Details of a Researcher - YOSHII Shinji

Papers - YOSHII Shinji

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Hybrid Endoscopic Resection With Endo-knife and Snare for Colorectal Lesions: A Systematic Review and Meta-analysis

Shinji Yoshii, Takefumi Kikuchi, Yuki Hayashi, Masahiro Nojima, Hiro-o Yamano, Hiroshi Nakase

Techniques and Innovations in Gastrointestinal Endoscopy ( Elsevier BV ) 25 ( 2 ) 135 - 145 2023 [Refereed]

Efficacy and Safety of Complete Endoscopic Resection of Colorectal Neoplasia Using a Stepwise Endoscopic Protocol with SOUTEN, a Novel Multifunctional Snare.

Shinji Yoshii, Marina Kubo, Mio Matsumoto, Takefumi Kikuchi, Yasunari Takakuwa

Clinical endoscopy 53 ( 2 ) 206 - 212 2020.03 [Refereed] [International journal]

BACKGROUND/AIMS: A multifunctional snare SOUTEN has a sharp tip at the top of the snare loop that enables incision of the mucosa, dissection of the submucosal layer, and snaring of lesion. This study assessed the efficacy and safety of complete endoscopic resection of colorectal neoplasia using SOUTEN. METHODS: We analyzed the rates of gross en bloc resection and complete resections of 108 consecutive tumors from 69 patients resected by precutting endoscopic mucosal resection (precutting), hybrid endoscopic submucosal dissection (hybrid), or conventional endoscopic submucosal dissection (conventional) using SOUTEN. RESULTS: Out of the 108 tumors, 50 were resected by precutting, 27 were resected by hybrid after attempting precutting, and the remaining 31 were resected by conventional after attempting precutting and hybrid resections. The median tumor sizes were 14.5 mm for precutting, 16.4 mm for hybrid, and 21.1 mm for conventional. The success rate of gross en bloc resection and histological complete resection were 100% and 94.0% for precutting, 96.4% and 96.4% for hybrid, and 100% and 100% for conventional method, respectively. No procedure-related complication occurred. CONCLUSION: By using SOUTEN, precutting and hybrid were successfully performed on 10-30 mm tumors with a shorter procedure time than conventional without major complications.

Validity of endoscopic features for the diagnosis of Helicobacter pylori infection status based on the Kyoto classification of gastritis.

Yoshii S, Mabe K, Watano K, Ohno M, Matsumoto M, Ono S, Kudo T, Nojima M, Kato M, Sakamoto N

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 32 ( 1 ) 74 - 83 2019.07 [Refereed] [International journal]

OBJECTIVES: Evaluation of Helicobacter pylori infection status (non-infection, past infection, current infection) has become important. This study aimed to determine the usefulness of the Kyoto classification of gastritis for diagnosing H. pylori infection status by endoscopy. METHODS: In this prospective study, 498 subjects were recruited. Seven well-experienced endoscopists blinded to the history of eradication therapy performed the examinations. Endoscopic findings were assessed according to the Kyoto classification of gastritis: diffuse redness, regular arrangement of collecting venules (RAC), fundic gland polyp (FGP), atrophy, xanthoma, hyperplastic polyp, map-like redness, intestinal metaplasia, nodularity, mucosal swelling, white and flat elevated lesion, sticky mucus, depressive erosion, raised erosion, red streak, and enlarged folds. We established prediction models according to a machine learning procedure and compared them with general assessment by endoscopists using the Kyoto classification of gastritis. RESULTS: Significantly higher diagnostic odds were obtained for RAC (32.2), FGP (7.7), and red streak (4.7) in subjects with non-infection, map-like redness (12.9) in subjects with past infection, and diffuse redness (26.8), mucosal swelling (13.3), sticky mucus (10.2) and enlarged fold (8.6) in subjects with current infection. The overall diagnostic accuracy rate was 82.9% with the Kyoto classification of gastritis. The diagnostic accuracy of the prediction model was 88.6% for the model without H. pylori eradication history and 93.4% for the model with eradication history. CONCLUSIONS: The Kyoto classification of gastritis is useful for diagnosing H. pylori infection status based on endoscopic findings. Our prediction model is helpful for novice endoscopists. (UMIN000016674).

