No abstract

According to the findings, EBL should be considered safe, effective, and superior to endoclips for the treatment of colonic diverticular hemorrhage. The EBL procedure should be attempted as the initial therapy especially for the right-sided disease.

Although lower gastrointestinal bleeding generally has a less severe course and stops spontaneously in most cases without therapeutic intervention, some patients require endoscopic, surgical, or angiographic treatment depending on the nature of the bleeding. We applied endoscopic band ligation (EBL) with a water-jet scope to bleeding colonic diverticula and evaluated the efficacy and safety of EBL retrospectively. Five consecutive patients were diagnosed as having colonic diverticular hemorrhage, and were treated with EBL at St Luke's International Hospital in Tokyo from June 2009 to August 2009. Comorbid diseases, usage of anti-platelet agents, hemoglobin level on admission, procedural time, complications such as perforation and abscess formation, and rebleeding after EBL were retrospectively evaluated. In all cases, EBL achieved successful immediate hemostasis without any procedural complications. In four of five cases, bleeding colonic diverticula were everted after EBL. The mean length of hospital stay after EBL was 5 days (range 4-8 days). No patient exhibited clinical evidence of further bleeding during the mean follow-up period of 3 months (range 2-4 months), and no further intervention was needed after EBL. EBL with a water-jet scope is considered to be a safe and effective endoscopic treatment for colonic diverticular hemorrhage.

Endoscopic submucosal dissection and preoperative assessment with EUS are effective for treating rectal carcinoid tumors and enabling en bloc resection.

Patients with polycystic ovary syndrome (PCOS) had significantly higher levels of total insulin-like growth factor (IGF-I) than those in age- and weight-matched controls (PCOS, 230 ± 21 ng/ml; control, 180 ± 16 ng/ml; mean ± SE, p < 0.05) as well as free IGF-I (PCOS, 3.8 ± 0.2 ng/ml; control, 3.0 ± 0.2 ng/ml; p < 0.05). These elevated levels of IGF-I were correlated slightly with levels of LH and LH/FSH ratio (r = 0.171, p < 0.05 and r = 0.239, p < 0.01, respectively). Elevated fasting levels of insulin and decreased levels of IGF binding protein (32K-BP) were also observed in PCOS, and the levels of 32K-BP in PCOS were negatively correlated with insulin (r = -0.39, p < 0.01). These results suggest that elevated IGF-I levels and decreased 32K-BP levels in the circulation are one of the endocrinological features of PCOS and that insulin is responsible for the clinical manifestation of decreased 32K-BP levels in PCOS.