We described the pathological conditions, clinical features, definitive diagnostic methods, and other features of intestinal tuberculosis, CMV enterocolitis, and amebic colitis, whose incidences are high in patients with chronic infectious enterocolitis, focusing mainly on colonoscopic diagnosis. These diseases have no specific clinical symptoms, and colonoscopy plays a very important role in their diagnosis. These diseases may be suspected on the basis of colonoscopic findings, and examinations specific to each disease are then performed, which frequently leads to definitive diagnosis. Intestinal tuberculosis is characterized by specific deformations, atrophic scars, and circular ulcers of the right-sided colon including the ileocecal area. In some cases, diagnostic imaging of the chest becomes is essential for diagnosis. CMV enterocolitis mostly occurs in immunocompromised patients, and has no particular sites of occurrence. Although it is frequently characterized by punched-out ulcers, it can exhibit various types of ulceration. Amebic colitis most commonly occurs in the cecum and rectum, and multiple ulcers accompanied by surrounding protrusions or redness are characteristic of it. CMV enterocolitis and amebic colitis frequently exhibit various concomitant ulcers.

View full abstract

Background and aim : Conscious sedation is universally used to reduce patient discomfort, anxiety, and pain during endoscopy, so that the endoscopic procedures can be effectively and safely completed. In Japan, three benzodiazepines, including diazepam, midazolam and flunitrazepam, are approved for intravenous use administer during endoscopy. However, only a few studies have compared these benzodiazepines with respect to their effectiveness and the safety. This study compared the effectiveness, the safety, and recovery time of midazolam and flunitrazepam during diagnostic upper gastrointestinal endoscopy.
Patients and Method : Forty patients were sedated with i.v. midazolam (average dose 2.65 mg : M-Group), and thirty-seven patients were sedated with i.v. flunitrazepam (average dose 0.33 mg : F-Group). After the drug was given, a diagnostic upper gastrointestinal endoscopy was done by one of 5 staff endoscopists. Depth of sedation, vital signs, patient's tolerance, the endoscopic procedure's technical ease and the sedation recovery time were evaluated by one independent observer for all patients.
Results : The two groups were not significantly different with respect to : gender, age, BMI, ASA risk class, experience with previous upper upper gastrointestinal endoscopy, and procedure duration. Depth of sedation evaluated by OAA/S was significantly deeper in the M-Group than in the F-Group, although a moderate sedation level was maintained in both groups. There was no difference in the vital signs, including blood pressure, heart rate, and pulse oximetry between the groups ; as well, no clinical complications were observed in either groups. There were no statistically significant differences between the two groups with respect to the number of excellent technical ease, and the sedation recovery time (about 40 min in the both groups). However, the patient's 100 mm Visual Analogue Scale assessment of tolerance was significantly lower in the M-Group (7.9mm) than in the F-Group (26.8 mm). Complete amnesia of the endoscopic procedure occurred in 55% of the M-Group and 19% of the F-Group.
Conclusion : The safety of midazolam and flunitrazepam was almost the same with respect to vital sign and the sedation recovery time. However, the effectiveness of midazolam including depth of sedation and patients tolerance was significantly better than flunitrazepam. Midazolam caused less discomfort and was more frequently associated with amnesia than flunitrazepam.

View full abstract

We report a case of 63-year-old man with quadruple cancers of the esophagus, stomach, duodenum and sigmoid colon. All cancers were treated with curative endoscopic resection. At first, a cancer in the sigmoid colon was treated by endoscopic mucosal resection (EMR), then a cancer in the duodenum was treated by endoscopic submucosal dissection (ESD). After that, a cancer in the stomach was treated by endoscopic mucosal resection using ligating device (EMRL), then two heterochronous cancers in the esophagus were treated by ESD. He is alive and well 4 months after the last esndoscopic resection. The incidence of double cancer has recently increased, but quadruple cancers remain extremely rare. Quadruple cancers in the gastrointestinal tract, and head and neck area were reported as very rare cases in Japan. This is the first report to treat all quadruple cancers in the gastrointestinal tract endoscopically. Multiple cancers in the gastrointestinal tract, and head and neck area occur more often than in other organs, mainly because of risk factors such as smoking and alcohol consumption. So we think periodic endoscopic follow up is necessary even for patients with cancer who had been treated curatively.

View full abstract

A 77-year-old male on hemodialysis for chronic renal failure developed to our hospital because of anemia. On endoscopic examination, diffuse antral vascular ectasia (DAVE) and an early gastric cancer (IIc) located on the greater curvature of the antrum. The gastric cancer was resected by endoscopic submucosal dissection (ESD). DAVE was treated by endoscopic ablation using argon plasma coagulation (APC). This is the first reported case of DAVE complicated with the early gastric cancer treated by endoscopic resection.

