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Volume 52, Issue 9
Displaying 1-13 of 13 articles from this issue
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Shinya KODASHIMA, Mitsuhiro FUJISHIRO, Kazuhiko KOIKE2010 Volume 52 Issue 9 Pages 2665-2677
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSNumerous endoscopic imaging modalities have been developed, and these play important roles in the early detection and detailed inspection of gastrointestinal neoplasms. Image-enhanced endoscopy is one of the endoscopic techniques subdivided by the endoscopic classification of endoscopic imaging. Image-enhanced endoscopy is mainly subdivided into the digital, optical-digital, and chromoendoscopy methods ; narrow band imaging (NBI), which uses a light source with different characteristics from ordinary white light, is classified as an optical-digital method ; and FICE and i-scan, which use ordinary white light, are classified as digital methods. These methods are designed to improve visualization of the microvascular pattern and/or mucosal pattern in the gastrointestinal tract, and the usefulness of these methods for detecting and diagnosing GI neoplasms has been reported. These appear to be a promising modality to improve diagnostic accuracy of GI neoplasms.View full abstractDownload PDF (1858K)
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Masahiro SAKAGUCHI, Miyuki TAKAO, Takashi HASHIMOTO, Kanji AMEMOTO, Ky ...2010 Volume 52 Issue 9 Pages 2678-2686
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSWe performed 27,982 emergency gastroendoscopies from 1999 to 2008. Among these, 573 cases were upper gastrointestinal bleeding, 384 cases were bleeding gastroduodenal ulcers and erosions, and 256 cases were bleeding gastric ulcers. We evaluate herein the usefulness and limitation of endoscopic hemostasis based on clinical annual transition. In the past two years, we have found that 32.8% of bleeding gastroduodenal ulcers were caused by the use of NSAIDs and anticoagulants. The prevalence of anticoagulant therapy had increased the bleeding gastroduodenal ulcers which had once decreased before. The endoscopic appearance was also changed, gastric angle ulcers decreased in number, whereas gastric body ulcers and erosions increased over the same period. Although the effectiveness of endoscopic hemostasis for bleeding gastroduodenal ulcers can be influenced by the amount of bleeding and severity of coexistent disease, it has been estimated to be as high as 96.6% overall. Special attention should be paid in those patients who had received anticoagulant therapy, because most of them were elderly or had a severe coexistent disease. Our findings suggest that, under proper endoscopic performance, a good hemostatic outcome can be achieved even in those cases where patients have received anticoagulants.View full abstractDownload PDF (943K)
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Yoshiki MIZUKAMI, Koji KONO, Fumihiko MITSUI, Yoshihiko KAWAGUCHI, Yu ...2010 Volume 52 Issue 9 Pages 2687-2692
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSA 65-years-old patient with hypopharyngeal carcinoma had a postoperative, high grade stricture following an esophagojejunostomy. Although endoscopic dilatation using a balloon dilator had been performed for several years, the patient suffered from complete obstruction of the esophagojejunostomy. For safe insertion of guide-wire, we performed a normograde endoscopic approach as well as retrograde endoscopy from a gastrotomy. Safe dilatation with BA non-covered stent was achieved and the patient was able to take a diet per os on the 7th day and discharged on the13th postoperative day.View full abstractDownload PDF (671K) -
Hiroyoshi KURIHARA, Hiroyuki OKUDA, Kazuya SUZUKI, Tokuma TANUMA, Kent ...2010 Volume 52 Issue 9 Pages 2693-2699
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSA 76-year-old woman complained of nausea and was referred to our hospital. Esophagogastroduodenoscopy (EGD) revealed circumferential desquamation of the mucosal surface of the upper thoracic esophagus. Symblepharon and blisters in her extremities and trunk were observed on physical examination. A skin biopsy revealed significant infiltration of neutrophils and eosinophils into the subepithelial blisters. Direct immunofluorescence microscopy detected continuous granular deposits of C3 and linear deposits of IgG and IgA in the epithelial basement membrane zone. Collectively, mucous membrane pemphigoid was diagnosed. We believe examination for involvements of other organs can help in making a diagnosis of such a rare disease entity whenever we find atypical esophageal lesions.View full abstractDownload PDF (943K) -
