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Nagano-shi, Japan

Sugimoto S.,Keio University | Mizukami T.,Endoscopy Center
World Journal of Gastroenterology | Year: 2015

Colonoscopy techniques combining or replacing air insufflation with water infusion are becoming increasingly popular. They were originally designed to reduce colonic spasms, facilitate cecal intubation, and lower patient discomfort and the need for sedation. These maneuvers straighten the rectosigmoid colon and enable the colonoscope to be inserted deeply without causing looping of the colon. Water-immersion colonoscopy minimizes colonic distension and improves visibility by introducing a small amount of water. In addition, since pain during colonoscopy indicates risk of bowel perforation and sedation masks this important warning, this method has the potential to be the favored insertion technique because it promotes patient safety without sedation. Recently, this water-immersion method has not only been used for colonoscope insertion, but has also been applied to therapy for sigmoid volvulus, removal of lesions, lower gastrointestinal bleeding, and therapeutic diagnosis of abnormal bowel morphology and irritable bowel syndrome. Although a larger sample size and prospective head-to-head-designed studies will be needed, this review focuses on the usefulness of water-immersion colonoscopy for diagnostic and therapeutic applications. © The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved. Source

Ishikawa H.,Kyoto Prefectural University of Medicine | Mutoh M.,National Cancer Center Research Institute | Iwama T.,Saitama University | Suzuki S.,Nagoya City University | And 8 more authors.
Endoscopy | Year: 2016

Background and study aims: Colectomy protects against colorectal cancer in familial adenomatous polyposis (FAP); however, some patients with FAP refuse surgery. The aim of this study was to evaluate the feasibility and safety of endoscopic management of these patients. Patients and methods: A retrospective review of medical records was performed to identify adult patients with FAP who refused colectomy and were managed by repeated colonoscopies to remove numerous polyps between 2001 and 2012. Polyps were removed by hot snare polypectomy or endoscopic mucosal resection. Polyps of < 10 mm in size and without endoscopic features suggesting cancer were discarded without histological examination; the remaining polyps were examined histologically. Results: Of the 95 eligible patients, five (5.3 %) were excluded. The remaining 90 patients (median age at first visit 29 years [range 16 - 68 years]; 46 males) were followed for a median of 5.1 years (interquartile range [IQR] 3.3 - 7.3 years). During this period, a total of 55 701 polyps were resected without adverse events such as bleeding or perforation. The median numbers of endoscopic treatment sessions and polyps removed per patient were 8 (IQR 6 - 11) and 475 (IQR 211 - 945), respectively. Five patients had noninvasive carcinoma (Category 4.2 according to the revised Vienna classification), detected within 10 months from the start of the follow-up period. All of these patients were treated endoscopically, without signs of recurrence during a median follow-up of 4.3 years (IQR 2.0 - 7.1 years). No invasive colorectal cancer was recorded during the study period. Two patients (2.2 %) underwent colectomy because the polyposis phenotype had changed to dense polyposis. Conclusion: Endoscopic management of FAP is feasible and safe in the medium term. © Georg Thieme Verlag KG Stuttgart · New York. Source

Mizukami T.,Endoscopy Center | Ogata H.,Keio University | Hibi T.,Keio University
World Journal of Gastroenterology | Year: 2012

Colonoscopy sometimes causes pain during insertion, especially in difficult cases. Over-insufflation of air causes elongation or acute angulations of the colon, making passage of the scope difficult and causing pain. We previously reported a sedative-risk-free colonoscopy insertion technique, namely, "Water Navigation Colonoscopy". Complete air suction after water infusion not only improves the vision, but also makes water flow down to the descending colon, while the sigmoid colon collapses and shortens. While non-sedative colonoscopy can be carried out without pain in most cases, some patients do complain of pain. Most of these patients have abnormal colon morphology, and the pain is caused while negotiating the "hairpin" bends of the colon. The "hairpin" bends of the colon should be negotiated by gently pushing the full-angled colonoscope. The proximal 10-20 cm from the angulated part of the conventional colonoscope is stiff, with a wide turning radius, therefore, a conventional colonoscope cannot be negotiated through the "hairpin" bends of the colon without stretching them and causing pain. The "passive-bending colonoscope" has a flexible tip with a narrow turning radius, so that the scope can be negotiated through the "hairpin" bends of the colon with a minimum turning radius and minimal discomfort. Therefore, the intubation and pain-reducing performance of the "passive-bending colonoscope" was assessed in difficult cases. © 2012 Baishideng. Source

