We have described the endoscopic diagnoses of Campylobacter enterocolitis and Salmonella enterocolitis, which must be differentiated from ulcerative colitis (UC), intestinal tuberculosis and Yersinia enterocolitis, which must be differentiated from Crohn’s disease (CD), and amebic colitis, which must be differentiated from UC and CD. Inflammatory bowel disease (IBD) must be differentiated from infectious enterocolitis because if immunosuppressants, the main treatment for IBD, are administered for infectious enterocolitis, the condition may worsen. Additionally, infectious enterocolitis can be cured with antibiotics, and if it is misdiagnosed as IBD, the patient may continue to receive drug treatment, including immunosuppressants. To prevent misdiagnosis, it is necessary to understand and exclude infectious enterocolitis if UC or CD is diagnosed. The most important factor in diagnosis is whether infectious enterocolitis can be suspected based on endoscopic images. If suspected, tests specific to each type of infectious enterocolitis must be performed for a definitive diagnosis.

Early detection of pancreatic cancer is crucial considering its extremely poor prognosis and high mortality rate. This review focuses on the application of endoscopic modalities for the diagnosis of early pancreatic cancer, specifically high-grade pancreatic intraepithelial neoplasia and invasive pancreatic cancers measuring ≤10 mm in diameter. Indirect imaging findings, such as main pancreatic duct stenosis, dilation, caliber irregularity, branch duct dilation, focal pancreatic parenchymal atrophy, and hypoechoic changes around the pancreatic duct, are valuable for identifying early pancreatic cancers in the absence of overt tumor formation. We discuss the potential for these findings to be detected using endoscopic techniques, including EUS and endoscopic retrograde pancreatography. Furthermore, we review the current role and future potential of endoscopy-based cytological and histological diagnostics for early pancreatic cancer, focusing on EUS-guided tissue acquisition and pancreatic juice cytology via nasopancreatic drainage.

A 67-year-old man was referred to our department after a foreign body was found in the descending duodenum during routine EGD. Although initially suspected to be metallic, but CT did not show any obvious foreign bodies. A subsequent EGD at our institution identified a bag closure adherent to the inferior duodenal angle, forming a mucosal fistula. Considering the low possibility of dropout from the duodenum during the session, removal of the bag closure was deferred, and we performed experiments on the deformation and damage of the bag closure using endoscopic instruments outside the body. After two weeks, endoscopic removal was successfully achieved using a hard hood and grasping forceps to deform and extract the bag closure without complications. Here, we report a rare case of endoscopic removal of a bag closure adherent to the duodenal mucosa, forming a fistula.

A 66-year-old man underwent human leukocyte antigen-mismatched cord blood transplantation for myelodysplastic syndrome (MDS), achieving successful graft engraftment at day 22 posttransplantation. After three months, the patient presented with vomiting, diarrhea, and fever. Endoscopic evaluation revealed findings consistent with ileocolonic Crohn’s disease (CD); a bamboo-joint-like appearance in the lesser curvature of the stomach (esophagogastroduodenoscopy), small intestinal notches and erosions (capsule endoscopy), and a longitudinal ulcer and cobblestone-like appearance in the sigmoid colon (colonoscopy). Nutritional therapy and vedolizumab were initiated; however, mild mucosal inflammation persisted. Twelve months posttransplantation, MDS recurred and progressed to leukemia. Azacitidine and venetoclax were initiated for MDS, and vedolizumab was discontinued. Five months into MDS treatment, follow-up colonoscopy showed mucosal healing of CD. Here, we report a case of CD complicated with MDS.

A 76-year-old woman was diagnosed with a colorectal lipoma of approximately 6 cm-diameter during a close examination for diarrhea. As symptomatic colorectal lipomas are indicated for treatment, ESD was performed because the mass had prolapsed from the anus. The discovery of colorectal lipomas is expected to increase with the widespread use of colonoscopy, and resection is recommended in cases of concern regarding the development of intussusception. EMR for large pedunculated lipomas is associated with a high risk of colon perforation, and ESD is recommended to avoid complications.

Since its approval for clinical use in Japan in 2015, photodynamic therapy (PDT) has been widely performed. The outcome of treatment for lesions within the scope of physician-initiated clinical trials (defined as having two or fewer residual recurrent lesions, a depth of less than T2, a maximum diameter of less than 3 cm, a circumferential extent of less than half the circumference, and not extending to the cervical esophagus) is favorable. As PDT is a local laser treatment, the operators should position themselves such that the laser can be applied perpendicularly to the lesion while maintaining an appropriate distance. In recent years, outcomes of PDT for lesions beyond the clinical trial criteria have also been reported, and some of these lesions may be curable. We hope this article will contribute to expanding treatment opportunities for esophageal cancer patients.

The development of colorectal cancer is associated with the adenoma-carcinoma sequence, and the detection and endoscopic resection of colorectal adenomas, which are precancerous lesions, have been shown to reduce the incidence and mortality of colorectal cancer. The standard treatments for lesions ＞ 10 mm are hot snare polypectomy (HSP) and EMR. However, the proportion of invasive cancers 10-19 mm in size is low, and safer new techniques are required. We focused on the settings of the high-frequency power supply in HSP and developed a low-power pure-cut (LPPC) HSP that minimizes thermal injury to the muscular layer while allowing for appropriate submucosal resection using the low-output pure cutting mode (PureCut mode). In animal model studies, LPPC HSP resected the submucosal layer in all cases while preserving a thicker residual submucosal layer and reducing thermal injury to the muscularis propria compared with conventional HSP. Furthermore, clinical trials have evaluated the application of LPPC HSP for colorectal adenomas 10-14 mm in size, confirming a 100% success rate, a high en bloc resection rate, and an R0 resection rate, while minimizing adverse events (only one case of immediate bleeding [1.1%]).

Compared to HSP and EMR, LPPC HSP can reduce thermal injury and improve safety while resecting superficial parts of the submucosal layer. This technique may become a new standard treatment, particularly for colorectal adenomas 10-14 mm in size.

Objective: Whether metal stents (MS) or plastic stents (PS) yield better outcomes for malignant biliary obstruction in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is controversial. We aimed to compare outcomes of initial EUS-HGS performed with MS or PS.

Methods: In this single-center retrospective study, we included patients (MS/PS groups: n = 151/72) with unresectable malignant biliary obstruction and performed multivariable analysis. The landmark date was defined as day 100 and used to evaluate the time to recurrent biliary obstruction (TRBO).

Results: The clinical success rate was similar in both groups. The mean total bilirubin percentage decrease at week 2 was significantly higher in the MS group than in the PS group (-45.1% vs. -23.7%, P = 0.016). Median TRBO was significantly different between the MS and PS groups (183 and 92 days, respectively; P = 0.017). TRBO within 100 days was comparable in both groups but was significantly shorter only after 100 days in the PS group (adjusted hazard ratio 12.8, P ＜ 0.001). Adverse events were significantly more common in the MS group (23.8% vs. 9.7%, P = 0.012), although they occurred relatively frequently even with PS in the cholangitis subgroup (P_interaction = 0.034). After endoscopic re-intervention, TRBO tended to be longer with revision PS (hazard ratio 0.40, P = 0.47).

Conclusions: Although MS provided early improvement of jaundice and long stent patency, PS provided a better safety profile and comparable stent patency until 100 days. PS might also be an adequate and optimal palliation method in EUS-HGS.