GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
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Volume 53, Issue 3
Displaying 1-12 of 12 articles from this issue
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  • DIAGNOSIS OF EARLY GASTRIC CANCER WITH MAGNIFYING ENDOSCOPY USING NARROW-BAND IMAGING
    Kenshi YAO, Takashi NAGAHAMA, Toshiyuki MATSUI, Akinori IWASHITA
    2011 Volume 53 Issue 3 Pages 1063-1075
    Published: 2011
    Released on J-STAGE: June 14, 2011
    DOIhttps://doi.org/10.11280/gee.53.1063
    JOURNAL FREE ACCESS
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    Recently, magnifying endoscopy (ME) has been applied to the diagnosis of early gastric cancer. In addition, ME with narrow-band imaging (NBI) can visualize various anatomical components. In order to understand the principles behind such techniques, we describe herein the difference between magnifying ratio and resolution, NBI technique and standard endoscopy techniques. Furthermore, we should familiarize ourselves with the microanatomy which can be visualized with NBI-ME, and how this is achieved. As for the microvascular architecture (V), subepithelial capillaries, collecting venules and pathological microvessels are visualized, whereas for the microsurface structure (S), the marginal crypt epithelium and white opaque substance are visualized. We proposed the so-called “VS classification system” for the diagnosis of early gastric caner with NBI-ME. There are several preliminary reports which have described the clinical usefulness of NBI-ME. However, studies investigating the use of NBI-ME for early gastric cancer are limited in number and in quality. More and better-designed studies are needed in order to evaluate the possible indication for NBI-ME and the additional value of NBI over white light imaging.
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  • TWO CASES OF SUPERFICIAL ESOPHAGEAL CANCER DIAGNOSED WITH THE METALLIC SILVER SIGN IN THE ESOPHAGUS SHOWINGMANY IODINE-UNSTAINED AREAS
    Satoshi ASAI, Takatoshi KADOWAKI, Seitaro SASSA, Norifumi HIROOKA, Tet ...
    2011 Volume 53 Issue 3 Pages 1076-1083
    Published: 2011
    Released on J-STAGE: June 14, 2011
    DOIhttps://doi.org/10.11280/gee.53.1076
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    The metallic silver sign is the finding whereby a positive pink color sign (PC sign) area changes to silver with narrow band imaging (NBI) observation. Although it has been reported that the metallic silver sign is useful for diagnosis of superficial esophageal cancer especially in the esophagus, demonstrating many iodine-unstained areas because it stands out from the surround mucosa and is easy to detect, there are only a few studies on this application. We report two cases of superficial esophageal cancer which were detected with the metallic silver sign in the esophagus, showing many iodine-unstained areas, and treated with endoscopic submucosal dissection.
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  • A CASE OF HEMORRHAGIC RADIATION-INDUCED GASTRITIS REQUIRING GASTRECTOMY AFTER FAILURE OF ENDOSCOPIC HEMOSTASIS
    Koichi KUDOH, Shuji TADA, Hiroyuki EGUCHI, Kenichi YOSHIDA, Masayoshi ...
    2011 Volume 53 Issue 3 Pages 1084-1089
    Published: 2011
    Released on J-STAGE: June 14, 2011
    DOIhttps://doi.org/10.11280/gee.53.1084
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    A 72-year-old female had a metallic stent placed combined with radiation therapy for hilar bile duct cancer, and had been undergoing systemic chemotherapy. She was transferred to our hospital for hematemesis. Upper GI endoscopic examination revealed regional edematous mucosa on the posterior wall of the gastric antrum, and widespread bleeding was found. A diagnosis of radiation gastritis was made, and endoscopic procedures were repeated. However, as it was difficult to establish hemostasis, a distal gastrectomy was performed. Although radiation gastritis is rare, it should be considered when gastrointestinal hemorrhage occurs in a patient with a history of upper abdominal radiotherapy.
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  • A CASE OF MULTIPLE MYELOMA WITH GASTROINTESTINAL INVOLVEMENT
    Yosuke MOCHIZUKI, Yasuharu SAITO, Osamu INATOMI, Yusuke KOIZUMI, Shige ...
    2011 Volume 53 Issue 3 Pages 1090-1096
    Published: 2011
    Released on J-STAGE: June 14, 2011
    DOIhttps://doi.org/10.11280/gee.53.1090
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    A 74-year-old man was referred to our hospital for the treatment of hypercalcemia, renal dysfunction and hyperproteinemia together with lumbago. He was finally diagnosed as having multiple myeloma in February 2008. Melphalan and prednisone were administered, and the disease reached a stable condition. In September of the same year, he presented with abdominal pain and fullness. Contrast-enhanced CT revealed marked thickening of the rectal wall, and a mass in the right hepatic lobe. Enteroclysis and colonoscopy showed stricture of the rectum. Upper GI endoscopy showed a submucosal-like lesion with ulceration at the anterior wall of the gastric fundus. Histological examination of the biopsies from these lesions indicated infiltration of myeloma cells. Chemotherapy with bortezomib demonstrated poor efficiency, and the patient died five months later. Many studies have reported that extramedullary multiple myeloma lesions occur chiefly in the liver, the spleen, the kidneys, and the lymph nodes. However, it is comparatively rare in the gut. The sites most frequently involved are the small bowel and the stomach, and multiple lesions occurring simultaneously in two or more sites in the gut as in this case are very rare.
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  • A CASE OF AIDS-RELATED GASTRIC KAPOSI'S SARCOMA INCIDENTALLY REVEALED DURING AN UPPER GASTROINTESTINAL CHECKUP
    Kae OURA, Shigeaki AONO, Kazuyo YASUDA, Toshihiko TORIGOE, Tatsuya FUJ ...
