GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 35, Issue 6
Displaying 1-24 of 24 articles from this issue
  • Akimichi CHONAN
    1993 Volume 35 Issue 6 Pages 1269-1281
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    To evaluate the ability of endoscopic ultrasonography (EUS) in diagnosing the depth of invasion of depressed type early gastric cancers, 200 cases examined by EUS were evaluated.
    Classificatin based on fibrosis pattern was histopathologically suggested : (1) group F (-), fibrosis was not visible ; (2) group Fsm, fibrosis was limited to sm layer ;(3) group Fpm ≤, fibrosis was visible in pm layer or more (Figure 1). The results were as follows; 1) In group F (-), there was no change of the third layer or more in m or sml cancer. But interruption of the third layer was shown in sm2 cancer (Figure 2, Table 3). In group Fsm, gastric wall of m or sml cancer showed no thickening or inward growth only. On the other hand, sm2 cancer showed both the inward and outward growth (Figure 3, 4, Table 4). In group Fpm≤, m or sml cancer showed no thickening of gastric wall or inward growth only (Figure 3, 4, Table 4).
    2) According to these indices, EUS classification of depressed type early gastric cancers was proposed (Figure 5). In group F (-), the depth of invasion was accurately diagnosed by EUS, 84.1% in m cancer, 75.0% in sml cancer and 83.3% in sm2 cancer, respectively. In group Fsm, the depth of invasion was accurately diagnosed, 81.7% in m cancer, 83.3% in sml cancer and 72.2% in sm2 cancer, respectively. In group Fpm, the depth of invasion was accuratelly diagnosed, 100% in m cancer and 75.0% in sml cancer except for the cancerous foci associated with open ulcer.
    3) It was suggested that the ability of EUS diagnosis for the depth of invasion in depressed type early gastric cancers was improved.
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  • Naofumi OSAKA, Kiyoshi ASHIDA, Masahiro SAKAGUCHI, Masaya TANAKA, Hiro ...
    1993 Volume 35 Issue 6 Pages 1282-1289
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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    The proton pump inhibitor (PPI) has a more powerful, and longer lasting action in inhibiting gastric acid secretion than the H2-blocker, and thus it is an antiulcer agent with the earlier cure for ulcer lesions. However, concerns have been expressed that it presents a peculiar healing morphology such as protrusions of the base of ulcers, in many cases which could lead to relapse of the ulcer. In this study differences between PPI and H2-blocker in regard to morphological changes in the ulcer were assessed. Seventy-six patients (46 were administered PPI and 30 were administered H2-block-ers) with active gastric ulcers were observed every two weeks using an electronic endos-cope (TGS-50B ; Toshiba-Machida). The pattern of regenerated mucous membrane was evaluated by imaging analysis to calculate the oval specification (OSF) value. Black ink drops were deposited at 4 locations on the periphery of the ulcer, and the changes in the distance between ink spots were studied. Although no difference was observed in the OSF value during the active stage, during the healing process and scarring stage, the PPI group showed significantly higher values (Figure 4). In our study of ink spots distances, no significant difference was observed between the two groups. Therefore it is thought that the appearance of a long and narrow regenerative mucousal pattern with a high OSF value in the PPI group is not resulted from shrinkage of the ulcer but rather the rapid expansion of regenarated mucous membrane.
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  • Toshinari KANAMORI, Makoto ITOH, Yoshifumi YOKOYAMA, Naotomo OHNO, Kun ...
