Mizue Matsuura

Feasibility of deep sedation with a combination of propofol and dexmedetomidine hydrochloride for esophageal endoscopic submucosal dissection.

The aim of the present study was to evaluate the efficacy and safety of sedation with a combination of propofol (PF) and dexmedetomidine (DEX) compared with sedation with benzodiazepines in esophageal endoscopic submucosal dissection (ESD).

Lubiprostone Decreases the Small Bowel Transit Time by Capsule Endoscopy: An Exploratory, Randomised, Double-Blind, Placebo-Controlled 3-Way Crossover Study

The aim of this study was to investigate the usefulness of lubiprostone for bowel preparation and as a propulsive agent in small bowel endoscopy. Six healthy male volunteers participated in this randomized, 3-way crossover study. The subjects received a 24 μg tablet of lubiprostone 60 minutes prior to the capsule ingestion for capsule endoscopy (CE) and a placebo tablet 30 minutes before the capsule ingestion (L-P regimen), a placebo tablet 60 minutes prior to CE and a 24 μg tablet of lubiprostone 30 minutes prior to CE (P-L regimen), or a placebo tablet 60 minutes prior to r CE and a placebo tablet again 30 minutes prior to CE (P-P regimen). The quality of the capsule endoscopic images and the amount of water in the small bowel were assessed on 5-point scale. The median SBTT was 178.5 (117–407) minutes in the P-P regimen, 122.5 (27–282) minutes in the L-P regimen, and 110.5 (11–331) minutes in the P-L regimen (P = 0.042). This study showed that the use of lubiprostone significantly decreased the SBTT. We also confirmed that lubiprostone was effective for inducing water secretion into the small bowel during CE.

Effectiveness of therapeutic barium enema for diverticular hemorrhage.

AIM To evaluate the effectiveness of barium impaction therapy for patients with colonic diverticular bleeding. METHODS We reviewed the clinical charts of patients in whom therapeutic barium enema was performed for the control of diverticular bleeding between August 2010 and March 2012 at Yokohama Rosai Hospital. Twenty patients were included in the review, consisting of 14 men and 6 women. The median age of the patients was 73.5 years. The duration of the follow-up period ranged from 1 to 19 mo (median: 9.8 mo). Among the 20 patients were 11 patients who required the procedure for re-bleeding during hospitalization, 6 patients who required it for re-bleeding that developed after the patient left the hospital, and 3 patients who required the procedure for the prevention of re-bleeding. Barium (concentration: 150 w%/v%) was administered per the rectum, and the leading edge of the contrast medium was followed up to the cecum by fluoroscopy. After confirmation that the ascending colon and cecum were filled with barium, the enema tube was withdrawn, and the patients position was changed every 20 min for 3 h. RESULTS Twelve patients remained free of re-bleeding during the follow-up period (range: 1-19 mo) after the therapeutic barium enema, including 9 men and 3 women with a median age of 72.0 years. Re-bleeding occurred in 8 patients including 5 men and 3 women with a median age of 68.5 years: 4 developed early re-bleeding, defined as re-bleeding that occurs within one week after the procedure, and the remaining 4 developed late re-bleeding. The DFI (disease-free interval) decreased 0.4 for 12 mo. Only one patient developed a complication from therapeutic barium enema (colonic perforation). CONCLUSION Therapeutic barium enema is effective for the control of diverticular hemorrhage in cases where the active bleeding site cannot be identified by colonoscopy.

Sa2027 Lubiprostone Decreases Small-Bowel Transit Time and Improves Visualization of the Small Bowel in Capsule Endoscopy: A Double-Blind, Placebo-Controlled 3-Way Crossover Study

