The purpose of this study was to determine the endoscopic features of duodenal involvement in mantle cell lymphoma. Eleven patients with multiple protruding lesions were analyzed in this study. Macroscopically, multiple minute polyploid lesions, verrucous lesions, the mixed type of multiple minute polyploid lesions and verrucous lesions and submucosal tumor-like lesions were observed in 3, 3, 2 and 3 cases respectively. The multiple tiny polyploid lesions were not associated with erosive changes. Meanwhile, all verrucous lesions and submucosal tumor-like lesions presented with an erosive surface except for one verrucous lesion. In order to diagnose mantle cell lymphoma as early as possible, lesions in the duodenum presenting these endoscopic findings need to be biopsied.

View full abstract

Background : Accurate preoperative diagnosis of a mucinous gastric cancer is challenging. Several studies have described endoscopic characteristics of early mucinous gastric cancer (EMGC) ; however, to the best of our knowledge, findings of narrow-band imaging with magnifying endoscopy (NBI-ME) of EMGC have yet to be investigated.
Objective : In this case-series, we evaluated the usefulness of NBI-ME to preoperatively identify mucinous components within the early stage gastric cancer.
Methods : Six cases of EMGC at our institution from July 2007 to January 2011 were reviewed. We compared the NBI-ME findings with the corresponding histology. NBI-ME findings investigated in this study were as follows : 1) color, 2) micro-surface pattern, 3) micro-vascular pattern and 4) whitish structures and substances on the lesions.
Results : EMGC evaluated in this study consisted of 5 cases of differentiated-type mucosal cancer (pap-tub1-tub2) and 1 case of undifferentiated-type mucosal cancer (sig). A whitish mucous was observed between the irregular granular or papillary structures in the former cases, while no such surface structures were observed in the latter case. In addition, variously sized whitish round structures were observed in 5 (83.3%) of the 6 EMGCs. Histology indicated that the majority of mucus discharge could be found between cancerous glands. A cotton wool appearance was observed in 2 (33.3%) cases, which represented mucus discharged in large amounts histologically. These findings were characteristic of EMGC.
Conclusion : Endoscopic examination using NBI-ME would be useful for diagnosing EMGC.

View full abstract

The patient was a 66-year-old female who complained of dysphagia. Upper gastrointestinal endoscopy showed a pedunculated polypoid lesion covered with a whitish lining based on a submucosal tumor-like protrusion in the thoracic esophagus. Biopsy specimens revealed a lobular architecture under the normal squamous epithelium. Immunohistochemical analysis demonstrated Factor VIII and CD31 in the tumor cells and suggested the lesion was a type of hemangioma. The lesion was diagnosed as a pyogenic granuloma of the esophagus, and endoscopic submucosal dissection was performed. Although pyogenic granuloma is benign, endoscopic treatment is recommended because of the risk of hemorrhage. Cases of pyogenic granuloma of the esophagus are rare, and to our knowledge, only 16 cases including our case have been reported in Japan. This is the first case presenting a POLYPOID LESION on a SUBMUCOSAL TUMOR-LIKE base.

View full abstract

We report here two cases of superficial esophageal squamous cell carcinoma (SESCC) on esophageal varices. The first case was a 59-year-old man and the second was a 47-year-old man. Both of these men had alcoholic liver cirrhosis, and they had SESCC lesions on esophageal varices diagnosed based on the results of narrow-band imaging magnified endoscopy (NBIME). The results also indicated the lesion extended into the muscularis mucosae. We removed these two tumors by ESD following intravariceal endoscopic injection sclerotherapy of underlying varices with fluoroscopic guidance (intra-EIS).
En bloc resection of the lesions was achieved without any adverse events.
Histological evaluation of the sampled specimens showed the lesions were squamous cell carcinomas that had invaded the muscularis mucosae (T1a-MM).
There was no cancer recurrence within 24 months for the first case and no recurrence within 18 months in the second case.
ESD following intra-EIS could be a reliable and safe endoscopic therapy for SESCC lesions on esophageal varices.

View full abstract

The patient was a 70-year-old woman. An esophagogastroduodenoscopy (EGD) performed for preoperative screening prior to sigmoid colon cancer removal revealed a protruded semi-pedunculated lesion on the lower posterior wall of the cardia. Biopsy specimens from the apex of the lesion were histologically diagnosed as moderately-to well-differentiated tubular adenocarcinoma, although specimens obtained from the base of the lesion were found to be non-neoplastic. Endoscopic treatment was then scheduled after her colorectal surgery, but EGD performed 3 and 7 months later did not show the presence of a lesion. EGD performed 15 months later, however, revealed type 0-IIc cancer at the site where the protruded lesion was originally identified. The cancer was radically excised utilizing ESD. We report here a case of early-diagnosed gastric cancer that showed a change in morphology from type 0-I to type 0-IIc, which could be followed up chronologically.

