Alcohol-related upper gastrointestinal diseases encompass a spectrum of conditions, prominently including esophageal squamous cell carcinoma, alongside head and neck cancers such as hypopharyngeal cancer, and gastric cancer. Notably, esophageal squamous cell carcinoma exhibits a strong association with the ethanol content in alcohol and the aldehydes generated during alcohol metabolism. To identify patients at high risk for alcohol-related upper gastrointestinal diseases, it is important to utilize alcohol-related questionnaires and genetic polymorphism association tests targeting alcohol metabolism enzymes. Furthermore, image-enhanced endoscopy is useful for diagnosing hypopharyngeal and esophageal squamous cell carcinomas. Early diagnosis of alcohol-related upper gastrointestinal diseases requires performing endoscopic observations tailored to the patientʼs risk level.

A 66-year-old woman was referred to our hospital with unsteadiness, abdominal pain, and black tarry stools. Upper gastrointestinal endoscopy with insufflation revealed poor gastric wall extension and an ulcerative lesion measuring approximately 8 cm around the lesser curvature of the middle body of the stomach. A gastric ulcer with a gastrojejunal fistula was diagnosed because an opening in the jejunum was observed at the base of the gastric ulcer, and radiographic examination showed that the ulcer was connected to the upper jejunum. Histological findings showed that the ulcer was not malignant and was caused by Helicobacter pylori infection or administration of non-steroidal anti-inflammatory drugs. After conservative treatment, the ulcer was scarred, and only a gastrojejunal fistula remained, with no recurrence of the ulcer or symptoms. The presence of a gastrojejunal fistula should be considered when a large ulcerative lesion with poor gastric wall extension is observed on endoscopic insufflation.

An 82-year-old man underwent gastrectomy and Billroth Ⅱ reconstruction for gastric ulcers at the age of 32 years. The patient was admitted to our hospital with right upper abdominal pain. Abdominal CT revealed a thickened anastomotic wall and a dilated afferent loop. The patient was diagnosed with an afferent loop obstruction and acute pancreatitis caused by gastric cancer. An endoscopic drainage tube was urgently inserted and his clinical condition improved immediately. After drainage, a plastic stent was successfully inserted into the stricture in exchange for the tube. After the procedure, the afferent loop obstruction did not relapse for two months until the patient died of gastric cancer. Endoscopic therapy using plastic stents for malignant afferent loop obstructions has rarely been reported. Here, we report a case in which endoscopic plastic stenting was effective for malignant afferent loop obstruction.

A 74-year-old man with a history of chronic pancreatitis underwent follow-up contrast-enhanced abdominal computed tomography that revealed an elevated rectal lesion. CS revealed an edematous, elevated lesion in the rectum with a positive cushion sign and stenosis in the sigmoid colon, which was difficult to pass the scope through. CS under fluoroscopy was planned; however, the contrast agent could not reach the oral aspect of the stenosis. A guidewire was advanced toward the oral aspect of the stricture under catheter guidance. The guidewire appeared from the elevated rectal lesion, confirming the diagnosis of a sigmoidorectal fistula. The patient subsequently underwent laparoscopic low anterior resection on a standby basis. The resected specimen showed multiple diverticula in the sigmoid colon and the pathological diagnosis revealed a sigmoidorectal fistula formed by diverticulitis. The elevated lesion in the rectum was thought to be a temporary change during the course of fistula formation.

A 22-year-old man was referred to our hospital with right upper abdominal pain. Blood tests revealed elevated levels of hepatobiliary enzymes. CT revealed a cystic mass, approximately 60 mm in size, in the duodenum compressing the bile duct. Based on these examinations, a duodenal duplication cyst was suspected, and upper gastrointestinal endoscopy was performed. A pouch-like structure occupying the lumen was observed in the descending duodenal limb. After endoscopic ultrasound guided puncture and placement of an endoscopic nasobiliary drainage tube in the cyst, cholangitis quickly resolved. Endoscopy was performed again at a later date, the gallstones were removed by lavage, and a duodenal duplication cyst was diagnosed based on the biopsy results. Subsequently, ERCP was performed, and a duodenal duplication cyst communicating with the common bile duct was identified.

Peroral endoscopic myotomy (POEM) has become the standard treatment for achalasia, especially because it allows access to deeper layers beyond the submucosal layer that were previously accessible only through surgical procedures. As a result, ʼsubmucosal endoscopyʼ has emerged as a novel diagnostic and therapeutic strategy in therapeutic endoscopy. Submucosal endoscopy is a comprehensive concept that includes endoscopic techniques facilitating safe access to the submucosal and muscle layers as well as deeper cavities. One technique performed endoscopically within the submucosal tunnel is peroral endoscopic tumor resection (POET), which involves the endoscopic removal of subepithelial lesions. This article provides a detailed overview of the indications and practical aspects of POET.

Malignant esophageal stricture is associated with esophageal passage obstruction and dysphagia, which affect patient nutritional status, quality of life, and prognosis. Endoscopic esophageal stenting is an option for such patients when resection is impossible. If stenting improves nutritional status, chemotherapy can be administered, prolonging life expectancy. However, in patients with mild stenosis or esophagogastric junction lesions, stents may migrate into the stomach. This paper describes the procedure and tips for endoscopic esophageal stenting, which uses an over-the-scope clip with strong tissue-grasping force to secure the stent to the esophageal wall and prevent stent migration.

Objectives: To examine whether reasonable detection rate of endoscopically diagnosed lesions as adenoma (“endoscopic” adenoma detection rate [ADR]) could be calculated with a database generated from colonoscopy reports and whether it could be used as a surrogate colonoscopy quality indicator of “pathological” ADR.

Methods: A lesion-by-lesion database of colonoscopies performed between 2010 and 2020 at eight Japanese endoscopy centers and corresponding pathology database were integrated. Differences in numbers of detected polyps, “endoscopic” and “pathological” adenomas, and what these differences could be attributed to were examined. Polyp detection rate (PDR), “endoscopic” and “pathological” ADRs, and correlation coefficients between “pathological” ADR and PDR or “endoscopic” ADR by each endoscopist were calculated.

Results: Overall, 129,065 colonoscopy reports were analyzed. Among a total of 146,854 polyps, more “endoscopic” adenomas (n = 117,359) were observed than “pathological” adenomas (n = 70,076), primarily because adenomas were not resected on site, rather than because of a misdiagnosis. In all patients analyzed, PDR, “endoscopic” and “pathological” ADRs were 56.4% (95% confidence interval [CI] 56.2-56.7), 48.0% (95% CI 47.7-48.3), and 32.7% (95% CI 32.5-33.0), respectively. “Endoscopic” and “pathological” ADRs from each endoscopist showed a high correlation in hospitals where adenomas were usually resected at the time of examination.

Conclusions: By appropriately describing endoscopically diagnosed lesions as “adenomas” in endoscopy reports, “endoscopic” ADR might be used as a surrogate colonoscopy quality indicator of “pathological” ADR (UMIN000040690).