Yoshifumi Nakagawa

Endoscopic closure of a large ERCP-related lateral duodenal perforation by using endoloops and endoclips

An 88-year-old man with recurrent obstructive jaundice esulting from common bile duct cancer underwent ERCP. he patient’s medical history included a cholecystectomy years earlier and 4 episodes of obstructive jaundice ecause of biliary stent occlusion. At insertion of a duoenoscope into the duodenum, a perforation measuring bout 30 mm occurred in the lateral wall of the descending uodenum (Fig. 1A). The patient was inoperable because f advanced age and comorbidities. After informed conent was obtained, we tried endoscopic repair of this erforation. Closure with endoclips alone failed because he hole was too large. We decided to close the perforaion with endoloops (MAJ-254; Olympus Optical Co Ltd, okyo, Japan) and endoclips (HX-610-090; Olympus) by sing a 2-channel endoscope (GIF-2TQ260M; Olympus) ith a distal attachment (disposable distal attachment, -201-13404; Olympus). The 2-channel endoscope alowed simultaneous insertion of an endoloop and an enoclip applicator device (HX-110QR/HX-610-090; Olymus). By using the endoclip, we anchored the endoloop

Helicobacter pylori Eradication Improves Gastric Atrophy and Intestinal Metaplasia in Long-Term Observation

Background and Aim:Helicobacter pylori has been shown to cause atrophic gastritis and intestinal metaplasia (IM), both of which are precancerous lesions. To clarify the mechanism by which H. pylori eradication prevents gastric cancer, we monitored atrophy and IM improvement in gastric mucosa over a long period after H. pylori eradication. Methods: We monitored 118 patients (72 males, 46 females; mean age 61.3 ± 5.1 years) for a mean of 8.6 years (range 5–13) after successful H. pylori eradication. Biopsy specimens were taken from the greater curvatures of the antrum (A2) and the corpus (B2). Results: Atrophy was significantly decreased in patients with successful H. pylori eradication, both at A2 (from 1.60 ± 0.09 to 1.02 ± 0.08; p < 0.001) and B2 (from 0.71 ± 0.10 to 0.02 ± 0.02; p < 0.001), and IM score was significantly decreased at B2 (from 0.17 ± 0.12 to 0.00 ± 0.00; p < 0.05), but not at A2 (from 0.60 ± 0.11 to 0.43 ± 0.09; p = NS). In patients without successful eradication, however, there were no differences in scores over time. Before eradication, IM score was significantly higher in males than in females, both at A2 (0.81 ± 0.12 vs. 0.25 ± 0.10; p < 0.05) and B2 (0.32 ± 0.08 vs. 0.07 ± 0.04; p < 0.05). Conclusion: We were able to monitor the gastric mucosa for a mean of 8.6 years after H. pylori eradication, the longest period reported to date. Significant improvements in gastric atrophy and IM after H. pylori eradication may decrease the risk of gastric cancer.

Histological characteristics of gastric mucosa prior to Helicobacter pylori eradication may predict gastric cancer

Abstract Objective. Although Helicobacter pylori (H. pylori) eradication has been shown to inhibit gastric cancer, it does not completely suppress it. Therefore, risk factors of gastric cancer development following H. pylori eradication were examined. Material and methods. A total of 2355 patients (1501 males and 824 females) underwent successful eradication of H. pylori. Endoscopic atrophy, histological gastritis, atrophy, intestinal metaplasia (IM), and operative link for gastritis assessment (OLGA) staging were subsequently evaluated. Results. Following eradication, 33/2355 patients (25 males and 8 females) developed gastric cancer. Compared to a nongastric cancer group that was matched according to gender and age, the incidence of endoscopic atrophy (3.52 ± 1.45 vs. 4.85 ± 1.18, p < 0.001), histological atrophy at the greater curvature of the antrum (1.42 ± 0.80 vs. 1.95 ± 0.86, p = 0.0059), inflammation (2.05 ± 0.59 vs. 2.33 ± 0.66, p = 0.031), IM at the greater curvature of the corpus (0.06 ± 0.30 vs. 0.24 ± 0.54, p = 0.029), the ratio of OLGA-stage 0–II/III, IV (13/8 vs. 55/11, p = 0.038) were significantly higher for the gastric cancer group. Multivariate analysis also showed the highest odds ratio (6.26, 95% confidence interval or CI, 1.28–30.60, p = 0.023) for IM at the greater curvature of the corpus. Conclusions. Severe endoscopical atrophy, OLGA staging, histological atrophy at the antrum, inflammation, and particularly IM at the corpus, were identified as risk factors for gastric cancer development following H. pylori eradication. Therefore, eradication should be performed before these predictors develop.

