Clinical Application of L-Menthol in the Upper Gastrointestinal Endoscopic Procedure

Kikuchi, Hitomi; Hikichi, Takuto; Takagi, Tadayuki; Suzuki, Rei; Watanabe, Ko; Nakamura, Jun; Sugimoto, Mitsuru; Waragai, Yuichi; Konno, Naoki; Asama, Hiroyuki; Takasumi, Mika; Watanabe, Hiroshi; Obara, Katsutoshi; Ohira, Hiromasa

doi:10.5387/fms.2015-18

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…As regards tumor location, trainees missed the lesions in the lower or lesser curvature of the stomach compared with experienced endoscopists. We speculated that insufficient air insufflation and poor upside angulation were attributed to a high miss rate in the lesser curvature, and poor observation due to gastric peristalsis might result in missing EGCs in the lower stomach [ 29 ]. EGCs in the posterior wall are difficult to detect because of the tangential endoscopic vision to the posterior wall [ 30 ]; however, no significant difference in detection rates was noted.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of False-Negative Early Gastric Cancers: A Retrospective Study of Endoscopic Submucosal Dissection Cases

Oka

Iwai

Okuda

et al. 2021

Gastroenterology Research and Practice

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Background. We frequently encounter early gastric cancer (EGC) that could not be detected in the previous esophagogastroduodenoscopy even if the procedure was annually performed. However, little evidence exists regarding the characteristics of false-negative EGCs. Our aim was to reveal the clinical features of false-negative EGCs. Methods. We retrospectively reviewed cases of endoscopic submucosal dissection (ESD) for EGCs in Fukuchiyama City Hospital between January 2013 and May 2019. False-negative EGCs were defined as EGCs within 3 years of negative endoscopy. We evaluated the clinical characteristics of false-negative and initially detected EGCs and the difference in the detected and last missed endoscopy in false-negative EGCs. The miss rates of false-negative EGCs were compared between trainees (nonboard-certified endoscopists) and experienced endoscopists (board-certified endoscopists); thereafter, the characteristics of false-negative EGCs missed by trainees were investigated. Results. Of 219 cases, 119 were classified as false-negative EGCs. False-negative EGCs were characterized as smaller lesions, which presented with normal color or gastritis-like appearance, and were diagnosed after ESD and H. pylori eradication ( P < 0.01 ). The rate of trainees in the last missed endoscopy was significantly higher than that in the detected endoscopy. The miss rate of false-negative EGC by trainees was higher than that of experienced endoscopists but not significantly different (0.70% vs. 0.57%, P = 0.08 ). The false-negative EGCs missed by trainees were characterized as reddish or well-differentiated lesions, which were located in the lower or lesser curvature of the stomach ( P < 0.05 ). Conclusion. The characteristics of false-negative EGCs were similar to those of H. pylori-eradicated EGC. Procedures with shortened examination time and those performed by trainees were risk factors of missing false-negative EGCs. Trainees should pay attention to reddish or well-differentiated EGCs located in the lower or lesser curvature of the stomach.

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Section: Discussionmentioning

confidence: 99%

Clinical Features of False-Negative Early Gastric Cancers: A Retrospective Study of Endoscopic Submucosal Dissection Cases

Oka

Iwai

Okuda

et al. 2021

Gastroenterology Research and Practice

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“…10 Antiperistaltic and antispasmodic effects of peppermint oil or L-menthol have been studied in several trials. [11][12][13] Japanese researchers have confirmed that L-menthol could improve the stability of the visual field both in endoscopic diagnosis and treatment, including gastric endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), [14][15][16] thereby making it a useful antispasmodic drug for upper GI endoscopy.…”

Section: Introductionmentioning

confidence: 99%

Antiperistaltic effect and safety of l‐menthol oral solution on gastric mucosa for upper gastrointestinal endoscopy in Chinese patients: Phase III, multicenter, randomized, double‐blind, placebo‐controlled study

