Progression of duodenal neoplasia to advanced adenoma in patients with familial adenomatous polyposis.

Background: Patients with familial adenomatous polyposis (FAP) have a lifetime risk of developing duodenal adenomas approaching 100%, and the relative risk for duodenal cancer compared with the general population is high. We conducted a retrospective study to investigate the progression of non-ampullary duodenal adenomas (NADAs) and risk factors for advanced lesions in patients with FAP.

Methods: Of 248 patients with 139 pedigrees at 2 institutes, we assessed 151 patients with 100 pedigrees with a pathogenic germline variant in the adenomatous polyposis coli gene, excluding mosaic variants.

Genotype-phenotype correlation for extracolonic aggressive phenotypes in patients with familial adenomatous polyposis.

Familial adenomatous polyposis (FAP) patients develop various life-threatening extracolonic comorbidities that appear individually or within a family. This diversity can be explained by the localization of the adenomatous polyposis coli (APC) variant, but few reports provide definitive findings about genotype-phenotype correlations. Therefore, we investigated FAP patients and the association between the severe phenotypes and APC variants.

Feasibility of underwater endoscopic mucosal resection for endoscopic management of gastric neoplasms in patients with familial adenomatous polyposis.

Background: Underwater endoscopic mucosal resection (UEMR) has been developed as an effective endoscopic intervention for colon, rectum, and duodenum neoplasms. However, there are no comprehensive reports regarding the stomach, and its safety and efficacy are unknown. We aimed to examine the feasibility of UEMR for gastric neoplasms in patients with familial adenomatous polyposis (FAP).

Efficacy and safety of intensive downstaging polypectomy (IDP) for multiple duodenal adenomas in patients with familial adenomatous polyposis: a prospective cohort study.

Background: Patients with familial adenomatous polyposis (FAP) risk developing multiple duodenal adenomas (MDAs), leading to duodenal cancer and death. We investigated the efficacy and safety of intensive downstaging polypectomy (IDP) for MDAs integrated with new-generation procedures.

Methods: This prospective phase II study, conducted at a tertiary cancer center, enrolled patients with FAP who had MDAs.

Utility of an artificial intelligence system for classification of esophageal lesions when simulating its clinical use.

Previous reports have shown favorable performance of artificial intelligence (AI) systems for diagnosing esophageal squamous cell carcinoma (ESCC) compared with endoscopists. However, these findings don't reflect performance in clinical situations, as endoscopists classify lesions based on both magnified and non-magnified videos, while AI systems often use only a few magnified narrow band imaging (NBI) still images. We evaluated the performance of the AI system in simulated clinical situations.

Gastric neoplasms in patients with familial adenomatous polyposis: endoscopic and clinicopathologic features.

Background And Aims: Gastric neoplasms in patients with familial adenomatous polyposis (FAP) occur at a high rate and can cause death. The endoscopic findings of gastric neoplasms in these patients are characteristic but not well recognized. To identify the relevant characteristics to enable early detection, we retrospectively investigated endoscopic findings of gastric neoplasms in patients with FAP and then compared the clinical, histopathologic, and genetic features among subgroups.

Delineating the extent of esophageal squamous cell carcinoma.

Background: Lugol chromoendoscopy has been conventionally used for the detection and delineation of esophageal squamous cell carcinoma (SCC). However, the boundaries of some lesions are unclear even with Lugol chromoendoscopy, and there is a risk of residual lesions or over-excision. This study aimed to evaluate the utility of narrow-band imaging (NBI) for the delineation of esophageal SCC in endoscopic resection.

Curative value of underwater endoscopic mucosal resection for submucosally invasive colorectal cancer.

Background And Aim: Occasionally, colorectal tumors without characteristics of deep submucosal invasion are found to be invasive upon pathological evaluation after endoscopic resection (ER). Because the resection depth for underwater endoscopic mucosal resection (UEMR) has not been clarified, we evaluated the feasibility of UEMR for pathologically invasive colorectal cancer (pT1-CRC).

Methods: We retrospectively investigated data on the backgrounds and outcomes of patients with pT1-CRC who underwent UEMR between January 2014 and June 2019 at our institute.

Esophageal metal stent for malignant obstruction after prior radiotherapy.

