Search

Widely used polymethylmethacrylate substrates for in vitro sun protection factor (SPF) testing of sunscreens do not mimic the rough surface structure of skin, and in addition, sample loading is less than that used in in vivo SPF testing (2.00 mg cm−2). We have developed a skin-mimicking substrate (SMS), which has furrows and ridges on its surface, like human skin. A comparison of the photodegradation profiles of sunscreens on commercially available substrates (including SMS) at the recommended application amounts, and on SMS at various application amounts showed that the photodegradation rate of photounstable sunscreen was dependent on the application amount being higher at lower application amounts. SMS at the recommended application amount of 2.00 mg cm−2 provided in vitro SPF values that were comparable with in vivo SPF values. Our results confirm that, in order to develop a reliable in vitro SPF method, which is consistent with in vivo SPF determination, it is important to use the same application amount of sample as in the in vivo method, in order to take proper account of sunscreen photostability. [ABSTRACT FROM AUTHOR]

Watch a video of this article [ABSTRACT FROM AUTHOR]

The article presents the case study of a 78-year-old man who was referred for endoscopic resection of a flat elevated 50-mm gastric tumor, and was treated with gel immersion endoscopy.

The article presents a case study of a 54-year-old woman with familial adenomatous polyposis, who was referred for resection of a large adenoma in the proximal jejunum.

The article discusses the aspects of the window-blind pocket in the distal rectum muscle layer while using the endoscopic submucosal dissection technique for the treatment of gastrointestinal tumors.

A response by Yoshimasa Miura and Masato Hatao to a letter to the editor about their article "Algorithm for in vitro Sun Protection Factor Based on Transmission Spectrum Measurement with Concomitant Evaluation of Photostability," in the 2008 issue is presented.

An innovative hybrid powder prepared through computer simulation allowed a new foundation to be developed having a fine, smooth texture that has never been achieved before. The optical structure/design of the powder was based on the results of measurements and analyses conductedon the optical characteristics of a baby's fine skin that is the envy of many women. In order to achieve the optimal optical characteristics, the Finite Differential Time Domain (FDTD) method to solve Maxwell's differential equation by difference and time domain was applied to the computer simulation method. For the synthesis of the hybrid powder based on the optical model, a proprietary shape regulation coating technology was used, in which flaky substrates were coated with micro-spherical forms of barium sulfate crystals. The developed hybrid powder exhibited optical characteristics that showed a significant diffusion characteristic in the visible light region. The foundation containing this powder could conceal pores, fine wrinkles, freckles, and spots, and provided a fine, smooth texture owing to its microscopic reflection characteristics that has never been available from a conventional foundation. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 14-month boy with tarry stools and anemia. Topics discussed include history of tarry stools before 5-months, diagnosis by esophagogastroduodenoscopy, and hypoechoic heterogeneous lesion revealed by endoscopic ultrasonography. Also mentioned are the presence of pancreatic tissue outside its normal localization, gastrointestinal stromal tumor, and diagnosis of pancreatic rest.

Objectives: This study aimed to elucidate the clinical course and management of adverse events (AEs) after endoscopic resection (ER) for superficial duodenal epithelial tumors (SDETs). Methods: Consecutive patients who underwent ER of SDETs between January 2008 and July 2018 at 18 Japanese institutions were retrospectively enrolled. The study outcomes included the clinical course, management, and risk of surgical conversion with perioperative AEs after ER for SDETs. Results: Of the 226 patients with AEs, the surgical conversion rate was 8.0% (18/226), including 3.7% (4/108), 1.0% (1/99), and 50.0% (12/24) of patients with intraoperative perforation, delayed bleeding, or delayed perforation, respectively. In the multivariate logistic analysis, involvement of the major papilla (odds ratio [OR] 12.788; 95% confidence interval [CI] 2.098–77.961, P = 0.006) and delayed perforation (OR 37.054; 95% CI 10.219–134.366, P < 0.001) were significant risk factors for surgical conversion after AEs. Delayed bleeding occurred from postoperative days 1–14 or more, whereas delayed perforation occurred within 3 days in all cases. Conclusions: The surgical conversion rate was higher for delayed perforation than those for other AEs after ER of SDETs. Involvement of the major papilla and delayed perforation were significant risk factors for surgical conversion following AEs. In addition, reliable prevention of delayed perforation is required for 3 days after duodenal ER to prevent the need for surgical interventions. [ABSTRACT FROM AUTHOR]

The article discusses the new techniques for direct percutaneous endoscopic jejunostomy using double-ballon endoscopy and magnetic anchors.

