GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 46, Issue 7
Displaying 1-14 of 14 articles from this issue
  • Kiyotaka OKAWA, Hiroshi TSUKUDA, Tetsuya AOKI, Mizuki OHHIRA, Kazuki A ...
    2004 Volume 46 Issue 7 Pages 1323-1332
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Ischemic colitis was morphologically classified into circular, longitudinal, transverse and macular lesions on the basis of endoscopic findings in the acute stage of the disease. Longitudinal lesions were seen most frequently. When endoscopic findings were divided qualitatively into vasodilation, scale-pattern, pseudomembranelike appearance and cyanotic appearance, the scale-pattern was most frequent. When these qualitative endoscopic features were compared with pathological findings, the severity of ischemia evaluated pathologically increased in the order of vasodilation, scale-pattern, pseudomembranelike appearance, and cyanotic appearance. This endorsed the validity of the qualitative endoscopic classification. When observed at higher magnifications, the scale-pattern was found to be composed of white innominate sulcus discernible from small reddish segments representing intramucous bleeding. These results suggest that the most typical endoscopic feature of ischemic colitis in its acute stage is the major lesion showing longitudinal pseudomembranelike appearance and surrounding scale-patterns, accompanied by minor lesions such as scale-patterned transverse lesions or macular lesions.
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  • Tadayuki TAKAGI, Atsushi IRISAWA, Katsutoshi OBARA, Takuto HIKICHI, Go ...
    2004 Volume 46 Issue 7 Pages 1333-1339
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    We reported the endoscopic characteristics of gastric varices caused by pancreatic diseases in G cases (chronic pancreatitis ;1, pancreatic carcinoma ; 4, metastatic pancreatic carcinoma ;1). In all cases, it was considered that localized portal hypertension was caused by the obstruction of the splenic vein due to the infiltration of pancreatic inflammation or carcinoma. The endoscopic features of these gastric varices were identified as widespread tortuous gastric varices locating from the cardia to the lower gastric body. These findings were seen in all cases. It was considered that these gastric varices were formed via two routes ; the collaterals from the short gastric vein to the portal vein via coronary veins and those from the short gastric vein to the portal vein via the gastro-epiploic vein. Thus, the formation of these gastric varices was considered specific endoscopic findings in the localized splenic venous hypertension. In addition, variceal bleeding was seen in 2 patients whose portal veins were not functioned as buffer vessels of hypertension in the splenic vein (liver cirrhosis in 1, post distal gastrectomy in 1). It is important to understand the hemodynamics of varices in cases with localized portal hypertension.
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  • Yasuhiro SHIOAKI, Kazuma KOIDE, Hideaki KURIOKA, Yohei HOSOKAWA
    2004 Volume 46 Issue 7 Pages 1340-1345
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Small cell carcinoma arising in the esophagus is a relatively rare diagnose. We present a case of superficial small cell carcinoma of the esophagus with liver metastasis treated by operation and chemotherapy. The patient was a 75-year-old woman. She complained of constipation and had the occult blood of stool pointed out by her home doctor. Endoscopic examination revealed a tumor in the abdominal esophagus, and biopsy demonstrated carcinoma. She underwent operation under the diagnosis of squamous cell carcinoma of the esophagus. During the operation, one of multiple liver metastases was diagnosed as small cell carcinoma by analysis of freshly prepared frozen sections. An abdominal esophagectomy with proximal gastrectomy was performed without any lymph node dissection. A plateau esophageal tumor, lcm in diameter, was histologically composed of small cell carcinoma with the invasion depth of sm3. These small cells were positive for synaptophysin and ACTH, and electoron microscopical examination demonstrated intracytoplasmic neurosecretory glanules. The patient recieved post-operative chemotherapy consisting of Carboplatin and etoposide. Liver metastasis was once disappeared by computed tomography. But the patient died of rapid progress of the liver metastasis, to months after the surgery.
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  • Takashi SAKAKIBARA, Gohshi KANZAKI, Toshinarix KOBAYASHI, Noburu SAKAK ...
    2004 Volume 46 Issue 7 Pages 1346-1349
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 73-year-old woman was diagnosed to have an esophageal fistula caused by a ruptured aortic aneurythm. Endoscopy was considered to be important to make the diagnosis. In general, endoscopic features of are varied and there are no characterized findings. The presence of coagula in the esophagus in this case suggested the possibility of esophageal fistula. In cases with the fistula, biopsy or hemostasic procedures seem to be hazardrous for the risk of bleeding.