    1993 Volume 35 Issue 6 Pages 1290-1298_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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    The endoscopic technique originally developed to remove gastric lesions with intrasub-mucosal injection of saline remains room for improvement when applied to flat lesions in the colon. The thin submucosal layer possibly allows mechanical procedures to affect the proper muscle. The narrow and tortuous channel of the colon may also make it hard to place a cutting snare on an appropriate site of the lesion area. In this study we assessed the advantages of our removal method in 355 flat lesions in the colon. The notable procedures of our method as compared to the original technique are as follows: 1) injection of saline to produce a larger protrusion for the following snaring procedure, 2) placing a cutting snare on the midportion of the protrusion to protect the proper muscle layer against mechanical damage, 3) an use of a hexagonal shaped-cutting snare with a small needle which we devised to fix it correctly on the lesion area and 4) cutting off tissue by combining a larger current power (60 W) and tight squeeze of the snare to minimize the tissue damage. We estimated our technique as to be useful when a lesion was removed successfully within 3 minutes. High useful rates were obtained regardless of the protrusion shapes and of the location of lesions (shapes : subpedunculated, 97.5% ; sessile, 97.2% and broadly-based, 96.2%, locations : between folds, 98.9%, on a fold, 98.0% and behind a fold or inner site of curved area, 91.3%). Histology of resected specimens revealed clearly that the submucosal tissue was cut off its upper part, suggesting strongly that the proper muscle was insusceptible to mechanical procedure. It was also confirmed histologically that the tissue damage of the cut ends of resected specimens was minimal. No complications occurred in all cases. From the present results, we conclude that our method is practical and safe technique for removing the flat colon tumors endoscopically which have been detected increasingly by recent advance of endoscopy.
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  • Motonobu OZAKI, Yoshihisa URITA, Sachio OHTSUKA
    1993 Volume 35 Issue 6 Pages 1299-1306_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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    We observed duodenal ulcers using the transparent hood devised as a treatment instrument in endoscopic surgery. With 365 pictures of 100 cases of duodenal ulcers without the transparent hood and 112 pictures of 25 cases of duodenal ulcers observed with the attachment of the transparent hood, a review and comparison were made on how the lesion was properly and clearly observed. Among pictures of duodenal ulcers as a whole, the rate of pictures that displayed ulcers adequately was 70.5% in the group with the transparent hood. Thus, the rate was significantly high (p <0.01) as compared with the rate of 54.0% in the group without the transparent hood. Furthermore, the rate of the clear pictures of the image was significant-ly high (p <0.05%) in the group with the transparent hood. Particularly, the ulcers just beyond the pyloric channel had a higher detection rate, and the observant ability and the degree of a clearness in this portion were increased markedly. By using the transparent hood, it was possible to keep a constant distance between a lesion and the tip of the scope. Therefore, we could obtain clear visual fields even for a deformed and narrowed duodenal bulb, and we could easily insert the scope into the descending part of the duodenum.
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  • Masahiro HIRANO, Seiji TSUNADA, Takanori KOYAMA, Takashi OHYAMA, Hiroy ...
    1993 Volume 35 Issue 6 Pages 1307-1312_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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    A 57-year-old male was admitted to our hospital with complaints of melena, general fatigue, and anemia. He had liver cirrhosis, hepatocellular carcinoma, and esophageal varices, which were treated by injection sclerotherapy. Endoscopic examination revealed a pedunculated polypoid lesion, approximately 15 mm in size, on the greater curvature of the antrum. The top of the polyp was covered with coagulation tissue. Esophageal varices were completely eradicated with treatment. A barium follow-through study of the small bowel, and barium enema study of the colon did not reveal any abnormal findings. Endoscopic polypectomy was performed for the treatment of melena. Histological diagnosis was capillary hemangioma. Capillary hemangioma of the stomach is a rare lesion in Japan, and this is the first case that pedunculated capillary hemangioma was treated by endoscopic polypectomy.
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  • Yukihiro NAKAJIMA, Masaki NAKAMURA, Hideto TANIGUCHI, Hitoshi YAMAMOTO ...
    1993 Volume 35 Issue 6 Pages 1315-1320_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS

    A 53-year-old, male patient with primary small cell carcinoma of intermediated type of the esophagus with squamous cell carcinoma was reported.
    Tumor was protruding and located in the middle part of the esophagus.
    Its size was 4.0×3.0×2.5 cm and squamous cell carcinoma extended surrounding tumor. The histopathological findings of the resected tumor demonstrated rosset formation, but Fontana-Masson method and the Grimerius method revealed negative reactions in tumor cells.
