GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 36, Issue 8
Displaying 1-12 of 12 articles from this issue
  • Shinya MARUTA, Yoshihisa TSUKAMOTO, Yasumasa NIWA, Hidemi GOTO, Satosh ...
    1994 Volume 36 Issue 8 Pages 1553-1560
    Published: August 20, 1994
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Pre-operative diagnosis of the depth of invasion and lymph node metastasis is impor-tant to decide the treatment of early gastric cancer. Endoscopic ultrasonography (EUS) was used to assess the indication for Dl-gastrectomy (gastrectomy with Nl lymph node dissection). Between April 1984 and September 1993, 596 cases with early gastric cancer, who underwent surgery, were evaluated clinico-pathologically. In 268 of 596 patients, EUS was performed pre-operatively. The ultrasonographic findings were compared with his-tological findings. The incidence of lymph node metastasis in mucosal cancer was significantly lower than that in submucosal cancer, and that in differentiated type was significantly lower than that in undifferentiated type. No lymph node metastasis were seen in mucosal cancer without ulceration within the tumor focus. In mucosal cancer with ulceration, the incidence of lymph node metastasis in cases with U1-II ulceration was lower than that in cases with U1-III, and IV ulceration. In 130 cases of types I, II-l, and II-2 in EUS pattern, 110 cases (84.6%) were mucosal cancer, and 101 cases (77.7%) were accurately diagnosed the depth of ulceration within the tumor focus. There was only one case of lymph node metastasis of Group 1 lymph node (nl) in this 130 cases. In conclusion, the indication for Dl-gas-trectomy seemed appropriate in cases with types I, II-1, and II-2 in EUS patterns.
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  • WITH SPECIAL REFERENCE TO THE DETECTABILITY OF DEGREE OF 5UBMUCOSAL CARCINOMATOUS INFILTRATION
    Tooru ASHIHARA, Eisai CHO, Masatsugu NAKAJIMA, Kenjirou YASUDA, Hideka ...
    1994 Volume 36 Issue 8 Pages 1561-1567
    Published: August 20, 1994
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    EUS was attempted in 102 lesions with early colorectal tumor for the diagnosis of carcinomatous invasion. These lesions were histologically confirmed by surgical or endoscopic resection ; 44 with adenoma, 37 with mucosal carcinoma and 21 with sub-mucosal carcinoma. In these series, 44 lesions with adenoma were dealt as mucosal invasion, and 21 lesions with submucosal carcinoma were divided into three groups, sml, sm2, and sm3, according to the degree of carcinomatous infiltration within the submucosal layer. EUS diagnosis of tumor invasion were correct in 93 of 102 lesions (91%) ; 68 of 76 (89%) in protruded lesions and 25 of 26 (96%) in superficial lesions. Detection of the degree of submucosal infiltration with EUS was possible in 13 of 21(62%) lesions with submucosal carcinoma ; 7 of 14 (50%) in protruded lesions and 6 of 7 (86%) in superficial lesions. It provided a high accuracy rate in the lesions less than 7 mm in height. The most important factors in the EUS diagnosis of carcinoma invasion or submucosal carcinoma infiltration was the shape and height of the lesions. It is concluded that EUS is of great value for the detection of infiltration degree of submucosal carcinoma as well as for the diagnosis of early colorectal tumor invasion.
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  • Koji OH, Mitsuo OKADA, Yuichi MASUDA, Kazuhiro MAEDA, Toshihiro SAKURA ...
    1994 Volume 36 Issue 8 Pages 1568-1580_1
    Published: August 20, 1994
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    The ability of EUS to diagnose the depth of cancer invasion was investigated in 183 patients with gastric cancer, consisting of 104 early cancers, 31 advanced cancers simulat-ing early cancer and 48 Borrmann's type advanced cancers. The depth of cancer invasion was classified as the mucosa (m), submucosa (sm), muscularis propria (mp), and subserosa (ss) and serosa (s). Moreover, the depth of invasion into the submucosa and the muscularis propria were divided into 3 subtypes {(sm1, sm2, sm3) and (mp1, mp2, mp3)}, respectively. The results obtained were as follows ; 1) The diagnostic accuracy was 64.5% in all 183 cases ; 70.6% in m cancers, 32.1% in sm cancers, 77.8% in mp cancers, and 83.6% in ss and s cancers, respectively. The rate was significantly lower in sm cancers than in others. 2) Accuracy rates for sml, sm2 and sm3 cancers were 14.3%, 72.7% and 15.4%, respectively, and significantly lower in sml and sm3 cancers than that in sm2 cancers. These results caused a lower diagnostic accuracy of cancer invasion in sm cancers, compared with others. 3) In early gastric cancer, the diagnostic accuracy of diagnosing the depth of cancer invasion was significantly lower in depressed types than in elevated types and much lower with increasing size of lesion. 4) The diagnostic accuracy of cancer invasion was significantly lower in cases with fibrosis accompaning peptic ulcer or ulcer scar than in cases without them. 5) The reasons for incorrect assessment of cancer invasin by EUS were fibrosis accompaning peptic ulcer in 29.2%, microinvasion in 24.6%, and massive invasion into the submucosa in 15.4%. The 3 above factors accounted for approximately 70% of incorrect diagnosis by EUS.
