GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 37, Issue 10
Displaying 1-21 of 21 articles from this issue
  • Yuichi SHIMIZU, Hiroyuki TSUKAGOSH, Tomohiko NAKAZATO, Mitsuru KAWARAZ ...
    1995 Volume 37 Issue 10 Pages 2157-2165_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    The ability of ultrasonic miniature probe to diagnose the depth of invasion was investigated in 48 lesions with superficial esophageal carcinoma between December 1993and December 1994. The depth of invasion was classified as ml or m2, m3, or sm1, and sm2 or more over.By using the 20 MHz miniature probe, it was possible to detect mucosal carcinorna clearly, and the diagnostic accuracy was 83.3%in 48 lesions. The reasons for incorrect diagnosis were insufficiency of imaging, broadness of the lesion, micro invasion, and artifact of endoscopic biopsy. Another problem for diagnosis is that normal nine layerd structure could not be visualized in same cases. In these cases, it is considered that the thickness of tumorous echo will lie a index for diagnosis. Though some problems remain unsolved, the imaging procedures using miniature probe is considered to be useful for the pre-operative diagnosis of the depth of invasion in superficial esophageal carcinoma.
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  • Kouji UNO, Masatsugu NAKAJIMA, Kenjiro YASUDA, Eisai CHO, Hidekazu MUK ...
    1995 Volume 37 Issue 10 Pages 2166-2175_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Five patients with inoperable malignant esophageal stenosis were treated by using a newly designed polyurethane-covered self-expanding metallic stent(SEMS). These polyurethane-covered SEMS were hand-made by soaking uncovered Z-stents in polyureth-one solution. The stenting was perfarmed successfully in all five patients without any severe complications. Only one patient had a chest pain which was in need of analgesics after stenting. Oral intake of food was much improved soon after the procedure. No obstruction of the stents occurred during the follow-up observations from 18 to 103 days because the stents could completely protect the ingrowth of the tumors. There were two late complica-tions recognized; the one with stent migration and the other with restenosis due to the overgrowth of the tumor, but those were released by reinsertion of new stmts. These results apparently showed that the use of polyurethane-covered SEMS was effective in the management of malignant esophageal stenosis, because of its technichal easiness, low complication rate and capability of protecting tumor ingrowth.
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  • Satoshi ITANO, Norihiko TERADA, Osamu HASHIMOTO, Hiroyoshi MATSUKAWA, ...
    1995 Volume 37 Issue 10 Pages 2176-2184
    Published: 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    AGML following upper endoscopic examination(ES)was discussed. At our hospita1 36 cases were experienced for recent 3 years and the frequency of this series was O.429%among total upper Gr endoscopy. The sexual ratio was 21:15 and the mean age was 43.3 years in the male and 48.5 years in the female. AGML developed after the first ES in 22 cases and after the second ES in 8 cases. The frequency of AGIVIL was higher in the younger endoscopists. The endoscopic findings lust before AGML showed almost normal or only a little abnormality. Most of the patients started to feel severe pain and/or nausea 7 to 8 days after ES. Urgent ES revealed hemorrhagic erosion in 30 patients (83.3%). Main lesion occupied the antrum in all cases and spread to the body and/or the bulb in some cases. Despite mental stress or excessivc drinking and eating were suspected to be the cases, the cause of AGML following ES was unknown. The lesions healed earlier than those of the chronic gastric ulcer with conventional antiulcer treatment. In 30 cases followed by repeated ES, the hemorrhagic changes were disappeared in 3 to 4 days and 83.3%of them were healed within 21 days.
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  • Takanobu HAYAKUMO, Masatsugu NAKAJIMA, Kenjiro YASUDA, Eisai CHO, Hide ...