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  • Tatsuya NOGAMI, Ryosuke OBI, Ryota HORI, Naotoshi SHIBAHARA, Yutaka SH ...
    2004 Volume 46 Issue 7 Pages 1350-1354
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 33-year-old women, who needed PEG because of bulbar palsy with multiple sclerosis 8 years ago, had a gastric hyperplastic polyp in contact with PEG. In this case, we suspect that the polyp was caused by mechanical stimulation of the internal bumper to the gastric mucosa. Gastric hyperplastic polyps can cause gastric hemorrhage and gastric cancer and therefor, gastric hyperplastic polyps related to the internal bumper are important potential long term complications of PEG.
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  • Kazuto SHIBUYA, Tadashi BANDO, Kouki KAMIYAMA, Isaya HASHIMOTO, Yuko T ...
    2004 Volume 46 Issue 7 Pages 1355-1359
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 54-year-old female was underwent papillectomy for the adenoma of the duodenal Vater. Nine months later, the duodenal adenoma was recurred. We treated the recurrent lesion with endoscopic ablation using three sessions of argon plasma coagulation (APC). We have followed up more than two years and four months, but no recurrence has occurred. We thought that APC was an useful therapeutic measure as one of a therapy for recurrent adenoma of the duodenal papilla Vater.
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  • Toshihiko KONDO, Tomohide TAKAHASHI, Chihiro SHIGEMATSU
    2004 Volume 46 Issue 7 Pages 1360-1363
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 23-year-old man who had underwent appendectomy for acute appendicitis developed intestinal fistula arising from the appendiceal stump. Conservative theraphy was unsuccesful and the fistula was closed by endoscopic closure of the orifice of the appendix. Enterocutaneous fistula after appendectomy was rare. However, this type of fistula was intractable and often requires a reoperation, we suggest that the endoscopic approach is one of the options for the treatment of intractable fistula of postappendectomy.
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  • Hiroshi MATSUBARA, Kimio NAKANISHI, Kazuaki DOI, Hiroya IMAOKA, Yoshik ...
    2004 Volume 46 Issue 7 Pages 1364-1367
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 46-year-old woman developed abdominal pain, diarrhea and tarry stools while she was treated with anti-tuberculosis agents for pulmonary tuberculosis. Except for the anti-tuberculosis agents, she did not take any antibiotics before admission. Endoscopic examination of the colon revealed many pseudomembranous lesions in the lower large intestine. Bacterial culture of the coat was negative for Clostridium difficile and any other pathogenic organisms. However, Clostridium difficile toxin was positive. The pseudomembranous colitis was successfully controlled by discontinuation of the anti-tuberculosis drugs along with the administration of vancomycin and lactic acid bacteria. We reported this case because the delayed onset of pseudomembranous colitis after antituberculous chemotherapy is rare.
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  • Yoshiyasu KISAKA, Eiji TAKESHITA, Teruki MIYAKE, Masafumi HIROOKA, His ...
    2004 Volume 46 Issue 7 Pages 1368-1372
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    A 20-years-old female was admitted to our hospital with a history of fever for four weeks. She also complained of upper abdominal pain. Laboratory tests suggested the existence of severe inflamation. Abdominal ultrasonography revealed only a hyper echoic shadow between the liver and the abdominal wall. The patient was diagnosed to have Fitz-Hugh-Curtis syndrome due to the presence of Anti-Chlamydia trachomatis anti-body, a hyperechoic shadow between the liver and the abdominal wall by abdominal ultrasonography and abdominal pain. Even, after conservative therapy, her abdominal pain was not disappeared, so we decided to perform laparoscopy for assessing both the existence and the severity of the adhesion. Laparoscopic examination revealed the existence of, so called, "violin string adhesions" between the anterior wall of the liver capsule and the abdominal wall, and Chlamydia tra-chomatis antigen in ascitic fluid was positive. The clearance of adhesion let to relieve her abdominal pain. In conclusion, a diagnosis of Fitz-Hugh-Curtis syndrome should be considered in f emele patients presenting with upper abdominal pain without any apparent causes. Laparoscopy appears to be beneficial not only for the diagnosis but also therapy in patients with Fitz -Hugh-Curtis syndrome.
