In this nationwide retrospective study, we sought to evaluate the oncologic and functional outcomes and safety of transoral surgery (TOS) for hypopharyngeal and laryngeal squamous cell carcinomas in Japan and to clarify the appropriate indications for various TOS modalities. Data were obtained from the Head and Neck Cancer Registry of Japan. Patients who underwent transoral or endoscopic resection between 2011 and 2016 were selected. Detailed clinical information was collected from 55 institutions using web-based case report forms. Surgical modalities analyzed included endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), endoscopic laryngopharyngeal surgery (ELPS), transoral laser microsurgery (TLM), and transoral videolaryngoscopic surgery (TOVS). In total, 1825 patients were included (hypopharyngeal cancer, 62.5 %; laryngeal cancer, 37.5 %). Most cases (77.5 %) were T1 or lower, and 90.8 % were Stage II or earlier. TLM is predominantly used for glottic cancers, ELPS/ESD for superficial hypopharyngeal lesions, and TOVS for more advanced tumors, reflecting distinct indications for each modality. The 5-year disease-specific survival (DSS), recurrence-free survival (RFS), and overall survival (OS) were 97.1 %, 84.3 %, and 85.4 %, respectively. The laryngeal preservation rate was 98.2 %. Tracheostomy was performed in 5.0 % of cases, mainly for airway protection; major complications, including pneumonia (2.4 %), hemorrhage (1.1 %), fistula formation (0.4 %), and vocal cord fixation (2.6 %), occurred in <3 % of patients. Postoperative functional outcomes were favorable, with persistent dysphagia (Functional Outcome Swallowing Scale stage ≥ 3) in 1.6 % and tube feeding dependence in 1.8 %. Non-robot-assisted TOS demonstrated excellent oncologic control and functional preservation of the larynx with low complication rates in early-stage hypopharyngeal and laryngeal cancers. Each surgical modality has distinct indications depending on the tumor site, depth of invasion, and institutional expertise. These findings support the use of TOS as a safe and effective treatment option for selected patients. Further procedural standardization and data accumulation are required to refine the indications and facilitate their broader adoption in clinical practice.

Transanal Minimally Invasive Surgery (TAMIS) is frequently used to treat rectal lesions that are not amenable to conventional polypectomy or endoscopic resection. Few studies have reported long-term outcomes of TAMIS. This study aims to assess the long-term outcomes in patients who underwent TAMIS for rectal lesions. Patients who underwent TAMIS for rectal neoplasms at a tertiary care center between June 2010 and August 2023 were retrospectively reviewed. The assessment of oncological outcomes, reported separately for benign and malignant lesions, was limited to patients with adenomatous polyps, serrated polyps, or adenocarcinomas as indicated in the postoperative histopathology report. The primary outcomes were long-term oncological outcomes, including local recurrence, distant metastasis, mortality, disease-free and overall survival rates. The current study included a total of 208 individuals, of whom 74 (35.6 %) were female, with a median age of 64 (19.3) years. Upon postoperative histopathological examination, adenomatous lesions were identified in 109 (52.4 %) patients, serrated adenoma in 7 (3.4 %) patients, negative pathology in 18 (8.7 %) patients, and adenocarcinoma in 74 (35.5 %) patients. The median follow-up duration was 37 months. During the follow-up period, local recurrence occurred in 1 patient (0.8 %) with benign disease, 16 months after TAMIS. Additionally, recurrence occurred in 8 (9.4 %) patients with malignant disease at a median follow-up of 23.5 months. Distant metastasis was observed in 1 patient (0.8 %) who initially had benign disease seven months after experiencing malignant recurrence. Furthermore, distant metastasis was noted in 5 patients (5.9 %) with malignant disease. No disease-related mortality was recorded during the follow-up period for benign lesions. However, 5 (5.9 %) patients with malignant disease experienced mortality associated with rectal adenocarcinoma. The 3-year disease-free and overall survival rates for patients with malignant disease were 91 % and 96.6 % (p = 0.015), respectively. TAMIS is an effective technique for rectal lesions, offering an acceptable short- and long-term oncological outcome for both benign and malignant lesions.

