Zinc intake has reduced hospitalizations in patients with ulcerative colitis (UC), highlighting the need to maintain blood zinc levels. This prospective study investigated whether the promotion of ...zinc intake and a Japanese diet (high in n-3 fatty acids) could induce clinical remission in patients with mild active UC. Patients with mild active UC were randomly assigned to either (1) continue an unrestricted diet or (2) receive nutritional guidance promoting zinc intake and a Japanese diet. The primary endpoint was clinical remission at 24 weeks. Secondary endpoints were the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores, Clinical Activity Index (CAI), Geboes Histopathology Score (GHS), and biomarkers, including zinc levels, measured at 12 and 24 weeks. Nutritional assessments were performed using the Food Frequency Questionnaire. The CAI, UCEIS, and GHS scores were significantly lower in the intervention group than in the control group, with a significantly higher proportion of patients achieving clinical remission. Furthermore, the intervention group exhibited weight gain and significantly increased blood zinc levels. The combination of promoting dietary zinc intake and a Japanese diet rich in n-3 fatty acids can induce clinical remission in patients with mild active UC.
Several new treatments for ulcerative colitis have been developed recently. The depletion of leukocytes by granulocyte and monocyte adsorption apheresis (GMA) was developed and adapted for patients ...with ulcerative colitis with rare adverse events. We investigated whether treatment with GMA and prednisolone (GMA + PSL) is more effective than PSL alone for patients with moderate to severe ulcerative colitis. Forty-seven patients with moderate to severe ulcerative colitis were retrospectively analyzed. Among the 47 patients, 27 received PSL, while 20 received GMA + PSL. The clinical activity of ulcerative colitis was evaluated using the Lichtiger clinical activity index (CAI) and serum levels of C-reactive protein. Mayo endoscopic score (MES) was used to examine endoscopic activity. The clinical remission rate was significantly higher in the GMA + PSL group than in the PSL group (65% vs 29.6%, p = 0.0206). The mucosal healing rate was also significantly higher in the GMA + PSL group than in the PSL group (60% vs 26%, p = 0.0343). The combination of GMA and steroids may be more effective than steroids alone for inducing clinical remission and mucosal healing in patients with moderate to severe ulcerative colitis.
Background and Aim
The adenoma detection rate is an important indicator of colonoscopy quality and colorectal cancer incidence. We compared the adenoma detection rates between white light imaging ...(WLI) and linked color imaging (LCI) colonoscopy.
Methods
Patients undergoing colonoscopy for positive fecal immunochemical tests, follow‐up of colon polyps, and abdominal symptoms at three institutions were randomly assigned to the LCI or WLI groups. Mean adenoma number per patient (including based on endoscopists' experience), adenoma detection rate, cecal intubation time, withdrawal time, mean adenoma number per location, and adenoma size were compared.
Results
The LCI and WLI groups comprised 494 and 501 patients, respectively. No significant differences in the cecal intubation rate (LCI vs WLI: 99.5% vs 99.4%), cecal intubation time, and withdrawal time were noted between groups. The mean adenoma number per patient was significantly higher in the LCI group than in the WLI group (1.07 vs 0.88, P = 0.04), particularly in the descending 0.12 (58/494) vs 0.07 (35/501), P = 0.01 and sigmoid colon 0.41 (201/494) vs 0.30 (149/501), P ≤ 0.001. However, the adenoma detection rate was 47.1% in the LCI group and 46.9% in the WLI group, with no significant difference (P = 0.93). The total number of sessile‐type adenomas was significantly higher in the LCI group than in the WLI group (346/494 vs 278/501, P = 0.04). As for polyp size, small polyps (≤ 5 mm) were detected at a significantly higher rate in the LCI group (271/494 vs 336/501, P = 0.04).
Conclusion
Linked color imaging is significantly superior to WLI in terms of mean adenoma number per patient.
We herein report a case of intraperitoneal abscess as a postoperative complication of gastric endoscopic submucosal dissection (ESD). A 70-year-old man who underwent ESD for early gastric cancer ...sought consultation for abdominal pain on postoperative day 28. Abdominal computed tomography revealed intraperitoneal abscess rupture. He underwent image-guided laparoscopic irrigation. His postoperative course was favorable, and he was discharged after 27 days. Intraoperatively, a white plaque adhering to the gastric wall was surrounded by a large pus volume and suspected to be ESD-associated. We present this case with a literature review of the association between intraperitoneal abscess and ESD.
Objectives
To evaluate whether laser‐cut covered self‐expandable metallic stents (LC‐CSEMSs) can be the first choice for patients with unresectable distal malignant biliary obstruction (DMBO).
...Methods
Patients with unresectable DMBO who received LC‐CSEMS (September 2014‐December 2020) or braided CSEMS (B‐CSEMS) (July 2013‐December 2020) placement for biliary drainage were enrolled. Outcomes, including endoscopic CSEMS removal, of LC‐CSEMSs and B‐CSEMSs were compared.
