GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 52, Issue 5
Displaying 1-12 of 12 articles from this issue
  • Akiko CHINO, Takanori SUGANUMA, Naoyuki URAGAMI, Teruhito KISHIHARA, T ...
    2010 Volume 52 Issue 5 Pages 1381-1392
    Published: 2010
    Released on J-STAGE: November 07, 2011
    JOURNAL FREE ACCESS
    Radiation is among the first choice of treatments for pelvic malignancies such as prostate and uterine cancer. However, radiation also induces acute and chronic side effects on the small and large bowels including hemorrhagic sigmoidproctitis, ulcer, stenosis and fistula formation. Bloody stools is the most frequent symptom of chronic radiation-induced enterocolitis, followed by defecation disorder and anal pain. Classification for radiation-induced enterocolitis is based on the time course, severity and pathology. It is mandatory to understand these classifications precisely in order to devise a proper treatment strategy for this disease. Although there has been no established guideline for treatment of radiation-induced hemorrhage, many authors have reported the effectiveness of an endoscopic approach. In particular argon, plasma coagulation is an easy, safe and effective treatment. On the other hand radiation-induced enterocolitis with ulcer formation is associated with a very fragile mucosa and therefore a more appropriate treatment should be a topical enema which is effective on both the hemorrhage and ulcer rather than the endoscopic approach. Hyperbaric oxygen therapy is a promising approach for radiation-induced bowel perforation and stenosis. Surgery is sometimes effective for radiation-induced fistula and stenosis, but its indication should be carefully examined because surgery is also accompanied by a high morbidity rate.
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  • Masaki SUZUKI, Hiroyoshi ONODERA, Shinichi SUZUKI, Makoto ABUE, Tetsuy ...
    2010 Volume 52 Issue 5 Pages 1393-1402
    Published: 2010
    Released on J-STAGE: November 07, 2011
    JOURNAL FREE ACCESS
    [Background and Aim] Optical coherence tomography (OCT) is a new technique with high resolution 10 times greater than the resolution of intraductal ultrasonography (IDUS). The aim of this study is to validate the effectiveness of OCT by performing visual inspections comparing images from OCT and IDUS demonstrating the ability to diagnose horizontal extension of the bile duct cancer and intraductal papillary-mucinous neoplasm of the pancreas (IPMN). [Patients and Methods] In total, 10 cancer cases were examined with both OCT and IDUS, 6 of which developed from bile duct structure and 4 from the pancreatic duct. Four cases out of 10 were examined by transpapillary probe insertion in vivo. The images taken from the 10 cases were visually evaluated histopathologically. [Results] This study demonstrated that OCT surpasses IDUS in obtaining high resolution despite its limited penetration depth of approx. 1 to 2 mm. The results demonstrated that the images from OCT had demarcated layers such as a mucosal layer, a fibromuscular or connective tissue layer, and a subserosal layer. Also the images proved that OCT could clearly describe the mucosal thickness of inflammation from the intramural extension of bile duct cancers. What is more, minor hyperplastic change in the pancreatic duct could be depicted with high accuracy. [Conclusion] This study has proved the effectiveness of OCT on images of horizontal extension of bile duct cancers and IPMN.
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  • Yoshiyuki MURAWAKI, Teiji YOSHIMURA, Masahiko MIURA, Manabu KISHINA, T ...
    2010 Volume 52 Issue 5 Pages 1403-1407
    Published: 2010
    Released on J-STAGE: November 07, 2011
    JOURNAL FREE ACCESS
    A 75-year-old man was admitted to our hospital with epigastralgia and hematemesis. Endoscopy revealed a huge submucosal hematoma in the antrum of the stomach, which was the source of the bleeding. The hematoma ruptured, leading to the formation of an ulcer. Since gastric mucosal biopsy revealed amyloid deposition, and IgA-κ-type M protein was detected in the serum, the patient was diagnosed as having AL amyloidosis due to multiple myeloma. We were able to endoscopically observe the submucosal hematoma transform into an ulcer.
