GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 54, Issue 7
Displaying 1-14 of 14 articles from this issue
  • Hiroshi KAWAKAMI, Mototsugu KATO, Satoshi HIRANO, Naoya SAKAMOTO
    2012 Volume 54 Issue 7 Pages 1975-1990
    Published: 2012
    Released on J-STAGE: July 26, 2012
    JOURNAL FREE ACCESS
    The controversy over whether and how to perform preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA) remains unsettled. Arguments against PBD before pancreatoduodenectomy have recently been gaining momentum. However, the complication-related mortality rate is as high as 5% for patients with HCA who have undergone major liver resection, and liver failure is a major cause of postoperative death. This suggests the need for PBD to treat jaundice in HCA patients scheduled for major surgical resection of the liver and to perform major surgery only after recovery of the hepatic function. However, no definite criteria or guidelines outlining indications for PBD are currently available. In patients with HCA, PBD may be performed by either percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD). No consensus has been reached regarding which PBD method is more appropriate. No reported study has compared the effectiveness of PTBD, endoscopic biliary stenting and endoscopic nasobiliary drainage in patients with HCA. Recently, a few Japanese high-volume centers have recommended EBD of the future remnant lobe for PBD in patients expected to undergo definitive surgery for HCA. This review summarizes the purpose, transition, current situation, and future of PBD in HCA patients undergoing PBD.
    Download PDF (3980K)
  • Ryuji MOTOJIMA, Shinichi MIYAZAKI, Taito AOKI, Kouichi NAKAJIMA, Yasus ...
    2012 Volume 54 Issue 7 Pages 1991-1999
    Published: 2012
    Released on J-STAGE: July 26, 2012
    JOURNAL FREE ACCESS
    [Purpose]The aim of this study was to determine the relationship between reflux esophagitis of residual esophagus (RE-re) and the state of the gastric mucosa and the acidity of the gastric tube of the patients who had undergone esophagectomy and gastric tube reconstruction for thoracic esophageal carcinoma. [Methods]A series of 117 patients underwent upper endoscopy, biopsy of gastric tube mucosa and the pH of the gastric tube was measured. RE-re was graded according to the Los Angeles classification System (LA grade). We measured the pH at the upper gastric tube under direct vision through an endoscope using a micro-pH glass electrode. A biopsy of the mucosa was taken from the upper part and the lower part of the gastric tube, and we assessed Helicobacter pylori (Hp) infection, mucous atrophy and intestinal metaplasia (IM). [Result]As for the cases in whom Hp infection progressed, the pH of the gastric tube was high and RE-re outbreak decreased. Similarly, as for the cases in whom atrophy and IM progressed, the pH of the gastric tube was high and RE-re outbreak decreased. [Conclusion]It was thought that RE-re had a close relationship with Hp infection and the mucosa of the gastric tube.
    Download PDF (1025K)
  • Shuko IWATANI, Hiroko NEBIKI, Hirotsugu MARUYAMA, Shinsuke HIRAMATSU, ...
    2012 Volume 54 Issue 7 Pages 2000-2005
    Published: 2012
    Released on J-STAGE: July 26, 2012
    JOURNAL FREE ACCESS
    We encountered a case of superficial esophageal carcinoma with giant intramural metastasis to the stomach. Esophageal and gastric lesions were identified on endoscopy in a 76-year-old man. The esophageal lesion was 7 mm in diameter and located in the lower thoracic esophagus. The gastric lesion was a giant submucosal tumor approximately 70 mm in diameter, located in the posterior wall of the upper gastric body. On endoscopic ultrasonography-guided fine needle aspiration and biopsy, the gastric lesion was diagnosed as squamous cell carcinoma. Endoscopic ultrasonography revealed the esophageal lesion as a superficial carcinoma invading the submucosa, diagnosed on biopsy as also representing squamous cell carcinoma. Stomach wall metastasis from a superficial esophageal carcinoma was therefore diagnosed.
    Download PDF (1257K)
  • Takashi NONAKA, Takaomi KESSOKU, Yuji OGAWA, Kento IMAJYO, Shogo YANAG ...
