ESD can be considered a standard treatment for EGC based on its expanded indications and low incidences of local recurrence and lymph node metastasis.

In recent years, due to the increasing prevalence of upper gastrointestinal endoscopy, there have been an increasing number of reports on duodenal adenoma and early stage cancer. However, endoscopic techniques for the resection of duodenal adenomas are difficult, due to the anatomical features of the duodenum, and the long distance to the lesion. There have only been a few reports on the use of endoscopic techniques for duodenal adenomas compared to those focused on the stomach and large intestine. For duodenal adenomas, we used a conventional endoscope for lesions proximal to the major duodenal papilla, and a short-type double balloon endoscope for lesions distal to the papilla. The en-bloc resection rate was 93.8%. There was only one case of microperforation. Endoscopic manipulation is considered difficult in the deep areas of the duodenum, but double balloon endoscopy enabled stable manipulation and successful resection of the tumor in the majority of cases.

Endoscopic mucosal resection has been recognized as a standard method for treating mucosal tumors of the stomach in Japan. In our department, we have treated mucosal defects after this procedure by using metallic clips to prevent and manage complications related to endoscopic mucosal resection. In the present study, we explain the new technique, the ‘loop‐and‐clips’ method, which uses clips and a detachable snare to close large mucosal defects after endoscopic mucosal resection.

No abstract

Background and Aim:  A cut‐off value of 2.5‰ for the 13C‐urea breath test (UBT) is recommended in Japanese persons, based on the result of a multicenter trial in patients prior to treatment for eradication of Helicobacter pylori. The cut‐off value of 2.5‰ has also been used in the assessment of eradication after treatment. The 6–8‐week evaluation after treatment is recommended in the guidelines of the Japanese Society of Gastroenterology. The present study aimed to prospectively re‐assess the cut‐off value of the 13C‐UBT at 6 weeks after treatment by using the results obtained at 6 months as an indication of true positive or true negative H. pylori infection status. Methods:  One hundred and ninety patients who were positive for H. pylori underwent eradication treatment, and 177 patients of these patients who were assessed as having true positive or true negative H. pylori status  at  6 months  after  treatment  were  evaluated  in  this  study.  Eradication  was  assessed  by 13C‐UBT,  culture,  and  histology  at  6 weeks  and  at  6 months  after  treatment,  and  the  cut‐off  value  of 13C‐UBT at 6 weeks was re‐assessed. Results:  A cut‐off value of 3.5‰. at 6 weeks after treatment showed 97.2% diagnostic accuracy, while a cut‐off value of 2.5‰ at 6 weeks showed 96.0% diagnostic accuracy. For a 3.5‰ cut‐off value, only five patients were positive by 13C‐UBT and were negative by culture and histology at 6 weeks, and three patients were true positive and two were false positive by the 13C‐UBT at 6 months. Conclusion:  A cut‐off value of 3.5‰ for the 13C‐UBT is recommended at 6 weeks after eradication treatment in Japanese persons.