菅野 武

Introduction: Gel-immersion endoscopy (GIE) is a technique used to maintain a clear view during gastric endoscopic submucosal dissection (ESD). We aimed to identify cases most likely to benefit from GIE for ESD bleeding by reviewing our clinical experience and determining the associated factors. Methods: We retrospectively analyzed 470 lesions in 380 patients who underwent gastric ESD between October 2020 and March 2023. The patients were divided into conventional method (CM, n=433) and GIE groups (n=37). We compared the clinical and pathological characteristics between the groups. Univariate and multivariate logistic regression analyses were used to identify factors associated with GIE use. Among the GIE group, hemostasis times under gas, water, and gel conditions were compared using the Kruskal–Wallis test. Results: Multivariate analysis revealed that dialysis (odds ratio [OR]: 15.3), concurrent antiplatelet and anticoagulant use (OR: 9.5), and tumor location in the middle third (OR: 3.5), upper third (OR: 5.7), or remnant stomach (OR: 9.3) were independently associated with GIE use. No significant differences in overall hemostasis time were observed between gas, water, or gel. Of the nine bleeding events exceeding 300 s under gas immersion, seven achieved successful hemostasis by switching to GIE, with a median of 32 s to locate the source and 140 s to complete hemostasis. Conclusion: Dialysis, combined antithrombotic use, and certain tumor locations were key factors influencing GIE for ESD bleeding. Although the overall hemostasis times did not differ, GIE may be particularly beneficial in high-risk scenarios.

Background Long COVID symptoms, especially brain fog, significantly impair patient quality of life (QOL); however, effective treatments remain elusive. Japanese traditional medicine (JTM, usually called Kampo medicine) is often used adjunctively to treat patients with diverse manifestations of long COVID. Objective To evaluate the effectiveness of JTM in treating long COVID using a comprehensive QOL assessment. Methods This single-center, prospective observational study evaluated QOL changes in patients with symptoms persisting beyond 28 days from the onset of COVID-19 (long COVID) who visited our general medicine outpatient department between October 2021 and August 2024. The treatment plan was determined by the attending physician based on the patient’s condition. The health-related QOL (HR-QOL) was comprehensively assessed using EuroQol-5 demensions-5levels (EQ-5D-5L) scores (ranging from −0.025 to 1.000, with higher values indicating better HR-QOL) at baseline and 3 months after the first visit. The formulations and factors associated with QOL changes were analyzed using multivariate logistic regression analyses. Results We analyzed 112 patients. The most common symptoms were fatigue (83.9%). The median (interquartile range) HR-QOL of the entire cohort significantly increased from 0.711 (0.561–0.711) at baseline to 0.833 (0.671–0.890) at 3 months (p < 0.0001); the proportion of patients exceeding the national standard significantly increased from 7.1% to 20.4% (p = 0.0037). The brain fog patients group (50.0%, N = 56), the median (interquartile range) HR-QOL of the entire cohort significantly increased from 0.677 (0.551–0.770) at baseline to 0.750 (0.623–0.846) at 3 months (p < 0.005). However, the proportion of patients achieving the Japanese average HR-QOL did not show improvement significantly. A total of 101 patients (90.2%) were treated with JTM, and a combination of kamikihito and saikokeishito was administered to 20 patients. Multivariate regression analysis revealed that the combination usage was associated with greater improvements in the HR-QOL in all patients (odds ratio 5.4) and brain fog patients’ group (odds ratio 6.1). Conclusion Long COVID treatment involving JTM improved the patients’ QOL at 3 months. The combination of kamikihito with saikokeishito may be a potential treatment option for long COVID. However, a randomized controlled trial is required to confirm its efficacy.

Objectives Computer‐aided diagnosis (CADx) is anticipated to enhance the prediction of colorectal polyp histology. This study aims to compare the diagnostic accuracy of CADx in the optical diagnosis of colorectal polyps, evaluating its performance against that of both experienced and inexperienced endoscopists. Methods The protocol of this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42024585097). Three electronic databases including MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched in September 2024. A bivariate random effects model was employed. The primary outcome was the comparison of sensitivity and specificity between CADx and experienced endoscopists; the secondary outcome was the comparison between CADx and inexperienced endoscopists. Results Twenty‐one studies involving 5477 polyps were included. The pooled sensitivities of CADx and experienced endoscopists were 0.87 (95% confidence interval [CI] 0.82–0.91) and 0.88 (95% CI 0.83–0.91), respectively (P = 0.93). The pooled specificities of CADx and experienced endoscopists were 0.85 (95% CI 0.78–0.90) and 0.87 (95% CI 0.82–0.92), respectively (P = 0.53). In nine studies comparing CADx with inexperienced endoscopists, the pooled sensitivities were 0.88 (95% CI 0.82–0.92) for CADx and 0.85 (95% CI 0.78–0.90) for inexperienced endoscopists (P = 0.46). The pooled specificities were 0.84 (95% CI 0.78–0.88) for CADx and 0.77 (95% CI 0.70–0.83) for inexperienced endoscopists (P = 0.16). Conclusion Computer‐aided diagnosis does not demonstrate superior diagnostic accuracy in optical diagnosis of colorectal polyps compared to endoscopists, regardless of their experience level.