Sayo Ito

Background: Colorectal cancer can be cured by minimally invasive therapies such as endoscopic or surgical treatment if detected at an early stage, and it is important to increase the number of cases detected as early as possible in terms of medical cost-effectiveness. The purpose of this article was to comprehensively review the current status of endoscopic diagnosis and management of early colorectal neoplasia from a Japanese perspective. Summary: Regarding diagnosis, qualitative diagnosis and depth diagnosis using advanced endoscopic imaging such as narrow-band imaging (NBI) and chromoendoscopy are important to determine the treatment strategy. As for endoscopic treatment, it is fundamental to select the appropriate treatment method according to lesion size and morphology, and the use of modified endoscopic resection for intermediate-sized lesions and endoscopic submucosal dissection for large lesions is an issue for the future. Conclusions: This narrative review article summarizes the current status of endoscopic diagnosis and treatment in Japan in comparison with Europe and the United States. In particular, we discuss the determination of treatment strategies based on detailed endoscopic diagnoses, advances in modified endoscopic mucosal resection (EMR) for intermediate-sized lesions, and the fact that, as a country that pioneered endoscopic submucosal dissection (ESD), Japan has a broader range of indications compared to Europe and the United States.

Endoscopic resection of proximal colonic lesions located behind the flexure is challenging because poor visualization of the oral side of the lesion makes it difficult to capture the entire lesion. Water immersion improves scope maneuverability and alleviates luminal angulation by reducing luminal distension [1]. Thus, underwater endoscopic mucosal resection (UEMR) could be effective for poorly visualized polyps such as orifice- or diverticular-related polyps [2] [3]. Nevertheless, suboptimal visualization of proximal margins in the deflated lumen would hamper assured snaring in UEMR [4]. We present a case of successful en bloc resection using tip-in UEMR of a proximal colonic lesion with poor visualization due to the location behind the flexure ([Fig. 1]). A 68-year-old man was referred with a protruded lesion of 19 mm in size at the hepatic flexure. As the lesion was diagnosed as an adenoma, UEMR was attempted to improve scope maneuverability and its visualization. However, poor visualization of the oral side of the lesion did not ensure snare capturing of the entire lesion. To assure proximal margin, a spot-shaped mucosal incision at the proximal site of the lesion was made with a snare tip using a cut current ([Fig. 2]), and the lesion was within the snare ([Fig. 3]). Stable snare manipulation owing to an anchored tip could achieve en bloc resection without adverse events ([Fig. 4], [Video 1]). Histopathological examination revealed high-grade dysplasia ([Fig. 5]). In this case, tip-in UEMR has several advantages. First, reduced luminal distension could improve scope maneuverability and flexure angulation. Second, the tip-in maneuver could assure proximal margins even in poor visualization. Third, the anchoring snare tip could secure the snare capturing even where scope maneuverability was poor. This case suggests that tip-in UEMR is an effective technique for polyps with poor visualization and scope maneuverability. Endoscopy_UCTN_Code_TTT_1AQ_2AD_3AC Article published online: 20 January 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

We present the case of a 53-year-old man who was referred after fecal immunochemical test-positive colonoscopy revealing a polyp in the appendiceal orifice (AO). In our initial examination, the polyp could not be visualized with air insufflation or water immersion ([Fig. 1]), even with traction using biopsy forceps. A repeat colonoscopy 3 months later failed to expose the lesion, even with traction using a multi-loop traction device (Boston Scientific Co. Ltd, Tokyo, Japan). Subsequently, a non-traumatic tube was carefully inserted into the appendiceal lumen ([Fig. 2]). Continuous water infusion through the tube generated hydraulic pressure that extruded the polyp into the cecal lumen, thus permitting stable visualization ([Fig. 3]). The lesion appeared pedunculated with a 10-mm head. Magnifying narrow band imaging revealed Japan NBI Expert Team classification Type 2A, consistent with adenoma. After placement of a hemostatic clip at the stalk base, en bloc resection was performed using underwater endoscopic mucosal resection. Complete resection was confirmed endoscopically and additional prophylactic clips were applied ([Fig. 4]). The procedure was completed without any adverse events. Histopathological examination revealed a tubular adenoma with negative margins ([Fig. 5]). Polyps at the AO often require surgery because of difficulties in visualization and access [1]. To the best of our knowledge, this is the first report of targeted water infusion into the appendix via a non-traumatic tube to expose an AO polyp and enable safe resection using standard tools ([Video 1]). The safety of appendiceal intubation and irrigation is supported by reports of endoscopic retrograde appendicitis therapy [2] [3]. This simple and reproducible maneuver may expand endoscopic options and help avoid surgery for AO polyps. Endoscopy_UCTN_Code_TTT_1AQ_2AD_3AB Article published online: 13 January 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

Background and Aims: Patients with autoimmune pancreatitis (AIP) sometimes show characteristic ophthalmologic findings, such as dacryoadenitis and dry eye. However, the ocular findings in AIP patients thus far have not fully been analyzed, especially in patients treated long term with corticosteroids (CS). We aimed to study the current and previous history of ocular diseases in AIP patients and changes of the common ophthalmologic findings during the CS treatment. Methods: We retrospectively analyzed the history of ophthalmologic diseases in 105 AIP patients and further examined the changes in the ophthalmologic findings and associated factors occurring during CS treatment in 63 patients. Results: Several common ophthalmic diseases, including cataract (33.3%) and glaucoma (6.3%), were recognized in approximately one-third of the AIP patients at their initial diagnosis. Behcet uveitis was seen in the past histories of two AIP patients. During 70 months of CS treatment, exacerbation of cataract was recognized in 31.7%, and new onset of glaucoma in 7.9%. Univariate and multivariate analyses demonstrated the cumulative CS amount as a significant risk of cataract exacerbation (p<0.05) and diffuse pancreatic swelling at the initial diagnosis as a risk of Mikulicz’s disease (p<0.01). Conclusions: An ophthalmologic check at the initial diagnosis and monitoring during CS treatment is required for patients with AIP. Promising steroid-sparing agents are expected to lessen the adverse ophthalmologic events caused by CS.

