Clinical Endoscopy

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 PubReader ePub: 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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Peroral Pancreatoscopy with Videoscopy and Narrow-Band Imaging in Intraductal Papillary Mucinous Neoplasms with Dilatation of the Main Pancreatic Duct: Yui Kishimoto, Naoki Okano, Ken Ito, Kensuke Takuma, Seiichi Hara, Susumu Iwasaki, Kensuke Yoshimoto, Yuto Yamada, Koji Watanabe, Yusuke Kimura, Hiroki Nakagawa, Yoshinori Igarashi; Clin Endosc 2022;55(2):270-278. Published online December 6, 2021; DOI: https://doi.org/10.5946/ce.2021.083; Correction in: Clin Endosc 2023;56(2):261

Background
/Aims: Endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMNs) is useful in determining whether the lesions are benign or malignant. This study aimed to examine the usefulness of peroral pancreatoscopy (POPS) in determining the prognosis of IPMNs.
Methods
POPS with videoscopy was performed using the mother–baby scope technique. After surgery, computed tomography/magnetic resonance cholangiopancreatography or ultrasonography and blood tests were performed every 6 months during the follow-up.
Results
A total of 39 patients with main pancreatic duct (MPD)–type IPMNs underwent POPS using a videoscope, and the protrusions in the MPD were observed in 36 patients. The sensitivity and specificity of cytology/biopsy performed at the time of POPS were 85% and 87.5%, respectively. Of 19 patients who underwent surgery, 18 (95%) patients had negative surgical margins and 1 (5%) patient had a positive margin.
Conclusions
In IPMNs with dilatation of the MPD, POPS is considered effective if the lesions can be directly observed. The diagnosis of benign and malignant lesions is possible depending on the degree of lesion elevation. However, in some cases, slightly elevated lesions may increase in size during the follow-up or multiple lesions may be simultaneously present; therefore, careful follow-up is necessary.

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Identification of the course of plastic stent‐induced pancreatic duct mucosal change in chronic pancreatitis using peroral pancreatoscopy (with video)
Kensuke Takuma, Naoki Okano, Yusuke Kimura, Koji Watanabe, Hiroki Nakagawa, Kensuke Hoshi, Masashi Miura, Naobumi Tochigi, Yoshinori Igarashi, Takahisa Matsuda
DEN Open.2025;[Epub] CrossRef
Pancreatoscopy-Guided Endotherapies for Pancreatic Diseases
Yuri Hanada, Raj J. Shah
Gastrointestinal Endoscopy Clinics of North America.2024; 34(3): 417. CrossRef
Peroral pancreatoscopy with videoscopy and narrow-band imaging in intraductal papillary mucinous neoplasms with dilatation of the main pancreatic duct
Yui Kishimoto, Naoki Okano, Ken Ito, Kensuke Takuma, Seiichi Hara, Susumu Iwasaki, Kensuke Yoshimoto, Yuto Yamada, Koji Watanabe, Yusuke Kimura, Hiroki Nakagawa, Yoshinori Igarashi
Clinical Endoscopy.2023; 56(2): 261. CrossRef
Predicting Malignancy by Peroral Pancreatoscopy of an Intraductal Papillary Mucinous Neoplasm with a Dilated Main Pancreatic Duct: Is Seeing Enough?
Yun Nah Lee, Jong Ho Moon
Clinical Endoscopy.2022; 55(2): 213. CrossRef

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Accuracy of Endoscopic Diagnosis for Mild Atrophic Gastritis Infected with Helicobacter pylori: Takuma Okamura, Yugo Iwaya, Kei Kitahara, Tomoaki Suga, Eiji Tanaka; Clin Endosc 2018;51(4):362-367. Published online April 26, 2018; DOI: https://doi.org/10.5946/ce.2017.177

