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Objectives: The endoscopic pressure study integrated system (EPSIS) represents an innovative approach for evaluating lower esophageal sphincter function by monitoring intragastric pressure using diagnostic gastroscopes. This study aimed to assess the feasibility and validity of employing ultrathin gastroscopes for EPSIS. Methods: A retrospective analysis was conducted on a database of consecutive patients who underwent EPSIS using both ultrathin and regular gastroscopes between September 2021 and October 2023. The study compared EPSIS parameters between the two gastroscope types to evaluate the correlation of key metrics. Results: Thirty patients underwent EPSIS with both ultrathin and regular gastroscopes. Significant positive correlations were observed in the pressure waveform: maximum intragastric pressure (mmHg) (ρ = 0.82, P < 0.001) and intragastric pressure gradient (mmHg/s) (ρ = 0.80, P < 0.001) when comparing the two gastroscopes. Maximum intragastric pressure (15.5 [5.3–20.3] vs. 18.5 [3.4–21.6], P < 0.001) and pressure gradient (0.16 [0.013–0.41] vs. 0.24 [0.0039–1.13], P < 0.001), (median [range]) were significantly lower with ultrathin gastroscopes. Conclusions: This study establishes that EPSIS parameters obtained with an ultrathin gastroscope exhibit a significant correlation with those obtained using a regular gastroscope, with each EPSIS parameter consistently lower. These findings support the viability of EPSIS for ultrathin gastroscopy and highlight its potential as a diagnostic tool for assessing lower esophageal sphincter function. [ABSTRACT FROM AUTHOR]

The field of minimally invasive endoscopic treatment has seen a continual progression, marked by significant advancements in treatment devices and the refinement of endoscopic techniques. While endoscopic resection has become the standard for treating superficial gastrointestinal neoplasms, a proactive approach becomes imperative when dealing with lesions that extend beyond the submucosal layer and deeper into the muscularis propria. The ongoing evolution of endoscopic closure techniques has facilitated the introduction of advanced procedures such as endoscopic muscularis dissection, endoscopic subserosal dissection, and endoscopic full‐thickness resection. This evolution is achieved by the commitment to improve the efficacy and precision in treating challenging lesions. Nevertheless, there is currently a lack of definitive guidelines or consensus regarding the specifics of deeper layer dissection. Drawing from prior research and clinical insights, this review discusses indications, techniques, clinical outcomes, and future perspectives of deeper layer dissection. [ABSTRACT FROM AUTHOR]

Background and Aims: Killian‐Jamieson diverticulum (KJD) is a relatively uncommon variant of pharyngoesophageal diverticula, distinct from the more prevalent Zenker diverticulum. However, literature on endoscopic management of KJD remains limited. This study aimed to elucidate the efficacy and safety of peroral endoscopic septotomy (POES) as a treatment approach for symptomatic KJD. Methods: In this retrospective observational study, we investigated the outcomes of nine consecutive patients who underwent POES for KJD between January 2019 and May 2023. Follow‐up data of at least 2 months post‐treatment were analyzed. The primary outcome measure was the technical success rate of POES. Secondary outcomes encompassed the clinical success rate, defined as symptomatic improvement 2 months after POES, and the incidence of adverse events. Results: All patients presented with dysphagia, with a median symptom duration of 6 months (interquartile range [IQR]: 3–12 months). The median diverticulum size was 32 mm (IQR: 24–42 mm). The median duration of the operation time was 66 min (IQR: 60–109). A 100% technical success rate was achieved, with complete closure of the defect in all cases. There were no adverse events related to this treatment. The median hospitalization duration was 5 days (IQR: 4–6), and the clinical success rate was 88.9%. Follow‐up barium esophagograms exhibited significant improvement in the flow of the barium for all patients. Conclusions: Despite the relatively limited case volume, our findings underscore that POES is a safe and efficacious approach for managing symptomatic KJD. [ABSTRACT FROM AUTHOR]

