DEN open最新文献

{"title":"Innovative Therapeutic Endoscopy of the Upper Gastrointestinal Tract: Review of the Japan Gastroenterological Endoscopy Society Core Sessions","authors":"Mikitaka Iguchi,&nbsp;Tomoki Michida,&nbsp;Yasuhiko Abe,&nbsp;Hisashi Doyama,&nbsp;Noriya Uedo,&nbsp;Hajime Isomoto,&nbsp;Masayuki Ohta,&nbsp;Junko Fujisaki","doi":"10.1002/deo2.70385","DOIUrl":"https://doi.org/10.1002/deo2.70385","url":null,"abstract":"<p>The Japanese Gastroenterological Endoscopy Society (JGES) established four core sessions on endoscopic treatment for upper gastrointestinal diseases under the theme ‘Innovative Therapeutic Endoscopy’ between 2023 and 2024. This review summarizes these sessions and compiles them as a conference report. At the 105th JGES Core Session, 14 studies were presented as frontiers of treatment for upper gastrointestinal stenosis. At the 106th JGES Core Session, 13 research findings were presented as developments of new endoscopic techniques for the management of neoplastic lesions in the upper digestive tract. At the 107th JGES Core Session, reports were presented from 14 institutions concerning innovations in therapeutic endoscopy, including endoscopic treatment advancements for upper gastrointestinal diseases in internal medicine and surgery. At the 108th JGES Core Session, research from 11 institutions was presented on endoscopic treatment for upper gastrointestinal bleeding. These four core sessions enabled us to recognize the current state of treatment and management approaches for neoplastic lesions, strictures, and bleeding in the upper gastrointestinal tract, and to clarify future challenges. We hope this will contribute to the advancement of upper gastrointestinal endoscopic therapy.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70385","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148616284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefit of Linked-Color Imaging in Artificial Intelligence-Assisted Diagnosis of Early Gastric Cancer: A Pilot Study With Propensity Score Adjustment","authors":"Ahmed Nashaat Mohamed,&nbsp;Yosuke Minoda,&nbsp;Ryohei Maruoka,&nbsp;Yusuke Suzuki,&nbsp;Hiroki Fukuya,&nbsp;Hirotaka Tsuru,&nbsp;Masafumi Wada,&nbsp;Yoshimasa Tanaka,&nbsp;Takatoshi Chinen,&nbsp;Tomohiko Moriyama,&nbsp;Haruei Ogino,&nbsp;Eikichi Ihara,&nbsp;Yoshihiro Ogawa","doi":"10.1002/deo2.70381","DOIUrl":"https://doi.org/10.1002/deo2.70381","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Artificial intelligence (AI)-assisted endoscopy represents a promising approach for lesion detection, yet frequent false-positive detections impair clinical utility by disrupting examinations and diminishing physician confidence. Linked-color imaging (LCI), an image-enhanced endoscopy technique that amplifies mucosal and vascular contrast, may address this limitation. This investigation evaluated whether LCI reduces false-positive AI detections compared with white-light imaging (WLI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study analyzed consecutive AI-assisted upper endoscopies performed between March 2024 and June 2025. WLI and LCI were performed sequentially within the same endoscopic session in each patient. False-positive AI detections were compared between modalities using two computer-aided detection (CAD) versions. Propensity score adjustment was used as a sensitivity analysis for baseline differences between CAD Versions I and II.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 66 initially screened cases, 63 remained after excluding patients with prior gastric surgery. LCI reduced false-positive AI detections compared with WLI (median 2 vs. 5; <i>p</i> &lt; 0.001). In CAD version–stratified sensitivity analyses, LCI reduced false-positive AI detections in both Version I (5 to 2; <i>p</i> = 0.01) and Version II (2 to 0; <i>p</i> = 0.03). This reduction remained consistent across atrophic grades. Both imaging modalities identified all gastric lesions, achieving 100% detection sensitivity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LCI assessment performed after WLI observation yielded fewer false-positive CAD-EYE detections while maintaining lesion detection sensitivity. However, because the observation sequence was fixed, these findings should be interpreted cautiously and require confirmation in prospective or counterbalanced studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Trial Registration</b>: N/A (retrospective study).