Immunoglobulin G4 (IgG4)-related disease (RD) is a systemic fibroinflammatory condition characterized by infiltration of IgG4-positive plasma cells (PCs). Gastrointestinal involvement may present as submucosal tumor-like lesions and poses diagnostic challenges. We report a case of a 59-year-old man with gastric submucosal tumor-like lesions detected during routine screening. Endoscopic submucosal dissection (ESD) was used for the diagnosis and treatment. A histopathological examination revealed abundant IgG4-positive PC infiltration in the submucosa; however, these findings did not fulfill the comprehensive diagnostic criteria for IgG4-RD. IgG4-RD-like gastric lesions can mimic submucosal tumors. ESD may provide diagnostic and therapeutic benefits when a conventional biopsy is insufficient. Cautious interpretation of IgG4-positive PC infiltration in gastrointestinal specimens is required.

Background and Aim Computer-aided detection (CADe) combined with linked color imaging (LCI) has shown potential in improving adenoma detection rates (ADRs) during colonoscopies. However, the comparative effectiveness of these supportive methods, based on the type of tip hood, remains unclear. We aimed to compare the ADR between Endo-Wing-assisted colonoscopy with LCI and CADe (ELC) and transparent hood-assisted colonoscopy with LCI and CADe (TLC). Methods This single-center, non-blinded prospective randomized controlled trial enrolled 800 patients who underwent colonoscopy between August 2024 and August 2025. Participants were randomly assigned to either the ELC ( n = 400) or TLC group ( n = 400). The primary outcome was ADR. Secondary outcomes included the polyp detection rate, adenomas per colonoscopy, and procedural parameters. Results The ELC group demonstrated a significantly higher ADR compared to the TLC group (58.00% vs. 39.75%, P < 0.001; relative risk 1.45; 95% CI: 1.25-1.67). This superiority was consistent among expert endoscopists (61.78% vs. 42.17%, P < 0.001) as well as trainees (53.14% vs. 35.76%, P = 0.002). Furthermore, the ELC group achieved a higher polyp detection rate (61.25% vs. 45.75%, P < 0.001) and recorded a greater number of adenomas per colonoscopy (1.17 vs. 0.73, P < 0.001). This advantage was particularly pronounced for small adenomas (≤5 mm) and sessile and flat lesions. Conclusions ELC demonstrated a significant improvement in the ADR compared to the TLC approach, particularly for diminutive and sessile adenomas. This superiority was consistent across varying levels of endoscopist experience, indicating broad clinical applicability.

Ulcerative colitis (UC) is associated with an increased risk of infectious complications, particularly during anti-tumor necrosis factor (anti-TNF) therapy. Pyogenic hepatic abscess is a rare but potentially life-threatening extraintestinal complication of UC. Optimal biologic management following deep infection during anti-TNF therapy remains unclear. Mirikizumab, a selective interleukin-23 p19 inhibitor, may have a more favorable infectious safety profile than anti-TNF agents. We report the case of a 19-year-old woman with pancolitis-type UC who developed persistent fever, worsening diarrhea, hematochezia, and subsequent right upper quadrant abdominal pain during maintenance therapy with adalimumab. Contrast-enhanced computed tomography revealed active colitis complicated by hepatic abscess. Adalimumab was discontinued, and intravenous ceftriaxone plus metronidazole therapy was initiated. After confirmation of infection control and abscess regression, induction therapy with mirikizumab was initiated for active UC. Clinical symptoms rapidly improved, and the patient achieved sustained clinical and endoscopic remission without recurrence of the hepatic abscess during long-term follow-up. This case suggests that mirikizumab can be successfully administered after adequate infection control in a patient with UC complicated by hepatic abscess during anti-TNF therapy. However, larger studies are needed to determine the optimal biologic option as a second-line treatment for patients requiring treatment reintroduction after deep infection.

