Although functional dyspepsia is highly prevalent and is often seen in outpatient clinic, the pathophysiology of the disease remains unknown due to the presence of multiple factors. Traditionally, research has focused on the gastric mucosa and gastric function because of the presence of symptoms such as “postprandial fullness” and “epigastralgia”. However, recent research into the core pathophysiology of functional dyspepsia has focused on the duodenum. The major pathophysiology observed in functional dyspepsia is that low-grade inflammation associated with eosinophil and mast cell infiltration causes mucosal barrier dysfunction, and various foreign substances stimulate the afferent nerves and gastrointestinal hormones, leading to impaired gastric adaptive relaxation and gastric motility.

Patients with biliopancreatic disease tend to have a high prevalence of sarcopenia. Sarcopenia has been reported to be a poor prognostic factor in patients with acute and chronic pancreatitis and biliary tract and pancreatic cancer. Moreover, sarcopenia has been reported as a risk factor for biliary stent obstruction in malignant biliary obstructions and a predictor of treatment efficacy after endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) as pain relief treatment and after EUS-guided drainage and endoscopic necrosectomy for walled-off necrosis (WON). Evaluating sarcopenia before biliopancreatic disease treatment and endoscopy is important, as it is then possible to predict the treatment efficacy and suggest appropriate nutritional and exercise therapy.

A 72-year-old woman who underwent right breast-conserving surgery for breast cancer presented for evaluation of a stomach tumor, which was detected during a routine -CT examination for breast cancer recurrence. Contrast-enhanced CT revealed a gastric antral submucosal tumor (SMT), showing strong and prolonged enhancements during the portal venous and delayed phases, respectively, and an SMT in the upper gastric body, showing delayed enhancement and accompanied by non-contrast areas. On EUS, the antral SMT appeared as a well-circumscribed, oval, hyperechoic mass originating from the muscularis propria, whereas the upper gastric body SMT appeared as an oval, heterogeneous, hypo-echoic mass with a-echoic areas originating from the muscularis propria. EUS-guided fine needle biopsy (EUS-FNB) was performed to establish the histopathological diagnosis. Preoperatively, antral SMT was diagnosed as a gastric glomus tumor (GGT) and upper gastric body SMT as a gastrointestinal stromal tumor (GIST). Laparoscopic and endoscopic cooperative surgery was performed for the GGT and laparoscopic partial gastrectomy for the GIST. Here, we present a detailed comparison of imaging findings between GGT and GIST; therefore, our study significantly contributes to the literature. We report a rare case of GGT presenting concomitantly with GIST that was successfully diagnosed preoperatively using EUS-FNB.

Intra-aortic balloon occlusion (IABO) is a device that controls arterial bleeding and maintains cardiac and cerebral blood flow by blocking the descending aorta. It is mainly used for hemorrhagic shock caused by trauma; however, its application has been expanding recently, including in obstetrics.

In this study, we report two cases of severe gastrointestinal bleeding in which an endoscopic approach was performed with IABO. IABO enabled us to identify the source of bleeding in the first case (duodenal ulcer) and select an appropriate surgical technique and led to successful endoscopic hemostasis in the second case (rectal ulcer).

Endoscopic hemostasis with IABO has been successful for gastric ulcers and duodenal hemorrhage. We are the first to report a case of IABO for lower gastrointestinal bleeding. IABO may be useful in the diagnosis and treatment of gastrointestinal bleeding.

A 51-year-old man underwent colonoscopy for endoscopic resection of polyps which were detected by CT colonography. Cold Snare Polypectomy (CSP) was performed for resection of an adenomatous polyp present in the splenic flexure. Two hours after the endoscopy, the patient experienced a sudden epigastric pain. Abdominal CT showed a mass-like thickening of the colon wall at the splenic flexure, leakage of contrast medium from the blood vessels in the wall, and hemorrhagic ascites in the abdominal cavity. The patient was diagnosed with intra-abdominal hemorrhage post a CSP procedure and underwent partial resection of the transverse colon through transverse colostomy. The surgical specimen showed a marked hematoma in the muscle layer below the site of CSP; however, no perforation was evident.

A 79-year-old woman with complete situs inversus and gallstone pancreatitis underwent emergency ERCP. A duodenoscope was inserted with the patient in the left lateral decubitus position. However, as the scope reached the papilla, the physician was in a cramped posture and unable to stretch the scope. Although bile duct cannulation could be performed using the pancreatic guidewire method, it was difficult to maintain a stable view of the papilla and subsequent biliary procedure, such as EST and stone removal, and only a plastic stent could be placed in the bile duct and pancreatic duct. After 2 weeks, ERCP was performed to remove the bile duct stone. Similar to the initial ERCP, the scope was inserted in the left lateral decubitus position. After insertion into the stomach, the scope was rotated 360° clockwise and advanced towards the duodenum. By this technique, the physician was able to maintain a good posture after reaching the papilla, and the scope was stretched easily by applying left torque. After stretching the scope, EST and stone removal were successful.

Devised scope insertion method during ERCP for patients with complete situs inversus is useful as it allows good physician posture and scope position after reaching the papilla and facilitates subsequent ERCP procedures.

Previous studies have indicated that the success of transnasal endoscopy depends on factors such as scope diameter, nasal pretreatment, nasal meatus selection, and the endoscopistʼs skill. However, whether the breathing method affects transnasal endoscopy remains unclear. Our recent research has revealed that nasal breathing is more effective than oral breathing when conducting and undergoing transnasal endoscopy. In this article, we explain the breathing method during transnasal endoscopy.

Laparoscopic and endoscopic cooperative surgery (LECS) is a procedure that combines laparoscopic gastric resection and ESD for local resection of gastric submucosal tumors with appropriate and minimal surgical resection margins. This technique avoids excessive resection of the gastric wall and reduces postoperative complaints such as dumping syndrome or early bloating. To apply this technique to treat early gastric cancer, it is necessary to accurately diagnose lymph node metastasis and prevent peritoneal dissemination. The sentinel lymph node theory holds true for cT1N0 early gastric cancer, 4 cm or less, and that lymph node dissection can be omitted if sentinel lymph node metastasis is negative. For node-negative cases by sentinel lymph node biopsy, oncologically safe reduction surgery may be possible. To prevent peritoneal dissemination, various LECS-related procedures have been developed. We have developed a sealed endoscopic full-thickness resection (EFTR) technique in which the serosa is covered with a silicone sheet and full-thickness resection is performed endoscopically. LECS with sentinel node navigation is expected to be a useful individualized minimally invasive surgery for early gastric cancer that is not eligible for ESD.

The exchange of gastrointestinal endoscopy between Japan and China began in 1972. Half a century ago, Japanʼs endoscope technology was still developing. At the request of the Japan-China Friendship Association, I was invited to Beijing Union Medical Hospital and gave a demonstration of gastrointestinal endoscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography.