Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

Background/Aims: Bowel urgency is an important symptom for quality of life determination in patients with ulcerative colitis (UC). Few clinical studies have focused on bowel urgency as an efficacy endpoint. Budesonide foam enema has shown efficacy for clinical and endoscopic improvement in mild-to-moderate UC. We evaluated the improvement of clinical symptoms (bowel urgency), safety, and treatment impact of twice-daily budesonide foam enema on the quality of life in patients with UC. Methods: This open-label, multicenter, prospective observational study comprised a 4-week observation period assessing the effectiveness and safety of twice-daily budesonide foam enema. Mild-to-moderate UC patients who had bowel urgency were included. Patients collected data daily in an electronic patient-reported outcome system or logbooks. The primary endpoint was the rate of resolution of bowel urgency at the end of the 4-week observation period. The rate of bowel incontinence was also assessed. Results: Sixty-one patients were enrolled. Of patients with a final evaluation, the rate of resolution of bowel urgency was 58.5% (31/53; 95% confidence interval, 44.1%–71.9%). Bowel urgency decreased over time, with a significant difference observed on day 7 versus day 0. Bowel incontinence showed a decreasing trend from day 5, with a significant difference confirmed on day 12 versus day 0. The clinical remission rate was 64.4% (38/59; 95% confidence interval, 50.9%–76.4%). One adverse event not related to budesonide rectal foam occurred. Conclusions The findings suggest that bowel urgency can be improved early with twice-daily budesonide foam enema. No new safety signals were observed.

Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

Background/Aims: Bowel urgency is an important symptom for quality of life determination in patients with ulcerative colitis (UC). Few clinical studies have focused on bowel urgency as an efficacy endpoint. Budesonide foam enema has shown efficacy for clinical and endoscopic improvement in mild-to-moderate UC. We evaluated the improvement of clinical symptoms (bowel urgency), safety, and treatment impact of twice-daily budesonide foam enema on the quality of life in patients with UC. Methods: This open-label, multicenter, prospective observational study comprised a 4-week observation period assessing the effectiveness and safety of twice-daily budesonide foam enema. Mild-to-moderate UC patients who had bowel urgency were included. Patients collected data daily in an electronic patient-reported outcome system or logbooks. The primary endpoint was the rate of resolution of bowel urgency at the end of the 4-week observation period. The rate of bowel incontinence was also assessed. Results: Sixty-one patients were enrolled. Of patients with a final evaluation, the rate of resolution of bowel urgency was 58.5% (31/53; 95% confidence interval, 44.1%–71.9%). Bowel urgency decreased over time, with a significant difference observed on day 7 versus day 0. Bowel incontinence showed a decreasing trend from day 5, with a significant difference confirmed on day 12 versus day 0. The clinical remission rate was 64.4% (38/59; 95% confidence interval, 50.9%–76.4%). One adverse event not related to budesonide rectal foam occurred. Conclusions The findings suggest that bowel urgency can be improved early with twice-daily budesonide foam enema. No new safety signals were observed.

Background/Aims: Bowel urgency is an important symptom for quality of life determination in patients with ulcerative colitis (UC). Few clinical studies have focused on bowel urgency as an efficacy endpoint. Budesonide foam enema has shown efficacy for clinical and endoscopic improvement in mild-to-moderate UC. We evaluated the improvement of clinical symptoms (bowel urgency), safety, and treatment impact of twice-daily budesonide foam enema on the quality of life in patients with UC. Methods: This open-label, multicenter, prospective observational study comprised a 4-week observation period assessing the effectiveness and safety of twice-daily budesonide foam enema. Mild-to-moderate UC patients who had bowel urgency were included. Patients collected data daily in an electronic patient-reported outcome system or logbooks. The primary endpoint was the rate of resolution of bowel urgency at the end of the 4-week observation period. The rate of bowel incontinence was also assessed. Results: Sixty-one patients were enrolled. Of patients with a final evaluation, the rate of resolution of bowel urgency was 58.5% (31/53; 95% confidence interval, 44.1%–71.9%). Bowel urgency decreased over time, with a significant difference observed on day 7 versus day 0. Bowel incontinence showed a decreasing trend from day 5, with a significant difference confirmed on day 12 versus day 0. The clinical remission rate was 64.4% (38/59; 95% confidence interval, 50.9%–76.4%). One adverse event not related to budesonide rectal foam occurred. Conclusions The findings suggest that bowel urgency can be improved early with twice-daily budesonide foam enema. No new safety signals were observed.

A 32-year-old woman was diagnosed with Takayasu's arteritis 5 years ago and underwent aortic valve replacement for aortic regurgitation 1 year ago. She had been taking Prednisolone and Azathioprine for Takayasu's arteritis, but these drugs were switched to subcutaneous Tocilizumab 4 months ago. One month ago, she had dyspnea on exertion, and 2 days ago, chest discomfort appeared, and she came to our hospital. Blood tests showed CRP 0.02 mg/dl, and echocardiography and CT showed perivalvular leakage and aortic root pseudoaneurysm, which led us to suspect aortic root pseudoaneurysm due to Takayasu's arteritis and to perform emergency surgery. Although a circumferential pseudoaneurysm was observed at the aortic root, no destruction of the prosthetic valve was observed. The suture from the previous surgery was attached to the sawing cuff of the prosthetic valve, and the prosthetic valve was not fixed to the aortic annulus and could be easily removed. The Bentall operation was performed using a bioprosthetic valve. The histopathological diagnosis was subacute infective endocarditis, and the patient was diagnosed with a pseudoaneurysm of the aortic root due to infection. The patient had a good postoperative course and was discharged home on the 19th day. We report a case of Takayasu's arteritis with valve annular abscess after AVR, which was treated surgically during biologic drug administration.

