This book originated when Dr. Toshiaki Hirasawa, one of the coauthors of this book, sent out quiz-style emails to residents and medical staff at Cancer Institute Hospital of JFCR. The email quiz had been developed as a teaching tool for use in resident training. A series of slides were attached that showed images of various unusual cases Dr. Hirasawa had worked with, as well as cases where lesions were missed.

In the first email distribution, the slides were not accompanied by the associated diagnoses. Instead the recipients were left to examine the images and come to a diagnosis on their own. The actual diagnoses were distributed a few days later. The clinical cases were all very instructive; they included typical cases, difficult-to-diagnose cases, cases where lesions were missed, and so on. The results were very positive. We staff doctors also found them beneficial.

In fact the emails proved so informative that Dr. Masahiro Igarashi, who was Director of the Department of Gastroenterology at the time, thought that it would be a good idea to turn the emails into a series of articles for a Japanese journal called Clinical Gastroenterology. The articles turned into a long-running serial, appearing in every issue and were subsequently collected and revised for inclusion in this volume.

The Cancer Institute Hospital of JFCR is a high-volume center, performing ESD for early cancer on almost 500 cases annually. All the cases are treated only after they have been examined at conferences. In fact, when surgeries are added in, it would be possible for a physician to study close to 1,000 cases of gastric cancer a year simply by attending the conferences. This book can be regarded as a comprehensive compilation of clinical cases that are experienced every day at the Cancer Institute Hospital of JFCR.

This book is so helpful, so packed with invaluable information, that readers will immediately find themselves looking at endoscopic images in a whole new way, starting with the very next endoscopy they perform. I was fortunate to have the opportunity to review all the clinical cases when they were written up for Clinical Gastroenterology. The data and the conclusions were so impressive and convincing that I was literally nodding non-stop while I looked over the material. In this book, you will find a wealth of practical information, including tips on detecting lesions,how to use endoscopes, and details on actual practice.

When we look at the clinical cases introduced in this book, we cannot avoid noticing that there are doctors today who are fully skilled in endoscopic submucosal detection (ESD), yet are unable to make an accurate diagnosis. On the other hand, there are doctors who have technical skill of ESD, yet totally incapable of finding and diagnosing them. This book attempts to solve these problems, making it a must-have for anyone who wants to master everything from detection to diagnosis using conventional endoscopy, which in turn is prerequisite that must be mastered before using magnifying endoscopy.

I have been watching as Dr. Hirasawa devoted all his energy to the creation of this book, so I cannot help feeling even more impressed by the result. As I have already mentioned, this extraordinary project had its genesis in our everyday work. Now it has turned into a single complete book. I hope that all doctors -- whether they are just starting out or have years of experience -- will find it helpful in their daily practice.

Finally, I would just like to congratulate Dr. Hirasawa on the completion of this book.

October 2016

Junko Fujisaki
Gastroenterological Medicine Department,
Cancer Institute Hospital of JFCR

And this book have just tranlated in English. I would like the doctors doing ESD all over the world to read this book.

March 2019

Junko Fujisaki

1 Normal gastric mucosa and gastritis

Normal gastric mucosa (Helicobacter pylori [H. pylori]-uninfected) / H. pylori-infected gastritis (H. pylori current infection and past infection)

2 Classification of gastric cancer and clinical characteristics

Classification of gastric cancer / Histogenesis and growth patterns of gastric cancer and clinical characteristics

1 Findings you need to consider in order to detect gastric cancer

Relationship with the background mucosa / Findings on the surface (cancerous area) / Findings on the margins

2 Factors and findings which make gastric cancer easy to miss

Sites that are easy to overlook / Lesions that are difficult to be found / Indigo carmine -- a magic potion that unveils hidden cancerss

51 Cases are described.