Azusa Kawasaki

Objectives: White globe appearance (WGA) is a small white lesion with a globular shape identified during magnifying endoscopy with narrow‐band imaging. However, the association between WGA and metachronous gastric cancer remains unclear. Methods: This study involved patients who underwent endoscopic submucosal dissection (ESD) for first‐episode single gastric cancer at our institution between January 2012 and December 2018 and who had at least one endoscopic follow‐up after resection. WGA‐positive gastric cancer was defined by the presence of WGA, and metachronous gastric cancer was defined as new cancer arising at a different site ≥1 year after ESD. The primary endpoint was a comparison of the incidence of metachronous gastric cancers in patients with WGA‐positive versus WGA‐negative gastric cancer. Univariate and multivariate analyses were conducted using the following variables: WGA status, sex, age, and severe atrophy. Results: In total, 160 WGA‐positive and 284 WGA‐negative gastric cancer cases were included. Metachronous gastric cancers were significantly more frequent in the WGA‐positive group ( p < 0.01). Univariate analysis identified Helicobacter pylori infection ( p = 0.049), WGA positivity ( p < 0.01), and a longer observation period ( p < 0.01) as factors significantly associated with metachronous gastric cancers. In the multivariate analysis, only WGA positivity was a significant independent risk factor ( p < 0.01). Conclusions: WGA may be a predictive marker for metachronous gastric cancers. In cases of WGA‐positive gastric cancer, endoscopic follow‐up should be conducted with heightened attention to the risk of metachronous lesions.

INTRODUCTION: The early detection of gastric neoplasms (GNs) leads to favorable treatment outcomes. The latest endoscopic system, EVIS X1, includes third-generation narrow-band imaging (3G-NBI), texture and color enhancement imaging (TXI), and high-definition white-light imaging (WLI). Therefore, this randomized phase II trial aimed to identify the most promising imaging modality for GN detection using 3G-NBI and TXI. METHODS: Patients with scheduled surveillance endoscopy after a history of esophageal cancer or GN or preoperative endoscopy for known esophageal cancer or GN were randomly assigned to the 3G-NBI, TXI, or WLI groups. Endoscopic observations were performed to detect new GN lesions, and all suspected lesions were biopsied. The primary endpoint was the GN detection rate during primary observation. Secondary endpoints were the rate of missed GNs, early gastric cancer detection rate, and positive predictive value for a GN diagnosis. The decision rule had a higher GN detection rate between 3G-NBI and TXI, outperforming WLI by >1.0%. RESULTS: Finally, 901 patients were enrolled and assigned to the 3G-NBI, TXI, and WLI groups (300, 300, and 301 patients, respectively). GN detection rates in the 3G-NBI, TXI, and WLI groups were 7.3, 5.0, and 5.6%, respectively. The rates of missed GNs were 1.0, 0.7, and 1.0%, the detection rates of early gastric cancer were 5.7, 4.0, and 5.6%, and the positive predictive values for the diagnosis of GN were 36.5, 21.3, and 36.8% in the 3G-NBI, TXI, and WLI groups, respectively. DISCUSSION: Compared with TXI and WLI, 3G-NBI is a more promising modality for GN detection.

Background/Aims: The etiology of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. Recent studies have reported conflicting associations between duodenal tumor development and Helicobacter pylori infection or endoscopic gastric mucosal atrophy. As such, the present study aimed to clarify the relationship between SNADETs and H. pylori infection and/or endoscopic gastric mucosal atrophy.Methods: This retrospective case-control study reviewed data from 177 consecutive patients with SNADETs who underwent endoscopic or surgical resection at seven institutions in Japan over a three-year period. The prevalence of endoscopic gastric mucosal atrophy and the status of H. pylori infection were compared in 531 sex- and age-matched controls selected from screening endoscopies at two of the seven participating institutions.Results: For H. pylori infection, 85 of 177 (48.0%) patients exhibited SNADETs and 112 of 531 (21.1%) control patients were non-infected (p<0.001). Non-atrophic mucosa (C0 to C1) was observed in 96 of 177 (54.2%) patients with SNADETs and 112 of 531 (21.1%) control patients (p<0.001). Conditional logistic regression analysis revealed that non-atrophic gastric mucosa was an independent risk factor for SNADETs (odds ratio, 5.10; 95% confidence interval, 2.44–8.40; p<0.001).Conclusions: Non-atrophic gastric mucosa, regardless of H. pylori infection status, was a factor independently associated with SNADETs.

Endoscopic omental packing (EOP) is a technique used to close gastric perforations and is particularly useful for large defects [1]. We developed the pre-looping technique (PLT) as a simple and safe method of snare delivery into the stomach, and reported applications of the clip-and-snare method using PLT (CSM-PLT) as a traction method for endoscopic submucosal dissection (ESD) [2] [3]. We hereby describe a case where CSM-PLT was used for EOP during intraoperative perforation of gastric ESD. Perforation occurred during ESD for gastric cancer in the greater curvature of the lower body. Although conventional EOP was performed ([Fig. 1]) and subsequent ESD was completed, the perforation reopened immediately after removal of the lesion ([Fig. 2]). We performed EOP using CSM-PLT as follows. The endoscope was withdrawn and the snare (SD-221U-25; Olympus, Tokyo, Japan) was looped around the transparent cap on the outside of the endoscope ([Fig. 3]); the endoscope with snare attached was then reinserted. A hemostatic clip (HX-610-090; Olympus) was inserted through the endoscope channel and used to grasp the omentum, taking care not to completely release the clip from the deployment device. The pre-looped snare was then loosened from the transparent cap and moved along the device toward the hemostatic clip, which was then grasped with the snare and released from the deployment device. The snare was used independently of the endoscope to apply the appropriate tension to the omentum and firmly attach it to the stomach wall using clips. Once traction was no longer required, the snare was loosened and removed ([Fig. 4], [Video 1]). Video 1 Endoscopic omental packing in combination with the clip-and-snare method using pre-looping technique for gastric perforation. The patient’s subsequent clinical course was good and scarring of the post-ESD ulcer was confirmed ([Fig. 5]). CSM-PLT represents a simple and reliable method for EOP. Previous reports demonstrated the effectiveness of EOP for gastric wall closure after endoscopic full-thickness resection [4] [5]; we propose that CSM-PLT is also applicable in such cases. Endoscopy_UCTN_Code_CPL_1AH_2AZ Article published online: 15 June 2023 © 2023. 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 Rüdigerstraße 14, 70469 Stuttgart, Germany

A 73-year-old female was admitted to our hospital with abdominal pain and diarrhea. Computed tomography detected distension of the small intestine. A palmar erythema, multiple oral ulcers, and desquamation of the fingers appeared after hospitalization. Small-bowel endoscopic images showed multiple ulcers. We attributed this case to infection with Yersinia pseudotuberculosis based on the changes in Y. pseudotuberculosis antibody titers throughout the course of the illness. This report is valuable, as it illustrates the endoscopic characteristics of a Y. pseudotuberculosis infection with skin lesion and ileus, which may enable us to deepen the pathologic understanding of this disease.