We compared the clinical efficacy and safety of endoscopic stenting in malignant colorectal obstruction between elderly patients over 75 years old and younger patients. From April 2017 to November 2021, 61 patients with malignant colorectal obstruction were performed stenting procedures to relieve the obstruction. Uncovered self-expanding metal stents (SEMS) were placed endoscopically under fluoroscopic guidance in all patients. Stent placement was technically successful in 61/61 (100%). Bridge to surgery (BTS) /best supportive care (BSC) (16/19 vs 19/7, p=0.04), CROSS Score (before placing SEMS) (1.7 vs 1.8, p=0.64), CROSS Score (after placing SEMS) (4.0 vs 4.0, p=1.0), time to recommencing food intake (2.9±1.7 vs 2.7±1.3 days, p=0.63), and hospital stay (18±12 vs 14±9 days, p=0.20) were not significantly different between the two groups, while other complications were not significantly different between the two groups. There were no significant differences between the elderly and young groups with respect to overall survival (522 vs 1416 days, p=0.66). Stent placement for colorectal obstruction is an effective and relatively safe procedure for elderly people over 75 years old.

Background: We developed the "Thin silicone loop band (TSLB) ", an endoscopic submucosal dissection (ESD) traction device made of thin elastic silicone molded into a 10-mm-diameter ring. The TSLB can be attached to an EZ clip and passed through the working channel of an endoscope. Aim: To examine the efficacy of TSLB. Methods: Two endoscopists performed ESD with a needle knife for a 20-mm-diameter virtual lesion with an ESD training model. Twelve lesions treated by conventional ESD (group C, n=6) and ESD with TSLB (group T, n=6) were evaluated for submucosal dissection speed. Results: Mean submucosal dissection speed was 50.1±23.3 mm²/min in group C and 82.2±43.1 mm²/min in group T. TSLB traction was successful in all lesions. Discussion: TSLB may be a simple and useful ESD traction device that improves submucosal dissection speed.

Basaloid cell carcinoma (BSC) is rare disease with poor prognosis. Here we report a case of BSC resected by endoscopic submucosal dissection (ESD) and summarize the clinicopathological characteristics of BSC. An 80-year-old man was referred to our hospital because of an enlarging and protruding lesion three months after ESD. A pathological evaluation of the previous ESD revealed squamous cell carcinoma (SCC), and the horizontal margin was suspected to be positive. Our further investigation showed bulging mucosa with rough surface depressions on the top surrounded by normal epithelium at 34 cm from the incisor teeth. The lesion appeared to be growing into subepithelial layer and was temporarily diagnosed as BSC or poorly-differentiated SCC. The patient underwent ESD. The final pathological diagnosis was BSC, and the margin was negative. Radiation therapy was performed as an additional therapy, and the patient is now doing well without recurrence.

An 80-year-old woman was diagnosed with squamous cell carcinoma on biopsy by the index esophagogastroduodenoscopy. One month later, the subsequent esophagogastroduodenoscopy revealed that the lesion decreased in size, and no cancer cells were noted on biopsy specimen. Based on the index biopsy histology, we diagnosed esophageal squamous cell carcinoma in cStage I (cT1bN0M0). Robot-assisted esophagectomy was performed approximately 2 months after the diagnosis. Postoperative pathological examination revealed no cancer cells in the primary lesion. One lymph node (left main bronchus lymph node) showed squamous cell carcinoma metastasis. The patient neither underwent treatment in the 2 months between diagnosis and surgery nor chemotherapy before that. The tumor had spontaneously regressed, but had metastasized to the lymph node.

Spontaneous regression of malignant tumors is a rare phenomenon, especially in esophageal cancers, and the mechanism has not yet been elucidated. In this report, we describe a case of esophageal cancer that spontaneously regressed and discuss the relevant literature.

