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Background: Needle knives are the most commonly used instrument during endoscopic treatment for gastric submucosal tumors (SMTs). The conventional resection method involves fully extending the needle-shaped knife head, which allows it to more easily penetrate the muscularis propria while stripping the muscle layer of the tumor. We propose a semi-blunt dissection method that can effectively reduce damage to the muscularis propria., Methods: A total of 113 patients who underwent endoscopic resection of gastric SMTs originating from the muscularis propria were retrospectively analyzed. The conventional method consisted of 73 patients; The other group consisted of 40 patients underwent the semi-blunt dissection method., Results: There was no significant difference between the two groups in age, sex, or lesion location. The intraoperative operational variable, the maximum diameter of gastric muscularis propria damage, was significantly greater in conventional method group than the other group (1.06 ± 0.48 cm vs. 0.46 ± 0.09 cm, p < 0.001). There was also no significant difference between the two groups in terms of histological diagnosis, postoperative complications and the percentage of histologically positive resection margins., Conclusion: The semi-blunt dissection method has certain advantages in the endoscopic resection of gastric tumors originating from the muscularis propria, including a small extent of gastric muscularis propria damage and a shorter postoperative hospital stay., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol has been approved by the Ethical Committee of the Peking University People’s Hospital with an approval number (2024PHB480) and performed according to the Declaration of Helsinki. Ethical Committee of the Peking University People’s Hospital waived need for written informed consents due to the retrospective nature of this study. Consent for publication: Not applicable. Conflicts of interest: All authors have no have no conflicts of interest to disclose. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Detecting and demarcating early gastric cancers (EGC) after eradication therapy of Helicobacter pylori (H. pylori) is a challenging task due to the fact that the lesion's surface is covered with gastritis-like tissue (non-neoplastic epithelium covering the cancerous tissue). However, our study aimed to investigate the endoscopic alterations of EGC within 3 months after eradication, which has not been reported clearly yet., Methods: Consecutive EGC patients who underwent two gastroscopies (one with H. pylori infection and another within 3 months after successful H. pylori eradication) were enrolled. The endoscopic photographs were evaluated for the endoscopic features and confidence level of demarcation line (DL), invasion depth, and histopathological classification by three highly experienced endoscopists. The DL estimated by endoscopy was compared with that of postoperative pathological examination., Results: 45 pairs of EGC cases before and after eradication were enrolled. All the confidence level of DL (High confidence: 15.6% vs. 93.3%, p value = 0.000) and invasion depth (High confidence: 37.8% vs. 80.0%, p value = 0.000) and histopathological classification (High confidence: 31.1% vs. 91.1%, p value = 0.000) were significantly improved after eradication. A higher confidence level of DL before eradication was correlated with severe atrophy score (p value = 0.036). The inter-observer agreements for DL, invasion depth, and histopathological classification were 0.85 and 0.75 and 0.78, respectively., Conclusions: DL of EGC becomes much more apparent after eradication in the short-term. Eradication therapy is necessary even shortly prior to the procedure of endoscopic submucosal dissection (ESD) to help precise pre-procedure diagnosis and avoid incomplete resection., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol was approved by the institutional ethics committee of Shanghai East Hospital, and it was performed in accordance with the Declaration of Helsinki and its subsequent amendments. Informed consent was obtained from all the participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Gastric duplication cysts (GDCs) are rare cystic neoplasms that are often difficult to distinguish from other entities. Accurate diagnosis of cysts before resection is difficult even using the most advanced imaging techniques. We present a case of a gastric duplication cyst in a 17-year-old female, presenting with discomfort in the upper abdomen. Gastroscopy showed a submucosal mass about 40 mm in diameter on the side of the greater curvature of stomach. Computed tomography (CT) reveals a submucosal prominence in the body of stomach, which could indicate a foregut cyst or an ectopic structure. Endoscopic ultrasonography (EUS) showed a submucosal bulge of the corpus body of stomach, and may be lipomas. Patients undergo endoscopic submucosal dissection (ESD) to relieve symptoms and confirm the diagnosis of lesions. The procedure went smoothly and the solid cystic lesions were completely removed. Histopathological examination reveals gastric duplication with mixed hemangioma, and intrinsic fat liquefaction. After resection, the patient was successfully discharged from the hospital, and during the 6-month follow-up period, there are no symptoms or evidence of disease recurrence. This is a rare case of gastric duplication with mixed hemangioma. ESD can be used as an alternative treatment to provide a definitive diagnosis., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2025 Elsevier GmbH. All rights reserved.)

Background: There is a lack of sufficient evidence on whether mixed-type differentiated predominant early gastric cancer (MD-EGC) can be treated endoscopically by referring to the criteria for differentiated-type early gastric cancer (EGC). This study aims to evaluate the efficacy of endoscopic submucosal dissection (ESD) in MD-EGC., Methods: Patients with differentiated-type EGC treated with ESD first from January 2015 to June 2021 were reviewed, including MD-EGC and pure differentiated-type EGC (PD-EGC). Clinical data, including the clinicopathological characteristics, resection outcomes of ESD, and recurrence and survival time, were collected, and the difference between MD-EGC and PD-EGC was tested., Results: A total of 48 patients (48 lesions) with MD-EGC and 850 patients (890 lesions) with PD-EGC were included. Compared with PD-EGC, MD-EGC had a higher submucosal invasion rate (37.5% vs. 13.7%, P <0.001) and lymphatic invasion rate (10.4% vs. 0.4%, P <0.001). The rates of complete resection (70.8% vs. 92.5%, P <0.001) and curative resection (54.2% vs. 87.4%, P <0.001) in MD-EGC were lower than those of PD-EGC. Multivariate analysis revealed that MD-EGC (OR 4.26, 95% CI, 2.22-8.17, P <0.001) was an independent risk factor for noncurative resection. However, when curative resection was achieved, there was no significant difference in the rates of recurrence ( P =0.424) between the 2 groups, whether local or metachronous recurrence. Similarly, the rates of survival( P =0.168) were no significant difference., Conclusions: Despite the greater malignancy and lower endoscopic curative resection rate of MD-EGC, patients who met curative resection had a favorable long-term prognosis., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Study Aims: Diffuse infiltrative gastric cancer can be difficult to diagnose owing to a lack of endoscopic features in the superficial mucosa. Moreover, a forceps biopsy may not reveal a pathological diagnosis. We aimed to evaluate the diagnostic yield and safety of endoscopic mucosal resection (EMR) and 'open-lid submucosal biopsy', a technique wherein EMR followed by biopsy of the ulcer floor is performed for a pathological diagnosis., Patients and Methods: This retrospective observational study involved patients with suspected diffuse invasive gastric cancer on endoscopy and cross-sectional imaging in whom endoscopic forceps biopsy did not lead to a pathological diagnosis. Patients who underwent EMR and open-lid submucosal biopsy were included. The primary outcome was the total diagnostic yield. The secondary outcomes were the diagnostic yields of EMR and open-lid submucosal biopsy and incidence of complications., Results: Between June 2011 and February 2022, EMR and open-lid submucosal biopsy for diagnostic purposes were performed on seven patients without complications. EMR was diagnostic in four (57%) cases of diffuse infiltrative gastric cancer. Open-lid submucosal biopsy was diagnostic in five (71%) cases. As the primary endpoint, the combination of EMR and open-lid submucosal biopsy led to a pathological diagnosis in six cases (86%). Secondary analysis revealed gastric adenocarcinoma in 9 of 22 (41%) EMR specimens, while open-lid submucosal biopsies were positive for adenocarcinoma in 14 of 60 specimens (23%)., Conclusions: The combination of EMR and open-lid submucosal biopsy was safe and showed good accuracy for the diagnosis of diffuse infiltrative gastric cancer.

Background and Aims: Tunneled endoscopic submucosal dissection (T-ESD) and pocket creation-method ESD (PCM-ESD) are considered to have technical advantages over conventional ESD (C-ESD). However, data comparing these techniques for ESD of gastric lesions are limited., Methods: PubMed and Cochrane databases were reviewed for relevant studies from their inceptions to October 31, 2023. Studies comparing T-ESD or PCM-ESD (T/PCM-ESD) with C-ESD for gastric lesions were included. The primary outcomes were dissection speed and en-bloc resection. Secondary outcomes were R0 resection, recurrence, perforation, and post-ESD bleeding. A random effects meta-analysis was conducted., Results: Eight observational studies (359 patients with T/PCM-ESD, 670 patients with C-ESD) were included. T/PCM-ESD was associated with a significantly faster dissection speed (mean difference, 4.42 mm 2 /min; 95% confidence interval [CI], 2.05-6.79; I 2  = 79%). There were no significant differences between the groups in terms of en-bloc resection (risk ratio [RR], 1.01; 95% CI, 1.00-1.03; I 2  = 0%), R0 resection (RR, 1.03; 95% CI, 0.99-1.07; I 2  = 0%), and recurrence (RR, 0.73; 95% CI, 0.14-3.84; I 2  = 0%). Although T/PCM-ESD was associated with a significantly lower risk of perforation (RR, 0.21; 95% CI, 0.06-0.80; I 2  = 0%), post-ESD bleeding rates were not significantly different., Conclusions: T/PCM-ESD facilitates faster and safer gastric ESD than C-ESD, with similar en-bloc resection, R0 resection, and recurrence rates. A future randomized controlled control trial is required., Competing Interests: Disclosure R. T. Pasam disclosed no financial relationships. The following authors disclosed financial relationships: H. Aihara: consultant for Olympus America, Boston Scientific, Fujifilm, BioDevek, ConMed, and Micro-Tech; research support from Boston Scientific; and advisory board member for EndoQuest Robotics and BioDevek; C. C. Thompson: consultant for Apollo Endosurgery, Boston Scientific, Medtronic, Endoquest Robotics, EnVision Endoscopy, ERBE, FujiFilm, and Olympus., (Copyright © 2025 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Elevation of early-stage gastrointestinal cancer using submucosal injection materials (SIMs) and postoperative wound care with adhesive materials are crucial for preventing complications arising from endoscopic submucosal dissection (ESD). Several types of SIMs have been developed; however, they often provide insufficient tissue elevation and fail to adequately adhere to the defect following the removal of early-stage gastrointestinal cancer. In this study, we present the development of injectable Cat-PBA-ApGltn hydrogels, which are based on catechol group-modified Alaska pollock gelatin (Cat-ApGltn) and phenylboronic acid-modified Alaska pollock gelatin (PBA-ApGltn), serving as multifunctional SIMs. A Cat-ApGltn/PBA-ApGltn mixed solution formed a hydrogel within 3 seconds. The resulting Cat-PBA-ApGltn hydrogels were easily injected manually through a 23 G needle due to their shear-thinning properties. Additionally, 10 w/v% Cat-PBA-ApGltn hydrogels demonstrated a 2.3-fold increase in mucosal elevation (7.2 ± 0.4 mm) compared with a commercially available SIM (3.1 ± 0.7 mm). The 10 w/v% Cat-PBA-ApGltn hydrogel, when adhered to porcine gastric submucosa, exhibited a burst strength 7 times greater than the average human intragastric pressure. Furthermore, the Cat-PBA-ApGltn hydrogels demonstrated biodegradability without inducing severe inflammation upon implantation in rat subcutaneous tissue. These Cat-PBA-ApGltn hydrogels hold promise as multifunctional SIMs, boasting injectability, excellent elevation, adhesion capabilities, and biodegradability., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

For gastric leiomyomas measuring ≥5 cm, endoscopic resection is necessary. The larger size of these tumors significantly impairs the resection field of view, increasing the risk of intraoperative bleeding and perforation and potentially leading to incomplete tumor removal. The combination of dental floss and tissue clip traction techniques is commonly used for resecting mucosal lesions but is rarely reported for submucosal tumors. We recently completed a case of endoscopic resection of a giant gastric leiomyoma in the body of the stomach, approximately 7 cm in length, using endoscopic submucosal dissection with dental floss clip traction. The dissection was carefully controlled within the muscularis propria layer, avoiding damage to the serosa. No bleeding or perforation occurred. A special technique was employed to avoid damage to the muscle layer. By combining this technique with tissue forceps, better traction stability may have been achieved. During the traction process, slight tension was consistently maintained between the swelling and the muscle layer, preventing perforation due to traction. The resection field remained clear throughout the procedure, which lasted 50 minutes in total. The final outcome was satisfactory. This method may be worthy of clinical application.

Oxyntic gland adenomas (OGAs) are benign gastric neoplasms composed of gland-forming epithelial cells with predominantly chief cell differentiation resembling oxyntic glands confined to the mucosa. If the tumor has submucosal invasion, it should be classified as gastric adenocarcinoma of fundic gland type. The OGAs can pose a diagnostic challenge, as they can resemble aggressive gastric neoplasms. There are no current guidelines on the management of OGA. Due to the relatively small size and low malignant potential, these lesions are typically managed endoscopically. In this case, we are reporting a 22-year-old woman who was diagnosed with OGA during evaluation of iron deficiency anemia and underwent successful endoscopic resection., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Endoscopic resection of gastric submucosal tumors (SMTs) possesses minimal trauma, expedited recovery, and reduced costs. Nonetheless, intraoperative challenges, including imprecise surgical risk assessment, prevail. Hence, we investigated the correlation between preoperative CT observation features and perioperative parameters for predicting outcomes in SMT patients., Methods: Subjects diagnosed with SMT and undergoing endoscopic surgery conducted at West China Hospital's Endoscopy Center from September 2019 to October 2023 were retrospectively selected. Endoscopic ultrasonography (EUS) and computer tomography (CT) were utilized for evaluating SMT. The study assessed the correlation between preoperative CT findings and perioperative parameters., Results: Increased lesion size on contrast-enhanced CT correlates with increased operative duration, hospital stay, postoperative antibiotic use. Of utmost significance, we observed a significantly higher intraoperative perforation rate for patients with tumor outgrowth compared to those with lesion involvement of the lumen (96.88% vs 29.11%, P < 0.001). These patients also demonstrated an increased risk of postoperative blood stream infections (P = 0.012), necessitating higher antibiotic grade (P = 0.048), along with prolonged gastrostomy tube retention (P = 0.001) and hospitalization (P = 0.018). In addition, CT provides a more accurate and comprehensive assessment of tumor size (P = 0.037) and growth pattern (P = 0.026) than EUS., Conclusion: CT assessment of tumor size closer to reality than EUS. Importantly, these features can assist in pinpointing lesions with elevated surgical complexity and high risk of complications, leading to improved preoperative preparation, thereby increasing anticipation of surgical risks and reducing incidence of complications., Competing Interests: Declarations. Disclosure: Yuxiang Chen, Mo Chen, Zhu Wang, Junchao Wu, Jinlin Yang, Li Yang and Kai Deng have no conflicts of interest to disclose., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

To date, no prospective study has been conducted to compare the safety and effectiveness of endoscopic snare resection with an elastic band (ESR-EB) and endoscopic snare resection with a transparent cap (ESR-C) for treating gastric muscularis propria lesions. We aimed to compare the safety and effectiveness of ESR-EB with those of ESR-C for gastric muscularis propria lesions less than 10 mm in diameter. A total of 64 patients were enrolled prospectively from May 2023 to November 2023 at Shenzhen Hospital of Southern Medical University, the First Affiliated Hospital of Shantou University, and the People's Hospital of Zhongshan City. The study compared clinical characteristics, tumour features, and surgical outcomes between the two groups. Of 64 patients, 29 underwent ESR-C, and 35 underwent ESR-EB. There were no differences in age, gender, location, tumour size, growth pattern, resection time, histology diagnosis, or follow-up time (P > 0.05). Complete resection was achieved in all the patients. The operation time was significantly greater in the ESR-C group than in the ESR-EB group (41.31 ± 9.87 min vs. 26.26 ± 10.32 min, P = 0.000). In the ESR-C cohort, 21 patients (72.41%) had perforation, and 1 patient (3.45%) had bleeding. In the ESR-EB group, 7 patients (20.00%) had perforation. The complication rate varied significantly between the two groups (P = 0.000). No recurrence or metastasis was observed in either group during the follow-up period. Both ESR-C and ESR-EB achieved a 100% complete resection rate for gastric muscularis propria lesions less than 10 mm in diameter.ESR-EB had the potential to reduce the operation time and lower the occurrence of complications. Chinese Clinical Trial Registry Identifier ChiCTR2300072856., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Disclosures: Drs. Zhaohui Liu, Xiangyu Wang, Genhua Yang, Jiefeng Li, Yongsheng Lu, Dayong Sun and Ruinuan Wu have no conflicts of interest or financial ties to disclose., (© 2024. The Author(s).)

Background: Submucosal invasion in early-stage gastric cancer (GC) is a critical determinant of prognosis and treatment strategy, significantly influencing the risk of lymph node metastasis and recurrence. Identifying risk factors associated with submucosal invasion is essential for optimizing patient management and improving outcomes., Aim: To comprehensively analyze clinical, imaging, and endoscopic characteristics to identify predictors of submucosal invasion in patients with early-stage differentiated GC., Methods: A retrospective study was conducted at our institution from January 2019 to January 2023, including 268 patients diagnosed with early-stage differentiated GC who underwent surgical resection or endoscopic submucosal dissection. Data were collected on demographic, clinical, imaging, and endoscopic characteristics, with endoscopic images reviewed independently by two gastroenterologists. Statistical analysis included univariate and multivariate logistic regression to identify significant predictors of submucosal invasion, and receiver operating characteristic (ROC) curve analysis to evaluate the predictive value of continuous variables., Results: A total of 268 patients were included, with 178 males and 90 females, and a mean age of 61.5 ± 9.8 years. Univariate analysis showed that male gender, history of alcohol consumption, smoking, and computed tomography-detected gastric wall thickening were more prevalent in patients with submucosal invasion. Significant endoscopic predictors included tumor location in the upper two-thirds of the stomach, depressed morphology, marginal elevation, and high color differences on white-light endoscopy (WLE) and linked color imaging (LCI). Multivariate analysis identified upper stomach location [odds ratio (OR): 5.268], depressed type (OR: 5.841), marginal elevation (OR: 4.132), and LCI color difference ≥ 18.1 (OR: 4.479) as significant predictors. ROC analysis showed moderate predictive value for lesion diameter, WLE, and LCI color differences (area under the curve: 0.630, 0.799, and 0.760, respectively)., Conclusion: Depressed-type lesions, marginal elevation, location in the upper two-thirds of the stomach, and significant color differences on LCI are high-risk indicators for submucosal invasion. These findings suggest that such lesions warrant more aggressive intervention to prevent disease progression and improve patient outcomes., Competing Interests: Conflict-of-interest statement: The authors declare that they have no competing interests., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Pharmacologic prophylaxis for gastric ulcer is commonly prescribed in patients hospitalized in the intensive care unit (ICU). The aim of the study was to assess the current prevalence and risk factors for gastric mucosa lesion in ICU patients receiving standard pharmacologic prophylaxis undergoing endoscopy for percutaneous gastrostomy implantation., Methods: Patients hospitalized in the mixed medical-surgical ICU undergoing percutaneous endoscopic gastrostomy (PEG) were analyzed. We excluded patients receiving either no or high doses of intravenous proton pump inhibitor (PPI), only patients receiving standard doses of PPI were included. Data retrieved from the electronic medical records included: demographics, risk factors for gastric mucosa lesion (use of stimulants, comorbidities, medications, treatment methods in the ICU, laboratory derangements) and endoscopic findings. The study compared a group of patients with gastric mucosa lesions (cases) vs. patients without gastric mucosa lesions (controls). Inter-group comparisons between cases and controls were performed. Depending on the type of distribution continuous variables were assessed using two-sample t-test or Mann-Whitney test, whereas categorical variables with Chi-squared or Fisher exact test. Odds ratio (OR) with 95% confidence interval (95% CI) were calculated. Statistical significance was assumed at p < 0.05., Results: Patients with no prophylaxis (n = 8) or receiving high doses (> 40 mg per day) of proton pump inhibitor (n = 2) were excluded. There were 182 patients receiving standard intravenous dose of PPI, 63 (34.6%) women and 119 (65.4%) men, with median age 61.5 (interquartile range IQR 46.0-70.0) years. Majority of patients (n = 169, 92.9%) were receiving pharmacological prophylaxis for venous thromboembolism. There were 53 (29.1%) patients with gastric mucosa lesion. The only risk factor that was significantly different between cases and controls was history of gastric ulcer (p = 0.04) with OR 3.8 (95% CI 1.1-12.5; p = 0.03)., Conclusions: Majority of various risk factors for gastric ulceration may not predict gastric mucosa lesion in ICU patients receiving standard pharmacological prophylaxis undergoing endoscopy for PEG implantation. We found that history of gastric ulcer may be a risk factor for gastric ulceration in the ICU patients. Patients with history of gastric ulcer might benefit from higher than standard doses of anti-ulcer medication when hospitalized in the ICU., Competing Interests: Declarations. Ethics approval and consent to participate: Due to retrospective character of the study, the Bioethics Committee of Medical University of Silesia decided that the study does not require an ethical review and waived the requirement for an informed consent (Ethics Committee of Medical University of Silesia in Katowice decision number: PCN/CBN/0022/KB/292/21). The study was conducted according to the principles expressed in the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To analyze the efficacy of curative endoscopic submucosal dissection (ESD) for patients with early cardia and non-cardia gastric cancer. Methods: Clinical data of patients with early gastric cancer who underwent curative ESD treatment in the Department of Gastroenterology, Zhongda Hospital, Southeast University from August 2016 to July 2023 were retrospectively collected. According to the location of lesions and postoperative pathology, the patients were divided into cardia group (early cardia gastric cancer and high-grade intraepithelial neoplasia) and non-cardia group. Follow-up ended in October 2023. Basic clinical information, endoscopy features and histopathological results, postoperative complications and prognosis were compared between the two groups. Kaplan-Meier method was used to present the survival curve and compare the metachronous recurrence-free survival rate and overall survival rate between the two groups. Results: A total of 279 patients were included, including 96 patients in the cardia group (83 males and 13 females), aged [ M ( Q 1 , Q 3 )] 68 (65, 74) years, and 183 patients in the non-cardia group (136 males and 47 females), aged 67 (59, 72) years. The follow-up duration after ESD was 35 (22, 53) months. Differences in postoperative pathological types and lesion invasion depth between the two groups were statistically significant (all P <0.05). The cardia group had the highest proportion of well/moderately differentiated adenocarcinoma [69.8% (67/96)] and T1-M3 invasion depth [58.3% (56/96)], while the non-cardia group had the highest proportion of well/moderately differentiated adenocarcinoma [52.5% (96/183)] and T1-M1 invasion depth [43.2% (79/183)]. The proportion of merging esophageal mucosal lesions [13.5% (13/96) vs 5.5% (10/183)] and deep cystic gastritis [19.8% (19/96) vs 2.7% (5/183)] in the cardia group were higher than those in the non-cardia group (all P <0.05). There were no statistically significant differences in postoperative complication rates [4.2% (4/96) vs 2.2% (4/183)] and mortality rates [1.0% (1/96) vs 2.2% (4/183)] between two groups (all P >0.05). The rate of metachronous recurrence in the cardia group [11.5% (11/96) vs 4.9% (9/183)] was higher than that in the non-cardia group ( P =0.044). The 1-year, 3-year, 5-year metachronous recurrence-free survival rates were 97.9%, 89.6%, 79.8% in the cardia group and 100.0%, 96.3%, 92.1% in the non-cardia group, with statistically significant difference ( P =0.015); the 1-year, 3-year, 5-year overall survival rates were 100.0%, 100.0%, 97.1% in the cardia group and 99.5%, 98.3%, 98.3% in the non-cardia group, with no statistically significant difference ( P =0.597). Conclusion: Compared to the non-cardia group, patients with early cardia gastric cancer treated with curative ESD have a poorer prognosis, with a higher incidence of metachronous recurrence.

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: Osamu Dohi received a collaboration research grant from Fujifilm Co., Ltd. All other authors have no conflict of interest to be disclosed.

Background and Aims: Endoscopic submucosal dissection (ESD) is a technically challenging resection technique for en bloc removal of dysplastic and early cancerous GI lesions. We conducted a single-arm retrospective study evaluating the safety and efficacy of a new through-the-needle injection-capable electrosurgical knife used in upper and lower ESD procedures performed at 6 U.S. academic centers., Methods: Data were retrospectively collected on consecutive cases in which the new ESD knife was used. The primary efficacy endpoint was successful ESD (en bloc resection with negative margins). Secondary efficacy endpoints included en bloc resection rate, curative resection rate, median ESD time, and median dissection speed. The safety endpoint was device- or procedure-related serious adverse events., Results: ESD procedures of 581 lesions in 579 patients were reviewed, including 187 (32.2%) upper GI and 394 (67.8%) lower GI lesions. Prior treatment was reported in 283 (48.9%) patients. Successful ESD was achieved in 477 (82.1% of 581) lesions-lower for patients with versus without submucosal fibrosis (73.6% vs 87.0%, respectively; P < .001) but similar for those with versus without previous treatment (81.7% vs 82.3%, respectively; P = .848). A total of 443 (76.2% of 581) lesions met criteria for curative resection. Median ESD time was 1.0 (range, 0.1-4.5) hour. Median dissection speed was 17.1 (interquartile range, 5.3-29.8) cm 2 /h. Related serious adverse events were reported in 15 (2.6%) patients, including delayed hemorrhage (1.9%), perforation (0.5%), or postpolypectomy syndrome (0.2%)., Conclusion: A newly developed through-the-needle injection-capable ESD knife showed a good success rate and excellent safety at U.S., Centers: (Clinical trial registration number: NCT04580940.)., Competing Interests: Disclosure H. Aihara: Consultant for Olympus America, Boston Scientific, Fujifilm, ConMed, MicroTech, BioDevek, and EndoQuest Robotics; advisory board for BioDevek and EndoQuest Robotics. M. O. Othman: Consultant for Olympus America, Boston Scientific, AbbVie, ConMed, Neptune Medical, Creo Medical, Lumendi, and Apollo; research grants from Lucid Diagnostics, AbbVie, Nestlé, ConMed, Olympus America, and Boston Scientific. S. A. Jawaid: Consultant for Creo Medical, Boston Scientific, Lumendi, and ConMed; grant support from the Texas Society of Gastrointestinal Endoscopy. E. Gorgun: Consultant for Boston Scientific, Olympus America, and Lumendi. N. Sharma: Consultant for Boston Scientific, Medtronic, Steris, and Olympus America. U. D. Siddiqui: Consultant for Olympus America, Boston Scientific, Cook, Medtronic, ConMed; research support: Olympus America and Boston Scientific. J. A. Peetermans: Full-time employee of Boston Scientific. M. J. Rousseau: Full-time employee of Boston Scientific. M. Nishimura: Consultant for Boston Scientific, Olympus America, and Fujifilm. All authors received financial research support from Boston Scientific for this study., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Motohiko Kato received lecture fees and clinical research fees from Fujifilm. The other authors declare no conflicts of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