Background: We previously reported outcomes of endoscopic resection for duodenal tumors in a large cohort. This study investigated the frequency and characteristics of synchronous and metachronous lesions, and their association with colorectal advanced adenoma (CAA) and colorectal cancer (CRC). Methods: Patients underwent duodenal endoscopic resection during January 2008 to December 2018. Background and characteristics, incidence of synchronous and metachronous lesions, and incidence of CAA and CRC were investigated. Patients without synchronous lesions were classified as the single group, and those with synchronous lesions as the synchronous group. Patients were also classified as the metachronous and non-metachronous groups. The characteristics among the groups were compared. Results: We included 2658 patients with 2881 duodenal tumors: 2472 (93.0%) patients had single, 186 (7.0%) had synchronous, and 54 (2.0%) had metachronous lesions. The 5-year cumulative incidence of metachronous lesions was 4.1%. In total, 208 (7.8%) had CAA and 127 (4.8%) patients had CRC, and colonoscopy was performed in 936 (35.2%) patients. The incidence of CAA in the synchronous groups tended to be higher compared with that in the single groups (11.8% vs 7.5%, adjusted risk ratio 1.56), and the incidence of CRC in the metachronous groups tended to be higher compared with that in the non-metachronous groups (13.0% vs 4.6%, adjusted risk ratio 2.75), but there was no difference after adjusting for colonoscopy. Conclusions: This study showed the incidence of synchronous and metachronous duodenal lesions. There was no significant difference in incidence of CAA and CRC among each group, but further studies are warranted. [ABSTRACT FROM AUTHOR]

Background and aims: Early gastric cancer (EGC) lesions are often subtle and endoscopically poorly visible. The aim of this study is to evaluate the additive effect of linked color imaging (LCI) next to white-light endoscopy (WLE) for identification of EGC, when assessed by expert and non-expert endoscopists. Methods: Forty EGC cases were visualized in corresponding WLE and LCI images. Endoscopists evaluated the cases in 3 assessment phases: Phase 1: WLE images only; Phase 2: LCI images only; Phase 3: WLE and LCI images side-to-side. First, 3 expert endoscopists delineated all cases. A high level of agreement between the expert delineations corresponded with a high AND/OR ratio. Subsequently, 62 non-experts indicated their preferred biopsy location. Outcomes of the study are as follows: (1) difference in expert AND/OR ratio; (2) accuracy of biopsy placement by non-expert endoscopists; and (3) preference of imaging modality by non-expert endoscopists. Results: Quantitative agreement between experts increased significantly when LCI was available (0.58 vs. 0.46, p = 0.007). This increase was more apparent for the more challenging cases (0.21 vs. 0.47, p < 0.001). Non-experts placed the biopsy mark more accurately with LCI (82.3% vs. 87.2%, p < 0.001). Again this increase was more profound for the more challenging cases (70.4% vs. 83.4%, p < 0.001). Non-experts indicated to prefer LCI over WLE. Conclusion: The addition of LCI next to WLE improves visualization of EGC. Experts reach higher consensus on discrimination between neoplasia and inflammation when using LCI. Non-experts improve their targeted biopsy placement with the use of LCI. LCI therefore appears to be a useful tool for identification of EGC. [ABSTRACT FROM AUTHOR]

