Background
Tip-in endoscopic mucosal resection (EMR) is a modified EMR technique using which en bloc resection of large colorectal sessile polyps can be performed; however, its usefulness for ...colorectal sessile polyps of > 20 mm has not been reported. This study examined treatment outcomes of tip-in and conventional EMR for large colorectal sessile polyps of ≥ 20 mm.
Methods
This was a retrospective case–control study conducted at a single tertiary center in Japan. Subjects included those with large colorectal sessile polyps of ≥ 20 mm, excluding pedunculated-type polyps, who underwent endoscopic resection between January 2010 and January 2019. The primary outcome was endoscopic treatment outcomes when using tip-in and conventional EMR, and the secondary outcome was the local recurrence rate after endoscopic treatment.
Results
Forty-three colorectal lesions were treated using tip-in EMR and 83 using conventional EMR. Tip-in EMR had a significantly higher en bloc resection rate (90.7% vs. 69.8.%), and significantly shorter treatment duration (6.64 ± 0.64 min vs. 10.47 ± 0.81 min) than conventional EMR. However, for lesions > 30 mm, en bloc resection rate was 50.0% and 52.6% for tip-in and conventional EMR, respectively, indicating no significant difference. Perforation rates with tip-in and conventional EMR were 4.6% and 3.6%, respectively, indicating no significant difference. Local recurrence was examined in 80 cases who were followed up for > 6 months after endoscopic resection; recurrence rate was 0% and 7.0% in tip-in and conventional EMR cases, respectively, without significance difference.
Conclusions
Tip-in EMR showed high en-block resection rate, particularly in polyps of < 30 mm, and no residual tumor was found. This technique is a potential endoscopic treatment alternative for large colorectal sessile polyps of ≥ 20 mm.
The patient was a 32-year-old woman who had a 20-year history of intestinal Behçet's disease without ocular involvement. At the age of 12, she developed oral aphthosis, genital ulcers, erythema ...nodosum on the lower limbs, and soon developed lower abdominal pain. Colonoscopic examination revealed a round punched-out ulceration in the ileocecal region. Human leukocyte antigen (HLA)-B51 (B5) antigen was negative. Drug therapies with salazosufapyridine and prednisolone was started. When prednisolone was reduced to 15 mg/d, the ileocecal lesion recurred and in addition, diabetes mellitus developed. The patient had been suffered corticosteroid dependence with severe side effects. Since the induction of thalidomide at the age of 14, partial remission that allowed for outpatient visits was maintained for more than 10 years, but negative C-reactive protein (CRP) and endoscopically mucosal healing of the ileocecal ulcer on colonoscopy were not achieved.Switch from thalidomide to adalimumab (ADA) was introduced at the age of 26 because of reproductive concern. Since introduction of ADA, no recurrence of genital ulcer or skin lesions had been observed. Negative inflammatory reaction was maintained. Colonoscopy performed after the switch to ADA revealed sustained endoscopic mucosal healing in ileocecal ulcer. ADA may have a more specific anti-inflammatory effect on intestinal BD than thalidomide.
In our previous studies, we carried out air-water counter-current flow experiments under flooding conditions in vertical pipes of 40 mm diameter with combinations of sharp-edged or rounded top and ...bottom ends to measure counter-current flow limitation (CCFL), pressure gradient dP/dz, and void fraction αG. We obtained the wall and interfacial friction factors, fw and fi, and proposed a correlation of fw. In the present study, we carried out similar experiments with sharp-edged top and bottom ends, and obtained fw and fi. We proposed a correlation of fi for all flow patterns including smooth film (SF) and rough film (RF) due to flooding at the top and bottom ends, respectively. By using the one-dimensional annular flow model and the proposed fw and fi correlations, we computed the liquid volume fraction αL,cal and compared it with the experimental data αL,exp. The computation gave two solutions of αL,cal for SF and RF, which agreed relatively well with the αL,exp values for SF and RF in the regions of low gas superficial velocity JG and high JG, respectively.
