GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
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Volume 58, Issue 6
Displaying 1-11 of 11 articles from this issue
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  • CURRENT STATUS OF THE OVER-THE-SCOPE CLIP SYSTEM
    Noriko NISHIYAMA, Hirohito MORI, Hideki KOBARA, Tsutomu MASAKI
    2016 Volume 58 Issue 6 Pages 1135-1148
    Published: 2016
    Released on J-STAGE: June 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1135
    JOURNAL FREE ACCESS
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    Refractory gastrointestinal (GI) diseases involving bleeding, perforations, fistulas and postoperative leakages have mainly required invasive surgery. In consideration of the aging society in Japan, minimally invasive therapy with endoscopic approach may be desirable. A newly-developed, endoscopic full-thickness suturing device, called the “Over-The-Scope Clip (OTSC)”, was clinically introduced in Western countries in 2009. The OTSC has an advantage over conventional devices like hemoclips in terms of grasping and applying persistent force on the target tissue. Currently, the efficacy of the OTSC system has been widely known since its usage was approved in Japan in 2011. Although the OTSC is still challenging to use for the treatment of chronic fistula, the OTSC system provides an excellent clinical outcome for refractory GI diseases. The OTSC, an innovative device, can open a new discipline of minimally invasive endoscopic therapy.
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  • A CASE OF VERRUCOUS CARCINOMA OF THE ESOPHAGUS THAT WAS RESECTED BY ESD AFTER OBSERVATION OF ITS MORPHOLOGICAL CHANGES IN THE EARLY STAGE
    Yoshiyuki MURAWAKI, Masahiko MIURA, Teiji YOSHIMURA, Takashi TANIMURA, ...
    2016 Volume 58 Issue 6 Pages 1149-1154
    Published: 2016
    Released on J-STAGE: June 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1149
    JOURNAL FREE ACCESS
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    We experienced a case whereby we observed morphological short-term changes of early verrucous carcinoma before performing endoscopic submucosal dissection (ESD). The patient was a 60-year-old male. Endoscopy revealed a white mucosal lesion in the thoracic esophagus that was not stained by Iodine's staining. Upon examination of the biopsy tissue, esophageal epidermization was suspected because of its slight cellular atypicality. One year later, the same lesion had changed into a superficial and protruding lesion with small white nodules. Merely one month after this, the white nodules of the same lesion were healing, and its protrusions had become prominent. Biopsy tissue was diagnosed as well-differentiated squamous cell carcinoma. Therefore, we resected the lesion by ESD for diagnostic and therapeutic purposes. The postoperative pathological diagnosis was a well-differentiated squamous cell carcinoma of T1a-MM, consistent with verrucous carcinoma due to its histological features.
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  • ENDOSCOPIC INJECTION SCLEROTHERAPY WITH N-BUTYL-2-CYANOACRYLATE FOR ILEAL VARICES BY USING A SINGLE BALLOON ENTEROSCOPE
    Takeshi MIZUMOTO, Toshio KUWAI, Hirotaka KOUNO, Kazuki BOUDA, Ken YAMA ...
    2016 Volume 58 Issue 6 Pages 1155-1160
    Published: 2016
    Released on J-STAGE: June 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1155
    JOURNAL FREE ACCESS
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    A 69-year-old man presented to the emergency room with hematochezia. We performed video capsule enteroscopy (VCE), and active bleeding was found at the ileum. On the following day, balloon enteroscopy (BAE) was performed. No active bleeding was observed. A solitary submucosal tumor (SMT) was observed approximately 100cm from Bauhin's valve. We performed clipping to mark the location of the SMT. Two days after clipping, melena recurred, and the patient's blood pressure (BP) decreased. CT angiography showed intestinal varices, which had formed by the clipping. Two days later, the patient was administered 2.0 ml of N-butyl-2-cyanoacrylate by endoscopic injection sclerotherapy (EIS) with BAE. Thereafter, the melena ceased, and the patient's BP and hemoglobin level normalized.
    Because of difficulties in diagnosis and treatment, bleeding from ileal varices is generally massive and life-threatening. BAE is a useful modality for patients with bleeding from ileal varices.
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  • A CASE OF ANEMIA CAUSED BY BLEEDING FROM JEJUNAL METASTASIS FROM RENAL CELL CARCINOMA
    Matsuki UMEHARA, Eiki NOMURA, Yu SASAKI, Takeshi SATO, Kazuhiro SAKUTA ...
