Alkaline phosphatase and leucine aminopeptidase activities in the endoscopic target biopsy specimens were investigated by histochemical method in 94 cases with duodenal ulcer, with special reference to their healing and recurrence processes and the follow-up studies were done enzyme-histochemically in 5 cases of them. In the cases of poor healing and recurrence, there were found delayed recovery of enzyme activities in the epithelium, intense alkaline phosphatase activity in fibroblasts and the proliferative connective tissue of the interstitium and intense leucine aminopeptidase activity in the interstitial tissue. The enzyme-histochemical findings observed in the cases of rapid healing and no recurrence, on the other hand, were recovery of intense enzyme activities in the epithelium and diffuse alkaline phosphatase activity in the cell-infiltrated interstitial tissue. A combination of endoscopic observation and enzyme-histochemical examination using the target biopsy specimens is considered to be a useful means for judging the healing tendency and the recurrence in duodenal ulcer.

View full abstract

The reports of early cancer of the large intestine have been accumulated in Japan since the development of endoscopic polypectomy. We have defined the early cancer of the large intestine as that with involvement limited to the mucosa and the submucosa, as in the definition of the early cancer of the stomach. It was characteristic in previously reported cases that the shape of the early cancer that the size was within 10-20 mm and that a focal carcinoma was frequent. These findings suggested a close relationship between an adenoma and a cancer in the large intestine. An animal experiment was carried out to see an initial change of malignancy as an early cancer and to study endoscopical differentiation bet ween adenoma and early cancer. Polypoid lesions developed in the colon infusing a chemical car cinogen, MNNG, into the colons of the rats and rabbits were repeatedly observed by endos copy with proper intervals. 79 out of 97 rats survived for 30 weeks, and 175 polypoid lesions were found in 61 rats on necropsy. But in rabbits, significant polypoid lesions did not derelop for up to 80 weeks. The lesions of the colon appeared as a tiny flat prominence at first, and then gradually enlarged. As they grew, the shape changed from Yamada's Type I-II to Type III-IV. Spontaneos falling-off of 15 lesions of Yamada's Type III-IV was observed during this experiment. Histology of the 175 polypoid lesions of rats was : 20 carcinomas, 7 adenomas with severe atypia, 107 adenomas and 41 otherlesions. There was no difference in the endoscopic appearance of an adenoma and a cancer concerning redness, erosion and hemorrhage . But, as the polypoid lesions got bigger, focal atypism was more often recognized in histology. Scanning electron micrscopy performed on 3 adenomas and 3 cancers showed differences in opening pattern of pits and nature of the surfacc between an adenoma and a cancer.

View full abstract

The recent improvements on both technic and instrument have made endoscopic polypectomy easier and safer. The endoscopic polypectomy has become popular, but complications such as bleeding, perforation, electric short circuit and intestinal gas explosion have still been reported on occasions. One hundred and fifty six samples of intestinal gas from 117 cases are collected in three ways such as during colonoscopy, surgical operation and autopsy. Through the analysis of three groups, it was comfirmed that inflammable gas; hydrogen was the highest in surgical operation group, followed by autopsy group. On the contrary methane was the highest in autopsy group. Therefore inflammable gas was found to be explosive in surgical operation and autopsy group. It is surprising that the highest score of hydrogen was 48.03 vol% in surgical operation group. Both hydrogen and methane were noted at the lowest concentration in colonoscopy group. The anesthetic gas; dinitrogen oxide appeared only in surgical operation group, due to a dead space effect caused by GOF inhalation. It may be contributed to replacement as incombustible gas for prevention of intestinal gas explosion. Ordinarily we use a modified Brown's preparation. Using magnesium citrate and low fat and no residue diet, it was cofirmed that hydrogen concentration is definitely lower than inadequate preparation. A direct method of preventing intestinal gas explosion is effective when the incombustible calbon dioxide gas is insufflated before endoscopic polypectomy. It is necessary to insufflate carbon dioxibe for more than 150 sec, using suction and insufflation repeatebly. If the two channel fiberscope is used for polypectomy, suction and insufflation can be manuplated conveniently at the same time through the empty channel. Recent models install the insufflation channel and button for carbon dioxide. The premixed gas (N₂O+O₂) inhalation is useful to prevent intestinal gas explosion utilizing the dead space effect during endoscopic polypectomy.

