GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
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Volume 51, Issue 2
Displaying 1-13 of 13 articles from this issue
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  • CURRENT STATE AND PROBLEM OF TRANSNASAL ENDOSCOPY IN ENDOSCOPIC SCREENING FOR GASTRIC CANCER
    Mitsugi YASUDA, Rika AOKI, Ryusuke TORISU
    2009 Volume 51 Issue 2 Pages 181-193
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.181
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    Transnasal endoscopy involves less pain to the subject than peroral endoscopy with a conventional endoscope and the subject's hemodynamics and oxygen saturation are stable during the examination. This makes the procedure suitable for gastric cancer screening since such screening emphasizes the acceptance and safety of the examination. However, the procedure has several demerits in comparison to endoscopy with a conventional endoscope in that it involves pain in the nasal cavity during insertion and offers poorer image quality and maneuverability. Additionally, its diagnostic accuracy has not been fully assessed. Thus, obtaining appropriate informed consent in accordance with conditions at the facility where the procedure will be performed and determining the indications for the procedure are crucial. Tailored pretreatment and close observation carefully undertaken by an experienced endoscopic specialist are required.
    In the future, proof that transnasal endoscopy's diagnostic accuracy is comparable to past results achieved with endoscopic screening is needed for the procedure to be fully included within the framework of endoscopic screening. In addition, fostering numerous endoscopic specialists, reducing procedure-related disparities among facilities, and implementing strict quality control are essential for the wider use of the procedure as part of organized screening.
    In terms of today, drafting of guidelines is expected to help deal with the involved nature of pretreatment and also resolve the variance in methodologies. Individual manufacturers are expected to work on developing new endoscopes that remedy the problems of image quality and maneuverability.
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  • A CASE OF EOSINOPHILIC ESOPHAGITIS WITH PLEURAL EFFUSION
    Hideki MINEMATSU, Kiyoyuki HAYAFUJI, Yasuharu SAITO, Atsuhiro OGAWA, T ...
    2009 Volume 51 Issue 2 Pages 194-200
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.194
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    A 58-year-old man was referred to our hospital because of dysphagia and urticaria. Serum eosinophil level was high. Upper gastrointestinal endoscopy revealed that the esophageal wall was a thickened with white exudate stuck to the surface. Biopsy specimen showed eosinophilic infiltration in the esophageal epithelium. Thoracic CT showed esophageal wall thicking and bilateral pleural effusion. We diagnosed it as eosininophlic esophagitis. The symptom immediately improved by the steroid therapy. Eosinophilic esophagitis is a rare disease in Japan and this case was thought to be worth repoting.
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  • A CASE OF GASTRIC CANCER WITH METASTASIS TO THE ESOPHAGUS
    Naohisa YOSHIDA, Kazuyuki KANEMASA, Kyoko SAKAI, Yoshio SUMIDA, Syunsu ...
    2009 Volume 51 Issue 2 Pages 201-206
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.201
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    A 64-year-old man was referred to our hospital in March 2007, because he had been diagnosed as having gastric cancer with multiple liver metastasis in another hospital. EGD revealed diffuse ulceration and fold thickness on body of the stomach. Computed tomography revealed a wall thickness of total body of the stomach and multiple liver metastasis. He was diagnosed to have gastric cancer, cStage IV. Chemotherapy using S-1 was performed. However, the effect of chemotherapy decreased gradually. EGD was performed in December 2007 because of difficulty of oral intake. EGD showed longitudinal nodules of the lower esophagus. Histopathological examination showed adenocarcinoma in the submucosa of the esophagus. The lesion was diagnosed as metastasis of the esophagus from gastric cancer.
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  • HYPERPLASTIC POLYP DEVELOPING AFTER ENDOSCOPIC MUCOSAL RESECTION OF EARLY GASTRIC CANCER WAS REDUSED IN SIZE BY ERADICATION OF HELICOBACTER PYLORI
    Ayami MATSUI, Shinya AOKI, Akira FURUDOI, Takashi ISHIGAKI, Hiroyuki I ...
    2009 Volume 51 Issue 2 Pages 207-212
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.207
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    A 59-year-old man, who was found by endoscopy to have a polypoid mass, 1.0cm in diameter at the anterior wall of the gastric angle, was admitted to our hospital for the purpose of resection. The exiced specimen obtained form endoscopic mucosal resection (EMR) revealed well differentiated adenocarcinoma. No tumorous component was detected around the cut end, suggesting a curative resection. Endoscopic examination at 3 months after EMR revealed a polyp, 0.7cm in diameter, on the scar of the first resection, which grew to 1.5cm in diameter during the next 2 years. We performed biopsy, showing hyperplastic polyp, then we tried eradication of Helicobacter Pylori. The polyp remarkably reduced in size by the eradication.
