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Volume 57, Issue 1
Displaying 1-11 of 11 articles from this issue
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Shiko KURIBAYASHI, Akiyo KAWADA, Hiroko HOSAKA, Taku TOMIZAWA, Hidetos ...2015 Volume 57 Issue 1 Pages 3-14
Published: 2015
Released on J-STAGE: February 13, 2015
JOURNAL FREE ACCESSSince Barrett's esophagus is a risk factor for developing adenocarcinoma, it is important to detect dysplastic areas in Barrett's esophagus. However, it is difficult to detect dysplastic areas because of inflammation caused by gastroesophageal reflux. Several methods, such as chromoendoscopy with methylene blue, crystal violet or indigo carmine, magnification endoscopy with acetic acid spraying and image-enhanced endoscopy, are used for the detection of dysplasia or cancer.
There are two layers of muscularis mucosae in Barrett's esophagus of which the deeper layer is the essential layer of the esophagus. Therefore, Barrett's-associated intramucosal adenocarcinoma or Barrett's adenocarcinoma infiltrating within the lamina propria is an indication for endoscopic treatment. Although endoscopic resection and ablation are performed for the treatment of Barrett's adenocarcinoma, endoscopic resection, which allows us to make pathological assessment precisely, is more common in Japan.View full abstractDownload PDF (2340K)
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Daisuke YAMAGUCHI, Kenta NIO, Tomomi YOSHIOKA, Yasuhisa SAKATA, Ryo SH ...2015 Volume 57 Issue 1 Pages 15-20
Published: 2015
Released on J-STAGE: February 13, 2015
JOURNAL FREE ACCESSBrachyspira pilosicoli (B. pilosicoli) is the etiologic agent of human and animal intestinal spirochetosis ; however, it is rarely implicated as a cause of sepsis. A 61-year-old female patient presented to Saga Medical School Hospital with symptoms of fever and lower abdominal pain. We diagnosed the patient as having sepsis based on her symptoms of high fever and tachycardia. The patient had rheumatoid arthritis and was receiving steroid therapy. Abdominal CT scan showed thickened intestinal wall. Colonoscopy revealed multiple erythematous lesions in the ascending and transverse colon. Histopathological examination of biopsy specimens identified intestinal colonization by bacteria. Blood cultures were positive after 10 days of incubation. The isolate was identified as B. pilosicoli by nucleotide sequencing analysis of bacterial 16S rRNA gene. The patient was treated successfully with antibiotics, and her clinical symptoms improved. This case suggests that B. pilosicoli colitis can cause sepsis in immunocompromised patients.View full abstractDownload PDF (3560K) -
Kousuke MINAGA, Youhei YABUUCHI, Hiroyoshi IWAGAMI, Keiichi HATAMARU, ...2015 Volume 57 Issue 1 Pages 21-29
Published: 2015
Released on J-STAGE: February 13, 2015
JOURNAL FREE ACCESSAn 86-year-old male was admitted to our hospital for evaluation of obstructive jaundice and upper abdominal pain. Two months earlier, he had undergone palliative Billroth II gastroenterostomy for bleeding due to duodenal cancer. Computed tomography demonstrated a dilated bile duct and lower bile duct stricture due to probable duodenal cancer invasion. Therefore, endoscopic retrograde cholangiopancreatography (ERCP) was attempted using a long pediatric colonoscope (PCF-240L). Although we could endoscopically reach the papilla of Vater, repeated attempts to cannulate the bile duct were unsuccessful. Endoscopic ultrasonography (EUS) demonstrated a dilated intrahepatic bile duct in the left lobe (B2) ; therefore, an EUS-guided rendezvous technique was performed. We punctured the dilated bile duct (B2) via the transgastric approach under EUS guidance using a 19-gauge FNA needle, and a long 0.035-inch guidewire was advanced across the lower bile duct stricture and papilla into the duodenum. The echoendoscope was then removed and a long pediatric colonoscope (PCF-240L) was inserted. The transpapillary guidewire was retrieved with a grasping forceps, biliary cannulation was successfully performed, and a plastic stent was deployed. There were no procedure-related complications and the serum bilirubin level decreased to the normal range. In the context of failed conventional ERCP, the EUS-guided rendezvous technique appears to be an effective alternative method of biliary drainage in patients with surgically altered gastrointestinal anatomy and an endoscopically accessible papilla.View full abstractDownload PDF (2276K) -
Atsushi NISHIDA, Makoto SHIOYA, Mariko OHARA, Hiroshi HASEGAWA, Rie OS ...2015 Volume 57 Issue 1 Pages 30-37
Published: 2015
Released on J-STAGE: February 13, 2015
JOURNAL FREE ACCESSRadiation-induced injury is a rare cause of gastrointestinal bleeding. We report a 70-year-old woman with recurrent hemorrhage from radiation-induced telangiectasias in the duodenum. She had undergone surgery for cholangiocarcinoma three years previously and received radiation therapy for recurrence in lymph nodes behind the uncinate process of the pancreas. Four months after the completion of radiation therapy, she was referred to our hospital because of the passage of tarry stools and severe anemia. Upper gastrointestinal endoscopy showed edematous and friable mucosa with multiple telangiectasias in the bulbs and descending part of the duodenum. There was active bleeding from the telangiectasias. We attempted to treat the telangiectasias in the descending part of the duodenum by argon plasma coagulation (APC). However, APC and empirical treatment with mucosal protectants were unsuccessful. Therefore, we administered octreotide, an analogue of somatostatin. After the administration of octreotide, the tarry stools stopped and the APC therapy and red blood cell transfusion were no longer necessary. The drug was well tolerated and there were no serious adverse events. No recurrence of bleeding from radiation-induced duodenitis has occurred over the following two months. We suggest that administration of octreotide in combination with APC is beneficial for the treatment of patients with refractory radiation-induced hemorrhagic duodenitis. To the best of our knowledge, this is the first report of the use of octreotide for the treatment of radiation-induced hemorrhagic duodenitis.View full abstractDownload PDF (1658K) -