Additional colectomy after endoscopic excision of malignant polyps: is it always necessary?

Changing landscape in stage, treatment and survival of gastric cancer in China 1998-2022: Insights of 40,158 patients from the National Gastric Cancer Cohort.

Mobilization or resection of the Eustachian tube through an endoscopic transpterygoid approach (ETPA) improves access to the anterior petrous region. This maneuver is particularly beneficial for resecting extradural skull base malignancies where complete removal of involved or affected bone is necessary. Preservation of the Eustachian tube may potentially decrease hearing morbidity; however, this modification may also result in less than complete resection of these lesions. Many patients receive adjuvant radiotherapy, which can itself cause secondary hearing impairment. We sought to determine whether a significant difference in hearing outcomes exists between open and ETPA (Carrau Prevedello Kasemsiri classification type E) approaches, which would justify further investigation into Eustachian tube preservation. A single-center retrospective review was performed comparing patients who underwent either open or endoscopic resection of a petroclival malignancy. Demographic variables, baseline hearing function, preoperative and postoperative audiometric data, and rates of mitigating strategies were collected. Twenty-nine open and 31 endocopic endoansal transptreygoid class E approach resections were included. New subjective hearing loss (71% open vs 77 % ETPA; P = .56), persistent loss (68% vs 77%; P = .39), and use of mitigating strategies (45% vs 68%; P = .13) did not differ significantly. Median time to hearing loss was 18 months for open vs 6 months for ETPA (P = .21). Pure-tone audiometry remained lower after ETPA at all timepoints. Postoperative radiotherapy increased the risk of permanent hearing loss (adjusted hazard ratio 3.92; P = .043), and prior mitigation was protective (adjusted hazard ratio 0.18; P = .023). Surgical approach was not independently associated with hearing loss (adjusted hazard ratio 1.86; P = .102). The ETPA approach was not associated with a higher rate of new post-treatment hearing loss compared with open, while yielding higher rates of gross total resection. Future studies may help to further characterize hearing morbidity after Eustachian tube manipulation.

Distant metastasis occurs in 1% to 4% of patients with papillary thyroid carcinoma (PTC) and most commonly involves the lungs and bones, with skull base involvement being exceedingly rare. We present a case of a 58-year-old male patient who experienced skull-base metastasis of tall-cell variant PTC 4 years after multimodal treatment of aggressive disease. The patient presented to the otolaryngology clinic with left-sided postnasal drip, anosmia, ptosis, and proptosis. Magnetic resonance imaging of head showed a 1.9 × 2.7 × 4.4 cm mass with extensive invasion of the sinonasal cavities, cribriform plate, and left orbit, complicated by a postobstructive mucocele. In-office biopsy was consistent with metastatic PTC. He underwent endoscopic surgical debulking followed by postoperative radiation therapy. This case demonstrates how PTC with aggressive features can develop anterior skull base metastases years after initial treatment. Management required recognition of this diagnostic challenge and combined endoscopic resection and stereotactic radiotherapy, achieving local control while preserving neurologic function. The patient has remained stable at 7-month follow-up.

Totally endoscopic resection of right atrial myxoma on beating heart: a case serries.

Endoscopic resection of a giant long-pedunculated Brunnerʼs gland hyperplasia in the duodenum

ABSTRACTBackgroundThe current guidelines recommend cold snare polypectomy (CSP) for removing intermediate‐size sessile serrated lesions (SSLs) measuring 10–20 mm. However, these supporting data come from single‐arm or retrospective studies, underscoring the need for randomized controlled trials to confirm its efficacy. This study aimed to compare the efficacy of CSP and cold endoscopic mucosal resection (EMR) with that of hot EMR in achieving complete histological resection of intermediate‐size SSLs.MethodsThis was a multicenter, randomized, non‐inferiority trial. A total of 113 patients with 159 intermediate‐size SSLs were randomized into three groups: CSP, cold EMR, and hot EMR. The primary outcome was the complete histological resection, defined as tumor‐free horizontal and vertical margins, regardless of whether resection was en bloc or piecemeal. Secondary outcomes included en bloc resection rate, polypectomy time, and procedural complications.ResultsThe complete histological resection rates were 90.6% for CSP, 88.5% for cold EMR, and 87.0% for hot EMR, demonstrating the non‐inferiority of CSP and cold EMR compared to hot EMR. CSP had a shallower vertical resection depth, which was improved by submucosal injection. CSP also had shorter polypectomy and total procedure times. The En bloc resection rates were 69.8% for CSP, 78.9% for cold EMR, and 88.9% for hot EMR. Although the en bloc resection rate was lower with CSP compared with hot EMR, it improved with submucosal injection.DiscussionCSP and cold EMR are effective alternatives to hot EMR for removing intermediate‐size SSLs, providing strong support for their recommendations in guidelines. Further research is warranted to evaluate the long‐term residual rate.

