Clinical Endoscopy

Review

Potassium-competitive acid blocker-associated gastric mucosal lesions: Kimitoshi Kubo, Noriko Kimura, Mototsugu Kato; Clin Endosc 2024;57(4):417-423. Published online February 29, 2024; DOI: https://doi.org/10.5946/ce.2023.279

Since the introduction of vonoprazan, a potassium-competitive acid blocker (P-CAB), it has been demonstrated to reversibly inhibit gastric acid secretion by engaging in potassium-competitive ionic binding to H+/K+-ATPase. In contrast, proton pump inhibitors (PPIs) achieve H+/K+-ATPase inhibition through covalent binding to cysteine residues of the proton pump. Reported cases have indicated an emerging trend of P-CAB-related gastropathies, similar to those associated with PPIs, as well as unique gastropathies specific to P-CAB use, such as the identification of web-like mucus. Pathologically, parietal cell profusions, which show a positively correlated with hypergastrinemia, have a higher incidence in P-CAB users compared to PPI users. Thus, this review aims to summarize the endoscopic and pathological findings reported to date concerning P-CAB-related gastric mucosal lesions. Additionally, it seeks to discuss the differences between the PPIs and P-CABs in terms of the formation and frequency of associated gastropathies. This review highlights the evident differences in the mechanism of action and potency of acid inhibition between P-CABs and PPIs, notably contributing to differences in the formation and frequency of associated gastropathies. It emphasizes the necessity to distinguish between P-CAB-related and PPI-related gastropathies in the clinical setting.

Citations

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Yasutoshi Shiratori, Yuntae Kim, Katsuyuki Fukuda, Nobumi Suzuki, Yoku Hayakawa, Yosuke Tsuji, Tsutomu Nishida, Shu Kiyotoki, Tetsuya Sumiyoshi, Kenkei Hasatani, Naohiro Yoshida, Yasuhiko Hamada, Kazuhiro Furukawa, Keiji Ogura, Takuma Okamura, Nobuo Toda,
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Development of Stability Indicating Densitometric Method for Estimation of Tegoprazan used in the Treatment of Gastroesophageal Reflux Disease
Mitalben Parmar, Dimal Shah, Usmangani Chhalotiya
Journal of Research in Pharmacy.2026; 30(1): 237. CrossRef
AGA Clinical Practice Update on Management of Gastric Polyps: Expert Review
Anna M. Buchner, Robert J. Huang, Gregory Y. Lauwers, Hashem B. El-Serag
Clinical Gastroenterology and Hepatology.2026; 24(4): 893. CrossRef
Co-existence of Ménétrier’s Disease and Collagenous Colitis: A Diagnostic and Therapeutic Challenge
Shigeto Mashiko, Daiki Murata, Ryohei Takahashi, Daisuke Fukushi, Takahiro Ohara, Katsutoshi Furukawa
Journal of General Internal Medicine.2026; 41(9): 2629. CrossRef
Gastric acid secretion therapy: long-term effects on gastric mucosa and polyp formation
Hiroko Suda, Koichi Sakurai, Ken Haruma
Expert Review of Gastroenterology & Hepatology.2026; 20(5): 395. CrossRef
Association between Gastric Acid Suppression Therapy and Scattered White Spots in the Duodenum: A Retrospective Observational Study
Mamoru Ito, Masakuni Kobayashi, Akira Dobashi, Takanori Tominaga, Ryuta Fujii, Shunsuke Uchiyama, Maki Saihara, Keiko Shimoyama, Naoya Tada, Naoto Tamai, Machi Suka, Kazuki Sumiyama
Endoscopy International Open.2026;[Epub] CrossRef
Potassium-Competitive Acid Blockers as a New Frontier in Acid-Related Disorders and the Role of South Korean Pharmacological Innovation
Jyotsna S. Ranbhise, Manish Kumar Singh, Hyeong Rok Yun, Sunhee Han, Sung Soo Kim, Insug Kang
Pharmaceuticals.2026; 19(8): 1168. CrossRef
Profound gastric mucosal changes and severe rebound acid hypersecretion after long‐term Vonoprazan use: A case report
Hiroko Suda, Sachi Eto, Koichi Sakurai
DEN Open.2025;[Epub] CrossRef
Bloqueadores ácidos competitivos de potasio (PCABs): estado del arte
José Augusto Urrego, William Otero, Hugo Cedrón, Hernando Marulanda, Alejandro Piscoya, Juan Sebastián Frías-Ordoñez, Lina Otero
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A Three‐Way Comparison of Nodular Lesions in H. pylori‐Induced Gastritis, Non‐Helicobacter pylori Helicobacter (NHPH)‐Induced Gastritis, and NHPH‐Induced MALT Lymphoma Reveals Their Distinct Endoscopic Predictors: Distribution for Bacterial Etiology and M
Yuki Kitadai, Hidehiko Takigawa, Akinori Nagao, Daisuke Shimizu, Misa Ariyoshi, Takeshi Takasago, Akiyoshi Tsuboi, Hidenori Tanaka, Ken Yamashita, Yuichi Hiyama, Yoshihiro Kishida, Yuji Urabe, Akira Ishikawa, Toshio Kuwai, Shiro Oka
Helicobacter.2025;[Epub] CrossRef
Comparative Efficacy of Potassium-Competitive Acid Blockers (P-CABs) Versus Proton Pump Inhibitors (PPIs) in the Management of Erosive Esophagitis: A Systematic Review
Haseeb Raza, Bhavna Singla, Shivam Singla, Sunita Kumawat, Jeevanjyot S Malhans, Jasleen Kaur, Muhammad Usman, Ishrat Fatima, Rana Salman
Cureus.2025;[Epub] CrossRef
Whitish gastric mucosa on upper gastrointestinal endoscopy
Eun Jeong Gong, Chang Seok Bang
Clinical Endoscopy.2024; 57(2): 277. CrossRef
Vonoprazan-Associated Mucosal Redness: A Report of Two Cases
Masaya Iwamuro, Yoshiyasu Kono, Takehiro Tanaka, Seiji Kawano, Nobumasa Ikeda
Cureus.2024;[Epub] CrossRef
Prevalence and factors associated with web‑like mucus in the stomach after vonoprazan use
Satoshi Shinozaki, Hirotsugu Sakamoto, Hiroyuki Osawa, Tomonori Yano, Hironori Yamamoto
Biomedical Reports.2024;[Epub] CrossRef