Factors Associated With Risk for Colorectal Cancer Recurrence After Endoscopic Resection of T1 Tumors

Shinji Yoshii, Masanori Nojima, Katsuhiko Nosho, Saori Omori, Takaya Kusumi, Hiroyuki Okuda, Hiroyuki Tsukagoshi, Masahiro Fujita, Hiroyuki Yamamoto, Masao Hosokawa

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY ( ELSEVIER SCIENCE INC ) 12 ( 2 ) 292 - + 2014.02 [Refereed] [International journal]

BACKGROUND & AIMS: More information is needed on the long-term outcomes of patients who undergo endoscopic resection of colorectal tumors. We evaluated recurrence of colorectal cancer (CRC) after endoscopic resection or a combination of endoscopic research and surgery for T1 colorectal tumors. METHODS: We conducted a retrospective study of 389 patients with T1 CRC treated by endoscopic resection from January 1989 to December 2008 in Sapporo, Japan. We compared outcomes between patients who underwent subsequent surgery (ER + SURG, n = 205) and those who did not (ER only, n = 184) and statistically adjusted baseline differences between the groups according to the propensity scores. RESULTS: There was almost no risk of cancer recurrence among patients without indications for surgery recommended by the Japanese Society for Cancer of the Colon and Rectum (these indications include tumors with vertical margins, deep submucosal invasion, lymphatic or venous invasion, poor differentiation, or high-grade budding). Among patients with indications for surgery, the cumulative risks of recurrence (CRRs) were 3.7% in the ER + SURG group and 20.1% in the ER only group (P = .001). However, the patients with only deep submucosal invasion had a low CRR, even without surgery (2.3% in the ER + SURG group and 3.4% in the ER only groups, P = .867). In contrast, patients with indications for surgery other than deep submucosal invasion (high-risk patients) had much better outcomes when they also underwent surgery (CRRs: 5.8% in the ER + SURG group vs 58.0% in the ER only group, P < .001). CONCLUSIONS: On the basis of a retrospective study of patients who underwent endoscopic resection for T1 CRC, those with tumors with only submucosal invasion are at low risk for cancer recurrence. However, patients with other high-risk tumor features have greater risks for cancer recurrence and benefit from subsequent surgery.

A rare case of delayed duodenal perforation due to an over-the-scope clip.

Yujiro Kawakami, Shinji Yoshii, Masahiro Taniguchi, Yoshiharu Masaki, Taro Sugawara, Yasutoshi Kimura, Hiroshi Nakase

Endoscopy 56 ( S 01 ) E331-E333 2024.12 [International journal]

Clinical performance of fecal calprotectin, lactoferrin, and hemoglobin for evaluating the disease activity of IBD and detecting colorectal tumors.

Tsukasa Yamakawa, Takakazu Miyake, Yoshihiro Yokoyama, Tomoe Kazama, Yuki Hayashi, Daisuke Hirayama, Shinji Yoshii, Hiro-O Yamano, Satoshi Takahashi, Hiroshi Nakase

JGH open : an open access journal of gastroenterology and hepatology 8 ( 6 ) e13077 2024.06 [International journal]

BACKGROUND AND AIM: Recently, noninvasive fecal markers have been used as indicators of intestinal inflammation in patients with inflammatory bowel disease (IBD). We conducted a clinical validation study to measure fecal calprotectin (Cp), lactoferrin (Lf), and hemoglobin (Hb) levels using an all-in-one kit in patients with IBD and colorectal tumors and aimed to clarify the utility of these fecal markers. METHODS: In this study, 104 patients were analyzed, including 25 patients with ulcerative colitis (UC), 20 with Crohn's disease (CD), 48 with colorectal tumors, and 13 healthy controls (HC). Of the 48 patients with colorectal tumors, 14 had invasive cancer. We validated the utility of fecal Cp, Lf, and Hb levels by simultaneously measuring fecal markers in patients with IBD and colorectal tumors. RESULTS: Fecal Cp and Lf had almost equivalent abilities in detecting clinical remission in patients with UC; however, fecal Cp was slightly superior to Lf. Regarding colorectal tumors, fecal Cp and Lf levels tended to be higher in patients with adenomas and colorectal cancer than in HCs. Although fecal Hb alone had the best sensitivity and specificity for detecting colorectal cancer, it had relatively low sensitivity for detecting advanced neoplasms and colorectal cancer. CONCLUSION: Fecal Cp and Lf can be used as almost equivalent biomarkers to assess the clinical activity in patients with UC. Fecal Hb is the most useful marker for screening colorectal cancer; however, adding fecal Cp and Lf may compensate for the low sensitivity of detecting for advanced colorectal tumors based on Hb alone.

