Digestive Endoscopy最新文献

{"title":"Upper Gastrointestinal Endoscopy in Elderly Patients: An Individualized Decision-Making Approach for Screening and Surveillance","authors":"Satoshi Ono,&nbsp;Takehiro Sugii,&nbsp;Hiroki Shigematsu,&nbsp;Yutaka Ogikubo,&nbsp;Takumi Hayashi,&nbsp;Yuki Sato,&nbsp;Yusuke Horikoshi,&nbsp;Kazushi Masatani,&nbsp;Takuro Tomino,&nbsp;Shun Osumi,&nbsp;Kazushi Fukagawa,&nbsp;Shosuke Hosaka,&nbsp;Masahiro Akishita,&nbsp;Mitsuhiro Fujishiro","doi":"10.1111/den.70260","DOIUrl":"https://doi.org/10.1111/den.70260","url":null,"abstract":"<div>\u0000 \u0000 <p>Population aging has led to a growing number of elderly individuals undergoing upper gastrointestinal (UGI) endoscopy for screening and surveillance. Although UGI endoscopic screening has been shown to reduce gastric and esophageal cancer mortality in high-risk regions, evidence specific to very elderly populations (≥ 80 years) remains limited. This review summarizes current epidemiologic data, risk stratification approaches, procedural considerations, examination quality, surveillance strategies, and future directions for UGI endoscopy in elderly patients, with particular emphasis on individuals aged ≥ 80 years. We highlight the importance of individualized decision-making that incorporates oncologic risk, frailty, comorbidity burden, life expectancy, procedural burden, and patient preferences. Quality-enhancing and burden-reducing strategies, including image-enhanced endoscopy and transnasal endoscopy, may help optimize the benefit–harm balance when endoscopy is considered appropriate. As global populations continue to age, generating high-quality evidence tailored to very elderly individuals will be essential to optimize the benefits and minimize the risks of UGI endoscopy.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148783784","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":"Comparative Performance of Image-Enhanced Endoscopy for Adenoma and Sessile Serrated Lesion Detection: A Network Meta-Analysis","authors":"Satoshi Shinozaki,&nbsp;Jun Watanabe,&nbsp;Tomonori Yano","doi":"10.1111/den.70262","DOIUrl":"https://doi.org/10.1111/den.70262","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Image-enhanced endoscopy (IEE) technologies have been developed to improve colorectal polyp detection, but their comparative efficacy remains uncertain. We performed a network meta-analysis to compare the efficacy of major IEE modalities on colorectal polyp detection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched MEDLINE, Embase, and CENTRAL for randomized controlled trials comparing seven IEE modalities (autofluorescence imaging, blue-light imaging, flexible spectral imaging color enhancement, i-scan, linked color imaging [LCI], narrow band imaging [NBI], and texture and color enhancement imaging [TXI]) with white-light imaging (WLI). The primary outcome was the comparison of performance of IEE systems in adenoma detection rate (ADR); the secondary outcome was sessile serrated lesion detection rate (SSLDR). We estimated the number needed to screen (NNS) with 95% credible intervals (CrIs). Study credibility was assessed using the Confidence in Network Meta-analysis (CINeMA) framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-three randomized controlled trials encompassing 34,364 patients were included. Compared with WLI, moderate-confidence evidence supported improvements in ADR with TXI (NNS 13, 95% CrIs 7–32), LCI (NNS 17, 95% CrIs 11–31), and NBI (NNS 35, 95% CrIs 18–139), whereas low-confidence evidence supported benefits for i-scan (NNS 7, 95% CrIs 3–18). Direct comparison across IEEs demonstrated little-to-no clinically meaningful differences in ADR. For SSLDR, moderate-confidence evidence supported improvements with LCI (NNS 29, 95% CrIs 15–96) and NBI (NNS 38, 95% CrIs 19–143) compared with WLI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LCI demonstrated the most robust and reproducible performance across multiple analyses with moderate-confidence evidence, although differences among IEE modalities were generally modest.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148783787","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":"Indications and Curability Criteria for Endoscopic Resection of Early Gastric Cancer in Elderly Patients: Current Standards and Future Perspectives","authors":"Masau Sekiguchi,&nbsp;Ichiro Oda","doi":"10.1111/den.70257","DOIUrl":"10.1111/den.70257","url":null,"abstract":"<div>\u0000 \u0000 <p>Population aging has substantially altered the epidemiology and management of gastric cancer, particularly in East Asia, where a growing proportion of patients with early gastric cancer (EGC) are elderly. Current Japanese guidelines define indications and curability criteria for endoscopic resection (ER) irrespective of