GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 55, Issue 6
Displaying 1-16 of 16 articles from this issue
  • Tetsuji TAKAYAMA, Toshi TAKAOKA, Hidetoshi AOKI, Koichi OKAMOTO
    2013 Volume 55 Issue 6 Pages 1787-1795
    Published: 2013
    Released on J-STAGE: August 28, 2013
    JOURNAL FREE ACCESS
    Adenoma is recognized as a precursor lesion of colorectal cancer in the traditional colorectal carcinogenesis theory, the adenoma-carcinoma sequence. Another colorectal carcinogenesis theory, the so-called serrated pathway, was recently proposed, and traditional serrated adenoma (TSA) and sessile serrated adenoma/polyp (SSA/P) have been additionally recognized as precursor lesions of colorectal cancer. The cancer component in adenoma, TSA and SSA/P has been reported to account for approximately 10%. This indicates that the malignant potential of the three precursor lesions is equivalent. Hamartomatous polyps, including Peutz-Jeghers syndrome and juvenile polyposis, also have the potential to develop into carcinoma lesions, although at a relatively low incidence. Dysplasia occurs on the longstanding inflammatory background mucosa in cases of ulcerative colitis (dysplasia-carcinoma sequence). Aberrant crypt foci are clusters of abnormal crypts which can be visualized using a stereoscopic microscope or magnifying endscope after staining the mucosal surface with methylene blue. It has been suggested that ACF are the earliest detectable precancerous lesions of colorectal cancer. However, it still remains controversial whether ACF actually develop into a polyp and carcinoma eventually.
    Download PDF (6833K)
  • Shigetsugu TSUJI, Hisashi DOYAMA, Yoshibumi KANEKO, Kunihiro TSUJI, Sa ...
    2013 Volume 55 Issue 6 Pages 1796-1805
    Published: 2013
    Released on J-STAGE: August 28, 2013
    JOURNAL FREE ACCESS
    [Purpose]The aim of this study was to clarify the discrepancies in the histologic diagnosis of early gastric cancer between biopsy diagnosis and postoperative pathologic diagnosis, and also to determine the optimal number of endoscopic biopsy specimens required to obtain an accurate diagnosis of early gastric cancer. [Methods]The efficacy of biopsy-based preoperative diagnosis was evaluated in 1330 cases (1083 cases of early gastric adenocarcinoma and 247 cases of gastric adenoma) treated by endoscopic submucosal dissection (ESD) and surgery between January 2004 and July 2010, by comparing the preoperative and postoperative diagnoses. According to the Japanese Gastric Cancer Association classification, epithelial changes present in the biopsy specimens were categorized into Groups III-IV, as well as into the differentiated, undifferentiated or mixed type. Early gastric carcinoma histology was classified into 4 subtypes : pure differentiated (PD), a mixture of differentiated and undifferentiated (differentiated-type predominant : MD ; undifferentiated-type predominant : MU) and pure undifferentiated (PU). [Result]The 359 cases diagnosed as Group III by preoperative biopsy were as follows : adenoma, 66.6% ; PD, 32.9% ; MD, 0.6% ; MU, 0% : PU, 0%. The corresponding percentages for the other classifications were 3.4%, 92.6%, 4.0%, 0% and 0%, respectively (Group IV ; 176 cases), 0.4%, 88.6%, 8.9%, 1.4% and 0.7%, respectively (undifferentiated ; 174 cases), 0%, 4.6%, 3.4%, 8.6% and 83.3%, respectively (differentiated ; 570 cases), and 0%, 25.5%, 33.3%, 19.6% and 21.6%, respectively (mixed ; 51 cases). This study demonstrated that two biopsy specimens were sufficient to provide the correct pathologic diagnoses in early gastrointestinal cancer, and additional biopsies did not increase the accuracy. [Conclusion]Discrepancies between preoperative biopsy-based diagnoses and postoperative pathological diagnoses are not uncommon. Therefore, clinical management based on careful endoscopic observation is of vital importance. Nevertheless, increasing the number of biopsies does not improve the accuracy of histological diagnosis (with two being the optimal number of biopsy specimens). In addition, ESD may at times be required for total biopsy.
