The most common reason for surgical treatment of Crohnʼs disease is small bowel stricture. Some evidence revealed the efficacy of immunomodulators and biologics in patients with inflammatory strictures but not in patients with fibrotic strictures. Endoscopic balloon dilatation (EBD) using balloon-assisted enteroscopy is recommended for the treatment of small bowel strictures to avoid intestinal resection, because of its safe, effective and minimally invasive nature. Once resected, the function of the intestinal tract cannot be recovered. The disadvantages of EBD include the need for repeated dilatations to avoid surgery. Although stricturotomy using a needle knife and stent placement instead of balloon dilatation have been introduced, these alternative methods are still challenging. Several novel drugs targeting fibrosis have been developed, and the clinical application of these drugs is awaited.

A 75-year-old man underwent screening upper gastrointestinal endoscopy, which detected a submucosal tumor measuring 2 cm in the angulus on the lesser curvature side. His condition was monitored by periodic endoscopy, but the tumor showed a growth tendency in the sixth year of monitoring. In the seventh year, mucosal cutting biopsy led to the diagnosis of solid-type poorly differentiated adenocarcinoma. Epstein-Barr virus (EBV) was detected and the preoperative diagnosis was gastric carcinoma with lymphoid stroma (GCLS). Based on these findings, we performed total gastrectomy. This case is considered to be valuable in that it allowed us to follow the natural course of GCLS, and we therefore report our experience.

We present two patients with Crohn’s disease. The first patient was a 38-year-old woman with a history of gastric ulcers who tested negative for Helicobacter pylori IgG and who was referred to our hospital for further examinations. Upper gastrointestinal endoscopy revealed multiple scars with small granular mucosae in the gastric body and fornix, and pathological examination of biopsied specimens from the multiple scars revealed the presence of granulomas. Total colonoscopy revealed aphthous ulcerations, and biopsied specimens from the aphthous ulcerations revealed noncaseating epithelioid cell granulomas. The patient was diagnosed with Crohn’s disease. The second patient was a 30-year-old man with a history of duodenal ulcers who visited our hospital with complaints of epigastralgia. He previously underwent successful treatment for H. pylori eradication, and he tested negative for H. pylori IgG. Upper endoscopy revealed an ulcer in the duodenum and multiple erosions in the gastric antrum. Because of his past history of anal fistula, we suspected Crohn’s disease. Colonoscopy revealed erosions in the terminal ileum, ulcers on Bauhin’s valve, and aphthous ulcerations in the sigmoid colon. Noncaseating epithelioid cell granulomas were detected in each biopsied specimen, and the patient was diagnosed with Crohn’s disease.

Crohn’s disease should be considered when peptic ulcers are refractory to treatment, H. pylori infection is negative, and when there is no history of using nonsteroidal anti-inflammatory drugs.

A 37-year-old man with sigmoid colon cancer underwent sigmoidectomy. Colonoscopy revealed a submucosal tumor at the anal side of the anastomosis. When we cut the surface of the tumor open, fluid with sticky contents was observed and removed. A specimen was obtained from the inner surface of the tumor. Pathologic examination did not reveal any atypical cells. Therefore, we diagnosed this case as implantation cyst.

The Helicobacter pylori (H. pylori) infection status is related to the risk for gastric diseases. Endoscopists should carefully observe the gastric areas where high-risk disease is more likely to occur according to the H. pylori infection status. The method of diagnosis of H. pylori infection by endoscopy is to evaluate characteristic features of gastric mucosal change related to H. pylori infection according to the Kyoto classification of endoscopic gastritis. RAC (regular arrangement of collecting venules) is characteristic of patients who are not infected with H. pylori. Diffuse redness of the gastric mucosa and the degree of endoscopic atrophy are useful markers for detecting patients with H. pylori infection. The presence of map-like redness is useful for detecting patients with previous H. pylori infection. However, some patients who are receiving a PPI (proton pump inhibitor) have faint RAC because of thickened gastric mucosa and may be mistakenly diagnosed with H. pylori infection. Some patients with H. pylori infection or previous H. pylori infection have visible collecting venules in the corpus and the diagnosis of present or past H. pylori infection may be missed. In some other patients, it is difficult to diagnose diffuse redness of the gastric mucosa. Therefore, multi-point analysis of gastric mucosal change should be used for endoscopic diagnosis of H. pylori infection. However, endoscopists should take a balance of observation for H. pylori infection status and for other diseases to avoid overlooking clinically more important diseases including malignancies.

The incidence of Barrettʼs esophagus (BE)-related neoplasia in Western countries has increased in the past several decades and, even in Eastern countries, it appears to be increasing. Endoscopic therapies are the first-line treatment for BE-related neoplasia; however, there is still no standardized treatment strategy. Most of the data have been published from Western countries where the ultimate goal of treatment is complete eradication of BE mucosa removing subtle synchronous lesions and preventing metachronous neoplasia. A multimodality approach that combines endoscopic resection and radiofrequency ablation (RFA) has been widely accepted in the West. In contrast, the lack of access to RFA treatment in the East has meant that endoscopic resection is the only feasible option. There is a wide divergence in treatment strategies for BE-related neoplasia between the East and the West. It is very important to consider these basic differences in the context of the currently available evidence to date. Therefore, the purpose of this article is to review the recent literature and to provide an overview of the endoscopic treatment options for BE.