Digestive Endoscopy最新文献

{"title":"Comparative Performance of Artificial Intelligence-Based Computer-Aided Detection Systems for Colorectal Polyps: A Systematic Review and Network Meta-Analysis","authors":"Satoshi Shinozaki,&nbsp;Jun Watanabe,&nbsp;Takeshi Kanno,&nbsp;Katsuyuki Nakazawa,&nbsp;Tomonori Yano","doi":"10.1111/den.70138","DOIUrl":"10.1111/den.70138","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Computer-aided detection (CADe) is anticipated to enhance adenoma detection rate (ADRs). The aim of this study was to systematically collect randomized-controlled trials comparing colonoscopy with CADe to standard colonoscopy without CADe in ADRs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a Bayesian network meta-analysis of randomized-controlled trials. Three electronic databases including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched. The primary outcome was the comparison of the performance of CADe systems in ADRs; the secondary outcome was the sessile serrated lesions detection rates (SSLDRs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 48 randomized controlled trials involving 38,986 patients were included in the quantitative analysis. Several CADe systems improved ADR compared with controls that ENDO-AID (risk ratio [RR] 1.26, 95% credible interval [CrI] 1.14–1.40), CADEYE (RR 1.18, 95% CrI 1.10–1.26), and GI Genius (RR 1.15, 95% CrI 1.08–1.22) were supported by moderate confidence evidence according to the Confidence in Network Meta-Analysis (CINeMA). For SSLDR, ENDO-AID (RR 1.36, 95% CrI 1.03–1.79) and GI Genius (RR 1.25, 95% CrI 1.08–1.46) may offer improved detection compared with controls. Across multiple sensitivity analyses excluding studies by withdrawal time, conflicts of interest, limited study numbers, image-enhanced endoscopy, non-parallel design, single-center settings, operator experience, or earlier publication years, the direction and magnitude of ADR improvements with CADe systems remained largely consistent with the primary analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Based on the CINeMA framework, the certainty of evidence ranged from low to moderate, indicating that some CADe systems are likely to improve ADR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 4","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WEO Newsletter: Histopathology for Endoscopists","authors":"","doi":"10.1111/den.70140","DOIUrl":"10.1111/den.70140","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 3","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Based Prediction of Invasion Depth in Colorectal Cancer via Endoscopic Imaging (With Video): A Narrative Review","authors":"Daiki Nemoto,&nbsp;Kazutomo Togashi,&nbsp;Xin Zhu,&nbsp;Satoshi Shinozaki,&nbsp;Takuto Hikichi","doi":"10.1111/den.70139","DOIUrl":"10.1111/den.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Endoscopic prediction of colorectal cancer (CRC) invasion depth is essential for determining optimal treatment strategy. Artificial intelligence (AI) may assist in distinguishing between superficial (Tis/T1a) and deeply invasive (T1b) lesions to avoid unnecessary surgery. In this narrative review, we summarize recent advances in this field.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A database search of PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov was conducted in September 2025 to identify original peer-reviewed studies that developed or validated AI-based models using endoscopic imaging for invasion-depth prediction. Studies reporting diagnostic metrics such as sensitivity, specificity, accuracy, and AUC were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten studies met the inclusion criteria, categorized into three groups: (1) AI prediction using image-enhanced endoscopy, (2) AI prediction using white-light imaging, and (3) AI prediction using multi-modal data (imaging with clinical information). The latest models achieved high performance for T1b CRC diagnosis (e.g., AUC 0.851), with some demonstrating performance comparable to expert endoscopists. However, a pooled analysis was not performed due to dataset heterogeneity and limited sample sizes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI-assisted systems show promise for improving the prediction of invasion depth in CRC and supporting real-time decision-making. However, limited sample sizes for training and test datasets and an imbalance in the training dataset remain key challenges. Large-scale, multicenter validation studies and the development of open-access databases are essential for clinical implementation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 3","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Definite Step Toward Clinical Implementation of AI-Assisted Rapid On-Site Evaluation During EUS-TA","authors":"Yuki Fujii,&nbsp;Kazuyuki Matsumoto,&nbsp;Motoyuki Otsuka","doi":"10.1111/den.70137","DOIUrl":"10.1111/den.70137","url":null,"abstract":"&lt;p&gt;Rapid on-site evaluation (ROSE) has played an important role in improving diagnostic performance of endoscopic-ultrasound-guided tissue acquisition (EUS-TA) for pancreatic masses [&lt;span&gt;1-3&lt;/span&gt;]. The diagnostic accuracies for pancreatic cancer with or without ROSE do not differ with the use of EUS-guided fine-needle biopsy (EUS-FNB) needles according to results mainly obtained from high-volume centers [&lt;span&gt;4&lt;/span&gt;]. Whether similar outcomes can be achieved in institutions with less procedural experience remains unclear. ROSE may increase diagnostic accuracy in diagnostically difficult cases requiring repeat EUS-TA and may help avoid unnecessary additional punctures by enabling the real-time assessment of specimen adequacy [&lt;span&gt;5, 6&lt;/span&gt;]. Despite these benefits, the global shortage of cytopathologists, along with the associated human resource and economic burdens associated with ROSE, has limited the widespread use of ROSE. As such, artificial-intelligence-assisted ROSE (AI-ROSE) is increasingly attracting attention as a solution to these challenges and as a tool to standardize EUS-TA among institutions. Although several AI-ROSE systems have been developed, key issues regarding the diagnostic accuracy, processing speed, and real-world clinical applicability remain unresolved [&lt;span&gt;7-9&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Ashida et al. provide a comprehensive evaluation of an AI-ROSE system for pancreatic EUS-TA [&lt;span&gt;10&lt;/span&gt;]. The researchers advanced the system beyond proof-of-concept: the system rapidly achieved high diagnostic accuracy, distinguishing the system from previous AI-ROSE methods. First, the diagnostic framework closely captures how cytopathological evaluations are performed in clinical practice. Rather than using a simple binary classification, the authors designed a five-tier system consolidated into three clinically meaningful categories, incorporating the diagnostic uncertainty associated with borderline or atypical lesions. This approach represents methodological advance that aligns well with real-world decision-making. In an independent validation cohort, the system accurately diagnosed 95.1% of malignant lesions. Second, the authors directly compared the diagnostic accuracy as well as evaluation time between AI-ROSE and human evaluators, including endoscopists with different levels of experience and cytopathologists. AI-ROSE outperformed all human evaluators in terms of diagnostic accuracy, and 120 clusters were assessed in approximately 6 s, which was much faster than the humans. This speed system directly supports real-time decision-making during EUS-TA.&lt;/p&gt;&lt;p&gt;The main contribution of AI-ROSE is the ability to stabilize cytological assessment and reduce interobserver variability without additional human effort. Even experienced cytopathologists may be affected by fatigue, and evaluations are affected by differences in human experience, which impact diagnostic consistency. In this con","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 3","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12983989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pressure-Opening Cannulation: A Novel Rendezvous Technique for Severe Biliary Anastomotic Strictures","authors":"Kentaro Yamao,&nbsp;Takuya Ishikawa,&nbsp;Hiroki Kawashima","doi":"10.1111/den.70112","DOIUrl":"10.1111/den.70112","url":null,"abstract":"<p>Endoscopic management of biliary anastomotic strictures after pancreaticoduodenectomy is a well-known challenge [<span>1</span>]. When the orifice is impassable, surgery is often the only option. We present a novel technique, the Pressure-Opening Cannulation (utilizing a dye-guided rendezvous approach), for a case where conventional ERCP failed.</p><p>A 65-year-old man presented with recurrent cholangitis 7 months after subtotal stomach-preserving pancreatoduodenectomy. Initial ERCP was performed for CT-confirmed bile duct dilation. However, the procedure failed because the scarred anastomosis offered no discernible orifice (Figure 1a). A PTBD was then placed to manage the cholangitis. PTBD cholangiography confirmed contrast medium eventually accumulated in the jejunum (Figure 1b, black arrowheads), although real-time flow was unidentifiable due to the severe stricture. Antegrade attempts to pass a guidewire via the PTBD route also failed because the wire repeatedly deflected off the firm stricture. Although the success of cannulation remained uncertain, a second ERCP was performed to identify the orifice.</p><p>During a second ERCP, we injected indigo carmine from the PTBD. This dye-guided method pinpointed the orifice's exact location endoscopically for the first time (Figures 1c and 2a). Although various techniques for indirectly identifying an orifice using dye or gel are known [<span>2-5</span>], the stricture remained too tight for guidewire passage.