Clinical Endoscopy

Original Articles

Improved visibility of palisade vessels within Barrett’s esophagus using red dichromatic imaging: a retrospective cross-sectional study in Japan: Chise Ueda, Shinwa Tanaka, Tetsuya Yoshizaki, Hirofumi Abe, Masato Kinoshita, Hiroya Sakaguchi, Hiroshi Takayama, Hitomi Hori, Ryosuke Ishida, Shinya Houki, Hiroshi Tanabe, Eri Nishikawa, Madoka Takao, Toshitatsu Takao, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama; Clin Endosc 2025;58(2):269-277. Published online November 11, 2024; DOI: https://doi.org/10.5946/ce.2024.122

Background
/Aims: Visualization of palisade vessels (PVs) in Barrett’s esophagus is crucial for proper assessment. This study aimed to determine whether red dichromatic imaging (RDI) improves PV visibility compared with white-light imaging (WLI) and narrow-band imaging (NBI).
Methods
Five expert and trainee endoscopists evaluated the PV visibility in Barrett’s esophagus using WLI, NBI, and RDI on 66 images from 22 patients. Visibility was rated on a 4-point scale: 4, excellent; 3, good; 2, fair; and 1, poor. The color difference between the most recognizable PV spots and surrounding areas with undetectable blood vessels was also analyzed.
Results
Mean visibility scores were 2.6±0.7, 2.3±0.6, and 3.4±0.4 for WLI, NBI, and RDI, respectively. The RDI scores were significantly higher than the WLI (p<0.001) and NBI (p<0.001) scores. These differences were recognized by trainees and expert endoscopists. Color differences in PVs were 7.74±4.96 (WLI), 10.43±5.09 (NBI), and 15.1±6.54 (RDI). The difference in RDI was significantly higher than that in WLI (p<0.001) and NBI (p=0.006).
Conclusions
RDI significantly improved PV visibility compared to WLI and NBI based on objective and subjective measures.

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Improvement in the Visibility of Submucosal Layers and Vessels with Amber-Red Color Imaging in Colorectal Endoscopic Submucosal Dissection
Naohisa Yoshida, Rafiz Abdul Rani, Ken Inoue, Reo Kobayashi, Naoto Iwai, Osamu Dohi, Felipe Rodrigo Donoso Guillén, Gabriel Mezzano Puentes, German Rodrigo Lobos Gonzalez, Patricio Sepulveda Valdebenito, Francisco López-Köstner, Thevaraajan Jayaraman, Ryo
Digestive Diseases and Sciences.2026; 71(7): 2939. CrossRef

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Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum: Nobuaki Ikezawa, Takashi Toyonaga, Shinwa Tanaka, Tetsuya Yoshizaki, Toshitatsu Takao, Hirofumi Abe, Hiroya Sakaguchi, Kazunori Tsuda, Satoshi Urakami, Tatsuya Nakai, Taku Harada, Kou Miura, Takahisa Yamasaki, Stuart Kostalas, Yoshinori Morita, Yuzo Kodama; Clin Endosc 2022;55(3):417-425. Published online May 12, 2022; DOI: https://doi.org/10.5946/ce.2021.245

Abstract PDF Supplementary Material

Background
/Aims: Endoscopic submucosal dissection (ESD) for diverticulum-associated colorectal lesions is generally contraindicated because of the high risk of perforation. Several studies on patients with such lesions treated with ESD have been reported recently. However, the feasibility and safety of ESD for lesions in proximity to a colonic diverticulum (D-ESD) have not been fully clarified. The aim of this study was to evaluate the feasibility and safety of D-ESD.
Methods
D-ESD was defined as ESD for lesions within approximately 3 mm of a diverticulum. Twenty-six consecutive patients who underwent D-ESD were included. Two strategic approaches were used depending on whether submucosal dissection of the diverticulum-related part was required (strategy B) or not (strategy A). Treatment outcomes and adverse events associated with each strategy were analyzed.
Results
The en bloc resection rate was 96.2%. The rates of R0 and curative resection in strategies A and B were 80.8%, 73.1%, 84.6%, and 70.6%, respectively. Two cases of intraoperative perforation and one case of delayed perforation occurred. The delayed perforation case required emergency surgery, but the other cases were managed conservatively.
Conclusions
D-ESD may be a feasible treatment option. However, it should be performed in a high-volume center by expert hands because it requires highly skilled endoscopic techniques.

