林 芳和

Gastric mucosal changes associated with long-term potassium-competitive acid blocker and proton pump inhibitor (PPI) therapy may raise concern. In contrast to that for PPIs, the evidence concerning the safety of long-term potassium-competitive acid blocker use is scant. Vonoprazan (VPZ) is a representative potassium-competitive acid blocker released in Japan in 2015. In order to shed some comparative light regarding the outcomes of gastric mucosal lesions associated with a long-term acid blockade, we have reviewed six representative gastric mucosal lesions: fundic gland polyps, gastric hyperplastic polyps, multiple white and flat elevated lesions, cobblestone-like gastric mucosal changes, gastric black spots, and stardust gastric mucosal changes. For these mucosal lesions, we have evaluated the association with the type of acid blockade, patient gender, Helicobacter pylori infection status, the degree of gastric atrophy, and serum gastrin levels. There is no concrete evidence to support a significant relationship between VPZ/PPI use and the development of neuroendocrine tumors. Current data also shows that the risk of gastric mucosal changes is similar for long-term VPZ and PPI use. Serum hypergastrinemia is not correlated with the development of some gastric mucosal lesions. Therefore, serum gastrin level is unhelpful for risk estimation and for decision-making relating to the cessation of these drugs in routine clinical practice. Given the confounding potential neoplastic risk relating to H. pylori infection, this should be eradicated before VPZ/PPI therapy is commenced. The evidence to date does not support the cessation of clinically appropriate VPZ/PPI therapy solely because of the presence of these associated gastric mucosal lesions.

BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) is a minimally invasive and effective treatment for rectal tumors but maintaining a clear surgical field during the procedure is challenging, especially for novice operators. This study aimed to investigate whether continuous drainage using a Foley catheter could enhance efficiency and safety of rectal ESD performed by novice endoscopists under expert supervision. PATIENTS AND METHODS: This retrospective study involved 26 patients who underwent rectal ESD between March 2023 and October 2024. Patients were divided into two groups: those who received continuous drainage with Foley catheter placement (n = 12) and those who did not (n = 14). Key outcomes evaluated were dissection speed, total procedure time, R0 resection rates (complete tumor resection with clear margins), and occurrence of any adverse events (AEs) during or after the procedure. All procedures were performed by novice endoscopists under expert guidance. RESULTS: The results showed that dissection speed was significantly higher in the Foley catheter group, with a median of 18.6 mm²/min compared with 10.5 mm²/min in the non-catheter group ( P = 0.027). Although total procedure time and sodium hyaluronate usage were lower in the catheter group, these differences were not statistically significant. Importantly, no AEs were reported in either group. CONCLUSIONS: Foley catheter placement notably improved efficiency of rectal ESD performed by novice endoscopists, particularly by increasing dissection speed. This technique may contribute to safer and more effective ESD. However, larger studies are needed to confirm these findings and further assess their benefits.