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Telemedicine is a broad term that encompasses all aspects of utilizing information and communication technologies to provide health services at distant sites. The primary goal of telementoring is the education and training of gastrointestinal (GI) endoscopists particularly in areas where there is a shortage of endoscopy trainers. Telementoring in GI endoscopy can help to provide teaching and skills training both in simulator-based learning, and endoscopic skills training in the context of patient care. This position statement aims to outline the role of telementoring within GI endoscopy, offering a general model for the introduction and evaluation of a telementoring program that incorporates both simulators for junior trainees and skills training for practicing endoscopists. We hope to highlight its utility and implementation in remote locations. WEO recognizes that telementoring is valuable to expand access to high-quality endoscopy training especially in parts of the world where there is a shortage of endoscopy trainers and this document can serve as a guide in the planning and implementation of telementoring programs.
The incidence of esophageal adenocarcinoma (EAC) arising in patients with long-segment Barrett's esophagus (LSBE) in Japan remains to be elucidated. This study aims to investigate the incidence of EAC in Japanese LSBE cases.
This is a multicenter prospective cohort study involving 32 hospitals throughout Japan. Consecutive patients with Barrett's esophagus with a maximal length of ≥ 3 cm were prospectively enrolled. The study was initiated in June 2011, and the eligible cases were scheduled to undergo subsequent annual endoscopies for 10 years, concluding in December 2021. The cancer incidence was calculated with 95% confidence intervals and expressed as %/year of follow-up.
The initial registry comprised 343 participants. After excluding 16 cases with prevalent EAC and 60 cases with < 1 year of follow-up, a total of 267 cases with LSBE were followed up for 1–10 years (58.0 ± 35.5 months), making the total patient-years 1290.4. During the observation period, 13 new EACs were identified, leading to an estimated EAC incidence of 1.01 (0.57–1.73)%/year. All the incident EAC cases were diagnosed as early cancers. Individuals who developed EAC demonstrated a higher prevalence of ever smoking (76.9% vs. 33.5%, p = 0.002) compared to those who did not.
This prospective, 10-year follow-up study revealed a substantial EAC incidence in Japanese LSBE cases, 1.01 (0.57–1.73)%/year, similar to values reported in Western countries. This result is a significant indicator for developing effective endoscopy surveillance for Japanese LSBE. UMIN000016043.
Y. Saito, T. Sakamoto, E. Dekker, et al. “First report from the International Evaluation of Endoscopic classification Japan NBI Expert Team: International multicenter web trial,” Digestive Endoscopy 36, no. 5 (2024): 591–599.
The affiliation for authors A.P. and H.M. (affiliation 16) was incorrect. It should have read: “University Hospital of Augsburg, Augsburg, Germany.”
We apologize for this error.
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Endoscopic submucosal dissection (ESD) for lesions extending into the appendiceal orifice remains technically challenging due to limited accessibility and risks of perforation or appendicitis [1]. Although techniques such as traction methods [2] and tapered hoods [3] have been reported, a standardized strategy has not yet been established. Herein, we report successful underwater ESD (UESD) [4] for a colorectal tumor involving the appendiceal orifice using the continuous irrigation method (CIM) [5], which provides improved visualization and facilitates precise mucosal incision and submucosal dissection by generating water pressure (Video S1). A 47-year-old woman underwent colonoscopy following positive fecal occult blood test results. The procedure revealed a flat, isochromatic lesion measuring 35 mm (type 0-IIa) in the cecum (Figure 1a–c). The lesion was suspected to be a sessile serrated lesion (SSL) and extended into the appendiceal orifice (Figure 1d). ESD was planned using a small-caliber tapered conical hood to improve access to the appendiceal orifice. After lesion marking (Figure 2a), mucosal incision began on the appendiceal side. However, bleeding and bubbles obscured the endoscopic view; therefore, CIM was initiated. CIM rapidly cleared the visual field and utilized water pressure to effectively separate the lesion from the appendiceal orifice, facilitating accurate incision (Figure 2b–d). Circumferential incision and subsequent submucosal dissection were successfully completed under stable visualization provided by CIM (Figure 2e–l). The procedure lasted 91 min.
