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Competing Interests: The authors declare that they have no conflict of interest.

Background: Total colectomy is the standard treatment for familial adenomatous polyposis (FAP). Recently, an increasing number of young patients with FAP have requested the postponement of surgery or have refused to undergo surgery. We aimed to evaluate the effectiveness of intensive endoscopic removal for downstaging of polyp burden (IDP) in FAP., Method: A single-arm intervention study was conducted at 22 facilities. Participants were patients with FAP, aged ≥ 16 years, who had not undergone colectomy or who had undergone colectomy but had ≥ 10 cm of large intestine remaining. For IDP, colorectal polyps of ≥ 10 mm were removed, followed by polyps of ≥ 5 mm. The primary end point was the presence/absence of colectomy during a 5-year intervention period., Results: 222 patients were eligible, of whom 166 had not undergone colectomy, 46 had undergone subtotal colectomy with ileorectal anastomosis, and 10 had undergone partial resection of the large intestine. During the intervention period, five patients (2.3 %, 95 % confidence interval [CI] 0.74 %-5.18 %) underwent colectomy, and three patients died. Completion of the 5-year intervention period without colectomy was confirmed in 150 /166 patients who had not undergone colectomy (90.4 %, 95 %CI 84.8 %-94.4 %) and in 47 /56 patients who had previously undergone colectomy (83.9 %, 95 %CI 71.7 %-92.4 %)., Conclusion: IDP in patients with mild-to-moderate FAP could have the potential to be a useful means of preventing colorectal cancer without implementing colectomy. However, if the IDP protocol was proposed during a much longer term, it may not preclude the possibility that a large proportion of colectomies may still need to be performed., Competing Interests: T. Takayama received a research grant from Fujifilm Co., Ltd., outside the submitted work. S. Hori received personal fees from Fujifilm Co., Ltd., Fujifilm Medical Co., Ltd., and Kaneka Medix Co., Ltd., outside the submitted work. Y. Takeuchi received personal fees from Olympus, Boston Scientific Japan, Daiichi-Sankyo, Miyarisan Pharmaceutical, Asuka Pharmaceutical, AstraZeneca, EA Pharma, Zeria Pharmaceutical, Fujifilm, Kaneka Medix, and Kyorin Pharmaceutical, outside the submitted work. H. Ishikawa, M. Yamada, Y. Sato, S. Tanaka, C. Akiko, M. Tajika, H. Doyama, Y. Ohda, T. Horimatsu, Y. Sano, K. Tanakaya, H. Ikematsu, Y. Saida, H. Ishida, H. Kashida, S. Kiriyama, K. Lee, J. Tashiro, N. Kobayashi, T. Nakajima, S. Suzuki, and M. Mutoh declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Competing Interests: None

There are currently no plastic pancreatic duct stents that have been designed for endoscopic ultrasonography (EUS)-guided placement. This study prospectively evaluated the feasibility and efficacy of a new, single-pigtail, plastic stent. Eight patients with main pancreatic duct stricture or stenotic pancreatojejunostomy underwent EUS-guided placement of the pancreatic duct stent. The stent was placed successfully in all cases (8/8). Treatment success was achieved in all cases (8/8). A mild adverse event associated with the procedure was observed in one patient but there were no other adverse events during a mean follow-up of 7.4 months. This new pancreatic duct stent appears to be feasible and effective for EUS-guided stenting., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Study Aims: Endoscopic submucosal dissection (ESD) in the colon has rapidly come into widespread use. However, as complications such as bleeding and perforation often occur, and the procedure time is longer for ESD than for endoscopic mucosal resection (EMR), development of safer and more reliable devices are required especially for colorectal ESD. We report on a new device, the Mucosectom2-short blade (M2-SB) for colorectal ESD and describe its safety and efficacy., Patients and Methods: The study included 30 patients with lesions diagnosed as colorectal tumor: a nongranular-type laterally spreading tumor (LST) larger than 20 mm or a granular-type LST larger than 30 mm, or lesions that were evaluated as being difficult to remove even by piecemeal EMR., Results: All lesions were resected en bloc using this new device, with free lateral and vertical margins. The procedure time was 61 minutes and there was no bleeding or perforation related to the procedure., Conclusion: The M2-SB seems to be a safe and efficient tool for colorectal ESD., (© Georg Thieme Verlag KG Stuttgart · New York.)