Meng

Zhi

et al. 2021

Digestive Endoscopy

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Objective The topical antispasmodic agent l‐menthol is commonly used for gastric peristalsis suppression during diagnostic upper gastrointestinal (GI) endoscopy. We evaluated the efficacy and safety of a single dose l‐menthol solution in suppressing gastric peristalsis during upper GI endoscopy in Chinese patients. Methods In this phase III, multicenter, randomized, double‐blind, placebo‐controlled study (ClinicalTrials.gov: NCT03263910), 220 patients scheduled to undergo upper GI endoscopy at five Chinese referral centers received a single dose of either 160 mg of l‐menthol (n = 109) or placebo (n = 111). Both treatments were sprayed endoscopically on the gastric mucosa. An independent committee evaluated the degree of gastric peristalsis (peristaltic score: grade 1–5). Results At baseline, the proportion of patients with grade 1 peristalsis (no peristalsis) did not differ between the groups. The proportion of patients with grade 1 peristalsis post‐treatment was significantly higher in the l‐menthol group (40.37%, 44/109) versus the placebo group (16.22%, 18/111; P < 0.001); the difference between the groups was 24.15% (95% confidence interval: 12.67%–35.63%; P < 0.001). In the l‐menthol group, 61.47% of patients had grade 1 peristalsis after endoscopy versus 24.55% in the placebo group (P < 0.001). The ease of intragastric examination correlated significantly with the grade of peristalsis. The incidence of adverse events was comparable between the groups (P = 0.340). Conclusions During upper GI endoscopy, a single dose of l‐menthol solution (160 mg) sprayed on the gastric mucosa significantly attenuated gastric peristalsis versus placebo, thereby improving the visual stability without any safety concerns.

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“…Spraying peppermint oil [14,15] or L-menthol [16,17] onto the gastric mucosa during endoscopic procedure has been shown to suppress gastric peristalsis. Moreover, we have explored the benefits of peppermint oil or L-menthol in the endoscopic identification and margin determination of EGC [17,18]. Mori et al [19] have also reported that spraying L-menthol mixed with indigo carmine onto lesions allowed clear visualization of the margins of gastric lesions.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of L-Menthol Spray Application on Lesions for the Endoscopic Clarification of Early Gastric Cancer: Evaluation by the Color Difference

et al. 2019

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Introduction: Although L-menthol spray application on lesions has been shown to be effective for the endoscopic clarification of early gastric cancer (EGC), the currently available data are all based on subjective evaluations. Objectives: This study was aimed to objectively evaluate the effectiveness of L-menthol spray for the endoscopic classification of EGC. Methods: Patients with EGC treated by endoscopic submucosal dissection were included. Images taken by white light imaging (WLI) and narrow band imaging (NBI) before and after spraying L-menthol directly on a lesion were saved. The primary endpoint was a change in the color difference between the EGC lesion and surrounding mucosa (ΔE_xy) before and after L-menthol spray application. The secondary endpoints were patient factors related to the change in ΔE_xy after L-menthol spray application and the pathological findings. Results: Fifty cases of EGC were included in the analysis. The median ΔE_xy was significantly larger after L-menthol spray application than before, as assessed by either WLI (p <0.001) or NBI (p < 0.001). An increased ΔE_xy after L-menthol spray application was noted in 76 and 92% of patients by WLI and NBI, respectively. The percentage of patients with a ΔE_xy ≥5 (a level distinguishable by human eyes) was significantly larger after L-menthol spray application either by WLI (p <0.001) or NBI (p < 0.001). Pathologically, mucosal vasodilatation and stromal edema were noted after L-menthol spray application in the evaluated 2 cases. Conclusions: These results objectively demonstrate that L-menthol provides benefits in the endoscopic clarification of EGC.

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Clinical Application of L-Menthol in the Upper Gastrointestinal Endoscopic Procedure

Cited by 5 publications

References 9 publications

Clinical Features of False-Negative Early Gastric Cancers: A Retrospective Study of Endoscopic Submucosal Dissection Cases

Clinical Features of False-Negative Early Gastric Cancers: A Retrospective Study of Endoscopic Submucosal Dissection Cases

Antiperistaltic effect and safety of l‐menthol oral solution on gastric mucosa for upper gastrointestinal endoscopy in Chinese patients: Phase III, multicenter, randomized, double‐blind, placebo‐controlled study

Effectiveness of L-Menthol Spray Application on Lesions for the Endoscopic Clarification of Early Gastric Cancer: Evaluation by the Color Difference

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