</p><p>To overcome this challenge, we utilized our Pressure-Opening technique. From the antegrade PTBD route, an assistant applied steady manual pressure using a 10-mL syringe, which transiently hydrodistended the stricture, allowing synchronized cannulation. Potential risks of overdistention include cholangitis, bile leak, and pain. Thus, pressure was applied intermittently while monitoring the patient's condition, including vital signs and fluoroscopic images. Using this dual-access rendezvous, the guidewire was successfully inserted (Figure 2b). The stricture was then dilated and a stent was placed without complications (Figure 2c). Cholangitis resolved, avoiding high-risk reoperation (Video SI). Pressure-Opening Cannulation is an effective option for severe anastomotic strictures previously considered impassable.</p><p>Conceptualization: K.Y.; data curation: K.Y.; formal analysis: K.Y. and T.I.; writing – original draft: K.Y.; writing – review and editing: T.I. and H.K. All authors critically reviewed and revised the manuscript draft and approved the final version for submission.</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>T.I. is an Associate Editor of <i>Digestive Endoscopy</i>. H.K. has received lecture fees from Fujifilm Medical. Other authors declare no conflicts of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 3","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Language Model-Driven Analysis and Report Generation of Endoscopy Videos—A Pilot Study","authors":"Davide Massimi,&nbsp;Luca Di Stefano,&nbsp;Tommy Rizkala,&nbsp;Marco Spadaccini,&nbsp;Yuichi Mori,&nbsp;Maddalena Menini,&nbsp;Giulio Antonelli,&nbsp;Kareem Khalaf,&nbsp;Raf Bisschops,&nbsp;Daniel von Renteln,&nbsp;Prateek Sharma,&nbsp;Douglas K. Rex,&nbsp;Michael Bretthauer,&nbsp;Carlo Castoro,&nbsp;LLM Working Group,&nbsp;Alessandro Repici,&nbsp;Cesare Hassan","doi":"10.1111/den.70134","DOIUrl":"10.1111/den.70134","url":null,"abstract":"<p>Multimodal large language models (MLLMs) can automatically analyze clinical video, but evidence from full esophagogastroduodenoscopy (EGD) and the impact of on-screen computer-aided detection/diagnosis (CAD) overlays on MLLM behavior remain unclear. We tested whether an MLLM can produce clinically adequate EGD reports and whether a CAD overlay changes performance. We analyzed five complete EGD videos with Gemini 2.5 Pro in paired versions: (1) clean video and (2) the same video with a CAD overlay. Five blinded endoscopists rated report adequacy in three domains. MLLM accuracy for landmarks/lesions was further assessed by two blinded expert endoscopists using the time-window rule (a model detection counted as correct if it occurred within ±2 s of the expert-annotated timestamp). In this retrospective pilot study, five archived diagnostic EGD procedures from five patients were available as full-length videos. Across five raters, MLLM Completeness was judged adequate in 56.0% (14/25 ratings) with Clean-Video versus 48.0% (12/25 ratings) with Overlay-Video (<i>p</i> = 0.500). Visualization was identical (36.0% [9/25 ratings] for both; <i>p</i> = 1.000). Lesions characteristics were identical (16.0% [4/25] for both; <i>p</i> = 1.00). For the Landmark agreement, the overall accuracy of the MLLM with Clean-Video vs. Overlay-Video was: 0.55 [95% CI 0.43–0.67] vs. 0.33 [0.23–0.46], <i>p</i> = 0.029; sensitivity 0.53 [0.40–0.66] vs. 0.35 [0.24–0.49], <i>p</i> = 0.122; specificity 0.67 [0.35–0.88] vs. 0.22 [0.06–0.55], <i>p</i> = 0.125. In this pilot study, Gemini 2.5 Pro demonstrated inadequate performance for clinical EGD reporting. These hypothesis-generating findings suggest substantial optimization and larger-scale validation are required before deployment.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 3","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12972633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforating Veins Detected by Endoscopic Ultrasonography Are Useful in Predicting the Recurrence of Esophageal Varices After Endoscopic Variceal Ligation Combined With Argon Plasma Coagulation","authors":"Yukari Tezuka,&nbsp;Jun Takada,&nbsp;Takao Miwa,&nbsp;Kiichi Otani,&nbsp;Naoya Masuda,&nbsp;Hiroki Taniguchi,&nbsp;Kentaro Kojima,&nbsp;Sachiyo Onishi,&nbsp;Masaya Kubota,&nbsp;Takashi Ibuka,&nbsp;Masahito Shimizu","doi":"10.1111/den.70132","DOIUrl":"https://doi.org/10.1111/den.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Few attempts have been made to determine the risk factors for the recurrence of esophageal varices (EV) and the optimal surveillance interval. This study analyzed whether endoscopic ultrasonography can be used to predict EV recurrence and determine the optimal timing for surveillance endoscopy post-treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated patients with EVs who underwent endoscopic variceal ligation (EVL) combined with argon plasma coagulation (APC), followed by endoscopic ultrasonography (EUS) using a miniature ultrasonic probe 1 month after APC. Factors associated with EV recurrence were assessed using the Fine-Gray competing risk regression model, with death considered as the competing risk. The cumulative incidence of EV recurrence was estimated using the cumulative incidence function, and groups were compared using Gray's test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 163 eligible patients, 37 (23%) experienced EV recurrence during a median follow-up period of 36 months (interquartile range: 15–76 months). Multivariable analysis revealed that the presence of