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  • Atsushi HIRAYAMA, Toshihiro SUGA, Akira FUJINAGA, Hiroyuki MIYAKAWA, T ...
    2004 Volume 46 Issue 7 Pages 1373-1379
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Self-expandable metallic stenting (SEMS) was performed in 15 cases of duodenal malignant stenosis by applying an ileus aid system longovertube with balloon tip (Sumitomo bakelite CO. LTD.) devised for ileus tube. Compared with the conventional overtube guided method, the new method showed increase in the success rate for insertion, and the insertion time was considerably shortened. As a consequence, previously seen problems caused by the bending of the tube in the stomach and duodenum became easier to avoid, and in turn the chances for complications in the early stage, such as aspiration pneumonia, perforation, and bleeding, became rare.
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  • [in Japanese], [in Japanese], [in Japanese]
    2004 Volume 46 Issue 7 Pages 1380-1381
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
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  • Takako EGUCHI, Takuji GOTODA, Ichiro ODA, Hisanao HAMANAKA, Noriaki HA ...
    2004 Volume 46 Issue 7 Pages 1382-1387
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Background ; Endoscopic mucosal resection (EMR) is widely accepted as a minimally invasive treatment for early gastric cancer (EGC) in Japan. However the criteria for EMR must be strictly adhered to otherwise patients will miss the chance for additional therapy. We assess the important factor in expanding the indication of EMR. Methods ; we investigated 1101 EGCs which had been resected by EMR at the National Cancer Center Hospital (NCCH) according to the indication recommended by Japanese Gastric Cancer Association (JGCA) and the expanded indication proposed by NCCH. Curability and local recurrence of the EMRs were assessed related to the applied indication and the number of resected specimens. Results ; The recurrence rate of non-evaluable resection was higher than that of evaluable resection (p<0.0001). 83 lesions among 772 leisons in the JGCA group were non-evaluable. 37 leisons among 329 lesions in the NCCH group were non-evaluable. There was no difference in the rate of non-evaluable resection between JGCA and NCCH groups (p=0.8329). However the rate of curative resection was lower in the NCCH group than in the JGCA group (p=0.0009). In piecemeal resection, there was no difference in the rate of non-evaluable resection between JGCA and NCCH groups (p=0.0527). In one-piece reseection, the rate of non -evaluable resection was lower in NCCH group than JGCA group (p=0.0137). Conclusion ; Based on our series of cases we propose one-piece resection as a gold standard for EMR. Because it enables accurate histological evaluation even in the EMR according to the expanded indication.
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  • Yoshio TOYOTA, Hirohito HONDA, Kenichirou KUBO, Masahiko NAKASONO, Tos ...
    2004 Volume 46 Issue 7 Pages 1388-1396
    Published: July 20, 2004
    Released on J-STAGE: May 09, 2011
    JOURNAL FREE ACCESS
    Background: In patients with Helicobacter pylori infection, gastric endoscopy usually shows diffuse mucosal redness that disappears after successful H pylori eradication. However, some infected patients do not show such redness. Therefore, disagreement continues concerning the need for gastric endoscopy in suspected H pylori infection. Methods : Usefulness of a hemoglobin index (IHb) in diagnosis and follow up of H pylori gastritis was examined endoscopically and histopathologically. Results : Patients with infection showed a higher mean IHb than those without infection (70.0±10.0 vs 54.3±4.7, P<0.0001). Sensitivity, specificity and accuracy of IHb for diagnosing H. pylori infection based on a cutoff value of 00 was higher than for the endoscopist's evaluation of diffuse redness (sensitivity 95.7 vs 92.6%, specificity 32.4 vs 66.6%, accuracy 93.0 vs 87.2%). Hemoglobin indices also reflected histolosically evident mucosal inflammatory changes more closely than did the endoscopist's evaluation. Hemoglobin indices significantly decreased after H. pylori eradication, as did histologic findings of mucosal congestion and numbers of eryth-rocytes in foveolae. Both histologic findings correlated positively with hemoglobin indices. Conclusion : The IHb is an objective endoscopic measure of mucosal inflammation that is useful in the diagnosis and follow up of H pylori gastritis.
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  • [in Japanese], [in Japanese]
    2004 Volume 46 Issue 7 Pages 1397-1400
    Published: 2004
    Released on J-STAGE: January 29, 2024
    JOURNAL FREE ACCESS
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