Objective Ulcerative colitis (UC) follows a relapsing-remitting course. Identifying modifiable clinical relapse prognostic factors remains challenging. Patients with inflammatory bowel disease commonly exhibit zinc deficiencies. In this study, we aimed to determine whether hypozincemia is independently associated with the risk of relapse. Methods Baseline serum zinc levels were measured in patients with UC in clinical remission (i.e., partial Mayo score <3) from a single center between April 2015 and March 2025. Patients were classified as having hypozincemia (serum zinc <80 μg/dL) or normozincemia (serum zinc ≥80 μg/dL). The primary outcome was clinical relapse within one year. Relapse-free survival was assessed using a Kaplan-Meier survival analysis. Independent predictors of relapse were evaluated using multivariable Cox proportional hazards models adjusted for inflammatory markers, serum albumin levels, and previous biologic therapy. Results Overall, 102 patients were included (50 with hypozincemia and 52 with normozincemia). The hypozincemia group experienced clinical relapse more frequently than the normozincemia group (74.0% vs. 34.6%, P<0.001). Relapse-free survival was significantly shorter in patients with hypozincemia (log-rank: P<0.001). A multivariable Cox regression analysis showed that normozincemia was independently associated with a reduced relapse risk (adjusted hazard ratio, 0.42; 95% confidence interval, 0.24-0.74; P=0.003). C-reactive protein and serum albumin were not significant predictors. Serum zinc levels were weakly correlated with the inflammatory biomarkers. Conclusion Hypozincemia was independently associated with an increased clinical relapse risk in patients with UC in remission. Baseline assessment of serum zinc levels may provide additional prognostic information beyond that of conventional inflammatory and nutritional markers.

BACKGROUND/OBJECTIVES:The incidence of pancreatic cancer is increasing, and it has a poor prognosis. Also, it is often refractory to standard chemotherapy. Psychological stress influences the development of some malignant neoplasms; however, its immunological mechanism is unclear. In this study, we investigated whether water avoidance stress (WAS) promotes mouse orthotopic pancreatic cancer growth and the mechanism through which WAS influences anticancer immunological responses. METHODS:Mouse pancreatic adenocarcinoma cells were orthotopically inoculated into the pancreas of mice. After 2 weeks, the mice were assigned to receive either WAS or sham. After 6 weeks of tumor inoculation, the tumor volume was calculated. The peritumoral interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α) were measured; lymphocytes in the pancreas were isolated and analyzed. CD4+ and CD8+ T lymphocyte peritumoral infiltration and intercellular adhesion molecule 1 (ICAM-1) expression were analyzed. Tumor-bearing mice were subjected to either WAS or control; the number of adhesive lymphocytes was calculated. RESULTS:WAS promoted pancreatic cancer growth, and suppressed peritumoral IFN-γ mRNA expression, and cytotoxic T lymphocyte peritumoral infiltration. WAS also suppressed peritumoral lymphocyte adhesion, ICAM-1 expression in the vascular endothelium in the peritumoral region, and peritumoral TNF-α mRNA expression. CONCLUSION:Our results suggest that in the peritumoral region, WAS suppressed anticancer immunological responses by the suppression of TNF-α secretion, ICAM-1 expression, lymphocyte adhesion, cytotoxic T lymphocyte infiltration, and IFN-γ secretion, thereby promoted pancreatic cancer growth. Inducing the upregulation of adhesion molecules and augmentation of cytotoxic T cell recruitment may lead to the development of new treatments for pancreatic cancer.

