Digestive Endoscopy最新文献

{"title":"Underwater endoscopic submucosal dissection with an insulated tip knife using diluted saline","authors":"Akihiro Maruyama,&nbsp;Makoto Kobayashi,&nbsp;Motoyoshi Yano","doi":"10.1111/den.14917","DOIUrl":"10.1111/den.14917","url":null,"abstract":"<p>Owing to buoyancy, underwater endoscopic submucosal dissection (ESD) offers improved visibility of the submucosal layer.<span>¹</span> Previous research has demonstrated the effectiveness and speed of employing an insulated tip (IT) knife for ESD.<span>^{2, 3}</span> However, due to the current flow in the surrounding saline, employing large electrode devices such as an IT knife becomes challenging. Distilled water without electrolytes does not provide effective submucosal dissection. To address this, we utilized diluted saline (1:2 mixture of saline and distilled water) to modulate electrical flow via impedance difference (Fig. 1). We used this solution for underwater ESD, avoiding dimethicone to maintain transparency. Moreover, indigo carmine and undiluted hyaluronic acid were added to the local injection to aid visibility and protect the submucosal hyaluronic acid. There were three male cases and one female case, with three lesions in the stomach and one lesion in the colon. The average age was 79.2 years, the average resection time was 55 min, the average volume of flooding solution used was 1600 mL, and the average diameter of the lesions was 23.5 mm. We used an ITknife2 and ITknife nano (Olympus, Tokyo, Japan). A VIO-300D (Erbe Elektromedizin, Tubingen, Germany) was employed as a high-frequency surgical device. While there was no significant change in lesion elevation when using diluted saline compared to normal saline as the flooding solution, current leakage into the surrounding liquid was reduced, allowing for submucosal dissection. In underwater ESD, suctioning air to maintain a clear view is crucial. The reduction in current leakage into the surrounding flooded solution decreased the bubbles generated during submucosal dissection. Consequently, less effort was required to suction bubbles to maintain a clear view (Video S1). No incidents of postbleeding or perforation were observed. The use of diluted saline has expanded the options for underwater ESD devices.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1384-1385"},"PeriodicalIF":5.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14917","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal bowel preparation for colonoscopy","authors":"Naoto Tamai,&nbsp;Kazuki Sumiyama","doi":"10.1111/den.14914","DOIUrl":"10.1111/den.14914","url":null,"abstract":"<p>There is robust evidence to indicate a strong correlation between the bowel preparation status and adenoma detection rate (ADR), which directly impacts the incidence and mortality rate of postcolonoscopy colorectal cancer. Therefore, improving bowel preparation has been of increasing interest. In Japan, commercially available bowel preparation agents include polyethylene glycol, oral sodium sulfate, sodium picosulfate-magnesium citrate, magnesium citrate, and oral sodium phosphate; each has its own strengths and limitations. The timing of administration can also influence the efficacy of bowel preparation and patient tolerability. Furthermore, meta-analyses have suggested predictive factors for inadequate bowel preparation. A detailed understanding of these factors could contribute to reducing the need for repeat colonoscopy within 1 year, as recommended for patients with inadequate bowel preparation. Recent advancements, such as oral sulfate tablets, present promising alternatives with higher patient satisfaction and ADRs than traditional methods. Achieving optimal bowel preparation requires enhanced instructions, individualized regimens, and a comprehensive understanding of patient backgrounds and the characteristics of various bowel preparation agents. This article provides a concise overview of the current status and advancements in bowel preparation for enhancing the quality and safety of colonoscopy.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 2","pages":"139-146"},"PeriodicalIF":5.