Photodynamic diagnosis with special reference to gastric cancer with a laser-equipped video image endoscope

This review focuses on the studies to investigate the feasibility of 5-aminolevulinic acid （5-ALA）-mediated photodynamic diagnosis（PDD） in particular, for detecting gastric cancer and upper GI tumors in the earlier stage. Using a prototype endoscope equipped with a blue laser light excitation for protoporphyrin IX, a photosensitizer, 5-ALA-mediated PDD was conducted in 30 cases of gastric cancer and upper GI tumors. 5-ALA solution was given orally 3 hours before PDD. Red fluorescence signal and intensity was assessed as for clinicopathological features of the cases. The laser-based endoscopy could detect upper GI tumors as red fluorescent navigation （PDD-positive） in 77%（23/30）．There were nominal adverse events. Thus, 5-ALA-PDD using the blue laser-equipped endoscope offers a promising diagnostic tool for the other digestive tumors such as colonic and pancreatic tumors. Further studies on the basic mechanisms of the difference in fluorescence intensity are warrant to be executive

Salvage Photodynamic Therapy Using Talaporfin Sodium for Local Failure of Esophageal Squamous Cell Carcinoma

[Background] Talaporfin sodium photodynamic therapy (TS-PDT) for local failure after chemoradiotherapy (CRT) in patients with esophageal squamous cell carcinoma has recently been reported to be highly effective and less invasive, compared to other treatment modalities. TS-PDT was recently introduced at the Tottori University Hospital, Japan. The aim of this study is to clarify the efficacy and safety of PDT in our hospital. [Methods] This was a single-center observational study. We examined eight cases of TS-PDT performed between January 2016 and December 2019. The main endpoints were local complete remission (L-CR) rate and the adverse events. In addition, age, gender, histology, tumor location, TNM stage, tumor depth, irradiation dose, and overall survival (OS) were examined. [Results] The patients included 7 men and a woman, with an average age of 72.1 years (range 63–82 years). The baseline clinical stages before CRT or radiotherapy were stage I in 1, stage II in 3, stage III in 3, and stage IVA in 1 patient. The T stage on endoscopic assessment before TS-PDT was T1 in 6 patients and T2 in 2 patients. Treatment outcomes and adverse events were evaluated. There were no treatment-related deaths, and no significant adverse events occurred intraoperatively or postoperatively. The L-CR rate was 7/8 (87.5%); T1 cases had 100% (6/6) L-CR, while T2 cases had 50% (1/2). The 2-year OS rates were 87%. [Conclusion] TS-PDT was observed to be safe and effective in the first eight cases of its application following its introduction in our hospital

Randomized Controlled Trial Comparing the Usefulness of Endoscopic Ultrasound Processor

[Background] Although endoscopic ultrasonography (EUS) is a useful tool for diagnosing pancreatobiliary diseases, not many facilities perform this technique as it is difficult to master. Currently, two new EUS systems exist: EU-ME2/GF-UCT260, manufactured by Olympus, and SU-1/EG-580UT, manufactured by Fujifilm. Some reports have compared new EUS models to older versions, but the operability and image quality of these two latest systems have not been compared. Our study aimed to compare the usefulness of these two types of EUS. [Methods] Forty consecutive patients were recruited and randomized in a two-arm clinical trial; Arm 1: EU-ME2/GF-UCT260 was used only for observation and SU-1/EG-580UT for EUS-fine needle aspiration (FNA); Arm 2: SU-1/EG-580UT was used only for observation and EU-ME2/GF-UCT260 for EUS-FNA. Using a crossover design, we evaluated image findings, ease of scope insertion, and visibility of the gastrointestinal (GI) tract. Each procedure was scored using a 5-point scale (Clinical Trial ID: UMIN000031373). [Results] SU-1/EG-580UT was significantly better in terms of lesion-delineating capacity: lesion border (P < 0.001), internal echo (P < 0.001). Significantly easier scope insertion was observed with SU-1/EG-580UT with respect to any insertion into the piriform recess (P = 0.018), the pylorus ring (P < 0.001), and the superior duodenal angle (P < 0.001). Visibility during gastrointestinal observation was also significantly better with the SU-1/EG-580UT (P < 0.001) than with the EU-ME2/GF-UCT260. [Conclusion] SU-1/EG-580UT EUS demonstrated superior performance during ultrasonic endoscopic GI observation, operability, and ultrasonic image quality. The result of the superior ultrasound imaging quality of SU-1/EG-580UT EUS will aid in the identification of small pancreatic malignancies with unclear borders and prove useful in evaluating mural nodules of IPMN in detail. These findings could result in an increased use of EUS and improve identification and prognosis of patients with pancreatobiliary diseases

