GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 40, Issue 10
Displaying 1-11 of 11 articles from this issue
  • Junichi YOSHIKAWA
    1998 Volume 40 Issue 10 Pages 1835-1843
    Published: October 20, 1998
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Diagnostic utility of endoscopic ultrasonography (EUS) for the determination of the depth of gastric cancer invasion was evaluated and tried to improve the EUS criteria for the diagnosis. Accuracy rate of the diagnosis by the traditional EUS criteria was 72% for 170 patients with gastric cancer determined by histological studies for them. Many cases overdiagnosed by the EUS were revealed to have ulcer scar with fibrosis and many of them showed tapering or smooth disruption of the third hyperechoic layer. On the other hand, many cases of correct diagnosis without ulcer had an irregular disruption of the third hyperechoic layer. The cases with highly thickening of the fourth hypoechoic layer suggested the presence of advanced cancer, however, the cases with mild thickening of the fourth hypoechoic layer were unable to evaluate of the depth of cancer invasion. In this study, new criteria was established by the addition of the degree of thickening of the fourth hypoechoic layer and shape of the third hyperechoic layer to the traditional EUS diagnostic criteria. The main improvement of new criteria are as follows ; (1) Those showing type of highly thickening of the fourth hypoechoic layer were diagnosed as subserosal or serosal cancer. (2) Those showing type of tapering or smooth disruption of the third hyperechoic layer with normal or mild thickening of the fourth hypoechoic layer were diagnosed as mucosal cancer. (3) In the cases with mild thickening of the fourth hypoechoic layer, those showing type of irregular disruption of the third hyperechoic layer were diagnosed as muscularis propria cancer and those showing type of thickening of the third hyperechoic layer without disruption were diagnosed as subserosal or serosal cancer. The total accuracy rate by new criteria was improved up to 81%, accuracy rate of mucosal cancer was especially improved up from 59% to 84%.
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  • Kenichi FUJITA, Tatsuo YAMAKAWA, Masami KARIBE, Kouzo NAGAI
    1998 Volume 40 Issue 10 Pages 1844-1850
    Published: October 20, 1998
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    The aim of this study is to investigate how much endoscopists and assistants are polluted with gastrointestinal contents at the time of endoscopic gastric biopsy. Prior to endoscopy, the irrigation channel of gastrofiberscope was filled up with 5 ml of starch gel. And polluted spots with starch gel on the gown were stained by spray of 0.005% iodine solution after endoscopic biopsy of gastric lesions. Number of endoscopists and assistants involved in this study was 13 and 20, respectively. Number of biopsied specimen taken from each patient was varied from 3 to 13. Samples taken from biopsy channel of 5 patients were submitted for bacterial culture and its results were compared with that of the gown used by endoscopists and assistants. Moreover, the usefulness of plastic apron for infection prevention was investigated with questionnaire into the medical personnel involved in this study. Polluted spots by starchgel on the gown of endoscopists were remarkable in the abdominal area. Especially, the right side of the abdomen was more polluted by gastric contents than that of the left side. Pollution rate was 8/13 (61%) in the right and 6/13 (46%) in the left. However, interestingly enough, polluted spots of the gown by starch gel was more remarkable on the gown worn by assistants than that of endoscopists. Rate of pollution was over 80% at the abdominal area and 60% at the chest. Although bacterial species detected on the gown were different from that of the sample obtained from biopsy channel in the majority of cases, same species of bacteria noted in the irrigation channel were detected at the abdominal area of the gown in 1 of 5 assistants. These facts suggest the capability of bacterial infection between medical personnel and patients. This risk was seemed to be preventable by the use of a plastic apron.
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  • Hidetaka SHIGETA, Makoto SEKI, Hirotoshi OHTA, Masashi UENO, Tomoyuki ...
