GASTROENTEROLOGICAL ENDOSCOPY

COLONOSCOPIC MISS RATES OF NEOPLASMS DETERMINED BY SURVEILLANCE COLONOSCOPIES

Takatoshi NAKASHIMA, Kouichi YASUTAKE, Hogara NISHISAKI, Shigeya HIROH ...

2000 Volume 42 Issue 8 Pages 1289-1297
Published: August 20, 2000
Released on J-STAGE: May 09, 2011

DOIhttps://doi.org/10.11280/gee1973b.42.1289

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Six hundred and thirty-three patients whose neoplastic polyps were removed from October 1991 throgh September 1995 were eligible if they underwent repeated colonoscopy at least 2 times after the previous polypectomy within 3 years. We considered neoplasms newly detectedat lst and 2nd surveillance colonoscopies as missed neoplasms. An neoplasm was defined asadvanced neoplasm if it was large (≥5mm)or had high-grade dysplasia or cancer. Miss rate was increased according to the number of resected tumors. However, the sizeand histological grade of resected tumors didn't influence the miss rate. Adenomas with low-grade dysplasia or less than 5mm in diameter or with flat or depressed form are more oftenmissed significantly than adenomas with another types. And right colon adenomas were missedmore often than left colon and rectum significantly. The overall miss rate for total neoplasmaswas 30.5%, 9%for advanced neoplasma. The results suggest the need for surveillance colonoscopy within 3 years after endoscopic resection for colorectal neoplasms and improvement in colonoscopy technology.

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ACASE OF EARLY ESOPHAGEAL ADENOCARCINOMA ARISING FROM SHORT SEGMENT BARRETT ESOPHAGUS

Yasuhiro OSHIMO, Naoya OTSU, Masahiro OTA, Michio IMAMURA, Sunjin KIM, ...

2000 Volume 42 Issue 8 Pages 1298-1303
Published: August 20, 2000
Released on J-STAGE: May 09, 2011

DOIhttps://doi.org/10.11280/gee1973b.42.1298

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A case of early esophageal adenocarcinoma arising from short segment Barrett esophaguswas reported. A 78-year-old man was admitted to our hospital because of abnormal shadowin gastro-intestinal series of the mass survey. Endoscopic examination revealed a nodularsurfaced O-Ila type elevated lesion 15mm in diameter in a columnar epitherium lined esophagusof which the longest part was 2.5cm from the esophago-gastric junction Mechylene blue(MB)stained the elevated lesion slightly and its's anal-side mucosa strongly, which suggested thatintestinal mataplasia existed, and clarified the border between the lesion and it's surroundingmocosa. Biopsy specimen from the lesion revealed low garade dysplasia, so diagnosis of lowgrade dysplasia arising from short segment Barrett esophagus was made. Endoscopic mucosalresection was performed. Pathological examination of the resected specimen showed welldifferentiated adenocarcinoma and intestinal metaplasia in it's surrounding mucosa. MBselectively stains intestinal mataplasia in Barrett's esophagus. Dysplasia, which mostly asrisesfrom intestinal mataplasia, will be stained slightly or unstained by MB like gastric adenomaarising from intestinal metaplasia. MB staining method is considered to be useful for diagnosisof intestinal metaplasia and dysplasia in Barrett's esophagus.

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AN ENDOSCOPIC FOLLOW-UP STUDY OF THE DEVELOPMENT OF DIFFUSE ANTRAL VASCULAR ECTASIA

Megumi IIDA, Yoshitake SATOMURA, Yoshiya TACHIBANA, Hiroshi YONEJIMA, ...

2000 Volume 42 Issue 8 Pages 1304-1309
Published: August 20, 2000
Released on J-STAGE: May 09, 2011

DOIhttps://doi.org/10.11280/gee1973b.42.1304

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A 74-year-old male, who had been treated liver cirrhosis and heart failure due to aortic stenosis (post aortic valve replacement state), was admitted to our hospital because of tarry stools and anemia in July, 1997. On admission, endoscopic examination revealed one eryth-ematous spot showing oozing hemorrhage on the lesser curvature of the antrum of the stomach. In December, 1998, he was readmitted to our hospital with a complaint of melena. Endoscopic examination demonstrated 30 to 40 erythematous spots with oozing hemorrhage distributing in the distal portion of the antrum of the stomach, diagnosed as diffuse antral vascular ectasia (DAVE). In January, 1999, these lesions were diffusely scattered throughout the antrum, and the duodenal bulb. The full picture of DAVE has been observed developing from an erythematous spot of the antrum in about only one and half years in this case.