Results
Overall, 124 patients received LC‐CSEMSs placement, and 121 B‐CSEMSs. Technical success, clinical success, and procedure‐related adverse event rates with LC‐CSEMSs were 100%, 96.8%, and 6.5%, respectively, and 100%, 95.9%, and 5.8%, respectively, for B‐CSEMSs, with no significant difference (P > .99, .75, and >.99, respectively). The recurrent biliary obstruction (RBO) rates with LC‐CSEMSs and B‐CSEMSs were 9.7% (12/124) and 13.2% (16/121), respectively (P = .43). The median time to RBO with LC‐CSEMSs and B‐CSEMSs was 198 (interquartile range IQR, 124‐244) days and 191 (IQR, 106‐271) days (P = .41). The endoscopic removal success rates of LC‐CSEMSs and B‐CSEMSs were 88.9% (8/9) and 90% (9/10) (P > .99), although there were a small number of cases.
Conclusions
The non‐inferiority of LC‐CSEMSs was proven. LC‐CSEMSs can be considered as the first choice for patients with unresectable DMBO.
Highlight
Covered self‐expandable metallic stents are widely used for unresectable distal malignant biliary obstruction. Tanisaka and colleagues proved the non‐inferiority of the laser‐cut versus the braided covered self‐expandable metallic stent, including for stent removal. Minimal shortening and ease of placement may make it the first choice for unresectable distal malignant biliary obstruction.
The indications for endoscopic submucosal dissection (ESD) in superficial nonampullary duodenal epithelial tumors (SNADETs) remain controversial because the procedure is technically challenging. ...Moreover, the effectiveness of clip-and-thread traction-assisted ESD (TA-ESD) for SNADETs has not been assessed. The aim of the current study was to compare the effectiveness of duodenal TA-ESD and conventional ESD for SNADETs.
SNADETs treated with conventional ESD or TA-ESD between April 2017 and March 2021 at Saitama Medical University International Medical Center were evaluated retrospectively.
There were 49 cases of conventional ESD and 32 cases of TA-ESD for SNADETs. Using a propensity score–matched design, we selected 26 pairs of cases with conventional ESD and TA-ESD. In the unmatched cohort, patients treated with TA-ESD were characterized by a higher R0 (no tumor identified at the lateral or vertical margins) resection rate (P = .004), more frequent poor submucosal lifting because of fibrosis (P = .014), and shorter follow-up period (P = .0004) than patients treated with conventional ESD. In the propensity score–matched pairs, patients treated with TA-ESD were characterized by a higher rate of R0 resection (P = .021) and a shorter follow-up period (P = .0061). The findings regarding R0 resection rates were confirmed by multivariate logistic regression models, which found a higher odds ratio (OR) for R0 resection in patients who underwent TA-ESD than in patients who underwent conventional ESD both in the unmatched cohort (OR, 17.0; 95% confidence interval, 1.6-178.8; P = .018) and in the propensity score–matched pairs (OR, 26.7; 95% confidence interval, 1.5-460.2; P = .024).
Our findings suggest TA-ESD may increase the rate of R0 resection in patients with SNADETs in comparison with conventional ESD.
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Objectives
This study aimed to evaluate the trainees’ practice and learning curve in short‐type single‐balloon enteroscopy (short SBE)‐assisted endoscopic retrograde cholangiopancreatography (ERCP) ...for patients with surgically altered anatomy (SAA) and determine how to train these trainees.
Methods
The data of short SBE‐assisted ERCP procedures between September 2011 and June 2021 were analyzed.
Results
Three trainees and 180 cases were included in the analysis. Each trainee performed 60 cases between April 2016 and June 2021. The trainees' completion rate was 73.9% (95% confidence interval CI, 66.8‐80.1%). Adverse events occurred in 5.0% of cases (95% CI, 2.3‐9.3%). The trainee who experienced colonoscopy and ERCP the most achieved better outcomes of enteroscopy success (reaching the target site) and trainee’s completion rates than those of the others (P = .03 and .02, respectively). The learning curve for trainee’s completion showed a significant improvement after 60 cases (P = .001). Multiple logistic regression analysis indicated that Roux‐en‐Y reconstruction was the factor affecting trainees’ completion failure.
Conclusions
Short SBE‐assisted ERCP trainees has a substantial learning curve. If trainees do not have much experience with colonoscopy and ERCP procedures, it may be beneficial for them to start performing short SBE‐assisted ERCP procedures on non‐Roux‐en‐Y reconstruction cases.
Evaluation of trainees' practice and learning curves in short‐type single‐balloon enteroscopy‐assisted ERCP for patients with surgically altered anatomy revealed that trainees' successful completion rates significantly improved after 60 cases. Tanisaka et al. conclude that short‐type single‐balloon enteroscopy‐assisted ERCP poses a substantial learning curve for trainees.
Rituximab (RTX) is effective for treating cancer, but reports of RTX-associated enterocolitis are limited. We herein report the case of a 65-year-old man who developed RTX-induced ileocolitis. He was ...diagnosed with gastric mucosa-associated lymphoid tissue lymphoma (MALToma) and treated with RTX. He complained of bloody diarrhea after RTX. Mucosal inflammation on colonoscopy indicated RTX-induced ileocolitis. He was treated with corticosteroids, and his symptoms improved. We reviewed the RTX-associated gastrointestinal adverse events and classified the features into ulcerative colitis, Crohn's disease, microscopic colitis, and ileocolitis. To our knowledge, this is the first case of a Japanese patient who developed RTX-induced ileocolitis.
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