A 62-year-old woman with obstructive jaundice was diagnosed with pancreatic head cancer. She developed fever after endoscopic placement of a biliary stent. We initiated treatment with sulbactam/cefoperazone for cholangitis; however, fever and elevation of inflammatory biomarkers persisted. We performed abdominal ultrasonography, which showed debris within a huge hepatic cyst (16 cm), and we diagnosed hepatic cyst infection. EUS-guided transgastric cyst drainage was performed. We punctured the cyst from the upper gastric corpus using a 19 G needle. We advanced a guide-wire into the cyst, dilated the puncture route using a 7F dilator, and inserted a 7F, 7-cm double-pigtail plastic stent. Following the procedure, the inflammatory response subsided with reduction in cyst size. She was discharged on day 9 after cyst drainage. No relapse of the hepatic cyst infection was observed.

A 66-year-old man with a history of Billroth II procedures for duodenal ulcer presented to our department with obstructive jaundice due to unresectable pancreatic cancer.

We inserted a fully covered metal stent. However, he returned to the hospital because of the pancreatic fistula 3 weeks later. After removing the stent, endoscopic retrograde cholangiopancreatography (ERCP) showed stenosis of the main pancreatic duct, lesion of the pseudocysts, and leakage of contrast material from the pancreatic head. Therefore, we inserted a 5-Fr endoscopic nasopancreatic drainage tube to bridge the disruption. On day 23 of hospitalization, we replaced the 5-Fr stent with a 7-Fr stent because of persistent stenosis and disruption. Computed tomography showed improvement and the patient was discharged. In this case, endoscopic transpapillary drainage was useful for treatment of pancreatic fistula for reconstructing the intestinal tract.

Colonic diverticular bleeding is the most frequent cause of lower gastrointestinal hemorrhage, and it tends to increase. We previously developed the endoscopic detachable snare ligation (EDSL) method as a new method of endoscopic hemostasis [Endoscopy 2015, 47 (11): 1039-42]. The EDSL method is a method of ligature hemostasis using a transparent hood and an endoloop with a diameter of 20 mm. In this procedure, the endoloop is expanded over the tip of the hood and the hood is pressed against the colonic wall so that the diverticulum is at the center. Then, the endoloop is ligated while sucking the diverticulum into the hood. In the multicenter study conducted by our group, the early rebleeding rate was 7.9% [Gastrointest Endosc 2018, 88 (2): 370-377]. The EDSL method is a useful hemostatic method and may become the first choice among endoscopic hemostasis methods in the future.