Administering sedation for endoscopic retrograde cholangiopancreatography (ERCP) involves using medications to reduce the patient's level of consciousness during a procedure, which can alleviate patient anxiety and discomfort, and improve clinical outcomes. Due to the complexity of the procedure and physiological changes induced by the prone position, meticulous sedation management is essential during ERCP. Before the procedure, a detailed history taking and physical examination are important. If the Mallampati or American Society of Anesthesiologists classification scores are high, anesthesia provider assistance should be considered. Both standard sedation with a combination of midazolam and opioids and balanced propofol sedation can be used safely. During the procedure, monitoring of vital signs, oxygen saturation, and electrocardiogram is important. For high-risk patients, capnography should also be considered. In particular, personalized approaches, including dosage adjustments and more vigilant monitoring during the procedure, are critical for high-risk patients. To ensure safe ERCP, endoscopists must be familiar with the characteristics of sedatives, as well as the types and dosages of antagonists. To prevent hypoxia during the procedure, preoxygenation and the use of high-flow nasal cannula can be considered, and a laryngeal mask can be useful if intubation is difficult in emergency situations. Above all, care must be taken to avoid excessive doses of sedatives, and it is crucial to continually assess the necessity of ERCP for each patient.

Administering sedation for endoscopic retrograde cholangiopancreatography (ERCP) involves using medications to reduce the patient's level of consciousness during a procedure, which can alleviate patient anxiety and discomfort, and improve clinical outcomes. Due to the complexity of the procedure and physiological changes induced by the prone position, meticulous sedation management is essential during ERCP. Before the procedure, a detailed history taking and physical examination are important. If the Mallampati or American Society of Anesthesiologists classification scores are high, anesthesia provider assistance should be considered. Both standard sedation with a combination of midazolam and opioids and balanced propofol sedation can be used safely. During the procedure, monitoring of vital signs, oxygen saturation, and electrocardiogram is important. For high-risk patients, capnography should also be considered. In particular, personalized approaches, including dosage adjustments and more vigilant monitoring during the procedure, are critical for high-risk patients. To ensure safe ERCP, endoscopists must be familiar with the characteristics of sedatives, as well as the types and dosages of antagonists. To prevent hypoxia during the procedure, preoxygenation and the use of high-flow nasal cannula can be considered, and a laryngeal mask can be useful if intubation is difficult in emergency situations. Above all, care must be taken to avoid excessive doses of sedatives, and it is crucial to continually assess the necessity of ERCP for each patient.

Administering sedation for endoscopic retrograde cholangiopancreatography (ERCP) involves using medications to reduce the patient's level of consciousness during a procedure, which can alleviate patient anxiety and discomfort, and improve clinical outcomes. Due to the complexity of the procedure and physiological changes induced by the prone position, meticulous sedation management is essential during ERCP. Before the procedure, a detailed history taking and physical examination are important. If the Mallampati or American Society of Anesthesiologists classification scores are high, anesthesia provider assistance should be considered. Both standard sedation with a combination of midazolam and opioids and balanced propofol sedation can be used safely. During the procedure, monitoring of vital signs, oxygen saturation, and electrocardiogram is important. For high-risk patients, capnography should also be considered. In particular, personalized approaches, including dosage adjustments and more vigilant monitoring during the procedure, are critical for high-risk patients. To ensure safe ERCP, endoscopists must be familiar with the characteristics of sedatives, as well as the types and dosages of antagonists. To prevent hypoxia during the procedure, preoxygenation and the use of high-flow nasal cannula can be considered, and a laryngeal mask can be useful if intubation is difficult in emergency situations. Above all, care must be taken to avoid excessive doses of sedatives, and it is crucial to continually assess the necessity of ERCP for each patient.

Administering sedation for endoscopic retrograde cholangiopancreatography (ERCP) involves using medications to reduce the patient's level of consciousness during a procedure, which can alleviate patient anxiety and discomfort, and improve clinical outcomes. Due to the complexity of the procedure and physiological changes induced by the prone position, meticulous sedation management is essential during ERCP. Before the procedure, a detailed history taking and physical examination are important. If the Mallampati or American Society of Anesthesiologists classification scores are high, anesthesia provider assistance should be considered. Both standard sedation with a combination of midazolam and opioids and balanced propofol sedation can be used safely. During the procedure, monitoring of vital signs, oxygen saturation, and electrocardiogram is important. For high-risk patients, capnography should also be considered. In particular, personalized approaches, including dosage adjustments and more vigilant monitoring during the procedure, are critical for high-risk patients. To ensure safe ERCP, endoscopists must be familiar with the characteristics of sedatives, as well as the types and dosages of antagonists. To prevent hypoxia during the procedure, preoxygenation and the use of high-flow nasal cannula can be considered, and a laryngeal mask can be useful if intubation is difficult in emergency situations. Above all, care must be taken to avoid excessive doses of sedatives, and it is crucial to continually assess the necessity of ERCP for each patient.