Akiko MATSUDA, Naohiko MAKINO, Tomohiro TOZAWA, Yushi IKEDA, Hideyuki ...2015 Volume 57 Issue 1 Pages 38-45
Published: 2015
Released on J-STAGE: February 13, 2015
JOURNAL FREE ACCESSWe report herein on a 72-year-old man who suffered from liver abscess in the lateral segment due to biliary infection. Endoscopic retrograde cholangiopancreatography (ERCP) was performed on the first day of the illness, and multiple bile duct stones were revealed. A 5Fr nasal bile duct drainage tube was inserted in the bile duct. On the 6th day, T2-intensified images of MRI demonstrated that the liver abscess in the lateral segment had grown larger, and ascites had collected on the liver surface. The patient had progressive worsening of breathing, and continuous positive pressure ventilation (CPPV) was started on the 7th day. Although treatment of the liver abscess was needed urgently, it was difficult to puncture the abscess percutaneously because of a large quantity of ascites. Therefore, EUS-guided liver abscess drainage (EUS-LAD) was carried out on the 13th day, and a 7Fr nasal bile duct drainage tube was inserted in the liver abscess. After drainage, the breathing condition improved, and MRI revealed significant reduction of the abscess on the 40th day. We consider that EUS-guided drainage is effective and a new therapeutic strategy for liver abscess.View full abstractDownload PDF (974K) -
Yoshiaki ISONO, Shimpei MATSUSAKI, Hiroki TANAKA, Tomomasa TOCHIO, Hir ...2015 Volume 57 Issue 1 Pages 46-51
Published: 2015
Released on J-STAGE: February 13, 2015
JOURNAL FREE ACCESSA 90-year-old woman was admitted to our hospital for acute cholangitis due to choledocholithiasis. We attempted to perform endoscopic biliary drainage (EBD) using a side-viewing duodenal endoscope (outer diameter 13.5 mm). However, a membranous stricture at the esophageal orifice hindered insertion of the endoscope. Nevertheless, it was possible to pass a small-caliber endoscope (outer diameter 5.5 mm, working channel 2.0 mm) through the stricture and advance it into the duodenum. After deep biliary cannulation, a guidewire was advanced into the bile duct. Endoscopic cholangiography showed bile duct dilatation and a bile duct stone (diameter 18mm). Finally, a 5-Fr biliary stent that had been made from an endoscopic naso-biliary drainage tube (5-Fr pig tail type) was placed. Hence, EBD using a small-caliber endoscope may be a useful technique for the treatment of acute cholangitis in patients with digestive tract obstruction.View full abstractDownload PDF (2256K)
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[in Japanese], [in Japanese]2015 Volume 57 Issue 1 Pages 52-53
Published: 2015
Released on J-STAGE: February 13, 2015
JOURNAL FREE ACCESSDownload PDF (1436K)
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Tsuyoshi HAYASHI, Michihiro ONO, Hirotoshi ISHIWATARI, Naoki UEMURA, J ...2015 Volume 57 Issue 1 Pages 54-65
Published: 2015
Released on J-STAGE: February 13, 2015
JOURNAL FREE ACCESSEndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an established tool for definitive diagnosis of pancreatic/peripancreatic lesion, lymphadenopathy, and submucosal tumor, and is now widely performed at Japanese community hospitals. However, endosonographers sometimes face difficulties in obtaining adequate material, which is a major reason that pathologists cannot make a definitive diagnosis. Although acquisition of reliable methods of detecting the lesion, puncturing the lesion, and processing specimens is important, introduction of rapid on-site evaluation during EUS-FNA is essential to improve its diagnostic validity.View full abstractDownload PDF (5974K)
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Yoshiki KOIKE, Dai HIRASAWA, Naotaka FUJITA, Yuki MAEDA, Tetsuya OHIRA ...2015 Volume 57 Issue 1 Pages 66-74
Published: 2015
Released on J-STAGE: February 13, 2015
JOURNAL FREE ACCESSAims : To assess the usefulness of Thread-Traction-method (TT method) in esophageal endoscopic submucosal dissection (ESD).
Methods : A total of 40 consecutive lesions treated by esophageal ESD were included in the study. The TT method was used (TT group) in 20 lesions and 20 lesions were treated by conventional ESD (C group) after randomization. A clip with a thread was attached to the oral edge of the lesion after entire mucosal incision in the TT group. The hook knife method was used in all cases.
Results : ESD was performed in all cases. Effective counter traction was created by the TT method, and efficient dissection operation was possible. In the TT group, significant shortening of the dissection time was achieved as compared with the C group (19.8 min vs 31.8 min, p=0.044). Mean number of local injections during dissection was significantly less in group TT compared with that in group C (0.6 times vs 2.2times, p<0.001). As for the amount of local injection, group TT reguired significantly less compared with group C (2.6ml vs 7.5ml, p<0.01). No complication, were encountered study.
Conclusions : The TT method in esophageal ESD contributes to shortening of the dissection time with safety. It is expected for the TT method to become widespread as a safe and useful procedure.View full abstractDownload PDF (1287K)
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[in Japanese], [in Japanese]2015 Volume 57 Issue 1 Pages 75-78
Published: 2015
Released on J-STAGE: February 13, 2015
JOURNAL FREE ACCESSDownload PDF (612K)
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[in Japanese]2015 Volume 57 Issue 1 Pages 79
Published: 2015
Released on J-STAGE: February 13, 2015
JOURNAL FREE ACCESSDownload PDF (509K)
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