Fecal microbiota transplantation (FMT), which is a therapeutic approach for restoring normal functions of the intestinal microbiota by transplanting bacterial flora among feces derived from a healthy donor, has recently been evaluated in the context of treating patients with ulcerative colitis (UC). The therapeutic potential of FMT for treating various diseases has been extensively investigated in recent years. The high efficacy of FMT for the treatment of therapy-refractory, recurrent Clostridium difficile infection (CDI), an intestinal disease also linked to dysbiosis, was demonstrated by Von Nood et al. Two randomized placebo-controlled trials of FMT in patients with UC were reported in 2015 ; however, the efficacy of FMT treatment in patients with UC remains controversial. In 2017, a third randomized controlled trial in UC patients was reported in Australia. In this trial, multidonor intensive FMT was performed five times a week for eight weeks, resulting in remissions and positive responses. The multidonor intensive FMT was proven to be effective ; however, this treatment takes a large amount of time and is associated with complications. Thus, we have created a more effective and simple strategy for performing FMT in UC patients. We previously reported that FMT following triple antibiotic therapy (AFM : amoxicillin, fosfomycin and metronidazole) synergistically contributed to the recovery of the phylum Bacteroidetes composition, which was associated with the endoscopic severity of UC and a high clinical improvement rate. We named this combination therapy as A-FMT therapy, which stands for AFM plus FMT therapy. Standardization of donor screening and FMT techniques is needed to improve the efficacy and safety of FMT. Currently, no standard procedure for administering FMT therapy to UC patients has been established. More effective, simple, and personalized strategies for performing FMT in UC patients need to be developed.

Background and Aim : Elucidating the endoscopic findings of Campylobacter enterocolitis and Salmonella enterocolitis is useful for differential diagnosis from other diseases.

Method : Over the past 7 years, we experienced 138 Campylobacter enterocolitis and 23 Salmonella enterocolitis cases. We retrospectively analyzed their clinical characteristics and endoscopic findings.

Results : Regarding the clinical symptoms, there were no significant differences between Campylobacter enterocolitis and Salmonella enterocolitis. The rate of any endoscopic findings on the descending colon, sigmoid colon and rectum among the Campylobacter enterocolitis cases was significantly higher than that among the Salmonella enterocolitis cases. Characteristic findings of the colonic mucosa were intramucosal hemorrhage and edema in both diseases. The rate of an ulcer on Bauhin’s valve among the Campylobacter enterocolitis cases was significantly higher than that among the Salmonella enterocolitis cases. On the other hand, the rate of colonic ulcers among the Campylobacter enterocolitis cases was significantly lower than that among the Salmonella enterocolitis cases.

Conclusions : Characteristic findings of the colonic mucosa are intramucosal hemorrhage and edema in both diseases. The presence of an ulcer on Bauhin’s valve or colonic ulcers may be useful to endoscopically differentiate between Campylobacter enterocolitis and Salmonella enterocolitis.

An 18-year-old male presenting with abdominal pain and melena was admitted to our hospital. On esophagogastroduodenoscopic examination, longitudinal ulcers were observed at the duodenum and a bamboo joint-like appearance was observed at the gastric cardia. Biopsy specimens from the duodenum revealed non-caseating granuloma. There were no remarkable findings on both colonoscopic examination and small intestinal endoscopic examinations (capsule enteroscopy and double balloon enteroscopy). The patient was diagnosed with Crohn’s disease confined to the stomach and duodenum without involvement of the small intestine or colon.

A 79-year-old woman who suffered from anorexia, nausea, and discomfort in the upper abdomen, presented to our hospital. Abdominal computed tomographic (CT) scan and esophagogastroduodenoscopy revealed a large hepatic cyst with air fluid level and a fistula between the duodenal bulb and the hepatic cyst. The diagnosis of hepatoduodenal fistula was made. We first chose conservative management because there were no signs of acute panperitonitis. As the fistula decreased in size, it did not function as a drainage route from the hepatic cyst. The hepatic cyst became infected and required small incision laparotomy and placement of a drainage tube. As a result, the fistula closed spontaneously over time and the hepatic cyst shrunk. We could avoid emergent or elective laparotomy by performing non-invasive treatment. It may be critical to drain out food residue and intestinal fluid from a hepatic cyst by placing a drainage tube through the percutaneous transhepatic route in conservative management of a hepatoduodenal fistula.

