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Workshops on "Innovative Therapeutic Endoscopy" for upper gastrointestinal tract diseases were held four times as the Japan Gastroenterological Endoscopic Society (JGES) Core Sessions at the 93rd to 96th Biannual Meetings of the JGES. A total of 48 research presentations (including two invited lectures) were reported, and various discussions were held on these topics. When the research presentations were categorized according to the therapeutic procedure, endoscopic submucosal dissection (ESD) was the most frequent with 28 presentations (58.3%), followed by laparoscopy endoscopy cooperative surgery (LECS) with six presentations (12.5%). When the research presentations were classified by the target organ of the therapeutic procedures, the duodenum was the most frequent with 26 presentations (54.1%), followed by the stomach with 13 presentations (27.1%). The most important issue was the establishment of a safe and reliable endoscopic resection method for duodenal lesions. Issues related to gastric ESD were establishing an efficient traction method and a method to prevent post‐ESD bleeding in high‐risk patients. Other important issues were establishment of an efficient traction method and methods of preventing delayed bleeding in high‐risk patients who undergo gastric ESD, expansion of indications for minimally invasive treatment using LECS for gastric cancer, the development of endoscopic full‐thickness resection (EFTR) for gastric submucosal tumors (SMTs), and improvement of per‐oral endoscopic myotomy (POEM) for esophageal achalasia and per‐oral endoscopic tumor resection (POET) for esophageal SMTs. Through the JGES Core Sessions, it is expected that the minimally invasive treatments using endoscopes developed in Japan will be further advanced. [ABSTRACT FROM AUTHOR]

Endoscopic submucosal dissection (ESD) is a rigorous and technically sophisticated method for removal of lesions within the gastrointestinal tract. Despite having advantages of en‐bloc resection of lesions, regardless of size, and widespread use in Japan and Asia, ESD has not become widely adopted in the USA for a variety of reasons. Based upon Japanese education and the master‐apprentice model, modification to the education system and additional techniques designed to facilitate broader adoption are required for trainees in the USA. This article will review the current state of education and training for ESD in the USA. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal system (GIS) malignancy with pregnancy is a very rare condition and is not common outside Japan. The incidence is between 0.025-0.1% for each pregnancy. GIS malignancies are diagnosed late in pregnancy and detected at an advanced stage. The most common cause of this condition is that the symptoms such as vomiting, nausea, loss of appetite and abdominal growth are mistaken with pregnancy and malignancy is overlooked. Especially in the second trimester, symptoms such as nausea and vomiting, weight loss, melena, hematemesis and deep anemia should suggest malignancy. Upper GIS endoscopy and colonoscopy are the recommended screening methods in these patients, especially in the third trimester.Case Presentation: We present a rare case presenting to our emergency room with the complaint of bloody vomiting, at the 36th week of gestation with a live singleton pregnancy, and receiving the diagnosis of undifferentiated gastric carcinoma from the biopsy taken from the ulcerated lesion on the stomach cardia, with upper GIS endoscopy performed due to deep anemia, who underwent simultaneous cesarean section and subtotal gastrectomy.Conclusion: Gastrointestinal system (GIS) malignancy with pregnancy is a very rare condition, but it should be considered when symptoms such as nausea and vomiting, weight loss, melena, hematemesis and deep anemia occur, especially in the second trimester, and endoscopic screening should be recommended. Because of the delay in diagnosis of malignancy and the detection in advanced stages, patients should be referred for treatment without delay. [ABSTRACT FROM AUTHOR]

Background: Despite the high prevalence of gastroesophageal reflux disease (GERD), its risk factors are still a subject of controversy. This is probably due to inadequate distinction between reflux esophagitis (RE) and non-erosive reflux disease (NERD), and is also due to inadequate evaluation of adjacent stomach. Our aim is therefore to define background factors of RE and NERD independently, based on the evaluation of Helicobacter pylori infection and gastric atrophy. Methods: We analyzed 10,837 healthy Japanese subjects (6,332 men and 4,505 women, aged 20–87 years) who underwent upper gastrointestinal endoscopy. RE was diagnosed as the presence of mucosal break, and NERD was diagnosed as the presence of heartburn and/or acid regurgitation in RE-free subjects. Using GERD-free subjects as control, background factors for RE and NERD were separately analyzed using logistic regression to evaluate standardized coefficients (SC), odds ratio (OR), and p-value. Results: Of the 10,837 study subjects, we diagnosed 733 (6.8%) as RE and 1,722 (15.9%) as NERD. For RE, male gender (SC = 0.557, OR = 1.75), HP non-infection (SC = 0.552, OR = 1.74), higher pepsinogen I/II ratio (SC = 0.496, OR = 1.64), higher BMI (SC = 0.464, OR = 1.60), alcohol drinking (SC = 0.161, OR = 1.17), older age (SC = 0.148, OR = 1.16), and smoking (SC = 0.129, OR = 1.14) are positively correlated factors. For NERD, HP infection (SC = 0.106, OR = 1.11), female gender (SC = 0.099, OR = 1.10), younger age (SC = 0.099, OR = 1.10), higher pepsinogen I/II ratio (SC = 0.099, OR = 1.10), smoking (SC = 0.080, OR = 1.08), higher BMI (SC = 0.078, OR = 1.08), and alcohol drinking (SC = 0.076, OR = 1.08) are positively correlated factors. Prevalence of RE in subjects with chronic HP infection and successful HP eradication denotes significant difference (2.3% and 8.8%; p<0.0001), whereas that of NERD shows no difference (18.2% and 20.8%; p = 0.064). Conclusions: Significantly associated factors of NERD are considerably different from those of RE, indicating that these two disorders are pathophysiologically distinct. Eradication of Helicobacter pylori may have disadvantageous effects on RE but not on NERD. [ABSTRACT FROM AUTHOR]

