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Objectives: Comprehensive assessments of the long‐term outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the elderly are unavailable. We aimed to create a scoring system to predict the long‐term prognosis after ESD for EGC among patients aged ≥75 years. Methods: We conducted retrospective studies of two cohorts: a single‐center cohort (2006–2011) for developing the scoring system, and a multicenter cohort for validating the developed system (2012–2016). In the development cohort, factors related to death after ESD were identified using multivariable Cox regression analysis, and a predictive scoring system was developed. In the validation cohort, the scoring system was validated in 295 patients. Results: In the development cohort, Charlson comorbidity index (CCI) ≥3 (hazard ratio [HR] 3.017), high psoas muscle index (PMI) (HR 2.206), and age ≥80 years (HR 1.978) were significantly related to overall survival after ESD. Therefore, high CCI, low PMI, and age ≥80 years were assigned 1 point each. The patients were categorized into low (≤1 point) and high (≥2 points) score groups based on their total scores. In the validation cohort, 184 and 111 patients were assigned to the low‐ and high‐score groups, respectively. In comparisons based on Kaplan–Meier curves, the 5‐year survival rate was 91.5% in the low‐score group and 57.8% in the high‐score group (log‐rank test; P < 0.001). Conclusion: Our scoring system including high CCI, low PMI, and age ≥80 years could stratify the long‐term prognosis of elderly patients aged ≥75 years after ESD for EGC. [ABSTRACT FROM AUTHOR]

Background and Aim: Needle‐based confocal laser endomicroscopy (nCLE) allows for real‐time optical biopsies during endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA). Little is known about nCLE imaging of gastrointestinal subepithelial lesions (GI‐SEL); therefore, we determined its feasibility. Methods: We carried out EUS, nCLE, and finally FNA in 25 patients with GI‐SEL between November 2015 and December 2018. We retrospectively compared nCLE findings with pathological findings of EUS‐FNA or surgical specimens. For concordance analysis, two endoscopists independently validated representative nCLE images 5 months or more after examinations. Results: Adequate sample acquisition rate of EUS‐FNA was 67% per needle pass and 96% per patient. EUS‐FNA was diagnostic in 80% (20/25), suspicious in 4% (1/25), and nondiagnostic in 16% (4/25). nCLE image acquisition rate was 100% and its concordance rate with final pathology was 88% (22/25), which was not significantly different from diagnostic and suspicious EUS‐FNA. nCLE could differentiate GI stromal tumors (GISTs) from leiomyoma, in that GISTs were characterized by contrast‐enhanced densely populated spindle cell tumors with unenhanced rod‐shaped nuclei in 93% of 14 patients, whereas leiomyomas were characterized by narrower spindle cell tumors with fewer and smaller unenhanced nuclei in 100% of three patients. In rectal metastasis from lung adenocarcinoma, some pleomorphic dark nests were observed. At concordance analysis between the two endoscopists' validation results, κ value was 0.560 (P < 0.001), indicating moderate agreement. There were no adverse events associated with nCLE and EUS‐FNA. Conclusion: Needle‐based confocal laser endomicroscopy can be safe and useful for on‐site detection of abnormalities of GI‐SEL (UMIN 000013857). [ABSTRACT FROM AUTHOR]

Background and Aim: Early‐stage gastric cancer (EGC) found after Helicobacter pylori (Hp) eradication often displays non‐tumorous regenerative epithelium and/or maturated tumorous epithelium overlying the cancerous tissue, which may confuse endoscopic and histological diagnosis. Probe‐based confocal laser endomicroscopy (pCLE) enables in vivo real‐time optical biopsy. We compared the diagnostic yields for these EGC cases using conventional white light endoscopy (WL), magnifying endoscopy with narrow‐band imaging (ME‐NBI), pCLE, and endoscopic biopsy; we also compared the accuracy of the horizontal extent diagnosis between ME‐NBI and pCLE. Methods: This study enrolled 30 patients with 36 EGC lesions after successful Hp eradication. Diagnostic yields of WL, ME‐NBI, pCLE, and endoscopic biopsy were prospectively compared. Four points of cancerous margins (oral, anal, anterior, and posterior sites) were also prospectively evaluated with M‐NBI and pCLE to determine the horizontal extent of the EGC. Results: Diagnostic yield was significantly higher with pCLE than with WL and endoscopic biopsy (97 vs 72%, 97 vs 72%, P = 0.0159, 0.0077, respectively), whereas it did not differ from ME‐NBI (88.9%, P = 0.371). Height of non‐tumorous regenerative epithelium or maturated atypical glands was 104.7 ± 34.2 μm in the pCLE‐positive cases, whereas it was 188.3 ± 27.1 μm in a pCLE‐negative case (P = 0.0004). Diagnostic accuracy of the horizontal margin of EGC was significantly higher with pCLE than with ME‐NBI (92 vs 70%, P = 0.0159). Conclusion: pCLE may be helpful for the diagnosis of ambiguous ECG found after Hp eradication because it enables real‐time scanning throughout the lesion and detection of subsurface microstructure. [ABSTRACT FROM AUTHOR]