GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
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Volume 51, Issue 1
Displaying 1-15 of 15 articles from this issue
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  • ENDOSCOPIC DIAGNOSIS OF INTESTINAL MALIGNANT LYMPHOMA
    Shotaro NAKAMURA, Takayuki MATSUMOTO, Mitsuo IIDA
    2009 Volume 51 Issue 1 Pages 3-9
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.3
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    The endoscopic features of malignant lymphoma of the small and large intestines were reviewed. The most frequent histologic type is diffuse large B-cell lymphoma (DLBCL), and follicular lymphoma and T-cell lymphomas are more frequent in intestinal cases than in gastric cases. Endoscopically, intestinal lymphomas are classified as polypoid, ulcerative (including stricturing, non-stricturing and aneurysmal sub-forms), multiple lymphomatous polyposis (MLP), diffuse, or mixed types. A significant correlation is observed between these endoscopic and histologic types ; most cases of ulcerative type are histologically DLBCL, while the majority of tumors of polypoid type are comprised of MALT lymphoma or DLBCL. In MLP type, follicular lymphoma and mantle cell lymphoma are frequent, while diffuse type is characteristic of T-cell lymphomas and immunoproliferative small intestinal disease. In addition to conventional esophagogastroduodenoscopy and colonoscopy, double-balloon endoscopy is useful for the detection and accurate diagnosis of intestinal malignant lymphoma.
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  • THE EVALUATION OF HISTOLOGICAL ATYPIA AND DEPTH OF INVASION OF COLORECTAL LESIONS USING MAGNIFIED ENDOSCOPY WITH NARROW-BAND IMAGING
    Toshiki NIKAMI, Shoichi SAITO, Hisao TAJIRI, Masahiro IKEGAMI
    2009 Volume 51 Issue 1 Pages 10-19
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.10
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    Purpose:This study aimed to clarify the usefulness of magnified endoscopy with narrow-band imaging (NBI) to diagnose the degree of histological atypia and depth of invasion in colorectal neoplastic lesions.
    Methods:A total of 247 colorectal lesions in 232 patients were analyzed. Each lesion was observed under magnified endoscopy with NBI and chromoendoscopy, and was classified according to the microvascular features observed on NBI system. The microvascular features were classified as follows:Type 1, invisible;Type 2, slight dilatation;Type 3V, regular arrangement of dilated vessels in villous lesions;Type 3I, irregular arrangement of dilated vessels;Type 4, disruptive and sparse vessels. The findings of NBI magnified endoscopy, together with the pit structure noted on NBI, were compared to chromoendoscopy findings.
    Results:97% of lesions with microvascular Type 4 were submucosal massively invasive cancer lesions. With respect to differentiating intramucosal or submucosal slight invasion from submucosal massive invasion, the calculated sensitivity, specificity and accuracy of NBI magnified endoscopy were 78.9%, 95.9%, and 90.5%, respectively.;chromoendoscopy had 82.5% sensitivity, 95.9% specificity, and 91.6% accuracy.
    Conclusion:NBI magnified endoscopy and magnified chromoendoscopy were almost equivalent in determining the depth of early colorectal cancer invasion. This result indicates that NBI magnified endoscopy is useful for determining treatment strategy.
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  • TWO CASES OF GIANT AGAR BEZOARS REMOVED ENDOSCOPICALLY
    Hiroshi SUGIYAMA, Takayuki NAKANISHI, Yasuhiro OSHIMA, Ken GOTO, Akihi ...
    2009 Volume 51 Issue 1 Pages 20-25
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.20
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    The patients were 59-year-old and 83-year-old women who came to our hospital because of nausea after drinking agar solution. Upper gastrointestinal endoscopy revealed light green and elastic hard foreign bodies of the fist size in the stomach. They were diagnosed as agar bezoars, considering the present history. We attempted to remove them with various instruments endoscopically, but failed. Then, we attempted to insert the endoscopy with a transparent hood into an agar bezoar, and slowly pull it by sucking. We could remove a fragment about 1 cm in size. We repeated this procedure with an overtube. We struggled with difficulties, but could almost completely remove the agar bezoars.
    Therefore, this technique may be useful for treating giant and hard agar bezoars. It is considered very dangerous to drink heavy agar solution at hungry time.
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  • A CASE OF ENDOSCOPIC SNARE PAPILLECTOMY FOR A CARCINOID TUMOR OF THE MAJOR DUODENAL PAPILLA
    Misato SAWA, Yoshinori IGARASI, Naoki OKANO, Kaori YOSHIZAWA, Takahiko ...
