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Background and study aims: We examined the efficacy of a novel endoscopic ligation technique with O-ring closure (E-LOC) to prevent bleeding after gastric endoscopic submucosal dissection (ESD). Patients and methods: This single-center prospective study involved consecutive patients who underwent gastric ESD with antithrombotic agents. E-LOC was performed by anchoring the nylon loop with hemoclips on both defect edges and/or the exposed muscle layer and using the O-ring band ligation around these deployed clips. The primary outcome was the post-ESD bleeding rate. The secondary outcomes were the complete closure rate, procedure time, sustained closure rate, and complications. Results: Forty-eight patients were finally analyzed. The post-ESD bleeding rate was 0%, the complete closure rate was 97.9%, and the mean closure time was 29.9 minutes. The sustained closure rate was 95.8% on postoperative day 2–3 and 33.3% on postoperative day 10–11. No complications occurred. Conclusions: E-LOC may be an effective option for closing mucosal defect after gastric ESD. However, the preventive effect on post-ESD bleeding should be further investigated in the high risk groups.

Background and study aims Exposed endoscopic full-thickness resection (EFTR) enables the operator to obtain a sufficient surgical margin. However, insufflation leakage and secure endoscopic full-thickness closure (EFTC) remain problematic. This study aimed to evaluate the safety and feasibility of a new exposed EFTR. Patients and methods Exposed EFTR was performed for 2-cm virtual lesions in different locations of the upper stomach in four dogs. EFTR mainly involved half-circumferential EFTR of the endpoint and clip-line traction. Pulley traction was applied with the forward approach for the greater curvature. EFTC involved endoscopic ligation with O-ring closure to diminish insufflation leakage, followed by over-the-scope clip closure. Results Complete resection and technical success were achieved in all four cases. One case of intraoperative bleeding was endoscopically managed. No postoperative complications occurred in any cases. The median maximum resected size was 27.5 mm. The median procedure time of the total operation, EFTR, and EFTC was 76, 37, and 35.5 minutes, respectively. The 1-month survival rate was 100 %. Conclusions This therapeutic strategy may lead to the establishment of exposed EFTR.

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Esophagogastroduodenoscopy (EGD) has a high risk of virus transmission during the current coronavirus disease 2019 era, and preventive measures are under investigation. We investigated the effectiveness of a newly developed patient-covering negative-pressure box system (Endo barrier®) (EB) for EGD. Eighty consecutive unsedated patients who underwent screening EGD with EB use were prospectively enrolled. To examine the aerosol ratio before, during, and after EGD, 0.3- and 0.5-μm aerosols were measured every 60 s using an optical counter. Moreover, the degree of contamination of the examiners’ goggles and vinyl gowns was assessed before and after EGD using a rapid adenosine triphosphate (ATP) test for simulated droplets. Data were available in 73 patients and showed that 0.3- and 0.5-μm particles did not increase in 95.8% (70/73) and 94.5% (69/73) of patients during EGD under EB. There were no significant differences in the total 0.3- or 0.5-μm particle counts before versus after EGD. The difference in the ATP levels before and after EGD was −0.6 ± 16.6 relative light units (RLU) on goggles and 1.59 ± 19.9 RLU on gowns (both within the cutoff value). EB use during EGD may provide a certain preventive effect against aerosols and droplets, decreasing examiners’ exposure to viruses.

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The schlieren photographs of in-cylinder processes in a spark-ignited premixed charge gasoline engine were observed via a transparent collimating cylinder and were presented in comparison with a pressure analysis. The schlieren photographs of the spark, the initial flame and the unburned gas ejection from the piston crevice, which is unable to be observed by direct photography, were clearly taken. It shows that the small difference in the initial combustion process among cycles is intensified by the movement of the piston during the expansion stroke. Finally, this difference appears as the cycle by cycle variation in the pressure and the rate of heat release. The observed flame size increased faster and was larger than the burned gas estimated from the pressure. The difference between them is large enough and can not be explained without considering the mixing of burned and unburned gases inside the flame front.