    Electron microscopic studies showed no neurosecretory granules. There were no metastatic findings on initial examination, however, he died from liver and lung metastsis in 9 months after combined treatment of surgury, chemotherapy and radiotherapy.
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  • Tomoko KOORI, Shinichi ATSUMI, Hideaki ISE, Shigeru SUGAI, Satoshi MOT ...
    1993 Volume 35 Issue 6 Pages 1321-1326_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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    We report a case of early adenocarcinoma existing in Barrett's esophagus which was found during follow-up of its clinical course. A 67-years-old man consulted on our outpatient clinic with a complaint of abdominal discomfort. The initial endoscopic examination showed Barrett's esophagus. Adenocarcinoma was found at the same location 3 years later. An elevated lesion, which was demonstrated at the lower part of the esophagus on barrium meal examination, consisted of well differentiated tubular adenocar-cinoma with endoscopic biopsy. In addition, dye and balloon endoscopies were performed and recognized to be remarkably useful for the diagnosis of small cancerous lesion in the Barrett's epithelium. The surgical specimen showed that lower part of the esophagus was lined by ectopic columnar epithelium with islets of squamous epithelium remained within Barrett's epithelium. Carcinoma was 1.4×1.4 cm in size and cancerous invasion was limited within the submucosa (sm) in which esophageal glands were seen microscopically. Although the etiologic relationship between Barrett's esophagus and esophageal adenocarcinoma remains to be elucidated, 22 reported cases of adenocarcinoma existing in the Barrett's epithelium including our case were reviewed.
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  • Akira KATO, Hideo YANAI, Hiroshi FUJIMURA, Masahiro TADA, Tomoharu YOS ...
    1993 Volume 35 Issue 6 Pages 1329-1333_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 72 year-old man was admitted to our hospital for further examination of anemia. Gastric endoscopy revealed an early gastric cancer, a hyperplastic polyp, and two polypoid lesions. The two polypoid lesions had little mucosal changes on their surface, and a dell on each tops. Endoscopic ultrasonography revealed echo-free areas of various sizes in the submucosal layer, therefore gastric cysts were suspected. For histological examination and therapy, strip-biopsy of the lesions were done. Histological examination of the resected lesions showed mainly tubular type growth of the foveolar cells and partly cystic apperance by dilatation of some tubi. Gastric hamartomas were diagnosed.
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  • Noriyuki HORIKI, Masataka MURAYAMA, Yoshiyuki FUJITA, Hiroaki SASAKI, ...
    1993 Volume 35 Issue 6 Pages 1334-1338_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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    A 79-year-old man was admitted to our hospital with complaints of tarry stools and anemia. Emergency endoscopic examination of the stomach revealed 3 distinct malignant ulcerating lesions. Biopsy specimens showed poorly differentiated adenocarcinomas and gastrectomy was performed. The histopathological diagnosis was malignant hemangioen-dothelioma (angiosarcoma). Five months later, he appeared complained of anal bleeding and colonoscopy demonstrated bleeding from polypoid lesion of the rectum, and poly-pectomy was performed. The histopathological finding was also angiosarcoma. Followed-up examination showed the recurrence in anastomotic region of the residual stomach, the cecum and ascending colon. Multif ocal angiosarcome of the stomach and colon is a very rare occurrence. As multifocal malignant hemangioendothelioma of the gastrointestinal tract is extremely rare, was reported this case with a review of literatures.
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  • Chifumi YAMAMOTO, Mituo IIDA, Norio KOHROGI, Yuzuru NAKAO, Hiroshi SUE ...