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A CASE OF MULTIPLE DUODENAL CARCINOIDS ASSOCIATED WITH HYPERGASTRINEMIA

Hideki SATO, Tomoaki WATANABE, Kimitoshi KATO, Nobuaki KANEDA, Hisashi ...

2000 Volume 42 Issue 8 Pages 1310-1315
Published: August 20, 2000
Released on J-STAGE: May 09, 2011

DOIhttps://doi.org/10.11280/gee1973b.42.1310

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A 75-year-old female was found to have a Y-2-like elevated lesion, measuring 15 mm in diameter, and in its close vicinity three Y-1-like protrusive lesions, 3 to 5 mm in diameter, in the duodenal bulb on upper GI examination. Only one of these four lesions, the one of 5 mm in size, was diagnosed as carcinoid on biopsy. Endoscopic ultrasonography and other diagnostic explorations suggested multiple duodenal carcinoids, and partial duodenectomy was performed. Pathologically, the 15-mm elevated lesion was diagnosed as a carcinoid tumor invaded to the submucosa and the smaller 5-mm lesion was confined to mucosal level. Preoperative labora-tory findings revealed high serum gastrin levels. Immunohistochemically, the resected tumor was positive for gastrin. A rare case of multiple duodenal carcinoids, of which only six cases including our own, was described.

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ACASE OAF HEMAORRAHAGIC MULITIPLAE COLONIC ULCAERATIONSASSOCIATED WITH NONSTEROIDALANTIINFALAMMATOARY DRUGS, SUCCESSFULLY TRAEATED BY AENDOSCOPIC HAEMOSTASIS

Hiroichiro UEDA, Mitoshi FURUZONO, Jun MATSUMOTO, Terukatsu ARIMA

2000 Volume 42 Issue 8 Pages 1316-1322
Published: August 20, 2000
Released on J-STAGE: May 09, 2011

DOIhttps://doi.org/10.11280/gee1973b.42.1316

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Acase of hemorrhagic mu.ltiple colonic u.lcerations associated with NSAIDs, successfullytreated by elldoscopic hemostasis was reported. The patient was a 56-year-old man.He hadsuddenly bloody stool ten days after taking antibiotics and NSAIDs(mefenamic acid anddiclofenac sodium)for treatment of acute tonsilitis. Emergent cololloscopy revealed multipleulcerations in the total colon, and that the main bleeding pint was exposed vessel in the ulcerexisting ileocecal regioll. After the clipping and injection of 2 ml ethanol, hemostasis wasachieved. It was seemed that mefenamic acid and/or diclofenac sodium was a cause of thosecolonic ulcerations. By discnntinuing use of mefenamic acid and diclofenac sodium, thoseulceratins were rapidly healed. NSAIDs should be considered as one of cause of lowergastrointestinal bleeding. Emergent endoscopy and endoscopic hernostasis should be activelyperfoemed for lower gastrointestinal bleeding as well as upper gastrointestinal bleeding.

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A CASE OF STRICTURE-TYPE ISCHEMIC COLITIS SUCCESSFULLY TREATED BY CONTINUOUS INTRAVENOUS INFUSION OF PROSTAGLANDIN E₁

Seiji KIMURA, Kazuo SUZUKI, Tadashi AIZAWA, Tetsu ENDOH, Hiroshi KANAZ ...

2000 Volume 42 Issue 8 Pages 1323-1331
Published: August 20, 2000
Released on J-STAGE: May 09, 2011

DOIhttps://doi.org/10.11280/gee1973b.42.1323

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A 75-year-old male was admitted to our hospital because of sudden bloody diarrhea after enema on October 24, 1998. The initial colonoscopy disclosed a longitudinal deep ulcer with circular inflammation in the sigmoid colon and a marked narrowing of the lumen. Barium enema showed poor distension and mucosal irregularity with thumb-printing extending from the splenic flexure to the sigmoid colon. Mucosal biopsy revealed typical findings of ischemic colitis. After a month barium enema demonstrated a severe stricture (8mm in diameter of the lumen) at the SD junction and colonoscopy disclosed active inflammation with a longitudinal open ulcer in the sigmoid colon. We made a diagnosis of ischemic colitis of the stricture type. Despite conservative treatment for over 2 months, the stricture remained to be unchanged. He underwent a trial of continuous intravenous infusion of prostaglandin E₁ (80μ/day) for a total of 5 weeks under the condition of intravenous hyperalimentation. Subsequent colonoscopy showed considerable improvement of severe stenosis with healed scar of the longitudinal ulcer. Barium enema performed 5 months after the treatment revealed that the stricture had been improving up to 23mm in diameter of the lumen. It is suggested that the infusion therapy of prostaglandin E₁ is an effective conservative treatment for ischemic colitis of the stricture type, and should he cosidered before surgical treatment.

