Perioperative management has been conducted through an interdisciplinary approach by various staff members, originally in the operating room. Meanwhile, an interdisciplinary approach for endoscopy is needed as endoscopic procedures increase in complexity and procedure times lengthen with the advancement in technology. In this review, we discuss a history of perioperative management, recommendations by the World Health Organization, essentials of the handbook for standardization of periprocedural management for gastrointestinal endoscopy, and the benefits of standardization of periprocedural management and its supporting tools. Furthermore, we propose the goals of gastrointestinal endoscopy procedures and periprocedural management and describe a future perspective from the point of view of anesthesiologists.

Gastric subepithelial tumors (SET) represent one of the most frequently encountered lesions during routine endoscopy. Although EUS is essential for diagnosis of SET, EUS alone cannot accurately diagnose mesenchymal tumors. Histopathological evaluation and immunohistochemical analysis are essential to conclusively diagnose SET; therefore, various tissue collection techniques such as a boring biopsy, endoscopic ultrasound-guided fine needle aspiration/biopsy (EUS-FNA/B), and mucosal incision-assisted biopsy (MIAB) are used in clinical practice. In this article, we present an overview of EUS-FNA/B and MIAB for gastric SET, focused on the findings of current clinical research in this field.

This study reports the case of a female in her forties who had a history of successful Helicobacter pylori eradication. She had undergone an EGD procedure as part of an annual medical check-up. The results revealed a small, slightly reddish elevated lesion along with erosion in the posterior wall of the antrum. A biopsy sample revealed dense expansion caused by a signet-ring cell carcinoma in the proper mucosal layer of the erosion site as well as the surrounding area of elevation. The protrusion was considered to be caused by dense growth of the carcinoma, though the form of the lesion changed from flat to slightly depressed before ESD was performed. The possibility of a protruding type of mucosal signet-ring cell carcinoma should be considered in the stomach of patients post eradication.

A 63-year-old man was admitted to our hospital with sore throat and fever. He was diagnosed with Coronavirus Disease 2019(COVID-19), and on the 3rd day after diagnosis, he started on ventilatory management. On the 25th day, the patient presented with over 3 L of watery diarrhea, which continued daily. When the diarrhea did not improve with various treatments, on the 98th day, a double-balloon endoscopy of the small intestine was performed, and diffuse loss of villi structure in the jejunum was noted. Due to massive pleural effusion, the patient succumbed to circulatory and respiratory failure 111 days after admission to the hospital. The pathological autopsy revealed that the mucosal epithelium had been exfoliated from the entire small intestine. As this case shows, some COVID-19 cases are associated with severe diarrhea; further investigation is needed to elucidate the pathogenesis of COVID-19-associated diarrhea.

A 72-year-old man with a history of lumbar spinal canal stenosis underwent preoperative chest and abdominal computed tomography, which revealed mediastinal and presacral tumors containing a rich fatty component. We suspected a soft-tissue malignancy such as liposarcoma and performed a transrectal endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) for evaluation of the presacral tumor. Histopathological evaluation of the biopsy specimen confirmed diagnosis of myelolipoma, and we decided to follow up him without surgery. Although a biopsy is necessary for selection of an optimal treatment strategy, transrectal EUS-FNB of soft-tissue tumors is associated with the risk of complications such as bleeding and infection and dissemination including needle tract seeding. We report a rare case of a presacral myelolipoma diagnosed using transrectal EUS-FNB, without any complications.

A 79-year-old woman was referred to our hospital in October 2018 for follow-up of colonoscopy (CS) performed 2 years prior to presentation. We performed CS 6 days after the initial consultation and incidentally identified a press-through package (PTP) in the descending colon. The PTP was successfully removed using a retrieval net. Based on a literature search of the Igaku Chuo Zasshi (ICHUSHI) database, this is the fifth case of a PTP found in the colon and removed endoscopically. Accidentally ingested PTPs are occasionally detected and removed from the upper gastrointestinal tract endoscopically. Limited data are available regarding the prevalence of PTPs that pass beyond the pylorus and cause perforation or are spontaneously excreted. Treatment guidelines are unavailable for such complications. We report a rare case of an incidentally detected PTP that was successfully removed endoscopically from the descending colon, together with a literature review.

