Real-time tele-endoscopic guidance for endoscopic antireflux mucosectomy using a novel high-speed mobile network...

Advances in telemedicine and high-speed mobile networks, including multichannel 4G and 5G connectivity, have enabled real-time remote endoscopic support across international settings without imposing additional demands on institutional internet infrastructure. These technologies enhance access to expert guidance for complex procedures, improving safety and facilitating knowledge transfer. However, real-world clinical applications of international tele-endoscopic support remain limited.

We describe the implementation of a tele-endoscopy system (Medical Edge; Zao-X, Tokyo, Japan) using a high-speed mobile network and present a case of endoscopic antireflux mucoplasty performed under real-time remote guidance. An 80-year-old man with postgastrectomy gastroesophageal reflux disease (GERD) refractory to medical therapy was selected. The system provided high-definition, low-latency imaging, bidirectional audio communication, video pausing, and on-screen annotation, enabling precise procedural instruction. Representative endoscopic findings are shown in the esophagus and remnant stomach, as well as a small sliding hiatal hernia.

The procedure was completed without intraoperative or postoperative adverse events. The patient was discharged on postoperative day 4. Follow-up endoscopy demonstrated reduction of a sliding hiatal hernia and complete resolution of reflux esophagitis. Symptom scores improved, with the frequency scale for the symptoms of GERD score decreasing from 15 to 6, and the GERD questionnaire score improving from 9 to 4 by postoperative day 14.

This case demonstrates the feasibility and clinical utility of real-time international tele-endoscopic guidance using a high-speed mobile network system.