The oncologic outcomes of pedunculated-type T1 colorectal cancer (CRC) remain unknown. We determined the risk factors for lymph node metastasis (LNM) and recurrence and evaluated the survival according to the treatment method. In this multicenter retrospective study involving 4673 patients with T1 CRC, we analyzed 444 patients with pedunculated-type T1 CRC treated between 2009 and 2016. Treatment included local resection (LR) alone (n = 169), surgery with lymph node (LN) dissection alone (n = 83), and LR followed by additional surgery with LN dissection (n = 192). Factors associated with LNM and recurrence, relapse-free survival (RFS) and overall survival (OS) by treatment were analyzed. The median follow-up period was 64 months. LNM and recurrence were observed in 25 (5.6

Abstract Topic Esophageal Cancer: Non-Surgical Treatment of Esophageal Cancer Background For prevention of post-ESD esophageal stricture, we have routinely performed local triamcinolone injection for high-risk lesions. During a period when triamcinolone was unavailable, prednisolone was used as an alternative. We investigated whether prednisolone demonstrates equivalent preventive efficacy to triamcinolone in preventing post-ESD stricture. Methods This retrospective observational study was conducted at a single tertiary cancer center. Between October 2024 and September 2025, 250 esophageal lesions underwent ESD at our institution. Non-circumferential lesions measuring ≥ 2.5 cm that received local steroid injection (either triamcinolone or prednisolone) were included. Until May 2025, triamcinolone was used; thereafter, prednisolone replaced triamcinolone due to unavailability. Our indications for local steroid injection were mucosal defects involving ≥3/4 of the circumference or lesions judged by the operator to be at high risk of stricture, such as those with pre-existing stenosis. Both agents were used following institutional approval for off-label use. Cases requiring oral steroids were excluded. Finally, 33 lesions in 31 patients were analyzed, including the triamcinolone group (n=25) and the prednisolone group (n=8). Stricture was defined as the inability to pass a standard endoscope during any follow-up endoscopy, and stricture rates were compared between groups. Results In the prednisolone and triamcinolone groups, lesion locations (Ce/Ut/Mt/Lt/Jz) were 3/2/2/1/0, and 1/4/12/7/1, respectively. Mean lesion diameter (mm) was 41.2 (SD 9.5) and 33.6 (SD 9.3), respectively. Circumferential extent of the mucosal defects (≤1/2, 1/2–3/4, >3/4) was 1/5/2 and 10/8/7, respectively. Overall stricture rate was significantly higher in the prednisolone group than in the triamcinolone group (50.0% [4/8] vs. 8.0% [2/25], p=0.016). In subgroup analysis, for mucosal defects involving 1/2–3/4 of the circumference, stricture rates were 60% (3/5) and 12.5% (1/8), respectively, and for ≥3/4 circumferential defects, 50% (1/2) and 14.3% (1/7), respectively. Conclusion Local prednisolone injection showed a significantly higher stricture rate than triamcinolone injection, suggesting insufficient preventive efficacy against post-ESD esophageal stricture. Despite the small sample size, the magnitude of difference raises concerns about using prednisolone as an alternative to triamcinolone. Caution is warranted when substituting prednisolone for triamcinolone in preventing post-ESD stricture, and further investigation with larger cohort is needed.

BACKGROUND:We developed an endoscopic imaging technology, oxygen saturation imaging (OS imaging), to assess real-time tissue oxygenation levels. However, its clinical impact remains unclear. This prospective observational study evaluated the association between pretreatment tumor oxygen saturation (StO2) quantified by OS imaging and the outcomes of patients with head and neck squamous cell carcinoma (HNSCC) receiving radiotherapy (RT). METHODS:The primary endpoint was the association between pretreatment tumor StO2 and complete response rate at 8 weeks after RT completion. Secondary endpoints were the impact of StO2 on 1-year overall survival, progression-free survival, and local failure rates. RESULTS:Of 50 patients with HNSCC enrolled from 2019 to 2022, 42 who underwent RT and OS imaging are analyzed. Of those, 41 received concurrent platinum-based chemotherapy. Median pretreatment StO2 is significantly lower in tumor tissue than in normal mucosa (61% vs. 66%, respectively). Complete response rates at 8 weeks after RT are not significantly different between the hypoxia (StO2 ≤ 61%, n = 22) and non-hypoxia (StO2 > 61%, n = 20) groups (86% vs. 100%, respectively). After a median follow-up of 36 (range: 9-53) months, the hypoxia group has significantly worse 1-year overall survival (91% vs. 100%), progression-free survival (77% vs. 95%), and local failure (18% vs. 5%) rates than the non-hypoxia group. CONCLUSIONS:Despite not meeting the primary endpoint, our findings suggest that pretreatment tumor StO2 is correlated with 1-year outcomes after RT, and OS imaging may be useful for identifying RT-resistant hypoxic tumors in HNSCC.

