Endoscopic ultrasonography (EUS) in 67 patients with esophageal carcinoma was performed to make a diagnosis of the depth of carcinomatous invasion. Thirty-four cases including 36 lesions among 67 cases were evaluated for the diagnosticity of EUS as to the depth of carcinomatous invasion by comparing with the histological findings of the resected specimens. The results were as follows ; (1) The overall accuracy of diagnosis with EUS for the depth of its invasion was 58% (21/36). The diagnostic accuracy during the early period of this study was 22% (2/9), and was 90% (19/27) during the late period. (2) Macroscopically, the depth of its invasion in all protruded types were accurately diagnosed, but the accuracy of the diagnosis for the depth of its invasion in superficial types and ulcerative types was inferior to that of protruded types. (3) The causes of misdiagnoses for the depth of its invasion in a₀ cases were that it was unable to detect the lesion of carcinoma limited to the muscularis mucosae, and that it was difficult to visualize the lower layer because it had been compressed by massive cancer in the upper layer. (4) All of a_1-3 cases but one were accurately diagnosed. (5) The scanning method in the air-free water using the balloon whitch prevent the regurgitation of the air-free water was a safe and useful technique for the diagnosis of ao cases.

View full abstract

There are many kinds of color enhancement method. We have used equipmets of image processing (LA500) made by PIAS company and color corrector (CCS-4360) made by FOR-A company for color enhancement. They can separate the pictures of electronic endoscope to red, green and blue component. After a gray level of each components is enhanced, the composition of three components gives us the electronic endoscopic color image of which gray level and color are enhanced. The pictures of many kinds of gastrointestinal disease are changed to clear images by these methods. This image processing can make the pictures of esophageal varices, submucosal vein, variable redness and early gastric cancer (IIb) clear. We have analyzed the gastrointestinal pictures of electronic endoscope. The information which we obtained from the analyzed pictures is helpful for creating color enhanser (No. 2) made by Olympus company. We use this equipment for color enhancement of electronic endoscopic pictures. We obtained the same results for LA500 and color corrector (CCS-4360). This image processing unit (LA500) is not real time, but color corrector (CCS-4360) made by FOR-A company and color enhancer (No. 2) made by Olympus company are real time, they can apply moving color image. So both equipments are useful for clinical diagnosis.

View full abstract

In order to clarify the role of mucosal endogenous prostaglandin in the healing process of gastric ulcers, gastric mucosal PGE₂ and 6-keto PGF₁ a contents in the healing process were measured in 17 patients with gastric ulcers and these results were compared between H₂-blocker therapy and the combination therapy of H₂-blocker and sofalcone. 1) Gastric mucosal PGE₂ and 6-keto PGF₁α contents were not influenced by H₂-blocker therapy and these were significantly increased by the combination therapy. 2) Ratio of PAS stain positive areas per total mucosal areas of gastric ulcer scars was not significantly different between the both therapy, but it had a tendency to be higher in the combination therapy. 3) There was a positive correlation between mucosal PGE₂ contents of gastric ulcer scars and ratio of PAS stain positive areas per total mucosal areas. In summary, mucosal endogenous PG may play a role of healing process in gastric ulcers.

View full abstract

Endoscopic ultrasonography (EUS) enables us to evaluate the wall structure of the upper GI tract exactly. Therefore, it is possible to judge the depth of invasion of gastric cancer by identifying which layer the ultrasonographic change extends to. However, depressed types of early gastric cancer are often accompanied by ulcerative change in the tumor foci. And the ultrasonographic picture is also influenced by the ulcerative change. So in 73 early gastric cancers of depressed type, ultrasonographic appearance was evaluated. These cases were classified by their EUS echo patterns. Those cases which had ultrasonographic abnormal findings in the first three layers were classified into Type I, II and III. Those cases, whose ultrasonograhic change extended to the fourth or fifth layer, were classified into Type UL. Then, comparison was made between echo patterns and pathological findings. Sixty cases (82%) were accompanied by ulcerative change in the tumor foci. These cases were found to have fibrosis associated with the ulcerative change within the tumor foci and the echo patterns mainly reflected the form and nature of the fibrosis. In 92% of 12 cases showing Type I, in 88% of 17 cases Type II-1 and in 71% of 7 cases Type II-2, cancerous tissue limited to the mucosa pathologically. In 81% of 16 cases showing Type II-3, in 100% of 1 case Type III, cancerous tissue extended into the submucosa. In the cases of Type UL, the 71% were m cancer. Recognition of ultrasono-graphic patterns has enabled us to judge the depth of the tumor invasion into the gastric wall more exactly, even if gastric cancer is accompanied by ulcerative change.

