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The recent advances in endoscopic imaging technologies make great changes in the management of colorectal polyps. These changes include optical histologic diagnosis with high definition colonscopy, new management strategies such as resect and discard or do not resect, and differentiation of depth of submucosal invasion. In this focused review series, these new paradigms in management of colorectal polyps are discussed by three, world famous authors. First, Amit Rastogi explained optical diagnosis of small colorectal polyp with high definition colonoscopy using narrow band imaging. Second, Cesare Hassan explained new paradigms for colonoscopic management of diminutive colorectal polyps: resect and discard or do not resect. In the last, Shinji Tanaka described, in detail, endoscopic assessment of invasive colorectal cancer: slight vs. deep submucosal invasion. These focused review series introduce the new roles of current colonoscopy to readers and will help the readers to know how to use the new imaging technologies and paradigms in clinical practices.

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Optical diagnosis of polyp histology can potentially result in enormous cost savings by way of the "resect and discard" strategy for diminutive polyps and the "do not resect" strategy for diminutive hyperplastic polyps in the distal colon. Narrow Band Imaging (NBI) highlights the surface mucosal and vascular pattern on polyps and has been shown to accurately characterize adenomatous and hyperplastic polyps by experts. However, the results have been a little discouraging amongst lesser experienced endoscopists. Studies have also shown that using the NBI diagnosis of diminutive polyp histology, experts can accurately define the future surveillance colonoscopy intervals. However nonexperts in academic or community setting have as yet failed to achieve the recommended thresholds. The subjectivity in assessment by endoscopists leads to the variable accuracy rates and can be circumvented by computer based automated tools. Although initial experience with a few computer based algorithms have shown accuracies comparable to experts, further refinement and validation will be required before these can be implemented in clinical practice. Incorporation of optical diagnosis of diminutive polyps into clinical practice is bound to face several hurdles. But the potential for enormous cost saving makes it an attractive strategy that can make colonoscopy more cost effective.

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The possibility to predict in vivo the histology of colorectal polyps by advanced endoscopic imaging has resulted in the implementation of a more conservative management for diminutive lesions detected at colonoscopy. In detail, a predict-and-do-not-resect strategy has been proposed for diminutive lesions located in the rectosigmoid tract, whilst a predict-resect-and-discard policy has been advocated for nonrectosigmoid diminutive polyps. Recently, the American Society for Gastrointestinal Endoscopy set required thresholds to be met, before allowing the adoption of these policies in the clinical field. The ability of current endoscopic imaging in reaching these thresholds would depend on a complex interaction among the accuracy of advanced endoscopic imaging in differentiating between adenomatous and hyperplastic lesions, the prevalence of (advanced) neoplasia within diminutive lesions, and the type of surveillance intervals recommended. Aim of this review is to summarize the data supporting the application of both a predict-and-do-not-resect and a predict-resect-and-discard policies, also addressing the potential pitfalls associated with these strategies.

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Among early colorectal carcinoma, endoscopic treatment is generally indicative for cases with intramucosal to submucosal (SM) superficial invasion, because cases with SM deep invasion should be treated surgically due to the risk of lymph node metastasis. It is important, therefore, to distinguish between superficial and deep SM invasion in early colorectal carcinoma prior to treatment. In this review we assessed the clinical usefulness and knack of pit pattern and narrow band imaging (NBI) diagnosis using magnifying observation. V_N type pit pattern, type C3 in NBI Hiroshima classification and NBI type 3 in NBI international colorectal endoscopic (NICE) classification are useful predictors of SM deep invasion. In NBI magnifying observation evaluation of both the vascular pattern and surface pattern are important. We have to use pit pattern diagnosis and NBI magnifying diagnosis as the situation demands with the knowledge of both advantage and disadvantage in each diagnostic method.

