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Background: Transnasal esophagogastroduodenoscopy (EGD) has been suggested to be better tolerated by the cardiovascular system with a lower elevation of systolic blood pressure (BP) than oral EGD. However, limited information is available on the precise comparison of cardiovascular responses between the two endoscopic procedures using the same ultrathin scope. Methods: A prospective patient-centered randomized study was performed to examine BP, pulse rate (P) and peripheral blood oxygen saturation (SpO2) during nasal and oral EGD using the same ultrathin endoscope. The acceptability of EGD was also assessed using a visual analog scale. A total of 1147 patients were divided into four groups: patients who preferred oral or nasal EGD underwent endoscopy according to their preference (preferred group) and patients without preference were randomly assigned to oral and nasal EGD (randomized group). Results:The study design excluded a bias of the patient's preference. The randomized group involved 149 patients among whom 74 and 75 cases were assigned to the transnasal and oral EGD groups, respectively. The results in the randomized group confirmed a significantly lower elevation of BP in patients undergoing transnasal EGD than those undergoing oral EGD, while the increase in P was slightly smaller in patients undergoing the nasal procedure. Changes in SpO2 were minimal in either procedure. Analyses of patient acceptability showed a favorable evaluation of nasal EGD. Conclusions: The present study confirmed less cardiovascular stress using nasal EGD than oral endoscopy when compared using the same ultrathin scope.

References1 Mori A, Asano T, Maruyama T et al. Trans− nasal ERCP/ENBD using an ultrathin esoph− agogastroduodenoscope.

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Juvenile hemochromatosis (JH), type 2A hemochromatosis, is a rare autosomal recessive disorder of systemic iron overload due to homozygous mutations of HJV (HFE2), which encodes hemojuvelin, an essential regulator of the hepcidin expression, causing liver fibrosis, diabetes, and heart failure before 30 years of age, often with fatal outcomes. We report two Japanese sisters of 37 and 52 years of age, with JH, who showed the same homozygous HJV I281T mutation and hepcidin deficiency and who both responded well to phlebotomy on an outpatient basis. When all reported cases of JH with homozygous HJV mutations in the relevant literature were reviewed, we found—for the first time—that JH developed in females and males at a ratio of 3:2, with no age difference in the two groups. Furthermore, we found that the age of onset of JH may depend on the types of HJV mutations. In comparison to patients with the most common G320V/G320V mutation, JH developed earlier in patients with L101P/L101P or R385X/R385X mutations and later in patients with I281T/I281T mutations.