A computed tomography (CT) scan showed the PTP location in the esophagus (Fig. 4 A 70-year-old woman presented to our hospital complaining of a sore throat after accidentally ingesting PTP sheets. a, b A computed tomography scan showed the PTP sheets located in the esophagus. To address this, we used a Loop Cutter (FS-5L-1; Olympus, Tokyo, Japan), whose teeth can penetrate the PTP plastic sheet to secure a firm grip. [Extracted from the article]

The safety of long-term proton pump inhibitor (PPI) and vonoprazan (VPZ) use is a relatively recent concern. Gastric mucosal redness was reported as a VPZ-associated lesion in a previous study. The aim of this study was to investigate the prevalence and risk factors for gastric mucosal redness. Between December 2020 and November 2021, 1,101 patients who underwent esophagogastroduodenoscopy were reviewed. The cohort was divided into four groups: Control (n=580), histamine-2 receptor antagonist (H2RA) (n=65), PPI (n=146) and VPZ groups (n=310). Gastric mucosal redness was present in 48/1,101 patients (4%). The prevalence in controls, H2RA, PPI and VPZ groups was 1.9% (11/580), 1.5% (1/65), 6.2% (9/146) and 8.7% (27/310), respectively. Both the PPI and VPZ groups had a significantly higher prevalence of gastric mucosal redness compared with the control group (P<0.001). In the multivariate analysis, PPI and VPZ use were significantly associated with gastric mucosal redness. Fundic gland polyps, gastric hyperplastic polyps, multiple white and flat elevated lesions, cobblestone-like mucosa, and stardust gastric mucosa were also significantly associated with PPI and VPZ use in the multivariate analysis. Back-to-back analysis showed that gastric mucosal redness was not seen before starting PPI/VPZ in most patients. The duration of treatment with VPZ was investigated to determine if it affected the prevalence of gastric mucosal redness. There were no significant differences in treatment duration among patients with and without gastric mucosal redness (mean ± standard deviation: 3.0±1.5 vs. 2.5±1.4 years, P=0.077). In conclusion, the prevalence of gastric mucosal redness was low but was associated with PPI and VPZ use. [ABSTRACT FROM AUTHOR]

Background and Aim: Small-caliber endoscopy has lower resolution than normal-caliber endoscopy, limiting its use in routine outpatient practice. Flexible spectral imaging color enhancement (FICE) strengthens the color contrast of depressed-type early gastric cancer without magnification. The aim of the present study was to evaluate the detection of depressed-type early gastric cancer using small-caliber endoscopy with the FICE system. Methods: Eighty-two patients diagnosed with depressed-type early gastric cancer by standard endoscopy and biopsy were evaluated by small-caliber endoscopy. FICE images and conventional images were compared. Color differences in all 82 lesions were measured between malignant lesions and the surrounding mucosa using the Commission Internationale de L'Eclairage (CIE) 1976 color space. Results: Most cancers were readily detected as reddish lesions on FICE images. Lines of demarcation between the malignant lesion and the surrounding mucosa were easily identified with FICE images, as such cancers could be clearly distinguished from the surrounding atrophic mucosa. Greater median color differences between malignant lesions and the surrounding mucosa were present in FICE images compared with conventional images, resulting in images with better contrast (27.2 vs 18.7, P < 0.0001). Conclusions: Small-caliber endoscopy with the FICE system provides better color contrast of depressed-type early gastric cancers than conventional small-caliber endoscopy, and the FICE system may facilitate the diagnosis of this type of cancer as a new endoscopic modality. [ABSTRACT FROM AUTHOR]

Abstract: In order to design cosmetics producing the optical properties that are required for a beautiful skin, the radiation transfer in the skin has been numerically investigated by the Monte Carlo method and the effects of skin texture and cosmetics on the radiation transfer have been empirically investigated using an artificial skin. The numerical analysis showed that the total internal reflection suppresses large portion of radiation going out through the skin surface Additionally, the experimental study revealed that skin texture and cosmetics not only diffusely reflect the incoming radiation, but also lead the internally reflected radiation to the outside of the skin. [Copyright &y& Elsevier]