Abstract PDF PubReader ePub

Background
/Aims: This study examined the accuracy of endoscopic evaluation for determining the Helicobacter pylori infection status in patients with mild atrophy who might not exhibit characteristic endoscopic findings.
Methods
Forty endoscopists determined the H. pylori infection status of 50 randomly presented H. pylori-positive and H. pylorinegative cases on the basis of a list of established findings.
Results
The median clinical endoscopy experience was 7 years (range, 1–35 years), including 22 board-certified endoscopists (55%) of the Japan Gastroenterological Endoscopy Society. The mean accuracy rate of endoscopic diagnosis was 67% and was unrelated to experience status (experienced vs. trainee: 69% vs. 65%, p=0.089) and total years of experience (R² =0.022). The most frequently selected endoscopic findings were regular arrangement of collecting venules (59%), atrophy (45%), and red streak (22%), which had fair accuracy rates of 67%, 65%, and 73%, respectively. By contrast, the accuracy rates of nodularity (89%) and mucosal swelling (77%) were highest. The 20 endoscopists who more frequently identified these findings diagnosed H. pylori infection significantly more accurately than did the other endoscopists (71% vs. 64%, p=0.008).
Conclusions
Careful attention to nodularity and mucosal swelling in patients with mild atrophy may enhance diagnosis, enable prompt treatment, and avoid possible long-term carcinogenesis.

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Citations to this article as recorded by

The Diagnostic Performance of Linked Color Imaging Compared to White Light Imaging in Endoscopic Diagnosis of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis
Jae Gon Lee, In Kyung Yoo, Abdullah Ozgur Yeniova, Sang Pyo Lee
Gut and Liver.2024; 18(3): 444. CrossRef
Endoscopic Features According to Helicobacter pylori Infection Status
Jun-young Seo, Ji Yong Ahn
The Korean Journal of Medicine.2023; 98(3): 117. CrossRef
Role of linked color imaging for upper gastrointestinal disease: present and future
Sang Pyo Lee
Clinical Endoscopy.2023; 56(5): 546. CrossRef
Clinical usefulness of linked color imaging in identifying Helicobacter pylori infection: A systematic review and meta-analysis
Yu Zhang, Jing-Zhai Wang, Xuan Bai, Peng-Li Zhang, Qiang Guo
World Journal of Gastrointestinal Endoscopy.2023; 15(12): 735. CrossRef
Characterization of the cagA-gene in Helicobacter pylori in Mongolia and detection of two EPIYA-A enriched CagA types
Oyunbaatar Altanbayar, Avarzed Amgalanbaatar, Chimeddorj Battogtokh, Narmandakh Bayarjargal, Dana Belick, Malte Kohns Vasconcelos, Colin R. Mackenzie, Klaus Pfeffer, Birgit Henrich
International Journal of Medical Microbiology.2022; 312(3): 151552. CrossRef
Risk factors for early gastric cancer: focus on Helicobacter pylori gastritis
Hee Seok Moon
Journal of the Korean Medical Association.2022; 65(5): 259. CrossRef
Usefulness of the Kyoto Classification Score for Prediction of Current Helicobacter pylori Infection
Heejun Kang, Chul-Hyun Lim, Sukil Kim, Arum Choi, Jung-Hwan Oh
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2022; 22(4): 281. CrossRef
Clinical Features of False-Negative Early Gastric Cancers: A Retrospective Study of Endoscopic Submucosal Dissection Cases
Kohei Oka, Naoto Iwai, Takashi Okuda, Tasuku Hara, Yutaka Inada, Toshifumi Tsuji, Toshiyuki Komaki, Junichi Sakagami, Yuji Naito, Keizo Kagawa, Yoshito Itoh, Fabiana Zingone
Gastroenterology Research and Practice.2021; 2021: 1. CrossRef
Gastritis: The clinico-pathological spectrum
Massimo Rugge, Edoardo Savarino, Marta Sbaraglia, Ludovica Bricca, Peter Malfertheiner
Digestive and Liver Disease.2021; 53(10): 1237. CrossRef
What Is New in Helicobacter pylori Diagnosis. An Overview
Maria Pina Dore, Giovanni Mario Pes
Journal of Clinical Medicine.2021; 10(10): 2091. CrossRef
Deep learning for diagnosis of precancerous lesions in upper gastrointestinal endoscopy: A review
Tao Yan, Pak Kin Wong, Ye-Ying Qin
World Journal of Gastroenterology.2021; 27(20): 2531. CrossRef
In situ Diagnosis of Helicobacter pylori Infection Using the Endoscopic Kyoto Scoring System
Eunsun Lim, Ik Hyun Jo, Yeon-Ji Kim, Woo Chul Chung
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2021; 21(4): 322. CrossRef
Helicobacter pylori Gastritis in Children—The Link between Endoscopy and Histology
Ana-Maria Teodora Domșa, Raluca Lupușoru, Dan Gheban, Radu Șerban, Cristina Maria Borzan
Journal of Clinical Medicine.2020; 9(3): 784. CrossRef
The role of linked color imaging in endoscopic diagnosis of Helicobacter pylori associated gastritis
Sang Pyo Lee, Jin Lee, Sea Hyub Kae, Hyun Joo Jang, Dong Hee Koh, Jang Han Jung, Sun-Ju Byeon
Scandinavian Journal of Gastroenterology.2020; 55(9): 1114. CrossRef
Gastritis: An Update in 2020
Massimo Rugge, Kentaro Sugano, Diana Sacchi, Marta Sbaraglia, Peter Malfertheiner
Current Treatment Options in Gastroenterology.2020; 18(3): 488. CrossRef
The endoscopic predictors of Helicobacter pylori status: a meta-analysis of diagnostic performance
Ben Glover, Julian Teare, Hutan Ashrafian, Nisha Patel
Therapeutic Advances in Gastrointestinal Endoscopy.2020; 13: 263177452095084. CrossRef
Helicobacter pylori Infection and the Kyoto Classification of Gastritis
Sun-Young Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2019; 19(2): 81. CrossRef
Review: Diagnosis of Helicobacter pylori infection
Athanasios Makristathis, Alexander M. Hirschl, Francis Mégraud, Emilie Bessède
Helicobacter.2019;[Epub] CrossRef
Accuracy of Endoscopic Diagnosis of Mild Atrophic Gastritis with Helicobacter pylori Infection
Dae Bum Kim, Woo Chul Chung
Clinical Endoscopy.2018; 51(4): 310. CrossRef