Background/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO). Methods: Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared. Results: Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS. Conclusions No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

Purpose: It aims to investigate the contents of food supplies, gastrointestinal symptoms, and stated preferences of evacuees during the first two weeks after the earthquake. Methods: Thirty-four evacuees from evacuation shelters and 12 evacuees from geriatric care facilities were surveyed.Subjective and comprehensive nutritional assessment questionnaires were administered to the evacuees, and their dissatisfaction and preferences were also recorded in an open-ended format. Results: Weight decreased, remained unchanged, increased, or was unknown for 4, 24, 6, and 0 evacuees from the shelters and in 0, 8, 1, and 3 evacuees from the facilities. The number of respondents who reported a decrease, change, or decrease in food intake was 4, 22, and 1 from the evacuation centers and 1, 10, and 1 from the facilities, indicating a large number of changes in the evacuation centers. Reasons for weight gain included “feeling that they should not leave food behind,” “eating a lot of high-calorie food,” and “eating sweets and cup noodles.” Constipation was the most common gastrointestinal symptom (n=5) in the evacuation centers, while diverse symptoms were reported from the facilities. Constipation in the facilities was thought to be related to the high carbohydrate content of the food. Only two respondents were satisfied with the shelter, and the majority complained of dissatisfaction. The most common complaints were “I don’t like bread in the morning (I prefer rice);” “Too sweet;” and “Onigiri (rice ball) is too big,” but there were also complaints about the eating environment on the floor, such as “I lose [my] appetite when eating on the floor due to abdominal pressure” (I prefer to eat on a chair at a table). The majority of the respondents in the facilities did not have any complaints. All of the respondents in the shelters expressed a wide variety of food preferences, including vegetables, rice in the morning, meat, fruit, and foods that were not available due to lack of refrigeration, such as carbonated beverages and ice cream. Some respondents expressed that they were tired of being given food unilaterally and having no choice, such as “I want to choose my own food” and “I want a vending machine [to choose my own food].” There were almost no requests for food at the facilities, and the majority of the respondents were satisfied with their situation. The food was supplied by volunteers and the SelfDefense Forces, which were out of sync with the needs of the evacuees at the evacuation center. However, at the facilities, food was sent to a geriatric care facility in a remote area that accounted for the needs of the victims. Conclusion Evacuees were grateful for the food supplies immediately after the disaster, but gradually became dissatisfied.Meals are one of the pleasures in evacuation centers and are important for reducing mental stress. Evacuation centers should consider the needs of evacuees when providing food to evacuees.

Purpose: It aims to investigate the contents of food supplies, gastrointestinal symptoms, and stated preferences of evacuees during the first two weeks after the earthquake. Methods: Thirty-four evacuees from evacuation shelters and 12 evacuees from geriatric care facilities were surveyed.Subjective and comprehensive nutritional assessment questionnaires were administered to the evacuees, and their dissatisfaction and preferences were also recorded in an open-ended format. Results: Weight decreased, remained unchanged, increased, or was unknown for 4, 24, 6, and 0 evacuees from the shelters and in 0, 8, 1, and 3 evacuees from the facilities. The number of respondents who reported a decrease, change, or decrease in food intake was 4, 22, and 1 from the evacuation centers and 1, 10, and 1 from the facilities, indicating a large number of changes in the evacuation centers. Reasons for weight gain included “feeling that they should not leave food behind,” “eating a lot of high-calorie food,” and “eating sweets and cup noodles.” Constipation was the most common gastrointestinal symptom (n=5) in the evacuation centers, while diverse symptoms were reported from the facilities. Constipation in the facilities was thought to be related to the high carbohydrate content of the food. Only two respondents were satisfied with the shelter, and the majority complained of dissatisfaction. The most common complaints were “I don’t like bread in the morning (I prefer rice);” “Too sweet;” and “Onigiri (rice ball) is too big,” but there were also complaints about the eating environment on the floor, such as “I lose [my] appetite when eating on the floor due to abdominal pressure” (I prefer to eat on a chair at a table). The majority of the respondents in the facilities did not have any complaints. All of the respondents in the shelters expressed a wide variety of food preferences, including vegetables, rice in the morning, meat, fruit, and foods that were not available due to lack of refrigeration, such as carbonated beverages and ice cream. Some respondents expressed that they were tired of being given food unilaterally and having no choice, such as “I want to choose my own food” and “I want a vending machine [to choose my own food].” There were almost no requests for food at the facilities, and the majority of the respondents were satisfied with their situation. The food was supplied by volunteers and the SelfDefense Forces, which were out of sync with the needs of the evacuees at the evacuation center. However, at the facilities, food was sent to a geriatric care facility in a remote area that accounted for the needs of the victims. Conclusion Evacuees were grateful for the food supplies immediately after the disaster, but gradually became dissatisfied.Meals are one of the pleasures in evacuation centers and are important for reducing mental stress. Evacuation centers should consider the needs of evacuees when providing food to evacuees.