Gif h260z

All ESD procedures were performed with a standard single-channel endoscope (GIF-Q260J or GIF-H260Z, Olympus Optical Co. Ltd., Tokyo, Japan). The typical procedure sequence consisted of marking, mucosal incision, and then submucosal dissection with simultaneous hemostasis. The details of each step are described below.
Firstly, lesion was examined via chromoendoscopy using indigo carmine dye spraying. After making several marking dots circumferentially around the lesion with a needle knife (KD-10Q-1-A, Olympus Optical Co. Ltd., Tokyo, Japan) or a needle knife papillotome (MTW Endoscopy, Wesel, Germany), a saline solution containing epinephrine (0.01 mg/mL) mixed with indigo carmine was injected into the submucosal layer by using a 21-gauge needle in order to lift the lesion away from the muscle layer. A circumferential incision was made in the mucosa by using a needle knife and an insulated-tip knife (KD-610L, Olympus Optical Co. Ltd., Tokyo, Japan). The submucosal layer was dissected directly with various knives until complete removal was achieved. Endoscopic hemostasis was performed with hemoclips or hemostatic forceps whenever bleeding or exposed vessels were observed.

ESD was done with a single channel endoscope with jet function available (GIF Q260J, Olympus Optical Co. Ltd., Tokyo, Japan). Chromoendoscopy (using indigo carmine) and magnification endoscopy with narrow-band imaging (ME-NBI, GIF H260Z, Olympus Optical Co. Ltd., Tokyo, Japan) were used to define the carcinomatous area. A dual knife (KD-611L, Olympus Optical Co. Ltd., Tokyo, Japan) was used to mark the lesion. Saline mixed with epinephrine (0.01 mg/mL) and 0.5% indigo carmine was injected into the submucosa to lift the lesion. A circumferential mucosal incision was made around the lesion using a dual knife and/or IT knife 2 (KD-650L, Olympus Optical Co. Ltd., Tokyo, Japan). Lesions were completely removed by submucosal dissection using an IT knife 2 and/or a dual knife. Endoscopic hemostasis was performed either with hemostatic forceps (FD-410LR, Olympus Optical Co. Ltd., Tokyo, Japan) or the knife itself for bleeding or an exposed vessel. All visible vessels on the artificial ulcer were coagulated using hemostatic forceps, irrespective of the presence or absence of bleeding. For synchronous multiple lesions, marking was performed for all lesions initially. Resections subsequently were performed in the same way (Fig. 1A–H).

Stored images were retrieved from the computerized database of the Department of Endoscopy, Hiroshima University Hospital by use of a digital image filing system, Nexus (Fujifilm Co., Ltd., Tokyo, Japan). The size per endoscopic image was approximately 500 kb. These images were obtained during the EGD procedure with a GIF-H260 or GIF-H260Z endoscope (Olympus Optical Co., Ltd., Tokyo, Japan), after obtaining the written informed consent of the patient. The standard image series consisted of 34 images: 5 of the prepylorus and antrum, 4 of the angulus, 21 of the corpus (9 look-ups and 12 look-downs), and 4 of the cardia and fornix. The data were presented to the investigators as a PowerPoint presentation (Microsoft, Redmond, WA, USA) and were assessed on a 17-inch standard-definition monitor.

We analyzed a total of 102 patients with GHPs who were subjected to endoscopic resection at the Miyoshi Central Hospital and histopathologically diagnosed by the Department of Molecular Pathology, Nara Medical University, Japan, between 2013 and 2019. As written informed consent was not obtained from the patients for their participation in the present study, all identifying information was removed from patient samples prior to their analysis to ensure strict privacy protection (unlinked anonymization). All procedures were performed in accordance with the Ethical Guidelines for Human Genome/Gene Research enacted by the Japanese Government and with the approval of the Ethics Committee of Nara Medical University, Japan (approval number, 937, 20 October 2014).
The endoscopic examination was performed by the two co-authors (TM and KN) using a GIF-H260 or GIF-H260Z endoscope (Olympus Optical Co., Ltd., Tokyo, Japan) under white light observation, contrasted chromoendoscopy, and narrow band imaging.