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Background and Aim: We aimed to elucidate the feasibility of endoscopic resection (ER) for salvage and metachronous lesions following chemoradiotherapy (CRT) and radiotherapy (RT) for laryngopharyngeal cancer. Methods: Consecutive patients who underwent ER for superficial laryngopharyngeal cancer between March 2005 and September 2022 were retrospectively reviewed and stratified into salvage (16 patients, 16 lesions), metachronous (18 patients, 27 lesions), and naïve RT (217 patients, 306 lesions) groups. Salvage lesions were residual or local recurrent after CRT, and metachronous lesions were second primary lesions in the irradiated field following complete response. Short‐term outcomes were evaluated, including R0 resection, en bloc resection, procedure time, adverse events, local recurrence rate, and clinical course. Results: The en bloc resection rates were 88%, 93%, and 88%; R0 resection rates were 50%, 52%, and 56%; procedure times were 25, 27, and 25 min, in the salvage, metachronous, and naïve RT groups, none of which were significantly different among the three groups. Although adverse event rates tended to be higher in the salvage and metachronous groups than in the naïve RT group, the differences were not significant (18%, 15%, and 8%). The cumulative local recurrence rates at 2 years were 21%, 13%, and 6%, significantly higher in the salvage group than in the naïve RT group. The local control rates with ER alone were 94%, 93%, and 97%; none were significantly different among the three groups. Conclusion: ER for salvage and metachronous superficial lesions can be safely performed, suggesting its acceptability as a minimally invasive treatment. [ABSTRACT FROM AUTHOR]

Objectives: Endoscopic hand suturing (EHS) is a novel technique for closing a mucosal defect after endoscopic submucosal dissection (ESD). We investigated the technical feasibility of colorectal EHS using a modified flexible through‐the‐scope needle holder. Methods: This was a prospective multicenter study conducted at two referral centers between June 2022 and April 2023. This study included colorectal neoplasms 20–50 mm in size located in the sigmoid colon or rectum. A modified flexible through‐the‐scope needle holder, with an increased jaw width to facilitate needle grasping, was used for colorectal EHS. The primary end‐points were sustained closure rate on second‐look endoscopy (SLE) performed on postoperative days 3–4 and suturing time for colorectal EHS. Secondary end‐points included complete closure rate and delayed adverse events. Results: We enrolled 20 colorectal neoplasms in 20 patients, including four patients receiving antithrombotic agents. The tumor location was as follows: lower rectum (n = 8), upper rectum (n = 2), rectosigmoid colon (n = 4), and sigmoid colon (n = 6), and the median mucosal defect size was 37 mm (range, 21–65 mm). The complete closure rate was 90% (18/20 [95% confidence interval (CI) 68.3–98.8%]), and the median suturing time was 49 min (range, 23–92 min [95% CI 35–68 min]). Sustained closure rate on SLE was 85% (17/20 [95% CI 62.1–96.8%]). No delayed adverse events were observed. Conclusion: EHS demonstrated a high sustained closure rate. Given the long suturing time and technical difficulty, EHS should be reserved for cases with a high risk of delayed adverse events. [ABSTRACT FROM AUTHOR]

Objectives: There are several types of colorectal cancer (CRC) according to the detection methods and intervals, including interval CRC (iCRC) and postcolonoscopy CRC (PCCRC). We aimed to examine their proportions and characteristics. Methods: We conducted a multicenter prospective study using questionnaires in Japan ("C‐DETECT study"), in which differences in CRC characteristics according to detection methods and intervals were examined from consecutive adult patients. Because the annual fecal immunochemical test (FIT) was used in population‐based screening, the annual FIT‐iCRC was assessed. Results: In total, 1241 CRC patients (1064 with invasive CRC) were included. Annual FIT‐iCRC (a), 3‐year PCCRC (b), and CRC detected within 1 year after a positive FIT with noncompliance to colonoscopy (c) accounted for 4.5%, 7.0%, and 3.9% of all CRCs, respectively, and for 3.9%, 5.4%, and 4.3% of invasive CRCs, respectively. The comparison among these (a, b, c) and other CRCs (d) demonstrated differences in the proportions of ≥T2 invasion ([a] 58.9%, [b] 44.8%, [c] 87.5%, [d] 73.0%), metastasis ([a] 33.9%, [b] 21.8%, [c] 54.2%, [d] 43.9%), right‐sided CRC ([a] 42.9%, [b] 40.2%, [c] 18.8%, [d] 28.6%), and female sex ([a] 53.6%, [b] 49.4%, [c] 27.1%, [d] 41.6%). In metastatic CRC, (a) and (b) showed a higher proportions of BRAF mutations ([a] [b] 12.0%, [c] [d] 3.1%). Conclusions: Annual FIT‐iCRC and 3‐year PCCRC existed in nonnegligible proportions. They were characterized by higher proportions of right‐sided tumors, female sex, and BRAF mutations. These findings suggest that annual FIT‐iCRC and 3‐year PCCRC may have biological features different from those of other CRCs. [ABSTRACT FROM AUTHOR]