【内視鏡治療後サーベイランスの現状-異時性多発病変を中心に】15ヵ月で急速な発育進展を来したと考えるSSL由来進行大腸癌の1例

山川司, 山野泰穂, 中村隼人, 三宅高和, 菅原太郎, 吉井新二, 長谷川匡, 仲瀬裕志

胃と腸 ( (株)医学書院 ) 59 ( 6 ) 883 - 887 2024.06

＜文献概要＞患者は80歳代,男性.肝腫瘤の精査目的のために当科に紹介され受診となり肝細胞癌と診断された.貧血があり大腸内視鏡検査を行ったところ,上行結腸に5mm大の0-IIa型病変を認めSSLと診断した.その後,高齢のため肝細胞癌は経過観察となっていたが,初回の内視鏡検査から15ヵ月後に血便を生じ,再度大腸内視鏡検査を行ったところ,上行結腸に進行大腸癌を認めた.病変の裾野には鋸歯状と考えられる開大した腺管構造を認め,腫瘍の遺伝子変異解析ではBRAF変異陽性であった.病理組織学的にも大腸鋸歯状病変由来の癌として矛盾せず,本症例は15ヵ月の経過で増大したSSL由来進行大腸癌と考えられた.

【大腸内視鏡治療-CP/EMR/ESD/Underwater関連手技の今】Precutting EMR/Hybrid ESD

吉井新二, 三宅高和, 山川司, 山野泰穂, 仲瀬裕志

臨床消化器内科 ( (株)日本メディカルセンター ) 39 ( 6 ) 655 - 662 2024.05

＜文献概要＞ESDの技術的困難性とEMRのサイズ制限を克服して一括切除をするために,粘膜切開・粘膜下層剥離とスネア切除を組み合わせたprecutting EMR/hybrid ESDは有用な手技である.Precutting EMRの適応は,スネアが滑って一括切除が難しい20mm程度までのEMR適応病変で,hybrid ESDは,スネアのサイズ制限から,30～40mm程度までのESD適応病変と考える.スネアリングする際は,粘膜下層が十分にトリミングされて深い溝がつくられていることが重要である.スネアリング時に病変部が落ち込んでくる場合は,分割切除になりやすいため,粘膜下層剥離を追加することが重要である.

ESD後穿孔における縫縮困難例への対策

山川司, 吉井新二, 秋田浩太朗, 三宅高和, 川上裕次郎, 柾木喜晴, 山野泰穂, 仲瀬裕志

Gastroenterological Endoscopy ( (一社)日本消化器内視鏡学会 ) 66 ( Suppl.1 ) 1019 - 1019 2024.04

内視鏡用軟性持針器を用いた内視鏡的手縫い縫合の導入経験

山川司, 吉井新二, 三宅高和, 山野泰穂, 仲瀬裕志

Gastroenterological Endoscopy ( (一社)日本消化器内視鏡学会 ) 66 ( 3 ) 286 - 292 2024.03

早期消化管癌に対する内視鏡治療後の粘膜欠損部に対して,後藤らにより内視鏡用軟性持針器と逆戻り防止弁付き縫合糸を用いた内視鏡的手縫い縫合法(endoscopic hand-suturing;EHS)が開発された.当科にて内視鏡用軟性持針器を用いてEHSを施行した5症例(胃3症例,大腸2症例)を検証した.EHSは全例で完遂でき縫合時間も既報と遜色ない結果であった.導入初期には胃症例で創部離開を1例認めたものの,全例で治療後の合併症は認めなかった.各病変の縫縮に要した時間は切除時間と同程度であったが,経験症例数が増えるに従って1針あたりの縫合時間は短縮傾向であった.EHSは様々な臨床応用が期待されるが,新規導入にあたってはトレーニングモデルを活用し十分な準備が必要である.(著者抄録)

An Analysis of Delayed Bleeding in Cases of Colorectal Endoscopic Submucosal Dissection Due to Types of Direct Oral Anticoagulants in Japan.

