Randomized controlled trial of sodium phosphate tablets vs polyethylene glycol solution for colonoscopy bowel cleansing

AIM:To compare efficacy,patient compliance,acceptability,satisfaction,safety,and adenoma detection rate of sodium phosphate tablets(NaP,CLICOLONTM)to a standard 4 L polyethylene glycol(PEG)solution for bowel cleansing for adults undergoing colonoscopy.METHODS:In this multicenter,randomized,prospective,investigator-blind study,the relatively young(19-60years)healthy outpatients without comorbidity were randomly assigned to one of two arms.All colonoscopy were scheduled in the morning.The NaP group was asked to take 4 tablets,5 times the evening before and4 tablets,3 times early on the morning of the colonoscopy.The PEG group was asked to ingest 2 L of solution the evening before and 2 L early in the morning of the procedure.Adequacy of bowel preparation was scored using the Boston bowel preparation scale.RESULTS:No significant differences were observed between the NaP group(n=158)and PEG group(n=162)in bowel cleansing quality(adequate preparation93.0%vs 92.6%,P=0.877),patient compliance(P=0.228),overall adverse events(63.3%vs 69.1%,P=0.269),or adenoma detection rate(34.8%vs 35.2%,P=0.944).Patient acceptability,satisfaction,and patient rating of taste were higher in the NaP group than in the PEG group(P<0.001).CONCLUSION:NaP tablets,compared with PEG solution,produced equivalent colon cleansing,did not cause more side effects,and had better patient acceptability and satisfaction in the relatively young(age<60years)healthy individuals without comorbidity.An oral tablet formulation could make bowel preparation less burdensome,resulting in greater patient participation in screening programs.

Chemical ablation of the gallbladder using alcohol in cholecystitis after palliative biliary stenting

Chemical ablation of the gallbladder is effective in patients at high risk of complications after surgery. Percutaneous gallbladder drainage is an effective treatment for cholecystitis; however, when the drain tube cannot be removed because of recurrent symptoms, retaining it can cause problems. An 82-year-old woman presented with cholecystitis and cholangitis caused by biliary stent occlusion and suspected tumor invasion of the cystic duct. We present successful chemical ablation of the gallbladder using pure alcohol, through a percutaneous gallbladder drainage tube, in a patient who developed intractable cholecystitis with obstruction of the cystic duct after receiving a biliary stent. Our results suggest that chemical ablation therapy is an effective alternative to surgical therapy for intractable cholecystitis.

Usefulness of magnifying endoscopy in post-endoscopic resection scar for early gastric neoplasm:A prospective short-term follow-up endoscopy study

AIM:To investigate the relationship between post-endoscopic resection(ER) scars on magnifying endoscopy(ME) and the pathological diagnosis in order to validate the clinical significance of ME.METHODS:From January,2007 to June,2008,124 patients with 129 post-ER scar lesions were enrolled.Mucosal pit patterns on ME were compared with conventional endoscopy(CE) findings and histological results obtained from targeted biopsies.RESULTS:CE fi ndings showed nodular scars(53/129),erythematous scars(85/129),and ulcerative scars(4/129).The post-ER scars were classified into four pit patterns of sulci and ridges on ME:47 round;54 short rod or tubular;19 branched or gyrus-like;and9 destroyed pits.Sensitivity and specificity were 88.9% and 62.5%,respectively,by the presence of nodularity on CE.Erythematous lesions were high sensitivity(100%),but specificity was as low as 36.7%.The range of the positive predictive value (PPV) on CE was as low as 10.6%-25%.Nine type  pit patterns were diagnosed as tumor lesions,and 120 cases of type pit patterns revealed non-neoplastic lesions.Thus,the sensitivity,specificity,and the PPV of ME were 100%.CONCLUSION:ME findings can detect the presence of tumor in post-ER scar lesions,and make evident the biopsy target site in short-term follow-up.Further large-scale and long-term studies are needed to determine whether ME can replace endoscopic biopsy.

Endoscopic diverticulotomy with an isolated-tip needle-knife papillotome (Iso-Tome) and a fitted overtube for the treatment of a Killian-Jamieson diverticulum

A Killian-Jamieson diverticulum (KJD) is an unfamiliar and rare cervical esophageal diverticulum. This diverticulum originates on the anterolateral wall of the proximal cervical esophagus through a muscular gap (the Killian-Jamieson space) below the cricopharyngeal muscle and lateral to the longitudinal muscle of the esophagus. To date, only surgical treatment has been recommended for a symptomatic KJD due to its close proximity to the recurrent laryngeal nerve and the concern of possible nerve injury. Recently, traditional open surgery for a symptomatic KJD is being challenged by the development of new endoscopic techniques and devices. We present here a case of a symptomatic KJD that was successfully treated with the flexible endoscopic diverticulotomy using two new devices. An isolated-tip needle-knife papillotome (Iso-Tome) was used for the dissection of the tissue bridge of the diverticulum. And a flexible overtube with a modifi ed distal end (a fi tted overtube) was used for adequate visualization of the tissue bridge of the diverticulum and protection of the surrounding tissue during dissection of the tissue bridge. Our successful experience suggests that the flexible endoscopic diverticulotomy with the use of appropriate endoscopicdevices can be a safe and effective method for the treatment of a symptomatic KJD.