Kosuke Takahashi

Takehiko Koga, Yusuke Ishida, Akihisa Ohno, Ryota Sagami, Yoshitaka Nakamura, Makoto Hinokuchi, Kosuke Takahashi, Hidefumi Nishikori, Nao Fujimori, Yasuhisa Hiroshima, Hiroki Taguchi, Shinichi Hashimoto, Eisuke Ozawa, Hiroaki Tsuji, Naoaki Tsuchiya, Takanori Kitaguchi, Keisuke Matsumoto, Makoto Fukuyama, Tatsuro Nii, Fumihito Hirai. Gut and Liver -0001;0:. https://doi.org/10.5009/gnl260042

The optimal first-line device for endoscopic retrograde cholangiopancreatography (ERCP) removal of small common bile duct stones (CBDS) remains uncertain. Whether basket geometry – independent of device category – influences procedural efficiency has not been evaluated in a randomized trial. We aimed to compare a spiral-configured 8-wire basket with a standard 8-wire basket for small CBDS. In this multicenter randomized controlled trial, patients with CBDS ≤8 mm were randomly assigned (1:1) to stone extraction using a standard or spiral-configured 8-wire basket. Among 200 randomized patients, 193 underwent basket insertion (spiral group 97, standard group 96). First-line procedural success without device escalation within 10 minutes was significantly higher in the spiral group (97.9% vs. 85.4%; 95%CI 4.9 to 20.1; P = 0.004), corresponding to a number-needed-to-treat of 8. The spiral basket required fewer sweeps (mean [SD]: 2.71 [1.41] vs. 3.31 [1.67]; P = 0.01) and shorter procedure time (3.96 [2.86] vs. 5.48 [4.38] minutes; P = 0.01). Adverse event rates were comparable between groups. Mean device-related costs were lower in the spiral group (mean difference –108 USD; bootstrap 95%CI –185 to –42). A spiral basket configuration improved early procedural efficiency and reduced device escalation and device-related costs, without improving the final stone clearance rate or increasing adverse events. The spiral basket was not compared with balloon extraction and should not be interpreted as superior to it. Although the device evaluated is currently available primarily in Japan, the geometric principle underlying its advantage may inform device development more broadly.

Intravenous anesthesia during endoscopic retrograde cholangiopancreatography (ERCP) is associated with a high incidence of respiratory depression. High-flo

Background: Sarcopenia is a major complication of liver cirrhosis (LC), but current Japan Society of Hepatology (JSH) criteria are based on muscle mass and strength and do not incorporate physical performance. We investigated whether the five‐time chair stand test (5T‐CST) identifies high‐risk patients not detected by conventional sarcopenia assessment. Methods: We retrospectively analyzed 241 patients with LC who underwent the 5T‐CST. Low physical performance was defined as a 5T‐CST time ≥ 12 s. Patients were classified according to their handgrip strength and physical performance, with focus on those with normal handgrip strength. Results: Longer 5T‐CST duration was associated with lower handgrip strength and sarcopenia, but not low skeletal muscle mass index. Among 151 patients with normal handgrip strength and survival data, 27 (17.9%) had low physical performance. This subgroup had preserved muscle mass but more ascites and hepatic reserve impairment and lower survival (mortality, 29.6% vs. 12.1%; log‐rank p = 0.007). In a principal analysis restricted to this subgroup, adjusted for mALBI grade and hepatocellular carcinoma (HCC), low physical performance independently predicted mortality (hazard ratio, 4.70; 95% CI, 1.94–11.37; p < 0.001). In the overall cohort ( n = 237), it remained predictive after adjustment for age, sex, mALBI grade, HCC, and sarcopenia (hazard ratio, 2.74; 95% CI, 1.45–5.16; p = 0.002). Conclusions: Among patients with LC and normal handgrip strength, the 5T‐CST identified a subgroup at a high risk of mortality. Adding this simple test to sarcopenia assessment may help identify patients otherwise missed by handgrip strength alone.