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Immunoglobulin G4 (IgG4)-related disease (RD) is a systemic fibroinflammatory condition characterized by infiltration of IgG4-positive plasma cells (PCs). Gastrointestinal involvement may present as submucosal tumor–like lesions and poses diagnostic challenges. We report a case of a 59-year-old man with gastric submucosal tumor–like lesions detected during routine screening. Endoscopic submucosal dissection (ESD) was used for the diagnosis and treatment. A histopathological examination revealed abundant IgG4-positive PC infiltration in the submucosa; however, these findings did not fulfill the comprehensive diagnostic criteria for IgG4-RD. IgG4-RD–like gastric lesions can mimic submucosal tumors. ESD may provide diagnostic and therapeutic benefits when a conventional biopsy is insufficient. Cautious interpretation of IgG4-positive PC infiltration in gastrointestinal specimens is required.

Delayed perforation after gastric endoscopic mucosal resection (EMR) is a rare but serious complication that can lead to intra-abdominal abscess (IAA) formation. Efficacy of endoscopic ultrasound (EUS)-guided drainage for IAA remains to be elucidated. A man in his 50s was admitted for EMR of hyperplastic polyps located in the gastric body. The procedure was performed uneventfully; however, on postoperative day (POD) 4, the patient developed a sudden fever accompanied by an elevation in inflammatory markers. Abdominal computed tomography (CT) revealed a localized area of increased fat attenuation, leading to a diagnosis of delayed perforation. The patient's condition temporarily improved with conservative therapy; however, fever and elevated inflammatory markers recurred on POD 17. CT demonstrated IAA requiring drainage. On POD 22, EUS-guided transgastric drainage was performed using a nasobiliary drainage tube and double-pigtail stent. After drainage, fever and inflammatory markers promptly alleviated; follow-up CT demonstrated shrinkage of the abscess cavity. The clinical course was uneventful. EUS-guided transgastric drainage could be a safe and effective therapeutic option for IAA secondary to delayed perforation after gastric EMR, particularly when conservative therapy fails and percutaneous drainage is not feasible.

Rectal arteriovenous malformations (AVMs) are rare vascular anomalies that pose diagnostic challenges because they may resemble submucosal tumor–like lesions. A 54-year-old man presented with recurrent hematochezia, and a colonoscopy revealed a protruding lesion near the dentate line. Contrast-enhanced computed tomography and angiography confirmed a rectal AVM classified as Cho type IIIb/Yakes type II. Transcatheter arterial embolization with N-butyl-2-cyanoacrylate–Lipiodol (NL) was performed. A rectal ulcer that developed 2 weeks after treatment was successfully managed with topical hydrocortisone. Follow-up colonoscopy demonstrated progressive lesion regression without recurrence at 3 years. This case underscores that rectal AVMs may mimic submucosal tumors and require a multimodal diagnostic approach. Transcatheter arterial embolization with NL represents an effective therapeutic option.

Malakoplakia is a rare chronic granulomatous disease associated with impaired macrophage phagocytosis of bacteria. Because colonic malakoplakia presents with varied endoscopic appearances, its characteristic features have not been clearly defined, and differentiation from colorectal neoplasms during endoscopy may be difficult. We report a case of colonic malakoplakia with adenomatous features evaluated using magnifying narrow-band imaging (NBI). A patient receiving hemodialysis and corticosteroid therapy for immunoglobulin A nephropathy underwent total colonoscopy after a positive fecal immunochemical test. Two reddish polyps were identified in the ascending colon. Magnifying NBI showed either absent or regular surface patterns with fine, thread-like vessels, along with areas resembling adenomatous changes. Although malignant features were not observed, a definitive diagnosis could not be established endoscopically. Consequently, both lesions were resected using cold snare polypectomy. Histopathological examination revealed a granulation tissue-like inflammatory lesion composed of histiocytes containing Michaelis–Gutmann bodies in the lamina propria and submucosa, leading to a diagnosis of malakoplakia. Based on this diagnosis, a surveillance colonoscopy was scheduled for 1 year later.

Prophylactic percutaneous endoscopic gastrostomy (PEG) placement for nutritional management prior to chemoradiotherapy is a common procedure in patients with head and neck cancer, for which serious complications are rare. Herein, we present a case of abdominal wall abscess that developed 12 days following prophylactic PEG placement in a patient with laryngeal cancer. This rare complication was initially difficult to diagnose due to subtle abdominal symptoms. In this case, antibiotic treatment alone was inadequate, necessitating drainage tube insertion. This case highlights that delayed diagnosis can lead to necrotizing fasciitis, a potentially fatal condition that should be considered in the differential diagnosis.

Gastric peroral endoscopic tunneled stricturotomy (G-POETS) has emerged as a novel procedure to treat post-sleeve gastrectomy stenosis. We present a case series highlighting the use of G-POETS to treat sleeve stenosis. Clinical success was assessed using the Dakkak-Bennett Dysphagia Score and the Gastroparesis Cardinal Symptom Index. Clinical success was observed in five out of six patients. No adverse events occurred due to G-POETS. The first literature review on the use of G-POETS for sleeve stenosis was performed.