Naohisa Yoshida, Yoshikazu Hayashi, Daichi Togo, Shiro Oka, Kazunori Takada, Shusei Fukunaga, Yoshinori Morita, Takemasa Hayashi, Kazuhiro Kozuka, Yosuke Tsuji, Takashi Murakami, Takeshi Yamamura, Yoriaki Komeda, Yoji Takeuchi, Kensuke Shinmura, Hiroko Fukuda, Shinji Yoshii, Shoko Ono, Shinichi Katsuki, Kazumasa Kawashima, Daiki Nemoto, Hiroyuki Yamamoto, Yutaka Saito, Naoto Tamai, Aya Iwao, Yuki Itoi, Shigetsugu Tsuji, Yoshikazu Inagaki, Yutaka Inada, Koichi Soga, Daisuke Hasegawa, Takaaki Murakami, Hiroyuki Yoriki, Kohei Fukumoto, Takayuki Motoyoshi, Yasuki Nakatani, Yasushi Sano, Mikitaka Iguchi, Shigehiko Fujii, Hiromitsu Ban, Keita Harada, Koichi Okamoto, Hitoshi Nishiyama, Fumisato Sasaki, Kazujhiro Mizukami, Takashi Shono, Ryo Shimoda, Tadashi Miike, Naoyuki Yamaguchi

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 22 ( 2 ) 271 - 282 2024.02 [International journal]

BACKGROUND & AIMS: Reported rates of delayed bleeding (DB) after endoscopic resection using direct oral anticoagulants (DOACs) are high and heterogeneous. This large-scale multicenter study analyzed cases of DB after colorectal endoscopic submucosal dissection related to various types of DOACs in Japan (the ABCD-J study) with those associated with warfarin. METHODS: We retrospectively reviewed 1019 lesions in patients treated with DOACs and 459 lesions in patients treated with warfarin among 34,455 endoscopic submucosal dissection cases from 47 Japanese institutions between 2012 and 2021. The DB rate (DBR) with each DOAC was compared with that with warfarin. Risk factors for DB in patients treated with DOACs or warfarin were also investigated. RESULTS: The mean tumor sizes in the DOAC and warfarin groups were 29.6 ± 14.0 and 30.3 ± 16.4 mm, respectively. In the DOAC group, the DBR with dabigatran (18.26%) was significantly higher than that with apixaban (10.08%, P = .029), edoxaban (7.73%, P = .001), and rivaroxaban (7.21%, P < .001). Only rivaroxaban showed a significantly lower DBR than warfarin (11.76%, P = .033). In the multivariate analysis, heparin bridging therapy (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.27-3.73, P = .005), rectal location (2.01, 1.28-3.16, P = .002), and procedure time ≥55 minutes (2.43, 1.49-3.95, P < .001) were significant risk factors for DB in the DOAC group. The DB risk in the DOAC group (OR, (95% CI)) was 2.13 (1.30-3.50) and 4.53 (2.52-8.15) for 1 and 2 significant risk factors, respectively. CONCLUSIONS: Dabigatran was associated with a higher DBR than other DOACs, and only rivaroxaban was associated with a significantly lower DBR than warfarin.

Systemic Mastocytosis Observed by Image-Enhanced Endoscopy.

Ryota Seto, Shinji Yoshii, Tomoe Kazama, Tsukasa Yamakawa, Shintaro Sugita, Hiro-O Yamano, Hiroshi Nakase

The American journal of gastroenterology 118 ( 12 ) 2114 - 2114 2023.12 [International journal]

Jejunal Angiodysplasia in an Elderly Patient with Aortic Stenosis: Significance of Von Willebrand Factor as an Etiologic Factor.

Toshiyuki Kubo, Shinji Yoshii, Hiro-O Yamano, Masato Saito, Koichi Sakata, Shintaro Sugita, Tadashi Hasegawa, Hisanori Horiuchi, Hiroshi Nakase

Internal medicine (Tokyo, Japan) 62 ( 14 ) 2059 - 2062 2023.07 [Domestic journal]

Heyde's syndrome is a disease in which patients with aortic stenosis (AS) bleed from angiodysplasia. An 80-year-old woman with a history of severe AS was referred to our hospital with melena and anemia. The patient underwent jejunal resection after repeated blood transfusions. A pathological examination revealed angiodysplasia, and the patient's plasma lacked high-molecular-weight von Willebrand factor (VWF) multimers, leading to the diagnosis of Heyde's syndrome. The patient underwent transcatheter aortic valve implantation (TAVI) one year after the diagnosis, and the VWF index recovered. This is a valuable case in which the pathological analysis of angiodysplasia associated with Heyde's syndrome was possible.

