Search Results (167)

Background: Endoscopic submucosal dissection (ESD) is widely used for the treatment of gastric neoplasia; however, the large artificial ulcer created during the procedure requires several weeks to heal. Although proton pump inhibitors (PPIs) are routinely administered after ESD, evidence comparing individual PPIs for artificial ulcer healing in real-world practice remains limited. This study compared the effectiveness of oral ilaprazole and oral esomeprazole as maintenance therapy after gastric ESD. Methods: This retrospective single-center study included patients who underwent gastric ESD between January 2020 and December 2024. All patients received intravenous PPI therapy for two days after ESD and were subsequently prescribed either oral ilaprazole 20 mg once daily or esomeprazole 40 mg once daily for 8 weeks. The primary outcome was complete artificial ulcer healing at 8 weeks. The secondary outcome was post-discharge delayed bleeding. Results: A total of 229 patients were analyzed (147 in the esomeprazole group and 82 in the ilaprazole group). The overall 8-week ulcer healing rate was 94.3%, with no significant difference between the ilaprazole and esomeprazole groups (97.5% vs. 92.5%, p = 0.114). In multivariate analysis, artificial ulcer size ≥ 30 mm was the only independent predictor of incomplete ulcer healing (odds ratio 20.850, 95% confidence interval 1.884–230.712, p = 0.013). Post-discharge delayed bleeding occurred in 8 patients (3.4%), all in the esomeprazole group (p = 0.032). No treatment-related adverse events were observed. Conclusions: Ilaprazole demonstrated ulcer-healing efficacy comparable to esomeprazole after gastric ESD. Artificial ulcer size ≥ 30 mm was the principal determinant of delayed healing, whereas the treatment group was not independently associated with healing outcomes. Ilaprazole may be considered a reasonable maintenance PPI option in routine post-ESD management. Full article

Aims/Purpose: In case of superficial neoplastic GI lesions the depth of infiltration is associated with the risk of nodal metastasis and guides the choice between minimally invasive endoscopic treatments and resective surgery. The aim of the study was to compare the performance of the endoscopic evaluation and EUS in identifying early tumors fit for endoscopic resection. Methods: Retrospective study on patients affected by early-appearing neoplastic GI lesions. We compared the high-definition endoscopic assessment of the lesions according to the Paris classification (classifying them as fit or unfit for endoscopic resection, according to guidelines) and the EUS staging (classifying them as intramucosal or submucosal) to the histological staging after resection. Results: From 4/2022 to 6/2025 57 patients were included. Lesions were located in the esophagus (19), stomach (29), and rectum (9); they underwent EMR—endoscopic mucosal resection—(six), ESD—endoscopic submucosal dissection—(29), upfront surgical resection (18), or upfront TEM—transanal endoscopic microsurgery (four); thereafter, 11 patients underwent surgery or TEM after not-radical endoscopic treatment or complications. After endoscopic assessment 42 lesions were considered fit for endoscopic resection: nine (21.4%) yielded HGD, 19 (45.3%) T1a, and 14 (33.3%) T1b; 15 were considered unfit for endoscopic resection: one (6.7%) yielded T1a, 14 (93.3%) T1b. Endoscopic accuracy for identifying intramucosal lesions (HGD or T1a) thus fit for endoscopic resection was 73.7%. EUS staged 29 lesions as uT1a: eight (27.6%) yielded HGD, 8 (27.6%) T1a, and 13 (44.8%) T1b; EUS staged 28 lesions as uT1 b: one (3.6%) yielded HGD, 12 (42.8%) T1a, and 15 (53.6%) T1b. EUS accuracy for identifying intramucosal lesions (HGD or T1a) was 54.4%, but it showed a 91.7% PPV for the N0 status. Conclusions: The endoscopic evaluation was more accurate than EUS (73.7% vs. 54.4%, p < 0.05) in distinguishing GI intraepithelial or intramucosal lesions fit for endoscopic resection, with a markedly higher NPV. EUS could rather be considered as a complementary tool to exclude suspicious lymph nodes before endoscopic resection. Full article