Background: Fungi may colonize the small intestine and may be pathogenic and/or cause GI symptoms. In one study, 27% of patients with unexplained GI symptoms had SIFO (Jacobs et al). Whether SIFO causes symptoms and whether symptom profiles differ between those with or without SIFO is unknown. Our aim was to determine the presence of fungal overgrowth in patients with unexplained GI symptoms and to compare the symptom profiles of SIFO +ve and -ve patients. Methods: Patients with chronic gastrointestinal (GI) symptoms and negative endoscopy and computerized abdominal tomography (CAT) scan referred to motility center, underwent duodenal aspiration/culture. Under aseptic precautions, 3mL of duodenal juice was aspirated from the 3rd/4th parts of duodenum during esophagogastroduodenoscopy by using a 2mm Liguory catheter and cultured for fungi. Patients scored the frequency, intensity and duration of abdominal pain, belching, bloating, fullness, indigestion, nausea, diarrhea, vomiting, gas for previous 2 weeks on a Likert-like scale from 0-3 (frequency: 0=none, 1= 1 episode/wk. intensity: 0 = no symptoms, 1 = mild, 2 = moderate, 3 = severe symptom. Duration: 0 = none, 1= 30 min.). Mann-Whitney U test was used to compare symptom scores of SIFO +ve vs SIFO -ve patients. Results: 150 patients (F/M=117/33), mean age 47 years, and symptom duration of >6 months were enrolled. Duodenal culture yielded a positive fungal culture in 25.3% (38/150) patients. 37 (97.4%) were Candida spp.; 31 (83.8%) Candida Albicans, 6 (16.2%) Candida Glabrata, and 1 (2.6%) was Penicillum spp. 16 (42.1%) grew ≥102 CFU/ mL, 11 (28.9%) grew ≥103 CFU/mL, 4 (10.5%) grew ≥104 CFU/mL, and 3 (7.9%) grew ≥105 CFU/mL. Predominant symptoms were abdominal pain, bloating, fullness, nausea and gas, but symptom scores were not different between patients with or without SIFO, all p= ns (Table 1). Median total symptom scores were not significantly different in SIFO +ve vs SIFO -ve group; 45.043 vs 46.428 (p=0.651). Conclusion: Approximately 25% of patients with chronic GI symptoms may have SIFO. Symptoms do not appear to differentiate between those with or without SIFO and duodenal culture appears to be the only method of identifying this problem. Table 1:

Comparison of Clinical Findings with Symptom Assessment Systems (GerdQ and FSSG) for Functional Gastrointestinal Diseases

Background/Aims: We conducted a trial to evaluate the FSSG questionnaire and GerdQ questionnaire for diagnostic accuracy given correlation with clinical findings. Methods: One hundred three consecutive patients who were seen in the Yokohama City University hospital with a gastrointestinal symptom in May 2011 were enrolled as potential subjects. Of these, 94 patients underwent upper gastrointestinal endoscopy, and clinical symptoms were evaluated using both the FSSG and GerdQ questionnaires. Results: There were 94 subjects with GERD and 9 subjects with functional dyspepsia as defined by the Rome III criteria. We investigated the sensitivity and specificity of FSSG and GerdQ for GERD. For FSSG, the sensitivity was 0.564, the specificity was 0.778, and the odds ratio was 4.462. For GerdQ, the sensitivity was 0.298, the specificity was 0.889, and the odds ratio was 3.363. When combining the FSSG and GerdQ, the sensitivity was 0.255, the specificity was 0.888, and the odds ratio was 2.722. When using either the FSSG or GerdQ, the sensitivity was 0.723, the specificity was 0.888, and the odds ratio was 5.307. Conclusions: We conclude that having patients complete both the FSSG and GerdQ may be more useful in routine medical examinations than completing only one questionnaire.

The α-glucosidase inhibitor voglibose stimulates delayed gastric emptying in healthy subjects: a crossover study with a 13C breath test

The gastrointestinal effects of α-glucosidase inhibitors have not been sufficiently investigated. The aim of this study was to determine whether a single dose of pre-prandial voglibose might affect the rate of gastric emptying, determined using the 13C breath test. Ten healthy male volunteers participated in this randomized, two-way crossover study. The subjects fasted overnight and received 0.2 mg voglibose or a placebo 2 h before a test meal. They were then served a liquid test meal consisting of 200 kcal per 200 ml that contained 100 mg 13C-acetate. Breath samples were collected under both conditions until 150 min after the meal. A comparison of the control and voglibose conditions revealed that for gastric emptying rates (with values expressed as median: range), T1/2 [(87.9: 78.0–104.9 min) vs (88.4: 74.3–106.3 min), p = 1], Tlag [(47.1: 39.6–60.1 min) vs (45.4: 31.2–63.3 min), p = 0.432], β [(1.89: 1.68–2.18) vs (1.90: 1.35–2.15), p = 0.846] and κ [(0.81: 0.71–0.98) vs (0.81: 0.50–0.94), p = 0.922] did not significantly differ between conditions. A significant difference between the control and voglibose conditions was found for the GEC [(4.28: 4.09–4.44) vs (4.06: 3.69–4.50), p = 0.0138]. In conclusion, this study demonstrated that the ingestion of oral voglibose led to delayed gastric emptying of a liquid meal.

