Katsuro Morozumi

A prospective randomized trial of either famotidine or omeprazole for the prevention of bleeding after endoscopic mucosal resection and the healing of endoscopic mucosal resection‐induced ulceration

Background : It has been reported that inhibitors of gastric acid secretion prevent bleeding after endoscopic mucosal resection for mucosal gastric neoplasm. However, uncertain whether an histamine2‐receptor antagonist or proton‐pump inhibitor is more effective.

Resection area of 15 mm as dividing line for choosing strip biopsy or endoscopic submucosal dissection for mucosal gastric neoplasm.

Background Endoscopic mucosal resection (EMR) is effective treatment for mucosal gastric neoplasm. Endoscopic submucosal dissection (ESD), a novel EMR method, has been reported to enable en bloc resection more frequently than conventional EMR methods such as strip biopsy (SB). However, ESD requires more time than SB. A small lesion can be resected en bloc and effectively treated with SB. Goal To evaluate using a 15 mm resection area as the dividing line between SB and ESD prospectively. Study SB was applied for resection area less than 15 mm (SB group) and ESD for 15 mm or larger resection (ESD group). We compared characteristics of lesions and outcomes of EMR between the 2 groups. Results Ninety lesions were prospectively assigned to SB group (36 lesions) and ESD group (54 lesions). The average neoplasm size was 9.0±3.9 mm in the SB group and 19.1±11.3 mm in the ESD group (P<0.01). The average resection time was 11.7±5.8 minutes in the SB group and 128.9±102.8 minutes in the ESD group (P<0.01). The complete resection rate was 91.6% in the SB group and 83.3% in the ESD group (P=0.25). The complication rate was not significantly different between SB group and ESD group (11.1% vs. 16.7%, P=0.12). During follow-up (median 23±5 mo), 1 patient in each group, who had piecemeal resection at original EMR had recurrent neoplasm. Conclusions Gastric mucosal neoplasms which require only small (<15 mm) resection can be treated with SB, as effectively as with ESD.

Endoscopic hemostasis: Safe treatment for peptic ulcer patients aged 80 years or older?

Background and Aim: Recently, the number of peptic ulcer patients aged 80 years or older has been increasing. However, little information is available concerning therapeutic endoscopy for these patients. The objective of this study was to evaluate the efficacy of endoscopic hemostasis for peptic ulcer bleeding in patients aged 80 years or older.

7142 Endoscopic hemoclipping for upper gastrointestinal bleeding due to mallory-weiss syndrome.

Aim: Endoscopic treatment with sclerotherapy or thermal methods has been widely used for upper gastrointestinal (UGI ) bleeding due to Mallory-Weiss syndrome (MWS). However, the potential drawback of thermal methods and the injection of sclerosing agents is that these may cause excessive tissue injury leading to necrosis and perforation. Recently, endoscopic hemoclipping was shown to be highly effective for as a hemostatic treatment for UGI bleeding. Hemoclipping causes less damage to the surrounding area than sclerotherapy or thermal methods. However, the efficacy and safety of hemoclipping for MWS bleeding has not been reported. The aim of the present study was to assess prospectively the usefulness of endoscopic hemoclipping for MWS bleeding. Methods: This prospective study was performed over a 5 year period beginning in January 1994. When patients were diagnosed with MWS by endoscopy , hemoclipping was performed for patients with active bleeding , visible vessel and/or red clots (Group H). The remaining patients with old clots and linear tears in the Esophagogastric junctional (EGJ) mucosa as the only possible origin of bleeding were conservatively treated (Group C). The clinical data and outcome of endoscopic treatment were compared between these two groups. Results: A total of 58 patients underwent emergency endoscopy for UGI bleeding due to MWS from January 1994 to August 1999. During endoscopic examination, active bleeding was found in 17 patients (29%), a visible vessel in one patient (2%) and red clots in 8 patients (14%); Hemoclipping was performed on all 26 patients. Of the remaining 32 patients, 12 patients (21%) had old clots, and 20 (34%) had linear tears without stigmata of recent hemorrhage in the EGJ; these patients did not receive hemoclipping. Significantly more patients in Group H had shock and trasfusional requirements over 800ml than in Group C [the former 4 (17%) vs 0, the latter 4 (17%) vs 0]. The mean hemoglobin level on admission was significantly lower in Group H (10.6±2.9g/dl)than in Group C (12.2±3.0g/dl). Significantly more patients in Group H had critical concomitant diseases than in Group C [14 (54%) vs 8 (25%)]. However, all patients in Group H successfully underwent endoscopic hemostasis with no rebleeding. No patients in Conservative group had rebleeding. No complications related to the endoscopic procedures and no hospital deaths were found in either group. Conclusion : Endoscopic hemoclipping provided an effective and safe modality for securing hemostasis for MWS bleeding.

7141 Endoscopic treatment of hemorrhagic gastric ulcer in patients aged 80 years or more.

BACKGROUND/AIMS Hemorrhagic gastric ulcer is a more serious disorder in elderly patients than in young patients. This study aimed to evaluate the efficacy of endoscopic treatment for hemorrhagic gastric ulcer in patients aged 80 years or more. METHODOLOGY A total of 269 patients underwent endoscopic treatment for hemorrhagic gastric ulcer with hemoclipping and pure ethanol injection, either alone or in combination. These patients were divided into two groups: elderly (> or = 80 years old) and younger (< 80 years) groups. The clinical data, endoscopic findings and outcomes of endoscopic treatment were compared between these two groups. RESULTS Patients in the elderly group had a significantly higher incidence of concomitant disease (73% vs. 23%), anemia (7.9 +/- 2.1 g/dL vs. 9.3 +/- 2.8 g/dL) and large ulcer (23% vs. 6%) compared with the younger group. However, all patients in the elderly group underwent endoscopic hemostasis successfully with no complications and no deaths. The rebleeding rate was not significantly different (8% vs. 4%) between the two groups. CONCLUSIONS Elderly patients with hemorrhagic gastric ulcer have high incidences of severe ulcer disease and concomitant medical problems. Endoscopic hemostasis for hemorrhagic gastric ulcer is effective and safe, even for such elderly patients.