Since the first report by Peter Vilmann in 1992, EUS-FNA has been recognized as a general practice in Europe and the United States for about ten years. In Japan, on the other hand, since 2010 when it was included in the insurance coverage, it has spread even more rapidly. In this symposium, we invited Professor Manoop Bhutani, who has been involved in research and clinical practice of EUS-FNA since the early days in the United States, as a keynote speaker, and Dr. Vikram Bhatia, New Delhi, India, as a designated speaker. EUS-FNA's progress so far and interventional EUS as an EUS-FNA-related procedure are widely solicited, and the trajectory and new developments so far will be held in a symposium format. We are looking forward to applications not only for retrospective analysis at the high volume center on EUS-FNA, but also for new developments using EUS-FNA related procedures.

The incidence of Barrett's adenocarcinoma is rising in Western countries and gradually increasing in Japan as well. Nonetheless, significant discrepancies persist in the diagnostic and therapeutic strategies for Barrett’s adenocarcinoma between the East and West, leading to many unresolved issues. In terms of diagnosis, persistent challenges are evident in the detection and characterization of LSBE cancer, as well as in the selection of endoscopic imaging modalities (such as NBI/BLI, acetic acid, and TXI/LCI). The validation of the JES-BE Classification and JGES Guidelines is still under investigation. The potential contribution of AI technology to the diagnostic process also warrants exploration. A novel concept, akin to post-colonoscopy colorectal cancer (PCCRC) and termed post-endoscopy Barrett's neoplasia, is another issue to be discussed. In terms of treatment, preventive measures for strictures following extensive resections hold significant importance. Furthermore, the debate surrounding the eradication of residual LSBE after endoscopic resection continues. In this session, we cordially invite researchers to share their studies covering various aspects related to existing research and cutting-edge approaches.

ERCP-based trans-papillary treatment is the first choice for benign biliary strictures, with balloon dilation and stenting commonly used to relieve the stricture. Stenting involves the placement of multiple plastic stents or fully-covered metal stents. For cases following gastrointestinal reconstruction, EUS-antegrade treatment has been attempted. Trans-papillary metal stent placement is a widespread method for treating malignant distal biliary strictures. New metal stents, such as large-bore and stents with anti-reflux valves, have been developed. The usefulness of EUS-guided hepaticogastrostomy (EUS-HGS) and EUS-guided choledochoduodenostomy (EUS-CDS) as primary drainage methods has also been reported. The endoscopic drainage strategy for malignant hilar biliary strictures still needs to be standardized: uncovered metal stents have been employed in stent-in-stent, side-by-side, and hybrid methods. The side-by-side placement of slim fully-covered metal stents is another technique. The usefulness of inside stents positioned within the bile duct has been documented when using plastic stents. Combinations of EUS-HGS with trans-papillary stenting and EUS-HGS with EUS-guided hepaticoduodenostomy (EUS-HDS) have also been attempted. Recently, the efficacy of biliary RFA for both benign and malignant biliary strictures has been reported. We invite you to submit unique research findings, clinical experiences, or technical advances on this topic. By sharing new knowledge and techniques, we aim to further evolve the treatment strategies for biliary strictures, ultimately benefiting the participants in this panel discussion.

Interventional endoscopic ultrasound (I-EUS) has been indicated for patients with failed ERCP. Currently, EUS-guided fine needle aspiration/biopsy, or EUS-guided biliary/pancreatic drainage are widely attempted. More recently, EUS-guided injection therapy, radiofrequency ablation, coiling therapy, gastrojejunostomy, or other innovative techniques have been developed. We also should pay attention to improvement of the dedicated devices for I-EUS. Although I-EUS may be promising technique, device or technique improvement to prevent adverse event is also important to develop I-EUS as primary treatment technique. In this panel discussion, we would like to discuss about recent improvement of various techniques, novel devices, and clinical results of I-EUS.

In recent years, remarkable advancements have been observed in the field of EUS. The progress is wide-ranging, including the enhancement of EUS-related facilities such as new equipment and devices, innovative technology, genetic analysis using specimens obtained by EUS, and EUS-AI diagnosis. In this session, we would like presentations related to novel and innovative challenges using EUS. Topics might include the results of new clinical data, the development and expansion of indications for interventional EUS, the usefulness of specialized treatment tools, treatments for complications, and others. If it is a novel challenge using EUS, we would like to welcome even a small number of cases. We hope for presentations that shed a positive and exciting light on the future of EUS. We look forward to your active participation and contributions on hot topics.

Small intestine is the most important digestive organ. There are many kinds of diseases such as neoplasm and polyposis, inflammatory bowel disease, vascular disease, mal-formation, and functional disease. Endoscopy has been the leading modality for investigating the physiology and diagnosing and treatment for diseases of this longest gastrointestinal tract. Here, we would like to discuss the progress of endoscopic devices and their utilizations in the workshop.

The role of endoscopy in the treat-to-target (T2T) based practice of IBD is becoming increasingly important with the expansion of molecular targeted therapies, the evolution of evaluation modalities such as balloon endoscopy, capsule endoscopy and MRI, and the widespread use of non-invasive biomarkers such as LRG and calprotectin. T2T strategy, the most important challenge is the lack of markers to provide a basis for determining the best individualized treatment. The role of endoscopy is to provide guidance on which drugs to select for which patients to achieve their goals. The precise pathophysiology of the inflamed intestinal tract is determined by imaging findings, AI, and biopsy tissue, leading to the best treatment options. The endoscopic dilatation by balloon or radial incision and cutting also plays an important role in achieving the goal. In this issue, we would like to discuss how endoscopy can guide the optimal treatment of T2T for IBD.

Endoscopic treatment of epithelial tumors in the gastrointestinal tract has made great progress in Japan with the development of ESD. However, endoscopic treatment of submucosal tumors (SMT) of the gastrointestinal tract in Japan is mainly performed as combination of laparoscopic and endoscopic procedures, and treatment using transluminal flexible endoscopy alone has not yet been fully established. On the other hand, treatment of gastrointestinal SMT by transluminal endoscopy alone is practiced in other countries, including China, and frequently reported. In this session, we would like to share the current status of endoscopic treatment of SMT of the esophagus, stomach, duodenum, and large intestine (GIST, leiomyoma, neuroendocrine tumor, etc.) in Japan and discuss future prospects (whether it is generally feasible in Japan). We would like to invite abstracts widely to the results of combination of laparoscopic and endoscopic procedures and new innovations in treatment using transluminal endoscopies.