Red blood cell distribution width as a novel marker for predicting bleeding after endoscopic resection for early gastric cancer.

Takada Yumemi, Shinji Yoshii, Tsukasa Yamakawa, Yuki Hayashi, Takakazu Miyake, Yoshihiro Yokoyama, Gota Sudo, Kei Mitsuhashi, Masanori Nojima, Hiro-O Yamano, Hiroshi Nakase

DEN open 3 ( 1 ) e123 2023.04 [International journal]

OBJECTIVES: Endoscopic resection (ER) is a minimally invasive treatment for early gastric cancer (EGC); however, there is a high occurrence of bleeding. This study aimed to clarify the significance of red blood cell distribution width (RDW) as a predictive risk factor for bleeding after ER for EGC. METHODS: We conducted a retrospective study based on data for patients who underwent ER for EGC from 2019 to 2021. This study included 79 lesions in 54 patients who underwent ER for EGC. The primary outcome was the association between RDW before ER and bleeding within 28 days of treatment. Receiver operating characteristic (ROC) curves were constructed, wherein areas under the curve (AUCs) and 95% confidence intervals were calculated to compare the discriminatory power of RDW for predicting bleeding. RESULTS: Endoscopic submucosal dissection was used as the resection method for 73 lesions, whereas endoscopic mucosal resection was used for six lesions. En bloc resection was performed in all cases. There were no cases of perforation; however, bleeding after ER occurred in five cases (9.3%). ROC curve analysis of bleeding after ER showed that the AUC was 0.843 with a good diagnostic performance. When the cut-off value of RDW was set at 14.4%, sensitivity and specificity were 80% and 85.7%, respectively. There was a bleeding rate of 36.4% (4/11) at an RDW of ≥14.4%, which was significantly higher than that of 2.3% (1/43) at an RDW of <14.4%. CONCLUSION: RDW can be a predictor of bleeding risk after ER for EGC.

An older patient with active ulcerative colitis and coronavirus disease 2019 (COVID-19) pneumonia successfully treated with the combination of anti-TNFα therapy and azathioprine.

Tsukasa Yamakawa, Keisuke Ishigami, Sae Ohwada, Tomoe Kazama, Daisuke Hirayama, Shinji Yoshii, Hiro-O Yamano, Hiroshi Nakase

Clinical journal of gastroenterology 16 ( 2 ) 187 - 192 2023.04 [Domestic journal]

A 77-year-old patient with ulcerative colitis (UC) was transferred to our department because of worsening bloody diarrhea and abdominal pain, which was consistent with a UC flare. Two days after admission, she complained of cough and high fever. The polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive, and a computed tomography showed pneumonia in the left lobe, consistent with coronavirus disease 2019 (COVID-19) pneumonia. However, frequent bloody diarrhea and abdominal pain due to the UC flare persisted; therefore, an additional immunosuppressive agent needed to be considered. We initiated infliximab biosimilar (IFX-BS), and her abdominal symptoms improved. However, they deteriorated after the second IFX-BS infusion. After confirming that the patient was negative for SARS-CoV-2 by PCR, we administered a combination of azathioprine and IFX-BS. The combination treatment improved her intestinal symptoms without worsening COVID-19 pneumonia. She has remained in remission for over a year since her discharge.

Immune-related colitis and pancreatitis treated with infliximab.

Sae Ohwada, Keisuke Ishigami, Yoshihiro Yokoyama, Tomoe Kazama, Yoshiharu Masaki, Mamoru Takahashi, Shinji Yoshii, Hiro-O Yamano, Hirofumi Chiba, Hiroshi Nakase

Clinical journal of gastroenterology 16 ( 1 ) 73 - 80 2023.02 [Domestic journal]