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Case Report: Successful endoscopic resection of a huge rectal tumor extending to the dentate line and associated with a diverticulum by endoscopic submucosal dissection
Bing-Jie Yan, Yu-Fan Li, Ze Qi, Ming-Wei Zhang, Lei Li
Frontiers in Medicine.2026;[Epub] CrossRef
Endoscopic submucosal dissection for a colorectal tumor with coexisting muscle-retracting sign and underlying diverticulum: the first reported case
Taiji Yoshimoto, Daisuke Matsuyama, Ayaka Nakanishi, Kei Nakatani, Kosuke Nagakura, Hiroo Ishii, Hiroshi Takihara
Oxford Medical Case Reports.2026;[Epub] CrossRef
Novel technique “short myotomy” during endoscopic submucosal dissection for a diverticulum‐associated colonic lesion
Ryosuke Kobayashi, Kingo Hirasawa, Shin Maeda
Digestive Endoscopy.2025; 37(2): 211. CrossRef
Predictive Factors for Procedure Time for Closure of Mucosal Defect Following Colorectal Endoscopic Submucosal Dissection
Hideaki Kazumori, Rurika Masatsugu, Kousuke Fukuda, Koji Onishi, Yasuhiko Ohno
JGH Open.2025;[Epub] CrossRef
Endoscopic cap-assisted mucosal resection of intradiverticular polyp
Lorenzo Del Nero, Massimo Conio
Clinical Endoscopy.2025; 58(5): 768. CrossRef
Current roles of colonoscopy in minimally invasive colorectal surgery: Preoperative guidance, intraoperative colonoscopy, and combined endoscopic-laparoscopic surgery
Yuuri Hatsuzawa, Shingo Tsujinaka, Tomoya Miura, Yoh Kitamura, Atsushi Mitamura, Kentaro Sawada, Makoto Hikage, Toru Nakano, Chikashi Shibata
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Closure with a dual-action tissue clip for full-thickness defects following endoscopic submucosal dissection of a lesion involving a colonic diverticulum
Ryosuke Kobayashi, Kingo Hirasawa, Atsushi Sawada, Masafumi Nishio, Chiko Sato, Shin Maeda
Endoscopy.2025; 57(S 01): E1421. CrossRef
Endoscopic submucosal dissection for diverticulum using combination of countertraction and circumferential-inversion method
Hiroshi Takayama, Yoshinori Morita, Toshitatsu Takao, Douglas Motomura, Madoka Takao, Takashi Toyonaga, Yuzo Kodama
Endoscopy.2024; 56(S 01): E91. CrossRef
Traction-assisted endoscopic submucosal dissection for resection of ileocecal valve neoplasia: a French retrospective multicenter case series
Clara Yzet, Timothée Wallenhorst, Jérémie Jacques, Mariana Figueiredo Ferreira, Jérôme Rivory, Florian Rostain, Louis-Jean Masgnaux, Jean Grimaldi, Romain Legros, Pierre Lafeuille, Jérémie Albouys, Fabien Subtil, Marion Schaefer, Mathieu Pioche
Endoscopy.2024; 56(10): 790. CrossRef
The role of cap-assisted endoscopy and its future implications
Sol Kim, Bo-In Lee
Clinical Endoscopy.2024; 57(3): 293. CrossRef
Strategies to successfully complete complex ESD in the colon
David Barquero Declara, Alex Blasco Pelicano, Claudia Berbel Comas, Alfredo Mata Bilbao
Endoscopy International Open.2024; 12(07): E914. CrossRef
Successful planned piecemeal endoscopic resection using gel immersion and an over-the-scope clip for a lesion extensively extended into the colonic diverticulum
Tomoaki Tashima, Takahiro Muramatsu, Tomonori Kawasaki, Tsubasa Ishikawa, Shomei Ryozawa
VideoGIE.2023; 8(4): 167. CrossRef
Future therapeutic implications of new molecular mechanism of colorectal cancer
Sen Lu, Cheng-You Jia, Jian-She Yang
World Journal of Gastroenterology.2023; 29(16): 2359. CrossRef
Iatrogenic colorectal perforation caused by a clip
Hirotaka Oura, Yasuki Hatayama, Erika Nomura, Harutoshi Sugiyama, Daisuke Murakami, Makoto Arai, Takayoshi Nishino
Endoscopy.2023; 55(S 01): E1091. CrossRef

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Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy: Kei Matsumoto, Shinwa Tanaka, Takashi Toyonaga, Nobuaki Ikezawa, Mari Nishio, Masanao Uraoka, Tomoatsu Yoshihara, Hiroya Sakaguchi, Hirofumi Abe, Tetsuya Yoshizaki, Madoka Takao, Toshitatsu Takao, Yoshinori Morita, Hiroshi Yokozaki, Yuzo Kodama; Clin Endosc 2022;55(1):86-94. Published online August 13, 2021; DOI: https://doi.org/10.5946/ce.2021.084

Abstract PDF Supplementary Material: Background
/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Different reconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomotic site. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastric cancers at the anastomotic site.
Methods
We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at the anastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and non-Billroth II groups.
Results
The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm; p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation time was longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth II group.
Conclusions
Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with a background of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involved longer operative times and more frequent bleeding episodes than that in patients without Billroth II.

