Application of Endoscopy in the Diagnosis and Treatment of Digestive System Diseases

Dear Colleagues,

Endoscopic examination has become an indispensable tool for diagnosing and treating gastrointestinal (GI) diseases. This minimally invasive procedure enables direct visualization of the GI tract, allowing for the accurate identification of pathological changes such as inflammation and tumors. Driven by technological innovations and new clinical insights, this field continues to evolve rapidly.

Recent years have witnessed remarkable advances in the treatment of upper GI tract diseases. The widespread eradication of Helicobacter pylori has significantly impacted the incidence of gastric tumors, prompting a re-evaluation of screening and surveillance strategies. Image-enhanced endoscopy (IEE) and artificial intelligence (AI) are revolutionizing diagnostic accuracy, while minimally invasive treatments such as endoscopic submucosal dissection (ESD), underwater endoscopic mucosal resection (U-EMR), and full-thickness resection are expanding therapeutic possibilities. Furthermore, in the endoscopic treatment of esophageal achalasia and gastroesophageal reflux disease (GERD), peroral endoscopic myotomy (POEM) and its derivative techniques are gaining attention as groundbreaking therapeutic methods.

In the lower GI tract, image-enhanced endoscopy and high-magnification observation, combined with AI-assisted diagnosis, are improving early detection and characterization of lesions. Therapeutic procedures—including cold forceps polypectomy (CFP), cold snare polypectomy (CSP), EMR, U-EMR, ESD, and hybrid ESD—have been refined through the development of new devices and techniques. However, challenges remain, such as determining appropriate treatment indications for colorectal serrated lesions and addressing small intestinal tumors in the context of advanced small-bowel endoscopy.

For inflammatory bowel diseases (ulcerative colitis and Crohn’s disease), technological innovations such as capsule endoscopy, balloon-assisted endoscopy, special light observation, and ESD are at the forefront of improving diagnosis and treatment.

The field of biliary and pancreatic tumors is witnessing significant progress. Advances in imaging and tissue diagnosis, including peroral cholangioscopy and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), are enhancing diagnostic precision. Interventional EUS is expanding therapeutic options, while the endoscopic management of conditions such as acute pancreatitis, benign biliary strictures, and autoimmune pancreatitis continues to evolve.

In advanced malignancies, the roles of endoscopic biopsy, management of immune checkpoint inhibitor-related adverse events, and minimally invasive procedures are being actively explored.

Through this Special Issue, we aim to highlight the latest advances, share current challenges, and introduce new insights from the field of gastrointestinal endoscopy. We invite submissions that address technological innovations, clinical applications, and future directions in order to develop a more effective clinical system for patients and practitioners alike.

We look forward to receiving your valuable contributions and to advancing the field together.

Dr. Yoriaki Komeda
Guest Editor

Dr. Konosuke Nakaji
Guest Editor Assistant

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• image-enhanced endoscopy (IEE)
• artificial intelligence (AI)
• endoscopic submucosal dissection (ESD)
• peroral endoscopic myotomy (POEM)
• underwater endoscopic mucosal resection (U-EMR)
• helicobacter pylori eradication
• capsule endoscopy
• balloon-assisted endoscopy
• endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA)
• interventional EUS
• colorectal serrated lesions