Masao Toki

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.

Gastric mucosal longitudinal tears after drowning

A 90-year-old man with spondylosis deformans but no other pertinent medical history was found drowning in a public bath. He was successfully resuscitated by mouthto-mouth respiration without cardiac massage; regurgitation of gastric contents was noted during resuscitation. Three hours after admission to the hospital he had tarry stools and a decrease in hematocrit from 31.1% to 21.5%. EGD revealed several longitudinal mucosal tears with visible vessels in the upper body of the stomach and a massive blood clot in the stomach (A; arrowhead indicates visible vessel). Hemostasis was achieved by endoscopic clipping (B; arrow indicates clip). He had no further bleeding and was discharged in stable condition. DISCLOSURE All authors disclosed no financial relationships relevant to this publication.