Endoscopic ultrasonography (EUS) was performed in 65 cases with duodenal ulcer. The results were as follows; 1) The depth of duodenal ulcer could be evaluated by EUS in 57 of 65 cases. Linear ulcers were significantly deeper than single or kissing ulcers. 2) The fusion of the second layer and fourth layer could be recognized at active stage, healing stage, and scarring stage, in 52.2% (12/23), 82.6% (19/23) and 84.2% (16/19), respectively. 3) The ulcer echo was seen at active stage, healing stage and scarring stage, in 87.0% (20/23), 87.0% (20/23) and 84.2% (16/19), respectively. 4) The ridge with duodenal kissing ulcer was not detected by EUS. 5) The destruction of the five-layer structure was visualized in the ridge with duodenal linear ulcer. Furthermore, hyperechoic and hypoechoic spots were mixed in the ridge. These findings had not been changed during the follow-up period. In conclusion, the present study suggests that the recurrence of the duodenal ulcer is more often observed, that the component of the ridge with linear ulcer is mainly scar tissue histologically, and that the recurrence of the duodenal linear ulcer may often occur on the ridge.

View full abstract

Twenty-seven cases with chronic hepatitis C who received interferon (IFN) treatment were selected for this study. These cases were divided into 12 cases of complete responder (CR) and 15 cases of no responder (NR). Laparoscopic findings, histological findings and serum markers for hepatic fibrosis: aminoterminal peptide of type III procollagen (PIIIP), 7s domain of type IV collagen (IV-7s), tissue inhibitor of metalloproteinase (TIMP) were studied before and after interferon treatment. In many of CR group, whitish markings or whitish changes of the liver surface were laparoscopically increased with histological improvement after IFN treatment. In addition, improvement of fibrotic score of liver histology and also decrease of the levels of serum markers for hepatic fibrosis were observed. From these results, it was suggested that laparoscopic findings demonstrating increase of whitish markings or whitish changes of liver surface may reflect the disappearance of inflammation rather than hepatic fibrosis.

View full abstract

We reported clinical benifits of endoscopic pancreatic stent, using 11 patients with chronic pancreatitis. All the subjects had abdominal and/or back pain and had stenosis of main pancreatic duct (MPD) in head of pancreas. We inserted scent into MPD via major papilla in 7 cases and via minor papilla in 4 cases. The diameter of used stent were 7, 8.5 and 11.5 Fr respectively, Average follow-up term after stenting are 11.7 months. Clinical symptoms were improved in all cases. Result of the exocrine function test was improved particular in 2 cases with the decreased diameter of the MPD more than 4 mm after stenting. Pancreatic endocrine function showed no change in all cases. Stent was patent in all cases for the following term. In conclusion, the pancreatic stent in patients with chronic pancreatitis showing stenosis of MPD are expected to improve clinical symptoms and to be safe endoscopic therapy.

View full abstract

A rare case of superficial esophageal cancer overlying leiomyoma was reported. A 70 year-old man was referred to our hospital with chest discomfort symptom. Esophagography showed a small protruding lesion, measuring 15 × 15 × 10 mm, arising from the left wall of the upper intrathoracic esophagus. Endoscopic examination revealed a slight erosion on its surface, and lugol spray technique showed an unstained area over the tumor. Biopsy specimen taken from the surface of the lesion showed squamous cell carcinoma. Endoscopic mucosal resection was performed. The resected specimen revealed superficial carcinoma over a submucosal tumor. Microscopic findings showed well differentiated squamous cell carcinoma mainly confined to epithelium with invasion to a part of the submucosa, and submucosal leiomyoma composed of interlaced bundles of spindle-shaped smooth muscle cells. The causative relation between the esophageal leiomyoma and the squamous cell carcinoma is unclear but, in this case, constant mechanical stimulation might have caused malignant deterioration of the epithelium overlying the leiomyoma.

View full abstract

A 23-year-old woman visited to our hospital to take the mass survey. Roentgenographic and endoscopic examination showed mucosal bridges in the upper body. Endoscopic examination and histological findings of the biopsy specimen showed gastric ulcer scars. Therefore, we considered that this mucosal bridge was not congenital but acquired. Some cases of mucosal bridge in inflammatory bowel disease were reported, but reports of gastric mucosal bridge in Japan are rare.

