Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society最新文献

Objectives: To develop a procedure that matches magnifying endoscopic images with narrow-band imaging to 3D tissue structures using a tissue-clearing technique and to qualitatively and quantitatively analyze specified structures in gastrointestinal neoplasms.

Methods: Endoscopically resected formalin-fixed paraffin-embedded gastrointestinal tissues (three esophagus, four stomach, seven colon) were made transparent by ethyl cinnamate. They were then subjected to fluorescent staining of nuclei and blood vessels followed by 3D imaging using a confocal laser scanning microscope. A one-to-one correspondence between magnifying endoscopic and 3D reconstructed images was established using vessels and crypts with characteristic shapes as guides, and the depth and caliber of specified vessels were measured.

Results: All tissues were optically cleared, which allowed 3D visualization of vascular structures and nuclei in all layers. In the esophagus, intraepithelial papillary capillary loops and subepithelial capillary networks were identified. In the upper part of the stomach, polygonal subepithelial capillary loops surrounding the pits were observed, while in the lower part, surface epithelium with ridge-like structures and coiled vessels were observed. A honeycomb pit structure and surrounding vascular structures were identified in the colon. Quantitative analysis showed the various contrasts of a single continuous vessel in the endoscopic image were due to different depths at which the vessel tortuously ran.

Conclusion: We established a procedure to allow one-to-one correspondence between magnifying endoscopic and 3D reconstructed images and to measure the depth and caliber of endoscopically visualized vessels of interest. This method is expected to improve endoscopic diagnosis and further the development of endoscopic imaging technologies.

Obesity is a worldwide epidemic and present significant health-care burdens for individuals and health-care systems. Bariatric endoscopy is an evolving field known for benefits including being minimally invasive, reversible, and organ preserving, providing a promising alternative to traditional bariatric surgery. Various endoscopic procedures targeting on the stomach and small bowel have been developed. Amongst all, endoscopic sleeve gastroplasty (ESG) is shown to be more effective, durable, and safe. It utilizes endoscopic suturing device to perform full-thickness plication of gastric wall, thereby restricting stomach volume and altering gastric mobility to induce satiety. Its application was recently addressed by the National Institute for Health Care Excellence (NICE), the American Society for Gastrointestinal Endoscopy (ASGE), the European Society for Gastrointestinal Endoscopy (ESGE), the International Federation for the Surgery of Obesity and Metabolic Diseases (IFSO) and the World Gastroenterology Organization (WGO). This review aims to provide a comprehensive summary of ESG and discusses potential future developments.

Chronic Helicobacter pylori (Hp) infection is the largest etiological factor for gastric cancer, but in recent years the reports of Hp-naïve gastric neoplasms (HpNGNs) have increased as the Hp-infected population in Japan has been declining. The histopathologic spectrum of HpNGNs differs significantly from that of conventional Hp-infected gastric neoplasms. Molecularly, the former harbor considerably fewer genetic and epigenetic abnormalities, reflecting the absence of chronic inflammatory conditions in the gastric mucosa. The majority of HpNGNs fall within several specific histological entities; each arise from particular background mucosa. Most originate from the fundic gland mucosa and have a gastric immunophenotype, as seen in foveolar-type gastric adenoma (FGA), oxyntic gland adenoma (OGA)/gastric adenocarcinoma of fundic gland type (GA-FG), signet-ring cell carcinoma (SRCC), and sporadic fundic gland polyp with dysplasia (FGPD). In contrast, tumors arising from the pyloric or cardiac gland mucosa have a diverse immunophenotype, as seen in intestinal-type gastric dysplasia (IGD) and gastric cardiac carcinoma. FGA, FGPD, SRCC, and IGD are mostly found as small intramucosal lesions. OGA/GA-FG frequently progresses to invasive carcinoma, but only a few have lymph node metastases. Thus, these tumors are regarded as precancerous lesions by Western pathologists, while in Japan they tend to be diagnosed as carcinomas, even in cases of low-grade dysplasia. Gastric cardiac carcinomas, on the other hand, are often found as advanced carcinomas and harbor a high malignant biological potential. A new diagnostic framework for gastric neoplasms is required in the present era of Hp-naïve individuals in Japan.