    1998 Volume 40 Issue 10 Pages 1851-1856
    Published: October 20, 1998
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 44-year-old woman received uppergastrointestinal endoscopy and a tumor was found incidentally at the papila of Vater. Biopsy specimen from the tumor revealed carcinoid and pyrolus-preserving pancreaticoduodenectomy was then performed in our hospital. The tumor was 7mm in diameter and located in the submucosal layer. The carcinoid tumor of the papilla of Vater is rare and small cases of less than 10 mm in diameter are much rare and only 5 cases have been reported. Pancreaticoduodenectomy with lymph node dissection should be performed because malignant potential is high even if a tumor is small.
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  • Yuji INOUE, Shigeru SUZUKI, Mamoru SUZUKI, Yoko MURATA, Bunei IIZUKA, ...
    1998 Volume 40 Issue 10 Pages 1857-1863
    Published: October 20, 1998
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Forty two patients with early colorectal cancer were studied to evaluate the results of endscopic piecemeal polypectomy from 1992 to 1996. The number of piecemeal resection was most frequent, about 5 times, in nodule-aggregating lesions in configuration of tumor and about 6 times in lesions over 30mm in size of tumor. There were 36 patients in whom all piecemeal specimens could be obtained. The average maximum diameter of the specimen was about 14mm and the depth of cancer invasion could be diagnosed in all patients. In 35 patients with mucosal cancer, no recurrence was seen. In 4 of 7 patients with submucosal cancers, complete resections was performed, but local recurrence was seen in 1 patients. In 3 patients residual cancer was noted and additional surgical resec-tions was performed. Two patients had residual cancer in resected specimens and another patient . had lymph node metastases. These results showed that endoscopic piecemeal polypectomy was useful for mucosal cancer but should be indicated cautiously for sub-mucosal cancer.
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  • Toshifumi OZAWA, Yuko OKUYAMA, Koji OKUMURA, Toyoichi TSUCHIYA, Nobuo ...
    1998 Volume 40 Issue 10 Pages 1864-1871
    Published: October 20, 1998
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    In a 57-year-old man, abnormal findings at the lesser curvature of the lower gastric body was detected in a health check-up. Endoscopic examination revealed type III+IIc lesion at same portion. Histological examination of the biopsied specimen revealed adenocarcinoma cells. After three times of endoscopic examination, the patient was introdeced and admitted to our hospital. Double contrast study revealed a IIa+IIc lesion with central elevation at the lesser curvature aspect of the lower gastric body. Endoscopic findings revealed a ha + IIc with central elevation. The Shape of the lesion changed from III + IIc to ha + IIc during the three months. The value of alpha-f etoprotein elevated from 7.8 ng/ml on the initial health check-up to 147.6 on admission. Because of lympha-denopathy at the No. 1 portion, total gastrectomy was performed. Histological examina-tion of the resected specimen showed papillary and solid tumor of poorly differentiated adenocarcinoma which was massively invaded into the submucosal layer (sm 3). The part of poorly differentiated adenocarcinoma in the submucosal layer was positive for im-muological staining of alpha-fetoprotein except the part of papillary adenocarcinoma in the mucosal layer. Based on a review of the literature, this is the first case of early gastric cancer that changed in its form in a short time with elevation of AFP value.
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  • Masahiko ARAI, Hiroyasu USHIMARU, Yasuharu IMAI, Kiyoshi FURUTA, Masuo ...
    1998 Volume 40 Issue 10 Pages 1872-1878
    Published: October 20, 1998
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A case of early duodenal carcionoma arising from Brunner's glands was reported. Thepatient was a 55-year-old woman. Upper gastrointestinal endoscopy of general healthscreening revealed a submucosal tumor-like elevated lesion with a central depression andbridging folds in the 2nd portion of the duodenum. Biopsy disclosed well differentiatedadenocarcinoma. Hypotonic duodenography also revealed an elevated lesion, 20 × 17mm insize, in the same position. Abdominal US, CT and ERCP showed no abnomality. Partialduodenectomy was performed. Pathological examination of the resected specimen showedthat well differentiated adenocarcinoma with submucosal invasion(sm)was present in apart of the Brunnerioma. This case was, therefore, diagnosed as carcinoma of Brunner'sglands origin by histochemical study using galactose oxidase-cold thionin Schiff andparadoxical concanavalin A staining. Duodenal carcinoma arising from Brunner's glandsis extremely rare. We studied 24 similar cases reported in Japan.