Background: Duodenal ulcers are classified into bulbar and post-bulbar ulcers. The aim of this study is to compare the long-term outcomes of patients with post-bulbar ulcer bleeding and those with bulbar ulcer bleeding. Methods: A total of 272 patients with hemorrhagic duodenal ulcers requiring hospitalization were included. Their medical records were retrospectively reviewed. Results: All patients were categorized as bulbar or post-bulbar bleeding ulcer groups. The post-bulbar ulcer group had more patients of advanced age, concurrent malignancy, diabetes mellitus, hypertension, cirrhosis, and chronic kidney disease undergoing hemodialysis. We performed long-term follow-up for an average of 2.6 years. The mortality rate during the follow-up period in the post-bulbar ulcer group was significantly higher than that in the bulbar ulcer group (p < 0.001). The PNED score was a better predictor of 30-day mortality compared to the complete Rockall score and the Glasgow-Blatchford Score. Predictors of mortality were evaluated using a Cox proportional hazards regression model. In multivariate analysis, post-bulbar ulcer, concurrent malignancy, cirrhosis, antiplatelet/anticoagulant use, and transfusion were significant predictors of mortality. Conclusions: Patients with post-bulbar ulcers have a poorer prognosis than those with bulbar ulcers. After the diagnosis of hemorrhagic post-bulbar duodenal ulcer, close follow-up is necessary. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (H. pylori) eradication success increases the incidence of erosive esophagitis by normalization of gastric acid secretion. The aim of this study is to clarify predictors and timing for the development of symptomatic gastroesophageal reflux disease (GERD) after successful H. pylori eradication based on long-term follow-up. From April 2014 to October 2020, 330 patients with H. pylori infections treated with a standard triple-drug regimen were enrolled, and their records retrospectively reviewed. Development of symptomatic GERD was defined as requiring proton pump inhibitor or vonoprazan therapy to treat symptoms. The mean follow-up period was 2.8 years, and symptomatic GERD developed in 41 (12%) patients during the study period. Overall rates of GERD-symptom free patients at 6 months, 1, and 2 years after eradication were 97%, 93%, and 89%, respectively. We evaluated predictors for the development of symptomatic GERD using a Cox proportional hazards regression model. In multivariate analysis, being a current smoker, having functional dyspepsia, hiatal hernia, and severe gastric atrophy were identified as significant predictive factors. The GERD domain score in the Izumo scale was significantly decreased 1 month after vonoprazan therapy consistent with effective treatment of symptomatic GERD. The rate of development of symptomatic GERD after successful H. pylori eradication is low over long-term follow-up and is easily controlled by vonoprazan therapy. However, patients with smoking habits, functional dyspepsia, hiatal hernia, or severe gastric atrophy should be followed carefully after eradication. [ABSTRACT FROM AUTHOR]

B Correction: J Gastroenterol b https://doi.org/10.1007/s00535-023-01964-1 In the original publication of the article, in Table 2, the value of "CP/EMR/UEMR/ESD/surgery SP a sp /follow" under the column "Non-metachronous group ( I n i = 2604)" should be moved under the "Metachronous group ( I n i = 54)" column. The original article can be found online at https://doi.org/10.1007/s00535-023-01964-1. [Extracted from the article]

Background: Double-balloon endoscopy (DBE) has become a new standard in enteroscopy. However, it may be difficult to make a diagnosis or plan treatment strategy with endoscopic visualization alone. The addition of endoscopic ultrasonography (EUS) has the potential to improve the ability to establish the diagnosis and develop a treatment strategy. The present study was conducted to assess the feasibility and usefulness of EUS with DBE. Methods: EUS with DBE was performed in 31 of 891 patients who underwent DBE from July 2004 to March 2011 at Jichi Medical University Hospital. We analyzed the EUS findings for lesions and evaluated the usefulness of EUS considering the following three factors: qualitative diagnostic value for lesions, depth grading of lesions, and evaluation of the structure of severe strictures prior to endoscopic balloon dilation. Results: EUS was performed for 31/32 lesions (97 %) in 31 patients. EUS findings were informative for 29/32 lesions (91 %). EUS findings were useful for establishing a qualitative diagnosis in 15/25 lesions (60 %). EUS findings for depth grading provided useful information for determining the therapeutic strategy in 11/13 lesions (85 %). EUS with DBE was useful in the evaluation of strictures for all six lesions (100 %). The overall usefulness of EUS with DBE on decision making was 72 % (23/32) in this study. Conclusions: EUS with DBE is feasible and useful. It provides additional information on small-bowel disease and contributes to establishing a precise diagnosis and selection of an appropriate therapeutic strategy. [ABSTRACT FROM AUTHOR]

