GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
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Volume 51, Issue 8
Displaying 1-14 of 14 articles from this issue
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  • A NEW CLASSIFICATION AND PRECISE DEFINITIONS OF ENDOSCOPIC IMAGING
    Hisao TAJIRI, Hirohumi NIWA
    2009 Volume 51 Issue 8 Pages 1677-1685
    Published: 2009
    Released on J-STAGE: July 26, 2012
    DOIhttps://doi.org/10.11280/gee.51.1677
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    The authors hereby describe a classification for endoscopic imaging into object-oriented classification, and provide precise definitions of individual terms. Endoscopic imaging is divided into categories : (1) conventional endoscopy (white light endoscopy), (2) image-enhanced endoscopy, (3) magnified endoscopy, (4) microscopic endoscopy, and (5) tomographic endoscopy. Image-enhanced endoscopy is sub-divided into digital, optical-digital and chromoendoscopy methods. The optical-digital method involves conversion of the optical characteristics of the light used for illumination or imaging with a light source differing in optical characteristics from ordinary white light. At the same time, this method involves signal processing within a video processor in a specially designed way, to yield enhanced images. This method usually encompasses NBI (narrow band imaging), AFI (auto-fluorescence imaging) and IRI (infra-red imaging). Magnified endoscopy is subdivided into optical and digital methods. Microscopic endoscopy is subdivided into optical and confocal methods. Tomographic endoscopy is subdivided into endoscopic ultrasonography and OCT (optical coherence tomography). It is desirable that uniform and correct terminology will be promulgated throughout the academic and clinical spheres, worldwide, to facilitate further advances in endoscopic diagnosis and treatment.
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  • CASES OF GASTRIC FUNDIC GLAND POLYPS INCREASING IN THE SIZE DURING THE LONG-TERM THERAPY WITH PROTON PUMP INHIBITOR
    Kayoko SUGAWARA, Yukinori IMAI, Eiko SAITO, Kenji FUJIMORI, Shin ARAI, ...
    2009 Volume 51 Issue 8 Pages 1686-1691
    Published: 2009
    Released on J-STAGE: July 26, 2012
    DOIhttps://doi.org/10.11280/gee.51.1686
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    It is reported that gastric fundic gland polyps (FGPs) increase in the size during the long-term therapy with PPI. To clarify the mechanism of such enlargement, we studied the clinical and pathological features of 13 patients (3 men and 10 women, mean age 70.5 years old) in whom FGPs grew up during PPI treatment. PPI was given for treatment of GERD in 12 patients and for prevention of peptic ulcer in 1 patient. The duration (mean±2SE) between the initiation of the therapy and the time when enlargement of FGP was diagnosed was 29.9±8.3 months. The diameters of FGP were smaller than 5 mm in all patients before the initiation of the therapy, but they ranged between 5 and 15 mm after the long-term therapy. Enlarged FGPs showed the blister-like appearance on endoscopy. All patients were negative for H. pylori infection. Serum gastrin level was elevated in 4 of 8 patients. Light microscopic examination of FGP excised by endoscopic mucosal resection revealed cystic dilatation of many fundic glands with mucous cell and parietal cell hyperplasia. There existed no histological finding showing endocrine cell micronests or carcinoid tumor. It is suggested that the long-term administration of PPI inhibited secretion of gastric acids, leading to provoke hyperplastic cystic changes in the fundic glands in cases of H. pylori-negative patients.
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  • A CASE WITH SUPERFICIAL ESOPHAGEAL CANCER LOCATED SOLELY ON ESOPHAGOGASTRIC VARICES REQUIRING ENDOSCOPIC MUCOSAL RESECTION
    Taku HARADA, Shojiro YAMAMOTO, Yoshihiro TAHARA, Tadashi MIIKE, Hiroo ...
    2009 Volume 51 Issue 8 Pages 1692-1699
    Published: 2009
    Released on J-STAGE: July 26, 2012
    DOIhttps://doi.org/10.11280/gee.51.1692
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    We here report a case with esophageal cancer located on solely esophageal varices, requiring an endoscopic mucosal resection.