    1993 Volume 35 Issue 6 Pages 1341-1349_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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    We reported two cases of eosinophilic gastroenteritis with eosinophilic infiltration in the whole gastrointestinal tract. The first case was a 63-year-old man, who complained of nausea, abdominal pain and watery diarrhea after cholecystectomy. The second case was a 14-year-old man who had suffered from bronchial asthma and was admitted with the chief complaints of abdominal pain and watery diarrhea. In both cases, laboratory findings revealed remarkable eosinophilia. Microscopic examination of the biopsied specimens taken from the esophagus, stomach, duodenum, upper jejunum and sigmoid colon showed eosinophilic infiltration. In the first case, pathological finding of the resected gallbladder also showed eosinophilic infiltration. Therefore, we diagnosed them as eosinophilic gastroenteritis. There have been no reports describing that eosinophilic infiltration was confirmed in the whole gastrointestinal tract in patients with eosinophilic gastroenteritis. Our cases suggest that this disease may usually involve the whole gastrointestinal tract.
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  • Kazuhiro SUZUKI, Kiyoshi ASHIDA, Masaya TANAKA, Hiroya TAKIUCHI, Naohu ...
    1993 Volume 35 Issue 6 Pages 1350-1356_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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    We reported a case of duodenal duplication accompanied by lipoma, which was histologically examined after endoscopic polypectomy. A patient, 65 years old man, was diagnosed as duodenal polyp when he visited to a hospital to examine anemia in March 1990. Endoscopic polypectomy was undergone in January, 1991 based on the diagnosis of submucosal tumor with cystic lesion as a result of further examinations, including EUS. Histologically, the tumor was duodenal duplication including the gastric surface epithelium like mucosa in the cystic lesion at the head of the tumor and accompaning by lipoma of the base. Except thus case, any case of duodenal duplication with lipoma has not been reported as far as our investigation.
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  • Yukiya HAKOZAKI, Tatsuoki SHIRAHAMA, Masashi KATOH, Kensei YAMAGUCHI, ...
    1993 Volume 35 Issue 6 Pages 1359-1363_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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    Mucosal damages in the small intestine due to non-steroidal anti-inflammatory drugs (NSAIDs) have been called attension as the "diaphragm disease". A 62-year-old female had been administered 150mg/day of diclof enac sodium in the form of suppositories for about 5 years to treat rheumatoid arthritis. Because of right lower abdominal pain colonoscopy was performed, revealing a shallow annular ulcer and intestinal stenosis in the terminal ileum. Infiltration of inflammatory cells, mainly lymphocytes, and fibrous connective tissues were found histologically in biopsy specimens taken from the lesion, but there were no specific findings such as granuloma formation or vasculitis. Based on these findings, a small intestinal ulcer caused by NSAIDs was suspected. Administration of the NSAID was discontiued and the ulcers had disappeared one month later at the time of colonoscopy. As the etiology, it is considered that NSAIDs may involve disturbances in the intestinal wall barrier mechanism and reduce prostaglandin synthesis in the mucosa. The so-called diaphragm disease with endoscopic findings of small intestinal lesions due to NSAIDs is rare and was reported here in.
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  • Yuhiko MURATA, Takasi WATANABE, Noriaki TAMURA, Osamu KIMURA
    1993 Volume 35 Issue 6 Pages 1364-1370_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A rare case of primary malignant lymphoma of the rectum presenting rapid morphological changes observed by sequential endoscopic studies is reported. A 46-year-old female complaining of vague epigastric pain was diagnosed as having a rectal flat-elevated varices-like submucosal tumor and seropositive for HTLV-1 antibody. Approximately 3 months after the initial endoscopy, she complained of bloody stools. The second endoscopy showed the lesion seen previously growing to a protruded tumor with reddish erosion. Biopsy was negative for malignancy. Two weeks later, the third endoscopy showed a loburated enlarged tumor. Biopsy revealed malignant lymphoma. One more week later, the forth endoscopy showed the lesion protruded more sharply from the surrounding mucosa with a central ulcer. Abdominoperineal excision of the rectum with R2 lymph node dissection was performed on Feb. 15, 1991. Surgical specimens showed a lobular protuberant submucosal tumor. Histopathological study showed a follicular lymphoma, medium-sized cell type accoording to LSG classification. Immunostaining of the frozen sections showed positive for B-cell markers and producing monoclonal IgM lambda-chain. Involvement of the regional lymph nodes and distant metastasis were not identified. Postoperative chemotherapy and irradiation for the involved field were done for suspicion of residual tumor cells at the surgical stump. The patient is well free from disease for 20 months after surgery. With regard to family history, her husband and mother-in-law with whom she had been live for nearly 20 years also died of malignant lymphoma of the stomach and tonsil, respectively. The familial clustering of this disease and seropositiveness of HTLV-1 antibody suggests an infectious agent and/or environmental factor may play a role in the etiology of malignant lymphoma.