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  • Mamoru NISHINO, Manabu ISHIHARA, Ryo FURUYA, Kazuhiro MORI, Kazuo YOSH ...
    1994 Volume 36 Issue 8 Pages 1583-1590_1
    Published: August 20, 1994
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Endoscopic examination of the upper gastrointestinal tract in 17, 788 cases from April 1983 to March 1993 revealed in 130 persons to have ulcers of the pylorus, 3 % of the 4, 392 peptic ulcers. The 130 patients with pyloric channel ulcer included 90 men and 40 women whoes age ranged from 25 to 86 years, the average age being 52.0 years. Upper abdominal pain, hunger pain, nausea and vomiting were observed more frequently in patients with pyloric channel ulcer than in patients with gastric or duodenal ulcers. The incidence of independent pyloric channel ulcer was 41.5%, while the incidence for combined gastric, duodenal and gastroduodenal ulcer was 23.8%, 22.3% and 12.4% respectively. Regarding number and form of pyloric channel ulcer, 106 of the cases (81.5%) were single ulcers, while 12 cases (9.2%) were linear ulcers. Pyloric channel ulcers were frequently located on the lesser curvature (35.0%) and on the anterior wall (31.9%). Gastric ulcer associated with pyloric channel ulcers were frequently located on the lesser curvature (87.5%), in the anglus (56.3%) and on the lesser curvature of the anglus (approximately 50%). Regarding gastric mucosal lesions erythema was observed more frequently in patients with pyloric channel ulcer (33.3%) than in patients with gastric or duodenal ulcer.
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  • Michiko YAMAGATA, Yukiko OTA, Yasuhisa KUMAKURA, Ken KIHIRA, Mikio HIR ...
    1994 Volume 36 Issue 8 Pages 1591-1596_1
    Published: August 20, 1994
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 78-year-old man was admitted to our hospital with a complaint of pharyngeal discomfort. Endoscopic examination revealed an early gastric carcinoma (ha type) in the prepyloric portion, a gastric adenoma on the anterior wall of the antrum and a superficial esophageal carcinoma above the hernial sac of the esophagus. The gastric carcinoma and adenoma were restricted to the mucosa, and we performed an endoscopic mucosal resec-tion (EMR) using a cap for Stiegmann-Goff Ligator fitted on the tip of a one channel panendoscope. The cancer or adenoma-bearing mucosa was packed inside the cap under full endoscopic suction and cauterized by a snare. Though the esophageal carcinoma was supposed to invade into sm, we performed the same procedure because he had pulmonary dysfunction which could not bear a surgical operation. Here we report a case of simultane-ous superficial esophageal carcinoma and early gastric cancer treated by EMR, success-fully maintaining the gastrointestinal function.
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  • Tamotsu FUKUDA, Masayuki SHINOHARA, Shunsuke ORINO, Tetsuya SAIJO, Sus ...
    1994 Volume 36 Issue 8 Pages 1597-1605
    Published: August 20, 1994
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 59-year-old woman who had undergone right ophthalmectomy for chroidal malig-nant melanoma in 1977, visited to our hospital because of abdominal discomfort in 1990. Abdominal ultrasonography and abdominal CT showed multiple tumors in both lobes of the liver, and gastroscopy showed a black elevated lesion in cardiac region of the stomach. Chroidal malignant melanoma metastating to the liver and the stomach on 13 years after surgery were suggested by past history and histology of the stomach and the liver. Chroidal and cutaneous malignant melanoma at early stage has better prognosis but has higher late reccurence rate (0.98%-6. 7%) like mammary cancer and renal cancer. But, only 11 cases of late recurrence of metastatic malignant melanoma has been reported in Japan. There are some reports that surgical and medical treatment is effective for early metastatic region of malignant melanoma. It is considered that the careful observation of early chroidal and cutaneous malignant melanoma after surgery by chest X-ray, ultrasono-graphy, abdominal CT, and upper gastrointestinal examination are useful for the detection of metastatic region.
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  • Toshihiko UEYAMA, Kenji KAWAMOTO, Ikuko IWASHITA, Kouji MASUDA
    1994 Volume 36 Issue 8 Pages 1606-1611_1
    Published: August 20, 1994
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    We reported a case of ulcerative colitis with a rare and unique complication. The case was a 50 year-old man with a history of ulcerative colitis for three years, who complicated internal fistula between the transverse and descending colon at the colonic splenic flexure. There was neither clinical nor pathological evidence of Crohn's disease. The presence of a internal fistula in the colon, which is characteristic in Crohn's disease, is distinctly unusual in ulcerative colitis, and has never been reported in the literature.
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  • Tsuyoshi FURUKAWA, Yoshihisa TSUKAMOTO, Yasuo NAITOH, Yoshiki HIROOKA, ...