Gastric cancer (GC) is the fifth most common malignancy worldwide, with 968,784 new cases reported in 2022. Since 1975, when stomach cancer was the most common cancer, its incidence has declined in many regions. This decline can be attributed to improved food preservation and recognition of Helicobacter pylori (H. pylori) as a group 1 carcinogen in intestinal-type GC. The aim of this review was to summarize current strategies for primary and secondary prevention of GC, with an emphasis on H. pylori management, dietary factors, novel biomarkers, and screening approaches relevant in Europe. Papers from large databases, namely Web of Science, Scopus, and PubMed/MEDLINE, were selected (reviews, guidelines, and peer-reviewed studies) from about the last 1–5 years. The research was conducted using the keywords gastric cancer, prevention, primary prevention, secondary prevention, and endoscopy guidelines on prevention of gastric cancer. Primary prevention of GC is directed at screening for H. pylori and dietary changes. Secondary prevention is supported by traditional tumor markers, pepsinogen-based serological biopsy, newer blood-based markers, and major technological progress in endoscopy. High-definition endoscopy, magnification, virtual chromoendoscopy, and artificial intelligence have improved the detection of preneoplastic lesions and early cancer, while advanced therapeutic techniques such as endoscopic mucosal resection and endoscopic submucosal dissection permit organ-sparing treatment. Large projects, including GISTAR, EUROHELICAN, TOGAS, and EUCanScreen, are expected to clarify optimal screening strategies. Although GC incidence has declined, it remains a common and significant malignancy. Understanding the facets of primary and secondary prevention of GC will lead to a reduction in the burden of this disease. Full article

Gastric-type lesions in the duodenum, including pyloric gland adenoma and gastric foveolar metaplasia, have been increasingly recognized for their unique histogenesis and potential link through the metaplasia–neoplasia sequence. However, the coexistence of neoplastic and non-neoplastic gastric-type lesions within the same histological section has not been previously reported. Here, we present a case of a 73-year-old Japanese woman who underwent endoscopic submucosal dissection for a 34 × 20 mm elevated lesion in the duodenal bulb. Based on the preoperative biopsy results, pyloric gland adenoma was diagnosed; however, histopathological examination of the resected specimen revealed a far more complex picture. The main lesion consisted of two contiguous components: a hyperplastic polyp with gastric foveolar-type phenotype (Lesion I) and a pyloric gland adenoma mixed with gastric foveolar-type hyperplastic polyp (Lesion II). Importantly, the transitional zone between these components demonstrated histological continuity, with areas showing admixture of hyperplastic and adenomatous features within the same microscopic field. A separate hyperplastic polyp with gastric foveolar-type phenotype (Lesion III) was also identified, separated from Lesions I and II by intervening normal duodenal mucosa. All lesions shared a gastric-type mucin phenotype (MUC5AC-positive, CD10-negative), and extensive Brunner’s gland hyperplasia was observed throughout the specimen. This case provides compelling morphological evidence for a histogenetic link between non-neoplastic gastric-type hyperplasia and pyloric gland adenoma, supporting the concept of a metaplasia–neoplasia sequence in the duodenum. Furthermore, the presence of an additional separate lesion with the same phenotype suggests a field change in the development of gastric-type lesions. Full article

