In endoscopic injection sclerotherapy, 5% ethanolamine oleate (5% EO) is an effective sclerosing agent when used intravariceally, though it produces deep esophageal ulceration when failed in intravariceal injection. Endoscopic changes of esophagus after paravariceal injection of 5% EO containing meglumine amidotrizoate (5% EOMA) were examined in 35 patients who underwent endoscopic embolization of esophageal varices under X-ray monitoring. All of the paravariceal injection have been done unexpectedly because of reasons such as sudden peristaltic movement of esophagus or smaller size of varices. Determination whether the injection was paravariceal or intravariceal has been made by retrospective examination of X-ray films. Occurrence rate of esophageal ulceration was elevated from 14% to 62-100% when the amount of 5% EOMA exceeded 2.0 ml per one paravariceal injection. Major complications due to paravariceal injection of 5% EOMA were massive bleeding from esophageal ulcer (1 case), broad sublation of esophageal mucosa (2 cases), obstruction of esophagus by giant hematoma (1 case), and delayed perforation to pleural cavity (1 case). The last one was dead, others were treated conservatively and cured. As an experimental study, submucosal injection of 1%, 2.5%, and 5% EO have been done in the esophagus of dog (10 dogs) under the direct vision of endoscope. After one week, dogs were sacrificed after esophagof iberscopy. Esophagus was fixed in the 10% formaldehyde, and processed to histology. Occurrence rate of esophageal ulceration was increased according to the concentration and the volume of injected EO. Histologic examination revealed furthermore widely spread submucosal lesion with edema, inflammatory cells infiltration, bleeding, and necrosis, surrounding the area of undermining esophageal ulcer.

View full abstract

Toshiba-Machida developed an electronic endoscope (TV Endoscope) in 1985, which was incorporated a CCD (charge coupled device) in its tip and had a highly resolving power (about 100, 000 picture elements). We can, therefore, observe and record the mucosal surface structure such as gastric pits which cannot be observed by using the standard type of fiberscope. In order to record more clearly such minute surface structure and make it possible to process easily their images by the computor, we added an aperture controller to TV-Endoscope system, which could control the frequency characteristic of NTSC color picture signals. Then we could get more easily and cheaper the similar edge enhancement of the TV-Endoscopic pictures with the hardware than with the software.

View full abstract

Six hundred and thirty-five colorectal polyps were diagnosed among 312 cases by endoscopy during the past six years (1980-1985). All but 22 early cancers in 16 cases excised by operation were excised endoscopically. The histopathological study of the polyps were identified 433 lesions (68.2 per cent) as adenoma, 78 lesions (12.3 per cent) as early cancer (m: 53 lesions, sm : 25 lesions) and 124 lesions (19.5 per cent) as others. The following results were obtained. 1) The ratio of early cancer to adenoma was slightly elevated in female compared to that in male. 2) The age was distributed highest in the fifties in both adenoma and early cancer. 3) The larger the size of polyp was, the higher the frequency of early cancer was. 4) The ratio of early cancer to adenoma was higher in the rectum, the sigmoid, and the ascending colon than the descending and transverse colon. 5) The frequency of early cancer with adenoma was 89.7 per cent and that without adenoma was 10.3 per cent. 6) Among early cancers with adenoma, m cancer dominated in cancer in adenoma and sm cancer dominated in adenoma in cancer. 7) Both m and sm cancers were found most in the shape of Is. “m” cancer was found in the next in the shape of Ip while sm cancer was found in the shape of II a or IIa+IIc. 8) All the early cancers without adenoma were sm cancers and had the shape of IIa+IIc or IIa. Most of results was consistent with the concept of adenoma-carcinoma sequence. However, further meticulous analyses of accumulated cases were needed in order to clarify the natural course of cancer including the process of malignant change.