View full abstract

We report a case performed percutaneous endoscopic duodenostomy successfully. The patient was a 90-year-old woman who had suffered from repeated aspiration pneumonia. It was difficult to perform percutaneous endoscopic gastrostomy because of her previous partial gastrectomy. We performed percutaneous endoscopic duodenostomy without any complication. Percutaneous endoscopic duodenostomy is a useful method of enteral feeding for patients with prior abdominal surgery in selected cases.

View full abstract

A 60-year-old man had been admitted to the another hospital because of abdominal pain and diarrhea for a week before the current admission. Colonoscopy at 1 month progressively showed 2 small ulcers in the ascending colon. His symptoms had not been relieved by the administration of antibiotics. A tender mass was palpated in the right lower quadrant of the abdomen. Blood test showed increased c-reaction protein and white blood cell count. Colonoscopy revealed the edematous mucosa and the skipped large ulcers with pseudomembrane in the cecum, ascending colon, hepatic flexure, and splenic flexure. Histologic examination of the biopsy specimens showed numerous trophozoites of ameba, and we diagnosed amebic colitis. We administered oral metronidazol (1500mg daily) for 14 days. His symptoms immediately disappeared following this treatment. Of value in this case was that we could endoscopically follow the course of amebic colitis that was rapidly exacerbated in a short time.

View full abstract

A 73-year-old man who had received endoscopic sphincterotomy (EST) for a common bile duct stone and acute cholangitis three years before, was admitted for investigation of right upper quadrant abdominal pain and fever. Computed tomography (CT), magnetic resonance cholangiopancreatography and ultrasonography showed an elongated common bile duct stone with mild dilatation of the bile duct. Furthermore, CT revealed that the common bile duct stone contained a needle-shaped material, presenting a characteristic bright dot corresponding to the density of bone. Under a diagnosis of a common bile duct stone containing a nidus of fish bone, EST was performed. A friable and elongated stone containing needle-shaped material was removed from the common bile duct. The component analysis of the needle-shaped material showed mainly calcium and phosphorus, suggesting that the needle-shaped material seemed to be a fish bone. An unusually elongated shaped stone of the common bile duct, which contains a bright dot of bone density on CT, should be considered as common bile duct stone containing a nidus of fish bone.

View full abstract

In principle, endoscopes with a regular diameter have been used without sedation for upper gastrointestinal endoscopy in a medical check-up at the Matsue Red Cross Hospital. Subjects can freely select either a barium meal X-ray study or endoscopy, and a large proportion of subjects, as much as 90%, have selected endoscopy. An excellent endoscopist-examinee relationship is indispensable for comfortable endoscopy for the examinees and it is necessary to recognize that endoscopy is not a daily activity for them. Talking to an examinee repeatedly during the examination gives rise to a feeling of ease and it is presumed that “verbal anesthesia” praising the examinee is effective. In addition, when examinees are feeling tense, it may be effective to provide care that an endoscopist or a co-medical worker puts a hand on their shoulder. While it is expected that transnasal endoscopy prevails and the number of institutes where a sedative is used increases in the future, basic attitude towards examinees will be universal.

View full abstract

Aim : Hepatocellular carcinoma (HCC) nodules close to the liver surface exhibit high recurrence compared to those in distal parts of the liver. Moreover, when nodules remain adjacent to the gastrointestinal tract or gallbladder, severe complications such as perforation of those organs may occur due to invasive therapy. Percutaneous radiofrequency ablation (PRFA) with artificial ascites or laparoscopic radiofrequency ablation (LRFA) are used to treat these patients to avoid complications. The purpose of the present study was to assess the efficacy and safety of these two methods.
Methods : Subjects comprised 74 patients (48 men, 26 women ; mean age, 68.5 ± 8.0 years ; range, 46—89 years) with 86 HCC nodules. PRFA with artificial ascites was carried out for 37 patients (44 nodules) and LRFA was used for 37 patients (42 nodules). Clinical profiles were compared between groups.
Results : No significant differences in clinical profiles were found between patients treated by PRFA or LRFA. Mean number of treatments was significantly lower for LRFA (1.0 ± 0.0) than for PRFA (2.1 ± 1.0, P<0.001). Mean number of PRFA treatments was 2.2 ± 1.0 in patients with HCC nodules >2 cm in diameter, whereas all tumors were completely ablated with only one session of LRFA. The safety margin was significantly wider for LRFA than for PRFA.
Conclusion : LRFA is a better treatment option for ablation of HCC nodules >2.0 cm in diameter.

View full abstract