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Background: Hyaluronic acid (HA) provides a long-lasting and distinct mucosal elevation for EMR, but expense and inconvenience have limited its adoption., Objective: To evaluate the safety and efficacy of an over-the-counter 0.15% HA preparation for EMR., Design: Retrospective study., Setting: Veterans Administration Hospital and university hospital., Patients: 30 patients with a total of 32 colonic lesions and 1 duodenal lesion., Intervention: EMR by using HA., Main Outcome Measurements: En bloc resection rate and complications., Results: EMR was successful in all cases. En bloc resection was achieved in 26 of the 28 lesions up to 25 mm in diameter. Two lesions, both with fibrosis from prior attempted resection, had trace residual tissue necessitating cauterization with argon plasma. Five lesions measuring 30 mm to 60 mm all required piecemeal resection. There was one complication, a postpolypectomy bleed., Limitations: Small number of patients and retrospective design., Conclusions: EMR may be performed safely and effectively by using an inexpensive, over-the-counter 0.15% HA preparation. Further studies are needed to verify the results of this study and to compare the safety and efficacy of this HA preparation with saline solution., (Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.)

Background: Giant hemicircumferential and greater nonampullary duodenal adenomas or laterally spreading tumors (LSTs) may be amenable to safe endoscopic resection, but little data exists on outcomes or risk stratification., Design: We interrogated a prospectively maintained database of all patients who underwent endoscopic resection between January 2008 and November 2010. The resection technique was standardized. Major complications were defined as perforation, bleeding requiring readmission with hemoglobin drop of more than 20 g/L, or other substantial deviations from the usual clinical course. Outcomes were analyzed in 2 groups: giant lesions (>30 mm) and conventional duodenal polyps (<30 mm in diameter). Statistical evaluation was performed by using a χ(2) test., Results: A total of 50 nonampullary duodenal polyps and LSTs were resected from 46 patients (23 men, mean age 59.4 years, range 35-83 years). Nineteen were giant hemicircumferential and greater LSTs (mean size 40.5 mm, range 30-80 mm), and 31 were less than 30 mm in diameter (mean size 14.5 mm, range 5-25 mm). Intraprocedural bleeding occurred more frequently in giant lesions (57.8% vs 19.3%, P = .005) and was treated with a combination of soft coagulation and endoscopic clips with hemostasis achieved in all cases. Major complications, mostly bleeding related, occurred in 5 patients (26.3%) with giant lesions and 1 patient (3.2%) with a smaller lesion (P = .014). There were no deaths., Limitation: Retrospective observational study in a tertiary center., Conclusions: Endoscopic resection of giant nonampullary duodenal LSTs is a successful treatment. However, it is hazardous and associated with significantly higher complication rates, primarily bleeding, when compared with conventional duodenal polypectomy. Safer and more effective hemostatic tools are required in this high-risk location., (Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.)

In Nigeria, where the carrier rate of hepatitis B antigen (HBsAg) is between 5 and 10%, it must be assumed that the instrument used for upper gastrointestinal endoscopy has had contact with an HBsAg-positive patient. The risk of type B hepatitis transmission via upper gastrointestinal endoscopy was evaluated, therefore, in 61 patients who were followed for 1 year after the procedure. Four of these patients were "carriers" of HBsAg. None of the study group developed jaundice or hepatomegaly during the follow-up period. In 21 patients, serial liver function tests and screening for HBsAg were obtained. None of the 19 seronegative patients developed abnormal liver function tests or converted to HBsAg-positive. It is concluded that, while transmission of HBsAg is theoretically possible, the risk appears minimal. HBsAg positivity should not be a contraindication, therefore, in patients who need endoscopic assessment for definitive management.

Fifty-one patients who underwent endoscopic sphincterotomy for suspected dysfunction of the sphincter of Oddi were evaluated retrospectively. The procedure resulted in complete abolition of pain allowing discontinuation of analgesics in 31 of the 46 patients available for follow-up. Patients with a dilated bile duct and delayed drainage of contrast material as demonstrated at endoscopic retrograde cholangiopancreatography (ERCP) had a more favorable response to sphincterotomy than those with normal ductal findings (p = 0.01). There was a higher complication rate in those without ductal dilation and delayed drainage compared to those with these ERCP abnormalities (p = 0.03). Sphincter of Oddi manometry was obtained in 29 patients prior to sphincterotomy; 24 were available for follow-up. A favorable outcome for sphincterotomy did not correlate with manometric assessment, particularly in patients with an abnormal ductal system.