GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 58, Issue 11
Displaying 1-16 of 16 articles from this issue
  • Katsuaki KATO, Takashi CHIBA, Takenobu SHIMADA, Daisuke SHIBUYA
    2016 Volume 58 Issue 11 Pages 2251-2261
    Published: 2016
    Released on J-STAGE: November 20, 2016
    JOURNAL FREE ACCESS FULL-TEXT HTML

    The purpose of cancer screening conducted as a public policy is to reduce the cancer death rate by carrying out examinations in asymptomatic persons for early detection and early treatment of the specified cancer. Since the death rate decreased after the endoscopy screening program was introduced, the endoscopy screening program in addition to barium X-ray examination has been permitted by the Ministry of Health, Labor and Welfare for use in population-based screening for gastric cancer in Japan from 2016. In the endoscopic examination performed as secondary prevention, precise management to secure a high quality of the examination is necessary. The final outcome of population-based screening for gastric cancer is a reduction in death rate, but it takes a long time to obtain the result. Therefore, evaluation by “an index of the technique and system” and “the process index” is necessary to monitor the accuracy of the screening program. In the endoscopy screening program in which many general physicians perform the screening, it is important to develop safety countermeasures against serious complications such as bleeding, shock, laceration, perforation, etc., and to establish a system in which the screening images are double-checked by the regional reading committee in order to maintain the quality of the screening program. This review article outlines the concepts of accuracy control that physicians who participate in the endoscopic screening program for gastric cancer as a public policy should know.

  • Juichiro YOSHIDA, Shinya YAMADA, Takahiro SUZUKI, Hideki FUJII, Naoya ...
    2016 Volume 58 Issue 11 Pages 2262-2267
    Published: 2016
    Released on J-STAGE: November 20, 2016
    JOURNAL FREE ACCESS FULL-TEXT HTML

    A 68-year-old man had a positive fecal occult blood test and was referred to our hospital for examination. Colonoscopy revealed multiple polyps and diverticula from the descending colon through the sigmoid colon. The patient underwent endoscopic mucosal resection (EMR) of eight lesions. Two of these lesions were found to be early colorectal carcinomas. One of the malignancies was a 20-mm early carcinoma in the sigmoid colon, which was mainly tub2 and partly undifferentiated. The margin was clear, but the tumor extended close to the margin. Regarding the other carcinoma, the extent of infiltration was unclear because of partial resection. Based on these findings, additional resection of the two cancerous lesions was recommended, and laparoscopic D1 lymph node dissection was performed. Although no residual tumor was detected at the sites of scarring after EMR, three cancers were found inside diverticula included in the resected specimen. One of these tumors had infiltrated the subserosa and metastasized to a lymph node (no. 241), leading to the diagnosis of T3N1M0 cancer (stage Ⅲb). The patient received adjuvant chemotherapy and is currently being followed up. Colorectal cancer rarely arises in the mucosa of a diverticulum, and no case of multiple diverticular cancers has been previously reported.

    Here we report a patient with multiple colorectal cancers arising in diverticula, which could not be detected by preoperative colonoscopy.

  • Miwa SATAKE, Tatsuya MIKAMI, Manabu SAWAYA, Yuki SAKAMOTO, Chikara IIN ...
    2016 Volume 58 Issue 11 Pages 2268-2272
    Published: 2016
    Released on J-STAGE: November 20, 2016
    JOURNAL FREE ACCESS FULL-TEXT HTML

    A 67-year-old man with diabetes mellitus was admitted to our hospital for endoscopic mucosal resection (EMR) of a polyp in the transverse colon. The EMR was done successfully without any obvious intraoperative procedural complications. The next day, he presented with a fever of 39.8 degrees Celsius. The complete blood cell count showed an elevated WBC count. Physical examination showed normal abdominal findings. CT showed a low-density tumor and a “target sign” at the transverse colon near the clips of EMR. Based on the CT findings, laboratory data and endoscopic findings, we made the diagnosis of colonic intussusception caused by a submucosal abscess. The intussusception was reduced by air insufflation under colonoscopy. Closing the ulcer under insufficient preparation and susceptibility to infection related to diabetes mellitus were suspected to have caused colonic abscess.

