GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
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Volume 53, Issue 12
Displaying 1-14 of 14 articles from this issue
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  • PAST, PRESENT AND FUTURE OF DIGESTIVE ENDOSCOPY AND CHALLENGES GIVEN TO JAPAN
    Hirohumi NIWA
    2011 Volume 53 Issue 12 Pages 3701-3735
    Published: 2011
    Released on J-STAGE: April 24, 2012
    DOIhttps://doi.org/10.11280/gee.53.3701
    JOURNAL FREE ACCESS
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    Digestive endoscopy has been developed from the early endoscope to the rigid gastroscope, flexible gastroscope, gastrocamera, fiberscope, then the video endoscope. Recently, capsule endoscopy has also appeared on the scene. The key to the advancement which occurred over that time was the development of the optical source. As to the early endoscope, Bozzini's Lichtleiter was introduced in 1804 as a pioneer followed by several kinds of other early endoscopes, including Desormeaux's endoscope, then the development and application of various types of rigid gastroscope were attempted. The flexible gastroscope with limited flexibility has been improved to the gastrocamera, fiberscope, and finally the videoendoscope with enhanced flexibility. The videoendoscope has now become the main device with other functions. The author describes herein the story of development and advancement of devices, and the struggles experienced during that period. In recent years, videoendoscopy has made various image processing and the use of invisible imaging energy such as ultraviolet or infrared ray observation possible. Furthermore, narrow band imaging (NBI) and fluorescence endoscopy (AFI) have been added in clinical practice. Because the phrase “endoscopy with special light” had wings, the author expressed an opinion about it and proposed a new classification of endoscopic observational method. Also, focusing on the devices, the future prospect is described. Considering the past, present and future of endoscopy, the author would like to address the expectation for Japan from foreign, especially Asian, countries, and the challenges given to Japan.
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  • DIAGNOSIS AND MANAGEMENT OF GASTROINTESTINAL STROMAL TUMORS (GISTS) OF THE STOMACH
    Shusaku TSUTSUI, Kiyokazu NAKAJIMA, Takuya YAMADA, Tetsuo TAKEHARA
    2011 Volume 53 Issue 12 Pages 3736-3748
    Published: 2011
    Released on J-STAGE: April 24, 2012
    DOIhttps://doi.org/10.11280/gee.53.3736
    JOURNAL FREE ACCESS
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    The gastrointestinal stromal tumour (GIST) is the most common sarcoma of the intestinal tract, known to be refractory to conventional chemotherapy or radiation. Cure can be obtained only by complete surgical removal of the GIST. GISTs are considered to be driven by a gain-of-function mutation in the c-kit or PDGFRA gene. Recognition of the key role played by the receptor tyrosine kinases KIT and PDGFRα in the pathogenesis of GISTs led to the development of imatinib. Imatinib exhibited remarkable clinical effects on advanced GISTs. Its efficacy is dependent on the KIT mutation status. However, the clinical efficacy of imatinib has been limited by the concerns that patients will develop a refractory disease that is resistant to imatinib. Although sunitinib bas been approved as second-line therapy for GISTs following imatinib failure, the benefits of this drug also limited by the emergence of refractory disease. No agent has yet reached regulatory approval for the management of GISTs following the failure of both imatinib and sunitinib. Thus, advanced cases of GIST may require a multidisciplinary approach. The rapid improvement of our understanding of GIST biology and resistance mechanisms towards imatinib and sunitinib will facilitate the development of novel treatment strategies.
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  • THE EFFICACY AND THE TOLERABILITY OF 1 LITER OF POLYETHYLENE GLYCOL PREPARATION REGIMEN WITH THE COMBINED USE OF AN ELEMENTARY DIET IN SCREENING COLONOSCOPY
    Makoto TAKENOUCHI, Hideo OSHIMA
    2011 Volume 53 Issue 12 Pages 3749-3755
    Published: 2011
    Released on J-STAGE: April 24, 2012
    DOIhttps://doi.org/10.11280/gee.53.3749
    JOURNAL FREE ACCESS
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    Objectives : Preparation regimens for colonoscopy are mainly dependent on ingesting a large volume of laxatives and the large volume itself is the main cause of discomfort. The aim of this study was to examine the bowel cleansing efficacy and the tolerability of 1 liter polyethylene glycol (PEG) regimen with the combined use of an elementary diet (Elental®) in screening colonoscopy.
