Abstract
We describe a case with rectal bleeding from a rectal ulcer after endoscopic mucosal resection (EMR), successfully treated with an ecabet sodium (ES) enema. A 44-year-old woman with a laterally spreading rectal tumor of a granular type, 60 mm in diameter, underwent piecemeal EMR. After the EMR, she suffered from rectal bleeding on several occasions over a period of 1 month. Although she was repeatedly treated with thermocoagulation by a heater probe to stop the bleeding, a rectal ulcer with visible vessels still remained at the resected site. Because the rectal ulcer was considered to be intractable, an ES enema was used twice a day (1.5 g) for 2 weeks, which improved rectal bleeding. Colonoscopic findings revealed that the ulcer improved with mucosal healing after the ES enema treatment. This represents the first report of an ES enema treatment in a patient with a rectal ulcer after EMR. Further studies are needed to determine the effectiveness and safety of using an ES enema in patients with EMR-related refractory colorectal ulcers.
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Tanaka S, Oka S, Chayama K. Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol. 2008;43:641–51.
Binmoeller KF, Bohnacker S, Seifert H, Thonke F, Valdeyer H, Soehendra N. Endoscopic snare excision of “giant” colorectal polyps. Gastrointest Endosc. 1996;43:183–8.
Christie JP. Colonoscopic excision of large sessile polyps. Am J Gastroenterol. 1977;67:430–8.
Nitvatvongs S, Snover DC, Fang DT. Piecemeal snare excision of large sessile colon and rectal polyps: is it adequate? Gastrointest Endosc. 1984;30:18–20.
Walsh RM, Ackroyd FW, Shellito PC. Endoscopic resection of large sessile colorectal polyps. Gastrointest Endosc. 1992;38:303–9.
Bedogni G, Bertoni G, Ricci H, Conigliaro R, Pedrazzoli C, Rossi G, et al. Colonoscopic excision of large and giant colorectal polyps. Technical implications and results over eight years. Dis Colon Rectum. 1986;29:831–5.
Kinoshita M, Kume E, Tamaki H. Roles of prostaglandins, nitric oxide and the capsaicin insensitive sensory nerves in gastroprotection produced by ecabet sodium. J Pharmacol Exp Ther. 1995;275:494–501.
Kono T, Nomura M, Kasai S, Kohgo Y. Effect of ecabet sodium enema on mildly to moderately active ulcerative proctosigmoiditis: an open-label study. Am J Gastroenterol. 2001;96:793–7.
Tanaka S, Haruma K, Oka S, Takahashi R, Kunihiro M, Kitadai Y, et al. Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc. 2001;54:62–6.
Kakushima N, Fujishiro M, Kodashima S, Kobayashi K, Tateishi A, Iguchi M, et al. Histopathologic characteristics of gastric ulcers created by endoscopic submucosal dissection. Endoscopy. 2006;38:412–5.
Lin HJ, Hsieh YH, Tseng GY, Perng CL, Chang FY, Lee SD. A prospective, randomized trial of endoscopic hemoclip versus heater probe thermocoagulation for peptic ulcer bleeding. Am J Gastroenterol. 2002;97:2250–4.
Onoda Y, Magaribuchi T, Tamaki H. Effects of 12-sulfodehydroabietic acid monosodium salt (TA-2711), a new anti-ulcer agent, on gastric secretion and experimental ulcers in rats. Jpn J Pharmacol. 1989;51:65–73.
Kinoshita M, Tamaki H. Possible mechanism of increase in gastric mucosal PGE2 and PGI2 generation induced by ecabet sodium, a novel gastroprotective agent. Dig Dis Sci. 1997;42:83–90.
Onoda Y, Magaribuchi T, Tamaki H. Effects of the new anti-ulcer agent 12-sulfodehydroabietic acid monosodium salt on duodenal alkaline secretion in rats. Arzneimittelforschung. 1990;40:576–8.
Fu HY, Kawahara A, Nakai R, Matsumura N, Kawano S. Effects of the drugs enhancing mucosal protective agents on RGM-1 strain for expression of COX-2 and production of PGE2 (in Japanese). Prog Med. 2002;22:2024–8.
Ichikawa T, Ishihara K, Hayashida H, Hiruma H, Saigenji K, Hotta K. Effects of ecabet sodium, a novel gastroprotective agent on mucin metabolism in rat gastric mucosa. Dig Dis Sci. 2000;45:606–13.
Ito Y, Sugawara Y, Takaiti O, Nakamura S. Metabolic fate of a new anti-ulcer drug (+)-(1R, 4aS, 10aR)-1, 2, 3, 4, 4a, 9, 10, 10a-octahydro-1, 4a-dimethyl-7-(1-methyl)-6-sulfo-1-phenan-threnecarboxylic acid 6-sodium salt pentahydrate (TA-2711). II. Distribution in the rat stomach. J Pharmacobiodyn. 1991;14:547–54.
Iizuka M, Itou H, Konno S, Shirasaka T, Horie Y, Shindo K, et al. Efficacy of ecabet sodium enema on steroid resistant or steroid dependent ulcerative colitis. Gut. 2006;55:1523.
Monteleone G, Caprioli F. Drug evaluation: TA-2711E in the treatment of active distal ulcerative colitis. Curr Opin Investig Drugs. 2007;8:423–8.
Pearson JP, Roberts NB. Mucosal protective effects of ecabet sodium: pepsin inhibition and interaction with mucus. Clin Sci Lond. 2001;100:411–7.
Sasaki K, Iizuka M, Konno S, Shindo K, Sato A, Horie Y, et al. Ecabet sodium prevents the delay of wound repair in intestinal epithelial cells induced by hydrogen peroxide. J Gastroenterol. 2005;40:474–82.
Mitsuyama K, Tomiyasu N, Masuda J, Yamasaki H, Tsuruta O, Sata M. High affinity of ecabet sodium for inflamed colonic mucosa in ulcerative colitis. Dig Dis Sci. 2007;52:1442–3.
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Yoshioka, K., Ueno, Y., Tanaka, S. et al. Efficacy of ecabet sodium enema on intractable rectal ulcer after piecemeal endoscopic mucosal resection for rectal tumor. Clin J Gastroenterol 3, 285–288 (2010). https://doi.org/10.1007/s12328-010-0174-9
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DOI: https://doi.org/10.1007/s12328-010-0174-9