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Original Articles

Efficacy and Safety of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasms: A Latin American Cohort Study: Fernando Palacios-Salas, Harold Benites-Goñi, Luis Marin-Calderón, Paulo Bardalez-Cruz, Jorge Vásquez-Quiroga, Edgar Alva-Alva, Bryan Medina-Morales, Jairo Asencios-Cusihuallpa; Clin Endosc 2022;55(2):248-255. Published online November 12, 2021; DOI: https://doi.org/10.5946/ce.2021.192

Abstract PDF

Background
/Aims: Endoscopic submucosal dissection (ESD) is the preferred technique for treating early gastric cancer (EGC). However, very few studies have been conducted in South America. This study aimed to assess the efficacy and safety of ESD for EGC.
Methods
We analyzed data from a prospective cohort from 2013 to 2020. A total of 152 superficial gastric neoplasms that fulfilled the absolute or expanded criteria for ESD were included. Outcomes were en bloc, R0, and curative resection rates, incidence of adverse events, and length of procedure.
Results
The age of the enrolled patients was 68.4±11.3 years. The number of included patients based on the absolute and expanded indications was 150 and 2, respectively. En bloc, R0, and curative resections were achieved in 98.0%, 96.1%, and 89.5% of the cases, respectively. Bleeding and perforation were reported in 5.9% and 6.6% of the cases, respectively. Histopathological examination revealed lowgrade dysplasia, high-grade dysplasia, well-differentiated adenocarcinoma, and poorly differentiated adenocarcinoma in 13, 20, 117, and 2 cases, respectively.
Conclusions
Our study shows that ESD performed by properly trained endoscopists in reference centers is safe and effective, with comparable therapeutic outcomes to those reported in the Eastern series.

