Gastric subepithelial lesions (SELs) < 20 mm are frequently identified during routine endoscopy and account for approximately 90% of all SELs. Although most are benign, a substantial proportion represents gastrointestinal stromal tumors (GISTs), which carry malignant potential even at this small size. Histological confirmation is critical for appropriate risk assessment and treatment planning. However, the diagnostic yield of endoscopic ultrasound-guided tissue acquisition (EUS-TA) is limited for SELs < 20 mm due to technical challenges such as lesion mobility and short needle stroke. Mucosal incision-assisted biopsy (MIAB), which enables direct visualization and targeted sampling, has emerged as a practical alternative. This narrative review summarizes current evidence on endoscopic diagnostic approaches for SELs < 20 mm, including both sampling methods (EUS-TA, MIAB) and nonsampling techniques such as contrast-enhanced EUS, elastography, and artificial intelligence (AI)-assisted image analysis. Each modality has distinct advantages and limitations, and selection should be based on lesion characteristics, endoscopist experience, and resource availability. Nonsampling modalities offer complementary information and are expected to become increasingly relevant. A comprehensive understanding of available diagnostic techniques is essential to support accurate clinical decision-making for SELs < 20 mm.
胃上皮下病变（SELs）
{"title":"Endoscopic Diagnosis of Gastric Subepithelial Lesions < 20 mm: Current Strategies and Emerging Solutions.","authors":"Yosuke Minoda, Shuzaburo Nagatomo, Haruei Ogino, Nao Fujimori, Eikichi Ihara","doi":"10.1111/den.70079","DOIUrl":"10.1111/den.70079","url":null,"abstract":"<p><p>Gastric subepithelial lesions (SELs) < 20 mm are frequently identified during routine endoscopy and account for approximately 90% of all SELs. Although most are benign, a substantial proportion represents gastrointestinal stromal tumors (GISTs), which carry malignant potential even at this small size. Histological confirmation is critical for appropriate risk assessment and treatment planning. However, the diagnostic yield of endoscopic ultrasound-guided tissue acquisition (EUS-TA) is limited for SELs < 20 mm due to technical challenges such as lesion mobility and short needle stroke. Mucosal incision-assisted biopsy (MIAB), which enables direct visualization and targeted sampling, has emerged as a practical alternative. This narrative review summarizes current evidence on endoscopic diagnostic approaches for SELs < 20 mm, including both sampling methods (EUS-TA, MIAB) and nonsampling techniques such as contrast-enhanced EUS, elastography, and artificial intelligence (AI)-assisted image analysis. Each modality has distinct advantages and limitations, and selection should be based on lesion characteristics, endoscopist experience, and resource availability. Nonsampling modalities offer complementary information and are expected to become increasingly relevant. A comprehensive understanding of available diagnostic techniques is essential to support accurate clinical decision-making for SELs < 20 mm.</p>","PeriodicalId":72813,"journal":{"name":"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society","volume":"38 1","pages":"e70079"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond Helicobacter pylori Eradication: Endoscopic Surveillance of the Post-Eradication Stomach.","authors":"Tatsunori Satoh","doi":"10.1111/den.70101","DOIUrl":"https://doi.org/10.1111/den.70101","url":null,"abstract":"","PeriodicalId":72813,"journal":{"name":"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society","volume":"38 1","pages":"e70101"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Interpreting the Gastric Atrophy-ESCC Association: Avoiding Causal Overreach and Advancing Mechanistic Insights.","authors":"Jae Yong Park","doi":"10.1111/den.70103","DOIUrl":"https://doi.org/10.1111/den.70103","url":null,"abstract":"","PeriodicalId":72813,"journal":{"name":"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society","volume":"38 1","pages":"e70103"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neovaginal Diversion Colitis Successfully Treated With Mesalazine Suppositories: Endoscopic Documentation of Healing.","authors":"Shinichiro Kawatoko, Marimo Mori, Junji Umeno","doi":"10.1111/den.70100","DOIUrl":"10.1111/den.70100","url":null,"abstract":"","PeriodicalId":72813,"journal":{"name":"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society","volume":"38 1","pages":"e70100"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12802533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chang Rong, Yulong Liu, Jing Hu, Ting Cheng, Zhipeng Tai, Shuai Li, Yi Shen, Bo Zhang, Yankun Gao, Xiaoming Zheng, Kaicai Liu, Mingzhai Sun, Xingwang Wu
Background: The early prediction of secondary loss of response (SLOR) after infliximab (IFX) treatment in Crohn's disease (CD) patients can help optimize treatment strategies. This study developed and validated a multimodal deep learning model that uses baseline endoscopic ulcer lesions to predict SLOR. Additionally, a deep learning-based ulcer detection model was established to automatically identify ulcer lesions.
Methods: A total of 385 CD patients from three centers were retrospectively analyzed. An ulcer detection model was developed to identify endoscopic ulcer lesions from 12,092 endoscopic images. Following lesion localization, 2189 ulcer images were selected and used to train feature fusion models, while clinical data were incorporated to construct a multimodal model for SLOR prediction. These models were validated in two external test cohorts.