View full abstract

A 68-year-old male underwent a routine medical check-up. Gastroscopic examination revealed an early cancer surrounded by a slight elevation on the lesser curvature of the cardia. In order to determine the line of invasion of cancer cells and to confirm a diagnosis of the surrounding elevation, we performed endoscopic ultrasonography, which showed that the cancer cells were within the mucosa and the surrounding elevation was a lipoma, 15×7mm in size, in the submucosal layer. The cancer lesion was removed by endoscopic mucosal resection. Histological examination of the resected tissue confirmed the findings of ultrasonography.

View full abstract

The diagnosis of unclassified non-specific ulcers of the small intestine was made clinically and pathologically for a 54-year-old man who was admitted to the hospital because of melena and general malaise. Clinical evaluation was carried out as follows. None of gastrof iberscopy, colonof iberscopy, abdominal angiography and ^99mTC human serum albumin scintigraphy could detect the bleeding point at the first event. However, ^99m Tc HSA scintigraphy showed the hot spot clearly at the terminal ileum when the recurrent episode occurred. A small round shaped ulcer and a longitudinal ulcer were seen at the corresponding position, using the intraoperative endoscopy. Based on the pathohistological findings of the resected specimen, these ulcers were refered to Ul-II, with sharp margin and slight inf iltratiion of lymphocytes, without forming any Granuloma or abnormal vascular constraction was not found in the submucosal tissue. He is will without further episode after the resection of fifty centimeters of the region including these ulcers.

View full abstract

A 40-year-old woman was admitted to our hospital with a chief complaint of large amount of hematochezia. Colonofiberscopy showed an ulcerative lesion in the terminal ileum. A diagnosis of primary malignant lymphoma was made from the histology of the biopsied specimen. Ileum including a part of large intestine was removed surgically. A diagnosis of diffuse, mixed-sized T-cell malignant lymphoma was comfirmed from the positive findings to immunochemical stain with UCHL-1. After the operation, chemotherapy with VEPA was carried out, but one year later, the tumor was recurred both in tonsil and residual ileum. The tumor in the residual ileum was resected and chemotherapy with CHOP was carried out following the surgical procedure. However, the tumor was noted in the colon a half year later. Although salvage chemotherapy was carried out, she expired three years later from her first visit to our hospital.

View full abstract

A 59-year-female had been suffering from periodic pain in the umbilical region and vomiting since 1 month prior to examination. Barium meal study revealed intussuception for which she was hospitalized. Colonoscopy revealed a tumor measuring 4cm in diameter which invaginated into the ascending colon from small intestine. Microscopic examination of the biopsied specimens from the tumor showed malignant lymphoma. Ileocecal resection was performed. Histological diagnosis of the resected tumor was non-Hodgkin's lymphoma (diffuse, large cell type). In the present study, the authors refered 24 recent Japanese reports of malignant lymphoma of the ileum associated with intussuception, and discussed their clinical features.

View full abstract

A 42-year-old-male came to our hospital with a complaint of anal bleeding. The colonoscopic examination revealed a nodular tumor, measuring to mm in diameter, at the ileocecal valve. Carcinoid tumor was diagnosed by histological examination of biopsy specimen. Then ileocecal resection with regional lymph node dissection was performed. Histological examination of the resected tissue showed that the carcinoid tumor was located mainly in the submucosal layer with the invasion into the muscular layer at the top of the tumor. No definite metastasis was seen in the lymph node or liver. This case was diagnosed as carcinoid tumor of the ileocecal valve. Only five similar cases including our case have been reported in Japan.

View full abstract

A 61-year-old man was admitted to our hospital for further evaluation of an abdominal tumor. Abdominal ultrasonography, CT, and MRI demonstrated the presence of a large mass with ascitic septations in the peritoneal cavity, although the origin of the mass was not apparent. Percutaneous tumor biopsy revealed gelatinous fluid with adenocarcinomatous cells. Colonoscopy revealed a large pedunculated polyp in th transverse colon, and endoscopic biopsy specimens from this polyp were shown to be tubular adenoma histologically. It was suspected that the abdominal tumor might be a pseudomyxoma peritonea then resection of the tumor and partial colectomy involving the segment with the polyp was performed. At laparotomy, there was a large tumor in the peritoneal cavity with massive mucinous material, the tumor appeared to originate from the pedunculated polyp of 40 mm in siqe in the tranxverse colon. The appendix was normal. Pathologically, the final diagnosis was a pseudomyxoma peritonea originating from the mucinous adenocarcinoma, identified as the pedunculated polyp. Recent work has shown that pseudomyxoma peritonei occurs secondary to malignant mucosecreting tumors, mainly origination from the appendix or ovary. According to the literature, this is a rare case of pseudomyxoma peritonei originating from mucinous adenocarcinoma of the colon presenting as a pedunculated polyp.

