Clinical Endoscopy

Role of functional endoscopy: Ippei Tanaka, Haruhiro Inoue; Received March 14, 2026 Accepted May 19, 2026 Published online July 30, 2026; DOI: https://doi.org/10.5946/ce.2026.111 [Epub ahead of print]

Abstract PDF: Endoscopy has evolved to include the assessment of gastrointestinal function, an approach known as functional endoscopy. In this review, we summarize the current evidence on the endoscopic pressure-integrated system (EPSIS) as a representative modality in this field. Initial studies demonstrated the diagnostic utility of the EPSIS for gastroesophageal reflux disease by revealing significant associations between EPSIS parameters and 24-hour pH monitoring, as well as endoscopic findings such as erosive esophagitis and Barrett’s esophagus. The usefulness of the EPSIS was also demonstrated in diagnosing achalasia and in the evaluation of treatment efficacy following antireflux mucosal interventions and peroral endoscopic myotomy. Dynamic changes in the gastric cardia during EPSIS were observed as the intragastric pressure increased. These changes were categorized into three sequential phases, referred to as the phase concept. In healthy individuals, all three phases function appropriately, whereas in patients with acid reflux, dysfunction is observed in one or more phases. Despite these promising findings, several aspects of the EPSIS remain to be clarified, and most previous studies have been conducted at a single center. Future multicenter prospective studies are warranted to accumulate robust evidence and further establish the clinical utility of the EPSIS.

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Factors influencing lateral margin diagnosis challenges in Barrett’s esophageal cancer: a bicenter retrospective study in Japan: Ippei Tanaka, Shuhei Unno, Kazuki Yamamoto, Yoshitaka Nawata, Kimihiro Igarashi, Tomoki Matsuda, Dai Hirasawa; Clin Endosc 2025;58(1):85-93. Published online November 11, 2024; DOI: https://doi.org/10.5946/ce.2024.068

Background
/Aims: We aimed to clarify the clinicopathological characteristics and causes of Barrett’s esophageal adenocarcinoma (BEA) with unclear demarcation.
Methods
We reviewed BEA cases between January 2010 and August 2022. The lesions were classified into the following two groups: clear demarcation (CD group) and unclear demarcation (UD group). We compared the clinicopathological findings between the two groups. Furthermore, we measured the length and width of the foveolar structures, as well as the width of marginal crypt epithelium (MCE).
Results
We analyzed data from 68 patients with BEA, including 47 and 21 in the CD and UD groups, respectively. Multivariate analysis revealed long-segment Barrett’s esophagus (LSBE) as the sole significant risk factor for BEA (odds ratio, 12.17; 95% confidence interval, 2.84–47.6; p=0.001). Regarding pathological analysis, significant differences were observed in the length and width of the foveolar structure between cancerous and surrounding mucosa in the CD group (p=0.03 and p=0.00, respectively); however, no significant difference was observed in the UD group (p=0.53 and p=0.72, respectively). Nevertheless, the width of MCE in the cancerous area was significantly shorter than that in the surrounding mucosa in both groups (p<0.05, and p<0.05, respectively).
Conclusions
LSBE is a significant risk factor for BEA in the UD group. The width of MCE may be an important factor in the endoscopic diagnosis of BEA.

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Predictive Factors for Technical Difficulty During Endoscopic Submucosal Dissection of Superficial Barrett's Esophageal Adenocarcinoma
Koyo Kido, Yusuke Horiuchi, Manabu Takamatsu, Hiroyuki Yamamoto, Chika Fukuyama, Akiyoshi Ishiyama, Toshiaki Hirasawa, Hayato Nakagawa, Toshiyuki Yoshio
Journal of Gastroenterology and Hepatology.2026; 41(3): 1009. CrossRef

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Usefulness of the S-O clip for duodenal endoscopic submucosal dissection: a propensity score-matched study: Ippei Tanaka, Dai Hirasawa, Hiroaki Saito, Junichi Akahira, Tomoki Matsuda; Clin Endosc 2023;56(6):769-777. Published online May 24, 2023; DOI: https://doi.org/10.5946/ce.2022.195

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal tumors (SNADETs) is associated with a high rate of en bloc resection. However, the technique for ESD remains challenging. Recent studies have demonstrated the effectiveness of S-O clips in colonic and gastric ESD. We evaluated the efficacy and safety of duodenal ESD using an S-O clip for SNADETs.
Methods
Consecutive patients who underwent ESD for SNADETs between January 2011 and December 2021 were retrospectively enrolled. Propensity score matching analysis was used to compare patients who underwent duodenal ESD with the S-O clip (S-O group) and those who underwent conventional ESD (control group). Intraoperative perforation rate was the primary outcome, while procedure time and R0 resection rate were the secondary outcomes.
Results
After propensity score matching, 16 pairs were created: 43 and 17 in the S-O and control groups, respectively. The intraoperative perforation rate in the S-O group was significantly lower than that in the control group (p=0.033). A significant difference was observed in the procedure time between the S-O and control groups (39±9 vs. 82±30 minutes, respectively; p=0.003).
Conclusions
The S-O clip reduced the intraoperative perforation rate and procedure time, which may be useful and effective in duodenal ESD.

