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Epstein-Barr virus-associated gastric cancer (EBVaGC) has been reported to be associated with chronic inflammation of the gastric epithelium caused by Helicobacter pylori infection. Autoimmune gastritis (AIG) is also believed to increase the risk of carcinogenesis. We herein report a case of multiple EBVaGCs that arose in a patient with AIG, highlighting the potential for multiplicity of this entity. In this case, a total of four metachronous EBVaGCs were found after initial Endoscopic submucosal dissection for EBVaGC, all of which were treated endoscopically. This case demonstrates that patients with AIG should be monitored closely for development of EBVaGC.

Objective According to consensus guidelines, eosinophilic esophagitis (EoE) is defined as a clinicopathological entity whose symptoms and histology must always be considered together. However, endoscopic findings typical of EoE are often seen in asymptomatic esophageal eosinophilia (aEE). We aimed to clarify the clinicopathological features of aEE. Methods We retrospectively compared cases of aEE and those of symptomatic EoE. Patients or Materials We reviewed 146 patients who underwent upper gastrointestinal endoscopy and were confirmed histopathologically to have esophageal eosinophil infiltration of at least 15 eosinophils per high-power field. They were divided into the aEE group (n=75) and the EoE group (n=71). Patients' clinicopathological findings were then collected and examined. Results The EoE group experienced dysphagia (47.9%), heartburn (40.8%), food impaction (40.8%), chest pain (16.9%), and other symptoms (8.5%). There was no significant difference between the two groups with regard to age, sex, current smoking status, or alcohol consumption. The aEE group had a significantly higher body mass index (p

Pharyngeal squamous cell carcinoma (PSCC) is associated with a high likelihood of metachronous carcinogenesis, which is known to have a poor prognosis. This study aimed to identify comprehensive risk evaluation indicators for metachronous carcinogenesis after endoscopic submucosal dissection (ESD) of superficial PSCC.The risk of metachronous carcinogenesis was evaluated in 144 patients with superficial PSCC (with no history of PSCC or esophageal squamous cell carcinoma) who underwent initial ESD from 2008 to 2020. Multiple lugol-voiding lesions (LVLs) in the background pharyngeal and esophageal epithelium were evaluated as endoscopic indicators. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score was analyzed as a serum marker.The median follow-up period was 4.3 years. The coincidence rate for pharyngeal and esophageal LVL grade was 55%. The cumulative 3-year metachronous PSCC rate was 18.9%. The cumulative 3-year second metachronous PSCC rate was 43.9%. Forward stepwise multivariate Cox proportional hazards regression analysis identified pharyngeal LVL grade and a lower HALP score as significant independent predictors. Pharyngeal LVL grade was superior to esophageal LVL grade as a predictor of metachronous PSCC. A lower HALP score was significantly associated with younger age in forward stepwise multivariate logistic regression analysis.Patients with a history of superficial PSCC remain at risk for metachronous carcinogenesis over time, and long-term follow-up is imperative. Comprehensive evaluation of endoscopic features with a novel serum marker, namely, the HALP score, can help predict metachronous carcinogenesis.

Helicobacter pylori (H. pylori) is an important risk factor for gastric cancer and is a recognized carcinogen. Although eradication of H. pylori reduces the incidence of gastric cancer, cases can still occur after eradication therapy. A number of such cases have been reported, and their early clinicopathological characteristics are becoming clearer. Some reports mention that endoscopic diagnosis of gastric cancer may be difficult after eradication therapy, because the cancer is covered by non-cancerous epithelium. However, there are few reports on advanced gastric cancer after eradication therapy, and its characteristics remain poorly understood. In view of the predicted increase in frequency of advanced gastric cancer after eradication therapy in the near future, it is important to be aware of these cases. In this report, we describe three cases of advanced gastric cancer detected during routine follow-up after eradication.

