Risk Factors Associated with Painful Colonoscopy and Prolonged Cecal Intubation Time in Female Patients.

Objectives: Few studies have examined risk factors leading to painful colonoscopy and prolonged cecal intubation time in female patients. We aimed to determine the factors associated with painful colonoscopy and prolonged cecal intubation time in female patients. Methods: This retrospective study analyzed prospectively collected data from a randomized controlled trial with female patients who underwent colonoscopy. Multivariate logistic and linear regression analyses were performed using the following factors that might be associated with painful colonoscopy and prolonged cecal intubation time, respectively: age, body mass index, history of colonoscopy, previous abdominal surgery, routine use of laxatives, inadequate bowel preparation, sigmoid colon diverticulosis, use of a small-caliber colonoscope, and an inexperienced operator. Results: The study enrolled 219 female patients aged >20 years. Using the receiver operating characteristic curve, painful colonoscopy was defined in cases where the visual analogue scale of overall pain was ≥50 mm. Logistic regression analysis for risk factors associated with painful colonoscopy revealed that sigmoid colon diverticulosis [odds ratio (OR), 2.496; 95% confidence interval (CI), 1.013-5.646; p=0.028] was a risk factor for painful colonoscopy; conversely, the use of a small-caliber colonoscope was a negative factor for painful colonoscopy (OR, 0.436; 95% CI, 0.214-0.889, p=0.022). In linear regression analysis, inadequate bowel preparation was significantly associated with prolonged cecal intubation time (ß-coefficient, 3.583; 95% confidence interval, 0.578-6.588; p=0.020). Conclusions: Female patients with sigmoid colon diverticulosis are more likely to experience severe pain during colonoscopy, and those with inadequate bowel preparation may require more time for cecal intubation.

N-Aryl Indoles as a Novel Class of Potent NaV1.7 Inhibitors.

A novel class of potent NaV1.7 inhibitors has been discovered. The replacement of diaryl ether in compound I was investigated to enhance mouse NaV1.7 inhibitory activity, which resulted in the discovery of N-aryl indoles. The introduction of the 3-methyl group is crucial for high NaV1.7 in vitro potency. The adjustment of lipophilicity led to the discovery of 2e. Compound 2e (DS43260857) demonstrated high in vitro potencies against both human and mouse NaV1.7 with high selectivity over NaV1.1, NaV1.5, and hERG. In vivo evaluations revealed 2e demonstrating potent efficacy in PSL mice with excellent pharmacokinetics.

The safety and efficacy of Ringer's solution loading with rectal diclofenac for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: The RESOLUTION-PEP study.

Objectives: We evaluated the safety and efficacy of aggressive hydration with rectal non-steroidal anti-inflammatory drugs for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Methods: This prospective, single-arm, multicenter trial was conducted at 12 institutions between October 2020 and August 2021. We enrolled 231 patients who had intact papillae and were scheduled to undergo ERCP. All patients were administered rectal diclofenac before ERCP. They received aggressive hydration with intravenous lactated Ringer's solution in an initial bolus of 5 ml/kg at the start of ERCP, followed by 3 ml/kg/h for 8 h after the procedure. The primary outcome was the occurrence of PEP. Secondary outcomes included PEP severity, hyperamylasemia, and adverse events. Results: The mean age of the patients was 68.8 ± 13.7 years, and 81 patients (35.1%) were 75 years or older. Thirteen patients developed PEP (5.6%, 95% confidence interval 3.0%-9.4%). There were 11 cases (4.8%) of mild pancreatitis and two cases (0.9%) of severe pancreatitis. Forty-five patients (19.5%) developed hyperamylasemia and one patient developed non-severe peripheral edema. Conclusions: Aggressive hydration combined with rectal diclofenac may be a promising strategy for the prevention of PEP. Furthermore, it is safe even for older individuals.

Efficacy of Endoscopic Resection for Rectal Neuroendocrine Tumors Smaller than 15 mm.

