Clinical Endoscopy

Endoscopic findings are associated with histologic types of primary small intestinal lymphoma: a retrospective study in Japan: Masafumi Kitamura, Mio Sakaguchi, Hirotsugu Sakamoto, Satoshi Shinozaki, Manabu Nagayama, Tomonori Yano, Yusuke Ono, Takuma Kobayashi, Kunihiko Oguro, Shoko Miyahara, Masahiro Okada, Katsuyuki Nakazawa, Keijiro Sunada, Noriyoshi Fukushima, Hironori Yamamoto; Received July 23, 2025 Accepted October 11, 2025 Published online January 29, 2026; DOI: https://doi.org/10.5946/ce.2025.239 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Although endoscopic diagnosis of primary small intestinal lymphoma (PSIL) is important, the association between endoscopic findings and histologic types remains unclear. This study aimed to evaluate the diagnostic accuracy of endoscopic classifications and biopsies in PSIL.
Methods
We retrospectively reviewed 100 lesions from 49 patients with PSIL who underwent double-balloon enteroscopy between 2005 and 2020. Endoscopic findings were classified into six macroscopic types: polypoid, ulcerative, multiple nodules, diffuse, concentric stenosis, or unclassified.
Results
Of the 100 lesions, 47 were multiple nodules, 32 were ulcerative, 8 were polypoid, 7 were diffuse, 4 were concentric stenosis, and 2 were unclassified. Diffuse large B-cell lymphoma (DLBCL) was mainly ulcerative (72%) or polypoid (75%), whereas follicular lymphoma appeared as multiple nodules (98%) or concentric stenosis (100%) (p<0.001, Cramér’s V=0.41). The ulcerative type was associated with DLBCL (sensitivity, 0.74; specificity, 0.87), and multiple-nodule type were associated with follicular lymphoma (sensitivity, 0.75; specificity, 0.97). The overall diagnostic yield of the biopsy was 95%. Interobserver agreement was substantial (κ=0.69; agreement, 78%).
Conclusions
Endoscopic findings were significantly associated with histologic types. Endoscopic findings and biopsies provide a high diagnostic yield, supporting their central role in the diagnostic management of PSIL.

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Utility of underwater endoscopic mucosal resection combined with a protruding anchor by saline injection for superficial non-ampullary duodenal tumors: a retrospective study in Japan: Yoshie Nomoto, Satoshi Shinozaki, Yoshimasa Miura, Hiroyuki Osawa, Yuji Ino, Tomonori Yano, Nikolaos Lazaridis, Hironori Yamamoto; Clin Endosc 2025;58(4):561-568. Published online March 12, 2025; DOI: https://doi.org/10.5946/ce.2024.181

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Underwater endoscopic mucosal resection (UEMR) is the standard resection method for superficial non-ampullary duodenal tumors (SNADETs). We developed a novel UEMR technique that creates an anchor by protruding the distal fold with a saline injection (UEMR-A). The aim of this study was to clarify the usefulness of UEMR-A compared to conventional UEMR (UEMR-C).
Methods
This retrospective observational study included patients who underwent UEMR for SNADETs.
Results
A total of 141 patients were included and divided into UEMR-A (n=54) and UEMR-C (n=87) groups. Lesion resection was performed significantly more frequently by an expert endoscopist in the UEMR-C group compared to the UEMR-A group (p<0.001). The procedure time for UEMR-A was significantly shorter than that for UEMR-C (p=0.018), despite the additional time required for submucosal injection. The R0 resection rate was significantly higher in the UEMR-A group than in the UEMR-C group (p=0.004). The horizontal margins were significantly clearer in the UEMR-A group than in the UEMR-C group (p=0.018). Multivariate analysis revealed that the use of UEMR-A was the only significant positive factor for R0 resection.
Conclusions
The UEMR-A technique for SNADETs appears to improve R0 resection rates and reduce procedure times compared to the UEMR-C technique.

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Advancement of endoscopic treatment in GI tract
Yoshimasa Miura
Journal of Nihon University Medical Association.2025; 84(3): 119. CrossRef
Evaluation of a modified underwater endoscopic mucosal resection technique for duodenal neoplasms: clinical implications and future directions
Ji Yong Ahn
Clinical Endoscopy.2025; 58(4): 544. CrossRef
Reply to the comments on ‘Utility of underwater endoscopic mucosal resection combined with a protruding anchor by saline injection for superficial non-ampullary duodenal tumors: a retrospective study in Japan'
Hironori Yamamoto, Yoshie Nomoto, Satoshi Shinozaki, Yoshimasa Miura, Hiroyuki Osawa
Clinical Endoscopy.2025; 58(6): 953. CrossRef
A reformative underwater endoscopic mucosal resection technique for superficial non-ampullary duodenal tumors
Yiheng Yao, Guolei Shi, Xingjie Shen, Liang Liu
Clinical Endoscopy.2025; 58(6): 951. CrossRef

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Roles of Capsule Endoscopy and Balloon-Assisted Enteroscopy in the Optimal Management of Small Bowel Bleeding: Hani Abutalib, Tomonori Yano, Satoshi Shinozaki, Alan Kawarai Lefor, Hironori Yamamoto; Clin Endosc 2020;53(4):402-409. Published online July 30, 2020; DOI: https://doi.org/10.5946/ce.2020.143

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The small bowel had long been considered a dark unapproachable tunnel until the invention of capsule endoscopy and doubleballoon enteroscopy in the 21st century, which revolutionized the diagnosis and management of small bowel diseases, including bleeding. Various imaging modalities such as computed tomographic enterography, angiography, capsule endoscopy, and balloonassisted enteroscopy play vital roles in the diagnosis and management of small bowel bleeding. The choice of modality to use and timing of application differ according to the availability of the modalities, patient’s history, and physician’s experience. Small bowel bleeding is managed using different strategies as exemplified by medical treatment, interventional radiology, endoscopic therapy, or surgical intervention. Balloon-assisted enteroscopy enables endoscopic interventions to control small bowel bleeding, including electrocautery, argon plasma coagulation, clip application, and tattooing as a prelude to surgery. In this article, we clarify the recent approaches to the optimal diagnosis and management of patients with small bowel bleeding.

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Sang Pyo Lee, Hyun Joo Jang, Sea Hyub Kae, Jae Gon Lee, Ji Hye Kwon
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Medical Engineering & Physics.2022; 110(1): 103901. CrossRef

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Double-Balloon Endoscopy-Assisted Balloon Dilation of Strictures Secondary to Small-Intestinal Lymphoma: Shogo Magome, Hirotsugu Sakamoto, Satoshi Shinozaki, Masahiro Okada, Tomonori Yano, Keijiro Sunada, Alan Kawarai Lefor, Hironori Yamamoto; Clin Endosc 2020;53(1):101-105. Published online July 10, 2019; DOI: https://doi.org/10.5946/ce.2019.015

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