Efficacy of rebamipide for low-dose aspirin-related gastrointestinal symptoms.

Gastrointestinal symptoms are a problematic issue for patients who take low-dose aspirin for long time. We conducted a pilot study to investigate the efficacy of combination therapy with proton pump inhibitor and rebamipide. This was a prospective, randomized, double-blind, placebo-controlled cross-over study. All the subjects received aspirin 100 mg and omeprazole 20 mg. The subjects were divided into two groups and received either rebamipide 300 mg or placebo, which was prescribed for 4 weeks. The subjects were instructed to record their gastrointestinal symptom rating scale before the study and 1 and 4 weeks after beginning the protocol. These scores of the groups were compared before and after the treatment to evaluate the severity of their symptoms and the number of symptom items present in each group. For the subjects receiving rebamipide, the total prevalence of lower gastrointestinal symptoms was significantly different from the placebo group (p=0.0093) at week 4. No troublesome symptoms were observed in the rebamipide group. Inconclusion, the administration of rebamipide prevented the occurrence of troublesome symptoms, especially lower gastrointestinal symptoms, in patients taking aspirin and omeprazole. Rebamipide is a candidate drug for combination therapy with proton pump inhibitors to prevent low-dose aspirin-induced gastrointestinal symptoms.

Evaluation of selective cyclooxygenase‐2 inhibitor‐induced small bowel injury: Randomized cross‐over study compared with loxoprofen in healthy subjects

Non‐steroidal anti‐inflammatory drugs have the potential to injure the mucosa of the upper digestive tract and small bowel, whereas celecoxib (a selective cyclooxygenase‐2 inhibitor) has less influence on the entire digestive tract mucosa. The present study was conducted to compare the extents of small bowel mucosal injury induced by celecoxib and loxoprofen (the most frequently used non‐steroidal anti‐inflammatory drugs in Japan).

Difference between urban and rural regions in Japan in estimated risk of esophageal cancer based on a health risk appraisal model that includes an alcohol flushing questionnaire

BackgroundMany environmental and genetic factors are presumed to be involved in the etiology of esophageal squamous cell carcinoma (ESCC). We developed a health risk appraisal model that includes an alcohol flushing questionnaire (HRA-F) to estimate the ESCC risk. The purpose of this study was to use the HRA-F model to assess regional differences in the ESCC risk between rural and urban regions in Japan.MethodsWe compared the HRA-F scores for risk of ESCC of 1,043 medical screening examinees (442 men and 601 women) in a rural region of Oita Prefecture and 1,016 medical screening examinees (610 men and 406 women) in a central region of Tokyo, Japan.ResultsAfter adjustment for age, there was no difference between the frequencies of current or former facial flushers in the two populations. Oita men consumed more alcohol than Tokyo men, but Oita women consumed less alcohol than Tokyo women. There was no difference between Oita and Tokyo in the suppressive effect of flushing on alcohol consumption. Oita individuals of both genders reported less smoking, lower green and yellow vegetable intake, and lower fruit intake than did Tokyo individuals. The risk of ESCC quantitatively assessed based on the HRA-F scores was higher in Oita men than in Tokyo men, but a higher proportion of women were at high risk in Tokyo than in Oita.ConclusionThe HRA-F model was useful for identifying regional differences in ESCC risk and persons at high risk of ESCC in the Japanese population.