Clinical Endoscopy

Efficacy of additional tissue sections for diminutive colorectal adenomas pathologically diagnosed as normal mucosa: a retrospective, cross-sectional study in Japan: Tsuyoshi Ishii, Toshihiro Nishizawa, Hidenobu Watanabe, Masaya Sano, Ai Fujimoto, Yoshiyuki Takahashi, Ryo Shimizu, Hirotoshi Ebinuma, Takahisa Matsuda, Osamu Toyoshima; Clin Endosc 2025;58(4):577-585. Published online July 7, 2025; DOI: https://doi.org/10.5946/ce.2024.265

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Background
/Aims: Endoscopists occasionally encounter discrepancies between endoscopic and pathological diagnoses after colorectal polypectomies. This study aimed to evaluate the efficacy of additional sections for diagnostic discrepancies.
Methods
We examined polyps endoscopically diagnosed as adenomas or suspected adenomas that were resected and pathologically diagnosed as adenomas or normal mucosa. Adenomas pathologically diagnosed with initial sections were categorized as the “adenoma by initial section” group. Based on the re-diagnosis with additional sectioning, they were assigned to the “adenoma by additional section” or “normal mucosa by both sections” groups.
Results
In the initial pathological diagnosis of 993 lesions, 850 were diagnosed as adenomas and 143 as normal mucosa. Additional sections corrected the pathological diagnoses in 23.8% (34/143) of cases. The rate of high confidence was significantly higher in the “adenoma by additional section” group than in the “normal mucosa by both sections” group (64.7% vs. 38.5%, p<0.01). Lesions in the “adenoma by additional section” group were significantly smaller than those in the “adenoma by initial section” group (2.7 vs. 3.8 mm, p<0.05).
Conclusions
Diminutive adenomas can cause discrepancies between endoscopic and pathological diagnoses. Additional sections may help revise the pathological diagnoses, particularly for lesions with high confidence.

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Mixed lesions in premalignant colorectal polyps
Toru Arano, Toshihiro Nishizawa, Hidenobu Watanabe, Mari Mizutani, Teppei Akimoto, Masaya Sano, Hirotoshi Ebinuma, Hidekazu Suzuki, Keisuke Hata, Osamu Toyoshima
Journal of Clinical Biochemistry and Nutrition.2026; 78(1): 83. CrossRef

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Risk Factors for Prolonged Hospital Stay after Endoscopy: Toshihiro Nishizawa, Shuntaro Yoshida, Osamu Toyoshima, Tatsuya Matsuno, Masataka Irokawa, Toru Arano, Hirotoshi Ebinuma, Hidekazu Suzuki, Takanori Kanai, Kazuhiko Koike; Clin Endosc 2021;54(6):851-856. Published online March 16, 2021; DOI: https://doi.org/10.5946/ce.2020.292

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Background
/Aims: The recovery room used after endoscopy has limited capacity, and an efficient flow of the endoscopy unit is desired. We investigated the duration of hospital stay after endoscopy and the risk factors for prolonged hospital stay among outpatients.
Methods
We retrospectively studied consecutive patients who underwent esophagogastroduodenoscopy or colonoscopy at the Toyoshima Endoscopy Clinic. We collected data on age, sex, body weight, midazolam and pethidine dosage, respiratory depression during endoscopy, and duration of hospital stay after endoscopy (scope out to check out). Risk factors for prolonged hospital stay (>100 minutes) were identified using multiple logistic regression analysis.
Results
We enrolled 3,898 patients, including 3,517 (90.2%) patients tested under sedation and 381 (9.8%) patients tested without sedation. Overall, 442 (11.3%) patients had prolonged stay (>100 min). The mean time difference between sedation group and non-sedation group was 44.2 minutes for esophagogastroduodenoscopy and 39.1 minutes for colonoscopy. Age (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.014−1.036), female sex (OR, 1.657; 95% CI, 1.220−2.249), and midazolam dose (OR, 1.019; 95% CI, 1.013−1.026) were independently associated with prolonged hospital stay after esophagogastroduodenoscopy, with similar results for colonoscopy.
Conclusions
Old age, female sex, and midazolam dose were independent risk factors for prolonged hospital stay after endoscopy.

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Zoilo K. Suarez, Alexandria Lenyo, Philip M. Frasse, Derek J. Platt, Thomas Hollander, Talwinder Nagi, Michael DeDonno, Vladimir Kushnir, Juan Reyes Genere
DEN Open.2026;[Epub] CrossRef
Remimazolam, a novel drug, for safe and effective endoscopic sedation
Jae Min Lee, Yehyun Park, Dong Won Ahn, Jun Kyu Lee, Kwang Hyuck Lee
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Impact of low anterior resection syndrome after rectal surgery on sleep quality
Akira Toyoshima, Toshihiro Nishizawa, Osamu Toyoshima, Ryuji Akai, Manabu Kaneko, Shin Sasaki
Surgery Today.2025; 55(12): 1868. CrossRef
Efficacy of additional tissue sections for diminutive colorectal adenomas pathologically diagnosed as normal mucosa: a retrospective, cross-sectional study in Japan
Tsuyoshi Ishii, Toshihiro Nishizawa, Hidenobu Watanabe, Masaya Sano, Ai Fujimoto, Yoshiyuki Takahashi, Ryo Shimizu, Hirotoshi Ebinuma, Takahisa Matsuda, Osamu Toyoshima
Clinical Endoscopy.2025; 58(4): 577. CrossRef
Risk factors for suspected infectious fever after diagnostic upper endoscopy: propofol overdose in a retrospective study from Korea
Sunmin Lee, Jung-Hwan Lee, Jongbeom Shin, Boram Cha, Ji-Taek Hong, Kye Sook Kwon
Clinical Endoscopy.2025; 58(5): 703. CrossRef
Timing of Endoscopic Intervention for Esophageal Food Impaction and Its Impact on Patient Outcomes
Mark S. Obri, Momin Samad, Suhib Alhaj, Ammad Chaudhary, Sheema Rehman, M. Ramzi Almajed, Courtney Rose, Lonni Schultz, Kevin Harris, Suraj Suresh
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Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef
TXI (Texture and Color Enhancement Imaging) for Serrated Colorectal Lesions
Toshihiro Nishizawa, Osamu Toyoshima, Shuntaro Yoshida, Chie Uekura, Ken Kurokawa, Munkhbayar Munkhjargal, Miho Obata, Tomoharu Yamada, Mitsuhiro Fujishiro, Hirotoshi Ebinuma, Hidekazu Suzuki
Journal of Clinical Medicine.2021; 11(1): 119. CrossRef

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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

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Cancers.2020; 12(10): 2849. CrossRef
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