</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148616283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traction-assisted Endoscopic Retrograde Cholangiopancreatography Using an S-O Clip for Difficult Biliary Cannulation in Billroth II Reconstruction With Tumor-associated Distortion","authors":"Katsuyuki Dainaka,&nbsp;Ryota Ujihara,&nbsp;Tsuyoshi Sawai,&nbsp;Takashi Otsuka,&nbsp;Juichiro Yoshida,&nbsp;Hideki Fujii,&nbsp;Naoya Tomatsuri,&nbsp;Hideki Sato","doi":"10.1002/deo2.70386","DOIUrl":"https://doi.org/10.1002/deo2.70386","url":null,"abstract":"<p>Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is technically challenging, especially when the papilla is poorly oriented relative to the endoscope. We report a case of traction-assisted ERCP using an S-O clip for difficult biliary cannulation in a patient with Billroth II reconstruction and tumor-associated distortion. A patient with a history of distal gastrectomy with Billroth II reconstruction for gastric cancer presented with obstructive jaundice caused by recurrent gastric cancer with biliary stricture. During double-balloon enteroscopy-assisted ERCP, marked papillary malorientation due to distortion of the afferent limb made standard biliary cannulation difficult. To improve papillary visualization, an S-O clip was placed on a mucosal fold on the oral side of the papilla, and the loop was anchored to the anal-side intestinal wall to create clip-to-wall traction. This maneuver improved frontal visualization of the papillary orifice and stabilized the biliary axis, allowing successful biliary cannulation with an MTW ERCP catheter and guidewire. Endoscopic sphincterotomy and plastic stent placement were then completed without adverse events. Although similar traction-assisted ERCP techniques have been reported, this case highlights the usefulness of the method in tumor-associated distortion, where traction did not dramatically reposition the papilla but provided sufficient frontal visualization for biliary cannulation. Traction-assisted ERCP may be a useful adjunctive technique in selected cases with altered anatomy and compromised papillary orientation.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70386","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148616452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Utility and Safety of a Novel Ultraslim Catheter-Type Peroral Cholangioscope/Pancreatoscope: A Single-Center Case Series","authors":"Hiroyuki Kojima,&nbsp;Shuntaro Mukai,&nbsp;Atsushi Sofuni,&nbsp;Takayoshi Tsuchiya,&nbsp;Reina Tanaka,&nbsp;Ryosuke Tonozuka,&nbsp;Kazumasa Nagai,&nbsp;Yukitoshi Matsunami,&nbsp;Hirohito Minami,&nbsp;Noriyuki Hirakawa,&nbsp;Kyoko Asano,&nbsp;Kento Shionoya,&nbsp;Kazuki Hama,&nbsp;Takao Itoi","doi":"10.1002/deo2.70388","DOIUrl":"https://doi.org/10.1002/deo2.70388","url":null,"abstract":"<p>Peroral cholangioscopy (POCS) and peroral pancreatoscopy (POPS) enable direct intraductal visualization for pancreatobiliary disease diagnosis and management. Nonetheless, conventional devices have relatively large diameters, limiting their use in narrow ducts. This single-center, retrospective, observational study aimed to evaluate the feasibility and safety of a novel ultraslim catheter-type POCS/POPS (UCPOCS/UCPOPS) (distal outer diameter: 2.3 mm) in 12 patients who underwent UCPOCS or UCPOPS from November 2022 to August 2024. UCPOCS was performed in eight patients with bile duct stones (<i>n</i> = 3), biliary strictures (<i>n</i> = 2), intrahepatic cholangiocarcinoma (<i>n</i> = 1), post-hepatectomy biliary bleeding (<i>n</i> = 1), and acute cholecystitis requiring endoscopic naso-gallbladder drainage (<i>n</i> = 1). UCPOPS was performed in four patients for postoperative pancreatic duct evaluation (<i>n</i> = 2) and intraductal papillary mucinous neoplasm assessment (<i>n</i> = 2). Technical success, defined as successful scope insertion into the target duct, was achieved in all cases. Clinical success was achieved in 11/12 cases (91.7%), including diagnostic clinical success in 10/11 diagnostic cases (90.9%) and procedural utility success in 1/1 procedural utility case (100%). The smallest successfully visualized duct measured 1.8 mm in diameter based on fluoroscopic estimation at the intended insertion site. One patient developed mild post-endoscopic retrograde cholangiopancreatography pancreatitis, which resolved with conservative management; no other adverse events were observed. The median total procedure time and scope insertion time were 42 and 7 min, respectively. These findings indicate that the UCPOCS or UCPOPS is a feasible and safe intraductal visualization tool for pancreatobiliary diseases, particularly in patients with narrow ducts or challenging anatomy.