Immune checkpoint inhibitors (ICIs) exert antitumor effects by inducing the immune response to tumor cells; however, this also leads to an increased incidence of immune-related adverse events (irAEs). Enteritis is the most common irAE caused by anti-CTLA-4 antibodies, and its frequency and pathophysiology vary based on the combination of ICIs and other antitumor drugs (cell-mediated anticancer or molecular target drugs). Enteritis is therefore considered an irAE that requires special attention. The following section outlines the recent findings.
The high-risk groups for pancreatic cancer include those with a history of pancreatic cancer, familial pancreatic cancer, hereditary pancreatitis, or hereditary pancreatic cancer syndrome. Familial pancreatic cancer is defined as having a history of two or more first-degree relatives with pancreatic cancer. Surveillances for the early detection of pancreatic cancer in individuals at risk are being conducted worldwide. In particular, the Cancer of the Pancreas Screening (CAPS), which is mainly conducted in the United States, has a policy of surveillance based on endoscopic ultrasonography (EUS) and magnetic resonance imaging (MRI). There are many similar methods available worldwide with various reports on their usefulness.
In Japan, expert consensus statements have been issued and multicenter prospective intervention studies have been initiated.
Background: In determining the surgical procedure for low rectal cancer, the resection margin is very important. Pillar-like elevation (PE) of the mucosa extending from the distal tumor edge is often observed during preoperative colonoscopy. In this study, we examined the clinicopathological significance of PE.
Method: A total of 94 patients with lower rectal cancer who underwent surgical resection at the National Defense Medical College were analyzed. We investigated the relationship between PE and clinicopathologic findings that included the length of intramural cancer spread.
Results: PE was observed in 10 cases (10.6%). Distal intramural cancer spread was observed more frequently in PE-positive cases (60.0%) than in PE-negative cases (9.5%) (P = 0.0006). In contrast, PE length did not correlate with the length of intramural cancer spread.
Conclusion: PE was not indicative of the extent of intramural distal tumor spread. Even if PE is observed preoperatively, it may be sufficient to take the distal resection margin recommended in the JSCCR guidelines.
A 62 year-old man underwent a gastroscopy for the purpose of an annual checkup. A 6-mm protrusion lesion in the middle of his thoracic esophagus was detected, and biopsy revealed squamous cell carcinoma. For endoscopic therapy, he was referred to our hospital. About one month later, we tried to operate via endoscopic submucosal resection (ESD) and discovered that the protrusion had enlarged remarkably by 20mm. ESD was still carried out and the pathological evaluation confirmed esophageal carcinosarcoma. In general, carcinosarcomas are detected when the tumor grows considerably large; at this point, the patient will likely experience chest discomfort or dysphagia. In this case report, however, the protrusion was considerably smaller and the patient had no complaints, but the tumor had been growing rapidly for about a month already. It is unusual to detect carcinosarcomas that are small in size, but we should anticipate this disease when we observe a protrusion lesion with fur in the esophagus.
A 55-year-old-man presented with tarry stool and heart palpitations. The patient was diagnosed with hemorrhagic duodenal lipoma based on computer-tomography and endoscopic findings. Endoscopic ultrasonography (EUS) with X-ray fluoroscopy findings indicated that treatment with laparoscopy and endoscopy cooperative surgery for duodenal tumors (D-LECS) was possible. During surgery, the duodenum was first mobilized laparoscopically. Next, endoscopic mucosal resection (ESD) was performed and seromuscular sutures were applied to the area surrounding the ESD ulcer. This procedure was found to decrease the risk of stenosis and delay perforation. Therefore, it is important that the gastroenterologist and surgeon reach a consensus when deciding the treatment.
A 53-year-old man underwent sigmoidectomy with diverting loop ileostomy for sigmoid-vesical fistula owing to diverticulitis of the sigmoid colon. After 5 months, ileostomy closure was scheduled; however, preoperative endoscopic examination revealed complete anastomotic obstruction. Although surgery was considered, minimally invasive endoscopic treatment was deliberated. Endoscopic incision and balloon dilatation using trans-ileostomic and anal endoscopes were successfully performed without intestinal perforation, and the patient underwent successful ileostomy closure. The combined antegrade-retrograde endoscopic rendezvous technique for complete occlusion of the anastomotic site appears to be a minimally invasive and effective treatment method.
