DEN open最新文献

{"title":"Pipeline esophageal varices: Insights from clinical cases and models","authors":"Keita Maki,&nbsp;Hiroaki Haga,&nbsp;Kyoko Hoshikawa,&nbsp;Tomohiro Katsumi,&nbsp;Fumiya Suzuki,&nbsp;Fumi Uchiyama,&nbsp;Yoshiyuki Ueno","doi":"10.1002/deo2.70054","DOIUrl":"10.1002/deo2.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>While esophageal varices (EVs) are typically treated endoscopically, other options such as interventional radiology or surgical treatment are considered when endoscopic treatment is challenging. Pipeline EVs are difficult to treat endoscopically due to their large diameter, and currently, no specific treatment guidelines have been established.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed cases of pipeline EVs treated at our hospital and analyzed previously reported cases to collect evidence for the formulation of treatment guidelines. Additionally, we created EV simple models to evaluate the safety margin of endoscopic variceal ligation for varices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our analysis included 14 cases of pipeline EVs (four cases treated at our hospital from 2013 to 2024 and 10 previously reported cases from 1990 to 2024). Endoscopic treatment alone was insufficient in six cases (42.9%), and five cases (35.7%) required interventional radiology or surgical intervention. Using EV simple models with varying diameters, EVL was inadequate for varices with diameters of 20 mm or larger.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There are few reported cases of pipeline EVs, making it difficult to determine a treatment algorithm. In our study using an EV simple model, it was suggested that endoscopic variceal ligation is effective in blocking blood flow for EVs with a diameter of 15 mm or less. It is important that we understand there are EVs, such as pipeline EVs, for which there are limitations to safely occluding blood flow with endoscopic variceal ligation, and it may be necessary to develop treatment strategies that include methods other than endoscopic therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examination of endoscopic intracanal observation with an ultrafine-diameter scope","authors":"Takeshi Jinno,&nbsp;Kazuya Miyaguchi,&nbsp;Daiki Muraishi,&nbsp;Toshiyuki Narumi,&nbsp;Kanji Kabasawa,&nbsp;Hideki Ohgo,&nbsp;Yoshikazu Tsuzuki,&nbsp;Hiroyuki Imaeda","doi":"10.1002/deo2.70053","DOIUrl":"10.1002/deo2.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The endoscopic channel can be damaged by instruments during use and cleaning, leading to contamination, infection, and increased repair costs. However, few devices are available to observe the inside of the endoscopic channel. This study employed an ultrafine-diameter scope to examine damage in the endoscopic channel.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty-eight endoscopes used at our institution were examined for scratches, discoloration, or deformation in the endoscopic channel using an ultrafine-diameter scope.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Damage was observed in seven of the 24 observation endoscopes and 27 of the 34 therapeutic endoscopes, with damage being more common in the therapeutic endoscopes. Scratches were observed in nine of the 25 upper gastrointestinal endoscopes, 23 of the 24 colonoscopes, and one of the two echoendoscopes. Additionally, two colonoscopes, one echoendoscope, and one double-balloon endoscope showed indentation or narrowing near the curvature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The use of an ultrafine-diameter scope enabled the detection of minute damage and deformations in the channel. Periodic observation with the ultrafine-diameter scope may promote the long-term use of the scopes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological evaluation of the efficacy of endoscopic treatment for sessile serrated lesions comparing endoscopic mucosal resection, cold snare polypectomy, and underwater endoscopic mucosal resection","authors":"Kaizo Kagemoto,&nbsp;Koichi Okamoto,&nbsp;Yasuyuki Okada,&nbsp;Motoko sei,&nbsp;Shota Fujimoto,&nbsp;Mai Yagi,&nbsp;Takeshi Mitsuhashi,&nbsp;Hiroyuki Ueda,&nbsp;Takanori Yoshimoto,&nbsp;Takanori Kashihara,&nbsp;Tomoyuki Kawaguchi,&nbsp;Yoshifumi Kida,&nbsp;Yasuhiro Mitsui,&nbsp;Yutaka Kawano,&nbsp;Masahiro Sogabe,&nbsp;Hiroshi Miyamoto,&nbsp;Yasushi Sato,&nbsp;Naoki Muguruma,&nbsp;Tetsuji Takayama","doi":"10.1002/deo2.70051","DOIUrl":"10.1002/deo2.