Endoscopic full-thickness resection (EFTR) has emerged as a minimally invasive treatment for small gastrointestinal subepithelial neoplasms (SETs). In particular, the development of novel closure methods such as clip-line and various endoscopic suturing techniques has enabled the secure closure of any resultant defects. During the Advanced Therapeutic Endoscopy session at the Endoscopic Forum Japan 2025, we summarized the current status of EFTR for SETs and discussed future clinical applications for epithelial neoplasms from oncological and technical perspectives. Although predominantly documented in gastric subepithelial neoplasms, EFTR is also used to treat select esophageal, duodenal, and colorectal SETs. While extensively evaluated for gastric gastrointestinal stromal tumors (GISTs), relatively low R0 resection rates have limited its broader clinical adoption; however, the novel no-touch EFTR technique could overcome this challenge and facilitate the adoption of this procedure for small gastric GISTs. Applying EFTR to epithelial tumors requires strict assessment of oncological clearance, given the risks of lymph node metastasis and peritoneal seeding following full-thickness breaches. At the end of the session, we voted on the appropriateness of EFTR for epithelial neoplasms across different organs, balancing oncological risks against technical feasibility. All nine participants (100%) supported EFTR for rectal lesions, and eight (89%) supported its use for gastric lesions. Future investigations and technical innovations are required to expand the clinical indications for EFTR in epithelial neoplasms.

INTRODUCTION:Colorectal serrated lesions (SLs) are recognized as precursors of colorectal cancer (CRC); however, their detection rates and prevalence remain inadequately defined. We aimed to assess their detection rates and estimate their prevalence in the Asia-Pacific, as well as to examine their associated factors. METHODS:This was a multicenter prospective study in the Asia-Pacific. Asymptomatic individuals aged 40-74 years undergoing first-time colonoscopy for CRC screening were prospectively enrolled. To ensure precise prevalence estimates, colonoscopy procedures involved repeated proximal colon inspection using pan-chromoendoscopy with indigo carmine dye. Detection rates of proximal SLs and sessile serrated lesions (SSLs) were calculated. Mixed-effects logistic regression analyses, accounting for institution-level variability, were performed to identify factors associated with proximal SL and SSL detection. Associations between SLs and synchronous advanced colorectal neoplasia (ACN) were evaluated. RESULTS:Among 965 participants, detection rates of proximal SLs and SSLs were 16.1% (95% confidence interval [CI], 13.8-18.5) and 8.6% (6.9-10.6), respectively. Institutional differences affected detection of proximal SLs (adjusted median OR, 1.44; 95% CI, 1.25-1.79) and SSLs (1.34; 1.18-1.62). A family history of CRC was associated with higher SSL detection (adjusted odds ratio [OR], 2.36; 95% CI, 1.29-4.33). Detection of proximal SLs was associated with synchronous ACN (OR, 1.94; 95% CI, 1.24-3.02 and 1.90; 1.18-3.07, respectively). DISCUSSION:This multicenter study demonstrates that detection rates and estimated prevalence of SLs are higher than previously reported in the Asia-Pacific and highlights the impact of institutional differences, challenging the notion of their low regional prevalence. TRIAL REGISTRATION:UMIN-CTR number, UMIN 000042890.

