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Volume 54, Issue 8
Displaying 1-12 of 12 articles from this issue
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Takeshi BABA, Atsuo SHIDA, Hiroaki AOKI, Tokuyasu YOKOTA, Hideaki KURI ...2012 Volume 54 Issue 8 Pages 2213-2218
Published: 2012
Released on J-STAGE: October 22, 2012
JOURNAL FREE ACCESSEsophageal intramural hematoma is an uncommon disease. We report the case of a 77-year-old man who developed an esophageal intramural hematoma due to a thermal burn. The patient had a past history of cerebral infarction and was taking low-dose aspirin for the same. He began complaining of difficulty in swallowing after accidentally drinking hot shark fin soup. He was subsequently admitted to our hospital for close examination and treatment. Endoscopy revealed a dark purple submucosal hematoma in the lumen from the upper esophagus to the esophagogastric junction. He was diagnosed with an esophageal intramural hematoma due to a thermal burn and was administered conservative treatment. The patient's symptoms resolved by the 7th hospital day, and follow-up endoscopy revealed complete resolution of the hematoma. However, mucosal defects due to submucosal tears were observed in the entire esophagus, most of which healed by the 21st hospital day. The patient's recovery was otherwise uneventful, and he was discharged without symptoms on the 28th hospital day.View full abstractDownload PDF (3267K) -
Hiroshi IMAMURA, Takahisa MURAO, Hiroshi MATSUMOTO, Kenichi TARUMI, No ...2012 Volume 54 Issue 8 Pages 2219-2224
Published: 2012
Released on J-STAGE: October 22, 2012
JOURNAL FREE ACCESSA 57-year-old woman underwent upper gastrointestinal endoscopy after an abnormality was detected during a mass X-ray screening program. Endoscopy revealed a submucosal tumor approximately 1 cm in diameter at the greater curvature of the gastric body. She had previously undergone surgery for carcinoma of the left breast. Endoscopic ultrasonography revealed a solid submucosal tumor, which was tentatively diagnosed as a metastatic gastric tumor from the primary breast tumor. Endoscopic submucosal dissection was performed for definitive diagnosis and treatment. Histological examination of the resected specimen revealed a gastric neuroendocrine tumor with lymph vessel invasion. Therefore, standard gastrectomy with lymph node dissection was performed. Histological examination of the resected gastric tissue revealed lymph node metastasis from the gastric neuroendocrine tumor. These findings suggest that sporadic neuroendocrine tumors with submucosal invasion have high malignant potential even if they are minute or small.View full abstractDownload PDF (1181K) -
Shinichi TAKANO, Masahiko OTAKA, Kazuo MIURA, Akira MATSUI, Tatsuya YA ...2012 Volume 54 Issue 8 Pages 2225-2231
Published: 2012
Released on J-STAGE: October 22, 2012
JOURNAL FREE ACCESSA 77-year-old man was detected with a 2-cm submucosal tumor (SMT)-like lesion in the duodenal bulb. The lesion had a depression on its surface. Endoscopic ultrasonography revealed that it was a submucosal tumor. However, because this lesion was soft and movable without erosions and ulcerations, we assumed it to be intramucosal and performed endoscopic mucosal resection. Histological examination of the resected specimen revealed that the tumor cells resembled those in Brunner's gland adenoma. Immunohistochemical findings were positive for pepsinogen-I, MUC6, and CDX2 and partially positive for H+/K+-ATPase, MUC5AC, and CD10. These staining characteristics were consistent with those of mucous neck cells and primitive chief cells of the fundic glands. In addition, a gastric-to-intestinal transition was indicated by CDX2 and CD10 expression. A diagnosis of mucous neck cell adenoma of the duodenal bulb arising from ectopic gastric mucosa was made. To the best of our knowledge, this is the first reported case of a duodenal bulb adenoma arising from ectopic gastric mucosa and comprising fundic gland cells (mucous neck cells).View full abstractDownload PDF (2733K) -
Kentaro SHIKATA, Hiroyuki KOBAYASHI, Shuji KOCHI, Shingo ENDO, Minako ...2012 Volume 54 Issue 8 Pages 2232-2237
Published: 2012
Released on J-STAGE: October 22, 2012
JOURNAL FREE ACCESSA 51-year-old man underwent screening by upper gastrointestinal endoscopy, which revealed a tiny IIa+IIc-like depressed lesion in the second part of the duodenum. The lesion was slightly reddish and surrounded by whitish protrusions. Magnifying endoscopy combined with narrow band imaging (NBI) system revealed that the lesion contained a regular and diminutive network of microvessels within the central depression. Following crystal violet staining, magnifying endoscopy revealed the characteristic IIIL pit pattern commonly observed in colonic adenomas. In addition, the light blue crest commonly observed in normal duodenal mucosa was indistinct. These endoscopic findings suggested a diagnosis of an epithelial tumor. Endoscopic ultrasound (EUS) revealed that the lesion was restricted to the mucosa. The examination of the lesion that measured 7mm following endoscopic mucosal resection revealed that the lesion was an adenoma with moderate epithelial atypia. A classification system for magnifying endoscopy findings for duodenal as well as gastric and colorectal neoplasms is required.View full abstractDownload PDF (1027K) -
Masashi FUKUSHIMA, Chiharu KAWANAMI, Masaya WADA, Naoto SHIMENO, Satok ...2012 Volume 54 Issue 8 Pages 2238-2245
Published: 2012
Released on J-STAGE: October 22, 2012
JOURNAL FREE ACCESSA 58-year-old man presenting with intestinal obstruction was referred to our hospital in November 2008. Abdominal computed tomography and magnetic resonance imaging revealed diffuse intramural masses with fat deposition in the small intestine. Double-balloon endoscopy (DBE) revealed multiple yellowish submucosal tumors in the duodenum and jejunum. On the basis of these findings, the case was diagnosed as intestinal lipomatosis. Partial resection of the jejunum was performed followed by endoscopic resection. Intestinal lipomatosis is extremely rare, and our study describes a case that was diagnosed and treated using DBE.View full abstractDownload PDF (1149K) -