    Method : A total of 421 fecal occult blood positive patients were assigned to 2 liters PEG regimen with a ready-made diet for colonoscopy (group A (n=201)) or 1 liter PEG regimen with Elental® (group B (n=220)). Both preparation regimens included the use of 75 mg picosulfate sodium the night before the procedure. The patients were mainly male (98%) and relatively younger (45-60, mean 52.6 years old). The quality of bowel cleansing was scored with a 5-point scale (1 (poor) to 5 (excellent)) by the endoscopist who performed the colonoscopy. The bowel cleansing score, total ingested PEG volume, frequency of bowel openings, and adverse effects were compared between groups.
    Results : The bowel cleansing score was better in group 1, but the difference in scores was relatively small (3.91 vs. 3.76, p=0.008). Total ingested PEG volume and number of bowel openings were much lower in group 2 (2.00 liters vs. 1.10 liters, p<0.001 and 8.59 vs. 6.20, p<0.001), and adverse effects were also fewer in group 2 (23.1% vs. 12.5%, p=0.045). Time required for bowel cleansing was more or less similar in both groups.
    Conclusion : With the combined use of Elnetal®, it is possible to reduce the volume of PEG needed for bowel preparation without impairment of bowel cleansing and to improve the tolerability of bowel preparation.
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  • EXAMINATION OF THE ENDOSCOPIC NASO- GALLBLADDER DRAINAGE FOR ACUTE CHOLECYSTITIS
    Hideki MIYATA, Toshiyasu IWAO, Koji YOSHIDA, Jun USIO, Masashi SATO, A ...
    2011 Volume 53 Issue 12 Pages 3756-3762
    Published: 2011
    Released on J-STAGE: April 24, 2012
    DOIhttps://doi.org/10.11280/gee.53.3756
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    We retrospectively studied the efficacy and problems of endoscopic naso- gallbladder drainage (ENGBD) for acute cholecystitis in 153 cases. We mainly chose those patients (about 34.6%) who were taking an anticoagulant and those patients (about 22.9%) whose acute cholecystitis was suspected of being complicated with gallbladder cancer. Technical success was obtained in about 87.6% and the salvage rate was about 98.0%. The period required for symptom improvement was about 3.2 days. As a whole, complications occurred about 7.2% and we experienced a cystic duct perforation. In addition, in 3 cases (about 1.96%) gallbladder cancer was preoperatively identified and we were thus able to avoid additional excision. The operation was successfully completed in an average of around 25.1 min which meant it could be accomplished in a relatively short time. We can expect further improvement in both the surgical equipment and technical skill, but we believe it is a currently effective method with appropriate patient selection.
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  • TWO CASES OF LAPAROSCOPIC PARTIAL GASTRIC RESECTION FOR EARLY GASTRIC CANCER, THE LOCATION OF WHICH MADE IT DIFFICULT TO PERFORM ENDOSCOPIC SUBMUCOSAL DISSECTION
    Kiyoaki TANIGUCHI, Tsuyoshi SASAGAWA, Satoshi TAKEICHI, Takuji YAMADA, ...
    2011 Volume 53 Issue 12 Pages 3763-3768
    Published: 2011
    Released on J-STAGE: April 24, 2012
    DOIhttps://doi.org/10.11280/gee.53.3763
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    Endoscopic submucosal dissection (ESD) for early gastric cancer has gained popularity and its indication has been expanding recently. Although elevated early gastric cancer is a good indication for ESD, the difficulty of the procedure depends on the location of the tumor. We report on two cases of early gastric cancer treated with laparoscopic partial gastric resection (LPGR) because the tumors were both located at the top of the fornix, which was considered to be a difficult location for ESD. ESD for gastric cancer located at the fornix or the greater curvature is technically difficult because of breathing fluctuation, and the rate of complications, such as bleeding and perforation, is relatively high. On the other hand, LPGR has an easier approach for resecting those areas of the stomach with minimal invasion. En bloc complete resection is possible when preoperative endoscopic marking is performed. LPGR should be considered as an alternative to ESD for treating early gastric cancer when the tumor is located in a difficult area.