OBJECTIVES:Esophagogastroduodenoscopy (EGD) is useful for early detection of gastric cancer; however, quality indicators for its performance remain unestablished. We aimed to investigate the candidate quality indicators for EGDs conducted in patients undergoing surveillance following endoscopic submucosal dissection (ESD) for gastric neoplasms. METHODS:This study is a single-center, retrospective, observational analysis. We analyzed data from post-ESD surveillance EGDs between April 2015 and March 2022. The data were divided into Periods A (April 2015-March 2017) and B (April 2017-March 2022). From Period A, we calculated each endoscopist's gastric biopsy rate (gBR), gastric positive biopsy rate (gPBR), and mean examination time as potential quality indicators for EGD performance. In Period B, we calculated the gastric neoplasm detection rate, encompassing cancer and adenoma, as the primary outcome measure. We analyzed the associations between endoscopist quality indicators in Period A and clinical outcomes in Period B. RESULTS:A total of 6792 EGDs from 2552 patients, conducted by 12 endoscopists, were analyzed. A positive correlation with gastric neoplasm detection rate was observed for gBR (r = 0.621, p = 0.03), but not for the other indicators. Endoscopists with a high gBR (> 36%) had a significantly higher gastric neoplasm detection rate than those with a lower gBR (≤ 30%) (3.6% vs. 2.0%, p < 0.05). CONCLUSIONS:A higher gBR was associated with an increased gastric neoplasm detection rate in patients undergoing post-ESD surveillance. This finding suggests the potential of gBR as a quality indicator for EGD performance in this setting.

Sedation is an essential component of upper gastrointestinal endoscopy because it reduces patient discomfort and anxiety while improving patient acceptance and procedural quality. In Japan, benzodiazepines such as midazolam and opioid analgesics have long been widely used in routine clinical practice; however, many of these agents historically lacked formal insurance approval for sedation during gastrointestinal endoscopy. Propofol is also a useful sedative because of its rapid onset and recovery, but its use in Japan has been limited because of concerns regarding respiratory and cardiovascular depression and the need for management by anesthesia-trained personnel. Against this background, the approval of remimazolam for sedation during gastrointestinal endoscopy in June 2025 represented a major turning point in Japanese endoscopic sedation practice. Remimazolam is an ultra-short-acting benzodiazepine rapidly metabolized by carboxylesterases and reversible with flumazenil. Japanese phase III trials demonstrated high sedation success rates and rapid recovery during upper gastrointestinal endoscopy, including in elderly patients. Compared with midazolam, remimazolam shortened awakening and ambulation times, whereas compared with propofol, it may cause fewer respiratory and cardiovascular adverse events. This review summarizes the current status of upper gastrointestinal endoscopic sedation in Japan, focusing on the clinical evidence and positioning of the newly approved ultra-short-acting benzodiazepine, remimazolam.

Gastric cancer remains a major global health burden, particularly in Asia, where widespread implementation of endoscopic screening has increased the detection of early gastric cancer (EGC). With advances in endoscopic techniques, endoscopic resection (ER), especially endoscopic submucosal dissection, has become the standard treatment for EGC with a negligible risk of lymph node metastasis (LNM). Undifferentiated-type EGC (UD-EGC) is associated with a higher risk of LNM than differentiated-type EGC. However, favorable long-term outcomes can be achieved with curative resection. Despite this, accurate endoscopic detection, characterization, and delineation of UD-EGC remain a challenge because of their subtle morphology and unique growth pattern. Image-enhanced endoscopy, particularly magnifying endoscopy with narrow-band imaging, plays an important role in diagnosis and assessment of the lateral extent of the lesion. In Japan, accumulating evidence, including prospective multicenter trials, has led to the classification of intramucosal UD-EGC ≤2 cm without ulceration, as an absolute indication for ER in the latest clinical guidelines. Short and long-term outcomes after curative ER for UD-EGC are comparable to those after surgical resection. This review summarizes the current literature on the diagnosis and endoscopic management of UD-EGC, providing a comparative overview of differences in endoscopic treatment recommendations among international guidelines.

