Yuto Shimamura

Efficacy of single-incision needle-knife biopsy for sampling subepithelial lesions

Background and study aimsu2003Single-incision needle-knife (SINK) biopsy is a diagnostic method for acquiring tissue samples for subepithelial lesions (SELs). A single linear incision is made in the overlying mucosa and tissue samples are obtained by passing conventional biopsy forceps through the opening and deep into the lesion. The aim of this study was to describe the efficacy and safety of this technique. Patients and methodsu2003Consecutive patients who underwent SINK biopsy for an upper gastrointestinal SEL between October 2013 and September 2015 were retrospectively reviewed. Resultsu2003Forty-nine patients underwent 50 SINK biopsies. Sufficient sampling for a definite pathologic diagnosis was obtained in 42 (86u200a%) cases, with 91u200a% (40/44) having sufficient sample to perform immunohistochemistry when deemed clinically relevant. Of the 26 patients with prior non-diagnostic biopsies or FNA, a specific diagnosis was obtained in 85u200a% (22/26). There were no significant adverse events. Conclusionsu2003SINK biopsy is a safe and feasible strategy for obtaining a definitive tissue diagnosis with immunohistochemistry for SELs.

Multipoint traction technique in endoscopic submucosal dissection

re 1. A, A pale depressed lesion along the greater curvature of the stomach. Examination of biopsy specimen revealed poorly differentiated adenonoma. B, After mucosal incision, multipoint traction method was applied as follows: the snare was grasped with the clip after pulling out the scope. cope was reintroduced and advanced to the lesion, where the snare-bound clip was deployed on the anal side of the specimen. Additional clips were on the lesion to create multipoint traction. C, By pulling the snare, the submucosal layer could be clearly visualized. D, Submucosal dissection was rmed under ideal visualization, and the lesion was resected en bloc. E, A 40-mm flat erythematous lesion in the midesophagus was noted on routine scopy. F, The lesion remained unstained after iodine staining, thus raising suspicion for squamous cell neoplasia. G, After circumferential incision a water jet–assisted triangle tip knife, the multipoint traction method was applied. The scope was withdrawn, and the coagulation forceps was used to the snare. This was then advanced to the lesion, and the clip was deployed to anchor the oral edge of the specimen. Two clips were added for ipoint traction. H, The snare was pulled to create adequate traction. I, Submucosal dissection was carried out uneventfully, and the specimen esected en bloc.

Role of video capsule endoscopy in patients with constitutional mismatch repair deficiency (CMMRD) syndrome: report from the International CMMRD Consortium

Background and study aimsu2002 Constitutional mismatch repair deficiency (CMMRD) syndrome, also known as biallelic mismatch repair deficiency (BMMRD) syndrome is a rare autosomal-recessive genetic disorder that has a high mortality due to malignancy in childhood and early adulthood. The small bowel phenotype in CMMRD is not well described and surveillance protocols for small bowel cancer have not been well established. This study was conducted to evaluate the usefulness and clinical impact of video capsule endoscopy (VCE) for small bowel surveillance. Patients and methodsu2002 We retrospectively reviewed the prospectively maintained International CMMRD Consortium database. Treating physicians were contacted and VCE report data were extracted using a standardized template. Resultsu2002 Among 58 patients included in the database, 38 VCE reports were collected from 17 patients. Polypoid lesions were first detected on VCE at a median age of 14 years (range: 4u200a–u200a17). Of these, 39u200a% in 7 patients (15/38) showed large polypoid lesions (>u200a10u200amm) or multiple polyps that prompted further investigations. Consequently, three patients were diagnosed with small bowel neoplasia including one patient with adenocarcinoma. Small bowel neoplasia and/or cancer were confirmed histologically in 35u200a% of the patients (6/17) who had capsule surveillance and the lesions in half of these patients were initially visualized on VCE. Multiple polyps were identified on eight VCEs that were completed on three patients. Ten VCEs (28u200a%) were incomplete due to slow bowel transit; none required capsule removal. Conclusionsu2002 Small bowel surveillance in patients with CMMRD should be initiated early in life. VCE has the potential to detect polyps; however, small bowel neoplasias are often proximal and can be missed, emphasizing the importance of concurrent surveillance with other modalities. Meeting presentations u2002Digestive Disease Week 2017 and World Congress of Pediatric Gastroenterology, Hepatology and Nutrition 2016.

Endoscopic treatment of Barrett's esophagus: What can we learn from the Western perspective?

The incidence of Barretts esophagus (BE)‐related neoplasia in Western countries has increased in the past several decades and, even in Eastern countries, it appears to be increasing. Endoscopic therapies are the first‐line treatment for BE‐related neoplasia; however, there is still no standardized treatment strategy. Most of the data have been published from Western countries where the ultimate goal of treatment is complete eradication of BE mucosa removing subtle synchronous lesions and preventing metachronous neoplasia. A multimodality approach that combines endoscopic resection and radiofrequency ablation (RFA) has been widely accepted in the West. In contrast, the lack of access to RFA treatment in the East has meant that endoscopic resection is the only feasible option. There is a wide divergence in treatment strategies for BE‐related neoplasia between the East and the West. It is very important to consider these basic differences in the context of the currently available evidence to date. Therefore, the purpose of this article is to review the recent literature and to provide an overview of the endoscopic treatment options for BE.