Feasibility and Safely of Oral Rehydration Therapy before Upper Gastrointestinal Endoscopic Submucosal Dissection

Background/Aims. Preoperative oral rehydration therapy (PORT), often used before surgery, is rarely performed before endoscopy. Only a few reports of PORT before upper gastrointestinal endoscopy are available. This study is aimed at evaluating the safety and feasibility of PORT before upper gastrointestinal endoscopic submucosal dissection (ESD). Methods. We used alginade water (125 mL, Nestle Co., Kobe, Japan) for PORT. Alginade water is a flavored sports drink, which is palatable and promotes wound healing due to a high concentration of alginate. We conducted a single-center single-arm prospective feasibility study of PORT in 244 patients who underwent upper gastrointestinal ESD. The group wherein PORT was administered up to two hours before ESD (n=120) was compared with the historical control group (non-PORT group, n=120). We investigated the total fluid intake, hematocrit change, complications due to PORT, complications during ESD, ESD procedure time, and length of hospital stay in each group. Results. The average fluid intake in the PORT group was 462.6 mL. No complications were observed due to PORT and ESD, and significant differences in the ESD procedure time or hospital stay was not noted. Conclusion. PORT up to two hours before upper gastrointestinal ESD is feasible

Performance Status Is a Predictive Factor of Improvement after Colonic Stenting in Patients with Malignant Stenosis due to Extraparenteral Malignant Tumors

Endoscopic stenting with self-expandable metallic stents is widely accepted for the treatment of malignant colorectal obstruction. Generally, stenting is performed as a bridge-to-surgery for primary colorectal cancer (CRC). Furthermore, palliative colonic stenting is performed for extraparenteral malignant tumors (EPMTs). However, predictive factors for improving clinical outcomes after colonic stenting for EPMTs remain unclear. This study is aimed at evaluating patients with EPMTs who underwent colonic stenting and investigating factors influencing clinical improvement after the stenting procedure. Twenty-one patients with colorectal obstruction by EPMTs were treated using self-expandable metallic stents over a period of 8 years. We divided the enrolled patients into the clinically improved and nonimproved groups after colonic stenting. Variables, including age; sex; type of primary cancer; serum albumin level; location of the obstruction; stent type, length, and diameter; prior chemotherapy treatment; ascites; Eastern Cooperative Oncology Group performance status (PS); technical and clinical success rates; stent-related adverse events; and mortality rates, were evaluated. Technical failure was not observed in all cases. Clinical success, defined as the passage of stool and improvement in the colorectal obstruction scoring system (CROSS) without adverse events, was observed in the 14 patients. Univariate analyses revealed no significant differences in factors other than PS before stenting (P=0.04) between the improved and nonimproved groups. Colonic stenting for EPMTs was effective. PS may be an independent risk factor of clinical outcomes after stenting

Comparison of endoscopic band ligation devices used for colonic diverticular bleeding: in vivo animal study

Abstract Background and Aim Endoscopic band ligation (EBL), used for the treatment of colonic diverticular bleeding, has a lower rebleeding rate than endoscopic clipping. However, different devices are used in Japan and the Western countries; no animal studies have been conducted to elucidate the safety of such devices. We compared two EBL devices, the first used in Japan and the second used in Western countries. Methods and Results The Japanese and Western EBL devices were compared by assessing the EBL safety at 40 sites in an animal model with a normal colon that is anatomically similar to the human colon. Macroscopic and pathological examinations were performed to evaluate the layer ligated by the band and the presence of perforation. The findings on day 1 and day 7 after EBL were compared. The ligated layer was the muscularis propria at 39 sites; the layer was not evaluated at one site where the band was unintentionally removed during the endoscopic procedure. Pathologically, there was no perforation at any of the assessed sites. There was no statistical difference in any of the pathological variables between the two devices or between days 1 and 7 after EBL. The total procedure time was significantly shorter with the Western EBL device. Conclusions In this animal study, both evaluated devices were safe for EBL, without differences in the macroscopic and pathological variables after EBL. Ligation of the muscularis propria layer did not result in perforation

Feasibility and safety of colonoscopy performed by nonexperts for acute lower gastrointestinal bleeding: post hoc analysis

Background and study aims It remains unclear whether the experience of endoscopists affects clinical outcomes for acute lower gastrointestinal bleeding (ALGIB). We aimed to determine the feasibility and safety of colonoscopies performed by nonexperts using secondary data from a randomized controlled trial for ALGIB. Patients and methods We analyzed clinical outcomes in 159 patients with ALGIB who underwent colonoscopies performed by two groups of endoscopists: experts and nonexperts. We compared endoscopy outcomes, including identification of stigmata of recent hemorrhage (SRH), successful endoscopic treatment, adverse events (AEs), and clinical outcomes between the two groups, including 30-day rebleeding, transfusion, length of stay, thrombotic events, and 30-day mortality. Results Expert endoscopists alone performed colonoscopies in 96 patients, and nonexperts performed colonoscopies in 63 patients. The use of antiplatelets and warfarin was significantly higher in the expert group. The SRH identification rate (24.0 and 17.5 %), successful endoscopic treatment rate (95.0 and 100 %), rate of AEs during colonoscopy (0 and 0 %), transfusion rate (6.3 and 4.8 %), length of stay (8.0 and 6.4 days), rate of thrombotic events (0 and 1.8 %), and mortality (0 and 0 %) were not different between the expert and nonexpert groups. Rebleeding within 30 days occurred more often in the expert group than in the nonexpert group (14.3 vs. 5.4 % P = 0.0914). Conclusions The performance of colonoscopies for ALGIB by nonexperts did not result in worse clinical outcomes, suggesting that its use could be feasible for nonexperts for diagnosis and treatment of ALGIB