perforating veins (PVs) was a significant factor for EV recurrence (sub-distribution hazard ratio, 4.30; 95% confidence interval, 2.13–8.71; <i>p</i> &lt; 0.001). The cumulative incidence of EV recurrence was significantly higher in patients with PV than in those without (6-month and 1-year recurrence rates: 27.3% and 41.6% vs. 3.9% and 5.5%, respectively; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PVs detected using EUS independently predict EV recurrence risk after EVL combined with APC. Given that patients with PVs experience a high recurrence rate within 6 months, comprehensive surveillance endoscopy at 6-month intervals is recommended in the first year post-treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 3","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147564570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforating Veins Detected by Endoscopic Ultrasonography Are Useful in Predicting the Recurrence of Esophageal Varices After Endoscopic Variceal Ligation Combined With Argon Plasma Coagulation","authors":"Yukari Tezuka,&nbsp;Jun Takada,&nbsp;Takao Miwa,&nbsp;Kiichi Otani,&nbsp;Naoya Masuda,&nbsp;Hiroki Taniguchi,&nbsp;Kentaro Kojima,&nbsp;Sachiyo Onishi,&nbsp;Masaya Kubota,&nbsp;Takashi Ibuka,&nbsp;Masahito Shimizu","doi":"10.1111/den.70132","DOIUrl":"https://doi.org/10.1111/den.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Few attempts have been made to determine the risk factors for the recurrence of esophageal varices (EV) and the optimal surveillance interval. This study analyzed whether endoscopic ultrasonography can be used to predict EV recurrence and determine the optimal timing for surveillance endoscopy post-treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated patients with EVs who underwent endoscopic variceal ligation (EVL) combined with argon plasma coagulation (APC), followed by endoscopic ultrasonography (EUS) using a miniature ultrasonic probe 1 month after APC. Factors associated with EV recurrence were assessed using the Fine-Gray competing risk regression model, with death considered as the competing risk. The cumulative incidence of EV recurrence was estimated using the cumulative incidence function, and groups were compared using Gray's test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 163 eligible patients, 37 (23%) experienced EV recurrence during a median follow-up period of 36 months (interquartile range: 15–76 months). Multivariable analysis revealed that the presence of perforating veins (PVs) was a significant factor for EV recurrence (sub-distribution hazard ratio, 4.30; 95% confidence interval, 2.13–8.71; <i>p</i> &lt; 0.001). The cumulative incidence of EV recurrence was significantly higher in patients with PV than in those without (6-month and 1-year recurrence rates: 27.3% and 41.6% vs. 3.9% and 5.5%, respectively; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PVs detected using EUS independently predict EV recurrence risk after EVL combined with APC. Given that patients with PVs experience a high recurrence rate within 6 months, comprehensive surveillance endoscopy at 6-month intervals is recommended in the first year post-treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 3","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147564497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serrated Lesions in Ulcerative Colitis: Beyond Endoscopic Resection","authors":"Shinji Yoshii","doi":"10.1111/den.70133","DOIUrl":"10.1111/den.70133","url":null,"abstract":"&lt;p&gt;Colectomy remains the standard curative treatment for ulcerative colitis-associated neoplasia (UCAN). This is clearly stated in international guidelines and reflects two key features of ulcerative colitis (UC): chronic inflammation and a high risk of multifocal neoplasia [&lt;span&gt;1-3&lt;/span&gt;]. Even with recent advances in endoscopic imaging and resection techniques, local treatment alone cannot remove the long-term cancer risk in the diseased colon. When discussing endoscopic management in UC, it is therefore essential to recognize that colectomy, rather than endoscopic resection, remains the definitive oncologic therapy.&lt;/p&gt;&lt;p&gt;Within this framework, improved endoscopic diagnosis has expanded the role of endoscopic resection for carefully selected, well-demarcated visible lesions in UC [&lt;span&gt;1, 4&lt;/span&gt;]. In selected patients, this approach may allow deferral of immediate colectomy. However, it should be regarded as a conditional, organ-preserving strategy and not as a curative alternative. Endoscopic resection in UC is appropriate only when it is part of a long-term management plan that recognizes that cancer risk remains and requires strict surveillance [&lt;span&gt;2-5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this context, Nishio et al. evaluated the short- and long-term outcomes of endoscopic resection for serrated lesions in patients with UC [&lt;span&gt;6&lt;/span&gt;]. Their retrospective exploratory study showed that endoscopic resection of serrated lesions is technically feasible and can be performed with acceptable short-term safety. Notably, their cohort included one case of invasive cancer arising from a traditional serrated adenoma, and metachronous UC-associated neoplasia developed in 50% of patients with ulcerative colitis-associated serrated adenomas during follow-up. This finding indicates that, while endoscopic resection is technically valid, its oncologic limitations should not be overlooked.