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14914","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic submucosal dissection vs. endoscopic mucosal resection in the treatment of early Barrett's neoplasia: Systematic review and meta-analysis","authors":"Megui Marilia Mansilla Gallegos,&nbsp;Igor Logetto Caetité Gomes,&nbsp;Vitor Ottoboni Brunaldi,&nbsp;Alexandre Moraes Bestetti,&nbsp;Sergio Barbosa Marques,&nbsp;Nelson Tomio Miyajima,&nbsp;Hiram Menezes Nascimento Filho,&nbsp;Pedro Henrique Veras Ayres da Silva,&nbsp;Angelo So Taa Kum,&nbsp;Wanderley Marques Bernardo,&nbsp;Eduardo Guimarães Hourneaux de Moura","doi":"10.1111/den.14892","DOIUrl":"10.1111/den.14892","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic resection is the preferred approach to treat early Barrett's neoplasia, reducing the need for surgical interventions. However, the best choice between endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) remains unclear. The study aimed to compare the efficacy and safety of EMR vs. ESD for early Barrett's neoplasia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An electronic search was conducted in MEDLINE, Central Cochrane, EMBASE, and LILACS until November 2023. Studies comparing ESD vs. EMR in the treatment of patients with early Barrett's neoplasia were included. This study was performed according to the Preferred Report Items for Systematic Reviews and Meta-Analyses guidelines. The ROBIN-I tool was used to analyze the risk of bias and GRADE to measure the quality of the evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 9352 patients from 15 observational studies were included. Patients undergoing ESD had significantly higher rates of en-bloc (odds ratio [OR] 25.96, 95% confidence interval [CI] 13.82, 48.74; <i>I</i>² = 52%; <i>P</i> &lt; 0.00001) and R0 (OR 5.10, 95% CI 3.29, 7.91; <i>I</i>² = 73%; <i>P</i> &lt; 0.00001) with a higher risk of adverse events, including bleeding, stricture formation, and perforation. In a subgroup analysis of patients who did not receive radiofrequency ablation, ESD had a lower recurrence rate than EMR (OR 0.22, 95% CI 0.05, 0.94; <i>I</i>² = 88%; <i>P</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Endoscopic submucosal dissection is more effective than EMR in treating early Barrett's neoplasia at the expense of higher adverse events rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1299-1311"},"PeriodicalIF":5.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lariat hooking method as an easy and quick preparation of clip-and-thread technique for endoscopic submucosal dissection","authors":"Satoshi Ono,&nbsp;Chinari Tanaka,&nbsp;Kazushi Fukagawa","doi":"10.1111/den.14913","DOIUrl":"10.1111/den.14913","url":null,"abstract":"<p>Endoscopic submucosal dissection (ESD) for neoplastic lesions of the gastrointestinal tract is widely accepted as a minimally invasive treatment. Against this backdrop, the effectiveness of countertraction in ESD has been reported for difficult cases, and among various devices, the threaded clip technique is frequently used as a simple and inexpensive method.<span>^1-3</span> However, ligating threads is a very detailed process and sometimes requires time and effort. In this report we describe an easy and quick way, the lariat hooking method (LHM), to ligate thread to the clip (Video S1). LHM requires only a reopenable clip with some gap between the arms (StellaClip; HOYA, Tokyo, Japan) and a thread tied in the lariat style. To attach the thread to the clip, insert the clip into the lariat, open the clip, hook the proximal thread between the arms of the clip, and close the clip lightly (Fig. 1). After these procedures, grasp the edge of the lesion using the clip tied to the thread and release the clip as usual. The advantage of this method is not only its simplicity, but also the reliability that the thread is firmly ligated directly to the main body of the clip, not the clip arm. When a thread is ligated to the arm of a clip as a conventional method, the traction force to pull the thread is transmitted to only one arm of the clip, resulting in the clip acting in the direction of opening, sometimes causing the clip to come off. However, LHM applies traction force in the same direction as the direction of the clip, allowing the lesion to be tensioned more consistently (Fig. 2). Thus, LHM is considered to be an effective method to prepare the clip-and-thread in a short time and at the same time to perform ESD with stable countertraction.</p><p>Authors received samples of re-openable clips from HOYA Corp. C.T. is employed by HOYA Corp.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1382-1383"},"PeriodicalIF":5.