GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
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Volume 54, Issue 10
Displaying 1-11 of 11 articles from this issue
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  • THE INVESTIGATION OF THE CLINICAL FEATURE OF EOSINOPHILIC ESOPHAGITIS
    Hiroaki KUSUNOSE, Syuichi OHARA, Shirou HAMADA, Yasushi KITAGAWA, Hiro ...
    2012 Volume 54 Issue 10 Pages 3399-3407
    Published: 2012
    Released on J-STAGE: October 31, 2012
    DOIhttps://doi.org/10.11280/gee.54.3399
    JOURNAL FREE ACCESS
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    Case reports of eosinophilic esophagitis (EoE) have been gradually increasing in Western countries, but in Japan only a few reports have been reported so far. We examined the five cases of EoE that were definitively diagnosed with endoscopic biopsies of the esophagus (more than 20 eosinocytes /HPF) in our facility. All patients were male with a mean age of 46.8 years (range 20-61 years). In these five patients, the predominant symptom was dysphagia in two patients, epigastralgia in one, no or slight symptoms in two in whom the condition was coincidentally diagnosed during a health checkup. Edoscopic examination revealed linear furrows in all patients (100%), transient or segmental concentric rings in four patients (80%), whitish papules scattered over the mucosal surface in two patients (40%), and a rough whitish mucosal surface in four patients (80%). Peripheral eosinophilia was seen in three patients. Four patients were treated with a proton pump inhibitor (in three patients) and topical steroid therapy (in one patient), and the symptoms, endoscopic findings and histological findings completely disappeared after two months in the three patients who could be followed. In one patient followed with no treatment, endoscopic findings and histological findings disappeared after six months. The further accumulation of cases and a long-term follow up is needed to solve the cause and long term prognosis of EoE.
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  • A NAÏVE CASE OF SEGMENTAL TYPE ULCERATIVE COLITIS ASSOCIATED WITH ULCERATIVE GASTRODUODENITIS
    Toshifumi OZAWA, Eiko WACHI
    2012 Volume 54 Issue 10 Pages 3408-3417
    Published: 2012
    Released on J-STAGE: October 31, 2012
    DOIhttps://doi.org/10.11280/gee.54.3408
    JOURNAL FREE ACCESS
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    A 12-year-old man who had been diagnosed as having a mild clinical stage of the segmental type ulcerative colitis (UC) was maintained with medical therapy. He was admitted complaining of epigastric pain and vomiting after four months. Endoscopic examination showed redness, small white erosions, a diffuse edematous mucosa-like crack with spontaneous bleeding in the entire stomach. Redness was seen in the duodenum, with small white erosions, edematous mucosa and swollen villi. Biopsied specimen revealed numerous inflammatory cells and neutrophils were obtained from a similar crypt abscess in the mucosa. Involvement of Helicobacter pylori and drugs could be ruled out in this case, so it was strongly suspected to be associated with UC. After administration of prednisolone and 5-aminosalicylic acid (750 mg , three times daily) ground to powder, his symptoms and endoscopic abnormalities all disappeared and the histological findings also significantly improved. There have been no reported cases of diffuse ulcerative upper-gastrointestinal mucosal inflammation in segmental type of UC except our case.
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  • A CASE OF POORLY DIFFERENTIATED ADENOCARCINOMA IN AN EARLY STAGE DEVELOPED FROM LEFT SIDE COLON
    Hironori AOKI, Masafumi NOMURA, Shinya MITSUI, Tokuma TANUMA, Masabumi ...
    2012 Volume 54 Issue 10 Pages 3418-3425
    Published: 2012
    Released on J-STAGE: October 31, 2012
    DOIhttps://doi.org/10.11280/gee.54.3418
    JOURNAL FREE ACCESS
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    We present herein on a rare case of an early stage, poorly differentiated adenocarcinoma developed from the left side colon. A 61-year-old man came to our center for a detailed examination of a depressed lesion of the descending colon. He was a referral from his home doctor. A biopsy finding that his home doctor performed was Group 4. As a result of close inspection, we diagnosed the lesion as an early colonic cancer that was suspected of submucosal invasion. We performed endoscopic submucosal dissection (ESD) with the patient's approval. The pathological diagnosis was poorly differentiated adenocarcinoma with submucosal invasion and mild lymphatic vessel invasion. Based on the patient's wishes, we performed surgical colonic resection and lymph node resection for a radical cure, but there was no residual carcinoma or lymph node metastasis. The final diagnosis was IIc, 10×10mm, por1>tub2, pSM (1500μm), int, INFb, ly1, v0, pN0, Stage I.
