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Objectives: Japanese guidelines recommend posttreatment endoscopy once or twice a year after endoscopic submucosal dissection (ESD) for early gastric cancer. However, the impact of endoscopy intervals on metachronous gastric cancer (MGC) remains unclear, especially the difference between 1‐year and half‐a‐year intervals. We aimed to investigate this difference. Methods: This study retrospectively investigated 2429 patients who underwent gastric ESD between May 2001 and June 2019 at our hospital. Patients who developed MGC were classified based on those who underwent the previous endoscopy within at least 7 months (short‐interval group) and within 8–13 months (regular‐interval group). Propensity score matching (PSM) was used to adjust for possible confounders. The primary outcome was the proportion of MGC beyond curative ESD criteria established in the guidelines. Results: A total of 216 eligible patients developed MGC. The short‐ and regular‐interval groups included 43 and 173 patients, respectively. Overall, no patients in the short‐interval group had MGC beyond curative ESD criteria, while 27 patients in the regular‐interval group did. The proportion of MGC beyond curative ESD criteria was significantly lower in the short‐interval group than in the regular‐interval group before (P = 0.003) and after (P = 0.028) PSM. Although not significant, the short‐interval group tended to have a higher stomach preservation rate than the regular‐interval group (P = 0.093). Conclusion: Our study indicated a possible benefit of biannual surveillance endoscopy in the early post‐ESD period. [ABSTRACT FROM AUTHOR]

Objectives: Severe submucosal fibrosis is a crucial technical difficulty encountered during endoscopic submucosal dissection (ESD) in patients with ulcerative colitis (UC). We aimed to identify predictors of severe submucosal fibrosis in patients with UC. Methods: We retrospectively included 55 tumors resected using ESD from 48 consecutive patients with UC. We analyzed the clinicopathological characteristics and treatment outcomes between the F0/1 (none to mild submucosal fibrosis) group (n = 28) and F2 (severe submucosal fibrosis) group (n = 27). Results: No significant difference was found between the F0/1 and F2 groups in en bloc resection rate (100% vs. 96%, P = 0.49), the R0 resection rate (100% vs. 93%, P = 0.24), and the dissection speed (0.18 vs. 0.13 cm2/min, P = 0.07). Intraoperative perforation was more common in the F2 group (30%) than in the F0/1 group (8%; P = 0.01). Multivariable analysis showed that a longer duration of UC (≥10 years; odds ratio [OR] 6.11; 95% confidence interval [CI] 1.20–31.03; P = 0.03) and scarring of background mucosa of the tumor (OR 39.61; 95% CI 3.91–400.78; P < 0.01) were independent predictors of severe submucosal fibrosis. Conclusion: Long UC duration and scarring background mucosa were predictors of severe submucosal fibrosis associated with perforation during ESD. [ABSTRACT FROM AUTHOR]

Objectives: Gastrointestinal endoscopy (GIE) is useful for the early detection and treatment of many diseases; however, GIE is considered a high‐risk procedure in the coronavirus disease 2019 (COVID‐19) pandemic era. This study aimed to explore the rate of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) positivity in saliva and gastrointestinal fluids to which endoscopy medical staff are exposed. Methods: The study was a single‐center cross‐sectional study. From June 1 to July 31, 2020, all patients who underwent GIE at Yokohama City University Hospital were registered. All patients provided 3 mL of saliva. For upper GIE, 10 mL of gastric fluid was collected through the endoscope. For lower GIE, 10 mL of intestinal fluid was collected through the endoscope. The primary outcome was the positive rate of SARS‐CoV‐2 in saliva and gastrointestinal fluids. We also analyzed serum‐specific antibodies for SARS‐CoV‐2 and patients' background information. Results: A total of 783 samples (560 upper GIE and 223 lower GIE samples) were analyzed. Polymerase chain reaction (PCR) on saliva samples did not show any positive results in either upper or lower GIE samples. However, 2.0% (16/783) of gastrointestinal fluid samples tested positive for SARS‐CoV‐2. No significant differences in age, sex, purpose of endoscopy, medication, or rate of antibody test positivity were found between PCR positive and PCR negative cases. Conclusions: Asymptomatic patients, even those with no detectable virus in their saliva, had SARS‐CoV‐2 in their gastrointestinal tract. Endoscopy medical staff should be aware of infection when performing procedures. The study was registered as UMIN000040587. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a patient who underwent Billroth II gastrectomy and developed a large common bile duct stone. The authors used laser lithotripsy with balloon enteroscopy-assisted peroral cholangioscopy (BE-POCS) to successfully remove the stone. This procedure, which involves the use of a slim cholangioscope and a Holmium YAG laser, proved effective in treating difficult stones in patients with altered anatomy. This report highlights the potential benefits of laser lithotripsy with BE-POCS for managing bile duct stones in patients who have undergone gastric surgery. [Extracted from the article]