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Background: In the absence of Helicobacter pylori (HP) infection, a characteristic gastric mucus adhesion may appear during the use of vonoprazan. We named this novel characteristic mucus "web-like mucus" (WLM). This study aimed to determine the incidence and risk factors for WLM. Methods: Between January 2017 and January 2022, 5665 patients were enrolled in this study. The patients were divided into a proton-pump inhibitor (PPI)-prescribed group (n = 2000), a vonoprazan-prescribed group (n = 268), and a no-PPI/vonoprazan-prescribed (n = 3397) group, and the presence of WLM was examined. After excluding four patients with autoimmune gastritis, the remaining 264 patients in the vonoprazan group were divided into WLM and non-WLM groups, and their clinical features were analyzed. Results: A total of 55 (21%) patients had WLM, all in the vonoprazan-prescribed group. There were no significant differences in factors such as, sex, age, chronic kidney disease, diabetes mellitus, HP eradication history, smoking, or alcohol consumption between the WLM and non-WLM groups. The median duration from the start of vonoprazan administration to the endoscopic detection of WLM was 2 (1–24) months. Conclusions: WLM appears to be a characteristic feature in patients treated with vonoprazan. [ABSTRACT FROM AUTHOR]

Objectives: Gastrointestinal endoscopy (GIE) is useful for the early detection and treatment of many diseases; however, GIE is considered a high‐risk procedure in the coronavirus disease 2019 (COVID‐19) pandemic era. This study aimed to explore the rate of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) positivity in saliva and gastrointestinal fluids to which endoscopy medical staff are exposed. Methods: The study was a single‐center cross‐sectional study. From June 1 to July 31, 2020, all patients who underwent GIE at Yokohama City University Hospital were registered. All patients provided 3 mL of saliva. For upper GIE, 10 mL of gastric fluid was collected through the endoscope. For lower GIE, 10 mL of intestinal fluid was collected through the endoscope. The primary outcome was the positive rate of SARS‐CoV‐2 in saliva and gastrointestinal fluids. We also analyzed serum‐specific antibodies for SARS‐CoV‐2 and patients' background information. Results: A total of 783 samples (560 upper GIE and 223 lower GIE samples) were analyzed. Polymerase chain reaction (PCR) on saliva samples did not show any positive results in either upper or lower GIE samples. However, 2.0% (16/783) of gastrointestinal fluid samples tested positive for SARS‐CoV‐2. No significant differences in age, sex, purpose of endoscopy, medication, or rate of antibody test positivity were found between PCR positive and PCR negative cases. Conclusions: Asymptomatic patients, even those with no detectable virus in their saliva, had SARS‐CoV‐2 in their gastrointestinal tract. Endoscopy medical staff should be aware of infection when performing procedures. The study was registered as UMIN000040587. [ABSTRACT FROM AUTHOR]

Abstract: Background: The eradication rate of vonoprazan‐based first‐line triple therapy (combined with clarithromycin and amoxicillin) (V‐AC) was reported to be 97.6% in patients with clarithromycin (CAM)‐susceptible Helicobacter pylori in a phase III study, whereas our real‐world, prospective, multicenter cohort study yielded an eradication rate <90%. Objective: To validate the eradication rate of V‐AC using CAM‐susceptible testing in a multicenter, prospective, randomized trial. Methods: We included 147 treatment‐naïve H. pylori‐positive patients [41 with CAM‐resistant infections and 106 with CAM‐susceptible infections]. The CAM‐susceptible group patients were randomized to either the V‐AC group (vonoprazan 20 mg bid, amoxicillin 750 mg bid, and clarithromycin 200 or 400 mg bid) or PPI‐AC group (lansoprazole 30 mg, rabeprazole 10 mg, or esomeprazole 20 mg bid; amoxicillin 750 mg bid; and clarithromycin 200 or 400 mg bid). All CAM‐resistant H. pylori were eradicated by V‐AC, as measured by the urea breath test around 8 weeks after eradication. Safety was evaluated by patient questionnaires. Results: The intention‐to‐treat and per‐protocol eradication rates of V‐AC in the CAM‐susceptible H. pylori‐infected patients were 87.3% (95% confidence interval 75.5%‐94.7%) and 88.9% (77.4%‐95.8%). The respective eradication rates of PPI‐AC were 76.5% (62.5%‐87.2%) and 86.7% (73.2%‐94.9%). No significant difference was observed between the V‐AC and PPI‐AC regimes in terms of the intention‐to‐treat (P = .21) or per‐protocol (P = .77) analyses. The questionnaire scores did not differ significantly between the groups. Both the intention‐to‐treat and per‐protocol eradication rates of V‐AC in the CAM‐resistant patients were 82.9% (67.9%‐92.8%). Conclusion: The eradication rate of V‐AC treatment in the CAM‐susceptible H. pylori‐infected patients was <90%, as was that by PPI‐AC, thus V‐AC is not ideal regimen in CAM‐susceptible H. pylori. However, the 82.9% eradication rate of V‐AC in the CAM‐resistant infections may indicate the potential of V‐AC with modified dose, dosing interval, and treatment duration. (UMIN000016337). [ABSTRACT FROM AUTHOR]

