Long-term endoscopic gastric mucosal changes up to 20 years after Helicobacter pylori eradication therapy.

Helicobacter pylori eradication therapy reduces the risk of gastric cancer. However, it is unclear whether the severity of risk factors for gastric cancer such as atrophy and intestinal metaplasia are reduced after eradication in the long term. We aimed to study long-term changes in endoscopic risk factors for gastric cancer up to 20 years post-eradication. The endoscopic severity of gastritis according to the Kyoto Classification of Gastritis in 167 patients was retrospectively evaluated over an average follow-up 15.7 years. A significant improvement in mean total gastric cancer risk score (4.36 ± 1.66 to 2.69 ± 1.07, p < 0.001), atrophy (1.73 ± 0.44 to 1.61 ± 0.49, p = 0.004), and diffuse redness (1.22 ± 0.79 to 0.02 ± 0.13, p < 0.001) was observed compared to baseline in the Eradication group. However, there was no change in the never infection and current infection groups. The frequency of map-like redness increased over time until 15 years (3.6% to 18.7%, p = 0.03). The Cancer group had significantly higher risk scores at all time points. Endoscopic atrophy significantly improved in eradicated patients over long-term, suggested that eradication is one of the key elements in gastric cancer prevention. Individualized surveillance strategies based on endoscopic gastritis severity before eradication may be important for those at risk of gastric cancer.

Investigation of the relationship between colonoscopy insertion difficulty factors and endoscope shape using an endoscopic position detection unit.

In this study, we investigated the relationship between the cecal intubation time (CIT) and the form and method used for passing through the sigmoid/descending colon junction (SDJ) and the hepatic flexure using an endoscopic position detection unit (UPD), with reference to various factors [age, sex, body mass index (BMI), history of abdominal and pelvic surgery, and diverticulum]. A total of 152 patients underwent colonoscopy with UPD. The mean age was 66.9 ±â€…12.4 years, and the male to female ratio was 3.6:1. The average CIT time was 14.3 ±â€…8.2 min. Age, number of experienced endoscopies, history of abdominal and pelvic surgery, BMI, and diverticulum were associated with prolonged CIT; SDJ passage pattern was straight: 8.6 ±â€…5.0, alpha loop: 11.8 ±â€…5.6, puzzle ring-like loop: 20.2 ±â€…5.0, reverse alpha loop: 22.4 ±â€…9.7, and other loop: 24.7 ±â€…10.5. The hepatic flexure passing method was in the following order: right rotation maneuver: 12.6 ±â€…6.6, push maneuver: 15.1 ±â€…5.9, and right rotation with positional change maneuver: 20.5 ±â€…7.2. In conclusion, colonoscopy with UPD revealed an association between CIT and SDJ passage pattern and hepatic flexure passing method.

Investigation of the New Advantages of Colonoscope Insertion with an Endoscopic Position Detection Unit.

BACKGROUND: The use of an endoscopic position detection unit (UPD) enables better and more objective understanding of the shape and position of the colonoscope. Here, we investigated the reproducibility of the insertion of a colonoscope with UPD. MATERIALS AND METHODS: Study participants were 122 patients who received a colonoscopy with UPD twice for the purpose of large bowel screening and surveillance. The mean age of participants was 69.7 ± 10.4 years, and the male-to-female ratio was 9.2:1. The colonoscope insertion technique was primarily based on the shaft-holding, shortening insertion method. The cecal intubation time was recorded; the method used for passing through the sigmoid/descending colon junction (SDJ) and the hepatic flexure. RESULTS: The mean cecal intubation time was 990 ± 511 s. The cecal intubation time and the patterns for passing through the SDJ and hepatic flexure were significantly correlated between the first and second colonoscopies. CONCLUSION: Use of a UPD revealed good reproducibility of colonoscope insertion. This is the first time we have proved that both time and pattern are inserted in much the same way for the first and second times. In patients' conducted UPD combination TCS after the second time, it was suggested that individual tailor-made insertions are possible based on the information from the first time.

Present status and the future of ultrathin endoscopy.