Background Although almost all cases of gastric cancer are caused by Helicobacter pylori (HP) infection, there are some rare exceptions. Furthermore, the clinicopathological characteristics of gastric cancer may differ depending on HP infection status. This study aimed to determine the clinicopathological characteristics of undifferentiated-type gastric cancer (UD-GC) according to HP status. Methods The study involved 83 patients with UD-GC who were selected from 1559 patients with gastric cancer who underwent endoscopic resection at our hospital and whose HP infection status was confirmed. Clinicopathological characteristics were evaluated according to HP status (eradicated, n = 28; infected, n = 32; not infected, n = 23). Results In patients without HP infection, UD-GCs were Conclusion The clinicopathological characteristics of UD-GC were similar between HP-infected patients and HP-eradicated patients. Three of four patients with eradicated HP whose UD-GC developed ≥ 10 years after eradication were not eligible for endoscopic treatment and required additional surgery resection. In contrast, UD-GC was curable by endoscopic resection in all patients without HP infection.

Introduction: The Japanese guidelines for endoscopic submucosal dissection (ESD) of Barrett’s esophageal adenocarcinoma (BEA) recommend image-enhanced magnifying endoscopic examination for diagnosing the lateral extent of superficial esophageal adenocarcinoma. The Japan Esophageal Society Barrett’s Esophagus (JES-BE) classification is proposed recently and is useful in terms of diagnostic accuracy. In this study, we retrospectively examined the usefulness of the JES-BE classification for differential diagnosis and determination of the extent of BEA originating in short-segment Barrett’s esophagus. Methods: The study reviewed 51 lesions which underwent ESD for BEA. The circumference of the esophagogastric junction was divided into four parts, and the lesions were divided into those in the right anterior portion (RA group; n = 33) and those in other portions (non-RA group; n = 18). Clinicopathological characteristics and clinical outcomes were compared between the two groups. Results: JES-BE classification findings as “dysplasia” were seen in 48 out of 51 (94.1%) BEA lesions retrospectively. There was no significant difference in histological type, tumor depth, lymphovascular invasion, or the proportion of tumors with a positive or unknown horizontal or vertical margin status between the groups. The proportion of tumors with type 0-I morphology was significantly higher in the RA group (p = 0.023). The tumor size was significantly greater in the RA group (p = 0.034). According to the JES-BE classification, 31 lesions (93.9%) in the RA group and 17 lesions (94.4%) in the non-RA group were diagnosed as dysplasia. There was also no significant difference in the rate of consistency between the endoscopic and histopathological findings on the lateral extent of the lesion (90.9% vs. 83.3%; p = 0.612). Discussion/Conclusions: The JES-BE classification may be useful for determining the extent of BEA.

Introduction: Esophageal cancers other than two types, squamous cell carcinoma (SCC) and adenocarcinoma, are commonly referred to as special type of esophageal cancer (STEC). Studies on STECs have been limited because of its low prevalence. Therefore, we aimed to clarify the clinicopathological findings and the long-term outcomes of STECs that were managed with ESD. Methods: We reviewed 713 patients with 1089 lesions who underwent ESD for primary esophageal cancer except Barrett’s esophageal cancer. Patients were classified into the SCC group and the STEC group, respectively. Their clinicopathological findings and long-term outcomes including diseases specific survival (DSS) were collected and examined. Results: A total of 19 consecutive patients (1.7 %) were diagnosed with STEC. Nine patients were diagnosed with basaloid carcinoma, 6 with adenosquamous carcinoma, 2 with mucoepidermoid carcinoma, 2 with salivary duct-type carcinoma, and 1 with neuroendocrine cell carcinoma. There was significantly more pT1b esophageal cancer (47.4% vs. 11.0%, p