Objectives: Anti‐reflux mucosectomy (ARMS) and anti‐reflux mucosal ablation (ARMA) were developed as interventions for proton pump inhibitor (PPI)‐refractory/‐dependent gastroesophageal reflux disease (GERD). Although ARMS and ARMA are established treatments for PPI‐refractory GERD, reliance on natural healing for ulcer scar formation introduces uncertainty and bleeding risk. To address these issues, we introduced a novel approach called anti‐reflux mucoplasty (ARM‐P), which involves immediate closure of mucosal defects following mucosectomy. This pilot study aims to evaluate the safety, feasibility, and efficacy of ARM‐P. Methods: A retrospective single‐center study was conducted using prospectively collected data from October 2022 to July 2023. Patients with PPI‐refractory/‐dependent GERD who underwent ARM‐P were included. The study evaluated technical success of ARM‐P, before and after ARM‐P GERD‐Health Related Quality of Life Questionnaire, GerdQ, and Frequency Scale for the Symptoms of GERD scores, along with PPI discontinuation and endoscopic esophagogastric junction morphology. Results: A total of 20 patients with a median age of 61.5 years underwent the ARM‐P procedure. The procedure achieved 100% technical success without adverse events. After ARM‐P, 55.0% discontinued PPI usage and 15.0% reduced PPI dose by half. Median GERD‐Health Related Quality of Life Questionnaire score improved from 21 to 6 (P = 0.0026), median GerdQ score improved from 9 to 7 (P = 0.0022), and median Frequency Scale for the Symptoms of GERD score decreased from 16 to 7 (P = 0.0003). Median Hill's Classification significantly improved from grade III to grade I (P = 0.0001). Conclusions: This study presents the first pilot report of ARM‐P, demonstrating its procedural safety, technical feasibility, and short‐term efficacy. [ABSTRACT FROM AUTHOR]

Objectives: The endoscopic pressure study integrated system (EPSIS) is a novel diagnostic tool used to evaluate lower esophageal sphincter (LES) function. EPSIS allows the measurement of intragastric pressure (IGP) during gastric insufflation through esophagogastroduodenoscopy (EGD) and records its pressure waveform. This study aimed to assess the usefulness and applicability of EPSIS as an adjunct diagnostic modality for achalasia. Methods: This case–control study was conducted using a database of patients who underwent EGD, barium swallow (BS), high‐resolution manometry (HRM), and EPSIS between January 2022 and December 2022. The achalasia (experimental) group (n = 35) consisted of patients with a definitive diagnosis of achalasia. The control group (n = 34) consisted of patients with no abnormalities in EGD, BS, or HRM and no abnormal acid reflux confirmed with 24‐h pH‐impedance monitoring. EPSIS findings were compared between the two groups and characterized by the waveform pattern (uphill or flat), maximum IGP (IGP‐Max), pressure difference, and the gradient of the waveform. Results: All patients in the achalasia group showed an uphill pattern, in contrast to 21 patients (61.8%) in the control group. IGP‐Max demonstrated the best diagnostic accuracy for achalasia, with a cut‐off value of 15.8 mmHg (100% sensitivity, 58.8% specificity, and area under the curve [AUC] 0.78). The pressure gradient also demonstrated good diagnostic accuracy, with a cut‐off value of 0.40 mmHg/s (80% sensitivity, 61.8% specificity, and AUC 0.76). Conclusion: This study demonstrated that EPSIS can be applied as a diagnostic modality in patients with achalasia. [ABSTRACT FROM AUTHOR]

Introduction: In early 2020, the Japanese government declared a nationwide state of emergency for the COVID‐19 pandemic. We investigated the impact of the emergency declaration on endoscopy adherence and conducted a follow‐up study of patients with canceled examinations at a tertiary endoscopy facility in Japan in 2020. Methods: We compared the number of endoscopies performed, and cancelations at the endoscopy unit between 2019 and 2020 and used the Bayesian structural time series (BSTS) model to estimate the decrease in the number of endoscopies in 2020. We administered a questionnaire to those who had not undergone a scheduled endoscopy. Results: Of 14 146 and 13 338 scheduled examinations, 1233 (8.7%) and 1403 (10.5%) were canceled in 2019 and 2020, respectively. During both years, age < 50 years, age > 80 years, upper endoscopy, and experience of endoscopy in the past 5 years were significantly associated with cancelations. In 2020, cancelations in the 14th–26th week of the year, including the period of state of emergency, increased significantly, and more women canceled. Of the 409 questionnaire‐respondents, 174 (42.5%) indicated that COVID‐19 had influenced their cancelation, and 315 (77.0%) had not undergone similar endoscopic examinations since then. The BSTS model predicted a decrease of 957 (95% CI −1213 to −708, P =.003) examinations. Conclusion: In 2020, despite low numbers of COVID‐19 cases in the study site, the number of endoscopies decreased, and cancelation increased. Further research is needed on the future impact of a decrease in the number of endoscopies during a COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to clarify the prognostic factors for patients with esophageal squamous cell carcinoma (ESCC) invading into the muscularis mucosa (pT1a‐MM) or submucosa (pT1b‐SM) after endoscopic submucosal dissection (ESD). Methods: This retrospective study enrolled such patients at 21 institutions in Japan between 2006 and 2017. We evaluated 15 factors, including pathological risk categories for ESCC‐specific mortality, six non‐cancer‐related indices, and treatment strategies. Results: In the analysis of 593 patients, the 5‐year overall and disease‐specific survival rates were 83.0% and 97.6%, respectively. In a multivariate Cox analysis, male sex (hazard ratio [HR] 3.56), Charlson comorbidity index (CCI) ≥3 (HR 2.53), ages of 75–79 (HR 1.61) and ≥80 years (HR 2.04), prognostic nutrition index (PNI) <45 (HR 1.69), and pathological intermediate‐risk (HR 1.63) and high‐risk (HR 1.89) were prognostic factors. Subsequently, we developed a clinical risk classification for non‐ESCC‐related mortality based on the number of prognostic factors (age ≥75 years, male sex, CCI ≥3, PNI <45): low‐risk, 0; intermediate‐risk, 1–2; and high‐risk, 3–4. The 5‐year non‐ESCC‐related mortality rates for patients without additional treatment were 0.0%, 10.2%, and 45.8% in the low‐, intermediate‐, and high‐risk groups, respectively. Meanwhile, the 5‐year ESCC‐specific mortality rates for the pathological low‐, intermediate‐, and high‐risk groups were 0.3%, 5.3%, and 18.2%, respectively. Conclusions: We clarified prognostic factors for patients with pT1a‐MM/pT1b‐SM ESCC after ESD. The combined assessment of non‐ESCC‐ and ESCC‐related mortalities by the two risk classifications might help clinicians in deciding treatment strategies for such patients. [ABSTRACT FROM AUTHOR]