Objectives: The endoscopic pressure study integrated system (EPSIS) measures intragastric pressure (IGP) during esophagogastroduodenoscopy. Previous research demonstrated that EPSIS correlates with the 24-h impedance-pH (MII-pH) test and shows lower maximum IGP (IGP-Max) and a flatter waveform gradient in gastroesophageal reflux disease (GERD) patients, attributed to lower esophageal sphincter dysfunction. Although endoscopic antireflux therapy (EARTh) is effective for GERD, the MII-pH monitoring, the gold standard for assessing treatment outcomes, requires hospitalization and can be a burden. EPSIS offers a noninvasive alternative for evaluating post-EARTh outcomes. This study aimed to assess EPSIS as an additional diagnostic tool in this context.

Methods: We conducted a retrospective analysis of GERD patients who underwent EARTh and were subsequently assessed using EPSIS within 6 months, from May 2018 to April 2024. Changes in IGP parameters, including IGP-Max and waveform gradient, were analyzed pre- and post-EARTh. Additionally, the study examined Hill's Classification following EARTh.

Results: Out of 39 patients assessed with EPSIS before and after EARTh, the average age was 55 years (standard deviation [SD] 16.7), with 64.1% male. Postoperative IGP-Max increased from 15.2 mmHg to 18.0 mmHg (P = 0.004), and the pressure gradient improved from 0.16 mmHg/s to 0.28 mmHg/s (P < 0.001). Hill's Classification improved significantly from a mean of 2.2 (SD 0.7) to 1.1 (SD 0.3) (P < 0.001).

Conclusion: This study indicates that EPSIS is a reliable diagnostic tool for evaluating the effects of EARTh and holds potential as a supplementary tool for assessing GERD treatment outcomes.

Objectives: We aimed to determine the compliance, safety, and acceptance of colon capsule endoscopy (CCE) and small bowel capsule endoscopy (SBCE) in an out-of-clinic setting remotely supported by medical staff.

Methods: We enrolled 30 examinees (24 with CCE and six with SBCE) who had not undergone CE at six gastroenterological centers. All examinees were provided with instructions on equipment and bowel preparations.

Results: CCE was performed at home (n = 16) or at the workplace (n = 8). Compliance with data-recorder alerts was 100% for bowel preparation and 79% for equipment operation. Total capsule colonoscopy was achieved in 83.3%. The overall adequate endoscopic cleansing rate was 83.3%, and abnormalities, including colorectal polyps, were detected in 37.5%. CCE malfunction, such as the inability to automatically detect the small bowel mucosa occurred in one (4.2%). One experienced mild abdominal pain that required no treatment. Inquiries were present from half of the examinees. The proportions of examinees who desired and refused CCE at the next examination were 67% and 4%, respectively. SBCE was performed at home (n = 4) or at the workplace (n = 2). Compliance with the procedures was 100%. Whole small bowel images were recorded for all examinees. The overall adequate endoscopic clearness rate was 100%. One abnormality was detected. Inquiries were present from half of the examinees. There were no adverse events or malfunctions. The proportion of examinees who reported "quite easy" and "fairly easy" was 66%.

Conclusion: CCE and SBCE with all procedures in the out-of-clinic setting supported by remote consultations were feasible. A multicenter prospective study of the safety and acceptance of capsule endoscopy examinations at home (HomeCam-J study) (jRCTs042220163).

Endoscopic intraductal radiofrequency ablation (ID-RFA) can curatively treat residual intraductal lesions after endoscopic papillectomy. This study aimed to verify the tissue invasiveness of ID-RFA using a novel RF generator and to explore its appropriate settings in an animal experiment, followed by a small clinical study. Pig liver specimens were ablated using a dedicated RF catheter and two RF generators to investigate structural differences between them and the ablation effects produced under various voltage and power settings. Appropriate settings for the novel generator were sought to provide an ablation effect equivalent to that with the recommended settings for a conventional generator. The ablation effect was also observed at various ablation times in vitro. Then we performed ID-RFA in five patients. Each generator has a different structure, and no novel generator settings are identical to the recommended conventional generator settings. Obtaining adequate ablation requires both sufficient power and sufficient voltage. Based on the validation experiments, we concluded that the appropriate novel generator settings were 125 Vp and 30 W for 30 s. In the clinical study, good tumor ablation was obtained with no recurrence after a single ID-RFA treatment, although the incidence of ductal stricture was relatively high. ID-RFA for residual intraductal lesions may potentially be curative. However, excessive ablation should be avoided. To ensure safe and effective ID-RFA, a thorough understanding of the RF generator specifications is required.