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14913","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk-scoring system predicting need for hospital-specific interventional care after peroral endoscopic myotomy","authors":"Hirofumi Abe,&nbsp;Shinwa Tanaka,&nbsp;Hiroya Sakaguchi,&nbsp;Chise Ueda,&nbsp;Hitomi Hori,&nbsp;Tatsuya Nakai,&nbsp;Tetsuya Yoshizaki,&nbsp;Fumiaki Kawara,&nbsp;Takashi Toyonaga,&nbsp;Masato Kinoshita,&nbsp;Satoshi Urakami,&nbsp;Shinya Hoki,&nbsp;Hiroshi Tanabe,&nbsp;Yuzo Kodama","doi":"10.1111/den.14909","DOIUrl":"10.1111/den.14909","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Early identification of patients needing hospital-specific interventional care (HIC) following endoscopic treatment is valuable for optimizing postoperative hospital stays. We aimed to develop and validate a risk-scoring system for predicting HIC in patients who underwent peroral endoscopic myotomy (POEM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included patients with esophageal motility disorders who underwent POEM at our hospital between April 2015 and March 2023. HIC was defined as any of the following situations: fasting for gastrointestinal rest to manage adverse events (AEs); intravenous administration of medications such as antibiotics and blood transfusion; endoscopic, radiologic, and surgical interventions; intensive care unit management; or other life-threatening events. A risk-scoring system for predicting HIC after postoperative day (POD) 1 was developed using multivariable logistic regression and was internally validated using bootstrapping and decision curve analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 589 patients, 50 (8.5%) experienced HIC after POD1. Risk scores were assigned for four factors as follows: age (0 points for &lt;70 years, 1 point for 70–79 years, 2 points for ≥80 years), preoperative prognostic nutritional index (0 points for &gt;45, 1 point for 40–45, 4 points for &lt;40), postoperative surgical site AEs on second-look endoscopy (7 points), and postoperative pneumonia on chest radiography (6 points). The discriminative ability (concordance statistics, 0.85; 95% confidence interval, 0.78–0.91) and calibration (slope 1.00; 0.74–1.28) were satisfactory. The decision curve analysis demonstrated its clinical usefulness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This risk-scoring system can predict the HIC after POD1 and provide useful information for determining discharge.</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"247-256"},"PeriodicalIF":5.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic ultrasound-guided rendezvous techniques for difficult biliary cannulation: Technical review","authors":"Takuji Iwashita,&nbsp;Shinya Uemura,&nbsp;Ryuichi Tezuka,&nbsp;Akihiko Senju,&nbsp;Shota Iwata,&nbsp;Yosuke Ohashi,&nbsp;Masahito Shimizu","doi":"10.1111/den.14908","DOIUrl":"10.1111/den.14908","url":null,"abstract":"<p>Endoscopic retrograde cholangiopancreatography (ERCP) is the standard procedure for the diagnosis and treatment of biliary diseases. However, selective biliary cannulation, the essential first step in ERCP, can sometimes fail due to anatomical variations or technical limitations. In these cases, the endoscopic ultrasound-guided rendezvous technique (EUS-RV) offers a valuable salvage option. Nevertheless, it is crucial to be aware of potential adverse events associated with bile duct puncture. To optimize the success rate and safety of EUS-RV, understanding the basic techniques, technical tips for each procedural step, and troubleshooting strategies for potential difficulties is essential. This review article summarizes the clinical outcomes and technical considerations of EUS-RV, including a comprehensive analysis of the current evidence.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 1","pages":"68-76"},"PeriodicalIF":5.