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Background and Aim: There has been no report on a direct comparison between linked color imaging (LCI) and second‐generation narrow‐band imaging (2G‐NBI) for surveillance of epithelial neoplasms in the upper gastrointestinal tract (UGIT). The aim of this study was to verify the superiority of LCI to 2G‐NBI for surveillance esophagogastroduodenoscopy and to clarify how each endoscopic system should be used. Methods: This study was conducted as an open‐label, two‐arm‐parallel (1:1), multicenter, randomized controlled trial at six institutions. Patients aged 20–85 years with a treatment history of epithelial neoplasms in the UGIT were recruited. Patients were assigned to a 2G‐NBI group and an LCI group, and esophagogastroduodenoscopy was performed with primary image‐enhanced endoscopy followed by white light imaging (WLI). The primary endpoint was the detection rate of one or more epithelial neoplasms in the primary image‐enhanced endoscopy. A WLI‐detected epithelial neoplasm was defined as a lesion that was detected in only WLI. Results: A total of 372 patients in the 2G‐NBI group and 378 patients in the LCI group were analyzed. Epithelial neoplasms in the UGIT were detected by 2G‐NBI in 18 patients (4.6%) and were detected by LCI in 20 patients (5.3%) (P = 0.87). WLI‐detected epithelial neoplasms were in 11 patients in the 2G‐NBI group (3.0%) and in 1 patient in the LCI group (0.27%) (P = 0.003). Conclusions: Linked color imaging did not show superiority to 2G‐NBI for the detection of epithelial neoplasms. Also, the percentage of WLI‐detected epithelial neoplasms in primary NBI was significantly higher than that in primary LCI. [ABSTRACT FROM AUTHOR]

Motilin, a 22‐amino‐acid peptide produced in the upper small intestine, induces strong gastric contraction in fasted state. In many rodents, motilin and its cognate receptors exist as pseudogenes, which has delayed motilin research in the past decades. Recently, the house musk shrew (Suncus murinus) was developed as a useful model for studying motilin and gastrointestinal motility. However, due to a lack of motilin‐producing cell lines and difficulties in culturing small intestinal cells, the regulatory mechanisms of motilin secretion and its messenger RNA (mRNA) transcription have remained largely unclear. In this study, we generated small intestinal organoids from S. murinus for the first time. Using methods similar to mouse organoid generation, we found crypt‐like budding structures 3 days after isolating intestinal tissues. The organoids grew gradually with time. In addition, the generated organoids were able to be passaged and maintained for 6 months or longer. Motilin messenger RNA (mRNA) and immunopositive cells were observed in both S. murinus intestinal organoids and primary tissues. This is the first report of intestinal organoids in S. murinus, and our results suggest that S. murinus intestinal organoids could be useful for analyzing motilin secretion and transcription. [ABSTRACT FROM AUTHOR]

Objectives: Evaluation of Helicobacter pylori infection status (non‐infection, past infection, current infection) has become important. This study aimed to determine the usefulness of the Kyoto classification of gastritis for diagnosing H. pylori infection status by endoscopy. Methods: In this prospective study, 498 subjects were recruited. Seven well‐experienced endoscopists blinded to the history of eradication therapy performed the examinations. Endoscopic findings were assessed according to the Kyoto classification of gastritis: diffuse redness, regular arrangement of collecting venules (RAC), fundic gland polyp (FGP), atrophy, xanthoma, hyperplastic polyp, map‐like redness, intestinal metaplasia, nodularity, mucosal swelling, white and flat elevated lesion, sticky mucus, depressive erosion, raised erosion, red streak, and enlarged folds. We established prediction models according to a machine learning procedure and compared them with general assessment by endoscopists using the Kyoto classification of gastritis. Results: Significantly higher diagnostic odds were obtained for RAC (32.2), FGP (7.7), and red streak (4.7) in subjects with non‐infection, map‐like redness (12.9) in subjects with past infection, and diffuse redness (26.8), mucosal swelling (13.3), sticky mucus (10.2) and enlarged fold (8.6) in subjects with current infection. The overall diagnostic accuracy rate was 82.9% with the Kyoto classification of gastritis. The diagnostic accuracy of the prediction model was 88.6% for the model without H. pylori eradication history and 93.4% for the model with eradication history. Conclusions: The Kyoto classification of gastritis is useful for diagnosing H. pylori infection status based on endoscopic findings. Our prediction model is helpful for novice endoscopists. (UMIN000016674). [ABSTRACT FROM AUTHOR]

Background and Aim Prophylactic clipping has been widely used to prevent post-procedural bleeding in colon polypctomy. However, its efficiency has not been confirmed and there is no consensus on the usefulness of prophylactic clipping. The aim of the present study was to evaluate the preventive effect of prophylactic clipping on post-polypectomy bleeding. Methods A multicenter randomized controlled study was conducted from January 2012 to July 2013 in Japan. Patients who had polyps <2 cm in diameter were divided into a clipping group and a non-clipping group by cluster randomization. After endoscopic polypectomy, patients allocated to the clipping group underwent prophylactic clipping, whereas the procedure was completed without clipping in patients allocated to the non-clipping group. Occurrence of post-polypectomy bleeding was compared between the two groups. Results Seven hospitals participated in this study. A total of 3365 polyps in 1499 patients were evaluated. The clipping group consisted of 1636 polyps in 752 patients, and the non-clipping group consisted of 1729 polyps in 747 patients. Post-polypectomy bleeding occurred in 1.10% (18/1636) of the cases in the clipping group, and in 0.87% (15/1729) of those in the non-clipping group. The difference was -0.22% (95% confidence interval [CI]: -0.96, 0.53). Upper limit of the 95% CI was lower than the non-inferiority margin (1.5%), and we could thus prove non-inferiority of non-clipping against clipping. Conclusion Prophylactic clipping is not necessary to prevent post-polypectomy bleeding for polyps <2 cm in diameter. [ABSTRACT FROM AUTHOR]

The article offers information on cold snare polypectomy (CSP), which is considered a safer procedure in terms of postpolypectomy bleeding in patients on antithrombotic drugs. CSP is known for its safety and efficacy, and is now extensively carried out in Japan. According to the guidelines proposed by the Japan Gastroenterological Endoscopy Society, endoscopic treatment procedures are classified into two categories according to risk of bleeding.