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Volume 54, Issue 1
Displaying 1-14 of 14 articles from this issue
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Noboru HANAOKA, Hiroyasu IISHI, Ryu ISHIHARA, Noriya UEDO, Masaharu TA ...2012 Volume 54 Issue 1 Pages 3-10
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSBarrett's Esophagus is a common complication in patients with gastroesophageal reflux disease and premalignant lesion of adenocarcinoma. The more frequent and longer lasting the symptom of reflux, the greater the risk of adenocarcinoma. In western country the number of patients with adenocarcinoma arising from Barrett's esophagus is increasing. Recently, improvements in endoscopic imaging technology have enabled identification of dysplasia and early stage adenocarcinoma in Barrett's esophagus. However, some issues such as diagnosis, screening, surveillance and treatment have been unresolved.View full abstractDownload PDF (2070K)
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Kouichi NONAKA, Shin ARAI, Shinichi BAN, Koji NAGATA, Takashi SHONO, Y ...2012 Volume 54 Issue 1 Pages 11-18
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSObjective : The purpose of this study was : (1) to observe, via narrow band imaging (NBI) magnifying endoscopy, discolored depressed lesions, in which the differential diagnosis included gastric adenoma and well-differentiated adenocarcinoma, and which were classified as Group III by biopsy ; (2) to characterize them by their endoscopic appearance ; and (3) to evaluate the usefulness of our previously reported system (which is useful for the diagnosis of IIa-like gastric lesions) for the classification of these lesions by type.
Methods : Nine discolored depressed lesions, classified as Group III by biopsy, were studied in patients who had undergone conventional endoscopy and NBI magnifying endoscopy in our department during the 16 months between November 2008 and February 2010. These lesions were observed with NBI magnifying endoscopy, classified according to our proposed system of type classification, and compared with the results of the pathological examination of the resected specimens and with 59 discolored, flat-elevated lesions (classified as Group III by biopsy) that had been observed during the same period.
Results : Pathological examination of all nine resected specimens led to a diagnosis of well-differentiated adenocarcinoma. Based on NBI magnification findings, 0, 0, 2, 3, and 4 lesions were classified as Type I, II, III, IIIs, and IV, respectively. The discolored depressed lesions resembled elevated lesions with a depression, such as type IIa+IIc, with respect to NBI findings, pathological features, and the site of the lesion.
Conclusion : These results suggest that our proposed system of type classification is also useful for the differential diagnosis of benign vs. malignant, discolored, depressed lesions.View full abstractDownload PDF (2617K)
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Akihiro SHINJI, Kenji MUKAWA, Hiroshi OHTA, Kenichi KOMATSU, Michiharu ...2012 Volume 54 Issue 1 Pages 19-23
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSA 54-year-old man came to Suwa Red Cross Hospital with pharyngeal pain and dysphagia. Laryngoscopy revealed a deficit of the uvula and wide ulceration of the pharynx. Imaging studies revealed a mass lesion with an unclear border extending from the epipharynx to the oropharynx. Pathological findings of the biopsy specimen from pharyngeal ulcer showed infiltration of inflammatory cells, including plasma cells and lymphocytes. Epithelial dysplastic cells were not apparent. Preoperative examination of the infection revealed a marked elevated titer level of RPR and TPHA. Considering the clinical and pathological findings we diagnosed the patient as having tertiary syphilis. Antibiotic therapy with AMPC 1500 mg/day was started, and his symptoms improved after 2 months.View full abstractDownload PDF (2622K) -
Tetsuya UEO, Tetsuya ISHIDA, Hideyasu NAGAMATSU, Ryoichi NARITA, Ken T ...2012 Volume 54 Issue 1 Pages 24-32
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSThe first case was a 74-year-old man, in whom endoscopic examination showed a submucosal tumor in the fundus of the stomach. The second case was a 61-year-old woman, in whom endoscopic examination showed a semi-pedunculated polyp in the upper stomach. In both cases, endoscopic ultrasonography (EUS) showed a multilobular anechoic region in the third layers of the gastric wall. Under the diagnosis of a gastric Hamartomatous Inverted Polyp (HIP), we resected these tumors endoscopically. Histological examination revealed that both of the tumors were composed of a submucosal proliferation of cystically dilated gastric glands and fibromusucular elements. Based on these findings, we diagnosed these tumors as a gastric HIP. EUS was useful for the diagnosis of gastric HIP. Endoscopic submucosal dissection (ESD) led to a detailed histological examination in the present cases, and it could be useful treatment of submucosal tumors of the HIP type.View full abstractDownload PDF (5035K) -