View full abstract

Two cases of fistula between the pancreatic duct and duodenum are reported. The first patient was a 69-year-old man who was found to have multiple pancreatic stones over 20 years ago. On admission, the pancreatic stones were no longer visible. The disappearance of the stones is suspected to be related to the formation of a pancreaticoduodenal fistula. The second patients was 67-year-old man in whom a suspicion of mucinproducing tumor complicated by pancreaticoduodenal fistula had been made. Since biopsy specimen failed to show any evidence of maligancy, the fistula was suspected to be formed as mechanical perforation by mucin.

View full abstract

A 84-year-old male was admitted to our hospital because of jaundice and diagnosed as having inoperable cholangiocarcinoma at the hilum of the liver. Endoscopic retrograde cholahgiopancreatography (FRCP) revealed a severe stricture of bilateral hepatic bile ducts and two endoscopic naso-biliary drainage (ENBD) tubes were inserted into each hepatic bile duct. As serum bilirubin level decreased day by day, we attempted to implant two pieces of self-expandable metallic stents, Wallstent, on his 15th day in hospital. One Wallstent was introduced and implanted along the left ENBD tube. Subsequently, duodenoscope was inserted again and the other Wallstent was implanted along the right ENBD tube. Although the first stent was already implanted, it was easy to insert the second stent and both of two stents were expanded adequately. The patient was discharged on his 22nd day in hospital. No obstruction of the stents occured and he died of heart failure 3 months later. While transpapillary stenting is very useful to shorten hospital stay, it had been presumed impossible to duodenoscopically implant two pieces of self-expandable metallic stents into bilateral hepatic bile ducts. However, we experienced a case with cholangiocarcinoma at the hilum in whom two pieces of Wallstents could be implanted simultaneously using duodenoscopy.

View full abstract

The studied subjects were 87 patients with drug-induced mucosal lesions in gastrointestinal (GI) tract, who were seen in our clinic for the past 10 years. Patient's ages ranged from 13 to 80 years (median, 52yr). 40 patients were male and 41 female. They included 7 patients with esophageal lesions, 58 with gastric lesions, 4 with duodenal lesions and 18 with eolonic lesions. The common drugs involved in upper GI tract lesions, were nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antibiotics, tranquilizers, potassium chloride, antineoplastic drugs and combination of them. The lower GI tract lesions were two kinds of antibitic-associated colitis, pseudomembranous colitis and acute hemorrhagic colitis. A major facto-producing esophageal injury was long-term retention of causative agents in the lower esophagus due to postoperative rest in bed and/or intake of drugs without water. Drug-induced gastric lesions had various characteristic features, and were common in old aged woman. Most of them had orthopedic disorders such as rheumatoid arthritis, bone fractures and other diseases with neuralgia. Endoscopic features with drug-associated ulcers were multiple, irregular formed and hemorrhagic. Occasionally single trench ulcer was found. AGML with severe symptoms such as hematoemesis, severe epigastralgia was found in 30% in patients with drugassociated gastric lesions. In antibiotic-associated colitis, pseudomembranous colitis were more frequent in older people, which developed after administrations of cephem-family antibiotics in 50% of the patients. On the other hand, acute hemorrhagic colitis were common in young people, and 61% of them received penicillin-family antibiotics. The periods from drug intake to onset of the disorders were within a week in esophageal ulcer and AGML, within 2 weeks in duodenal ulcer and antibiotic-associated colitis, and over a month in gastritis and gastric ulcer respectively. Emergent endoscopy should be performed to confirm the diagnosis of drug-induced GI mucosal lesions, and the administration of causative agents should be stopped as early as possible.

View full abstract