A mixture of higher molecular weight sodium hyaluronate with a sugar solution (particularly 20 % dextrose), with or without glycerin, should be regarded as a cost-effective option for creating SFCs instead of the conventional SH solution made with the same amount of a 1 % 800 kDa SH preparation and normal saline.

Full-thickness resection for gastric malignancy carries a risk of peritoneal dissemination due to opening of the gastric lumen. We evaluated the feasibility and safety a novel method of full-thickness resection without transmural communication, called nonexposed endoscopic wall-inversion surgery in ex vivo and in vivo porcine models. Six explanted porcine stomachs and 6 live pigs were used for this study. After marking and submucosal injection around 3 cm simulated lesions, the seromuscular layer was laparoscopically cut and sutured with the lesion inverted to the inside. Consecutively, a mucosubmucosal incision was made endoscopically. Three pigs used for the survival study were monitored for 7 days. All 12 lesions were successfully resected en bloc without perforation. The 3 pigs survived for 1 week without adverse events, and necropsy revealed neither leakage nor abscess formation related to the operation. We demonstrated nonexposed endoscopic wall-inversion surgery to be technically feasible and safe in both ex vivo and in vivo porcine studies.

Figure 2 The edematous stroma was filled with enlarged serpiginous veins and arterioles, leading to a diagnosis of angiodysplasia. Angiodysplasia is one of the major causes of lower gastrointestinal bleeding, often encountered during emergency colonoscopy. The typical endoscopic appearance is often reported to be a slightly elevated reddish lesion, reflecting the dilated, tortuous veins in the submucosa. Lesions having a polypoid morphology are extremely rare. This case suggests us the possibility of angiodysplasia as a polypoid lesion, and the need for care when performing biopsy or endoscopic polypectomy. Figure 1 A healthy 59-year-old man underwent colonoscopy because of a positive fecal blood test. A yellowish-white lobulated polyp, 15-mm in size with a ªbabys handº-like morphology, was seen. Endoscopic polypectomy for suspected leiomyoma was performed without complication. Images in Focus 379This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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