Endoscopic population-based screening for gastric cancer began in April 2016, and the use of transnasal ultrathin esophagogastroduodenoscopy (UT-EGD) has rapidly become popular. With UT-EGD, discomfort associated with an examination is reduced, patient satisfaction is high, and adverse effects on cardiopulmonary function are fewer. Consequently, UT-EGD is a good option for gastric screening in an aging society. Because of the narrower diameter of the endoscope, however, image quality is inferior to that obtained using transoral conventional esophagogastroduodenoscopy (C-EGD). As a result, lesions observed by UT-EGD must be viewed at close proximity and chromoendoscopy should be used concurrently, which is burdensome for the endoscopist. Recent innovations by endoscope manufacturers have enabled dramatic improvements in transnasal UT-EGD and facilitated Hi-Vision imaging. Furthermore, image enhancement that allows for observation on a par with transoral C-EGD is now feasible. In the future, UT-EGD will be equipped with functions that permit magnified endoscopic image. It is anticipated that a multiroute transition between transnasal and transoral UT-EGD will become possible.

Phagocytosis of ultrasound contrast agent microbubbles by Kupffer cells.

Delayed parenchymal phase images of the liver more than 5 min after IV injection of ultrasound contrast agents are thought to be related to the phagocytosis of contrast agent microbubbles by macrophages. In this study, we examined whether liver-specific macrophages, Kupffer cells, phagocytosed the microbubbles and whether their elimination affected the delayed parenchymal images of the liver. Phase-contrast microscope observations showed that Kupffer cells phagocytosed various contrast agents in vitro. Among the contrast agents used, 99% of Sonazoid and Optison, and 47% of Levovist were phagocytosed, whereas only 7.3% of SonoVue and 0% of Imavist were phagocytosed. Elimination of Kupffer cells in vivo by gadolinium chloride (GdCl(3)) resulted in decreased intensity of the delayed parenchymal images with Sonazoid and Levovist, while SonoVue showed no changes compared with control. Our findings suggested that Kupffer cells phagocytosed contrast agents and they were responsible for the delayed images of contrast ultrasound in the liver.

Usefulness of contrast-enhanced ultrasonography with a new contrast mode, Agent Detection Imaging, in evaluating therapeutic response in hepatocellular carcinoma treated with radio-frequency ablation therapy.

Objective: The therapeutic response of radio-frequency ablation (RFA) for hepatocellular carcinoma (HCC) was evaluated by contrast-enhanced ultrasonography (US) using a new contrast mode, agent detection imaging (ADI), and its usefulness was compared with that of dynamic computed tomography (CT). Materials and methods: Forty patients with 64 nodules diagnosed as HCC histologically and/or by various imaging modalities were evaluated with ADI (1 and 7 days after treatment) and Dynamic CT (7 days after treatment). Results: ADI and dynamic CT revealed residual lesions in 15 and 12 nodules, and no residual lesions in 45 and 52 nodules, respectively. ADI yielded indeterminate findings in four nodules; although the vascular phase showed minute residual tumor vessels, the tumor appeared to be completely contained within the ablated area in the delayed phase. In these indeterminate cases, US-guided biopsies of the areas of residual vascularity revealed no viable cancer cells; only degenerated tissues. Conclusion: In assessing the therapeutic response of RFA for HCC, ADI has a similar competence to dynamic CT. Even if the vascular phase of contrast-enhanced US shows minute residual vessels, as long as the tumor is safely contained within the ablated area in the delayed phase, the cancer cells are likely to be degenerated.

Differential diagnosis of hepatic nodules using delayed parenchymal phase imaging of levovist contrast ultrasound: comparative study with SPIO-MRI.

T2-weighted fast spin echo images and T2*-weighted gradient-echo images of superparamagnetic iron oxide magnetic resonance imaging (SPIO-MRI) have been reported to reflect the number and function of macrophages in reticuloendothelial organs and be useful to differentiate malignant tumors from benign nodules of liver. We tried to prove that contrast-enhanced ultrasound can diagnose hepatocellular carcinoma (HCC) by comparing the findings of SPIO-MRI and the findings of the liver parenchyma on the delayed parenchymal phase of ultrasound imaging using the intravenous contrast agent Levovist, not through the evaluation of vascular imaging. Forty-six patients (52 nodules) with histopathological diagnosis of hepatic tumors were studied. They consisted of 11 non-malignant nodules (six regenerative nodules and five dysplastic nodules) and 41 HCC. All the patients were examined by Levovist contrast-enhanced ultrasonography and SPIO-MRI. The delayed liver parenchymal images of contrast-enhanced ultrasound using the intravenous contrast agent Levovist were similar to those observed on SPIO-MRI. The similarity of both findings suggests that delayed phase imaging by Levovist is closely related to the number and function of Kupffer cells in liver tumors. The diagnostic accuracy of contrast-enhanced ultrasound for HCC was high (90.4%) demonstrating that it is as reliable as SPIO-MRI.