GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
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Volume 57, Issue 12
Displaying 1-14 of 14 articles from this issue
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  • CURRENT STATUS OF THE “RESECT AND DISCARD” STRATEGY
    Yoji TAKEUCHI, Masao HANAFUSA, Noriya UEDO, Ryu ISHIHARA, Hiroyasu IIS ...
    2015 Volume 57 Issue 12 Pages 2623-2632
    Published: 2015
    Released on J-STAGE: December 25, 2015
    DOIhttps://doi.org/10.11280/gee.57.2623
    JOURNAL FREE ACCESS
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    The “Resect and Discard” strategy, which omits formal pathological diagnosis of certain lesions based on endoscopic diagnosis with high confidence, is a promising proposal to reduce costs and efforts related to pathological diagnosis after polypectomy for adenoma, as well as reduce adverse events and costs related to unnecessary polypectomy for hyperplastic polyps. However, this strategy requires 1) accurate differentiation between a non-neoplastic lesion and neoplastic lesion, and 2) precise diagnosis of small or diminutive invasive cancers, when it is adapted to clinical practice. The American Society of Gastrointestinal Endoscopy recommends that the target lesion in the United States should be colorectal polyps ≤ 5mm in size, and the technology used in the strategy should satisfy the following two thresholds : 1) >90% agreement in determining post-polypectomy surveillance intervals compared with decisions based on pathologic assessment, and 2) ≥90% negative predictive value for rectosigmoid polyps (when used with high confidence) with adenomatous histology.
    Although the “Resect and Discard” strategy still has problems to be solved, such as the education system, it has enough reasons to be realized because the final goal of endoscopic diagnosis is real-time pathological diagnosis in vivo. Therefore, we should watch the movement of this strategy carefully.
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  • A CASE OF BRAIN ABSCESS AFTER ENDOSCOPIC ESOPHAGEAL DILATATION
    Kazuto TAKAHASHI, Hiroyuki SUTO, Yoshihiko OZAKI, Tatsushi NAITO, Kazu ...
    2015 Volume 57 Issue 12 Pages 2633-2638
    Published: 2015
    Released on J-STAGE: December 25, 2015
    DOIhttps://doi.org/10.11280/gee.57.2633
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    A sixty-one-year-old man was admitted to the hospital with numbness and paralysis in his left hand six days after a second esophageal balloon dilatation for cicatricial stricture that had developed after esophageal endoscopic submucosal dissection. Brain abscess was diagnosed on plain head CT and enhanced head MRI. He was treated with antibiotics, but his condition did not improve. Therefore, a craniotomy for drainage was performed. The causative organism was α-Streptococcus. The patient's numbness and paralysis disappeared. It was speculated that esophageal balloon dilatation was involved in the development of the brain abscess. Here we report a rare and valuable case of brain abscess after endoscopic esophageal dilatation.
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  • LONG-TERM FOLLOW-UP OF A GASTRIC ADENOCARCINOMA OF THE FUNDIC GLAND TYPE : A CASE REPORT
    Yoshiaki ISONO, Youichirou BABA, Hiroki TANAKA, Katsumi MUKAI, Tomohir ...
    2015 Volume 57 Issue 12 Pages 2639-2646
    Published: 2015
    Released on J-STAGE: December 25, 2015
    DOIhttps://doi.org/10.11280/gee.57.2639
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    A 57-year-old woman had undergone endoscopic submucosal dissection (ESD) for early-stage gastric adenocarcinoma 7 years previously. Subsequently, she received treatment for Helicobacter pylori, and underwent endoscopic follow-up once a year. Two years after ESD, follow-up esophagogastroduodenoscopy revealed a discolored lesion, measuring 3 mm in diameter, at the greater curvature of the lower body of the stomach. Although we performed endoscopic biopsy of the lesion three years later, it was difficult to confirm the diagnosis. Seven years after ESD, gastric adenocarcinoma of fundic gland type was suspected based on a biopsy specimen from the lesion. Hence, we performed ESD. Histological examination of the resected specimen confirmed gastric adenocarcinoma of fundic gland type. The lesion was limited to the mucosa. On immunohistochemical analysis, the lesion was partially positive for pepsinogen-I, and positive for the mucin MUC6 ; the MIB-1 labeling index was ≤ 3%. Gastric adenocarcinoma of fundic gland type has been reported to be a new variant of gastric adenocarcinoma. Herein, we report a rare case of a minute gastric adenocarcinoma of fundic gland type that was followed up over a long period.