Objective Gastrointestinal lesions of non-tuberculous mycobacteria (NTM) are regarded as opportunistic infections. A large number of positive specimens of NTM were identified in an intestinal fluid ...culture in the endoscopy unit and it was considered to be a pseudo-outbreak. Methods We reviewed the hospital, laboratory, and colonoscopy records of 263 consecutive patients whose intestinal fluids were analyzed for a mycobacterial culture by colonoscopy at St. Marianna University Hospital, between January 2009 and December 2018. The endoscopy reprocessing procedures were reviewed and samples of water used in the endoscopy unit were cultured. Results An intestinal fluid culture of 154 (58.6%) patients tested positive for NTM (M. intracellulare; 125 cases, M. gordonae; 14 cases, M. avium; 4 cases, M. abscessus; 3 cases, and 8 other cases). In 182 cases (69.2%), an intestinal mucosal culture was performed simultaneously with a fluid culture and tested positive for NTM in 2 cases. Next, we examined the endoscopy unit for any possible environmental contamination. NTM were detected in the tap water used to prepare the antifoaming solution in the endoscopy unit. The water faucets in the endoscopy unit were considered to be the source of the contamination of NTMs. Conclusion We observed that a large number of cases tested positive due to contaminated water that had been used in an endoscopy unit, thus leading to a pseudo-outbreak of NTM.
Objectives: The colonoscopic identification of stigmata of recent hemorrhage (SRH) in patients with colonic diverticular bleeding (CDB) is difficult. Factors that influence the identification of SRH ...in the diagnosis of CDB were investigated.Methods: This was a retrospective study of 487 early colonoscopy patients with acute lower gastrointestinal bleeding who were diagnosed with CDB. Comorbidities, medications, bowel preparation, use of a transparent cap, use of a water-jet scope, colonoscopy by an expert colonoscopist, and use of a nontraumatic (NT) tube were assessed. A multivariate analysis was used to estimate the odds ratio and 95% confidence interval.Results: Of the 487 colonoscopy patients diagnosed with CDB, 191 (39%) were definitively identified with SRH. The use of a transparent cap, a water-jet scope, an expert colonoscopist, and an NT tube were independent predictive factors for SRH on univariate analysis. A multivariable logistic regression model showed that colonoscopy by an expert colonoscopist and the use of an NT tube were predictive factors for SRH.Conclusions: Intradiverticular water injection with an NT tube by an expert colonoscopist is useful in identifying CDB, and may help achieve effective endoscopic hemostasis.
Gastric cancer(GC)is one of the most common malignancies and remains the second leading cause of cancer-related death worldwide.There is an increasing understanding of the roles that genetic and ...epigenetic alterations play in GCs.Recent studies using nextgeneration sequencing(NGS)have revealed a number of potential cancer-driving genes in GC.Whole-exome sequencing of GC has identified recurrent somatic mutations in the chromatin remodeling gene ARID1A and alterations in the cell adhesion gene FAT4,a member of the cadherin gene family.Mutations in chromatin remodeling genes(ARID1A,MLL3 and MLL)have been found in 47%of GCs.Whole-genome sequencing and whole-transcriptome sequencing analyses have also discovered novel alterations in GC.Recent studies of cancer epigenetics have revealed widespread alterations in genes involved in the epigenetic machinery,such as DNA methylation,histone modifications,nucleosome positioning,noncoding RNAs and microRNAs.Recent advances in molecular research on GC have resulted in the introduction of new diagnostic and therapeutic strategies into clinical settings.The antihuman epidermal growth receptor 2(HER2)antibody trastuzumab has led to an era of personalized therapy in GC.In addition,ramucirumab,a monoclonal antibody targeting vascular endothelial growth factor receptor(VEGFR)-2,is the first biological treatment that showed survival benefits as a single-agent therapy in patients with advanced GC who progressed after firstline chemotherapy.Using NGS to systematically identify gene alterations in GC is a promising approach with remarkable potential for investigating the pathogenesis of GC and identifying novel therapeutic targets,as well as useful biomarkers.In this review,we will summarize the recent advances in the understanding of the molecular pathogenesis of GC,focusing on the potential use of these genetic and epigenetic alterations as diagnostic biomarkers and novel therapeutic targets.