&lt;/p&gt;&lt;p&gt;An important message from the Nishio study is that serrated lesions in UC should not be automatically considered sporadic. Although these lesions may appear similar to sporadic serrated lesions on endoscopy, the development of metachronous UCAN after resection suggests that at least some arise within an inflammation-related, neoplasia-prone mucosal field [&lt;span&gt;6&lt;/span&gt;]. This observation suggests that management strategies for sporadic colorectal neoplasia should not be directly applied to patients with UC without careful consideration of the disease background. One possible explanation for these findings is that the molecular and pathological backgrounds of TSA or ulcerative colitis-associated serrated adenomas may differ from those of sporadic sessile serrated lesions. Chronic inflammation and long-standing mucosal injury in UC may promote an inflammation-related serrated pathway, resulting in a neoplasia-prone field effect rather than isolated sporadic tumorigenesis.&lt;/p&gt;&lt;p&gt;These findings emphasize that UC-associated lesions should be managed within a multidisciplinary ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 3","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147370827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Green Endoscopy in a Warming World: Bridging Environmental Footprints and Everyday Practice in Japan","authors":"Kenichiro Imai","doi":"10.1111/den.70131","DOIUrl":"10.1111/den.70131","url":null,"abstract":"&lt;p&gt;Climate change has begun to affect routine clinical practice; heat-related illnesses, supply chain disruptions, and disaster-related care are now reported daily. Greenhouse gas (GHG) emissions are well-recognized as a major cause of global heating. Notably, it has been estimated that the healthcare sector causes approximately 4.4% of total GHG emissions worldwide [&lt;span&gt;1&lt;/span&gt;]. Gastrointestinal (GI) endoscopy is used for screening, diagnostic, and therapeutic purposes and plays a significant role in any healthcare facility. As its use has grown over time, GI endoscopy units may increasingly become a major waste-producing area of the hospital. Direct and indirect GHG emission can be classified into emissions in pre-, during, post-endoscopy. In pre-endoscopy, GHG includes staffs and patients travel, freights of medical equipments or materials, medical and non-medical equipment (endoscope washer disinfectors, endoscopy system), consumables (drugs, devices). During endoscopy, emissions come from gas/electricity energy and medical gases (CO2). Emissions from staffs travel and waste (water, hazardous and non-hazardous equipments) were included in post-endoscopy. The European Society of Gastrointestinal Endoscopy (ESGE) has released a statement on the need to increase the implementation of sustainable daily practices [&lt;span&gt;2&lt;/span&gt;]. However, awareness of this environmental issue remains limited among healthcare professionals [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;It became more challenging to focus on medical waste management in GI endoscopy, as medical workers experienced increased demand for personal protective equipment, such as masks, glasses, gowns, and gloves during the COVID-19 pandemic. A recent web-based survey conducted by the ESGE Green Endoscopy Working Group revealed that many participants did not consider GI endoscopy to be a large contributor to climate change; only 41% of European participants thought that they needed to optimize the appropriate use of GI endoscopy procedures, and 34% thought it was important to reduce reliance on single-use devices [&lt;span&gt;3&lt;/span&gt;]. More recently, a questionnaire study among 114 Japanese healthcare professionals revealed that many were interested in the ecological impacts of their practices, in recycling the packaging of devices, and in making improved device selections from an ecological perspective; however, on the other hand, 84% of Japanese responders prioritized cost over ecological concerns when selecting a device, and only 12% reported that they could not reduce unnecessary endoscopy procedures [&lt;span&gt;4&lt;/span&gt;]. Although these data could not be compared directly due to different backgrounds in Europe and Japan, the current awareness and attitude on this environmental issue could be described.&lt;/p&gt;&lt;p&gt;In a recent issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Baddeley and Hayee comprehensively review the current status and challenges of “green endoscopy” [&lt;span&gt;5&lt;/span&gt;]. Their review emphasizes the need to carefull","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 3","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.70131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}