A 55-year-old male was referred to our hospital due to chronic upper left abdominal pain. A blood test showed an elevated level of CA19-9. Abdominal CT revealed a 60mm tumor near the tail of the pancreas. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was performed but a definitive diagnosis was not established. Ten days after EUS-FNA, he was admitted to our hospital with an infection and rupture of the tumor. Based on a diagnosis of tumor perforation and surrounding abscess, percutaneous drainage was performed. Surgery was also performed to rule out malignancy. Pathological examination of the resected specimen revealed lymphoepithelial cyst of the pancreas. This report describes the adverse events of EUS-FNA in patients with cystic lesions of the pancreas.
The case was a 57-year-old woman. During the colonoscopy at a private practice, a sliding tube accidentally slipped into the colon. The patient was transported to our hospital due to difficulty in removal of the sliding tube. A close examination revealed that the tube slipped into the descending colon. By using an endoscope, an ileus tube, and another sliding tube under X-ray fluoroscopy, we succeeded in removing the tube. The patient started eating the day after the treatment, and she was discharged 2 days after the treatment. Thus, the endoscopic removal of a sliding tube that has slipped into the descending colon was difficult as it cannot simply be pulled out, and some ingenuity was required.
Red dichromatic imaging (RDI) is a next-generation image-enhancement technique that uses three wavelengths (red, amber, and green). RDI has 3 modes—modes 1 and 2 are used during colorectal endoscopic submucosal dissection (ESD). RDI improves the visibility of blood vessels and tissues, which helps visualize the bleeding point clearly and maintain clear visibility during colorectal ESD with submucosal fatty tissue. The operator should have sufficient understanding of the characteristics of RDI and use it as per the situation.
Pancreatobiliary endoscopy (PBE) on a child is a technically difficult and high-risk procedure with the possibility of severe postoperative complications. Due to the rarity of the performed procedure and a shortage of qualified specialists, several institutions lack the adequate infrastructure needed to conduct a PBE. However, despite lacking dedicated endoscopes and other devices in our institution, we regularly perform a relatively large number of PBEs on children. We employ standard endoscopes and devices for adult patients to perform PBE on children, under conscious sedation, in the presence of a pediatrician/pediatric surgeon. Procedures are performed smoothly in the operation theatre under general anesthesia with the aid of a well-constructed PBE performance system. In this article, we have elaborated on our methods of obtaining informed consent, anesthesia, procedural details, and the introduction of the PBE collaborationsystem in our institution. Furthermore, we have laid prime emphasis on addressing the emotional ordeal of the children undergoing the procedure, apart from the physical discomfort experienced by them.
Objectives: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) uses a thin needle, rendering unclear whether the collected sample contains pathological evidence. We examined the usefulness of our target sample check illuminator (TSCI) through a multicenter prospective trial.
Methods: We included 52 consecutive patients. After assessing EUS-FNB samples by conventional (visual observation) and TSCI methods, we evaluated consistency with the histopathological diagnosis. We compared the target sample confirmation rate between conventional and TSCI methods and evaluated the diagnostic ability separately.
Results: Comparison between the conventional and TSCI methods revealed the following: (ⅰ) for all cases: sensitivity, 51.0% (25/49) vs. 95.9% (47/49) (P = 0.001); specificity, 100% (3/3) vs. 66.7% (2/3); positive predictive value (PPV), 100% (25/25) vs. 97.9% (47/48); and negative predictive value (NPV), 11.1% (3/27) vs. 50.0% (2/4) (P = 0.002);(ⅱ) for pancreatic masses: sensitivity, 28.0% (7/25) vs. 96.0% (24/25) (P＜0.001); specificity, 100% (2/2) vs. 100% (2/2); PPV, 100% (7/7) vs. 100% (24/24); and NPV, 10.0% (2/20) vs. 66.7% (2/3) (P＜0.001) (the TSCI method showed significantly better sensitivity and NPV than the conventional method); and (ⅲ) for lymph node tumors: sensitivity, 75.0% (18/24) vs. 95.8% (23/24) (P = 0.025); specificity, 100% (1/1) vs. 0% (0/1); PPV, 100% (18/18) vs. 95.8% (23/24); and NPV, 14.3% (1/7) vs. 0% (0/1).
Conclusions: The TSCI improved the sensitivity, NPV, and accuracy of target sample confirmation for pancreatic mass EUS-FNB. Although the proportion of samples not including a target region was quite low, which could strongly influence our results, the TSCI method can be used in EUS-FNB when rapid on-site evaluation cannot be performed. (A multicenter prospective study for the utility of a target sample check illuminator, Clinical Trial ID: UMIN000023349).