GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
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Volume 55, Issue 2
Displaying 1-16 of 16 articles from this issue
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  • DIAGNOSIS AND TREATMENT OF ENLARGED FOLD GASTRITIS
    Yoko MURAYAMA, Tamana SANOMURA, Yasuhisa SHINOMURA, Hiroyuki NISHIBAYA ...
    2013 Volume 55 Issue 2 Pages 237-249
    Published: 2013
    Released on J-STAGE: May 21, 2013
    DOIhttps://doi.org/10.11280/gee.55.237
    JOURNAL FREE ACCESS
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    Enlarged folds in the gastric corpus are often observed during radiographic or endoscopic examination of adults. A major cause of enlarged gastric folds is Helicobacter pylori (H. pylori) -induced enlarged fold gastritis. The characteristics of H. pylori-induced enlarged fold gastritis are accompanied by foveolar hyperplasia, a massive infiltration of inflammatory cells into the corpus mucosa and hypochlorhydria. The odds ratio for gastric cancer and the prevalence of diffuse type early gastric cancer in the corpus region tend to increase with increasing fold width. With the eradication of H. pylori, fold width improves, dirty mucus disappears and these factors recover to within the normal range. As a result, identifying the gastric cancer becomes easier. Enlarged fold gastritis may be a major risk factor for gastric cancer among H. pylori-infected persons. Further studies are necessary to elucidate whether eradication of H. pylori is effective for the prevention of gastric cancer in H. pylori-infected persons with enlarged fold gastritis.
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  • TWO CASES OF THE RECTAL MUCOSAL PROLAPSE SYNDROME IN WHICH ENDOSCOPIC SUBMUCOSAL DISSECTION WAS EFFECTIVE
    Tsuyotoshi TSUJI, Setsuya OOTANI, Hayato AOKI, Hajime ISHII, Satoko TS ...
    2013 Volume 55 Issue 2 Pages 250-256
    Published: 2013
    Released on J-STAGE: May 21, 2013
    DOIhttps://doi.org/10.11280/gee.55.250
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    The mucosal prolapse syndrome (MPS) is caused by the excessive mechanical stimulus of ‘straining’ at the time of chronic constipation and defecation. The basic medical treatment of MPS is to normalize the defecation. No report has as yet suggested that endoscopic mucosal resection would be effective, although there have been reports in which surgical therapy was effective. We performed endoscopic submucosal dissection (ESD) in two MPS cases for the purpose of en-block resection and formation of a submucosal scar with fibrosis for fixation of the membrane. Post-ESD, the ulcer changed to a scar, and the clinical symptoms improved in both cases. Although ESD has not been recommended as a cure for MPS, taking the safety of the procedure into account, our findings suggest that it could become an effective and minimally-invasive treatment for those cases which have not responded to conservative treatment.
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  • TWO CASES OF ESOPHAGEAL ULCER CAUSED BY DABIGATRAN
    Kyoichi KASSAI, Eri ISHIDA, Yuka KOBAYASHI, Koichi SOGA, Daisuke KANEM ...
    2013 Volume 55 Issue 2 Pages 257-261
    Published: 2013
    Released on J-STAGE: May 21, 2013
    DOIhttps://doi.org/10.11280/gee.55.257
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    We present herein on two cases of dabigatran-related esophageal ulcer. The first case was a 75-year-old man. He felt an esophageal obstruction and tended to belch after administration of dabigatran for atrial fibrillation. Endoscopic examination showed shallow ulcers in the middle esophagus. Dabigatran was continued and the ulcers healed with administration of a proton pump inhibitor. The second case was a 68-year-old woman. She felt heartburn after administration of dabigatran for paroxysmal atrial fibrillation. Endoscopic examination showed shallow ulcers in the middle esophagus. Dabigatran was stopped and the ulcers healed with administration of a proton pump inhibitor. Dabigatran is a new anticoagulant drug expected to be used frequently for atrial fibrillation, therefore it is necessary to recognize that dabigatran may cause esophageal ulcers.