An 82-year-old male was admitted to our hospital because of lower digestive tract bleeding. After previous surgical operation for spinal canal stenosis, diclofenac sodium was administered for many years due to low back pain. On lower digestive tract endoscopy, a diaphragm-like stricture was observed in the vicinity of the transverse colon-splenic flexure area, and an ordinary endoscope could not be passed through the stricture. For this reason, a nasogastric endoscope was used and the cecum was observed. Multiple ulcerative lesions and 11 diaphragm-like strictures were observed from the ileocecal region to the transverse colon. Disease-specific findings were not observed in biopsy specimens nor in tissue culture. Laparoscopic-assisted enlarged right hemicolectomy was performed to excise the portion of the colon with strictures. The diagnosis of nonsteroidal anti-inflammatory drug (NSAID)-induced colonic lesions was made. There are few reported cases of NSAIDs-induced diaphragm-like colonic stricture. We report this case including histological findings.

Colonoscopy was performed on a 45-year-old Japanese woman who was positive for fecal occult blood. A Ⅱa-like polyp, approximately 5 mm in diameter, was found in the hepatic flexure. Its surface was reddish and smooth, without erosion. Endoscopic mucosal resection of the polyp was performed for diagnosis and treatment. Microscopically, inflammatory cell infiltration was observed on the epithelial surface and an increased number of fibroblastic cells was noted in the lamina propria. Immunohistochemical studies showed that the fibroblastic cells were positive for vimentin, GLUT-1 and claudin-1, but not for desmin, c-kit, CD34, α-smooth muscle actin, S-100 or epithelial membrane antigen. The Ki-67 labeling index was less than １%. These results suggested that the lesion in the hepatic flexure was a benign fibroblastic polyp (perineurioma). Benign fibroblastic polyps (perineuriomas) of the colon are rare, and there have been no reports of cases with the endoscopic and histopathological features observed in our case. Herein, we report our experience of a case of a benign fibroblastic polyp (perineurioma) in the hepatic flexure.

Blue laser imaging (BLI ; Fujifilm Co., Tokyo, Japan) and linked color imaging (LCI) are two systems of narrow band imaging observation in the laser endoscopic system. BLI itself has two modes including BLI mode and BLI-bright mode. The BLI mode is useful for determining tumor characteristics. The BLI-bright mode is brighter than the BLI mode and is useful for tumor detection. On the other hand, LCI is brighter than the BLI-bright mode and may improve colorectal polyp detection. In this chapter, we demonstrate the efficacy of BLI and LCI for detection and characterization of colorectal polyps.

Endoscopic biliary drainage using a self-expandable metal stent (SEMS) or plastic stent has been widely performed in patients with malignant hilar biliary obstruction (MHBO). Uncovered SEMSs have generally been used in endoscopic biliary SEMS placement for unresectable MHBO. Recently, several articles reported endoscopic biliary covered SEMS placement for MHBO. We describe the current status of endoscopic biliary covered SEMS placement for MHBO. We also describe our techniques and clinical outcomes of endoscopic biliary side-by-side placement using a partially covered SEMS in patients with unresectable MHBO.

Background and Aim : The risk of developing colorectal cancer is higher in patients with ulcerative colitis (UC) than in the general population. Guidelines recommend surveillance colonoscopy (SCS) to reduce mortality ; however, few studies have assessed physicians’ adherence to guidelines. This study was aimed to clarify the current status of SCS and adherence to guidelines through the characteristics of cancer/dysplasia surveillance for UC patients in Japan.

Methods : A questionnaire was mailed to 541 physicians who attended meetings on inflammatory bowel disease.

Results : The respondents encountered a median of 100 UC cases. Thirty percent of the respondents had never managed a UC patient with cancer. Fifty-one percent of the respondents had never diagnosed colorectal cancer with UC. Forty-seven percent of the respondents considered extensive colitis and left-sided colitis as indications for SCS, and 38% carried out SCS regardless of the disease extent. Sixty-three percent of the respondents started SCS at 7-10 years after UC onset, whereas 20% started SCS at 3 years or less. Fifty-two percent of the respondents obtained targeted biopsies only, and chromoendoscopy was used by 49% of the respondents as a special technique for surveillance. Median number of biopsies at SCS was five per patient ; it was three among patients whose biopsy was carried out by physicians who obtained targeted biopsies only and seven among those carried out by physicians who obtained step biopsies and targeted biopsies (P ＜ 0.0001).

Conclusion : A considerable proportion of the respondents did not follow the guidelines when selecting patients for surveillance and carrying out SCS.