The purpose of this study was to clarify the clinical characteristics and treatment outcomes of Barrett's esophageal adenocarcinoma (BEA) patients who underwent endoscopic submucosal dissection (ESD), including changes over time. To evaluate the clinical characteristics and outcomes of patients with BEA who underwent ESD at 6 institutions in Kagoshima Prefecture from September 2007 to July 2020. In addition, we divided the 12-year period from 2008 to 2019 into the first half and the second half, and added esophageal squamous cell carcinoma in which ESD was performed every 6 years, and compared the percentage of BEA to the total number of esophageal ESD. BEA was more common in elderly men with a history of smoking. ESD for BEA could be performed safely. The absolute number of BEAs increased over time. The number of esophageal cancers underwent ESD in this prefecture is increasing year by year, and includes a certain frequency of BEA.

Background: Elobixibat is a novel bile acid transporter inhibitor for the treatment of chronic constipation. Its new pharmacological mechanism, which is different from conventional drugs, is expected to become one of the new treatment options.

Objectives: The aim of this study was to evaluate the efficacy and safety of elobixibat in patients with chronic constipation.

Methods: This was a prospective study from April 2019 to March 2021 at our hospital. A total of 32 patients (male; 21, mean age; 72.3 years) with symptoms of chronic constipation were enrolled. Among them, 16 patients (50.0%) were aged 75 years or older. Elobixibat 10 mg/day was administered for two weeks, and followed by 10 weeks assigned either 5, 10 or 15 mg/day according to the degree of symptom control. Changes in the Constipation Scoring System (CSS) score and the Bristol Stool Form Scale (BSFS) were measured before and 2, 4 and 12 weeks after elobixibat administration. In addition, LDL cholesterol concentrations were measured before and 4 and 12 weeks after elobixibat administration.

Results: At 2 weeks, the total CSS score was significantly improved from 11.69±4.51 to 7.56±4.05, and maintained at 4 and 12 weeks. The improvement of score was confirmed in six of eight CSS items, except for abdominal pain and duration of suffering from disturbed defecation. The BSFS was also significantly improved from 2.56±1.71 to 4.47±0.87, and maintained at 4 and 12 weeks nearly close to score of 4, indicating the normal stool form. At 4 weeks, LDL cholesterol concentrations were significantly decreased from 104.5±30.3 mg/dL to 92.2±28.7 mg/dL, and maintained at 12 weeks. Adverse events were observed in 13 of 32 patients (40.6%), and most common events were abdominal pain in nine patients (28.1%) and diarrhea in seven patients (21.9%).

Conclusion: Our findings suggest that elobixibat may be a useful treatment option in the elderly and male patients with chronic constipation.

A 71-year-old man was diagnosed with a bowel obstruction caused by rectal cancer. He underwent intersphincteric resection and 12 courses of adjuvant chemotherapy (mFOLFOX6). He showed no recurrence during the follow-up. However, he experienced right hypochondrial pain and was admitted with a diagnosis of acute cholangitis with disseminated intravascular coagulation. On day 18 of hospitalization, he developed a sudden headache and a simple head computed tomography showed a cerebral hemorrhage. He died on the same day. We considered that the cause of the hemorrhage was a hemorrhagic cerebral infarction or a cerebellar metastasis.

A 77-year-old man who underwent liver anterior resection for hepatocellular carcinoma. At postoperative day (POD) 15, he had blood stool. Urgent colonoscopy examination showed oozing from a cecal ulcer with border irregularity. Clinical findings and the results of stool culture could not identify the cause of cecal ulcer. The pathological findings from ulcer biopsy revealed that not only local abscess but also small number of epithelial apoptosis were observed in the crypts. He was diagnosed with an NSAIDs-induced cecal ulcer due to usage of postoperative pain killer medicine. The oozing from a cecal ulcer was naturally stopped. A postoperative usage of NSAIDs for elderly patients after surgery should be avoided as far as possible to prevent NSAIDs-induced colitis.