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  • A CASE OF IDIOPATHIC DIFFUSE ESOPHAGEAL SPASMS SUCCESSFULLY TREATED WITH STELLATE GANGLION BLOCK
    Jirou EGUCHI
    2013 Volume 55 Issue 2 Pages 262-266
    Published: 2013
    Released on J-STAGE: May 21, 2013
    DOIhttps://doi.org/10.11280/gee.55.262
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    A 61-year-old man visited our clinic with sudden onset of hiccups and vomiting. Following an initial diagnosis of reflux esophagitis, several medications were commenced However, his symptoms worsened, and other symptoms such as appetite loss, sore throat and chestpain appeared during swallowing. He was therefore admitted to our hospital. An upper gastrointestinal series of the esophagus showed a beaded appearance and suggested diffuse esophageal spasms. Although the symptoms were refractory to the medications, they improved remarkabley following a stellate ganglion block.
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  • A CASE OF METASTATIC MALIGNANT MELANOMA OF THE GASTROINTESTINAL TRACTS
    Yosuke MOCHIZUKI, Yasuharu SAITO, Osamu INATOMI, Shigeki BAMBA, Mitsua ...
    2013 Volume 55 Issue 2 Pages 267-274
    Published: 2013
    Released on J-STAGE: May 21, 2013
    DOIhttps://doi.org/10.11280/gee.55.267
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    A 68-year-old man was referred to our hospital with general fatigue in July 2010. Blackish nodular lesion 15 mm diameter were noted on the skin at the top of his head. Chest and abdominal computed tomography images revealed bilateral mediastinal and hilar lymphadenopathy, with multiple lung and liver metastases. He was hospitalized due to severe malaise, and diagnosed histopathologically with a bone marrow puncture as having malignant melanoma with systemic metastases. Endoscopic examination undertaken due to anemia showed multiple blackish lesions in the esophagus, stomach, and duodenum, and biopsy of the gastric lesion led to the diagnosis of metastatic malignant melanoma. Although chemotherapy was planned, the patient's general condition deteriorated quickly and he died three weeks after the initial visit. Malignant melanoma metastases in the gastrointestinal tract are relatively more commonly seen in autopsies on patients with disseminated melanoma, but are rarely diagnosed ante-mortem because of the nonspecific symptoms and signs of metastases, which include appetite loss, weakness, fatigue, bleeding, anemia, and abdominal pain.
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  • A CASE OF A GRANULAR CELL TUMOR IN THE CECUM DIAGNOSED FROM ENDOSCOPIC ULTRASONOGRAPHY (EUS) FINDINGS AND AN EXACT BIOPSY
    Daisuke KANEMITSU, Kyoichi KASSAI, Yuka KOBAYASHI, Koichi SOGA, Yoshik ...
    2013 Volume 55 Issue 2 Pages 275-280
    Published: 2013
    Released on J-STAGE: May 21, 2013
    DOIhttps://doi.org/10.11280/gee.55.275
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    A 52-year-old male came to our hospital complaining of lower abdominal pain. A colonoscopy examination revealed a yellowish-white submucosal tumor 4mm in diameter in the cecum. We diagnosed it as a granular cell tumor based on the endoscopic ultrasonography findings and the biopsy findings, and we performed endoscopic mucosal resection of the tumor. The tumor cells were situated from the deeper colonic mucosa to submucosa, and contained abundant cytoplasm with eosinophilic granules on H-E staining. Detailed immunohistochemical staining showed that the cells were positive for S-100 protein and PAS-positive granules in the cytoplasm.
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  • ANORECTAL CONDYLOMA ACUMINATUM TREATED WITH ENDOSCOPIC SUBMUCOSAL DISSECTION
    Kenjiro SUZUKI, Takashi SUZUKI, Naotaka FUJITA, Yutaka NODA, Dai HIRAS ...