    2016 Volume 58 Issue 6 Pages 1161-1166
    Published: 2016
    Released on J-STAGE: June 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1161
    JOURNAL FREE ACCESS
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    A 78-year-old man was referred to our clinic for examination of progressive anemia. He had undergone left nephrectomy for renal cell carcinoma (RCC) three years earlier. Esophagogastroduodenoscopy, total colonoscopy, and computed tomography did not identify any origin for the gastrointestinal bleeding. Capsule endoscopy (CE) revealed a hemorrhagic tumor on the jejunum. We performed double-balloon endoscopy (DBE). Histopathological findings of the biopsy specimen suggested metastasis from RCC, and jejunectomy was performed. At 16 months' follow-up after jejunectomy, there was no recurrence of anemia. Small intestinal metastasis from RCC is rare and its symptoms are atypical (anemia, melena, vomiting, abdominal pain, etc.). We should consider the possibility of small intestinal metastasis in patients with intestinal bleeding or progressive anemia who have a history of RCC. CE and DBE are very useful and complementary diagnostic tools for identification of small intestinal metastasis.
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  • TIPS FOR THE ENDOSCOPIC DIAGNOSIS OF GASTRIC ADENOCARCINOMA OF THE FUNDIC GLAND TYPE (CHIEF CELL PREDOMINANT TYPE)
    Hiroya UEYAMA, Kenshi MATSUMOTO, Akihito NAGAHARA, Takashi YAO, Sumio ...
    2016 Volume 58 Issue 6 Pages 1169-1177
    Published: 2016
    Released on J-STAGE: June 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1169
    JOURNAL FREE ACCESS
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    Gastric adenocarcinoma of the fundic gland type (chief cell predominant type, GA-FG-CCP) has recently been proposed as a new, rare variant of gastric adenocarcinoma. However, the endoscopic features of GA-FG-CCP have not been investigated in detail. The aim of this study was to elucidate the clinicopathological and endoscopic features of GA-FG-CCP, and describe tips for the endoscopic diagnosis of GA-FG-CCP.
    The most common features of GA-FG-CCP on conventional endoscopy (CE) were 1) shape of a submucosal tumor, 2) whitish color, 3) dilated vessels with branching architecture, and 4) background mucosa without atrophic change. The endoscopic findings of GA-FG-CCP by magnifying endoscopy with narrow-band imaging (ME-NBI) did not meet the criteria for the usual type of gastric cancer. However, we detected the four most frequent features of GA-FG-CCP on ME-NBI as follows : 1) indistinct line of demarcation between the lesion and the surrounding mucosa, 2) dilatation of crypt opening, 3) dilatation of intervening part between the crypts, and 4) microvessels without distinct irregularity. These features were present due to the location of tumor origin and congestion by pressure from the tumor.
    The endoscopic diagnosis of GA-FG-CCP could be made by recognizing these endoscopic features of GA-FG-CCP on CE and ME-NBI. In addition, to diagnose GA-FG-CCP correctly by pathological examination of biopsy specimens, these endoscopic features and clinicopathological features should be taken into consideration.
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  • TOKYO CRITERIA 2014 FOR TRANSPAPILLARY BILIARY STENTING
    Hiroyuki ISAYAMA, Tsuyoshi HAMADA, Ichiro YASUDA, Takao ITOI, Shomei R ...
    2016 Volume 58 Issue 6 Pages 1178-1184
    Published: 2016
    Released on J-STAGE: June 20, 2016
    DOIhttps://doi.org/10.11280/gee.58.1178
    JOURNAL FREE ACCESS
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    It is difficult to carry out meta-analyses or to compare the results of different studies of biliary stents because there is no uniform evaluation method. Therefore, a standardized reporting system is required. We propose a new standardized system for reporting on biliary stents, the ‘TOKYO criteria 2014’, based on a consensus among Japanese pancreatobiliary endoscopists. Instead of stent occlusion, we use recurrent biliary obstruction, which includes occlusion and migration. The time to recurrent biliary obstruction was estimated using Kaplan-Meier analysis with the log-rank test. We can evaluate both plastic and self-expandable metallic stents (uncovered and covered). We also propose specification of the cause of recurrent biliary obstruction, identification of complications other than recurrent biliary obstruction, indication of severity, measures of technical and clinical success, and a standard for clinical care. Most importantly, the TOKYO criteria 2014 allow comparison of biliary stent quality across studies. Because blocked stents can be drained not only using transpapillary techniques but also by an endoscopic ultrasonography-guided transmural procedure, we should devise an evaluation method that includes transmural stenting in the near future.
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