Objectives: Guidelines for magnified endoscopic diagnosis of esophageal squamous cell carcinoma (SCC) have been proposed by the Japan Esophageal Society. Type B1, B2, and B3 reflect increasing tumor invasion depths (within mucosal epithelium or into lamina propria mucosa [T1a‐EP/LPM], into muscularis mucosa or superficial invasion into submucosa [T1a‐MM/T1b‐SM1], and into submucosa [T1b‐SM2], respectively). The diagnostic accuracy of type B1 and B3 is high, but accuracy of type B2 is low. We aimed to improve the diagnostic accuracy of type B2. Methods: We retrospectively reviewed 248 SCC lesions treated with endoscopic submucosal dissection between January 2012 and July 2018 and identified the B2 lesions. The maximum diameter of the area presenting B2 was measured and evaluated in relation to tumor invasion, for which receiver‐operating characteristic (ROC) curves were generated. The optimal area size for distinguishing T1a‐EP/LPM from T1a‐MM or deeper invasion was determined. Results: There were 78 lesions with B2, of which 26 (33%) were T1a‐MM or T1b‐SM1 SCCs. ROC curve analysis indicated that the optimal cut‐off for the target area showing B2 was 4 mm. The invasion depth (EP/LPM: MM/SM1: SM2) of B2 observed in an area with a diameter <4 mm (B2‐Narrow) and those with diameter ≥4 mm (B2‐Broad) was 46:11:1 and 1:15:4, respectively. To predict T1a‐MM or deeper invasion, B2‐Broad had a sensitivity, specificity, positive predictive value, and negative predictive value of 61%, 98%, 95%, and 79%, respectively. Conclusion: The diagnostic accuracy of type B2 was improved by evaluating the area of type B2. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion The endoscopic pressure study integrated system (EPSIS) is an endoscopic diagnostic system utilized for evaluation of lower esophageal sphincter function. Although previous studies have determined that EPSIS was effective as a tool for the diagnosis of achalasia, it remains uncertain if EPSIS can detect significant changes before and after peroral endoscopic myotomy (POEM), which is the premier treatment for achalasia. This study aimed to evaluate the effectiveness of EPSIS as an objective diagnostic tool for assessing the clinical effect of POEM.We conducted a retrospective analysis of patients who underwent POEM from January 2022 to December 2023. The patients underwent EPSIS preoperatively and 2 months postoperatively. Intragastric pressure (IGP) parameters, including the maximum IGP, IGP difference, and waveform gradient were compared pre‐ and post‐POEM. These parameters also were compared between two groups: the postoperative gastroesophageal reflux disease (GERD) group and the non‐GERD group.A total of 50 patients were analyzed. The mean maximum IGP was significantly lower postoperatively than preoperatively (15.0 mmHg vs. 19.8 mmHg, P < 0.001). The mean IGP difference and waveform gradient were also significantly lower postoperatively than preoperatively (8.0 mmHg vs. 12.2 mmHg, P < 0.001; and 0.26 mmHg/s vs. 0.43 mmHg/s, P < 0.001, respectively). The mean postoperative waveform gradient was significantly lower in the GERD group (17 patients, 34%) than in the non‐GERD group (33 patients, 66%) (0.207 mmHg vs. 0.291 mmHg, P = 0.034).The results supported the use of EPSIS as an effective diagnostic tool for assessing the effect of POEM. [ABSTRACT FROM AUTHOR]

