流血和与内视镜的 submucosal 解剖联系的人工的胃的溃疡的管理

Endoscopic submucosal dissection (ESD), an endoscopic procedure for the treatment of gastric epithelial neoplasia without lymph node metastases, spread rapidly, primarily in Japan, starting in the late 1990s. ESD enables en bloc resection of lesions that are difficult to resect using conventional endoscopic mucosal resection (EMR). However, in comparison to EMR, ESD requires a high level of endoscopic competence and a longer resection time. Thus, ESD is associated with a higher risk of adverse events, including intraoperative and postoperative bleeding and gastrointestinal perforation. In particular, because of a higher incidence of intraoperative bleeding with mucosal incision and submucosal dissection, which are distinctive endoscopic procedures in ESD, a strategy for endoscopic hemostasis, mainly by thermo-coagulation hemostasis using hemostatic forceps, is important. In addition, because of iatrogenic artificial ulcers that always form after ESD, endoscopic hemostasis and appropriate pharma-cotherapy during the healing process are essential.

Japanese apricot improves symptoms of gastrointestinal dysmotility associated with gastroesophageal reflux disease

AIM: To investigate the effects of Japanese apricot(JA) consumption on gastroesophageal reflux disease(GERD)-related symptoms.METHODS: Participants included individuals living in Minabe-cho,a well-known JA-growing region,who received specific medical check-ups by the local community health service in 2010.GERD-related symptoms were examined in 1303 Japanese individuals using a validated questionnaire,the Frequency Scale for Symptoms of GERD(FSSG),which consists of 7 questions associated with acid reflux symptoms and 5 questions asking about gastrointestinal dysmotility symptoms.Each question was answered using a 4-point scale,with higher scores indicating more severe GERDrelated symptoms.Subjects were divided into two groups according to their intake of dried and pickled JA: daily intake(≥ 1 JA daily)(392 subjects) and none oroccasional intake(< 1 JA daily)(911 subjects).FSSG scores were compared between subjects who consumed JA daily and those who did not.Next,subjects were stratified by age,gender and Helicobacter pylori(H.pylori) status for subanalyses.RESULTS: Those who ate JA daily were significantly older than those who did not(60.6 ± 10.5 years vs 56.0 ± 11.0 years,P < 0.001).Total FSSG scores were significantly lower in subjects with daily JA intake than in those with none or only occasional intake(2.13 ± 3.14 vs 2.70 ± 3.82,P = 0.005).In particular,subjects who consumed JA daily showed significantly improved FSSG dysmotility scores compared with subjects who did not(1.05 ± 1.58 vs 1.46 ± 2.11,P < 0.001).In contrast,the FSSG reflux score did not differ between subjects with and without daily intake of JA(1.08 ± 1.90 vs 1.24 ± 2.11,P = 0.177).Subanalysis indicated that improvement in dysmotility by JA intake was specifically observed in non-elderly(1.24 ± 1.68 vs 1.62 ± 2.22,P = 0.005) and H.pylori-negative subjects(0.99 ± 1.58 vs 1.57 ± 2.06,P < 0.001).GERD patients(total FSSG score ≥ 8) were less frequently observed among subjects with daily intake of JA as compared to those without daily intake of JA(6.1% vs 9.7%,P = 0.040).CONCLUSION: Daily JA intake may improve digestive dysmotility symptoms,resulting in relief of GERD symptoms.The effect is more obvious in non-elderly and H.pylori-negative subjects.

Diazepam during endoscopic submucosal dissection of gastric epithelial neoplasias

AIM:To investigate risk factors and adverse events related to high-dose diazepam administration during endoscopic submucosal dissection for gastric neoplasias.METHODS:Between February 2002 and December 2009,a total of 286 patients with gastric epithelial neoplasia underwent endoscopic submucosal dissection in our hospital.To achieve moderate sedation,5-7.5 mg of diazepam was administered intravenously by non-anesthesiologists.Intermittent additional administration of 2.5-5 mg diazepam was performed if uncontrollable body movement of the patient was observed.All patients were classified into groups based on the required diazepam dose:low-dose (≤ 17.5 mg,n=252) and high-dose (> 17.5 mg,n=79).RESULTS:Differences between the low-and highdose diazepam groups were observed in lifetime alcohol consumption (0.30 ± 0.48 vs 0.44 ± 0.52 tons,P=0.032),body weight (58.4 ± 10.3 vs 62.0 ± 9.9 kg,P=0.006),tumor size (15 ± 10 vs 23 ± 18 mm,P < 0.001),lesion location (P < 0.001) and the presence of ulcerative findings (14/238 vs 18/61,P < 0.001).Multivariate analysis identified all five variables as independently related to required diazepam dosage.In terms of adverse reactions to diazepam administration,paradoxical excitement was significantly more frequent in the high-dose diazepam group (P < 0.001).CONCLUSION:Intermittent administration of diazepam enabled safe completion of gastric endoscopic submucosal dissection except in patients who were alcohol abusers or obese,or who showed complicated lesions.