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  • RUPTURED PSEUDOANEURYSM OF THE GASTRODUODENAL ARTERY TREATED WITH TRANSCATHERTER ARTERIAL EMBOLIZATION
    Kaori SUGIURA, Yuichi SHIMODATE, Yousuke MITANI, Kyoko HAMAGUCHI, Akir ...
    2015 Volume 57 Issue 12 Pages 2647-2652
    Published: 2015
    Released on J-STAGE: December 25, 2015
    DOIhttps://doi.org/10.11280/gee.57.2647
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    A 56-year-old man presented to a local clinic complaining of malaise and loss of appetite. Laboratory data revealed a markedly low hemoglobin level (3.2g/dl), and he was referred to our hospital for further investigation. Upper gastrointestinal endoscopy revealed an ulcerative lesion in the duodenal bulb without active bleeding. Following emergency hospitalization, upper gastrointestinal endoscopy revealed hemorrhage from an ulcerative lesion in the superior duodenal angulus, and endoscopic repair was undertaken. Contrast enhanced CT showed a gastroduodenal artery aneurysm, and conservative treatment was commenced, but hemorrhage recurred. Transcatheter arterial embolization with metallic coils was performed, and the patient's clinical course was good. Endoscopic repair of a hemorrhaging gastroduodenal artery aneurysm can be difficult. Transcatheter arterial embolization should be considered when endoscopic repair is difficult in cases of hemorrhage from a gastroduodenal artery aneurysm.
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  • A CASE OF PRIMARY JEJUNUM CANCER THAT WAS DISCOVERED AFTER THE PATIENT DEVELOPED HEMORRHAGIC SHOCK
    Atsushi ARITSUKA, Katsushi HIRAMATSU, Takashi OHNO, Kazuya OHFUJI, Hid ...
    2015 Volume 57 Issue 12 Pages 2653-2659
    Published: 2015
    Released on J-STAGE: December 25, 2015
    DOIhttps://doi.org/10.11280/gee.57.2653
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    A 58-year-old man was admitted to our emergency department because of melena with hemorrhagic shock occurring during anticoagulant therapy for atrial fibrillation. Contrast-enhanced CT raised the suspicion of bleeding from the jejunum.
    Emergency oral small bowel endoscopy showed a 2-cm, type 2 tumor in the upper jejunum, which was diagnosed as a moderately to well-differentiated tubular adenocarcinoma upon examination of the biopsy specimen. The patient underwent partial small bowel resection with adjacent lymph node dissection. He has been followed up for 3 years, and has shown no signs of recurrence. Small bowel cancer is a rare tumor that is difficult to diagnose at a relatively early stage. This case is suggestive in that, despite the small tumor size, the patient developed hemorrhagic shock during anticoagulant therapy, which led to the diagnosis of small bowel cancer on small bowel endoscopy. We report this case with a review of the literature.
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  • A CASE OF PARARECTAL DESMOID TUMOR IN WHICH ENDOSCOPIC ULTRASOUND WAS USED FOR PREOPERATIVE DIAGNOSIS AND DECISION-MAKING ABOUT APPROPRIATE TREATMENT
    Masaya ISHIDA, Shigenao ISHIKAWA, Tomoki INABA, Ichiro SAKAKIHARA, Kum ...
    2015 Volume 57 Issue 12 Pages 2660-2666
    Published: 2015
    Released on J-STAGE: December 25, 2015
    DOIhttps://doi.org/10.11280/gee.57.2660
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    A 67-year-old man was referred to our hospital for further examination of a tumor in the pelvis. CT scan revealed a tumor of 25mm in diameter located close to the anterior wall of the rectum. We could not determine whether the tumor was adhered to the rectum by CT scan and MRI. FDG-PET scan showed slight uptake in the mass, and we made the diagnosis of a low-grade malignant tumor such as a desmoid tumor and planned surgical resection. However, EUS showed a movable tumor with a uniformly low echoic level that was adjacent to the rectum. We therefore changed the surgical procedure from lower anterior resection of the rectum to transperineal resection of the tumor and its pathological diagnosis was a desmoid tumor. EUS was useful for making the preoperative diagnosis and the decision of appropriate treatment in this case.