A 43-year-old female underwent gastroscopy due to abdominal discomfort. Gastroscopy showed a submucosal eminence at the greater curvature of the antrum, with smooth surface mucosa, biopsy pathology suggests inflammation. We scheduled an endoscopic ultrasonography (EUS) for her. EUS revealed that the size of the lesion was about 8.7mm*10.8mm, with hypoechoic changes, which originated in the submucosa. Endoscopic submucosal dissection was performed, and representative photomicrographs of histologic sections were shown. The patient was diagnosed with gastric inverted hyperplastic polyp (GIHP) with heterotopic pancreas (HP).

Background: The aim of this study was to compare and analyze the clinical effects of endoscopic submucosal dissection (ESD) and endoscopic band electrocision ligation (EEL) in the removal of gastric submucosal tumors (SMTs)., Method: We analyzed the clinical data of 130 patients with gastrointestinal SMTs (diameter ≤10 mm) who underwent endoscopic resection, including 62 cases in the EEL group and 68 in the ESD group, and compared indicators such as surgical time, intraoperative and postoperative complications, postoperative hospital stay, and surgical cost, between the EEL and ESD group., Results: EEL surgery time (8.9 ± 1.1 min) was significantly shorter than the ESD group (62.3 ± 2.8 min) ( p  < .05), EEL surgery cost (5126.8 ± 26.5 yuan) was significantly lower than the ESD group (15721.3 ± 39.6 yuan) ( p  < .05), and intraoperative blood loss was also markedly lower in the EEL group (5.6 ± 1.7 ml) compared to the ESD group (42.3 ± 3.5 ml) ( p  < .05). There was no statistically significant difference in postoperative hospitalization time or postoperative complication incidence between the two groups ( p  > .05)., Conclusions: In treating gastric muscular, mucosal, or submucosal tumors with a diameter of less than 10 mm, the EEL surgical method was superior to the ESD surgical method in terms of surgical time, intraoperative blood loss, and cost. There was no difference in hospital stay and postoperative complication rate between the two methods, which was worthy of clinical application.

Competing Interests: Mitsuru Esaki is a consultant for AI Medical Service Inc. Haruei Ogino is part of an endowed course supported by Miyarisan Pharmaceutical Co., Ltd.; Fujifilm Medical Co., Ltd.; Terumo Corporation; and Fancl Corporation. Eikichi Ihara received lecture fees from Takeda Pharmaceutical Co., Ltd. and EA Pharma Co., Ltd. The other authors declare no conflicts of interest.

Competing Interests: O. Haruei is part of an endowed course supported by Miyarisan Pharmaceutical Co., Ltd.; Fujifilm Medical Co., Ltd.; Terumo Corporation; and Fancl Corporation. I. Eikichi received lecture fees from Takeda Pharmaceutical Co., Ltd. and EA Pharma Co., Ltd. R. Maruoka, M. Esaki, Y. Minoda, Y. Otsuka, and K. Haraguchi declare that they have no conflicts of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: S. Shichijo has received honoraria from Fujifilm Medical, Olympus, EA Pharma, Astra Zeneca, AI Medical Service, and Janssen Pharmaceutical. N. Uedo has received honoraria from Olympus, Fujifilm Medical, Boston Scientific, Daiichi-Sankyo, Takeda Pharmaceutical, EA Pharma, Otsuka Pharmaceutical, AstraZeneca, Miyarisan Pharmaceutical, and AI Medical Service. H. Mori, K. Higashino, and T. Michida declare that they have no conflict of interest.

Competing Interests: The authors declare that they have no conflict of interest.

Background: Submucosal fibrosis is associated with adverse events of endoscopic submucosal dissection (ESD). The present study mainly aimed to establish a predictive model for submucosal fibrosis in patients with early gastric cancer (EGC) undergoing ESD., Methods: Eligible patients with EGC, identified at Qilu Hospital of Shandong University from April 2013 to December 2023, were retrospectively included and randomly split into a training set and a validation set in a 7:3 ratio. Logistic regression analyses were used to pinpoint the risk factors for submucosal fibrosis. A nomogram was developed and confirmed using receiver operating characteristic (ROC) curves, calibration plots, Hosmer-Lemeshow (H-L) tests, and decision curve analysis (DCA) curves. Besides, a predictive model for severe submucosal fibrosis was further conducted and tested., Results: A total of 516 cases in the training group and 220 cases in the validation group were recruited. The nomogram for submucosal fibrosis contained the following items: tumour location (long axis), tumour location (short axis), ulceration, and biopsy pathology. ROC curves showed high efficiency with an area under the ROC of 0.819 in the training group, and 0.812 in the validation group. Calibration curves and H-L tests indicated good consistency. DCA proved the nomogram to be clinically beneficial. Furthermore, the four items were also applicable for a nomogram predicting severe fibrosis, and the model performed well., Conclusion: The predictive models, initially constructed in this study, were validated as convenient and feasible for endoscopists to predict submucosal fibrosis and severe fibrosis in patients with EGC undergoing ESD.

