Shingo Endo

Endoscopic submucosal dissection by using a grasping-type scissors forceps: a preliminary clinical study (with video).

BACKGROUND Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcoming of this method is the difficulty of fixing the knife to the target lesion. It can lead to an unexpected incision and result in major complications, such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping-type scissors forceps (GSF), which can grasp and incise the targeted tissue by using electrosurgical current. OBJECTIVE To evaluate the efficacy and safety of ESD by using GSF for the removal of gastric neoplasms in human beings. DESIGN Prospective, uncontrolled, single center. SETTING Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan. PATIENTS Four patients with early gastric neoplastic lesions. INTERVENTIONS After marking and injection of a solution into the submucosa, the lesion was separated from the surrounding normal mucosa by complete incision around the lesion by using the GSF. A piece of submucosal tissue was grasped and cut with the GSF by using electrosurgical current to achieve submucosal excision. MAIN OUTCOME MEASUREMENT Technical success and complications. RESULTS All lesions were treated easily and safely, without any unexpected incisions. No delayed hemorrhage and perforation occurred. An en bloc resection and a negative resection margin was obtained in all cases. LIMITATIONS The small number of patients and an uncontrolled study. CONCLUSIONS ESD with GSF appeared to be an easy, safe, and technically efficient method for resecting GI neoplasms.

Prospective comparative study on the acceptability of unsedated transnasal endoscopy in younger versus older patients

Goals The aim of this prospective study was to compare the acceptance and tolerance for unsedated transnasal esophagogastroduodenoscopy (EGD) between younger and older patients. Background Little information is available on comparisons of younger and older patients with regard to acceptance and tolerance of transnasal EGD. Study A total of 260 patients were referred for unsedated transnasal EGD and divided into 2 groups according to their age: less than 60 years of age (group A, n=160) and 60 years of age and older (group B, n=100). A questionnaire for tolerance was completed by each patient (a validated 0 to 10 scale where “0” represents no discomfort/well tolerated and “10” represents severe discomfort/poorly tolerated). Results In 94.4% of group A and 95.0% of group B, insertions were successfully completed (P>0.05). Between groups A and B, discomfort during nasal anesthesia (1.7±0.2 vs. 1.6±0.2) and overall tolerance during procedure (1.7±0.2 vs. 1.5±0.2) were similar (P>0.05). However, discomfort during insertion was significantly greater in group A than in group B (2.5±0.2 vs. 1.9±0.2, P=0.02). Of all, 97.4% of group A and 94.7% of group B were willing to undergo unsedated transnasal EGD in the future (P>0.05). Conclusions There was no significant difference in acceptability between younger and older patients for unsedated transnasal EGD. Otherwise, younger patients experienced significantly more discomfort during insertion than did older patients.

Newly developed all in one EUS system: one cart system, forward-viewing optics type 360 degrees electronic radial array echoendoscope and oblique-viewing type convex array echoendoscope.

Most endosonographers use radial scanning instruments for diagnostic imaging, and use longitudinal scanning instruments primarily for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The use of two separate instruments for radial and longitudinal scanning means 2 different echoendoscopes are required, each with its own dedicated US processing unit. Currently available electronic radial echoendoscopes and linear instruments made by the same company require the same other brand US unit. Furthermore, no forward-viewing optics type 360 degrees electronic radial echoendoscope currently exists. We have developed an all-in-one one cart EUS system that saves space and is available for both the forward-viewing type 360 degrees radial electronic echoendoscope and the oblique-viewing type convex echoendoscope. These scopes have a transducer with variable frequency (5.0, 7.5, 10.0, 12.0 MHz) and color and power Doppler flow mapping capabilities. We performed a clinical development test for thirteen patients with sixteen lesions (Radial EUS on 8 lesions and EUS-FNA on 8 lesions) using this new EUS system. These new instruments provided satisfactory US and endoscopic images. The forward-viewing optics of the prototype enhanced intubation and instrument advancement. The radial scanning prototype provided an adequate diagnosis in 8 (100%) out of 8 lesions for EUS. The convex type achieved successful puncture in 8 (100%) out of 8 lesions and collection of adequate specimen for diagnosis of EUS-FNA in 4 (50%) out of 8 lesions. There were no complications in this series. This new system appears to be an attractive alternative for efficient EUS.

