GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
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Volume 58, Issue 5
Displaying 1-12 of 12 articles from this issue
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  • NECESSITY OF CHANGE IN THE ENVIRONMENT THAT SURROUNDS CLINICAL RESEARCH AND ITS IMPLEMENTATION
    Hiromu KUTSUMI, Hayato YOSHINAKA, Hirofumi TSUBOI, Yumie KAWASHIMA
    2016 Volume 58 Issue 5 Pages 1035-1043
    Published: 2016
    Released on J-STAGE: May 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1035
    JOURNAL FREE ACCESS
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    Recently, many incidents that raised questions about the reliability of clinical research in Japan have occurred. Ethical guidelines were revised and a statement about the cooperation between industry and academia was issued from the medical industry community. Scientific validity and ethical validity are required when performing clinical research. Researchers must remember that each clinical research study must be fully explained to patients and that patients are free to agree or decline to participate in the clinical study. Researchers need to have training in performing clinical research, strive for protection of human subjects, manage conflicts of interest, and ensure the reliability of the data. In order to promote high-quality clinical research, a division that supports clinical research in each institution is needed.
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  • A CASE OF ILEAL STRICTURES AFTER ILEOCOLIC SIDE-TO-SIDE ANASTOMOSIS
    Teruo KIYAMA, Kunihisa SHIOZAWA, Kendai KANESHIMA, Munehiro SAWA, Masa ...
    2016 Volume 58 Issue 5 Pages 1044-1049
    Published: 2016
    Released on J-STAGE: May 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1044
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    A 59-year-old man was admitted to our hospital for a feeling of weakness and abdominal pain. He had a history of appendectomy and laparotomy for ileus 38 years ago. He was found to be anemic. Colonoscopy revealed multiple ulcerations with two fistulas, which ran in the longitudinal direction, in the transverse colon. Barium enema revealed dilation of the lumen of the transverse colon and fistulous openings from a dilated ileum and a contracted ileum. The patient was diagnosed with blind loop syndrome due to ileocolic side-to-side anastomosis, and laparotomy was performed. The ileocolic anastomosis was resected and the short circuit was released. Annular strictures of the proximal and the distal ileum were seen at the anastomotic site, and histological examination revealed erosion in the mucosa and acute peritonitis at the anastomotic site of the ileum. Endoscopic diagnosis, such as diagnosis of ileal strictures, was important because blind loop syndrome by short circuit of the small intestine and colon is an indication for surgical removal of the short circuit.
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  • A CASE OF PHLEGMONOUS COLITIS CURED BY CONSERVATIVE TREATMENT
    Tesshin TEI, Tsugitaka ISHIDA, Kaori INOUE, Hidetoshi KANEMASA, Yoichi ...
    2016 Volume 58 Issue 5 Pages 1050-1055
    Published: 2016
    Released on J-STAGE: May 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1050
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    A 61-year-old man presented to our hospital with a two-week history of fever and lower abdominal pain. On physical examination, lower abdominal tenderness was found. Laboratory tests showed elevated white blood cell count and C-reactive protein level. Abdominal computed tomography demonstrated diffuse thickening of the walls of the sigmoid colon and rectum. Colonoscopy revealed mucosal edema and multiple white spots at the sigmoid colon and rectum. After performing biopsy of the white spots, we observed discharge of pus. Pus discharge was also observed at the dark red rectal mucous membrane. We made a diagnosis of phlegmonous colitis. The patient was cured by antibiotic treatment and was discharged from the hospital on the 27th day.
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  • A CASE OF EFFECTIVE ENDOSCOPIC TREATMENT USING A DIATHERMIC SHEATH FOR ANASTOMOTIC STRICTURE FORMATION AFTER SUBTOTAL STOMACH-PRESERVING PANCREATICODUODENECTOMY
    Makoto ABUE, Keisuke TSUKAMOTO, Takehumi MIYAZAKI, Tomoyuki OIKAWA, Hi ...
    2016 Volume 58 Issue 5 Pages 1056-1062
    Published: 2016
    Released on J-STAGE: May 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1056
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    The patient was a 78-year-old man who had undergone subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) for intraductal papillary mucinous carcinoma (IPMC). Four months after surgery, enzyme levels of the hepatobiliary system were elevated, and abdominal ultrasonography showed biliary sludge and expansion of peripheral bile ducts. Since an anastomotic stricture was suspected based on the diagnostic imaging, we performed endoscopic retrograde cholangiography (ERC) using a single-balloon endoscope. With this approach, severe stricture of the biliary-enteric anastomosis was visualized. Although a 0.025-inch guide wire could pass through the anastomotic stricture, it was not possible to pass a biliary balloon dilation catheter through the stricture. Therefore, we decided to incise the anastomotic stricture using a 6-Fr diathermic sheath (Cysto-Gastro-Set, Germany), which was advanced over the guide wire. An incision was made in the anastomotic stricture using an electrosurgical generator. Then, we performed balloon dilatation and completed the treatment. The patient experienced no serious complications with this procedure.
    We suggest that dilatation treatment using a diathermic sheath is a useful option for the management of biliary-enteric anastomotic stricture formation after surgery.
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  • A CASE OF BOUVERET SYNDROME TREATED BY ENDOSCOPIC LITHOTRIPSY
    Tomoko YAMABATA, Natsuko TATSUMI, Kazuyuki OGITA, Takashi TORII, Kazuh ...