    2013 Volume 55 Issue 2 Pages 281-286
    Published: 2013
    Released on J-STAGE: May 21, 2013
    DOIhttps://doi.org/10.11280/gee.55.281
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    A 76-year-old woman with the chief complaint of anemia underwent a total colonoscopy, which revealed a flat elevation spreading in the anal canal and the lower portion of the rectum. Endoscopic submucosal dissection (ESD) was carried out. Histological examination of the resected specimen verified condyloma acuminatum with koilocytosis and mild to moderate atypia of the squamous epithelium. No other lesions were found in the vulva or perianal region. A human papilloma virus-DNA assay was positive for both the low risk group and the high risk group. ESD is considered a possible treatment option in selected cases of condyloma acuminatum.
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  • AUTOAMPUTATION OF A COLONIC TUMOR AFTER ENDOSCOPIC REDUCTION OF INTUSSUSCEPTION : A CASE REPORT
    Masanori KOBAYASHI, Hitohiko KOIZUKA, Yoichiro AOKI, Toshiko OGAMI, So ...
    2013 Volume 55 Issue 2 Pages 287-293
    Published: 2013
    Released on J-STAGE: May 21, 2013
    DOIhttps://doi.org/10.11280/gee.55.287
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    We report herein on a case of autoamputation of a colonic tumor after endoscopic reduction of an intussusception. A 25-year-old woman was admitted to our hospital for abdominal pain in the right lower quadrant. Abdominal ultrasonography and contrast enhanced computed tomography revealed colonic intussusception. For reduction and diagnosis, colonoscopy was performed, which showed a tumor in the cecum causing invagination of the ascending colon. The tumor, measuring 20 millimeters in diameter, was suspected as being a juvenile polyp. Fifty days after the first colonoscopy, the patient underwent colonoscopy for re-evaluation and endoscopic resection of the tumor, but the tumor had disappeared.
    Adult intussusceptions are rare, and most adult intussusceptions are caused by malignancy, which requires surgical treatments. But recently, similar to our case, there are case reports of intussusceptions treated only with endoscopic reduction which occurred from benign diseases. In our case, we thought that the tumor had detached spontaneously and had been cured completely due to the endoscopic reduction. On the other hand, there are risks to endoscopic reduction, such as intestinal perforation. In addition, if the lead point is malignant, endoscopic reduction can cause intraluminal seeding or venous tumor dissemination. Nevertheless, colonoscopy may provide information to avoid unnecessary surgery. If the situation allows, we should consider endoscopic reduction.
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  • A CASE OF ANTIBIOTIC-ASSOCIATED HEMORRHAGIC COLITIS INDUCED BY ORAL ADMINISTRATION OF FOSFOMYCIN
    Chiaki KUSUMOTO, Hideyuki OHTANI, Tetsuro HAMAMOTO, Tatsuaki HORI, Ich ...
    2013 Volume 55 Issue 2 Pages 294-299
    Published: 2013
    Released on J-STAGE: May 21, 2013
    DOIhttps://doi.org/10.11280/gee.55.294
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    FOSFOMYCIN (FOM) is usually used for enteric infection in addition to the new quinolone antibiotics. We report herein on a case of antibiotic-associated hemorrhagic colitis (AAHC) induced by oral administration of FOM. A-30-year-old man with abdominal pain and bloody stool was admitted to our hospital. Antibiotic therapy with FOM 1,500 mg/day had been started for enterocolitis-associated diarrhea at another clinic 4 days prior to visiting our hospital. Abdominal CT scans visualized edematous wall thickness between the cecum and sigmoid colon. Colonoscopy showed an erosive lesion with mild stenosis of the ascending colon. Klebsiella oxytoca was detected in the stool culture examination. AAHC and enterohemorrhagic Escherichia coli infection were considered as a differential diagnosis, so we stopped oral administration of FOM and prescribed Levofloxacin (LVFX) together with an intestinal probiotic remedy. Eight days later, the symptoms had disappeared and the abnormal CT findings had improved. A drug-induced lymphocyte stimulation test (DLST) against FOM showed highly positive findings compared with controls.
