Toshio Kuwai

Objectives: Self‐expandable metal stents (SEMSs) are used as a bridge to surgery (BTS) or for palliation (PAL) in malignant colorectal obstruction, but high axial force may contribute to perforation. We prospectively evaluated the efficacy and safety of the low‐axial‐force Naturfit colonic stent in both settings. Methods: This prospective multicenter single‐arm study enrolled 208 patients at 11 Japanese institutions between 2019 and 2022 (BTS, n = 137; PAL, n = 71). The primary endpoint was clinical success of colorectal stenting; secondary endpoints included technical success, adverse events, surgical outcomes after BTS stenting, and 12‐month palliative outcomes. Results: Technical success and clinical success of colorectal stenting were both 99.0%, with perforation in three patients (1.4%). In the BTS cohort, clinical success of BTS was 97.1%; no perforations occurred, and early and late adverse‐event rates were 1.5% and 3.7%. All patients underwent elective surgery; colostomy and laparoscopic surgery rates were 4.4% and 87.6%. In the palliative cohort, clinical success of colorectal stenting was 98.6%, late adverse events occurred in 16.9%, and 12‐month overall survival and stent patency were 46.6% and 67.6%. Conclusions: Naturfit achieved high technical and clinical success of colorectal stenting with a low perforation rate. These findings support its feasibility for malignant colorectal obstruction in both BTS and palliative settings, although comparative studies are needed to determine relative advantages over other SEMSs. Trial Registration: University Hospital Medical Information Network Clinical Trial Registry: UMIN000035224

Objectives: Gel immersion can provide a stable immersion environment during endoscopic mucosal resection (EMR). However, its application in superficial esophageal squamous lesions remains limited. In this study, we evaluated a gel immersion EMR (GI‐EMR) technique in which submucosal injection was intentionally performed before snaring for selected small superficial esophageal squamous lesions. Methods: This single‐center, retrospective case series included consecutive patients who underwent GI‐EMR with submucosal injection for superficial esophageal squamous lesions ≤15 mm in size between January and March 2026. The primary outcome was the histological en bloc resection rate, while secondary outcomes included technical success, endoscopic en bloc resection rate, procedure time, adverse events, and histopathological findings. Results: GI‐EMR with submucosal injection was attempted for 13 lesions, achieving a technical success rate of 92% (12/13). One procedure was discontinued because adequate lifting could not be achieved due to post‐chemoradiotherapy scarring. The endoscopic and histological en bloc resection rates were both 85% (11/13) on an intention‐to‐treat basis. The median procedure time was 4.25 min (range, 2.0–11.0 min). No intraoperative or delayed perforation, post‐procedure bleeding, or gel‐related adverse events occurred. Conclusions: GI‐EMR with submucosal injection was technically feasible for selected superficial esophageal squamous lesions ≤15 mm, with no serious procedure‐related adverse events observed in this small case series. Trial Registration: N/A

Introduction: Hereditary diffuse gastric cancer (HDGC), caused by germline mutations in the CDH1 gene, carries a high risk of diffuse gastric cancer (DGC). In HDGC, gastric cancer lesions are often poorly visible during endoscopy, increasing the likelihood of being missed. We aimed to investigate the clinicopathological characteristics of lesions that were either detected or missed during endoscopic evaluation in patients with HDGC. Methods: We conducted a retrospective review of patients diagnosed with HDGC between January 2017 and October 2024 at five institutions. Patients who underwent prophylactic or therapeutic total gastrectomy with detailed preoperative endoscopic evaluation were included. Results: Among the seven patients diagnosed during the study period, five underwent gastrectomy and were analyzed. Histopathological examination identified 146 lesions, of which 39 (27%) were detected endoscopically. No clinicopathological differences were observed between detected and undetected lesions except for tumor size and anatomical location. Detection was significantly lower in the upper (U) region (1%) than in the middle (M) (81%) and lower (L) (68%) gastric regions (p <0.01). Lesions in the U region were significantly smaller, and even among those ≥4 mm, the detection rate remained substantially lower than that in the M/L regions (17% vs. 95%, p <0.01). Conclusion: Lesions in the U gastric region are particularly challenging to detect endoscopically, especially when they are small. Improved detection may require advancements in high-resolution and image-enhanced endoscopy, AI-assisted image analysis, and optimized observation techniques. These improvements may enable earlier diagnosis and intervention, ultimately leading to better outcomes for patients with HDGC.

Video 1 Gel immersion endoscopic mucosal resection in superficial esophageal cancer. Endoscopic submucosal dissection (ESD) is widely used for the treatment of superficial esophageal cancers in Japan, and endoscopic mucosal resection (EMR) is commonly reserved for small lesions. Conventional EMR techniques, including cap-assisted EMR or the two-channel method, require dedicated accessories.[1] [2] In contrast, gel-immersion EMR (GI-EMR) can be performed without distal attachment; the procedure has demonstrated favorable efficacy and safety in the treatment of gastric and duodenal tumors.[3] [4] However, its use for superficial esophageal cancer, particularly in patients with pharyngoesophageal stenosis, has not been reported. A 71-year-old man with a history of chemoradiotherapy (CRT) for pharyngeal cancer and ESD for esophageal cancer underwent follow-up endoscopy, which revealed a 10-mm type 0-IIa lesion in the mid-thoracic esophagus, considered to be limited to the epithelium and lamina propria mucosa and deemed suitable for endoscopic resection. ESD was attempted but discontinued because the endoscope with a distal attachment could not be advanced due to post-CRT pharyngeal stenosis. Therefore, GI-EMR was performed (Video 1). An EG-840TP endoscope (Fujifilm, Tokyo, Japan) with an outer diameter of 7.9 mm—the largest endoscope that can pass through the stricture—was used. After marking ([Fig. 1a]), gel injection created a clear working space. Following submucosal injection, en bloc resection was performed using a snare ([Fig. 1b and c]). After resection, minor bleeding was noted and successfully controlled using Coagrasper (Olympus, Tokyo, Japan). The total procedure time from marking to hemostasis was 18 minutes. No adverse events were reported. Histopathology showed squamous cell carcinoma confined to the mucosa (pT1a), without lymphovascular invasion and with negative margins, indicative of curative resection ([Fig. 1d]). This case demonstrates that GI-EMR may be a feasible alternative when a standard-diameter endoscope cannot be advanced and ESD or cap-assisted EMR is technically challenging. Endoscopy_UCTN_Code_TTT_1AO_2AG_3AC Received: 09 March 2026 Accepted after revision: 13 May 2026 Article published online: 16 June 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