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Efficacy of the Envelope Method in Applying Polyglycolic Acid Sheets to Post-Endoscopic Submucosal Dissection Ulcers in Living Pigs: Hiroya Sakaguchi, Toshitatsu Takao, Yoshitaka Takegawa, Yuki Koga, Kazunori Yamanaka, Masataka Sagata, Shinwa Tanaka, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama; Clin Endosc 2021;54(1):64-72. Published online July 16, 2020; DOI: https://doi.org/10.5946/ce.2020.014

Abstract PDF Supplementary Material

Background
/Aims: Application of polyglycolic acid (PGA) sheets using fibrin glue in post-endoscopic submucosal dissection (ESD) ulcers to prevent bleeding has been reported to be difficult with the conventional delivery method because of gravity. This study assessed the usefulness of the envelope-based delivery system with and against gravity in living pigs.
Methods
PGA sheets were applied on post-ESD ulcers with and against gravity six times each using the conventional and envelope methods, respectively. The PGA sheet delivery time and the endoscopic and histological findings of the treated ulcer floors were compared.
Results
With gravity, the median PGA sheet application time was 1.00 (0.68–1.30) min/cm² and 0.32 (0.18–0.52) min/cm² with the conventional and envelope techniques (p=0.002), respectively, and against gravity, it was 1.20 (1.13–1.63) min/cm² and 0.50 (0.39–0.58) min/cm² (p=0.002), respectively. Against gravity, the endoscopic and histological findings revealed that the conventional group had insufficient fixation of the PGA sheets, but the envelope groups had sufficient fixation. The results with gravity were similar between the groups.
Conclusions
The envelope method makes it possible to deliver PGA sheets to the stomach quickly and cover ulcers appropriately both with and against gravity in living pigs.

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Konjac glucomannan/sodium alginate/ε-poly-l-lysine hydrogel promotes esophageal and colonic wound healing
Tianyu Zhou, Zhaoxue Liu, Lei Xu, Xinli Mao, Haifeng Jin, Yangyang Xiong, Guangwu Chen, Yong Lv, Li Cen, Chunren Wang, Yu Zhang, Kexin Ye, Qien Shen, Jiaming Zhou, Bin Lv, Jianying Dai, Chaohui Yu, Zhe Shen
International Journal of Biological Macromolecules.2025; 306: 141146. CrossRef
Endoscopic sealing hemostasis with polyglycolic acid sheet and fibrin glue as a novel endoscopic hemostatic technique: a report of three cases
Kai Korekawa, Atsushi Kunimitsu
Clinical Journal of Gastroenterology.2024; 17(4): 626. CrossRef
Advances in Valorization of Biomass-Derived Glycolic Acid Toward Polyglycolic Acid Production
Congzhi Liu, Guochun Yan, Jie Gao, Haixin Guo, Qidong Hou
Catalysts.2024; 14(12): 903. CrossRef
Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy
Kei Matsumoto, Shinwa Tanaka, Takashi Toyonaga, Nobuaki Ikezawa, Mari Nishio, Masanao Uraoka, Tomoatsu Yoshihara, Hiroya Sakaguchi, Hirofumi Abe, Tetsuya Yoshizaki, Madoka Takao, Toshitatsu Takao, Yoshinori Morita, Hiroshi Yokozaki, Yuzo Kodama
Clinical Endoscopy.2022; 55(1): 86. CrossRef
The importance of pH adjustment for preventing fibrin glue dissolution in the stomach: an in vitro study
Yoshitaka Takegawa, Toshitatsu Takao, Hiroya Sakaguchi, Tatsuya Nakai, Kazuhiro Takeo, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama
Scientific Reports.2022;[Epub] CrossRef
A Novel Self-Assembled Gel for Gastric Endoscopic Submucosal Dissection-Induced Ulcer: A Preclinical Study in a Porcine Model
Meng Li, Haifeng Jin, Changpei Shi, Bin Lyu, Xiao Ying, Yuan Shi
Frontiers in Pharmacology.2021;[Epub] CrossRef

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Reasons for Diagnostic Failure in Forty-Five Consecutive Mucosal Cutting Biopsy Examinations of Gastric Subepithelial Tumors: Yoshiko Nakano, Toshitatsu Takao, Yoshinori Morita, Shinwa Tanaka, Takashi Toyonaga, Eiji Umegaki, Yuzo Kodama; Clin Endosc 2020;53(5):575-582. Published online February 14, 2020; DOI: https://doi.org/10.5946/ce.2019.150