A nanofiber nonwoven textile with metallic magnetic material coating was fabricated, and the effect of electromagnetic wave shielding was evaluated. The nanofiber nonwoven textile with an average diameter of about 500 nm was spun by electrospinning. The metallic magnetic material was coated by sputtering on the textile surface. EMI shielding effect of the textile with metallic magnetic material coating was about 90% in the GHz band. Because the textile has thin, light, flexible, and breathable characteristics, it will be versatile for various electromagnetic wave shielding applications. [ABSTRACT FROM AUTHOR]

It has been very difficult to develop a miniaturized temperature sensor device using the conventional temperature-sensitive ferrites, such as Mn-Zn ferrite, which is due to difficulty of the high-frequency operation, because of their low natural resonance frequency (below 1 MHz) and low electrical resistivity (around 10[sup2] - 10[sup4] Ω·cm). The authors have recently developed a polycrystalline Mn-substituted Li-Zn-Cu ferrite with a high natural resonance frequency beyond 10 MHz and high resistivity over 10[sup6] Ω·cm, which exhibited strong temperature-dependent magnetic properties. It was considered that the transmission-line device using a new temperature-sensitive ferrite as an electromagnetic-field propagation substrate enables us to obtain a novel chip temperature-sensing micro device, because of the possibility of high-frequency operation due to a high resonance frequency and high resistivity of the new ferrite. We have simulated a quarter-wavelength resonator using the Mn-substituted Li-Zn-Cu ferrite substrate and its temperature-dependent properties. Since the quarter-wavelength transmission-line resonator includes distributed inductance and capacitance depending on the temperature-sensitive electromagnetic property of the ferrite substrate, this type of device operates as an integrated LC resonator-type temperature sensor. In this study, the integrated resonator-type temperature sensor using a spiral strip-line structure with the Mn-substituted Li-Zn-Cu ferrite substrate was fabricated, and its temperature-dependent characteristics were evaluated. [ABSTRACT FROM AUTHOR]

Vonoprazan, a novel potassium-competitive acid blocker, results in greater inhibition of gastric acid secretion than proton pump inhibitors (PPI). The aim of this study was to assess the long-term outcomes of patients with PPI-resistant gastroesophageal reflux disease (GERD) treated with vonoprazan. The medical records of patients with symptomatic GERD treated with vonoprazan for 1 year were retrospectively reviewed. Changes in abdominal symptoms were assessed using the Izumo scale, a self-reported questionnaire which is useful in evaluating the symptoms of GERD, epigastric pain, postprandial distress, constipation and diarrhea, and is commonly used in routine clinical practice. A total of 30 patients were included and stratified into a non-erosive (n=22) and erosive group (n=8). At baseline, postprandial distress symptoms were significantly greater in the non-erosive group compared with the erosive group (P=0.013). Even with vonoprazan therapy, symptoms of GERD in the non-erosive group were refractory compared with the erosive group, and required additional treatment in a larger proportion of patients (45 vs. 13%). GERD symptoms in the non-erosive group significantly improved from baseline and remained better after 1 year of vonoprazan therapy, similar to the erosive group. In addition, vonoprazan improved epigastric pain and postprandial distress symptoms in the non-erosive group, and 1 year of vonoprazan therapy did not aggravate constipation or diarrhea. In conclusion, 1 year of vonoprazan therapy improves GERD symptoms in patients with PPI-resistant GERD. [ABSTRACT FROM AUTHOR]