    Download PDF (809K)
  • Tomoyuki HAYASHI, Hisashi DOYAMA, Kenichi TAKEMURA, Yasuhito TAKEDA, Y ...
    2013 Volume 55 Issue 6 Pages 1806-1811
    Published: 2013
    Released on J-STAGE: August 28, 2013
    JOURNAL FREE ACCESS
    The number of patients requiring antithrombotic therapy for secondary prevention of ischemic heart disease or brain ischemia is on the increase. Moreover, patients on antithrombotic drugs carry a high risk of bleeding after gastric endoscopic submucosal dissection (ESD). In many cases, postoperative bleeding occurs after resumption of antithrombotic therapy. Herein, we examined the rate of postoperative bleeding, timing of postoperative bleeding, and the rate of resumption of antithrombotic drug therapy in patients with postoperative bleeding. A total of 227 lesions in patients were resected via gastric ESD, after which the patients received antithrombotic therapy. The postoperative bleeding rate in cases prescribed thienopyridine derivatives was significantly higher than that in cases not prescribed thienopyridine derivatives (p<0.001). The timing of postoperative bleeding after ESD in cases prescribed thienopyridine derivatives was significantly later than that in the cases not prescribed thienopyridine derivatives (p = 0.03). The resumption rate of antithrombotic therapy at the time of postoperative bleeding in cases prescribed thienopyridine derivatives was significantly higher than that in the cases not prescribed thienopyridine derivatives (p = 0.003). There was no significant difference in the postoperative bleeding rate between the patients in whom the antithrombotic therapy was withdrawn for a short period preoperatively, based on the guideline of the Japan Gastroenterological Endoscopy Society in 2005 (2008-2012), and those in whom it was withdrawn for a long period preoperatively (2002-2007). Among antithrombotic drugs, thienopyridine derivatives, in particular, have a strong tendency to cause bleeding after gastric ESD, and in many cases, postoperative bleeding occurred after resumption of intake of the thienopyridine derivatives.
    Download PDF (640K)
  • Isao FUJITA, Tatsuya TOYOKAWA, Shizuma OMOTE, Akiko OKAMOTO, Rika MIYA ...
    2013 Volume 55 Issue 6 Pages 1812-1817
    Published: 2013
    Released on J-STAGE: August 28, 2013
    JOURNAL FREE ACCESS
    Case 1 was a 58-year-old man and case 2 was a 91-year-old man. Both cases developed upper abdominal pain and high fever a day after ESD performed for early gastric cancer. CT showed diffuse thickening of the gastric wall. Examination of the blood counts and blood biochemical examination showed high counts of white blood cells and elevation serum CRP levels. Both cases were administered antibiotics, however, since the general condition worsened rapidly, emergency operation was performed in both. Both patients were eventually diagnosed as having phlegmonous gastritis. Phlegmonous gastritis is a rare complication developing after ESD. It is important to carefully observe patients after ESD, especially when they develop severe pain and pyrexia.
    Download PDF (3927K)
  • Yosho FUKITA, Tsutoshi ASAKI, Yoshiki KATAKURA, Toru SAITO, Yasushi KI ...
    2013 Volume 55 Issue 6 Pages 1818-1826
    Published: 2013
    Released on J-STAGE: August 28, 2013
    JOURNAL FREE ACCESS
    Herein, we describe a rare case of a hemorrhagic jejunal diverticulum containing ectopic gastric mucosa. A 27-year-old woman was admitted to our hospital with a history of tarry stools and dizziness. She had experienced anemia-induced syncope at the age of 24 years, at which time esophagogastroduodenoscopy (EGD) and colonoscopy had revealed no abnormalities. On admission, her hemoglobin level was 6.9 g/dL. Computed tomography of the abdomen showed a tumorous lesion measuring 25 mm in diameter in the proximal jejunum, that showed staining with contrast material. EGD revealed a protruding lesion in the proximal jejunum, and oozing of blood was observed from the surface of the lesion. Pathological examination of the biopsy specimens revealed the presence of granulated tissue. In the EGD examination performed 4 months later, the protruding lesion was found to have almost disappeared and the formation of a deep recess with elevation of the margins was observed. Subsequently, surgery was undertaken. During the operation, a smooth red-colored protrusion was observed on the anti-mesenteric side located 2 cm distal from the ligament of Treitz ; accordingly, wedge resection of the jejunum was performed. Pathological analysis of the resected specimen revealed a true diverticulum of the jejunum containing ectopic gastric mucosa. Retrospective inspection of the protruding lesion that was observed endoscopically at admission suggested inversion of the diverticulum, and the formation of a deep recess observed 4 months later seemed to represent spontaneous reduction of the inverted diverticulum.