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19 Crossref

Barrett's Esophagus - With Emphasis on Endoscopic Disgnosis: Jun Haeng Lee, M.D.; Korean J Gastrointest Endosc 2009;39(4):185-198. Published online October 30, 2009

Abstract PDF: Barrett's esophagus is a metaplastic change of the esophageal mucosa, such that the normal squamous epithelium is replaced by specialized columnar epithelium. During the last decades, there has been a significant change in the definition, endoscopic diagnosis, pathologic diagnosis, surveillance and management of Barrett's esophagus. Because of the rising prevalence of gastroesophgeal reflux disease in Korea, problems related to Barrett's esophagus are expected to be much more common in the near future. In this review, methods of endoscopic diagnosis of Barrett's esophagus are discussed in detail. Management strategies in the context of Korean epidemiology are also suggested. (Korean J Gastrointest Endosc 2009; 39:185-198)

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내시경적 조기 진단으로 내과적 치료에 성공한 급성 봉소염성 위염 ( Acute Phlegmonous Gastritis Diagnosed Early Endoscopically and Treated Successfully with Antibiotics ): Korean J Gastrointest Endosc 2001;23(4):225-229. Published online November 30, 2000

Abstract PDF: Phlegmonous gastritis is a rare disorder caused by suppurative bacterial infection of the gastric wall. The mortality rate remains extremely high and the gastrectomy has been thought to be an effective form of treatment. We report a case of acute phlegmonous gastritis developed in a patient with advanced alcoholic liver cirrhosis, and recovered with early endoscopic diagnosis and antibiotics alone. (Korean J Gastrointest Endosc 2001;23:225-229)`

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과산화수소에 의해 유발된 대장염 1예 ( A Case of Hydrogen Peroxide Induced Colitis ): Korean J Gastrointest Endosc 1999;19(4):659-667. Published online November 30, 1998

Abstract PDF: Endometriosis is the abnormal growth of endometrial tissue outside the uterine cavity. Involvement of the gastrointestinal tract is seen in 3∼34% of patients affected by this condition. Although the commonest sites involved are the sigmoid colon and rectum, only 4 cases have been reported in Korea. The most frequent symptoms are lower abdominal and pelvic pain typically worsening at the time of menstruation. Bleeding per rectum is uncommon since the mucosa is rarely involved. Endoscopy has not been thought to be helpful in the evaluation of patients with suspected colonic endometriosis. However, endoscopy is often used as the first test in patients with rectal bleeding, excluding malignancy or other sources of bleeding. There are few reports of endoscopic documentation of colorectal endometriosis. A 26 year-old woman having a history of endometriosis with cyclic hematochezia and lower abdominal pain is herein reported. A flexible sigmoidoscopy revealed a protrusion of hyperemic mucosa with a surrounding fold formation on the rectum 8 cm above the anal verge. The subsequent biopsy of the lesion gave rise to a diagnosis of endometriosis. (Korean J Gastrointest Endosc 19: 667∼670, 1999)