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The preparation for video capsule endoscopy (VCE) of the bowel suggested by manufacturers of capsule endoscopy systems consists only of a clear liquid diet and an 8-hour fast. While there is evidence for a benefit from bowel preparation for VCE, so far there is no domestic consensus on the preparation regimen in Korea. Therefore, we performed this study to recommend guidelines for bowel preparation before VCE. The guidelines on VCE were developed by the Korean Gut Image Study Group, part of the Korean Society of Gastrointestinal Endoscopy. Four key questions were selected. According to our guidelines, bowel preparation with polyethylene glycol (PEG) solution enhances small bowel visualization quality (SBVQ) and diagnostic yield (DY), but it has no effect on cecal completion rate (CR). Bowel preparation with 2 L of PEG solution is similar to that with 4 L of PEG in terms of the SBVQ, DY, and CR of VCE. Bowel preparation with fasting or PEG solution combined with simethicone enhances the SBVQ, but it does not affect the CR of VCE. Bowel preparation with prokinetics does not enhance the SBVQ, DY, or CR of VCE.

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• Endoscopic Ultrasound Elastography for Pancreatic Cancer Diagnosis: A Step Forward?
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Enteritis cystica profunda is a very rare disease in which a mucin-filled cystic space is surrounded partially with nonneoplastic columnar epithelium in the submucosa of the small intestine. Most of the cases are accompanied by intestinal diseases, and the disease usually occurs in the jejunum and the ileum and there has been no report of a case that occurred in the ampulla of Vater. A 58-year-old healthy female patient without any particular symptom visited the hospital to get additional examination for a mass found on the ampulla of Vater by accident. In esophagogastroduodenoscopy, a cystic mass showing a positive pillow sign was found on the ampulla of Vater. Endoscopic retrogradecholangiopancreatography was conducted as choledochocele was suspected, but no abnormality was found in the biliary system. In endoscopic ultrasonography, multiseptated cystic structures were detected in the submucosal layer of the duodenum. The lesion was resected completely through endoscopic snare polypectomy and the case was histologically diagnosed as enteritis cystica profunda.

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• Enteritis cystica profunda: Case report and literature review
  Ricardo E. Núñez-Rocha, Felipe Girón, Mario Latiff, Carlos Eduardo Rey, Lina Rodríguez, Juan David Hernández
  International Journal of Surgery Case Reports.2023; 106: 108148.     CrossRef
• Enteritis cystica profunda with lipoma in the second portion of the duodenum: a case report
  Beom Jin Shim, Seung Keun Park, Hee Ug Park, Tae Young Park
  Journal of Yeungnam Medical Science.2022; 39(1): 72.     CrossRef
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  International Journal of Surgery Case Reports.2016; 28: 42.     CrossRef
• A Case of Enteritis Cystica Profunda Accompanied by a Lipoma in the Duodenal Bulb
  Dae Sung Lee, Hae Ryong Jeong, Jin Ok Kim, Hye Jin Tae, Ho Soon Choi, Hye In Ahn, Seung Sam Paik
  Korean Journal of Medicine.2014; 86(3): 314.     CrossRef

Early esophageal cancer is defined as a tumor invading the mucosa with or without lymph node or distant organ metastasis. In the current guidelines for early esophageal cancer, absolute indication for endoscopic resection include lesions limited to the epithelium or lamina propria mucosa not exceeding two-thirds of the circumference, and relative indications include lesions limited to the muscularis mucosa or the upper third of the submucosal layer and not accompanied by clinical evidence of lymph node metastasis. After endoscopic submucosal dissection for early esophageal cancer, locally recurrent cancer can occur, especially in the case of incomplete resection. Here, we report a rare case of a submucosal tumor-like recurrence after endoscopic resection of early esophageal cancer.

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• Long-Term Outcome after Endoscopic Submucosal Dissection in Patients with Superficial Esophageal Squamous Cell Carcinoma: A Single-Center Study
  Dong Chan Joo, Gwang Ha Kim, Do Youn Park, Joon Hyung Jhi, Geun Am Song
  Gut and Liver.2014; 8(6): 612.     CrossRef

A fibrovascular polyp is a rare benign disease of the upper digestive tract and is usually located in the esophagus. To our knowledge, this is the first case of gastric fibrovascular polyp presenting with melena reported in the English literature. The polyp was well visualized on endoscopy and removed with laparoscopic wedge resection. Histology confirmed fibrovascular polyp of the stomach.

