GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
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Volume 56, Issue 7
Displaying 1-14 of 14 articles from this issue
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  • THE SAFETY OF ENDOSCOPIC SPHINCTEROTOMY IN PATIENTS RECEIVING ANTIPLATELET THERAPY
    Takeshi TOMODA, Toru UEKI, Syunsuke SAITO, Tomoo FUJISAWA, Toru NAWA, ...
    2014 Volume 56 Issue 7 Pages 2150-2155
    Published: 2014
    Released on J-STAGE: July 29, 2014
    DOIhttps://doi.org/10.11280/gee.56.2150
    JOURNAL FREE ACCESS
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    Guidelines for the management of anticoagulant and antiplatelet therapy for endoscopic procedures provided by the Japan Gastroenterological Endoscopy Society were revised in 2012. In the new guidelines, high-risk endoscopic procedures such as endoscopic sphincteropapillotomy (EST) should be performed without discontinuation of antiplatelet drug in patients with a high risk of thromboembolism. However, no report suggests an association between the use of antiplatelet drug and post-EST bleeding in Japan. Therefore, we examined hemorrhagic complications in patients who underwent EST while they continued to take antiplatelet drug. From October 1, 2010 to January 1, 2013, we performed 312 ESTs in patients with various diseases. In 238 patients who did not take anticoagulant and antiplatelet drug, immediate hemorrhage or post-EST hemorrhage was observed in 16 patients (6.7%) and 6 patients (2.5%), respectively. Among the 45 patients who had taken some anticoagulant and antiplatelet drug and had stopped taking the drugs before EST, immediate hemorrhage or post-EST hemorrhage was observed in 3 patients (6.7%) and 2 patients (4.4%), respectively. Among 29 patients who had taken some anticoagulant and antiplatelet drug and continued aspirin or cilostazol, immediate hemorrhage or post-EST hemorrhage was observed in 2 patients (6.9%) and no patients, respectively. Our findings suggest that antiplatelet drugs do not cause a significant increase in the risk of bleeding in patients treated with EST.
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  • PRIMARY MALIGNANT MELANOMA OF THE ESOPHAGUS TREATED BY ENDOSCOPIC SUBMUCOSAL DISSECTION
    Takahiro OSUGA, Tamotsu SAGAWA, Yasuhiro SATOU, Tokiko NAKAMURA, Koush ...
    2014 Volume 56 Issue 7 Pages 2156-2162
    Published: 2014
    Released on J-STAGE: July 29, 2014
    DOIhttps://doi.org/10.11280/gee.56.2156
    JOURNAL FREE ACCESS
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    A 70-year-old man was referred to our hospital on suspicion of esophageal malignant melanoma.
    Biopsy of the melanosis was performed by endoscopy. Pathological findings suggested malignant melanoma.
    Endoscopic examination showed a black, flat, elevated lesion with a diameter of 10mm. CT and PET findings showed no evidence of lymph node or distant metastases. No pigmented lesions in the skin or eyes were observed. We conducted endoscopic submucosal dissection (ESD) for the purpose of total biopsy. Atypical cells that contained melanin granules, resulting from the basal layer, were observed histologically to infiltrate into the lamina propria and mucosal epithelium (junctional activity). They were positive for S-100 and MELAN-A by immunostaining. He was diagnosed with malignant melanoma of the esophagus because there was no evidence of systemic malignant melanoma of the skin or mucous membranes.
    The tumor had invaded the lamina propria and the tumor specimen had negative margins without lymphatic invasion or vascular invasion. Although we recommended additional surgical resection, because the patient refused surgery, he is currently under observation without treatment. Although 10 months have passed after endoscopic surgery, there is no evidence of recurrence.
    In this case, resection of esophageal malignant melanoma by ESD was possible because it had been discovered at a very early stage during follow-up of esophageal melanosis.
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  • A CASE OF DUODENAL ADENOCARCINOMA OF BRUNNER'S GLAND ORIGIN REMOVED BY ENDOSCOPIC MUCOSAL RESECTION
    Tadanobu NAGAYA, Tetsuya ITO, Etsuo HARA, Yoko JIMBO, Toshiharu TATAI, ...
