Development of Novel Intra-gastric Satiety-inducing Devices to Promote Weight Loss in a Porcine Model

Introduction: Minimally invasive procedures can impact the treatment of obesity by bridging the gap between medical and surgical therapy. Therefore, we developed a device that can be placed under endoscopic guidance to reduce the rate of weight gain and promote weight loss and evaluated its safety and efficacy in a porcine model. Methods: The intra-gastric satiety inducing device (ISD) is a modified partially covered self-expandable esophageal stent connected to a star-shaped disk part. Eight juvenile pigs were randomly divided into ISD (n=5) and control (n= 3) groups. The ISD was placed under endoscopic and fluoroscopic guidance and fixed to the pig’s nose by a string. Animal behavior, body weight, serum ghrelin hormone, and the ISD position were monitored weekly. Four pigs were sacrificed 6 weeks after ISD placement or in case of complications. One pig had the ISD removed at 6 weeks and was followed up for an additional 4 weeks to check for rebound effects (rebound pig). Hematoxylin& eosin and Masson's trichrome staining, and immunostaining for the interstitial cell of Cajal (ICC) were performed after sacrifice. Results: The ISD placement was technically successful in all pigs without any immediate complications. Two ISDs (40%) migrated at 4 and 5 weeks after placement and their data were included in the analysis at the respective time points. The ISD group had significantly lower median percentage weight gain ratio from week 1 to week 6 compared to the control group: 4% vs 26% at week 1 (p=0.025), 15% vs 47% at week 2 (p=0.025), 29% vs 49% at week 3 (p= 0.024), 49% vs 71% at week 4 (p=0.043), 56% vs 82% at week 5 (p=0.034), and 46% vs 88% (p = 0.05), respectively. The rebound pig showed a higher rate of weight gain compared to the control from week 7 to week 10: 105%, 126%, 142%, and 157% vs 97%, 99%, 102%, and 107%, respectively. The median ghrelin hormone levels in the ISD group from week 1 to week 6 were 20.9, 32.3, 28.3, 41.4, 47, 39.7 ng/L. The ISD induced reversible inflammatory changes in the distal esophagus and the fundus of the stomach. The number of the ICCs (median, range) was lower in the ISD (3, 1-4) compared to the control (9.5, 7-16), and the rebound (11.5, 8-15) pigs. Conclusion: The ISD reduces the rate of weight gain in juvenile pigs and induces reversible inflammation and tissue hyperplasia. The mechanism of action of the ISD may be related to pressure effect on the gastric fundus or alteration of gastric motility.Docto

Preparation and Application of Graphene Oxide/MWCNT Film-Based Substrate for LDI-MS

본 발명은 그라핀 옥사이드/다중벽 탄소나노튜브(GO/MWCNT) 이중층 박막의 제조와 레이저 탈착/이온화 질량분석을 위한 기판으로서의 활용 방법에 관한 것으로, 더욱 상세하게는 GO/MWCNT 이중층 박막 기판을 LDI-MS 기판으로 사용하여 소형 분자를 검출하는 방법 및 환원형 GO/MWCNT(RGO/MWCNT) 이중층 박막 기판을 LDI-MS 기판으로 사용하여 소수성 분자를 검출하는 방법에 관한 것이다

Prospective evaluation of the efficacy of peroral endoscopic myotomy in patients with achalasia

Peroral endoscopic myotomy (POEM) is an endoscopic alternative to surgical myotomy in patients with achalasia. This study aimed to evaluate the efficacy and clinical outcomes of POEM. A total of 20 patients with achalasia who underwent POEM between October 2016 and November 2017 were prospectively recruited. The intraoperative esophagogastric junction distensibility index (mm(2)/mm Hg) was measured pre- and post-myotomy using an endoluminal functional lumen imaging probe. Clinical response was defined as Eckardt score <= 3. Health-related quality of life was measured by the 36-item short-form health survey score. POEM was successfully completed in all cases. The median procedure time was 68.5 minutes (range 50.0-120.0), and the median myotomy length was 13 cm (range 11-18). Major adverse events were encountered in 2 cases. Overall, clinical responses were observed in all patients during a median follow-up of 11.9 months (range 1.2-26.2). Postoperative esophagogastric junction distensibility index was significantly higher than baseline (from 1.3 [range 0.8-6.9] to 6.3 [range 25-19.2], P < .001). The median Eckardt scores were decreased after POEM (5 [range 2-11] to 1 [range 0-3], P < .001), and the 36-item short-form health survey score was also improved significantly after POEM (67.5 [range 34.5-93.9] to 85.7 [range 53.4-93.3], P = .004). POEM is an effective treatment for achalasia, based on the improvement of both symptoms and objective measures. Clinicaltrial.gov NCT 0298988

