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Significant atrophic gastritis in the fundic gland region is a well-known endoscopic finding observed in autoimmune gastritis (AIG). The endoscopic features of early AIG have not been reported. Iron deficiency, vitamin B12 deficiency, anemia, or neurological symptoms may not be observed in the early stages of AIG, and it may thus be difficult to diagnose early AIG based on clinical findings. We treated a 50-year-old Japanese female whose condition was suspected to be early AIG. The endoscopic findings showed normal gastric pyloric gland mucosa, and diffuse reddened and edematous gastric fundic gland mucosa. Pathologically, local infiltration of lymphocytes and decrease of parietal cells was present in a deep part of the gastric fundic gland mucosa. Blood tests showed that the titer of parietal cell antibody (PCA) was 1:320 and the gastrin level was 820 pg/ml. We determined that the patient had AIG because she also had Hashimoto’s disease, the PCA titer was high, the serum gastrin level was slightly increased, and inflammation was observed only in the gastric body on the endoscopic images. To the best of our knowledge, this is the first case report of endoscopic findings that suggest early AIG, before atrophic changes were observed.

A 47-year-old Japanese woman presented with epigastric discomfort and anorexia. Upper endoscopy showed type 4 advanced gastric cancer in the gastric antrum with stenosis of the pyloric portion. Abdominopelvic CT revealed peritoneal dissemination, and stage IV advanced gastric cancer was diagnosed. Laparoscopic gastrojejunostomy and enterostomy were performed. Trousseau syndrome occurred 7 days post-surgery. Despite appropriate treatment, the patient developed a pulmonary embolism 13 days later and died 18 days post-surgery. Even in young cancer patients without lifestyle disease complications, it is important to pay attention to Trousseau syndrome as part of cancer management.

The accidental ingestion of a press-through package (PTP) sheet is associated with the risk of gastrointestinal injury and puncture. When pain occurs in the laryngeal pharynx, the PTP may already be stuck in the upper esophageal region, and urgent endoscopic treatment is necessary. A plain chest X-ray image should be performed first to identify the ingested PTP, but this was not successful in the present two patients. As a next step, a CT scan (which involves high radiation exposure) is commonly used. In our patients (a 76-year-old woman and a 59-year-old man), tomosynthesis was used to confirm the presence and location of a PTP sheet as a pre-endoscopic diagnosis. With tomosynthesis, the level of radiation exposure was reduced to approx. 1/10 of that of simple CT; the imaging time is also shorter at ~ 5 s. Tomosynthesis can be performed at approx. 1/3–1/4 the cost of simple CT. The usefulness of tomosynthesis as a pre-endoscopic diagnostic tool was demonstrated in our patients, and its further utilization is expected.