Since the 1960s, when the practical use of endoscopes started in the clinical setting, Japan has always led the world in endoscopic medicine, in both the instruments themselves and diagnosis or treatment techniques. However, due to extensive globalization, Japanese pharmaceutical and medical device industries are currently facing various problems and losing international competitiveness almost on a daily basis. To achieve victory in the era of globalization of medicine and medical fields including the endoscope, it is indispensable to establish cooperation among industry, academia and government to solve a number of problems. Our society in general should play a major role in endoscope-related cooperation between industry and academia. It is necessary to promote new medical devices, to study methods to evaluate their safety and effectiveness, and to educate and enlighten, for example, through the ability to propose clinical trial designs. It is also necessary to pay attention to society-led guidance, to create educational programs for training regulatory scientists and to cooperate with the Pharmaceuticals and Medical Devices Agency, Japan (PMDA) in personnel training. Support for nationwide clinical trials and establishment of a liaison council (industry-academia-government forum) concerning the development and review of medical devices should also be promoted. Furthermore, it is desirable that activities will be conducted with a strong spirit to contribute to world welfare through the parallel development of endoscope technology and endoscopic technique in the future, for example, by sending physicians to leading endoscopic facilities in Europe and America and taking the initiative in activities to spread the use of the endoscope in Asia, such as endoscopy education and hands-on courses.

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Recent reports suggest that magnifying endoscopy with narrow band imaging (ME-NBI) is useful for the differential diagnosis of superficial gastric lesions. However, interpretation of the image is sometimes difficult even for experts, so it is unknown whether ME-NBI is useful also to endoscopists without expertise in ME-NBI. The aim of this study was to investigate the usefulness of ME-NBI for the novices to distinguish benign from malignant lesions of the stomach. Twenty-four participants, none of whom had expertise in ME-NBI, diagnosed the white light endoscopy (WLE) images of 50 superficial gastric lesions (17 cancers, 33 benign lesions). After presentation of 10 ME-NBI examples (5 cancers, 5 benign lesions), the participants again diagnosed the same 50 lesions with WLE as well as corresponding ME-NBI images. Adding ME-NBI to conventional WLE images significantly improved the diagnostic accuracy of superficial gastric lesions, from 62.8% with WLE to 72.8% with WLE plus ME-NBI (P<0.001). In conclusion, ME-NBI is useful to distinguish superficial lesions of the stomach even for observers without ME-NBI expertise.

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A 72-year-old male, who presented with epigastric discomfort, underwent an upper gastrointestinal endoscopy which revealed multiple ulcers and erosions in the gastric body. Histologic examination of multiple gastric biopsies showed Russell bodies and Helicobacter pylori (H. pylori) infection. We reviewed all cases of Russell body gastritis previously described to examine its clinical, endoscopic and microscopic features and possible pathogenetic mechanisms. In a case report of Russell body gastritis Tazawa and Tsutsumi described a case of H. pylori-related gastritis for the first time in 1998 characterized by the presence of a conspicuous plasma cell infiltrate with Russell bodies. There are only twelve case reports and 4 cases in Japan of so-called Russell body gastritis.

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We describe a patient who had a hamartomatous inverted polyp (HIP) of the stomach. A 59-year-old woman was admitted to our hospital for further examination of a protruding lesion of the stomach. A tumor in the anterior wall of the upper body of the stomach was incidentally revealed during an upper gastrointestinal X-ray series at a mass screening. Gastrointestinal endoscopy disclosed a pedunculated submucosal tumor (SMT). The tumor was resected endoscopically. Histological examination revealed submucosal proliferation of gastric glands and the adjacent cystic structure. The surface of the tumor was covered with normal mucosa. A definite diagnosis of HIP was made. Some complications such as bleeding, obstruction and coexisting gastric cancer have been reported. Though it is difficult to make a definite diagnosis before resection, we should consider an HIP in the differential diagnosis of gastric SMT.

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A 71-year-old male patient underwent curative endoscopic submucosal dissection for gastric adenoma. A histologically confirmed hyperplastic polyp developed at the resection site, and the size was reduced after successful Helicobacter pylori (H pylori) eradication. After the H pylori eradication, another adenoma was observed and curatively resected endoscopically, but no hyperplastic polyp developed at the second resection site. Comparisons of pre- and post-resection conditions between the two adenomas revealed that H pylori infection and proton pump inhibitor use are possible causes of, and H pylori eradication is one of the treatment options for, such a polyp.