Patients with various cancers benefit from immune checkpoint inhibitors. However, immune checkpoint inhibitor-induced adverse events have also been reported, such as colitis. Prednisolone is the first-line treatment for immune-related adverse events, but second-line therapy for patients refractory to steroids has not been established. Furthermore, the inflammatory cytokine expression pattern in the intestinal mucosa of patients with steroid-refractory immune-related colitis remains unclear. We present the case of a 48-year-old man diagnosed with immune-related colitis and pancreatitis induced by pembrolizumab for advanced lung cancer. First, we administered 50 mg/day of prednisolone, and the patient's abdominal symptoms improved. However, the pancreatic enzyme levels did not return to normal. Furthermore, the patient's diarrhea worsened and hematochezia appeared at a 40 mg/day prednisolone dose. A mucosal cytokine analysis identified a low interleukin-10 messenger RNA level, which has been associated with a poor response to prednisolone. Thus, we administered 5 mg/kg of infliximab; the patient's diarrhea and hematochezia immediately improved, and the pancreatic enzyme levels returned to normal. Infliximab was administered three times every 2 weeks. After, the patient's colitis and pancreatitis did not recur. To our knowledge, this is the first report demonstrating the effectiveness of infliximab for immune-related colitis and pancreatitis.

Endoscopic full-thickness resection using an over-the-scope clip for colon cancer within a diverticulum.

Takakazu Miyake, Shinji Yoshii, Hiroshi Nakase

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 35 ( 1 ) e30-e32 2023.01 [International journal]

Extensive mucosal sloughing of the small intestine and colon in a patient with severe COVID-19.

Tsukasa Yamakawa, Keisuke Ishigami, Ayumu Takizawa, Yumemi Takada, Sae Ohwada, Yoshihiro Yokoyama, Tomoe Kazama, Daisuke Hirayama, Shinji Yoshii, Hiro-O Yamano, Rina Ohizumi, Naofumi Bunya, Taro Sugawara, Mitsuhiro Tsujiwaki, Shintaro Sugita, Satoshi Takahashi, Eichi Narimatsu, Hiroshi Nakase

DEN open 2 ( 1 ) e42 2022.04 [International journal]

Patients with coronavirus disease 2019 (COVID-19) primarily cause respiratory symptoms. However, gastrointestinal (GI) symptoms can also occur. The endoscopic characteristics of the GI tract in COVID-19 patients remain unclear. We herein report a 62-year-old male with severe COVID-19 who needed multidisciplinary treatment, including extracorporeal membrane oxygenation (ECMO). Despite the improvement in his respiratory status, GI bleeding developed. Capsule endoscopy and colonoscopy revealed extensive mucosal sloughing in the lower intestinal tract. Additionally, we performed a comprehensive analysis of the mRNA expression levels of various proinflammatory cytokines in the intestinal mucosal tissues. The results suggested a significant elevation of IL-6, which could be involved in the pathophysiology of the GI involvement in COVID-19. Further investigation with more clinical data, including endoscopic findings and molecular analyses, will contribute to a comprehensive understanding of COVID-19-associated GI injury.

Artificial intelligence-assisted endoscopy changes the definition of mucosal healing in ulcerative colitis.

Hiroshi Nakase, Takehiro Hirano, Kohei Wagatsuma, Tadashi Ichimiya, Tsukasa Yamakawa, Yoshihiro Yokoyama, Yuki Hayashi, Daisuke Hirayama, Tomoe Kazama, Shinji Yoshii, Hiro-O Yamano

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 33 ( 6 ) 903 - 911 2021.09 [International journal]

The relevance of endoscopic monitoring of ulcerative colitis (UC) has been translated into the new concept of "mucosal healing (MH)" as the therapeutic goal to achieve because a large amount of scientific data have revealed the favorable prognostic value of a healed mucosa in determining the clinical outcome of UC. Recent interest in MH has skewed toward not only endoscopic remission but also histological improvement (so called histological MH). However, we should recognize that there have been no prospectively validated endoscopic scoring systems of UC activity in previous clinical trials. Artificial intelligence (AI)-assisted endoscopy has been developed for gastrointestinal cancer surveillance. Recently, several AI-assisted endoscopic systems have been developed for assessment of MH in UC. In the future, the development of a new endoscopic scoring system based on AI might standardize the definition of MH. Therefore, "The road to an exact definition of MH in the treatment of UC has begun only now".

Novel injectable needle-type knife, ProKnife for colorectal endoscopic submucosal dissection.

Shinji Yoshii, Hiro-O Yamano, Hiroshi Nakase

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 33 ( 6 ) e137-e139 2021.09 [International journal]

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