    2011 Volume 53 Issue 3 Pages 1097-1102
    Published: 2011
    Released on J-STAGE: June 14, 2011
    DOIhttps://doi.org/10.11280/gee.53.1097
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    A man in his fifties had an upper gastrointestinal X-ray examination, and the examination revealed multiple elevated lesions in his gastric body. He had a secondary endoscopic examination that showed multiple dusky-red elevated lesions similar to hyperplastic polyps in the stomach. After one month, he had tarry stools and a high fever, and he was diagnosed as having acquired immunodeficiency syndrome (AIDS). We added immunohistochemical staining to the biopsy specimens from the secondary endoscopic examination. The multiple elevated lesions histopathologically are identified as Kaposi's sarcoma. In those patients where multiple elevated lesions are identified which are dusky-red, with a central depression and superficial irregularity, AIDS-related Kaposi's sarcoma should be borne in mind as a potential diagnosis.
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  • TWO CASES OF TRANSIENT TYPE ISCHEMIC PROCTITIS
    Kiyotaka OKAWA, Wataru UEDA, Koji SANO, Yuki ARIMOTO, Yuki KUBO, Takes ...
    2011 Volume 53 Issue 3 Pages 1103-1108
    Published: 2011
    Released on J-STAGE: June 14, 2011
    DOIhttps://doi.org/10.11280/gee.53.1103
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    We report herein on 2 cases of transient type ischemic proctitis after constipation for 5 days and oral administration of a laxative. The patients had no history of abdominal aortic surgery, pelvic surgery, connective tissue disease/vasculitis, arteriovenous fistula and so on, and the disease was considered to have occurred mainly because of intestinal factors. In addition, both cases showed lesions just above the anus. Although marked elevation of the C-reactive protein (CRP) level was observed, this level rapidly decreased after conservative treatment. Ischemic proctitis has been thought to occur mainly because of vascular factors, but the findings of the present cases are considered valuable because they indicate that the disease may occur mainly because of intestinal factors.
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  • EXPERIENCE OF IMPLANTING METALLIC STENTS FOR THE MALIGNANT STRICTURE OF THE AFFERENT LOOP IN ROUX-EN-Y REBUILDING
    Akihiko KIDA, Koichiro MATSUDA, Satoshi HIRAI, Akiyoshi SHIMATANI, You ...
    2011 Volume 53 Issue 3 Pages 1109-1116
    Published: 2011
    Released on J-STAGE: June 14, 2011
    DOIhttps://doi.org/10.11280/gee.53.1109
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    We report on a case of postoperative pancreatic head cancer presenting with obstructive jaundice due to stricture of the afferent loop of the Roux-en-Y rebuilding from peritoneum metastasis. A metallic stent was implanted to counteract the obstructive jaundice with a double-balloon endoscope (DBE) placed at malignant stricture of the afferent loop, bringing improvement of the symptoms such as icterus, fever and stomachache. An over-tube was first inserted until just before the stricture of the afferent loop with DBE and then the guidewire was placed ahead of the stricture using DBE. Leaving the over-tube and the guidewire, in place, the DBE was removed. An uncovered nickel titanium sulphate (NiTiS) metallic stent, 10 cm×20 mm (Taewoong Medical Co, Ltd, Korea) was implanted safely at the stricture of the afferent loop along the guidewire. Although this case was comparatively unusual as the cause of the obstructive jaundice was related to pancreatic cancer our results suggest, that it is possible to implant a metallic stent into the malignant stricture of afferent loop of a Roux-en-Y reconstruction with DBE.
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  • A STUDY OF THE COMTAMINATION RISK FOR THE COLONOSCOPIST
    Yoshimitsu KOBAYASHI, Shunsuke OHNISHI, Reizo ONISHI, Ryo TAKEMURA, Mi ...
    2011 Volume 53 Issue 3 Pages 1117-1121
    Published: 2011
    Released on J-STAGE: June 14, 2011
    DOIhttps://doi.org/10.11280/gee.53.1117
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    Aim : To clarify the contamination risk for the colonoscopist during colonoscopic procedure.
    Methods : Colonoscopists performed colonoscopy with a medical face-guard, and the number and the area of droplets on the face-guard were counted after colonoscopy.
    Results : More use of the instrument channel tended to increase the droplets count and area. There were more droplets on the left side than right side of the face-guard. Therefore, the droplets dispersed from the instrument channel appeared to be a risk for contamination.
    There were more droplets on the face-guard of colonoscopists who had less experience than others, and it appeared that their inexperience with the use of the instrument channel increased the infection risk.
    Conclusion : We suggest that colonoscopists and ancillary staff who are involved in colonoscopy should wear gowns and goggles to prevent contamination during the colonoscopy.
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  • TECHNICAL CONSIDERATION OF STENTING FOR GASTRODUODENAL OBSTRUCTIONS
    Iruru MAETANI
    2011 Volume 53 Issue 3 Pages 1124-1133
    Published: 2011
    Released on J-STAGE: June 14, 2011
    DOIhttps://doi.org/10.11280/gee.53.1124
    JOURNAL FREE ACCESS
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    Malignant gastroduodenal obstructions are a serious symptom in patients with stomach, pancreatico-biliary and metastatic cancers. Gastroduodenal stenting is now widely used as an alternative to surgical gastrojejunostomy.
    There are two placement techniques : the over-the-wire (OTW) and through-the scope (TTS) methods. In the latter method, the entire procedure can be performed under endoscopic control. Therefore, the TTS method stent placement is much easier to complete as compared with the OTW method. The TTS method with a dedicated enteral stent is obviously a desirable technique, reducing the procedure time and lightening the burden on patients. However, the key to the successful treatment is that we should recognize the stent characteristics and choose the method appropriate to the stent to be used.
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