Nowadays, endoscopic submucosal dissection (ESD) is commonly performed for the removal of large gastrointestinal lesions. Endoscopic mucosal defect closure after ESD is vital to avoid adverse events. In recent years, many innovative instruments have emerged and proved to be beneficial. In this paper, we conducted a thorough literature review and summarized the closure methods for large-size post-ESD mucosal defects over decades. We separated these methods into five categories based on the operational principle: "side closure" method, "ring closure" method, "layered closure" method, "hand suturing closure" method, and "specially designed device closure" method. Side closure with clips assisted by instruments such as threads or loops is applicable for each segment of the gastrointestinal tract to prevent postoperative bleeding. If the defect tension is too large to close with the traditional side closure methods, zigzag closure and ring closure could be applied to gather the bilateral defect edges together and achieve continuous closure. In the stomach and rectum with a high risk of submucosal dead space between the submucosa and muscular layers, side closure methods with muscle layer grasping clip or layered closure methods could enable the involvement of the deep submucosa and muscle layers. The ring closure method and specially designed devices including over-the-scope clip, Overstitch, and X-tack could resolve perforation effectively. Individual closure method requires endoscope reinsertion or sophisticated operation, which may be limited by the deep location and the narrow lumen, respectively. Although specially designed devices are expected to offer promising prospectives, the cost-effectiveness remains to be a problem., (© 2024 The Author(s). Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background and Aims: EMR and endoscopic submucosal dissection (ESD) are minimally invasive endoscopic techniques, developed for the removal of benign and early malignant lesions throughout the GI tract. Submucosal injection of a marking agent can help to identify lesions during surgery. Endoscopic resection frequently involves "lifting" of the lesions by injection of a substance within the submucosal space to create a cushion for safe resection. This review summarizes the current techniques and agents available for endoscopic marking and lifting of GI tract lesions., Methods: The MEDLINE database was searched through April 2023 for relevant articles related to the lifting and marking aspect of EMR by using key words such as "endoscopy" or "endoscopic" combined with "marking," "tattoo," and "lifting." The report was drafted, reviewed, and edited by the American Society for Gastrointestinal Endoscopy Technology Committee and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy., Results: This technology review describes the techniques for endoscopic tattoo placement and submucosal lifting, along with currently available agents, safety, and costs., Conclusions: Endoscopists performing EMR and ESD have several choices in submucosal injection materials for lifting and marking agents for tattoos. These may be commercially prepared agents or off-the-shelf materials with or without additives to facilitate visualization. A thorough understanding of the indications, techniques, properties of various agents, costs, and adverse events is necessary in choosing the appropriate materials and technique to optimize lesion resection in EMR and ESD., Competing Interests: Disclosure The following authors disclosed financial relationships: A. Bhatt: Consultant for Medtronic, Inc, US Endoscopy, Olympus Corporation, and Intuitive Surgical Inc; patent-holder for a commercial device licensed to Medtronic, Inc. V. S. Akshintala: Board member for Origin Endoscopy Inc; consultant for Dragonfly Endoscopy Inc; research support from Abbvie, Boston Scientific Corporation, and Medtronic. Y. Chen: President of Chess Medical; consultant for Boston Scientific Corporation. K. K. Das: Consultant for Olympus Medical Systems Corporation; patent-holder with Interpace Biosciences. A. Kahn: Consultant for MiMedx. K. Krishnan: Consultant for Boston Scientific Corporation and Olympus Corporation of the Americas. G. Leung: Consultant for Boston Scientific Corporation, Steris Corporation, AI Medical Service, and Mirai Medical. D. R. Lichtenstein: Consultant for Olympus Corporation of the Americas and Boston Scientific Corporation; speaker for Olympus Corporation of the Americas and Boston Scientific Corporation; Clinical Events Committee for Boston Scientific Corporation (chair) and SafeHeal; advisory board and research committee for Iterative Health; GI boards committee for the American Board of Internal Medicine. G. Mishra: Consultant for Pentax of America, Inc and Cook Medical LLC. V. Raman Muthusamy: Consultant for Medtronic and Boston Scientific Corporation; research support from Boston Scientific Corporation; stock options/equity in Capsovision; advisory board for Endogastric Solutions and Motus GI. J. V. Obando: Shareholder with Surgenly LLC. S. Pawa, T. Rustagi, G. Trikudanathan: Consultant for Boston Scientific Corporation. M. Saumoy: Consultant for Becton, Dickinson and Company and Intuitive Surgical, Inc. A. J. Trindade: Consultant for Pentax of America, Inc, Boston Scientific Corporation, Lucid Diagnostics, and Exact Science. J. Yang: Consultant for Cook Medical, Interscope, and Steris. R. Law: Consultant for Conmed Corporation, Boston Scientific Corporation, Olympus America Inc, and Medtronic USA Inc; royalties from UpToDate. All other authors disclosed no financial relationships., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Background: Composite tumors are neoplasms comprising two distinct, yet intermingling, cell populations. This paper reports a rare phenomenon where early gastric signet-ring cell carcinoma (SRCC) and gastric mucosa-associated lymphoid tissue (MALT) lymphoma coexist within the same lesion., Case Summary: A 40-year-old woman presented to the West China Hospital for examination, which revealed a whitish, shallow, and uneven mucosal lesion in the stomach. The lesion was diagnosed as a poorly differentiated adenocarcinoma, including SRCC with atypical lymphoid hyperplasia associated with Helicobacter pylori infection, based on histopathological examination of the biopsy specimen. The lesion was excised using segmental gastrectomy. However, histological examination of the surgical specimen confirmed that it was a poorly differentiated gastric adenocarcinoma with features of SRCC and MALT lymphoma. These two entities were stage I and coexisted in the same lesion., Conclusion: It is uncommon for gastric SRCC and MALT lymphoma to coexist without distinct borders. Surgical resection is effective for these lesions., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: To investigate the safety and efficacy of endoscopic subserosal dissection for patients with submucosal tumors in the upper gastrointestinal tract., Methods: This retrospective single-center study included 16 patients who underwent ESSD. All patients were enrolled from July 2018 to Dec 2021. Parameters such as demographics, size, resection margin, complications, pathological features, procedure time and follow-up were investigated and analyzed., Results: Our study achieved 100% en bloc resection and 100% R0 resection. The most common location was the corpus with a mean tumor size of 2.78 ± 1.56 cm. The mean age, procedure time, were 53.4 ± 10.3 years, 85.31 ± 46.64 min respectively. Acocording to National Institutes of Health classification, 7 (13, 53.85%), 5 (13, 38.46%) ,and 1 (13, 7.69%) objects belonged to the very low, low, and intermediate classification, respectively. Immunohistochemistry results showed a 100% positive rate of CD34, DOG-1, CD117, and Ki67. A mean follow-up of 9.3 ± 2.5 months showed no recurrence or metastasis., Conclusions: ESSD is effective and safe surgical procedure for curative removal of gastrointestinal submucosal tumors in the upper gastrointestinal tract, and it can be preferred for patients with no metastasis., (© 2024. The Author(s).)

Background: Endoscopic resection (ER) of gastric submucosal tumors (G-SMTs) is challenging due to the difficulty of exposure. Traction-assisted ER has been shown to provide better outcomes than traditional endoscopic operation by exposing the dissection plane. In this study, we investigated the efficacy and safety of the snare traction-assisted method in ER of G-SMTs., Method: From May 2021 to March 2023, we used snare traction-assisted method to treat 24 patients with 24 G-SMTs in our department. Clinical characteristics and the outcomes of ER were recorded., Result: The mean tumor diameter was 1.8±0.9 cm. Six G-SMTs underwent endoscopic submucosal dissection (ESD), and 18 underwent endoscopic full-thickness resection (EFTR). En bloc resection and R0 resection was achieved in all the 24 lesions. The average procedure time was 45.4 ± 23.4 minutes. The patients were discharged in 5.0 days after procedures, without delayed bleeding or other adverse events., Conclusion: Snare traction-assisted method provides an effective traction for endoscopic resection of G-SMTs even if the tumor is difficult to remove. While further studies comparing the snare traction-assisted method with the conventional procedure are necessary.

