Confocal microendoscopy is a novel endoscopic modality that makes it possible to inspect the mucosal layer during ongoing endoscopy and whose magnification is about 500 times on a 19-inch monitor. Although fluorescein is required for the examination, we can obtain high resolution, gray-scale images. When we use the fluorescein sodium intravenously as a contrast agent, we can diagnose whether a target lesion is benign or malignant from the observation of crypt architecture and microvessel pattern. However, we cannot see the nucleus in the epithelial cell. In Europe they have used it to diagnose malignancy in patients with ulcerative colitis or Barrett's esophagus. Using this new technology, we can observe Helicobacter pylori in vivo in the infected stomach and collagenous bands beneath the epithelium layer in col-lagenous colitis. Future challenges are the development of three-dimensional displays, improve-ment in endoscopic equipment, faster acquirement of images, and the development of safer contrast agents. We can expect this endoscopic modality to inspect the movement of molecules in vivo physiologically or innovatively diagnosis cancer cells through the development of fluorescein agents along with the method of binding it to some specific marker.

View full abstract

The Aim of this prospective study is to investigate the cardiorespiratory parameter and accetability of transnasal gastrointestinal endoscopy in comparison with transoral gastrointestinal endoscopy on conscious sedation. Diagnostic gastrointestinal endoscopy was performed in 100 patients. Patients were randomly assigned to one of two type of conscious sedation gastrointestinal endoscopy : Transoral and trannasal group. Systolic and diastolic blood pressure, pulse rate and arterial oxygen saturation were measureded before, 2-3 minutes after insertion and just after endoscopic examination. Systolic and diastolic blood pressure, pulse rate and arterial oxygen saturation were not significantly different between two groups. In contrast, rate pressure product (RPP) was significantly greater in transoral group. Transnasal gastrointestinal endoscopy is safer than tranoral gastrointestinal endoscopy and is easier to accept.

View full abstract

A 73-year-old man was referred to our hospital because of cancer screening. In 1995 upper gastrointestinal endoscopy revealed a submucosal tumor in the greater curvature of the anglus in the stomach. Four years later, the lesion had changed to an irregular depressed one. Biopsied specimen revealed no malignancy, in spite of anti-acid therapy, an irregular ulcer had been no changed in shape. In 2002, this ulcer changed more deeper and EUS showed a strong echo with acoustic shadow in the outside of the stomach and its invasion to the gastric wall. Abdominal CT and gastrography showed a calcificated lymphnode at the greater curvature of the stomach. Biopsied specimen revealed epitheloid cell granuloma with Langhans's giant cells and caseous necrosis. Therefore, diagnosis of gastric tuberculosis with calcificated lymphadenitis penetrating the stomach was made, and administration of anti-tuberculosis agents was started. It should be kept in mind that resistant ulcerative lesion to anti-acid agents was sometimes difficult in difference diagnosis to gastric tuberculosis.

View full abstract

A 80-year-old man was referred to our hospital complained of tarry stool and appetite loss. Upper GI endoscopy revealed III+IIc like lesion (adenocarcinoma) in cardia and submucosal elevated lesion in prepyrolic region and type 2 lesion (small cell carcinoma) in the duodenal bulbus. Because of his herniplesia after cerebral hemorrhage, his activity of daily life was low and he and his family chose chemotherapy rather than operation. He received S-1 combined with CDDP therapy (80 mg of TS-1 administered for 14 days followed by 14 days rest+ 10 mg/day of CDDP was administered from day 8 for 5 days). After 2 courses of chemotherapy, both lesion was dramatically improved. Small cell carcinoma of the duodenum is very rare and known to be aggressive with early dissemination and metastasis, early diagnosis and treatment including chemotherapy should be considered.

