-
Ryukichi AKASHI, Takeaki KIYOZUMI, Katsuro SAGARA
2005 Volume 47 Issue 12 Pages
2623-2631
Published: December 20, 2005
Released on J-STAGE: May 09, 2011
JOURNAL
FREE ACCESS
Difficulty in selectively inserting a papillotome into the bile duct remains a major clinical problem that has plagued endoscopists since the advent of endoscopic papillotomy. To deal with this problem, various techniques to access the bile duct have developed through a process of trial and error. Recently, the term "precut" is often heard at medical conferences. For endoscopists, the use of this word creates confusion because several slightly different procedures are available. This article describes the characteristics of different procedures to propose standardized terminology. An assessment of recent numbers of studies and patients indicates that the needle-knife technique and pancreatic sphincter precutting are mainly used to access the bile duct. Clinical studies indicate that pancreatic sphincter precutting has a slightly lower incidence of complications than the needle-knife technique. Recent reports indicate that pancreatic sphincter precutting is being performed in increasing numbers of patients. Whether placement of a pancreatic stent helps to prevent complications after either procedure should be addressed in future studies.
View full abstract
-
Taro AOKI, Kenji KOBAYASHI, Kiyonori NISHIOKA, Takashi MATSUMOTO, Taic ...
2005 Volume 47 Issue 12 Pages
2632-2637
Published: December 20, 2005
Released on J-STAGE: May 09, 2011
JOURNAL
FREE ACCESS
Background : Endoscopic ultrasonography (EUS) is one of the modalities in preoperative staging of gastric center, and is able to detect ascites around gastric wall. In this study, we assessed clinical diagnostic significance of ascites detected by EUS (EUS-ascites). Study : The retrospective analysis was made in 85 gastric cancer patients. All patients diagnosed worse than T2 stage underwent EUS staging before surgery. The result of preoperative EUS-ascites detection was compared with the status of peritoneal dissemination including peritoneal washing cytology (CY/P factor), and the status of ascites detected by CT (CT-ascites). Results : Twenty seven of 85 patients (31.8%) had EUS-ascites, and the accuracy, sensitivity, and specificity of EUS in staging CY/P factor were as follows : overall accuracy, 83.5% ; sensitivity, 74.1% ; specificity, 86.4%. Five CT-ascites were also detected by EUS. Furthermore, 22 of 27 (81.5%) EUS-ascites positive patients were not found to have ascites by CT. CY/P factor was positive in 16 of 22 (72.7%) EUS-ascites positive and CT-ascites negative patients. Conclusions : EUS is a more valuable diagnostic modality in the predicting CY/P factor than CT. We performed explorating laparoscopy in 7 of 27 EUS-ascites positive patients, and could make a choice of the best treatment.
View full abstract
-
Hideaki ARIMA, Miwako ARIMA
2005 Volume 47 Issue 12 Pages
2638-2645
Published: December 20, 2005
Released on J-STAGE: May 09, 2011
JOURNAL
FREE ACCESS
The patient was a 75-year-old woman who had dysphagia. Upper gastrointestinal endoscopy revealed a semipedunculated, superficial polypoid type (0-Ip) lesion, 4 cm in diameter, in the lumen of the middle thoracic esophagus. A superficial slightly depressed type (0-IIc) lesion (about 25 mm) was present around the polypoid lesion. Magnifying endoscopy showed abnor-mal microvessels. Biopsy revealed carcinosarcoma. Endoscopic ultrasonography disclosed no enlargement of the cervical, thoracic, or abdominal lymph nodes. The patient was given a 0-Ip+IIc type esophageal carcinosarcoma invading the muscularis mucosae (m3) and the surface layer of the submucosa (sml). Endoscopic mucosal resection (EMR) was performed. This was the first case of carcinosarcoma that we radically treated by EMR.
View full abstract
-
Takayoshi YAMADA, Satoru TAMURA, Tomoko ONISHI, Toshiki ICHIMORI, Tomo ...
2005 Volume 47 Issue 12 Pages
2646-2651
Published: December 20, 2005
Released on J-STAGE: May 09, 2011
JOURNAL
FREE ACCESS
A 71-year-old man was referred for the evaluation of a pedal edema. His abdomen was soft and flat with normal bowel sound. Superficial lymph nodes were not palpable. All other physical examinations were unremarkable. His urinalysis was normal. The complete blood cell count showed anemia with a hemoglobin of 8.lg/dl (normal=13.9-18.lg/dl). The proteinogram showed total protein was 3.8g/dl (normal=6.5-8.0g/dl). The αl-antitrypsin clearance was high level in 168m1/day. He was suspected protein losing gastroenteropathy from these results. Upper gastrointestinal endoscopy showed type 1 gastric cancer, approximately 10cm in diameter, on the greater curvature of upper to middle portion of the gastric body. The surface was villous and fragile with easy bleeding, and mucin adhesion was remarkable. He was diagnosed as adenocarcinoma (tub 1) by biopsy specimens, and a total gastrectomy was performed. Histopathological findings showed that the general stage of disease was stage IB with depth invasion of sml, Infα, lyl, v0 and nl (No4sa). The leg adema, anemia and hypo-albuminemia improved remarkably after the operation.