</p><p><b>Trial Registration</b>: N/A.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70388","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148616451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Endoscopic Submucosal Dissection for Primary Esophageal Mucosa-Associated Lymphoid Tissue Lymphoma","authors":"Junya Makiyama,&nbsp;Hiroko Fukuda,&nbsp;Kyoko Minamino,&nbsp;Yukiyoshi Moriuchi,&nbsp;Koichi Ohshima","doi":"10.1002/deo2.70384","DOIUrl":"https://doi.org/10.1002/deo2.70384","url":null,"abstract":"<p>Primary esophageal extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is extremely rare, and its optimal management has not been established. We report a case of primary esophageal MALT lymphoma that was successfully treated by endoscopic submucosal dissection (ESD). A 70-year-old woman presented with an elevated lesion in the lower esophagus that was detected incidentally on computed tomography. Endoscopy and endoscopic ultrasonography revealed a subepithelial lesion confined to the submucosal layer without apparent invasion of the muscularis propria. Although an endoscopic biopsy suggested a low-grade lymphoma, a definitive diagnosis could not be established because of the limited tissue volume. Therefore, ESD was performed to obtain an adequate specimen for definitive diagnosis, and complete resection was achieved as a result. Histopathological and immunohistochemical examinations of the resected specimen confirmed primary esophageal MALT lymphoma. The patient has remained in complete remission for 3 years without additional therapy. This case suggests that ESD may be a diagnostic and therapeutic option for primary esophageal MALT lymphoma.</p><p><b>Trial Registration</b>: N/A.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70384","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Contrasting Scintigraphy-Negative Pediatric Meckel's Diverticula Identified and Localized by Intestinal Ultrasound and Double-Balloon Enteroscopy: A Report of Two Cases","authors":"Saki Kasai,&nbsp;Masumi Nagata,&nbsp;Keisuke Jimbo,&nbsp;Nobuyasu Arai,&nbsp;Yuichiro Miyake,&nbsp;Mitsuyoshi Suzuki,&nbsp;Takahiro Kudo,&nbsp;Go Miyano,&nbsp;Hiromichi Shoji","doi":"10.1002/deo2.70379","DOIUrl":"10.1002/deo2.70379","url":null,"abstract":"<p>Scintigraphy-negative Meckel's diverticulum (MD) is diagnostically challenging in children, particularly when the underlying pathology differs between cases. Technetium-99^m pertechnetate scintigraphy is widely used for diagnosis; however, false-negative results may occur when ectopic gastric mucosa is absent or when the diverticulum is inverted. We report two pediatric cases with contrasting scintigraphy-negative MD in which intestinal ultrasound (IUS) suggested target lesions, and double balloon enteroscopy (DBE) enabled direct diagnosis and preoperative localization.</p><p>Case 1 was a 13-year-old boy with recurrent abdominal pain and hematochezia. IUS revealed localized ileal wall thickening with a hyperechoic polypoid lesion, and transanal DBE identified a pedunculated ulcerated mass approximately 80 cm proximal to the ileocecal valve. Surgical pathology confirmed inverted MD with ectopic gastric mucosa. Case 2 was an 11-year-old girl with recurrent abdominal pain initially treated as ileitis. IUS revealed localized ileal wall thickening with increased vascularity and a blind-ending tubular structure, and DBE showed a double-lumen appearance consisting of the true ileal lumen and a blind-ending diverticular lumen. Pathology confirmed MD without ectopic mucosa. DBE enabled direct diagnosis and preoperative marking without complications in both cases. These cases suggest that IUS may help identify target lesions and that DBE is useful for definitive diagnosis and preoperative localization in children with suspected MD despite negative scintigraphy.