View full abstract

Pneumatosis cystoids intestinalis (PCI) is characterized by the presence of gas retained within the submucosal or subserosal layer of the intestinal wall. A 71-year-old man complained of equivocal abdominal symptoms including abdominal flatulence, diarrhea, and constipation, since the age of 50 years. On total colonoscopy (TCS) and double contrast enema, many cystic elevated lesion, resembling submucosal tumors, were seen in the ascending colon and transverse colon. The same findings were noted on computed tomography colonography. Further more, gas retained within the submucosal tumor-like lesions of the intestinal wall was observed. Based on these findings the diagnosis of PCI was confirmed. The patient is being treated conservatively and there has been no change after one year of follow-up. We found CTC to be useful in non-invasively diagnosing PCI basedon finding intestinal cysts and gas retained within the intestinal wall. Therefore, CTC is indicated to confirm the diagnosis of PCI in patients for whom other examinations are too difficult to do.

View full abstract

We report two cases of advanced colorectal cancers had different infiltration each layer under submucosa. One was a 63-year-old female in the rectum, and the other was a 72-year-old female in the acending colon. Barium-enema, colonoscopy, and echo-endoscopy showed cancer lesion resembling a submucosal tumor (SMT). On pathology both lesion were found to be de-novo well-differentiated adenocarcinoma located in the mucosa. In the first case the poorly differentiated adenocarcinoma was found to have infiltrated from the submucosa to the subserosa ; there was evidence of severe fibrosis and lymphocytic infiltration. The second case had a moderately-differentiated adenocarcinoma with fibrotic changes from the submucosa to subserosa ; which was poorly-differentiated at the subserosa. Both cases had infiltrating cancerous lesions that resembled SMT. The 49 cases of colorectal cancers resembling SMT reported in Japan we reviewed.

View full abstract

The present case was an 80-year-old man who had been given corticosteroid after being diagnosed with acute crescentic glomerulonephritis. After presenting with a chief complaint of melena, the patient underwent colonoscopy, which revealed multiple ulcers in the terminal ileum. Since the patient was positive for CMV antigenemia (C7-HRP), multiple ulcers in the terminal ileum., and biopsy immunostaining identified CMV-positive cells by anti-CMV antibody, the patient was diagnosed as having CMV ileitis. The ulcers healed following administration of ganciclovir, however, they recurred six months later. Herein, we report our experience with a rare case of CMV ileitis, for which lesions were confirmed by performing endoscopy at onset, recovery, and relapse.

View full abstract

Gastrointestinal (GI) bleeding is an emergency condition that we often encounter in ordinary practice. Endoscopic hemostatic procedures for hemorrhagic lesions in the GI tract are classified into four groups as follows : 1. chemical spraying such as epinephrine or thrombin, 2. mechanical ligation such as endocrip, 3. local injection of medicine such as absolute ethanol or hypersaline-epinephrine, and 4. cauterization using high frequent current or heater probe. These procedures have advantages and disadvantages respectively, therefore it is important to select a suitable procedure according to bleeding status and a kind of lesions. We should have two or more favorite endoscopic hemostatic procedures. When we perform emergency endoscopy for a patient with GI bleeding, we should grasp enough about his general condition, complications, and medical history. Furthermore, informed consent and infection control are essential. Getting suitable endoscopic view is a key point for successful endoscopic hemostasis, and choice of scope or using cap that is fitted on the top of scope are useful to achieve that. If we could not control GI bleeding in spite of performing endoscopic hemostatic procedures, we should consider about surgical treatment or interventional radiology without being too late.

View full abstract

Aim : A case of an infected pancreatic pseudocyst in which cystgastrostomy was successfully performed with a new therapeutic echoendoscope and fluoroscopic guidance is presented. Methods : A curved linear array echoendoscope (GF-UCT240-AL5; Olympus) with an instrument channel 3.7 mm in diameter was used in combination with the Aloka SSD-5000 display unit. It enabled endoscopic video viewing. The cyst puncture was performed using a 1-mm diathermic needle housed in a 5 Fr Teflon tube. Following the endoscopic ultrasound (EUS) -guided puncture, a 10 Fr stent was placed in the pancreatic pseudocyst without an exchange of endoscope. Results : The procedure was well tolerated for the patient and there were no complications. The cyst was resolved and the stent was removed 8 weeks later. Conclusion : This new therapeutic echoendoscope may provide a more effective, safer and less time-consuming method of endoscopic pseudocyst drainage.

View full abstract