Clinical Endoscopy

Current perspectives on combining endoscopy and minimally invasive surgery for upper gastrointestinal tumors: Eriko Koizumi, Osamu Goto; Received December 28, 2025 Accepted March 3, 2026 Published online May 22, 2026; DOI: https://doi.org/10.5946/ce.2025.472 [Epub ahead of print]

Abstract PDF PubReader ePub: Recent advances in endoscopy have expanded the therapeutic spectrum of minimally invasive gastrointestinal surgery. Several modified procedures have been developed to reduce the risk of bacterial contamination and tumor cell dissemination associated with intentional perforation in classical laparoscopic and endoscopic cooperative surgery (LECS), including inverted LECS and non-exposed approaches. Long-term outcomes of these procedures for gastric lesions have recently been reported, supporting their favorable safety and efficacy. Moreover, the incorporation of sentinel lymph node navigation into non-exposed techniques represents a promising strategy for function-preserving gastric cancer surgery, and recent phase III trials have begun to evaluate its clinical value and long-term outcomes. Additionally, endoscopic full-thickness resection has recently been gaining wider acceptance in Japan and is facilitated by staged strategies that integrate endoscopic resection with single-port placement. Combined endoscopic procedures have been applied to the pharynx, esophagus, and duodenum with excellent short-term outcomes; nonetheless, long-term data remain limited. Ongoing innovations and multicenter studies may refine indications, standardize techniques, and validate safety and efficacy. Overall, the integration of endoscopy and surgery is likely to become increasingly critical in achieving both oncological curability and organ preservation in the management of gastrointestinal tumors.

422 View
27 Download

Three-dimensional imaging of subepithelial tumors: feasibility and utility in preoperative assessment—a retrospective single-center observational study in Japan: Eriko Koizumi, Osamu Goto, Yumiko Ishikawa, Tsugumi Habu, Hiroto Noda, Shun Nakagome, Kazutoshi Higuchi, Katsuhiko Iwakiri; Clin Endosc 2025;58(6):865-870. Published online November 6, 2025; DOI: https://doi.org/10.5946/ce.2025.097

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasound and conventional computed tomography (CT) are useful for preoperative assessment of subepithelial tumors (SETs). However, surgical approaches are sometimes changed intraoperatively owing to unexpected discrepancies between the planned and actual visualizations of tumors because preoperative images are typically two-dimensional.
Methods
In this study, we evaluated the feasibility of morphological evaluation using three-dimensional (3D) reconstruction of SETs and its utility in preoperative assessments. We included 15 lesions with a diameter of 1 to 5 cm that were evaluated by CT and pathologically diagnosed as mesenchymal tumors. We examined the feasibility of 3D reconstruction of lesions by evaluating sphericity using CT images with reference to circularity, which was measured from endoscopic ultrasound still images. Furthermore, the predictability of planned surgery determined using 3D images was investigated.
Results
The median lesion diameter was 22 mm. There were 10, 3, and 2 lesions of gastrointestinal stromal tumors, leiomyomas, and schwannomas, respectively. 3D reconstruction was feasible for all lesions, with a median sphericity of 0.85, aligning with the median circularity (0.88). The predictability of the 3D-based surgical approach was 90%.
Conclusions
3D reconstruction of SETs is feasible and useful for preoperative determination of the surgical approach.

Citations

Citations to this article as recorded by

Assessing the utility of three-dimensional imaging for preoperative assessment of gastric subepithelial tumors
Dong Chan Joo, Gwang Ha Kim
Clinical Endoscopy.2025; 58(6): 854. CrossRef

2,030 View
61 Download
1 Web of Science
1 Crossref

Three-Dimensional Flexible Endoscopy Can Facilitate Efficient and Reliable Endoscopic Hand Suturing: An ex-vivo Study: Jun Omori, Osamu Goto, Kazutoshi Higuchi, Takamitsu Umeda, Naohiko Akimoto, Masahiro Suzuki, Kumiko Kirita, Eriko Koizumi, Hiroto Noda, Teppei Akimoto, Mitsuru Kaise, Katsuhiko Iwakiri; Clin Endosc 2020;53(3):334-338. Published online April 24, 2020; DOI: https://doi.org/10.5946/ce.2019.207

