Abstract: up to 400 Japanese characters or 200 English words
Welcome
We are pleased to announce The 4th Functional Endoscopy Conference. Through lectures and live demonstrations of functional endoscopic examinations, the conference will explore techniques and insights into the diagnosis of functional gastrointestinal disorders.
By sharing clinical experience and observing examinations in practice, we aim to deepen our understanding and bring useful insights into everyday clinical care. We look forward to welcoming you.
Conference Overview
Date & TimeSaturday, January 9, 2027, 9:00–16:00 JST (tentative)
Venue9th-floor Auditorium, Showa Medical University Koto Toyosu Hospital
FeeJPY 7,000
RegistrationPlease complete the registration form below.
ChairHaruhiro Inoue, Digestive Diseases Center, Showa Medical University Koto Toyosu Hospital
We welcome abstracts on the endoscopic diagnosis of functional gastrointestinal disorders, including case reports, clinical research, experience with implementing and using examinations in clinical practice, technical innovations, and studies of diagnostic utility. We invite you to share your experience and research findings.
Submission deadline: Monday, November 30, 2026 Abstract: up to 400 Japanese characters or 200 English words, excluding the title, authors, and affiliations.
Abstracts may be submitted in Japanese or English. Please email the presentation title, author names, affiliations, and abstract to the address below.
The following sessions are planned. The detailed program will be posted here once finalized.
01Educational Lectures
02Live Demonstrations of Functional Endoscopic Examinations
03Free Paper Presentations
About
The Functional Endoscopy Conference provides a forum for sharing clinical experience and research findings, and for discussing the endoscopic diagnosis of functional gastrointestinal disorders. Through lectures, live demonstrations, and free paper presentations, we aim to share knowledge that can inform everyday practice.
Explore selected studies on functional endoscopy from our center, organized by topic.
Select “Key Points & Article Details” to expand the summary and bibliographic information for each paper.
01
Concepts & New Developments
From the foundations of functional endoscopy to the phase concept and EFSIS.
2025 Endoscopy EFSIS
EFSIS: Simultaneous Endoscopy and Esophageal Manometry
Combining endoscopic images and pressure measurements for dynamic assessment of the antireflux mechanism.
Key Points & Article Details
Case and video report
Study Overview
This report introduces EFSIS, which simultaneously records endoscopic images, intragastric pressure, belching sounds, and high-resolution manometry (HRM). In a 35-year-old man, the lower esophageal sphincter (LES), upper esophageal sphincter (UES), and esophageal peristalsis were assessed sequentially.
Key Points
Phase 3 is subdivided into Phase 3A, involving UES contraction, and Phase 3B, involving esophageal peristalsis after UES relaxation. This report demonstrates the feasibility of integrating multiple signals for functional assessment.
Article Details
Dynamic functional evaluation of the anti-reflux mechanism with simultaneous endoscopy and manometry as a provocative test.
Inoue H, Tanabe M, Abiko S, et al. Endoscopy. 2025;57(Suppl 1):E1351-E1352.
The Phase Concept: Three Phases of the Antireflux Mechanism
Observing the gastric cardia, lower esophageal sphincter, and esophageal clearance as a coordinated sequence.
Key Points & Article Details
Observational study | 30 patients
Study Overview
Endoscopic videos from 30 patients examined for indications other than reflux symptoms were analyzed. The antireflux mechanism was assessed in three phases: Phase I (the gastric component), Phase II (the LES), and Phase III (esophageal clearance).
Key Points
The study proposes a framework for understanding antireflux function dynamically by relating anatomical changes to intragastric pressure. Further validation in patients with relevant disorders and comparison with other functional tests are needed.
Assessing motility, reflux, and sphincter function alongside gastrointestinal morphology.
Key Points & Article Details
Review
Study Overview
This review explains functional endoscopy, which adds dynamic observation of peristalsis, reflux, and sphincter activity to conventional morphological assessment. Using EPSIS as a representative example, it discusses intragastric pressure, the scope holding sign (SHS), and observation of belching.