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  • DILATED SURFACE VESSELS AS AN ENDOSCOPIC CHARACTERISTIC OF EARLY GASTRIC CANCER OF FUNDIC GLAND TYPE ; A REPORT OF 6 CASES OF GASTRIC CANCER OF FUNDIC GLAND TYPE WITHOUT EXPOSURE OF CANCER GLANDS ON THE SURFACE
    Makoto ABE, Masahiro NAKAGAWA, Reiji HIGASHI, Ken HIRAO, Tsuneyoshi OG ...
    2015 Volume 57 Issue 12 Pages 2667-2673
    Published: 2015
    Released on J-STAGE: December 25, 2015
    DOIhttps://doi.org/10.11280/gee.57.2667
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    Gastric cancer of fundic gland type that is not associated with chronic atrophic gastritis caused by Helicobacter pylori infection has recently been proposed. This cancer emerges at the deep layer of the mucosa and, thus, often invades the submucosal layer at a high rate even when it is small. We report endoscopic characteristics of 6 cases of early gastric cancer of fundic gland type without exposure of cancer glands on the surface. The mean diameter of the lesions was 6.0mm. We found submucosal invasion in 2 cases (400μ and 130μ), and the other four were confined to the mucosal layer. Endoscopically, most of them were small, gradually elevated lesions covered with normal fundic gland gastric mucosa mimicking a fundic gland cyst polyp or a submucosal tumor. There was no irregular change in their surface pattern even under image-enhanced endoscopic observation, but we often observed dilated vessels on their surface (83%). Thus, when we observe dilated vessels on the surface of a small lesion like a fundic gland cyst polyp or submucosal tumor, we should perform biopsy for the possibility of gastric cancer of fundic gland type at its early stage.
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  • EMERGENCY ENDOSCOPY FOR ACUTE GASTROINTESTINAL BLEEDING : PROGNOSTIC VALUE OF ENDOSCOPIC HEMOSTASIS AND THE AIMS65 SCORE IN JAPANESE PATIENTS
    Shotaro NAKAMURA, Takayuki MATSUMOTO, Hiroshi SUGIMORI, Motohiro ESAKI ...
    2015 Volume 57 Issue 12 Pages 2676-2684
    Published: 2015
    Released on J-STAGE: December 25, 2015
    DOIhttps://doi.org/10.11280/gee.57.2676
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    Background and Aim : To evaluate the prognostic factors, including risk scores (Glasgow-Blatchford score and AIMS65) in patients with acute upper or lower gastrointestinal bleeding.
    Methods : The medical records of patients who had undergone emergency gastrointestinal endoscopy for suspected gastrointestinal bleeding during the past 5 years were retrospectively analyzed.
    Results : A total of 232 endoscopies (130 esophagogastroduodenoscopies, 102 colonoscopies) for 192 patients met the inclusion criteria. Median age was 66 years, and 64% of patients were males. Endoscopy identified causes for bleeding in 173 patients (post-endoscopic interventions for neoplastic lesions in 36 cases, colonic diverticula in 34, gastroduodenal ulcers in 29, gastric erosions in 15, vascular ectasia in 14, post-biopsy bleeding in 13, malignant tumors in 10, inflammatory conditions in 9, esophagogastric varices in 5, Mallory-Weiss tears in 4, nasal bleedings in 3, and injury by swallowed blister pack in 1), whereas the source of bleeding remained obscure in 19 patients. Blood transfusion was given in 97 patients (51%), and 97 (51%) underwent endoscopic hemostasis. During the follow-up period, 49 patients (26%) experienced rebleeding, 7 of whom were treated by interventional radiology. Thirty-nine patients (20%) died as result of various diseases. The probabilities of overall survival (OS) after 3 and 5 years were 71% and 67%, respectively. Cox multivariate analysis revealed blood transfusion, co-existing malignancy, absence of endoscopic hemostasis, and high AIMS65 score to be independent prognostic factors for poor OS.
    Conclusion : The AIMS65 score is useful for predicting the prognosis of patients with acute gastrointestinal bleeding.
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