It was proposed by Fujinuma et al. that mucosal polyp consisted of normal submucosa tissue without evidence of changes of tubules and lamina propria. They reported eight cases of mucosal polyp and we have experienced five cases of such polyps. In this paper, thirteen cases including recent five cases were re-evaluated morphologically and histologically. Thirteen mucosal polyps were diagnosed in thirteen cases among 21481 colonoscoped cases during the period from January 1982 to October 2000. Their ages were distributed from 40 to 76 years old, and the average was 58.8 years old. Of those polyps, 7 polyps were located in the sigmoid colon, 3 in rectum, 2 in transverse colon, and 1 in ascending colon. The polyp was always single throughout the colon. Their height was 1 to 100 mm. Morphologically, 5 polyps were hemispherical, 4 polyps were pedunculated, 3 polyps were spherical, and 1 was flat elevated. Pedunculated polyps were all more than 8mm in height. The appearance of the surface seemed to be similar to the surround-ing mucosa, and the border was unclear. One case of pedunculated polyps was observed by endoscopic ultrasonography. It showed almost normal architecture with a raised third layer. Thirteen mucosal polyps were all removed endoscopically. Histological examination showed the polyps were composed of normal mucosa with normal tubules without inflammatory infiltration, and the submucosal layer consisted of fibrosis, edema, lymphectasia, and an-gioectasia. The features of submucosa seemed to appear as the height of polyps increased. Muscularis mucosae layer was thin in several polyps. The concept of colonic muco-submucosal elongated polyp (CMSEP) which Matake et al. proposed is considered unacceptable, because the definition of CMSEP is limited to pedunculat-ed polyps. The concept of mucosal polyp implying CMSEP is considered to be more appropri-ate.

View full abstract

A 35-year-old male who had been treated with an immuno-suppressant after renal trans-plantation underwent an esophagogastroduodenoscopy (EGD), which revealed a punched-out shallow ulceration 20mm in diameter at the lower esophagus. Histological examination revealed Cowdry-A cells and multi-nuclear cells in the biopsied specimens. Furthermore, immunohistological examination revealed the presence of antigens to the Herpes simples virus (HSV) in the lesion. Therefore, the lesion was diagnosed as an ulceration caused by HSV infection. Aciclovir administered orally at a dosage of 800mg per was started for the treatment of the lesion. A follow-up EGD performed 1 month later revealed complete regression of the lesion. Cases like this are rare, but they indicate that lesions associated with HSV infection should be considered when EGD is carried out in immunocompromized patients.

View full abstract

We report a case with asymptomatic vascular ectasia of the stomach. Protruded vascular ectasia/AVM simulating SMT of the stomach has been reported one case in japan, which of the colon has been reported 13 cases in Japan. Therefore, we studied these cases including our case. The patient, a 71-year-old female, had no history of gastrointestinal bleeding. X-ray and endoscopy revealed a gastric submucosal tumor (20×15mm in diameter) on the greater curva-ture of the upper body. Endoscopic ultrasonography showed a hypoechoic structure in the third layer of the stomach. The lesion was resected by endoscopic mucosal resection (EMR). Pathohistological examination revealed irregularly dilated arteries and veins located in the submucosa, and was diagnosed to be vascular ectasia of the stomach. The post EMR course was good.

View full abstract

We report a case in which endoscopic pancreatic stenting was effective for the postoperative stricture of the anastomosis of the main pancreatic duct and the duodenal bulb. A 32-year-old Japanese male with a history of reccurent acute pancreatitis was admitted to our hospital with severe abdominal pain and back pain, and the serum level of pancreatic enzymes was elevated. He had been injured by traffic accident and undergone operation of the pancreas twice at the age 20. He was treated by the conservative therapy, and the condition was improved biochemically. However, endoscopic retrograde pancreatography showed a stricture of the anastomosis of the main pancreatic duct and the duodenal bulb, and dilatation of the distal pancreatic duct. The stricture was considered to be the cause of recurrent acute pancreatitis and endoscopic pancreatic stent placing was performed. General condition got better after treatment, and the serum level of pancreatic enzymes was normalized. The stent was naturally removed after 3 months with no recurrence. MRCP revealed no recurrence of the stricture. He has been free from complications after the stent removal. In conclusion, endoscopic pancreatic stenting can be one of the therapeutic alternatives for the postoperative stricture of the anastomosis of the main pancreatic duct and digestive tract.

View full abstract

A 65-year-old male was admitted to our hospital because of anal bleeding and lower abdominal pain. Colonoscopy revealed necrotic mucosa in the upper rectum, and he was made a diagnosis of ischemic colitis. He underwent conservative treatment. However, barium enema showed a stenosis of the rectum and symptoms of ileus were developed. We carried out endoscopic decompression using a drainage-tube and treated by endoscopic balloon dilatation using a polyethylene telephtalate (PET) balloon dilator. The stenosis was improved and symptons were relieved. This case suggests that the endoscopic balloon dilatation therapy with monitoring dilatation pressure is useful for patients with stricture type of ischemic colitis.

View full abstract

We experienced a case of detorsion of cecal volvulus by colonoscopic maneuver. An 83-years-old man who was confined to bed for cerebral infarction was admitted to our hospital complaing of abdominal distension and abdominal pain. Suspecting ileus of the colon, we performed a colonoscopy, we found the torsion of the cecum. Colonoscopic detorsion was successful. This is the first reported case of colonoscopic detorsion of cecal volvulus in Japanese literature.

View full abstract

A 29-year-old man presented with the cheif complaints of constipation and abdominal distension. Barium enema revealed rectal stenosis with thumb printing like findings, and colonoscopy revealed severe proctitis with small ulcerative lesions from 5 to 15 cm above the anal verge. Laboratory tests revealed a positive reaction in serologic tests for syphilis and HIV. Immunobiochemical staining of rectal biopsy specimens demonstrated Treponema pallidum and a diagnosis of syphilitic proctitis was confirmed. The patient's condition rapidly improved with penicillin therapy. Syphilitic proctitis is rare in Japan, and only sixteen cases have been reported to date in the Japanese literature. We report the first case of syphilitic proctitis with HIV infection positive in Japan.

View full abstract