The pathological diagnosis was SSL. CIM is a simple approach that improves visualization by clearing air bubbles and bleeding during UESD. Additionally, CIM supports mucosal incision and submucosal dissection through the water pressure effect and facilitates hemostasis via temporary compression, thus enabling safe and efficient en bloc resection of lesions involving the appendiceal orifice.
Takahiro Muramatsu wrote and edited the manuscript. Takahiro Muramatsu approved the manuscript. Takahiro Muramatsu, Masakatsu Fukuzawa, and Takao Itoi reviewed the literature and revised the manuscript for intellectual content.
The authors received no specific funding for this work.
Informed consent was obtained from the patient for the publication of this report.
The authors declare no conflicts of interest.
Percutaneous transhepatic liver abscess drainage (PTAD) and endoscopic ultrasound-guided liver abscess drainage (EUS-LAD) have several limitations. Recently, because of technical improvements in echoendoscope maneuvers, EUS-guided access for the right hepatic lobe has been reported. The aim of this multicenter, retrospective study was to compare clinical outcomes of PTAD and EUS-LAD including the right hepatic lobe in West Japan.
This retrospective, multicenter study included consecutive patients with liver abscesses between January 2019 and November 2024. The primary outcome in this study was the clinical success rate compared between EUS-LAD and PTAD.
During the study period, 1012 consecutive patients developed liver abscesses. Of them, 734 patients were excluded, 43 underwent EUS-LAD and 235 patients underwent PTAD. After propensity score-matched analysis, the clinical success rate was significantly higher in the EUS-LAD group (97.7%, 42/43) than in the PTAD group (79.1%, 34/43) (p = 0.007). After a propensity score-matched analysis, 25 patients were included in each group. The clinical success rate was significantly higher in the EUS-LAD group (100%, 25/25) than in the PTAD group (84%, 21/25) (p = 0.037). Adverse events were also significantly higher in the PTAD group (16%, 5/25) than in the EUS-LAD group (p = 0.025). In addition, the median length of hospital stay was significantly shorter in the EUS-LAD group (15 days) than in the PTAD group (22 days) (p = 0.005).
EUS-LAD using a metal stent might be one of the options, but further randomized, controlled trials are needed.
The role of endoscopic papillectomy (EP) for ampullary neuroendocrine tumors (Amp-NETs) remains uncertain due to concerns regarding lymph node (LN) metastasis and recurrence. This study evaluated the long-term outcomes of EP for Amp-NETs, focusing on recurrence and procedural safety.
Patients with histologically confirmed Amp-NETs who underwent EP at a single tertiary center between 2004 and 2018 were retrospectively reviewed. Inclusion criteria were tumor size < 3 cm and absence of radiologic evidence of LN or distant metastasis. Outcomes assessed included recurrence, procedure-related adverse events, and recurrence-free survival (RFS).
Thirty-four patients were included. En bloc resection was achieved in 33 patients (97.1%), while complete resection was achieved in 19 patients (55.9%). Over a median follow-up of 68.5 months, recurrence occurred in three patients (9.1%). All recurrences occurred exclusively in patients with positive resection margins (20%, 3/15), whereas no recurrence was observed in margin-negative patients (0%, 0/19). Early adverse events occurred in 13 patients (38.2%; bleeding n = 12, pancreatitis n = 3), while late adverse events developed in 4 patients (11.8%; papillary stricture), all of which were managed successfully with endoscopic treatment.
EP is a safe and effective option for small, well-differentiated Amp-NETs without radiologic evidence of LN metastasis. Although the incomplete resection rate is concerning, the absence of recurrence in margin-negative patients supports EP as a viable treatment option in carefully selected cases. Patients with positive margins warrant close surveillance and consideration of additional surgery.
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