At the surface side of the lesion, the tumor cells contain abundant PAS-positive granules more than the surrounding non-neoplastic squamous epithelium, suggesting that the tumor has rich glycogen granules. gl Esophageal squamous cell carcinoma darkly stained with iodine is extremely rare. Iodine staining is the gold standard for detecting esophageal squamous cell carcinoma (ESCC) during endoscopic examination because the lesion is usually recognized as an unstained area after iodine spraying.[[1]] However, we experienced an ESCC that is recognized as a darkly stained area with iodine. At the surface side of the lesion, the tumor cells contain abundant PAS-positive granules more than the surrounding non-neoplastic squamous epithelium, suggesting that the tumor has a large amount of glycogen granule (Fig. [Extracted from the article]

Delirium is a common and serious acute neuropsychiatric syndrome characterized by inattention and global cognitive dysfunction. Delirium is associated with higher morbidity, higher mortality and longer hospitalization, but its aetiology remains unclear. We successfully treated five cases of delirium within 1 day with ramelteon, a novel selective melatonin receptor agonist. This suggests that correction of the circadian rhythm disturbance, one of the main symptoms of delirium, plays a crucial role in its treatment and sheds new light on a therapeutic strategy for treatment of delirium. [ABSTRACT FROM AUTHOR]

Understory bamboo species are important and influential components of temperate forests in at least several parts of the world. Here we report a study testing the effect of forest fragmentation on the dynamics of the dwarf bamboo Sasa chartacea and on forest herb communities in the Tokachi plain of Hokkaido, Japan. We studied 16 forest fragments of different sizes and small plots established in these fragments to examine the relationship between the abundance of S. chartacea, landscape and environmental conditions, and forest herb communities. Sasa chartacea was more abundant near forest edges and in smaller fragments, suggesting that the species has expanded its local range and increased its abundance in response to forest fragmentation. Edge-related changes in light and soil moisture might have facilitated this range expansion. The species richness of forest herbs was strongly negatively related to the density of S. chartacea. Because much larger variation in species richness was explained by S. chartacea density than distance to the nearest forest edge, the expansion of S. chartacea has likely excluded other understory species by competition. In addition, the density of S. chartacea significantly explained variation in the species composition of forest herbs across plots. Taken together, our results emphasize the key roles of dwarf bamboos in changing plant communities following forest fragmentation. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion The gastroesophageal junction (GEJ) consists of various anatomical components that together form a barrier to prevent reflux of gastric content. This study introduces a novel phase concept to dynamically evaluate the antireflux barrier (ARB) during endoscopy and analyzes its functionality.We reviewed previously the recorded endoscopic videos of subjects who underwent the endoscopic pressure study integrated system (EPSIS) from February to April 2024 for indications other than gastroesophageal reflux disease symptoms. This device was used as an auxiliary tool to measure intragastric pressure (IGP) during endoscopy with a retroflex view. The ARB dynamic was divided into three phases: Phase I (gastric phase), Phase II (lower esophageal sphincter phase), and Phase III (esophageal clearance phase). We evaluated the morphological changes in the ARB during insufflation using EPSIS.The median age of the 30 subjects was 58 years (interquartile range [IQR] 46.5–68.8), including 20 men and 10 women. Endoscopic findings and IGPs were recorded during the three phases. In Phase I, at low IGP (median 6.75 mmHg), the gastroesophageal flap valve and longitudinal folds were observed in 80% of cases. In Phase II, at moderate IGP (median 11.8 mmHg), the scope holding sign was observed in 86.7%. In Phase III, at high IGP (median 19 mmHg) inducing belching, peristalsis was observed in 80% of cases with median recovery time of 5 s.The phase concept provides a valuable framework for understanding the antireflux mechanism. Further research is needed to validate these findings in GEJ disorders and explore correlations with other modalities. [ABSTRACT FROM AUTHOR]

This paper reports a special-purpose CT for early detection of lung cancer and presents the basic idea. The parallel use of the following two systems is investigated as the diagnosis-support image display method needed in such a system, and a satisfactory result is obtained. (1) The maximum intensity projection (MIP) is applied as a means to realize the two-dimensional projection display from the three-dimensional information composed of 40 slices of lung tissue while retaining the information concerning the pathological shadows. When the simple MIP is applied, there is a large disturbance due to unnecessary organ signals. Consequently, a method is developed in which unnecessary information is deleted by thresholding; (2) The automatic recognition of candidates for the pathological shadows is applied to each slice. Only the CT image containing a shadow candidate is displayed on CRT, which helps to reduce greatly the number of cross sections to be displayed. In the automatic recognition of the pathological shadow, the quoit filter recently developed by the authors is employed. [ABSTRACT FROM AUTHOR]