New Paradigm in Gastrointestinal Cancer Treatment

polyglycolic acid sheets with fibrin glue with or without TA injection, may be useful to avoid postoperative stricture. Gastric cancer is the third leading cause of cancer-related deaths worldwide. Geographically, gastric cancer is very common in East Asia, where the prevalence rate of Helicobacter pylori infection is high. Chronic gastric infection due to H. pylori initially causes chronic active gastritis, which can then lead to the development of peptic ulcers, atrophic gastritis, and gastric cancer. A protective effect against gastric cancer has been reported to persist for more than 10 years after H. pylori eradication. Therefore, H. pylori can be considered one of the most important causes of gastric cancer. H. pylori -associated gastric cancer is one of the best examples of inflammation-related cancer. Therefore, it is clear that eradication of H. pylori reduces the risk for gastric cancer even in the presence of severe gastric atrophy and intestinal metaplasia. Thus, H. pylori eradication is the most effective strategy for the prevention of gastric cancer. Adachi et al. [2] attempted to determine whether metronidazole (MNZ)-based triple therapy is superior to clarithromycin (CAM)-based triple therapy as a first-line eradication treatment for H. pylori . They found that MNZ-based triple therapy containing esomeprazole and amoxicillin (AMPC) is superior to clarithromycin (CAM)-based triple therapy containing esomeprazole and AMPC as a first-line eradication treatment against H. pylori . The first Kindai International Symposium on Gastrointestinal Cancer (KISGIC) was held on July 8, 2017 in Osaka, Japan. The main theme of this symposium was: “New paradigm in gastrointestinal cancer treatment.” This symposium focused on recent progress on upper gastrointestinal cancer, lower intestinal cancer, pancreatobiliary cancer, and liver cancer. Endoscopic submucosal dissection (ESD) has been widely used in the resection of superficial esophageal cancers. Since its use has been extended to cases involving large esophageal tumors occupying nearly the whole lumen or the whole circumference of the lumen, the occurrence of esophageal stricture has increased. Although endoscopic injection of triamcinolone (TA) is widely used for the prevention of postoperative stricture, a significant number of patients still develop stricture after TA injection therapy. Okamoto et al. [1] performed a retrospective review of the data from 57 patients treated with nearor whole-circumferential ESD and with TA injection. They found that an extensive circumferential mucosal defect (covering more than 75% of the circumference) was associated with a high risk of developing postoperative esophageal stricture, even after preventive injection of TA. Authors concluded that endoscopic TA injection is not sufficient for the prevention of esophageal stricture in patients bearing a mucosal defect covering more than seven-eighths of the circumference after ESD. In such cases, alternative strategies, including the application of Published online: December 20, 2017