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14908","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic hand suturing has the potential to reduce bleeding after gastric endoscopic submucosal dissection in patients on antithrombotic agents: Multicenter phase II study","authors":"Osamu Goto,&nbsp;Yoshinori Morita,&nbsp;Hiroshi Takayama,&nbsp;Kingo Hirasawa,&nbsp;Chiko Sato,&nbsp;Tsuneo Oyama,&nbsp;Akiko Takahashi,&nbsp;Seiichiro Abe,&nbsp;Yutaka Saito,&nbsp;Hiroyuki Ono,&nbsp;Noboru Kawata,&nbsp;Toshiaki Otsuka,&nbsp;Katsuhiko Iwakiri","doi":"10.1111/den.14911","DOIUrl":"10.1111/den.14911","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The risk of postoperative bleeding is high after gastric endoscopic submucosal dissection (ESD) in patients continuously treated with antithrombotic agents (ATAs). The effectiveness of endoscopic hand suturing (EHS) on bleeding after gastric ESD was investigated in patients at high risk of delayed bleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with neoplasms ≤2 cm who underwent gastric ESD and continued to receive perioperative ATAs were enrolled in this multicenter phase II study. The mucosal defect was closed with EHS after removing the lesion. Postoperative bleeding rate was assessed for 3–4 postoperative weeks as a primary outcome measure. The technical success of EHS and adverse events were also assessed. Based on expected and threshold postoperative bleeding rates of 10% and 25%, respectively, we aimed to include 48 patients in the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 49 patients were enrolled in the study, and 43 patients were finally registered as the per-protocol set. The postoperative bleeding rate was 7.0% (3/43 patients; the upper limit of one-sided 95% confidence interval [CI], 17.1% and 97.5% CI, 19.1%). The upper limits of the CI were below the threshold value (25%), and the postoperative bleeding rate was below the expected value (10%). The technical EHS success rate, closure maintenance rate on postoperative day 3, and postoperative subclinical bleeding rate were 100%, 83%, and 2%, respectively. No severe adverse events related to EHS were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Endoscopic hand suturing may prevent postoperative bleeding in patients undergoing gastric ESD while being treated continuously with ATAs (UMIN000038140).</p>\u0000 </section>\u0000 </div>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 3","pages":"266-274"},"PeriodicalIF":5.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of self-expanding metal stents on long-term survival outcomes as a bridge to surgery in patients with colon cancer obstruction: Current state and future prospects","authors":"Hao-Yu Zhang,&nbsp;Zhen-Jun Wang,&nbsp;Jia-Gang Han","doi":"10.1111/den.14905","DOIUrl":"10.1111/den.14905","url":null,"abstract":"<p>Since self-expanding metal stents (SEMS) were first introduced in acute colon cancer obstruction, the increased rate of primary anastomosis and improved quality of life following SEMS placement have been clearly shown. However, it was demonstrated that SEMS are associated with higher recurrence rates. Although several trials have shown that overall and disease-free survival in patients following SEMS placement is similar with patients undergoing emergency surgery, obstruction and a high incidence of recurrence imposed many concerns. The optimal time interval from SEMS to surgery is still a matter of debate. Some studies have recommended a time interval of ~2 weeks between SEMS insertion and elective surgery. A prolonged interval of time from SEMS insertion to elective surgery and the administration of neoadjuvant chemotherapy (NAC) has been proposed. SEMS-NAC might have advantages for improving the surgical and long-term survival outcomes of patients with acute colon cancer obstruction, which is an optional approach in the management of acute colon cancer obstruction.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 12","pages":"1312-1327"},"PeriodicalIF":5.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-devices-in-one-channel method for minor papilla cannulation","authors":"Kiyoaki Ochi,&nbsp;Tsuneyoshi Ogawa,&nbsp;Toru Ueki","doi":"10.1111/den.14907","DOIUrl":"10.1111/den.14907","url":null,"abstract":"<p>Minor papilla cannulation is performed in patients with pancreas divisum and acute recurrent pancreatitis<span>¹</span>; however, it can be a technically challenging procedure.