近年，内視鏡機器の進歩，発展と治療薬の改善によりGERD の診断，治療や，ピロリ除菌療法も変化してきた．当院での検討ではGERD に関してはここ数年において増加傾向は見られなかったが，治療に関しては，ボノプラザン（VPZ）の登場で，第一選択薬としてのプロトンポンプ阻害薬（PPI）の使い分けが必要となるかもしれない．除菌治療に関しては，明らかにVPZ を使用した除菌療法で除菌率が高値であった．今後もさらに内視鏡機器，薬剤の改良発展が進むと思われ，適切に対応するには，それぞれの分野で，お互いに十分なコミュニケーションをとる必要があると思われた．

　Background: Arterial stiffness is a predictor of cardiovascular disease and is associated with atherosclerotic risk factors. The effects of atherosclerotic risk factors on vascular age and subsequent change were investigated in patients scored according to the cardio-ankle vascular index (CAVI).

　Methods: Patients comprised 181 men and 116 women scored according to the CAVI twice at our center. All were divided into the following 3 groups based on vascular age as evaluated according their CAVI score: low vascular age (LVA); equivalent vascular age (EVA); or high vascular age (HVA). They were then divided into the following 3 groups by comparing vascular age evaluated one year later with that obtained at the initial evaluation: change upward; no change; or change downward. The mean values of atherosclerotic risk factors and changes were compared among each group. Atherosclerotic risk factors comprised atherosclerosis-related diseases (hypertension, dyslipidemia, and diabetes), age, height, weight, Body Mass Index (BMI) score, abdominal circumference, Risk Factor (RF) score (number of atherosclerotic risk factors), metabolic score (propensity to metabolic syndrome), blood pressure (BP), cholesterol, triglyceride, fasting blood sugar (FBS), HbA1c, and smoking score.

　Results: In men, the LVA group showed a lower RF score, metabolic score, BP, FBS, and HbA1c, and a higher HDL-cholesterol (HDL-C) score. Vascular age changed upward with increasing HDL-C and downward with increasing abdominal circumference. In women, the LVA group showed a higher BMI score.

　Conclusions: The effects of atherosclerotic risk factors on vascular age were greater in men. In women, the BMI score was associated with vascular age.

　Background: Patients with gastrointestinal cancer tend to develop thrombotic diseases. Endoscopic submucosal dissection (ESD) to treat gastrointestinal lesions is thought to put patients at possible risk for thrombosis because the same posture must be maintained for long periods.

　Objectives: We aimed to clarify the incidence of thrombosis and hypercoagulation after ESD to treat gastrointestinal neoplasms.

　Methods: We selected 565 consecutive patients with esophageal (76 patients), gastric (274 patients) or colorectal (215 patients) neoplasms that were treated by ESD between April, 2010 and October, 2018. We determined the prevalence of thrombosis at six months after ESD from medical charts and compared plasma d-dimer values (when available) before and immediately after ESD.

　Results: Thrombotic events did not arise in any patients after ESD. Pre- and postoperative ddimer was found in 100 patients. Values for d-dimer were high before, and significantly elevated after ESD in 24 and 35 of 100 patients, respectively. Multivariate analysis associated antithrombotic agents and age ≥75 years with high preoperative d-dimer values, and identified upper gastrointestinal lesions and underlying chronic kidney disease as significant factors related to elevated ddimer level.

　Conclusions: We found that ESD is safe and that early-stage gastrointestinal cancer is not a high risk for thrombosis. Upper gastrointestinal lesions and chronic kidney disease seem to be predisposing factors for hypercoagulation states, indicating that endoscopists should consider the possibility of thrombosis after ESD in such patients.

「告知」

本誌50巻2号（ｐ95～ｐ100）に掲載された論文『経皮的炭酸ガス分圧測定装置の睡眠時無呼吸症候群における臨床的有用性の検討』は、不備があることから、著者から取 り下げの申請がなされ、編集委員会で受理した。

さらに同論文の修正論文を本誌Ｐ１に掲載する。

　睡眠時無呼吸症候群（SAS）は睡眠時に起こる上部気道の狭窄や閉塞状態により肺胞換気量の減少を伴うため，低酸素血症ばかりではなく高炭酸ガス血症状態であることが考えられている．

　このような病態において，動脈血炭酸ガス分圧は病状の把握や治療による経過を知る上で大切な指標であり，SAS 患者は覚醒時にも肺胞低換気状態の可能性が疑われる．そのためにSASの診断時や治療開始時に覚醒時の精密評価として非侵襲的に動脈血炭酸ガス分圧を測定し，その有用性を検討した．

　経皮的炭酸ガス分圧（PtcCO₂）測定装置（TOSCA 500^TM）を用いPtcCO₂ を測定し初診覚醒時におけるSAS の重症度と関連を検討した．

　SAS の重症度やBMI とは有意な相関関係は認められなかったが，睡眠関連低換気障害（SRHD）や肥満肺胞低換気症候群（OHS）などの評価のためにPtcCO₂ の測定は有用と考えられる．