View full abstract

Photodynamic therapy (PDT) and local interstitial hyperthermia with low power Nd : YAG laser were carried out to nude mice in an attempt to study their therapeutic effects for further investigation. Pieces of solid tumor of human pancreatic carcinoma were subcutaneously transplanted in the backs of 28 nude mice which were 5-weeks old female. The following experimental therapies were begun 5-6 weeks after the transplantation. 1) PDT : Argon-dye laser was irradiated into a tumor with 300-400 mW for 10 minutes in 72 hours after intravenous injection of hematoporphyrin derivative (HpD) in a dose of 3 mg/kg. Histological changes detected after 7 days were coagulated necrosis and fibrosis in the tissues ranging from 30 to 50 % by the ratio of the area. 2) Local Interstitial Hyperthermia : An interstitial probe was punctured under controlling temperature near the margin of the tumor at 42°-43°c with 3W for 10-20 minutes. This therapy caused a marked amount of necrosis in the pancreatic tumors after 7 days. For the mechanism, it seems that one is the effect of both hyperthermia and low power Nd : YAG laser energy to cancer cells, and the other is a damage of tumor vessels caused secandarily by this therapy in vivo. Two patients with gastric cancer have been treated by local interstitial hyperthermia with low power Nd: YAG laser. It has proved to be very effective.

View full abstract

The healing process of gastric ulcer by the treatment with a H₂-blocker was examined endoscopically, and the findings were compared with those in patients treated with other anti-ulcer agents to clarify characteristics effects of the agents as well as their significance. One handred patients treated with H₂-blocker and 72 control patients with other anti-ulcer agents were studied. Elevation of tissue around or in the floor of the lesions was noted in 22 (22%) of those treated with H₂-blocker and in 7 (9.7%) of the controls, the frequency being significantly higher in the former group. According to the endoscopic staging, the occurence of elevation was significantly more common in the H₂-blocker group than in the controls in A₂ and S₁ stages. The incidence of elevation showed a positive correlation with pretreatment size of the lesion. Furthermore, shallow white coat on the ulcer floor was seen significantly more frequently in the H₂-blocker group. The two groups showed no difference in the degree of redness of the ulcer around the ulcer. Biopsy specimen taken from the lesions showed tissue elevation contained new granulation tissues. The above results suggest that tissue elevation and shallow white coat are the features of ulcerative lesions characteristically observed during the treatment with H₂-blocker. These are considered to be the results of marked growth of granulation tissue due to the active promotion of the healing caused by the potent inhibitory effect of the agent on acid secretion as well as the rapid process of tissue regeneration that follows. However, similar but less notable changes were observed in the control patients who showed rapid healing, indicating that these features are not specific to the treatment with H₂-blocker.

View full abstract

Upper gastrointestinal endoscopic findings of 85 patients with rheumatoid arthritis (RA) were described. Seventy-three patients had pathological findings. Sixty-nine patients had gastric mucosal injury (GMI) including ulcer 30, erosions 22 and erythema 17 cases. Other lesions included hyperplastic polyp 3, IIc type early gastric cancer 2 and amyloidosis 5 cases. Ulcers were characterized by shallow and irregular shape and tended to occur as multiple lesions. These results indicate that the incidence of gastric mucosal lesions is high and lesions are diverse in RA. Therefore, careful observation including frequent biopsy study is essential for these patients. With regard to the relationship between clinical condition and GMI in these patients, the incidence of GMI tended to be higher as the more severe the disease activity and the longer the disease duration, which suggests that RA or antirheumatic drugs are contributory to the occurrence of GMI in patients with RA.