Sung J.J.Y.,Institute of Digestive Disease | Lau J.Y.W.,Institute of Digestive Disease | Ching J.Y.L.,Institute of Digestive Disease | Wu J.C.Y.,Institute of Digestive Disease | And 5 more authors.
Annals of Internal Medicine | Year: 2010

Background: It is uncertain whether aspirin therapy should be continued after endoscopic hemostatic therapy in patients who develop peptic ulcer bleeding while receiving low-dose aspirin. Objective: To test that continuing aspirin therapy with protonpump inhibitors after endoscopic control of ulcer bleeding was not inferior to stopping aspirin therapy, in terms of recurrent ulcer bleeding in adults with cardiovascular or cerebrovascular diseases. Design: A parallel randomized, placebo-controlled noninferiority trial, in which both patients and clinicians were blinded to treatment assignment, was conducted from 2003 to 2006 by using computergenerated numbers in concealed envelopes. (ClinicalTrials.gov registration number: NCT00153725) Setting: A tertiary endoscopy center. Patients: Low-dose aspirin recipients with peptic ulcer bleeding. Intervention: 78 patients received aspirin, 80 mg/d, and 78 received placebo for 8 weeks immediately after endoscopic therapy. All patients received a 72-hour infusion of pantoprazole followed by oral pantoprazole. All patients completed follow-up. Measurements: The primary end point was recurrent ulcer bleeding within 30 days confirmed by endoscopy. Secondary end points were all-cause and specific-cause mortality in 8 weeks. Results: 156 patients were included in an intention-to-treat analysis. Three patients withdrew from the trial before finishing followup. Recurrent ulcer bleeding within 30 days was 10.3% in the aspirin group and 5.4% in the placebo group (difference, 4.9 percentage points [95% CI, -3.6 to 13.4 percentage points]). Patients who received aspirin had lower all-cause mortality rates than patients who received placebo (1.3% vs. 12.9%; difference, 11.6 percentage points [CI, 3.7 to 19.5 percentage points]). Patients in the aspirin group had lower mortality rates attributable to cardiovascular, cerebrovascular, or gastrointestinal complications than patients in the placebo group (1.3% vs. 10.3%; difference, 9 percentage points [CI, 1.7 to 16.3 percentage points]). Limitations: The sample size is relatively small, and only low-dose aspirin, 80 mg, was used. Two patients with recurrent bleeding in the placebo group did not have further endoscopy. Conclusion: Among low-dose aspirin recipients who had peptic ulcer bleeding, continuous aspirin therapy may increase the risk for recurrent bleeding but potentially reduces mortality rates. Larger trials are needed to confirm these findings. © 2010 American College of Physicians. Source

Mizukami T.,Endoscopy Center | Hiroyuki I.,Keio University | Hibi T.,Keio University
Digestive Endoscopy | Year: 2010

Large colonic polyps have large vessels, which often cause post-polypectomy hemorrhage. Some of the stalks of large pedunculated polyps are formed by the weight of the polyps and disappear after polypectomy. There are some reports suggesting that pre-ligation with Endoloop R may minimize the risk of post-polypectomy hemorrhage. However, the current density increases more at the site of pre-ligation as compared with that at the site of polypectomy, because polypectomy is carried out with gradual snaring. This implies that burn injury may also occur at the site of pre-ligation, causing the loss of pre-ligation and, consequently, post-polypectomy hemorrhage. Ligation of stalks after polypectomy is very difficult. The Endoloop R rolls back when it is tightened, because of the lack of torsional stiffness. We have developed a simple and improved post-polypectomy ligation technique using the Anchor clip. Before polypectomy, an Endoclip R is placed partially at the base of the pedunculated polyp. When the stalk is tightened completely with the Endoclip R before polypectomy, burn injury occurs around the Endoclip R. The Anchor clip at the base of the pedunculated polyp holds the stalk after polypectomy and the constricted part formed by the Anchor clip prevents the rolling up of the Endoloop R and helps in easy ligation of the stalk. We have used the Anchor clip for 50 patients. Application of the Endoloop R after polypectomy was impossible in two patients. The remaining 48 patients underwent Endoloop R-assisted polypectomy with the Anchor clip, and in none of the cases did bleeding occur after polypectomy. © 2010 Japan Gastroenterological Endoscopy Society. Source

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