View full abstract
-
Eigo KOJIMA, Yoshiyuki OOISHI, Susumu TSUKAHARA
2005 Volume 47 Issue 12 Pages
2652-2657
Published: December 20, 2005
Released on J-STAGE: May 09, 2011
JOURNAL
FREE ACCESS
A 55-year-old man was admitted for the treatment of a 15mm Brunner's adenoma which was located on the superior duodenal angulus. During endoscopic submucosal dissection (ESD), a pinhole perforation occurred incidentally. After clipping the perforated hole, ESD was continued and the tumor was cut en bloc. No surgical operation was needed after clipping for the perforation. This tumor consisted of atypical glands which showed expansive proliferation in the submucosal layer. Therefore, we diagnosed the tumor as a true-type Bru nner's adenoma. A true-type Brunner's adenoma is an extremely rare tumor ; Only four cases including ours have been reported in Japan.
View full abstract
-
Shuichi YOKOSAWA, Taiji AKAMATSU, Takashi MURAKI, Noriko MISAWA, Kazuh ...
2005 Volume 47 Issue 12 Pages
2658-2663
Published: December 20, 2005
Released on J-STAGE: May 09, 2011
JOURNAL
FREE ACCESS
A 44-year-old woman was admitted at a certain hospital because of lower abdominal pain, diarrhea and loss of weight in July 2003. Colonoscopy showed a submucosal tumor-like lesion located at the cecum. In October, she was referred to our hospital. We performed colonoscopy, abdominal computed tomography and FDG-PET, but correct diagnosis was not obtained. Because it was thought that the tumor was not malignant, she was observed with conservative treatment. She was admitted in February 2004, under the diagnosis of intestinal obstruction. In April, ileocecal resection was done. Histologically, the resected specimen was diagnosed as an intestinal endometriosis.
View full abstract
-
Kazuhide IWAKAWA, Hitoshi TANAKA, Keizo SUGIYAMA, Mikio ICHIKAWA, Shin ...
2005 Volume 47 Issue 12 Pages
2664-2669
Published: December 20, 2005
Released on J-STAGE: May 09, 2011
JOURNAL
FREE ACCESS
A 79-year-old woman suffering from anemia was diagnosed endoscopically as 1 type cecal advanced cancer measuring 3cm in diameter. Abdominal CT examination showed 4cm mass at the root of the mesenterium. Ileocecal resection was performed, and the tumor at the top of the appendix had invaginated into the cecum completely. Histopathological examination revealed well differentiated adenocarcinoma, and the mucinous carcinoma at the center of the lesion invaded to the inverted serosal surface. Peritoneal tumor by biopsy demonstarated mucinous carcinoma, and was diagnosed as peritoneal dissemination. We experienced an extremely rare case of appendiceal carcinoma invaginating into the cecum associated with localized peritoneal dissemination.
View full abstract
-
[in Japanese], [in Japanese]
2005 Volume 47 Issue 12 Pages
2670-2671
Published: December 20, 2005
Released on J-STAGE: May 09, 2011
JOURNAL
FREE ACCESS
-
Hironori YAMAMOTO, Hiroto KITA, Keijiro SUNADA, Tomohiko MIYATA, Tomon ...
2005 Volume 47 Issue 12 Pages
2672-2680
Published: December 20, 2005
Released on J-STAGE: May 09, 2011
JOURNAL
FREE ACCESS
When the feasibility of performing ESD in the colon is discussed, it is important to understand the difference of the features between the colon and stomach. When piecemeal EMR or ESD is chosen for the treatment of laterally spreading tumors in the colon, one should select one of the procedures by considering the risk/benefit ratio. In order to perform ESD safely in the colon, it is almost necessary to use sodium hyaluronate solution for the injection to create a submucosal cushion. Local injection of sodium hyaluronate can provide thickness and some stiffness to the thin and soft colonic wall. Safety margin for ESD is obtained from the long-lasting thickening created by the injection of sodium hyaluronate. For the mucosal incision and the submucosal dissection, electrosurgical knives suitable for front viewing approach should be selected. It is also useful to use a transparent hood attached to the endoscope tip to assist the incision and the dissection. A good strategy to maintain the submucosal thickening throughout the procedure and wise usage of gravity are also important factors for successful ESD. By selecting an appropriate technique, ESD can be performed safely even in the colon. Moreover, development and improvement of the instruments and techniques, ESD in the colon will become applicable more and more.
View full abstract
-
[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
2005 Volume 47 Issue 12 Pages
2681-2690
Published: December 20, 2005
Released on J-STAGE: May 09, 2011
JOURNAL
FREE ACCESS
-
[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
2005 Volume 47 Issue 12 Pages
2691-2695
Published: December 20, 2005
Released on J-STAGE: May 09, 2011
JOURNAL
FREE ACCESS
-
[in Japanese]
2005 Volume 47 Issue 12 Pages
2696-2699
Published: 2005
Released on J-STAGE: January 29, 2024
JOURNAL
FREE ACCESS
-
2005 Volume 47 Issue 12 Pages
2704-2707
Published: December 20, 2005
Released on J-STAGE: May 09, 2011
JOURNAL
FREE ACCESS