Citations

Citations to this article as recorded by

Chilean Association of Digestive Endoscopy (ACHED) guidelines for the detection of early gastric cancer and surveillance of gastric premalignant conditions in high-risk populations
Gonzalo Latorre, Alberto Espino, Raúl Araya, Matías Arteaga, Harold Benites-Goñi, María Ester Bufadel, Dacio Cabrera-Hinojosa, Roberto Candia, Julian Cordero, Oscar Corsi, Pablo Cortés, Felipe Donoso, Fabian Emura, Carolina Heredia, Daniel Martínez, Rodri
Gastroenterología y Hepatología.2026; 49(3): 502633. CrossRef
Chilean Association of Digestive Endoscopy (ACHED) guidelines for the detection of early gastric cancer and surveillance of gastric premalignant conditions in high-risk populations
Gonzalo Latorre, Alberto Espino, Raúl Araya, Matías Arteaga, Harold Benites-Goñi, María Ester Bufadel, Dacio Cabrera-Hinojosa, Roberto Candia, Julian Cordero, Oscar Corsi, Pablo Cortés, Felipe Donoso, Fabian Emura, Carolina Heredia, Daniel Martínez, Rodri
Gastroenterología y Hepatología (English Edition).2026; 49(3): 502633. CrossRef
Treatment of early gastric cancer in Sweden: A nationwide registry-based cohort study
Henrik Maltzman, Peter Elbe, Martin Jeremiasen, Masami Omae, Francisco Baldaque-Silva, Erik von Seth, Mats Lindblad, Fredrik Klevebro
Scandinavian Journal of Surgery.2026;[Epub] CrossRef
Outcomes and validity of risk stratification tools for endoscopic submucosal dissection of early gastric cancer in Western Australia
Ciaran Judge, Abir Halder, Puraskar Pateria, Tzeng Khor, Niroshan Muwanwella, Marcus Chin, Krish Ragunath
JGH Open.2024;[Epub] CrossRef
Disección submucosa endoscópica en cáncer gástrico temprano indiferenciado: evaluación de los primeros casos y análisis de su aplicación como indicación absoluta en Perú
Fernando Palacios-Salas, Luis Marin-Calderón, Juan Chirinos-Vega, Paulo Bardalez-Cruz, Patricia Valera-Luján, Dacio Cabrera-Hinojosa, Harold Benites-Goñi
Revista de Gastroenterología del Perú.2024; 44(4): 333. CrossRef
Short-Term and Long-Term Outcomes of Liver Cirrhosis in Gastric Neoplasm Patients Undergoing Endoscopic Submucosal Dissection
Xu-Rui Liu, Lian-Shuo Li, Fei Liu, Zi-Wei Li, Xiao-Yu Liu, Wei Zhang, Dong Peng
Journal of Laparoendoscopic & Advanced Surgical Techniques.2023; 33(7): 640. CrossRef
Endoscopic submucosal dissection for early gastric cancer: It is time to consider the quality of its outcomes
Gwang Ha Kim
World Journal of Gastroenterology.2023; 29(43): 5800. CrossRef
Endoscopic diagnosis of early gastric cancer
Dong Chan Joo, Gwang Ha Kim
Journal of the Korean Medical Association.2022; 65(5): 267. CrossRef
Therapeutic approach to non-curative resection after endoscopic treatment in early gastric cancer
Eun Jeong Gong, Chang Seok Bang
Journal of the Korean Medical Association.2022; 65(5): 284. CrossRef

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Laser-cut-type versus braided-type covered self-expandable metallic stents for distal biliary obstruction caused by pancreatic carcinoma: a retrospective comparative cohort study: Koh Kitagawa, Akira Mitoro, Takahiro Ozutsumi, Masanori Furukawa, Yukihisa Fujinaga, Kenichiro Seki, Norihisa Nishimura, Yasuhiko Sawada, Kosuke Kaji, Hideto Kawaratani, Hiroaki Takaya, Kei Moriya, Tadashi Namisaki, Takemi Akahane, Hitoshi Yoshiji; Clin Endosc 2022;55(3):434-442. Published online October 28, 2021; DOI: https://doi.org/10.5946/ce.2021.161

Abstract PDF

Background
/Aims: Covered self-expandable metallic stents (CMSs) are widely used for malignant distal biliary obstructions (MDBOs) caused by pancreatic carcinoma. This study compared the efficacy and safety of the laser-cut-type and braided-type CMSs.
Methods
To palliate MDBOs caused by pancreatic carcinoma, the laser-cut-type CMSs was used from April 2014 to March 2017, and the braided-type CMSs was used from April 2017 to March 2019. The tested self-expandable metallic stents were equipped with different anti-migration systems.
Results
In total, 47 patients received CMSs for MDBOs (24 laser-cut type, 23 braided-type). The time to recurrent biliary obstruction (TRBO) was significantly longer in the braided-type CMSs (p=0.0008), and the median time to stent dysfunction or patient death was 141 and 265 days in the laser-cut-type CMSs and braided-type CMSs, respectively (p=0.0023). Stent migration was the major cause of stent dysfunction in both groups, which occurred in 37.5% of the laser-cut-type CMSs and 13.0% of the braidedtype CMSs. There were no differences in the survival duration between the groups.
Conclusions
The TRBO was significantly longer for the braided-type CMSs with an anti-migration system than for the laser-cuttype. Stent migration tended to be less frequent with the braided-type CMSs than with the laser-cut-type CMSs.