View full abstract

Recently, not a few endoscopists have been interested in magnifing endoscopic observation of the minute gastric mucosal lesions, and several magnifing fiberscopes have been developed successfully. This time, we have had a chance to use the newly developed magnif ing f iberscope (GIF-HM), which was devesed by Olympus Optical Company. We compared this newmodeled fiberscope with an upper gastrointestinal fiberscope GIF-D3 about the specific features of those two apparatus. Their capacities are expressed on Table I. The f ibererscope GIF-HM is a foward-viewing type similar to GIF-D3, but its maximal magnif ing rate is about thirty-five times. There is no need of changing a light guide and the object can be continuously magnified smoothly, when we make it close to the gastric mucosa. also we can use the zooming effect from 10 to 70 mm in distance. Using GIF-HM for the purpose of ordinary and magnif ing observation, we could easily observe the gastric angle, and there were no blind areas in the stomach. In addition, observation could be easily performed in the esophagus and duodenal bulb. Summarization was described on Table 4. We thought, magnifing fiberscope GIF-HM was useful not only for magnif ing observation, but also for ordinary observation through the upper gastrointestinal tract.

View full abstract

The findings of conventional endoscopic retrogrograde pancreatography (ERP) were compared with those of 3.5 times magnified ERP in 47 cases, which were consisted of 5 cases of normal ERP, 28 cases of minimal chronic pancreatitis, 6 cases of moderate chronic pancreatitis, 6 cases of avvanced chronic pancreatitis and 2 cases of pancreatic cancer. The results obtained were as follows; 1) The number of visible branches in the third order increased in magnified ERP. 2) Magnifying ERP made the findings of the main pancreatic duct clearer in 37% of cases examined, and offered new findings in 21% of the cases. By the magnification, the findings of branches of the pancreatic duct bedame more clearified in 66% and new findings appeared in 25%. 3) The comparative study between the magnified endoscopic retrograde pancreatogram and its histology was performed in 5 cases. There were good correspondences.4) In order to compare the figure of pancreatic duct in magnifying ERP with that in conventional ERP, it is necessary to make the amount of the contrast material equal in both methods. However, it was frequently difficult to obtain equal opacif ication of the pancreatic duct. As mentioned above, magnifying ERP will be useful to the precise visualization of the branches of pancreatic duct, and have clinical significance in the diagnosis of minimal chronic pancreatitis.

View full abstract

This paper describes 18 cases of duodenal polyp with mucus secretion. The polyp in 15 cases out of them was localized in the duodenal bulb. The structure was hemispherical in contour, measuring about 1 cm. in diameter. The small orifice-like formation with the transparent mucus secretion was recognized through endoscopic observation. 4 types of orifice shape were noted endoscopically. The lumen connected to the orifice was found under dissecting microscopy. The wall of the lumen was composed of villous projections with gastric epithelium. Brunner's gland drained into the lfmen. Of the 18 patients, 17 were male and one was female. The age varied from 41 to 74 years. The complaints of the patients were nonspecific and their relation to the polyp was questionable. Enlargement, bleeding, obstruction and malignant change were not recognized through the follow-up study.

View full abstract

It has been thought that an excessive reflux of duodenal contents from the duodenum to the stomach due to an abnormal pyloric function plays an improtant role in the formation of a gastric ulcer. In this paper, the correlation of associated gastric ulcer with a deformity of the duodenal bulb or the pyloric ring was studied in patients with a duodenal ulcer. The incidence of associated gastric ulcers or scars was three times or more higher in patients with marked deformity of the duodenal bulb and pyloric ring than in patients with out them. Associated gastric lesions were many more in the antrum. compaired with controls. These results may imply that the deformity of the pyloric ring impair the protective mechanism against duodenogastric reflux, and that the increased ref ulx of the duodenal juice causes a gastric ulcer.

View full abstract

We have experienced 88 cases with 105 foci of protruded atypical epithelium (ATPFs) in the past 11 years, including 22 operated cases with 27 foci and out of them 38 cases with 48 foci which have been followed up clinically. Consequently the following results were obtained. 1) The mean age at the dhagnosis of ATPFs was 63.1 years and a male to female ratio was 3.2 to 1. 2) ATPFs were found in the gastric antrum in 58%, and their maximum diameter were less than 2.0cm in 91%. 3) Gastric carcinoma was associated in 19%. 4) Of 16 ATPFs confirmed postoperatively, 11 were diagnosed properly as Group IV by endoscopic biopsy preoperatively (63%), and the remainder were interpreted as Group IV (37%). 5) No malignant transformation was encountered among the foci of Group IV. 6) During the follow-up period, 3 foci increased in size (6.5%) and 4 decreased in size (8.7%). 7) There were some lesions, which were regarded as Group IV by endoscopic biopsy though carcinoma was strongly suspected by X-ray or endoscopy. 8) ATPFs less than 2.0cm in size should be followed up by performing X-ray and endoscopy including endoscopic biopsy once a year. It is desirable for those over 2.1 cm in size to be operated on.

