/26) in the prophylactic APC group and 21.4% (6/28) in the non‐APC group (P = 0.434). The post‐procedure pancreatitis rates were 23.1% (6/26) and 35.7% (10/28), respectively (P = 0.310). The rate of tumor persistence did not differ between the two groups at 1 month (12.5% vs 7.4%, P = 0.656), 3 months (4.2% vs 3.7%, P = 1.00), 6 months (8.3% vs 3.7%, P = 0.595), and 12 months (0% vs 3.7%, P = 1.00). There were no procedure‐related mortalities or serious complications. Conclusion: Prophylactic APC may not be effective in reducing delayed post‐papillectomy bleeding or remnant tumor ablation immediately after conventional papillectomy (Clinical trial registration—cris.nih.go.kr; KCT0001955). [ABSTRACT FROM AUTHOR]