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Recently, various endoscopic treatments for colorectal polyps have been reported, including cold snare polypectomy (CSP) and underwater endoscopic mucosal resection (UEMR), in addition to EMR. However, a precise treatment strategy for sessile serrated lesions (SSL) has not been established. In this study, we analyzed the clinicopathological features of SSL resected by EMR, CSP, and UEMR to determine the most suitable treatment for SSL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 92 SSL resected via EMR (<i>n</i> = 11), CSP (<i>n</i> = 36), and UEMR (<i>n</i> = 45) were retrospectively enrolled between February 2021 and October 2022. To evaluate pathological findings, we examined SSL samples, which were stretched before formalin fixation and sectioned at 2-mm intervals. Primary outcomes were the R0 resection rate and thickness of submucosal (SM) tissue specimens for each treatment. In addition, we evaluated SSL with dysplasia (SSLD) and the inverted growth pattern which may affect the vertical margin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The R0 resection rate significantly differed among the three groups (EMR, 73%; CSP, 42%; UEMR, 87%, <i>p</i> = 0.001). The median thickness of SM tissue resected by CSP (0 µm) was significantly less than that by EMR (362 µm) and UEMR (325 µm; <i>p</i> &lt; 0.001). All four SSLDs were diagnosed endoscopically. Five SSLs with inverted growth patterns were pathologically diagnosed. Of these, two SSLs with inverted growth patterns could not be diagnosed endoscopically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>UEMR is considered to be a suitable treatment option for SSL. CSP results were pathologically insufficient. Therefore, surveillance to evaluate local recurrence is important, and the results of further multicenter prospective studies should be referred.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a novel traction device (TRACMOTION) for endoscopic submucosal dissection using a scissor-type knife: An animal pilot study and clinical experiences","authors":"Yuko Miura,&nbsp;Yosuke Tsuji,&nbsp;Ryohei Miyata,&nbsp;Ayano Fujisawa,&nbsp;Hiroyuki Tsukihara,&nbsp;Mitsuhiro Fujishiro","doi":"10.1002/deo2.70052","DOIUrl":"10.1002/deo2.70052","url":null,"abstract":"<p>A newly developed articulated through-the-scope traction device, TRACMOTION, has been used clinically for endoscopic submucosal dissection (ESD). However, there are few reports on the characteristics of this device and the lesion types for which it is most effective. Therefore, we evaluated its optimal use, efficacy, and safety clinically in animals. Subsequently, we confirmed the safety and efficacy of ESD using this device in humans. Two live swine were used; one underwent conventional ESD (C-ESD) and the other traction-assisted ESD (T-ESD). To examine the traction effect at each resection site, three ESD ulcers (greater curvature/anterior wall/posterior wall) with a diameter of approximately 40 mm were created in each swine. Based on our preliminary experiments, scissor-type and needle-type knives were used in the T-ESD and C-ESD groups, respectively. The primary endpoint was the resection speed, and the secondary endpoint was the degree of muscle layer damage. T-ESD was faster than C-ESD on the posterior wall, similar to the greater curvature, and T-ESD was slower than C-ESD on the anterior wall. There were no cases of intraoperative perforations. Obvious muscle layer damage was observed in post-C-ESD wounds on the anterior wall. The submucosal layer was retained in all post-T-ESD wounds. Although this study showed that ESD with TRACMOTION may be safe and effective, it is necessary to consider that it may be unsuitable for some lesions. This may be due to device characteristics and requires further validation.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of sedation with pentazocine or pethidine hydrochloride for endoscopic ultrasonography in outpatients: A single-center retrospective study","authors":"Makiko Urabe,&nbsp;Kenji Ikezawa,&nbsp;Yusuke Seiki,&nbsp;Ko Watsuji,&nbsp;Yasuharu Kawamoto,&nbsp;Takeru Hirao,&nbsp;Yugo Kai,&nbsp;Ryoji Takada,&nbsp;Takuo Yamai,&nbsp;Kaori Mukai,&nbsp;Tasuku Nakabori,&nbsp;Hiroyuki Uehara,&nbsp;Kazuyoshi Ohkawa","doi":"10.1002/deo2.70048","DOIUrl":"10.1002/deo2.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasonography (EUS) plays an important role in the diagnosis of pancreatobiliary diseases. However, an appropriate sedation method for EUS has not been established. Therefore, this study aimed to examine the safety and complications of sedation with pentazocine or pethidine hydrochloride for outpatient diagnostic EUS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 1302 consecutive cases in our department that underwent outpatient diagnostic EUS between April 2019 and September 2021. Until June 2020, EUS was performed under sedation with midazolam and pentazocine (pentazocine group) in principle; after June 2020, sedation with midazolam and pethidine hydrochloride (pethidine hydrochloride group) was used. A cohort of patients with comparable backgrounds was identified using propensity score matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 486 cases were included in this study. Sedation-related adverse events during the endoscopic procedures were not significantly different between the groups. The median time spent in the recovery room after EUS was significantly shorter in the pethidine hydrochloride group than in the pentazocine group (69 versus vs. 77 min; <i>p </i>&lt; 0.001). The frequency of nausea or vomiting after EUS was significantly lower in the pethidine hydrochloride group than in the pentazocine group (0% [0/486] vs. 6.2% [29/486]; <i>p </i>&lt; 0.001). The frequency of readmission to the recovery room