We report the case of a woman in her seventies who had diabetes mellitus and hemodialysis with chronic renal failure. She was treated for acute bronchitis with azithromycin for 3 days after 1 week, she had dysphagia and was referred to our hospital for further examination. Esophagogastroduodenoscopy revealed redness, erosion and multiple elevated yellow-white plaques and stenosis of the lower esophagus. Histopathologic findings included granulation tissue formation, fibrinous exudate, and infiltration consisting mainly of neutrophils with pseudomembrane. She was treated with vonoprazan fumarate, after 7 weeks, the pseudomembranous esophagitis improved endoscopically. After 1 and 8 months, the anterior chest wall was distended. MRI revealed arthritis of the sternocostal joint and abscess formation in the chest wall. The abscess ruptured in its natural course, and then improved. The patient continues to be monitored.

The patient is a man in his 50s. He visited our hospital because of a feeling lump in his chest after eating meat with persistent dysphagia. A plain CT scan of the chest revealed an esophageal foreign body proximal to the second natural constriction, followed by endoscopic foreign body removal. Sub-circumference ectopic gastric mucosa of the upper esophagus was found at the upper end of the foreign body, which seems to have a relationship with the impaction.

A 89-years-old female was complained with anorexia and edema of the lower limb a few months ago and visited a nearby doctor. She was pointed out leukocytosis by blood test. CT examination showed prominent thickening of the gastric wall. Esophagogastroduodenoscopy showed multiple lymphomatous polyposis throughout the esophagus, gastric giant folds with redness and erosion in the greater curvature. Colonosocpy showed swelling of the folds with dilated vessels. Pathological findings of gastric biopsy specimens showed diffuse proliferation of atypical lymphocytes in the gastric mucosa, positive for cyclinD1, Bcl-1, CD5. She was diagnosed of mantle cell lymphoma. After 7 courses of R-CHOP therapy, the lesions were improved, however, relapse occurred. She underwent radioisotope treatment by Ibritumomab tiuxetan, and the lesions were sustained. We reported the case of mantle cell lymphoma with various findings in the gastrointestinal tract. Pathological examination of biopsy specimens is necessary for the diagnosis of mantle cell lymphoma, even if it has esophageal flat elevated lesions or swelling of gastric and colonic folds.

A 42-year-old man presented with a submucosal tumor (SMT) -like elevated lesion with epithelial changes at the apex on the posterior wall of the fornix (lesion 1) as identified by esophagogastroduodenoscopy. He was referred to our hospital, and esophagogastroduodenoscopy revealed two more SMT-like elevated lesions, respectively located on the upper gastric body (lesion 2) and on the fornix (lesion 3). Cancer was not confirmed in any of the lesions despite three times biopsies. Based on the endoscopic findings, low-grade differentiated-type adenocarcinoma was suspected. A total gastrectomy was consequently performed. Histopathologic examination revealed that all lesions were low-grade differentiated-type adenocarcinoma, with lesions 1 and 2 identified as pyloric gland type gastric adenocarcinoma and lesion 3 identified as fundic gland mucosa type gastric adenocarcinoma. Low-grade differentiated-type adenocarcinoma can be difficult to diagnose using biopsy; therefore, it is necessary for endoscopists and pathologists to cooperate together to evaluate these lesions.

A 40-year-old quadriplegic female with vomiting and abdominal distension that did not improve visited our clinic. She had a history of repeated episodes of gastric volvulus. Abdominal computed tomography suggested gastric volvulus and she was admitted to our hospital (day 1). A nasogastric tube was inserted on day 1. The gastric volvulus was released, and she did not relapse. The abdominal distension improved, and she was discharged on day 13.

Although rare in adults, gastric volvulus may require emergency surgery; therefore, in patients who present with vomiting, it is important to keep in mind gastric volvulus among the differential diagnoses. The diagnosis of gastric volvulus in this patient could be made from her previous abdominal symptoms, and imaging findings.

Neuroendocrine tumors (NETs) of the gastroenteric system are rare neoplasms with an estimated incidence of 3.51 per 100,000, and the incidence of NETs has increased. Small NETs are usually asymptomatic and sometimes detected by screening endoscopy.

We reported three cases of gastroduodenal NETs diagnosed by screening endoscopy. As for gastric NETs, they had type A gastritis. Gastric tumors were recognized as yellowish SMT-like lesions and duodenal tumor was recognized as yellowish depressed lesion. Pathology showed their nested, trabecular arrangement, and they were found to be positive for synaptophysin through immunohistochemistry. As all tumors were G1 and limited to the submucosa, endoscopic resection was performed.