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strangulated Ileus Caused by Clips Used for Closure of an Appendiceal Endoscopic Submucosal Dissection Perforation: A Case Report","authors":"Miuzen Kanamori,&nbsp;Yohei Minato,&nbsp;Susumu Banjoya,&nbsp;Tomoya Kimura,&nbsp;Koichi Furuta,&nbsp;Nao Takeuchi,&nbsp;Rikimaru Sawada,&nbsp;Shouichi Satou,&nbsp;Yuhki Sakuraoka,&nbsp;Ken Ohata","doi":"10.1002/deo2.70383","DOIUrl":"10.1002/deo2.70383","url":null,"abstract":"<p>Perforation developing during endoscopic submucosal dissection (ESD) for colorectal lesions can necessitate halting of the procedure and performing emergency surgery. In some cases, conservative treatment of the perforation is possible using endoscopic clips or over-the-scope-clips (OTSCs). In the case presented herein, while perforation closure was successfully achieved with conventional through-the-scope clips (hereafter referred to as “conventional clips”), the patient developed ileus as a complication, necessitating emergency surgery. The patient was a 69-year-old man who developed strangulated ileus caused by conventional clips placed for closure of a bowel perforation developing after ESD for a lesion in the cecum. We placed several conventional clips and OTSCs to close the perforation and confirmed the absence of any leak at a second-look examination. However, 10 days later, the patient visited our emergency department complaining of abdominal pain. Abdominal contrast-enhanced computed tomography revealed that a segment of the small intestine was drawn into the closing device, resulting in the development of strangulated ileus. We performed laparoscopic surgery and identified the conventional clips that had become caught in the small intestinal serosa/mesentery and led to the formation of a closed bowel loop and bowel obstruction. We released the loop without resection of the intestine. The damaged serosa and mesentery were sutured, and the patient was discharged on hospital day 8. Based on our experience, we suggest that the treating surgeon should bear in mind that even conventional clips used for perforation closure have the potential to grasp organs adjacent to the wall and cause obstruction and the development of symptoms after hospital discharge.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Large Language Models in the Clinical Management of Patients With Upper Gastrointestinal Bleeding: Insights From Real-World Patient Data","authors":"Mohsen Rajabnia,&nbsp;Farbod Davoodi,&nbsp;Mahsa Hajisafarali,&nbsp;Shadi Asadinia,&nbsp;Mahsa Shiri,&nbsp;Fatemeh Shirzad,&nbsp;Peyman Saeedi,&nbsp;Mahsa Mohammadi","doi":"10.1002/deo2.70373","DOIUrl":"10.1002/deo2.70373","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate large language models (LLMs) for pre-endoscopy (PE) risk stratification and prediction of endoscopic findings in upper gastrointestinal bleeding (UGIB), and compare their performance with clinical risk scores, conventional machine learning (ML) models, and hybrid approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter retrospective study included 384 patients with UGIB who underwent endoscopy. Five LLMs (GPT-5, Gemini-2.5-Flash, Llama 4, Grok, and DeepSeek R1) were tested using structured zero-shot prompts based on PE clinical and laboratory data. Their performance in identifying high-risk patients was compared with the Glasgow-Blatchford Score (GBS), AIMS65, PE Rockall score, and ML models. Hybrid LLM–score models were also assessed. Two gastroenterologists evaluated the quality of LLM-generated justifications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>GBS showed the best discriminative performance among clinical scores (area under the receiver operating characteristic curve [AUROC] 0.73). Among LLMs, GPT-5 achieved the highest accuracy (0.66), while Grok showed the best-balanced performance (0.59; F1 0.47). Gemini-2.5-Flash had the highest sensitivity (0.89) but low specificity (0.21). Endoscopic prediction performance was modest, with Gemini-2.5-Flash achieving the highest exact-match accuracy (0.34) and micro-F1 (0.38). Hybrid models improved performance over standalone LLMs but did not outperform GBS alone (best: GBS+GPT-5, AUROC 0.670. LLMs showed higher