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  • A CASE OF ALLERGIC GRANULOMATOUS ANGITIS-ACCOMPAINED BY COLONIC CHANGES WITH MANY APHTHOUS LESIONS
    Akemi KAMATANI, Ichiro HIRATA, Yoshio KAMIYA, Naoko MARUYAMA, Toshiaki ...
    2012 Volume 54 Issue 10 Pages 3426-3432
    Published: 2012
    Released on J-STAGE: October 31, 2012
    DOIhttps://doi.org/10.11280/gee.54.3426
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    A 56 year old woman had been suffering from recurrent attacks of bronchial asthma for 15 years and she sometimes had pneumonia. She was admitted to our hospital complaining of DOE (dyspnea on exertion), diarrhea and purpura on her legs. Gastrointestinal endoscopy showed a reddish and edematous mucosa at the duodenal bulb. On colonoscopy the mucosa appeared red and edematous with an erosive lesion and many aphthous lesions were extending from the rectum to cecum. Some irregular ulcers were shown in some parts of the sigmoid colon. Each biopsy revealed only eosinophilic infiltration of the mucosa. Skin biopsy results showed vasculitis. Based on these findings, a diagnosis of allergic granulomatous angitis (AGA) was made. After PSL40 mg / day and cyclophosphamide 400 mg / day therapy was initiated, the DOE and diarrhea abated. Colonoscopy examination performed after the treatment demonstrated a decreased number of mucosal erosions, aphthae and ulcers. PSL-dose tapering was stopped at 30 mg / day and the patient was discharged, since no aggravation of symptoms was observed. We report herein on a rare case of AGA with colonic changes and the greatest number of aphthous lesions we have encountered.
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  • A CECOSTOMY SUCCEEDED IN ADDING THE FUNCTION OF A COLOSTOMY BY USING A RETRACTOR MADE OF SILICONE
    Takeshi NISHIKAWA, Koichi TOMIKASHI, Naoya KIDA, Kanako IMAEDA, Hideta ...
    2012 Volume 54 Issue 10 Pages 3433-3439
    Published: 2012
    Released on J-STAGE: October 31, 2012
    DOIhttps://doi.org/10.11280/gee.54.3433
    JOURNAL FREE ACCESS
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    A man somewhere in his 60's who had a history of multiple myeloma for years complained of fever and abdominal pain. CT findings showed an abdominal abscess due to perforation of the sigmoid colonic diverticulum. Although percutaneous drainage was effective and the abscess disappeared, the abdominal pain persisted. A colostomy was apparently required but it was hard to perform any surgical procedure because of the patient's poor general condition. Therefore, firstly we performed a percutaneous endoscopic cecostomy (PEC) and secondly dilated the fistula with a balloon. We finally succeeded in adding the function of a colostomy to this procedure using a retractor made of silicone. We did not experience any severe complications during these procedures, and obtained some degree of efficacy.
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  • ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SUBMUCOSAL INVASIVE GASTRIC CANCER AND CURABILITY CRITERIA
    Shu HOTEYA, Toshiro IIZUKA, Satoshi YAMASHITA, Daisuke KIKUCHI, Masano ...
    2012 Volume 54 Issue 10 Pages 3446-3454
    Published: 2012
    Released on J-STAGE: October 31, 2012
    DOIhttps://doi.org/10.11280/gee.54.3446
    JOURNAL FREE ACCESS
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    Aims : The aims of the present study were to evaluate the feasibility of endoscopic submucosal dissection (ESD) as curative treatment for node-negative submucosal invasive early gastric cancer (EGC) and to consider further expansion of the curability criteria for submucosal invasive EGC.
    Methods : A total of 977 EGC in 855 patients treated by ESD were enrolled. They were divided into intramucosal cancer (M) ; minimally submucosal invasive cancer (<500μm from the muscularis mucosa) (SM1) ; and deeper submucosal invasive cancer (>500μm from the muscularis mucosa) (SM2). The technical feasibility of ESD for SM1 and M were compared, and the clinical prognosis of SM1 was evaluated. Furthermore, the volume of carcinoma invading to the submucosal layer, which we called the SM volume index, was calculated virtually to analyze its correlation with lymphatic-vascular invasion.
    Results : There were no statistical differences in technical outcomes and complications between M and SM1. Curative resection rates were significantly better in M than in SM1 (M, 92.6%；SM1, 63.8%). No local recurrences and distant metastases were found in 48 SM1 patients declared to have undergone curative resections. Most cases (72.0%) with successful ESD but non-curative resection exceeded 30 mm in maximum size, and no local recurrences and metastases were found in these patients. The SM volume index of these cases was comparatively small.
    Conclusion : The technical and theoretical validity of ESD for SM1 was validated. The possibility of further expansion of the curability criteria for submucosal invasive cancers was suggested by the evaluation of the SM volume index.
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