View full abstract

Colonoscopy is understood to be a painful examination for patients. So we devised a new pain relief method by microwave TSUBO treatment (Silver Spike Point electrotherapy: S. S. P.) and compared this with traditional method. S. S. P. treatment on cutaneous TSUBO was started at 30 Hz, 20mA, electric stimuli and for 15 minutes continued and shut off at the end of the examination. On the other hand the control group was a routine method with butropium bromide. (1) A painful sensation ratio was 30% by S. S. P. treatment group and 70% by the control group. The painful Index also decreaed in S. S. P. treatment group compared with the control group and it was statistically significant. (2) S. S. P. treatment group was very stable on vital signs, especially a shock index before, during and after the examination and also had a slight side effect on systemic status. S. S. P. treatment is a simplified oriental HART anesthetic procedure (Acupuncture) which is very simple and has no serious side effects. This method blocks only fine nerve fibers (slow pain) and if complication snch as perforation occured, pain (sharp pain) was discovered at early stage, and could prevent the hazared. This procedure could induce selective nervous system block at colonoscopy. On the other hand, there were two points of the demerit. Firstly, an induction time electric current was too long and secondly, maltiple examinations were impossible in a short time. The device with short electric current is expected in the near future. It is concluded that S. S. P. treatment at colonoscopy could bring better understanding between doctor and patient and has two merits of pain relief and safety for patint.

View full abstract

A 72 year-old-woman was admitted to the department of dermatology of kyoto prefecutural university of medicine under the diagnosis of malignant melanoma. She was treated with chemotherapy and cobalttherapy. As mild dysphagia developed, she visited our clinic. Upper G-I series with barium meal and endoscopic examination were perf omed. An irregular barium coated lesion was revealed in the middle intrathoracic esophagus by x-ray examination. The shallow depression with ill-defined margin was detected by endoscopic study. This lesion was unstained by the Lugol's dye spraying method, which is useful for the detection of esophageal cancer. Histological examination revealed squamous cell carcinoma. This is a very rare case of superficial depressed esophageal cancer associated with malignant melanoma.

View full abstract

To the best of our knowledge, there has been no reports of aorto-esophageal fistula induced by swallowing a fish bone so far in Japan. Therefore, this case is worth recording and a literature is also reviewed. A 56-year-old man visited to our hospital because of dysphagia and anterior chest pain developed after eating a flatfish on Nov. 26, 1984. Laboratory findings showed leukocytosis and positive CRP test but no abnormal findings except for calcification in the right diaphragm were seen in chest X-ray film. Urgent endoscopy was performed on the same day of the first consultation. Endoscopic findings of the esophagus showed a fish bone, about 5 cm in length stuck in the esophagus at 30 cm from the incisors and the fish bone being removed endoscopically with biopsy forceps. On the 13th day after removal of the fish bone, he was admitted because of vomiting a small quantity of blood clots and severe anterior chest pain. No abnormal findings, e. g. ischemic changes were seen in ECG. On the next day following admission, he vomited a large amount of brightred blood and was shocked due to acute blood loss. He was finally suffocated to death by misswallowing blood into the bronchus in spite of intensive resuscitation. At autopsy, there was a fistula between the esophagus and the descending aorto. Histological findings of the esophagus stuck with fish bone showed desquamation of the esophageal mucosa and infiltration of inflammatory cells into submucosa and those of the descending aorta stuck with fish bone showed abruption of the elastic fibers of tumica media.

View full abstract

Two cases of esophageal papilloma were reported. Case 1. A 67-year-old male patient was admitted to our hospital, complaining of abdominal fullness. Upper GI series and endoscopic examination revealed a protruded lesion covered with a granular surface in the middle esophagus. In application of ultrasonic endoscope, we could correctly diagnose the width and depth of the lesion. Furthermore, the electronic endoscope by means of the method of "WATER LOADING" was useful for judgement of its form. The size of the resected tumor by endoscopic polypectomy was 7 × 2 × 8mm. Histological finding disclosed esophageal squamous cell papilloma. Case 2. A 71-year-old female was admitted to our institution with a complaint of epigastric discomfort. Upper GI series and endoscopic examination revealed a polypoid lesion of Yamadatype III in the lower esophagus. The biopsy specimens showed esophageal squamous cell papilloma. The esophageal papilloma was treated by laser, because of inadequate condition such as heart failure with arrhythmia for endoscopic polypectomy. To our knowledge, only 27 cases of esophageal papilloma have been reported in Japan including our 2 cases. However, it seems that esophageal papilloma will be potentially malignant. Therefore, it is absolutely necessary to collect suitable number of cases and follow these cases for long term.