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• Results of laparoscopic intragastric surgery
  S. Bonnet, V. Basso, A. De Carbonnières, J.-M. Ferraz, A. Blain, B. Gayet, D. Fuks
  Journal of Visceral Surgery.2021; 158(6): 469.     CrossRef
• Résultats de la résection intra-gastrique laparoscopique
  S. Bonnet, V. Basso, A. de Carbonnières, J.-M. Ferraz, A. Blain, B. Gayet, D. Fuks
  Journal de Chirurgie Viscérale.2021; 158(6): 513.     CrossRef
• Giant fibroepithelial polyp of the thigh and retroperitoneal fibromatosis in a young woman: a rare case
  Ruchi Gupta, Shuchi Smita, Ruchi Sinha, Neetu Sinha, Lakshmi Sinha
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• A Case of Fibrovascular Polyp of the Stomach: Sonographic and Computed Tomographic Findings
  Yun Kyung Shin, Hyun Cheol Kim, Dal Mo Yang, Sang Won Kim, Sun Jung Rhee, Jong Soo Shin, Kyu Yeoun Won
  Iranian Journal of Radiology.2016;[Epub]     CrossRef
• Giant fibrovascular polyp in the hypopharynx: a case report and review of the literature
  Mineko Oka, Rumi Ueha, Takaharu Nito, Tatsuya Yamasoba
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Hypopharyngeal cancers are often diagnosed at an advanced stage and have a poor prognosis. Even when they are diagnosed at an operable stage, surgery often results in substantial morbidity and decreased patients' quality of life. Although the endoscopic diagnosis of early hypopharyngeal cancer is difficult, recent developments in advanced imaging endoscopy have enabled easier diagnosis of these lesions. Endoscopic resection of early hypopharyngeal cancer is a potential minimally invasive treatment that can preserve the function and quality of life of patients. Reports of this procedure are limited, however. We report a case of hypopharygeal cancer treated with endoscopic resection.

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• Identify metabolism-related genes IDO1, ALDH2, NCOA2, SLC7A5, SLC3A2, LDHB, and HPRT1 as potential prognostic markers and correlate with immune infiltrates in head and neck squamous cell carcinoma
  Ce Li, Shuai Chen, Wenming Jia, Wenming Li, Dongmin Wei, Shengda Cao, Ye Qian, Rui Guan, Heng Liu, Dapeng Lei
  Frontiers in Immunology.2022;[Epub]     CrossRef
• Endoscopic resection for superficial hypopharyngeal/laryngeal cancer and clinical pathway options
  Wei‐Chen Huang, Li‐Hsiang Cheng, Tien‐Yu Huang, Yu‐Lueng Shih, Wei‐Kuo Chang, Tsai‐Yuan Hsieh, Peng‐Jen Chen
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  JUKE MA, LIANG YU, JIAJUN TIAN, YAKUI MU, ZHENGHUA LV, JIDONG ZOU, JIANFENG LI, HAIBO WANG, WEI XU
  Molecular Medicine Reports.2014; 9(6): 2587.     CrossRef

Xanthogranulomatous inflammation (XGI) is a rare benign inflammatory disease characterized by aggregation of lipid-laden foamy macrophages. This disease entity has been described in various organs but most commonly in the kidney and gallbladder. The occurrence of this disease in the lower gastrointestinal tract is extremely rare. Its clinical importance is that it can be misdiagnosed as an infiltrative cancer. In this case report, a 52-year-old male complained of right lower quadrant abdominal pain for a period of 3 months. Abdominal computed tomography revealed appendiceal mass and colonoscopy revealed multiple erythematous nodular lesions in the terminal ileum and appendiceal orifice, mimicking appendiceal cancer. Right hemicolectomy was done and the pathological specimen revealed XGI of the terminal ileum. To our knowledge, this is the first case of XGI in terminal ileum presenting as abdominal pain and the appendiceal mass on radiologic findings.

