Clinical Endoscopy

Efficacy of additional tissue sections for diminutive colorectal adenomas pathologically diagnosed as normal mucosa: a retrospective, cross-sectional study in Japan: Tsuyoshi Ishii, Toshihiro Nishizawa, Hidenobu Watanabe, Masaya Sano, Ai Fujimoto, Yoshiyuki Takahashi, Ryo Shimizu, Hirotoshi Ebinuma, Takahisa Matsuda, Osamu Toyoshima; Received September 28, 2024 Accepted January 10, 2025 Published online July 7, 2025; DOI: https://doi.org/10.5946/ce.2024.265 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Endoscopists occasionally encounter discrepancies between endoscopic and pathological diagnoses after colorectal polypectomies. This study aimed to evaluate the efficacy of additional sections for diagnostic discrepancies.
Methods
We examined polyps endoscopically diagnosed as adenomas or suspected adenomas that were resected and pathologically diagnosed as adenomas or normal mucosa. Adenomas pathologically diagnosed with initial sections were categorized as the “adenoma by initial section” group. Based on the re-diagnosis with additional sectioning, they were assigned to the “adenoma by additional section” or “normal mucosa by both sections” groups.
Results
In the initial pathological diagnosis of 993 lesions, 850 were diagnosed as adenomas and 143 as normal mucosa. Additional sections corrected the pathological diagnoses in 23.8% (34/143) of cases. The rate of high confidence was significantly higher in the “adenoma by additional section” group than in the “normal mucosa by both sections” group (64.7% vs. 38.5%, p<0.01). Lesions in the “adenoma by additional section” group were significantly smaller than those in the “adenoma by initial section” group (2.7 vs. 3.8 mm, p<0.05).
Conclusions
Diminutive adenomas can cause discrepancies between endoscopic and pathological diagnoses. Additional sections may help revise the pathological diagnoses, particularly for lesions with high confidence.

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Effectiveness of a novel ex vivo training model for gastric endoscopic submucosal dissection training: a prospective observational study conducted at a single center in Japan: Takahito Toba, Tsuyoshi Ishii, Nobuyuki Sato, Akira Nogami, Aya Hojo, Ryo Shimizu, Ai Fujimoto, Takahisa Matsuda; Clin Endosc 2025;58(1):94-101. Published online November 4, 2024; DOI: https://doi.org/10.5946/ce.2024.108

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Background
/Aims: The efficacy of endoscopic submucosal dissection (ESD) for early-stage gastric cancer is well established. However, its acquisition is challenging owing to its complexity. In Japan, G-Master is a novel ex vivo gastric ESD training model. The effectiveness of training using G-Master is unknown. This study evaluated the efficacy of gastric ESD training using the G-Master to evaluate trainees’ learning curves and performance.
Methods
Four trainees completed 30 ESD training sessions using the G-Master, and procedure time, resection area, resection completion, en-bloc resection requirement, and perforation occurrence were measured. Resection speed was the primary endpoint, and learning curves were evaluated using the Cumulative Sum (CUSUM) method.
Results
All trainees completed the resection and en-bloc resection of the lesion without any intraoperative perforations. The learning curves covered three phases: initial growth, plateau, and late growth. The transition from phase 1 to phase 2 required a median of 10 sessions. Each trainee completed 30 training sessions in approximately 4 months.
Conclusions
Gastric ESD training using the G-Master is a simple, fast, and effective method for pre-ESD training in clinical practice. It is recommended that at least 10 training sessions be conducted.

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Revista Española de Enfermedades Digestivas.2025;[Epub] CrossRef

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The "Two-Sword Fencing" Technique in Endoscopic Submucosal Dissection: Toshihiro Nishizawa, Toshio Uraoka, Yasutoshi Ochiai, Hidekazu Suzuki, Osamu Goto, Ai Fujimoto, Tadateru Maehata, Takanori Kanai, Naohisa Yahagi; Clin Endosc 2015;48(1):85-86. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.85

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