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Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder caused by pathogenic variants in TGFBR1 or TGFBR2. It is characterized by vascular fragility, skeletal abnormalities, and predisposition to allergic and inflammatory conditions, including monogenic inflammatory bowel disease (IBD). We report a pediatric case of IBD with a TGFBR2 variant, presenting active colonic inflammation and pseudopolyposis, treated with adalimumab.

At age 7, the patient presented with abdominal pain and bloody stools. Upon referral, colonoscopy demonstrated mucosal fragility, prominent pseudopolyposis, and an anal fissure, accompanied by a skin tag was identified. Genetic analysis revealed a heterozygous TGFBR2 c.1583G>A (p.Arg528His) variant and heterozygous MEFV E148Q and P369S-R408Q variants. Colchicine treatment for suspected familial Mediterranean fever-associated enteritis had a limited effect. Adalimumab treatment was initiated, leading to endoscopic improvement, with resolution of anemia and inflammatory markers in the blood test. This report presents the clinical course and endoscopic features potentially specific to the TGFBR2 c.1583G>A variant, with reference to previously published cases.

Gastroparesis is a chronic gastric motility disorder marked by delayed gastric emptying in the absence of mechanical obstruction. For patients with symptoms refractory to medical and dietary therapy, Gastric Peroral Endoscopic Myotomy (G-POEM) has emerged as a minimally invasive, pylorus-targeted intervention that directly addresses pyloric dysfunction.

Technical success rates consistently exceed 95%, reflecting procedural standardization and a favorable learning curve. Short-term symptom improvement is reported in up to 80% of patients and is often accompanied by enhanced gastric emptying and quality of life (QOL). Long-term outcomes show sustained clinical success of 50%–77.5% at 3–4 years, influenced by disease etiology and neuromuscular progression. Endoluminal functional lumen imaging probe, a functional imaging tool that measures pyloric distensibility, has shown promise in identifying optimal candidates and assessing procedural efficacy, though standardized predictive thresholds are still lacking.

Overall, G-POEM has become a leading pylorus-directed therapy for refractory gastroparesis. Comparative data suggest that G-POEM offers superior clinical efficacy and durability relative to botulinum toxin injection and gastric electrical stimulation, with fewer complications than surgical pyloroplasty.

This review integrates the current clinical evidence supporting G-POEM, with a focus on patient selection, procedural outcomes, QOL, and durability of response. It also examines comparative data with alternative therapies and addresses ongoing areas of controversy, including procedural technique, repeat intervention, and the predictive value of prior pyloric-directed therapies. G-POEM represents a safe and effective treatment modality for appropriately selected patients and continues to shape the landscape of gastroparesis management.

A 62-year-old man underwent partial nephrectomy for right renal cell carcinoma (RCC). Four years later, esophagogastroduodenoscopy revealed gastric mucosal redness with a smooth surface. Two more years later, the red lesion showed a morphological change to a reddish elevation, which prompted a biopsy. Histopathological examination led to the diagnosis of gastric metastasis of RCC. As the tumor resided within the submucosa and no other organ metastasis was found after nephrectomy by that time, endoscopic submucosal dissection (ESD) was performed and successfully resected. No evidence of local recurrence was noted for 7 years after ESD. Topical resection, such as ESD, can be considered an option to treat the gastric metastasis of RCC for which there are no established treatment guidelines. In this case report, we aimed to investigate a rare case of gastric metastasis of RCC, which was monitored endoscopically, showing morphological changes over several years, and was successfully resected by ESD.