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  • Hidetoshi AOKI, Atsunobu KURINAGA, Yasumasa IKEDA, Ken-ichi KITAZOE, M ...
    1998 Volume 40 Issue 10 Pages 1879-1883
    Published: October 20, 1998
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A82-year-old man who had received resection of sigmoid colon cancer four years agowas referred to our hospital for post-operative follow-up colonoscopy. Colonoscopyrevealed a slightly raised white-yellowish soft plaque at the sigmoid colon measuring aboutlcm in diameter. The lesion was negative for non lifting sign, and we perfermedendoscopic mucosal resection of the lesion. The histological finding of the specimen washistiocytic granuloma in the mucosa and the cytoplasm of these histiocytes showed roundlaminated inclusions(Michaelis-Gutmann bodies)that were positive for iron and calcium, thus confirming it to be a case of malacoplakia.
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  • Tetsuya AOKI, Kiyotaka OKAWA, Takashi NAKAI, Kouji SANO, Shigeyoshi HA ...
    1998 Volume 40 Issue 10 Pages 1884-1888
    Published: October 20, 1998
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    The patient was a 67-year-old woman. Owing to a positive result in occult blood test;she visited our department for detailed examination. Barium enema and colorectalendoscopy were performed, and a lobulated protruding tumor with irregular surfaced waCfound at the opening of the appendix. Appendiceal cancer was suspected, operation wayperformed, and a primary early appendiceal cancer(carcinoma in adenoma)was found.Finding of primary appendiceal cancer in the early stage is rather rare, and carefulobservation in barium enema and colorectal endoscopy appeared necessary.
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  • Ryozo IWAZAKI, Akihito NAGAHARA, Kazuki OHTA, Katsuyori IIJIMA, Yasuhi ...
    1998 Volume 40 Issue 10 Pages 1889-1896
    Published: October 20, 1998
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    We treated two cases of gastric endocrine cell carcinoma with multiple liver metas-tasis by CAP⋅ PVP Hybrid chemotherapy. Case 1 was a 58-year-old man. The cancerwas type 3'shaped and accompanied with enormous liver metastasis, and chemotherapywas not effective to the tumors. Case 2 was 69-year-old-man, with type 5'gastric cancerwith multiple liver metastasis. In this case, type 5'gastric cancer with liver metastasis wasremarkably reduced by two courses of chemotherapy. However, re-chemotherapy was noteffective after liver metastasis had rapidly enlarged. Gastric endocrine cell carcinoma isarare disease with a poor prognosis and early metastasis to the liver. Effective therapeuticstrategy, including chemotherapy, needs to be urgently established.
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  • Gen TOHDA, Shotaro KOSAKA, Seijyu HIGASHI, Yasuni NAKANUMA, Isamu MIYA ...
    1998 Volume 40 Issue 10 Pages 1897-1903
    Published: October 20, 1998
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A24-year-old women was admitted to our hospital for evaluation of hepatic dysfunction. She was diagnosed as ulcerative colitis in our hospital in 1987(at age of 16). She wastreated with salazosulfapyridine and prednisolone, and she had been well with no relapsefor four years. Endoscopic retrograde cholangiogram showed beaded appearances of theintrahepatic bile ducts and irregular stricture of the intra-and extrahepatic bile ducts.Hepatic needle biopsy revealed mild periductal fibrosis. She had no history of bile ductsurgery and choledochlithiasis. From overall results, she was diagnosed as primarysclerosing cholangitis. We confirmed that the remission of ulcerative colitis by bariumenema study and colonoscopy. Reported cases of primary sclerosing cholangitis associated with ulcerative colitis inJapan were reviewed. The most cases had pancolitis, and sclerosing change of intra-andextrahepatic bile ducts. Whether primary sclerosing cholangitis might precede or followulcerative colitis remains to be controversial. This case was daignosed before the development of irreversible fibrosis, and responsive to steroid therapy.
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  • 1998 Volume 40 Issue 10 Pages 1904
    Published: October 20, 1998
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
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