GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 64, Issue 3
Displaying 1-16 of 16 articles from this issue
  • Tomonori YANO, Yusuke HASHIMOTO, Yusuke YODA
    2022 Volume 64 Issue 3 Pages 229-238
    Published: 2022
    Released on J-STAGE: March 22, 2022
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    Photodynamic therapy (PDT) is an anti-cancer treatment that consists of a photosensitizer (PS), which is followed-by laser illumination with a wavelength specific to the PS. In the early 1990s, a first generation porphyrin-based PS was approved for early gastric cancer or superficial esophageal cancer. However, its use was not widespread due to the high incidence of skin phototoxicity and long sunshade period, and the subsequent development of ESD for early gastrointestinal cancer. In the western countries, conventional PDT has been used for the eradicative treatment of Barrettʼs esophagus or palliative treatment of advanced esophageal cancer or cholangiocarcinoma. Although favorable results for these treatments have been reported, drug-free radio frequency ablation has become the mainstream for those indications. PDT using second generation PS with less phototoxicity and requiring a shorter sunshade period was introduced as a treatment for local failure after chemoradiotherapy for esophageal cancer, and was approved with excellent efficacy and safety after clinical trials in Japan in 2015. Now approved for local failure of esophageal cancer, 2nd generation PDT is gradually becoming popular in our country; however, the indicated cases are still limited for the treatment of GI cancer. In recent years, there have been several molecularly targeted or tumor-specific approaches using drug delivery systems that are supported by basic research, and photoimmunotherapy that targets EGFR is in clinical trials. Growing knowledge of PDT will encourage its clinical application in the future.

  • Takahiro NISHIKAWA, Koji NONOGAKI, Masanao NAKAMURA
    2022 Volume 64 Issue 3 Pages 239-248
    Published: 2022
    Released on J-STAGE: March 22, 2022
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    Capsule endoscopy is a minimally invasive and simple method of gastrointestinal tract examination, making it indispensable for diagnosing small intestinal diseases. Furthermore, colon capsule endoscopy significantly contributes to colorectal tumor screening in patients in whom colonoscopy is difficult to perform. However, reading the obtained images is a time-consuming and burdensome task. Furthermore, clinicians must be familiar with the images to make an accurate diagnosis, but there is a shortage of such individuals. To overcome these problems, a capsule endoscopy reading support network and capsule endoscopy reading support technician certification system have been established. The former comprises a system wherein capsule endoscopy images obtained at different examination facilities are read remotely at reading support centers, thereby reducing the burden of image analysis and standardizing diagnoses across different examination facilities. At the reading support centers, several capsule endoscopy images must be read accurately and rapidly. Furthermore, it is crucial to develop an efficient reading system comprising capsule endoscopy reading support technicians and to improve and maintain the image-reading ability at these centers. This article reviews the current status of capsule endoscopy reading support centers and challenges faced by them.

  • Yuki TAMURA, Yumeo TATEYAMA, Hiroaki NARUSE, Yuhei SUZUKI, Tomoyuki MA ...
    2022 Volume 64 Issue 3 Pages 249-255
    Published: 2022
    Released on J-STAGE: March 22, 2022
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    A 67-year-old woman was found to have a gastric submucosal tumor with a 3-cm diameter in the fundus. At routine follow-up, the tumor showed growth, so a detailed examination was planned. However, she developed epigastric pain and tarry stool before the detailed examination was performed and was thus admitted. A gastroduodenal endoscopic examination revealed gastroduodenal invagination of the submucosal tumor arising from the gastric fundus. She was diagnosed with ball valve syndrome. Endoscopic reduction was difficult, so surgical treatment was selected. Pathological findings revealed that the tumor was a gastrointestinal stromal tumor (GIST). Cases of ball valve syndrome caused by a GIST of the fundus are relatively rare. We herein report this case with a review of the literature.

  • Yusuke KIMURA, Ken ITO, Naoki OKANO, Yui KISHIMOTO, Susumu IWASAKI, Ts ...
    2022 Volume 64 Issue 3 Pages 256-261
    Published: 2022
    Released on J-STAGE: March 22, 2022
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    An 84-year-old woman with a history of laparoscopic cholecystectomy and Roux-en-Y choledochojejunostomy (CDJ) for post-cholecystectomy bile duct stenosis was admitted to our hospital following an acute cholangitis diagnosis due to suspected CDJ anastomotic stricture. After conservative treatment with fasting, fluid replacement, and antibiotics, endoscopic retrograde cholangiopancreatography (ERCP) was performed using a balloon-assisted enteroscope (BAE). Multiple membranous stenoses were observed in the small bowel. A BAE was advanced through the small bowel strictures by endoscopic balloon dilation. Finally, the passage allowed access to the CDJ anastomosis.