Is Double-Balloon Colonoscopy a Better Aid to Unskilled Colonoscopists than Conventional Colonoscopy?

BACKGROUND AND STUDY AIMS To compare the clinical outcome of double-balloon colonoscopy (DBC) with conventional colonoscopy (CC) for colon evaluation performed by an unskilled colonoscopist. PATIENTS AND METHODS Between June 2008 and November 2008, 1544 colonoscopies were performed in our hospital. Fifty-eight patients, (29 male and 29 female ; 19-86 years; mean age, 63 years) involving 60 intubations, were enrolled in this study and were assigned randomly to the DBC or CC group. One first-year GI fellow was enrolled and performed these 60 consecutive colonoscopies (30 DBCs, 30 CCs). Completion rate of colonoscopy, cecal intubation time, and rate of analgesic agent usage were analyzed. RESULTS Completion of DBC was 100% (30/30), while completion of CC was 73% (22/30). There was a statistically significant difference (p < 0.05). The mean cecal intubation time was 36.2 +/- 14.4 minutes (DBC) and 36.5 +/- 15.2 minutes (CC). There was no statistically significant difference. Analgesic agent was used with 19 intubations (63%) (DBC) and with 27 intubations (90%) (CC) (p < 0.05). CONCLUSIONS For inexpert endoscopists, using DBC has a higher rate of effectiveness than using CC and can decrease the discomfort of patients during colonoscopic procedures.

W1250 Effect of Nutritional Supplementation with Zinc and Vitamin C in Acute Hemorrhagic Rectal Ulcer Patients: A Randomized Clinical Trial

Introduction: Green tea polyphenols, particularly -(-) epigallocatechin 3-gallate (EGCG), have sparked considerable interest as potential therapeutic agents for chronic inflammatory diseases due to their anti-oxidant and anti-inflammatory effects. Aim: Analyze the ability of EGCG to inhibit production of pro-inflammatory cytokines in human peripheral blood mononuclear cells (PBMCs) In Vitro to gauge its anti-inflammatory effects in immune cells from IBD patients. Methods: PBMCs were obtained from 4 colitis patients and 4 normal controls and enriched for monocytes or lymphocytes by plastic adherence. CD14+ macrophages, CD4+CD45+RO+ and CD4+CD45+RA+ T cells were isolated respectively by microbead technology. Three experiments were performed: 1) Lipopolysaccharide (LPS) stimulated CD14+ macrophages alone, 2) co-cultured with CD4+CD45+RO+ or CD4+CD45+RA+ T cells, or 3) anti-CD3 Ab stimulated CD4+CD45+RO+ T cells were incubated in the presence of EGCG (0-10 ng/μl) for 3 and 6 days. Supernatants were collected for cytokine analysis by ELISA. Results: LPS stimulated CD14+ macrophages, or CD4+CD45+RO+ T cells co-cultured with LPS stimulatedmacrophages experienced a dose-dependent reduction in pro-inflammatory cytokine production as shown in table 1. Co-culture of CD14+ macrophages with CD4+CD45+RO+ T cells resulted in a 92% reduction of IL-17 production. There was no change in IL-17 production when CD4+CD45+RA+ T cells were substituted. When evaluated in LPS stimulated CD14+ macrophages alone, EGCG elicited a similar reduction in cytokine production. Reduced cytokine levels were not due to loss of cell viability. Discussion: These results reveal that EGCG produces a significant anti-inflammatory effect by reducing the production of the pro-inflammatory cytokines TNFα, IL-1β, IL-6, and IFNγ. The ability of EGCG to increase apoptosis in lymphocytes from colitis patients, but not from healthy controls, suggests that it may offer a clinical benefit by this mechanism, as well. We are currently conducting a clinical trial in patients with ulcerative colitis to evaluate the clinical correlation of these findings. Table 1