Takayuki OSE, Aya HORAI, Kento TAKATORI, Naoto KITAJIMA, Tokuyuki KONO ...2012 Volume 54 Issue 1 Pages 33-38
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSTwenty five years after a Billroth II (B-II) procedure for an advanced gastric cancer, a 75-year-old man was referred for persistent abdominal pain and progressive anemia. Abdominal CT and small-caliber colonoscopy revealed advanced primary duodenal cancer of the horizontal portion. Although radical surgery was proposed, it was converted to exploratory surgery due to advanced permeation of the cancer. Positive examination of the afferent loop is necessary, if persistent abdominal pain or gastrointestinal bleeding occurs after a gastrectomy with B-IIor Roux-Y reconstruction.View full abstractDownload PDF (2706K) -
Akie SANO, Yasufumi ITO, Naoyuki HAYAZAKI, Tsuneko IKEDA, Ken-ichirou ...2012 Volume 54 Issue 1 Pages 39-43
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSWe report on a case of a 69-year-old man with colon cancer presenting on the mucosal bridge. The patient was admitted to our hospital under the diagnosis of lung cancer and prostate cancer. A left lobectomy was performed. Total colonoscopy revealed mucosal bridges and many inflammatory polyps of the sigmoid colon. One polypoid lesion on the mucosal bridge was a non-inflammatory polyp. We suspected this polyp was an early colon cancer occurring on the mucosal bridge. Endoscopic mucosal resection of the polyp was performed. Histological findings showed a well differentiated adenocarcinoma. Eight months later the patient underwent an operation for advanced gastric cancer.View full abstractDownload PDF (2587K) -
Takaya OGUCHI, Takayuki WATANABE, Masahiro MARUYAMA, Tetsuya ITO, Sugu ...2012 Volume 54 Issue 1 Pages 44-49
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSA 16-year-old boy suffered a blunt force upper abdominal lesion while maintaining a tennis court. He developed appetite loss and nausea one week later and was diagnosed as having obstructive jaundice at another hospital. Three weeks after the injury, he was referred to our hospital for further treatment. Endoscopic retrograde cholangiography revealed a suprapancreatic biliary stricture of approximately 10 mm with biliary dilatation above it. A 7 Fr biliary plastic stent was inserted. One week later, the biliary stricture was dilated with a 4 mm bile duct expansion balloon and two 7 Fr biliary plastic stents were placed. Endoscopic retrograde cholangiography showed improvement of the stricture three months afterwards and the stents were removed. There has been no biliary restenosis for nine months since removal of the stents. A suprapancreatic biliary stricture following blunt abdominal trauma is rare, and its treatment has not yet been established. We report herein on a case that was healed successfully using endoscopic treatment.View full abstractDownload PDF (1739K) -
Seitaro ADACHI, Kazunari NAKAHARA, Chiaki OKUSE, Yoshichika OISHI, Ryu ...2012 Volume 54 Issue 1 Pages 50-56
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSA 69-year-old female, who has been under treatment for megaloblastic anemia attributed to postgastrectomy syndrome, was admitted to our hospital for the treatment of a common bile duct stone. ERCP was undertaken with a 200 cm double-balloon enteroscope because the patient had undergone a Roux-en-Y reconstruction. Although the papilla of Vater could be reached, replacement of the double-balloon enteroscope with a conventional endoscope through the over tube was impossible because of difficulty due to shortening of the intestinal tract. We then tried to perform the procedure with only the double-balloon endoscope without exchanging endoscopes. Although selective biliary cannulation was difficult, it became possible by using a 6 Fr tapered catheter with the manipulated tip as the cannula, and complete stone removal was achieved. We present herein on a case of successful endoscopic removal of a bile duct stone in patient with Roux-en-Y reconstruction by using 200 cm double-balloon enteroscope on its own, but further refinements of the endoscope and the biliary accessories may improve the therapeutic success in this situation.View full abstractDownload PDF (2151K)
