Meidong Xu

Background: Esophageal squamous cell carcinoma (ESCC) accounts for approximately 90% of esophageal cancers in China and is associated with poor prognosis. Insensitivity to cisplatin (CDDP) poses a major challenge for ESCC treatment. UDP-glycosyltransferase 8 (UGT8), the sole enzyme responsible for catalyzing the conversion of ceramide to galactosylceramide (GalCer), regulates sphingolipid metabolism; however, its role in ESCC remains unclear. Methods: UGT8 expression and clinical relevance were analyzed using public databases, patient tumor samples, and tissue microarrays. Functional assays were conducted to assess the effects of UGT8 on ESCC cell proliferation, migration, invasion, and apoptosis in vitro, as well as tumor growth and metastasis in vivo. ChIP assays were performed to evaluate ELF4-mediated transcriptional regulation of UGT8. ELISA assays were used to quantify cellular ceramide levels. Flow cytometry was performed to measure apoptosis and surface GalCer expression. The therapeutic efficacy of UGT8 inhibition, alone or in combination with CDDP, was evaluated in preclinical models. Results: UGT8 was significantly upregulated in ESCC and correlated with advanced tumor stage, metastasis, and poor patient survival. UGT8 promoted malignant phenotypes while suppressing apoptosis. Genetic or pharmacological inhibition of UGT8 disrupted sphingolipid homeostasis, characterized by increased ceramide accumulation and reduced GalCer production, leading to enhanced apoptosis and suppressed tumor growth. Importantly, pharmacological targeting of UGT8 with UGT8-IN-1 enhanced the antitumor activity of CDDP in preclinical models. Mechanistically, ELF4 directly transcriptionally activated UGT8 to promote ceramide metabolic remodeling. Conclusions: UGT8 is transcriptionally activated by ELF4 and plays a critical role in driving ESCC progression. Targeting UGT8 may represent a promising translational strategy to sensitize ESCC to chemotherapy and improve therapeutic outcomes.

Achalasia is a rare esophageal motility disorder, and peroral endoscopic myotomy (POEM) is an effective treatment. However, symptom recurrence after POEM poses challenges for clinical management. This study aims to evaluate the short-term efficacy of repeat POEM (re-POEM) in patients with recurrent achalasia. This retrospective study included patients with achalasia who underwent re-POEM at Tongji University Affiliated East Hospital between March 2019 and June 2023. Data were collected on patient characteristics, perioperative details, and symptom assessments, including Eckardt scores (evaluating dysphagia, regurgitation, chest pain, and weight loss), the interval between initial and re-POEM, intraoperative and postoperative complications, and follow-up outcomes. Eight patients (aged 25–76 years, 2 males) underwent re-POEM successfully (including 2 cases of achalasia with concurrent esophageal spasm, and individualized treatment was carried out for these 2 patients, including a long muscle incision). Procedure duration ranged from 39 to 107 minutes. Within 6 months post-procedure, all patients experienced symptom relief. During follow-up, 7 patients maintained an Eckardt score of 0. One patient developed mild dysphagia, which was managed with balloon dilation, and another reported occasional mild acid reflux. Re-POEM appears to be a safe and effective therapeutic option for patients with recurrent achalasia. Patients with concurrent esophageal spasm also need more personalized treatment. These preliminary observations require confirmation in larger studies with longer follow-up.