Objectives: This study aimed to examine the clinical characteristics of colonic diverticular bleeding (CDB) in elderly individuals.Methods: This retrospective case-control study was conducted at a ...single tertiary center. A total of 519 patients (356 men and 163 women; mean age of 73.1 ± 12.5 years) with CDB and hospitalized between January 2004 and May 2019 were analyzed. The subjects were divided into two groups: the elderly (274 individuals aged ≥75 years; mean age, 82.1 ± 5.3 years) and non-elderly (245 individuals aged <75 years; mean age, 63.0 ± 10.3 years) groups. Primary outcomes were early and late rebleeding rates, and secondary outcomes were the risk factors for late rebleeding in elderly individuals. Rebleeding occurring within 30 days of hospitalization was defined as early rebleeding, whereas rebleeding occurring after 31 days was defined as late rebleeding.Results: The early rebleeding rates were 30.6% and 33.1% (p = 0.557) in the elderly and non-elderly groups, respectively. The late rebleeding rates were 42.3% and 30.6% (p = 0.005) in the elderly and non-elderly groups, respectively. The 3-year recurrence-free survival was 63.6% in the elderly group and 75.6% in the non-elderly group (log-rank test: p < 0.001). Multivariate analysis revealed the use of non-steroidal anti-inflammatory drugs (NSAIDs) odds ratio (OR), 3.55, chronic kidney disease (OR, 2.89), and presence of bilateral diverticula (OR, 1.83) as the independent risk factors for late rebleeding in elderly individuals.Conclusions: Elderly individuals with CDB require careful follow-up even after discharge. Furthermore, it is important to consider discontinuing NSAIDs to prevent rebleeding.
Introduction: Sedative-analgesic agents are reported to reduce the pain and discomfort of esophagogastroduodenoscopy (EGD), but the specific effects of these agents on examination of the ...esophagogastric junction (EGJ) are unknown. We conducted a prospective, randomized, double-blind clinical trial in which we compared the effects of midazolam and pethidine hydrochloride on EGJ examination during EGD. Methods: The 32 patients included in the study were chosen from among 80 patients scheduled to undergo EGD at our hospital between February 2016 and May 2018. Patients were randomly allocated to intravenous administration of midazolam (n=16) or pethidine (n=16). The midazolam was administered to patients at the same dose as during the previous examination, whereas the pethidine was administered at a dose of 35 mg. Perfect observation was defined as examination of the full circumferential extent of the EGJ. The primary study endpoint was the percentage of patients in whom perfect observation was achieved. Results: Perfect observation was achieved in six patients (37.5%) in the midazolam group and nine patients (56.3%) in the pethidine group (between-group difference: 18.8%, 95% confidence interval CI: -59.0% to 21.5%; P=0.29). The mean extent of EGJ examination was 65.0±38.3% in the midazolam group and 78.6±27.3% in the pethidine group (intergroup difference: -13.6%, 95% CI: -37.8% to 10.3%; P=0.25). The mean visual analog scale score for pain and discomfort during endoscopy was 0.75±2.02 in the midazolam group and 2.25±1.77 in the pethidine group, indicating significantly higher levels of discomfort in the pethidine group (intergroup difference: -1.50, 95% CI: -2.87 to -1.30; P=0.033). There was no between-group difference in the number of procedural accidents or degree of the endoscopists' satisfaction. Conclusion: Midazolam was superior to pethidine in relieving discomfort during EGD, but pethidine tended to be better than midazolam for observing the EGJ.
Interferon regulatory factors (IRFs) are transcription factors known to play key roles in innate and adaptive immune responses, cell growth, apoptosis, and development. Their function in ...tumorigenesis of gastric cancer remains to be determined, however. In the present study, therefore, we examined epigenetic inactivation of IRF1–9 in a panel of gastric cancer cell lines. We found that expression of IRF4, IRF5, and IRF8 was frequently suppressed in gastric cancer cell lines; that methylation of the three genes correlated with their silencing; and that treating the cells with the demethylating agent 5‐aza‐2′‐deoxycytidine (DAC) restored their expression. Expression of IRF5 in cancer cells was enhanced by the combination of DAC treatment and adenoviral vector‐mediated expression of p53, p63, or p73. Interferon‐γ‐induced expression of IRF8 was also enhanced by DAC. Moreover, treating gastric cancer cells with DAC enhanced the suppressive effects of interferon‐α, interferon‐β, and interferon‐γ on cell growth. Among a cohort of 455 gastric cancer and noncancerous gastric tissue samples, methylation of IRF4 was frequently observed in both gastric cancer specimens and noncancerous specimens of gastric mucosa from patients with multiple gastric cancers, which suggests IRF4 methylation could be a useful molecular marker for diagnosing recurrence of gastric cancers. Our findings indicate that epigenetic IRF inactivation plays a key role in tumorigenesis of gastric cancer, and that inhibition of DNA methylation may restore the antitumor activity of interferons through up‐regulation of IRFs. (Cancer Sci 2010)
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