Abstract Background and Aims: Phosphorylation is a key post-translational modification that regulates protein activity, localization, and interactions. By mapping phosphorylation patterns, phosphoproteomics provides real-time insights into how cancer cells reprogram their signaling networks to promote growth, survival, metastasis, and therapy resistance. While conventional deep phosphoproteomics requires a relatively large amount of clinical samples, we have developed a highly sensitive method using endoscopic biopsy samples which can offer excellent quality for hosphoproteomic analysis. In this study we evaluated the phosphoproteomic landscape in fresh-frozen endoscopic biopsies from patients with colorectal cancer (CRC). Methods: Endoscopic biopsy specimens were obtained from 102 treatment-naïve CRC patients and snap-frozen in liquid nitrogen within 20 seconds of collection. Ultra-deep proteome and phosphoproteome analyses were performed using tandem mass tag (TMT)-based multiplexing. Genomic profiling was conducted with a targeted, high-multiplex PCR-based next-generation sequencing (NGS) panel. Results: Ultrasensitive mass spectrometry-based proteomics using 204 naïve colorectal cancer specimens and 204 normal tissue adjacent to the tumor (NAT) quantified an average of 23985 phosphorylation sites. Consensus clustering clearly divided colorectal cancer into subtype 1 (proliferative type, 33%), subtype 2 (EMT type, 25%), Subtype 3 (Metabolic type, 20%), and subtype 4 (Abnormal RNA splicing type, 21%). Kinase activity profiles were obtained from phosphoproteome data and kinases that are specifically activated or inactivated in each subtype were identified. While concordance between these phosphoproteomic subtypes and the consensus molecular subtypes (CMS) was low, sidedness was associated with different kinome activity of tumor and NAT. Conclusions: This proof-of-concept study demonstrates that phosphoproteomic analysis can delineate CRC subtypes independent of CMS classification and provide detailed kinase activity landscapes. Our pioneering approach enables robust clinical phosphoproteomics from small endoscopic biopsies, offering a promising tool for monitoring therapeutic kinase activities and advancing precision oncology. Citation Format: Jun Adachi, Hirokazu Shoji, Hidekazu Hirano, Yosui Nojima, Satoshi Muraoka, Yutaka Saito, Ken Kato, Narikazu Boku, Yukihide Kanemitsu. Phosphoproteomic subtyping and characterization of colorectal cancer by comprehensive phosphoproteomics of fresh frozen endoscopic biopsy specimens [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 3874.

Early-onset colorectal cancer (EO-CRC) is a growing global health challenge with poorly understood etiology. While gut microbiota and metabolites are implicated in colorectal carcinogenesis, EO-CRC-associated signatures remain poorly characterized. This study presents the first large-scale multi-omics analysis in Japan cohort to characterize gut microbial and metabolic features of EO-CRC, with cross-cohort validation in an independent China cohort. We enrolled 510 participants (EO-CRC n = 120, late-onset CRC [LO-CRC] n = 282, young healthy controls [yHC] n = 59, old healthy controls [oHC] n = 49); after age- and sex-matching, 324 samples were analyzed using metagenomics, metabolomics, and quantitative polymerase chain reaction (qPCR). Fourteen species formed a shared CRC-associated microbiome core enriched in both EO-CRC and LO-CRC relative to age-matched controls, of which seven were reproducible across both Japan and China cohorts. Beyond this core, 34 and 21 species were enriched exclusively in EO-CRC and LO-CRC, respectively. Among EO-CRC-specific virulence findings, the bft gene of enterotoxigenic Bacteroides fragilis, fadA of Fusobacterium nucleatum, and bai operon genes were enriched in EO-CRC, with cross-cohort validation for fadA and bai operon, and stage-specific enrichement of deoxycholic acid at Stage 0 providing preliminary metabolomic support. Targeted clbP qPCR revealed enrichment of colibactin-producing Escherichia coli specifically in EO-CRC against a background of age-increasing carriage. Metabolomic profiling identified kynurenine enrichment and depletion of vitamin B-related metabolites (pyridoxine, riboflavin, and nicotinamide) as EO-CRC-specific findings; LO-CRC showed distinct enrichment of carnitine, succinate, and spermine with relative butyrate depletion. The choline degradation pathway was enriched specifically in EO-CRC based on Enteropathway analysis. Species-based random forest classifiers distinguished EO-CRC from controls (AUPRC = 0.828; SD = 0.013; 95