The coronavirus pandemic significantly impacted endoscopic practice. During lower gastrointestinal endoscopy, infectious substances disseminate; therefore, we developed an infection control device (STEP-L) for lower gastrointestinal endoscopy and examined its usefulness.STEP-L wraps around the patient's buttocks and covers the endoscope. Using lower endoscopy training models, three endoscopists performed 18 colonoscopies with STEP-L (group S) and without (group C). Endoscopic insertion time and pigmented areas of ​​gloves and diapers after the examination were compared between both groups.Insertion of the endoscope up to the cecum was possible in all 18 examinations. The insertion time to the cecum was 52.4 ± 19.0 s in group S and 53.9 ± 13.3 s in group C. The pigmented areas of the ​​gloves measured 39,108.0 ± 16,155.3 pixels in group C, but were significantly reduced to 2610.5 ± 4333.8 pixels in group S (Using STEP-L does not change the insertion time, and is technically feasible. STEP-L significantly reduces the adhesion of virtual pollutants to the surroundings, suggesting that this device is useful for infection control during lower gastrointestinal endoscopy.

Objective Endoscopic submucosal dissection (ESD) for gastric cancer in the remnant stomach poses some specific technical difficulties due to severe fibrosis and the presence of surgical staples. Therefore, we clarified the feasibility and safety of removing staples. Methods We retrospectively analyzed ESD outcomes of cases of gastric cancer in the remnant stomach. Patients and Materials This study reviewed 227 patients who underwent ESD for gastric cancer in the remnant stomach or gastric conduit. Patients were divided into those in whom resection extended to the anastomotic site or suture line (AS group; n=90) and those without such extension (non-AS group; n=137). The AS group was further divided into cases in which staples were removed (staple group; n=22) and those in which they were not (control group; n=68). Results The rates of specimen damage and curative resection and the duration and speed of the procedure were significantly worse in the AS group than the non-AS group. There were no significant differences between the staple group and the control group in the curative or complete resection rates, and no complications occurred in the staple group. In a propensity score-matched analysis, the rate of specimen damage was significantly lower in the staple group than in the control group (p=0.002), and the procedure speed tended to be faster (p=0.077). Conclusions Staple removal may improve the outcomes of ESD in patients with gastric cancer in the remnant stomach or gastric conduit by reducing the risk of specimen damage and increasing the procedure speed without complications.

Background and Aims Superficial pharyngeal cancers are being detected and treated using endoscopy in many medical facilities with increasing frequency. However, the reports focus on the hypopharynx. We identified reliable treatments by adapting the method for each region of the pharynx. Here, we introduce our methods for treating various pharyngeal regions and show their long-term results. Methods Of 308 consecutive patients who underwent pharyngeal endoscopic submucosal dissection between February 2007 and December 2018 at our institution, we selected 293 patients who were diagnosed histologically with squamous cell carcinoma. The patients were divided into 4 groups based on the specific location of superficial pharyngeal lesions and the short- and long-term outcomes, such as technical success, adverse events, overall survival, and case-specific survival, were evaluated. Results The procedure time was 51 minutes at location A where cancer develops most commonly. The rate of en bloc resection was 99.4%, and the R0 resection rate was 82.6%. With regard to adverse events, there were 2 cases of postoperative hemorrhage, both treated with endoscopic hemostasis. The average observation period was 61.2 months overall, with 14 cases of recurrent lymph node metastasis. The 5-year survival rate was 84.1%, and cause-specific survival was 100%. Conclusions Adaptation of the treatment method according to the location of the lesion led to good results. Endoscopic treatment of superficial pharyngeal cancer is both feasible and beneficial.