A 78-year-old woman was admitted to our hospital with high fever. Computed tomography showed a liver abscess. She received treatment with antibiotics. We could not find the cause of liver abscess. Six months later, liver abscess had recurred, and she was treated with percutaneous abscess drainage along with antibiotic therapy. The cause of recurrent liver abscess was suspected a foreign body which existed in the intestinal tract for six months. CS revealed that the foreign body was a toothpick penetrating the sigmoid colon, which was removed endoscopically. The patient was discharged from the hospital 1 month after removal of the foreign body. No recurrence of the liver abscess was observed 6 months after discharge. Identification and removal of the foreign body, which was the cause of the liver abscess, prevented recurrence of the liver abscess. Although surgical treatment may be required to remove the foreign body, endoscopic removal was possible in this case.

Small bowel capsule endoscopes have been developed as a first-line tool for exploring the entire small bowel. The patency capsule is a tag-less capsule used to evaluate gastrointestinal patency prior to small bowel capsule endoscopy. Colon capsule endoscopy has been shown to be an alternative to conventional colonoscopy as well as CT colonography in cases in which a previous colonoscopy was incomplete, or for patients who are unsuitable to undergo colonoscopy. However, ingestion of these capsules is sometimes difficult for young children and even adults with dysphagia because of foreign bodies measuring as large as 11 × 26-31 mm. Even if ingested, they can lodge in the esophagus or stomach for long durations. In such cases, endoscopic capsule placement is available using the AdvanCE^Ⓡ delivery device, polypectomy snares, nets, etc. Endoscopic deployment of capsule endoscopes has been reimbursed for patients younger than 15 years of age in Japan since April 2022.

Here, we demonstrate the devices, technical procedures, and indications of endoscopic deployment of capsule endoscopes based on the findings of the AdvanCE-J study (Safety and Efficacy of the Endoscopic Delivery of Capsule Endoscopes in Adult and Pediatric Patients: A Multicenter Japanese Study).

In recent years, ERCP has evolved into treatment as well as diagnosis, but the use of guide wires is essential for the success of the procedure. The guide wire has three functions: seeking (of the target site), leading (each device to the target site), and landmark (the pancreatic bile duct under fluoroscopy). Consequently the procedure efficiency and goal achievement rate increase, and accidents reduce. Recently, a wide variety of guide wires have been placed on the market due to the increase and complexity of treatment procedures, but the endoscopist undertakes sufficient measures and countermeasures against accidents regarding the shape of each guide wire, compatibility with the treatment tool, and operability. In this article, we will explain the basics and tips of guidewire operation in ERCP-related procedures, as well as troubleshooting, based on case presentations.

The revised 2014 Japanese Guidelines for Gastric Cancer Screening approved gastric endoscopy for use in population-based screening. Thus, it is expected that gastric cancer will be detected earlier, and gastric cancer mortality further decreased, with the widespread use of endoscopy and Helicobacter pylori eradication therapy. However, due to an increasingly aging population and relatively low gastric cancer screening rates, gastric cancer remains the leading cause of cancer death in Japan. While the era of endoscopic gastric cancer screening has begun, it does present challenges, such as limited/varying regional availability of endoscopists. This review describes the history of gastric cancer screening in Japan, achievements in endoscopic gastric cancer screening in Japan and Korea, efforts underway to improve screening by stratifying individuals according to gastric cancer risk, and initiatives by the Japan Gastroenterological Endoscopy Society aimed at improving screening, including the implementation of a board certification program for screening endoscopists.

The proportion of female doctors among the members of the Japan Gastroenterological Endoscopy Society (JGES) is increasing every year. Female endoscopists require a variety of supports to advance their careers while giving birth and raising their children.

A questionnaire survey among female endoscopists was conducted in order to clarify what kind of support is needed. Responses were received from 1,494 individuals, accounting for 28% of all female members of the JGES, and the answers were analyzed.

The most common obstacles to career development were “giving birth and child-rearing” and “oneʼs physical condition and stamina.” In terms of career support, the most common answers were “introduction of a team system instead of a solo attending physician system,” “securing substitute staff for emergencies,” and “improvement in childcare when her child is sick.”

As for initiatives that should be undertaken by the JGES, respondents indicated that it would be beneficial to hold educational lectures and conferences online, as well as increase the number of career support training facilities and provide information about such facilities.

To provide high-quality endoscopic examination and treatment for patients in the future, career support for female endoscopists is an essential task, and the entire JGES must work on this as a project toward ensuring a gender-equal society.