Recently, high-density printed circuit boards (HD-PCBs) with less than 50 μm/50 μm line/space has been developed. In the HD-PCB, since the spacing between adjacent signal lines becomes very small, the crosstalk electromagnetic interference among adjacent lines becomes serious. In general, in order to suppress the crosstalk, the ground line is located at the spacing between signal lines because of the decrease of mutual capacitance among adjacent signal lines. The authors have proposed a magnetic method for reducing the crosstalk. The composite magnetic material was filled in the spacing between signal lines instead of the ground line. The magnetic composite is composed of Fe-Si-B-Cr amorphous particles with a mean diameter of 6 μm and epoxy resin. From the experiments using the PCB-TEG with a 130 μm/50 μm line/space and 25-mm line length, the crosstalk was suppressed in the wide frequency range by using the magnetic composite. In the case of using 51 vol.% amorphous composite, the crosstalk suppression was up to 20 dB around 1 GHz. The influence of the magnetic composite on the transmission and reflection in the main signal line was very small. Therefore, the proposed method is effective for crosstalk suppression without influence on the signal transmission. [ABSTRACT FROM AUTHOR]

Gastric endoscopic mucosal resection is challenging due to the slippery mucosa, abundant blood vessels, and the presence of mucus. We developed gel immersion endoscopy to secure the visual field, even in a blood-filled gastrointestinal lumen in 2016. Clear gel with appropriate viscosity, instead of water, can prevent rapid mixture with blood and facilitate identification of the culprit vessel. We further optimized the gel for endoscopic treatment, and the resultant product, Viscoclear (Otsuka Pharmaceutical Factory) was first released in Japan in 2020. The viscosity of this gel has been optimized to maximize endoscopic visibility without compromising the ease of its irrigation. The aim of this study is to clarify the effectiveness of gel immersion endoscopic mucosal resection for small-sized early gastric neoplasms. Seven lesions in seven patients were treated by gel immersion endoscopic mucosal resection. The size of all lesions was under 10 mm. The median procedure time was 4.5 min. Intraoperative bleeding occurred in four of seven lesions immediately after snare resection and was easily controlled by endoscopic hemostatic forceps during the gel immersion endoscopy. The R0 resection rate was 100%. In conclusion, gel immersion endoscopic mucosal resection may be a straightforward, rapid, and safe technique for resecting superficial gastric neoplasms <10 mm in diameter., Competing Interests: Tomonori Yano holds patents and is the inventor of the dedicated gel for the gel immersion method and has received royalties and honoraria from Otsuka Pharmaceutical Factory. He has received research funding and honoraria from Fujifilm and honoraria from Olympus. Hironori Yamamoto has consultant relationships with Fujifilm and received honoraria, grants, and royalties from the company. Edward J. Despott has received academic grants and speaker honoraria from Fujifilm and Olympus. The other authors declare no conflict of interest., (© 2024 The Author(s). DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)

Background: Gastroesophageal reflux disease (GERD) symptoms frequently recur after cessation of acid blockers. The presence of a hiatal hernia may worsen GERD symptoms and increase the risk of esophageal malignancy. The aim of this study is to clarify the timing and predictors for recurrence of GERD symptoms after cessation of vonoprazan (VPZ) therapy., Methods: A retrospective observational study involved 86 patients who underwent cessation of VPZ therapy for symptomatic GERD. Collated data from medical record review included the endoscopic findings and Izumo scale score., Results: The mean duration of continuous VPZ therapy before cessation was 7.9 months. GERD symptoms requiring the resumption of VPZ therapy recurred in 66 of 86 patients (77%). Kaplan-Meier analysis showed that overall recurrence-free rates at 6 months, one and two years after VPZ cessation were 44%, 32% and 23%, respectively. Alcohol use, the presence of a hiatal hernia and long-term therapy for more than six months were identified as significant positive predictors for symptomatic recurrence. Notably, hiatal hernia had the highest hazard ratio in both univariate and multivariate analyses. The recurrence-free rate in patients with a hiatal hernia was much lower at 6 months than in patients without a hiatal hernia (15% and 51%, respectively p  = 0.002). After the symptomatic recurrence, GERD symptoms improved significantly after one-month VPZ therapy., Conclusion: The rate of symptomatic recurrence after VPZ cessation in patients with GERD is considerable. Cessation of acid suppression therapy should be cautious in patients with both a hiatal hernia and GERD.