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  • EARLY GASTRIC ADENOCARCINOMA OF THE FUNDIC GLAND TYPE(CHIEF CELL PREDOMINANT TYPE) OBSERVED WITH MAGNIFYING ENDOSCOPY USING NARROW BAND IMAGING : REPORT OF A CASE
    Takashi FUJISAWA, Shigemitsu UEYAMA, Sachiko OUCHI, Yasumichi SEKI, Te ...
    2011 Volume 53 Issue 12 Pages 3769-3775
    Published: 2011
    Released on J-STAGE: April 24, 2012
    DOIhttps://doi.org/10.11280/gee.53.3769
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    A 50-year-old man underwent endoscopic examination for a medical follow up after endoscopic treatment of common bile duct stones. Esophagogastroduodenoscopy showed a depressive lesion with a fine granular surface and fold convergence at the great curvature of the gastric body. The findings of magnifying endoscopy with narrow band imaging showed irregular microvascular and a microsurface pattern with a demarcation line. Endoscopic submucosal dissection (ESD) was performed. The pathological examination revealed a very well differentiated adenocarcinoma invading submucosal layer accompanied by cystic changes and fibrosis. Mucinhistochemistry showed a gastric phenotype and was positive for Pepsinogen-Icharacteristic for chief cells. We diagnosed the tumor as a M/Gre, 40×42 mm, Type 0-IIa+IIc, very well differentiated adenocarcinoma, pSM2, ly0·v0, pHM0, pVM0, pN0, fundic gland type (chief cell predominant type).
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  • COLONIC MUCO-SUBMUCOSAL ELONGATED POLYP : A CASE REPORT
    Hiroyuki OZASA, Yasumi ARAKI, Toshihiro NOAKE, Goichi KAMIYAMA, Yasue ...
    2011 Volume 53 Issue 12 Pages 3776-3782
    Published: 2011
    Released on J-STAGE: April 24, 2012
    DOIhttps://doi.org/10.11280/gee.53.3776
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    We report on a case of a 44-year-old man presenting with a positive fecal occult blood test. A barium enema study showed a long pedunculated polyp, 50 mm in length, in the descending colon. An endoscopic examination showed the polyp had normal mucosa. Unevenness and swelling was observed at the head of the polyp. A colonoscopic polypectomy was performed. Histologically, the polyp was characterized by normal mucosa, and an edematous submucosal layer with dilated vessels and lymphatics, and there was no muscular layer. This polyp was diagnosed as a colonic muco-submucosal elongated polyp (CMSEP). We evaluated the case clinicopathologically and reviewed 59 cases of CMSEP in the Japanese literature.
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  • A CASE OF INTRADUCTAL PAPILLARY-MUCINOUS CARCINOMA OF THE BILE DUCT WITH MICROINVASION
    Koichi KAGAWA, Yoshinari FURUKAWA, Souichirou YAMASAKI, Mutsumi HANANO ...