Results: The ulcer detection model achieved precision values of 0.853 in the validation cohort. The multimodal model outperformed the clinical model in predicting SLOR with areas under the ROC curve (AUCs) of 0.892, 0.847, and 0.824 in the internal validation cohort, external test cohort 1, and external test cohort 2, respectively. Gradient-weighted class activation mapping (Grad-CAMs) revealed highly pronounced activation of the ulcerated area in SLOR patients in the model, providing crucial support for model prediction.
Conclusions: The ulcer detection model effectively identifies ulcer lesions, increasing diagnostic efficiency. The multimodal model, which integrates baseline endoscopic images and clinical data, offers a potential tool for early SLOR prediction.
{"title":"A Multimodal Feature Fusion Model for Predicting Secondary Loss of Response After Infliximab Treatment in Crohn's Disease Patients: A Multicenter Study.","authors":"Chang Rong, Yulong Liu, Jing Hu, Ting Cheng, Zhipeng Tai, Shuai Li, Yi Shen, Bo Zhang, Yankun Gao, Xiaoming Zheng, Kaicai Liu, Mingzhai Sun, Xingwang Wu","doi":"10.1111/den.70097","DOIUrl":"10.1111/den.70097","url":null,"abstract":"<p><strong>Background: </strong>The early prediction of secondary loss of response (SLOR) after infliximab (IFX) treatment in Crohn's disease (CD) patients can help optimize treatment strategies. This study developed and validated a multimodal deep learning model that uses baseline endoscopic ulcer lesions to predict SLOR. Additionally, a deep learning-based ulcer detection model was established to automatically identify ulcer lesions.</p><p><strong>Methods: </strong>A total of 385 CD patients from three centers were retrospectively analyzed. An ulcer detection model was developed to identify endoscopic ulcer lesions from 12,092 endoscopic images. Following lesion localization, 2189 ulcer images were selected and used to train feature fusion models, while clinical data were incorporated to construct a multimodal model for SLOR prediction. These models were validated in two external test cohorts.</p><p><strong>Results: </strong>The ulcer detection model achieved precision values of 0.853 in the validation cohort. The multimodal model outperformed the clinical model in predicting SLOR with areas under the ROC curve (AUCs) of 0.892, 0.847, and 0.824 in the internal validation cohort, external test cohort 1, and external test cohort 2, respectively. Gradient-weighted class activation mapping (Grad-CAMs) revealed highly pronounced activation of the ulcerated area in SLOR patients in the model, providing crucial support for model prediction.</p><p><strong>Conclusions: </strong>The ulcer detection model effectively identifies ulcer lesions, increasing diagnostic efficiency. The multimodal model, which integrates baseline endoscopic images and clinical data, offers a potential tool for early SLOR prediction.</p>","PeriodicalId":72813,"journal":{"name":"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society","volume":"38 1","pages":"e70097"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Partial Injection Underwater Endoscopic Mucosal Resection for a Colorectal Flat Lesion.","authors":"Hidenori Kimura, Kazuo Shiotsuki, Takuji Iwashita","doi":"10.1111/den.70095","DOIUrl":"10.1111/den.70095","url":null,"abstract":"","PeriodicalId":72813,"journal":{"name":"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society","volume":"38 1","pages":"e70095"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comment on: \"The One-Minute Triple Stretch Reduces Musculoskeletal Discomfort in Endoscopic Assistants: A Crossover Trial With Motion Analysis\".","authors":"Shyam Sundar Sah, Abhishek Kumbhalwar","doi":"10.1111/den.70092","DOIUrl":"10.1111/den.70092","url":null,"abstract":"","PeriodicalId":72813,"journal":{"name":"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society","volume":"38 1","pages":"e70092"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"High Incidence of Metachronous Lesions After Endoscopic Removal in Patients With Ulcerative Colitis: Results of a Long-Term Follow-Up in Multicenter Registry Study.","authors":"Shunichi Yanai, Tadakazu Hisamatsu, Takayuki Matsumoto","doi":"10.1111/den.70087","DOIUrl":"10.1111/den.70087","url":null,"abstract":"","PeriodicalId":72813,"journal":{"name":"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society","volume":"38 1","pages":"e70087"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Traction-assisted closure technique for peroral endoscopic myotomy. Watch a video of this article.
牵引辅助封闭技术用于经口内窥镜下肌切开术。观看本文的视频。
{"title":"Traction-Assisted Closure Technique for Peroral Endoscopic Myotomy.","authors":"Hiroki Fukuya, Yoshitaka Hata, Eikichi Ihara","doi":"10.1111/den.70084","DOIUrl":"10.1111/den.70084","url":null,"abstract":"<p><p>Traction-assisted closure technique for peroral endoscopic myotomy. Watch a video of this article.</p>","PeriodicalId":72813,"journal":{"name":"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society","volume":"38 1","pages":"e70084"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01Epub Date: 2025-04-14DOI: 10.1111/den.15037
Satoshi Ono, Chinari Tanaka, Mitsuhiro Fujishiro
{"title":"Loop-assisted reopenable clip-over-the-line method as a modified closure method for a mucosal defect after gastric endoscopy submucosal dissection.","authors":"Satoshi Ono, Chinari Tanaka, Mitsuhiro Fujishiro","doi":"10.1111/den.15037","DOIUrl":"10.1111/den.15037","url":null,"abstract":"","PeriodicalId":72813,"journal":{"name":"Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society","volume":" ","pages":"893-894"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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