Assessment of gastroesophageal reflux disease by serodiagnosis of Helicobacter pylori-related chronic gastritis stage

AIM:To evaluate the association of Helicobacter pylori(H.pylori)-related chronic gastritis stage with upper gastro-intestinal symptoms and gastro-eso-phageal reflux disease(GERD).METHODS:Subjects underwent upper gastrointestinal endoscopy,a questionnaire using a frequency scale for symptoms of GERD(FSSG),and measurements of serum H.pylori-antibody and pepsinogen(PG)levels.They were classified into the following 4 groups in terms of H.pylori-related chronic gastritis stage:Group A(n = 219),H.pylori(-)PG(-);Group B(n = 310),H.pylori(+)PG(-);Group C(n = 279),H.pylori(+)PG(+);and Group D(n = 17),H.pylori(-)PG(+).RESULTS:Reflux esophagitis occurred in 30.6% of Group A,14.5% of Group B,6.8% of Group C,and 0% of Group D(P < 0.001).Scores for acid reflux sympto-ms decreased significantly with chro-nic gastritis stage(from Group A to D)(P < 0.05),while scores for dysmotility symptoms did no-t differ significantly.The prevalence of nonerosive reflux disease(NERD)did not differ amo-ng groups.However,in subjects with GERD,the prevalence of NERD tended to increase with chronic gastritis stage(P = 0.081).CONCLUSION:Acid reflux sympto-ms and the prevalen-ce of reflux esophagitis can be assessed by measuring both serum H.pylori-antibody and PG levels.

Usefulness of continuous suction mouthpiece during esophagogastroduodenoscopy: A single-center, prospective,randomized study

AIM: To develop a new continuous suction mouthpiece(CSM) and evaluate its usefulness for screening esophagogastroduodenoscopy(EGD).METHODS: A total of 196 patients who were scheduled to undergo screening EGD were assigned to one of two groups: a group using the CSM and a group using a conventional mouthpiece. Extent of salivary flow,frequency of saliva suction, number of choking episodesduring the examination, and incidence of aspiration pneumonia after the examination were evaluated and compared between the two groups. Adverse events during and after EGD were also examined. In addition, the oral cavity was meticulously examined after the EGD.RESULTS: The same number of patients was randomly allocated to each group. There were no significant differences between the two groups in sex, age,biopsy procedure, duration of procedure and depth of sedation. Aspiration pneumonia and other significant adverse events were not observed in either group. The grade of extent of salivary flow was significantly lower in patients with the CSM than in patients with the conventional mouthpiece(P < 0.001). Although there was no significant difference, less frequent suctioning and fewer choking episodes were observed in patients with the CSM than in patients with the conventional mouthpiece(P = 0.082 and P = 0.084, respectively). In addition, there were no patients in the CSM group who required saliva suctioning during the procedure.CONCLUSION: Use of the CSM during screening EGD can reduce the extent of salivary flow. The device is expected to reduce complications and contamination with saliva.

Causative factors of discomfort in esophagogastroduodenoscopy: A large-scale cross-sectional study

BACKGROUND It is important to reduce patient discomfort in esophagogastroduodenoscopy.Remedial measures can be taken to alleviate discomfort if the causative factors are determined;however,all the factors have not been elucidated yet.AIM To clearly determine the factors influencing discomfort in transoral esophagogastroduodenoscopy using a large-size cross-sectional study with readily available data.METHODS Consecutive patients who underwent screening transoral esophagogastroduodenoscopy consecutively between August 2017 and October 2017 at a health check-up center were included.Discomfort was evaluated using a face scale between 0 and 10 with a 6-level questionnaire.Univariate and multiple regression analyses were performed to investigate the factors related to the discomfort in esophagogastroduodenoscopy.Univariate analysis was performed in both the unsedated and sedated study groups.Age,sex,height,body mass index,smoking status,alcohol intake,hiatal hernia,history of gastrectomy,biopsy during examination,Lugol’s solution usage,administration of butylscopolamine with/without a sedative(pethidine,midazolam,or both),endoscope model,history of endoscopy,and endoscopists were considered as possible factors of discomfort.RESULTS Finally,1715 patients were enrolled in this study.Overall,the median discomfort score was 2 and the interquartile range was 2-4.High discomfort(score≥6)was recorded in 18%of the participants.According to univariate analysis,in the unsedated group,young age(P<0.001),female sex(P<0.001),and no history of endoscopy(P<0.001)were factors associated with increased discomfort.Significant differences were also noted for height(P=0.007),smoking status(P=0.003),and endoscopists(P<0.001).In the sedation group,young age(P<0.001),female sex(P<0.001),and no history of endoscopy(P=0.004)were associated with increased discomfort;additionally,significant differences were found in smoking status(P<0.001),type of sedation(P<0.001),and endoscopists(P=0.027).There was also a marginal difference due to alcohol intake(P=0.055).Based on multiple regression analysis,young age,female sex,less height,current smoking status,and presence of hiatal hernia[regression coefficients of 0.08,P<0.001(for-1 years);0.45,P=0.013;0.02,P=0.024(for-1 cm);0.35,P=0.036;and 0.34,P=0.003,respectively]were factors that significantly increased discomfort in esophagogastroduodenoscopy.Alternatively,sedation significantly reduced discomfort and pethidine(regression coefficient:-1.47,P<0.001)and midazolam(regression coefficient:-1.63,P=0.001)significantly reduced the discomfort both individually and in combination(regression coefficient:-2.92,P<0.001).A difference in the endoscopist performing the procedure was also associated with discomfort.CONCLUSION Young age,female sex,and smoking are associated with esophagogastroduodenoscopy discomfort.Additionally,heavy alcohol consumption diminished the effects of sedation.These factors are easily obtained and are thus useful.