Clinical impact of endoscopic devices for colorectal endoscopic submucosal dissection.

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) allows the en bloc resection of large colorectal tumors. This requires a safe and effective ESD instrument. We compared colorectal ESD outcome using a bipolar or monopolar knife. METHODS: We retrospectively studied 122 patients and 125 lesions in consecutive cases treated at our hospital. Patients were divided into a bipolar knife group (BKG; n = 45) and a monopolar knife group (MKG; n = 80). Comparisons were based on age and gender, tumor morphology, size and location, specimen size, procedure time, complications, and en bloc resection and curative resection rates. RESULTS: There were no significant differences in age and gender, tumor morphology, size and location, or specimen size between the 2 groups. The procedure time was significantly shorter in the MKG than in the BKG (p < 0.05). The number of patients for whom the procedure time exceeded 120 min was significantly lower in the MKG than in the BKG (p < 0.05). CONCLUSIONS: In this study, the monopolar knife was shown to be effective for colorectal ESD with a shorter procedure time.

[A case of pseudomembranous colitis concomitant with toxic megacolon and paralytic ileus].

A 60-year-old man was diagnosed as pseudomembranous colitis with chief complaint of fever and abdominal distension after a cerebral operation. It was ineffective although vancomycin hydrochloride (VCM) was given orally. Complications occurred. The patient had toxic megacolon and paralytic ileus. VCM was administrated via an ileus tube. In addition, the bowel was lavaged and VCM was sprayed by colonoscopy. This therapy was very effective. Generally, a patient with pseudomembranous colitis concomitant with toxic megacolon or/and paralytic ileus is considered to have a poor prognosis, however, he completely recovered by a combination of medical treatment.