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Pulmonary alveolar proteinosis (PAP) is a rare, diffuse lung disease marked by the accumulation of PAS-positive proteinaceous material within distal airspaces. Diagnostic procedures include bronchoalveolar lavage, transbronchial lung biopsy (TBLB), and surgical lung biopsy (SLB). Recently, transbronchial lung cryobiopsy (TBLC) has emerged as a promising technique for diagnosing parenchymal lung diseases. This case series investigates the efficacy of TBLC in diagnosing PAP and compares it to traditional TBLB methods. Key messages: Transbronchial lung cryobiopsy potentially increases diagnostic accuracy compared to conventional techniques and carries acceptable risk of procedural complications. Performing transbronchial lung cryobiopsy to obtain specimens should be considered for PAP. [ABSTRACT FROM AUTHOR]

Background/Aims: Pathological evaluation is crucial for diagnosing biliary lesions and deter- mining appropriate treatment strategies. However, tissue sampling via the transpapillary route can be difficult. In this study, we aimed to assess the efficacy and safety of a novel tapered-tip sheath system for tissue sampling from biliary strictures. Methods: This single-center, randomized, parallel-group clinical trial included patients aged 20 to 85 years admitted to Kyoto University Hospital for biliary strictures. The patients were randomly assigned (1:1) to a new or conventional method group. The primary outcome was technical success of biopsy at the target bile duct using the assigned method, as determined in accordance with the intention-to-treat principle. Adverse events were assessed in all eligible patients. Results: Fifty-six patients were assessed for eligibility between September 2020 and March 2023; 50 patients were enrolled. The patients were randomly divided into the new (n=25) method group and the conventional (n=25) method group. Technical success was achieved in 96.0% (24/25) and 48.0% (12/25) of patients in the new and conventional method groups, respectively (risk ratio, 2.00; 95% confidence interval [CI], 1.32 to 3.03; risk difference, 48.0%; 95% CI, 27.0% to 69.0%; p<0.001). Adverse events occurred in 4.0% (1/25) and 36.0% (9/25) of patients in the new and conventional method groups, respectively (risk ratio, 0.11; 95% CI, 0.02 to 0.81; risk difference, –32.0%; 95% CI, –52.3% to –11.7%; p=0.005). Conclusions: The novel tapered-tip sheath system is a promising option for precisely and safely delivering biopsy forceps to target sites, thereby facilitating the diagnosis of biliary strictures. [ABSTRACT FROM AUTHOR]

The article discusses the challenges in diagnosing intraductal biliary lesions and the importance of accurate differentiation between benign and malignant cases. Various methods, such as endoscopic retrograde cholangiopancreatography (ERCP)-guided brush cytology and peroral cholangioscopy-guided biopsy, are explored for tissue diagnosis. A novel tapered-tip sheath system is introduced as a more effective and safer method for biliary lesion tissue sampling, showing promising results in terms of diagnostic efficacy and procedural safety. However, further validation through multicenter studies is needed to ensure broader applicability and acceptance in clinical practice. [Extracted from the article]

Objective: Intestinal current measurement (ICM) provides a sensitive bioassay for assessment of cystic fibrosis transmembrane conductance regulator (CFTR) function in rectal biopsies ex vivo and is used as a diagnostic tool for cystic fibrosis (CF). Furthermore, ICM was shown to be sensitive to detect pharmacological rescue of CFTR function by CFTR modulators in people with CF carrying responsive CFTR mutations. Results from clinical trials of CFTR modulators across age groups indicate that CFTR function in the sweat duct may be age-dependent with children reaching higher levels than adults. However, little is known about age dependency of CFTR function in the intestinal epithelium. Methods: We investigated CFTR-mediated chloride secretion in rectal biopsies from 258 people without CF and 72 people with pancreatic-insufficient CF from 1 month to 68 years of age. Change in transepithelial short-circuit current in response to cyclic adenosine monophosphate (cAMP)-mediated (100 μM IBMX, 1 µM forskolin, basolateral) and cholinergic (100 μM carbachol, basolateral) stimulation was assessed as a readout for CFTR function using perfused micro-Ussing chambers. Furthermore, quantitative real-time PCR of CFTR and morphometric analysis of epithelial cells lining the crypts and surface of the rectal mucosa were performed to assess regulation at the levels of gene expression and epithelial cell densities. Results: We found that CFTR-mediated chloride secretion across rectal tissues, as determined from cAMP-mediated as well as cholinergic chloride-secretory responses was highest during infancy and early childhood and declined with age in people without CF (both P < 0.001). Although, there was no difference in cAMP-mediated currents in people with CF, potassium-secretory responses induced by cholinergic stimulation were also reduced with increasing age. Transcript analyses showed that CFTR mRNA expression was slightly increased with increasing age in people without CF (P < 0.05). Morphometric analyses demonstrated that CFTR expressing colonocytes at the crypt base were decreased with age (P < 0.05). A secondary analysis of the ICM data of our previous studies on the effects of lumacaftor/ivacaftor on CFTR function in F508del -homozygous people with CF aged 12 years and older and 2–11 year old children showed correlations of the change in cAMP-mediated and cholinergic chloride secretory response with the age of people with CF (P < 0.01 and P < 0.05, respectively). Conclusion: These results demonstrate that CFTR function in the rectal epithelium is reduced with increasing age and indicate that this change is likely due to a decline in the number of secretory colonocytes at the crypt base. These findings suggest that differences in CFTR expressing cells may explain increased functional responses to CFTR modulator therapies in children compared to adult people with CF. [ABSTRACT FROM AUTHOR]