Objectives: Self‐expandable metallic stents are widely used for malignant colorectal obstruction, and low axial force (AF) stents have been developed to reduce adverse events. The Niti‐S Enteral Colonic Uncovered Stent (MD/BB type) is a new low‐AF stent that maintains a 22 mm outer diameter despite using a 9Fr delivery system. This improves placement performance and reduces adverse events. We aim to evaluate the efficacy and safety of this stent. Methods: In this prospective, multicenter clinical study, we assess the efficacy and safety of the low‐AF Niti‐S MD/BB stent for colonic stenting. Of the 199 consecutive registered patients who underwent colorectal stenting with the Niti‐S MD/BB stents at 12 centers affiliated with the Japan Colonic Stent Safe Procedure Research Group between February 2019 and March 2023, 193 were included for analysis. The primary endpoint was the clinical success rate. The secondary endpoints included technical success and adverse events. Results: The technical success rate was 98.4% (190/193), and the clinical success rate was 95.9% (185/193). In all bridge‐to‐surgery cases, elective surgery was successfully performed as planned, and no perforations were observed. In palliative cases, three perforations occurred. Seven patients required surgery in the subsequent year due to adverse events. The 1‐year stent patency rate in PAL cases was 80.6%. Conclusion: This new low‐AF Niti‐S MD/BB stent demonstrated excellent safety and efficacy, with high technical and clinical success rates and a low incidence of adverse events. Thus, low‐AF stents may be a safe, user‐friendly option for obstructive colorectal cancer.

Introduction: A family history of chronic constipation (CC) is considered an important predisposing factor for developing CC. This study aimed to compare the associations of maternal and paternal histories of CC with constipation in offspring. Methods: Students at Hiroshima University completed a web-based health checkup questionnaire between April and June 2025. Data included baseline characteristics, lifestyle factors, family history of CC, Beck Depression Inventory (BDI), Eating Attitudes Test (EAT)-26, and Bulimic Investigatory Test (BITE). CC was diagnosed using the Rome IV criteria. Multivariate logistic regression analysis was performed to identify associated factors. Results: Among 5,518 participants, both maternal and paternal histories of CC were significantly associated with CC, showing similar strength of association (maternal: odds ratio [OR] = 3.47, 95% confidence interval [CI] = 2.82–4.27; paternal: OR = 3.41, 95% CI = 2.16–5.40; both p < 0.001). Other significant factors included higher EAT-26 score (OR: 4.27, 95% CI: 2.31-7.87, p<0.004), female sex (OR: 2.74, 95% CI: 2.28-3.28, p<0.001), lack of physical exercise (OR: 1.67, 95% CI: 1.40-1.98, p<0.001), and short sleep duration (OR: 1.45, 95% CI: 1.22-1.71, p=0.001). Conclusion: Both maternal and paternal histories of CC were similarly associated with CC. However, this association may be largely driven by unmeasured shared environmental factors and should be interpreted cautiously.

Introduction: Functional constipation (FC) is one of the most prevalent disorders of gut–brain interaction (DGBIs), associated with reduced quality of life and increased morbidity and mortality. Although several studies have examined risk factors in children, research focusing on adult populations is considerably limited. The present study investigated the association between family history and the clinical phenotype of FC using an adult cohort and a standardized constipation scoring system, building on prior population-based findings suggesting familial influences on disease prevalence and severity. Methods: A retrospective multicenter study of adults diagnosed with FC according to the Rome IV criteria was conducted at 9 Japanese centers. Collected data included family history, demographic characteristics, age at symptom onset, modified Constipation Scoring System (mCSS) scores before and after treatment, and prescribed medications, with onset age and mCSS selected to evaluate potential familial associations with earlier disease onset and greater symptom severity. Results: Data from 266 patients were analyzed. A family history was present in 30.1% of patients and was more common in women (34.5%) than in men (22.1%) (OR 1.86, 95% CI 1.04–3.31; p = 0.037). Among the women, a positive family history was associated with earlier onset (median 30 vs. 40 years, p = 0.043) and higher baseline mCSS scores (median 11 vs. 8, p = 0.039), whereas no significant associations were observed in men. Subscore analyses showed higher ratings for “feeling of incomplete evacuation” and “minutes in lavatory per attempt” in women with a family history. Although women with a family history required more medications, treatment response, as measured by improvement in mCSS, was comparable to those without such history. Conclusion: Family history is associated with sex-specific differences in the clinical presentation of FC. This pattern may reflect interactions between genetic susceptibility, hormonal factors, and shared familial environments.