In recent years, the radial incision and cutting(RIC)method has been developed as a treatment for intractable anastomotic stenosis after esophageal cancer surgery, and its usefulness is attracting attention. We report a case in which the RIC method was effective for endoscopic balloon dilatation-resistant anastomotic stenosis. The case was a 69-year-old woman. Transthoracic esophagectomy with three-field lymph node dissection, and narrow gastric tube reconstruction through antethoracic route, were performed for middle thoracic esophageal cancer. The patient suffered from Grade Ⅲa anastomotic leakage, but was discharged relieved. After discharge, the patient needed regular endoscopic balloon dilation for against intractable anastomotic stenosis. RIC was performed for the patient. Although stenosis relapsed after the RIC, the pain during balloon dilatation improved and oral intake can be continued without surgery. The required interval of dilatation was about 2 weeks before RIC, but it has been gradually extended to about 4 weeks after 1 year after the RIC. Moreover, oral intake and body weight of the patient were increased. The RIC method may be useful for intractable anastomotic stenosis after esophageal cancer surgery, and further case accumulation is needed.

Background: The eradication rate of vonoprazan-based first-line triple therapy (combined with clarithromycin and amoxicillin) (V-AC) was reported to be 97.6% in patients with clarithromycin (CAM)-susceptible Helicobacter pylori in a phase III study, whereas our real-world, prospective, multicenter cohort study yielded an eradication rate <90%., Objective: To validate the eradication rate of V-AC using CAM-susceptible testing in a multicenter, prospective, randomized trial., Methods: We included 147 treatment-naïve H. pylori-positive patients [41 with CAM-resistant infections and 106 with CAM-susceptible infections]. The CAM-susceptible group patients were randomized to either the V-AC group (vonoprazan 20 mg bid, amoxicillin 750 mg bid, and clarithromycin 200 or 400 mg bid) or PPI-AC group (lansoprazole 30 mg, rabeprazole 10 mg, or esomeprazole 20 mg bid; amoxicillin 750 mg bid; and clarithromycin 200 or 400 mg bid). All CAM-resistant H. pylori were eradicated by V-AC, as measured by the urea breath test around 8 weeks after eradication. Safety was evaluated by patient questionnaires., Results: The intention-to-treat and per-protocol eradication rates of V-AC in the CAM-susceptible H. pylori-infected patients were 87.3% (95% confidence interval 75.5%-94.7%) and 88.9% (77.4%-95.8%). The respective eradication rates of PPI-AC were 76.5% (62.5%-87.2%) and 86.7% (73.2%-94.9%). No significant difference was observed between the V-AC and PPI-AC regimes in terms of the intention-to-treat (P = .21) or per-protocol (P = .77) analyses. The questionnaire scores did not differ significantly between the groups. Both the intention-to-treat and per-protocol eradication rates of V-AC in the CAM-resistant patients were 82.9% (67.9%-92.8%)., Conclusion: The eradication rate of V-AC treatment in the CAM-susceptible H. pylori-infected patients was <90%, as was that by PPI-AC, thus V-AC is not ideal regimen in CAM-susceptible H. pylori. However, the 82.9% eradication rate of V-AC in the CAM-resistant infections may indicate the potential of V-AC with modified dose, dosing interval, and treatment duration. (UMIN000016337)., (© 2017 John Wiley & Sons Ltd.)