<span>²</span> We demonstrated the two-devices-in-one-channel method for minor papilla cannulation. A 50-year-old man was admitted to our hospital for recurrent pancreatitis. Pancreas divisum was suspected to be the cause of the recurrent pancreatitis. Subsequently, the patient underwent endoscopic treatment, during which a duodenoscope (model TJF 290 V; Olympus, Tokyo, Japan) was advanced to the minor duodenal papilla. We initially attempted wire-guided cannulation; we were unsuccessful because of the small size of the minor papilla, its loose fixation, and susceptibility to respiratory variability (Fig. 1). Therefore, we attempted minor papilla cannulation using the two-devices-in-one-channel method (Video S1). A slim catheter (model PR-110Q; Olympus), loaded with a 0.025 inch guidewire (Radifocus; Terumo, Tokyo, Japan) and small biopsy forceps (Radial Jaw4P; Boston Scientific, Marlborough, MA, USA) were inserted into the same channel of the duodenoscope. The forceps were then used to grasp the anal side of the minor papilla and pull it towards the scope to retract the catheter tip into the minor papilla. Following this procedure, we fixed the minor papilla and aligned the catheter with the pancreatic duct axis. After successful cannulation, sphincterotomy was performed, followed by the placement of a 7F, 5 cm pancreatic stent (Advanix; Boston Scientific). During the wire-guided cannulation, the endoscopist pushed the cannula with force, which can cause the pancreatic duct axis to bend easily if the minor papilla is inadequately fixed. However, using the two-devices-in-one-channel method and pulling the minor papilla toward the scope can help adjust the axis of the catheter to the pancreatic duct as it straightens the bend in the pancreatic duct. This method is, therefore, an effective technique not only for biliary cannulation<span>^{3, 4}</span> but also for minor papilla cannulation.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1290-1291"},"PeriodicalIF":5.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14907","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to “Randomized controlled trial of remimazolam compared with placebo in Japanese patients undergoing upper gastrointestinal endoscopy: Phase III investigator-initiated clinical trial”","authors":"Jae Yong Park","doi":"10.1111/den.14912","DOIUrl":"10.1111/den.14912","url":null,"abstract":"<p>In their multicenter randomized trial, Ichijima <i>et al</i>.<span>¹</span> demonstrated that remimazolam achieves significantly better sedation effect during upper gastrointestinal endoscopy than a placebo. However, using a placebo control is questionable, given remimazolam's established efficacy and the typically low placebo effect (&lt;5%). Using widely used sedatives as active comparators would have been more impactful; this limitation of study design reduces the impact of the research findings.</p><p>A recent meta-analysis reported propofol's superiority in terms of time to loss of consciousness and sedation success after the first dose, but with no differences in procedural outcomes.<span>²</span> Remimazolam had a better safety profile, showing lower risks of bradycardia, hypoxemia, and injection site pain. A Chinese study of 384 patients undergoing upper gastrointestinal endoscopy reported that the sedation success rate of remimazolam was noninferior to propofol (97.3% vs. 100%), with shorter time to full awakening and fewer circulatory and respiratory issues.<span>³</span></p><p>Considering the potential expansion of remimazolam use over traditional sedatives like midazolam, it is encouraging that studies targeting Asian populations are increasing, as pharmacodynamics and pharmacokinetics of benzodiazepine might vary by ethnicity or genetic polymorphism.<span>⁴</span> Metabolized by carboxylesterase 1, remimazolam exhibits dose-dependent sedative action and minimal tissue accumulation, largely independent of liver and kidney function. However, recent reports of re-sedation, delayed emergence, and anaphylaxis associated with remimazolam highlight the need for further research on carboxylesterase 1 polymorphism associations.<span>⁵</span></p><p>In conclusion, remimazolam, a new ultra-short-acting benzodiazepine, is notable for its rapid onset, efficacy, and safety, although recent discussions on adverse effects are emerging. Further studies are required to evaluate its efficacy and safety in prolonged sedation for therapeutic endoscopy. Additionally, research on its use in higher risk patients and the benefits of drug combinations with other sedative agents will greatly aid in standardizing its use in endoscopic procedures.</p><p>Authors declare no conflict of interest for this article.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"36 11","pages":"1280"},"PeriodicalIF":5.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14912","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}