Background and Aim: Hot snare excision using electrocautery is widely used for large colorectal polyps (>10 mm); however, adverse events occur due to deep thermal injury. Colorectal polyps measuring 10–14 mm rarely include invasive cancer. Therefore, less invasive therapeutic options for this size category are demanding. We have developed hot snare polypectomy with low‐power pure‐cut current (LPPC HSP), which is expected to contribute to less deep thermal damage and lower risk of adverse events. This study aimed to evaluate the efficacy and safety of LPPC HSP for 10–14 mm colorectal polyps, compared with conventional endoscopic mucosal resection (EMR). Methods: In this multicenter, retrospective, observational study, clinical outcomes of EMR and LPPC HSP for 10–14 mm nonpedunculated colorectal polyps between January 2021 and March 2022 were compared using propensity score matching. Results: We identified 203 EMR and 208 LPPC HSP cases. After propensity score matching, the baseline characteristics between the groups were comparable, with 120 pairs. The en bloc and R0 resection rates were not significantly different between EMR and LPPC HSP groups (95.8% vs 97.5%, P = 0.72; 90.0% vs 91.7%, P = 0.82). The rates of delayed bleeding and perforation did not differ between the groups. Conclusions: Compared with conventional EMR, LPPC HSP showed a similar resection ability without an increase in adverse events. These results suggest that LPPC HSP is a safe and effective treatment for 10–14 mm nonpedunculated colorectal polyps. [ABSTRACT FROM AUTHOR]

Background and Aim: Tip‐in endoscopic mucosal resection (EMR) has a high en bloc resection rate for large colorectal neoplasms. However, non‐experts' performance in Tip‐in EMR has not been investigated. We investigated whether Tip‐in EMR can be achieved effectively and safely even by non‐experts. Methods: This retrospective study included consecutive patients who underwent Tip‐in EMR for 15–25 mm colorectal nonpedunculated neoplasms at a Japanese tertiary cancer center between January 2014 and December 2020. Baseline characteristics, treatment outcomes, learning curve of non‐experts, and risk factors of failing self‐achieved en bloc resection were analyzed. Results: A total of 597 lesions were analyzed (438 by experts and 159 by non‐experts). The self‐achieved en bloc resection (69.8% vs 88.6%, P < 0.001) and self‐achieved R0 resection (58.3% vs 76.5%, P < 0.001) rates were significantly lower in non‐experts with <10 cases of experience than in experts, but not in non‐experts with >10 cases. Adverse event (P = 0.165) and local recurrence (P = 0.892) rates were not significantly different between experts and non‐experts. Risk factors of failing self‐achieved en bloc resection were non‐polypoid morphology (OR 3.4, 95% CI 1.6–7.3, P = 0.001), lesions with an underlying semilunar fold (OR 3.6, 95% CI 1.6–7.3, P < 0.001), positive non‐lifting sign (OR 3.1, 95% CI 1.2–8.0, P = 0.023), and non‐experts with an experience of ≤10 cases (OR 3.6, 95% CI 2.1–6.3, P < 0.001). Conclusion: The clinical outcomes of Tip‐in EMR for 15–25 mm lesions performed by non‐experts were favorable. [ABSTRACT FROM AUTHOR]