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  • A CASE OF PORTAL VEIN GAS OCCURING AFTER PHLEGMONOUS GASTRITIS AND DUODENITIS
    Sachie YASUI, Kenji TSUCHIDA, Takashi KAWAI, Tetsu OKAMOTO, Katuya TAB ...
    2009 Volume 51 Issue 2 Pages 213-221
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.213
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    We report a case of Portal Vein Gas (PVG) occurring after phlegmonous gastritis and duodenitis, with a background of Superior Mesenteric Artery Syndrome (SMAS). A 73-year-old man had been admitted for lower abdominal pain and diarrhea and treated for about two months. Upper abdominal distension and hemorrhagic vomiting suddenly appeared. The upper GI (Gastro-Intestinal) endoscopy revealed diffusely edematous and erosive changes with oozing hemorrhage in the gastric and duodenal mucosa. An abdominal CT scan examination showed remarkable swelling of the gastric wall. We diagnosed phlegmonous gastritis and duodenitis, and treated the patient with conservative therapy. With a complete relief of symptoms, the patient started meals. After the start of meals, abdominal pain and vomiting recurred. The abdominal CT scan showed gas in the superior mesenteric vein and dendritic gas in the portal vein which was spread to the liver edge. Dilatation of the stomach and duodenum and submucosal gas in the gastric and duodenal bulb were also detected. We diagnosed Portal Vein Gas (PVG) and decide to treat him conservatively. The patient was extraordinary emaciated (BMI 13.0) suggesting superior mesenteric artery syndrome (SMAS) as an underlying condition. We speculate that the meal intake caused the high pressure in the stomach and the duodenum by SMAS and PVG occurring through the mucosa damaged by phlegmonous gastritis and duodenitis. We should consider a possibility of SMAS in cases of the undernourished patients, especially with long confinement in bed.
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  • A CASE OF COLONIC PSEUDO-OBSTRUCTION TREATED WITH PERCUTANEOUS ENDOSCOPIC TRANSVERSE COLOSTOMY
    Kiyoshi KAJIYAMA, Michio YOSHIDA
    2009 Volume 51 Issue 2 Pages 222-227
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.222
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    A 75-year-old man was admitted for abdominal distension and vomiting. A plain abdominal X-ray films and the computed tomography (CT) scan showed marked dilatation of the colon and incarcerated incisional hernia. A maximum diameter of the colon was 15cm. After the conservative management with long tube for intestinal obstruction, the operation for incisional hernia was performed. Even after the operation, the patient couldn't stand up by himself after meals due to marked abdominal distension. The colonoscopy revealed that the dilatation of only transverse colon and no stricture or local recurrence of colon cancer. Some kinds of laxatives and other medicines were not effective. Percutaneous endoscopic transverse colostomy (PEC) was performed under local anesthesia because of refuse for transverse colectomy or colostomy. The postoperative course is satisfactory without complication. After decompression of massive gas in the transverse colon, patient's abdominal distension was disappeared. The patient's activities of daily living (ADL) were improved. Although PEC is an effective management for colonic pseudo-obstruction, on the other hand, some serious complications including fecal peritonitis were reported. It must be noted that PEC should only be considered in carefully selected cases. To my knowledge, there has been no report of the percutaneous endoscopic colostomy of the transverse colon.
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  • A CASE OF SIGMOID COLON CARCINOMA WITH INFLAMMATORY CHANGE AND DIFFUSE INFILTRATION
    Shigenao ISHIKAWA, Tomoki INABA, Koji MIYAHARA, Ryuichirou TSUZAKI, Ma ...
    2009 Volume 51 Issue 2 Pages 228-236
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.228
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    A 58-year-old man with a complaint of narrowing stools was referred to our hospital. Barium enema and colonoscopy revealed a 10-cm-long annular stricture in the rectum extending to the sigmoid colon, and the tumor was almost entirely covered with normal mucosa. Under careful endoscopic observation, biopsy specimens were obtained from the area where the tumor showed surface exposure, and the histological diagnosis was well differentiated adenocarcinoma. Endoscopic ultrasonography revealed thickening of the second and third layers in the annular stricture and a low-echoic mass in the anal part of the lesion. High anterior rectal resection with D3 lymph node dissection was done. Histologically, the stenotic lesion was composed of well differentiated adenocarcinoma invading to the muscular layer and of severe inflammatory cell infiltration into the submucosal layer associated with abscess formation. The patient has remained disease-free for 13 months since surgery. Colon cancer with inflammatory stenosis is rare, and only 11 cases including the present one have been reported in Japan.