INTRODUCTION:Eosinophilic gastrointestinal disease (EGID) is divided into eosinophilic esophagitis (EoE) and non-eosinophilic esophagitis eosinophilic gastrointestinal disease (non-EoE-EGID), based on the involved gastrointestinal organs. The present survey was performed to provide an overview of the current status of the epidemiology, diagnosis, and treatment of EGID in Asia. METHODS:Responses to the questionnaire were obtained from 228 doctors at various institutions in eight Asian countries. The questionnaire consisted of 52 questions on EoE and non-EoE EGID. RESULTS:Responses to questionnaire were obtained from 228 doctors from eight countries. The most common participation facilities were university hospitals, followed by public hospitals, private hospitals, and private clinics. 1-10 were the most frequent patients per year in each institution for both EoE and non-EoE-EGID. The 30s and 40s are common age groups for both EoE and non-EoE-EGID. Although endoscopic findings vary among countries, 15 or more eosinophil infiltrations in high-power fields as a diagnostic criterion are used in all countries for EoE. As treatments, the prescription rates of Proton pump inhibitor, diet, topical and systemic steroids, and biologics were similar among the eight countries in EoE. Non-EoE-EGID showed a similar trend to EoE in epidemiology, symptoms, diagnosis, and treatment. CONCLUSION:The questionnaire survey partially revealed the current status of the epidemiology, symptoms, diagnosis, and treatment of EGID in Asian countries.

ABSTRACT Background and Aims Laser endoscopy has a linked color imaging (LCI) mode which has been reported to be superior to white light imaging (WLI) in detecting early gastric cancer (EGC). In this study, we retrospectively investigated the characteristics of superficial gastric neoplasms detected not by WLI but by LCI. Patients and Methods From April 2018 to May 2023, EGC or gastric adenoma identified by EGD was observed using LCI after WLI. The size, location, macroscopic type, color, skill level of the endoscopists, and treatment were examined for lesions detected by WLI (WLI group) and lesions detected not by WLI but by LCI (LCI group). Results Eighty‐eight lesions of EGCs were differentiated adenocarcinomas, 13 undifferentiated adenocarcinomas, and 28 gastric adenomas. There were 117 lesions (90.7%) in the WLI group and 12 (9.2%) in the LCI group. The mean diameter was 22.9 mm in the WLI group and 9.3 mm in the LCI group, with the latter being significantly smaller (p = 0.003). The numbers of protruding, depressed, and flat lesions were 58, 59, and 0 in the WLI group, and 7, 4, and 1 in the LCI group, respectively, indicating that more protruding lesions were detected in the LCI group (p = 0.005). After multivariate analysis, there was a significant difference in diameter only in the LCI group compared to the WLI group (odds ratio, 0.834; 95% CI, 0.728–0.956). Conclusions LCI is more useful than WLI for detecting smaller superficial gastric neoplasms.

ABSTRACT Objectives Regular exchange of percutaneous endoscopic gastrostomy (PEG) catheters is crucial for preventing infection and maintaining function; however, procedure‐related complications and patient discomfort remain major concerns. This study aimed to compare the clinical outcomes of the conventional Ideal Button with those of the newly developed Ideal Button ZERO (Olympus Corporation). Methods In this retrospective observational study, we included 82 PEG catheter exchange procedures, performed in 42 patients. Because some patients underwent repeated exchanges, analyses were conducted on a per‐procedure basis. Patients were categorized into two groups: Group N (conventional to conventional Ideal Button exchange, n = 33) and Group Z (exchange to Ideal Button ZERO, n = 49). Group Z was further subdivided into subgroups Z1 (conventional to ZERO, n = 29) and Z2 (ZERO to ZERO, n = 20). The outcomes included the procedure time, complication rates (procedure‐related and postoperative), and family satisfaction score. Results Procedure‐related complications occurred only in Group Z (0/33 vs. 6/49; 0% vs. 12.2%) ( p = 0.076). Postoperative complication rates were similar between the groups (Group N 6/33 [18.2%] vs. Group Z 9/49 [18.4%], p = 1.00). However, procedure time was shorter in Group Z than in Group N (8.24 ± 5.21 vs. 6.14 ± 4.28 min, p = 0.049). Family satisfaction scores showed no significant differences between the groups (Group N: 3.88 ± 1.52 vs. Group Z: 3.94 ± 1.39, p = 0.854). Conclusions The new Ideal Button ZERO showed a reduced procedure time; however, it revealed a trend toward higher procedure‐related complications without clear superiority over conventional devices. Improved proficiency with the new device may reduce complication rates, warranting further investigation as its adoption increases. Trial Registration 2025‐047