    2014 Volume 56 Issue 7 Pages 2163-2170
    Published: 2014
    Released on J-STAGE: July 29, 2014
    DOIhttps://doi.org/10.11280/gee.56.2163
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    An 86-year-old man was found to have a duodenal submucosal tumor (SMT)-like lesion by esophagogastroduodenoscopy (EGD) that was classified as an adenocarcinoma based on a biopsy specimen. He was referred to our hospital for further examination and treatment. The tumor was located on the second part of the duodenum and had a depression on its apical surface. It was identified as an early carcinoma by duodenography, endoscopic ultrasonoscopy, and computed tomography (CT). Based on these findings, we treated the patient with endoscopic mucosal resection (EMR). Histological examination of the resected specimen revealed a well differentiated tubular adenocarcinoma that had invaded the submucosa, but not the lymphatic vessels or vessels. Histologically, the adenocarcinoma originated from hyperplasic Brunner's glands, and therefore we diagnosed it as a duodenal adenocarcinoma of Brunner's gland origin. Immunohistochemical staining indicated positive results for gastric mucin markers such as MUC5AC and MUC6, and negative results for intestinal mucin markers such as MUC2 and CD10. Thus, his duodenal tumor was believed to be a duodenal carcinoma arising from Brunner's glands.
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  • A CASE OF METASTASIS OF RENAL CELL CARCINOMA TO THE SMALL INTESTINE DETECTED BY SINGLE BALLOON ENDOSCOPY
    Masabumi KANEKO, Masafumi NOMURA, Shinya MITSUI, Tokuma TANUMA, Kayo M ...
    2014 Volume 56 Issue 7 Pages 2171-2176
    Published: 2014
    Released on J-STAGE: July 29, 2014
    DOIhttps://doi.org/10.11280/gee.56.2171
    JOURNAL FREE ACCESS
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    A 53-year-old woman underwent right nephrectomy for renal cell carcinoma in April 2009. She was found to have anemia around April 2010, but no source of bleeding was identified by gastroscopy or colonoscopy. Since small-bowel bleeding was suspected, single balloon enteroscopy was performed in July 2011, and four type 2-like lesions with submucosal tumor-like elevation were detected in the jejunum. These lesions were diagnosed as small bowel metastases from renal cell carcinoma by biopsy and partial enterectomy was performed.
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  • A CASE OF NON-OCCLUSIVE MESENTERIC ISCHEMIA IN THE UPPER JEJUNUM OBSERVED BY TRANSGASTROSTOMIC ENDOSCOPY
    Shigenori MASAKI, Hirokazu TAKAHASHI, Keisuke YAMAKITA, Shingo HONJO, ...
    2014 Volume 56 Issue 7 Pages 2177-2182
    Published: 2014
    Released on J-STAGE: July 29, 2014
    DOIhttps://doi.org/10.11280/gee.56.2177
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    An 83-year-old man was fed through a gastrostomy tube and underwent rehabilitation at our hospital due to aftereffects of subarachnoid hemorrhage. Non-occlusive mesenteric ischemia (NOMI) in the upper jejunum occurred in March 2012. Transgastrostomic endoscopy (TGE) was performed to inspect how the jejunal mucosa was damaged on day 1. Abrasion and edema of the mucosa with oozing were observed along a span of over 30 centimeters of the upper jejunum. Mucosal necrosis over a wide area was observed by TGE on day 9. This is a valuable case in which NOMI was observed by TGE.
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  • A CASE OF SUBCAPSULAR HEPATIC HEMATOMA AFTER ERCP
    Shigeto YOSHII, Kazuyoshi OTA, Ai MATSUURA, Tomoyuki SUEHIRO, Taiki MO ...
    2014 Volume 56 Issue 7 Pages 2183-2189
    Published: 2014
    Released on J-STAGE: July 29, 2014
    DOIhttps://doi.org/10.11280/gee.56.2183
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    An 86-year-old woman with several common bile duct stones was hospitalized. She underwent ERCP for choledocholithiasis with lithotripsy and stone extraction four times. At 30 hours after the 4th procedure, the patient complained of right upper quadrant abdominal pain. A computed tomography scan was performed, and revealed a cystic lesion on the surface of the right lobe of the liver. The cystic lesion was demonstrated by percutaneous needle aspiration to be a subcapsular hepatic hematoma. Because she was apyrexial and hemodynamically stable, she was conservatively managed with a broad-spectrum antibiotic and gradually recovered. Subcapsular hepatic hematoma is an extremely rare complication of ERCP, but the occurrence of abdominal pain after ERCP should raise the suspicion of this complication.
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  • A STUDY ON SAFE INSERTION OF A TRANSANAL ILEUS TUBE IN CASE OF DIFFICULTY WITH THE NORMAL PROCEDURE
    Takahiro ABE, Tsuyoshi ABE, Motoyoshi IZUMI, Emiko TANIDA, Tomohisa NA ...