Lubiprostone improves visualization of small bowel for capsule endoscopy: a double-blind, placebo-controlled 2-way crossover study

Background and study aims  Lubiprostone has been reported to be an anti-constipation drug. The aim of the study was to investigate the usefulness of lubiprostone both for bowel preparation and as a propulsive agent in small bowel endoscopy. Patients and methods  This was a double-blind, placebo-controlled, 2-way crossover study of subjects who volunteered to undergo capsule endoscopy (CE). A total of 20 subjects (16 male and 4 female volunteers) were randomly assigned to receive a 24-μg tablet of lubiprostone 120 minutes prior to capsule ingestion for CE (L regimen), or a placebo tablet 120 minutes prior to capsule ingestion for CE (P regimen). Main outcome was gastric transit time (GTT) and small-bowel transit time (SBTT). Secondary outcome was adequacy of small-bowel cleansing and the fluid score in the small bowel. The quality of the capsule endoscopic images and fluid in the small bowel were assessed on 5-point scale. Results  The capsule passed into the small bowel in all cases. Median GTT was 57.3 (3 – 221) minutes for the P regimen and 61.3 (10 – 218) minutes for the L regimen ( P  = 0.836). Median SBTT was 245.0 (164 – 353) minutes for the P regimen and 228.05 (116 – 502) minutes for the L regimen ( P  = 0.501). The image quality score in the small bowel was 3.05 ± 1.08 for the P regimen and 3.80 ± 0.49 for the L regimen ( P  < 0.001). The fluid score in the small bowel was 2.04 ± 1.58 for the P regimen and 2.72 ± 1.43 for the L regimen ( P  < 0.001). There was a significant difference between the 2 regimens with regard to image quality. The fluid score was more plentiful for the L regimen than for the P regimen. There were no cases of capsule retention or serious adverse events in this study. Conclusion  Our study showed that use of lubiprostone prior to CE significantly improved visualization of the small bowel during CE as a result of inducing fluid secretion into the small bowel.

Evaluation of endoscopic findings for discriminating between early carcinomas and low-grade adenomas in superficial elevated gastric lesions.

BACKGROUND/AIMS This study aimed to determine the useful endoscopic findings in a differential diagnosis between early carcinomas (EC) and low-grade adenomas (LGA) in superficial elevated gastric epithelial neoplasia during conventional endoscopy with white-light imaging (C-WLI). MATERIALS AND METHODS We investigated 270 consecutive cases of superficial elevated gastric epithelial neoplasias, which were removed by endoscopic submucosal dissection. The pathological diagnostic criteria were based on the revised Vienna classification: category 4 (mucosal high-grade neoplasia) or 5 (submucosal invasion by carcinoma) lesions were diagnosed as EC, while category 3 (mucosal low-grade neoplasia) lesions were diagnosed as LGA. The association between the postoperative pathological diagnoses (EC or LGA) and the following endoscopic findings: localized site, lesion size, color (reddish or whitish), shape (smooth, petal, or irregular), and presences of depression, erosion, ulceration, or nodularity on the surface, were evaluated. RESULTS Of 270 epithelial neoplasias, 222 (58 LGA and 164 EC) were retrospectively evaluated. Multiple logistic regression analysis revealed that the lesion size [odds ratio (OR), 1.216; p<0.001) and reddish color (OR, 5.274; p<0.001) were independent findings for EC. CONCLUSION The lesion size and reddish color were useful optical findings for discriminating between EC and LGA.

Can magnifying endoscopy with narrow-band imaging discriminate between carcinomas and low grade adenomas in gastric superficial elevated lesions?

Background and study aims: The aim of this study was to investigate the capability of magnifying endoscopy with narrow-band imaging (ME-NBI) to discriminate between early carcinomas (EC) and low grade adenomas (LGA) in gastric superficial elevated epithelial neoplasias. Patients and methods: We investigated 100 consecutive cases of gastric superficial elevated epithelial neoplasias that were removed using endoscopic submucosal dissection. The pathological diagnostic criteria were based on the revised Vienna classification; category 4 (mucosal high grade neoplasia) and category 5 (submucosal invasion by carcinoma) lesions were diagnosed as EC, whereas category 3 (mucosal low grade neoplasia) lesions were diagnosed as LGA. The associations between the postoperative pathological diagnoses and the ME-NBI findings were analyzed, and included the shape, specification, and area of irregularity in the microvascular architecture (MV) and the microsurface structure (MS). Results: Seventy-nine EC and 21 LGA cases diagnosed postoperatively were evaluated retrospectively. The lesion size (median; range (mm)) was significantly larger in the EC group (14; 2 – 95) compared to the LGA group (5; 2 – 16) (P < 0.001). Wavy forms in the MV shapes (P = 0.031), extension in the MV specifications (P = 0.035), and area with MV irregularity (P = 0.001) were found to be statistically significant predictive findings for EC. Villous forms in the MS shapes (P = 0.026), enlargement in the MS specifications (P = 0.044), and area with MS irregularity (P = 0.021) were also found to be statistically significant predictive findings for EC. The rates of preoperative sensitivity, specificity, and diagnostic accuracy of ME-NBI for discriminating EC were 86.1 %, 38.9 %, and 75 %, respectively. Conclusions: The present study suggests that ME-NBI is useful for the differential diagnosis of EC and LGA in gastric superficial elevated epithelial neoplasias. Study registration: UMIN000012925.