Background and study aimsTreatment of superficial cancer in the remnant esophagus after esophagectomy is highly invasive, and early detection and minimally invasive treatment are considered necessary. We performed endoscopic submucosal dissection (ESD) for superficial cancer in the remnant esophagus and evaluated its safety and efficacy.Patients and methodsThis study involved 28 patients (33 lesions) who underwent ESD for superficial esophageal cancer in the remnant esophagus after esophagectomy from January 2007 to December 2018. The safety and efficacy of ESD were evaluated retrospectively.ResultsThe average age of all 28 cases (24 men and 4 women) was 69.6 ± 5.3 years. The average duration of ESD from esophagectomy was 2826 ± 2197 days. Twenty-six of the 28 cases were treated under general anesthesia. All 33 lesions were resected en bloc. The complete resection rate was 81.8% (27/33). There were no serious adverse events such as perforation, intraoperative bleeding, postoperative bleeding, and pneumonia. The overall survival rate was 78.6% (22/28) with a mean observation period post-ESD of 1793 ± 1148 days. There was no local recurrence, lymph node metastasis, or distant metastasis.ConclusionsThe ESD procedure for superficial cancer of the remnant esophagus was performed with high rate of complete resection without serious complications. In addition, there was no local recurrence and lymph node metastasis, and so ESD for superficial cancer of the remnant esophagus can be considered a safe and effective treatment.

The mesio-angulated impaction of mandibular third molars makes them unsuitable as donor teeth for tooth autotransplantation. However, uprighted molars may be applicable for autotransplantation. This study aimed to determine the amount of periodontal ligament (PDL) on the root surfaces of extracted third molars after an application of uprighting force and to examine the amount of PDL at the tension and compression sites.In this prospective cohort study, 15 mesio-angulated mandibular third molars (iM8s) from 15 patients planned for orthodontic extraction, were uprighted using springs connected to miniscrews, whereas 15 nonopposing and fully erupted mandibular third molars from 15 other patients served as controls. The altered angulation was monitored and assessed from panoramic radiographs. All 30 molars, removed by simple extraction, were stained with 0.04% (w/v) toluidine blue to analyze the percentages of stained PDL on the root surfaces.An average period of 3.4 months was necessary to upright the iM8s at a mean rate of 8.3° per month. The mean percentage of stained PDL on the loaded iM8s was significantly greater than that on the unloaded molars (P 0.05). The mean percentages of stained PDL were significantly increased at the cervical and middle thirds and the buccal, mesial, and distal surfaces of the loaded iM8s compared with those of the unloaded molars (P 0.05), whereas the apical third and the lingual surface, corresponding to the compression sites, showed no significant increases.Orthodontic uprighting leads to significantly increased proliferative PDL on certain radicular portions and surfaces of iM8s, which might be useful for tooth autotransplantation.

Alveolar soft part sarcoma (ASPS) is a very rare soft tissue sarcoma. Primary ASPS of the gastrointestinal tract is especially rare. Due to the scarcity of cases, neither its clinicopathologic features nor its mutational background has been clarified. Here, we report a case of ASPS arising from the rectum, which was completely resected by endoscopic submucosal dissection. The lesion was a 17 × 16 × 15 mm semi-pedunculated mass in the upper portion of the rectum in a 46-year-old female. In terms of histology, tumor cells exhibited confluent eosinophilic cytoplasm, forming a sheet-like architecture. Periodic acid Schiff-positive diastase-resistant intracytoplasmic crystals were observed in the tumor cells. Fluorescence in situ hybridization revealed TFE3 rearrangement, and reverse transcription polymerase chain reaction revealed an ASPSCR1-TFE3 type 1 fusion. Negative PAX8 immunostaining and the absence of other massive lesions in postoperative imaging studies led to a diagnosis of primary ASPS of the rectum. The potential oncogenic role of the canonical ASPSCR1-TFE3 fusion transcript in gastrointestinal ASPS was indicated. Primary gastrointestinal ASPS remains a diagnostic pitfall in routine surgical pathology.