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  • Naonori KAWAKUBO, Kanpei SAIJO, Kouji OKAMOTO, Mitsuru SEO, Hitoshi IC ...
    2010 Volume 52 Issue 5 Pages 1408-1414
    Published: 2010
    Released on J-STAGE: November 07, 2011
    JOURNAL FREE ACCESS
    A 72-year-old male was admitted to our hospital for further examination of an elevated lesion of the stomach. He had undergone endoscopy at a clinic because of abdominal fullness. The elevated lesion was found in the antrum. The biopsy specimen taken from the lesion showed well-differentiated adenocarcinoma. Endoscopy performed in our hospital revealed an elevated lesion covered with normal mucosa at the greater curvature in the antrum. Endoscopic ultrasonography showed a well demarcated hypoechoic mass in the second and third layers of the gastric wall. Histology of the biopsy specimen from the lesion revealed atrophic mucosa and no carcinoma. Since then, endoscopy, endoscopic ultrasonography and histological examination have been repeated every 2-6 months. At the 6th examination, endoscopy showed a tumor with central ulceration. Histology of the biopsy specimen revealed well-differentiated adenocarcinoma. A laparoscopy-assisted distal partial gastrectomy was performed. In the resected specimen, a tumor with ulceration measuring 20 mm in diameter was found in the antrum. Histology revealed well-differentiated adenocarcinoma with papillary growth proliferating in the submucosal layer. We report herein on a case of early gastric cancer presenting as a submucosal tumor, which had been followed-up for eighteen months.
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  • Masaki YAMASHITA, Yasushi ADACHI, Hiroki TANAKA, Yasuyo ADACHI, Hirofu ...
    2010 Volume 52 Issue 5 Pages 1415-1420
    Published: 2010
    Released on J-STAGE: November 07, 2011
    JOURNAL FREE ACCESS
    Percutaneous endoscopic gastrostomy (PEG) is now the most common method of enteral nutrition in patients who require long-term tube feeding. Another aim of PEG is decompression for patients with stenotic diseases. A Japanese male in his nineties was admitted under a diagnosis of advanced gastric cancer with pyloric stenosis. Although he frequently vomited, he and his family refused surgical treatment, including gastric bypass surgery. In order to achieve both nutrition support and decompression simultaneously, a percutaneous endoscopic gastrostomy-jejunostomy (PEG-J) was planed. The PEG-J was scheduled in two steps and the second step involving placement of a gastrojejunal double lumen tube was performed using transgastronomic endoscopy (TGE) one week after the PEG. This tube can feed nutritional solution from the jejunal lumen and can drain gastric juice from a hole in the stomach. The patient could therefore be discharged, avoiding uncomfortable treatments, such as nasal gastric tube drainage and intravenous hyperalimentation from a central vein catheter. We think that PEG-J using a gastrojejunal double lumen tube might be an option for malignant pyloric stenosis.
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  • Shinya YAMADA, Katsura HIRANO, Yohei WASEDA, Satoko INAGAKI, Kazuhiro ...
    2010 Volume 52 Issue 5 Pages 1421-1425
    Published: 2010
    Released on J-STAGE: November 07, 2011
    JOURNAL FREE ACCESS
    A 73-year-old woman, presented with a large tumor in the rectum. We conducted an endoscopic submucosal dissection (ESD) to remove the tumor, which was 9 cm in diameter from Ra to Rs, and approximately five sixths the circumference of the rectum. Accordingly, the whole circumference of the rectum was resected. Although she did not experience any major surgical complications, the patient started to have difficulty with defecation from the 23rd day after the operation. An endoscopic examination revealed a stenosis in the resected part. Endoscopic balloon dilatation was conducted twice, which relieved the patient's symptom.