Minako IKEBE, Mitsuru MATSUDA, Satoshi HIRAI, Yosuke HORITA, Akiyoshi ...2012 Volume 54 Issue 8 Pages 2246-2251
Published: 2012
Released on J-STAGE: October 22, 2012
JOURNAL FREE ACCESSHere we report a case of small intestinal anisakiasis that was diagnosed using double-balloon enteroscopy (DBE). A 54-year-old man presenting with ileus-like symptoms associated with abdominal pain that exacerbated approximately one week after consuming raw fish slices was admitted to our hospital. Abdominal contrast-enhanced computer tomography (CT) revealed a small intestinal ileus and showed a localized thickening of the ileal wall with abnormal enhancement. The ileus resolved the next day. Transanal DBE that was performed on day 8 revealed a roughly semicircular red lesion approximately 1 m proximal to the ileocecal valve. Biopsy of the site revealed eosinophilic infiltration and Charcot-Leyden crystals associated with marked degranulation. Although an anisakis body was not detected, the diagnosis of small bowel anisakiasis was made on the basis of pathological findings of the biopsied specimen and a serial change in anisakis-specific IgG and IgA levels.View full abstractDownload PDF (2574K)
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[in Japanese], [in Japanese], [in Japanese]2012 Volume 54 Issue 8 Pages 2252-2253
Published: 2012
Released on J-STAGE: October 22, 2012
JOURNAL FREE ACCESSDownload PDF (2391K)
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[in Japanese], [in Japanese], [in Japanese]2012 Volume 54 Issue 8 Pages 2254-2255
Published: 2012
Released on J-STAGE: October 22, 2012
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ENDOSCOPIC HEMOSTASIS FOR NONVARICEAL UPPER GASTROINTESTINAL BLEEDING—STRATEGIES IN DIFFICULT CASES—Hiroyuki IMAEDA, Naoki HOSOE, Kazuhiro KASHIWAGI, Hideki OHGO, Minoru ...2012 Volume 54 Issue 8 Pages 2256-2268
Published: 2012
Released on J-STAGE: October 22, 2012
JOURNAL FREE ACCESSEndoscopic hemoclipping using short clips is the first choice of therapy for nonvariceal upper gastrointestinal bleeding in our department. In cases where lesions exhibit massive bleeding, or bleeding from large visible vessels, or in cases where hemostasis by hemoclipping proves insufficient, combination therapy including endoscopic injection of hypertonic saline with epinephrine or diluted epinephrine is performed. A transparent hood is useful for lesions that are difficult to keep a good view or tangent lesions in which hemostasis is difficult. An endoscope with a water jet is also useful for the detection of bleeding points, thus enabling rapid hemostasis. Although the development of endoscopic procedures and instruments enables us to achieve endoscopic hemostasis in the majority of cases with peptic ulcer bleeding, there are a few difficult cases such as those of bleeding from larger arteries present in deep ulcers. When endoscopic hemostasis fails, endoscopists should closely coordinate with radiologists and surgeons from an early stage, and interventional radiology or surgery should be performed without any delay.View full abstractDownload PDF (1822K)
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Takashi HISABE, Toshiyuki MATSUI, Masaki MIYAOKA, Kazeo NINOMIYA, Hiro ...2012 Volume 54 Issue 8 Pages 2269-2277
Published: 2012
Released on J-STAGE: October 22, 2012
JOURNAL FREE ACCESSBackground and Aim : Ulcerative colitis (UC) is not only characterized by pathological lesions localized to colonic mucosa, but also various complications involving other organs, including postoperative pouchitis. Among these complications, diffuse gastroduodenitis with lesions resembling colonic lesions has been reported, albeit rarely. The aim of the present study was to attempt to characterize the lesions of the upper gastrointestinal tract occurring as a complication of UC, and to assess the frequency and clinical course of these lesions.
Methods : A total of 322 UC patients who had undergone upper gastrointestinal endoscopy were retrospectively analyzed. We assessed the frequency of endoscopic findings, including diffuse gastroduodenal lesions resembling colonic lesions. Ulcerative gastroduodenal lesion (UGDL) associated with UC were diagnosed if lesions satisfied the following criteria : 1) improvement of the lesions with treatment of UC ; and/or 2) resemblance to UC in pathological findings.
Results : UGDL satisfying aforementioned criteria was found in 15 (4.7%) of 322 patients. All the 15 patients had UGDL accompanied by pancolitis or after proctocolectomy. Frequency in 146 patients with pancolitis was 6.2% (nine patients) and that in 81 patients who had undergone proctocolectomy was 7.4% (six patients). Four patients with UGDL had pouchitis. In all patients except one, the lesions resolved easily with medical treatment.
Conclusions : In more than half of the post-proctocolectomy patients, UGDL was related to occurrence of pouchitis. The existence of characteristic UGDL must be taken into account in the diagnosis and treatment of UC, and UGDL is possibly related to the occurrence of pouchitis.View full abstractDownload PDF (3210K)
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[in Japanese]2012 Volume 54 Issue 8 Pages 2278-2280
Published: 2012
Released on J-STAGE: October 22, 2012
JOURNAL FREE ACCESSDownload PDF (617K)
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[in Japanese], [in Japanese]2012 Volume 54 Issue 8 Pages 2281
Published: 2012
Released on J-STAGE: October 22, 2012
JOURNAL FREE ACCESSDownload PDF (497K)
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