Gastric mucosal changes associated with long-term potassium-competitive acid blocker and proton pump inhibitor (PPI) therapy may raise concern. In contrast to that for PPIs, the evidence concerning the safety of long-term potassium-competitive acid blocker use is scant. Vonoprazan (VPZ) is a representative potassium-competitive acid blocker released in Japan in 2015. In order to shed some comparative light regarding the outcomes of gastric mucosal lesions associated with a long-term acid blockade, we have reviewed six representative gastric mucosal lesions: fundic gland polyps, gastric hyperplastic polyps, multiple white and flat elevated lesions, cobblestone-like gastric mucosal changes, gastric black spots, and stardust gastric mucosal changes. For these mucosal lesions, we have evaluated the association with the type of acid blockade, patient gender, Helicobacter pylori infection status, the degree of gastric atrophy, and serum gastrin levels. There is no concrete evidence to support a significant relationship between VPZ/PPI use and the development of neuroendocrine tumors. Current data also shows that the risk of gastric mucosal changes is similar for long-term VPZ and PPI use. Serum hypergastrinemia is not correlated with the development of some gastric mucosal lesions. Therefore, serum gastrin level is unhelpful for risk estimation and for decision-making relating to the cessation of these drugs in routine clinical practice. Given the confounding potential neoplastic risk relating to H. pylori infection, this should be eradicated before VPZ/PPI therapy is commenced. The evidence to date does not support the cessation of clinically appropriate VPZ/PPI therapy solely because of the presence of these associated gastric mucosal lesions., Competing Interests: Satoshi Shinozaki, Hiroyuki Osawa, and Yoshimasa Miura have received honoraria from Takeda and Otsuka Pharmaceuticals. Hirotsugu Sakamoto, Tomonori Yano, and Hironori Yamamoto have received honoraria from Takeda Pharmaceutical. All other authors declare no conflict of interest., (© 2024 The Author(s). DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)

Background: The main therapeutic modality of early upper gastrointestinal neoplasms has shifted from surgery to endoscopic therapy. The role of endoscopy has also expanded not only for more accurate diagnosis of neoplasms but also for the determination of extent and depth of neoplasms with a combination of multiple electronically modified images acquired with image-enhanced endoscopy (IEE) for assessing the feasibility of endoscopic treatment., Summary: These IEE with or without magnifying endoscopy including narrow-band imaging, blue laser imaging, and linked color imaging (LCI) using narrow-band light have greatly changed the diagnosis for upper gastrointestinal neoplasms. These modalities produce high color contrast between cancer and surrounding mucosa at distant views and clear visualization of surface and vessels at close-up observations. LCI shows purple color of intestinal metaplasia (IM) distinct from other inflammatory gastric mucosae and facilitates the recognition of early gastric cancers often surrounded by IM. Recently, ultrathin endoscopy has provided high-resolution images similar to standard-caliber endoscopy. In addition, these advanced IEEs that integrate computer-assisted artificial intelligence systems are marked and will improve our diagnostic performance for neoplasia in the future., Key Message: New IEE with sufficient brightness and color contrast has increasingly been used based on accumulated evidence for early and accurate detection of neoplastic lesions. We provide recent articles relevant to endoscopic diagnosis with IEE on esophageal, gastric, and duodenal neoplasms. Endoscopic equipment that integrates artificial intelligence support system is now being introduced into routine clinical use and is expected to enhance early detection of neoplastic lesions., (© 2023 S. Karger AG, Basel.)