【背景】胃gastrointestinal mesenchymal tumor（GIMT）に対する標準治療は腹腔鏡下手術であるが，より低侵襲な内視鏡治療は普及していない．【目的】胃GIMTに対する内視鏡切除術の現状と課題を明らかにする．【方法】2014年から2024年までに当院において胃GIMTに対して内視鏡治療または腹腔鏡下治療が施行された102例を対象とした．内視鏡治療群（ER群）50例と腹腔鏡下治療群（LR群）52例を比較検討した．【結果】手術時間はER群/LR群：51/124.5分（p ＜0.01）とER群で有意に短く，R0切除率は有意差を認めなかった．ER群では30 mm以下の管内発育型腫瘍を適応としており，腫瘍径はER群/LR群：24/30 mm（p ＜0.01）とER群で小さく，管外発育病変はER群/LR群：4（8%）/15（29%）（p ＜0.01）とER群で少なかった．Clavien-Dindo Grade3aの偶発症を両群に1例ずつ認めた．ER群の偶発症は幽門前部小弯の遅発性穿孔であり，穿孔部へのPGA充填とOTSC縫縮により外科的治療を要さず保存的加療で改善した．【結論】経口回収可能な腔内発育型胃GIMTに対する内視鏡を用いた局所切除は腹腔鏡下手術と同等の安全性と確実性を有しつつ術時間を短縮できる可能性がある．

The patient is a man in his 50s. Preoperative esophagogastroduodenoscopic examination prior to surgery for left renal cancer revealed a gastric varix that had developed due to liver cirrhosis caused by nonalcoholic steatohepatitis. Endoscopic injection sclerotherapy (EIS) was performed to prevent potential perioperative bleeding from the gastric varix. The sclerosant, 5% ethanolamine oleate containing vascular contrast agent, was directly injected into the varix under X-ray monitoring. Endoscopy performed one month after EIS and contrast-enhanced computed tomography three months after EIS showed that the gastric varices had shrunk. EIS is an effective treatment to control and prevent bleeding from gastric varices.

A 65-year-old malewith squamous cell carcinoma of the lungs developed hematemesis one month after starting treatment using atezolizumab as a 6th-line therapy. Upper gastrointestinal endoscopy revealed mucosal erythema and erosions within the descending and horizontal legs of the duodenum. Similarly, capsule endoscopy showed mucosal erythema and erosions from the jejunum to the ileum. Moreover, histopathology demonstrated moderate neutrophilic infiltrate in the intrinsic layer of the duodenal mucosa,with regenerative changes in the epithelium. After treatment with steroids, colonoscopy showed no evidence of inflammation, including in the terminal ileum, and the patient's symptoms and endoscopic findings improved markedly.

A 71-year-old woman was admitted to hospital with abdominal distension. Abdominal contrast-enhanced CT revealed ileum obstruction due to intussusception caused by submucosal tumor. A nasal-ileal tube was positioned first, but the intussusception was not treated.

This patient in his 80s was transferred for suspected intestinal obstruction. Sigmoid volvulus was diagnozed by "coffee-bean sign" in abdominal X-ray and obstruction of the sigmoid colon with whirl sign in contrast-enhanced CT. Endoscopic detorsion was attempted but was in vain due to strong torsion and poor blood flow. Symptoms were temporarily relieved with endoscopic degassing. Three days later, abdominal distention recurred. The following colonoscopy showed worsened torsion and exposure of muscular layer, implicating impending perforation. Poor general condition made surgical intervention too risky. Insertion of a transanal ileus tube for decompression was considered, but the hard and thick tip made it impossible to be passed through the site of impending perforation. Instead, we placed a urinary ballooned (Foley) catheter and successfully decompressed. Symptoms were fully relieved without perforation during the course.

A 42-year-old woman was referred to our hospital with a complaint of abdominal pain. An abdominal CT scan revealed intussusception caused by a tumor of the sigmoid colon. The intussusception could not be unfastened by colonoscopy. Sigmoidectomy was performed. The histological diagnosis of the tumor was a benign neurogenic tumor. Adult intussusception often results from organic disease. Neurogenic tumors in gastrointestinal tract are rare.

A male in his 80s was diagnosed with reflux esophagitis and Barrett's esophagus, and underwent endoscopy annually. After treatment for chronic pharyngeal mycosis, he developed scar stenosis at the esophageal orifice and regular follow-up was performed with a small-caliber endoscope. A depressed lesion was found in the esophagogastric junction (EGJ), and biopsy examination revealed adenocarcinoma (tub1). The preoperative diagnosis was Barrett's esophageal adenocarcinoma (depth, DMM-SM1). After endoscopic balloon dilatation, a therapeutic endoscope could be inserted and endoscopic submucosal dissection (ESD) was performed. Pathological examination revealed poorly differentiated adenocarcinoma, pT1b-SM2, ly1, v1, pHM0, pVM0. He desired no additional surgery. Five months later, lymph node and distant metastases developed.

We report a case of a 38-year-old man who complained of abdominal pain and was diagnosed with intestinal tuberculosis. Ileocolonoscopy revealed white submucosal tumor (SMT) -like lesion at the terminal ileum and cecum. A biopsy of a white SMT-like lesion revealed caseating granulomas on pathological examination. He was diagnosed with intestinal tuberculosis, and received antituberculous therapy. A combination of rifampicin, isoniazid, pyrazinamide, and ethambutol was used for 2 months, followed by a combination of rifampicin and isoniazid for 4 months.

A 79-year-old female was referred to our hospital with a submucosal tumor (SMT) in the gastric angle found on plain computed tomography (CT) at another hospital. Esophagogastroduodenoscopy (EGD) showed a submucosal protuberance with small ulcers in the gastric angle, and biopsy showed no malignant findings. Contrast CT showed a 40-mm SMT in the gastric angle. EUS showed the mass as a well-defined 30-mm mass arising from the third layer, with a mixture of hypoechoic and hyperechoic features. EUS-FNA and biopsy showed no malignant findings. Three months later, EGD and contrast CT showed mildly enlarged ulcers. Reexamination of the EUS-FNA and pathology results revealed a small aggregate of epithelial-like cells with a background of mucus, and mucus-rich clear cytoplasm. Suspecting gastric mucinous carcinoma, laparoscopic pyloric gastrectomy was performed, and the pathological diagnosis was mucinous adenocarcinoma, pStage IA (pT1bN0M0).

A hemodialytic male in his 60s presented with intermittent chest pain and coffee-ground emesis. Esophagogastroduodenoscopy showed a well-circumscribed area with indistinct vascular pattern in the middle esophagus, followed by blackish ulcerative mucosa at the distal esophagus, ending abruptly at the squamocolumnar junction, which findings were compatible with AEML. With fasting and proton-pump inhibitors, his symptoms rapidly resolved. He did not appear at the follow-up appointment one month after hospital discharge. Five months after hospital discharge, he suffered cardiac arrest and died. AEML is an acute erosive esophagitis whose endoscopic appearance resembles that of severe reflux esophagitis (sRE). Our case-control study showed higher mortality from AEML than from sRE. The endoscopic finding of "well-circumscribed esophageal mucosa with indistinct vascular pattern" could be an endoscopic feature of AEML, and may be useful for distinguishing AEML from sRE.