BACKGROUND: Local resection, including endoscopic resection, is recommended for rectal neuroendocrine tumors (NETs) < 15 mm in patients without risk factors for metastasis, though the short- and long-term outcomes are unclear. AIMS: This study investigates the efficacy of endoscopic resection for rectal NETs < 15 mm. METHODS: The short- and long-term outcomes of patients with rectal NETs < 15 mm who underwent endoscopic resection and the outcomes of each endoscopic technique were analyzed. The tumors were stratified as < 10 mm (small-size group, SSG) and 10-14 mm (intermediate-size group, IMG). RESULTS: Overall, 139 lesions (SSG, n = 118; IMG, n = 21) were analyzed. All tumors were classified as G1 (n = 135) or G2 (n = 4) according to the 2019 World Health Organization grading criteria. The complete resection rate was not different between the groups (P = 0.151). Endoscopic submucosal dissection (ESD) and endoscopic submucosal resection with a ligation device (ESMR-L) achieved complete resection rates > 90% in the SSG. The ESMR-L procedure time (P < 0.001) and hospitalized period (P < 0.001) were significantly shorter than those of ESD. ESD achieved a complete resection rate of 80.0% in the IMG. The tumor size did not affect the overall survival or rate of lymph node/distant metastases. CONCLUSIONS: Endoscopic resection is a feasible and effective treatment for patients with rectal NETs < 15 mm without the risk factors of metastasis. ESMR-L and ESD are optimal techniques for resecting tumors smaller than 10 mm and 10-14 mm, respectively.

Endoscopic resection for a solitary Peutz-Jeghers type polyp in the duodenum: A case report with literature review.

A 68-year-old female patient was referred to our hospital with a 30-mm polyp in the second portion of the duodenum found via esophagogastroduodenoscopy. The polyp had an irregular, lobular surface and a thick stalk. In addition, white dots were detected on the surface. Magnifying endoscopy with narrow-band imaging showed a white material deep in the loop-shaped microvessels on the white dots. Endoscopic ultrasonography showed a hypoechoic elevated lesion from the mucosal layer, and a feeding vessel traversing the stalk to supply the head of the polyp. Endoscopic biopsy did not provide a definitive diagnosis. Endoscopic resection was conducted for a definitive diagnosis and treatment. The resected specimen showed a branching bundle of smooth muscle fibers covered by hyperplastic mucosa, consistent with a hamartomatous polyp. The patient had no mucocutaneous pigmentation or familial history of the hamartomatous polyp. The polyp was finally diagnosed as a solitary Peutz-Jeghers-type polyp. No recurrence has been observed for seven years postoperatively.

Factors Related to Difficulty in Endoscopic Submucosal Dissection for Superficial Esophageal Cancer.

BACKGROUND: Endoscopic submucosal dissection (ESD) for superficial esophageal cancer is technically challenging, and research on predictive factors related to the difficulty in the procedure is limited. This study aimed to investigate the factors predicting the difficulty in esophageal ESD. METHODS: This retrospective study analyzed 303 lesions treated at our institution between April 2005 and June 2021. The following 13 factors were evaluated: sex, age, tumor location, tumor localization, macroscopic type, tumor size, tumor circumference, preoperative diagnosis of histological type, preoperative diagnosis of invasion depth, previous radiotherapy for esophageal cancer, metachronous lesion located close to post-ESD scar, operator's skill, and use of a clip-and-thread traction method. Difficult esophageal ESD cases were defined as those requiring long procedure time (>120 min). RESULTS: Fifty-one lesions (16.8%) met the defined criterion for difficult cases of esophageal ESD. Logistic regression analysis identified tumor size larger than 30 mm (odds ratio: 9.17, 95% confidence interval: 4.27-19.69, p < 0.001) and tumor circumference more than half that of the esophagus (odds ratio 2.53, 95% confidence interval: 1.15-5.54, p = 0.021) as independent predictive factors related to difficulty in esophageal ESD. CONCLUSION: Tumor size larger than 30 mm and tumor circumference more than half that of the esophagus can predict difficulty in performing esophageal ESD. This knowledge can provide useful information for developing ESD strategies and selecting a suitable operator on a case-by-case basis to achieve favorable clinical outcomes.

The usefulness of image-enhanced endoscopy to distinguish gastric carcinoma in tumors initially diagnosed as adenomas by endoscopic biopsy: A retrospective study.

Superficial epithelial gastric neoplasms can be divided into adenomas and early carcinomas. Histological diagnosis by endoscopic forceps biopsy is crucial for the diagnosis and management of gastric neoplasms. It is difficult to distinguish features of gastric neoplasms in small biopsy specimens; hence, gastric carcinomas can be underdiagnosed as adenomas. Recent developments in image-enhanced endoscopy have improved the ability to differentiate between carcinomatous and non-carcinomatous lesions. To investigate the prevalence of gastric carcinoma in lesions initially diagnosed as adenomas by forceps biopsy and assess the usefulness of image-enhanced endoscopy in distinguishing carcinomas. A total of 142 lesions of gastric adenomas, diagnosed by biopsy and resected endoscopically between January 2010 and May 2020, were retrospectively evaluated. Images were captured by white-light endoscopy (WLE), magnifying endoscopy with narrow-band imaging (M-NBI), and magnifying endoscopy with acetic acid and narrow-band imaging (M-AANBI); they were analyzed and compared with histopathological results. The diagnostic performance of M-AANBI was compared with that of M-NBI. Of the 142 lesions, 58 (40.8%) were pathologically diagnosed as adenocarcinomas. On WLE images, a depressed macroscopic type and size ≥20 mm were significant predictors of carcinoma (P < .001); however, they displayed low sensitivities (32.8% and 41.4%, respectively). M-AANBI displayed significantly higher sensitivity, specificity, and accuracy for distinguishing carcinomas than M-NBI (94.8% vs 74.1%, 81.0% vs 72.6%, and 86.6% vs 73.2%, P < .05). In conclusion, carcinoma was prevalent in 40.8% of gastric lesions initially diagnosed as adenomas by forceps biopsy. M-AANBI may be more useful than M-NBI and WLE in distinguishing gastric carcinomas from adenomas.

