Pemafibrate, a novel selective PPARα modulator, attenuates tamoxifen-induced fatty liver disease.

Estrogen receptor (ER) antagonists, such as tamoxifen and toremifene, are widely used as adjuvant therapies for ER-positive breast cancer. These agents sometimes cause hepatosteatosis and steatohepatitis and it is problematic whether these agents should be withdrawn due to fatty liver disease and liver dysfunction. We herein describe a patient with fatty liver disease and hypertriglyceridemia during tamoxifen treatment, which significantly improved by adding pemafibrate, a novel PPARα activator designated as a selective PPARα modulator.

Non-alcoholic fatty liver disease later diagnosed as myotonic dystrophy.

Background: Myotonic dystrophy (MD) is sometimes accompanied by metabolic/endocrine disorders, including dyslipidemia, central obesity, and hypogonadism. Due to considerable individual differences in the severity and progression of myopathy, MD patients with minimal-to-mild muscle symptoms might be followed as having other diseases, such as non-alcoholic fatty liver disease (NAFLD).

Case Summary: A 40-year-old non-obese man without a history of regular ethanol consumption was referred to our hospital due to persistent liver dysfunction and hyperlipidemia.

Risk of Gastrointestinal Endoscopic Procedure-Related Bleeding in Patients With or Without Continued Antithrombotic Therapy.

Background: Prospective studies on bleeding risk during/after gastrointestinal endoscopic procedures are rare.

Aim: We investigated the risk of endoscopic procedure-related bleeding in patients with biopsy and/or cold snare polypectomy (CSP) in relation to antithrombotic therapy.

Methods: This prospective, observational single-center cohort study (NCT02594813) enrolled consecutive patients who underwent diagnostic esophagogastroduodenoscopy (EGD) or colonoscopy.

Safety and Effectiveness of Nurse-Administered Propofol Sedation in Outpatients Undergoing Gastrointestinal Endoscopy.

Background & Aims: Esophagogastroduodenoscopy (EGD) and colonoscopy are common outpatient gastrointestinal endoscopic procedures that frequently use sedation. We aimed to identify a protocol that combines safety with cost effectiveness.

Methods: We collected data from consecutive outpatients (age, 20-98 y) who underwent diagnostic EGD (n = 117,661) or colonoscopy (n = 32,550) with propofol sedation from January 2006 through December 2016.

Comparison of newly found polyps after removal of small colorectal polyps with cold or hot snare polypectomy.

Background And Study Aims: There are limited data regarding polyp recurrence following cold or hot snare polypectomy for small colorectal polyps. The aim of this study was to evaluate the prevalence of newly found polyp after cold or hot snare polypectomy and the predictive factors.

Patients And Methods: This was a retrospective case-control study at a single municipal hospital.

Biliary stenting as alternative therapy to stone clearance in elderly patients with bile duct stones.

Background And Study Aims: Endoscopic retrograde cholangio- pancreatography with stone retrieval following endoscopic sphinc- terotomy (ES) is the standard method for the management of cho- ledocholithiasis. However, biliary stenting is used to treat patients with endoscopically irretrievable bile duct stones, especially elderly and high-risk patients. The aim of this study was to evaluate the benefits and risks of biliary stenting versus stone clearance follow- ing ES in the management of choledocholithiasis.

Benefits and limitations of cap-fitted colonoscopy in screening colonoscopy.

Background: Colonoscopy is widely used to detect colorectal cancer and to remove precancerous lesions to reduce the risk of colonic cancer.

Aims: To examine the benefits and limitations of cap-fitted colonoscopy compared to conventional colonoscopy in terms of technical performance and colorectal adenoma detection rate.

Methods: Screening colonoscopies performed from 2009 to 2010 with or without a transparent cap were retrospectively examined to compare the rate of successful intubation, cecal intubation time, and number, size, shape, and location of adenomas detected.

Safety and effectiveness of propofol sedation during and after outpatient colonoscopy.

Aim: To study the safety and effectiveness of propofol sedation for outpatient colonoscopy.

Methods: Propofol was given by bolus injection with an age-adjusted standard protocol consisting of 60 mg for patients < 70 years old, 40 mg for patients age 70-89 years, and 20 mg for those ≥ 90 years, and additional injections of 20 mg propofol were given up to a maximum of 200 mg. The principal parameters were the occurrence of adverse events within 24 h after colonoscopy and overall satisfaction for this procedure.

Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps.

Background And Aim: The ideal method to remove small colorectal polyps is unknown. We compared removal by colon snare transection without electrocautery (cold snare polypectomy) with conventional electrocautery snare polypectomy (hot polypectomy) in terms of procedure duration, difficulty in retrieving polyps, bleeding, and post-polypectomy symptoms.

Methods: Patients with colorectal polyps up to 8 mm in diameter were randomized to polypectomy by cold snare technique (cold group) or conventional polypectomy (conventional group).

Techniques and Outcomes of Endoscopic Decompression Using Transanal Drainage Tube Placement for Acute Left-sided Colorectal Obstruction.

Background: If it is possible, endoscopic decompression for acute left-sided colorectal obstruction will be effective in critically ill patients. This study was to evaluate the techniques and outcomes of transanal drainage tube placement following urgent colonoscopy in management of acute left-sided colorectal obstruction.

Methods: From January 2000 to December 2009, 69 consecutive patients (36 males, age 38 to 94, mean = 71) were hospitalized because of acute left-sided colorectal obstruction.

Prospective comparison between sedated high-definition oral and unsedated ultrathin transnasal esophagogastroduodenoscopy in the same subjects: pilot study.

Background: Recently, quality as well as acceptability has been a concern regarding endoscopy. The aim of the present study was to compare the acceptability and quality of sedated high-definition esophagogastroduodenoscopy (sHD-EGD) using a newly developed high-definition videoscope with those of unsedated ultrathin esophagogastroduodenoscopy (uUT-EGD) using a 5.2 mm videoscope.

Low-dose propofol sedation for diagnostic esophagogastroduodenoscopy: results in 10,662 adults.

Objective: The use of propofol sedation during endoscopic procedures has increased in recent years. The aim of this study was to evaluate the safety and effectiveness of nurse-administered low-dose propofol sedation for diagnostic esophagogastroduodenoscopy (EGD).

Methods: We prospectively assessed the outcome and complications of low-dose bolus propofol for endoscopic sedation for diagnostic EGD.

Safety and driving ability following low-dose propofol sedation.

Background And Aim: Automobile driving is prohibited after midazolam sedation because of the slow recovery of psychomotor function. This study prospectively assessed the safety of low-dose propofol sedation (study 1) and compared driving ability following propofol and midazolam sedation (study 2).

Methods: Study 1: We prospectively investigated bolus injection of a low-dose of propofol (40-80 mg for <70 years and 30 mg for >or=70 years) for diagnostic esophagogastroduodenoscopy (EGD).

Propofol sedation for endoscopic procedures in patients 90 years of age and older.

Background And Aim: There are only a few studies on propofol sedation for very elderly patients. The present study was undertaken to evaluate the safety of propofol sedation in patients 90 years of age and older undergoing endoscopic procedures.

Methods: We prospectively assessed endoscopic procedures for patients 90 years of age and older using propofol sedation.