    2012 Volume 54 Issue 7 Pages 2006-2013
    Published: 2012
    Released on J-STAGE: July 26, 2012
    JOURNAL FREE ACCESS
    A 39-year-old man was admitted to our hospital for further examination of an elevated gastric lesion that had been incidentally identified in an upper gastrointestinal series as part of a medical checkup. Endoscopy revealed a peculiar elevated lesion, in the form of a whitish, flat elevation with conspicuous reddish nodularity in part, measuring 30 mm in diameter, at the greater curvature of the lower body of the stomach. No association with background gastric mucosa of chronic gastritis or intestinal metaplasia with Helicobacter pylori was apparent clinically. Biopsy specimens taken from the lesion showed proliferated atypical gastric glands, but distinguishing between tubular adenoma and tubular adenocarcinoma was difficult. As a result, endoscopic submucosal dissection was performed with en bloc resection of the lesion. Histologically, most of the tumor in the resected specimen comprised proliferated gastric glands with low-grade atypia, with positive immunohistochemical staining for MUC5AC and M-GGMC-1. However, some cancerous lesions were seen limited to the mucosa of the tumor. Final diagnosis of the tumor was pType 0-I+IIa, well-differentiated tubular adenocarcinoma in tubular adenoma, gastric type, 30 × 25 mm, pT1a(M), UL(-), ly(-), v(-), HM0, VM0. Adenomas with a gastric phenotype are considered to show a higher risk of malignant transformation, but distinguishing between malignant and benign tumors form biopsy specimens is difficult. Active application of endoscopic submucosal dissection may thus facilitate correct diagnosis and treatment of such cases.
    Download PDF (1446K)
  • Tomoki KOBAYASHI, Toshio KUWAI, Haruki KIMURA, Sohei YAMAMOTO, Keiichi ...
    2012 Volume 54 Issue 7 Pages 2014-2021
    Published: 2012
    Released on J-STAGE: July 26, 2012
    JOURNAL FREE ACCESS
    A 64-year-old female was referred to our department complaining of tarry stools while under admission for acute pyelonephritis. Single-balloon endoscopic examination revealed a solitary pedunculated polyp covered with a large quantity of hematomata in the ascending portion of the duodenum with a diameter of 30 mm. Given the risk of rebleeding and the fact that the lesion measured 30 mm, the polyp was resected with endoscopic polypectomy using single-balloon endoscopy. Histologically, the polyp consisted of branching bundles of smooth muscle fibers covered with hyperplastic epithelium. Because the patient did not have a past or family history of mucocutaneous pigmentation or gastrointestinal polyps, the case was diagnosed as a solitary Peutz-Jeghers type hamartomatous polyp of the duodenum. Solitary Peutz-Jeghers type hamartomatous polyps of the duodenum are extremely rare, and we reported on our case with a review of the literature.
    Download PDF (1146K)
  • Noriaki UNEDA, Shuji TADA, Takihiro KAMIO, Ken-ichi YOSHIDA, Yoki FURU ...
    2012 Volume 54 Issue 7 Pages 2022-2031
    Published: 2012
    Released on J-STAGE: July 26, 2012
    JOURNAL FREE ACCESS
    An 68-year-old woman was admitted to a hospital with purpura of the lower limbs and severe upper abdominal pain. Vomiting and massive melena were observed 23 days after admission, and she was immediately transferred to our hospital. Repeated massive bleeding from the jejunum occurred, for which emergency surgery was performed. Based on various clinical symptoms and histopathological findings of specimens from the resected jejunum, polyarteritis nodosa (PAN) was strongly suspected. Steroid pulse therapy, endoscopic hemostasis, and vascular embolization using catheters were conducted, but she died of massive gastrointestinal bleeding and multiorgan failure. As a result of the pathological anatomy, a final diagnosis of PAN was made. PAN, associated with gastrointestinal bleeding as the primary condition, is extremely rare, with its prognosis being poor. Prompt establishment of a diagnosis and intensive treatment are considered necessary.
    Download PDF (1689K)
  • Yoko ISHIBASHI, Emi MATSUZONO, Fumiaki YOKOYAMA, Nozomu SUGAI, Hideyuk ...