View full abstract

A case of hyperplasia of esophageal gland and lymphocyte infiltrations in a 57 yearold man with complaint of epigastric pain is reported. Barium studies of the upper gastro-intestinal tract showed an elevated lesion (measuring 5 × 8 mm), oval in shape situated in the lower esophagus. This was confirmed by endoscopic examination which revealed it's features as corresponding to those of a type III polyp on Yamada's classification. Its mucosa stained normally with Lugol's solution. Histopathological findings of the specimen obtained by diagnostic polypectomy showed hyperplastic esophageal glands and lymphocyte infiltrations covered with slightly hyperplastic squamous epithelium. This is the first case of hyperplastic glands and lymphocyte infiltrations showing a polypoid lesion of the esophagus in Japan.

View full abstract

A case of pernicious anemia associated with Hashimoto's thyroiditis who was found discolored annular zone in the stomach by endoscopic congo red test was reported. The patient, 56 years old female, has been diagnosed as pernicious anemia was treated with vitamine B₁₂ since 7 years before. She noticed general fatigue and facial edema. Thyroidal hypof unction, positive microsome test and thyroid test led to the diagnosis as Hashimoto's thyroiditis. Endoscopic examination showed severe atrophic gastritis in the body and discolored annular zone in the lower portion of the gastric body by congo red test. This may suggest that an autoimmune mechanism had related to the extension of this type-A gastritis. The discolored annular zone could be found in cases with other disease and may require further investigation.

View full abstract

Acute gastric volvulus which usually necessitates surgical procedures was successfully treated by endoscopic reduction. The patient was a 28-year-old man who had complained of nausea and abdominal pain for about 20 hours before admission. His upper abdomen was swollen. Chest X-ray examination demonstrates raised left diaphragm, and abdominal X-ray examination revealed a huge quantity of air and fluid filling a massively enlarged stomach beneath the diaphragm. Fluoroscopic examination of the stomach showed a gastric volvulus of mesenteric type and occlusion in the pyloric antrum. A forward-viewing endoscope was inserted in a reverse "alpha" direction. And the endoscope could be further inserted into the duodenum, when the patient was placed to a prone position. After the endoscope was pulled up with its tip hooking at the duodenum, rotation was corrected. Acute gastric volvulus can be treated for safety by endoscopic reduction, when passage of the cardiac part of the stomach is maintained and stranguration due to rotation is slight.

View full abstract

Gastric submucosal ectopic glands are not infrequently encountered in the examination of resected stomach. It is extremely rare for these lesions to have a definite stalk. We have experienced such a case with Yamada's Type III elevated lesion which was removed by endoscopic polypectomy with high frequency and confirmed by histopathological examination of the polypectomized specimen. Therefore, this case seems to be worth recording. A 70-year-old woman visited a local medical doctor because of anorexia. Upper gastrointestinal series revealed an abnormality and she was referred to our department and admitted for further check-up of it. X-ray and endoscopic findings showed a Yamada's Type III elevated lesion, 13 × 16 mm in size with an ulcer at the top on the posterior wall of the gastric antrum. It was diagnosed as a gastric submucosal tumor and endoscopic polypectomy with high frequency was performed. Gastric submucosal ectopic glands were confirmed by histopathological examination of the polypectomized specimen.

View full abstract

A case of diffuse eosinophilic gastroenteritis was reported. Eosinophilic gastroenteritis is a rare disorder, characterized by diffuse infiltration of eosinophils in the alimentary tract. Patient was a 23-year-old woman with a history of bronchial asthma and urticaria. She was admitted to our hospital due to recurrent nausea and vomiting. The white blood cell count was shown to be 46, 200 with 71% eosinophils and serum IgE level was 2, 400 U/ ml. Radioallergosorbent tests for pork and egg white were positive. Gastrointestinal endoscopy revealed edematous hypertrophic folds and multiple patchy erosion in the upper body of stomach and duodenum. Histological study of the affected areas showed infiltration of the eosinophils to mucosa. During the course of her admission, her condition gradually deteriorated with corresponding changes such as general edema and pericardial effusion, so predonisone therapy was instituted. She responded to this therapy, and she has been feeling well up to the present time.

