Recently, the diversification of chemotherapy has brought about an increase in the number of outpatients who receive prescription drugs at insurance pharmacies after the intravenous infusion of anticancer agents at hospitals. The problem is that insurance pharmacies do not have ample knowledge of treatment plans and disease stages, and the presence or absence of cancer notification. Moreover, medication regimens, including washout, periods, have become so complicated that patient compliance rates have shown a tendency to decline gradually.
  Such being the circumstances, we have come to think that it would be better to enter into partnership with the dispensary of Senboku Kumiai General Hospital for sharing information in order to give the patients more beneficial medication instructions.
  For a start, we met with the hospital pharmacists, exchanged necessary information and ideas, got acquainted with chemotherapy regimens, and shared the tools of medication teaching. Through the participation in the guidance given by hospital pharmacists to outpatients who began to receive chemotherapy, and lectures on chemotherapy and medication by physicians and hospital pharmacists of the general hospital, we have become able to offer more appropriate counsel to the outpatients. Furthermore, we created a channel between the dispensary and Senboku Chozai Pharmacy for feedback and for asking questions about not only the conditions of the patients but also the presence or absence of cancer notification.
  We believe that our efforts have contributed toward increasing the safety and efficacy of chemotherapy.

We report herein improved methods for the safe and successful completion of endoscopic papillectomy (EP). Between January 2008 and November 2011, 12 patients underwent double-snare retracting papillectomy for the treatment of lesions of the major duodenal papilla. The main outcomes were en bloc resection rates, pathological findings, and adverse events. All of the patients (mean age, 60.1 years; range, 38 to 80 years) were diagnosed with ampullary adenoma by endoscopic forceps biopsies prior to endoscopic snare papillectomy. En bloc resection by double-snare retracting papillectomy was successfully performed for all lesions (median size, 12.3 mm), comprising six tubular adenomas, one tubulovillous adenoma, three cases of epithelial atypia, one hamartomatous polyp, and one case of duodenitis with regenerative change. Significant hemorrhage and pancreatitis were observed in one case after EP. Adenoma recurrence occurred in three patients during follow-up (median, 28.5 months) at a mean interval of 2 months postoperatively (range, 1 to 3 months). No serious adverse events were observed. Double-snare retracting papillectomy is effective and feasible for treating lesions of the major duodenal papilla. Further treatment experience, including a single-arm phase II study, needs to be accumulated before conducting a randomized controlled study.
Adenoma/pathology/*surgery ; Adult ; Aged ; Aged, 80 and over ; Ampulla of Vater/pathology/*surgery ; Biopsy ; Common Bile Duct Neoplasms/pathology/*surgery ; Dissection/*methods ; Duodenoscopy/*methods ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Treatment Outcome

With increasing global life expectancy, the significance of geriatric assessment parameters has increased. Sarcopenia is a crucial assessment parameter and is defined as the age-related loss of muscle mass and strength. Sarcopenia is widely acknowledged as a risk factor for postoperative complications in diverse advanced malignancies and has a detrimental effect on the long-term prognosis. While most studies have primarily concentrated on the correlation between sarcopenia and advanced cancer, more recent investigations have focused on the relationship between sarcopenia and early-stage cancer. Endoscopic submucosal dissection (ESD), which is less invasive than surgical intervention, is extensively employed in the management of early-stage cancer, although it is associated with complications such as bleeding and perforation. In recent years, several reports have revealed the adverse consequences of sarcopenia in patients with early-stage cancer undergoing ESD. This literature review briefly summarizes the recent studies on the association between sarcopenia and ESD.