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  • Hidefumi SHIROSHITA, Masaaki TAJIMA, Toshio BANDOH, Tsuyoshi ARITA, Mi ...
    2010 Volume 52 Issue 5 Pages 1426-1431
    Published: 2010
    Released on J-STAGE: November 07, 2011
    JOURNAL FREE ACCESS
    During colonoscopy as part of a health check-up, a 50-year-old male patient was diagnosed as having a yellowish white submucosal tumor, about 1 cm in size, with a central depression in the right transverse colon. Endoscopic ultrasonography showed a low echoic heterogeneous tumor in the second and third layers of the colon wall. Because a definitive diagnosis could not be made based on histologic examination of the biopsy specimen, a tentative diagnosis of carcinoid tumor of the transverse colon was made by colonoscopy and endoscopic ultrasonography. Complete resection of the tumor by endoscopic mucosal resection was believed to be difficult, therefore we performed a laparoscopy-assisted transverse colectomy. Macroscopic examination showed a flat submucosal tumor with a central depression, 12 mm in diameter. Histological examination showed hyperplasia of glands with cystic dilatation reversing into the submucosa. No atypical gland was seen, and the lesion was diagnosed to be a hamartomatous inverted polyp. There were no surgical complications and the patient was discharged on the 24th day after the operation. Hamartomatous inverted polyps should be included in the differential diagnosis of colonic submucosal tumors.
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  • Kohei KOTANI, Koji SANO, Toshihiro TANAKA, Saori MATSUI, Wataru UEDA, ...
    2010 Volume 52 Issue 5 Pages 1432-1437
    Published: 2010
    Released on J-STAGE: November 07, 2011
    JOURNAL FREE ACCESS
    A 63-year-old woman was admitted to our hospital with fever and feces mixed with blood and pus. Colonoscopy revealed a slight elevated lesion covered with normal mucosa, and the drained pus at the center of the lesion in the rectosigmoid colon. Abdominal ultrasonography, computed tomography and MRI showed a cystic and heterogeneous lesion, suggesting a pelvic abscess. The patient was diagnosed as having an intrapelvic abscess draining itself spontaneously. Surgery was performed, and the operative findings showed swelling of the right ovary and adhesions among the appendix, uterus and rectum. The microscopic findings showed a right ovarian abscess and phlegmonous appendicitis, suggesting that the abscess had been formed by inflammation of the appendix affecting the right ovary. A rare case of spontaneous drainage of an ovarian abscess into the rectum is reported.
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  • Tomonori YANO, Kazuhiro KANEKO, Keiko MINASHI, Atsushi OHTSU
    2010 Volume 52 Issue 5 Pages 1440-1450
    Published: 2010
    Released on J-STAGE: November 07, 2011
    JOURNAL FREE ACCESS
    Fen gastrointestinal (GI) endoscopists have considered the early detection of head and neck cancer during upper GI endoscopy. However, the patient's background and risk factor are similar between esophageal cancer and head and neck cancer, therefore we have experienced some synchronous or metachronous double cancer cases in clinical practice. In addition, it has been reported that carcinoma in situ of the oropharynx and hypopharynx which was undetectable with the conventional endoscope, could be detected with a narrow band imaging (NBI) endoscopy system. If head and neck cancer can be detected at the early stage, it can be treated with endoscopic resection sparing the patient's pharynx, speaking and swallowing functions. This is very important from the point of organ preservation and the patient's quality of life. In order not to overlook lesions, systematic observation of the head and neck field is important during upper GI endoscopy. Furthermore, delicate endoscopic observation is advocated because it can easily cause pharyngeal reflex and makes observation difficult. The point of diagnosis for superficial head and neck cancer is “a well demarcated brownish area” with NBI observation, and “increased density of extended micro-capillaries” with magnifying observation. In this study, we would like to describe the details of our observation technique and diagnosis for superficial cancer in head and neck field during upper GI endoscopy.
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