    2014 Volume 56 Issue 7 Pages 2190-2195
    Published: 2014
    Released on J-STAGE: July 29, 2014
    DOIhttps://doi.org/10.11280/gee.56.2190
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    Transanal ileus tube insertion is useful to avoid emergency operation in case of ileus due to advanced colon carcinoma. However, in some cases, it is difficult to insert ileus tubes or guidewires through the stenotic portion. This study shows the potential of thin endoscopes and guidewires, which are usually used in endoscopic retrograde cholangiopancreatography (ERCP), in cases that failed by the standard method. We evaluated whether using nasal endoscopes and guidewires for ERCP could help with safe insertion of a decompressive tube through the malignant stenotic section of the colon without any complications. We reviewed 24 cases of insertion of a transanal ileus tube between October 2008 and August 2011 in our hospital. We evaluated the method of transanal ileus tube insertion. In 15 out of 24 cases, ileus tubes were inserted by an alternative procedure, without any complications.
    In cases with unsuccessful attempt to insert the decompressive tube, a thin endoscope or guidewires for ERCP can be used to facilitate safe insertion.
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  • A KNACK FOR PERCUTANEOUS ENDOSCOPIC GASTROSTOMY AND TECHNIQUES TO AVOID COMPLICATIONS
    Mikako TAKAHASHI
    2014 Volume 56 Issue 7 Pages 2198-2210
    Published: 2014
    Released on J-STAGE: July 29, 2014
    DOIhttps://doi.org/10.11280/gee.56.2198
    JOURNAL FREE ACCESS
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    Details of the percutaneous endoscopic gastrostomy (PEG) procedure such as classification of technique, endoscope insertion route (transnasal vs. transoral), effect of endoscope insertion position and design of the inserting point are described here.
    There are two methods of performing PEG, the pull/push method and introducer method. The two methods are distinguished by the catheter insertion route, i.e., whether it is inserted through the oral cavity or not. The pull/push method is, in other words, “upward” insertion and the introducer method is “downward” insertion.
    We must use different techniques and methods according to the specific cases. Especially in laryngeal MRSA carriers, patients with stenosis of esophagus, and head and neck tumor patients with an esophagus lesion, the introducer method is required. On the other hand, in patients with obesity and patients where gastropexy failed, the pull/push method is desired.
    In every case, gastropexy is required to safely perform PEG. Especially in case of inadvertent removal of the catheter before fistula formation, gastropexy inhibits progression of serious peritonitis.
    Complications of PEG include bleeding, inadvertent puncture of another organ, pneumonia, paralytic ileus, peritonitis, pneumoperitoneum, and wound infection.
    Misplacement of the catheter into the peritoneal cavity leading to misinjection of enteral formula is the most serious complication associated with catheter replacement. To avoid this complication, we must confirm that the new catheter is placed in the stomach.
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  • EFFICACY OF ACETIC ACID-SPRAYING METHOD IN DIAGNOSING EXTENSION OF BARRETT'S CANCER UNDER THE SQUAMOUS EPITHELIUM
    Taku YAMAGATA, Dai HIRASAWA, Naotaka FUJITA, Takashi OBANA, Toshiki SU ...
    2014 Volume 56 Issue 7 Pages 2211-2219
    Published: 2014
    Released on J-STAGE: July 29, 2014
    DOIhttps://doi.org/10.11280/gee.56.2211
    JOURNAL FREE ACCESS
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    Aim : Endoscopic diagnosis of the lateral extension of Barrett's cancer under the squamous epithelium (BCUS) is sometimes difficult because the cancer is unobservable in the esophageal lumen. The aim of the present study was to clarify the endoscopic features of the extension of BCUS and verify the usefulness of the acetic acid-spraying method (AAS) for diagnosis.
    Methods : A total of 25 patients with Barrett's cancer who had undergone endoscopic resection were included in this study. Histological examination of patients' resected specimens was performed to identify the presence of BCUS. Then, the endoscopic images of the BCUS cases were reviewed to summarize the findings and to evaluate the feasibility of diagnosing the extent of BCUS with each imaging technique.
    Results : Of the 25 patients, 10 (40%) had BCUS. With white-light imaging, subtle reddish change was observed in the area of BCUS in 80% of the patients, and a flat elevated lesion was recognized in 30%. With narrow band imaging, slight brownish change was observed in the area of BCUS in 86% of the patients. Slight white changes were visualized in all cases with AAS. The extension of BCUS was correctly diagnosed by white-light imaging, narrow band imaging and AAS in 50%, 43% and 100% of the cases, respectively. Histology verified the opening of cancerous glands, which extended under the squamous epithelium, into the esophagus in the area showing slight white changes by AAS.
    Conclusion : AAS can be useful for diagnosing the extension of BCUS.
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