This study indicates HCC might arise frequently from non-cirrhotic NASH. While further studies are needed to confirm this observation, both cirrhotic and non-cirrhotic NASH warrant regular screening for HCC.

Perforation is a major complication of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). However, there have been no reports on delayed perforation after ESD for EGC. We aimed to elucidate the incidence and outcomes of delayed perforation after ESD. Clinical courses in 1159 consecutive patients with 1329 EGCs who underwent ESD were investigated. Delayed perforation occurred in six patients (0.45 %). All these patients had complete en bloc resection without intraoperative perforation during ESD. Five of six perforations were located in the upper third of the stomach, while one lesion was found in the middle third. Symptoms of peritoneal irritation with rebound tenderness presented within 24 h after ESD in all cases. One patient did not require surgery because the symptoms were localized, and recovered with conservative antibiotic therapy by nasogastric tube placement. The remaining five patients required emergency surgery. There was no mortality in this case series.

Elastography for the pancreas can be performed by either ultrasound or endoscopic ultrasound (EUS). There are two types of pancreatic elastographies based on different principles, which are strain elastography and shear wave elastography. The stiffness of tissue is estimated by measuring the grade of strain generated by external pressure in the former, whereas it is estimated by measuring propagation speed of shear wave, the transverse wave, generated by acoustic radiation impulse (ARFI) in the latter. Strain elastography is difficult to perform when the probe, the pancreas and the aorta are not located in line. Accordingly, a fine elastogram can be easily obtained in the pancreatic body but not in the pancreatic head and tail. In contrast, shear wave elastography can be easily performed in the entire pancreas because ARFI can be emitted to wherever desired. However, shear wave elastography cannot be performed by EUS to date. Recently, clinical guidelines for elastography specialized in the pancreas were published from Japanese Society of Medical Ultrasonics. The guidelines show us technical knacks of performing elastography for the pancreas. Core tip: Elastography for the pancreas had been considered to be difficult to perform with adequate accuracy and reproducibility because the pancreas is a small organ located deep in center of the human body. This review introduces the recent innovation of elastography for the pancreas, and makes recommendations on how to use various elastographic modalities for the pancreas. The review also shows us what we can know by performing elastography for the pancreas. Elastography may be a promising imaging modality for differential diagnosis between malignant and benign pancreatic tumors, for early diagnosis of chronic pancreatitis, and for identifying high-risk patients for pancreatic cancer. TOPIC HIGHLIGHTKawada N, Tanaka S. Elastography for the pancreas: Current status and future perspective.

EUS-FNA was accurate in the evaluation of suspected pancreatic malignancy regardless of its size, location, or size of needles. It was useful also in the confirmation of small pancreatic malignancies less than 10mm.

Background and Aim: Although narrow-band imaging (NBI) is used increasingly in clinical situations, the significance of each NBI finding has not been investigated. The primary endpoint of the present study was to identify the significant NBI findings to diagnose esophageal mucosal high-grade neoplasia. Methods: Between August 2007 and January 2009, we detected 59 new superficial esophageal lesions. The video images of NBI were recorded digitally. NBI findings such as brownish dots (dilated intra-epithelial papillary capillary loop [IPCL]), tortuous IPCL, elongated IPCL, caliber change in IPCL, variety in IPCL shapes, demarcation line, brownish epithelium, and protrusion or depression were evaluated using the video images. The association between each NBI finding and diagnosis of mucosal high-grade neoplasia, and intra-and interobserver agreement was evaluated. Results: In univariate analysis, brownish epithelium, brownish dots, tortuous IPCL, variety in IPCL shapes and demarcation line were associated significantly with diagnosis of mucosal high-grade neoplasia. In multivariate analysis, brownish epithelium and brownish dots were confirmed to be independent factors. Odds ratios were 25.5 (95% confidence interval [CI]: 2.4-268) for brownish epithelium and 19.3 (95% CI: 1.8-207.7) for brownish dots. Intraobserver agreement was substantial for brownish epithelium and brownish dots. Interobserver agreement was moderate in brownish epithelium and brownish dots. Conclusions: Brownish epithelium and brownish dots were confirmed to be significant and reproducible NBI findings in the diagnosis of squamous mucosal high-grade neoplasia of the esophagus. Initial assessment of esophageal lesions should be done based on these findings.