    1995 Volume 37 Issue 10 Pages 2185-2192_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
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    Clinical evaluation of covered Strecker-stent(21 Fr.)specially made by using a silicone rubber(BiobraneR)is presented in the management of inoperable malignant biliary obstruc-tion in comparison with that of uncovered standard Strecker-stent (21 Fr.)and standard plastic stents(10 or 12 Frr.). Endoscopic retrograde biliary drainage(ERBD)was attempted in 82 patients with inoperable biliary or pancreatic malignancies;54 patients with pancreatic cancer, 13 with common bile duct cancer, 11 with gallbladder cancer, one with ampullary cancer and three with metastasis of gastric cancer. All patients had only an Obstruction of the extrahepatic bile duct excluding the hilar portion and had neither adjuvant chemotherapy nor radiation.In this series, standard plastic stents were used in 60 patients, uncovered standard Strecker-stent was applied in seven patients and specially designed covered Strecker-stent was employed in 15 patients. The obstruction rate of the uncovered Strecker-stent and plastic stent were 57% and 77%, and the mean patency of these stents taken by Kaplan-Meier's method was 99 days and 102 days respectively. The uncovered Strecker-stent was not able to provide the significant long-term patency compared to the conventional plastic stems due to the early obstruction caused by tumor ingrowth through its metallic mesh. On the other hand, the obstruction rate of the covered Strecker-stent was decreased in 40/and its mean patency term enlarged to 272 days because of preventing tu-mor ingrowth. These results suggest that the covered Strecker-stent has the superiority over the uncovered Strecker-stent and 10 Fr. or 12 Fr. plastic stent in the relief of malignant biliary stricture of the bile duct.
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  • Kiyoshi ASHIDA, Masami MURASE, Katsuhiko MIYAJI, Hiroshi HAZAMA, Hiroy ...
    1995 Volume 37 Issue 10 Pages 2193-2199_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 76-year-old man was admitted to our hospital because of severe cough afterradiation therapy and laser therapy for a esophageal cancer at upper part of intrathoracicesophagus. Endoscopy showed an ulceration without stenosis at this site (Figure 3) andexcretion of sputa from a small hole in this ulceration. An esophagotracheal fistula wasdiagnosed by roentgenogram with Gastrografin (Figure 4) . A silicone-covered expandablemetallic stent, 2cm in diameter and 10 cm in length, was easily left in situ of ulceration (Figure 7-a, 7-b) . Cough disapPeared soon after implantation and he was able to eat halfliquid diet. Subsequently, QOL was markedly improved. It was thought that this stent was useful for inoperable patients with esophagotracheal fistulas.
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  • Katuyuki KOICHI, Sigehiko OGAWA, Yumiko NAKANO, Naoki IKEDA, Tokio WAK ...
    1995 Volume 37 Issue 10 Pages 2201-2204_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    We experienced a case of corrosive injuries of gastrointestinal tract by HCI ingetion.A21 year-old man was admitted to the hospital because of an ingestion of 9.5% HCI.Thegastrointestinal endoscopy showed acute gastric mucosal lesion(AGML)on his firsthospital day. Endoscopic ultrasonogaphy(EUS)with intraductal catheter probe (20MHz)revealed marked thickening of the gastric 3rd layer with heterogenous hypoechoic internal echoes.The lesions encompassed the entire circumference of the gastric wall. These findingsnormalized after 11 days. EUS with intraductal catheter probe was thought to be usefull for the diagnosis of theextent of the corrosive lesions.
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  • Hironori TOKUMO, Kimiko TSUDA, Hiroaki MIYAKE, Hirofumi MARUYAMA, Shiz ...