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Three-dimensional (3D) flexible endoscopy, a new imaging modality that provides a stereoscopic view, can facilitate endoscopic hand suturing (EHS), a novel intraluminal suturing technique. This ex-vivo pilot study evaluated the usefulness of 3D endoscopy in EHS.
Methods
Four endoscopists (two certified, two non-certified) performed EHS in six sessions on a soft resin pad. Each session involved five stitches, under alternating 3D and two-dimensional (2D) conditions. Suturing time (sec/session), changes in suturing time, and accuracy of suturing were compared between 2D and 3D conditions.
Results
The mean suturing time was shorter in 3D than in 2D (9.8±3.4 min/session vs. 11.2±5.1 min/session) conditions and EHS was completed faster in 3D conditions, particularly by non-certified endoscopists. The suturing speed increased as the 3D sessions progressed. Error rates (failure to grasp the needle, failure to thread the needle, and puncture retrial) in the 3D condition were lower than those in the 2D condition, whereas there was no apparent difference in deviation distance.
Conclusions
3D endoscopy may contribute to increasing the speed and accuracy of EHS in a short time period. Stereoscopic viewing during 3D endoscopy may help in efficient skill acquisition for EHS, particularly among novice endoscopists.

Citations

Citations to this article as recorded by

Future Directions for Robotic Endoscopy–Artificial Intelligence (AI), Three-Dimensional (3D) Imaging, and Natural Orifice Transluminal Endoscopic Surgery (NOTES)
Cem Simsek, Hung Leng Kaan, Hiroyuki Aihara
Techniques and Innovations in Gastrointestinal Endoscopy.2023; 25(1): 95. CrossRef
A three-dimensional measurement method for binocular endoscopes based on deep learning
Hao Yu, Changjiang Zhou, Wei Zhang, Liqiang Wang, Qing Yang, Bo Yuan
Frontiers of Information Technology & Electronic Engineering.2022; 23(4): 653. CrossRef

7,360 View
111 Download
3 Web of Science
2 Crossref

The Efficacy of an Endoscopic Grasp-and-Traction Device for Gastric Endoscopic Submucosal Dissection: An Ex Vivo Comparative Study (with Video): Dirk W. Schölvinck, Osamu Goto, Jacques J. G. H. M. Bergman, Naohisa Yahagi, Bas L. A. M. Weusten; Clin Endosc 2015;48(3):221-227. Published online May 29, 2015; DOI: https://doi.org/10.5946/ce.2015.48.3.221

Abstract PDF Supplementary Material PubReader ePub

Background/Aims

To investigate whether the EndoLifter (Olympus), a counter-traction device facilitating submucosal dissection, can accelerate endoscopic submucosal dissection (ESD).

Methods

Two endoscopists (novice/expert in ESD) performed 64 ESDs (artificial 3-cm lesions) in 16 ex vivo pig stomachs: per stomach, two at the posterior wall (forward approach) and two at the lesser curvature (retroflex approach). Per approach, one lesion was dissected with (EL+) and one without (EL-) the EndoLifter. The submucosal dissection time (SDT), corrected for specimen size, and the influence of ESD experience on EndoLifter usefulness were assessed.

Results

En bloc resection rate was 98.4%. In the forward approach, the median SDT was shorter with the EndoLifter (0.56 min/cm² vs. 0.91 min/cm²), although not significantly (p=0.09). The ESD-experienced endoscopist benefitted more from the EndoLifter (0.45 [EL+] min/cm² vs. 0.68 [EL-] min/cm², p=0.07) than the ESD-inexperienced endoscopist (0.77 [EL+] min/cm² vs. 1.01 [EL-] min/cm², p=0.48). In the retroflex approach, the median SDTs were 1.06 (EL+) and 0.48 (EL-) min/cm² (p=0.16). The EndoLifter did not shorten the SDT for the ESD-experienced endoscopist (0.68 [EL+] min/cm² vs. 0.68 [EL-] min/cm², p=0.78), whereas the ESD-inexperienced endoscopist seemed hindered (1.65 [EL+] min/cm² vs. 0.38 [EL-] min/cm², p=0.03).

Conclusions

In gastric ESD, the EndoLifter, in trend, shortens SDTs in the forward, but not in the retroflex approach. Given the low numbers in this study, a type II error cannot be excluded.