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Safety and Feasibility of Laparoscopic and Endoscopic Cooperative Surgery With Endoscopic Submucosal Dissection for Large Superficial Non‐Ampullary Duodenal Epithelial Tumors
Masaru Hayami, Shoichi Yoshimizu, Naoki Miyazaki, Shintaro Yamamoto, Hiroyuki Yamamoto, Motonari Ri, Rie Makuuchi, Tomoyuki Irino, Manabu Takamatsu, Souya Nunobe
Annals of Gastroenterological Surgery.2026; 10(2): 460. CrossRef
Mitigating risk following upper gastrointestinal Endoscopic Submucosal Dissection: preventing bleeding, perforation and stricture formation
Giulio Calabrese, Rossella Maresca, Livio Bonacci, Tommaso Rozera, Giuseppe Spinosa, Federico Barbaro, Sandro Sferrazza
Best Practice & Research Clinical Gastroenterology.2026; : 102126. CrossRef
A Rare Subepithelial Lesion of the Proximal Colon Evaluated Using Miniprobe Endoscopic Ultrasonography: A Case Report
Hidetaka Hamamoto, Tomoki Matsuda, Mareyuki Endo
Cureus.2025;[Epub] CrossRef
A serendipitous application of an elastic traction device in endoscopic submucosal dissection
Ji Hyun Kim, Seung-Joo Nam, Sung Chul Park
Journal of Innovative Medical Technology.2025; 3(1): 25. CrossRef
Exploring different techniques for endoscopic submucosal dissection of gastrointestinal lesions: a review of the literature
Giulio Calabrese, Marcello Maida, Darshan Parekh, Yohei Minato, Alessandro Vitello, Alberto Murino, Rui Morais, Emanuele Sinagra, Daryl Ramai, Ken Ohata, Sandro Sferrazza
Expert Review of Anticancer Therapy.2025; 25(7): 755. CrossRef
Outcomes and safety of duodenal endoscopic submucosal dissection for nonampullary lesions: systematic review and meta-analysis
Alessandro Rimondi, Elisabetta Dell’Unto, Rui Morais, Gianluca Esposito, João Santos-Antunes, Gian Eugenio Tontini, Rehan Haidry, Jérémie Jacques, Edward John Despott, Alberto Murino
Gastrointestinal Endoscopy.2025; 102(4): 514. CrossRef
Optimizing Endoscopic Submucosal Dissection: A Meta-Analysis of the S–O Clip’s Impact on Procedural Outcomes and Lesion-Specific Applications
Fariha Hasan, Aizaz Ali, Umm E Salma Shabbar Banatwala, Bushra Zaman, Hassam Ali, Rahul Karna, Muhammad Ali Butt, Dushyant Singh Dahiya, Manesh Kumar Gangwani, Saurabh Chandan, Umar Hayat, Hareesha Rishab Bharadwaj, Hafiz Muzaffar Akbar Khan
Digestive Diseases and Sciences.2025; 70(11): 3901. CrossRef
Current Management of Duodenal Neoplasia: Endoscopic Treatment for Large Superficial Non-Ampullary Duodenal Epithelial Tumor
Kurato Miyazaki, Naohisa Yahagi, Motohiko Kato
Digestion.2025; 107(3): 282. CrossRef
A method of “Noninjecting Resection using Bipolar Soft coagulation mode; NIRBS” for superficial non-ampullary duodenal epithelial tumor: a pilot study
Mitsuo Tokuhara, Yasushi Sano, Yoshifumi Watanabe, Hidetoshi Nakata, Hiroko Nakahira, Shingo Furukawa, Takuya Ohtsu, Naohiro Nakamura, Takashi Ito, Ikuko Torii, Takeshi Yamashina, Masaaki Shimatani, Makoto Naganuma
BMC Gastroenterology.2024;[Epub] CrossRef
Traction methods for endoscopic submucosal dissection
Ji Hyun Kim, Sung Chul Park
Journal of Innovative Medical Technology.2024; 2(2): 47. CrossRef

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