    2009 Volume 51 Issue 1 Pages 26-33
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.26
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    The patient was a 65 year-old female, who was admitted because of cholangitis. ERCP revealed an elevated lesion of the duodenal major papilla looking like a submucosal tumor and endoscopic biopsy specimens revealed a carcinoid tumor. EUS demonstrated that the tumor was 5mm in diameter and located at the submucosal layer. As we diagnosed that the tumor invasion was limited within the submucosal layer, without clinical evidence of regional lymphadenopathy, endoscopic snare papillectomy was performed. Histological examination of the resected specimen revealed a carcinoid tumor the surgical margin of being free neither horizontal nor vertical, and also showed that there was no vascular infiltration. Up to now, there has not been the evidence of tumor recurrence after one year and six months.
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  • A CASE OF RUPTURED ILEAL VARICES THAT COULD BE POINTED OUT THE EXACT BLEEDING SITE WITH ENDOSCOPIC EXAMINATION
    Ryuichi NOGUCHI, Yousuke AIHARA, Futoyuki YOSHIDA, Shinya SAKURAI, Mas ...
    2009 Volume 51 Issue 1 Pages 34-40
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.34
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    A 57-year-old man was emergent admitted to our hospital because of massive lower intestinal bleeding and shock state. He had undergone the abdominal operations twice. Angiographic studies showed no evidence of bleeding site, but diagnosed the ileal varices. Colonoscopy revealed extravasation from the ileal varices. Since he had received side to side anastomosis of ileocolic operation, we can performed short cut approach. We thus successfully pointed out the bleeding point of the ileal varices by endoscopic colonoscopy. Therefore, the patient underwent distal side resection of ileum and right-hemicolectomy for the ileal varices. His postoperative course was uneventful.
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  • A CASE OF AN EARLY CECAL CANCER DERIVED FROM A HYPERPLASTIC POLYP DURING ENDOSCOPIC FOLLOW-UP
    Hideki ISHIBASHI, Hiroyuki KOBAYASHI, Yumi OSHIRO, Yuji SAKAI, Kouichi ...
    2009 Volume 51 Issue 1 Pages 41-47
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.41
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    A 67 year-old woman had been followed for a Is type sessile hyperplastic polyp in the cecum from 1998. In 2000, biopsy of the polyp showed malignancy, and ileocecal resection was performed. Pathology of the resected specimen showed a well differentiated adenocarcinoma invading the submucosa(SM2).
    Hyperplastic polyp of the colon is regarded as benign and non-neoplastic. However, recent observations have suggested that hyperplastic polyps of the right colon over 10mm in size have a malignant potential and therefore, should be carefully observed.
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  • A CASE OF SUSPECTED AUTOIMMUNE HEPATITIS SHOWING ODD SHAPED ATROPHIC LIVER
    Satoru JOSHITA, Tetsuya ICHIJO, Kaname YOSHIZAWA, Mana FUKUSHIMA, Mich ...
    2009 Volume 51 Issue 1 Pages 48-54
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.48
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    A 62-year old woman was admitted to our hospital presenting the elevation of serum levels of γ-GTP and the hepatic deformity. She had twice acute hepatitis for unknown cause and was treated with corticosteroid at 26 and 33 years old. On imaging examinations, liver parenchyma was severely atrophic except for the left lateral inferior area (S3) and the right posterosuperior area (S7). On laparoscopy, the surface of the liver was whitish and thick and the left lateral lobe presented as potato-like liver. The liver biopsy findings showed non active chronic hepatitis. Autoimmune hepatitis was a most likely diagnosis, considering the compensated hypertrophy following wide necrosis of the liver parenchyma. Laparoscopy was useful as a diagnostic measure in this case.
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  • MASSIVE SUBCAPSULAR HEPATIC HEMATOMA AND INTRAPERITONEAL HEMORRHAGE AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY
    Ikuta TANAKA, Hiroyuki HISAI, Shohei KIKUCHI, Ikumi UMEDA, Makoto YOSH ...
