GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 56, Issue 10
Displaying 1-14 of 14 articles from this issue
  • Shotaro NAKAMURA, Takayuki MATSUMOTO
    2014 Volume 56 Issue 10 Pages 3599-3606
    Published: 2014
    Released on J-STAGE: November 01, 2014
    JOURNAL FREE ACCESS
    The recent progress in the clinical diagnosis and treatment strategy in patients with gastrointestinal lymphoma is reviewed. Among all gastrointestinal lymphomas, the most frequent histologic type is mucosa-associated lymphoid tissue (MALT) lymphoma, followed by diffuse large B-cell lymphoma. Recently, the incidence of intestinal follicular lymphoma has been increasing. Balloon-assisted endoscopy and/or capsule endoscopy are essential tools for the diagnosis of small bowel lymphomas. Significant correlation is observed between the macroscopic forms and histologic types both in gastric lymphomas and in intestinal lymphomas. There are various therapeutic modalities including watchful waiting, antibiotics (such as Helicobacter pylori eradication), chemotherapy, radiotherapy, surgical resection, rituximab immunotherapy, and combinations of these. The optimal strategy should be determined based on the involved site, histologic type and clinical stage in each patient.
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  • Kiyonori KUSUMOTO, Akihiko HAMADA, Shinji KATSUSHIMA, Yoshinori MIZUMO ...
    2014 Volume 56 Issue 10 Pages 3607-3616
    Published: 2014
    Released on J-STAGE: November 01, 2014
    JOURNAL FREE ACCESS
    [Purpose] The purposes of this study were to evaluate the degree of awakening from sedation with propofol in patients who underwent upper esophagogastroduodenoscopy (EGD), and clarify the follow-up period required until the patient becomes able to leave the hospital safely. [Methods] The subjects were 104 patients who were sedated with propofol on EGD using the administration method established before this study. The evaluation items consisted of the mean blood pressure, arterial blood oxygen saturation, grip strength, visual acuity, Mini Mental State Examination (MMSE), and reflex nerve test. The results before examination were compared with those at 10 and 60 minutes after completion of the examination. [Results] There were significant decreases in the mean blood pressure, grip strength, and MMSE ten minutes after completion of examination. Although there was a significant decrease in blood pressure 60 minutes after completion of the examination, the value was higher than at 10 minutes. At 60 minutes, the grip strength and MMSE had returned to the pre-examination values. [Conclusion] EGD could be safely performed under sedation with propofol. Sixty minutes after completion of examination, items other than the mean blood pressure had returned to the pre-examination values. The blood pressure met the criterion for leaving the hospital. It may be possible to leave the hospital safely at 60 minutes after EGD.
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  • Michimasa UEDA, Yudai NOMURA, Tomikazu YAMAMOTO, Takahiro YAMADA, Atsu ...
    2014 Volume 56 Issue 10 Pages 3617-3623
    Published: 2014
    Released on J-STAGE: November 01, 2014
    JOURNAL FREE ACCESS
    A 67-year-old woman presented to our hospital because of bloody stools. Colonoscopy revealed an elevated lesion with erosion in the transverse colon. A biopsy specimen showed mucosa-associated lymphoid tissue (MALT) lymphoma on histological examination. Since eradication therapy for Helicobacter pylori failed to reduce the size of the tumor, it was surgically resected together with the regional lymph nodes. Histological examination of the sampled specimen showed involvement of some lymph nodes with the lymphoma. After resection of the transverse colon, MALT lymphoma was also found in the stomach by biopsy. The patient therefore underwent treatment with chemotherapy, resulting in remission of the lymphoma.
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  • Yoshihisa FUKUDA, Kanae SHINOZAKI, Taro ABE, Yusuke HIGUCHI, Rei OTA, ...
    2014 Volume 56 Issue 10 Pages 3624-3630
    Published: 2014
    Released on J-STAGE: November 01, 2014
    JOURNAL FREE ACCESS
    A 74-year-old man with a history of dysphagia due to stroke was admitted to our hospital in order to undergo percutaneous endoscopic gastrostomy (PEG). After receiving nutrition through the gastrostomy tube, he vomited repeatedly and developed aspiration pneumonia. He was diagnosed with gastric volvulus during endoscopic examination of the upper gastrointestinal tract. Removal of fixation sutures from the gastric wall enabled him to receive foods via the gastrostomy tube. Although PEG has been used for treatment of gastric volvulus in adults, we report a case of gastric volvulus associated with PEG.
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  • Yosho FUKITA, Hiroyuki ISHIBASHI, Ikuma YASUDA, Michifumi TOYOMIZU, Se ...
    2014 Volume 56 Issue 10 Pages 3631-3638
    Published: 2014
    Released on J-STAGE: November 01, 2014
    JOURNAL FREE ACCESS
    Herein, we describe a rare case of transient-type ischemic enteritis, in which the lesions were endoscopically observed during the acute and healing phases.
    A 91-year-old woman was transported to our hospital by ambulance because of sudden onset of hematochezia and lower abdominal pain. Abdominal computed tomography showed wall thickening of the distal ileum. Colonoscopy was performed 18 h after onset of symptoms, and revealed mucosal edema and purple protruding lesions in a continuous, circumferentially scattered pattern 10 cm behind the ileocecal valve. The protruding lesions were covered with a pseudomembrane and were suggestive of submucosal hematoma. Fluoroscopic examination of the small intestine with water-soluble contrast agent revealed approximately 20-cm long, thumbprint-shaped projections. After antibiotic administration and intravenous infusion following fasting, her symptoms gradually improved. Colonoscopy performed on hospitalization day 8 showed a circumferential ulcer with slough, and the endoscope could not be inserted because of lumen narrowing in the distal ileum. An oral diet was started, and no signs of bowel obstruction were noted ; therefore, the patient was discharged on day 14. Colonoscopy performed 8 months after disease onset showed an ulcer scar, but lumen narrowing in the distal ileum was not observed. Based on the clinical course and examination results, the patient was diagnosed with transient-type ischemic enteritis.