Background: Most of the public hospitals in Hong Kong provide a regular colorectal endoscopic submucosal dissection (ESD) service. The current retrospective study aims to review the long- and short-term outcomes of these services, so as to identify areas for improvement. Method and Results: From January 2017 to March 2020, 634 lesions in 623 patients were removed by an ESD technique in seven endoscopic units. The mean lesion size was 31 mm (SD 13 mm, range 10–95 mm), and the mean procedure time was 121 min (SD 67 min). En bloc resection and R0 resection could be achieved in 91.3% and 79.3% of the lesions, respectively. The intra-procedure perforation rate was 12.3%. The delayed bleeding rate was 2.1%, and the delayed perforation rate was 0.8%. Only 0.9% (6/634) of the procedures needed emergency surgical salvage due to complications. Most of the lesions were adenomas (564/634), and 55 of them were adenocarcinomas. The cumulative local recurrence rate was 4.0% at a mean follow-up of 34 months. In multivariate analysis, longer procedure time, submucosal fibrosis, hybrid ESD and piecemeal removal were associated with intra-procedure perforation. Risk factors for failed en bloc resection included non-granular and polypoid morphology, colonic location, longer procedure time and low centre volume. Malignant pathology without salvage surgery was the only independent risk factor for local recurrence. Conclusions: Colorectal ESD has been carried out in Hong Kong with acceptable short-and long-term outcomes despite the technique still being in the learning phase in some centres. Potential areas for improvement should include targeted training to speed up the procedure and enable better handling of difficult cases, aiming to decrease the perforation rate and local recurrence. Full article

Background: Lateral margin positivity (LM+) after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) may lead to residual disease and additional treatment. Subepithelial (SE) spread beneath normal mucosa has been suggested as a mechanism, but its association with LM+ is unclear. Methods: We retrospectively reviewed patients who underwent ESD for EGC from 2011 to 2021. Twenty-one LM+ cases were identified, and 227 LM– controls treated in 2019 were selected. Clinicopathologic and endoscopic factors were compared, and multivariate logistic regression was used to identify predictors. SE spread extent was evaluated pathologically. Results: Differentiation, Lauren classification, lesion size, and endoscopic color change were associated with LM+ in univariate analysis. Lesion size ≥ 2 cm was the only independent predictor. SE spread length was greater in LM+ cases than controls (5.80 ± 1.30 mm vs. 2.60 ± 2.36 mm, p = 0.004). SE spread ≥ 5 mm significantly increased the risk of LM+ (OR 15.077, 95% CI 1.550–146.670). Conclusions: SE spread—particularly when ≥5 mm—may contribute to LM+ by obscuring the true tumor boundary. Wider marking and resection margins may be considered in lesions with features suggesting SE spread. Full article

Per-oral flexible endoscopy has expanded minimally invasive options for the management of gastric subepithelial tumors (G-SETs). This narrative review appraises conventional and advanced endoscopic resections alongside hybrid laparoscopic–endoscopic procedures, within a size- and layer-based clinical framework. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) achieve high en bloc resection rates for small, intraluminal tumors arising from mucosa or submucosa. Traction strategies and dedicated traction devices may improve submucosal exposure, shorten procedure time, and reduce adverse events. Submucosal tunneling endoscopic resection (STER) has been developed to enucleate tumors originating from the muscularis propria while preserving mucosal integrity. However, tunnel creation and specimen retrieval become challenging for large tumors or for those located in the cardia or fundus. Endoscopic full-thickness resection (EFTR) enables controlled transmural excision of G-SETs arising from deeper wall layers. Exposed EFTR, combined with secure endoscopic closure, provides high en bloc and complete (R0) resection rates. Closure options range from through-the-scope clips—for small defects—to over-the-scope clips, endoloop-clip purse-string methods, reopenable-clip over-the-line techniques and endoscopic suturing systems—for larger defects. Non-exposed EFTR and device-assisted systems reduce the risk of peritoneal contamination, although complete resection rates are more variable. Hybrid approaches, including classical laparoscopic–endoscopic cooperative surgery (LECS) and non-exposure variants, combine endoscopic precision with the safety and closure capabilities of laparoscopic surgery, minimizing the amount of resected gastric wall. They are particularly suited to larger, awkwardly located or ulcerated G-SETs. Emerging traction platforms, flexible robotic systems, and AI-based tools may further broaden the role of per-oral flexible endoscopy for the treatment of G-SETs. However, evidence remains preliminary, and surgery continues to play a key role for large, extraluminal or anatomically prohibitive G-SETs. Full article