    1995 Volume 37 Issue 10 Pages 2205-2209_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    An 88-year-old female, who has had a senile dementia and a history of partialgastrectomy due to early gastric cancer 4 years ago, accidentally swallowed Calciumoxide, a desiccant for food. She complained epigastric pain and vomited immediately. Antipper gastrointestinal endoscopic examination 4 hours after the accident revealed thatCalcium oxide stuck diffusely onto the mucosa of the lower esophagus and remnantstomach. We tried to clean up Calcium Oxide with water through the aspiration channelof the endoscope. lt was not successful to exclude it because of its tight adhesion onto themucosa. She was treated with an antibiotic agent, corticosteroid and intravenouLs hyperalimentation with fasting. Next day, another endoscopic examination was performed tocheck the lesion and no Calcium oxide was found on both esophageal and gastric mucosa.However, corrosive injuries were observed to the same extent of Calcium oxide adhesion.More serious injury of esophageal mucosa was observed than that of gastric rnucosa. Thedifference of the injuries between the two organs was considered to have been due to theexistence of gastric juice in the stomach. That is, calcium Hydroxide (alkali), made fromCalcium Oxide with water by chernical reaction, was neutralized by'Hydrogen Chloride (acid) in gastric juice. Normal heading process was observed in each endoscopic examination performed on the llth and 27th days. Late phase disorder like esophageal stenosis hadnot recognized until this time. We reported the endoscopic findings of the injury caused by Calcium oxide andreviewed the characteristics of corrosive injury of the upper gastrointestinal tract.
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  • Chiaki NAGAKAWA, Mitsuyuki WATNABE, [in Japanese], Kouichi SHIRAISHI, ...
    1995 Volume 37 Issue 10 Pages 2211-2215_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 90-year-old fernale was admitted because of dyspnea on exertion. Severe anemia(Hb 3.89/dl), cardiomegaly and leg edema were noted. Stool occult blood was positive.She was diagnosed to have heart failure caused by severe anemia. Endoscapic examination of the upper gastrointestinal tract revealed multiple eryth-ematous spots consisting, of vascular ectasia distributing from the upper body to theantrum. dozing hemorrhage were observed on several spots of those areas. However suchlesions were not observed on the greater curvature of the midde and upper bodies thegastric mucosa generally revealed marked atrophy. With these endascopic findings shewas diagnosed to have diffuse antral vascular ectasia DAVE. To control her generalconditions, she was treated with blood transfusion and diuretics. Although her heart failurewas improved, gastric bleeding could not be controlled by injections of absolute ethanoland/or hypertonic saline epinephrine into the bleeding spots through a gastric fiberscope. She died of pneumonia. Histological findings of the autopsy specimen revealed typicalfindings of DAVE such as increased mucosal vascuiarity, the presence of intravascuiarfibrin thrombi, fibrosis of the lamina propria and mucosal atrophy. Liver cirrhosis andchronic renal failure, which had been reported to be frequently associated, were absent inthis case.
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  • Shigeru INOUE, Akimichi CHONAN, Toyohiko YUKI, Kazuhiko ISHIDA, Naotak ...
    1995 Volume 37 Issue 10 Pages 2216-2221_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 67-year-old male was admitted to our hospital for further examination of a polypoidlesion of the stomach. X-ray and endoscopic examinations revealed a semipedunculatedsubmucosal tumor on the greater curvature of the upper body of the stomach. Endoscopic ultrasonography demonstrated a multilobular aechoic region in the thirdlayer of the gastricwa11. Endoscopic polypectomy was performed under the diagnosis of submucosal heterotopia of gastric glands. The size of the resected specimen was 10× 9× 5mm. Histological1y, the polypoid lesion consisted of heterotopic glands in the submucosal layer, some ofwhich formed large cysts. The endascopic ultrasonographic findings well reflected thehistalogical findings. Thus, it is concluded that ultrasanagraphy is useful far the dzagnasisof submucosal heterotopia of gastric glands.
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  • Naoto MAEDA, Izuhito INKI, Hironobu ANDACHI, Takeaki SUOU, Hironaka KA ...
