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Objectives: The multi‐institutional, single‐arm, confirmatory trial JCOG0607 showed excellent efficacy of endoscopic submucosal dissection (ESD) for the expanded indication of intramucosal intestinal‐type early gastric cancer (EGC), which consists of two groups: lesions >2 cm if clinical finding of ulcer (cUL)‐negative, or those ≤3 cm if cUL‐positive because of the expected low risk of lymph node metastasis. However, the proportion of noncurative resections (NCR) requiring additional surgery was high (32.4%). This post hoc analysis aimed to explore the clinical factors associated with NCR. Methods: As the expanded indication includes two different groups, we explored the clinical factors associated with NCR separately in cUL‐negative (>2 cm) and cUL‐positive (≤3 cm) groups using the log–linear model. Results: Two hundred and sixty cUL‐negative and 206 cUL‐positive EGCs were analyzed. The proportions of NCR were 33.8% in the cUL‐negative group and 29.6% in the cUL‐positive group. A multivariable analysis demonstrated that moderately differentiated predominant histology diagnosed in pretreatment biopsy (risk ratio [RR] 1.93, 95% confidence interval [CI] 1.34–2.77, P < 0.001) and lesion in the upper stomach (RR 1.75, 95% CI 1.03–2.96, P = 0.038) in the cUL‐negative EGCs, and tumor size >2 cm (RR 1.78, 95% CI 1.22–2.58, P = 0.003) and female sex (RR 1.62, 95% CI 1.07–2.44, P = 0.021) in the cUL‐positive EGCs were independent factors associated with NCR. Conclusions: Clinical risk factors associated with NCR were different between cUL‐negative and cUL‐positive EGCs. To avoid NCR, we need to take these factors into account when deciding expanded indications for ESD. [ABSTRACT FROM AUTHOR]

Objectives: The Japan Endoscopy Database Project was initiated to develop the world's largest endoscopy data repository. This study describes the first phase of the colonoscopy project in Japan. Methods: Data were aggregated offline by integrating information from the endoscopy database software from January 2015 through March 2017. The study population included all patients who underwent colonoscopy at eight centers. Results: A total of 31,395 patients who underwent 38,497 colonoscopy procedures were registered. The majority of procedures were performed for screening (n = 14,156), followed by fecal immunochemical test positivity (n = 3960), abdominal symptoms (n = 3864), post‐colorectal surgery surveillance (n = 3431), post‐endoscopic treatment surveillance (n = 3757), thorough pre‐treatment examination (n = 2822), and therapeutic purposes (n = 6507). In the screening group, advanced cancers, early cancers, and adenomas were diagnosed endoscopically in 2.1%, 1.3%, and 28.7% of cases, respectively, while in the fecal immunochemical test‐positive group, they were diagnosed in 2.5%, 1.9%, and 41.6% of cases, respectively. The incidence of complications was 0.177% and 0.152% in the screening and fecal immunochemical test‐positive groups, respectively. The therapeutic procedures included 1446 cold forceps polypectomy procedures, 4770 cold snare polypectomy procedures, 368 hot biopsies, 2998 hot snare polypectomy procedures, 9775 endoscopic or piecemeal endoscopic mucosal resections, and 1660 endoscopic submucosal dissections. A total of 173 procedure‐related complications (0.82%) occurred in 21,017 therapeutic procedures performed in 15,744 patients. Conclusions: The first phase of the Japan Endoscopy Database Project established the proportions of the diagnostic and therapeutic colonoscopy procedures, and complication rates in real‐world settings. [ABSTRACT FROM AUTHOR]

Objectives: Photodynamic therapy (PDT) is an effective salvage endoscopic treatment for local failure at the primary site after chemoradiotherapy (CRT) in esophageal cancer patients. However, the contribution of local control by salvage PDT to the prognosis is unclear. We investigated whether complete response at primary site by salvage PDT could improve the prognosis. Methods: Between January 2008 and March 2016, 34 patients received salvage PDT for local failure of esophageal cancer limited to stage T1–2 after definitive CRT or radiotherapy. Local complete response (L‐CR) rate, adverse events, overall survival (OS), and progression‐free survival (PFS) were assessed retrospectively. Results: Local complete response rates after PDT were 68% (23/34; 95% CI, 50–83%) in all patients: 81% (17/21; 95% CI, 58–95%) for stage T1 and 46% (6/13; 95% CI, 19–75%) for stage T2 patients. Grade 3 esophageal stricture occurred in one patient. The median follow‐up was 26.0 months (range, 3.7–93.6 months); 21 patients died. The median survival times were 54.3 months in patients who achieved L‐CR after PDT (L‐CR group) and 19.8 months in those who did not (non‐CR group). The 2‐year OS rates were 79% (95% CI, 54–92%) in the L‐CR group and 40% (95% CI, 11–68%) in the non‐CR group (P = 0.0389; log‐rank test). The median PFS was 21.2 months in the L‐CR group and 1.9 months in the non‐CR group (P < 0.001; log‐rank test). Conclusion: Achieving L‐CR by salvage PDT for local failure after CRT in esophageal cancer was associated with good prognosis. [ABSTRACT FROM AUTHOR]

Background and Aim: Few studies have reported on a national, population‐based endoscopic retrograde cholangiopancreatography (ERCP) database. Hence, in 2015, we established a multicenter ERCP database registry, the Japan Endoscopic Database (JED) Project in preparation for a nationwide endoscopic database. The objective the present study was to evaluate this registry before the establishment of a nationwide endoscopic database. Methods: From 1 January 2015 to 31 March 2017, we collected and analyzed the ERCP data of all patients who underwent ERCP in four participating centers in the JED Project based on the JED protocol. Results: Four centers carried out 4104 ERCP on 2173 patients. Data entry of ERCP information (age, 100%; gender, 100%; American Society of Anesthesiologists Physical Status Classification System, 74.5%; scope, 92.7%; time to ERCP, 100%; antithrombotic drug information, 55.0%; primary selective common bile duct [CBD] cannulation methods, 73.0%; number of attempts at primary selective CBD cannulation, 67.6%; overall selective CBD cannulation methods, 68.9%; ERCP procedure time, 66.3%; fluoroscopy time, 65.1%; adverse events, 74.9%; serum amylase levels 1 day post‐ERCP, 36.5%) was accurately extracted from the four centers. Success rate of CBD cannulation by level of ERCP difficulty was 98.5%, 99.0%, and 96.4% in grades 1, 2, and 3, respectively. Complication rate by overall selective CBD cannulation method was 5.6%, 7.6%, and 10.5% in the contrast‐assisted technique, guidewire‐assisted technique, and cross‐over method, respectively. Conclusion: Data from this evaluation of the JED Project, a multicenter ERCP database registry, suggest the feasibility of establishing a nationwide ERCP database and its challenges. [ABSTRACT FROM AUTHOR]

The Japan Gastroenterological Endoscopy Society has developed endoscopic submucosal dissection/endoscopic mucosal resection guidelines. These guidelines present recommendations in response to 18 clinical questions concerning the preoperative diagnosis, indications, resection methods, curability assessment, and surveillance of patients undergoing endoscopic resection for esophageal cancers based on a systematic review of the scientific literature. [ABSTRACT FROM AUTHOR]