Clinical Endoscopy

Non-variceal upper gastrointestinal bleeding: advances and future directions in management: Waku Hatta, Yohei Ogata, Takashi Chiba, Naotaro Tanno, Makoto Kawabe, Kimiko Kayada, Yutaka Hatayama, Masahiro Saito, Akira Imatani, Tomoyuki Koike, Atsushi Masamune; Clin Endosc 2026;59(4):510-522. Published online December 17, 2025; DOI: https://doi.org/10.5946/ce.2025.202

Numerous clinical guidelines have been developed for the management of non-variceal upper gastrointestinal bleeding (NVUGIB), yet significant variations exist among the recommendations. This review summarizes the most recent evidence on NVUGIB management, structured across four key stages: pre-endoscopic management, endoscopic treatment, post-endoscopic care, and the identification and management of refractory bleeding. In the pre-endoscopic phase, several risk-scoring systems have been developed to predict mortality. A restrictive transfusion strategy, with a threshold of 7 to 8 g/dL, is now recommended for most patients. Pre-endoscopic administration of intravenous erythromycin also improves visualization during endoscopy. A wide array of endoscopic hemostasis techniques is available, with the choice of method depending on the underlying cause of bleeding. When endoscopic hemostasis fails, transcatheter arterial embolization (TAE) is generally preferred over surgery as the second-line intervention. Once hemostasis is achieved, high-dose acid suppression is essential, and the risk of rebleeding should be assessed. For patients who experience rebleeding, repeat endoscopic therapy is recommended as the first-line approach. However, determining the optimal timing for TAE remains a challenge. Because of the heterogeneity of clinical presentations, NVUGIB management should be personalized. Further research is needed to establish evidence-based, individualized treatment strategies.

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Management of upper gastrointestinal haemorrhage: an updated narrative review
Thomas Arkle, Abdelrahman Abdelaal, Leo Alexandre, Bhaskar Kumar, Nicholas Penney
Surgery (Oxford).2026;[Epub] CrossRef

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White spots around colorectal tumors are cancer-related findings and may aid endoscopic diagnosis: a prospective study in Japan: Kai Korekawa, Yusuke Shimoyama, Fumiyoshi Fujishima, Hiroshi Nagai, Takeo Naito, Rintaro Moroi, Hisashi Shiga, Yoichi Kakuta, Yoshitaka Kinouchi, Atsushi Masamune; Clin Endosc 2024;57(5):637-646. Published online June 21, 2024; DOI: https://doi.org/10.5946/ce.2024.027

Graphical Abstract Abstract PDF: Background
/Aims: During endoscopy, white spots (WS) are sometimes observed around benign or malignant colorectal tumors; however, few reports have investigated WS, and their significance remains unknown. Therefore, we investigated the significance of WS from clinical and pathological viewpoints and evaluated its usefulness in endoscopic diagnosis.
Methods
Clinical data of patients with lesions diagnosed as epithelial tumors from January 1, 2019, to December 31, 2020, were analyzed (n=3,869). We also performed a clinicopathological analysis of adenomas or carcinomas treated with endoscopic resection (n=759). Subsequently, detailed pathological observations of the WS were performed.
Results
The positivity rates for WS were 9.3% (3,869 lesions including advanced cancer and non-adenoma/carcinoma) and 25% (759 lesions limited to adenoma and early carcinoma). Analysis of 759 lesions showed that the WS-positive lesion group had a higher proportion of cancer cases and larger tumor diameters than the WS-negative group. Multiple logistic analysis revealed the following three statistically significant risk factors for carcinogenesis: positive WS, flat lesions, and tumor diameter ≥5 mm. Pathological analysis revealed that WS were macrophages that phagocytosed fat and mucus and were white primarily because of fat.
Conclusions
WS are cancer-related findings and can become a new criterion for endoscopic resection in the future.

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Non-Curative Resection: Should Clinicians Consider Providing Additional Surgery for All Patients?: Waku Hatta, Takuji Gotoda, Atsushi Masamune; Clin Endosc 2020;53(2):109-110. Published online March 6, 2020; DOI: https://doi.org/10.5946/ce.2020.043

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