Key Points
The review provides an overview of functional endoscopy and the physiological questions addressed by individual studies.
Article Details
Functional Endoscopy.
Inoue H, Shimamura Y. Digestion. 2024;105(1):58-61.
Studies comparing intragastric pressure, pressure waveforms, and endoscopic findings with conventional functional tests.
2026 DEN Open Health check-ups / silent GERD
EPSIS During Health Check-ups: Assessing Asymptomatic Reflux Esophagitis
Investigating the relationship between intragastric pressure, waveforms, and esophagitis in asymptomatic individuals.
Key Points & Article Details
Single-center retrospective study | 185 participants
Study Overview
The study analyzed 185 individuals who underwent upper gastrointestinal endoscopy and EPSIS during health check-ups between November 2024 and March 2025. Those with erosive esophagitis more often showed a flat waveform pattern and had lower maximum intragastric pressure than those without erosive esophagitis.
Key Points
Extending earlier work in symptomatic patients to asymptomatic individuals, this study explores the potential value of adding functional assessment to routine endoscopy.
Article Details
Utility of the Endoscopic Pressure Study Integrated System in Identifying Silent Gastroesophageal Reflux Disease During Routine Health Check-ups.
Nishikawa Y, Inoue H, Yamamoto K, et al. DEN Open. 2026;6(1):e70204.
Exploring small fluctuations in pressure waveforms as a potential marker of pathological acid reflux.
Key Points & Article Details
Retrospective study | 129 patients
Study Overview
The study analyzed 129 patients who underwent EPSIS and 24-hour impedance-pH monitoring. Wave height, defined as the difference between waveform peaks and troughs, tended to be greater in the 29 patients with pathological acid reflux.
Key Points
Alongside pressure difference and pressure gradient, wave height was investigated as a potential indicator of LES function and acid reflux.
Article Details
Wave height fluctuations in the waveforms of an endoscopic pressure study integrated system have the potential to predict acid reflux in gastroesophageal reflux disease (with video).
Abiko S, Shimamura Y, Inoue H, et al. Dig Endosc. 2025;37(9):981-988.
Comparing pressure measurements obtained with conventional and ultrathin gastroscopes.
Key Points & Article Details
Retrospective study | 30 patients
Study Overview
EPSIS measurements obtained with conventional and ultrathin gastroscopes were compared in the same 30 patients. Maximum intragastric pressure and pressure gradient were correlated between methods, but values obtained with the ultrathin gastroscope were lower.
Key Points
The study supports the feasibility of using an ultrathin gastroscope while highlighting the need to account for differences related to scope diameter when interpreting measurements.
Article Details
Endoscopic pressure study integrated system using an ultrathin gastroscope for the functional assessment of the lower esophageal sphincter.
Azuma D, Shimamura Y, Inoue H, et al. Dig Endosc. 2024;36(11):1225-1231.
Assessing esophagogastric junction function through intragastric pressure increases and waveform patterns.
Key Points & Article Details
Case-control study | 35 patients with achalasia and 34 controls
Study Overview
EPSIS findings were compared between 35 patients with achalasia and 34 controls. All patients with achalasia showed an uphill waveform pattern. The diagnostic performance of maximum intragastric pressure and pressure gradient was investigated.
Key Points
The study explores EPSIS as an adjunct to achalasia diagnosis, to be considered alongside esophageal manometry and other diagnostic assessments.
Article Details
Endoscopic pressure study integrated system for the diagnosis of achalasia.
Nishikawa Y, Inoue H, Shimamura Y, et al. Dig Endosc. 2024;36(5):565-572.
The Relationship Between EPSIS and High-resolution Manometry
Comparing intragastric pressure during endoscopy with measurements of LES pressure.
Key Points & Article Details
Retrospective study | 47 patients
Study Overview
In 47 patients with reflux symptoms, the study examined associations between EPSIS pressure difference and pressure gradient and LES pressure measured by HRM. Patients with a GERD pattern on EPSIS had lower basal LES pressure and related measures.
Key Points
The study helps relate EPSIS waveform changes to findings from conventional esophageal manometry.
Article Details
Association between endoscopic pressure study integrated system (EPSIS) and high-resolution manometry.
Fujiyoshi Y, Inoue H, Shimamura Y, et al. Endosc Int Open. 2022;10(6):E762-E768.
Does the Scope Holding Sign Reflect LES Contraction?
Comparing the endoscopic appearance of the LES gripping the scope with simultaneously recorded sphincter pressure.
Key Points & Article Details
Prospective pilot study | 11 participants
Study Overview
Endoscopy and HRM were performed simultaneously in 11 participants with normal esophageal motility. LES pressure was higher when the SHS was positive than when it was negative or at rest, demonstrating an association between the endoscopic finding and pressure changes.
Key Points
This small exploratory study evaluates the SHS as an endoscopic indicator of LES contraction and relaxation.
Article Details
Comparison of scope holding sign on endoscopy and lower esophageal sphincter contraction on high-resolution manometry: A pilot study.
Fujiyoshi Y, Inoue H, Shimamura Y, et al. DEN Open. 2022;2(1):e50.
Assessing Acid Reflux Using Pressure Difference and Gradient
Quantifying EPSIS waveforms and comparing them with 24-hour acid exposure.
Key Points & Article Details
Retrospective study | 57 patients
Study Overview
EPSIS and 24-hour impedance-pH monitoring were compared in 57 patients with GERD symptoms. The analysis examined associations of intragastric pressure difference and waveform gradient with pathological acid reflux.
Key Points
Pressure difference was associated with acid exposure time and showed diagnostic performance for pathological acid reflux. The study provides a basis for quantitative assessment of EPSIS waveforms.
Article Details
Characterization of intragastric pressure waveform in endoscopic pressure study integrated system: Novel diagnostic device for gastroesophageal reflux disease.
Shimamura Y, Inoue H, Rodriguez de Santiago E, et al. Dig Endosc. 2021;33(5):780-787.
Simplified EPSIS Without a Dedicated Intragastric Catheter
Investigating a simpler measurement technique using tubing connected to the endoscope’s working channel.
Key Points & Article Details
Pilot study | 20 patients
Study Overview
A conventional catheter-based method and a modified method using tubing connected to the working channel were compared in 20 patients. Waveform patterns agreed in all cases, and maximum intragastric pressure and pressure gradient also showed good agreement.
Key Points
The study demonstrates the feasibility of a simplified EPSIS technique that does not require insertion of a separate measurement catheter into the stomach.
Article Details
Simplified endoscopic pressure study integrated system for the diagnosis of gastroesophageal reflux disease.
Nishikawa Y, Inoue H, Shimamura Y, et al. Dig Endosc. 2021;33(4):663-667.
EPSIS in Barrett’s Esophagus and Erosive Esophagitis
Relating mucosal findings to intragastric pressure and waveform patterns to assess esophagogastric junction competence.
Key Points & Article Details
Single-center retrospective study | 104 patients
Study Overview
Among 104 patients who underwent EPSIS, 29 had erosive esophagitis and 42 had Barrett’s esophagus. Patients with either condition had lower maximum intragastric pressure and more frequent flat waveform patterns than those without the respective condition.
Key Points
The study links mucosal morphology with antireflux function assessed by EPSIS. It explores the assessment of associated esophagogastric junction dysfunction rather than the diagnosis of Barrett’s esophagus itself.
Article Details
Endoscopic pressure study integrated system reflects gastroesophageal junction competence in patients with erosive esophagitis and Barrett´s esophagus.
Iwaya Y, Inoue H, Rodríguez de Santiago E, et al. Dig Endosc. 2020;32(7):1050-1056.
Comparing intragastric pressure and waveforms during endoscopy with 24-hour pH monitoring.
Key Points & Article Details
Retrospective analysis | 59 patients
Study Overview
The analysis included 59 patients who underwent upper gastrointestinal endoscopy, EPSIS, and 24-hour pH monitoring. Maximum intragastric pressure and uphill or flat waveform patterns were evaluated for their association with GERD and their diagnostic performance.
Key Points
This early study explores the potential of EPSIS as a diagnostic adjunct that adds functional assessment to conventional endoscopy.
Article Details
Diagnostic performance of the endoscopic pressure study integrated system (EPSIS): a novel diagnostic tool for gastroesophageal reflux disease.
Inoue H, Shimamura Y, Rodriguez de Santiago E, et al. Endoscopy. 2019;51(8):759-762.
Studies assessing changes after treatment and informing safe examination practice.
2026 DEN Open Safety
EPSIS Safety: A Study of 1,205 Examinations
Examining the frequency and characteristics of adverse events over 10 years of experience.
Key Points & Article Details
Retrospective study | 1,205 examinations
Study Overview
The study reviewed 1,205 examinations performed between December 2015 and September 2024. Adverse events occurred in 35 examinations (2.9%): 32 cases of minor mucosal bleeding and three superficial mucosal lacerations.
Key Points
All events were mild and required no additional intervention. No serious adverse events were observed in this study. The findings emphasize careful monitoring of intragastric pressure increases and waveform patterns during examinations.
Article Details
Complications of Endoscopic Pressure Study Integrated System: Review of 1205 Cases in 10 Years’ Experience.
Iwasaki M, Tanaka I, Inoue H, et al. DEN Open. 2026;6(1):e70173.
Functional Assessment After Endoscopic Antireflux Therapy
Assessing the antireflux mechanism through changes in intragastric pressure before and after treatment.
Key Points & Article Details
Retrospective study | 39 patients
Study Overview
The study analyzed 39 patients who underwent EPSIS before and after endoscopic antireflux therapy. Maximum intragastric pressure and pressure gradient increased after treatment, and Hill grade also improved.
Key Points
The study explores the use of EPSIS to detect treatment-related changes and provide an adjunctive assessment of GERD treatment outcomes.
Article Details
Utility of endoscopic pressure study integrated system for gastroesophageal reflux disease after endoscopic antireflux therapy.
Yamamoto K, Inoue H, Tanaka I, et al. Dig Endosc. 2025;37(6):670-679.
Assessing Changes Before and After POEM with EPSIS
Investigating changes in intragastric pressure and waveforms after myotomy.
Key Points & Article Details
Retrospective study | 50 patients
Study Overview
The study analyzed 50 patients who underwent EPSIS before POEM and two months afterward. Maximum intragastric pressure, pressure difference, and pressure gradient decreased after treatment. Waveform differences according to the presence or absence of postoperative GERD were also examined.
Key Points
The study explores the potential for objective assessment of functional changes after achalasia treatment during endoscopy.
Article Details
Impact of peroral endoscopic myotomy on the endoscopic pressure study integrated system.
Nishikawa Y, Inoue H, Tanaka I, et al. Dig Endosc. 2025;37(2):157-166.
Extending pressure measurement techniques developed in the upper gastrointestinal tract to anorectal function.
2023 Ann Gastroenterol Lower GI tract
Applications in Anorectal Function
Assessing anal sphincter function using CO₂ insufflation and rectal pressure measurement during colonoscopy.
Key Points & Article Details
Pilot and feasibility study | 30 participants
Study Overview
Rectal pressure was measured during colonoscopy in 30 participants, comparing those aged 80 years or older with those younger than 80. Maximum rectal pressure was lower in the older group.
Key Points
This early study explores a lower gastrointestinal application of pressure-based endoscopic assessment to detect age-related changes in anorectal function. Its role in diagnosing conditions such as fecal incontinence requires further validation.
Article Details
Endoscopic carbon dioxide insufflation tolerance test on the anal sphincter for anorectal hypofunction: a pilot and feasibility study.
Toshimori A, Tanabe M, Shimamura Y, et al. Ann Gastroenterol. 2023;36(4):437-441.
