Although handheld ultrasound devices (HUDs) are commonplace, their ability to diagnose fecal retention (FR) remains unclear. This prospective observational study examined HUDs’ usefulness in diagnosing FR in patients with constipation in a palliative care setting. Between 10 December 2020 and 30 June 2022, we compared rectal ultrasonographic findings obtained using HUDs with clinical manifestations in 64 males and 70 females (48%, 52%, 68 ± 11 years old) with constipation who had undergone computed tomography (CT). FR was diagnosed using a HUD and compared with CT and digital rectal examination (DRE) results. In total, 42 (31%), 42 (31%), and 41 (31%) patients were diagnosed using HUDs, CT, and DRE, respectively. Thirty-nine (93%) patients in the CT group were also diagnosed with FR using HUDs. A total of 89 of 92 patients with a negative CT diagnosis also had a negative HUD diagnosis. Among the 41 patients in the DRE group, 37 were also diagnosed with FR using HUDs. Among 93 patients with a negative DRE diagnosis, 86 had a negative HUD diagnosis. The sensitivity, specificity, positive predictive value, and negative predictive value of HUDs for CT were 93%, 97%, 93%, and 97%, respectively. Those of HUDs for DRE were 88%, 94%, 86%, and 95%, respectively. The concordance rates for FR diagnosis were 128/134 for CT and HUDs and 123/134 for DRE and HUDs. HUD was useful for diagnosing FR in this setting. HUDs could provide valuable support for appropriate treatment selection. Developing a constipation treatment algorithm based on rectal ultrasonographic findings is warranted in the future.

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective diagnostic technique; however, few studies have evaluated the efficacy of trans-colorectal EUS-FNA. This study assessed the feasibility of trans-colorectal EUS-FNA.Methods: We retrospectively analyzed 76 consecutive patients who underwent trans-colorectal EUS-FNA for pelvic lesions between January 2013 and September 2023.Results: A total of 76 pelvic lesions were identified. The median number of EUS-FNA punctures was 3 (1–8). The median lesion size was 18.9 (8.2–100.0) mm. The success rate was 98.7% (75/76), with no reported adverse events. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA were 94.3% (50/53), 100% (22/22), 100% (50/50), 88.0% (22/25), and 96.0% (72/75), respectively. Malignancy was initially suspected in 65 patients before EUS-FNA; however, 25 patients showed benign results. Of these, three were later reexamined and diagnosed with malignancy, three underwent surgery and were found to have benign pathology, and 19 avoided unnecessary surgery.Conclusions: Trans-colorectal EUS-FNA is a safe and effective diagnostic procedure.

Objectives: Hilar cholangiocarcinoma often results in repeated early stent dysfunction and difficult‐to‐control cholangitis after drainage using endoscopic retrograde cholangiopancreatography (ERCP). In this study, we evaluated the effectiveness of additional drainage using endoscopic ultrasound‐guided biliary drainage (EUS‐BD) in patients with hilar cholangiocarcinoma who had difficult‐to‐control cholangitis after transpapillary drainage with ERCP alone. Methods: We retrospectively evaluated 20 patients with hilar cholangiocarcinoma who had difficult‐to‐control cholangitis after transpapillary drainage with ERCP at our hospital between 2017 and 2025 and therefore underwent additional drainage using EUS‐BD. We evaluated the time to recurrent biliary obstruction (TRBO) just before and after combined ERCP and EUS‐BD in these patients. Results: The Bismuth classification of stenosis was II in four cases (20.0%), IIIa in five cases (25.0%), IIIb in one case (5.0%), and IV in 10 cases (50.0%). The median (95% confidence interval) TRBO biliary obstruction just before and just after additional drainage with EUS‐BD was 16.5 days (7.0–27.0) and 91.0 days (53.0–NR), respectively, and additional drainage with EUS‐BD significantly prolonged stent patency. Conclusions: Combining ERCP with EUS‐BD for drainage was effective in patients with hilar cholangiocarcinoma who had stent dysfunction due to cholangitis that was difficult to control using transpapillary drainage with ERCP alone.