age. Consequently, gastrectomy with lymphadenectomy remains the standard treatment for EGC that exceeds established absolute and expanded ER indications or is classified as endoscopic curability (eCura) C-2 after ER. However, given the heterogeneity of metastatic risk and patient characteristics, uniform recommendation of gastrectomy may result in overtreatment in elderly patients. Nationwide registry data on patients undergoing gastrectomy have demonstrated that overall prognosis becomes increasingly limited and postoperative mortality rises with age, especially in men aged ≥ 75 years and women aged ≥ 80 years. These findings highlight the need to reconsider ER indications and post-resection management in elderly patients based on estimated lymph node metastasis (LNM) risk, operative mortality, and life expectancy. Recent studies suggest that expanding ER indications and redefining curability criteria in elderly patients using a higher acceptable LNM risk threshold, such as 10%, may represent a rational risk-adapted strategy. This concept is currently being evaluated in the multicenter phase III confirmatory trial conducted by the Japan Clinical Oncology Group (JCOG1902). Importantly, long-term outcomes in elderly patients with EGC are influenced by non–gastric cancer deaths. Therefore, management strategies should integrate tumor-related risk with patient-related factors, including comorbidities, nutritional status, frailty, and competing mortality risks, to achieve individualized and clinically meaningful care in this expanding population.</p>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708776","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":"Self-Harm–Associated Gastrointestinal Foreign Bodies: National Patterns of Management and Outcomes","authors":"David Wong Arias,&nbsp;Spencer R. Goble,&nbsp;Mauricio Torrealba","doi":"10.1111/den.70256","DOIUrl":"10.1111/den.70256","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Gastrointestinal foreign body ingestion or insertion can be an act of intentional self-harm. We aimed to provide a large-scale assessment of this clinical scenario.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective cross-sectional analysis of adult patients who presented with gastrointestinal foreign bodies and intent to self-harm. Hospitalizations were identified using the National Inpatient Sample from 2016 to 2023. Each hospitalization was characterized by the management methods used including no intervention, endoscopy, and surgery. Evaluated outcomes included ICU-level care, length of stay, and cost. Additionally, we assessed factors associated with the need for surgery after endoscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 16,150 hospitalizations were identified. The mean age was 33.9 years and most patients were male (65.7%). Over one-third (35.2%) of patients had a cluster B personality disorder while 39.3% had schizophrenia and 24.2% were incarcerated. The majority (61.2%) of patients were managed with endoscopy alone while 26.4% required no intervention and 12.3% required surgery. ICU-level care was increased in those who required surgery, but the difference was not statistically significant (4.5% vs. 3.0%; OR 1.54, 95% CI: 0.91–2.62, <i>p</i> = 0.111). Small bowel location was associated with the need for surgery after endoscopy (aOR 2.50, 95% CI 1.91–3.28; <i>p</i> &lt; 0.001). Over 12,000 hospital days and $25,000,000 were attributable to self-harm-associated gastrointestinal foreign bodies annually.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Self-harm–associated gastrointestinal foreign bodies occur predominantly in patients with significant psychiatric comorbidity. Although mortality and severe morbidity are uncommon, healthcare utilization is substantial. Small bowel location is a key predictor of the need for surgical intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686848","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":"After JCOG1217: Toward Risk-Adapted Steroid Prophylaxis for Post-ESD Esophageal Strictures","authors":"Kotaro Shibagaki,&nbsp;Norihisa Ishimura,&nbsp;Shunji Ishihara","doi":"10.1111/den.70258","DOIUrl":"10.1111/den.70258","url":null,"abstract":"&lt;p&gt;Endoscopic submucosal dissection (ESD) is an established treatment for superficial esophageal squamous cell carcinoma, enabling en bloc resection and precise histological assessment. However, post-ESD stricture remains a clinically important adverse event after extensive resection involving a large circumferential mucosal defect. Dysphagia requiring repeated endoscopic balloon dilation (EBD) can substantially impair quality of life and compromise the minimally invasive benefit of endoscopic treatment. Stricture prevention is therefore not merely a technical adjunct to esophageal ESD but an essential component of perioperative management.