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  • PREPARATION USING MOSAPRIDE CITRATE FOR AFTERNOON ESOPHAGOGASTRODUODENOSCOPY
    Maki MURAKAMI, Katsuhiro SUGIYAMA
    2013 Volume 55 Issue 2 Pages 300-303
    Published: 2013
    Released on J-STAGE: May 21, 2013
    DOIhttps://doi.org/10.11280/gee.55.300
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    Purpose : The effects of mosapride citrate were investigated as a gastrokinetic for gastric preparation prior to esophagogastroduodenoscopy (EGD) in the afternoon. Methods : Patients took 15 mg of mosapride citrate immediately after breakfast and then underwent EGD procedures in the afternoon after fasting for six hours. Their stomachs were endoscopically examined for the presence or absence of food residues. Each patient was questioned about distress or hunger pains from fasting. Results : In all 53 patients, no residue remained in their stomachs, and most patients reported no problems in connection with fasting. Conclusion : These findings indicate that mosapride citrate is a good candidate to use for gastric preparation. It is also argued that EGD can be performed safely and implemented successfully in the afternoon.
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  • TECHNIQUES OF METALLIC STENT PLACEMENT FOR MALIGNANT COLORECTAL OBSTRUCTION
    Shuntaro YOSHIDA, Hiroyuki ISAYAMA, Kazuhiko KOIKE
    2013 Volume 55 Issue 2 Pages 306-315
    Published: 2013
    Released on J-STAGE: May 21, 2013
    DOIhttps://doi.org/10.11280/gee.55.306
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    Endoscopic stenting with self-expandable metallic stents (SEMS) is a widely accepted procedure for the management of colonic obstruction due to the involvement of malignancies. This procedure has been reported to be an effective candidate for both palliative purposes and as a bridge to surgery. Because of its low invasiveness, this procedure had been selected along with bypass surgery or colostomy for patients with unresectable colonic obstructions. However, SEMS placement studies have only been able to be performed as clinical trials in Japan because the procedure was not yet covered by the government medical insurance system. SEMS placement for malignant colorectal obstruction started to be covered by the insurance system, and rapid increase of the use of this procedure is anticipated in Japan. SEMS placement is associated with severe complications, however, such as perforation and stent migration ; it is therefore necessary to establish a consensus for this procedure. The Japan Gastroenterological Endoscopy Society is currently attempting to build a common procedure, and we precisely report herein on the tips for the choice of catheter, guidewire, stent length and how to handle the scope.
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  • ENDOSCOPIC MANAGEMENT FOR BILIARY STRICTURES AFTER LIVING DONOR LIVER TRANSPLANTATION WITH DUCT-TO-DUCT RECONSTRUCTION
    Hironari KATO, Ichiro SAKAKIHARA, Hiroyuki OKADA, Kazuhide YAMAMOTO
    2013 Volume 55 Issue 2 Pages 316-328
    Published: 2013
    Released on J-STAGE: May 21, 2013
    DOIhttps://doi.org/10.11280/gee.55.316
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    Biliary complications after living donor liver transplantation (LDLT) with duct-to-duct reconstruction are one of the most common postoperative complications, and they are associated with postoperative morbidity and mortality. Biliary strictures are a major issue among all biliary complications, and which still require resolution. Endoscopic procedures such as balloon dilation and stent deployment are available as primary therapies for patients with biliary strictures after LDLT. However, endoscopic procedures after LDLT are more technically demanding than those after deceased donor liver transplantation (DDLT) or other biliary operations because of anatomy-associated reasons. Endoscopic procedures include the endoscopic retrograde cholangiography, the passage of the guidewire through the strictures, the balloon dilation and the stent deployment. Each procedure has its own difficulties which we should overcome. Moreover, in LDLT, it is sometimes difficult to understand the run of the bile ducts due to rotation and hypertrophy of the transplant liver. Therefore, we should have the information from the surgeon about the type of sutures and the image inspection such as MRCP before endoscopic procedures. Since each case is different regarding the degree of the strictures and the run of the bile ducts, specific treatments are necessary on a case-by-case basis. To obtain more favorable outcomes, more effective procedures with refined devices need to be established.
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