Primary esophageal lymphoma is a rare malignancy that is difficult to diagnose and treat. While there have been significant advances in understanding the pathogenesis, clinical features, and treatment options, there is a lack of consensus on the most effective treatment approach. This literature review provides a comprehensive overview of the use of available treatment options for primary esophageal lymphoma, including surgery, radiotherapy, and chemotherapy. The review also highlights the current knowledge gaps that need to be addressed through further research. While no single treatment modality has emerged as a clear front-runner, a combination of these treatments may be the most effective approach in managing primary esophageal lymphoma, tailored to the histological subtypes. [ABSTRACT FROM AUTHOR]

Endometriosis is an ectopic implantation of uterine tissue and can affect the thoracic cavity, resulting in Thoracic Endometriosis Syndrome (TES). TES is rare and presents with catamenial pneumothorax, haemothorax, and hemoptysis, often coinciding with menstruation. We report a case of a 46-year-old female with a decade-long history of hemoptysis and periodic chest pain associated with her menstrual cycle. High-resolution CT scans revealed persistent pneumothorax and pleural nodules. A dry thoracoscopy was performed, and biopsies confirmed the diagnosis of TES through histopathology and immunohistochemistry. This case highlights the importance of considering TES in women with cyclic respiratory symptoms and demonstrates the diagnostic value of dry thoracoscopy in benign conditions of the pleura. Raising awareness among clinicians is crucial for timely diagnosis and management of TES, reducing patient morbidity. [ABSTRACT FROM AUTHOR]

Background/Objectives: Robot-assisted bronchoscopy (RAB) is a novel platform for sampling peripheral pulmonary nodules (PPNs). To further clarify the role robot-assisted platforms have in diagnosing PPNs, we performed a review of the recent literature. Methods: A systematic review was performed in Medline from 2019 to 2024 using the search terms "robotic bronchoscopy", "diagnostic yield", "sensitivity", and "positive predictive value", alone and in combination. Studies that focused on earlier electromagnetic bronchoscopies were excluded. The patient demographic information, nodule characteristics, intra-procedure imaging modality, biopsy methods, diagnostic yield, sensitivity for malignancy, and adverse outcomes were analyzed. A total of 22 studies were available for the analyses. Results: The diagnostic yield was variable and ranged from 69 to 93%, with a median of 86%. The sensitivity ranged from 69% to 91.7%, with a median of 85%. The effect of the nodule size on the diagnostic yield was variable across the literature. Obtaining an eccentric or concentric view on a radial endobronchial ultrasound (rEBUS) was associated with a higher diagnostic yield than obtaining no view. A nodule appearance on CT imaging and the location were not definitively associated with a higher diagnostic yield. Fine needle aspiration usage ranged from 93.5 to 100%, with a median of 96.95%, while the use of biopsy forceps ranged from 2.7 to 96%, with a median of 69.9%. The most common complication was a pneumothorax, which occurred in 1–5.7% of cases, with a median of 1.6%. Conclusions: Robot-assisted transbronchial biopsies produce diagnostic yields that approach those of transthoracic needle aspirations. The nodule location and appearance may not affect the diagnostic yield. Obtaining a concentric or eccentric view on rEBUS is likely associated with an increased diagnostic yield. Additional prospective studies would better inform practitioners as this technology becomes more widespread. [ABSTRACT FROM AUTHOR]

