According to the guidelines established by the Japanese Gastric Cancer Association and Japan Gastroenterological Endoscopy Society, radical surgery is recommended for all patients who underwent non-curative endoscopic submucosal dissection (ESD)/endoscopic mucosal resection (EMR) for early gastric cancer (EGC) because of the potential risk of lymph node metastasis (LNM). However, 29-70％ of patients who underwent non-curative ESD/EMR have been followed up with no additional treatment. In addition, the rate of LNM among patients who underwent radical surgery after non-curative ESD/EMR is 4-11％. The strongest independent risk factor for LNM in patients who underwent non-curative ESD is lymphatic invasion, and there are other independent risk factors such as venous invasion as well. We previously reported a simple scoring system for predicting LNM in patients who underwent non-curative ESD, which may provide useful information in clinical practice. Meanwhile, patients with gastric cancer have become older. Thus, the establishment of a prognostic model for predicting overall survival including cancer-related mortality in elderly patients who underwent non-curative ESD/EMR is required.

Endoscopic gallbladder drainage includes transpapillary and transmural drainage. Although endoscopic transpapillary gallbladder drainage (ETGBD) has a relatively low success rate owing to the difficulty of passage through the cystic duct, it is an established method as an alternative to percutaneous transhepatic gallbladder drainage (PTGBD). Moreover, ETGBD is believed to prevent the recurrence of cholecystitis. A greater number of clinical studies have been conducted in patients who underwent endoscopic ultrasound-guided transmural gallbladder drainage (EUS-GBD) than in those who underwent ETGBD, since a brand-new method of EUS-GBD was introduced in 2007. The technical and clinical success rates of EUS-GBD are excellent ; furthermore, stone removal via the fistula with cholecystoscopy can be performed. EUS-GBD is potentially the first-line drainage method in patients with acute cholecystitis who are not eligible for surgery. In this review, the indications for endoscopic gallbladder drainage, methods of endoscopic gallbladder drainage, short-term and long-term outcomes, adverse events, and comparison with PTGBD are discussed based on the latest evidences.

We report the endoscopic findings of a case of esophageal intramural pseudodiverticulosis (EIPD), which was diagnosed using magnifying endoscopy assisted by narrow band imaging (NBI). The patient was a 75-year-old male whose chief complaint was dysphagia combined with weight loss. On upper endoscopy, the lower esophagus was stenotic, and orifices of an EIPD were detected on the oral side of the stricture. On NBI-assisted magnifying endoscopy, the orifices of the EIPD were seen as minute, brownish spots on the mucosa. Each of the spots was surrounded by intraepithelial papillary capillary loops with an eyelash-like appearance. The orifices were difficult to recognize during ordinary endoscopic examination. Magnifying endoscopy is useful for diagnosing EIPD, as it reveals characteristic findings of the condition.

A 62-year-old man with tarry stools was admitted to our hospital under the condition of loss of consciousness. We did not detect any bleeding source on upper gastrointestinal endoscopy ; therefore, we observed the duodenum to the jejunum near the ligament of Treitz using a colonoscope. We found a submucosal tumor with active bleeding at the jejunum near the ligament of Treitz, and successfully performed endoscopic hemostasis by using endoscopic clips. The tumor was later resected surgically and was diagnosed as a gastrointestinal stromal tumor (GIST). There are few reports of endoscopic hemostasis of small intestinal GISTs. We review the approach to endoscopic hemostasis of small intestinal GISTs.

A 79-year-old female was undergoing medical treatment for hypertension and hyperlipidemia at a doctor’s office. Because of deterioration of her general condition, she was brought to our hospital by ambulance. After careful examination, she was diagnosed with diabetic ketoacidosis and was immediately hospitalized. During the course of her treatment, she began to suffer from abdominal bloating. Abdominal computed tomography (CT) revealed colon dilation. Lower digestive tract endoscopy revealed various ulcerative lesions throughout the patient’s colon. Mucosal biopsy was subsequently performed, and the patient was diagnosed with intestinal cytomegalovirus infection. She was treated with ganciclovir, and her symptoms promptly improved. Following ganciclovir treatment, symptoms of constipation began to appear. Endoscopic examination of the lower gastrointestinal tract revealed colonic stenosis and it was impossible to pass the endoscope through the sigmoid colon. Endoscopic balloon dilatation was performed to treat the stenosis. Postprocedure recovery was good, and no signs of recurrence of colonic stenosis have been noted to date. As a result, surgery was not necessary in this case.

A 65-year-old man was scheduled for colonoscopy because fecal occult blood examination was positive.

When the colonoscope was inserted through the sigmoid colon, it suddenly became stuck and could not be inserted past this point.

A barium enema performed after colonoscopy showed that the sigmoid colon was involved in a left inguinal hernia. After the operation (tension-free hernioplasty), total colonoscopy was easily performed over a duration of about 5 minutes. Inguinal hernia frequently occurs in elderly people and is reported as a complication of colonoscopy. Before performing colonoscopy, it is important to perform a medical examination and interview the patient carefully about previous medical history.

Cholangioscopy can provide endoscopic direct visualization of the biliary system. At present, there are two types of cholangioscopes. One is the mother-baby system and the other is the direct cholangioscope. The mother-baby system requires the presence of two experienced endoscopists because baby cholangioscopes have been shown to be fragile. Recently, single-operator cholangioscopy (SOC) was introduced as the SpyGlass system. Direct cholangioscopy is also a form of single-operator cholangioscopy; however, it requires only one endoscope such as a conventional ultraslim endoscope. Compared with the mother-baby system, the advantages of direct cholangioscopy are the high-resolution images and large-diameter working channel. On the other hand, a disadvantage is the difficulty in inserting the ultraslim scope into the biliary system. For diagnostic purposes, cholangioscopy can be performed for differential diagnosis of benign and malignant lesions, diagnosis of tumor extension, and target biopsy from bile duct mucosa. The main therapeutic indication of cholangioscopy is the treatment of difficult stones. Findings that suggest malignancy are irregular, dilated and tortuous vessels, irregular papillogranular surface, and a nodular, elevated, surface-like submucosal tumor. In contrast, a fine network of thin vessels, flat surface without definite neovascularization, slightly homogeneous papillogranular surface and scale-like appearance without a primary mass are findings that suggest a benign condition.

Background and Aim : Colon capsule endoscopy (CCE) is a safe and effective method for detecting lesions in the colon. However, the sensitivity of CCE in detecting advanced colorectal cancer (CRC) has not been sufficiently evaluated. Therefore, the aim of the present study was to assess the sensitivity of CCE in detecting advanced CRC.

Methods : Patients previously diagnosed with advanced CRC by conventional colonoscopy underwent CCE. Primary outcome measure was the sensitivity of CCE in detecting advanced CRC per patient and per lesion. Secondary parameters measured were the sensitivity of CCE in detecting polyps ≥6 mm and ≥10 mm in size in a per-lesion analysis and the safety of CCE.

Results : Of the 21 advanced CRC lesions in 20 patients, 17 were detected by CCE. The per-patient and per-lesion sensitivities of CCE for detecting advanced CRC lesions were 85％ (95％ confidence interval [CI] : 62-97％) and 81％ (95％ CI : 58-95％), respectively. All advanced CRC lesions were diagnosed in the accessible region by CCE while the capsule was still functional. A significant association was found between incomplete CCE and failure to diagnose advanced CRC. No severe adverse events occurred.

Conclusion : The diagnostic capability of CCE in detecting advanced CRC was limited in cases of procedure incompletion. Refining procedures to increase CCE procedure completion rates are required to enhance CRC detection.