Background and Aim: The insulated‐tip (IT) knife nano is a high‐frequency electrosurgical knife designed to enhance the safety and efficiency of endoscopic submucosal dissection (ESD), particularly in anatomically narrow lumens such as the colorectum. Although it is commonly used in combination with needle knives for colorectal ESD, its efficacy in this context has not been substantiated through randomized controlled trials (RCTs). We aimed to evaluate whether the adjunctive use of the ITknife nano significantly reduces ESD procedure time for colorectal neoplasms. Methods: A single‐center RCT involving patients with colorectal neoplasms measuring 30–50 mm was randomized to receive ESD with either the DualKnife J alone (D‐group) or the addition of the ITknife nano (IT‐group). Allocation adjustment factors included lesion location, tumor size, and macroscopic type. The primary outcome was the ESD procedure time. Secondary outcomes included submucosal dissection speed, en bloc and R0 resection rate, and incidence of adverse events. Results: A total of 108 and 106 lesions in the D‐ and IT‐groups, respectively, were analyzed. There was no significant difference in procedure time between groups (111.8 min vs. 114.3 min, p = 0.789) nor in submucosal dissection speed (22.9 mm ² /min vs. 22.1 mm ² /min, p = 0.669). However, subgroup analysis on allocation factors revealed significantly faster dissection speed for rectum lesions in the D‐group (24.7 mm ² /min vs. 16.2 mm ² /min, p = 0.0496). Resection and safety outcomes were comparable between groups. Conclusions: The adjunctive use of the ITknife nano with the DualKnife J did not significantly reduce procedure time in colorectal ESD (jRCT1042180137). Trial Registration: University Hospital Medical Network Clinical Trials Registry: UMIN000030068; Japan Registry of Clinical Trials: jRCT1042180137

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We are grateful to the authors of the Letter to the Editor for their thoughtful and constructive comments regarding our recent article, “Benefits of macroscopic on-site evaluation in endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling. ” We appreciate this opportunity to respond to the points raised, which we address below. Our study primarily aimed to identify an optimal specimen collection method for FoundationOne CDx (F1CDx) using endoscopic ultrasound-guided tissue acquisition (EUS-TA), ensuring sufficient material for comprehensive genomic profiling. Received: 13 July 2025 Accepted: 01 August 2025 Article published online: 14 August 2025 © 2025. 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

Matched therapy based on comprehensive genomic profiling is a potential treatment option for patients with inoperable pancreatic cancer; however, the optimal method for obtaining tissue samples suitable for comprehensive genomic profiling using endoscopic ultrasound-guided tissue acquisition remains unclear. This study aimed to determine the optimal endoscopic ultrasound-guided tissue acquisition method to obtain samples for comprehensive genomic profiling.This retrospective study included 86 consecutive patients with pancreatic cancer who underwent comprehensive genomic profiling using FoundationOne CDx (Foundation Medicine Inc.) and endoscopic ultrasound-guided tissue acquisition between June 2019 and January 2023. Macroscopic visible core length was measured using on-site macroscopic evaluation in all patients. Foundation Medicine Inc. reported analysis results categorized as passed (successful FoundationOne CDx), qualified, or failed. We investigated factors predicting successful FoundationOne CDx treatment.Needles sized 22, 20, and 19 gauge were used in 63, one, and 23 patients, respectively. The stylet slow-pull and suction techniques were performed in 43 and 41 patients, respectively. Median total macroscopic visible core length in the formalin-fixed paraffin-embedded blocks subjected to FoundationOne CDx was 41 mm. The success rate for FoundationOne CDx was 66%. Multiple linear regression analysis revealed that macroscopic visible core length independently affected successful FoundationOne CDx (P = 0.0019).In tissue specimens obtained using endoscopic ultrasound-guided tissue acquisition, macroscopic visible core length can be associated with an appropriate sample for FoundationOne CDx.

Endoscopic submucosal dissection (ESD) and surgical local excision pose particular challenges for anorectal tumors extending beyond the dentate line, making technique selection difficult. We hypothesized that combining ESD and local excision (transanal endoscopy cooperative surgery; TaECS) can effectively resect such tumors. TaECS was performed for three patients with anorectal tumors extending beyond the dentate line between January and December 2022. TaECS was indicated for local resection of tumors extending beyond the dentate line with a low risk of lymph node metastases. TaECS was performed in an operating room after ensuring adequate bowel preparation. The oral side of the tumor was dissected endoscopically with resection margins precisely evaluated using magnifying endoscopy. The anal side was surgically dissected above the internal anal sphincter. The defect was repaired wtih bilateral V-Y advancement flap reconstruction. All three tumors were successfully resected in en bloc fashion without intraprocedural adverse events. No postoperative stricture and bleeding occurred. A postoperative abscess around the anastomosis was observed in one case. The anal sphincter was preserved in all cases. No recurrences were recorded at the 17- to 27-month follow-up. TaECS may be a viable treatment for minimally invasive local resection of anorectal tumors extending beyond the dentate line.