Gastric gastrointestinal stromal tumours (gGISTs) are among the predominant subtypes of gastric submucosal tumors (SMTs) with malignant potential. Accurate differentiation between gGISTs and non-gastric gastrointestinal stromal tumours (non-gGISTs) using current imaging tools, especially for small-diameter lesions (< 2.0cm), remains challenging. The aim of this study was to established a diagnostic nomogram model utilising endoscopic ultrasound (EUS) images to effectively distinguish small gGISTs from non-gGISTs. We conducted a multicentre retrospective study of consecutive patients who underwent endoscopic resection (ER) for gastric SMTs at two centres from March 2020 to June 2025. Clinical data, EUS characteristics and pathological features were collected and analysed. A nomogram model for the diagnosis of small gGISTs was established, followed by internal and external validation. A total of 496 patients were included in this study. The independent predictors of gGIST diagnosis were age ≥ 60years (OR (95% CI) 2.30 (1.20-4.44), P = 0.013), gastric cardia-fundus/body location (OR (95% CI) 6.09 (1.55-23.98), P = 0.010), and muscularis propria/submucosa origin (OR (95% CI) 6.71 (2.24-20.04), P < 0.001). The AUCs for the nomogram were 0.83 (95% CI 0.78-0.88), 0.81 (95% CI 0.73-0.89), and 0.87 (95% CI 0.81-0.92) in the training, internal validation, and external validation cohorts, respectively. Calibration curves showed excellent agreement between the predicted and actual probabilities for differentiating between small gGISTs and non-gGISTs. Decision curve analysis (DCA) demonstrated favourable clinical applications of the model. The external validation yielded an accuracy of 0.78, a sensitivity of 0.91, and a specificity of 0.71. A subgroup analysis between gGISTs and leiomyomas revealed that the AUC was 0.73 (95% CI 0.63-0.83), with an accuracy of 0.67, a sensitivity of 0.65, and a specificity of 0.74 in the external validation cohort. Patient age, lesion location, and origin layer were independent diagnostic factors for small gGISTs. The proposed nomogram served as a valuable tool for differentiating between small gGISTs and non-gGISTs.

Abstract Aim of the work This study assesses the limitations of transoral laser microsurgery (TLM) for early-stage laryngeal cancer involving the anterior commissure (AC), specifically examining the relationship between recurrence and thyroid cartilage invasion. Patients and methods A retrospective review of 32 T1–T2 glottic carcinoma patients treated with TLM between May 2023 and April 2025 analyzed recurrence and progression over 3–24 months. Concurrently, a cross-sectional analysis of five laryngectomy specimens from recurrent cases evaluated AC involvement and thyroid cartilage invasion. Results The cohort comprised 19 T1 and 13 T2 tumors. Recurrence occurred in 22 patients (54%), with 14 (63.6%) recurring at the same stage and 8 (36.4%) progressing. Salvage treatment consisted of 15 conservative surgeries (68.2%) and 7 total laryngectomies (31.8%). Histological analysis of all five laryngectomy specimens revealed tumor involvement of the cartilage. Conclusions AC involvement significantly impacts prognosis in early-stage laryngeal cancer. Given the increased recurrence risk after TLM or DRT associated with AC, vocal cord, supraglottic, or subglottic involvement, and the potential need for total laryngectomy, conservative surgical approaches should be considered cautiously in these cases.

