Endoscopic submucosal dissection (ESD) has become widespread, enabling endoscopic resection of a wide range of esophageal cancers. On the other hand, it has become clear that the risk of stricture after esophageal ESD is high when the circumferential mucosal defect after ESD exceeds 3/4 of the esophageal circumference. Currently, steroid injection therapy and oral steroid therapy are mainstream treatments for prophylaxis against esophageal ESD stricture. However, it is not clear whether steroid injection therapy and oral steroid therapy are useful and safe. Therefore, the Japanese Clinical Oncology Research Group is performing a randomized phase Ⅲ trial on the safety and efficacy of steroid injection therapy and oral steroid therapy as two methods of prophylaxis against esophageal ESD stricture. We also hope for the development of a tissue shielding method such as a polyglycolic acid sheet and autologous cell sheet transplantation as regenerative medicine.

About 20 years have passed since the emergence of computed tomography (CT) colonography. In the last two decades, great progress in the acceleration and multiplicity of the detectors in the CT apparatus has been made, leading to high-resolution CT images that were unimaginable before. CT colonography has many advantages. Neither intubation of an endoscope nor injection of barium is required in CT colonography. Subsequently, the examination time has been shortened and the physical burden has been greatly reduced. Technical expertise in colonoscopy is not required; thus, serious adverse events have rarely occurred in the clinical setting. With recent advances in CT colonographic techniques and bowel preparation methods including fecal tagging, the accuracy of CT colonography has been validated by many large-scale clinical trials. In Japan, the number of deaths from colorectal cancer is still increasing whereas the rate of colonoscopy following positive fecal immunochemical test has not increased. Therefore, CT colonography is expected to serve as an alternative to colonoscopy. CT colonography as a colon screening test has been covered by health insurance in Japan since 2012. At present, new technologies including reduction of radiation exposure dose, super-reduced-laxative volume and computer-aided diagnostic system are being developed. In the near future, CT colonography could become established as a more comfortable and more accurate colon screening test.

A 91-year-old woman underwent gastric endoscopic submucosal dissection （ESD） for early gastric cancer. On the following morning, she complained of upper abdominal pain and fever, and inflammatory response markers were elevated in blood biochemistry tests. Computed tomography revealed no signs of pneumonia or free air, but the gastric wall was severely thickened. Esophagogastroduodenoscopy revealed diffuse edematous changes of the mucosa of the gastric corpus. A diagnosis of acute phlegmonous gastritis was made, and Tazobactam/Piperacillin administration was immediately initiated, after which her symptoms rapidly improved. Phlegmonous gastritis after gastric ESD is a rare but serious incidental condition that requires early diagnosis by diagnostic imaging and appropriate administration of sufficient doses of antibiotics.

A woman in her 78s was diagnosed with ileus and was transferred to our hospital because conservative therapy failed to improve the ileus. Small bowel enteroclysis showed a circumferential stricture in the proximal jejunum. We performed double balloon enteroscopy, which showed a circumferential ulcer and a stricture in the jejunum. A biopsy obtained from the jejunal ulcer did not reveal any specific histopathological findings. Based on her medical history, she was diagnosed with aspirin-induced ulcer, and endoscopic balloon dilation (EBD) was performed four times in this patient. Her abdominal symptoms improved after EBD, and she was discharged. However, two months after discharge, she was re-admitted to our hospital with ileus. She underwent surgery, and intraoperatively we observed a stenotic site that was fixed to the retroperitoneum by a band-like material. This band was detached, and partial jejunal resection was performed. We report a patient with a secondary ulcer and a stricture in the small bowel due to an intraperitoneal band without a history of abdominal surgery.

The patient was a 75-year-old man with melena. Capsule endoscopy revealed colonic diverticular bleeding as well as 2- to 3-mm erosions scattered in the small intestine. The colonic diverticular bleeding was treated by endoscopic clipping. Two months later, administration of celecoxib was started for knee pain. Nine months later, black stools and iron-deficiency anemia were observed, and multiple ulcers were found in the intestine on capsule endoscopy. The patient was diagnosed as having nonsteroidal anti-inflammatory drug-induced small intestinal ulcer. The celecoxib therapy was discontinued, and administration of misoprostol, rebamipide, and polaprezinc was started. Capsule endoscopy performed three months after starting the treatment demonstrated improvement of the ulcers. Celecoxib is a cyclooxygenase-2 (COX-2) selective inhibitor and is considered to confer a low risk of mucosal injury, but the risk of mucosal injury may increase with chronic administration of celecoxib or combination therapy with a proton pump inhibitor. Therefore, careful attention should be paid to patients who are being treated with celecoxib.

The patient was a 73-year-old man with positive_fecal occult blood test. Colonoscopy revealed a lesion in the transverse colon. Histopathological analysis of a biopsy specimen indicated that the lesion was a moderately differentiated tubular adenocarcinoma, and was thus a candidate for surgical colectomy. When the preoperation endoscopy was performed on the 80th day after the first endoscopic examination, the lesion in the transverse colon had become a scar. Laparoscopic-assisted right hemicolectomy was performed. However, pathological examination of the surgical specimen revealed no neoplastic cells. Thus, it was believed that spontaneous regression of the malignant tumor had occurred.

Recently endoscopic placement of self-expandable metal stents (SEMS) has emerged as a safe and effective method of biliary drainage before surgery in pancreatic cancer patients. The current standard of care is to offer neoadjuvant therapy to patients with locally advanced pancreatic cancer. To achieve safe neoadjuvant treatment prior to surgery, pancreatic cancer patients with obstructive jaundice require biliary decompression. In general, fully covered SEMS (FCSEMS) were introduced to overcome tumor ingrowth, which is the main cause of stent dysfunction when using uncovered SEMS. FCSEMS have higher migration rates than uncovered SEMS but are easy to remove.

We here describe tips and the technique of FCSEMS placement for biliary drainage before surgery in pancreatic cancer patients.

The advent of electronic medical records brought image filing systems to many hospitals, as well as electronic endoscopic medical records. However, data integration among multiple different vendors has not yet been accomplished. We start the Japan Endoscopic Database (JED) Project endorsed by Japan Gastroenterological Endoscopy Society (JGES) from January 2015. The purposes of this project are as follows: (i) developing the worldʼs largest endoscopic database generated from daily use of the reporting system; (ii) capturing the actual performance of endoscopic practice in Japan; and (iii) standardizing the terminology and fundamental items for registry of clinical studies. Moreover, the JED project has the potential to automatically collect data about adverse events, competency and evaluation of residents, and actual numbers of procedures on a nationwide scale, certification for the specialty board system, and so on. We believe that this design paper will be helpful not only for future nationwide research but also for international research (UMIN000016093).