Ishiyama Akiyoshi, Namikawa Ken, Tokai Yoshitaka, Yoshimizu Shoichi, Horiuchi Yusuke, Yoshio Toshiyuki, Hirasawa Toshiaki, Tsuchida Tomohiro, Itoh Fumio, Fujisaki Junko
Department of Endoscopy Cancer Institute Hospital Gastroenterology Center Tokyo Japan.
Department of Gastroenterology St. Marianna University School of Medicine Kawasaki Japan.
JGH Open. 2021 May 6;5(6):653-657. doi: 10.1002/jgh3.12549. eCollection 2021 Jun.
l-Menthol has smooth muscle-relaxing and antiperistaltic effects. We examined its effectiveness against peristalsis resumption during endoscopic submucosal dissection (ESD) of gastric tumors.
We retrospectively examined clinical data of 485 patients (501 lesions) who underwent ESD for upper gastrointestinal tumors in 2017. We included 119 patients (127 lesions) in whom peristaltic movement resumed during ESD and l-menthol was applied; 366 patients (374 lesions) without l-menthol application were used as controls. Video recordings were reviewed to determine whether l-menthol suppressed peristalsis resumption.
In cases with l-menthol application, 2 (2.9%), 36 (14.3%), and 89 (71.2%) lesions were found in the upper (U), middle (M), and lower (L) regions, respectively. In the control group, the corresponding values were 66 (17.6%), 215 (57.5%), and 93 (24.9%), respectively. l-Menthol efficacy was observed in 116 of the 127 treated lesions (91.3%), over 90% of which were in the posterior wall of the U region, anterior wall and greater curvature of the M region, and anterior wall and lesser curvature of the L region. The most and least effective areas for l-menthol application were the anterior wall of gastric antrum and posterior wall of the M region, respectively. The mean time from application to peristalsis inhibition was 8.7 s. No adverse effects were observed; perforation and secondary hemorrhage were not significantly different between the groups.
Direct l-menthol application to the submucosal layer during mucosal resection affects smooth muscles and rapidly inhibits peristalsis resumption. Clinically, l-Menthol can be used to suppress peristalsis recurrence during ESD, without adverse effects.
l-薄荷醇具有平滑肌松弛和抗蠕动作用。我们研究了其在胃肿瘤内镜黏膜下剥离术（ESD）期间对蠕动恢复的抑制效果。
我们回顾性分析了2017年接受上消化道肿瘤ESD治疗的485例患者（501个病灶）的临床资料。其中包括119例（127个病灶）在ESD期间蠕动恢复且应用了l-薄荷醇的患者；366例（374个病灶）未应用l-薄荷醇的患者作为对照。通过查看视频记录来确定l-薄荷醇是否抑制了蠕动恢复。
在应用l-薄荷醇的病例中，上（U）、中（M）、下（L）区域的病灶分别有2个（2.9%）、36个（14.3%）和89个（71.2%）。在对照组中，相应数值分别为66个（17.6%）、215个（57.5%）和93个（24.9%）。在127个接受治疗的病灶中有116个（91.3%）观察到了l-薄荷醇的效果，其中超过90%位于U区域后壁、M区域前壁和大弯侧以及L区域前壁和小弯侧。l-薄荷醇应用最有效和最无效的区域分别是胃窦前壁和M区域后壁。从应用到蠕动抑制的平均时间为8.7秒。未观察到不良反应；两组之间穿孔和继发性出血无显著差异。
在黏膜切除期间直接将l-薄荷醇应用于黏膜下层会影响平滑肌并迅速抑制蠕动恢复。临床上，l-薄荷醇可用于抑制ESD期间的蠕动复发，且无不良反应。