Negative effect of prolonged cecal intubation time on adenoma detection in female patients.

Background and Aim: Withdrawal time of the colonoscope is associated with adenoma detection. However, the association between cecal intubation time and adenoma detection remains unclear. This study aimed to evaluate the association between cecal intubation time and adenoma detection. Methods: This retrospective study analyzed prospectively collected data from a randomized controlled trial on female patients who underwent colonoscopy in an academic hospital. The primary outcome was the mean number of all adenomas detected per patient. Secondary outcomes included the mean number of advanced, diminutive, small/large, right-sided colonic, and left-sided colonic adenomas detected per patient. Furthermore, the detection rates of all categories of adenoma were evaluated. Results: The analysis included 216 female patients aged ≥20 years. The correlation analysis did not reveal a significant relationship (P = 0.473) between cecal intubation and withdrawal times. The mean number of all adenomas detected per patient declined by approximately 30% (1.05-0.70) from the fastest to the slowest insertion time quartile. Adjusted regression analysis showed a significant decrease in the mean number of all adenomas detected per patient with increased intubation time (relative risk, RR = 0.87; 95% confidence interval, 0.76-0.99, P = 0.045), whereas the mean number of other categories of adenomas detected per patient and the detection rates of all categories of adenoma were not associated with the cecal intubation time. Conclusions: This study showed a significant association between prolonged cecal intubation time and decreased adenoma detection. The cecal intubation time may be a significant quality indicator for colonoscopy.

Label-Free Identification of Spore-Forming Bacteria Using Ultrabroadband Multiplex Coherent Anti-Stokes Raman Scattering Microspectroscopy.

Spore-forming bacteria accumulate dipicolinic acid (DPA) to form spores to survive in extreme environments. Vibrational spectroscopy is widely used to detect DPA and elucidate the existence of the bacteria, while vegetative cells, another form of spore-forming bacteria, have not been studied extensively. Herein, we applied coherent anti-Stokes Raman scattering (CARS) microscopy to spectroscopically identify both spores and vegetative cells without staining or molecular tagging. The spores were identified by the strong CARS signals due to DPA. Furthermore, we observed bright spots in the vegetative cells in the CARS image at 1735 cm-1. The vegetative cells contained molecular species with C=O bonds because this vibrational mode was associated with the carbonyl group. One of the candidate molecular species is diketopimelic acid (DKP), a DPA precursor. This hypothesis was verified by comparing the spectrum obtained by the vegetative cells with that of the DKP analogue (ketopimelic acid) and with the result obtained by DFT calculation. The results indicate that the observed vegetative cell is in the sporulation process. CARS spectra can be used to monitor the maturation and preformation of spores.

Obscure Gastrointestinal Bleeding Caused by a Small Intestinal Lymphatic-venous Malformation: A Case Report with a Literature Review.

A 44-year-old woman presented with severe anemia. We strongly suspected gastrointestinal bleeding; however, esophagogastroduodenoscopy, colonoscopy, and computed tomography showed no bleeding sources. Video capsule endoscopy revealed an actively bleeding submucosal lesion within the jejunum. Double-balloon enteroscopy revealed a 20-mm continuously bleeding submucosal lesion in the distal jejunum. We suspected small intestinal vascular malformation and performed surgical resection. The resected specimen pathologically comprised dilated, thin-walled lymphatic channels and blood vessels involving the small intestinal submucosa. Therefore, the patient was diagnosed with small intestinal lymphatic-venous malformation. Postoperatively, the patient recovered well, and recurrence was not observed.

Invasive Colon Cancer Inadvertently Resected by Cold Snare Polypectomy.