numerical performance than conventional ML models, but a statistical comparison was not possible due to unavailable instance-level data. Grok received the highest human evaluation score for explanation quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LLMs showed moderate performance in UGIB risk stratification and endoscopic prediction but were inferior to clinical scores, especially GBS. Hybrid models modestly improved over standalone LLMs but not GBS, supporting their use as adjunct tools rather than clinical decision-support systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>N/A</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13347626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulcerative Esophagitis With Marked Eosinophilic Infiltration and Fluorodeoxyglucose–Positron Emission Tomography Positivity Requiring Differentiation From Esophagogastric Junction Carcinoma","authors":"Yuta Kikuchi,&nbsp;Nobutoshi Hagiwara,&nbsp;Noriyuki Kawami,&nbsp;Nobuyuki Sakurazawa,&nbsp;Hideki Kogo,&nbsp;Mikito Suzuki,&nbsp;Hiromasa Komori,&nbsp;Yuhei Yamaguchi,&nbsp;Katsuhiko Iwakiri,&nbsp;Hiroshi Yoshida","doi":"10.1002/deo2.70377","DOIUrl":"10.1002/deo2.70377","url":null,"abstract":"<p>Esophagitis with marked eosinophilic infiltration, including eosinophilic esophagitis (EoE), can rarely present with ulceration or stricture. We report a rare case of positron emission tomography–positive esophagitis with marked eosinophilic infiltration accompanied by ulceration and stricture, requiring differentiation from esophagogastric junction carcinoma. A 50-year-old man with no history of allergies underwent computed tomography, which revealed para-esophageal lymphadenopathy and circumferential thickening of the distal esophagus. Endoscopy showed an ulcerated stricture with an iodine-unstained area. Positron emission tomography demonstrated fluorodeoxyglucose uptake at the lesion site. Multiple endoscopic biopsies (11 specimens) were negative for malignancy but revealed 70 eosinophils per high-power field, fulfilling the diagnostic criteria for EoE. Hiatal hernia was also observed, suggesting the possibility of concomitant reflux esophagitis. Significant dysphagia persisted due to the severe stricture. Therefore, endoscopic bougie dilation was carefully performed under general anesthesia. After 8 weeks of proton pump inhibitor therapy, mucosal healing was confirmed, and topical steroids were initiated for persistent eosinophilic infiltration. This case highlights that esophagitis with marked eosinophilic infiltration accompanied by ulceration and stricture may require differentiation from cancer.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric Metastasis of Uterine Leiomyosarcoma Detected During Surveillance Endoscopy and Resected by Endoscopic Submucosal Dissection After Multiple Metachronous Metastases: A Case Report","authors":"Yuiko Nagasawa,&nbsp;Takahiro Hiratsuka,&nbsp;Daisuke Minezaki,&nbsp;Wataru Miyoshino,&nbsp;Ryo Ogawa,&nbsp;Tomonori Akagi,&nbsp;Hidefumi Shiroshita,&nbsp;Yoshitake Ueda,&nbsp;Kazuhiro Mizukami,&nbsp;Masafumi Inomata","doi":"10.1002/deo2.70370","DOIUrl":"10.1002/deo2.70370","url":null,"abstract":"<p>Uterine leiomyosarcoma (uLMS) is a rare, aggressive uterine malignancy that usually metastasizes hematogenously, whereas gastrointestinal involvement is uncommon. A 69-year-old woman with uLMS treated by hysterectomy and adjuvant chemotherapy developed metachronous lung, sigmoid colon, gallbladder, and abdominal wall metastases. After treatment of these metastases, periodical surveillance endoscopy revealed a 15-mm subepithelial lesion with a shallow central depression in the lower gastric body. Endoscopic ultrasonography showed a well-defined submucosal lesion without muscularis propria invasion, and biopsy confirmed metastatic leiomyosarcoma. Endoscopic submucosal dissection (ESD) was performed, achieving en bloc resection without adverse events. This rare metachronous combination of gastric, colonic, and gallbladder metastases highlights that incidental gastric metastasis may occur during prolonged disease courses and suggests that ESD may be a useful minimally invasive option for local control of small gastric metastases.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"7 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}