Clinical Endoscopy

Gastric cancer presenting with ramucirumab-related gastrocolic fistula successfully managed by colonic stenting: a case report: Hiroki Fukuya, Yoichiro Iboshi, Masafumi Wada, Yorinobu Sumida, Naohiko Harada, Makoto Nakamuta, Hiroyuki Fujii, Eikichi Ihara; Clin Endosc 2023;56(6):812-816. Published online May 11, 2023; DOI: https://doi.org/10.5946/ce.2022.117

We report a rare case of gastric cancer presenting with a gastrocolic fistula during ramucirumab and paclitaxel combination therapy that was successfully managed with colonic stenting. A 75-year-old man was admitted to our hospital with the chief complaint of melena. Esophagogastroduodenoscopy revealed a large ulcerated tumor in the lower stomach, judged by laparoscopy as unresectable (sT4bN1M0). After four cycles of first-line chemotherapy with S-1 plus oxaliplatin, the patient showed disease progression, and second-line therapy with ramucirumab and paclitaxel was started. At the end of the third cycle, the patient had gastric antral stenosis, which necessitated the placement of a gastroduodenal stent. When the patient complained of diarrhea 10 days later, esophagogastroduodenoscopy revealed a fistula between the greater curvature of the stomach and the transverse colon. The fistula was covered by double colonic stenting, with a covered metal stent placed within an uncovered metal stent, after which leakage from the stomach to the colon stopped.

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Ramucirumab

Reactions Weekly.2024; 1989(1): 189. CrossRef
Metastatic bladder cancer forming a sigmoidorectal fistula after enfortumab vedotin therapy: a case report
Shinji Tamada, Daiki Ikarashi, Naoki Yanagawa, Moe Toyoshima, Kenta Takahashi, Tomohiko Matsuura, Shigekatsu Maekawa, Renpei Kato, Mitsugu Kanehira, Ryo Takata, Wataru Obara
Frontiers in Oncology.2023;[Epub] CrossRef

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Endoscopic Ultrasound–Guided Fiducial Placement for Stereotactic Body Radiation Therapy in Pancreatic Malignancy: Seong-Hun Kim, Eun Ji Shin; Clin Endosc 2021;54(3):314-323. Published online May 28, 2021; DOI: https://doi.org/10.5946/ce.2021.102

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Stereotactic body radiation therapy (SBRT) is an important treatment option for pancreatic cancer, which is known to be one of the malignancies with the worst prognosis. However, the high radiation doses delivered during SBRT may cause damage to adjacent radiosensitive organs. To minimize such damage, fiducial markers are used for localization during SBRT for pancreatic cancer. The development of endoscopic ultrasound (EUS) has enabled fiducial markers to be inserted into the pancreas using an EUS fine-needle aspiration (FNA) needle, unlike in the past when percutaneous placement was generally performed. For successful EUS-guided fiducial marker placement, it is necessary for the fiducial markers to be loaded within the EUS-FNA needles to have a low probability of complications and a low migration risk, and to be stably observed in SBRT imaging. A systematic review has shown that the technical success rate of EUS-guided fiducial marker placement is 96.27%, whereas the fiducial marker migration and adverse event rates are 4.33% and 4.85%, respectively. Nonetheless, standardized techniques for fiducial marker placement and the characteristics of optimal fiducial markers have not yet been established. This review will introduce the characteristics (e.g., materials and shapes) of fiducial markers used in fiducial marker placement for pancreatic cancer and will discuss conventional techniques along with their success rates, difficulties, and adverse events.