    1995 Volume 37 Issue 10 Pages 2222-2227_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A50-year-01d rnan with upper abdominal pain and fullness was admitted to ourmedical ward for further evaluation of duodenal lesion. A polypoid lesion was found in thebulb by upper gastrointestinal x-ray and endoscopic examination, and was surgicallyresected under a clinical diagnosis of a subrnucosal turnor. The resected specimen was 22× 11rnm in size, and was pathologically diagn.osed as a xanthorna located in the submucosallayer of the duodenum. There have not been no other reports on such kind of xanthoma which showed tumor1ike appearance in the duodenal bulb. We discussed the possible pathogenesis of thisinterested case and reviewed seme literatures.
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  • Fumiaki KIMURA, Yoshimitsu TERASAWA, Takaaki FUJII, Ichiro HARA, Akito ...
    1995 Volume 37 Issue 10 Pages 2229-2233_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Recentry we experienced two cases of juvenile intestinal tuberculosis with acute colitislike appearance. First case was a 24 year-old woman vvho came to our hospital withabdominal pain, diarrhea and melena. We performed emergency colonoscopy and collectedthe colonal lavage fluid. So we were able to make diagnosis that she had intestinaltuberculosis. Second case was a 34 year-ald man who came our hospital with abdominalpain and melena. we were able to make diagnosis that he had intestinal tuberculosis bythe same examinations as the first case. No pulmonary tuberculosis were found among thetwo cases. And only acute colitis like appearances were shown in these two cases. So iteras difficult to make diagnosis of intestinal tuberculosis only on endoscopy. We suggestthat emergency colonoscopy and analysis of collecting colonal lavage fluid far patients ofmelena are useful for rapid diagnosis of primary intestinal tuberculosis and that manyintestinal tuberculosis was overlooked by nontypical findings. Recently young people whobecame infected Mycobacterium tuberculosis were increasing. So the importance of preventing tuberculosis was suggested.
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  • Hideaki HASUOKA, Yoshiro TAKEUCHI, Tadashi MAEDA, Koji CHI, Hideo HARA ...
    1995 Volume 37 Issue 10 Pages 2234-2239
    Published: 1995
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    We experienced two cases of enterobiasis of the large intestine where Enterobiuswarms were incidentally detected at colonoscopy. base l was a 60-year-old woman whopresented with abdominal fullness. Colonoscopy revealed a white worm in the cecum. Anattempt to catch the worm with biopsy forceps failed because the worm escaped rapidly.The worm was successfully caught and removed after attenuated with working hot biopsyforceps. The Worm was identified as Enterobius vermicularis by its morphology. Case 2was a 37-year-old man, who was referred for colonoscopy because of a positive occultblood test in the mass-screening stool examination. Colonoscapy revealed a white wormin the descending colon and at the entrance of the appendix, respectively. The worms weresuccessfully removed in the same way as in Case 1. Enterobiasis causes perianal itchingat most, but its parasitic rate is still high. We reported these two cases because similarcases will be increasingly found with increasing occasions of calonoscopy. Successfulidentification will dead to the prevention and appropriate.
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  • Akio YAGO, Naotaka FUJITA, Yutaka NODA, Go KOBAYASHI, Katsumi KIMURA, ...
    1995 Volume 37 Issue 10 Pages 2240-2246_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
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    A63-year-old woman with liver cirrhosis was diagnosed as having a mucin-producingtumor of the pancreas. Pancreato duodenectomy was not elected as it was considered tobe a burden far the patient. Subsequent endascopic ultrasonagraphy during the 2.5-yearfollow-up period revealed growth of the papillary mass in the cyctzc cavity. The lesion vvasdiagnosed as carcinoma and surgical treatment was elected. Peroral pancreatoscopyshowed no tumor or abnormalities in the main pancreatic duct or at the entrance of thebranch. Uncinatectomy was performed. Histology verified a papillary adenocarcinomawithout parenchymal invasion. This report stresses the usefulness of the endoseopicapproach for follow-up and decision as the surgical procedures to he employed in patientswith this disease.
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  • Akiyosi KAMATA, Sachiko SUZUKI, Hiroya SAITOH, Yasuo SAKURAI, Miki YAM ...