Masaki UJIHARA, Takafumi ANDO, Mika TAKADA, Etsuko NAKAMURA, Hidemi GO ...2010 Volume 52 Issue 9 Pages 2700-2706
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSA 44-year-old woman was admitted to our hospital with severe abdominal pain and vomiting. Emergency surgery was conducted on the basis of a suspected acute abdomen due to strangulation ileus. Exploration revealed a moderate amount of turbid yellow ascites in the abdominal cavity, and thickening and redness of the intestinal wall between the pyloric part of the stomach and about 70 cm from the Treitz ligament. Eosinophilic gastroenteritis was diagnosed following pathological study of a biopsy of the duodenal mucosa obtained by gastroendoscopy. The patient's symptoms improved following treatment with steroids. The diagnosis of eosinophilic gastroenteritis in this case was hampered by the similarity of the clinical and CT imaging findings to those of strangulation ileus.View full abstractDownload PDF (1286K) -
Hideyuki HEMMI, Tsuneo FUKUSHIMA, Kaori MORIOKA, Tatsuya SHIRAKURA, Te ...2010 Volume 52 Issue 9 Pages 2707-2712
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSCrohn's disease in a pair of monozygotic male twins is reported. At the age of 11, the younger brother noticed abdominal pain, diarrhea and weight loss in April 2006. Multiple ulcerations from the ileocecum to the transverse colon and duodenal stenosis were found with endoscopic examinations. At 12 years of age, the elder brother also noticed diarrhea and weight loss in June 2008. Multiple aphtha from the descending colon to the rectum and duodenal tandem erosions were found with endoscopic examinations. Both were diagnosed as having Crohn's disease because a biopsy of the large intestine revealed epitheloid granuloma. The duodenal stenosis in the younger brother did not respond to a variety of conservative treatments and gastrojejunal anastomosis was undertaken in December 2007. Postoperatively, he returned to normal school life. The elder brother responded to 5-ASA and is now in remission. In Western countries, many familial occurrence of Crohn's disease have been observed and also numerous monozygotic cases have been found. Familial and twin onset strongly supported genetic factors in the pathogenesis of Crohn's disease. In Japan, only two cases of Crohn's disease in monozygotic twins have been reported previously.View full abstractDownload PDF (661K) -
Yasuro FUTAGAWA, Akira SAITO, Tadashi ANAN, Kunio MOMOSE, Isao ODAGI, ...2010 Volume 52 Issue 9 Pages 2713-2719
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSA 54-year-old male, who had undergone a total gastrectomy with Roux-en-Y reconstruction one year earlier for the treatment gastric cancer, was admitted under the diagnosis of acute calculus cholecystitis. Percutaneous transhepatic gallbladder biliary drainage (PTGBD) was performed and cholangiography via PTGBD revealed a stone had become lodged distally near the papilla in the non-dilated common bile duct. After removal with endoscopic lithotomy failed, we used the rendezvous technique which combines both interventional radiology and endoscopy to perform a successful lithotomy. The rendezvous technique is therefore considered to be a useful alternative for the treatment of choledocholithiasis in patients who have previously undergone Roux-en-Y reconstruction, in whom an endoscopic lithotomy is not possible.View full abstractDownload PDF (642K) -
Hideaki KINUGASA, Kazuhiro MATSUEDA, Yoshinao OZAKI, Kouichi KAGAWA, K ...2010 Volume 52 Issue 9 Pages 2720-2727
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSWe treated two cases of bleeding rectal varices with endoscopic injection sclerotherapy (EIS) using ethyl-2-cyanoacrylate. The first case was a bleeding rectal varix injected with ethyl-2-cyanoacrylate after endoscopic variceal ligation (EVL) and EIS with 5% ethanolamine oleate (EO). The second case was a varix injected with only ethy1-2-cyanoacrylate. No bleeding was noted at these treated varices. EIS with ethy1-2-cyanoacrylate, which has been reported to be effective in the treatment of bleeding gastric varices, may be a good treatment modality in controlling bleeding rectal varices.View full abstractDownload PDF (740K)
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[in Japanese], [in Japanese], [in Japanese]2010 Volume 52 Issue 9 Pages 2728-2729
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSDownload PDF (348K)