Objectives: Laryngopharyngeal reflux disease (LPRD) is an important cause of throat discomfort in the elderly. Our objective was to investigate the usefulness of barium swallow studies for the diagnosis of LPRD. Methods: The subjects were 59 patients at least 60 years of age with LPRD suspected on laryngoscopic findings. We evaluated esophageal clearance using a barium swallow study and the upper gastrointestinal tract endoscopic findings of gastroesophageal reflux disease according to the revised Los Angeles classification, and correlated these findings with the effect of rabeprazole, a proton pump inhibitor. Results: Among subjects with positive reflux findings in the esophageal phase of the barium swallow, rabeprazole was significantly effective (p = 0.0025). To identify nonerosive reflux disease, we analyzed the 50 cases with a negative Los Angeles classification of upper gastrointestinal tract endoscopic findings. Rabeprazole was again significantly effective in patients with positive findings for esophageal reflux (p = 0.0025). Conclusions: Among elderly patients with suspected LPRD, there was a positive correlation between impaired esophageal clearance on the barium swallow study and the effectiveness of rabeprazole. The barium swallow study could be a screening test for LPRD in elderly patients with throat discomfort. [ABSTRACT FROM AUTHOR]

This review is regarding the narrow-band imaging (NBI) system which has been developed at National Cancer Center Hospital East, Japan. The technology of the NBI system is based on modifying the spectral features by narrowing the bandwidth of spectral transmittance using various optical filters. The NBI system consists of three filters, 415–30 nm, 445–30 nm, and 500–30 nm, which are used as observing the fine capillaries in the superficial mucosa is essential to identify gastrointestinal neoplasms. The NBI system has been in development since 1999 and the first report of it's efficacy for gastrointestinal tract use was reported in 2001. In our pilot study, the NBI system may be sufficient to differentiate hyperplastic polyp from adenomatous polyp, and to visualize neoplasia with image processing in real-time during colonoscopy without the need for dye spraying. Herein, we propose the term ‘optical/digital chromoendoscopy’ using the NBI system and hope that this instrument will become standard endoscopy for in the 21st century. To estimate the feasibility and efficacy of using the NBI system for surveillance or screening examination, randomized control trials should be conducted in the future. [ABSTRACT FROM AUTHOR]

Although clinical trials using magnifying optical endoscopy have been reported, magnifying endoscopies have been remarkably developed in the period of electronic endoscopy. Magnifying electronic endoscopies with 80 or 100-fold magnification are used for routine endoscopic examination of upper gastrointestinal tract in Japan. Magnifying endoscopy is used to visualize the microstructure and microvascular architecture of gastrointestinal surface mucosa. Microsurface structure of the mucosa includes normal structure, changed structure by inflammation and biological response, and tumor-specific structure. Microvascular architecture includes normal vascular system and tumor microvessels. Magnifying endoscopy is starting to play an important role in diagnosis of any upper gastrointestinal diseases by assessment of magnified observation. Magnifying endoscopy holds a great deal of promise in the near future because magnifying endoscopic observation is approaching optical biopsy. [ABSTRACT FROM AUTHOR]

Aim: To evaluate number and quality of publications in gastroenterology, hepatology and digestive endoscopy from Western Europe (Belgium, Denmark, France, Germany, Great Britain, Italy, the Netherlands, Spain, Sweden, Switzerland), Japan and USA over a recent 5-year period. Methods: We screened by computer for full liver/gastrointestinal-related articles and reviews the top 40% of journals (according to the annual rating of the SCI Journal Citation Reports; Institute for Scientific Information database) in most clinical and basic science disciplines in the years 1992–1996. To be credited with an article, a given country had to be the site of the first institution where the work was conducted. Papers were rated according to the impact factor of the Institute for Scientific Information and to the ratio impact factor/mean European impact factor. Data were also normalized for nondefense research and development expenditure. Results and Conclusions: As randomly tested, the computer search had an error of ± 5–10%. In Europe, Great Britain achieved the highest total impact factor and the highest number of papers. Most of the British impact factor came from publications in British journals. The total USA impact factor exceeded that of Europe by 20%. The average impact factor for a single paper was highest for the USA and, in Europe, for Germany. The temporal trend of total impact factor showed Spain improving by 9% per year, with Germany and Italy also displaying a substantial growth. Expressed per funds allocated in nondefense research and development, Great Britain and the USA had the highest cumulative impact factor.Copyright © 2000 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article presents information about the conference titled "Fifth Japan-Korea Joint Symposium on Gastrointestinal Endoscopy," which was held on May 16, 2006 in Tokyo, Japan. The event was a prominent one for the endoscopists in Japan and Korea. During the event professor Teruo Kouzu delivered the lecture on esophagus cancer. Professor Kyu Yong Choi presented a paper on colorectal cancer.