Background: Endoscopic submucosal dissection (ESD) is an effective treatment for early-stage gastrointestinal cancers. However, traditional surgical instruments lack accuracy and force-sensing., Methods: A new type of continuum robot for ESD is designed. An accurate static model of the proposed continuum robot is established, considering cases where the robot bends into C-shapes and S-shapes. A force estimation method based on an accurate static model is proposed. Then, the accuracy of the static model and force estimation is verified through experiments. Finally, an ex-organ experiment is carried out., Results: The average position error of the proposed static model is 0.72 mm, accounting for 2.57% of the total robot length. The average error of force estimation is 19.53 mN. By gripping and cutting ex-porcine gastric mucosa, the robot's functionality is validated., Conclusion: This paper contributes to precise control and safe interaction of continuum robots., (© 2024 John Wiley & Sons Ltd.)

We report the case of a 68-year-old female patient who had a gastrointestinal stromal tumor involving muscularis propria of the gastric body that was removed through submucosal tunneling endoscopic resection, with favorable follow-up after 5 years, with no signs of recurrence.

Endoscopic resection (ER)-a minimal invasive procedure, compared to surgical gastrectomy, with the advantage of preserving the entire stomach and maintaining the patient's quality of life-is a widely used curative treatment for early gastric cancers (EGCs). Despite its advantages, such as the preservation of the whole stomach, a large area of the gastric mucosa with histologic changes such as atrophy and intestinal metaplasia remains after ER, and so does the risk of metachronous gastric cancers (MGCs). Therefore, regular surveillance endoscopy after curative ER of EGCs is important so that MGCs are detected early and so minimally invasive ER remains a treatment option. To date, the optimal interval for surveillance endoscopy after curative ER of EGCs has not been established. Therefore, this review summarizes the results of the published studies on this topic with the aim of establishing the optimal surveillance interval for early identification of MGCs. Based on my review, the median timing of MGC occurrence is within 3 years, and reports suggest biannual endoscopy during the first 3 years; however, the evidence suggests that individual patient characteristics may influence the risk of MGCs. Therefore, stratified endoscopic strategies for surveillance based on patient characteristics, such as age, family history of gastric cancer, synchronous gastric lesions, and corpus intestinal metaplasia, should be applied.

Background/aims: Lymphoepithelioma-like carcinoma (LELC) is a rare subtype of gastric cancer. We aimed to identify the clinicopathological features and rate of lymph node metastasis (LNM) to investigate the feasibility of endoscopic submucosal dissection for early gastric LELC confined to the mucosa or submucosa., Methods: We compared the clinicopathological characteristics of 116 early gastric LELC patients and 5,753 early gastric well- or moderately differentiated (WD or MD) tubular adenocarcinoma patients treated by gastrectomy., Results: Compared to WD or MD early gastric cancer (EGC) patients, early LELC patients were younger and had a higher prevalence of proximally located tumors. Despite more frequent deep submucosal invasion (86.2% vs 29.8%), lymphatic invasion was less frequent (6.0% vs 16.2%) in early LELC patients than in WD or MD EGC patients. Among tumors with deep submucosal invasion, the tumor size was smaller, lymphatic invasion was less frequent (6.0% vs 40.2%) and the rate of LNM was lower (10.0% vs 19.4%) in patients with LELC than in those with WD or MD EGC. The overall rate of LNM in early LELC patients was 8.6% (10/116). The risk of LNM in patients with mucosal, shallow submucosal invasive, or deep submucosal invasive LELC was 0% (0/6), 0% (0/10), and 10% (10/100), respectively., Conclusions: Early LELC is a distinct subtype of EGC with more frequent deep submucosal invasion but less lymphatic invasion and LNM than WD or MD EGCs. Endoscopic submucosal dissection may be considered curative for patients with early LELC confined to the mucosa or shallow submucosa, given its negligible rate of LNM.

Background: To date, there is still a lack of standardized management strategies for gastric low-grade dysplasia (LGD), which is a direct neoplastic precancerous lesion and requires specifically superficial destruction. Radiofrequency ablation (RFA) is expected to be an effective method for gastric LGD, but post-RFA pain may affect patients' satisfaction and compliance. The current study aimed to evaluate the value of a submucosal injection prior to RFA (SI-RFA) for postoperative pain and treatment outcomes., Methods: Between October 2014 and July 2021, gastric LGDs without risk factors (size >2 cm, unclear boundary, and abnormal microsurface and microvascularity) undergoing regular RFA and SI-RFA were retrospectively analyzed. Postoperative pain scores, wound healing, and clinical efficacy were compared. Propensity score matching, stratified analysis, and multivariable logistic regression were performed to control the confounding variables., Results: One hundred and ninety-seven gastric LGDs in 151 patients received regular RFA. Forty-nine gastric LGDs in 36 patients received SI-RFA. Thirty-six pairs of patients were selected for the assessment of postoperative pain by propensity score matching. Compared to regular RFA, SI-RFA significantly decreased the degree and duration of postoperative pain (OR, 0.32; 95% CI, 0.13-0.84; P = 0.020), improved wound healing rate (80.0% [36/45] vs . 58.9% [89/151], P = 0.012), increased the complete ablation rate (91.8% [45/49] vs . 86.3% [170/197], χ2 = 1.094, P = 0.295), but correlated with higher rates of local recurrence and progression (25.6% [10/39] vs . 13.2% [18/136], χ2 = 3.471, P = 0.062; 8.3% [3/36] vs . 0.9% [1/116], P  = 0.042). The multivariable logistic regression model confirmed that submucosal injection was associated with local recurrence (OR, 2.93; 95% CI, 1.13-7.58; P = 0.027)., Conclusions: Submucosal injections prior to RFA may reduce postoperative pain and scar formation while ensuring complete ablation of gastric LGD. However, local recurrence and progression should be considered seriously., (Copyright © 2024 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.)

Objective: To evaluate the safety and effectiveness of transparent cap-assisted blunt dissection (TCABD) in the endoscopic resection of gastric submucosal tumours (G-SMT) smaller than 2cm, as compared with conventional electronic knife dissection., Study Design: Randomised controlled analysis. Place and Duration of the Study: Department of Gastrointestinal Surgery, The School of Clinical Medicine, Fujian Medical University, The First Hospital of Putian City, Putian, China, from July 2020 to 2022., Methodology: Fifty-eight patients having G-SMT smaller than 2cm were included. They were randomly divided into two groups; undergoing transparent cap-assisted blunt dissection (BD group) and conventional endoscopic submucosal excavation (ESE group). The pathology, lesion size in long diameter (mm), operation time, the number of clips used to close the wounds, the number of snare used to resect the tumour, hospital days, hospitalisation expense, en bloc resection rate, and the complications including perforation, postoperative bleeding, and postoperative infection were compared between the two groups., Results: The mean long diameter in the BD group was 9.6 ± 3.6mm, while the conventional ESE group was 10.7 ± 4.5mm. As compared with the conventional ESE group, the operation time, the number of clips used to close the wounds, the number of snare used to resect the tumours, the hospital days, and the hospitalisation expense were all significantly decreased (p <0.05). The perforation rate was lower in the BD group (p <0.05)., Conclusion: TCABD was effective and safe in the endoscopic resection of G-SMT smaller than 2cm. TCABD could help to reduce the perforation rate, shorten the operation time and hospital days, and decrease the hospitalisation expense in the endoscopic resection of G-SMT., Key Words: Endoscopic submucosal excavation, Endoscopic full-thickness resection, Endoscopic resection, Submucosal tumour, Transparent cap-assisted blunt dissection.