ObjectivesThe endoscopic channel can be damaged by instruments during use and cleaning, leading to contamination, infection, and increased repair costs. However, few devices are available to observe the inside of the endoscopic channel. This study employed an ultrafine-diameter scope to examine damage in the endoscopic channel.MethodsFifty-eight endoscopes used at our institution were examined for scratches, discoloration, or deformation in the endoscopic channel using an ultrafine-diameter scope.ResultsDamage was observed in seven of the 24 observation endoscopes and 27 of the 34 therapeutic endoscopes, with damage being more common in the therapeutic endoscopes. Scratches were observed in nine of the 25 upper gastrointestinal endoscopes, 23 of the 24 colonoscopes, and one of the two echoendoscopes. Additionally, two colonoscopes, one echoendoscope, and one double-balloon endoscope showed indentation or narrowing near the curvature.ConclusionsThe use of an ultrafine-diameter scope enabled the detection of minute damage and deformations in the channel. Periodic observation with the ultrafine-diameter scope may promote the long-term use of the scopes.

Biologics against interleukin-5 were administered to five patients with eosinophilic gastroenteritis (EGE) and bronchial asthma (BA). BA and abdominal symptoms as well as changes in steroid dose and the blood eosinophil count were examined. The man-to-woman ratio was 1:4. The average age of onset was 63 years old. The duration of the disease was three to nine years. Four patients showed improved BA symptoms with mepolizumab or benralizumab, and three successfully discontinued steroids. Regarding abdominal symptoms, mepolizumab was effective in one of three cases, while benralizumab improved symptoms in three of four cases. Biologics targeting interleukin-5 are effective in some patients with EGE accompanied by BA.

Biologics against interleukin-5 were administered to five patients with eosinophilic gastroenteritis (EGE) and bronchial asthma (BA). BA and abdominal symptoms as well as changes in steroid dose and the blood eosinophil count were examined. The man-to-woman ratio was 1:4. The average age of onset was 63 years old. The duration of the disease was three to nine years. Four patients showed improved BA symptoms with mepolizumab or benralizumab, and three successfully discontinued steroids. Regarding abdominal symptoms, mepolizumab was effective in one of three cases, while benralizumab improved symptoms in three of four cases. Biologics targeting interleukin-5 are effective in some patients with EGE accompanied by BA.

A 64-year-old woman presented with abdominal pain, upper gastrointestinal bleeding, and purpura on her face and extremities. She had previously been treated with mesalazine for ulcerative colitis. Tests revealed anaemia, elevated inflammatory markers (erythrocyte sedimentation rate, 82 mm/h; C-reactive protein concentration, 13.05 mg/dL), and a high proteinase 3-specific antineutrophil cytoplasmic antibody level (94.8 U/mL). Computed tomography showed oedematous thickening of the intestinal wall from the ascending colon to the sigmoid colon. Colonoscopy revealed inflammation of the leukocytoclastic vasculitis, consistent with granulomatosis with polyangiitis mucosa, and the sigmoid colon had various ulcers with mucosal inflammation. Skin biopsy revealed leukocytoclastic vasculitis, indicative of granulomatosis with polyangiitis. Prednisolone (40 mg/day) and tacrolimus (4 mg) resolved the symptoms. To our knowledge, this is the first report of successful tacrolimus therapy for ulcerative colitis complicated by granulomatosis with polyangiitis.

Background:Esophageal carcinosarcoma is a rare type of esophageal cancer with a characteristic sausage shape that is often detected at an early stage; therefore, the depth of invasion is often submucosal. However, many cases of esophageal carcinosarcoma demonstrate lymphatic metastases, which require surgery. Case:We describe the case of a 46-year-old female patient who underwent upper gastrointestinal endoscopy that revealed a tumor shadow in the middle thoracic esophagus. The patient did not have symptoms such as dysphagia or chest pain. Subsequent upper gastrointestinal endoscopy with ultrasound and endoscopic submucosal dissection revealed carcinoma and sarcoma components that allowed the diagnosis of esophageal carcinosarcoma. Lymph node metastases and distant metastases were not observed. Discussion:Tumor resection of the center and base of the protruding lesion with a wide margin allows an early and correct diagnosis of typical and atypical esophageal carcinosarcoma cases. Tumor resection with a wide margin can predict metastasis. Conclusions:This rare case was correctly diagnosed during an early and asymptomatic stage.