    Download PDF (4769K)
  • Toshihiro TADANO, Kenji NOGUCHI, Katsuya ENDO, Mikako SUGIMURA, Masahi ...
    2013 Volume 55 Issue 6 Pages 1827-1834
    Published: 2013
    Released on J-STAGE: August 28, 2013
    JOURNAL FREE ACCESS
    A 39-year-old man was admitted to our hospital in a severe shock state following massive bloody stools. We performed upper and lower gastrointestinal endoscopic examinations and capsule ennedoscopy in order to locate the source of the bleeding. The capsule endoscopy revealed that the bleeding originated from the small intestine. Double-balloon enteroscopy revealed blood oozing from the smooth surface of an elevated lesion in the jejunum. Metallic clips and submucosal injection of black ink were applied adjacent to the lesion to mark the lesion. A partial jejunostomy was performed for the purpose of achieving hemostasis. The pathological diagnosis was a ruptured submucosal aneurysm. Herein, we have reported a rare case of a ruptured submucosal aneurysm in the small intestine detected by double-balloon enteroscopy. This experience indicated that a double-balloon endoteroscopy may be useful to clarify the location of a ruptured submucosal aneurysm in the small intestine and may increase the likelihood of achievement of rapid hemostasis.
    Download PDF (2158K)
  • Mitsuhiko SHIBUYA, Makoto ICHIBA, Wataru TAKAGI, Msashi YAMAMOTO, Shir ...
    2013 Volume 55 Issue 6 Pages 1835-1841
    Published: 2013
    Released on J-STAGE: August 28, 2013
    JOURNAL FREE ACCESS
    A 69-year-old male with chronic kidney disease (CKD) undergoing hemodialysis (HD) presented with melena. He had a history of cerebral infarction and was taking low-dose aspirin. Lower gastrointestinal endoscopy revealed stenosis in the transverse colon, which was diagnosed as colonic stenosis associated with a colonic ulcer induced by aspirin use. The stricture was treated by endoscopic balloon dilatation. Herein, we report a case of a colonic stenosis due to an ulcer induced by non-steroidal anti-inflammatory drug (NSAID) use.
    Download PDF (3845K)
  • Kazuya FUJIMORI, Takashi SHIGENO, Yasuhiro MARUYAMA, Masafumi MARUYAMA ...
    2013 Volume 55 Issue 6 Pages 1842-1847
    Published: 2013
    Released on J-STAGE: August 28, 2013
    JOURNAL FREE ACCESS
    An 86-year-old female who had been taking lansoprazole treatment for gastro-esophageal reflux disease was admitted to our hospital with a history of sudden onset of periumbilical pain followed by diarrhea and hematochezia. Colonoscopy revealed a mucosal tear in the descending colon near the splenic flexure, and a longitudinal ulcer associated with blood adhesion in the distal descending colon. Colonic mucosal biopsy revealed thickening of the subepithelial collagen bands and chronic inflammation in the lamina propria, consistent with the typical pathological features of collagenous colitis. The symptoms resolved soon after the lansoprazole treatment was withdrawn. Colonoscopy performed 6 months later revealed scar formation both at the site of the mucosal tear and the longitudinal ulcer, and microscopic examination of biopsy specimens showed disappearance of the collagen bands. Although cases of collagenous colitis usually manifest with chronic watery diarrhea, the case presented herein developed acute abdominal pain and bloody stools, similar to features of ischemic colitis.
    Download PDF (2637K)
  • Hiroyuki ISHIBASHI, Hiromi ABE, Akihiro MIYAKAWA, Tomohiro MATSUSHIMA, ...