Background: The incidence of colorectal cancer diagnosed before age 50 has been increasing worldwide. However, limited data describe the endoscopic and pathological features of colorectal lesions encountered and treated during routine colonoscopy in younger adults. This study aimed to characterize age-related differences in endoscopically resected colorectal neoplasia. Methods: We conducted a retrospective, single-center observational study of consecutively endoscopically resected colorectal neoplasia at a high-volume academic teaching hospital in Japan. Patient-level and lesion-level characteristics were compared between early-onset (<50 years) and later-onset (≥50 years) groups. Lesions were evaluated for location, morphology, size, histology, resection method, and advanced neoplasia status. Results: A total of 1299 patients with 3399 lesions were analyzed, including 498 early-onset patients with 940 lesions. Early-onset neoplasia showed a left-sided predominance, with higher proportions in the distal colon and rectum. Pedunculated morphology was more frequently observed in early-onset lesions. Early-onset disease was also associated with larger lesion size, a higher prevalence of high-grade tubular adenoma, and increased rates of advanced adenoma and advanced neoplasia, resulting in more frequent use of endoscopic mucosal resection or submucosal dissection. Conclusions: Endoscopically resected colorectal lesions in younger adults exhibit distinct anatomical and morphological features compared with later-onset cases, indicating heterogeneity at the premalignant stage. Full article

Background/Objectives: Large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs) are challenging lesions with a variable, yet non-negligible risk of advanced neoplasia. While correct management is therefore mandatory, a discrepancy often persists between guideline recommendations and daily endoscopic practice. To bridge this gap, we performed a comprehensive and structured review of the available evidence, aiming to synthesize the current knowledge and provide practice-oriented guidance for the optimal management of LNPCPs throughout the diagnostic–therapeutic pathway. Methods: A comprehensive literature review was independently performed. We systematically searched PubMed and Google Scholar up to December 2025. After the literature review, we identified the most clinically relevant and controversial aspects in the endoscopic management of LNPCPs. These key areas were then translated into focused, practice-oriented clinical questions. Results: We formulated 14 practice-oriented questions addressing the key steps of endoscopic management of LNPCPs. These questions cover the entire diagnostic–therapeutic pathway, including lesion detection, morphological characterization, optical diagnosis and risk stratification for submucosal invasion, selection of the optimal resection technique, and post-resection surveillance strategies. For each question, the current evidence was synthesized to provide concise, clinically applicable answers aimed at supporting real-world endoscopic decision-making. Conclusions: The endoscopic management of LNPCPs requires a structured and evidence-based approach that integrates accurate assessment, appropriate technique selection, and tailored post-resection surveillance. By framing current evidence into focused, practice-oriented questions, this review aims to bridge the gap between guideline recommendations and real-world endoscopic practice. The proposed framework may support endoscopists in daily clinical decision-making, promoting the appropriate use of advanced endoscopic techniques and ultimately improving patient outcomes. Full article

Objective: This umbrella review aimed to synthesize evidence from meta-analyses on the efficacy of rebamipide in major gastrointestinal disorders and dyspeptic symptoms. Methods: This umbrella review followed Joanna Briggs Institute standards and was registered in PROSPERO (CRD420251185686). A comprehensive search of MEDLINE, EMBASE, Cochrane, and Scopus (1 January 1985, to 10 September 2025) was conducted to identify systematic reviews and meta-analyses assessing rebamipide therapy. Methodological quality was appraised using AMSTAR-2, ROBIS, and GRADE tools. Pooled data were analyzed using fixed- or random-effects models according to heterogeneity, as assessed using the I² statistic. Results: Eleven meta-analyses (88 primary studies) were included. Rebamipide significantly improved H. pylori eradication (OR = 1.76; 95% CI: 1.44–2.16), reduced NSAID-induced mucosal injury (OR = 2.72; 95% CI: 1.89–5.14), enhanced ulcer healing after endoscopic submucosal dissection (OR = 2.28; 95% CI: 1.42–3.65), and alleviated dyspeptic symptoms (OR = 2.95; 95% CI: 1.04–8.37). Overall evidence quality was moderate to high, with low to moderate risk of bias. Conclusions: Rebamipide demonstrates consistent therapeutic benefits across diverse gastrointestinal disorders, improving H. pylori eradication rates, mucosal protection, ulcer healing, and symptom relief. These findings support rebamipide as an effective and well-tolerated adjunctive agent for the prevention and management of upper gastrointestinal diseases. Full article

