The liver that is involved in synthesis of serum proteins, regulation of metabolism and maintenance of homeostasis. Recent progress showed variety of opportunities that can be exploited for effective gene and cell therapies targeting pathogenic conditions arising both within and outside of the liver. Gene and cell therapies will be applied separately or in combination. The transfer and/or repopulation of cells into a target organ after manipulating genetic composition or sequence will lead to a new era of engineered cell therapies. The objective of this symposium provides collective information of recent progress in gene and cell therapies through the liver from basic and clinical results. We would like to also discuss how to overcome various problems including the administrative and regulatory hurdles encountered toward clinical application. We invite you all to participate in the special symposium of high scientific importance.

IgG4-related disease (IgG4-RD) is a new emerging disease entity of unknown etiology and has been found to affect the pancreas, bile duct, gall bladder, gastrointestinal tract, and other many organs. Therefore, IgG4-RD includes a wide variety of diseases, such as autoimmune pancreatitis, IgG4-related sclerosing cholangititis, IgG4-related cholecystitis, and so on. IgG4-RD responds well to steroid, but it is sometimes difficult to discriminate IgG4-RD from the progressive or malignant diseases such as primary sclerosing cholangitis, pancreatic cancer, and cholangiocarcinoma. Recently, several endoscopic techniques such as ERCP, EUS, IDUS, biopsy of biliary duct, and EUS-FNAB of pancreas are reported as useful methods for accurate diagnosis and therapy of IgG4-RD. In this session, we hope to discuss the effectiveness of those techniques and to elucidate the role of endoscopy for IgG4-RD.

ESD is a wonderful endoscopic treatment modality for GI neoplasia, which enables us to achieve reliable en-bloc resection. This technique has become a popular practice even in the colon and rectum, and The Japanese health care system has approved its reimbursement. However, colonic ESD is much difficult than gastric and esophageal ESD and involves a higher risk of complications. To provide high standard clinical care with this technique, it is necessary to select appropriate candidates, who meet the indication criteria for colorectal ESD through precise endoscopic diagnosis. Furthermore, newly devised instruments and technical ingenuities would be helpful to provide safe and reliable resection. Besides, careful pre-operative, intra-operative as well as post-operative management are quite important to avoid unfavorable complications. Also, establishment of a training system for colorectal ESD is a pending global need. To overcome various difficulties of this technique and achieve high quality colorectal ESD, we would like to discuss about those topics during this session.

Barrett's esophageal adenocarcinoma (BEA) is still rare in Japan compared to Western countries. According to several studies, a prevalence of BEA has been gradually increasing in Japan with an increase in patients with gastro-esophageal reflux disease or Barrett's esophagus. Earlier detection is important because that leads to better quality of life or prognosis of patients with BEA. It is often difficult to detect superficial Barrett's carcinomas (SBC) defined as superficial BEA or high-grade intraepithelial neoplasia due to those subtle abnormality of endoscopic findings. Therefore, worldwide standard method for the screening or surveillance of SBC is random biopsy (Seattle protocol). Recently, image enhanced endoscopies (IEE) including narrow-band imaging or acetic acid enhancing technique are thought to be useful to diagnose SBC. We hope to discuss how to detect and diagnose SBC using IEE or other special techniques. High-quality studies are needed to apply for this session. We sincerely look forward to characterizing SBC lesions with you in this session!

The controversy over whether and how to perform biliary drainage for preoperative/unresectable hilar biliary strictures (HBS) remains unsettled. Recently, arguments against preoperative endoscopic nasobiliary drainage before major surgical resection have been gaining momentum in a few Japanese high volume centers. Meanwhile, no definite guidelines outlining indications for biliary drainage in patients with unresectable HBS are currently available. However, in patients with unresectable HBS, "endoscopic" biliary drainage may　be performed by either plastic stent (PS) or uncovered self-expandable metallic stent (SEMS). At present, no consensus has been reached regarding which stent or approach is more appropriate, for example "PS(s) versus SEMS(s)", "conventional PS(s) versus inside PS(s)", "Which types of SEMS are appropriate?", "unilateral versus bilateral biliary drainage" and "side-by-side SEMSs versus stent-in-stent SEMSs about bilateral biliary drainage". Efficacy and long-term outcomes including stent patency and prognosis of these biliary drainage methods are not obvious. We expect to clarify current strategy and algorithmic perspective for HBS through the workshop.

The diagnosis and therapy for small-bowel diseases have evolved since the advent of capsule endoscopy and the latest enteroscopic modalities, such as double-balloon, single-balloon, and spiral enteroscopy. Capsule endoscopy includes PillCam SB2, Endocapsule, MiroCam, Omom, and CapsoCam. In addition, the PillCam patency system has extended the indications for capsule endoscopy by eliminating a risk of capsule retention in patients with known or suspected Crohn's disease and with histories of small bowel obstruction, chronic non-steroidal anti-inflammatory drugs use, radiation exposure, and small bowel resection. Although these enteroscopic modalities have disclosed various small-bowel pathologic conditions such as bleeding, obstruction, tumors, protein-losing enteropathy, and malabsorption syndrome, their etiology, diagnoses, and treatment occasionally remain challenging. There are still innominate small-bowel diseases. In this session, we are going to discuss the advantages and drawbacks of these modalities, and perspectives that will provide insights into understanding enigmas in this field.