View full abstract

In spite of the development of both x-ray and endoscopic examinations a few cases of malignant tumor of the small intestine have been reported. We experienced one case of malignant lymphoma which located in approximately 15 cm distal from Treitz ligament. Patient was 59-year-old housewife and admitted to our hospital with a chief complaint of intermittent pain in the left hypochondrium. Diagnosis of malignant lymphoma was made preoperatively by small intestinal biopsy under direct vision. Resected specimen by operation revealed low-graded protruded tumor with size of 3.5×5 cm. Surface of the tumor was somewhat irregular, in part of which linear ulceration was observed. Diagnosis of malignant lymphoma was confirmed by histologic examination. Discussions were also made on the endoscopic findings of 10 cases of malignant tumor of the small intestine descrided precisely.

View full abstract

More than 100 cases of early carcinoma of the esophagus have been reported owing to the recent progress in x-ray and endoscopic examinations but a rate of detection of early carcinoma at the esophagogastric junctional area is extremely low mainly because of difficulty in diagnosis. From November 1976 through August 1978, 4, 836 endoscopic studies were performed using GIF-P₂ to facilitate diagnosis of carcinoma in this area and 2 cases of early carmcinoa were found at the junctional area. Case 1: 62 year-old femele with well differentiated adenocarcinoma. Case 2 : 65 year-old male with superficial spreading type of squamous carcinoma (IIb).

View full abstract

Among 8 cases of malignant lymphoma of the stomach observed in this department during these 5 years, 2 cases coexisted with gastric carcinoma. This sort of concomitance in the same stomach has been reported only in 19 cases, including above two, in Japan. Numbers and histological types of the malignant lymphoma reported were 16 cases of reticulosarcoma, 2 cases of Hodgkin's disease and a case of unknown histological type. Histology of all the gastric carcinomas was adenocarcinoma. Among them, 10 cases were advanced cancer and 9 cases were early cancer; these were 4 cases of IIc type, 2 cases of IIb type, a case of I type, a case of IIa+IIc type and an unclassified case. It is noteworthy that early cancers were relatively common in the combined cases. Eleven cases (58%) of malignant lymphoma and 12 cases (63%) of carcinoma were found in the lower third (A) and 2 cases (11%) of the lymphoma and 3 cases (16%) of carcinoma were observed in the middle third (M) of the stomach. Among the lymphomas, 13 cases were ulcerating type, 5 cases were tumor-forming type and one case was diffusely-infiltrating type. Most of the gastric cancers, both early and advanced ones, were ulcerating type. The lesions of malignant lymphoma and cancer were located independently in 10 cases and in collision in 9 cases. There was no carcinosarcoma. The age and sex of these cases were distributed mostly in 50 to 60 year-old males.

View full abstract

A 57-year-old male visited the university hospital with complaints of anorexia and emaciation on January 1978. His complaints started at 1970 and he lost 20 Kgm during the last 8 years. Urinalysis revealed proteinuria, approximately 3 .5 gm to 6.5 gm per day, but no hematuria nor abnormal immunophoretic protein. Upper GI series showed ulcer scar on the gastric angulus. By endoscopy, besides the ulcer scar on the angulus, small erosive changewhich was highly suggestive of IIc type early carcinoma was found on the anterior aspect of the gastric antrum. Tubular adenocarcinoma was confirmed by histological examination of the biopsy specimen from the erosion and moreover a specimen from the lesser curve of the gastric body, where the mucosa was endoscopically atrophic, revealed amyloid deposit in the tunica propria. Gastrectomy was performed for the gastric carcinoma and a kidney biopsy at the surgery decided the diagnosis of systemic amyloidosis. This is the first case of primary amyloidosis with early gastric carcinoma in literatures and the valus of the upper GI tract biopsy to the diagnosis of amyloidosis was emphasised.

View full abstract

A 59-year-old female was diagnosed clinically as liver cirrhosis. An association of hepatoma was strongly suspected because her liver scintigram indicated a space-occpying lesion, the hepatic arteriography showed a tumor-like stain, and alpha-fetoprotein elevated significantly. On petitoneoscopy, a small cavernous hemangioma was discovered on the left liver lobe. Several small nodules were also observed on the right liver lobe, of which the diagnosis were not clear macroscopically. Needle biopsy was carried out, and a diagnosis of hemangioma was established. With the presentation of this case, the value of liver biopsy under peritoneoscopic control was discussed and the way of hemostasis was demonstrated.

View full abstract