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원저 : 식도 위장관 ; 연령과 성별에 따른 대장 및 직장암의 분포 변화에 대한 관찰 ( Original Articles : Esophagus , Stomach & Intestine ; A Study for The Changing Subsite Distribution of Colorectal Cancer with Age and Sex ): Korean J Gastrointest Endosc 1997;17(6):771-777. Published online November 30, 1996

Abstract PDF: Background
/Aims: Changes in subsite distribution of colorectal cancer have been shown in recent years. The carcinoma tend to shift to more proximal colon and this proximal shift is influenced by age and sex. This study was designed to delineate the relationship of age to subsite incidence of colorectal cancer and to define the role of gender in this difference. Method: We have analyzed the data by patients with colorectal cancer from 1985 to 1995 for elucidate the relationships between age, sex and prinmry location of colorectal cancer. 749 patients(male 454, female 295) were diagnosed of colorectal cancer performed by colonoscopy and/or sigmoidoeopy were divided into three groups by their location of cancer (Right colon: appendix, ascending colon, hepatic flexure, T-colon proximal 2/3 Left colon: T-colon distal 1/3, splenic flexure, descending colon, sigmoid colon Rectum: rectum). (Korean J Gastrointest Endosc 17: 771-777, 1997) (continue)

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원저 : 식도 위장관 ; 내시경으로 진단된 Mallory - Weiss 증후군 35예 ( Original Articles : Esophagus , Stomach & Intestine ; Observation of 35 Cases of Mallory - Weiss Syndrome Diagnosed by Endoscopy ): Korean J Gastrointest Endosc 1997;17(3):329-334. Published online November 30, 1996

Abstract PDF: 35 cases of Mallory-Weiss syndrome among 277 cases of upper gastrointestinal bleeding were ascertained by endoscopy at department of internal medicine St. Columban's hospital. The mean age was 41.6 years. All of 35 cases were found in male. Combined disease were gastritis(15 cases), peptic ulcer(7 cases) and esophageal varix(3 cases). The most common precipitating factor was vomiting, 22 cases among the 28 cases of vomiting(80%) developed after drinking. Endoscopic finding revealed active bleeding in 5 cases, blood clot without active bleeding in 22 cases, and scar change without bleeding evidence in 8 cases. Most cases had had hematemesis after active bleeding but 5 cases had had only melena without hematemesis. The Mallory-Weiss lacerations were located at stomach in 16 cases(46%), at esophagogastric junction in 11 cases(31%) and at esophagus in 8 cases. On the view of gastric direction, 14 cases were on anterior wall side, 9 cases were on posterior wall side, 11 cases were on lesser curvature side and one case was on great curvature side. Single lacerations were more common than multiple lacerations. (Korean J Gastrointest Endosc 17: 329-334, 1997)

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증례 : 식도 위장관 ; 상부 위장관을 침범한 아니사키스증 7예 ( Case Reports : Esophagus , Stomach & Intestine ; Report on 7 Cases of Anisakiasis Involved the Upper Gastrointestinal Tract ): Korean J Gastrointest Endosc 1996;16(2):242-247. Published online November 30, 1995

Abstract PDF: The anisakiasis disease that is infected through various kinds of larvae of the anisakis family when sea fish ia eaten uncooked or half-cooked. Sinee Van Thiel, a Netherlander, found in 1960 that anisakis larvae parasitize upon the human intestinal tract of the patients who suffer from ahdomieal pain after eating herrings, there have been a number of similar reports in North America and Japan, and the clinical importance of anisakis larvae for the acute gastrontestinal infection is rising. In general, as raw sea fish is not regarded as a source of parasite infestation, the patients who had eaten it and suffered from acute abdominal pain and vomiting are considered as and to be treated of food poisoning. But it is highly possible that some of them suffer from the acute gastrointestinal symptom caused by anisakis larvae. Thereby we report on 7 examples of anisakiasis taken through endoscopic diagnosis of the patients who have the acute upper abdominal pain after eating raw sea fish. (Ko rean J Gostrointest Endosc 16: 242~245, 1996)