    The difference in the endoscopic findings at admission and on day 8 in this case suggests that the endoscopic appearance may be different before and 48 h after disease onset, as is observed in ischemic colitis.
    Lumen narrowing may not be observed at disease onset, but may develop 8-9 days after onset, regardless of whether the ischemic enteritis is of the transient type or stricture type.
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  • Takumi KAWAKAMI, Kazuhiro KAMADA, Naoya TOMATSURI, Norimasa YOSHIDA
    2014 Volume 56 Issue 10 Pages 3639-3643
    Published: 2014
    Released on J-STAGE: November 01, 2014
    JOURNAL FREE ACCESS
    We experienced two cases of Henoch-Schönlein Purpura (HSP) using capsule endoscopy (CE) to evaluate the grade of intestinal disorder. Case 1 : A 54-year-old male presented with purpura on extremities, 5 days after he had abdominal pain. Inflammatory infiltrating cells were detected on skin biopsy. After two weeks of conservative therapy, his symptoms persisted and CE showed multiple areas of redness, edema and erosion in the small intestine. We concluded that additional treatment was needed and started steroid therapy. Case 2 : A 53-year-old male had abdominal pain and proteinuria a few days after eruption appeared on his extremities. Leukocytoclastic vasculitis was confirmed on skin biopsy. His anemia worsened two months after starting steroid therapy ; however, the intestinal mucosa was almost normal on CE. Therefore, we considered that bleeding in the gastrointestinal tract was unlikely and continued the steroid therapy. Capsule endoscopy was helpful for deciding the course of treatment for HSP.
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  • Yoshiaki SHIBATA, Yume OKADA, Toshihiko NAGAI
    2014 Volume 56 Issue 10 Pages 3644-3649
    Published: 2014
    Released on J-STAGE: November 01, 2014
    JOURNAL FREE ACCESS
    A 73-year-old man was referred to our hospital, complaining of alternating bouts of diarrhea and constipation. Colonoscopy showed a large number of polypoid lesions at the terminal ileum. Histological examination showed diffuse infiltration of atypical lymphocytes at the marginal zone of the lymph node follicle, and immunohistochemical analysis showed that they were positive for CD20, CD79α, and bcl-2, but negative for CD10, CD5, and cycline D1. We diagnosed mucosa-associated lymphoid tissue (MALT) lymphoma of the ileum, clinical stage II1 based on the Lugano International Conference classification. Ileocecal resection and partial resection of the ileum were performed. Pathologic examination showed multiple lymph node metastases in the mesenteric lymph nodes. Although adjuvant chemotherapy was performed with 2 courses of R-THP-COP, lymphoma recurred at 3 years after surgery. Complete remission was obtained again with chemotherapy by two courses of R-CHOP. Seven years after the surgery, the patient is still alive.
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  • Yasuyuki GEN, Hayato FUKUI, Akifumi FUKUI, Osamu DOHI, Masayasu JO, Ka ...
    2014 Volume 56 Issue 10 Pages 3650-3655
    Published: 2014
    Released on J-STAGE: November 01, 2014
    JOURNAL FREE ACCESS
    Cholecystocolic fistula is a rare complication of acute cholecystitis, and generally requires surgery. A 74-year-old man was admitted because of acute calculous cholecystitis. After PTGBD (percutaneous transhepatic gallbladder drainage) was carried out, a cholecystocolic fistula was observed. Because the patient was in a bedridden state with dementia, surgical therapy for the cholecystitis and the fistula would be difficult. Therefore, we tried endoscopic closure of the fistula using an over-the-scope clip (OTSC). Finally, the cholecystitis improved and the fistula was successfully closed.
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  • Naohisa YOSHIDA, Yuji NAITO, Nobuaki YAGI, Akio YANAGISAWA, Yoshito IT ...
    2014 Volume 56 Issue 10 Pages 3660-3670
    Published: 2014
    Released on J-STAGE: November 01, 2014
    JOURNAL FREE ACCESS
    A new endoscope system, “LASEREO”, developed by Fujifilm uses a semiconductor laser as the light source. It has the narrow-band light observation function, which is named Blue laser imaging (BLI), without a customized optical filter. The LASEREO system has 2 kinds of lasers whose wavelengths are 410 nm and 450 nm. Additionally, both of the bandwidths are less than about 2 nm, compared to the bandwidth of narrow band imaging (NBI) of 30 nm. The BLI mode allows us to see detailed vessels and clear surface patterns. By controlling the power of the 2 lasers, a “BLI-bright” mode can be set and this mode is brighter than the BLI mode, and it is expected to be useful for tumor detection. We have already reported the efficacy of BLI magnification for diagnosis of neoplastic tumors using the NBI classification such as Sano classification and Hiroshima classification in the multicenter study. Moreover, we have also reported the efficacy of BLI for diagnosis of non-neoplastic and neoplastic colorectal lesions. The diagnostic accuracy of BLI magnification was 84.3% (265/314). Additionally, the diagnostic accuracy was higher for polyps <20 mm in diameter than for polyps ≥20 mm in diameter (92.1% vs. 72.5% ; P=0.000003 [<0.001]). In view of morphology, the diagnostic accuracy was significantly lower for superficial polyps ≥20 mm in diameter than for superficial polyps <20 mm in diameter (70.0% vs. 82.9% ; P=0.03 <0.05). As a technical aspect for diagnosing colorectal lesions, BLI magnification allows better detection of surface pattern compared with NBI.
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