View full abstract

In the first place, 136 cases in whom colorectal adenoma and/or early cancer were detected using total colonoscopy or barium enema with subsequent total colonoscopy at the outpatient clinic were studied. Fifty point nine percent of the lesions were located proximal to the sigmoid-descending colon junction, whereas 27.2% of the cases (14.3% of the cases with lesions 6mm or more) had only lesions proximal to this junction. Approxi-mately half the cases had multiple lesions, which were mostly located on both sides of this junction. Therefore, the majority of cases with colorectal adenoma and/or early cancer, especially over 80% of cases with lesions 6mm or more, may be detected if screening sigmoidofiberscopy and subsequent total colonoscopy for cases with positive screening sigmoidofiberscopy are performed. Among 2, 170 cases screened with sigmoidofiberscopy at the physical checkup, 10 cases (0.46%), including 2 cases detected by subsequent total colonoscopy, had early cancers and 143 cases (6.6%) had adenomas. In screening for colorectal neoplasia, even cases without prior colorectal neoplasia should undergo the second sigmoidofiberscopy a year after the first sigmoidofiberscopy in order to detect the lesions which might be overlooked at the time of the first sigmoidofiberscopy. After that, sigmoidofiberscopy every two years and an annual fecal occult blood testing will be enough.

View full abstract

The authors used the 16mm film for, recording the images of electronic endoscopy, and studied about the picture quality of the 16mm film. Based on the number of TV monitor scanning lines, the total number of the pixells on the 16mm film which is neaded for the discrimination of the scanning lines is calculated. And that of 16mm film is revealed to be enough. Each TV scanning line was found to be completely distinguished by investigation of Modulation Transfer Function (MTF) and resolving power of the usual 16mm film which is used for the record of endoscopy images. In clinical cases the authors compared the images on the 16mm film with the same images on the 35mm film which are taken from the TV monitor images at the same time concerning the appearance of each scanning line and quality of the images. It is resulted that the images on the 16mm film are not inferior to those on the 35mm film. The 16mm film is easily managed and indexed in comparison with the 35mm film. The special 16mm camera for endoscopy with lens shutter can be used. And this camera is small and easy handling. In conclusion it is clear that the 16mm film is more useful than the 35mm film in recording the electronic endoscopy images.

View full abstract

Among 342 colorectal cancerous lesions in 324 cases resected by operation or polypectomy at our hospital, there were 35 lesions (10.2%) in 30 cases in which cancer invaded the submucosa (sm-cancer), and 27 lesions (7.9%) in 26 cases in which cancer invaded the muscularis propria (pm-cancer). The mean age of the patients was 58.5 years old in sm-cancers and 60.9 years old in pm-cancers, and the ratio of males is 70% in sm-cancers and 58% in pm-cancers. The chief complaint in over 50% of patients of both cancers was anal bleeding. But, 47% of patients of sm-cancers had an equivoval symptom or no symptom. In regard to fecal occult blood test (Guaiac method), the positive rate was 52% in smcancers and 70% in pm-cancers, respectively. The positive rates of serum CEA and anemia were not more than 10% in both cancers. Most of the both cancers were located in the rectum and sigmoid colon (77.1% of sm-cancers, 88% of pm-cancers). Sm-cancers showed various macroscopic types (Ip ;13 lesions, Is ; 9 lesions, ha ; 4 lesions, IIa+IIc ; 7 lesions), but most of pm-cancers were well-defined ulcerative type (well-defined ulcerative type ; 24 lesions, protruded type; 1 lesion, unclassified type ; 2 lesions). Sm-cancers were smaller than pm-cancers, namely the mean diameter was 1.8 cm in sm-cancers and 3.7 cm in pm-cancers. Pathologically, 12 Ip type lesions, 6 Is type lesions and 6 ha or IIa+IIc type lesions in sm-cancers and 10 lesions in pm-cancers were well differentiated adenocarcinoma. Adenoma component was found in 22 lesions (67%) in sm-cancers (Ip ; 93%, Is; 63%, IIa ; 25%, IIa+IIc ; 43%), and in only one lesion (3%) of pm-cancers.

View full abstract

Gastric f oveolar hyperplastic polyps in 10 patients with normal acid secretion were morphologically studied. Their characteristics were as follows : 1) Nine of 10 patients were female and 7 were less than 50 years old. 2) Eight of the lesions were solitary and 5 were located in the cardia. 3) Eight of all the 13 lesions were pedunculated. It has been generally accepted that hypochlorhydria or achlorhydria is common in patients with gastric foveolar hyperplastic polyp. However, this paper demonstrates the existence of foveolar hyperplastic polyp in patients with normal acid secretion and shows that they have certain common characteristics.