Citations

Citations to this article as recorded by

Endoscopic Submucosal Dissection Facilitating Techniques Among Non-experts: A Systematic Literature Review
Kavel Visrodia, Akira Dobashi, Fateh Bazerbachi, John Poneros, Amrita Sethi
Digestive Diseases and Sciences.2023; 68(6): 2561. CrossRef
Endoscopic mucosal resection and endoscopic submucosal dissection with an external additional working channel (EMR+ and ESD+) are equivalent to using a double-channel endoscope: a systematic evaluation in a porcine ex vivo model
Richard F. Knoop, Ahmad Amanzada, Golo Petzold, Volker Ellenrieder, Michael Engelhardt, Albrecht Neesse, Sebastian C. B. Bremer, Steffen Kunsch
Surgical Endoscopy.2023; 37(10): 7749. CrossRef
Endoskopische Resektion von Frühkarzinomen im Gastrointestinaltrakt
T. Blasberg, E. Wedi
Der Gastroenterologe.2022; 17(2): 109. CrossRef
Endoscopic submucosal dissection with an additional working channel (ESD+): a novel technique to improve procedure time and safety of ESD
Richard F. Knoop, Edris Wedi, Golo Petzold, Sebastian C. B. Bremer, Ahmad Amanzada, Volker Ellenrieder, Albrecht Neesse, Steffen Kunsch
Surgical Endoscopy.2021; 35(7): 3506. CrossRef
Endoscopic diagnosis and treatment of gastric dysplasia and early cancer: Current evidence and what the future may hold
Edward Young, Hamish Philpott, Rajvinder Singh
World Journal of Gastroenterology.2021; 27(31): 5126. CrossRef
Endoscopic submucosal dissection: an update on tools and accessories
Christopher Harlow, Arun Sivananthan, Lakshmana Ayaru, Kinesh Patel, Ara Darzi, Nisha Patel
Therapeutic Advances in Gastrointestinal Endoscopy.2020; 13: 263177452095722. CrossRef
Robot assisted tumor resection devices
Yutaka Saito, Kazuki Sumiyama, Philip Wai-yan CHIU
Expert Review of Medical Devices.2017; 14(8): 657. CrossRef
An update in the endoscopic management of gastric cancer
Samuel Han, Andrew Hsu, Wahid Y. Wassef
Current Opinion in Gastroenterology.2016; 32(6): 492. CrossRef
Is the Endoscopic Grasp-and-Traction Device Useful for Endoscopic Submucosal Dissection in Treating Early Gastric Cancer?
Joo Young Cho
Clinical Endoscopy.2015; 48(3): 181. CrossRef

10,868 View
89 Download
10 Web of Science
9 Crossref

The "Two-Sword Fencing" Technique in Endoscopic Submucosal Dissection: Toshihiro Nishizawa, Toshio Uraoka, Yasutoshi Ochiai, Hidekazu Suzuki, Osamu Goto, Ai Fujimoto, Tadateru Maehata, Takanori Kanai, Naohisa Yahagi; Clin Endosc 2015;48(1):85-86. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.85

PDF PubReader ePub

Citations

Citations to this article as recorded by

Clinical benefit of the multibending endoscope for gastric endoscopic submucosal dissection: a randomized controlled trial
Koichi Hamada, Yoshinori Horikawa, Yoshiki Shiwa, Kae Techigawara, Takayuki Nagahashi, Daizo Fukushima, Shinya Nishida, Ryota Koyanagi, Koichiro Kawano, Noriyuki Nishino, Michitaka Honda
Endoscopy.2021; 53(07): 683. CrossRef
Long-Term Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Cell Carcinoma
Toshihiro Nishizawa, Hidekazu Suzuki
Cancers.2020; 12(10): 2849. CrossRef
Usefulness of a multibending endoscope in gastric endoscopic submucosal dissection
Koichi Hamada, Yoshinori Horikawa, Ryota Koyanagi, Yoshiki Shiwa, Kae Techigawara, Shinya Nishida, Yujiro Nakayama, Michitaka Honda
VideoGIE.2019; 4(12): 577. CrossRef
Is the Double Channel Gastroscope Useful in Endoscopic Mucosal Resection for Large Sessile Colon Polyps?
Kwang An Kwon
Clinical Endoscopy.2015; 48(2): 89. CrossRef

8,101 View
53 Download
4 Web of Science
4 Crossref

Search