Background and Aim: Computer‐aided detection (CADe) systems can efficiently detect polyps during colonoscopy. However, false‐positive (FP) activation is a major limitation of CADe. We aimed to compare the rate and causes of FP using CADe before and after an update designed to reduce FP. Methods: We analyzed CADe‐assisted colonoscopy videos recorded between July 2022 and October 2022. The number and causes of FPs and excessive time spent by the endoscopist on FP (ET) were compared pre‐ and post‐update using 1:1 propensity score matching. Results: During the study period, 191 colonoscopy videos (94 and 97 in the pre‐ and post‐update groups, respectively) were recorded. Propensity score matching resulted in 146 videos (73 in each group). The mean number of FPs and median ET per colonoscopy were significantly lower in the post‐update group than those in the pre‐update group (4.2 ± 3.7 vs 18.1 ± 11.1; P < 0.001 and 0 vs 16 s; P < 0.001, respectively). Mucosal tags, bubbles, and folds had the strongest association with decreased FP post‐update (pre‐update vs post‐update: 4.3 ± 3.6 vs 0.4 ± 0.8, 0.32 ± 0.70 vs 0.04 ± 0.20, and 8.6 ± 6.7 vs 1.6 ± 1.7, respectively). There was no significant decrease in the true positive rate (post‐update vs pre‐update: 95.0% vs 99.2%; P = 0.09) or the adenoma detection rate (post‐update vs pre‐update: 52.1% vs 49.3%; P = 0.87). Conclusions: The updated CADe can reduce FP without impairing polyp detection. A reduction in FP may help relieve the burden on endoscopists. [ABSTRACT FROM AUTHOR]

Background and Aim: Hot snare polypectomy using blend or coagulation current is widely used; however, it causes deeper tissue heat injury, leading to adverse events. We hypothesized that hot polypectomy using low‐power pure cut current (PureCut, effect 1 10 W) could reduce deeper tissue heat injury. We conducted animal experiments to evaluate the deeper tissue heat injury and conducted a prospective clinical study to examine its cutting ability. Methods: In a porcine rectum, hot polypectomy using Blend current (EndoCut, effect 3 40 W) and low‐power pure cut current was performed. The deepest part of heat destruction and thickness of the non‐burned submucosal layer were evaluated histologically. Based on the results, we performed low‐power pure cut current hot polypectomy for 10–14 mm adenoma. The primary endpoint was complete resection defined as one‐piece resection with negative for adenoma in quadrant biopsies from the defect margin. Results: In experiments, all low‐power pure‐cut resections were limited within the submucosal layer whereas blend current resections coagulated the muscular layer in 13% (3/23). The remaining submucosal layer was thicker in low‐power pure cut current than in blend current resections. In the clinical study, low‐power pure‐cut hot polypectomy removed all 100 enrolled polyps. For 98 pathologically neoplastic polyps, complete resection was achieved in 84 (85.7%, 95% confidence interval, 77–92%). The lower limit of the 95% confidence interval was not more than 15% below the pre‐defined threshold of 86.6%. No severe adverse events occurred. Conclusions: A novel low‐power pure‐cut hot polypectomy may be feasible for adenoma measuring 10–14 mm. (UMIN000037678). [ABSTRACT FROM AUTHOR]

Background and Aim: It is unclear whether additional treatment should be considered given the recurrence risk after endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma (ESCC) when the vertical margin is positive or unclear (VM1/VMX) due to intralesional damage. This study aimed to elucidate the local recurrence risk of ESCC caused by intralesional damage during ESD. Methods: Among consecutive patients with pT1a ESCCs initially treated by ESD at our institution between January 2006 and December 2018, ESCCs diagnosed as VM1/VMX were retrospectively reviewed. Exclusion criteria were piecemeal resection and any additional treatment after ESD. Intralesional damage included the following three types: a macroscopic hole inside the lesion, an incision from the lateral margin of the specimen into the lesion, and crushing injury or burn effect into the deepest area of the lesion without an obvious hole. The local recurrence rate after ESD was primarily analyzed. Results: Of 1174 pT1a ESCCs initially treated using ESD, 22 lesions were histopathologically diagnosed as VM1/VMX due to intralesional damage (1.9%; 95% confidence interval [CI], 1.2–2.8%). At a median follow‐up period of 60.0 (interquartile range, 15.0–84.0) months, no local recurrence was observed (0.0%; 95% CI, 0.0–13.3%) among 21 lesions finally evaluated. Conclusions: The impact of intralesional damage during ESD for ESCC on local recurrence might be negligible. Follow‐up without additional treatment may be acceptable even if intralesional damage occurs and results in VM1/VMX after ESD for pT1a ESCCs. [ABSTRACT FROM AUTHOR]