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Ryuichi KUSAMA, Hiroyuki YOSHINO2012 Volume 54 Issue 1 Pages 57-63
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSAs the number of patients with a percutaneous endoscopic gastrostomy (PEG) increases, the misplacement of the tube into the abdominal cavity during the PEG tube exchange has become a serious problem. Endoscopic observation is thus required at tube exchange to make sure the tube is placed correctly. However, it is difficult to use this method for home care patients, and since the burden of this on patients is even greater and this method is very costly both in terms of time and money, a simpler checking method is required. We evaluated a method of directly checking the PEG tube using the Percutaneous Endoscopic Gastrostomy tube Scope (PEG Scope), and we were able to check the inside stopper of the PEG tube using a suitable tool. This method was useful also in the coloring-water-method negative patients as compared with others including the Sky Blue Method. Furthermore, we evaluated the use of the Advanced PEG Scope. As for the advanced PEG Scope, as compared with the former type, the inside stopper of the tube could be checked directly, more simply and with greater certainty. A PEG tube replacement method which uses the PEG Scope is therefore very useful. We believe that it is necessary to add this method using a PEG Scope to the guidelines as one of the after-exchange checking methods.View full abstractDownload PDF (3042K)
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[in Japanese], [in Japanese], [in Japanese]2012 Volume 54 Issue 1 Pages 64-65
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSDownload PDF (1628K)
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Akira SUGITA, Kazutaka KOGANEI, Kenji TATSUMI, Kyoko YAMADA, Ryo FUTAT ...2012 Volume 54 Issue 1 Pages 66-72
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSFistula-associated anal cancer is a rare condition with a poor prognosis because of difficulty in early diagnosis. An anal fistula is the most common anal complication in Crohn's disease and anorectal cancer, including fistula-associated anal cancer, is also most common in Japan. Most fistula-associated anal cancer has been found by changes in the clinical symptoms such as mucus discharge, anal bleeding and stricture which was not seen previously. It is important to notice any change in symptoms through regular digital examination, and to take biopsy in any lesion suspected as being cancerous under anesthesia in order to make an early diagnosis for fistula-associated anal cancer in Crohn's disease with a longstanding anal fistula. An optimal cancer surveillance program for fistula associated anal cancer should be established in Crohn's disease.View full abstractDownload PDF (3552K)
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Hiroshi HOSHINO, Hidemi GOTO2012 Volume 54 Issue 1 Pages 73-79
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSTo clarify the current status of infection control for gastroenterological endoscopy at practitioner clinics, we conducted a postal survey. Questionnaires were sent to 180 practitioners who were alumni of the Department of Gastroenterology, Nagoya University School of Medicine, and we received 109 replies. At 99 clinics, upper endoscopic examinations were conducted routinely, 34 exams per month at every clinic on average. Fifty-seven percent of the respondents were aware of the guidelines for infection control for endoscopy. Disinfectant was used as follows: glutaral 48%, electrolyzed acidic water 29% and others. The endoscope was washed and sterilized properly at 65% of clinics. ‘Reprocessable’ biopsy forceps were used at 89% of clinics and ‘disposable’ at 11%. Reprocessable forceps were prepared for the next use with the proper procedures at only 22% of clinics. Personal protective equipment was utilized as follows: plastic gloves 76%, surgical mask 29%, plastic apron 10%, and goggles 6%. At the clinics recognizing the guidelines, endoscopes were reprocessed with the proper procedures at a significantly high rate compared with the others. We would propose the following requirements: the need for awareness of the guidelines for all practitioners, and understanding of the guidelines by every practitioner.View full abstractDownload PDF (642K)
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[in Japanese]2012 Volume 54 Issue 1 Pages 80-82
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSDownload PDF (546K)
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[in Japanese], [in Japanese]2012 Volume 54 Issue 1 Pages 83
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSDownload PDF (500K)
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