Background/Objectives: Endoscopic treatment strategies for gastric foveolar-type adenoma with a raspberry-like appearance (GFA-R) have not yet been established. We aimed to clarify the efficacy and safety of endoscopic procedures for GFA-R. Methods: We extracted GFA-Rs, which were pathologically diagnosed in accordance with WHO classification, at our hospital from January 2009 to December 2023 by endoscopy and retrospectively analyzed their clinicopathological features and endoscopic outcomes. Results: Eighty-eight GFA-Rs were collected from 74 patients. The mean size of GFA-Rs was 4.2 mm (range, 1–10 mm). All lesions demonstrated intramucosal neoplasms without lymphovascular invasion. Endoscopic procedures included only biopsy (n=6), cold forceps polypectomy (CFP; n=42, as outpatient 38/42), cold snare polypectomy (CSP; n=4), endoscopic mucosal resection (EMR; n=36, as inpatient 36/36). The overall en bloc resection rate was 93.9 % (77/82), with rates of 92.9 % (39/42) for CFP, 75.0 % (3/4) for CSP, and 97.2 % (35/36) for EMR, respectively. Lesions smaller than 5 mm were more often treated with CFP while lesions larger than 5 mm were more often treated with EMR. No complications, such as post-operative bleeding or delayed perforation, occurred regardless of the endoscopic procedure. The mean follow-up period was 28.7 months (range, 2–165 months). No local recurrences occurred at 1 year (9–18 months) after an endoscopic procedure for 62 lesions, 2 years (19–30 months) for 40 lesions, and 3 years (31–42 months) for 24 lesions. Conclusions: These results suggest that endoscopic procedures for GFA-R are effective and safe regardless of the procedure used. Moreover, outpatient CFP may be a simple, useful, and cost-effective endoscopic procedure for GFA-R smaller than 5 mm.
Colonic diverticular disease is becoming increasingly common in Japan, paralleling population aging and changes in lifestyle and medication use. The predominance of right-sided diverticulosis in Asian populations, in contrast to the left-sided predominance in Western populations, influences clinical presentation and management. In Japan, diverticulitis has become a clinically important problem, and diverticular bleeding is currently the most frequent cause of acute lower gastrointestinal bleeding (LGIB). The Japanese Gastroenterological Association updated its clinical guidelines for diverticular bleeding and diverticulitis in 2026. Key domains including epidemiology, diagnostic and therapeutic strategies, and priority clinical and future research questions were addressed. Evidence was graded using the Grading of Recommendations Assessment, Development and Evaluation approach, and recommendations were formulated via a modified Delphi process with external review. These guidelines aim to provide Japanese and Asian evidence-based consensus that complements Western guidelines. Recommendations for acute LGIB and diverticular bleeding are as follows: risk stratification with the Shock Index and Oakland and NOBLADS scores guides triage; pre-colonoscopy contrast-enhanced computed tomography is the widely used diagnostic modality; routine colonoscopy within 24 h is not suggested for all patients; endoscopic band ligation or direct clipping is suggested post-detection of stigmata of recent hemorrhage; and early oral refeeding is suggested. Recommendations for diverticulitis are as follows: post-resolution colonoscopy is suggested to exclude colorectal cancer; outpatient treatment and withholding of antibiotics are suggested in selected uncomplicated cases; and primary anastomosis may be favored over Hartmann’s procedure in selected complicated cases.
Introduction: Prompt endoscopic hemostasis is required to control upper gastrointestinal bleeding. Current training relies on on-the-job exposure, with limited evidence supporting the use of dry-lab simulators. This study aimed to develop a structured, repeatable simulation-based training (SBT) program for thermal coagulation hemostasis and evaluate its efficacy. Methods: This single-center, assessor-blinded, randomized controlled trial was conducted at Tohoku University Hospital from December 2023 to June 2025. Nonexpert endoscopists were randomized into either an intervention group (five SBT sessions, including basic and hemostasis tasks, over 2 months) or a control group. Co-primary outcomes were procedure time and blinded video-based rubric scores for hemostasis at both low- and high-difficulty sites. Changes in self-efficacy were assessed using a visual analog scale (VAS). The analysis followed intention-to-treat principles. Results: Twenty participants were enrolled, with nine in the intervention group and 11 in the control group. At the final assessment, the intervention group demonstrated shorter procedure times at both the antrum (43.6 vs. 51.3 s, p = 0.02) and the upper gastric body (32.6 vs. 59.7 s, p < 0.01). Significant within-group reductions were observed only in the intervention group (effect sizes of 0.62 in the antrum and 0.80 in the upper body). Rubric-based scores improved at high-difficulty sites (p = 0.03). All five VAS domains improved significantly in the intervention group, whereas two domains increased in the control group. Conclusion: Structured SBT with a high-fidelity bleeding simulator improved technical performance, efficiency, and self-efficacy in coagulation hemostasis, representing a scalable framework for competency-based education.
Background: ERCP is the standard endoscopic approach for pancreatobiliary diseases, but it relies mainly on fluoroscopic assessment and cannot provide direct intraductal visualization. Ultrathin upper gastrointestinal endoscopes, originally developed for transnasal or pediatric endoscopy, have therefore been used as forward-viewing platforms for direct observation and therapy in the bile duct, pancreatic duct, gallbladder, and peripancreatic cavities. This review summarizes ultrathin endoscope-assisted interventions through both natural and created access routes, excluding dedicated mother-baby and digital single-operator cholangiopancreatoscopy systems as the main focus. Summary: Direct transpapillary peroral cholangioscopy is the most established application. It has been used for detection of residual stones, lithotripsy for difficult bile duct stones, evaluation of biliary strictures and intraductal tumors, targeted biopsy, and selective biliary drainage. Various access-assisting techniques and multibending ultrathin endoscopes have improved technical success. However, direct transpapillary insertion remains technically demanding because it requires scope exchange, reinsertion, ductal cannulation with a relatively large endoscope, and maintenance of intraductal stability. EUS-created access routes can provide stable conduits for direct endoscopic intervention. Key Messages: With the rapid development of dedicated cholangiopancreatoscopy, direct transpapillary use of ultrathin endoscopes is likely to become more selective and complementary. Created access routes may expand the value of ultrathin endoscopes, but evidence for these approaches remains limited, and their clinical role requires further evaluation.
