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Exendin-4 protects the hearts of rats from ischaemia/reperfusion injury by boosting antioxidant levels and inhibition of JNK/p(66) Shc/NADPH axis

Plain water is inadequate for ESD: insufficient conductivity higher diathermy settings required Isotonic saline (0.9% NaCl): electrolyte-rich conductive medium facilitates cutting, coagulation and vessel precoagulation ESGE 2023 guidelines explicitly endorse saline over water in immersion-assisted ESD SITE-PCM: especially powerful combination the pocket stabilises the dissection plane, SITE optimises optics, buoyancy and diathermy performance Asclepius tube: continuous drainage of excess saline without repeated through-the-scope suctioning Western cohort data (181 lesions, Royal Free): R0 92.3%, curative resection 90.6%, 93.4% under conscious sedation, 0.5% surgery rate Conclusion: SITE is not a competitor to conventional ESD it is a flexible adjunct, most valuable in fibrotic lesions, anatomically challenging segments, and for broadening access to ESD without general anaesthesia

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Serious but rare adverse effects include agranulocytosis (severe reduction in white blood cells), which requires immediate medical attention if signs of infection develop

Current clinical evidence does not support combining these substances safely, and most healthcare providers advise against it