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Application of intrahepatic fiducial markers in carbon ion radiotherapy for pancreatic cancer—Achieving higher precision treatment
Junya Nagata, Yohsuke Kusano, Masataka Komori, Yoshiki Takayama, Shogo Kurokawa, Atsushi Ito, Tadashi Kamada, Daisaku Yoshida, Shohei Kawashiro, Hiroyuki Katoh
Journal of Applied Clinical Medical Physics.2026;[Epub] CrossRef
EUS-Guided Fiducial Placement For GI Malignancies: A Tertiary Hospital’s 9-Year Experience
C Thanos, D Piskopou, K Tsitsigiannis, N Georgakopoulou, D Ntailianas, M Triantafyllou, N Kalakos, E Georgiou, T Argyropoulos, I Varmpompitis, A Striki, G Michalopoulos, I Karoumpalis
Endoscopy.2026; 58(S 03): S615. CrossRef
Interventional Endoscopic Ultrasonography: Advances in Application
Haidar Khan, Sharon Slomovich, Neal C. Shah, Frank Gress
Journal of Clinical Medicine.2025; 14(10): 3286. CrossRef
Fiducial Marker Placement for Gated Radiotherapy Using Real-Time Tumor-Tracking in Pancreatic Cancer: A Comparative Analysis of Transarterial and Percutaneous Approaches
Daisuke Kato, Daisuke Abo, Ryo Morita, Norio Katoh, Naoki Miyamoto, Ryota Yamada, Naoya Kinota, Takaaki Fujii, Kouji Yamasaki, Motoma Kanaya, Hidefumi Aoyama, Kohsuke Kudo
Journal of Vascular and Interventional Radiology.2025; 36(12): 2021. CrossRef
A Preliminary Controlled Trial of Endoscopic Ultrasound-guided Fiducial Markers to Guide Pancreas Surgery
Patrick W. Chang, Jonathan Sadik, Ara B. Sahakian, Ravi Kankotia, Christopher Ko, Jessica Serna, Alex Rodriguez, Helen Lee, Sujit Kulkarni, Yuri Genyk, Mohd Sheikh, James L. Buxbaum
Journal of Clinical Gastroenterology.2024; 58(9): 931. CrossRef
EUS-guided interventional therapies for pancreatic diseases
Rongmin Xu, Kai Zhang, Nan Ge, Siyu Sun
Frontiers in Medicine.2024;[Epub] CrossRef
Cardiac migration of an implanted hepatic fiducial marker used for stereotactic body radiation therapy - A case report
Youstina Soliman, Febin Antony, Mark Vivian, Sankar Venkatraman, Maged Nashed
Journal of Cancer Research and Therapeutics.2024; 20(5): 1628. CrossRef
Endoscopic Ultrasound-Guided Treatments for Pancreatic Cancer: Understanding How Endoscopic Ultrasound Has Revolutionized Management of Pancreatic Cancer
Sahib Singh, Antonio Facciorusso, Rakesh Vinayek, Sudhir Dutta, Dushyant Singh Dahiya, Ganesh Aswath, Neil Sharma, Sumant Inamdar
Cancers.2024; 17(1): 89. CrossRef
Development of devices for interventional endoscopic ultrasound for the management of pancreatobiliary diseases
Masahiro Itonaga, Masayuki Kitano, Reiko Ashida
Digestive Endoscopy.2023; 35(3): 302. CrossRef
Endoscopic Ultrasound-Guided Fiducial Placement for Stereotactic Body Radiation Therapy in Patients with Pancreatic Cancer
Irina M. Cazacu, Ben S. Singh, Rachael M. Martin-Paulpeter, Sam Beddar, Stephen Chun, Emma B. Holliday, Albert C. Koong, Prajnan Das, Eugene J. Koay, Cullen Taniguchi, Joseph M. Herman, Manoop S. Bhutani
Cancers.2023; 15(22): 5355. CrossRef
Endoscopic Management of Pancreatobiliary Malignancies
Dong Wook Lee, Eun Young Kim
Digestive Diseases and Sciences.2022; 67(5): 1635. CrossRef
Hot topics in therapeutic EUS
Daniela Tabacelia, Alexandru Martiniuc, Daniela Elena Burtea, Adrian Saftoiu, Cezar Stroescu
Endoscopic Ultrasound.2022; 11(3): 153. CrossRef

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Endoscopic Submucosal Dissection Followed by Concurrent Chemoradiotherapy in Patients with Early Esophageal Cancer with a High Risk of Lymph Node Metastasis: Hee Kyung Kim, Weon Jin Ko, Chang-Il Kwon, Ga Won Song, In Kyun Yoo, Ji Hyun Song, Hak Su Kim, Joo Young Cho; Clin Endosc 2019;52(5):502-505. Published online May 14, 2019; DOI: https://doi.org/10.5946/ce.2018.176

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Endoscopic submucosal dissection is recommended as an alternative therapy for early esophageal cancer. However, achieving curative resection in this procedure remains controversial since precise prediction of lymph node metastasis can be difficult. Here, we present the preliminary results of endoscopic submucosal dissection followed by concurrent chemoradiotherapy for early esophageal cancer with a high risk of lymph node metastasis. From May 2006 to January 2014, six patients underwent concurrent chemoradiotherapy after endoscopic submucosal dissection with a median follow-up period of 63 months. No complications were encountered during concurrent chemoradiotherapy. Although local recurrence did not occur in all patients, two patients were diagnosed with metachronous cancer. Overall, the survival rate was 100%. Thus, endoscopic submucosal dissection followed by concurrent chemoradiotherapy may be a feasible treatment for early esophageal cancer in patients with a high risk of lymph node metastasis. Future prospective large-scale studies are warranted to confirm our results.