Background/Objectives: Endoscopic submucosal dissection (ESD) is a state-of-the-art en bloc resection for early gastro-intestinal cancers and precursors developed and validated in Japan. Western expertise with this complex technique remains limited. Tutored training might be optimal for patients and ESD learning. We established ESD tutoring courses led by experienced Japanese experts to provide (i) optimal long-term curative outcomes and low complication rates for patients and (ii) hands-on training on difficult lesions for European endoscopists under direct expert supervision. Methods: Prospective data from 2011 to 2015 (follow-up to 12/2024) were analyzed. A total of 118 neoplasms (50% HGIEN and cancer) in 101 patients (median age 68 [37–91] years; 38% with significant comorbidities) were treated with expert or tutored ESD. Japanese experts performed 28 ESDs, while 22 trained beginners conducted 90 supervised procedures on difficult lesions during 5 live and 20 tutoring events (1–4 days each). Results: Analysis of the complete data showed curative and en bloc resection rates of 88% and 95%, respectively, with no recurrence after R0 resections during a median follow-up of 9.8 [1.5–14.9] years. Long-term survival remained recurrence-free after endoscopic resection of 3 recurrent adenomas (at R1/Rx) and curative surgery/2nd ESD for 5 non-curative ESDs. Adverse events occurred in 9.3% without emergency surgery or 30-day mortality. Comparing expert-only vs. tutored ESD procedures, beginners correctly applied curative ESD indications in 94% of 118 neoplasms. Experts resected larger lesions (22 cm²) at a rate of 9.3 cm²/h in 121 min. Tutored beginners achieved a 75% [25–100] self-completion rate on 33% smaller lesions in 112 min. Conclusions: ESD tutoring courses led by Japanese experts ensure excellent patient outcomes and standardized procedural training. This model may foster professional ESD performance across European referral centers. Full article

Background/Objectives: The prevalence of gastric subepithelial lesions (SELs) is rising. Endoscopic resection (ER) technique provides a minimally invasive alternative to manage gastric SELs. This study aims to evaluate the effectiveness and safety of ER for gastric myogenic tumors, and examine predictors for gastrointestinal stromal tumors (GISTs). Methods: The retrospective study was conducted between 2012 and 2024 at nine tertiary centers in Taiwan. We enrolled patients with endoscopic ultrasound (EUS)-documented gastric myogenic tumors managed by endoscopic muscular dissection (EMD), endoscopic subserosal dissection (ESSD), submucosal tunneling endoscopic resection (STER), and endoscopic full-thickness resection (EFTR). Clinical manifestation, endoscopic features, and outcomes were analyzed. Results: We enrolled 325 patients with 332 lesions [mean EUS size 14.5 mm, 153 (46.1%) leiomyoma, 152 (45.8%) GISTs, 27 (8.1%) other histology]. ER techniques were 193 (58.1%) EMD, 46 (13.9%) ESSD, 28 (8.4%) STER, and 65 (19.6%) EFTR. Technical success, en bloc, and R0 resection rates were 97.0%, 94.3%, and 88.9%, respectively. Twenty-four (9.0%) procedures were shifted to unintentional EFTR, and 21 (6.3%) patients had complications. No recurrence occurred during mean follow-up period of 921.4 days. Two (0.6%) patients died of non-procedure related reasons. Old age, fundus location, heterogeneous echotexture, and exophytic growth pattern were independent risk factors for GIST (all with p < 0.05). Using the above factors, we built a prediction model with sensitivity of 77.0%, specificity of 85.6%, and AUC of 0.8771. Conclusions: ER is an efficient and safe management for gastric myogenic tumors. The histological type could be predicted by demographic characteristics and EUS features. Full article