A 74-year-old man with anemia underwent colonoscopy, which revealed a 4-mm polyp in the ascending colon. The polyp was subsequently diagnosed as an adenomatous lesion according to the narrow-band imaging (NBI) International Colorectal Endoscopic classification/Japan NBI Expert Team classification and resected via cold snare polypectomy (CSP). However, a pathological examination revealed a well-differentiated adenocarcinoma with a positive vertical margin. We performed additional endoscopic resection at the CSP scar area, revealing residual submucosal cancer with lymphatic involvement. The patient then underwent additional surgical resection. In such cases, additional endoscopic resection might be a treatment option.

Autoimmune Pancreatitis with Massive Ascites and Multiple Pancreatic Cysts Successfully Treated with Prednisolone.

A 64-year-old man with a history of diabetes and gallstones was admitted to our institution with suspected pancreatic malignancy. Computed tomography (CT) revealed multiple pancreatic cysts and massive ascites, and endoscopic ultrasonography (EUS) revealed a 28×27-mm hypoechoic mass in the pancreatic head. An EUS-guided fine-needle aspiration biopsy was performed, and there were no malignant findings. Based on the test results and imaging findings, type 1 autoimmune pancreatitis was suspected. The patient was administered 30 mg of prednisolone daily. After 11 days, CT revealed that the pancreatic cysts and ascites had reduced in size.

Effect of adding acetic acid when performing magnifying endoscopy with narrow band imaging for diagnosis of Barrett's esophageal adenocarcinoma.

Background and study aims Magnifying endoscopy with narrow band imaging (M-NBI) was developed to diagnose Barrett's esophageal adenocarcinoma (BEA); however, this method remains challenging for inexperienced endoscopists. We aimed to evaluate a modified M-NBI technique that included spraying acetic acid (M-AANBI). Patients and methods Eight endoscopists retrospectively examined 456 endoscopic images obtained from 28 patients with 29 endoscopically resected BEA lesions using three validation schemes: Validation 1 (260 images), wherein the diagnostic performances of M-NBI and M-AANBI were compared - the dataset included 65 images each of BEA and non-neoplastic Barrett's esophagus (NNBE) obtained using each modality; validation 2 (112 images), wherein 56 pairs of M-NBI and M-AANBI images were prepared from the same BEA and NNBE lesions, and diagnoses derived using M-NBI alone were compared to those obtained using both M-NBI and M-AANBI; and validation 3 (84 images), wherein the ease of identifying the BEA demarcation line (DL) was scored via a visual analog scale in 28 patients using magnifying endoscopy with white-light imaging (M-WLI), M-NBI, and M-AANBI. Results For validation 1, M-AANBI was superior to M-NBI in terms of sensitivity (90.8 % vs. 64.6 %), specificity (98.5 % vs. 76.9 %), and accuracy (94.6 % vs. 70.4 %) (all P  < 0.05). For validation 2, the accuracy of M-NBI alone was significantly improved when combined with M-AANBI (from 70.5 % to 89.3 %; P  < 0.05). For validation 3, M-AANBI had the highest mean score for ease of DL recognition (8.75) compared to M-WLI (3.63) and M-NBI (6.25) (all P <  0.001). Conclusions Using M-AANBI might improve the accuracy of BEA diagnosis.

Dedifferentiated liposarcoma in the abdominal cavity: a case report.

Liposarcoma adherent to the mesentery is extremely rare and difficult to diagnose. A 70-year-old woman presented to the hospital with a right lower abdominal mass. After surgical resection, the patient was diagnosed with dedifferentiated liposarcoma of the transverse colon with a mesenteric origin, and chemotherapy was administered. Diagnosing dedifferentiated liposarcoma of the transverse mesocolon based on imaging findings alone is challenging. Surgical resection can aid diagnosis. Moreover, cancer-specific genetic testing was performed in this case because dedifferentiated liposarcoma is a disease for which novel therapeutic agents are expected to be developed.

Vapor-Induced Conversion of a Centrosymmetric Organic-Inorganic Hybrid Crystal into a Proton-Conducting Second-Harmonic-Generation-Active Material.

Chemical responsivity in materials is essential to build systems with switchable functionalities. However, polarity-switchable materials are still rare because inducing a symmetry breaking of the crystal structure by adsorbing chemical species is difficult. In this study, we demonstrate that a molecular organic-inorganic hybrid crystal of (NEt4)2[MnN(CN)4] (1) undergoes polarity switching induced by water vapor and transforms into a rare example of proton-conducting second-harmonic-generation-active material. Centrosymmetric 1 transforms into noncentrosymmetric polar 1·3H2O and 1·MeOH by accommodating water and methanol molecules, respectively. However, only water vapor causes a spontaneous single-crystal-to-single-crystal transition. Moreover, 1·3H2O shows proton conduction with 2.3 × 10-6 S/cm at 298 K and a relative humidity of 80%.