View full abstract

Paraganglioneuroma is a very rare tumor, mainly involving the second portion of the duodenum. Recently we have experienced a case of multiple paraganglioneuromas involving the major papilla and peripancreatic tissue. A 40-year-old man was investigated for an asymptomatic duodenal tumor detected by mass survey. X-ray studies and endoscopic examination of the duodenum showed two polypoid lesions of walnut-size; one involved the major papilla and the other involved the duodenum two to three centimeters distal to the former tumor. Biopsy specimen of the lesion involving the major papilla revealed normal duodenal mucosa only. However, the lesion had increased in size in a half year, pancreatoduodenectomy was performed. At laparotomy, other two tumors were detected in peripancreatic tissue in addition to the lesion involving the major papilla. All these tumors were diagnosed as paraganglioneuromas by histopathological examination of the resected specimen. Paraganglioneuroma is considered to be benign and nonfunctioning neoplasm in general. To our knowledge, this is the second case of multiple paraganglioneuromas.

View full abstract

We experienced a rare case of Crohn's colitis with muco-cutaneous lesions resembling Behcet's disease. A 29 years old female was admitted to our hospital complaing of diarrheas, abdominal pain, fever, and arthralgia. Physical examination showed erythema nodosum-like skin lesion, oral apthae, and genital ulcers. 14 months ago, radiographic and endoscopic studies showed multiple segmental linear ulcers in the transverse and distal descending colon. On admission, examination of the colon revealed "cobble stone" appearance in the transverse colon and linear ulcer in the descending colon. Sarcoid-like granuloma was not found in the colon biopsy specinem, but, histiocytic granulomatous inflammation with multinucleated giant cells was noted in the skin biopsy specimen. This skin lesion is granulomatous cutaneous disease caused by Crohn's disease. Based on these results, we concluded that skin biopsy is important to distinguish Crohn's disease from Behcet's disease.

View full abstract

A 73-year-old woman, who had past history of cholecystectomy 17 years before, visited to our hospital with a complaint of pale facial color. UGI examination detected no abnormality. Radiological and endoscopic examination of the colon showed four elevated cancerous lesions on the proximal colon (Figure 1-a, 1-b, and Figure 2-b). There were three other small polyps from the ascending colon to the sigmoid colon (Figure 2-a). Right-hemicolectomy was done after endoscopic polypectomy at the sigmoid colon. Pathological examination revealed synchronous four cancers, which were mucinous adenocarcinoma with an invasion to ss, moderately differentiated adenocarcinoma with an invasion to pm, well differentiated adenocarcinoma with an invasion to pm, and well differentiated adenocarcinoma in tubulo-villous adenoma (Figure 3, Figure 4, Figure 5 and Figure 6). Polyps were tubular adenoma, pathologically. The present case is considered to be valuable to consider the relationship between cholecystectomy and proximal colonic cancer.

View full abstract

A case of acute terminal ileitis due to Yersinia enterocolitica infection was reported. A 26-year-old woman was admitted because of right lower abdominal pain and diarrhea. Barium enema revealed marginal irregularity and numerous round defects of nodular appearance in the terminal ileum. Fiberoptic colonoscopy was carried out, and some irregular, white-coated and well-defined ulcers were observed in the same area. Biopsy and study of 300 serial sections showed infiltration of numerous lymphocytes, hyperplasia of lymph follicles and erosion. Careful study did not reveal granulomas. The antibody titer of Yersinia enterocolitica serotype 0:3 rose to 80× after 27 days from clinical onset, and then gradually fell to 0×.

View full abstract