    2009 Volume 51 Issue 1 Pages 55-60
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.55
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    Liver injury related to percutaneous endoscopic gastrostomy (PEG) placement is a rare major complication. We experienced massive subcapsular hepatic hematoma and intraperitoneal hemorrhage after PEG successfully managed conservatively. A 92-year-old woman with dementia was referred for PEG insertion because of appetite loss. CT revealed hepatomegaly of the lateral segment. After 1 : 1 finger compression and transillumination of the abdominal wall were confirmed, gastropexy using Funada's gastropexy device was performed at the site of puncture, and the 20Fr bumper-type-catheter was pushed into the stomach (Kangaroo Seldinger PEG kit, Nippon Sherwood) without difficulty. Fluologram showed the tip of the PEG tube in the stomach without peritoneal leakage. Four days after PEG, she developed hypotension and decreasing hemoglobin levels. Urgent CT demonstrated massive subcapsular hepatic hematoma in the lateral segment, intraperitoneal fluid and PEG tube without definite penetration of hepatic parenchyma. Given the high suspiction of hepatic injury, trascatheter arterial embolization was performed and she recovered with additional conservative management. She was transferred to the next hospital on 118 days after PEG. In conclusion, since liver injury associated to PEG with gastropexy may potentially cause fatal hemorrhage or result in abscess formation, it should be kept in mind.
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  • A CASE OF COLLAGENOUS COLITIS DIAGNOSED BY MAGNIFYING ENDOSCOPY
    Hiroshi ICHIBA, Yuji INOUE, Shinichi NAKAMURA, Sadahito KUWAO
    2009 Volume 51 Issue 1 Pages 61-65
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.61
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    A 71-year-old female suffered from long term watery diarrhea after taking an anticoagulant (cilostazol). Colonoscopic findings showed edematous mucosa, indistinct vascular transparency and granular appearance. Colonoc mucosal biopsy showed marked thickening of the subepithelial collagen band and a number of lympho-plasma cells in the lamina propria. A case of collagenous colitis caused by cilostazol has not been reported in Japan and a magnifying endoscopy with indigo carmine spraying was very useful in diagnosing this disease, which is worth reporting.
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  • ENDOSONOGRAPHY-GUIDED BILIARY DRAINAGE ; ESBD
    Jun HORAGUCHI, Naotaka FUJITA
    2009 Volume 51 Issue 1 Pages 76-83
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.76
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    Recently, there has been an increasing number of reports on a new endoscopic biliary drainage technique utilizing endosonographic guidance (endosonography-guided biliary drainage, ESBD), which can be employed in cases with difficult endoscopic biliary drainage (EBD) in stead of surgical drainage and percutaneous transhepatic biliary drainage (PTBD). ESBD enables establishment of internal biliary drainage via the abdominal esophagus, stomach, duodenum, or jejunum, and excellent results have been reported on its safety and effectiveness. In ESBD as in EBD, exchange of the stent is also possible. Development of devices dedicated to ESBD will increase the safety and reliability of this technique and accelerate the shift from PTBD to ESBD in many contexts.
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  • EFFECTIVENESS OF CYTODIAGNOSIS WITH PANCREATIC DUCT LAVAGE FLUID FOR PANCREATIC DUCTAL CARCINOMA —NEW SAMPLING TECHNIQUE—
    Tsunao IMAMURA, Yuko KOIZUMI, Rikako KOYAMA, Chikao OKUDA, Kazuo TAKEU ...
    2009 Volume 51 Issue 1 Pages 84-90
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.84
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    Background:Pancreatic carcinoma is one of the most lethal cancers. Because pancreatic carcinoma is still very difficult to diagnose in its early stage, many of these patients will be considered unsuitable for surgery. If a cytological diagnosis is obtained at initial endoscopic retrograde cholangiopancreatography (ERCP), suitable treatment will be initiated without delay.
    Methods:To increase the number of exfoliated cells from the pancreatic duct, we devised a new technique, pancreatic duct lavage fluid (PDLF), following bronchoalveolar lavage fluid. The present paper reports the effectiveness of cytological examination using PDLF in the diagnosis of pancreatic carcinoma. We examined 18 pancreatic carcinoma cases. After the endoscopic retrograde pancreatography (ERP), PDLF was collected from a double-lumen catheter inserted into the main pancreatic duct. Saline injected from the lumen for the injection, and PDLF was aspirated from the other lumen for the guidewire at the same time. The cytological examination was performed using PDLF.
    Results:Exfoliated cells were more frequently found in PDLF from all patients. In 15 cases (83%), cytological examination of PDLF revealed positive cytological results as the diagnosis of pancreatic carcinoma.
    Conclusion:Cytological examination using PDLF has a high sensitivity for detection of pancreatic carcinoma. The new examination, PDLF, is simple, safe and effective, so we expect PDLF to become widely popular.
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