Background:Optimal bowel preparation (BP) is crucial for a successful colonoscopy. Although multiple factors influence BP quality, including patient adherence to laxatives and dietary instructions, the stool state during BP should be properly evaluated to perform a colonoscopy of sufficient quality. Therefore, we developed a smartphone app to evaluate a patient's stool state during BP and a viewer to enable real-time monitoring by medical staff. Objective:This study aimed to assess the feasibility of performing colonoscopies of appropriate quality using the app-and-viewer system. Methods:This prospective observational study was conducted between November 2022 and December 2023, involving patients scheduled for colonoscopy at 10 Japanese institutions, comprising 6 tertiary hospitals, 3 regional general hospitals, and 1 community-based clinic. Patients who (1) underwent a colonoscopy at participating institutions, (2) were aged between 20 and 70 years, and (3) owned smartphones compatible with Android or iOS were included in the study. The patients downloaded the app on their smartphones and captured images of their stools during BP, while the medical staff reviewed the evaluation of the stools by the app via the viewer system. The primary end point was defined as the proportion of patients with a Boston Bowel Preparation Scale (BBPS) score of ≥6 among those who successfully used the app. Secondary end points included mean BBPS score, rate of an excellent BBPS score (≥8), adenoma detection rate, cecal intubation rate, and withdrawal time in negative colonoscopy. Additionally, we evaluated the usability of the app, medical staff workload burden with the app, and viewer usage via questionnaire surveys. Results:A total of 343 patients were enrolled, and 326 were ultimately included in the analysis. Overall, 99.1% (323/326, 95% CI 97.3%-99.8%) of the patients achieved the primary end point. The mean BBPS score was 8.5 (SD 1.0), and the proportion of excellent BBPS scores was 87.4% (285/326). The adenoma detection rate, cecal intubation rate, and mean withdrawal time in negative colonoscopy were 46.9% (153/326, 95% CI 41.4%-52.5%), 99.7% (325/326, 95% CI 98.3%-99.9%), and 10.7 (SD 5.9) minutes, respectively. In the questionnaire survey, 98.5% (321/326) of the patients reported that the tutorial was easy to understand, 96.0% (313/326) found stool image capture easy, and 87.8% (286/326) reported reduced anxiety regarding BP. Furthermore, 90.5% (295/326) of the patients indicated that they would like to use the app again for future colonoscopies. Among medical staff, 92.5% (62/67) considered the viewer system necessary, 89.6% (60/67) found it easy to use, and 89.6% (60/67) reported a reduction in workload burden. Conclusions:AI-based stool state assessment using the app and the viewer during BP was feasible across diverse BP methods and clinical environments. Favorable BP outcomes and high usability among patients and medical staff support the potential use of this approach in real-world colonoscopy practice.

The paramount challenge in precision oncology lies in further improving quality of life and response rates for individual patients. Efforts toward these goals are steadily expanding the scope of clinical implementation, despite ongoing challenges such as standardization, cost-effectiveness, and data harmonization. Building upon this maturing foundation, generative AI—which has evolved dramatically in recent years—is particularly valuable at this stage of advancing efficiency and adoption as an auxiliary technology linking literature, guidelines, trial protocols, and patient data. Specifically, through mutation interpretation, trial eligibility matching, and tumor board support, it is expected to contribute to advancing standardization, improving cost-effectiveness, accelerating data harmonization, and further accelerating human-centered decision-making. Accordingly, this review surveys the development history of generative AI and its current healthcare applications, organizing its implementation potential for precision oncology along three axes: (1) generative AI–based interpretation of genetic mutations and estimation of their pathological significance; (2) generative AI–driven verification of clinical trial eligibility; and (3) multimodal foundation models for imaging and pathology that compute “tumor phenotypes” using real-world data, contributing to report drafting and molecular surrogate estimation. In response, we propose a strategy centered on retrieval-augmented generation (RAG) and human-in-the-loop (HITL) workflows, encompassing data preparation based on OMOP, mCODE, and FHIR; multicenter prospective evaluation; auditable logs and governance aligned with Good Manufacturing Practice (GMP) and the EU AI Act; and a synthetic data strategy including differential privacy. Ultimately, this approach validates value through real-world outcomes and charts a path toward “learning oncology,” accelerating patient-centered decision-making and clinical trial development.