Clinical Outcomes of Enteral Feeding Protocol Via Percutaneous Endoscopic Gastrostomy: A Single-Center, Retrospective Study

Background: The development of the endoscopic technique has resulted in an increasing number of patients undergoing percutaneous endoscopic gastrostomy (PEG) insertion; however, the protocols for increasing the volume of feeding formula after PEG insertion have not been established. Therefore, we compared the clinical outcomes of patients receiving low- and high-volume increase in enteral feeding formula. Methods: A total of 215 patients who underwent PEG insertion between January 2016 and March 2019 were included. They were divided into 2 groups according to the increase in volume of feeding formula: the low-volume group (n = 135) received ≤150 mL/d, and the high-volume group (n = 80) received ≥300 mL/d. Patient characteristics, procedure, and feeding-related clinical outcomes were retrospectively reviewed using medical records. Results: The adverse events of the feeding protocol did not significantly differ between the 2 groups. The number of days needed to attain the calorie targets was significantly lower in the high-volume group than in the low-volume group (5.4 ± 3.0 vs 2.4 ± 1.5; P <.001). The duration of supplemental parenteral nutrition and the length of hospitalization were also significantly lower in the high-volume group (3.9 ± 3.3 vs 1.2 ± 2.2; P <.001 and 5.8 ± 2.7 vs 4.6 ± 2.6; P =.007, respectively). Conclusion: To rapidly attain the calorie targets in appropriately selected patients with PEG insertion, a high-volume increase in daily feeding can safely be recommended given the favorable outcomes

Clinical outcomes of tumor bleeding in duodenal gastrointestinal stromal tumors: a 20-year single-center experience

Background: Duodenal gastrointestinal stromal tumors (GISTs) are rare, and reports on duodenal GIST bleeding are few. We analyzed the risk factors and clinical outcomes of hemorrhagic duodenal GISTs and compared them with those of gastric GISTs. Methods: Primary duodenal GISTs surgically diagnosed between January 1998 and December 2017 were retrospectively reviewed. Furthermore, patients with duodenal GIST were compared with those with primary gastric GIST histopathologically diagnosed between January 1998 and May 2015 using previously published data. Results: Of the 170 total patients with duodenal GISTs, 48 (28.2%) exhibited tumor bleeding. Endoscopic intervention, embolization, and non-interventional conservative treatment were performed for initial hemostasis in 17, 1, and 30 patients, respectively. The 5-year survival rate was 81.9% in the bleeding group and 89.4% in the non-bleeding group (P = 0.495). Multivariate analysis showed that p53 positivity was a significant risk factor for duodenal GIST bleeding (hazard ratio [HR] 2.781, P = 0.012), and age ≥ 60?years (HR 3.163, P = 0.027), a large maximum diameter (comparing four groups: < 2, 2?5, 5?10, and ≥ 10?cm), and mitotic count ≥ 5/high-power field (HPF) (HR 3.265, P = 0.032) were risk factors for overall survival. The incidence of bleeding was significantly higher in duodenal GISTs than in gastric GISTs (28.2% vs. 6.6%, P < 0.001), and the re-bleeding rate after endoscopic hemostasis was also higher in duodenal GISTs than in gastric GISTs (41.2% vs. 13.3%, P = 0.118). Conclusion: In patients with duodenal GIST with old age, large tumor diameter, and mitotic count ≥ 5/HPF, a treatment plan should be established in consideration of the poor prognosis, although tumor bleeding does not adversely affect the prognosis. Duodenal GISTs have a higher incidence of tumor bleeding and re-bleeding rate after endoscopic hemostasis than gastric GISTs