Background and aims: In recent years, the submucosal tunneling principle underlying Peroral endoscopic myotomy (POEM) has emerged as a minimally invasive endoscopic option for the treatment of esophageal diverticulum (ED). However, evidence regarding its effectiveness across different types of ED remains limited. This study aimed to evaluate the clinical efficacy and safety of endoscopic myotomy for the management of esophageal diverticulum. Methods: This single-center retrospective case series included patients with ED who underwent POEM-based endoscopic myotomy at the East Hospital Affiliated to Tongji University between February 2019 and February 2023. Results: Seven patients (aged 44 to 80 years; four males) were included, comprising three with epiphrenic diverticulum, three with Zenker diverticulum (ZD), and one with mid-esophageal diverticulum. Different subtypes received tailored POEM-based procedures: epiphrenic diverticula underwent D-POEM; two cases with concomitant achalasia received combined POEM and D-POEM; ZD patients underwent z-POEM; and the mid-ED case received tunnel-technique myotomy. All procedures were technically successful, with mean operative times of 84 min (epiphrenic), 23 min (ZD), and 30 min (mid-ED). Intraoperative assessment demonstrated complete flattening of the diverticulum without residual fluid, and no clinical recurrence was documented during a median follow-up of 280 days. Conclusions: POEM-based endoscopic myotomy appears to be a feasible and minimally invasive treatment option for selected patients with ED. In patients with concomitant achalasia, combined POEM and diverticular myotomy may be feasible in selected cases.

INTRODUCTION: Large gastrointestinal stromal tumors (GISTs) exhibiting a predominantly extraluminal growth pattern are characterized by a rich vascular supply and close proximity to adjacent organs, which pose significant challenges for endoscopic full-thickness resection. The aim of this study was to evaluate the feasibility and therapeutic outcomes of reverse endoscopic full-thickness resection (R-EFTR) for gastric GISTs with a predominantly extraluminal growth pattern. METHODS: We conducted a retrospective analysis of 43 consecutive patients who underwent R-EFTR for gastric GISTs exhibiting a predominant extraluminal growth pattern between March 2019 and December 2024. Data on clinicopathologic characteristics, surgical parameters, and follow-up outcomes were collected and analyzed. RESULTS: Tumor sizes ranged from 2.0 to 5.0 cm, and en bloc resection by R-EFTR was successfully achieved in 41 tumors (95.3%). Notably, tumors larger than 3 cm significantly prolonged operative times ( P < 0.001). Successful closure of gastric wall defects was accomplished using through-the-scope twin clips in 41.9% of cases, while 58.1% were closed using endoloop clips. Closure with endoloop clips was associated with longer procedure time ( P = 0.037). The postoperative follow-up completion rate was 100%, achieved through clinic visits combined with endoscopic ultrasound and computed tomography. During the follow-up period, no patients experienced recurrence or metastasis. DISCUSSION: The findings of our study suggest that R-EFTR is a viable and effective treatment option for GISTs that exhibit a predominantly extraluminal growth pattern and measure between 2 and 5 cm. Tumor size greater than 3 cm was associated with increased procedural complexity, whereas the association with endoloop-clip closure should be interpreted cautiously.

Objectives: The universal adoption of endoscopic submucosal dissection (ESD) is limited by its technical demands, slow learning curve, long procedure time, and high risks of bleeding, muscular layer injury, and perforation. We developed the submucosal pressure ejection endoscopic dissection (SPEED) technique that combines pressure injection, incision, dissection, and coagulation and avoids frequent device exchange during ESD. We aimed to introduce this novel SPEED strategy and evaluate its therapeutic advantages for superficial gastrointestinal neoplasms. Methods: Altogether 985 patients who underwent ESD for early gastrointestinal tumors between January 2020 and April 2024 were included and divided into the SPEED group and the conventional ESD group. Clinical outcomes, including en bloc and R0 resection rates, resection time, intraprocedural application of hemostatic forceps, procedure‐related adverse events, and local recurrence, were evaluated. Results: SPEED achieved en bloc and R0 resection rates of 99.85% and 99.40%, respectively. Compared with conventional ESD, SPEED was associated with a shorter median resection time (33 min vs. 57 min), less frequent intraprocedural application of hemostatic forceps (2.71% vs. 19.25%), a lower intraprocedural perforation rate (0.15% vs. 2.48%), and a lower post‐procedure hemorrhage rate (1.51% vs. 5.90%). Conclusions: With the additional high‐pressure injection, the SPEED technique greatly improves ESD efficiency and ensures a clearer visual field during ESD, thereby reducing risk of complications. It efficiently improves the speed and safety of dissection during ESD.