after discharge was significantly lower in the pethidine group than in the pentazocine group (0 [0%] vs. 18 [3.7%], respectively; <i>p </i>&lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The combination of midazolam and pethidine hydrochloride is a more favorable anesthetic than the combination of midazolam and pentazocine for diagnostic EUS in outpatients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence rate of cholecystitis after initial gallbladder stenting versus secondary gallbladder stenting: A propensity score matching study","authors":"Ryota Nakabayashi,&nbsp;Hideki Kamada,&nbsp;Masahiro Ono,&nbsp;Toshiaki Kono,&nbsp;Naoki Fujita,&nbsp;Hiroki Yamana,&nbsp;Kiyoyuki Kobayashi,&nbsp;Joji Tani,&nbsp;Yasuhisa Ando,&nbsp;Hironobu Suto,&nbsp;Minoru Oshima,&nbsp;Keiichi Okano,&nbsp;Hideki Kobara","doi":"10.1002/deo2.70047","DOIUrl":"10.1002/deo2.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Limitations are sometimes encountered in the application of laparoscopic cholecystectomy to the treatment of acute cholecystitis. Endoscopic gallbladder stenting (EGBS) has emerged as an additional option. However, the long-term stent patency remains an issue. This study was performed to compare the efficacy of primary and secondary EGBS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty-one patients who underwent preplanned EGBS because of poor surgical tolerance from January 2006 to July 2023 were retrospectively analyzed. The patients were divided into the initial EGBS group, in which EGBS was performed as the first option (<i>n</i> = 37), and the secondary EGBS group, in which EGBS was performed following other treatments (<i>n</i> = 24). The primary endpoint was the 3-month recurrence rate, and the secondary endpoint was the technical success rate. Propensity score matching was performed to align the patients’ background factors between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After propensity score matching, six patients from each group were selected for analysis. The technical success rate was significantly higher in the secondary EGBS group (73.0% [27/37] vs. 95.8% [23/24], respectively). Furthermore, the 3-month recurrence rate was significantly higher in the initial than secondary EGBS group (66.7% [4/6] vs. 0.0% [0/6], respectively; <i>p</i> = 0.0232).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Secondary EGBS may effectively prevent recurrent cholecystitis in patients with poor surgical tolerance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11670053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upper gastrointestinal triple stenosis in a patient with trisomy 17p syndrome: Case report and literature review","authors":"Hiroko Ando,&nbsp;Hideki Mori,&nbsp;Kaoru Takabayashi,&nbsp;Noriko Matsuura,&nbsp;Tatsuhiro Masaoka,&nbsp;Juntaro Matsuzaki,&nbsp;Yoshimasa Saito,&nbsp;Motohiko Kato,&nbsp;Kenjiro Kosaki,&nbsp;Takanori Kanai","doi":"10.1002/deo2.70043","DOIUrl":"10.1002/deo2.70043","url":null,"abstract":"<p>Upper gastrointestinal stenosis, which can be congenital or acquired, can lead to dysphagia. The association between trisomy 17p syndrome, a rare chromosomal abnormality, and upper gastrointestinal stenosis is unclear. A 20-year-old man diagnosed with trisomy 17p syndrome was referred to our department due to recurrent vomiting. Esophagogastroduodenoscopy revealed stenotic areas in the esophagus, stomach, and duodenum. The congenital gastrointestinal stenosis present in both the duodenum and esophagus suggested that the stasis and reflux of digestive fluids exacerbated stenosis in the stomach and esophagus. Gastric acid suppression therapy and endoscopic dilation of the esophagus and duodenum effectively resolved the patient's vomiting symptoms.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profound gastric mucosal changes and severe rebound acid hypersecretion after long-term Vonoprazan use: A case report","authors":"Hiroko Suda,&nbsp;Sachi Eto,&nbsp;Koichi Sakurai","doi":"10.1002/deo2.70046","DOIUrl":"10.1002/deo2.70046","url":null,"abstract":"<p>Vonoprazan is a novel acid blocker with greater potency than proton pump inhibitors. A Japanese study reported no significant safety concerns over 5 years of Vonoprazan use; however, elevated serum gastrin and increased parietal cell and foveolar hyperplasia were observed, and long-term safety data beyond 5 years are limited. We report a case that used Vonoprazan for 6 years, complicated by significant gastric epithelial changes during treatment and acute duodenal mucosal lesions following its discontinuation. A 76-year-old, treated with proton pump inhibitors for over 10 years, was switched to Vonoprazan due to his worsening symptoms. After its use, hemorrhagic hyperplastic polyps became prominent. Given concerns about Vonoprazan's effect on the gastric epithelium, the medication was changed to high-dose H2 blocker therapy. Two months later, the patient complained of vomiting and black tarry stools. Esophagogastroduodenoscopy revealed a significant reduction of gastric polyps but multiple erosions and ulcers in the duodenum. This case indicates the potent effects of Vonoprazan on the gastric mucosa and the risk of severe rebound acid hypersecretion after its long-term use.