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Background and aim The histologic discrepancies between preoperative endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) specimens sometimes confuse the endoscope operator. This study aimed to analyze the limitation of the biopsy-based diagnosis before ESD and to evaluate which factors affect the discordant pathologic results between EFB and ESD. Methods A total of 1427 patients, who were diagnosed with gastric adenoma by EFB, were enrolled. Cancer confirmed on EFB was excluded (n = 513). We retrospectively reviewed cases and compared histologic diagnoses in the biopsy sample with the final diagnosis in the endoscopically resected specimen. Results The diagnosis was upgraded (from low-grade dysplasia to high-grade dysplasia or adenocarcinoma, or from high-grade dysplasia to adenocarcinoma) in 328 cases (23.0%), concordant in 944 (66.1%), and downgraded (from high-grade dysplasia to low-grade dysplasia or non-neoplasia, or from low-grade dysplasia to non-neoplasia) in 155 (10.9%). Multivariate logistic regression analysis showed that surface ulceration and depressed lesions were associated with significant risk factors for upgrading. Age younger than 60 years and size Conclusions Careful endoscopic observation should consider size, ulceration, and depression to ensure accurate diagnosis when a gastric neoplasm is suspected.

Background Covered metallic or plastic stent placement has become an important treatment for postoperative esophageal leakage; however, fluoroscopic guidance is also required. Here we present a novel stent insertion technique with a newly designed proximal-releasing, self-expanding metallic stent (PR-SEMS) and transnasal endoscope that can enable stent insertion without fluoroscopy as a new method to prevent stent migration. Objective To describe our experience with 7 patients who underwent PR-SEMS insertion with the direct-vision technique and our use of the transnasal endoscope without fluoroscopy. Design Prospective outcome study. Setting A tertiary-care referral university hospital. Patients This study involved all patients at our center who experienced postoperative esophageal leakage after esophagectomy, primary closure, or total gastrectomy. Intervention PR-SEMS insertion with the direct vision technique and use of transnasal endoscopy without fluoroscopy. Main Outcome Measurements Success rate of stent insertion, healing rate of postoperative esophageal leaks, and stent migration rate. Results All stents were placed at the expected location without complications. One patient had massive hematemesis and underwent surgery. The bleeding focus was the splenic artery, which was damaged during gastrectomy. A significant marginal ulcer occurred in one patient, and the stent was immediately retrieved with an endoscope. After stent removal, 4 postoperative leakages were completely healed, and 2 lesions were not occluded. The 2 remaining minimal lesions became completely occluded with conservative management after stent removal. Stent migration did not occur. Limitations A small number of patients. Further prospective, randomized, controlled trials are needed. Conclusion PR-SEMS insertion under transnasal endoscopic guidance is a feasible, safe, and effective treatment for postoperative esophageal leakage, and it can be performed as a bedside procedure. Our anchoring method is effective for the prevention of migration from nonobstructed lesions.

the large resection surface. Furthermore, a combined clip and PGA felt method may prevent postoperative complications.

methods: Between January and September 2010, 178 polyps 10mm were found in 134 patients who underwent total colonoscopy. MC vessels were evaluated according to the Sano-Emura classification. Biopsy and EMR was performed for 5mm and 10 mm polyps respectively. All specimens were analyzed histologically. Results: There were 65, 112 and 1 lesion diagnosed as Sano-Emura type I, II and IIIA respectively. Histopathology revealed 112/ 178 (63%) neoplastic and 66/178 (37%) non-neoplastic lesions. Sensibility, specificity and diagnostic accuracy were 97.4%, 93.2% y 96.1% respectively. Conclusions: Observation of MC vessels using the non sequential Exera magnifying NBI system is very useful and comparable to the sequential Lucera system for differentiating small colorectal polyps in Peru.