Background and Aim: Optimal tumor samples are crucial for successful analysis using commercially available comprehensive genomic profiling (CACGP). However, samples acquired by endoscopic ultrasound‐guided tissue acquisition (EUS‐TA) are occasionally insufficient, and no consensus on the optimal number of needle passes required for CACGP exists. This study aimed to explore the optimal number of needle passes required for EUS‐TA to procure an ideal sample fulfilling the prerequisite criteria of CACGPs. Methods: Patients who underwent EUS‐TA for solid masses between November 2019 and July 2021 were retrospectively studied. The correlation between the acquisition rate of an ideal sample and the number of needle passes mounted on a microscope slide was evaluated. Additionally, the factors predicting a successful analysis were investigated in patients scheduled for CACGP using EUS‐TA‐obtained samples during the same period. Results: EUS‐TAs using 22‐ and 19‐gauge (G) needles were performed in 336 and 57 patients, respectively. There was a positive correlation between the acquisition rate and the number of passes using a 22‐G needle (38.9%, 45.0%, 83.7%, and 100% for 1, 2, 3, and 4 passes, respectively), while no correlation was found with a 19‐G needle (84.2%, 83.3%, and 85.0% for 1, 2, and 3 passes, respectively). The analysis success rate in patients with scheduled CACGP was significantly higher with ideal samples than with suboptimal samples (94.1% vs 55.0%, P < 0.01). Conclusions: The optimal estimated number of needle passes was 4 and 1–2 for 22‐ and 19‐G needles, respectively. [ABSTRACT FROM AUTHOR]

Patients with ulcerative colitis (UC) are at a higher risk of developing colorectal cancer (CRC), and current guidelines recommend surveillance colonoscopy to detect and remove dysplasia to prevent CRC. However, detecting dysplasia in UC patients is challenging due to the inflamed mucosa. Recent advancements in endoscopy and diagnostic techniques have improved the detection of UC-associated neoplasia (UCAN). After detection, treatment options include colectomy or endoscopic resection (ER), but ER can be difficult due to indistinct margins and fibrosis. A recent study identified predictors of severe fibrosis in UC patients and assessed the feasibility of ER for tumors with severe fibrosis. The study found that longer UC duration and scarring background mucosa were predictors of severe fibrosis. The findings have clinical implications for selecting appropriate treatment and highlight the need for experienced endoscopists in managing UC-related lesions. [Extracted from the article]

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Background and Aim: Endoscopic resection of the ileocecal valve lesions (ICVL) and peri‐appendiceal orifice lesions (PAOL), is challenging. This study aimed to evaluate the feasibility of endoscopic submucosal dissection (ESD) for ICVLs and PAOLs compared with other cecal lesions (OCEL). Methods: This was a multicenter, retrospective cohort study conducted at a cancer center hospital and two community hospitals. Non‐pedunculated cecal lesions that were intended to be treated by ESD followed by at least one surveillance colonoscopy were included. The main outcome was curative resection defined as en‐bloc resection and R0 resection without risk factors of metastases. The secondary outcome was co lon preservation. Results: A total of 206 patients with 206 cecal lesions, including 37 ICVL, 27 PAOL, and 142 OCEL, who were to be treated with ESD were included in this study. Curative resection rates were 75.7% for ICVL, 70.4% for PAOL, and 77.5% for OCEL (P = 0.67). In the multivariate analysis of predictors of curative resection, tumor size (<40 mm) (odds ratio [OR] 2.40; 95% confidence intervals [CI], 1.14–5.04; P = 0.02) and a negative non‐lifting sign (OR 6.12; 95% CI, 2.55–14.60; P < 0.01) were significant. Colon preservation was achieved for 91.9% of the ICVL, 92.6% of the PAOL, and 90.8% of the OCEL (P = 0.947). Conclusions: Based on curative resection and colon preservation rates, ESD was found to be feasible for ICVL and PAOL. Large tumor size (≥ 40 mm) and positive non‐lifting signs were significant factors for non‐curative resection. [ABSTRACT FROM AUTHOR]