    1995 Volume 37 Issue 10 Pages 2247-2255_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
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    we experienced a case of early bile duct cancer associated with congenital choledochalcyst and anomalous arrangement of the pancreaticobiliary duct system. The patient wasa51-year-old woman, who was admitted to our hospital due to obstructive jaundice inNovember 19931 Endoscopic retrograde cholangiopancreatography(ERCP)revealed a:nornalous arrangement of the pancreaticobiliary duct system and a congenital choledochal cyst(Alonso-Lej, type I). Percutaneous transhepatic cholangioscopy(PTCS)demonstrated apapillary tumor of Ip type and IIa-like lesions around the main tumor in the bile duct cyst.Histological findings of the biopsied specimens showed papillary adenocarcinoma. Thedepth of invasion was suspected within the fibromuscular layer by endoscpic urtrasonography (EUS)and pancreatoduodenectamy was perfarmed. Pathological examination of theresected specimen revealed a papillary adenocarcinoma in both Ip and IIa-like lesions andthe depth of invasion was within the membranous layer slightly invading the fihromuscularlayer in the cyst wall.
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  • Tohru ISHII, Masafumi KOMATSU, Tsuyoshi ONO, Masato FUNAOKA, Junji KAT ...
    1995 Volume 37 Issue 10 Pages 2257-2261_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
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    Acase of idiopathic portal hypertension accompanied by periosis hepatis was reported. A13-year-old man vvas admitted to our hospital because of further evaluation of liverdysfunction and splenomegaly. Hematology showed mild thrombocytepenia. Abdominal US, CT, MRI showed splenomegaly and dilatation of portal, superior mesenteric andsplenic veins. Histology of the liver showed a dilatation of portal vein in the portal area, proliferation of collagen fibers, and than septal fibrosis. In addition, various forms of bloodfilled cavities within the hepatic parenchyma suggesting perioSis hepatis were demonstrated. With these histological findings, a peculiar appearance consisting of mildly granularliver surface accompanied by dark, royal purple speckles(spats)was demonstrated by Iaparoscopy.
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  • Koichi KATAOKA, Masako SUZUKI, Junko TAKATA, Itsuroh ENDOH, Yoshihiro ...
    1995 Volume 37 Issue 10 Pages 2262-2266_1
    Published: 1995
    Released on J-STAGE: May 09, 2011
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    Acute hemorrhagic rectal ulcer (AHRU) occurs suddenly with painless, massive freshrectal bleeding in aged patients suffering from serious primary disease. AHRU was firstproposed by Kohno et al. in 1980. We assessed the clinical findings, endoscopic images andtherapies in seven patients with AHRU seen over the past five years. The clinical findingsand endoscopic images were similar to those reported previously. AHRU was assumed tobe caused by circulatory impairment of rectal mucosa due to advanced age, seriousprimary disease and bed-ridden condition as well as placement of an analgesic suppasitoryand constipation. Six patients who had an exposed vessel.received endoscopic localinjection therapy. However, since the therapy failed to produce sufficient hemostaticeffects in 4 patients, a hemostatic procedure by digital cornpression was also performed.All patients had reliable hemflstasis without any recurrent bleeding. Therefere, thehemostatic procedure by digital compression was considered very useful for the treatmentof AHRU.
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  • 1995 Volume 37 Issue 10 Pages 2267-2316
    Published: 1995
    Released on J-STAGE: May 09, 2011
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  • 1995 Volume 37 Issue 10 Pages 2317-2333
    Published: 1995
    Released on J-STAGE: May 09, 2011
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  • 1995 Volume 37 Issue 10 Pages 2334-2343
    Published: 1995
    Released on J-STAGE: May 09, 2011
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  • 1995 Volume 37 Issue 10 Pages 2344-2366
    Published: 1995
    Released on J-STAGE: May 09, 2011
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  • 1995 Volume 37 Issue 10 Pages 2386
    Published: 1995
    Released on J-STAGE: May 09, 2011
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