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A CASE OF PEDUNCULATED COLON CANCER INVADING TO THE SUBMUCOSA WITH NON POLYPOID GROWTH (NPG)

Masaru KUBOKAWA, Hiroaki KUBO, Akira MARUOKA, Kaichiro HIROSHIGE, Akih ...

2000 Volume 42 Issue 8 Pages 1332-1337
Published: August 20, 2000
Released on J-STAGE: May 09, 2011

DOIhttps://doi.org/10.11280/gee1973b.42.1332

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A 40-year-old man was referred to our hospital because of positive fecal occult blood. Barium enema showed a pedunculated polyp with stalk in the sigmoid colon. Colonoscopy revealed a pedunculated tumor 10mm in diameter in the sigmoid colon with irregular depression on the top of the tumor. The stalk was covered with normal mucosa and had flexibility. Biopsy specimen from depression on the top of the tumor revealed well to poorly differentiated adenocarcinoma and lymphatic permeation was also suspected. We diagnosed as Ip type colon cancer invading to the submucosa and partial sigmoidectomy was performed. Histological examination of the resected specimen revealed moderately to poorly differentiated adenocar-tinoma with massive invasion to the submucosal layer and lymphatic permeation was also seen (ly, ). The pattern of tumor growth was thought to be non polypoid growth type. This case was interesting for considering the growth and progression of colorectal cancer.

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EXPERIENCES WITH TRANSPARENT CAP FOR IN CASES WITH THE LOCALLY RECURRED RECTAL CARCINOMA

Yuji INOUE, Shigeru SUZUKI, Toru TEZUKA, Naoko YAMAGISHI, Ken TAKASAKI

2000 Volume 42 Issue 8 Pages 1338-1343
Published: August 20, 2000
Released on J-STAGE: May 09, 2011

DOIhttps://doi.org/10.11280/gee1973b.42.1338

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Three cases of locally recurred rectal carcinoma were resected endoscopically by adopting transparent cap. The first case was a 59-year-old woman, who had recieved endoscopic piecemeal mucosal resection for the nodular-aggrating tumor (2cm in diameter) of the rectum (Rb). Histopathological study showed well differentiated tubular adenocarcinoma with submucosal invasion (sm massive). Sixteen months after endoscopic resection, the tumor recurred locally. This tumor was resected by endoscopic piecemeal resection using transparent cap. The second case was a 59-year-old woman who had recieved transanal tumor resection for the nodular-aggrating tumor (Scm in diameter) of the rectum (Rb). Histopathological study showed well differentiated tubular adenocarcinoma (m). Sixteen months after surgical resection, local recurrent (residial) tumor was noted. This tumor was resected by endoscopic resection using transparent cap. The third case was a 54-year-old man, who had recieved transsacral tumor resection for the nodular-aggrating tumor (5cm in diameter) of the rectum (Rb). Histopathological study showed well differentiated tubular adenocarcinoma with submucosal invasion (sm2). Five years after surgical resection, local recurrence was found. These tumor was resected by endoscopic piecemeal resection using transparent cap. Histopathologically, all resected specimen of recurrent (residial) tumor were diagnosed as well differentiated tubular adenocarcinoma (m).

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BENEFITS OF ENDOSCOPIC DRAINAGE FOR EXTERNAL BILE LEAKAGE AFTER CHOLECYSTECTOMY

Toshin TAKASHIMA, Saburo NAKAZAWA, Jyunji YOSHINO, Kazuo INUI, Takao W ...

2000 Volume 42 Issue 8 Pages 1344-1348
Published: August 20, 2000
Released on J-STAGE: May 09, 2011

DOIhttps://doi.org/10.11280/gee1973b.42.1344

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We reported the benefits of Endoscopic Nasobiliary Drainage(ENBD)for external bileleakage after cholecystectomy. We performed ENBD in seven patients with postoperative bile leakage. Six of seven patients(85.7%)were successfully treated within 10days. One patient was failed to be cannulated into common bile duct and repeat surgery was performed. We could evaluate successful drainage from. a point of view of the bile volume of the leakage and ENBD during the first two days. It is useful that the side hole at the tip of drainage tube is placed at the proximal of the fistula. ENBD is considerd the first choice of treatment for external bile leakage after cholecystectomy.

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[title in Japanese]

[in Japanese]

2000 Volume 42 Issue 8 Pages 1352-1355
Published: August 20, 2000
Released on J-STAGE: May 09, 2011

DOIhttps://doi.org/10.11280/gee1973b.42.1352

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