We reported a rare case of submucosal lesion of the duodenum in a 68-year-old male. It was accidentally found during an abdominal MRI examination. Further evaluation with gastroduodenoscopy revealed a 2 cm mass in the duodenal bulb. EUS identified a hypoechoic mass with a hyperechoic region inside, originating from the muscular layer, with poorly defined borders relative to the surrounding tissues. Following resection via endoscopic full-thickness resection (EFTR), pathological examination confirmed adenocarcinoma infiltrating the muscular layer, with chronic schistosomiasis.

Background and Aim: Transcolonic endoscopic appendectomy is an emerging minimally invasive alternative to traditional appendectomy, offering potential benefits such as reduced postoperative pain, faster recovery, and avoidance of external incisions. The variable anatomical location of the appendix, however, influences both the surgical approach and technical difficulty. The appendiceal stump—defined as the residual portion of the appendix after prior appendectomy—poses a unique challenge, as the main body of the appendix has already been removed. This study aimed to evaluate the feasibility, safety, and efficacy of transcolonic endoscopic appendectomy for the removal of appendiceal stump lesions. Methods: This retrospective study included patients who underwent the procedure between December 2020 and December 2024 after prior appendectomy for appendiceal remnant lesions. The primary outcome was technical success; secondary outcomes included postoperative complications, hospital stay, and recurrence. Results: Nine patients (mean age 60.7 years; 4 males, 5 females) were included. Lesion size averaged 1.34 cm. Complete en bloc resection was achieved in all cases. Mean operative time was 70 min, with fasting and hospitalization durations of 3.4 and 5.8 days, respectively. No postoperative complications occurred, and 3‐month colonoscopy showed no residual lesions or recurrence. Conclusions: Transcolonic endoscopic appendectomy for appendiceal stump lesions is a safe and effective minimally invasive treatment option within experienced endoscopic centers. Due to their anatomical simplicity, these lesions represent a straightforward indication, making the procedure suitable as an entry‐level application for endoscopists. Further investigation and structured training programs are warranted to assess long‐term outcomes and broaden the generalizability of this technique.

A 55-year-old female breast cancer patient underwent routine follow-up abdominal computed tomography, which revealed a dense shadow in the gastric antrum that had penetrated the gastric wall ([Fig. 1] a). She has no discomfort symptoms. Routine blood tests upon admission showed normal levels of inflammatory markers, including white blood cells, C-reactive protein, and procalcitonin. She received endoscopic treatment in our center. We found a cord-like submucosal protrusion with a smooth surface in the antrum of the stomach ([Fig. 1] b). Mini-probe endoscopic ultrasonography (EUS) detected a hyperechoic linear structure extending outward from the cavity ([Fig. 1] c). Given that foreign bodies may lead to serious complications [1], endoscopic treatment was performed ([Video 1]). After layer-by-layer dissection along the raised area to the muscularis propria, a translucent, needle-like foreign body was exposed at one end, surrounded by inflammatory granulation tissues ([Fig. 1] d). Attempts to remove the foreign body with foreign forceps were unsuccessful. Subsequently, further dissection and compression of the surrounding tissues were performed, ultimately successfully extracting the foreign body, and the wound was closed with endoscopic clips ([Fig. 1] e). After removal, the foreign body was identified as a fishbone measuring approximately 2.0 cm ([Fig. 1] f). The patient had an uneventful recovery, initiated a clear liquid diet on postoperative day 1, and was discharged on day 2. Extraluminal migration of the fishbone in the gaster is a rare complication, and cases where the fishbone cannot be visualized endoscopically are even rarer. Here, EUS localization and endoscopic submucosal dissection were combined to remove the foreign body, providing an effective therapeutic paradigm for endoscopic extracorporeal foreign body extraction. Endoscopy_UCTN_Code_TTT_1AO_2AB Article published online: 26 March 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany