Effects of aspirin and enoxaparin in a rat model of liver fibrosis

AIM To examine the effects of aspirin and enoxaparin on liver function, coagulation index and histopathology in a rat model of liver fibrosis.METHODS Forty-five male Sprague-Dawley rats were randomly divided into the control group(n = 5) and model group(n = 40). Thioacetamide(TAA) was used to induce liver fibrosis in the model group. TAA-induced fibrotic rats received TAA continuously(n = 9), TAA + low-dose aspirin(n = 9), TAA + high-dose aspirin(n = 9) or TAA + enoxaparin(n = 9) for 4 wk. All rats were euthanized after 4 wk, and both hematoxylin-eosin and Masson staining were performed to observe pathological changes in liver tissue. RESULTS Liver fibrosis was assessed according to the METAVIR score. Compared with untreated cirrhotic controls, a significant improvement in fibrosis grade was observed in the low-dose aspirin, high-dose aspirin and enoxaparin treated groups, especially in the high-dose aspirin treated group. Alanine aminotransferase and total bilirubin were higher, albumin was lower and both prothrombin time and international normalized ratio were prolonged in the four treatment groups compared to controls. No significant differences among the four groups were observed.CONCLUSION Aspirin and enoxaparin can alleviate liver fibrosis in this rat model.

Full-thickness myotomy is associated with higher rate of postoperative gastroesophageal reflux disease

AIM To compare long-term occurrence of gastroesophageal reflux disease(GERD) between two different types of peroral endoscopic myotomy(POEM) for achalasia.METHODS We included all patients with achalasia who underwent POEM at our hospital from August 2011 to October 2012 and had complete GERD evaluation with ≥ 3 years of follow-up. They were divided into circular or full-thickness myotomy groups according to the depth of myotomy. Demographics, Eckardt score, manometry results, 24-h pH monitoring, and GERD symptoms were recorded and compared between the two groups.RESULTS We studied 56 patients(32 circular myotomy and 24 fullthickness myotomy) with complete GERD evaluation. There was no significant difference between the two groups in terms of treatment success(defined as Eckardt score ≤ 3), postoperative Eckardt score, mean basal lower esophageal sphincter pressure, and 4-s integrated relaxation pressure(4s IRP). Postoperative abnormal esophageal acid exposure was found in 25 patients(44.6%). A total of 13 patients(23.2%) had GERD symptoms and 12 had esophagitis(21.4%). Clinically relevant GERD(abnormal esophageal acid exposure associated with GERD symptoms and/or esophagitis) was diagnosed in 13 patients(23.2%).Multivariate analysis revealed that full-thickness myotomy and low level of postoperative 4s IRP were predictive factors for clinically relevant GERD.CONCLUSION Efficacy and manometry are comparable between achalasia patients treated with circular or full-thickness myotomy. But patients with full-thickness myotomy and low postoperative 4sI RP have more GERD.

Peroral endoscopic myotomy for achalasia in patients aged ≥ 65 years

AIM:To investigate the safety and efficacy of peroral endoscopic myotomy(POEM) for achalasia in patients aged ≥ 65 years.METHODS:From November 2011 to August 2014,15 consecutive patients(aged ≥ 65 years) diagnosed with achalasia were prospectively recruited and all underwent POEM at our institution. Eckardt score,lower esophageal sphincter(LES) pressure,esophageal diameter,SF-36 questionnaire,and procedure-related complications were used to evaluate the outcomes.RESULTS:All 15 patients were treated successfully by POEM,with a median operation time of 55 min. Median myotomy length was 10 cm. Three patients underwent circular myotomy and 12 full-thickness myotomies. Symptoms remitted in all cases during post-POEM f o l l o w- u p o f 6- 3 9 m o. E c k a r d t s c o r e r e d u c e d significantly(pre-operation vs post-operation:8.0 vs 1.0,P < 0.05). Median LES pressure decreased from 27.4 to 9.6 mm Hg(P < 0.05). Median diameter of the esophagus was significantly decreased(pre-operation vs post-operation:51.0 mm vs 30.0 mm,P < 0.05). Only one patient had reflux,which was resolved with oral proton pump inhibitors. No serious complications related to POEM were found. The quality of life of the 15 patients improved significantly after POEM.CONCLUSION:POEM is a safe and effective technique for treatment of achalasia in patients aged ≥ 65 years,with improvement in symptoms and quality of life.