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Watch a video of this article. [ABSTRACT FROM AUTHOR]

Objectives: Esketamine is an S (+) enantiomer of ketamine with greater potency and similar psychomimetic effects compared to racemic ketamine. We aimed to explore the safety of esketamine in different doses as an adjuvant to propofol in patients undergoing endoscopic variceal ligation (EVL) with or without injection sclerotherapy. Methods: One hundred patients were randomized to receive sedation with propofol 1.5 mg/kg in combination with sufentanil 0.1 μg/kg (group S), esketamine 0.2 mg/kg (group E0.2), esketamine 0.3 mg/kg (group E0.3), or esketamine 0.4 mg/kg (group E0.4) for EVL (n = 25 each). Hemodynamic and respiratory parameters were recorded during the procedure. The primary outcome was the incidence of hypotension; secondary outcomes included the incidence of desaturation, positive and negative syndrome scale (PANSS) after the procedure, pain score after the procedure, and secretion volume. Results: The incidence of hypotension was significantly lower in groups E0.2 (36%), E0.3 (20%), and E0.4 (24%) than in group S (72%). The incidence of SpO2 ≤94% was significantly lower in group E0.4 (4%) than in group S (32%). No significant intergroup difference was found in the PANSS assessment. Conclusions: Combining 0.4 mg/kg esketamine with propofol sedation was optimal to facilitate EVL with stable hemodynamic status and better respiratory function during the procedure, without significant psychomimetic side‐effects. Trial registration: Chinese Clinical Trial Registry (Trial ID: ChiCTR2100047033, http://www.chictr.org.cn/showproj.aspx?proj=127518). [ABSTRACT FROM AUTHOR]

Watch a video of this article. [ABSTRACT FROM AUTHOR]

Background: Peri‐esophageal collateral veins have been reported to be associated with the recurrence of esophageal varices (EVs). In this study, we retrospectively analyzed whether endoscopic ultrasonography (EUS) findings obtained just before endoscopic injection sclerotherapy (EIS) are associated with the success rate of intravariceal injection, recurrence rate of EVs, and overall survival rate (OS) of patients. Furthermore, we investigated the independent predictors associated with these factors by multivariate analysis. Methods: A total of 91 patients with risky EVs treated by EIS were analyzed. The primary endpoint was to identify independent predictors associated with the success rate of intravariceal injection, recurrence rate, and OS by multivariate analysis, to confirm the usefulness of EUS examination. The secondary endpoint was to clarify differences in recurrence rate and OS between patients who underwent additional argon plasma coagulation (APC) and those who did not, by the propensity score matching method. Results: Luminal diameter of EVs and F factor were predictors of the success rate of intravariceal injection. APC was predictor of OS and recurrence of EVs. EUS findings were not associated with these factors. Propensity score matching (APC, 23; without APC, 23) showed that recurrence rate was significantly improved in the APC group (P = 0.050) and that OS had the tendency to be higher in the APC group (P = 0.068). Conclusion: Endoscopic ultrasonography findings before EIS were associated with successful intravariceal injection but were not associated with recurrence rate or OS. Additional APC could improve OS and reduce the recurrence of EVs. [ABSTRACT FROM AUTHOR]

Background: Red dichromatic imaging (RDI) is a novel image‐enhanced endoscopy released in 2020, which increases the visibility of deeper vessels. In this study, we retrospectively investigated whether RDI can shorten treatment times of endoscopic injection sclerotherapy (EIS), and which operational procedure times are affected compared with white light imaging (WLI). Methods: A total of 155 patients (RDI, 70; WLI, 85) with risky esophageal varices (EV), who were treated with EIS were analyzed. Treatment times were compared, and predictors associated with treatment time were analyzed by multivariate analysis. For 24 cases (RDI, 12; WLI, 12) in which treatment videos were recorded, the procedure times of each step (observation of EV, needle flush, positioning, puncture, observation of bleeding, hemostasis, observation after hemostasis) were measured. Regarding the seven patients with EV bleeding, color differences were calculated between the bleeding point and the blood pool using the CIE (L*a*b*) color measurement method, and results were compared between using RDI and WLI. Results: Treatment times were shorter in the RDI group (RDI vs. WLI = 35.1 vs. 42.2 min; P < 0.01). 'RDI function' and 'amount of sclerosant' were extracted as independent predictors of treatment time. Times for 'observation of EV' and 'observation of bleeding' were shorter in the RDI group (P = 0.01 and <0.01, respectively). Regarding the color difference, RDI significantly increased bleeding point visibility (RDI vs. WLI = 31.4 ± 11.8 vs. 8.6 ± 6.2, P < 0.001). Conclusion: Red dichromatic imaging can shorten the treatment time of EIS by increasing bleeding point visibility. [ABSTRACT FROM AUTHOR]

This is a significant study since it establishes objectively that RDI improves the EV visibility in intravariceal sclerotherapy for EVs by employing color difference evaluation. Endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL) has been used to treat potentially risky esophageal varices (EVs).1 Although the recurrence rate following endoscopic therapy of EVs has been reported to be lower with EIS, particularly with intravariceal sclerotherapy, than with EVL, EVL is widely applied worldwide due to its simplicity. In the current issue of I Digestive Endoscopy i , Furuichi I et al i .3 explored the utility of red dichromatic imaging (RDI), a novel image-enhanced endoscopic function, in the intravariceal sclerotherapy of EVs. [Extracted from the article]

We read with interest the research study by Abe I et al. i and congratulate the authors on their excellent results with complete eradication of varices in 91 patients after endoscopic ultrasonography (EUS) and endoscopic injection sclerotherapy (EIS).1 Esophageal varices recurred in one-third of patients, but the addition of argon plasma coagulation (APC) consolidation treatment in a subgroup resulted in significantly lower variceal recurrence. Reference 1 Abe M, Furuichi Y, Takeuchi H, Yoshimasu Y, Itoi T. Prognostic and recurrence factors after endoscopic injection sclerotherapy for esophageal varices: Multivariate analysis with propensity score matching. [Extracted from the article]

2 Abe M, Furuichi Y, Takeuchi H, Yoshimasu Y, Itoi T. Prognostic and recurrence factors after endoscopic injection sclerotherapy for esophageal varices: Multivariate analysis with propensity score matching. Moreover, excluding the patients on whom endoscopic ultrasonography (EUS) was not performed is a natural criterion because the purpose of this study is investigating the usefulness of EUS. [Extracted from the article]