&lt;/p&gt;&lt;p&gt;Among available prophylactic strategies, corticosteroid-based approaches have been the most widely adopted because of their efficacy, accessibility, and relatively low cost. Before JCOG1217 [&lt;span&gt;1&lt;/span&gt;], both local triamcinolone injection and oral prednisolone had shown favorable outcomes, but the supporting evidence was derived mainly from small, single-arm, or non-randomized comparative studies. In representative early studies, local triamcinolone injection reduced post-ESD stricture rates to 10%–19%, compared with 66%–75% in untreated or historical controls [&lt;span&gt;2, 3&lt;/span&gt;]. Oral prednisolone, usually initiated at 30 mg/day and tapered over several weeks, reduced stricture rates to 5.3%–17.6%, compared with 31.8%–68.7% after preemptive EBD or no prophylaxis [&lt;span&gt;4-6&lt;/span&gt;]; however, the 30 mg/day starting dose subsequently adopted in JCOG1217 was not established through dose-ranging evaluation, and neither routine dose reduction nor escalation can currently be recommended. Thus, both routes of steroid administration were clinically reasonable, but the available evidence was fragmented and insufficient to define the preferred approach after extensive esophageal ESD.&lt;/p&gt;&lt;p&gt;In this issue of &lt;i&gt;Digestive Endoscopy&lt;/i&gt;, Tanaka and colleagues report the results of JCOG1217, a multicenter, open-label, randomized phase 3 trial comparing oral prednisolone with local triamcinolone injection for the prevention of stricture after extensive esophageal ESD [&lt;span&gt;1&lt;/span&gt;]. The trial enrolled 281 patients from 45 institutions with superficial esophageal squamous cell carcinoma involving at least one-half, but not the entire circumference, of the esophageal lumen. Patients were randomized to receive either local triamcinolone injection, administered immediately after ESD at a total dose of 100 mg with avoidance of exposed muscle, or oral prednisolone, started at 30 mg/day on day 3 after ESD and tapered over 8 weeks, with prophylactic trimethoprim-sulfamethoxazole. The primary endpoint was stricture-free survival (SFS), and the trial was designed as a superiority trial testing whether oral prednisolone was superior to local triamcinolone injection, rather than establishing equivalence or noninferiority. Its importance lies in placing the two most widely used steroid-based strategies on the same multicenter ","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690478","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":"A Ruler Needs a Zero Point: Defining the Gastroesophageal Junction for Length-Based Risk Stratification in Barrett's Esophagus","authors":"Yugo Iwaya","doi":"10.1111/den.70259","DOIUrl":"10.1111/den.70259","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686831","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":"Endoscopic Ultrasound-Guided Tissue Acquisition for Parapharyngeal Space Lesions","authors":"Takuto Hikichi,&nbsp;Jun Nakamura,&nbsp;Tsunetaka Kato,&nbsp;Takumi Yanagita","doi":"10.1111/den.70253","DOIUrl":"10.1111/den.70253","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686812","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":"AI-Assisted Detection May Help Identify Visible but Missed Gastric Cancers During Routine Upper Endoscopy","authors":"Daisuke Murakami,&nbsp;Tomohiro Tada,&nbsp;Masayuki Yamato","doi":"10.1111/den.70255","DOIUrl":"10.1111/den.70255","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681072","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":"Importance of Endoscopic Ultrasound After Treatment of Esophageal Varices","authors":"Yoshihiro Furuichi,&nbsp;Ryohei Nishiguchi,&nbsp;Yuko Furuichi,&nbsp;Tomoyuki Fujiwara,&nbsp;Shirei Kobayashi,&nbsp;Koichiro Sato","doi":"10.1111/den.70251","DOIUrl":"10.1111/den.70251","url":null,"abstract":"","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671468","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":"Exploratory Analysis of Quality Indicators for Esophagogastroduodenoscopy During Surveillance Following Gastric Endoscopic Scubmucosal Dissection","authors":"Takeshi Uozumi,&nbsp;Masau Sekiguchi,&nbsp;Yasuhiko Mizuguchi,&nbsp;Mitsunori Kusuhara,&nbsp;Satoru Nonaka,&nbsp;Seiichiro Abe,&nbsp;Takahiro Fukuda,&nbsp;Yutaka Saito","doi":"10.1111/den.70254","DOIUrl":"10.1111/den.70254","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>r</i> = 0.621, <i>p</i> = 0.03), but not for the other indicators. Endoscopists with a high gBR (&gt; 36%) had a significantly higher gastric neoplasm detection rate than those with a lower gBR (≤ 30%) (3.6% vs. 2.0%, <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"38 8","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686851","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}