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Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are common premalignant cystic lesions of the pancreas. Most are incidentally discovered. The prevalence of malignancy at the time of initial identification of BD-IPMNs is very low and they harbor little threat of imminent malignant transformation. Therefore, despite their premalignant nature, immediate surgical resection for all BD-IPMNs is not recommended as the morbidity and mortality of surgery far outweigh the likely benefit of cancer prevention. The possibility of missing an opportunity to surgically cure early cancer, however, is a challenge given our limited understanding of the natural history along with suboptimal diagnostic tools. Consensus criteria for surveillance of BD-IPMNs and indications for surgery have been proposed in 2006 (a.k.a. Sendai criteria) and recently revised in 2012 (a.k.a. Fukuoka criteria). While the evidence to support current recommendations is limited, the trend of available data continues to support deliberate observation for most BD-IPMNs without high-risk stigmata or worrisome features of malignancy. Newer diagnostic tools with better accuracy for diagnosing BD-IPMNs and their dysplasia status are needed to improve clinical management.

Endoscopic ultrasonography and intraductal ultrasonography (IDUS) are useful for diagnosing tumor extension of the major duodenal papilla. Especially, IDUS makes it possible to diagnose early cancer that has never been correctly diagnosed by other modalities. On the other hand, we think that endoscopic resection therapy of the tumor that is benign adenoma or early cancer may be initially selected as a curative treatment similar to, endoscopic mucosal resection for early gastric or colonic cancer. Between 1993 and 2007, 91 patients with tumor of the duodenal major papilla underwent, endoscopic resection therapy at our institute. The indication for this therapy was defined as a case with adenoma or early cancer without infiltration into the bile and pancreatic ducts. The tumors were resected in a radical fashion using pure cutting current. Temporary endoscopic pancreatic duct stenting could prevent acute pancreatitis, which is important as an early complication. We have a few cases with late complications, but they were improved conservatively in all cases. We think that endoscopic resection therapy can be assessed as a safe and curative treatment of adenoma of the major duodenal papilla. In addition, it is occasionally estimated as a curative therapy for early cancer.

The incidence of colorectal neoplasia is increased in patients with long-standing and extensive ulcerative colitis (UC), and death from colorectal neoplasia is the most important factor for long-term mortality in patients with UC. To improve the prognosis of patients with UC-associated neoplasia, it is very important to diagnose it at an early or precancerous state in patients with long-standing UC. However, UC-associated neoplasia is often difficult to detect endoscopically and difficult to discriminate from inflammatory regenerative epithelium pathologically. There are three important problems in diagnosing UC-associated neoplasia: the first is how to detect UC-associated dysplasia and early cancer endoscopically; the second is how to discriminate UC-associated dysplasia from inflammatory regenerative epithelium pathologically; and the third is how to identify individuals at increased risk of neoplasia, especially dysplasia, in patients with long-standing and extensive UC. We reviewed the clinicopathological and genetic characteristics of UC-associated neoplasia focusing on these three problems.

A woman, aged 54 years, with a history of gastric ulcer and endometriosis, had no recent abdominal symptoms, but because a fecal occult blood test had turned out to be positive she underwent a barium enema examination, which was followed up by colonoscopy.A lesion of about 13 mm in diameter was found in the descending colon. Endoscopic resection was performed. The resection margins were free of tumor. On follow-up endoscopic examinations no local recurrence was found.

A man, aged 73 years, complaining of anorexia, cough, and rhinorrhea for a week, underwent a barium meal examination, which was followed up by an upper gastrointestinal (GI) endoscopic examination to rule out abnormalities. A lesion of about 5 mm in diameter was found in the corpus and was biopsied.Two months later he underwent endoscopic ultrasonographic examination and shortly thereafter endoscopic resection was performed. The resection margins were free of tumor. On follow-up endoscopic examinations, no local recurrence was found.

These are Major terminological problems relating to definitions of epithelial tumors of the whole gastrointestinal tract (squamous and glandular). Furthermore, the clinical implications vary from site to site. The definitional problems primarily involve epithelial atypia and the terminology of neoplastic lesions, namely dysplasia, adenomas, carcinoma in situ, and early cancer [1–8].

Early gastric cancer cases were analyzed in terms of growth patterns of the superficially speading (Super) type and the penetrating growth (Pen) type, the latter further subdivided into the Pen A-type which grows expansively and the Pen B type which has infiltration. This classification was then extended to include advanced cancer, and the natural history of gastric cancer was studied. While the Super type showed good prognosis after surgery, then Pen A type had a poorer prognosis except when confined to the mucosa. The prognosis of the Pen B type, which was good for cases in early stages, became poor once the lesion invaded the serosa. Such growth patterns were further studied in terms of cytophotometric DNA analysis. It was found that most Super-type cases have low ploidy, while most of the Pen A type have high ploidy and the Pen B type, which had retained low ploidy in the submucosal stage, developed high ploidy when the invasion reached the serosa. Such analyses led us to postulate that early cancer of the Super type progresses to the funnel-shaped advanced cancer with relatively good prognosis, while the Pen A type grows into box-shaped lesions corresponding to Lauren’s intestinal type, while the Pen B type became the mountain-shaped ones of the diffuse type. Based on data from annual check-ups, it was estimated that initially occurring low and high ploidy cancer may be approximately equally distributed. Thus, it is important to bear in mind that diagnostic advances may actually favor the detection of slow growing, low-malignant lesions, overlooking rapidly growing highly malignant lesions in their early stage before detection, thereby allowing them to progress to an advanced stage.

During the past fifteen years, resections were performed in 744 patients with early gastric cancer, leading to the discovery of synchronous multiple early cancer (MC) in 151 cases (20%). The frequency of old-aged patients and differentiated carcinoma was statistically higher (p

A new, simplified technique for endoscopic mucosal resection using a transparent plastic cap (EMRC) was introduced. A total of fifty-four cases of mucosectomy of the esophagus, stomach and colon were successfully performed using this procedure causing no severe complications such as mass bleeding and perforation. During the short-term follow-up period, no recurrence of tumor was evident. We believe that because of its technical simpleness and safety this EMRC procedure will become accepted by many digestive endoscopists.

Japanese research society for colorectal cancer defined early cancer as mucosal and submucosal cancer. of 22,652 cancers registrared with the society up to 1983, 1,585cases or 7% were early cancers Flat and depressed type early cancer (FDEC) accounted for only 0.5%, though 98% were protruded and elevated types. Due to recent advances in endoscopy, early cancer has incerased 20–30% of overall cancer, and FDEC accounted for 10–15% of rarly cancer. 90% of FDEC is 10mm or smaller in size, and higher rate of invasion. If FEDC is found 10mm or larger, surgical treatment should be considered. Screening started in 1992 using the immunological fecal occult blood test in Japan. According to joint study of 864,652 asymptomatic subjects, positive rate was 8.0%. Cancer was found in 0.17%, and 53.2% of cancer detected was early cancer. Efficasy of this screening, however, remains uncertain.