Background: To evaluate the safety and efficacy of biliary metallic stent (BMS) combined with radioactive 125I seed strands (RISS) for malignant hilar obstruction (MHO). Method: From January 2016 to January 2022, 317 patients with MHO underwent percutaneous trans-hepatic biliary drainage at our center. Among them, 40 patients underwent BMS combined with RISS treatment (experimental group), and 52 patients underwent BMS alone (control group). Primary endpoints were technical success, complications and stent patency time (SPT). Secondary endpoints were clinical success and overall survival (OS). Results: The technical success (100% vs. 100%) and clinical success rate (92.50% vs. 90.04%) showed no statistically significance between the experimental and control groups (P > 0.05). The Grade 3–5 early and late complications showed no significance between both groups (P > 0.05). The SPT [(8.2 ± 0.39) vs. (5.8 ± 0.33) months] and OS [(13.6 ± 0.81) vs. (11.7 ± 0.44) months)] of the experimental group showed significantly longer than that of the control group ((P < 0.05). Multivariate analysis revealed higher Bismuth type as an independent predictor for shorter OS (HR: 1.846, 95% CI: 1.019–3.341, P = 0.043) and SPT (HR: 1.959, 95% CI: 1.269–4.420, P = 0.009). Conclusion: Biliary metallic stent (BMS) placement combined with radioactive iodine-125 seed strands (RISS) is a safe and effective treatment option for patients with malignant hilar obstruction (MHO). However, multicenter randomized controlled trials are required to further validate the effectiveness and long-term benefits of this therapeutic approach. [ABSTRACT FROM AUTHOR]

Accurate and fast histological diagnosis of cancers is crucial for successful treatment. The deep learning-based approaches have assisted pathologists in efficient cancer diagnosis. The remodeled microenvironment and field cancerization may enable the cancer-specific features in the image of non-cancer regions surrounding cancer, which may provide additional information not available in the cancer region to improve cancer diagnosis. Here, we proposed a deep learning framework with fine-tuning target proportion towards cancer surrounding tissues in histological images for gastric cancer diagnosis. Through employing six deep learning-based models targeting region-of-interest (ROI) with different proportions of no-cancer and cancer regions, we uncovered the diagnostic value of non-cancer ROI, and the model performance for cancer diagnosis depended on the proportion. Then, we constructed a model based on MobileNetV2 with the optimized weights targeting non-cancer and cancer ROI to diagnose gastric cancer (DeepNCCNet). In the external validation, the optimized DeepNCCNet demonstrated excellent generalization abilities with an accuracy of 93.96%. In conclusion, we discovered a non-cancer ROI weight-dependent model performance, indicating the diagnostic value of non-cancer regions with potential remodeled microenvironment and field cancerization, which provides a promising image resource for cancer diagnosis. The DeepNCCNet could be readily applied to clinical diagnosis for gastric cancer, which is useful for some clinical settings such as the absence or minimum amount of tumor tissues in the insufficient biopsy. Highlights: A deep learning framework with optimized non-cancer and cancer ROI for accurate cancer diagnosis The non-cancer region is a promising resource for the current deep-learning framework to improve cancer diagnosis. The deep learning model reveals the histological image changes from potential remodeled microenvironment and field cancerization in the normal tissues surrounding tumors. The DeepNCCNet could be applied to clinical samles with insufficient biopsy. [ABSTRACT FROM AUTHOR]

Background: Kümmell's disease is characterized by ischemic osteonecrosis and nonunion after osteoporotic vertebral compression fractures, leading to intractable low back pain, pseudoarthrosis, kyphosis, and neurological dysfunction, which can seriously affect the quality of life and life expectancy of patients. Although many surgical methods have been reported, uniform standard procedures for Kümmell's disease are still lacking. Case presentation: This case described a new procedure for Kümmell's disease. A 67-year-old woman from China underwent semi-vertebral column resection through the posterior of the diseased vertebra, while the posterior ligament complex and the contralateral spinal structure were preserved. Subsequently, intervertebral titanium cage support bone graft fusion combined with posterior pedicle screw internal fixation was conducted, and the patient was followed up with for 22 months. Kyphosis Cobb angle was 20° 2 weeks post-surgery and was maintained at 20° even after 22 months. Titanium cage was in a good position 2 weeks and 22 months after surgery. Conclusion: This new spine surgery could completely decompress the spinal canal and reduce the iatrogenic destruction of spinal stability, which might be helpful for the reconstruction and maintenance of spinal stability. [ABSTRACT FROM AUTHOR]