    A 69-year-old woman was referred to our hospital for further evaluation of the with an esophageal lesion suspected of being a superficial cancer. On upper gastrointestinal endoscopy, a slightly depressed, superficial, reddish lesion located solely on esophageal varices was found, it was diagnosed as a superficial esophageal cancer using special endoscopic techniques. Treatment was first performed for the esophageal varices using endoscopic procedures (endoscopic injection sclerotherapy(EIS), endoscopic variceal ligation(EVL), and endoscopic clipping). After eradication of the varices, the disappearance of vessels under the cancer was confirmed by endoscopic ultrasonography(EUS). Since then, endoscopic mucosal resection(EMR)of the cancer lesion was carried out without the occurence of any severe complications. On histopathology, the intraepithelial cancer, was found to have been completely resected without lymphatic or vascular permeation.
    The approach used in this patient is useful for the diagnosis and the treatment of superficial esophageal cancer located solely on varices.
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  • A CASE OF POORLY DIFFERENTIATED ADENOCARCINOMA ARISING FROM SHORT SEGMENT BARRETT'S ESOPHAGUS
    Hideharu OKANOBU, Tomotaka TANAKA, Yoshio KUGA, Tomohiro MIWATA, Satos ...
    2009 Volume 51 Issue 8 Pages 1700-1706
    Published: 2009
    Released on J-STAGE: July 26, 2012
    DOIhttps://doi.org/10.11280/gee.51.1700
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    On endoscopy, a 60-year-old man was found to have a lower esophageal ulceration. In particular, the lesion belonged to the IIa+IIc type ; the lesion was located on the right anterior wall of the lower esophagus, and involved a short segment at Barrett's epithelium. On biopsy, it was diagnosed as a poorly differentiated adenocarcinoma. A sub-total esophagectomy was performed. On histology of the resected specimen, a poorly differentiated adenocarcinoma located at the IIc area of the tumor and a well to moderate differentiated adenocarcinoma located at the IIa area of the tumor were diagnosed. The lesion was 13×18 mm in size. The lesion originated in the short segment Barrett's esophagus, and massive submucosal invasion (sm2) without lymph node metastasis was noted.
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  • THREE CASES OF CHLAMYDIA TRACHOMATIS PROCTITIS FOUND BY FECAL OCCULT BLOOD
    Yutaka ISOZAKI, Kentarou SUZUKI, Tatsuzou MATSUYAMA, Naoyuki MATSUMOTO ...
    2009 Volume 51 Issue 8 Pages 1707-1713
    Published: 2009
    Released on J-STAGE: July 26, 2012
    DOIhttps://doi.org/10.11280/gee.51.1707
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    Three cases of Chlamydia trachomatis proctitis were presented. All patients were anymptomatic. Colonoscopic examination revealed numerous granular lesions spreading over the rectum. Histological findings of the biopsy specimens showed hyperplasia of the lymphoid follicles and diffuse infiltration of inflammatory cells. The antigen of Chlamydia trachomatiswas determined from rectal smear by enzyme immunoassay or polymerase chain reaction, and the diagnosis of Chlamydia trachomatisproctitis was made. All patients were treated with azithromycin hydrate. In case 1 and 3, colonoscopic findings improved remarkably and no Chlamydia trachomatisantigen was detected from a rectal smear after the medication. On the other hand, oral administration of azithromycin hydratewas not effective in case 2, where the colonoscopic findings did not improve, with sustaining positive Chlamydia trachomatis antigen from rectal smear.
    Gstroenterologists should pay attention to Chlamydia trachomatisproctitis when they examine patients with lymphoid follicular proctitis.
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  • A CASE OF PREOPERATIVELY DIAGNOSED EARLY ADENOCARTINOMA OF THE APPENDIX TREATED BY LAPAROSCOPY-ASSISTED RESECTION
    Yuki TANISAKA, Kazuhide IWAKAWA, Hajime SATO, Tsuyoshi MATSUMOTO, Eiji ...