Background and Aim: Preoperative determination of the invasion depth of superficial adenocarcinoma of the esophagogastric junction is important for appropriate endoscopic or surgical resection. There are no objective criteria regarding this; therefore, we investigated the factors associated with the invasion depth of superficial adenocarcinoma of the esophagogastric junction. Methods: This retrospective study evaluated patients with superficial adenocarcinoma of the esophagogastric junction who had undergone endoscopic or surgical resection at a Japanese tertiary cancer center between April 2004 and December 2017. We analyzed endoscopic features of intramucosal to slight submucosal (M–SM1; < 500 μm) and deep submucosal (SM2; ≥ 500 μm) adenocarcinoma of the esophagogastric junction and extracted significant factors associated with and assessed the diagnostic performance of endoscopic features for SM2 lesion. Results: A total of 106 cases were included in this study. Multivariate analysis indicated that depressed or protruded type (odds ratio [OR], 11.1), lesion size ≥ 15 mm (OR, 3.11), uneven surface (OR, 6.31), and subsquamous extension (OR, 5.41) were significantly associated with SM2 adenocarcinomas of the esophagogastric junction. When the macroscopic type was depressed or protruded, high sensitivity (97%) but fair specificity (46%) were observed for SM2 adenocarcinoma of the esophagogastric junction, whereas uneven surface and subsquamous extension showed high specificity (96% and 87%) but fair sensitivity (36% and 46%). Conclusions: Depressed or protruded type, lesion size ≥ 15 mm, uneven surface, and subsquamous extension were significantly associated with the invasion depth of superficial adenocarcinoma of the esophagogastric junction. These endoscopic features are useful in determining the treatment method preoperatively. [ABSTRACT FROM AUTHOR]

Aims: Lymphatic invasion (LI) and venous invasion (VI) are the strongest risk factors for lymph node metastasis in patients with early gastric cancer, and may predict their prognosis. We aimed to investigate interobserver agreement among pathologists before and after adding ancillary staining for diagnosing LI and VI in this setting. Methods and results: This retrospective study included 100 specimens of submucosal invasive gastric cancer from 100 patients treated using endoscopic resection. Three pathologists (expert, intermediate and trainee experience levels) independently evaluated individual LI and VI status using haematoxylin and eosin (H&E)‐stained slides, and re‐evaluated their decisions by reviewing corresponding D2‐40‐stained and elastin‐stained slides. Interobserver agreement was assessed using κ statistics. With the ancillary D2‐40 staining, there was an improved agreement for LI diagnoses between the expert and intermediate pathologist (H&E κ = 0.78, D2‐40 κ = 0.85) and between the expert and trainee pathologist (H&E κ = 0.37, D2‐40 κ = 0.56). With the ancillary elastin staining, there was an improved agreement for VI diagnoses between the expert and intermediate pathologists (H&E κ = 0.25, elastin κ = 0.63) and between the expert and trainee pathologists (H&E κ = 0.29, elastin κ = 0.45). Conclusions: With both the ancillary D2‐40 and elastin staining there was an improved interobserver agreement for LI and VI diagnoses, regardless of the pathologist's experience. This ancillary staining may be useful in improving the accuracy of LI and VI diagnoses, helping to improve the risk stratification of early gastric cancer patients. [ABSTRACT FROM AUTHOR]

As the tumor invaded the elastin fibers, which appeared to derive from the outer longitudinal muscle layer (Figure 1d), and invaded the adipose tissue of the subserosa (Figure 1b), invasion depth was regarded as subserosa. This tumor may invade the subserosa easily due to the lack of muscularis propria, which would be a barrier to tumor invasion of the subserosa. Segmental defects of the intestinal muscularis propria have been extensively reported in the pediatric population as a cause of intestinal obstruction or perforation.1 The diagnosis is based on pathological observation of segmental defects of the intestinal muscularis propria. [Extracted from the article]