Citations

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Comparison of the Usefulness of Covered and Uncovered Laser‐cut Metal Stents
Toshio Fujisawa, Masao Toki, Kei Saito, Yuta Hasegawa, Eisuke Iwasaki, Michihiro Saito, Katsuya Kitamura, Ryosuke Tonozuka, Takao Itoi, Ken Ito, Keiko Kaneko, Naminatsu Takahara, Tadakazu Hisamatsu, Hiroyuki Isayama
DEN Open.2026;[Epub] CrossRef
Multi-Hole Self-Expandable Metallic Stent for Malignant Distal Biliary Obstruction: A Literature Review
Koh Kitagawa, Shohei Asada, Jun-ichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Akira Mitoro, Hitoshi Yoshiji
Journal of Clinical Medicine.2026; 15(4): 1410. CrossRef
Moving-boundary elastica predicts looped-end braided stent crimping
Amr F. Mohamed, Philipp Berg, Mark Vekemans, Ted J. Vaughan, Adam J. Griebel, Alessandra Di Lorenzo, Daniel Behme, Stefan Jockenhoevel, Alexander Kopp
International Journal of Mechanical Sciences.2026; 327: 111959. CrossRef
Prevention of stent migration of covered self-expandable metal stents in distal malignant biliary obstruction: a review of literature
Jung Won Chun, Woo Hyun Paik, Sang Myung Woo, Jin Ho Choi, In Rae Cho, Woo Jin Lee, Ji Kon Ryu, Yong-Tae Kim, Sang Hyub Lee
Gastroenterology Report.2025;[Epub] CrossRef
From dogma to individualized care: the potential of 6-mm fully covered self-expandable metal stent in unresectable malignant distal biliary obstruction
Hyung Ku Chon
Clinical Endoscopy.2025; 58(4): 630. CrossRef
Duodenal Stenting Is Associated with Longer Biliary Patency in Endoscopic Ultrasound-Guided Biliary Drainage: Potential Role of Braided Biliary Stents
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Yuichi Waragai, Hiroyuki Asama, Hiroshi Shimizu, Kentaro Sato, Kento Osawa, Rei Ohira, Jun Nakamura, Mika Takasumi, Tsunetaka Kato, Takumi Yanagita, Mitsuru Otsuka, Takuto Hikichi, Hiromasa Ohira
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Braided-type stent versus laser-cut-type stent for patients with unresectable distal malignant biliary obstruction: a randomized controlled trial
Sho Hasegawa, Takamitsu Sato, Satoru Shinoda, Yusuke Kurita, Tomoki Ogata, Shinichi Nihei, Shin Yagi, Kunihiro Hosono, Itaru Endo, Noritoshi Kobayashi, Kensuke Kubota, Atsushi Nakajima
Gastrointestinal Endoscopy.2024; 99(5): 739. CrossRef
Removal of Duckbill‐type laser‐cut anti‐reflux metal stents: Clinical evaluation and in vitro study
Yuto Yamada, Takashi Sasaki, Tsuyoshi Takeda, Takeshi Okamoto, Takafumi Mie, Chinatsu Yonekura, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Takahisa Matsuda, Yoshinori Igarashi, Naoki Sasahira
DEN Open.2023;[Epub] CrossRef
Comparable Efficacy of Laser-Cut and Braided Self Expanding Metallic Biliary Stent: A Systematic Review and Meta-Analysis
Priyadarshini Loganathan, Saurabh Chandan, Babu P. Mohan, Shreyas Saligram, Douglas G. Adler
Digestive Diseases and Sciences.2023; 68(9): 3756. CrossRef
Evaluation of the mechanical properties of current biliary self-expandable metallic stents: axial and radial force, and axial force zero border
Wataru Yamagata, Toshio Fujisawa, Takashi Sasaki, Rei Ishibashi, Tomotaka Saito, Shuntaro Yoshida, Shizuka No, Kouta Inoue, Yousuke Nakai, Naoki Sasahira, Hiroyuki Isayama
Clinical Endoscopy.2023; 56(5): 633. CrossRef
Covered self-expandable metal stents for distal biliary obstruction from pancreatic carcinoma: what type of stent is preferred?
Hideyuki Shiomi, Ryota Nakano, Shogo Ota
Clinical Endoscopy.2022; 55(3): 369. CrossRef

