The main purpose of surveillance colonoscopy is reduction of morbidity and mortality from colorectal cancers. An appropriate surveillance program should be created with due regard to not only effectiveness towards morbidity and mortality but also burden, cost and capacity. Too many surveillance colonoscopies have been conducted in Japan compared with Western countries until now. Novel guidelines for the surveillance program based on risk stratification have been developed in Japan. The new guidelines are expected to be widely followed in colonoscopy practice.

The recent progress in the treatment of bile duct stones has been remarkable, and various devices and new endoscopic procedures have been developed. Although cases with large stones or impacted stones were difficult to treat by endoscopic retrograde cholangiopancreatography (ERCP)-associated procedures in the past, now endoscopic papillary large balloon dilation (EPLBD) and peroral cholangioscopic lithotripsy (POCSL) allow for easier and more assured treatment compared with a conventional transpapillary procedure. Furthermore, cases with surgically-altered anatomy or hepatolithiasis, which generally required invasive percutaneous or surgical procedures in the past, are now successfully treated with the advent of new procedures such as balloon enteroscopy-assisted ERCP (BE-ERCP) and endoscopic ultrasound-guided antegrade treatment (EUS-AG). To treat bile duct stones safely and efficiently, it is necessary to understand each procedureʼs features and select the most appropriate procedure amongst various options according to each facilityʼs resources, the patientʼs general condition, and condition of the stone (s), and then the procedure should be performed carefully and flexibly.

A 41-year-old female underwent upper gastrointestinal endoscopic examination as part of an annual medical check-up, which revealed whitish exudates in the lower esophagus. Biopsy samples subsequently obtained from the esophageal mucosa showed 78 eosinophils per high power field. The patient was diagnosed with eosinophilic esophagitis (EoE). Sublingual immunotherapy (SLIT) with cedar pollen extract for allergic rhinitis had been initiated 15 days prior to the endoscopic examination and she routinely swallowed the liquid medicine after intake. Following the diagnosis of EoE, the patient continued the sublingual intake, although she spit the liquid medicine out afterwards. Endoscopy was again performed three months later, which showed disappearance of the whitish exudates, and the histological findings were also improved. After 18 months, endoscopy and histological findings showed that EoE had completely disappeared, even though the patient had continued SLIT. She also reported that the symptoms of allergic rhinitis were improving.

A 37-year-old man underwent thymectomy for myasthenia gravis and subsequently received oral medication. Screening upper gastrointestinal endoscopy revealed a 20mm fading concave lesion on the posterior wall of the greater curvature of the stomach. He was diagnosed with signet-ring cell carcinoma based on histopathological examination of a biopsy specimen and was referred to our hospital for further management. Preoperative evaluation led to a diagnosis of early gastric cancer and he was scheduled for endoscopic submucosal dissection (ESD). Benzodiazepines are contraindicated for sedation in patients with myasthenia gravis, and a drug that does not cause muscle relaxation should be administered. Therefore, in this patient, we performed successful ESD using a combination of dexmedetomidine, pentazocine, and hydroxyzine for sedation. Dexmedetomidine is useful for limited sedation that is required during endoscopic procedures in patients with myasthenia gravis.

A 75-year-old man developed incarcerated inguinal hernia of the sigmoid colon while he was admitted for transient cerebral ischemic attack. Decompression of the hernia sac using colonoscopy led to notable shrinkage of the hernia sac and manual reduction was successfully achieved. He could undergo elective surgery for hernia repair, avoiding emergency surgery. Incarcerated inguinal hernia is an indication for urgent surgery, but various comorbidities pose a serious risk especially among elderly patients. This procedure made it possible to have an elective surgical option avoiding emergency surgery, and has rarely been reported thus far. We present this case with a review of the literature.

A 60-year-old man was admitted to our hospital with an elevated serum level of prostate-specific antigen detected on medical checkup. Magnetic resonance imaging revealed no abnormality of the prostate; however, a mass was identified in the left pelvis. Despite various examinations, the nature of the mass could not be determined; therefore, he underwent transcolonic endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) using a forward-viewing echoendoscope. Histological examination of the aspirated specimen revealed adenocarcinoma, with histological characteristics resembling those of prostate cancer. He subsequently underwent prostate biopsy, which revealed histologic features similar to those of the pelvic mass. Finally, he was diagnosed with prostate cancer with lymph node metastasis. We report a case in which transcolonic EUS-FNA using a forward-viewing echoendoscope was performed for less invasive diagnosis of a pelvic mass.

Direct visualization and sufficient counter-traction of the site to be dissected are essential for safe and efficient endoscopic submucosal dissection (ESD). Recently, several traction methods have been reported. We developed a novel hood that stores two elastic threads in its side pockets, named the Dual Traction Hood, to achieve more efficient traction during submucosal dissection by virtue of double tractions. We report three consecutive cases of deep colonic adenocarcinoma/adenoma treated using the present novel hood that stores dual elastic threads. After circumferential incision and submucosal dissection of the anal edge, the first thread was grasped and fixed to the anal edge by the first endoclip, and another ring of the thread was grasped and fixed to the opposite colonic wall by the second endoclip. The second traction was performed using the second thread in the same manner. By the above procedures, the present hood facilitated successful dual-traction and one-piece resection in all three cases. There were no adverse events during or after the procedures. We report the techniques for ESD using the present hood in conjunction with different endoknives and endoclips.

Recently, the opportunity of detecting superficial pharyngeal carcinoma has increased due to advances in endoscopic technology, and the endoscopic treatment of superficial pharyngeal carcinomas has recently come in the spotlight. Endoscopic laryngo-pharyngeal surgery (ELPS) is a minimally invasive surgery for superficial pharyngeal carcinoma that is performed by both endoscopists and an otolaryngologist. ELPS can be very quickly and safely performed for superficial pharyngeal carcinoma, and the treatment plan for a lesion can be decided based on the opinions of both the endoscopists and otolaryngologist in a good visual field, and ELPS can be very quickly and safely performed for superficial pharyngeal carcinoma. ELPS is thought to be an effective treatment for remnant pharyngeal carcinomas that could not be completely cured by chemoradiotherapy, and is expected to become one of the treatment methods for local recurrent pharyngeal carcinoma.

Zenker’s diverticulum (ZD) is a relatively rare disorder, but it may clinically manifest with symptoms such as dysphagia, regurgitation, and its associated complications. Open surgery and rigid endoscopic diverticulotomy have been performed for the treatment of ZD in the past. However, in recent years, flexible endoscopic septum division (FESD) has been performed and was positioned as the first-line treatment for ZD in the 2020 European Society of Gastrointestinal Endoscopy guidelines. FESD was approved as an advanced medical treatment in Japan in July 2020 and is expected to be covered by the Japanese health insurance system as a standard treatment for ZD. In this manuscript, we describe the technique and treatment schedule of FESD and follow-up of patients who have undergone FESD in detail.