Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD), is associated with various complications during its chronic remittent course. In the long-term duration of the disease process, colorectal cancer (CRC) in UC and CD and small intestinal cancer in CD are the most serious and life-threatening hazards. Evaluation of the incidence, risk factors and confounding factors have been considered with regard to CRC and / or intestinal cancer and surveillance methods have been established to lessen the burden of IBD patients. In this review recent epidemiological trends and risk factors, especially the trend of CRC in Japanese with IBD are presented and discussed. Finally, an endoscopic surveillance program should be indicated for those with UC and UD in Japan.

View full abstract

Background and Aims : The prevention of mucosal damage by LDA/NSAID is an important concern for general clinical practitioners. Our purpose was to determine yearly changes in the frequency of hemorrhagic LDA/NSAID ulcers in 562 cases of hemorrhagic gastro-duodenal ulcers and practitioners' attitudes on the prevention of hemorrhagic LDA/NSAIDs ulcers. Methods : We investigated the change in frequency of LDA ulcers and NSAID ulcers among digestive-tract hemorrhagic ulcers encountered between 2000 and 2012. We additionally distributed a questionnaire to determine the attitudes of general clinical practitioners concerning prevention of these hemorrhagic ulcers. Results : In contrast to the number of NSAID ulcers, which has been growing yearly, the number of LDA ulcers has been declining since reaching a peak in 2005. LDA ulcers recently dropped to 4% of hemorrhagic ulcers. Results of our questionnaire showed that when NSAIDs are prescribed, gastro-mucosal protective agents are the most used medicines for hemorrhagic-ulcer prevention with 27.9% of physicians prescribing a proton pump inhibitor (PPI). When LDAs are prescribed, a PPI is the most used medicine with a higher rate of 45.3%. Conclusion : It can be considered that the use of PPIs for preventive treatment of LDA ulcers is steadily becoming more common and digestive-tract hemorrhage due to LDA is decreasing.

View full abstract

A 76-year-old man was admitted with upper abdominal pain. Abdominal CT showed a cystic lesion 15 cm in diameter between the stomach and the pancreas and a pancreatic stone within the main pancreatic duct. Esophagogastroduodenoscopy (EGD) showed extra compression to the posterior wall of the gastric body. Six days after admission, he developed a high fever. We suspected a pancreatic pseudocyst caused by chronic pancreatitis and performed endoscopic ultrasound-guided drainage (EUS-D). After EUS-D, the intracystic infection was improved and he was discharged 2 months after admission. CT 9 months after discharge showed a thickening of the cystic wall, and a malignant tumor was suspected. Gastrointestinal tumor (GIST) of the stomach was confirmed by EUS-guided fine-needle aspiration, which was followed by laparotomy. We report this case because GISTs of this type and course are rare. We believe that this may be a valuable case for discussions of treatment of GISTs of the stomach that are associated with infections.

View full abstract

A 45-year-old male with no particular complaints underwent a medical examination. Transnasal upper gastrointestinal endoscopy showed a type IIc tumor, measuring approximately 5 mm in diameter, located on the right posterior wall in the 2nd portion of the duodenum. We performed an endoscopic resection of this lesion, which had been diagnosed as early duodenal cancer. Consequently, the duodenal cancer was successfully resected without any complications, and pathologically curative resection was achieved. There are no reports in the literature of early duodenal adenocarcinoma detected by transnasal endoscopy.

View full abstract

Long-term biliary stenting for cholangitis caused by common bile duct stones had been performed in a 94-year-old female. She was admitted to our hospital 4 years later at the age of 98 because of hemobilia caused by biliary stent migration. On the 8th day after admission, she went into hemorrhagic shock and CT scan revealed massive hemobilia and liver hemorrhage. TAE was performed and the bleeding was controlled successfully.

View full abstract

The typical endoscopic appearance of Chlamydia trachomatis proctitis is described as “salmon roe-like rectal mucosa” or “semispherical nodules.” However, we experienced cases with an atypical appearance of Chlamydia trachomatis proctitis, and we here report findings of colonoscopic examinations of such cases. We surveyed findings of 28 cases with the diagnosis of Chlamydia trachomatis proctitis. In many of our cases of Chlamydia trachomatis proctitis nodules were absent or the patient had atypical nodular lesions. At the first colonoscopic examination of the 28 cases, 3 (10.7%) had semispherical nodules, 15 (53.6%) had short nodules and 10 (35.7%) did not have nodules. Among these 10 cases, the lesions were described as “erosion,” “aphtha,” or “erythematous.” We believe that atypical colonoscopic findings of Chlamydia trachomatis proctitis occur in many cases and that there is a need for accumulation and consideration of more such cases.

View full abstract

We retrospectively analyzed cases with malignant colonic obstruction treated with a Niti-S D-type stent and clarified its usefulness. Colonic stenting was performed in 15 cases (12 palliatively ; 3 preoperatively). Colonic stents were properly deployed in all cases. The mean score using the Colorectal Obstruction Scoring System was 1.3 before stenting and 3.8 after stenting. Patients treated with colonic stenting preoperatively experienced rapid improvement in symptoms and underwent single-stage surgery after stenting. Among patients treated with colonic stenting palliatively, 2 developed colonic re-obstruction as a delayed adverse events during the mean follow-up period of 92 (17-380) days. Four patients received chemotherapy after stenting without adverse events. At present, two types of colonic stents are available under health insurance coverage in Japan. A prospective randomized study evaluating long-term outcomes with the use of these stents is needed.

View full abstract

Endoscopic ultrasound with a convex echoendoscope requires positioning of the transducer in three different stations such as the stomach, bulb and descending part of the duodenum. Basic maneuvers include advancement, rotation and deflection by which the bile duct and the duct and parenchyma of the pancreas are continuously observed through confirmation of neighboring organs and vessels. Doppler imaging is employed for discrimination of pancreatobiliary ducts from vessels. The transgastric approach provides images of the liver, the body and tail of the pancreas, and part of the pancreas head. Advancement of the echoendoscope along the portal vein demonstrates the head and body of the pancreas by the confluence. Clockwise rotation of the echoendoscope from the confluence demonstrates the tail of the pancreas. Observation from the bulb of the duodenum provides images of the gallbladder, bile duct, confluence, head of the pancreas, and part of the pancreas body. Clockwise and counterclockwise rotations of the echoendoscope from the confluence demonstrate the head and neck of the pancreas, respectively. Advancement of the echoendoscope along the bile duct demonstrates the proximal side of the duct. Observation from the descending part of the duodenum provides images of the head of the pancreas and the ampulla. After stretching the echoendoscope into the descending part of the duodenum, a longitudinal image of the abdominal aorta is achieved. The lower part of the pancreas head is located at the upper right side of the image. Slow withdrawal of the echoendoscope demonstrates the ampulla.

View full abstract

[in Japanese]

View full abstract