    2009 Volume 51 Issue 8 Pages 1714-1719
    Published: 2009
    Released on J-STAGE: July 26, 2012
    DOIhttps://doi.org/10.11280/gee.51.1714
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    We report a case of early appendiceal carcinoma which was diagnosed preoperatively, and treated by laparoscopy assisted resection. A67-year-old man had a positive occult blood test. Colonoscopy revealed a movable protruded lesion at the orifice of vermiform appendix, which was diagnosed as adenocarcinoma at the biopsy. Barium enema did not disclose vermiform appendix. we diagnosed early appendiceal carcinoma and enforced laparoscope-assisted ileocecal resection. The resected specimen showed a protruded mucosal lesion, which was pathologically diagnosed as well differentiated adenocarcinoma, 0-1p, m, ly0, v0. It is necessary to observe the orifice of vermiform appendix in detail to diagnose early appendiceal carcinoma.
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  • A CASE OF SMALL COLONIC GANGLIONEUROMA LOCATED IN THE DESCENDING COLON
    Atsunori KUSAKABE, Shigehiro SHIRAKI, Kei MATSUSAKO, Yoshihide NAKAYAM ...
    2009 Volume 51 Issue 8 Pages 1720-1724
    Published: 2009
    Released on J-STAGE: July 26, 2012
    DOIhttps://doi.org/10.11280/gee.51.1720
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    A 64-year-old male endoscopic mucosal resection for a colonic adenoma had a follow-up colonoscopy. On colonoscopy, a whitish, slightly elevated lesion, 2mm in diameter, which had a smooth surface, was found in the descending colon. On histology, proliferation of ganglion cells and nerve fibers within the lamina propria was noted. On immunostaining, the lesion was positive for S-100 protein. The patient had no history of von Recklinghausen's disease or multiple endocrine neoplasia. Ganglioneuroma occurring only in the colon is very rare. Of note, this patient had the smallest colonic ganglioneuroma reported in the literutune to date.
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  • A CASE OF RECTAL TRICHURIASIS RESULTING IN A GIANT, BLEEDING ULCER
    Yasuhisa FUJINO, Yoshihiro INOUE, Makoto ONODERA, Satoshi KIKUCHI, Shi ...
    2009 Volume 51 Issue 8 Pages 1725-1729
    Published: 2009
    Released on J-STAGE: July 26, 2012
    DOIhttps://doi.org/10.11280/gee.51.1725
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    On July 1, 2005 a 44-year-old man was seen due to diarrhea and anal pain that had begun a few days earlier. On digital rectal examination, rectal stenosis was noted and a colonoscopy was done. An ulcer, as well as a white, filiform worm on the ulcer base was found in the rectum. Due to excessive bleeding the entire worm could not be removed using forceps. The patient continued to have diarrhea and anal pain, he began having bloody stools on July 11. Colonoscopy at that time revealed a giant, bleeding ulcer in the rectum. Due to uncontrollable bleeding, he was referred to our hospital on July 27. Hemostasis was achieved endoscopically and his condition finally improved on July 28. A total colonoscopy was done ; no nematodes were identified. An examination of a stool specimen showed no parasite ova.
    At first, anisakiasis was suspected, as this is the most common and well-known type of nematodiasis. However, on endoscopy, the worm's body appeared to have a whip-like shape characteristic of the whipworm ; a thin, filamentous proterosoma connected to a thick hysterosoma. Therefore, a diagnosis of trichuriasis caused by whipworm was made.
    Whipworm is distributed widely throughout the world. The ingestion of polluted farm products can lead to infection. In general, whipworm infects the caecum ; it is also sometimes found in the appendix and colon. However, this parasite is rarely found in the rectum. Light trichuriasis infestation can be asymptomatic, although our patient developed severe symptoms. The unique location of infestation—the rectum—likely resulted in the severe morbidity observed in this case.
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  • A CASE OF THE RECURRENT INTRAPANCREATIC REMNANT BILE DUCT FATTY ACID CALCIUM STONES AFTER THE BILE TRACT RECONSTRUCTION SURGERY
    Takayoshi MEGURO, Takeshi YAMAMOTO, Kana NISHIOKA, Makoto YONECHI, Shi ...