Simple Summary: This study presents a comprehensive analysis of gene expression profiles in early-stage gastric cancer (GC) lesions, focusing on the background gastric mucosa in patients who underwent endoscopic submucosal dissection. We aimed to reveal differences in gene expression profiles between patients with single and multiple GCs and to construct a scoring system for distinguishing between these two conditions. Using four biopsied specimens per patient, lesion-specific gene profiles were derived and analyzed using DNA microarrays. Overall, 21 genes exhibiting distinct expression profiles in relation to the background gastric mucosa were extracted. A scoring system was constructed by assigning weighted values to these 21 genes, with an optimal cutoff value of −2.574, yielding 85.7% sensitivity and specificity. The findings indicate that, compared to patients with a single GC, patients with multiple GCs have a more similar gene expression between the background gastric mucosa and the GC lesions. Background: This study aimed to perform a comprehensive gene expression analysis in patients with early-stage gastric cancer (EGC) to identify gene expression profiles specific to gastric cancer (GC) lesions. Methods: Biopsy specimens were collected from one EGC lesion and three background mucosal areas of patients scheduled for endoscopic submucosal dissection (ESD). Lesion-specific gene profiles in these four biopsies were analyzed using DNA microarrays. Patients with concurrent EGCs at the time of an ESD or a history of GC were classified into the multiple GC group (n = 26), while those without such histories were assigned to the single GC group (n = 74). Results: After excluding patients with heterogeneous factors, 55 patients were analyzed. Twenty-one differential genes exhibiting distinct mean expression profiles stratified by background gastric mucosa were extracted between the single and multiple GC groups. A scoring system constructed using these genes to calculate the weighted expression values for each patient, with an optimal cutoff value of −2.574, yielded a sensitivity and specificity of 85.7%. Conclusions: This study identified the different gene expression profiles between synchronous and metachronous multiple GCs and single GCs in patients with EGC. The developed scoring system has potential to distinguish between single and multiple GCs. [ABSTRACT FROM AUTHOR]

Simple Summary: Diseases affecting the pancreas and bile ducts can cause serious health implications and are often challenging to diagnose because they rely on high-quality imaging and specialized procedures performed by skilled doctors. Artificial intelligence (AI) is already being used in some areas of endoscopy, but its role in diagnosing pancreaticobiliary diseases is still in its early stages. In this review, we explore how AI can be applied to advanced techniques like endoscopic ultrasound and cholangioscopy, highlighting its potential advantages, current challenges, and the opportunities it offers for the future. Our goal is to provide insights into how AI might improve accuracy and efficiency to these procedures, ultimately benefiting patients and shaping the future of pancreaticobiliary care. Pancreaticobiliary diseases can lead to significant morbidity and their diagnoses rely on imaging and endoscopy which are dependent on operator expertise. Artificial intelligence (AI) has seen a rapid uptake in the field of luminal endoscopy, such as polyp detection during colonoscopy. However, its use for pancreaticobiliary endoscopic modalities such as endoscopic ultrasound (EUS) and cholangioscopy remains scarce, with only few studies available. In this review, we delve into the current evidence, benefits, limitations, and future scope of AI technologies in pancreaticobiliary endoscopy. [ABSTRACT FROM AUTHOR]

In recent years, the combination of endobronchial ultrasound and endoscopic ultrasound has enabled "medical exploration" of the mediastinum for the study of mediastinal lymphadenopathies. These techniques are particularly important for the diagnosis and staging of lung cancers. Progress has been made with the availability of new-generation cutting needles for endoscopic ultrasound and new cryobiopsy needles for endobronchial ultrasound to improve the quality of samples. [ABSTRACT FROM AUTHOR]