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  • -THE OBSERVATION OF THE MUCOSAL INJURY AFTER NON-OPERATIVE REPLACEMENT-
    Yoshihiro MORIWAKI, Fumihiko KITOH, Hirotoshi AKIYAMA, Kuniyasu FUKUZA ...
    1993 Volume 35 Issue 6 Pages 1373-1379
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A case of sigmoid volvulus released by non-operative technique was reported, in which the mucosal damage after replacement was observed by means of colonofiberscope, and the change of peripheral blood endotoxin and lipidperoxide was also observed. Just after endoscopic replacement. fesh bloody stool was recognized, but a prominent ulcerative lesion was not detected by the endoscopic examination on the next day, then the risk for intestinal necrosis or perforation was thought to be low. The level of endotoxin did not increase through the course, which indicated that endotoxin was not absorbed from mildly damaged intestinal mucosa. The level of serum lipidperoxide was not increased, either, which indicated that severe ischemic change or reperfusion injury did not occur in the involeved bowel. Repeated endoscopic examination, measurement of serum endotoxin and lipid peroxide is thought to be usefull for folow up study of the damaged intestine after endoscopic replacement for sigmoid volvulus.
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  • Youji NAN, Nobuyoshi KUNO, Kumiko KURIMOTO, Tsuneya NAKAMURA, Seibi KO ...
    1993 Volume 35 Issue 6 Pages 1380-1385_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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    A 66-year-old man was referred to our hospital with complaints of itching and transient jaundice. A right nephrectomy had been performed 8 months before admission for renal cell carcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) showed a highly dilated main pancreatic duct with a filling defect. Biopsy specimens obtained through the main pancreatic duct revealed renal cell carcinoma. It was composed of clear cell and granular cell types. There was no evidence of hepatic or nodal metastasis on CT. Total pancreatectomy preserving the pylorus was performed. There are few reports on the diagnostic value of duodenoscopic biopsy through the main pancreatic duct regarding pancreatic metastasis from renal cell carcinoma.
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  • Takahiro SATO, Kiyoshi HIGASHINO, Manabu GOTO, Shigeharu KATO, Yoshita ...
    1993 Volume 35 Issue 6 Pages 1386-1389_1
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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    We tried endoscopic variceal ligation (EVL) of gastric varices by means of three-forked forceps and end-loop ligature. EVL was performed for gastric varices in a 43-year-old man after sclerotherapy of esophageal varices. Gastric varices were pulled to end-loop ligature by three forked forceps and were ligated. After the end-loop was closed and varices were ligated, the ligature was cut off with scissors forceps. As a result, gastric varices changed to be reddish-blackish just after EVL. It is concluded that this new method is useful for the treatment of gastric varices without bleeding and pain using a small amount of sclerosant.
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  • 1993 Volume 35 Issue 6 Pages 1390-1407
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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  • 1993 Volume 35 Issue 6 Pages 1408-1422
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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  • 1993 Volume 35 Issue 6 Pages 1423-1436
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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  • 1993 Volume 35 Issue 6 Pages 1437-1445
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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  • 1993 Volume 35 Issue 6 Pages 1445-1448
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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  • 1993 Volume 35 Issue 6 Pages 1448-1452
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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  • 1993 Volume 35 Issue 6 Pages 1453-1485
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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  • 1993 Volume 35 Issue 6 Pages 1486-1503
    Published: June 20, 1993
    Released on J-STAGE: May 09, 2011
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