    2012 Volume 54 Issue 7 Pages 2032-2038
    Published: 2012
    Released on J-STAGE: July 26, 2012
    JOURNAL FREE ACCESS
    A 29-year-old woman presented with lower abdominal pain, fever, diarrhea, and hematochezia, but without either nausea or vomiting. A CT scan revealed pancolitis and mesenteric infiltration. Colonoscopy revealed diffuse longitudinal reddened spots, edema, erosion and ulcers ranging from the rectum. A histopathological study of mucosal biopsy specimens showed neutrophil infiltration indicating infectious colitis as well as findings suggesting ischemic colitis. Cultures of feces and a biopsy specimen were positive for Staphylococcus aureus and negative for Campylobacter and the O serogroups of Escherichia coli, indicating a diagnosis of S. aureus enterocolitis. Few reports have described colonoscopic findings of S. aureus enterocolitis because colonoscopy is usually only used in the differential diagnosis of complex acute infectious enterocolitis. Endoscopy is thus useful to some degree for diagnosing S. aureus enterocolitis.
    Download PDF (1040K)
  • Yusuke SASAKI, Masatoshi TAKANO, Mishie TANINO, Masako TSUYUGUCHI, Tom ...
    2012 Volume 54 Issue 7 Pages 2039-2045
    Published: 2012
    Released on J-STAGE: July 26, 2012
    JOURNAL FREE ACCESS
    A 64-year-old woman with chronic renal failure had had hemodialysis for 25 years. Within a 1-year period, she developed 3 episodes of active bleeding from the right colon. A right-hemicolectomy was performed because the ischemic change seen on the colonic mucosa was persistent and endoscopic therapies could not control the bleeding. The histological findings revealed marked submucosal fibrosis and mesenteric phlebosclerosis was diagnosed. The patient's postoperative course was uneventful during one year of follow-up. We report herein on this interesting case of idiopathic mesenteric phlebosclerosis with repeated bleeding in a patient with chronic renal failure who was on long-term hemodialysis.
    Download PDF (2480K)
  • Sumio TSUDA
    2012 Volume 54 Issue 7 Pages 2048-2061
    Published: 2012
    Released on J-STAGE: July 26, 2012
    JOURNAL FREE ACCESS
    In order to acquire good insertion technique during a colonoscopy, it is important to know and use the characteristics of that section of the coloscope designed for insertion, namely the shaft and the distal flexible section. Characteristics of this part of a colonoscope consist of stiffness and elasticity of the shaft, torque transference of the shaft, length of the distal flexible section and so on. In this paper I first comment on the characteristics of this important segment of the colonoscope and then on the insertion technique using the characteristics of the segment. The difference in the characteristics among the various diameters of this segment and the way how to make the best use of these differences are also explained. I also show the important points in using a colonoscope with variable stiffness function and introduce a newly developed colonoscope having passive bending and a high force transmission insertion tube ; the OLYMPUS EVIS LUCERA PCF-PQ260 (Olympus Medical Systems Corp.).
    Download PDF (1265K)
  • Youichi KUMAGAI, Masakazu TOI, Kenro KAWADA, Tatsuyuki KAWANO
    2012 Volume 54 Issue 7 Pages 2062-2072
    Published: 2012
    Released on J-STAGE: July 26, 2012
    JOURNAL FREE ACCESS
    Observations of esophageal squamous cell carcinoma using magnifying endoscopy have now been performed extensively, and as a result, it has become clear that the morphology of the microvessels evident at the tumor surface reflects the depth of tumor invasion. In M1 and M2 cancer, the surface microvasculature reveals dilation and elongation of the intra-papillary capillary loops (IPCL). However, at this stage, some immature capillaries resembling IPCL also arise inside the tumor, and therefore the view of the microvasculature should be described as one showing “intermixing of modified IPCL and IPCL-like immature capillaries (IPCL-like abnormal capillary)”. As cancer invades into the muscularis mucosa (M3 or deeper), an obviously dilated and irregularly branched tumor-specific vasculature, more accurately described as “neovasculature”, can be observed.
    From our magnifying endoscopy observations and studies of the molecular profile of early esophageal cancer, we conclude that two major angiogenic steps exists in precancerous and M3 lesions in the early phase of cancer progression.
    In addition, it is now possible to study cell morphology using an endocytoscope with a much higher magnification (×400-×1000) than magnifying endoscopes currently on the market. The histology revealed in this way may reduce the need for conventional biopsy histology in the future.
    Download PDF (1574K)
feedback
Top