View full abstract

Melanosis involving the duodenum and stomach is extremely rare. This report describes endoscopic, light and electron microscopic and histochemical studies of five patients with melanosis of the duodenum, one of them complicating melanosis of the stomach. Melanosis was extended in the entire duodenum and upper jejunum in Case 1(Figure 1 and 2). The melanosis disappeared after the cessation of hydralazine and captopril (Figure 3). In Case 2, melanosis was observed in the pericardial region of the stomach and colon not only in the duodenum (Figure 6). In Case 3, 4 and 5, melanosis was seen in the bulb and second portion of the duodenum (Figure 9, 11 and 12). Histological examination revealed accumlations of dark-brown pigments in the upper lamina propria of the gastric and duodenal biopsies, occurring mostly in macrophages (Figure 4-a, 7-a and 10-a). The pigment in Case 1, 2, 4 and 5 had a positive reaction with special stains for melanin (Figure 4-b and 7-b) and negative with stains for iron. The pigment in Case 3, however, was positive for the iron stain (Figure 10-b) but negative for the melanin stain. Electron microscopic studies of the gastric and duodenal melanosis revealed irregular shaped electron-dense materials in the lysosomes of the macrophages (Figure 5 and 8). Our study shows that the occurrence of pigmentation in melanosis of the stomach is identical to that seen in the duodenum. The nature and source of the pigment is still contraversial. On the basis of the history of our patients and cases reported in the literature, it is conceivable that the possible sources of the pigment are medications that contain a benzen ring, ferrous sulfate or hemorrhage in the gastrointestinal tract. Despite the well-documentated histochemical characteristics and ultrastructure of the pigment, its precise chemical structure and mode of the formation need further investiga-tions.

View full abstract

Ultrasonic peritoneoscopy combined with a new puncture technique permits the performance of sonographically guided needle biopsy of focal lesions in the liver. Ultrasonic peritoneoscope was performed with a linear array probe (7.5 MHz) adjustable to the ultrasonic diagnostic equipment Toshiba SSA-90 A. The peritoneoscopic array was introduced through the trocar adjacent to the navel at the location of the so-called "second incision" and was visually guided under an ordinaly conventional optical peritoneoscope, which was introduced through the other independent trocar. Under local anesthesia a needle was inserted through the abdominal wall, usually through infracostal arch. Visualizing the tumor echo with the peritoneoscopic ultrasound transducer placed on the liver surface, the needle was inserted into the liver. The tip of the needle was guided into the tumor under visual control with the ultrasound monitor. A tumor of more than 1 cm in diameter, at the least, can be accurately punctured by this procedure, as far as the tumor is visualized ultrasonographically. Additionally, it is possible to use a needle of bigger diameter safely because the state of hemostasis at the site of puncture is well confirmed and even the hemostatic manipulation is possibly performed, if necessary. The procedure is proved highly valuable clinically not only for making the diagnosis by biopsy but also for performing the therapy by ethanol injection into the tumor.

View full abstract

Sixteen appendiceal lesions, which consited of 10 postoperative appendiceal inverted stumps, 4 cecal deformities, one appendiceal Crohn's disease and one invaginated appendix, have been found endoscopically during resent six years. It seemed very important for exact diagnoses to ask patients their past histories of appendectomy before examination, because most lesions found at the ileo-cecal region were related with appendectomy. We experienced a few rare cases including invagination and Crohn's disease of the appendix. Although appendiceal lesions were not so commonly recognized endoscopically, colonoscope should be inserted up to the cecum and orf ice of the appendix should be confirmed to prevent overlooking the ileo-cecal lesions.

View full abstract

The patient was a 73-year-old woman with liver cirrhosis. In July 1987, she developed the first hematemesis. An endoscopic examination showed blue varices with marked red color in the esophagus, and varices in the cardia with a red center. The esophageal varices were eradicated completely by endoscopic scierotherapy with 5% ethanolamine oleate injected intravasally into the esophagus, though the cardiac varices remained unaffected. In December 1987, she had a second hematemesis caused by rupture of the cardiac varices. Bleeding occurred from the red center of the cardiac varices. The red center predicting bleeding may be a significant indication for rupture of the cardiac varices. Bleeding was stopped by additional endoscopic sclerotherapy with 5% ethanolamine oleate injected intravasally into each of the cardiac varices, resulting in almost complete disappearance. To date, bleeding has not reoccurred, though a recent endoscopic examina-tion has revealed reccurence of cardiac varices. To prevent rupture of remaining gastric varices, not only esophageal varices but also gastric varices should be eradicated. In hemodynamics and in the histological structure of the mucosa, there is significant difference between the esophageal varices and gastric varices. Therefore in endoscopic injection sclerotherapy for gastric varices, it is important to maintain a long-term follow-up, with careful choice of sclerosing agent and dosage.