Bowel preparation is a key aspect of colonoscopy, and inadequate bowel preparation is associated with an increased rate of missed adenomas, cecal intubation failure, and unsatisfactory patient experience.[1] Various bowel preparation regimens have been developed to achieve adequate bowel preparation. The split-dose of PEG is better tolerated and more effective as compared to the single-dose regimen.[7] However, whether the day-before PMC regimen or the split-dose PMC regimen is superior remains unclear. [Extracted from the article]

Simple add-on robotic traction device to the conventional endoscope: Will it be an efficient and safe tool for novice training on endoscopic submucosal dissection? Endoscopic submucosal dissection (ESD) is an established technique for the treatment of early gastrointestinal neoplasms. Robot-assisted endoscopic submucosal dissection versus conventional ESD for colorectal lesions: Outcomes of a randomized pilot study in endoscopists without prior ESD experience (with video). [Extracted from the article]

This Editorial refers to the article by Aoki et al., p 585–591 of this issue. [ABSTRACT FROM AUTHOR]

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Two-component colloidal nanosheets in a Ti0.91O2--MnO2system with different compositions were restacked by flocculation with K ions. X-ray powder diffraction patterns of the products showed remarkably broad reflections. The structures suggested the presence of mixed layers of Ti0.91O2 and MnO2 connected by K ions. Powder pattern simulation was conducted using the matrix method, in an approach similar to that used for analyzing layered composite crystals with one-directional disorder. The following were considered: (1) stacking disorder in layered K-Ti-oxide, (2) stacking disorder in layered K-Mn-oxide, and (3) sequence probabilities of K-Ti-oxide and K-Mn-oxide sheets. Taking into consideration chemical composition, three types of probability tables were unified into one large probability table. For 00ζ calculation, z coordinates of all atoms were used. For h1k1ζ calculation except 00ζ, atom coordinates of the K-Ti-oxide sheet were used on an orthorhombic cell (a1 = 2.96, b1 = 3.77, C1 = 9.32 Å), and for h2k2ζ calculation except 00ζ those of the K-Mn- oxide sheet were used on a trigonal cell (a2 = b2 = 2.84, c2 = 7.10 Å). The agreement in pattern fitting between the experimental and calculated intensities was satisfactory in all composition ranges. From the results, the phase relationship of the misfit mixed-layer material in the binary restacked nanosheet system of Ti0.91O2--MnO2 flocculated with K ions was clarified. [ABSTRACT FROM AUTHOR]

Two-component colloidal nanosheets in a Ti0.91O2--MnO2system with different compositions were restacked by flocculation with K ions. X-ray powder diffraction patterns of the products showed remarkably broad reflections. The structures suggested the presence of mixed layers of Ti0.91O2 and MnO2 connected by K ions. Powder pattern simulation was conducted using the matrix method, in an approach similar to that used for analyzing layered composite crystals with one-directional disorder. The following were considered: (1) stacking disorder in layered K-Ti-oxide, (2) stacking disorder in layered K-Mn-oxide, and (3) sequence probabilities of K-Ti-oxide and K-Mn-oxide sheets. Taking into consideration chemical composition, three types of probability tables were unified into one large probability table. For 00ζ calculation, z coordinates of all atoms were used. For h1k1ζ calculation except 00ζ, atom coordinates of the K-Ti-oxide sheet were used on an orthorhombic cell (a1 = 2.96, b1 = 3.77, C1 = 9.32 Å), and for h2k2ζ calculation except 00ζ those of the K-Mn- oxide sheet were used on a trigonal cell (a2 = b2 = 2.84, c2 = 7.10 Å). The agreement in pattern fitting between the experimental and calculated intensities was satisfactory in all composition ranges. From the results, the phase relationship of the misfit mixed-layer material in the binary restacked nanosheet system of Ti0.91O2--MnO2 flocculated with K ions was clarified. [ABSTRACT FROM AUTHOR]