Abstract PDF

Background
/Aims: Mucosal cutting biopsy (MCB) is useful for the histopathological diagnosis of gastric subepithelial tumors (SETs). However, there is little information on cases in which MCB did not establish a diagnosis. In the current study, we aimed to investigate the characteristics of cases in which MCB was unsuccessful.
Methods
Cases in which MCB was used to histopathologically diagnose gastric SETs at Kobe University Hospital between August 2012 and October 2018 were retrospectively reviewed.
Results
Forty-five cases in which MCB was used to diagnose 43 gastric SETs in 43 patients were analyzed. The median tumor size was 20 mm (range, 8–50 mm). Pathological examinations resulted in definitive and suspected diagnoses and no diagnosis in 29 (gastrointestinal stromal tumor: n=17, leiomyoma: n=7, aberrant pancreas: n=3, others: n=2), 6, and 10 cases, respectively. Failure to expose the tumor according to retrospective examinations of endoscopic images was significantly associated with no diagnosis. Other possible explanations included a less elevated tumor, biopsy of the surrounding field instead of the tumor due to the mobility, and poor endoscope maneuverability due to the tumor being close to the cardia.
Conclusions
Clear exposure of gastric SETs during MCB may improve the diagnostic rate of such examinations.

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Endoscopic Diagnosis of Gastric Subepithelial Lesions < 20 mm: Current Strategies and Emerging Solutions
Yosuke Minoda, Shuzaburo Nagatomo, Haruei Ogino, Nao Fujimori, Eikichi Ihara
Digestive Endoscopy.2026;[Epub] CrossRef
Upfront unroofing of subepithelial lesions using cold snare in the upper and lower gastrointestinal tract: a retrospective study from Switzerland
Bernhard Morell, Jasmina El Hadad-Burla, Frans Olivier The, Fabian Reinisch, Christoph Gubler, Fritz Ruprecht Murray
Clinical Endoscopy.2026; 59(4): 633. CrossRef
Endoscopic ultrasound-guided bite-on-bite biopsy and endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of gastric tumors with negative malignant endoscopy biopsies: a retrospective cohort study
Liang Min, Yan Jin, Jiefei Chen, Hongyi Zhu, Chengbai Liang, Liang Lv, Yongjun Wang, Deliang Liu, Yuqian Zhou, Yi Chu, Yuyong Tan
Minimally Invasive Therapy & Allied Technologies.2025; 34(2): 96. CrossRef
Diagnostic ability and adverse events of mucosal incision‐assisted biopsy for gastric subepithelial tumors: Systematic review and meta‐analysis
Eriko Koizumi, Osamu Goto, Akihisa Matsuda, Toshiaki Otsuka, Yumiko Ishikawa, Shun Nakagome, Masahiro Niikawa, Tsugumi Habu, Keiichiro Yoshikata, Kumiko Kirita, Hiroto Noda, Kazutoshi Higuchi, Takeshi Onda, Jun Omori, Naohiko Akimoto, Hiroshi Yoshida, Kat
Digestive Endoscopy.2025; 37(3): 236. CrossRef
Technical outcomes and postprocedural courses of mucosal incision‐assisted biopsy for possible gastric gastrointestinal stromal tumors: A series of 48 cases (with video)
Eriko Koizumi, Osamu Goto, Shun Nakagome, Tsugumi Habu, Yumiko Ishikawa, Kumiko Kirita, Hiroto Noda, Kazutoshi Higuchi, Takeshi Onda, Teppei Akimoto, Jun Omori, Naohiko Akimoto, Katsuhiko Iwakiri
DEN Open.2024;[Epub] CrossRef
Utility and advantage of the unroofing technique for gastrointestinal subepithelial tumors: A multicenter retrospective cohort study
Masashi Yamamoto, Tsutomu Nishida, Ryotaro Uema, Takashi Kanesaka, Hiroyuki Ogawa, Shinji Kitamura, Hideki Iijima, Kengo Nagai, Shusaku Tsutsui, Masato Komori, Katsumi Yamamoto, Yoshiki Tsujii, Yoshito Hayashi, Tetsuo Takehara
DEN Open.2024;[Epub] CrossRef
Systematic Endoscopic Approach for Diagnosing Gastric Subepithelial Tumors
Gwang Ha Kim
Gut and Liver.2022; 16(1): 19. CrossRef
The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy
Masanari Sekine, Takeharu Asano, Hirosato Mashima
Diagnostics.2022; 12(4): 810. CrossRef
Advancements in the Diagnosis of Gastric Subepithelial Tumors
Osamu Goto, Mitsuru Kaise, Katsuhiko Iwakiri
Gut and Liver.2022; 16(3): 321. CrossRef
Mucosal Incision-Assisted Endoscopic Biopsy as an Alternative to Endoscopic Ultrasound-Guided Fine-Needle Aspiration/Biopsy for Gastric Subepithelial Tumor
Cheol Woong Choi, Joo Ha Hwang
Clinical Endoscopy.2020; 53(5): 505. CrossRef

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