In people aged >60 years, most IGC remain in an early stage for at least 2 years; however, at >2 years after a negative endoscopy, some are unresectable. These results suggest that most early-stage GC will not develop into advanced cancers within 2 years; thus, a 2-year interval might be within the permissible range for patients with negative endoscopy results for any lesions. Geriatr Gerontol Int 2018; 18: 997-1002.

A 62-year-old man with a chief complaint of dysphagia visited our hospital. Enhanced computed tomography showed the tumor near the duodenal wall and lymphadenopathy in the left supraclavicular fossa and para-aortic lymph node. Upper gastrointestinal endoscopy showed an ulcer accompanied with a fistula in the anterior wall of duodenal bulb, suggesting that the tumor penetrated into duodenal wall. Biopsy from the lymph node in the left supraclavicular fossa indicated diffuse large B-cell lymphoma. Although chemotherapy was planned, massive arterial bleeding occurred from the part of duodenal penetration. Endoscopic hemostasis was unsuccessfully performed. Therefore, we performed transcathether arterial embolization for hemostasis. After the procedure, the patient received six cycles of chemotherapy, and he achieved complete response. He has been alive 5 years without recurrence. There were many cases of gastrointestinal bleeding from primary gastrointestinal lymphomas, while there were few cases with nodal involvement by malignant lymphoma resulting in bleeding from gastrointestinal tract. We herein report a case of duodenal bleeding by nodal involvement of diffuse large B-cell lymphoma with review of literature.

Background Endocytoscopy (ECS) enables microscopic observation in vivo for the gastrointestinal mucosa; however, there has been no prospective study in which the diagnostic accuracy of ECS for lesions that have not yet undergone histological diagnosis was evaluated. We conducted a surveillance study for patients in a high-risk group of esophageal squamous cell carcinoma (ESCC) and evaluated the in vivo histological diagnostic accuracy of ECS. Methods This study was a multicenter prospective study. We enrolled 197 patients in the study between September 1, 2019 and November 30, 2020. The patients first underwent white light imaging and narrow band imaging, and ultra-high magnifying observation was performed if there was a lesion suspected to be an esophageal tumor. Endoscopic submucosal dissection (ESD) was later performed for lesions that were diagnosed to be ESCC by ECS without biopsy. We evaluated the diagnostic accuracy of ECS for esophageal tumorous lesions. Results ESD was performed for 37 patients (41 lesions) who were diagnosed as having ESCC by ECS, and all of them were histopathologically diagnosed as having ESCC. The sensitivity [95% confidence interval (CI)] was 97.6% (87.7–99.7%), specificity (95% CI) was 100% (92.7–100%), diagnostic accuracy (95% CI) was 98.9% (94.0–99.8%), positive predictive value (PPV) (95% CI) was 100% (91.4–100%) and negative predictive value (NPV) (95% CI) was 98.0% (89.5–99.7%). Conclusions ECS has a high diagnostic accuracy and there were no false positives in cases diagnosed and resected as ESCC. Optical biopsy by using ECS for esophageal lesions that are suspected to be tumorous is considered to be sufficient in clinical practice.

Inflammatory bowel disease (IBD) is a chronic disorder that involves a complex cytokine network. Despite an array of treatment options, no predictive biomarkers for response to IBD treatment have been established. We aimed to identify predictive biomarkers of therapeutic effectiveness in patients with IBD. Inflammatory cytokine gene expression was analyzed in biopsied samples of the inflamed ileal or colonic mucosa from patients with ulcerative colitis (UC) and Crohn's disease (CD). The relationship between mucosal cytokine gene expression and therapeutic response to corticosteroids and anti-TNF-α antibodies was investigated. Cytokines representative of helper T cell 2 (interleukin (IL)-4 and 5) and helper T cell 17 (IL-17, CCL20, IL-21, and IL-22) were higher in UC than CD. CCL11, CXCL1, CXCL2, CXCL8, OSM, and TGF-β expression was elevated in both UC and CD patients in corticosteroid-dependent cases compared to corticosteroid-free remission cases, with CXCL8 representing the best biomarker. IL-1α, IL-1β, IL-1RN, OSM, and IL-6 expression was elevated in anti-TNF-α antibody-resistant cases. RELA and STAT3 expression was increased in corticosteroid-dependent and anti-TNF-α antibody nonresponder patients, respectively. Mucosal chemokine, IL-1, and IL-6 gene expression can predict corticosteroid-dependent and anti-TNF-α antibody refractory cases. IL-1 and IL-6 and associated pathways are potential therapeutic targets for these cases. Clinical trial registration The study formed part of a comprehensive clinical trial listed under the University Medical Information Network—Clinical Trial Registration (UMIN-CTR) number 000041268, as initiated on August 1, 2020.

This case report highlights the clinical efficacy of endoscopic transpapillary drainage for gallbladder perforation in a high‐risk surgical patient with a history of steroid treatment for interstitial pneumonia. The usefulness of endoscopic transpapillary gallbladder drainage in high‐risk surgical patients with acute cholecystitis has not been established. In difficult cases of emergent surgery, such as described here, endoscopic transpapillary drainage is a promising method to manage gallbladder perforation and acute cholecystitis recurrence.