Endoscopic resection for gastric subepithelial lesions: overtreatment or the next step in optimization?

Endoscopic resection (ER) is increasingly utilized for early gastric cancer (EGC) due to its minimally invasive profile and comparable survival to gastrectomy (GR). However, concerns regarding oncologic efficacy and institutional volume impact persist. This study evaluates how ER volume quartiles impact outcomes and guideline adherence in EGC management. A retrospective analysis of the NCDB from 2010 to 2021 for patients with cT1aN0M0 gastric adenocarcinoma was performed comparing ER and GR. Primary outcomes were oncologic outcomes, rates of guideline adherence, and survival stratified by institutional ER volume tertiles (high, mid, low). Multivariable logistic, linear regression, and Cox proportional hazards models were used. A total of 1461 patients were analyzed; 937 (61.4%) undergoing ER and 524 (35.7%) GR. 57.5% of ER occurred in the latter half of the study time period, and increasing proportional ER utilization in EGC was observed over time. When stratified by ER volume tertiles, margin positivity (14.6% high volume vs. 13.7% mid vs. 15.5% low, p = 0.85), LVI rates (6.3% high vs. 9.5% mid vs. 9.7% low, p = 0.32), guideline discordant care (22.6% high vs. 22.3% mid vs. 24.3% low, p = 0.82), and survival (vs. low volume: high HR 1.04, p = 0.87; mid HR 1.27, p = 0.39) did not differ by institutional ER volume. High-volume centers preferentially used ER (OR 1.76, p < 0.01) compared to low and mid-volume centers. Guideline-discordant ER correlated with earlier years (OR 0.69, p = 0.03) but not institutional volume (vs. low volume: high OR 0.94, p = 0.76; mid OR 0.90, p = 0.61). ER for EGC is rapidly expanding across US institutions at all volume levels. ER achieves comparable oncological outcomes and survival independent of ER volume when guideline-concordant criteria are met, suggesting centralization may be unnecessary for EGC. The guideline discordant care rate of ~24% across all institutions highlights the need for adherence to ER criteria for EGC.

Early detection and optimal treatment could improve the outcomes of patients with colorectal cancer (CRC). No adequate method has been developed to meet these two requirements. Here, we aimed to identify differential circulating tumor DNA (ctDNA) methylation biomarkers associated with CRC, and then establish models for detection, stage stratification and clinical decision-making. A total of 636 participants were included in this prospective study. To identify differential ctDNA methylation biomarkers, we first performed a genome-wide analysis between tumor and adjacent normal tissues using the α-value, which is sensitivity to ctDNA methylation signals. After filtering with PBMC samples, 4965 biomarkers were identified. A panel of 21 biomarkers was selected after shrinkage. A ctDNA methylation-based CRC diagnostic model (cMCD) was constructed. The cMCD yielded a sensitivity of 87.82% (83.39%-91.41%) for the combined detection of advanced adenomas and CRC, and a specificity of 91.88% (88.54%-94.49%). The overall accuracy was 89.85% (87.50%-92.30%), which was much greater than that of tumor markers [CEA: 67.30% (63.50%-70.93%); CA19-9: 59.91% (55.98%-63.74%); CA72-4: 55.66% (51.70%-59.57%); all P < 0.001]. As the risk score and sensitivity of the cMCD tended to increase with tumor progression, we constructed another ctDNA methylation-based model to stratify stage (cMCSS) and further guide treatment selection, specifically for discriminating the Early-stage patients eligible for curative endoscopic resection and avoiding overtreatment. The cMCSS could discriminate 75.86% (68.81%-82.02%) of Early-stage patients (advanced adenomas and T1N0M0 CRCs), for whom endoscopic resection could achieve curative intent, and 89.45% (84.59%-93.19%) of Advanced-stage patients. The accuracy [83.42% (79.36%-86.96%)] was significantly greater than that of tumor markers [CEA: 60.20% (55.17%-65.08%); CA19-9: 51.77% (46.71%-56.83%); CA724: 46.17% (41.16%-51.25%); all P < 0.001]. The approach based on ctDNA methylation is a noninvasive and robust method for both early detection and tumor stratification of CRC and could benefit patients in clinical decision-making.