    2013 Volume 55 Issue 6 Pages 1848-1853
    Published: 2013
    Released on J-STAGE: August 28, 2013
    JOURNAL FREE ACCESS
    A 46-year-old man was admitted for the treatment of recurrent hemorrhage from esophageal varices associated with extrahepatic portal venous obstruction. He had a history of variceal rupture four times in the previous two years and had received endoscopic band ligation therapy each time. Endoscopy revealed recurrent esophageal variceal rupture, and contrast-enhanced CT showed extrahepatic portal obstruction with cavernous transformation of the portal vein with splenomegaly. Because the splenic vein was not connected to the superior mesenteric vein, but rather to the varices through the large left gastric vein, the condition was considered as “left-sided portal hypertension”, which causes difficulty in the treatment of associated esophageal varices. We performed partial splenic embolization shortly after the endoscopic injection sclerotherapy using 5% ethanolamine oleate. After the therapy, the blood flow in the left gastric vein and esophageal varices was totally blocked by a thrombus and endoscopy and EUS revealed eradication of the esophageal varices. Therefore, this combination therapy appears to be useful for the management of refractory varices.
    Download PDF (2432K)
  • Hideki KOBARA, Hirohito MORI, Shintaro FUJIHARA, Noriko NISHIYAMA, Mit ...
    2013 Volume 55 Issue 6 Pages 1854-1863
    Published: 2013
    Released on J-STAGE: August 28, 2013
    JOURNAL FREE ACCESS
    Full-thickness closure of GI wall defects is a long-cherished dream in the field of flexible endoscopy. A novel clipping device, the Over-The-Scope-Clip (OTSC) system, was developed to enable full-thickness closure for the treatment of GI bleeding, perforations and fistulae. Several studies have demonstrated the clinical feasibility of the OTSC system. However, there are no clinical reports of the use of the OTSC system in Japan. Therefore, we present our inaugural clinical experiences with the use of the OTSC system in 16 cases. Endoscopic OTSC closure was achieved in 14 out of the 16 cases. In 2 cases of bleeding from gastric ulcer, closure of the ulcers was attempted, but failed due to fibrotic changes. There were no clinically significant complications in any of the 14 successfully treated cases, during or after the procedure. Therefore, we believe that the OTSC system would be a useful and safe device for the management of GI bleeding, perforations and fistulae. However, the OTSC system may have some limitations if the target lesions show chronic fibrosis or measure larger than 3 cm in diameter.
    Download PDF (3325K)
  • Keisuke IWATA, Ichiro YASUDA, Masamichi ENYA, Tsuyoshi MUKAI, Masanori ...
    2013 Volume 55 Issue 6 Pages 1868-1875
    Published: 2013
    Released on J-STAGE: August 28, 2013
    JOURNAL FREE ACCESS
    Background : Celiac plexus neurolysis (CPN) is an established treatment for upper abdominal cancer pain. Recently, endoscopic ultrasound-guided CPN (EUS-CPN) was introduced and has enabled the performance of CPN under real-time imaging guidance, thereby making this technique much safer and easier. However, this procedure is not always efficacious, and a limited number of patients benefit from it. It should not be recommended for patients suspected of having unfavorable outcomes. We determined the predictive factors for response to EUS-CPN in order to enable rational selection of the therapeutic strategy.
    Patients and Methods : Forty-seven consecutive patients who underwent EUS-CPN at our institutions were eligible for this study. Absolute ethanol containing a contrast medium was injected just above the origin of the celiac trunk from the aorta under real-time EUS guidance, and abdominal computed tomography was performed immediately after the procedure to evaluate the distribution of the injected ethanol. The efficacy in pain relief was evaluated based on the pain score at day 7 after EUS-CPN.
    Results : Pain relief was obtained in 32 patients (68.1%). Multivariate analysis using a multiple logistic regression model revealed that direct invasion of the celiac plexus and distribution of ethanol only on the left side of the celiac artery were significant factors for a negative response to EUS-CPN (odds ratio = 4.82 and 8.67, P = 0.0387 and 0.0224, respectively).
    Conclusion : EUS-CPN seems to be less effective in patients with direct invasion of the celiac plexus. Ethanol should be injected on both sides of the celiac axis to obtain greater pain relief.
    Download PDF (1528K)
feedback
Top