Since endoscopic resection is considered for small size NETs (diameter of ≤ 10 mm), appropriate biopsy should be performed for small yellowish tumors.

Duodenal Brunner's gland hyperplasia is a relatively common duodenal elevated lesion, but there is currently no unified opinion on its diagnosis. Although there is little doubt about the diagnosis when the lesion presents with a typical appearance, it is often difficult to make a diagnosis in atypical cases. In this report, we describe a case of Brunner's gland hyperplasia, which was recognized by ultrasound endoscopy as a highly echogenic mass with multiple internal cystic components originating from the second and third layers, despite the atypical appearance of the mass.

A 60-year-old man was diagnosed with adenocarcinoma of the end of the ileum. No suspicious findings of submucosal infiltration were observed macroscopically, so EMR was performed for batch resection. Meanwhile, his daughter was examined at another hospital and found to possess a genetic mutation that indicated a family history of colorectal cancer. When he also underwent a genetic test, he was found to possess the same genetic mutation as her. Hereditary gastrointestinal cancer such as Lynch syndrome was considered, but no specific gene mutation could be detected. Gastrointestinal and genetic screening tests are important, and more cases should be studied in the future.

We evaluated a 48-year-old woman presenting with a positive fecal occult blood test result. The patient underwent colonoscopy, which identified a steeply elevated lesion in the cecum. Magnifying endoscopy with narrow-band imaging revealed a type 1 pit pattern, considered non-neoplastic mucosa. Furthermore, endoscopic ultrasonography identified a continuous homogeneous hypoechoic lesion in the fourth layer. We could not exclude a submucosal tumor based on these examination results. Therefore, we observed the area laparoscopically, which revealed appendiceal intussusception. Consequently, we performed a partial appendicectomy. Pathological examination confirmed endometrial glands in the muscularis propria, consistent with appendiceal endometriosis. This case emphasized that we should consider endometriosis-induced appendiceal intussusception as a differential diagnosis in childbearing-age women with an appendiceal mass.

Case was a male in his 60s. Colonoscopy revealed a submucosal tumor 5 mm in size in the transverse colon, and a Neuroendocrine tumor was suspected, and ESD was performed. Histopathological examination revealed a granuloma with caseous necrosis in the center. A nematode-like structure was found in the necrotic tissue, and anisakiasis was suspected. Cases of colon anisakiasis are rare and there is no report treated with ESD in Japan. We report a case of colon anisakiasis which was diagnosed and treated with ESD.

A man in his 40s with ulcerative colitis was noted to have a reddish protuberant lesion with depressed surface on the Bauhin valve. At first glance, this lesion was diagnosed colorectal cancer with submucosal invasion because the white light imaging showed submucosal tumor-like elevation. However, since there was no evidence of epithelial tumor on detailed magnified endoscopy, we thought that inflammatory fibrous polyp or pyogenic granuloma was more likely, so underwater EMR was performed. Pathological examination revealed a diagnosis of pyogenic granuloma. We report here a case of pyogenic granuloma that required differentiation from malignancy.

We report a case of colorectal cancer diagnosed by EUS-FNA using forward-view echo endoscope. A woman in her 50s who was introduced on suspicion of colon infiltration of other organ cancer. Her mass was located approximately 40 cm from her anus and was inaccessible with a squint endoscope. We performed EUS-FNA on the tumor using a forward-view echo endoscope. She was discharged without complications. She was diagnosed with sigmoid colon cancer, peritoneal dissemination, and ovarian metastasis by histopathological examination.

We present a case wherein an enterocutaneous fistula was endoscopically closed using an OTSC. A man in his 70s underwent an emergent colostomy and a subsequent sigmoidectomy for sigmoid colon cancer management. After two-stage surgery, an enterocutaneous fistula was identified between the descending colon and the abdominal surgical wound. Endoscopic examination revealed granulation tissue on the oral side of fistula. The granulation tissue was removed with a snare, and the fistula was closed using the OTSC system. Exudates decreased postoperatively and the patient was discharged without complications. This finding indicates that endoscopic closures using OTSC systems can be performed to close enterocutaneous fistulas.