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Unveiling Therapeutic Targets for Esophageal Cancer: A Comprehensive Review
Rakesh Acharya, Ananya Mahapatra, Henu Kumar Verma, L. V. K. S. Bhaskar
Current Oncology.2023; 30(11): 9542. CrossRef
Editorial “Discrepancy Between the Clinical and Final Pathological Findings of Lymph Node Metastasis in Superficial Esophageal Cancer”
Rian M. Hasson, Joseph D. Phillips
Annals of Surgical Oncology.2019; 26(9): 2662. CrossRef

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Is it Possible to Successfully Treat Locally Advanced Colon Cancer Using Pre-Operative Chemoradiotherapy?: Ji Hun Choi, Jae Hyun Kim, Won Moon, Seung Hun Lee, Sung Uhn Baek, Byung Kwon Ahn, Jung Gu Park, Seun Ja Park; Clin Endosc 2019;52(2):191-195. Published online November 9, 2018; DOI: https://doi.org/10.5946/ce.2018.088

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Pre-operative chemoradiotherapy (CRT) is a preferable treatment option for patients with locally advanced rectal cancer. However, few data are available regarding pre-operative CRT for locally advanced colon cancer. Here, we describe two cases of successful treatment with pre-operative CRT and establish evidence supporting this treatment option in patients with locally advanced colon cancer. In the first case, a 65-year-old woman was diagnosed with ascending colon cancer with duodenal invasion. In the second case, a 63-year-old man was diagnosed with a colonic-duodenal fistula due to transverse colon cancer invasion. These case reports will help to establish a treatment consensus for pre-operative CRT in patients with locally advanced colon cancer.

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Evaluation of colon cancer prognostic factors by CT and MRI: an up-to-date review
Ruggeri B. Guimarães, Eduardo O. Pacheco, Serli N. Ueda, Dario A. Tiferes, Fernanda L. Mazzucato, Aley Talans, Ulysses S. Torres, Giuseppe D’Ippolito
Abdominal Radiology.2024; 49(11): 4003. CrossRef

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Endoscopic Submucosal Dissection for Recurrent or Residual Superficial Esophageal Cancer after Chemoradiotherapy: Two Cases: Changhyeok Hwang, Young Hoon Youn, Sung-eun Choi, Young Hak Jung, Hae Yeul Park, Jae Jun Park, Jie Hyun Kim, Hyojin Park; Clin Endosc 2015;48(6):553-557. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.553

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We report two cases of endoscopic submucosal dissection (ESD) for recurrent or residual esophageal squamous cell carcinoma (ESCC) lesions after chemoradiotherapy for advanced esophageal cancer. Case 1 involved a 64-year-old man who had previously undergone chemoradiotherapy for advanced ESCC and achieved a complete response (CR) for 22 months, until metachronous recurrent superficial ESCC was detected on follow-up esophagogastroduodenoscopy (EGD). We performed ESD and found no evidence of recurrence for 24 months. Case 2 involved a 59-year-old man who had previously undergone chemoradiotherapy for advanced ESCC. He responded favorably to treatment, and most of the tumor had disappeared on follow-up EGD 4 months later. However, there were two residual superficial esophageal lugol-voiding lesions. We performed ESD, and he had a CR for 32 months thereafter. ESD can be considered a viable treatment option for recurrent or residual superficial ESCC after chemoradiotherapy for advanced esophageal cancer.

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Salvage Cryoballoon Ablation After Non-Curative Endoscopic Submucosal Dissection: The First Case Report on T1bN0M0 Esophageal Adenocarcinoma
Marianna Spinou, Eleni Nakou, Petros Zormpas, Antonis Pikoulas, George Tribonias
Reports.2025; 8(4): 265. CrossRef
Clinical efficacy of endoscopic submucosal dissection in the treatment of early esophageal cancer and precancerous lesions
Yue Wu, Haihui Zhang, Bingxi Zhou, Shuangyin Han, Yanrui Zhang
Journal of Cancer Research and Therapeutics.2018; 14(1): 52. CrossRef

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A Case of Argon Plasma Coagulation Therapy for Hemorrhagic Radiation-induced Gastritis: Mi Young Jang, M.D., Yong Keun Cho, M.D., Sung Jun Goh, M.D., Min Gyu Park, M.D., Dong Yup Lee, M.D., Yong Woo Seo, M.D., Gum Mo Jung, M.D. and Jin Woong Cho, M.D.; Korean J Gastrointest Endosc 2011;42(1):24-27. Published online January 30, 2011

Abstract PDF: Hemorrhagic radiation-induced gastritis is a rare but serious complication of upper gastrointestinal radiation treatment, and no simple and effective treatment method has yet been developed. Studies on effective treatment methods for achieving hemostasis in patients with hemorrhagic radiation-induced gastritis are necessary, because the new indications for upper gastrointestinal radiotherapy in the field digestive oncology can potentially lead to an increased incidence of radiation- induced gastric vasculopathy. For the first time in Korea and to the best of our knowledge, we report here on a 59-years-old male patient with hemorrhagic gastritis that was induced by external radiotherapy for ampullary adenocarcinoma. This was all well-treated using Argon plasma coagulation (APC). (Korean J Gastrointest Endosc 2011;42:24-27)

