The stomach, which is a highly acidic environment, comprises many indigenous bacteria besides Helicobacter pylori (H. pylori) and oral bacteria (non-H. pylori), forming an intragastric indigenous bacterial flora. In this study, 183 gastric fluid cultures were positive for non-H. pylori in 120 (65.7%) of the cases, and approximately 70% of the cases were on proton pump inhibitor. For the Kyoto classification of gastritis associated with non-H. pylori culture results, univariate analysis showed that culture positivity was significantly associated with atrophic gastritis, intestinal metaplasia, mucosal swelling, sticky mucus, hyperplastic polyps, and gastric cobblestone-like lesions, whereas culture negativity was significantly associated with regular arrangement of collecting venules and hematin. In multivariate analysis, only hematin showed a significant association. Changes in gastric microflora due to non-H. pylori should be observed using endoscopy.

Background and Aim: Few studies have reported the outcomes of colorectal stent placement in elderly patients. This study aimed to evaluate the usefulness of self-expandable metallic stents as a bridge to surgery for malignant colorectal obstruction in elderly patients.

Methods: We evaluated the outcomes of colorectal stent placement as a bridge to surgery in 38 elderly and 47 nonelderly patients.

Results: The success rates of colorectal stent placement and obstruction release were 97.4% and 100%, respectively, in the elderly group and 97.9% and 97.9%, respectively, in the non-elderly group. Colorectal obstruction scoring system (CROSS) before stenting and CROSS after stenting were 1.8±1.7 and 3.9±0.3 in the elderly group, and 1.5±1.7 and 3.8±0.7 in the non-elderly group. In both groups, obstruction symptoms promptly improved with stent placement.

Conclusion: Colorectal stent placement was safely performed in elderly patients, and their nutritional status was maintained until surgery.

An 81-year-old man with a submucosal gastric tumor was admitted to our hospital. EUS revealed a submucosal tumor, approximately 58 mm in diameter, in the gastric fornix. EUS-FNA using a 22-gauge Franseen needle was performed. After EUS-FNA, EGD revealed gushing bleeding at the puncture site. Therefore, we performed a hemostatic procedure with argon plasma coagulation (APC), which subsided the bleeding. CT showed gastric emphysema and hepatic portal venous gas following the hemostatic procedure. The following day, gastric emphysema improved and portal venous gas disappeared with conservative treatment. During hemostatic treatment with APC, argon plasma gas flowed into the intratumoral vessel, causing portal venous gas. Knowingly, this is the first report on the development of hepatic portal venous gas after APC.

A 72-year-old man was referred to our clinical department with chronic diarrhea. The upper and lower gastrointestinal endoscopy results were normal. Middle gastrointestinal endoscopy revealed no significant findings, edema of the small intestinal mucosa, or villous atrophy. The pathological findings of the small intestinal mucosa did not lead to an accurate diagnosis. Here, the patient was diagnosed with monomorphic epitheliotoropic intestinal T-cell lymphoma by comparing past and present pathological findings; however, the symptoms and endoscopic findings are rare. Here, we report this case because long-term survival is rare and it is difficult to prove recurrence of the disease.

A 78-year-old man experienced mucous and bloody stools for several months, which worsened after a second pembrolizumab administration for right middle lobe lung cancer. CS revealed erythematous and edematous mucosa throughout the colon, and biopsy revealed apoptosis. Therefore, the patient was diagnosed with immune-related enteritis, and prednisolone therapy was initiated. As the symptoms did not improve, endoscopy was reperformed, which revealed worsening inflammation of the entire colon and multiple rectal ulcerations. Histopathologically, apoptosis had disappeared, and the patient may have developed ulcerative colitis before pembrolizumab administration. Subsequently, the patient was treated with vedolizumab and improved rapidly. If inflammatory bowel disease symptoms are suspected, CS should be considered before initiating treatment with immune checkpoint inhibitors.

A 47-year-old man was diagnosed with chronic pancreatitis and stones in the main pancreatic duct. The patient was referred to our hospital with an enlarged pancreatic pseudocyst caused by a pancreatic stone and obstructive jaundice due to bile duct compression. Endoscopic retrograde cholangiopancreatography was performed for main pancreatic duct stenosis and obstructive jaundice. However, tapered cannulas and conventional stenosis-dilating devices cannot pass beyond the stenosis because of severe stenosis of the pancreatic duct. Therefore, we used a new drill dilator that does not require a pushing operation. The main pancreatic duct was straightened and passed over the stenosis without resistance by rotating the handle clockwise. We successfully implanted 5 Fr pancreatic duct and 7 Fr bile duct stents. Here, we describe a case in which a novel drill dilator was used for the dilatation of a severely stenotic main pancreatic duct with stones.

Capsule endoscopy is crucial for diagnosing small bowel bleeding and central to the diagnostic algorithm in small bowel endoscopy clinical practice guidelines. However, conventional capsule endoscopy has several unresolved issues, including blind spots because of its characteristics, inability to be used in patients with pacemakers or implantable cardioverter-defibrillators owing to electromagnetic interference concerns, and implementation cost concerns. In 2011, a capsule endoscopy system with four cameras capable of 360° panoramic imaging was reported and became available in Japan as CapsoCam Plus^Ⓡ from Nagase & Co., Ltd in 2021. Its features include the reduction of missed lesions through lateral-viewing cameras, no electromagnetic interference as data are stored within the capsule, and lower implementation costs compared with other medical devices, addressing many concerns of conventional systems. However, there are important considerations for its implementation, such as the need to retrieve the capsule postoperatively. This article explains the essential knowledge and operational points for introducing CapsoCam Plus^Ⓡ and its appropriate use in small bowel bleeding cases.

Objectives: The incidence of colorectal neuroendocrine tumors (NETs) has increased with colorectal cancer screening programs and increased colonoscopies. The management of colorectal NETs has recently shifted from radical surgery to endoscopic resection. We aimed to evaluate the short-term outcomes of various methods of endoscopic resection for colorectal NETs.

Methods: Among those registered in the C-NET STUDY, patients with colorectal NETs who underwent endoscopic treatment as the initial therapy were included. Short-term outcomes, such as the en bloc resection rate and R0 resection (en bloc resection with tumor-free margin) rate, were analyzed based on treatment modalities.

Results: A total of 472 patients with 477 colorectal NETs received endoscopic treatment. Of these, 418 patients with 421 lesions who met the eligibility criteria were included in the analysis. The median age of the patients was 55 years, and 56.9% of them were men. The lower rectum was the most commonly affected site (88.6%), and lesions ＜10mm accounted for 87% of the cases. Endoscopic submucosal resection with a ligation device (ESMR-L, 56.5%) was the most common method, followed by endoscopic submucosal dissection (ESD, 31.4%) and endoscopic mucosal resection using a cap (EMR-C, 8.5%). R0 resection rates ＜10mm were 95.5%, 94.8%, and 94.3% for ESMR-L, ESD, and EMR-C, respectively. All 16 (3.8%) patients who developed treatment-related complications could be treated conservatively. Overall, 23 (5.5%) patients had incomplete resection without independent clinicopathological risk factors.

Conclusion: ESMR-L, ESD, and EMR-C were equally effective and safe for colorectal NETs with a diameter ＜10mm.

Trial registration: This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000025215).