Background: Gastric endoscopic submucosal dissection (ESD) for lesions located on the greater curvature of the upper and middle (U/M) third of the stomach remains challenging, even for experienced endoscopists. Accordingly, we have developed a novel traction technique, termed the outside-lesion clip-thread method (O-CTM). In this method, a clip thread is attached to the healthy mucosa outside the circumferential incision line, and traction is applied to bring the scope and lesion into proximity for ESD. Here, we assessed the efficacy of ESD using the O-CTM compared to ESD without the O-CTM., Methods: We retrospectively reviewed data from 63 consecutive patients who underwent gastric ESD for 63 lesions located on the greater curvature of the U/M third of the stomach between September 2015 and April 2024. The primary outcome was the operation time, and secondary outcomes were resection speed, en bloc resection, R0 resection and complications in the O-CTM and without O-CTM ESD groups., Results: Of the 63 included lesions, 37 were resected without the O-CTM between September 2015 and June 2022 (without O-CTM group), and 26 lesions were resected using the O-CTM between July 2022 and April 2024 (O-CTM group). The O-CTM group had significantly shorter operation times (40 min vs. 77 min, p = 0.01) than the without O-CTM group. The resection speed was also significantly faster (20.1 mm 2 /min vs. 11.3 mm 2 /min, p = 0.02). No significant differences in en bloc resection rate, R0 resection rate, and complications were observed., Conclusions: Gastric ESD using O-CTM is beneficial when compared with the ESD without O-CTM in reducing operation time and improving resection speeds for treating lesions located on the greater curvature of the U/M region., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Endoscopic submucosal dissection (ESD) is widely used as a standard treatment regimen for early gastric cancers (EGCs). However, such an approach is time consuming and has a high risk of perforation and bleeding in some corner-site lesions because of the obscured view and difficulty in submucosal lifting. The newly developed pocket-creation method (PCM) provides a clearer view and better traction of the submucosal layer than conventional ESD (c-ESD). Nevertheless, no prospective randomized study has evaluated the efficacy of the PCM in EGCs and precancerous lesions., Methods: This was a prospective randomized controlled trial. Patients with superficial gastric neoplastic lesions ≥ 20 mm were randomly assigned to the PCM-ESD group or c-ESD group. The primary outcome was dissection speed., Results: There were 28 patients in the PCM-ESD group and 27 in the c-ESD group. The median dissection speed was significantly higher in the PCM-ESD group than in the c-ESD group (21.5 mm 2 /min vs 14.3 mm 2 /min, P < .001). Meanwhile, the operation time in the PCM-ESD group was significantly shorter than that in the c-ESD group (30 vs 40 min, P = .047). In multiple linear regression analysis, the treatment method was independently associated with the resection speed of ESD., Conclusion: PCM-ESD was an effective and safe treatment for EGCs and precancerous lesions., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: The incidence of local recurrence following gastric endoscopic submucosal dissection (ESD) remains a clinical concern. We aimed to evaluate the impact of narrow safety margin (< 1 mm) on the recurrence rate., Methods: A retrospective cohort study was conducted across two centers. Cases of R0-ESD with subsequent recurrence were compared to matched controls in a 1:2 ratio in a case-cohort analysis., Results: Over a median period of 25 months (IQR 14-43), a recurrence rate of 3% (95%CI 1.7-4.3) was observed, predominantly (13/21) following R0 resections with favourable histology. Endoscopic retreatment was feasible in 18 of 21 recurrences. The proportion of R0-cases where the safety margin in both horizontal (HM) and vertical (VM) margin exceeded 1 mm was similarly distributed in the recurrence and non-recurrence group, representing nearly 20% of cases. However, cases with HM less than 1 mm, despite VM greater than 1 mm, nearly doubled in the recurrence group (7.7% vs . 3.9%), and tripled when both margins were under 1 mm (23.1% vs . 7.7%). Despite this trend, statistical significance was not achieved ( p  = 0.05). In the overall cohort, the only independent risk factor significantly associated with local recurrence was the presence of residual tumor at the HM (HM1) or not assessable HM (HMx) (OR 16.5 (95%CI 4.4-61.7), and OR 11.7 (95%CI 1.1-124.1), respectively)., Conclusions: While not common or typically challenging to manage, recurrence post-ESD warrants attention and justifies rigorous post-procedural surveillance, especially in patients with HM1, HMx, and probably also in those with R0 resections but narrow safety margin.

Background: Changes in gastric microbiome are associated with gastric carcinogenesis. Studies on the association between gastric mucosa-associated gastric microbiome (MAM) and metachronous gastric cancer are limited. This study aimed to identify gastric MAM as a predictive factor for metachronous recurrence following endoscopic resection of gastric neoplasms., Method: Microbiome analyses were conducted for 81 patients in a prospective cohort to investigate surrogate markers to predict metachronous recurrence. Gastric MAM in non-cancerous corporal biopsy specimens was evaluated using Illumina MiSeq platform targeting 16S ribosomal DNA., Results: Over a median follow-up duration of 53.8 months, 16 metachronous gastric neoplasms developed. Baseline gastric MAM varied with Helicobacter pylori infection status, but was unaffected by initial pathologic diagnosis, presence of atrophic gastritis, intestinal metaplasia, or synchronous lesions. The group with metachronous recurrence did not exhibit distinct phylogenetic diversity compared with the group devoid of recurrence but showed significant difference in β-diversity. The study population could be classified into two distinct gastrotypes based on baseline gastric MAM: gastrotype 1, Helicobacter-abundant; gastrotype 2: Akkermansia-abundant. Patients in gastrotype 2 showed higher risk of metachronous recurrence than gastrotype (Cox proportional hazard analysis, adjusted hazard ratio [95% confidence interval]: 5.10 [1.09-23.79])., Conclusions: Gastric cancer patients can be classified into two distinct gastrotype groups by their MAM profiles, which were associated with different risk of metachronous recurrence., (© 2024. The Author(s) under exclusive licence to The International Gastric Cancer Association and The Japanese Gastric Cancer Association.)