View full abstract

A 68-year-old man had been suffering from abdominal distension for several weeks. Endoscopic examination found a bezoar in the remnant stomach.
The patient received dissolution therapy with cola. The following day, the partially dissolved persistent bezoar was mechanically broken up and removed using a snare. The combination of dissolution therapy with cola and endoscopy snare lithotripsy proved useful in removing the gastric bezoar.

View full abstract

A 73-year-old male underwent subtotal esophagectomy and posterior mediastinal gastric tube reconstruction for esophageal cancer. Six years after surgery, he underwent endoscopic submucosal dissection (ESD) for early-stage gastric tube cancer. There were no signs of perforation or any other coincidental complication ; however, fever and right pleural effusion developed the following day, indicating the possibility of mediastinitis or pleuritis. Although his condition improved with fasting and antibiotic medication, fever recurred 3 weeks after the ESD, and he had to be re-hospitalized. Right pyothorax was observed, and chest drainage revealed chylous fluid. The patient recovered with conservative treatment after drainage, and he was discharged 1.5 months later. This is the first case report of pyothorax and chylothorax after ESD for gastric tube cancer.

View full abstract

We report here a rare case of a gastric inflammatory fibroid polyp, which caused ball valve syndrome. An 85-year-old man who was followed up for a gastric submucosal tumor at our outpatient clinic was admitted to our hospital due to epigastric pain and vomiting. An emergency endoscopy, upper gastrointestinal series and abdominal computed tomography showed that the gastric submucosal tumor had prolapsed into the duodenum, and the symptoms were considered to have been induced by ball valve syndrome. Local surgical resection of the stomach was chosen to treat the ball valve syndrome. A surgical specimen revealed an inflammatory fibroid polyp in the stomach.

View full abstract

We have been working on the development of an endoscopic full-thickness resection (EFTR) method as the first step to establish a pure natural orifice translumenal endoscopic surgery (NOTES) as part of the Kagawa NOTES project, which is a collaborative project team involving industry, academia, and government in the fields of medicine and engineering. We introduced the EFTR technique with laparoscopic assistance as a hybrid NOTES approach for removal of endolumenal growth type gastric GISTs in 2009. In this paper, we retrospectively review the clinical outcomes of ten patients who underwent EFTR utilizing the hybrid NOTES approach. Considering our preliminary clinical experiences using the EFTR method and the hybrid NOTES approach, the development of a reliable suturing device and mechanical countertraction system is essential for the safe performance of pure endolumenal EFTR without laparoscopic support. In vivo animal experiment, we have developped non-insufflation EFTR using these devices such as suturing device and countertraction system.

View full abstract

In order to detect squamous cell carcinoma in the oropharyngeal and hypopharyngeal fields at an earlier stage, the use of a questionnaire is a practical means to identify patients with a high risk of developing neoplasia. Our screening procedure is as follows. First, the patient is asked to bow their head deeply in the left lateral position. We then put a hand on the back of the patient's head and push it forward. The patient is then asked to lift the chin as far as possible (lateral sniffing position). In order to inspect the oral cavity, we insert an endoscope without a mouthpiece and observe the upper, lateral and posterior wall of the oropharynx while the patient sticks the tongue forward. After observation of the buccal cavity, further oropharyngeal observation is carried out with a retroflexed endoscope inserted via the nose. The patient is asked to open the mouth wide, stick the tongue forward as far as possible and say “aah” during the oropharyngeal screening.
For examination of the hypopharynx and the orifice of the esophagus, the patient is asked to blow hard and puff their cheeks while the mouth remains closed. The endoscopist pulls the patient's chin forward with the right hand. The posterior wall of the hypopharynx and the postcricoid subsite are tight in most cases. The blowing technique to distend the pyriform fossae and the posterior pharyngeal wall enables the pharyngeal mucosa to be stretched out and also the postcricoid region and the orifice of the esophagus to be visualized in an open space.
Mucosal redness, a pale thickened mucosa, white deposits or loss of a normal vascular pattern are important characteristics to diagnose superficial carcinoma upon examination under white light. Also, well-demarcated areas covered with scattered dots observed upon closer observation indicates potential cancer. The use of image-enhanced endoscopy facilitates the visualization of superficial microvascular structures and allows the detection of a lesion at an earlier stage.

View full abstract