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A Case of Primary B Cell Mucosa-associated Lymphoid Tissue Lymphoma Presenting as a Solitary Rectal Mass: Jong Hoon Kim, M.D., Young-Soo Moon, M.D., Seuk Hyun Lee, M.D., Jun Sup Park, M.D.*, Won Ki Bae, M.D., Nam-Hoon Kim, M.D., Sunhee Chang, M.D.^†, Kyung-Ah Kim, M.D., Hye Ran Lee, M.D. and June Sung Lee, M.D.; Korean J Gastrointest Endosc 2008;36(2):102-106. Published online February 27, 2008

Abstract PDF: Primary extranodal B cell lymphoma of mucosa- associated lymphoid tissue (MALT) can develop in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, and breast. Its distribution in the GI tract is as follows: 50∼60% in the stomach, 20∼30% in the small intestine and ileocecal area and 10% in the colorectal area. Although autoimmune and infectious diseases are known as the main etiologies, H. pylori infection has been clearly shown to play a causative role in lymphomagenesis, especially in the stomach. H. pylori eradication therapy only can induce disease remission nearly in 80% of the cases of gastric MALT lymphoma. However, there is lack of evidence for the extragastric area. In this case, a 71-year-old woman with low abdominal pain was diagnosed as having a rectal MALT lymphoma that was noted as a solitary rectal mass in a colonoscopic examination. Remission induction was commenced by H. pylori eradication and radiation therapy. (Korean J Gastrointest Endosc 2008;36:102-106)

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원저 : 악성 담도 폐쇄에서 금속 배액관 삽입 후 강내 방사선 치료의 효과 ( The Efficacy of Intraluminal Radiotherapy after Metallie Stent Insertion in Malignant Biliary Tract Obstruction ): Korean J Gastrointest Endosc 2000;20(6):449-455. Published online November 30, 1999

Abstract PDF: Background
/Aims: Inoperable malignant biliary tract obstructions (MBTO) are best palliated by drainage procedures followed by radiation therapy. In order to administer high doses in a short time to the central part of the tumor, internal radiotherapy has been proposed for a palliative goa1. The aim of this study is to investigate the effect of intraluminal radiotherapy (ILRT) to the stent patency and patients survival time after expandable metallic stent insertion in MBTO. Methods: Between August 1996 and July 1998, 28 patients (17 females, 11 males, average age 61.4 years) with inoperable MBTO were provided with percutaneous transhepatic biliary drainage (12 patients; bile duct cancer, 8 patients; pancreatic head cancer, 4 patients; gallbladder cancer; 4 patients; lymph node metastasis from stomach cancer). The 14 patients were treated by only metallic stent. The other 14 patients were treated by metallic stent insertion and followed by ILRT. The ILRT was done by iridium-192 (mean dosage 23.3 Gray, 5 fractions). Results: There were no significant differences in the two groups regarding age, sex, type of disease, and location of the obstruction. The patients tolerated ILRT well. Conclusions: The ILRT after expandable metallic stent was safe and effective in stent patency and the patient's surviva1 time in inopcrable MBTO. (Korean J Gastrointest Endosc 2000;20:449-455)

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증례 : 항암화학요법과 방사선 병합요법으로 완전관해를 보인 위분문부로 벽내전이된 식도암 1예 ( Case Reports : A Case of Esophageal Cancer Showing Intramural Metastasis to the Stomach in Complete Remission with Preoperative Chemoradiotherapy ): Korean J Gastrointest Endosc 1994;14(3):349-356. Published online November 30, 1993

Abstract PDF: Esophageal carcinoma is a rare malignant neoplasm consisting of about 1.5% of the whole gastrointestinal tract neoplasm and has poor prognosis of which survival rate is below 5%. The squamous cell carcinoma of the esophagus could be multicentric in character and may have occured in 9.5-27% of incidence. The most common site is head and neck region. The metastasis of esophageal carcinoma occur through hematogenous, lymphatic spread, direct invasion and rarely intramural metastasis. Of theses, intramural metastasis has been occured in 7-14.3% of incidence and its presence has been regared to poor prognostic factor due to early regional or distant metastasis. Surgery, chemotherapy, radiotherapy alone or combination of these has been used as treatment modalities of esophageal cancer, but combination chemoradiotherapy with or without op- eration is prefered method than other at present. Authors report a case of esophageal carcinoma showing intramural metastasis to the gastric wall, which had the complete remission with preoperative chemoradiotherapy.

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