Biliary strictures represent a narrowing of the bile ducts, leading to obstruction that may result from benign or malignant etiologies. Accurate diagnosis is crucial but challenging due to overlapping features between benign and malignant strictures. This review presents a comprehensive diagnostic approach that integrates biochemical markers, imaging modalities, and advanced endoscopic techniques to distinguish between these causes. Imaging tools such as ultrasound, MRI/MRCP, and CECT are commonly used, each with distinct advantages and limitations. Furthermore, endoscopic procedures such as ERCP and EUS are key in tissue acquisition, enhancing diagnostic accuracy, especially for indeterminate or complex strictures. Recent innovations, including artificial intelligence and new endoscopic techniques, hold promise in enhancing precision and reducing diagnostic challenges. This review emphasizes a multidisciplinary strategy to improve diagnostic pathways, ensuring timely management for patients with biliary strictures. [ABSTRACT FROM AUTHOR]

Background: Primary cardiac lymphoma (PCL) is an exceedingly uncommon type of lymphoma that primarily affects the heart and/or pericardium, or manifests through cardiac symptoms due to myocardial infiltration. The infrequency of PCL, coupled with its non-specific clinical presentations, often complicates early diagnosis. This study aims to fill the existing gap in clinical knowledge regarding PCL by detailing a case of PCL and examining its clinical features, auxiliary examinations, treatment approaches, and prognostic outcomes, thereby facilitating early detection and enhancing patient care. Methods: A thorough search of the PubMed and Chinese National Knowledge Infrastructure (CNKI) database was performed using keywords "heart" and "lymphoma" or "primary cardiac lymphoma". This search encompassed publications from January 1, 2014, to November 1, 2024. Results: The review included 121 cases. These cases usually present with atypical symptoms, mainly circulatory and respiratory, including chest tightness, dyspnea, and edema, along with occasional neurological and gastrointestinal symptoms. Echocardiography served as the primary diagnostic method in 92.6% of cases, while a definitive diagnosis was achieved through pathological examination in all cases (100%). Treatment strategies predominantly included surgical intervention (44.6%) and chemotherapy (76.0%). Although surgery did not have a significant effect on survival rates, chemotherapy proved to be critical in improving patient survival. Conclusions: PCL, which arises in the cardiac or pericardial areas, is generally associated with a poor prognosis. It is essential for clinicians to develop a greater awareness and understanding of the characteristics of PCL to enhance early diagnosis. The timely initiation of chemotherapy is vital for improving survival rates and the overall quality of life for patients with PCL. [ABSTRACT FROM AUTHOR]

We assessed the diagnostic performance of the Narrow-Band Imaging (NBI) International Colorectal Endoscopic Classification (NICE) and the Japan NBI Expert Team classification (JNET) in predicting histological outcomes of advanced colorectal lesions. Additionally, we evaluated the sensitivity and positive predictive value (PPV) of the JNET and NICE classifications individually for high-grade lesions (including HGD adenomas, intramucosal carcinomas, and T1 carcinomas). This was a retrospective analysis of prospectively collected data, involving 211 patients (130 men, mean age 60 years) who underwent colonoscopy with endoscopic resection of advanced colorectal neoplasia (lesions ≥ 10 mm). Lesions were classified using both NICE and JNET criteria, and final histopathological results were used for comparison. Of the 257 lesions analyzed, the NICE classification accurately classifies a large proportion of lesions (93.8%). In JNET classification we observed 77.4% correctly classified lesions. Specifically, the sensitivity and positive predictive value (PPV) of the NICE classification for high-grade lesions were 100% and 24.4%, respectively. For the JNET classification, the sensitivity and PPV for high-grade lesions were 56.6% and 57.7%, respectively. The JNET classification, with a positive predictive value of 57.7% for high-grade colorectal lesions (including HGD adenomas, intramucosal carcinomas, and T1 carcinomas), should be used for decision-making regarding appropriate subsequent endoscopic therapy. [ABSTRACT FROM AUTHOR]