    The CDJ anastomosis stricture was scarred and dilated using a biliary balloon dilator. Currently, the patient is in stable condition without recurrence of cholangitis.

    This report describes a case of CDJ anastomosis stricture and nonsteroidal anti-inflammatory drug-induced multiple small bowel strictures treated with a BAE and endoscopic balloon dilation.

  • Hidetaka OKUBO, Mikiko FUJITA, Rie KURE, Toshimitsu FUJII, Syohei TOMI ...
    2022 Volume 64 Issue 3 Pages 262-269
    Published: 2022
    Released on J-STAGE: March 22, 2022
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    A 49-year-old man underwent a screening fluorodeoxyglucose positron emission tomography (FDG-PET), which revealed increased F-18 accumulation in the rectum. A fecal occult blood test was also positive. A subsequent colonoscopy revealed diffuse granular lesions in the lower rectum. Histopathological examination showed nonspecific inflammatory findings, such as inflammatory cell infiltration and lymphocyte aggregation. As the patient was asymptomatic, he was observed without any medications. Five months later, he developed symptoms of loose stool 4-5 times a day, abdominal pain, and tenesmus.

    The second colonoscopy showed diffuse granular lesions in the rectum and rough-surfaced mucosa with loss of vascularity from the rectum to the splenic flexure, as well as a cluster of micro-erosions around the appendiceal orifice. In the second histopathological examination, a decreased number of glandular ducts and goblet cells and diffuse infiltration of various inflammatory cells were observed. Based on these findings, the patient was diagnosed with left-sided ulcerative colitis. This report describes a case of ulcerative colitis progressing from the initial lesion to typical left-sided colitis. We also discuss differential diagnoses of rectal granular lesions.

  • Naomi UCHIYAMA, Hiroshi KAWAKAMI, Yoshimasa KUBOTA, Hiroshi HATADA, So ...
    2022 Volume 64 Issue 3 Pages 270-276
    Published: 2022
    Released on J-STAGE: March 22, 2022
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    A 65-year-old man with small bowel obstruction (SBO) and obstructive jaundice due to recurrence of cystic duct cancer was admitted to our division. He had history of gallbladder bed and extrahepatic bile duct resection (partial liver resection) with Roux-en-Y reconstruction. We performed EUS-guided hepaticogastrostomy (EUS-HGS) for biliary drainage and EUS-guided transluminal drainage of dilated jejunal limb. Obstructive jaundice and abdominal pain were resolved, thereby improving the patientʼs QOL. We searched PubMed for articles published between October 2000 and October 2021 using the terms “EUS-guided transluminal drainage, gastrojejunostomy, or gastroenterostomy” and “small bowel obstruction”. On the basis of search results, this is the first report on EUS-guided transmural drainage for SBO and jaundice due to recurrence of cystic duct cancer. It is difficult to improve prognosis and QOL of patients with SBO caused by recurrent cancer with surgical treatment. Thus, endoscopic internal drainage is desirable. In the future, the development of dedicated devices and elaborate indications for currently available devices are required.

  • Manabu HARADA, Ryoichi YAMAKAWA, Kunihiro KAWAUCHI, Satoru NYUZUKI, Ma ...
    2022 Volume 64 Issue 3 Pages 277-283
    Published: 2022
    Released on J-STAGE: March 22, 2022
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    [Aims]To evaluate the distance estimation accuracy of a novel three-dimensional (3D) endoluminal endoscopic system.

    [Methods]Experienced physicians (n = 5) and less experienced physicians and nurses (n = 7) were allowed up to five attempts to accurately grasp a 70-mm long screw while standing on a table using straight grasping forceps from a distance of 30, 50, and 100mm. The success rates for the first attempt as well as all five attempts were compared between 2D and 3D endoscopic systems.

    [Results]For the first attempt, using the 2D and 3D systems, the success rates were 8.3% and 50% from a distance of 30mm, 0% and 54.5% from 50mm, and 0% and 36.4% from 100mm, respectively. The success rate of grasping the screw from a 50-mm distance was significantly higher using the 3D system than using the 2D system (P<0.05). For all five attempts, using the 2D and 3D systems, the success rates were 75% and 100% from a distance of 30mm, 63.6% and 100% from 50 mm, and 45.5% and 90.9% from 100mm, respectively. The success rates were not significantly different between the systems; however, the 3D system tended to exhibit a higher success rate.

