Background and aim The ability to differentiate between mucosal (M) or microinvasive submucosal (SM1: depth of less than 500 lm) and invasive submucosal (SM2: depth of 500 lm or more) cancer is paramount when choosing the method of treatment for early gastric cancer (EGC). The ''non-extension sign'' relates to a localized increase in thickness and rigidity due to massive submucosal invasion by a cancer. The present study sought to assess the ability of conventional endoscopy (CE) to correctly identify SM2 cancer using only the non-extension sign. Methods This is a retrospective study based on a prospectively collected database. EGCs had been diagnosed according to invasion depth as M-SM1 or SM2. In terms of the endoscopic diagnostic criterion, lesions positive for the non-extension sign were classified as SM2 cancers, while those negative for the non-extension sign were classified as M-SM1 cancers. Histopathological findings were used as the gold standard. Results We examined a total of 863 lesions from 704 patients, comprising 104 true-positive, 733 true-negative, 9 false-positive, and 17 false-negative lesions. This yielded a sensitivity of 92.0 % (95 % confidence interval (CI), 87.0-97.0 %), a specificity of 97.7 % (95 % CI, 96.7-98.8 %), a positive predictive value of 85.9 % (95 % CI, 79.7-92.1 %), a negative predictive value of 98.8 % (95 % CI, 98.0-99.6 %), and a diagnostic accuracy of 96.9 % (95 % CI, 95.8-98.1 %). Conclusion The non-extension sign may be useful for accurately determining the suitability of minimally invasive endoscopic treatment. Nevertheless, considering the limitations of retrospective analysis, a further prospective study is warranted to confirm the diagnostic reliability of the non-extension sign.

The use of herbal medicine containing sanshishi is associated with the etiology of MP. Although it may not be the causative factor, it is necessary for gastroenterologists to be aware of the potential risk of herbal medicine containing sanshishi for the development of MP.

AIM:To classify changes over time in causes of lower gastrointestinal bleeding (LGIB) and to identify factors associated with changes in the incidence and characteristics of diverticular hemorrhage (DH). METHODS:A total of 1803 patients underwent colonoscopy for overt LGIB at our hospital from 1995 to 2013. Patients were divided into an early group (EG, 1995(EG, -2006 n = 828) and a late group (LG, 2007(LG, -2013 Author contributions: Kinjo K collected and analyzed the data, and drafted the manuscript; Matsui T designed and supervised the study; Washio M performed the statistical analysisl; Hisabe T, Ishihara H, Maki S, Chuman K, Koga A, Ohtsu K, Takatsu N, Hirai F and Yao K performed the colonoscopy and revised the manuscript for important intellectual content; all authors have read and approved the final version to be published.Institutional review board statement: This study was approved by the institutional review board of Fukuoka University Chikushi Hospital (R15-024) and was conducted in accordance with the Declaration of Helsinki.Informed consent statement: In this study, We do not necessarily need the individual agreement from a study subject. Because this study is retrospective study and based on the ethical guidelines for medical studies intended for people "taken from the human body undergoes No. 12 informed consent procedures was used samples not research". Information about the implementation of this research exposes to Fukuoka University Chikushi Hospital clinical research support Center home page. Conflict-of-interest statement:In connection with this manuscript, there is no Conflict of Interest to be disclosed with any companies.Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at matsui@ fukuoka-u.ac.jp. Participants gave informed consent was not obtained but the presented data are anonymized and risk of identification is low. Retrospective Studybetween patients with and without DH. RESULTS:Older patients (≥ 70 years old) and those with colonic DH were more frequent in LG than in EG (P < 0.01). Patients using ATDs as well as NSAIDs, male sex, obesity (body mass index ≥ 25 kg/m 2 ), smoking, alcohol drinking, and arteriosclerotic diseases were more frequent in patients with DH than in those without. CONCLUSION:Incidence of colonic DH seems to increase with aging of the population, and factors involved include use of ATDs and NSAIDs, male sex, obesity, smoking, alcohol drinking, and arteriosclerotic disease. These factors are of value in handling DH patients. Core tip: Colonic diverticular hemorrhage (DH) is the most frequent cause of lower gastrointestinal bleeding. A rapid increase in the incidence of colonic DH has been seen with the aging population. One reason is the widespread adoption of antithrombotic drugs (ATDs) since the early 2000s, based on guidelines to prevent ischemic heart disease and ischemic cerebrovascular disease. DH is more likely in patients who are older, are men, obesity, use nonsteroidal anti-inf...

Gene expression profiles in neoplasms suggest a predominance of lipid storage (lipogenesis/LD formation) over consumption (β-oxidation/excretion/lipolysis). Lipid accumulation and WOS in gastric epithelial neoplasms may be caused by impaired mitochondrial oxidation, lipoprotein excretion, and LD degradation.

Background and study aims: We previously reported our discovery of a white opaque substance (WOS) that is opaque to endoscopic light inside the epithelium while using magnifying endoscopy (ME) to examine gastric epithelial neoplasia. Histopathologic analysis revealed that the WOS comprises minute lipid droplets (LDs) accumulated within the neoplastic epithelium. In addition, the WOS was found in colorectal epithelial neoplasia, although it was unclear whether this WOS corresponded to an accumulation of LDs, as in the stomach. Therefore, the aim of the current study was to elucidate whether the WOS observed in colorectal epithelial tumors comprises LDs. Patients and methods: A consecutive series of 40 WOS-positive and 40 WOS-negative colorectal epithelial tumors was analyzed. One biopsy specimen was taken from each neoplasm. Cryostat sections were stained with oil red O for LD, and sections after formalin-fixation for LD were immunostained with anti-adipophilin antibody. Results: The prevalence of LDs stained with oil red O in WOS-positive vs. WOS-negative lesions was 47.5 % (19/40) vs. 5 % (2/40), respectively (P < 0.001). Furthermore, the WOS coincided with the expression of adipophilin; the prevalence of LDs stained by anti-adipophilin antibody in WOS-positive vs. WOS-negative lesions was 100 % (40/40) vs. 62.5 % (25/40), respectively (P < 0.001). Conclusions: This study elucidated for the first time that endoscopically visualized WOS in colorectal epithelial neoplasia may be composed of LDs accumulated in the neoplastic epithelium.