Background and study aims Off-the-job training (OFF-JT) ensures that all trainees receive a standardized level of ESD training, regardless of the clinical workload or the regional context. This study aimed to evaluate the efficacy of OFF-JT using a next-generation laptop-based mock-up endoscopy simulator (NLMES) in improving endoscopic submucosal dissection (ESD) skills among international trainees. Methods This study was a single-center, prospective pilot study employing a crossover design. International trainees in Group A underwent designated NLMES training and ESD observation during the early phase (Days 1-14), followed by ESD observation during the late phase (Days 15-28), whereas those in Group B followed the reverse schedule. On Days 1, 15, and 29, the trainees performed ESD using a biomaterial-free ESD model, and the ESD skills were assessed at each time point. The primary endpoint was the between-group comparison of improvement in dissection speed on Day 15. Results A total of 10 international trainees were enrolled in this study. On Day 15, the improvement in dissection speed was greater in Group A than in Group B, although the statistical difference was not significant (6.40 mm 2 /min; 95% confidence interval [CI] 0.50-12.31] vs. -0.76 mm 2 /min; 95% CI -8.91 to 7.39], P = 0.087). The within-group comparison of dissection speed between before and after NLMES training demonstrated significant differences in both groups. Conclusions OFF-JT using NLMES might be a promising approach improving international trainee ESD skills. Dissection speed increased during the period when NLMES training was received, highlighting the importance of OFF-JT.

Background and Aims Endoscopic self-expandable metal stent (SEMS) placement is established for malignant gastroduodenal obstruction, whereas its use in jejunal strictures has been rarely reported because of the technical challenges associated with small bowel anatomy. We describe a case in which stepwise placement of multiple duodenal SEMS treated multifocal jejunal strictures due to peritoneal dissemination. Methods A 62-year-old woman with advanced breast cancer and peritoneal dissemination presented with recurrent intestinal obstruction. Contrast study demonstrated multifocal stenoses involving the duodenum and jejunum, including a long jejunal stricture measuring approximately 15 cm. Endoscopic placement of multiple duodenal SEMS was performed across the duodenal and jejunal strictures, achieving sufficient luminal patency from the duodenum to the jejunum. Results After stent placement, obstructive symptoms improved. Oral intake was resumed 3 days after the procedure, allowing early discharge. The patient remained free from stent dysfunction for 5 months until transition to best supportive care. Conclusions Stepwise placement of multiple duodenal SEMS may represent a safe and effective palliative option for multifocal jejunal strictures secondary to peritoneal dissemination, enabling symptom relief and resumption of oral intake, although further studies are needed.

Objectives:Colonoscopy is a reliable technique for the detection, diagnosis, and treatment of adenomas and early cancer. Image-enhanced endoscopy (IEE) is important for detecting colorectal lesions. Texture and color-enhancement imaging (TXI) has recently emerged as a novel modality for IEE. Thus, TXI operates in two modes: mode 1 (TXI1) enhances the structure, color, and brightness, whereas mode 2 (TXI2) does not. We have previously reported the detection of colorectal adenomas using TXI. We aimed to determine the detection yields of TXI1 and TXI2 using the data from our previous study. Methods:We retrospectively analyzed the colonoscopy data from three institutions between August 2020 and January 2021. The patients were classified into two groups: TXI1 and TXI2. The mean number of adenomas detected per procedure (MAP), adenoma detection rate (ADR), and flat adenoma detection rate (FDR) were compared between groups. Results:The evaluations (95% confidence intervals) for the TXI1 versus TXI2 groups were as follows: MAP, 1.5 (1.3-1.7) versus 1.5 (1.3-1.7); ADR, 56.8% (47.3-65.9) versus 59.7% (50.3-68.6); and FDR, 68.6% (59.5-76.9) versus 63.9% (54.6-72.5), with no statistically significant differences between the groups. Conclusion:The detection rates of colorectal lesions were comparable between the TXI1 and TXI2 groups.

Background and aim Intensive downstaging polypectomy (IDP) has emerged as a colon-preserving strategy for patients with familial adenomatous polyposis (FAP). Low-power pure-cut current (LPPC) hot snare polypectomy (HSP) is associated with reduced risk of deep thermal injury and may lower the incidence of adverse events. The aim of this case series was to describe the feasibility and safety of LPPC-HSP in the setting of IDP in patients with FAP. Methods We performed LPPC-HSP IDP using a bipolar snare in three patients with FAP. Results All procedures were completed without intraprocedural or delayed adverse events. A total of 601 polyps (size ≤10 mm) were resected across three patients, achieving a mean resection time of 25.1 seconds per polyps. Conclusions LPPC-HSP may be a promising strategy for IDP, suggesting a reduced risk of procedure-related adverse events.