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A 60-year-old female had multiple myeloma treated with steroids. Her condition had gradually deteriorated resulting in pneumatosis cystoides intestinalis of the colon with serious constipation. Neither the serious constipation nor the lower abdominal discomfort was improved after treatment with oxygen using nasal cannula (5 l/min-10 hrs/day×7 days). Because the improvement of the subjective symptoms was not recognized, an individual cyst was carefully punctured with endoscopic needle knife to avoid complications (perforation, infection and bleeding). After 3 months, abdominal X-ray revealed that the honeycomb shadow had disappeared. Because there are few reports of PCI treated with endoscopy, we report on this successfully case of PCI treated with endoscopic puncture with needle knife.

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A 68-year-old female developed abdominal pain. An abdominal CT scan showed a cystic lesion of 5 cm in diameter, which was communicating with the ascending colon. This contained a huge fecalith. A giant colonic diverticulum with inflammatory change in the ascending colon was diagnosed. Physical findings were resolved with antibiotic therapy, but four days after the admission, abdominal pain recurred. The CT scan revealed a large bowel obstruction caused by the prolapsed fecalith from the giant diverticulum. An emergency colonoscopy was performed and the fecalith was crushed with forceps and a polypectomy snare. We report herein on a rare case of large bowel obstruction caused by a fecalith from the giant colonic diverticulum, which could be relieved by crushing the fecalith with endoscopic lithotripsy.

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A 76-year-old man was admitted due to fever and general fatigue. He had undergone three sessions of repeated transcatheter arterial chemoembolization (TACE) with arterial infusion therapy using cisplatin for multiple hepatocellular carcinoma at our hospital. An abdominal CT scan showed a low density area surrounding the spleen. Since US guided drainage revealed that the low density area was filled with bile juice, we performed endoscopic retrograde cholangiopancreatography (ERCP), which showed choledocholithiasis and the leakage of contrast medium from the peripheral intrahepatic bile duct to the extrahepatic area surrounding the spleen. Thus a diagnosis of an extrahepatic biloma surrounding the spleen was made, and an endoscopic biliary drainage (EBD) tube was placed. The biloma rapidly decreased. When endoscopic sphincterotomy (EST) and removal of the bile duct stone were performed after two weeks, ERCP showed no leakage of bile juice to the extrahepatic area. ERCP and EBD were useful for the diagnosis and treatment of an extrahepatic biloma surrounding the spleen.

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Granular cell tumors of the large intestine have become widely recognized in recent years as a consequence of the large number of case reports. However, very few assessments have been performed with regard to incidence levels in general gastroenterology clinics. At our facility, granular cell tumors of the large intestine were detected in 2 patients (0.03%) (a total of 4 lesions) during the three-year period from June 2004 to May 2007. In the same period, the number of patients with carcinoid tumors of the large intestine was 13 (0.24%). Hence, the ratio of the number of patients with colorectal carcinoid tumors to patients with granular cell tumors of the large intestine was 13 to 2.

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Administration of anticoagulants and antiplatelets is suspended during endoscopic treatment to prevent hemorrhagic complications. However, cessation of the drugs increases the risk of thromboembolism. In the Western guidelines, prevention of thromboembolism outweighs the risk of continuous bleeding. In Japan, the guidelines for management of anticoagulant and antiplatelet therapy in cardiovascular disease and the Japanese guidelines for the management of stroke which are areas of use of these drugs are not consistent with the guidelines issued by the Japan Gastroenterological Endoscopy Society. Furthermore, the new guidelines issued by the Society in 2005, guidelines that give consideration to the prevention of thrombosis, have not yet found a sufficient level of diffusion. This is an area in which it is difficult to build up evidence with the result that evidence is in short supply worldwide and these difficulties are an ineluctable problem in terms of safe endoscopic treatment. To meet this challenge, an “Examination Group for the Temporary Cessation of Safe Antithrombolytic Treatment” was set up by the Departments using antithrombotic drugs in combination with the Gastroenterology Departments in the area around Sapporo city to prepare Guidelines on the Temporary Cessation of Anticoaglants and Antiplatelets Administration, known as the “Sapporo Consensus”. Focusing mainly on the details of this consensus, we have given a general outline of the implications associated with the cessation of anticoagulant and antiplatelet drug administration in therapeutic endoscopy.

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Among the endoscopic interventional therapies that are available for pancreatobiliary diseases, endoscopic nasobiliary drainage (ENBD) is fundamental, since it does not require any devices or additional techniques other than a guide-wire, a drainage tube and ordinary cannulation. Furthermore, this procedure is very useful and effective for emergencies, especially for obstructive jaundice. In this paper, the basic skills needed for this procedure are documented mainly for beginners, as supervised by an expert doctor. The most important key to successful treatment is to keep a short distance between the papilla and tip of the endoscope throughout the procedure. In addition, the papilla and biliary tract should be treated very gently and carefully. Furthermore, while keeping the advantages and disadvantages of this technique in mind, appropriate management of ENBD is still required.

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