    1994 Volume 36 Issue 8 Pages 1612-1618_1
    Published: August 20, 1994
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 65-year-old male was diagnosed to have diffuse dilation of the main pancreatic duct (MPD) on US. EUS revealed a wall irregularity of the MPD only in the head of the pancreas. Duodenoscopic finding was a swollen major papilla with production of mucin from a dilated orifice. A balloon-occluded ERP showed defects only in the ducts of Wirsung and Santorini in the pancreatic head. Peroral pancreatoscopy (POPS) showed a papillary tumor with redness. Intraductal ultrasonography (IDUS) showed an intraductal echogenic area with fine reticular pattern (FRP) only in the pancreatic head and 3 layers of the pancreatic duct with external FRP in the distal portions. We made a diagnosis of main duct type mucin-producing tumor of the pancreas localized in the pancreatic head with no parenchymal involvement. Pancreatoduodenectomy was performed and the pathological examination revealed adenoma.
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  • Hayato OHKI, Satoshi NAKANO, Isao TAKEDA, Takashi KUMADA, Keiichi SUGI ...
    1994 Volume 36 Issue 8 Pages 1619-1625
    Published: August 20, 1994
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    We reported two cases of biliary ascariasis. Case 1: A 45-year-old female was admitted to our hospital complaining of severe epigastralgia. On admission, blood chemi-cal examination showed an elevation of serum amylase level which suggested acute pancreatitis. Case 2 : A 52-year-old male was admitted to our hospital complaining of jaundice and severe right upper quadrant pain. On admission, blood chemical examination showed an elevation of bile duct enzyme level, which suggested common bile duct stone. In both cases, endoscopic retrograde cholangiography (ERC) was performed and a string like translucency in the common bile duct was observed. They were diagnosed as biliary ascariasis. In both cases, ascaris was removed easily by using basket catheter after endoscopic sphincterotomy (EST).
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  • Noriaki YAJIMA, Hitoshi SUGAYA, Sakumi SAEGUSA, Michiko HORINAKA, Tosh ...
    1994 Volume 36 Issue 8 Pages 1626-1630_1
    Published: August 20, 1994
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 43-year-old Japanese male was admitted to our hospital because of a thorough examination of the liver. Abdominal US and CT revealed an enlarged and fatty liver but no findings suggestive of hepatic tumors. Laparoscopy disclosed an enlarged, whitish liver with irregular surface, and a round shaped, slightly elevated whitish focal lesion which was clearly demarcated, 4mm in size, on the left lobe of liver near the falciform ligament. Fine vessels were observed on the surface of this lesion. This lesion was not stainned after ICG (indocyanine green) injection. Histology of the biopsied lesion showed adenomatous bile duct among dense fibrous tissues, which were compatible with intrahepatic bile duct adenoma. The second laparoscopy, 2 years later, disclosed a whitish scarred lesion at the site where a tumor was located previously. It seems due to the effect of biopsy performed from the tumor at the first laparoscopy. Intrahepatic bile duct adenoma is rarely en-countered in clinical practice, and only 8 cases have been reported in Japan. Most of them were incidentally found on abdominal surgery or autopsy. It is a benign tumor and, therefore, it has been dealt as a clinically negligible disease. However, there may be more opportunities to find these lesions with the development of diagnostic modalities and intrahepatic bile duct adenoma should be borne in mind in the diagnosis of focal hepatic lesion.
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  • Kunitoshi NAKAGAWA
    1994 Volume 36 Issue 8 Pages 1631-1634_1
    Published: August 20, 1994
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 68-year-old man who underwent anatomically inappropriate lobectomy of the right liver at a neighboring hospital was referred to our department because bile containing pus exuded from a drain postoperatively. A fistulogram showed right intrahepatic ducts and an abscess cavity. Fistuloscopy demonstrated multiple silk sutures in the abscess cavity. The silk sutures, which had served as the infection source, were removed endoscopically. Absolute ethanol was injected into the right intrahepatic ducts open to the dissected surface of the liver, and the intrahepatic biliary mucosa was stabilized by coagulation. The intrahepatic ducts were blocked without any major complications and the bile fistula was completely closed.
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  • Yoshiyuki NISHIKAWA, Yasushi HOSOKAWA, Masahumi TAGASHIRA, Tohru OHNIS ...
    1994 Volume 36 Issue 8 Pages 1635-1639
    Published: August 20, 1994
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    We developed a new technique of endoscopic injection sclerotherapy combined with variceal ligation for treatment of esophageal varices. In this technique, taking an advan-tage of two channel endoscope, an injection needle and a device of endoscopic variceal ligation were inserted to each of the two channels. After intravariceal injection of 5% ethanolamine oleate, the esophageal varix at the site of injection was ligated while the injection needle was stuck onto the varix. This method prevented bleeding after injection sclerotherapy perfectly without balloon tamponade. Moreover, variceal ligation just after sclerotherapy may prolong a period of stagnation of ethanolamine oleate in the varix, resulting in enhancement of therapeutic effects.
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