The association between severe adverse events (SAEs) and prior radiotherapy or stent type remains controversial. Patients with esophageal or esophagogastric junctional cancer who underwent stent placement (2005-2019) were enrolled in this retrospective study conducted at a tertiary cancer institute in Japan. The exclusion criteria were follow-up period of < 1 month and insufficient data on stent type or cancer characteristics.

Magnifying endoscopy with crystal violet staining for immune checkpoint inhibitor-associated colitis.

Background And Aim: There exists no evidence on the relationship between endoscopic and histologic findings. Furthermore, even after multiple biopsy specimens were obtained, histologic examination usually fails to show the characteristic features of immune checkpoint inhibitor-associated colitis. In this study, we explored the endoscopic and histologic findings of immune checkpoint inhibitor-associated colitis.

Real-time assessment of video images for esophageal squamous cell carcinoma invasion depth using artificial intelligence.

Background: Although optimal treatment of superficial esophageal squamous cell carcinoma (SCC) requires accurate evaluation of cancer invasion depth, the current process is rather subjective and may vary by observer. We, therefore, aimed to develop an AI system to calculate cancer invasion depth.

Methods: We gathered and selected 23,977 images (6857 WLI and 17,120 NBI/BLI images) of pathologically proven superficial esophageal SCC from endoscopic videos and still images of superficial esophageal SCC taken in our facility, to use as a learning dataset.

Diagnosis of pharyngeal cancer on endoscopic video images by Mask region-based convolutional neural network.

Objectives: We aimed to develop an artificial intelligence (AI) system for the real-time diagnosis of pharyngeal cancers.

Methods: Endoscopic video images and still images of pharyngeal cancer treated in our facility were collected. A total of 4559 images of pathologically proven pharyngeal cancer (1243 using white light imaging and 3316 using narrow-band imaging/blue laser imaging) from 276 patients were used as a training dataset.

Long-term outcomes after endoscopic submucosal dissection for differentiated-type early gastric cancer that fulfilled expanded indication criteria: A prospective cohort study.

Background And Aim: Endoscopic resection for early gastric cancer (EGC) is widely performed. However, there is still a paucity of strong evidence regarding long-term outcomes after endoscopic submucosal dissection (ESD) for the expanded indication criteria of the Japanese guidelines (ver. 2010).

Stratification of gastric cancer risk using a deep neural network.

Background And Aim: Stratifying gastric cancer (GC) risk and endoscopy findings in high-risk individuals may provide effective surveillance for GC. We developed a computerized image- analysis system for endoscopic images to stratify the risk of GC.

Methods: The system was trained using images taken during endoscopic examinations with non-magnified white-light imaging.

Artificial intelligence for the detection of esophageal and esophagogastric junctional adenocarcinoma.

Background And Aim: Conventional endoscopy for the early detection of esophageal and esophagogastric junctional adenocarcinoma (E/J cancer) is limited because early lesions are asymptomatic, and the associated changes in the mucosa are subtle. There are no reports on artificial intelligence (AI) diagnosis for E/J cancer from Asian countries. Therefore, we aimed to develop a computerized image analysis system using deep learning for the detection of E/J cancers.

Application of Convolutional Neural Networks for Detection of Superficial Nonampullary Duodenal Epithelial Tumors in Esophagogastroduodenoscopic Images.

Objectives: A superficial nonampullary duodenal epithelial tumor (SNADET) is defined as a mucosal or submucosal sporadic tumor of the duodenum that does not arise from the papilla of Vater. SNADETs rarely metastasize to the lymph nodes, and most can be treated endoscopically. However, SNADETs are sometimes missed during esophagogastroduodenoscopic examination.

Effect of horizontal margin status and risk of local recurrence after endoscopic submucosal dissection for superficial esophageal cancer.

Background And Aim: Endoscopic submucosal dissection (ESD) sometimes results in bloc resection with a positive or inconclusive horizontal margin (HM1 or HMX, respectively) on histological evaluation. The specific risk for such situations is unclear. We therefore investigated the outcome of ESD with HM1 or HMX.

Endoscopic full-thickness resection of gastric gastrointestinal stromal tumor: a Japanese case series.

Background: Gastrointestinal stromal tumors (GISTs) are potentially malignant and are indicated for resection. The standard treatment for resectable GISTs is surgery, although endoscopic resection has been reported outside Japan. This study retrospectively analyzed the results of endoscopic resection of GISTs in Japan.