Gunma University Hospital

ABSTRACTObjectivesUnderwater endoscopic mucosal resection (UEMR) is widely performed for colorectal tumors. However, in our experience, it is sometimes difficult to keep a clear endoscopic view underwater, due to dirty fluid inflow or insufficient water pooling after grasping the polyp, or bleeding just after endoscopic resection. To compensate for such challenges, we reported modified UEMR (M‐UEMR) as a procedure for snaring underwater and undergas resection. Therefore, we conducted a prospective clinical trial to investigate the safety and efficacy of M‐UEMR.MethodsThis single‐center prospective study was conducted at Tokushima University Hospital. Patients with 10–25 mm colorectal polyps were enrolled. The polyps were snared underwater, then infused water was removed, and the lumen was inflated with CO2 for resection, as described in our previous report. Measured outcomes were R0 resection rate and adverse events such as bleeding, perforation, and post‐polypectomy syndrome. In addition, we evaluated the en bloc resection rate and thickness of submucosal (SM) tissue of the resected specimens.ResultsForty patients were enrolled, and the R0 resection rate was 80% (95% confidence interval [CI]: 64.4–90.9). No procedure‐related adverse events were observed. En bloc resection was 92.5% (95% CI: 79.6–98.4). The median thickness of SM tissue (range) was 574 µm (241–2632) at the center of the specimen.ConclusionM‐UEMR demonstrated a high R0 resection rate with a safe profile. M‐UEMR is expected to be utilized as an alternative technique to UEMR for colorectal polyps in patients with difficulty maintaining a clear visual field.

ABSTRACTIntroductionIntramural ureteral urothelial carcinoma can be difficult to diagnose, especially when presenting without mucosal abnormalities or positive cytology. In such cases, percutaneous biopsy may provide an alternative diagnostic approach.Case PresentationA 74‐year‐old man presented with acute renal failure caused by bilateral hydronephrosis. Cystoscopy showed no mucosal abnormality. Retrograde pyeloureterography revealed bilateral distal ureteral strictures, but urine cytology from ureteral catheters was negative. Imaging revealed a submucosal mass on the right dorsal bladder wall. Urothelial carcinoma was diagnosed on a computed tomography‐guided percutaneous trans‐extraperitoneal and transvesical biopsy. Neoadjuvant chemotherapy was administered and radical cystectomy performed. Pathology confirmed invasive urothelial carcinoma originating from the right intramural ureter at the ureterovesical junction with bladder muscle invasion.ConclusionThis case highlights the diagnostic challenges of intramural ureteral urothelial carcinoma presenting as a submucosal bladder tumor. Computed tomography‐guided percutaneous biopsy can be a safe and effective diagnostic option in such challenging cases.

Abstract Background In recent years, drug-coated balloons (DCB) have emerged as an alternative to drug-eluting stents (DES), particularly in small vessel disease1. While both DES and DCB are commonly utilized in small vessels, the optimal treatment strategy for tortuous coronary lesions remains unclear. Due to their complex anatomy, tortuous lesions pose significant challenges in percutaneous coronary intervention (PCI), and comparative data on the long-term clinical outcomes of DES and DCB in this setting remain limited. Purpose This study aimed to evaluate and compare the 3-year clinical outcomes of DES and DCB in the treatment of small, tortuous coronary lesions. Methods This retrospective, single-center study included all consecutive patients who underwent PCI for small vessel tortuous lesions treated with either DES or DCB. Tortuous coronary lesions were defined as those with an angulation of ≥45° in at least one segment. Patients with chronic total occlusion, in-stent restenosis, or those receiving stents or balloons ≥3 mm were excluded. Procedural characteristics, including pre- and post-procedural angiographic parameters, were assessed. The primary endpoint was the incidence of major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, cardiac death, non-fatal myocardial infarction (MI), and target vessel revascularization (TVR) at 3 years. Results A total of 290 patients were included, with 85 treated with DCB and 205 with DES between February 8, 2016, and March 25, 2023. The mean age of the overall population was 71.2 ± 9.1 years, with a median follow-up of 565.4 ± 377.4 days. Baseline characteristics, including age, chronic kidney disease, and left ventricular ejection fraction, were similar between groups. Angiographic characteristics, including reference vessel diameter, minimum lumen diameter, and percentage diameter stenosis, were comparable; however, lesion length was significantly longer in the DES group compared to the DCB group (28.1 ± 13.9 mm vs. 22.2 ± 11.0 mm, p = 0.004). Regarding procedural data, pre-dilatation was significantly more frequent in the DCB group than in the DES group (p < 0.01). At 3 years, there was no significant difference between the two groups in terms of all-cause mortality, cardiac death, or TVR. However, the incidence of MACE was significantly lower in the DES group compared to the DCB group (log-rank p = 0.023) (Figure 1). Conclusion Despite the lesion length being longer in the DES group, DES demonstrates superior outcomes compared to DCB in tortuous coronary lesions, particularly in reducing the incidence of MACE.Figure 1

Abstract Introduction Chagas disease (ChD), caused by Trypanosoma cruzi infection, leads to progressive cardiac damage driven by both parasite-induced and host immune-mediated mechanisms, yet contemporary human patient data remain limited in translating these findings into clinical practice. Given the underrepresentation of Central America—particularly El Salvador—in prior ChD human research, we conducted a cross-sectional study to identify clinical and laboratory markers that could guide treatment strategies for ChD patients in this region. Methods Clinical information and biological specimen were collected from Salvadorian patients with suspected Chagas disease. Blood and plasma were tested for parasitemia and laboratory markers, respectively. Chagas cardiomyopathy (CCM) definition was based on age-adjusted NT-proBNP thresholds. Results 191/200 (95.5%) were confirmed Chagas seropositive. 116/191 (61%) reported receipt of trypanocidals. Patients with CCM (35/191 [18%]) were older (median 57 [IQR 45–68] vs 40 [33–50], p<0.0001), more arrhythmic (37% vs 16%, p=0.009), and showed reduced ejection fraction (n=83) [%] (55 [48–58] vs 63 [59–68], p<0.001). Patients with CCM more frequently had elevated Troponin I (29% vs 1.3%, p<0.0001) and persistent parasitemia (23% vs 7.1%, p=0.010), showed higher anti-trypanosoma IgG [S/CO] (13 [12–15] vs 8.7 [5.8–12], p<0.0001), and were less likely to have received past trypanocidal therapy (43% vs 65%, p=0.021). After adjusting for age and sex, multivariate logistic regression confirmed the same variables as independent predictors of CCM. Discussions Our results depict significant morbidity among Salvadorian patients with Chagas disease. Clinical correlates of progression to CCM with risk stratification potential were determined.

The patient was a 56-year-old woman who had previously undergone living-donor kidney transplantation, followed by urinary diversion surgery due to recurrent pyelonephritis. Nine years after the urinary diversion, abdominal computed tomography performed for evaluation of lower abdominal pain revealed a renal calculus in the transplanted kidney. Percutaneous nephrolithotomy resulted in satisfactory stone fragmentation, but had to be performed again 14 months later to remove a residual stone that had increased in size.