    2009 Volume 51 Issue 8 Pages 1730-1735
    Published: 2009
    Released on J-STAGE: July 26, 2012
    DOIhttps://doi.org/10.11280/gee.51.1730
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    A 66-year-old man who underwent biliary tract reconstruction surgery due to recurrent bile duct stones after endoscopic sphincterotomy (EST) was admitted to our hospital complaining of abdominal pain. Endoscopic retrograde cholangiopancreatography (ERCP) revealed intrapancreatic remnant bile duct stones which were analyzed into fatty acid calcium were endoscpically extracted by basket catheter. The fluid collected in this remnant bile duct revealed high amylase titer. But, there were not anomalous arrangement of the pancreaticobiliary ductal system in this case. We discussed the pathogenesis of the stones formed in the intrapancreatic remnant bile duct.
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  • ENDOSCOPIC DIAGNOSIS AND TREATMENT FOR TUMOR OF THE PAPILLA OF VATER
    Shimpei MATSUSAKI, Hiroshi OKANO, Kenichirou NISHIKAWA, Tomohiro SASE, ...
    2009 Volume 51 Issue 8 Pages 1738-1747
    Published: 2009
    Released on J-STAGE: July 26, 2012
    DOIhttps://doi.org/10.11280/gee.51.1738
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    Although the treatment for tumor of the papilla of Vater is basically a surgical operation, endoscopic papillectomy (EP) has been newly developing in recent years. While it is agreed on its indication for adenomas without extension into bile duct or pancreatic duct, opinions vary on its extended application to early-stage cancer.
    Understanding of the particular anatomy of the papillary region is indispensable in diagnosing tumors of the papilla of Vater. For diagnosing the tumor extent, not only by determination of tumor invasion of duodenal wall (Du) and pancreas (Panc), but also the evaluation of bile duct and pancreatic duct extension by using EUS and IDUS is required. EP is technically difficult with high risk of complication, should be performed only by expert therapeutic endoscopists and management of pancreatitis and bleeding is particularly important.
    In this technical note, we would like to show how to manage imaging diagnosis and EP for tumor of the papilla of Vater.
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  • NEWLY DEVELOPED OPTIMAL BAND IMAGING SYSTEM FOR THE DIAGNOSIS OF EARLY GASTRIC CANCER
    Mitsuyo YOSHIZAWA, Hiroyuki OSAWA, Hironori YAMAMOTO, Kiichi SATOH, Hi ...
    2009 Volume 51 Issue 8 Pages 1748-1752
    Published: 2009
    Released on J-STAGE: July 26, 2012
    DOIhttps://doi.org/10.11280/gee.51.1748
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    Background : Magnifying narrow band imaging system is useful for the diagnosis of early gastric cancer. However, it is difficult for the operator of the scope to maintain the correct distance between the tip of the endoscope and the gastric mucosa for appropriate visualization. The newly developed optimal band imaging system can reconstruct good spectral images derived from ordinary endoscopic images and enhance the mucosal surface without magnification as well as with low magnification. This imaging technique is based on narrowing the bandwidth of the conventional image arithmetically, using spectral estimation technology.
    Methods : We evaluated endoscopic features of 30 lesions with elevated-type, 32 lesions with depressed-type and two lesions with fiat-type early gastric cancer using this new system.
    Results : We found the best images in all cases of early gastric cancers by using a specific combination of the following three wavelengths available in this system : 470 nm for blue, 500 nm for green and 550 nm for red. The optimal band images showed the depressed-type early gastric cancer as reddish lesions distinct from the surrounding yellowish non-cancerous area, leading to a clear demarcation line between the cancerous and non-cancerous mucosa without magnification. Moreover, 30-40-fold magnified optimal band images showed a clearly irregular microvascular pattern or a microstructure pattern of the mucosal surface in all types of gastric cancers.
    Conclusion : This new system can provide useful information for diagnosing various types of early gastric cancers without and with low magnification.
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