    [Conclusions]The novel 3D endoluminal endoscopic system is useful for accurate distance estimation.

  • Hiroyuki TAKAMARU, Yutaka SAITO
    2022 Volume 64 Issue 3 Pages 285-295
    Published: 2022
    Released on J-STAGE: March 22, 2022
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    The colon and rectum have a thinner wall than other gastrointestinal tracts. This anatomical characteristic makes endoscopic submucosal dissection (ESD) of the colon difficult. Therefore, careful attention is required for safely performing ESD of colorectal lesions.

    The Jet B-knife is a bipolar knife with a water injection function. This knife was developed to perform a mucosal incision and coagulation at the root of the knife. This makes it possible to perform incisional dissection safely with a low risk of perforation. In this article, we will review the use of bipolar devices, including Tighturn bipolar hemostatic forceps, as well as the generator settings.

  • Yuko HIRAGA, Chiyuki WATANABE
    2022 Volume 64 Issue 3 Pages 296-312
    Published: 2022
    Released on J-STAGE: March 22, 2022
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    Supplementary material

    Colorectal endoscopic mucosal resection (EMR) is generally carried out as outpatient surgery on a daily basis and is useful for treating Tis (M) carcinomas. EMR is advantageous because the procedure time, expense, and electrical burning of the muscularis propria is reduced compared with ESD. Disadvantages of EMR include difficulty controlling the excision depth and ascertaining whether a free resection margin was included in all circumferences of the lesion at snaring. The convenience of EMR allows for the resection of many lesions at one time; however, based on its aforementioned limitations, it is necessary to observe the ulcer base and incised margin immediately after the snare resection of each lesion.

    First, I observe the state of the ulcer floor and confirm the existence of perforation, bleeding, and the visible vessel. Next, I confirm the existence of the residual lesion with magnified endoscopic observation of the incised margin; if this is unclear, I also use image-enhanced endoscopy and chromoendoscopy. If piecemeal EMR was carried out, I carefully observe the lesion margin and ulcer base. If residual lesions are present, I perform additional treatment.

    Even after confirming that there is no residual lesion at the incised margin of the ulcer, it may be necessary to prevent the risk of delayed bleeding using clip closure. If conventional clip closure is difficult for large mucosal defects, other endoscopic closure methods may be explored.

    In summary, it is necessary to carefully observe the incision, not only before but also after colorectal EMR, and to add the required treatment to the margin to prevent delayed bleeding. These practices ensure that safe and reliable endoscopic surgeries can be performed on outpatients.

  • Masaki MATSUBARA, Noriaki MANABE, Maki AYAKI, Jun NAKAMURA, Takahisa M ...
    2022 Volume 64 Issue 3 Pages 313-322
    Published: 2022
    Released on J-STAGE: March 22, 2022
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    Supplementary material

    Objectives: The first aim of this study was to elucidate the detection rate of esophagogastroduodenoscopy (EGD) in patients complaining of dysphagia with esophageal motility disorders; the second was to clarify the useful parameters of EGD associated with esophageal motility disorders.

    Methods: Participants included 380 patients who underwent EGD before high-resolution manometry (HRM) for dysphagia. EGD findings were investigated according to the following five parameters: resistance when passing through the esophagogastric junction (EGJ), residue in the esophageal lumen, esophageal dilation, and spastic and nonocclusive contractions. HRM diagnoses were based on the Chicago classification (v3.0).

    Results: The percentage of abnormal EGD findings was 64.4% among patients with esophageal motility disorders, and the results differed for each esophageal motility disorder. The rate of abnormal EGD for both EGJ outflow obstruction and major disorders of peristalsis was significantly higher than that for manometrically normal subjects. On multivariate analysis, resistance when passing through EGJ, residue in the esophageal lumen, spastic and nonocclusive contraction were significantly associated with esophageal motility disorders. The sensitivity, specificity, positive predictive value, and negative predictive value of these parameters for detection of esophageal motility disorders were 75.1%, 86.6%, 84.8% and 77.8%, respectively.

    Conclusion: Esophagogastric junction outflow obstruction and major disorders of peristalsis can be screened with EGD. Among several endoscopic parameters, resistance when passing through EGJ, residue in the esophageal lumen, spastic and nonocclusive contraction are considered significantly useful indicators.

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