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A newly developed articulated through-the-scope traction device, TRACMOTION, has been used clinically for endoscopic submucosal dissection (ESD). However, there are few reports on the characteristics of this device and the lesion types for which it is most effective. Therefore, we evaluated its optimal use, efficacy, and safety clinically in animals. Subsequently, we confirmed the safety and efficacy of ESD using this device in humans. Two live swine were used; one underwent conventional ESD (C-ESD) and the other traction-assisted ESD (T-ESD). To examine the traction effect at each resection site, three ESD ulcers (greater curvature/anterior wall/posterior wall) with a diameter of approximately 40 mm were created in each swine. Based on our preliminary experiments, scissor-type and needle-type knives were used in the T-ESD and C-ESD groups, respectively. The primary endpoint was the resection speed, and the secondary endpoint was the degree of muscle layer damage. T-ESD was faster than C-ESD on the posterior wall, similar to the greater curvature, and T-ESD was slower than C-ESD on the anterior wall. There were no cases of intraoperative perforations. Obvious muscle layer damage was observed in post-C-ESD wounds on the anterior wall. The submucosal layer was retained in all post-T-ESD wounds. Although this study showed that ESD with TRACMOTION may be safe and effective, it is necessary to consider that it may be unsuitable for some lesions. This may be due to device characteristics and requires further validation.

Upper gastrointestinal stenosis, which can be congenital or acquired, can lead to dysphagia. The association between trisomy 17p syndrome, a rare chromosomal abnormality, and upper gastrointestinal stenosis is unclear. A 20-year-old man diagnosed with trisomy 17p syndrome was referred to our department due to recurrent vomiting. Esophagogastroduodenoscopy revealed stenotic areas in the esophagus, stomach, and duodenum. The congenital gastrointestinal stenosis present in both the duodenum and esophagus suggested that the stasis and reflux of digestive fluids exacerbated stenosis in the stomach and esophagus. Gastric acid suppression therapy and endoscopic dilation of the esophagus and duodenum effectively resolved the patient's vomiting symptoms.

Vonoprazan is a novel acid blocker with greater potency than proton pump inhibitors. A Japanese study reported no significant safety concerns over 5 years of Vonoprazan use; however, elevated serum gastrin and increased parietal cell and foveolar hyperplasia were observed, and long-term safety data beyond 5 years are limited. We report a case that used Vonoprazan for 6 years, complicated by significant gastric epithelial changes during treatment and acute duodenal mucosal lesions following its discontinuation. A 76-year-old, treated with proton pump inhibitors for over 10 years, was switched to Vonoprazan due to his worsening symptoms. After its use, hemorrhagic hyperplastic polyps became prominent. Given concerns about Vonoprazan's effect on the gastric epithelium, the medication was changed to high-dose H2 blocker therapy. Two months later, the patient complained of vomiting and black tarry stools. Esophagogastroduodenoscopy revealed a significant reduction of gastric polyps but multiple erosions and ulcers in the duodenum. This case indicates the potent effects of Vonoprazan on the gastric mucosa and the risk of severe rebound acid hypersecretion after its long-term use.

Small-bowel diverticulosis is relatively common, but there is no set treatment strategy for duodenal diverticulitis with stone impaction. A woman aged in her 70s presented with a chief complaint of abdominal pain, and she had been reconstructed by the Roux-en-Y method after total gastrectomy. We performed an enhanced computed tomography which revealed edematous wall thickening of the duodenum. We diagnosed her with duodenal diverticulitis and treated them with antibiotics but her disease was not cured, we therefore attempted endoscopic stone removal as a nonoperative treatment. After stone removal with a nonoperative procedure, when we contrasted the duodenal papillary diverticulum, it was found to form a fistula on the other side, and the successful treatment made her discharged on the 17th day. The duodenal diverticulitis with calculus is extremely rare, and there is no report to treat it using double-balloon endoscopy, therefore we report this case with a literature review.

A 75-year-old man presented with hematochezia. He had been diagnosed with prostate cancer (stage 1) 1 month previously and had undergone gold marker injection and hydrogel spacer insertion 3 weeks previously to prepare for radiotherapy. Hydrogel spacer insertion is a safe procedure that can prevent the side effects of radiotherapy for prostate cancer. A computed tomography evaluation identified a low-density area that extended from the prostate to the rectal wall. Magnetic resonance imaging of the abdomen revealed the hydrogel spacer between the anterior rectal wall and prostate. A colonoscopy revealed an approximately 2 cm ulcer in the rectum. The patient was diagnosed with a rectal ulcer with bleeding caused by hydrogel spacer insertion. Conservative follow-up was performed, and his condition improved over time. Radiotherapy for prostate cancer was initiated 4 months after hydrogel spacer insertion. The patient has not experienced any abdominal symptoms such as bloody stools since that time. Because the incidence of prostate cancer is increasing, the number of such cases is likely to increase in the future.