  • Eisuke NAKAO, Satoshi ASAI, Yuki KANO, Koutarou TAKESHITA, Takumi ICHI ...
    2016 Volume 58 Issue 11 Pages 2273-2278
    Published: 2016
    Released on J-STAGE: November 20, 2016
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    An 84-year-old woman had undergone subtotal colectomy for ulcerative colitis. She was admitted to the local clinic with abdominal distension, and was referred to our hospital on suspicion of bowel ileus. Small bowel volvulus was diagnosed based on the findings of abdominal CT. We performed endoscopic detorsion with an endoscopy position detecting unit (UPD) successfully. She experienced recurrence of small bowel volvulus seven weeks later, and endoscopic detorsion was performed successfully again. Thereafter, the patient passed away without another recurrence. Here we report a rare case of small bowel volvulus after subtotal colectomy that was safely treated by endoscopic detorsion with UPD.

  • Shinichi MORITA, Toru SETSU, Takahiro HOSHI, Tsutomu KANEFUJI, Masaaki ...
    2016 Volume 58 Issue 11 Pages 2279-2286
    Published: 2016
    Released on J-STAGE: November 20, 2016
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    A 70-year-old woman was hospitalized due to acute cholangitis one year after resection of the extrahepatic bile duct and choledochojejunostomy for malfusion of the pancreatobiliary ducts. She underwent percutaneous transhepatic biliary drainage (PTBD), and after her general condition improved, we tried to introduce a guidewire for internal drainage but were unable to do so because of severe anastomotic stenosis. Using a bronchoscope as a slim endoscope, we inserted the bronchoscope via the PTBD route and visualized a punctiform scar. Subsequently, we were able to pass the guidewire and a drainage tube through the stricture, followed by placement of a fully covered self-expanding metallic stent. The stricture became dilated and we removed the stent four months later. Thereafter, we injected contrast medium into the bile ducts via the PTBD route and confirmed dilatation of the stricture, allowing removal of the PTBD tube. This case illustrates that a fully covered self-expanding metallic stent can be used to dilate an area of biliary stricture continuously and can be removed later. This approach is effective and feasible for management of benign biliary strictures.

  • Yasuhiro IIZUKA, Shinya MANO, Katsumasa KOBAYASHI, Youhei FURUMOTO, To ...
    2016 Volume 58 Issue 11 Pages 2287-2293
    Published: 2016
    Released on J-STAGE: November 20, 2016
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    A 53-year-old woman developed a pancreatic pseudocyst after undergoing treatment for severe gallstone pancreatitis. Because of the enlarged pancreatic pseudocyst and constricted main pancreatic duct (MPD), we placed a 7-Fr. 7-cm straight pancreatic stent in the MPD endoscopically, but the stent migrated to a branch duct at the pancreatic head. We could not retrieve the stent by using a basket and balloon catheter. We led a guidewire into the stent through a flap on the pancreatic tail end of the stent and then pushed the stent toward the pancreatic tail by using a pushing device. Consequently, the papillary end of the stent was replaced with the MPD, allowing us to retrieve the stent by using a stent retriever. Because surgical operations were reported to be necessary for similar cases, this endoscopic retrieval method may be useful to avoid surgical operations.

  • Takuji IWASHITA, Shinya UEMURA, Ichiro YASUDA, Masahito SHIMIZU
    2016 Volume 58 Issue 11 Pages 2296-2304
    Published: 2016
    Released on J-STAGE: November 20, 2016
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    Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been used as a safe and reliable technique of obtaining pathological specimens from lesions inside or around the intestines. The importance of obtaining tissue specimens for histologic analysis has been increasing recently. Here, we report selection of the appropriate needles, techniques for FNA, and methods of processing FNA specimens as tips for obtaining tissue specimens by EUS-FNA on the basis of reported evidence as well as our experience.

