The Gastro Camera was developed in the 1950s, and since then, improvements have been made from the Fiberscope to the Videoscope, and now it is the era of high-definition electronic endoscopes such as optical magnification, image-enhance endoscopy (IEE), and endocytoscopic diagnosis.

The progress of endoscopic treatment has started from polypectomy to the development of ESD through the era of EMR along with the progress of diagnostic endoscopy.

Although there is debate about indications, the era of full-thickness resection, which is being advanced in the United States and China, will come, and AI and robot technology will be applied to endoscopic treatment in the near future.

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has influenced all medical systems. This outbreak immediately affected gastroenterologists as well as global physicians worldwide. However, the comorbidity spectrum of digestive system in patients with COVID-19 remains unknown. Additionally, there are few data on the risk of SARS-CoV-2 infection and COVID-19 aggravation in inflammatory bowel disease (IBD). Physicians and patients have great concern about whether IBD patients are more susceptible to SARS-CoV-2 infection and have worsened disease courses. Therefore, it is necessary to precisely ascertain the risk of SARS-CoV-2 infection and the COVID-19 severity in IBD patients and to acknowledge the IBD management during the COVID-19 pandemic with clinically reliable information from COVID-19 cohorts and IBD experts' opinions.

In this review, we highlight gastrointestinal symptoms in COVID-19 and clinical questions regarding IBD management during the COVID-19 pandemic and make comments corresponding to each question based on recent publications. At the moment, we propose four key points as follows: (1) no evidence that IBD itself increases the risk of SARS-CoV-2 infection, (2) to basically prioritize the control of disease activity of IBD, (3) no need for physicians to suddenly discontinue immunomodulatory or biologic therapy in patients with quiescent IBD, and (4) a need for careful observation of elderly (>60 years old) and IBD patients receiving corticosteroid treatment during the COVID-19 pandemic.

【Background and Aims】The number of elderly Japanese patients with gastric cancers treated with endoscopic submucosal dissection (ESD) is increasing. This study aimed to investigate the safety and efficacy of gastric ESD in patients aged ≥85 years. 【Methods】We included 149 patients with 165 gastric cancer treated with ESD at our hospital between April 2012 and December 2019, and they were categorized into two groups: the super-old (SO) group comprising patients aged ≥85 years and the non-super-old (NSO) group comprising patients aged ≤84 years. The clinical outcomes and follow-up after ESD and prognosis were evaluated. 【Results】The clinical outcomes between the two groups had no remarkable differences. However, the SO group had a significantly higher rate of patients who self-interrupted their follow-up checkup within 3 years (p=0.01) than the NSO group. Meanwhile, the 3-year overall survival rates were not significantly different between the two groups. 【Conclusions】Gastric ESD can be safely and effectively achieved even for elderly patients aged ≥85 years, with the possibility of preventing death from gastric cancer. However, elderly patients aged ≥85 years tend to self-interrupt their follow-up checkup.

We experienced 3 cases of invasive micropapillary carcinoma (IMPC) component in gastric intramucosal carcinoma, which we report with a brief review of the literature. The onset site was lower body in 3 patients. The histological type was well differentiated tubular adenocarcinoma in 2 patients and papillary adenocarcinoma in 1 patient. There was no lymphovascular invasion observed. They have progressed to date without recurrence. Early gastric cancer with IMPC component might not be so aggressive.

Both Helicobacter pylori (H. pylori) eradication and gastric acid secretion inhibitors such as proton pump inhibitors are effective therapy to prevent the recurrence of peptic ulcers. We reported three cases of gastric ulcers which developed during gastric acid suppressive therapy.

Case 1 was an 88-year-old man treated with proton pump inhibitor (lansoprazole 15 mg) therapy and low-dose aspirin (LDA: 100 mg/day) after a myocardial infarction. The patient visited our clinic and underwent upper gastrointestinal endoscopy for epigastric pain and melena. Multiple hemorrhagic ulcers were observed in the gastric antrum. He was H.pylori-negative and was treated by the potassium-competitive acid blocker (vonoprazan fumarate 20 mg/day) and misoprostol. Case 2 was an 84-year-old woman who received LDA (100 mg/day) as well as anticoagulant therapy (dabigatran etexilate) after an atrial fibrillation-related cerebral infarction, vonoprazan fumarate (10 mg/day) for gastro-esophageal reflux disease (GERD), and cyclooxygenase (COX) -2-selective inhibitor (celecoxib) therapy for lumbar pain. Upper gastrointestinal endoscopy showed an ulcer on the posterior wall of the upper gastric body and marked atrophic mucosa of the corpus. The patient had the eradication therapy for H.pylori two years ago and was confirmed as H.pylori-negative following the eradication treatment. Celecoxib was discontinued, and she was treated with vonoprazan fumarate (20 mg/day) and misoprostol. Case 3 was a 76-year-old woman. During H₂-receptor antagonist (nizatidine 300 mg/day) therapy for GERD, an ulcer was detected in the pyloric antrum by upper gastrointestinal endoscopy during follow-up. She had the eradication therapy five years ago and was confirmed as H.pylori-negative following eradication treatment. She had also received therapy for hypertension and hyperlipidemia but no COX-inhibitors. Her ulcer was further treated with vonoprazan fumarate (20 mg/day). It was a case that long-term stress might have been involved in the development.

As in the case reported here, the practicing doctor should recognize that gastric ulcer caused by the drugs occurs even if H.pylori is negative and takes the gastric acid secretion inhibitor, and considers appropriate measures for each case.