This review focused the current status and future possibilities of NOTES. In the past few years, numerous reports have been published describing the technical feasibility of NOTES for various surgical procedures, including tubal ligation, cholecystectomy, splenectomy, nephrectomy, gastrojejunostomy and transesophageal mediastinoscopy. Recently, several groups have reported a few cases of NOTES cholecystectomy, either via the transgastric or transvaginal route. These studies demonstrated that NOTES hold the potential to revolutionize flexible endoscopic treatments. With the availability of improved endoscopic instruments and tech niques, NOTES may play an important role in the future of gastroenterological field.

View full abstract

A 55-year-old Japanese woman was examined by the screening esophagogastroduodenos copy. Endoscopic findings were multiple white nodules and white villi around the papilla of Vater and skipping irregular mucosa of the 2nd and 3rd parts of the duodenum. Biopsy specimens demonstrated the follicular lymphoma of the duodenum. Double balloon endoscopy was performed to diagnose the extension of lesions and it revealed multiple white nodules in the jejunum and the ileum. Moreover biopsy specimens showed same findings as that of upper GI endoscopy. The double balloon endoscopy was useful for diagnosing the extention of follicular lymphoma.

View full abstract

It is considered difficult to remove foreign bodies located in the small bowel using flexible panendoscopy. Thus, one usually waits for the foreign body pass spontaneously without complications. However, surgical removal is necessary to remove foreign bodies if there is a possibility of mucosal injury or perforation of the intestinal tract. This report describes three cases in whom foreign bodies located in the small bowel were removed using Double Balloon Enteroscopy (DBE). The first patient, he had swallowed nail accidentally. The nail was located in the jejunum. The second patient, with known chronic idiopathic intestinal pseudoobstruction (CIIP), had a torn ileus tube located in the jejunum. The third patient with recurrent abdominal pain had a simple ulcer that had been diagnosed at another hospital ; press-through-pack (PTP) was located in the stenosis of the ileum. DBE makes it possible to remove swallowed foreign bodies located in the small bowel without the need to resort to surgery. It is likely that DBE might change the treatment strategy for dealing with foreign bodies located in the small bowel.

View full abstract

A 70-year-old man diagnosed as having crescentic and necrotizing glomerulonephritis presented with bloody stool under warfarin and corticosteroid therapy. Esophagogas troduodenoscopy, colonoscopy and computed tomography detected no active bleeding lesions. Double-balloon enteroscopy revealed a discrete ulcer in the ileum. Although CMV-antigenemia was negative, biopsied specimen from the ulcer revealed giant cells with including body and anti-CMV staining positive cells, so we diagnosed the lesion was CMV ileal ulcer. Outcome was favorable after anti-CMV therapy. Double-balloon enteroscopy was a useful examination to diagnose CMV ileitis.

View full abstract

A 61-year-old man was hospitalized because of lower abdominal pain and abdominal distention. Plain abdominal X-ray film showed gasf luid levels in the small intestine. Abdominal computed tomography showed paraileocecal abscess. Colonoscopic examination reveals appen dices aperture is enlarged in the shape of a Dharma doll and debouchement of albedo pus from the center. It was parenteral, and abscess alveus was contrasted gastrograf in from cupular part when we tried to contrast it. We thought that bowel causes adhesion because of abscess by appendicitis perforation and developed an ileus symptom than the above and did appendectomy and ileal adhesiotomy and performed abscess drainage. It included one's own experiments example that it performed an endoscopy, and paraileocecal abscess was able to confirm drainage, and it was 18 examples as far as it was able to search it by a medical central magazine. It was thought that it could be given test that it was effective in the colonoscopic examination how we hid a diagnosis and trerapeutic likelihood in for the case that ileocecal abscess was doubted.

View full abstract

A 59-year-old female was seen due to abdominal pain, diarrhea, bleeding, and weight loss of 3 years' duration. On colonoscopy multiple reddish polyps with white 'caps' were found from the rectum to the sigmoid colon. On histopathology, the biopsy specimens were found to consist of inflamed mucosa with elongated tortuous crypts that were attenuated towards the mucosal surface, and granulation 'cap' tissue was observed on the surface of the mucosa. Therefore cap polyposis was diagnosed. Since the patient was H. pylori positive, H. pylori eradication therapy was given. After this treatment, the patient's symptoms disappeared, and the polypoid lesions in the colon gradually resolved. The patient has had no recurrence during the 2 years since H. pylori eradication therapy was given.

View full abstract

Colonoscopy (CF) is an invasive examination. The frequency of adverse events during the preparative procedures for CF and CF is high. Serious adverse events, such as ileus and intestinal perforation, can occur. In particular, patient in whom PEG-electrolyte solution is used to prepare the gut for CF develop adverse events. Therefore, in our hospital, the appropriate preparations for CF are begun in all cases only after on abdominal ultrasound (US) has been done to rule out obvious neoplastic lesions, stenotic changes, or extensions into the intestinal tract wall. From April 2006 to February 2007, 679 CF examinations were done in our hospital, all of the 16 cases who had advanced colon cancer were identified on US prior to CF. No serious adverse events occurred after PEG-electrolyte solution was used to prepare patients for CF based on the US results. The rate of advanced colon cancers discovered using US prior to CF was 2.4%. On US done prior to CF, obstructive lesions, tumors, and other findings that can cause an ileus could be detected. Therefore, by first doing US appropriate preparation for CF can be chosen, and serious adverse events can be prevented. US is a non-invasive examination that does not expose the patient to radiation, unlike CT. US which can detect advanced colon tumors, obstructive lesions, and intestinal tract changes, done prior to CF allows the procedure to be done in a manner.

View full abstract

Endoscopic submucosal dissection (ESD) developing in the stomach has also been recog nized as one of the standard treatments for esophageal neoplasms in Japan. Advantage of ESD is to be controllable in size and shape, and to be resectable even in large and fibrotic neoplasms. The disadvantage is longer procedure time, heavier bleeding, and higher possibility of perforation. Accompanying complications, especially perforation, in the esophageal ESD may result in more life-threatening outcomes than those in the stomach ESD, so the safest way to accomplish successful en bloc resection without complication should be identified. All of the following key points should be at least adequately managed to reach the goal ; 1. preoperative evaluation of the patients, 2. preoperative evaluation of the lesions, 3. preparation of endoscopic equipment and devices, 4. perioperative monitoring and sedation, 5. technical strategy for resection, 6. how to cope with complication, 7. postoperative management. In this technical note, we would like to show how to manage the above points in our departments, aiming for the safest esophageal ESD without any complication.

View full abstract

Background: The usefulness of prophylactic pancreatic stent placement for preventing post-ERCP pancreatitis has been reported. We developed a new pancreatic duct stent, which was a 5-Fr, 4-cm-long stent with a single duodenal pigtail (Pit-stent). Patients and methods: Pancreatic duct stenting using a Pit-stent was attempted in 76 patients (40 men, 36 women ; mean age, 65yr ; age range, 42-91yr) at high risk of post-ERCP pancreatitis. The frequency of post-ERCP pancreatitis and spontaneous passage of the stent were investigated. Results : Pancreatic duct stent placement was successfully performed in 93% of the patients. One patient developed mild pancreatitis after ERCP (1.4%). Spontaneous passage of the stent was observed in 92%. There were no other complications or procedure-related deaths in this group. Conclusions : Pancreatic duct stent insertion may reduce the incidence of post-ERCP pancreatitis in patients at high risk of post-ERCP pancreatitis. Spontaneous migration of a pancreatic stent that contributes to lessening of the need for additional ERCP can be expected with the use of a Pit-stent.

View full abstract