Fundamentals, Diagnostic Capabilities, and Perspective of Narrow Band Imaging for Early Gastric Cancer

The development of image-enhanced endoscopy has dramatically improved the qualitative and quantitative diagnosis of gastrointestinal tumors. In particular, narrow band imaging (NBI) has been widely accepted by endoscopists around the world in their daily practice. In 2009, Yao et al. proposed vessel plus surface (VS) classification, a diagnostic algorithm for early gastric cancer using magnifying endoscopy with NBI (ME-NBI), and in 2016, Muto et al. proposed a magnifying endoscopy simple diagnostic algorithm for early gastric cancer (MESDA-G) based on VS classification. In addition, the usefulness of ME-NBI in the differential diagnosis of gastric cancer from gastritis, diagnosis of lesion extent, inference of histopathological type, and diagnosis of depth has also been investigated. In this paper, we narrative review the basic principles, current status, and future prospects of NBI

Current Topics in Esophageal Squamous Cell Carcinoma

Esophageal squamous cell carcinoma (ESCC) is one of the most deadly cancers due to its extremely aggressive nature and poor survival rate. Central to East Asia is one of regions with the highest incidence of ESCC. In these five papers, the international leaders of ESCC in Asia have taken various approaches to ESCC. Lin et al. compared intensity-modulated radiation therapy with three-dimensional stereoscopic radiation therapy with respect to treatment of ESCC. Song et al. demonstrated that (S)-10-Hydroxycamptothecin is useful in the ESCC cell lines as well as in vivo using a patients-derived xenograft tumor model in mice. Chen et al. showed Stromal cell-derived factor-1&alpha; expression is an independent prognostic predictor of ESCC. Lin et al. showed that the SUVLN/SUVTumor ratio of PET-CT was associated with ESCC prognosis. Yoon et al. investigated the association between sarcopenia and prognosis in the ESCC patients. All reports are an essential approach to overcoming ESCC

Special Issue &ldquo;The Next Generation of Upper Gastrointestinal Endoscopy&rdquo;

Upper gastrointestinal endoscopy is now widely used as a first-line procedure to investigate upper gastrointestinal symptoms in most countries around the world [...

Gastric Cancer Screening in Japan: A Narrative Review

Gastric cancer is the second leading cause of cancer incidence in Japan, although gastric cancer mortality has decreased over the past few decades. This decrease is attributed to a decline in the prevalence of H. pylori infection. Radiographic examination has long been performed as the only method of gastric screening with evidence of reduction in mortality in the past. The revised 2014 Japanese Guidelines for Gastric Cancer Screening approved gastric endoscopy for use in population-based screening, together with radiography. While endoscopic gastric cancer screening has begun, there are some problems associated with its implementation, including endoscopic capacity, equal access, and cost-effectiveness. As H. pylori infection and atrophic gastritis are well-known risk factors for gastric cancer, a different screening method might be considered, depending on its association with the individual’s background and gastric cancer risk. In this review, we summarize the current status and problems of gastric cancer screening in Japan. We also introduce and discuss the results of gastric cancer screening using H. pylori infection status in Hoki-cho, Tottori prefecture. Further, we review risk stratification as a system for improving gastric cancer screening in the future

Endoscopic Ultrasonography-Guided Fine Needle Aspiration for Extrahepatic Cholangiocarcinoma: A Safe Tissue Sampling Modality

Few studies have compared the diagnostic utility of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) tissue sampling for extrahepatic cholangiocarcinoma (ECC). We evaluated the efficacy and safety of EUS-FNA for diagnosing ECC compared with ERCP tissue sampling. Patients who underwent EUS-FNA or ERCP tissue sampling to differentiate ECC from benign biliary disease were enrolled retrospectively between October 2011 and March 2017. We evaluated diagnostic performances of EUS-FNA and ERCP tissue sampling based on pathological evaluation. We compared adverse events in EUS-FNA and ERCP tissue sampling. We enrolled 73 patients with biliary disease and performed EUS-FNA and ERCP in 19 and 54 patients, respectively. Sensitivity, specificity, and accuracy of ERCP tissue sampling were 76.0%, 100%, and 88.9%, respectively, and for EUS-FNA these were 81.8%, 87.5%, and 84.2%, respectively. Statistical values of ERCP tissue sampling and EUS-FNA were not significantly different. The adverse event frequency of EUS-FNA was significantly lower than that of ERCP tissue sampling (0% vs. 25.9%, p = 0.033). The diagnostic ability of EUS-FNA for ECC is similar to that of ERCP tissue sampling. EUS-FNA is a safer tissue sampling modality than ERCP for evaluating biliary disease