Recently, the ingenuity of endoscope manufacturers has resulted in high-definition ultra-thin transnasal endoscopes. Images equivalent to those obtained with standard-diameter endoscopes can now be obtained. Additionally, various combined enhanced observations are possible. It could be beneficial for gastric cancer screening in an aging society because it causes less pain during examination, has high patient satisfaction, and has a lesser impact on cardiopulmonary function than the standard endoscopes do. Post-Helicobacter pylori eradication gastric cancer accounts for the majority of cases of gastric cancer and are difficult to diagnose endoscopically due to the endoscopic features. Patients with long-term post-eradication gastric cancer have an increased risk of developing undifferentiated gastric cancer. Endoscopic findings associated with gastric cancer risk include a change from mucosal atrophy to intestinal metaplasia. We hope that ultra-thin transnasal endoscopy will contribute to screening for gastric cancer.

With the advancements in EUS and other techniques, surgeons are seeking accurate dissection lines when locating and resecting small pancreatic lesions. EUS-guided tattooing has been used to mark the surface of the pancreas, similar to that of the gastrointestinal tract, to determine the dissection line and provide a marker for the intraoperative ultrasound. Although reports on EUS-guided tattooing are limited and the methods used are varied, we have summarized the drugs, puncture needles, techniques, complications, the effectiveness of the technique, and the issues currently encountered.

In a 75-year-old male, EGD revealed a 2-cm, white, flattened, elevated lesion without iodine staining in the mid-thoracic esophagus. Although histopathological examination of the biopsy tissue revealed papilloma, superficial esophageal cancer could not be completely ruled out. ESD was performed as a diagnostic treatment. Pathological examination of the resected specimen revealed squamous cell carcinoma with a depth of pT1a-EP, which was consistent with verrucous carcinoma. Four years after the ESD, the patient is still being followed up without recurrence.

A 78-year-old man underwent a routine upper gastrointestinal endoscopy, which revealed a depressed lesion of 15mm at the lesser curvature of the gastric antrum. Histopathological diagnosis of the biopsy specimen revealed a well-differentiated adenocarcinoma. No obvious metastasis was detected. An ESD was performed. Histopathological examination of the ESD-acquired specimen revealed an intramucosal lesion with negative surgical margins and no lymphovascular invasion, indicating complete endoscopic resection. The lesion consisted of cells with clear cytoplasm, and immunostaining revealed positivity for AFP, glypican-3, and SALL4. Therefore, the patient was diagnosed with AFP-producing gastric cancer. Herein, we have reported a rare case of AFP-producing early gastric cancer that was completely resected endoscopically.

We aimed to perform ERCP using single-balloon endoscopy (SBE-ERCP) in a 78-year-old man with acute obstructive suppurative cholangitis due to common bile duct stones. He had already undergone Roux-en-Y reconstruction for gastric cancer. The bile duct cannulation was technically challenging due to a duodenal diverticulum whose papilla was located on the anal side. Thus, we used the Multi-loop traction device^TM (MLTD), which is used for endoscopic submucosal dissection, during the SBE-ERCP. An endoscopic clip was deployed with the MLTD to the duodenal mucosa on the anal side of the diverticulum. The endoscopic clip was hooked in the MLTD and pulled toward the anal side. Subsequently, the clip was attached to the ipsilateral duodenal mucosa. Finally, the papilla position was corrected to allow bile duct cannulation and plastic stent placement. The present study demonstrates the utility of MLTD for bile duct cannulation in patients with parapapillary diverticula after gastrointestinal tract reconstruction.

An 80-year-old woman presented to the hospital with acute abdominal pain. On examination, she had mild tenderness in the lower abdomen, but no signs of peritoneal irritation. Based on an abdominal CT and her medical history, she was diagnosed with small intestinal perforation by a fish bone. The fish bone had already been fallen out from the perforation site, causing minimal abdominal findings and a mild inflammatory response. Therefore, nonsurgical treatment was provided. Her symptoms and inflammatory response had improved by the ninth day of hospitalization. Abdominal CT revealed that the fish bone was residual in the ascending colon. Because it could have caused damage such as colonic perforation again, it was removed via CS. The patient's postoperative course was uneventful, and she was discharged on the 17th day of hospitalization. The strategy of treatment for residual the intestinal fish bone was discussed and reported based on previous reports similar to the present case.

The endoscopic pressure study integrated system (EPSIS) can be used to endoscopically evaluate lower esophageal sphincter (LES) function. As such, it is also an adjunct diagnostic method to 24-hour pH monitoring. Since air is continuously pumped into the stomach; it functions as a stress test of the potential of the LES. We believe that EPSIS may be a useful modality in the new field of “functional endoscopy”.

Esophageal and gastric varices occur in association with various background diseases that cause portal hypertension, such as liver cirrhosis and idiopathic portal hypertension. Treatment of esophageal and gastric varices may affect the pathophysiology of the background disease. Therefore, the treatment should be based on a thorough understanding of the pathophysiology and hemodynamics of the patientʼs background disease. In this article, we describe diagnostic methods for understanding the hemodynamics of esophageal and gastric varices, as well as appropriate endoscopic treatment methods that take these hemodynamics into account.

Screening endoscopy improves detection and prognosis of patients with gastric cancer. However, even expert endoscopists can miss early gastric cancer under standard white light imaging. Texture and color enhancement imaging (TXI) is an image-enhanced endoscopy that enhances brightness, surface irregularities such elevation or depression, and subtle color changes. A few image-oriented studies have compared the gastric color differences between neoplastic and peripheral areas under both white light imaging and TXI. The results not only suggested that the overall color differences to be more pronounced in TXI, but also that TXI mode 1 was superior to white light imaging in the visibility of early gastric cancer. Despite the promising results in these initial studies, it is unclear whether the superiority of the image-enhanced endoscopy will translate into an improvement in early gastric cancer detection in real practice. Therefore, large-scale prospective studies are necessary to investigate the efficacy of this new technology in the evaluation of patients undergoing screening endoscopy.