Objectives:To examine the annual trends in the occurrence of eosinophilic gastrointestinal disease (EGID) in Japan. Methods:This study examined data from patients with EGID who underwent endoscopy at 716 facilities between January 2015 and March 2023. Data extracted from the Japanese Endoscopy Database (JED) included endoscopic procedure counts, patient demographics, Helicobacter pylori infection status, comorbidities, and balloon dilatation. Analyses incorporated both confirmed and suspected EGID cases. Results:In total, 9,940,870 endoscopic procedures were performed, identifying 9669 cases of EGID. From 2015 to 2023, the Cochran-Armitage trend test showed a significant increase in cases of eosinophilic esophagitis (EoE), eosinophilic gastritis (EoG), and eosinophilic duodenitis (EoD) (p < 0.001). However, no significant trend was observed for eosinophilic enteritis (EoN) or eosinophilic colitis (EoC) (p = 0.136). The number of EoE cases increased, with reporting rates changing from 36 (0.0464%) in 2015 to 3631 (0.176%) in 2022 (p < 0.001). EoG + EoD cases increased from one (0.0013%) to 410 (0.0199%) (p < 0.001), while EoN + EoC cases remained stable (p = 0.136). Conclusions:The JED project data showed increasing detection of EoE, EoG, and EoD in Japan, while EoN and/or EoC cases remained stable. These findings are based on reporting rates from individuals undergoing endoscopy, rather than estimates from population-based endoscopist reporting rates.

Hospitalization for ulcerative colitis (UC) is potentially life-threatening. Severe disease in the Japanese criteria which modifies the Truelove–Witts’ criteria might encompass more fulminant cases than the definition for acute severe UC. However, few studies have investigated the predictive factors for clinical remission (CR) after medical treatments for severe hospitalized patients by Japanese criteria. Medical treatment selection, CR rates, and factors contributing to CR on day 14 were assessed in severe patients by Japanese criteria. We also investigated whether the reduction rate in patient-reported outcome 2 (PRO2) on day 3 could predict short-term prognosis. Eighty-five severe hospitalized patients were selected. Corticosteroids, tacrolimus, and infliximab were mainly selected as first-line treatments (76/85; 89.4

Abstract Background and Aim The use of a hood at the tip of a colonoscope enables aspiration, inversion of the diverticulum, and observation of the inside of the diverticulum. In most previous studies, a short hood was used; however, observation of the diverticulum is often inadequate. Long food is promising by previous research, but it was a retrospective study using propensity matching and has some limitations. We compared the identification rate of stigmata of recent hemorrhage (SRH) between the long and standard hoods in cases of suspected colonic diverticular hemorrhage (CDH) to confirm the usefulness of long hood by prospective randomized controlled trial. Methods Eighty patients (42 in the long hood group [L group] and 38 in the short hood group [S group]) who visited the Saitama Medical University Hospital and Tokai University Hachioji Hospital between December 2018 and July 2021 with a chief complaint of bloody stool and suspected CDH, based on the clinical course and imaging studies, were included. Patients were randomly assigned to the L or S group. Results Regarding patient background, age was significantly higher in the L group; however, no significant differences were found in medical history or history of antithrombotic medication or nonsteroidal anti‐inflammatory drug use. Identification rate of SRH was significantly higher in the L group (58.5%, 24/42 patients) than in the S group (26.3%, 10/38 patients) (P < 0.05). All patients were treated using the clip method, and the rate of rebleeding within 1 month was not significantly different between the two groups. Conclusion A long hood was more useful compared with a short hood in identifying SRH of CDH (UMIN000034603).