To clarify the current status of endoscopy-related musculoskeletal disorders (E-MSDs) in Japan, we conducted a multicenter questionnaire survey targeting gastroenterologists. Responses were obtained from 114 participants across 44 facilities and analyzed accordingly. Among the respondents, 68.4% experienced E-MSDs and 42.3% of them believed that the symptoms affected their daily routine. Age and years of endoscopic experience were significantly associated with symptom occurrence. Additionally, the number of colonoscopies performed was identified as a factor associated with the presence of left-hand symptoms. Notably, gastroenterologists who performed ≥10 endoscopic submucosal dissection procedures per month reported significantly higher symptom scores and a greater incidence of cervical and shoulder symptoms. These findings highlight the urgent need for increased awareness of E-MSDs among gastroenterologists in Japan, along with the development and implementation of effective preventive measures.

A male patient in his 70s was admitted with bloody stool. Upper gastrointestinal endoscopy revealed active bleeding from a submucosal lesion located opposite the duodenal papilla. Hemostasis was difficult to achieve, and histopathological analysis of the biopsy specimen revealed only necrotic tissue and inflammatory changes. Endoscopic ultrasonography (EUS) revealed a 35-mm hypoechoic lesion within the submucosal layer. EUS-guided tissue acquisition suggested a poorly differentiated or undifferentiated tumor. Given these findings, the patient underwent pancreaticoduodenectomy. The final diagnosis was primary duodenal epithelioid angiosarcoma.

A 79-year-old female presented to the emergency department with complaints of abdominal pain and hematemesis/melena. Blood tests revealed anemia (hemoglobin:10.0g/dl). Abdominal plain computed tomography demonstrated situs inversus totalis and a cystic structure with high attenuation extending from the descending to the horizontal portion of the duodenum, suggesting duodenal diverticular bleeding. An emergency upper gastrointestinal endoscopy was performed, which revealed an exposed vessel in the descending part of the duodenum after the removal of blood clots. Hemostasis was successfully achieved using the endoscopic clipping method. This case highlights that even in patients with situs inversus totalis, where endoscopic manipulation can be difficult, careful technique modifications and procedural planning can facilitate successful endoscopic hemostasis.

An 88-year-old female was admitted with a complaint of melena. Abdominal computed tomography revealed a dense mass and a target sign in the distal ileum, suggesting an intestinal mass and associated intussusception. However, there were no signs of intestinal obstruction or ischemic change. Retrograde single-balloon enteroscopy revealed a lesion in the distal ileum that appeared as a spherical mass in the frontal view, with a long stalk visible posteriorly. Detailed observation was challenging. At that time, intussusception was not observed. Contrast examination revealed a long and slender mass with a hemispherical, dome-shaped head. As the source of bleeding remained unidentified, enteroscopic clipping and tattooing were performed for preoperative marking. Given the patient's stable hemodynamic and respiratory status, single-incision laparoscopic surgery was performed one week later. Intraoperatively, the tattooed section of the ileum, demonstrating evidence of intussusception, was easily identified. The affected segment was exteriorized through the single-incision port, and the intussusception was relieved using the Hutchinson maneuver. Approximately 20cm of the ileum, including the tattooed segment, was resected, followed by reconstruction using a functional end-to-end anastomosis. Gross examination of the resected specimen revealed a 20×90mm polyp with a slender, "worm-like" appearance-typical of an enteric muco-submucosal elongated polyp (EMSEP). Histopathological analysis confirmed the presence of normal mucosa and submucosa with a variably prominent mixture of blood and lymphatic vessels. Although EMSEPs are frequently observed in the colon, they are exceedingly rare in the small intestine. Their detection during routine health screenings is challenging due to their location, and they often manifest as intussusception. Because endoscopic management of small EMSEPs can be challenging, lesion tattooing followed by laparoscopic surgery is a good treatment choice.