    2016 Volume 58 Issue 5 Pages 1063-1068
    Published: 2016
    Released on J-STAGE: May 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1063
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    An 89-year-old man was admitted to our hospital because of a one-week history of vomiting and loss of appetite. Gastroduodenoscopy revealed an ulcer and an impacted stone of 30mm in diameter in the posterior wall of the duodenal bulb. Upon comparison with the previous study, abdominal CT examination showed that a large stone in the gallbladder had migrated into the bulb through a cholecystoduodenal fistula. Bouveret syndrome refers to gastric outlet obstruction by a large gallstone following a cholecystoduodenal fistula. Mechanical lithotripsy was attempted and the stone was extracted successfully. In this case, a duodenocolic fistula was also revealed by contrast media. Endoscopic lithotripsy was useful to treat this rare syndrome.
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  • ENDOSCOPIC LITHOTRIPSY METHOD WITH A HANDMADE SNARE USING A GUIDEWIRE FOR RESECTION OF A BULKY PHYTOBEZOAR
    Masashi TAKATA, Hiroshi UETA, Yoichi ISHIKAWA, Yuri NAGATA, Yukari YAN ...
    2016 Volume 58 Issue 5 Pages 1069-1074
    Published: 2016
    Released on J-STAGE: May 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1069
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    We devised the ELG (Endoscopic Lithotripsy using a Guidewire) method with a handmade snare using a guidewire for resection of a bulky phytobezoar.
    A snare was created by bending a guidewire for the biliary tract into the shape of a loop. Each end of the guidewire was run through each of two snare sheaths in a 2-channel endoscope, and we could adjust the snare size freely.
    An advantage of the ELG method was that we were able to perform this method with the usual tools for endoscopic measures. We could increase the snare size and perform snaring easily. This snare had strong crushing power and there was no risk of the snare becoming incarcerated after snaring.
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  • ENDOSCOPY-ASSISTED LAPAROSCOPIC FULL-THICKNESS RESECTION FOR SUPERFICIAL NONAMPULLARY DUODENAL TUMORS
    Ken OHATA, Yohei MINATO, Hitoshi SATODATE, Kimiyasu YAMAZAKI, Masahiko ...
    2016 Volume 58 Issue 5 Pages 1075-1082
    Published: 2016
    Released on J-STAGE: May 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1075
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    Little is known about the biological potential of superficial nonampullary duodenal tumor (SNADT), and no standard treatments have been established. Surgical resection is sometimes too invasive because it is difficult to recognize the border of the lesion from outside the duodenum and remove it locally. On the other hand, the endoscopic approach requires a high level of technique and there is a possibility of delayed perforation and bleeding due to exposure to pancreatic juice and bile. To overcome these issues, we developed endoscopy-assisted laparoscopic full-thickness resection (EALFTR) as one of the methods of laparoscopic endoscopic cooperative surgery (LECS). EALFTR enables not only successful en bloc and full-thickness excision, but also complete closure of the defect, minimizing the risk of developing complications such as delayed perforation and bleeding. However, EALFTR is thought to be potentially associated with tumor dissemination. Additionally, EALFTR can only be performed on tumors of certain size and location. Although there are some problems to be solved, EALFTR would be one of the minimally invasive therapeutic options for the treatment of SNADT. Herein, we describe the method of performing EALFTR in detail.
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  • ENDOSCOPIC APPROACHES FOR THE DIAGNOSIS OF AUTOIMMUNE PANCREATITIS
    Atsushi KANNO, Atsushi MASAMUNE, Tooru SHIMOSEGAWA
    2016 Volume 58 Issue 5 Pages 1083-1093
    Published: 2016
    Released on J-STAGE: May 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1083
    JOURNAL FREE ACCESS
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    Autoimmune pancreatitis (AIP) is characterized by diffuse pancreatic enlargement and irregular narrowing of the main pancreatic duct (MPD). Immunoglobulin (Ig) G4-related sclerosing cholangitis (IgG4-SC) associated with AIP frequently appears as a bile duct stricture. Therefore, it is important to differentiate AIP and IgG4-SC from pancreatic cancer and cholangiocarcinoma or primary sclerosing cholangitis, respectively. Endoscopy plays a central role in the diagnosis of AIP and IgG4-SC because it provides imaging of the MPD and bile duct strictures as well as the ability to obtain tissue samples for histological evaluations. Diffuse irregular narrowing of MPD on endoscopic retrograde cholangiopancreatography (ERCP) is rather specific to AIP, but localized narrowing of the MPD is often difficult to differentiate from MPD stenosis caused by pancreatic cancer. A long stricture (>1/3 the length of the MPD) and lack of upstream dilatation from the stricture (<5 mm) might be key features of AIP on ERCP. Some cholangiographic features, such as segmental strictures, strictures of the lower bile duct, and long strictures with prestenotic dilatation, are more common in IgG4-SC than in cholangiocarcinoma. Endoscopic ultrasonography (EUS) reveals diffuse hypoechoic pancreatic enlargement, sometimes with hypoechoic inclusions, in patients with AIP. In addition, EUS-elastography and contrast-enhanced harmonic EUS have been developed with promising results. The usefulness of EUS-guided fine-needle aspiration has been increasingly recognized for obtaining adequate tissue samples for the histological diagnosis of AIP. Further improvement of endoscopic procedures and devices will contribute to more accurate diagnosis of AIP and IgG4-SC.
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