View full abstract

A case of so-called carcinosarcoma of the esophagus with extensive superficial spread was reported. A 36-year-old female was admitted to our hospital because of dysphagia. X-ray examination of the esophagus showed a tumor in the middle esophagus (Figure 1). Endoscopy of the esophagus revealed a tumor and extensive irregular mucosa which were not stained with Lugol's solution (Figure 2, 3). Total thoracic esophagectomy was perfored. Macroscopically, a tumor 4.0 x 1.7 cm in size with extensive superficial spread was noted (Figure 4, 6). Histologically, the tumor was mainly composed of sarcomatous element and superficially spreaded lesion was composed of squamous cell carcinoma (Figure 5). The diagnosis of the so-called carcinosarcoma of the esophagus with extensive superficial spread was made.

View full abstract

A 58-year-old female visited our hospital because of a further examinatoin of a polypoid lesion in the lower part of the gastric body pointed out by a practitioner. Endoscopy showed a sessile submucosal tumor with minimal depression on the top of the tumor. Upper GI series revealed a protruded lesion with smooth surface on the anterior wall of the lower part of the gastric body. Thus, gastric cartinoid was suspected at that time, and biopsy was done. The histology disclosed capillary hemangioma. Melena developed immediately after the X-ray examination. Two months later, this lesion completely disappeared on endoscopy and X-ray examination.

View full abstract

A 54-year-old male was referred to our hospital because of diarrhea and easy fatigabity. Barium meal examination of upper GI tract and the small intestine revealed innumerable polypoid lesions extending from the stomach to the ileum. Barium enema study revealed innumerable polypoid lesions in the cecum, ascending colon, sigmoid colon, and the rectum. Biopsied specimens taken from the stomach and a polypectomized specimen taken from the ascending colon were diagnosed as MLP. Histologically and clinically we could not diagnose this case as malignant lymphoma. Therefore, we observed without any treatment. Five and nine months later, reexamination were performed. The X-ray and endoscopic findings showed a decrease in number of polyps of the colon. In this case, improvement of MLP was observed without any treat-ment, so it seems difficult to make a definite diagnosis of benign or malignant characteris-tics at present.

View full abstract

A 74-year-old male was admitted to our hospital because of pain in the right hypochondrium due to cholecystlithiasis. At endoscopic examination of the duodenum an elongated lesion was found, and the base of it was attached to the mucosa of the second portion of the duodenum. The surface of the lesion was covered completely with normal duodenal mucosa. It was resected locally through the anterior wall incision of the duodenum simultaneously with cholecystectomy. Pathological examination revealed that the lesion consisted of normal duodenal mucosa and the submucosa including Brunner's glands. We think that it is a case of the disease which has been proposed recently by Inamoto et al as intraluminal duodenal protrusion (IDP), a type of congenital malformation.

View full abstract

A 56-year-old woman was admitted to our hospital with a complaint of epigastric pain. Physical examination showed slight tenderness and resistance in the epigastric area. A diagnosis of acute pancreatitis was made clinically because of elevation of serum and urinary amylase levels. ERCP was performed after improvement of clinical symptoms. Endoscopicafy, the major papilla was reddened and swollen, and an erosive lesion with converging folds was seen at the juxtapapillary area. Pancreatography demonstrated abnormal acinar filling in the head of the pancreas and fine ventral pancreatic duct. Follow-up ERCP 17 days after the initial examination showed improvement endoscopically, and fine ventral duct without connection to the main pancreatic duct and a smooth stenosis of the intrapancreatic bile duct on the radiograms. Malignancy was suspected angiographycally, and pancreatoduodenectomy was performed. Histological examination revealed localized pancreatitis due to inflammation of the duodenal diverticulum which extended into the pancreatic parenchyma aberrantly.

View full abstract

We experienced 2 cases of intestinal endometriosis. The first case was 39-year-old female who was admitted to our hospital complaining of right lower abdominal pain. Barium enema study and colonofiberscopy showed submucosal tumor of the sigmoid colon. Biopsy specimens were negative for endometriosis and malignancy. Partial colectomy, total hysterectomy and right oophorectomy were performed. Histologically endometrial tissue was found in the proper muscle layer of the sigmoid colon. The second case was 34 -year-old female who was admitted to our hospital because of melena during menstrual period. Barium enema study and colonofiberscopy showed a smooth elevated lesion with central reddish concavity of the sigmoid colon. Biopsy specimen revealed endometrial tissue in the mucosa. Anterior resection, simple hysterectomy and right oophorectomy were performed. Histologically endometrial tissue was found in the mucosa and proper muscle layer of the sigmoid colon. Literature review of 78 cases with intestinal en-dometriosis in Japan was made on age, symtoms, location, size and form, diagnosis and treatment. Only 6 cases had been definitely diagnosed by biopsy and it was suggested that the biopsy should be done at premenstrual phase and during menstrual period.

View full abstract