An 80-year-old Japanese male with alcoholic cirrhosis and esophageal varices was scheduled for the endoscopic treatment of incidentally discovered rectal varices. Prior to his admission, bleeding in the lower gastrointestinal tract due to ruptured rectal varices was observed, and endoscopic variceal ligation (EVL) was performed to stop the bleeding. Intraluminal ultrasonography (IDUS) was performed to identify the puncture site of the rectal varix in the F2 morphology, and a submucosal rectal varix was incidentally detected which was indistinguishable from the endoscopic findings. We decided to perform endoscopic injection sclerotherapy with simultaneous ligation (EISL) at the same site. Seven days later, contrast-enhanced CT showed thrombosis of the varicocele, and the patient was discharged from the hospital. The submucosal varicocele, which could not be identified by gross findings, was successfully intra-injected by using IDUS to determine the puncture site. EISL to minimize post-puncture hemorrhaging and to save the patient's life was successful.

An 80-year-old woman was hospitalized for acute cholangitis due to common bile duct stones. Abdominal computed tomography revealed a high degree of esophageal hiatal hernia. Endoscopic retrograde cholangiopancreatography (ERCP) with a JF-260V esophagogastroduodenoscope was attempted, but we were not able to insert the scope into the duodenum. By replacing it with the GIF-Q260J forward-viewing scope, it became possible to insert it into the duodenum and ERCP was performed. A 7 Fr double pigtail-type bile duct stent was placed. Nine days later, a second ERCP was performed with the GIF-Q260J and the bile duct stones were removed. She was discharged without postoperative complications. In cases of severe esophageal hiatal hernia, treatment with a direct endoscope may be an option.

An 80-year-old female visited our hospital with the chief complaint of appetite loss. Blood tests revealed increased inflammatory response, and computed tomography showed a gallbladder tumor. She was admitted to our hospital because of suspected gallbladder cancer, and endoscopic retrograde cholangiopancreatography was performed. An endoscopic tapered sheath, EndoSheather, was inserted into the gallbladder along a guidewire. The inner catheter was removed, and a biopsy forceps was inserted through the outer sheath. Histopathologic examination of three biopsy specimens led to the diagnosis of gallbladder cancer. EndoSheather could readily pass through strictures, because there is almost no caliber difference between the inner catheter and the outer sheath. Since the biopsy forceps could be inserted through the inner sheath, repeated biopsies could be performed. EndoSheather was useful for transpapillary biopsy of gallbladder tumors.

Cystic lesions arising from the intrapancreatic accessory spleen are relatively rare and often difficult to diagnose preoperatively. Identifying the intrapancreatic accessory spleen is important to preoperatively diagnose epidermoid cyst. In present cases, the intrapancreatic accessory spleen component located in the surgical specimen clearly matched with Endoscopic Ultrasonography (EUS) image findings, which can be clue for the preoperative diagnosis of epidermoid cyst in an intrapancreatic accessory spleen. Detailed evaluation by EUS was useful for preoperative diagnosis. In case of pancreatic cystic diseases, careful observation of the cystic lesion surrounding by EUS may lead to the preoperative diagnosis of epidermoid cyst and reduce surgery invasiveness.

A 45-year-old woman with no medical history presented for the evaluation of pancreatic cyst enlargement. A 3 cm pancreatic cyst was detected nine years ago at another hospital. As the cyst gradually enlarged, the patient was referred to our hospital. Computed tomography showed a 54-mm cystic lesion with a capsule in the pancreatic tail but no septum. MRI showed the capsule exhibiting a low-signal intensity, while the cyst exhibited a signal with high intensity and low diffusion on T2-weighted images. Endoscopic ultrasound showed a septal wall at the cyst margin and a 5-mm cyst-like lesion inside the cyst. The patient underwent surgery after mucinous cystic neoplasms (MCN) were suspected. Pathology showed no atypia in the epithelium and an ovary-like stroma under the epithelium, and a diagnosis of mucinous cystadenoma was made. MCN usually consists of small and large cysts with their convexity facing the lumen. We report a case of mucinous cystadenoma of the pancreas that was resected after long-term follow-up.