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  • PANCREATIC PSEUDOCYST SUCCESSFULLY TREATED WITH TRANSCUTANEOUS CYSTIC DRAINAGE AND TRANSPAPILLARY CYSTIC DRAINAGE
    Toru TAKAMATSU, Hiroyuki MIYATANI, Shinya USHIMARU, Hideaki HONDA, Tak ...
    2009 Volume 51 Issue 2 Pages 237-241
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.237
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    A 46-year-old male with alcoholic chronic pancreatitis and pancreatic head pseudocyst developed an infection in the pancreatic head pseudocyst. The first endoscopic retrograde pancreatography (ERP) did not show the pancreatic pseudocyst communicating with the main pancreatic duct. However, after percutaneous pseudocyst drainage, the second ERP showed that the pancreatic pseudocyst communicated with the main pancreatic duct. Transpapillary cystic drainage was successfully performed using 5Fr tube stent.
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  • INDICATION AND PRACTICAL PROCEDURES OF COLORECTAL ENDOSCOPIC MUCOSAL RESECTION (EMR) AND COLORECTAL SUBMUCOSAL DISSECTION (ESD) FOR COLORECTAL LATERALLY SPREADING TUMOR (LST)
    Shinji TANAKA, Shiro OKA, Sayaka OBA, Hiroyuki KANAO, Mayuko HIRATA, K ...
    2009 Volume 51 Issue 2 Pages 244-255
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.244
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    Although laterally spreading tumor (LST) lager than 20 mm in diameter tends to be piecemeal endoscopic mucosal resection (EMR), Cutting the adenomatous part never makes significant effects on pathological examination and curability of the lesion. LST-G showing adenoma or focal cancer in adenoma is the indication for piecemeal EMR with the condition that cancer part is resected en bloc perfectly. In such a procedure magnifying observation of pit pattern is essential prier to piecemeal EMR. On the other hand, the indication of colorectal ESD is as follows:1) Lesions difficult to be removed en bloc with a snare EMR in the size, such as LST-NG (particularly pseudo-depressed type), lesions showing type VI pit pattern, and large lesion with protruded type suspected to be carcinoma. 2) Lesions with fibrosis due to biopsy or peristalsis. 3) Sporadic localized lesions in chronic inflammation such as ulcerative colitis. 4) Local residual carcinoma after EMR. Technically in ESD, however, lesion with severe fibrosis is very difficult. To select best endoscopic therapy, we should consider not only clinicopathological features of the lesion but also skill level of colonoscopist, location of the lesion, capability of scope handling and predictive time for procedures including the possibility of surgical resection.
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  • DIFFUSE WHITE DEPOSITS OF THE DUODENUM MAY SUGGEST DELAYED GLUCOSE ABSORPTION
    Yoshihisa URITA, Kaoru DOMON, Susumu ISHIHARA, Makie NANAMI, Taketo YA ...
    2009 Volume 51 Issue 2 Pages 256-262
    Published: 2009
    Released on J-STAGE: July 17, 2012
    DOIhttps://doi.org/10.11280/gee.51.256
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    Background:The aim of the present study was to evaluate the relationship between white deposits observed in the duodenum and malabsorption of nutrients.
    Methods:132 consecutive subjects presenting with diagnostic upper endoscopy were recruited in this study. 13C-acetate was given intraduodenally in 65 patients and 13C-glucose in 67 patients. At the end of endoscopy, the tip of the endoscopy was placed in the second part of the duodenum and 20 mL water containing 100 mg 13 C-substrate was sprayed onto the duodenal mucosa. Breath samples were taken at baseline and at 10 min intervals.
    Results:There were no significant differences between 13CO2 excretion and the grade of white deposits after giving intraduodenal 13C-acetate. A delay in the 13CO2 excretion curve in patients with a body mass index of more than 26 was noted after giving 13C-glucose and there was a significant delay in 13CO2 excretion in the ‘diffuse’group as compared with the other two groups. The mean values of 13CO2 were significantly lower in obese patients than in non-obese subjects.
    Conclusion:Results from the duodenal infusion study using stable isotopes demonstrate a close association between diffuse white deposits on the duodenal mucosa and delayed glucose absorption.
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