    2011 Volume 53 Issue 12 Pages 3783-3790
    Published: 2011
    Released on J-STAGE: April 24, 2012
    DOIhttps://doi.org/10.11280/gee.53.3783
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    An asymptomatic 54-year old woman with an elevated biliary enzyme level underwent ultrasonography. It revealed a hyperechoic tumor in the liver Segment 4 and dilation of the left intrahepatic bile duct. A CT scan showed a multilocular cyst in S4 which contained an enhanced mural nodule. On MRI, the cystic tumorous lesion demonstrated a low intensity on T1-weighted imaging and high intensity on T2-weighted imaging. Endoscopic retrograde cholangiography (ERC) revealed a defect localized to the left bile duct. IDUS (Intraductal Ultrasonography) showed a hyperechoic elevated lesion in the left intrahepatic bile duct under the diagnosis of a suspected. Intraductal papillary neoplasm of the bile duct (IPNB) confined to the left lobe of liver, we performed an extended left lobectomy including the caudate lobe, resection of the extrahepatic bile duct, and cholecystectomy. The histopathological findings disclosed microinvasive carcinoma resembling an intraductal papillary mucinous neoplasm with papillary growth in the bile duct. Metastasis to the lymph nodes was not found. There has been no recurrence after surgery for sixteen months.
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  • USEFULNESS OF THIN, HIGH-RESOLUTION UPPER GASTROINTESTINAL ENDOSCOPY FOR HEALTH EXAMINATIONS
    Hideaki KAWABATA, Kenjiro YASUDA, Naomi MOCHIZUKI, Masao KOBAYASHI, Ma ...
    2011 Volume 53 Issue 12 Pages 3791-3797
    Published: 2011
    Released on J-STAGE: April 24, 2012
    DOIhttps://doi.org/10.11280/gee.53.3791
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    We evaluated the usefulness of a thin, high-resolution upper gastrointestinal endoscope (GIF-PQ260 ; Olympus Medical systems, 7.9 mm outer diameter, 140° width of vision) for health screening examinations. First, 100 consecutive patients underwent peroral unsedated esophagogastroduodenoscopy (EGD) using a high-resolution upper gastrointestinal endoscope, and the following 100 consecutive patients underwent peroral unsedated EGD using an ultrathin endoscope (GIF-XP260 ; Olympus Medical systems, 5.0 mm outer diameter, 120° width of vision). Based on the questionnaire, these two types of endoscope were compared regarding the patient tolerance, visual quality and operability. Visual quality and operability of the high-resolution upper gastrointestinal endoscope were significantly better than those of the ultrathin endoscope. Assessment of nausea and pharyngeal pain at insertion and during procedure between the two groups revealed no significant differences. Furthermore, overall tolerance was also similar in the two groups. Due to the priority of visual quality and operability, the high-resolution upper gastrointestinal endoscope proved more useful for screening EGD.
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  • VALIDITY OF ACTIVITY INDICES IN ULCERATIVE COLITIS : COMPARISON OF CLINICAL AND ENDOSCOPIC INDICES
    Fumihito HIRAI, Toshiyuki MATSUI, Kunihiko AOYAGI, Nagamu INOUE, Toshi ...
    2011 Volume 53 Issue 12 Pages 3811-3819
    Published: 2011
    Released on J-STAGE: April 24, 2012
    DOIhttps://doi.org/10.11280/gee.53.3811
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    Aim : Various different clinical indices (CI) and endoscopic indices (EI) have been used to evaluate the clinical disease activity of ulcerative colitis (UC). However, no standardized CI or EI of UC has been established. The aim of the present study was to determine whether or not any of the CI and/or EI for assessing the disease activity of UC could be established as a standard.
    Methods : The most frequently used CI and EI were identified from 100 published clinical trials dealing with UC, and representative CI and EI were selected. Seventy-four patients were enrolled in this study and their CI and EI were assessed prior to treatment and at 2, 4 and 8 weeks after treatment. Furthermore, changes over time and relationships among the indices were analyzed. In this study, the clinical activity index (CAI), the disease activity index (DAI), the Lichtiger index (LI) and the Seo index were selected as the representative CI, and the Baron score and the Rachmilewitz endoscopic index (REI) were selected as the representative EI.
    Results : A significant decrease in all the CI and EI was observed after treatment, as compared with the baseline values. Moreover, there were positive relationships among the CI and between the CI and EI.
    Conclusion : Our results demonstrated that all the CI and EI examined were almost equally useful for evaluating disease activity in UC patients. Further studies may help to determine which of the indices is the most suitable for use in UC clinical trials.
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