Background/Objectives: Endoscopic ultrasound-guided pancreatic duct drainage (EUS-guided PDD) has emerged as an important technique for managing pancreaticojejunostomy anastomotic strictures (PJAS) following pancreatoduodenectomy. However, long-term outcome data remain limited. This study aimed to evaluate the long-term outcomes of EUS-guided PDD for benign PJAS. Methods: This single-center retrospective cohort study included 46 patients who underwent technically successful EUS-guided PDD for benign PJAS between May 2011 and June 2025. The primary outcome was cumulative clinical fistula patency assessed by Kaplan–Meier analysis. Secondary outcomes included adverse events and risk factors for re-intervention. Results: Technical success was 95.83% (46/48), with clinical success in all technically successful cases. Cumulative clinical fistula patency rates were 82.20% at 1 year and 75.90% at 3 and 5 years. Postprocedural adverse events occurred in 28.26%. Unplanned re-intervention was required in 19.57%, exclusively among patients symptomatic before the initial procedure; symptomatic-status effects were therefore non-estimable. No independent predictors of unplanned re-intervention were detected, and no differences were observed between EUS-guided pancreaticogastrostomy (EUS-guided PGS) and EUS-guided pancreatojejunostomy (EUS-guided PJS). Conclusions: EUS-guided PDD achieved high technical and clinical success with durable long-term patency (82.20% at 1 year; 75.90% at 3 and 5 years). Differences between EUS-guided PGS and EUS-guided PJS and independent predictors of unplanned re-intervention were not detected; because all nine re-interventions occurred in patients symptomatic at baseline and none in asymptomatic patients, symptomatic-status effects were non-estimable.

Objectives: Various drainage methods have been used for unresectable malignant hilar biliary obstruction (MHBO). However, controlling cholangitis and obstructive jaundice is still challenging. We performed a phase I/II study of endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS) as primary drainage for MHBO. Methods: This prospective Phase I/II study included 20 patients requiring biliary drainage for MHBO recruited from June 2021 to December 2023. The primary endpoint was safety. The secondary endpoints were clinical efficacy, reintervention methods, and frequency. Results: The types of bile duct stenosis were Bismuth type I/II/IIIa/IIIb/IV; 4/1/5/3/7 cases. Fifteen cases (75%) had cholangitis before the EUS‐HGS was performed. Technical success rate; 100% (20/20), clinical success rate; 75% (15/20). The four cases in which clinical success was not achieved were Bismuth type IV with cholangitis and obstructive jaundice, and all cases required additional drainage for the right bile duct. Early adverse events were stent migration: one case (severe) and peritonitis: one case (mild). Conclusions: The safety of EUS‐HGS for the primary drainage of unresectable MHBO is acceptable. Regarding clinical efficacy, based on the results observed in patients with Bismuth type IV obstruction, we acknowledge that further investigation is warranted. Trial Registration : UMIN‐CTR: UMIN000047702.

Background/Objectives: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) often requires fistula dilation owing to the placement of a large diameter of the delivery stent. The recently developed delivery devices, which are as thin as 5.9/6.0 Fr, may save the need for fistula dilation. Therefore, we investigated whether large fistula dilation would be required or not in the case of this newly developed thin-diameter delivery stents. Methods: We conducted a retrospective study involving 33 patients implemented with a self-expandable metal stent (SEMS) during EUS-HGS. The patients were categorized based on the delivery device diameter into thin (n = 13; delivery device diameter: 5.9/6.0 Fr) and thick (n = 20; delivery device diameter: 8.5 Fr) groups. We compared the initial rate of success, technical success, and clinical success between the thin and thick groups. The initial rate of success was defined as successful stent placement without a balloon or large diameter mechanical dilation. Results: The rate of the initial stenting success was significantly higher in the thin group (100% [13/13]) compared with that in the thick group (65.0% [13/20]) (p = 0.027). In the thick group, seven cases with technical difficulty in terms of stent placement could be successfully completed with additional fistula dilation with a 9 Fr bougie dilator or 4 mm balloon dilator; this resulted in a technical success of 100% in both groups ultimately. The rate of clinical success was 100% and 95.0% in the thin and thick groups, respectively (p = 1.00). Conclusions: Thin delivery stents may facilitate stent placement without the need for a balloon fistula or large-diameter mechanical dilation.