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Tomonori YANO, Hironori YAMAMOTO2010 Volume 52 Issue 9 Pages 2730-2737
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSThe use of balloon assisted endoscopy has enabled endoscopic diagnoses of, and treatment for small-intestinal bleeding. Since the balloon assisted endoscope has an accessory channel and provides good maneuverability in the distal small-intestine, it is possible to perform endoscopic treatment such as cauterization, hemoclipping, injection, polypectomy and EMR. Vascular lesions, ulcerative lesions, neoplastic lesions, varices and the diverticulum can be sources of bleeding and appropriate endoscopic hemostatic methods should be selected according to the type of lesion on an individual basis.View full abstractDownload PDF (816K) -
Shunji FUJIMORI, Yoko TAKAHASHI, Tsuguhiko SEO, Choitsu SAKAMOTO2010 Volume 52 Issue 9 Pages 2738-2744
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSCapsule endoscopy was developed to visualize the entire small intestine. The major advantage of capsule endoscopy is that it is a painless procedure without any restriction of the patient's daily life. Briefly, after a 12h-fast, subjects were equipped with a sensor array and recorder belt pack and given a capsule (PillCam® SB, Given Imaging Ltd.; Yoqneam, Israel) to swallow. The capsule transmitted continuous video images for 8h, at which point the apparatus was disconnected and the images processed by a work station. Capsule endoscopy provides clear natural images of the small intestine allowing for the visualization of even minute lesions. However, the major disadvantages of capsule endoscopy are that the capsules sometimes fail to reach the cecum within their battery life. There are several reports to evaluate the preparation with and without prokinetics for capsule endoscopy. Recently, the PillCam® SB2, a new type of capsule endoscope for the small intestine, capable of transmitting continuous video images for over 10h, has become available in Japan. Endoscopy with capsules having a long battery life could increase the ratio of total enteroscopy. We herein introduce the capsule endoscopy procedure and methodology for medical staff to start capsule endoscopy.View full abstractDownload PDF (573K)
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Kensuke KUBOTA, Shingo KATO, Tomoyuki AKIYAMA, Koji FUJITA, Masato YON ...2010 Volume 52 Issue 9 Pages 2745-2754
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSAIM : We evaluated the characteristic endoscopic ultrasonography (EUS) findings of early autoimmune pancreatitis (AIP).
Methods : Nineteen patients with AIP who underwent EUS and endoscopic retrograde cholangiopancreatography (ERCP) were identified from our database. We reviewed the following features of EUS as being potentially characteristic of early AIP : hyperechoic foci, hyperechoic strands, lobularity, hyperechoic duct margins and reduced echogenicity. According to the Cambridge classification for chronic pancreatitis, we classified AIP into early AIP (Cambridge Grade 0-2) and advanced AIP (Grade 3-5) and examined the histopathological findings in each stage of AIP.
Results : Here were 9 cases of early AIP and 10 cases of advanced AIP. Five of the 9 early cases of AIP showed spontaneous remission without corticosteroid therapy (p<0.05). The EUS findings were as follows (early vs. advanced) ; hyperechoic foci, 100% (9/9) vs. 100% (10/10) ; hyperechoic strands, 66.7% (6/9) vs. 70% (7/10) ; lobularity, 77.8% (7/9) vs. 20% (2/10) ; hyperechoic duct margin, 90% (8/9) vs. 30% (3/10) ; and reduced echogenicity, 88.9% (8/9) vs. 90% (9/10). Lobularity and hyperechoic duct margins were detected at a significantly higher frequency in the early AIP than in advanced AIP patients (p<0.05). In relation to the histopathologic findings, acinar cells were preserved to a better extent in the cases of early AIP, whereas the acinar cells were reduced in number and replaced by massive fibrosis in the patients with advanced AIP.
Conclusions : Lobularity and hyperechoic duct margin are characteristic EUS features of early AIP, which has a more favorable prognosis, showing a higher frequency of spontaneous remission and preservation of acinar cells, than advanced AIP.View full abstractDownload PDF (832K)
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[in Japanese]2010 Volume 52 Issue 9 Pages 2755
Published: 2010
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSDownload PDF (150K)
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