Clinical impact of endoscopy position detecting unit(UPD-3) for a non-sedated colonoscopy

AIM:To evaluate whether an endoscopy position detecting unit(UPD-3) can improve cecal intubation rates, cecal intubation times and visual analog scale(VAS) pain scores, regardless of the colonoscopist's level of experience.METHODS:A total of 260 patients(170 men and 90women)who underwent a colonoscopy were divided into the UPD-3-guided group or the conventional group(no UPD-3 guidance).Colonoscopies were performed by experts(experience of more than 1000colonoscopies)or trainees(experience of less than 100colonoscopies).Cecal intubation rates,cecal intubation times,insertion methods(straight insertion:shortening the colonic fold through the bending technique;roping insertion:right turn shortening technique)and patient discomfort were assessed.Patient discomfort during the endoscope insertion was scored by the VAS that was divided into 6 degrees of pain.RESULTS:The cecum intubation rates,cecal intubation times,number of cecal intubations that were performed in<15 min and insertion methods were not significantly different between the conventional group and the UPD-3-guided group.The number of patients who experienced pain during the insertion was markedly less in the UPD-3-guided group than in the conventional group.Univariate and multivariate analysis showed that the following factors were associated with lower VAS pain scores during endoscope insertion:insertion method(straight insertion)and UPD-3guidance in the trainee group.For the experts group,univariate analysis showed that only the insertion method(straight insertion)was associated with lower VAS pain scores.CONCLUSION:Although UPD-3 guidance did not shorten intubation times,it resulted in less patient painduring endoscope insertion compared with conventional endoscopy for the procedures performed by trainees.

Identification of the Bacterial Gene in Patients Who Repeatedly Develop Streptococcal Pharyngitis

Background: We aimed at determining whether the pathogenic bacteria at the onset of disease are genetically different and whether this affects future choice of the therapeutic methods against group A β-hemolytic streptococcal acute pharyngitis/tonsillitis. Methods: A pharynx swab was collected from pediatric patients who visited our hospital. The swab was cultured, and hemolytic streptococcus was detected 230 times. We isolated pathogenic bacteria of patients infected more than once and examined the bacteria using pulse-field gel electrophoresis. Results: Based on gene search results, we found that if the period of developing relapse was within 1 month from the first infection, all patients had the same gene. However, all patients in whom reinfection occurred after 6 months or later had different pertinent genes. Conclusions: The number of relapse/reinfection is significant for this disease, and considerably caution is essential for its treatment. No changes to antibacterial drug administration may be necessary for the second administration unless more than 6 months have passed since the first infection.