GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
Volume 64, Issue 9
Displaying 1-14 of 14 articles from this issue
  • Kotaro SHIBAGAKI, Yusuke TAKAHASHI, Shunji ISHIHARA
    2022 Volume 64 Issue 9 Pages 1533-1540
    Published: 2022
    Released on J-STAGE: September 20, 2022
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    Foveolar-type gastric neoplasia (adenoma/carcinoma) refers to a gastric epithelial neoplasm with an immunophenotype characterized by gastric foveolar cell differentiation. This neoplasm presents as a small, reddish protruded polyp with a raspberry-like appearance in Helicobacter pylori-naïve gastric mucosa. The lesion commonly occurs in the gastric body or fornix and is small in size (≤5 mm). The papillary or gyrus-like microstructure, which typically shows a wide intervening portion and dilated irregular vessels is best viewed using narrow-band imaging with magnification endoscopy. Histopathologically, the lesion appears as an intraepithelial neoplasm with gastric foveolar cell differentiation. This tumor is usually diagnosed as carcinoma in Japan based on its gastric phenotype; however, it is classified as a foveolar-type gastric adenoma by the World Health Organization classification based on its non-invasiveness. The differential diagnosis in cases of H. pylori-naïve gastric mucosa includes a hyperplastic polyp or hamartoma, which shows similar morphological features; however, magnification endoscopy can distinguish between these lesions.

  • Kazuyuki MATSUMOTO, Hironari KATO
    2022 Volume 64 Issue 9 Pages 1541-1549
    Published: 2022
    Released on J-STAGE: September 20, 2022
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    Surgical resection is considered the standard of care for pancreatic neuroendocrine neoplasms (PNENs). However, the optimal therapeutic approach to small PNETs (≤2 cm in diameter) remains controversial, and the benefits of surgery should be balanced against potential operative complications. Recently, the use of EUS-guided ethanol injection therapy for patients with small PNETs has been reported. This novel therapy may serve as less invasive treatment in patients deemed poor surgical candidates or those rejected for surgery. In this article, we summarize the recent data including that obtained from animal studies and discuss treatment outcomes and current concerns associated with EUS-guided ethanol injection therapy.

  • Masafumi MINAMISAWA, Seiichi DAIKUHARA, Kazuyuki ONO, Yasuhiro KURAISH ...
    2022 Volume 64 Issue 9 Pages 1550-1556
    Published: 2022
    Released on J-STAGE: September 20, 2022
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    A 69-year-old woman had been taking a proton pump inhibitor (PPI) for reflux esophagitis since 2005 and also succeeded to Helicobacter pylori(H. pylori) eradication in 2015. EGD revealed multiple gastric polyps in 2017, one of them was suspected to be malignant based on biopsy findings. The polyp gradually enlarged with an irregular depression on its surface; therefore, endoscopic mucosal resection was performed for further diagnosis and treatment. Histopathological assessment confirmed adenocarcinoma on the fundic gland polyp (FGP); however, findings suggestive of gastric mucosal atrophy or H. pylori infection were absent. Gastric adenocarcinoma arising from a PPI-related FGP is rare. Thus, when adenocarcinoma on an FGP is suspected, carefully follow-up and endoscopic resection are recommended.

  • Shumpei KITADA, Yosuke KINOSHITA, Atsuki FUKUI, Yuji KAWATA, Yoshinori ...
    2022 Volume 64 Issue 9 Pages 1557-1563
    Published: 2022
    Released on J-STAGE: September 20, 2022
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    An 81-year-old man was admitted to our hospital for evaluation of upper abdominal pain and vomiting. Plain CT on admission revealed dilatation of the stomach. Gastric tube insertion followed by decompression led to improvement in symptoms, and EGD revealed no organic lesion to account for gastrointestinal obstruction. The patient experienced the same symptoms after meals, and we diagnosed gastric volvulus based on plain CT findings. Standard surgical treatment was associated with a high risk in this patient with respiratory dysfunction secondary to chronic obstructive pulmonary disease; therefore, we performed endoscopic four-point gastropexy as a minimally invasive alternative. Few studies have reported endoscopic gastropexy for gastric volvulus, and a definitive fixation method remains unclear. Endoscopic four-point gastropexy may be a useful therapeutic strategy to prevent recurrent gastric volvulus.

