Dexmedetomidine is safe and effective for reducing intraprocedural pain in colorectal endoscopic submucosal dissection.

Objectives: Endoscopic submucosal dissection (ESD) is effective for the resection of colorectal intramucosal lesions. This study was performed to examine the safety and effectiveness of using dexmedetomidine (DEX) in the anesthesia regimen of patients with colorectal lesions undergoing ESD. Methods: We retrospectively examined 287 consecutive patients who underwent ESD for colorectal lesions in our institution from January 2015 to December 2021. Outcomes including the frequency of intraprocedural pain and adverse events were compared between the DEX and no DEX groups. Moreover, univariate and multivariate analyses were conducted for each clinical factor of intraprocedural pain. Intraprocedural pain was defined as patient-reported abdominal pain or body movement during the procedure. Results: The incidence of intraprocedural pain was significantly lower in the DEX than in the no DEX group (7% vs. 17%, p = 0.02). The incidence of hypotension was also significantly higher in the DEX group (7% vs. 0%, p = 0.01), but no cerebrovascular or cardiac ischemic events occurred. In the univariate analyses, the diameter of the resected specimen, procedure time, no use of DEX, and total midazolam dose was associated with intraprocedural pain. The midazolam dose and DEX administration were significantly negatively correlated and the diameter of resected specimen and procedure time were significantly positively correlated. Multivariate logistic regression showed that no use of DEX was independently associated with intraprocedural pain (p = 0.02). Conclusions: Adding DEX to the anesthesia regimen in patients undergoing colorectal ESD appears to be safe and effective for reducing intraprocedural pain.

Two cases of esophageal basaloid squamous cell carcinoma which achieved long-term survival by endoscopic submucosal dissection and additional chemoradiotherapy.

Herein, we report two rare basaloid squamous cell carcinoma (BSCC) cases. Esophagogastroduodenoscopy revealed a submucosal tumor-like lesion and a biopsied specimen showed a finding suspected of BSCC in both cases. Both lesions underwent endoscopic submucosal dissection with en bloc resection, and long-term survival was achieved using additional chemoradiotherapy. The standard treatment for BSCC has not been determined, and there are few reports of esophageal BSCC treated using endoscopic resection. Endoscopic submucosal dissection and additional chemoradiotherapy for superficial BSCC may be effective treatment options.

Longly-attached cap can contribute to en bloc underwater endoscopic mucosal resection of 20-30 mm colorectal intramucosal lesions.

Background and study aims Underwater endoscopic mucosal resection (UEMR) is effective for colorectal intramucosal lesions. The aim of this study was to evaluate whether a longly-attached cap in UEMR improves the en bloc resection rate for 20-30 mm lesions. Patients and methods We performed a retrospective study at a tertiary institute. Candidates for the study were systematically retrieved from an endoscopic and pathological database from October 2016 to December 2020. We assessed the procedural outcomes with UEMR for lesions ≥ 20 mm in size and the clinical factors contributing to en bloc resection. Results A total of 52 colorectal lesions that underwent UEMR were included. The median procedure time was 271 (66-1264) seconds. The en bloc resection rate and R0 resection rate were 75 % and 73 %, respectively. Intraprocedural perforation occurred in one (1.9 %) case, but no bleeding occurred. Delayed bleeding occurred in one (1.9%) case, but no delayed perforation occurred. Regarding tumor size, macroscopic type, tumor location, and the presence or absence of a history of abdominal operation, there was no significant difference between the en bloc resection and piecemeal resection groups. The visibility of the whole lesion, a longly-attached cap, and sessile serrated lesions were more frequently observed in the en bloc resection group than in the piecemeal resection group ( P  < 0.001, P  = 0.01, and P  = 0.04, respectively). Multivariate analysis showed that a longly-attached cap was the only independent factor associated with en bloc resection ( P  = 0.02). Conclusions A longly-attached cap might contribute to en bloc resection.

Association of decreased variation of coefficient R-R interval with ischemic colitis and small bowel obstruction.

BACKGROUND: The parasympathetic nervous system exerts and controls intestinal tone. Several studies have suggested that the coefficient of the R-R intervals (CVRR) is useful for evaluating the parasympathetic nervous system. OBJECTIVES: This study aimed to evaluate the relationship between gastrointestinal emergencies, specifically ischemic colitis (IC) and small bowel obstruction (SBO), and the autonomic nervous system. METHODS: In this retrospective study, a total of 13 patients with IC or SBO aged ≧65 years were analyzed. CVRR was measured in patients with IC and SBO and controls. RESULTS: CVRR averaged to 8.8% ± 2.5% in controls, 1.4% ± 0.4% in patients with IC, and 2.4% ± 1.0% in SBO groups (p < 0.001). CVRR was significantly lower in patients with IC and SBO than that in controls. CONCLUSION: The results of this study demonstrate the possibility that CVRR may serve as a clinical index for assessing the functioning of the parasympathetic nervous system in patients with IC or SBO.

Endoscopic Treatment of Solitary Colonic Ganglioneuroma.

Ganglioneuromas (GNs) in adults are uncommon clinical entities, especially in the colon. Patients with GNs without multiple endocrine neoplasia or neurofibromatosis-I are normally asymptomatic; however, GNs can present with abdominal pain, weight loss, bleeding, and anemia, depending on the size and location. Here, we present a case of solitary colonic GN treated with endoscopic mucosal resection. A 40-year-old Japanese outpatient with a positive fecal occult blood test visited our hospital. We performed diagnostic colonoscopy, which revealed a polyp of 15-mm diameter in the ascending colon. Electromagnetic resonance imaging was performed, and the histological examination revealed benign polypoid spindle-cell proliferation, ganglion cells, and thick nerve bundles, which was positive for S-100 protein immunoreactivity consistent with GN.

Easy Detection and Fast Removal of Gastric Anisakis during Narrow-Band Imaging Endoscopy with L-Menthol Administration.

Anisakiasis is a parasitic disease caused by the ingestion of raw or uncooked seafood infected with third-stage larvae of the anisakid nematodes. A 45-year-old Japanese man presented with epigastric pain and itchy skin with rash on his arm, chest, and back after eating vinegar-marinated raw mackerel sushi. He underwent an emergent endoscopic examination using narrow-band imaging (NBI) that revealed two anisakid larvae. NBI showed the larvae more clearly than white light imaging on the cardiac region of the stomach. We sprayed L-menthol on the larvae for stopping their movement and then easily removed them using biopsy forceps. The macroscopic examination and genotype analysis of the specimens revealed the two larvae as belonging to A. simplex sensu stricto. Our case demonstrates the usefulness of endoscopic examination with NBI and of the L-menthol spray in visualizing and immobilizing the larvae for removal.