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• Imaging and Clinical Findings of Xanthogranulomatous Inflammatory Disease of Various Abdominal and Pelvic Organs: A Pictorial Essay
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  Journal of the Korean Society of Radiology.2024; 85(1): 109.     CrossRef
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  Kyra Ji-Young Lee, Jue Li Seah, Sandra O’Toole, Sanjay Warrier
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• Xanthogranulomatous inflammation requiring small bowel anastomosis revision: A case report
  William Wang, Maria Korah, Kovi E Bessoff, Jeanne Shen, Joseph D Forrester
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• Xanthogranulomatous Oophoritis in the Setting of Post-IVF Twin Pregnancy with History of Endometriosis: A Rare Case Report with Review of Literature
  Chinmay Shrikrishna Pendharkar, Sunita B.S, Ganesh Pendkur, Dheeraj J. Nandagawe
  Indian Journal of Medical and Paediatric Oncology.2022; 43(03): 314.     CrossRef
• Xanthogranulomatous appendicitis diagnosed on routine PET scan: a case report
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• A Case of Xanthogranulomatous Inflammation of Terminal Ileum Presenting as a Mass in a Woman with Severe Obesity
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  Case Reports in Pathology.2015; 2015: 1.     CrossRef
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• Xanthogranulomatous capsulitis mimicking a polypoid neoplasm disease: an unusual presentation of ruptured Poly Implant Prothèse (PIP) breast implant
  Fernando Hernanz, Sara Baeza, Eduardo Serna, Manuel Gómez-Fleitas
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Solitary pancreatic metastasis of esophageal cancer is extremely rare. We report the case of a 58-year-old male admitted with esophageal cancer. Additional asymptomatic solitary hepatic and pancreatic masses were observed in the staging work-up for esophageal cancer. The hepatic mass was confirmed as a primary hepatocellular carcinoma with an ultrasound-guided needle biopsy. An esophagectomy with a distal pancreatectomy and radiofrequency ablation for hepatocellular carcinoma were performed. Histologically, the pancreatic mass was confirmed to be a metastasis from the esophageal cancer. The patient has been followed up with chemotherapy.

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• A case of esophageal squamous cell carcinoma accompanied by pancreatic and bile duct metastases: Successful treatment starts with an accurate diagnosis
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  Molecular and Clinical Oncology.2023;[Epub]     CrossRef
• Malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer
  Takeshi Okamoto
  World Journal of Gastroenterology.2022; 28(10): 985.     CrossRef
• An extremely atypical presentation of esophageal squamous cell carcinoma with pancreatic and hepatic metastases
  Lei Zhang, Xin Long, Zheng-Nan Hu, Yu Wu, Jia Song, Bi-Xiang Zhang, Wei-Xun Chen
  Medicine.2021; 100(20): e25785.     CrossRef
• Primary squamous cell carcinoma of head of the pancreas
  Supratim Bhattacharyya, Padmalaya Devi, Subrat Samantara, KP Kunhi Mohammed
  Oncology Journal of India.2020; 4(3): 145.     CrossRef
• Successful resection of pancreatic metastasis from oesophageal squamous cell carcinoma: a case report and review of the literature
  Wataru Koizumi, Minoru Kitago, Masahiro Shinoda, Hiroshi Yagi, Yuta Abe, Go Oshima, Shutaro Hori, Kenta Inomata, Hirofumi Kawakubo, Miho Kawaida, Yuko Kitagawa
  BMC Cancer.2019;[Epub]     CrossRef
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  Current Pharmaceutical Design.2019; 25(13): 1477.     CrossRef
• An Entirely Atypical Presentation of Esophageal Squamous Cell Cancer with Pancreatic and Bone Metastases
  Eric Yoon, Yousef Nassar, Juan Tejada-Almonte, Muhammad Sohail Mansoor, Kavita Umrau, Sven Hida
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  Case Reports in Gastroenterology.2017; 11(1): 219.     CrossRef
• Esophageal Cancer Metastases to Unexpected Sites: A Systematic Review
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