© 2020 The Korean Association of Orthodontists. Objective: Preservation of the periodontal ligament (PDL) is vital to the success of tooth autotransplantation (TAT). Increased PDL volumes and facilitated tooth extraction have been observed upon orthodontic preloading. However, it is unclear whether any changes occur in the expressions of bone biomolecules in the increased PDL volumes. This study aimed to determine the expressions of runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), receptor activator of nuclear factor kappa-B ligand (RANKL), and osteoprotegerin (OPG) in PDL upon preloading. Methods: Seventy-two premolars from 18 patients were randomly assigned to experimental groups that received a leveling force for 1, 2, or 4 weeks or to a control unloaded group. Following extraction, PDL volumes from 32 premolars of eight patients (21.0 ± 3.8 years) were evaluated using toluidine blue staining. The expressions of the biomolecules in the PDL from 40 premolars of ten patients (21.4 ± 4.0 years) were analyzed via immunoblotting. Results: The median percentage of stained PDL was significantly higher at 2 and 4 weeks after preloading than in the unloaded condition (p < 0.05). The median RUNX2 and ALP expression levels were significantly higher at 2 and 4 weeks after preloading than in the unloaded condition (p < 0.05), whereas the median RANKL/OPG ratios were significantly higher at 1 and 4 weeks after preloading (p < 0.05). Conclusions: Orthodontic preloading for 4 weeks enhances PDL volumes as well as the expressions of RUNX2, ALP and the RANKL/OPG ratio in the PDL, suggesting this loading period is suitable for successful TAT.

The presence of Barrett’s mucosa in the esophageal remnant is a result of post-esophagectomy anastomotic site exposure to gastric acid and is regarded as a human model of Barrett’s esophagus onset. Here, we attempted to clarify the relationship between duodenogastric reflux and formation of columnar epithelium by following the changes over time after esophagectomy. A total of 96 patients underwent esophagectomy due to superficial cancer from April 2000 to March 2018 were included in this study. Cases were divided into two groups according to the reconstruction technique after esophagectomy as either the gastric pull-up (Ga) group and ileocolonic interposition (Ic) group. Previously obtained endoscopic pictures of the cases were reviewed retrospectively and chronologically. There were 24 cases of columnar epithelium in the Ga group (42%) and 1 in the Ic group (2.6%) (P

Metachronous cancer rate in the pharynx is high before and after the treatment of esophageal cancer. Endoscopic observation is difficult in the pharynx especially in the postcricoid area. Pharyngeal cancer in the postcricoid area has been often found in advanced stage. Valsalva maneuver has been reported to improve the visibility. From May 2017 we introduced a dedicated mouthpiece to conduct Valsalva maneuver. One hundred consecutive patients who had been observed throughout the pharynx by one endoscopist were enrolled. A total of 200 image files before and after introduction were made and reviewed by three endoscopists. We retrospectively evaluated the utility and safety of Valsalva maneuver. The visibility before introduction was Good in three cases, Moderate in 12 cases and Poor in 85 cases. Meanwhile, the visibility after introduction was Good in 58 cases, Moderate in 23 cases, and Poor in 19 cases (P

The quantity of remaining periodontal ligament (PDL) on the root surface of donor teeth is essential for the success of tooth autotransplantation. Preapplication of orthodontic loading increases this quantity on rat tooth root surfaces. However, little is known about the effects of preloading on human PDL or the ease of tooth extraction. This study aimed to determine the optimal duration of preloading for enhanced PDL on the root surface of extracted human premolars and for facilitating extraction.Sixty patients received orthodontic preloading with a bracket connected to an archwire on one of their maxillary first premolars for 2, 4, 6, or 8 weeks, whereas the contralateral premolar was not loaded as a control. Premolar extractions were performed with a record of the duration and difficulty of extraction. The extracted premolars were fixed and stained with toluidine blue. Digitized images were recorded under a stereomicroscope, and the percentage of stained PDL was analyzed.Orthodontic preloading for 4, 6, and 8 weeks significantly increased the percentage of stained PDL on the root surface compared with the control (P 0.05). The duration and difficulty of extraction were significantly less in preloaded than that of unloaded teeth after 4, 6, and 8 weeks (P 0.05).A 4-week duration of orthodontic preloading is suggested as the shortest duration to adequately enhance PDL and ease tooth extraction; both outcomes may be beneficial for tooth autotransplantation.

