title: Effects of gastric irrigation on bacterial counts before endoscopic submucosal dissection: a randomized case control prospective study.
abstract: OBJECTIVE
  The antiseptic effect of gastric irrigation before endoscopic submucosal dissection (ESD) has not yet been reported. The aim of the randomized prospective study is to evaluate the antiseptic effects of gastric irrigation of saline solution before ESD by evaluating bacterial count.
  
  
  METHODS
  This prospective randomized controlled trial included 50 patients diagnosed with early gastric cancer who were randomly divided into 2 groups (25 patients in each group) by using the opaque envelope method: the clean group (irrigation with 2 L saline solution before ESD) and the regular group (no irrigation). The gastric juice was collected and cultured before ESD. The entire stomach was irrigated using a water jet attached to an endoscope. After ESD with resection and removal of the tumor specimen, a postoperative culture of the gastric juice was obtained using the same method as the preoperative culture.
  
  
  RESULTS
  The mean log bacterial count of the post-gastric irrigation gastric juice was 5.08±0.75 in the regular group and 1.86±0.86 in the clean group. The difference in the bacterial counts was significant between the groups (P = 0.0004). The difference in the white blood cells (WBC) count on POD 1 was significant (P = 0.044). WBC count on POD 2 did not significantly differ between the groups (P = 0.3). The difference in the body temperature (BT) on POD 1 was significant (P = 0.017), On POD 2 the BT was not significant between the groups (P = 0.5). On POD 1, 88% of the patients in the regular group and 16% of the patients in the clean group had mild to moderate spontaneous pain (P = 0.0026). On POD 2 the proportion with mild to moderate spontaneous pain was 36% and 24% in the regular group and the clean group, respectively (P = 0.1).
  
  
  CONCLUSIONS
  Pre-ESD gastric irrigation with saline solution is effective and feasible for suppressing infection during the ESD procedure with favorable clinical outcomes. TRIAL REGISTRATION INFORMATION: The university hospital medical information network (UMIN) #000008691.
authors.affiliation: Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan. hiro4884@med.kagawa-u.ac.jp
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.forename: Kazi
authors.initials: K
authors.lastname: Rafiq
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishiyama
authors.forename: Shintaro
authors.initials: S
authors.lastname: Fujihara
authors.forename: Makoto
authors.initials: M
authors.lastname: Oryu
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
mesh_terms: D000368:Aged; D058491:Bacterial Load; D001831:Body Temperature; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D004210:Dissection; D004724:Endoscopy; D005260:Female; D005751:Gastric Lavage; D005753:Gastric Mucosa / Q000382:microbiology* / Q000601:surgery*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D064232:Visual Analog Scale
chemical_list: D002097:C-Reactive Protein