Background/Aims: Magnifying endoscopy with narrow-band imaging (ME-NBI) enables the visualization of detailed microsurface (MS) and microvascular (MV) structures in the gastrointestinal tract. White globe appearance (WGA) is a small whitish lesion with a globular shape identified during ME-NBI for early gastric cancer (EGC). This study aimed to investigate the associations between WGA, clinicopathological characteristics, and other ME-NBI findings in patients with EGC. Methods: The presence or absence of WGA in 122 patients (126 lesions) with an endoscopic diagnosis of EGC who underwent ME-NBI before endoscopic or surgical resection was prospectively collected and retrospectively analyzed. During ME-NBI, the MS and MV patterns and the presence of WGA and white opaque substances (WOS) were investigated. EGC cases were categorized as differentiated or undifferentiated type, and mucosal, submucosal, or advanced. Results: Of 126 lesions, WGA was observed in 25 (19.8%). WGA was associated with tumor size (≤2 cm [17/63, 27.0%] vs >2 cm [8/63, 12.7%]; p=0.044), histologic type (differentiated type [22/89, 24.7%] vs undifferentiated type [3/37. 8.1%]; p=0.033), and tumor location (upper third [1/11, 9.1%] vs middle third [18/58, 31.0%] and lower third [6/57, 10.5%]; p=0.017). Although WGA was observed more frequently in lesions with an oval/tubular MS pattern, a fine-network MV pattern, and the absence of WOS, the difference was not statistically significant (MS pattern, p=0.358; MV pattern, p=0.212; WOS, p=0.121, respectively). Conclusions: WGA was associated with small tumor size, differentiated-type histology, and middle-third tumor location, and was more frequently observed in lesions with an oval/tubular MS and fine-network MV patterns and the absence of WOS. [ABSTRACT FROM AUTHOR]

An increasing number of superficial non-ampullary duodenal epithelial tumors (SNADETs) have been detected recently owing to the development of endoscopic imaging technology and increased awareness of this disease. Endoscopic resection is the first-line treatment for SNADETs, with methods including cold snare polypectomy (CSP), conventional endoscopic mucosal resection (cEMR), underwater EMR (uEMR), and endoscopic submucosal dissection (ESD). Here, we review the current status and recent advances in endoscopic resection for SNADETs. Endoscopic resection in the duodenum is more difficult and has a higher risk of adverse events than that in other organs owing to specific anatomical disadvantages. SNADETs ≤10 mm in size are candidates for CSP, cEMR, and uEMR. Among these lesions, suspected carcinoma lesions should not be treated using CSP because of their low curability. cEMR or uEMR is considered for lesions sized 10 to 20 mm, whereas piecemeal EMR or ESD is considered for tumors >20 mm in size. In particular, ESD or surgical resection should be considered for suspected carcinoma lesions >30 mm in size. The treatment plan should be selected on a case-to-case basis, considering the balance between the risk of adverse events and the necessity of en bloc resection. [ABSTRACT FROM AUTHOR]

The diagnosis and early identification of intratracheal tumors relies on the experience of the operators and the specialists. Operations by physicians with insufficient experience may lead to misdiagnosis or misjudgment of tumors. To address this issue, a datasets for intratracheal tumor detection has been constructed to simulate the diagnostic level of experienced specialists, and a Knowledge Distillation-based Memory Feature Unsupervised Anomaly Detection (KD-MFAD) model was proposed to learn from this simulated experience. The unsupervised training approach could effectively deal with the irregular features of the tumorous appearance. The Downward Deformable Convolution Module (DDC) allowed the encoding phase to provide more detailed internal airway environment features. The Memory Matrix based on Convolutional Block focusing (CB-Mem) helped the student model store more meaningful normal sample features during training and disrupted the reconstruction of "tumor" images. Our model achieved an AUC-ROC of 97.60%, Acc of 93.33%, and F1-score of 94.94% on our self-built intratracheal endoscopy datasets, improving baseline performance by 5 to 10%. Our model also demonstrated superior performance over existing models in the public datasets in the same field. [ABSTRACT FROM AUTHOR]

There is currently a lack of standardized criteria for evaluating clinical complete response (cCR) in rectal cancer post-neoadjuvant chemoradiotherapy (nCRT), often resulting in discrepancies with true pathological complete response (pCR). Staging local lesions via MRI is challenged by tissue edema and fibrosis post-nCRT, while endoscopic biopsy accuracy is compromised by residual cancer foci in the muscular layer. Transanal local excision offers a relatively accurate assessment of lesion regression but poses challenges including impaired anal function and elevated complication rates. Building on current diagnostic frameworks, we propose enhancing cCR assessment by integrating histological criteria from transanal multipoint full-layer puncture biopsy (TMFP). This approach aims to improve accuracy while minimizing complications, offering promise for patients opting for observation-based treatments. Further research is needed for definitive conclusions. [ABSTRACT FROM AUTHOR]

Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area. Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version. Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients. [ABSTRACT FROM AUTHOR]