</p>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142879189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of non-anesthesiologist-administered sedation with dexmedetomidine and midazolam during endoscopic submucosal dissection of upper gastrointestinal tumors","authors":"Kenji Ishido,&nbsp;Satoshi Tanabe,&nbsp;Gen Kitahara,&nbsp;Yasuaki Furue,&nbsp;Takuya Wada,&nbsp;Akinori Watanabe,&nbsp;Hiromi Matsuda,&nbsp;Hirotsugu Okamoto,&nbsp;Chika Kusano","doi":"10.1002/deo2.70045","DOIUrl":"https://doi.org/10.1002/deo2.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The efficacy and safety of a sedation regimen combining dexmedetomidine and midazolam during endoscopic submucosal dissection for upper gastrointestinal tumors remains unclear. In this study, we aimed to evaluate the efficacy and safety of this sedation regimen, where non-anesthesiologists performed sedation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty-eight patients who underwent endoscopic submucosal dissection for upper gastrointestinal tumors, sedated by non-anesthesiologists, were retrospectively evaluated. The sedation was performed by non-anesthesiologists as part of on-the-job training (OJT) under anesthesiologists' supervision. Each non-anesthesiologist received OJT at least thrice. Proficiency levels were assessed during the third OJT session. The target sedation depth was a Richmond Agitation-Sedation Scale of −2 to −4, with 2 L/min of oxygen delivered via a nasal cannula at sedation initiation. The treatment completion rates, which measured efficacy and safety, were assessed by the frequencies of respiratory depression, hypotension, and bradycardia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 14, 52, and two patients with superficial esophageal cancer, early gastric cancer, and gastric adenoma, respectively. The median treatment time was 68 and 84 min for superficial esophageal cancer, early gastric cancer, and adenoma, respectively. Endoscopic submucosal dissection was completed in all patients. No severe sedation-related adverse events were reported; however, peripheral arterial oxygen saturation &lt;90%, hypotension, and bradycardia occurred in 1 (1.5%), 30 (44.1%), and 30 patients (44.1%), respectively. All 22 non-anesthesiologists who underwent the proficiency evaluation passed the test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A sedation regimen combining dexmedetomidine and midazolam can be feasibly administered by non-anesthesiologists. Further studies are needed to verify the effectiveness of OJT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/deo2.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142868751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of gastric cancer following colorectal endoscopic submucosal dissection for lesions more than 20 mm: A retrospective analysis","authors":"Yuri Tomita,&nbsp;Naohisa Yoshida,&nbsp;Hideki Ishikawa,&nbsp;Takahiro Otani,&nbsp;Reo Kobayashi,&nbsp;Hikaru Hashimoto,&nbsp;Ryohei Hirose,&nbsp;Osamu Dohi,&nbsp;Ken Inoue,&nbsp;Yukiko Morinaga,&nbsp;Yoshito Itoh","doi":"10.1002/deo2.70042","DOIUrl":"10.1002/deo2.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Colorectal endoscopic submucosal dissection (ESD) for large tumors is spreading worldwide. Gastric cancer (GC) sometimes occurs after colorectal ESD. However, its status including frequency and risk factors have not been examined well. In this study, we analyzed the detailed status of GC after colorectal ESD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-center retrospective study. Patients receiving colorectal ESD between 2010 and 2018 were reviewed. All patients were recommended to receive esophagogastroduodenoscopy (EGD) for screening. Finally, 436 patients receiving EGD, who underwent colorectal ESD for lesions of ≥20 mm were analyzed. The primary outcome was the GC rate after colorectal ESD, including intramucosal cancer. As a control, we compared it to the GC rate in matched Japanese national cancer registry data. The secondary outcome was risk factors for developing GC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age was 66.9 ± 10.6 and 55.3% were males. The GC rate was 5.96% (26/436) with a median observation period of 27 months. It was significantly higher than the mean GC rate in the diagnosed age calculated with the cancer registry (0.26%, observed value/expected value ratio [95% confidence interval]: 22.20 [14.50–32.53], <i>p</i> &lt; 0.01). The comparison between cases with and without GC showed that significant risk factors were male (<i>p</i> = 0.02) and smokers (<i>p</i> &lt; 0.01) and their GC rates were 8.3% and 10.9%. Also, in the limited cases, <i>Helicobacter pylori</i> infection (past and present) and atrophic gastritis were significant and their GC rates were 11.1% and 11.6%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The GC rate was high after resecting colorectal tumors of ≥20 mm, suggesting the necessity of EGD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"5 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}