Lower esophageal muscular ring, usually called A-ring, is a rare esophageal lesion that occasionally causes dysphagia or symptoms of reflux [1] [2]. There have been only a few case reports of attempts to treat muscular ring with the intramuscular injection of botulinum toxin (botox) [1] [3]. This report is believed to be the first of the use of peroral endoscopic myotomy (POEM) to treat esophageal muscular ring.
Abstract: Still debates exist whether Helicobacter pylori (H. pylori) eradication can impose the chance of gastric cancer prevention since the effects of H. pylori eradication on the development of metachronous gastric cancer (MGC) after endoscopic treatment. Supported with other evidences that eradication can prevent gastric cancer as well as rejuvenation of atrophic gastritis and some improvements of dyspeptic symptoms, in February 21, 2013, Japanese government decided to eradicate H. pylori in patients with chronic gastritis. This is largely due to sincere hope either to lessen gastric cancer incidence as well as mortality or improve the quality of life of Japanese people. Though H. pylori had been defined as class 1 carcinogen by IARC at 1994, several evidences confirmed that H. pylori played promoting actions gastric carcinogenesis rather than as initiator. With the findings that field cancerization is one of core pathways of H. pylori-associated gastric carcinogenesis, the answer to debates that eradication alone was insufficient to prevent MGC includes either the discovery of biomarkers to eradicate earlier before stepping into irreversible stage of gastric carcinogenesis or adoption of strategy to perform siTRP (short-term intervention to revert premalignant lesion). Therefore, surrounding break up should be considered as siTRP after the successful eradication to prevent H. pylori-associated gastric cancers.
Increasing clarithromycin resistance has led to the need for an alternative first-line therapy for the eradication of Helicobacter pylori (H. pylori) in Korea, and bismuth containing quadruple therapy (BQT) and tailored therapy (TT) have been proposed as alternative regimens. The aim of this study was to compare the eradication rates of BQT and TT as first-line H. pylori eradication therapies.H. pylori infection was diagnosed using the rapid urease test or dual-priming oligonucleotide-based multiplex polymerase chain reaction (DPO-PCR) during endoscopy. Patients positive for H. pylori were divided into two groups; those tested using the rapid urease test received empirical BQT (the BQT group) whereas those tested by DPO-PCR received TT (the TT group). Eradication rates, adverse events, and overall medical costs, which included diagnostic test and eradication regimen costs, were compared.Three hundred and sixty patients were included in the study (TT group 178, BQT group 182). The modified intention-to-treat eradication rates of BQT and TT were 88.2% (142/161) and 80.3% (118/147), respectively (p = .055), and corresponding eradication rates in the per-protocol population were 88.8% (142/160) and 81.4% (118/145) (p = .07). Compliance and adverse event rates were similar in the two groups. Average medical costs were $90.3 per patient in the TT group and $75.5 in the BQT group (p = .000).Empirical BQT and tailored therapy were similar in terms of H. pylori eradication rate, safety, and tolerability, but BQT was more cost-effective.
The concept of using natural orifices to reduce the complications of surgery, Natural Orifices Transluminal Endoscopic Surgery, has also been applied to therapeutic endoscopy. Endoscopic submucosal surgery (ESS) provides more treatment options for various gastrointestinal diseases than traditional therapeutic endoscopy by using the submucosal layer as a working space. ESS has been performed in various fields ranging from transluminal peritoneoscopy to peroral endoscopic myotomy. With further advances in technology, ESS will be increasingly useful for diagnosis and treatment of gastrointestinal diseases.
Cholecystitis complicates approximately 0.2% to 0.5% of endoscopic retrograde cholangiopancreatographys (ERCPs).The risk appears to be correlated with the presence of stones in the gallbladder (GB), possibly filling of the GB with contrast, and placement of metal stents.However, acute acalculous cholecystitis with perforation after ERCP is extremely rare.A 56-year-old male with chronic pancreatitis was admitted for endoscopic treatment of chronic pancreatitis.Two days after pancreatic stent insertion, he presented with acute cholangitis without bile duct dilatation.He underwent two plastic biliary stents insertion.After two days, he had complained of acute right upper abdominal pain with muscle guarding.Abdominal computed tomographic scan showed focal discontinuity of GB wall and fluid collection of pericholecystic area and pelvic cavity.He had been successfully managed by percutaneous GB drainage and biliary stent removal without operation.Herein we report a case of acute acalculous cholecystitis with perforation that developed after ERCPs.
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