Administering sedation for endoscopic retrograde cholangiopancreatography (ERCP) involves using medications to reduce the patient's level of consciousness during a procedure, which can alleviate patient anxiety and discomfort, and improve clinical outcomes. Due to the complexity of the procedure and physiological changes induced by the prone position, meticulous sedation management is essential during ERCP. Before the procedure, a detailed history taking and physical examination are important. If the Mallampati or American Society of Anesthesiologists classification scores are high, anesthesia provider assistance should be considered. Both standard sedation with a combination of midazolam and opioids and balanced propofol sedation can be used safely. During the procedure, monitoring of vital signs, oxygen saturation, and electrocardiogram is important. For high-risk patients, capnography should also be considered. In particular, personalized approaches, including dosage adjustments and more vigilant monitoring during the procedure, are critical for high-risk patients. To ensure safe ERCP, endoscopists must be familiar with the characteristics of sedatives, as well as the types and dosages of antagonists. To prevent hypoxia during the procedure, preoxygenation and the use of high-flow nasal cannula can be considered, and a laryngeal mask can be useful if intubation is difficult in emergency situations. Above all, care must be taken to avoid excessive doses of sedatives, and it is crucial to continually assess the necessity of ERCP for each patient.

Polytetrafluoroethylene (PTFE) grafts are artificial vascular grafts commonly utilized for reconstructing the middle hepatic vein during living donor liver transplantation. In this report, we present three cases of expanded PTFE (ePTFE) graft migration into the gastrointestinal tract. These migrations were incidentally discovered and later migrated grafts were successfully removed endoscopically. The first case involved a patient presenting with epigastric discomfort, with a migrated ePTFE graft observed in the duodenal lumen during esophagogastroduodenoscopy (EGD). In the second case, a patient who visited the emergency room with hematochezia was found to have a migrated ePTFE graft in the colonic lumen on colonoscopy. The third case involved a patient undergoing regular EGD after endoscopic submucosal dissection for early gastric cancer; graft migration into the duodenal lumen was documented over time through sequential surveillance EGDs. The graft was endoscopically removed after complete migration. Contrary to previous reports, the three cases presented here did not exhibit serious clinical symptoms, and they were successfully treated through endoscopic foreign body removal without complications. We believe these occasions were possible due to the slow migration of the graft and the concurrent spontaneous closure of the fistula tract.

Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker initially identified from colorectal cancer cell lines and is currently widely used in the diagnosis and monitoring of pancreatic and biliary tract cancers. Although CA 19-9 is not routinely screened in general checkups, increasing its screening has led to the frequent detection of elevated CA 19-9 levels in asymptomatic individuals. Patients with elevated CA 19-9 levels often visit clinics for concerns about malignancy, making cancer exclusion essential to exclude cancers through detailed medical history taking, physical examination, and imaging studies. However, many cases of elevated CA 19-9 levels result from benign causes, such as pancreatobiliary diseases, hepatic diseases, pulmonary diseases, or gynecologic conditions. Thus, to avoid unnecessary tests, clinicians must understand the various causes and mechanisms of CA 19-9 elevation. Integrating the patient’s symptoms and medical and family history facilitates appropriate test selection and minimizes unnecessary procedures.

Polytetrafluoroethylene (PTFE) grafts are artificial vascular grafts commonly utilized for reconstructing the middle hepatic vein during living donor liver transplantation. In this report, we present three cases of expanded PTFE (ePTFE) graft migration into the gastrointestinal tract. These migrations were incidentally discovered and later migrated grafts were successfully removed endoscopically. The first case involved a patient presenting with epigastric discomfort, with a migrated ePTFE graft observed in the duodenal lumen during esophagogastroduodenoscopy (EGD). In the second case, a patient who visited the emergency room with hematochezia was found to have a migrated ePTFE graft in the colonic lumen on colonoscopy. The third case involved a patient undergoing regular EGD after endoscopic submucosal dissection for early gastric cancer; graft migration into the duodenal lumen was documented over time through sequential surveillance EGDs. The graft was endoscopically removed after complete migration. Contrary to previous reports, the three cases presented here did not exhibit serious clinical symptoms, and they were successfully treated through endoscopic foreign body removal without complications. We believe these occasions were possible due to the slow migration of the graft and the concurrent spontaneous closure of the fistula tract.