Objective Clipping is a common technique for managing colonic diverticular bleeding (CDB), despite the lack of published evidence regarding its effectiveness. We aimed to evaluate the effectiveness of clipping for CDB in preventing early recurrent bleeding. Methods This dual-center retrospective study included 93 patients who underwent emergency hospitalization for bloody stool, diagnosed with definitive CDB, and treated with clipping or conservative treatment. The primary outcome was early recurrent bleeding. A logistic regression analysis was performed to assess the association between the occurrence of early recurrent bleeding and clipping with adjustment for propensity scores. Secondary outcomes included death, transfusion, length of hospitalization, need for transcatheter arterial embolization or surgery, and adverse events. Results The patient characteristics were similar between the clipping (n=85) and conservative treatment (n=8) groups. The rate of early recurrent bleeding was significantly lower in the clipping group than in the conservative treatment group [23.5% (20 cases) vs. 75% (6 cases), p=0.005]. In the propensity score-adjusted logistic regression analysis, the odds ratio for early recurrent bleeding in the clipping group was 0.094 (95% confidence interval, 0.008-0.633, p=0.026). Secondary outcomes were not significantly different between the two groups. Stigmata of recent hemorrhage (SRH) at the time of recurrent bleeding was identified in 79.2% of patients (19/24). In the clipping group, recurrent bleeding was observed in 62.5% of cases (10/16) from the same diverticulum. However, early recurrent bleeding tended to be less likely with direct clipping (p=0.072). Conclusion Clipping for definite CDB was more effective in preventing early recurrent bleeding than conservative treatment.

Introduction: Tongue spurs have been successfully used for the early treatment of anterior open bite (AOB). However, according to our knowledge, their effectiveness in the treatment of adults has not been evaluated. Objectives: The purpose of the study was to assess the dentoalveolar changes observed after the use of customized bonded shark-tooth-like spurs (JAWs) in adults with AOB. Methods: Twenty-three adults (22.1±4.4 years) with AOB were selected for the treatment. JAWs made from compomer cement were bonded on the lingual surfaces of the maxillary and mandibular anterior teeth to correct tongue-thrusting. Lateral cephalograms and 3D digital models were obtained to evaluate dentoalveolar features observed before and at three time points after JAWs use. Paired t-test and repeated measure ANOVA tests were used to compare dentoalveolar changes, and Pearson’s correlation was used to analyze the association of dentoalveolar changes and overbite changes. The significance level was set at p

Background. Gastroesophageal reflux disease is diagnosed endoscopically based on the presence of mucosal breaks. However, mucosal breaks can be judged differently depending on the endoscopist, even in the same image. We investigated how narrow-band imaging (NBI) and magnified endoscopy affect the judgment of mucosal breaks. Methods. A total of 43 consecutive patients were enrolled who had suspected mucosal breaks on white-light images (WLI) and underwent nonmagnified NBI (N-NBI) and magnified NBI (M-NBI) by a single endoscopist. From WLI, N-NBI, and M-NBI, 129 image files were created. Eight endoscopists reviewed the image files and judged the presence of mucosal breaks. Results. The 8 endoscopists determined mucosal breaks were present in 79.4 ± 9.5% (67.4%–93.0%) on WLI, and 76.7 ± 12.7% (53.5%–90.7%) on N-NBI. However, the percentage of mucosal breaks on M-NBI was significantly lower at 48.8 ± 17.0% (18.6%–65.1%) ( p < 0.05 ). Intraclass correlation between observers was 0.864 (95% CI 0.793–0.918) for WLI and 0.863 (95% CI 0.791–0.917) for N-NBI but was lower for M-NBI at 0.758 (95% CI 0.631–0.854). Conclusion. Rates of detection and agreement for mucosal breaks on WLI and N-NBI were high among endoscopists. However, these rates were lower on M-NBI.

Video Video 1 The video shows the method for removing surgical staples during endoscopic submucosal dissection for early gastric cancer on the suture line of remnant stomach. The staples were removed one by one using the knife in EndoCut mode while pulling out the staple.