Pancreatoscopy-assisted endoscopic mucosal resection combined with tetra-PEG hydrogel sealant spray in a porcine model: An innovative treatment method for main duct pancreatic intraductal neoplasms.

Superficial esophageal cancer (SEC) within a diverticulum is extremely rare and poses a high risk of perforation during endoscopic submucosal dissection (ESD), presenting unique technical challenges. This study aims to evaluate the feasibility, safety, and efficacy of ESD for treating SEC in diverticula. The retrospective study was conducted on patients diagnosed endoscopically with SEC in a diverticulum who subsequently underwent ESD with histological confirmation of esophageal cancer. Data on demographics, closure methods, incidence of adverse events, histopathological characteristics, and prognostic outcomes were collected from medical records and video recordings of endoscopic procedures and analyzed. Twelve patients were enrolled, and R0 resection was achieved in all cases. Post-ESD wound management varied, tailored to the defect characteristics: titanium clips were used to close wounds with a preserved superficial muscular layer in five patients (5/12, 41.7%), while endoscopic hand-suturing-developed by our research team primarily for closing large mucosal defects after endoscopic resection of colorectal tumors-was performed in three patients (3/12, 25.0%) with defects in the intrinsic muscular layer. Four patients (4/12, 33.3%) with small defects in the muscularis propria were left untreated. None of the patients experienced serious adverse events, such as post-operative bleeding or perforation, and there were no cases of recurrence or metastasis during follow-up. This study provides evidence supporting ESD as a feasible, effective, and safe treatment for SEC in diverticula. Tailoring closure techniques to the defect characteristics is crucial for preventing complications and achieving optimal clinical outcomes.

Verrucous carcinoma of the esophagus (VCE) is a rare variant of squamous cell carcinoma that poses diagnostic challenges due to nonspecific endoscopic and histologic findings. Its typical Candida overgrowth and hyperkeratotic, non-malignant superficial layer, combined with biopsy results showing fungal hyphae and minimal cytological atypia, are often misleading. Consequently, VCE is frequently diagnosed at advanced stages, limiting curative treatment options and contributing to poor outcomes. Clinicians should consider VCE in patients with persistent verrucous or hyperkeratotic esophageal lesions, especially in the setting of chronic Candida esophagitis. In this commentary, we reflect on seven cases diagnosed at a Dutch tertiary referral center to illustrate diagnostic pitfalls, discuss various treatment options, and offer guidance for improved recognition of VCE. By facilitating earlier diagnosis, curative treatment through endoscopic resection becomes more feasible, ultimately improving patient outcomes.

Design, optimization, and characterization of a thermo-responsive hydrogel as submucosal injection agent for endoscopic resection.

The anchor-pronged clip has been widely adopted for closure of large defects, offering enhanced tensile strength and grasping ability. However, reported real-world device and patient adverse events are limited in literature. Our focus is to identify the most commonly reported adverse events, device issues, and their clinical implications. The Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was analyzed from February 1, 2023 to December 31, 2024 to report post-marketing surveillance data on these anchor pronged clips. Approximately 135 reported cases with 187 device issues and 30 patient adverse events were examined. The most reported device problems were due to activation, position, or separation (53.5%). Common indications included defect closures after endoscopic submucosal dissection (ESD) (29.9%) and endoscopic mucosal resection (EMR) (23.9%). From the total reports analyzed, patient adverse events were noted in 21.1% (n = 30) of cases which comprised of hemorrhage (43.3%; n = 13), perforation (10.0%; n = 3), abdominal pain (6.7%; n = 2) among others. Our analysis of the MAUDE database suggests that the MANTIS™ clip demonstrates a favorable safety profile, particularly considering its intended use for closing large defects after advance tissue resections and ulcerations - procedures that inherently carry a higher risk of complications. This study provides valuable insight to help inform the risk/benefit discussions with patients and guide the development of future design iterations, ultimately enhancing patient outcomes and safety.

The retained-bridge traction strategy: a novel solution for secure defect closure following duodenal endoscopic full-thickness resection.