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원저 : 식도 위장관 ; 원발성 위 림프종의 내시경적 진단 ( Original Articles : Esophagus , Stomach & Intestine ; Endoscopic Diagnosis of Primary Gastric Lymyhoma ): Korean J Gastrointest Endosc 1996;16(2):156-167. Published online November 30, 1995

Abstract PDF: Primary gastric lymphorna represents one to 7% of all gastric cancer and is the most common type of extranodal lymphoma. In attempt to evaluate the endoscopic characteristics, we analysed clinical and endoscopic findings in 35 patients with primary gastric lymphoma between January 1980 and August 1994 at the Yonsei Medical Center. The results were as follows: 1) The mean age of patients was 47.1 years with male to female ratio of 1.5: l. 2) Gastroscopy was performed in all 35 patienits, which revealed polypoid lesion in one case(2.9%), ulcerative lesion in 15 cases(42.9%), ulcero-infiltrative lesion in 6 cases(17.1%) and diffuse infiltrative lesion in 2 cases(5.7%). Gastric lymphoma was suggested in 6 cases, advanced gastric cancer in 21 cases, early gastric cancer in 5 cases and benign gastric ulcer in 3 cases. Pathologic diagnosis of biopsy specimens were gastric lymphoma in 24 cases, adenocarcinoma in 5 cases and chronic superficial gastritis in one case. 3) The characteristics of the endoscopic findings in gastric lymphoma were intractable or recurrent ulcer in 10 cases, thickened and mounded ulcer margin in 9 cases, multiple ulcers in 9 cases, giant rugae in 7 cases and polypoid or depressed lesion with central ulceration in 4 cases. In conclusion, recognition of specific endoscopic findings such as intractable or recurrent ulcer, volcano-like ulcer, multiple ulcers, giant rugae and combined lesion, the possibility of a lymphoma should be considered and vigorous biopsy attempts should be carried out. Then if the first microscopic report does not suggest this diagnosis, a second investigation including jumbo biopsies, perhaps by diathermy, should be undertaken, (Korean J Gastrointest Endosc 16: 156-165, 1996)

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원저 : 조기위암의 내시경적 고찰 ( Original Articles : Endoscopic Review of Early Gastric Cancer ): Korean J Gastrointest Endosc 1995;15(2):185-193. Published online November 30, 1994

Abstract PDF: In order to decide on appropriate treatment strategy against gastric cancer, an accurate preoperative evaluation of the depth of cancer invasion is essential. We studied 165 cases(19%) of early gastric cancer among 706 cases of gastric cancer. resected over a 6 year period. A retrospective study of early gastric cancer was done to evaluate the endoscopic accuracy and lymph node metastasis status, the following results were obtained: 1) The proportion of EGC according to macroscopic type was 68.5% of depressed type(II, III, IIa+III, IIc+III, III+IIc, IIb+IIc), 26% of elevated type(I, IIa, IIa+ IIb, IIa+IIc), 5.5% of flat type(IIb). 2) In the view of accuracy of endoscopic diagnosis, the rate of accurate diagnosis suitable for postoperative macroscopic type was 37.5%, the rate of unsuitable typed EGC was 33.3%, overestimation(diagnosed to AGC) was 20.6% and underestimation(diagnosed to benign diseases)was 8.6%. Overall accuracy of endoscopic diagnosis was 70.8%. 3) The cases confined to the mucosa were 40.6% and others were submucosal cancers(59.4%). 4) Positive lymph node metastasis was found in 1.5% of M-cancer and 18.4% of SM-cancer(overall 11.5%). 5) Node positive rate of differentiated cancer was 10.5%, undifferentiated carcinoma was 15.4%. There was no signficant difference in frequency of nodal metastasis according tumor size and macroscopic type. 6) Tumors which satisfy the following criteria may not metastasize to lymph nodes:(1) confined to the mucosa; (2) less than 2.0cm in diameter; (3) macroscopically elevated or flat; (4) histologically well or moderately differentiated.

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