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Abstract Endoscopic ultrasound (EUS)‐guided transhepatic biliary drainage is usually performed with a 19‐gauge fine‐needle aspiration (FNA) needle and a 0.025‐inch guidewire. The combination of a 22‐gauge FNA needle and a 0.018‐inch guidewire is reported to be effective as a rescue option when the bile duct diameter is small or technically challenging. Experts in EUS‐guided transhepatic biliary drainage have reported that bile duct puncture with a 19‐gauge FNA needle is possible in most cases, but is not easy to reproduce by endoscopists with less experience in EUS‐guided transhepatic biliary drainage. We investigated the usefulness of EUS‐guided transhepatic biliary drainage using a 22‐gauge FNA needle and a 0.018‐inch guidewire during the procedure's induction phase. Consecutive patients who underwent EUS‐guided transhepatic biliary drainage at our institution from March 2021 to May 2023 were evaluated, and 37 were included. Biliary drainage was performed for malignant bile duct stricture in 36 patients and choledocholithiasis in one patient. The median target bile duct diameter was 4.5 mm (2.5–9.4). Biliary access, fistula dilation, and stent placement were successful in the 37 patients (100%). The median procedure time was 35 min (16–125). Adverse events occurred in four (10.8%) patients. EUS‐guided transhepatic biliary drainage using a 22‐gauge FNA needle and a 0.018‐inch guidewire is a useful and promising option for endoscopists with limited experience in EUS‐guided transhepatic biliary drainage in the procedure's induction phase.

Abstract Reports of needle tract seeding (NTS) as a complication of endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) have been increasing. To date, most of the reported cases of NTS have been diagnosed during the postoperative follow‐up period. Herein, we report a case of NTS that occurred during preoperative neoadjuvant chemotherapy after EUS‐FNA for resectable pancreatic cancer. The patient underwent transgastric EUS‐FNA for a pancreatic tail tumor. He was diagnosed as having resectable pancreatic cancer and received preoperative neoadjuvant chemotherapy. After completion of the chemotherapy, computed tomography showed a thick‐walled cyst‐like structure appearing between the pancreas and the gastric wall. Combined resection revealed adenocarcinoma invasion into the cyst‐like structure. Based on the clinical course, and surgical and pathological findings, the condition was diagnosed as NTS. It is thus crucial that after EUS‐FNA, a detailed review of the imaging findings be conducted in the preoperative period. If adhesions between the stomach and the pancreas are observed after transgastric EUS‐FNA, combined resection of the gastric wall should be considered.

Abstract Early gastric mixed neuroendocrine‐non‐neuroendocrine neoplasms (MiNENs) are rare diseases, with no data on their incidence and prognosis. We report the case of intramucosal gastric MiNENs for endoscopic submucosal dissection (ESD) treatment. An 80‐year‐old male underwent esophagogastroduodenoscopy for screening and was suspected of early gastric cancer type 0‐IIa+IIc on the lesser curvature of the antrum, for which ESD treatment was performed. Histopathologically, the diagnosis was MiNENs. Synaptophysin‐positive adenoductal structures were observed in the adenocarcinoma component, suggesting that adenocarcinoma had dedifferentiated into neuroendocrine carcinoma. The tumor was located within the mucosal layer, with lympho‐vascular invasion. The patient was kept under observation; however, 6 months after the ESD, computed tomography scan revealed prominent ascites, enlarged lymph nodes, and liver metastases, and MiNENs were suspected to have poor prognosis. If MiNENs diagnosis is made preoperatively or postoperatively, surgical resection may be considered as treatment regardless of the tumor depth or lympho‐vascular invasion.

Abstract We report on two patients with stasis symptoms, including vomiting and nausea that were caused by deformity, stenosis, and decreased gastric peristalsis associated with artificial ulcers after endoscopic submucosal dissection (ESD). In both cases, the symptoms remained unresolved despite repetitive endoscopic balloon dilation (EBD). Therefore, laparoscopic gastrojejunostomy was performed. Soon after the procedure, their food intake was improved. Laparoscopic gastrojejunostomy can be an option for the treatment of gastric outlet obstruction induced by a large field of gastric ESD that is refractory to EBD.