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Case Reports

A Rare Case of Coil Migration into the Duodenum after Embolization of a Right Colic Artery Pseudoaneurysm: Jeongmin Choi, Young Moon Kim; Clin Endosc 2021;54(6):920-923. Published online January 12, 2021; DOI: https://doi.org/10.5946/ce.2020.228

Abstract PDF

Transcatheter arterial embolization is a safe and effective treatment for visceral artery aneurysms; nevertheless, some complications can occur. Coil migration to other organs after embolization is extremely rare, and only 16 cases have been reported previously. We report a rare case of coil migration to the duodenal lumen after embolization of a right colic artery pseudoaneurysm. To the best of our knowledge, this is the first case of coil migration after a right colic artery embolization. The patient exhibited no symptoms and was treated conservatively without any intervention. Some previous reports have demonstrated spontaneous coil passage and successful conservative management. Our case supports conservative treatment as the primary treatment for asymptomatic patients. Clinicians should assess the risks and benefits of coil removal in asymptomatic patients before performing any intervention.

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Duodenal ulcer with endoscopically visible coil post pseudoaneurysm embolisation
Jessica Satya Graha, Joshua Haron Abasszade, Benhur Reynauld
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Ashita Ashish Sule, Shreya Sah, Justin Kwan, Sundeep Punamiya, Vishal G. Shelat
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Obstrucción biliar luego de migración de coils colocados para el manejo de pseudoaneurisma de la arteria hepática posterior a la colocación de prótesis biliar
R.A. Rincón-Sánchez
Revista de Gastroenterología de México.2025; 90(4): 627. CrossRef
Bile duct obstruction following migration of coils placed for managing hepatic artery pseudoaneurysm after biliary stent placement
R.A. Rincón-Sánchez
Revista de Gastroenterología de México (English Edition).2025; 90(4): 627. CrossRef
Case report: Duodenal obstruction caused by gastroduodenal artery pseudoaneurysm with hematoma: an unusual case and literature review
Yan-Yuan Zhou, Shao-Chung Wang, Chen-June Seak, Shu-Wei Huang, Hao-Tsai Cheng
Frontiers in Medicine.2023;[Epub] CrossRef
Assessing the aneurysm occlusion efficacy of a shear-thinning biomaterial in a 3D-printed model
Grant Schroeder, Masoud Edalati, Gregory Tom, Nicole Kuntjoro, Mark Gutin, Melvin Gurian, Edoardo Cuniberto, Elisabeth Hirth, Alessia Martiri, Maria Teresa Sposato, Selda Aminzadeh, James Eichenbaum, Parvin Alizadeh, Avijit Baidya, Reihaneh Haghniaz, Roho
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Tomomi Sadamitsu, Fumikazu Koyama, Toshihiro Tanaka, Hiroyuki Kuge, Masayuki Sho
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Acute Gastric Injury Caused by Undissolved Sodium Picosulfate/Magnesium Citrate Powder: Eun Young Ze, Chang Hwan Choi, Jeong Wook Kim; Clin Endosc 2017;50(1):87-90. Published online October 12, 2016; DOI: https://doi.org/10.5946/ce.2016.081

Abstract PDF

Sodium picosulfate/magnesium citrate (SPMC) is a widely used oral bowel cleansing agent considered to be relatively safe. However, partially dissolved or undissolved SPMC powder may cause severe injuries of the esophagus and stomach. We report a very rare case of acute gastric injury without esophageal damage caused by the ingestion of undissolved SPMC powder. A 69-year-old man experienced epigastric pain after swallowing SPMC powder without dissolving it in water in preparation for a screening colonoscopy. He realized his mistake immediately and subsequently drank 2 L of water. The esophagogastroduodenoscopy conducted after 12 hours indicated an acute gastric ulceration without injury of the esophagus or duodenum. The endoscopy conducted after 6 weeks of oral proton pump inhibitor treatment showed healing of the gastric injury. This suggested that drinking large amounts of water after ingesting partially dissolved or undissolved SPMC powder can prevent serious esophageal injury, but offers no preventive benefit for acute gastric injury.

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