Robot-assisted gastrointestinal endoscopic surgery (RAGES) has emerged as a critical approach for minimally invasive procedures, including Endoscopic Submucosal Dissection, polypectomy, hemostasis, and therapeutic interventions. However, manual manipulation of flexible endoscopes remains technically demanding and limits surgical precision. To enhance surgical efficiency, this paper proposes a joystick-controlled Endoscopic Robotic System (ERS) comprising a Flexible Arm Delivery Device (FDD) and Main Body Driving Device (MDD). Through systematic structural design and validation, the ERS achieves stable four-DOF control: 360° circumferential rotation, 180° bending, 280–330 mm axial delivery, and ±15° rotational compensation. Key innovations include dual-encoder slippage detection in the FDD and a gripper assembly addressing circumferential angle loss through real-time torque sensing. Experimental results confirm compatibility with dual-channel endoscopes without custom modifications. The system demonstrates proof-of-concept for comprehensive endoscopic control while maintaining compact design (<0.2 m² per module) and low manufacturing cost. Although force-sensing capabilities require further refinement, this work establishes a foundation for accessible robotic platforms in gastrointestinal endoscopy, with identified limitations guiding future development toward clinical viability. Full article

Background and Clinical Significance: Cryotherapy, particularly with the CryoBalloon Focal Ablation System (CbFAS), has emerged as a minimally invasive modality delivering targeted ablation through liquid nitrous oxide. While its role in treating Barrett’s esophagus and dysplasia is well established, its application in early esophageal adenocarcinoma (EAC) salvage treatment remains limited. Case Presentation: We report the case of an 84-year-old male with Barrett’s esophagus and multiple comorbidities who underwent endoscopic submucosal dissection (ESD) for a 3 cm esophageal adenocarcinoma (pT1bN0M0). Histology revealed deep submucosal invasion, perivascular infiltration, and positive margins, rendering the resection non-curative. Given surgical ineligibility, the patient underwent cryoballoon ablation six months later for recurrent intramucosal carcinoma proximal to the ESD scar. At three months, surveillance endoscopy showed residual Barrett’s esophagus with low-grade dysplasia. Conclusions: This case highlights the feasibility and safety of cryoballoon ablation as salvage therapy after non-curative ESD in inoperable EAC. To our knowledge, this represents the first report of salvage CbFAS in T1bN0M0 EAC, underscoring the need for further studies to define its role in the multimodal management of EAC. Full article

Endoscopic submucosal dissection (ESD) has revolutionized the management of early upper gastrointestinal (GI) carcinomas. While technically demanding, it offers, in experienced hands, definitive local therapy for early GI neoplasia by allowing complete En bloc resection of mucosal and superficially invasive neoplasms, thus enabling precise histopathological risk stratification and organ preservation. Appropriate patient selection relies on meticulous endoscopic assessment using high-definition and image-enhanced endoscopy to define lesion boundaries and predict invasion depth. The principal indications include high-grade intraepithelial neoplasia and early carcinomas without endoscopic evidence of deep submucosal invasion or lymph node metastasis risk factors. Pathological analysis of the resection specimens includes histological typing and grading per WHO classification and precise assessment of invasion depth—in case of submucosal invasion measurement in micrometers—and evaluation of margin status and lymphovascular invasion. The presence of risk factors such as deep invasion in the submucosa, poor differentiation, or lymphovascular invasion may require additional surgery, guided by validated risk scores such as the eCura system. This narrative review summarizes current clinical and pathological practices for ESD in upper GI lesions. This includes the discussion of technical and biological challenges and the need of accurate assessment of risk factors for systemic metastatic spread and local recurrence as a limitation for this sophisticated but highly effective therapeutic method. Full article