  • Naoki HOSOE, Haruhiko OGATA, Takanori KANAI
    2016 Volume 58 Issue 11 Pages 2305-2313
    Published: 2016
    Released on J-STAGE: November 20, 2016
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    Double-balloon enteroscopy (DBE) was first introduced in 2001. After the introduction of DBE, single-balloon enteroscopy (SBE) and spiral enteroscopy have been reported. These enteroscopy techniques are generically categorized as device-assisted enteroscopy (DAE). In Japan, some endoscopy centers have introduced DBE while other centers have introduced SBE in accordance with the existing videoscope system. In this review article, we focus on the difference between DBE and SBE, and the single operator method by using SBE. To achieve deep insertion using balloon-assisted enteroscopy, it is necessary to insert the distal end of the sliding tube (ST). Thus, when the ST is inserted into the deeper part using SBE that has no scope-balloon, endoscopists have to pay attention to careful insertion of the ST.

  • Yutaka SAITO, Takahisa MATSUDA, Takeshi NAKAJIMA, Taku SAKAMOTO, Masay ...
    2016 Volume 58 Issue 11 Pages 2314-2322
    Published: 2016
    Released on J-STAGE: November 20, 2016
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    Many clinical studies on narrow-band imaging (NBI) have reported the usefulness of NBI magnifying endoscopy for qualitative and quantitative diagnosis of colorectal lesions in Japan. However, critical discussions have raised issues such as i) the presence of multiple terms for similar findings, ii) the necessity of taking into account surface patterns, and iii) differences in NBI findings between elevated (polypoid growth, PG) and superficial lesions (non-polypoid growth, NPG).

    The Japan NBI Expert Team (JNET) was constituted with the aim of establishing a universal NBI magnifying endoscopic classification of colorectal tumors (JNET classification) in 2011.

    To establish a universal NBI magnifying endoscopic classification of colorectal tumors, the JNET, consisting of 38 NBI expert members, was formed within the “Research Group of the National Cancer Center Research and Development Fund” (Yutaka Saito Group) in 2011.

    First, a working group was organized consisting of young but experienced researchers from six institutions in order to establish common evaluation criteria of the JNET classification. Consequently, normal/hyperplastic lesions were classified as type 1, low-grade adenomas as type 2A, high-grade adenomas as type 2B, and deep submucosal invasive cancers as type 3, and a magnifying NBI scale that took into account the vascular and surface patterns was created for both PG and NPG tumors.

    A web-based interpretation study was conducted by a JNET member in order to determine the NBI findings and diagnostic criteria to be used in the universal classification system in 2013. A JNET classification system was established based on the results of univariate/multivariate analyses using a modified Delphi method at a consensus meeting on June 6, 2014.

    The JNET classification consists of four categories of vessel and surface patterns, i.e., Types 1, 2A, 2B, and 3. Types 1, 2A, 2B, and 3 are correlated with the histopathological findings of hyperplastic polyp/sessile serrated polyp (SSA/P), low-grade intramucosal neoplasia, high-grade intramucosal neoplasia/superficial submucosal invasive cancer, and deep submucosal invasive cancer, respectively.

    At present, validation studies for the JNET classification have been proposed to be conducted.

  • Yuji MAEHATA, Motohiro ESAKI, Shotaro NAKAMURA, Minako HIRAHASHI, Taka ...
    2016 Volume 58 Issue 11 Pages 2323-2331
    Published: 2016
    Released on J-STAGE: November 20, 2016
    JOURNAL FREE ACCESS FULL-TEXT HTML

    Background and Aim : We aimed to evaluate the long-term risk of cancer in the rectal remnant in patients with familial adenomatous polyposis after ileorectal anastomosis.

    Methods : Cumulative incidence and clinicopathological characteristics of cancer in the rectal remnant were retrospectively investigated in 27 patients with familial adenomatous polyposis who had undergone ileorectal anastomosis.

    Results : During the follow-up period ranging from 3.0 to 35.0 years (median, 21.1 years), cancer in the rectal remnant developed in 10 patients. Cumulative risk of cancer in the rectal remnant 30 years after surgery was 57%. Five patients had metastases and three patients died of cancer in the rectal remnant after proctectomy. There was a trend towards a higher incidence of cancer in the rectal remnant in patients with small-intestinal adenoma and congenital hypertrophy of the retinal pigment epithelium. Multivariate analysis revealed that the ocular lesion was an independent risk factor associated with cancer in the rectal remnant.

    Conclusion : Subtotal colectomy with ileorectal anastomosis does not seem to be an appropriate prophylactic surgery in patients with familial adenomatous polyposis.

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