  • Noriyuki IMAZU, Shin FUJIOKA, Yasuharu OKAMOTO, Hiroyuki MASUHARA, Yut ...
    2022 Volume 64 Issue 9 Pages 1564-1571
    Published: 2022
    Released on J-STAGE: September 20, 2022
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    Two cases of extreme hypermagnesemia occurred after administration of bowel preparation with magnesium citrate for colonoscopy. Neither patient had renal dysfunction but both had a history of bowel resection for treatment of colorectal cancer. Each patient presented with bowel obstruction secondary to fecal impaction at the rectal anastomosis or severe anastomotic stricture at the sigmoid colon. The hypermagnesemia improved in each with the successful release of the bowel obstruction by digital disimpaction or balloon dilation under systemic management. In a patient with a possible intestinal obstruction, the risk of hypermagnesemia incidence with bowel preparation with magnesium products should be considered regardless of renal function.

  • Hiroki HASHIGUCHI, Ryohei KUMANO, Keichi YAMADA, Narika TAKEYAMA, Toyo ...
    2022 Volume 64 Issue 9 Pages 1572-1578
    Published: 2022
    Released on J-STAGE: September 20, 2022
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    A 73-year-old man who was regularly followed up for alcoholic chronic pancreatitis accompanied by main pancreatic duct stones presented with sudden-onset persistent epigastric pain while at home. CT revealed a pancreatic stone (10mm) in the papilla of Vater and common bile duct and main pancreatic duct dilatation at the site of the initial obstruction. The patient was diagnosed with obstructive jaundice, acute cholangitis, and acute pancreatitis secondary to an incarcerated pancreatic stone. Immediate ERCP revealed an ivory white pancreatic stone at the pancreatic duct orifice. The patient underwent emergency endoscopic pancreatic sphincterotomy and stone removal using a balloon catheter, which led to symptom resolution.

  • Toshiro IIZUKA
    2022 Volume 64 Issue 9 Pages 1579-1587
    Published: 2022
    Released on J-STAGE: September 20, 2022
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    EUS for esophageal diseases is highly useful for determining treatment strategies. Because the diagnosis of esophageal disease is largely based on technical factors, a well-established examination with a standardized technique is needed to improve the accuracy of findings. Soft balloon EUS and gel immersion EUS have different pros and cons; however, practicing each diagnostic method would be helpful in gaining a working knowledge about each toolʼs characteristics. Esophageal submucosal tumor and superficial esophageal cancer are good candidates for diagnosing with EUS. When T1b cancer is suspected and endoscopic treatment is being considered, EUS can be very useful in determining the possibility of an endoscopic resection with a negative vertical margin. Regarding the soft balloon method, there are some potential risks of both overdiagnosis owing to compression or lymphatic follicles just below the tumor and underdiagnosis owing to microinvasion. In terms of the gel immersion method, importance should be placed on ensuring that the procedure is performed in a completely immerged area.

  • Kohei YAMANOUCHI, Furitsu SHIMADA, Shotaro NAKAMURA
    2022 Volume 64 Issue 9 Pages 1588-1595
    Published: 2022
    Released on J-STAGE: September 20, 2022
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    Percutaneous endoscopic gastrostomy (PEG) is a beneficial treatment for patients with dysphagia and those having difficulty with oral nutrition ingestion. In addition, these patients may have poor general condition or serious underlying diseases such as cardiovascular disease, chronic respiratory illness, and neurological disorder. Preoperative risk evaluation of patients who receive PEG is important to reduce minor, as well as major, adverse events. Based on this evaluation, the appropriate gastrostomy tube placement method (i.e., pull/push method or introducer method) and managing the perioperative period in advance should both be considered. In this article, the techniques for PEG and preoperative risk management are described.

  • Hiroaki IKEMATSU, Tatsuro MURANO, Kensuke SHINMURA
    2022 Volume 64 Issue 9 Pages 1596-1606
    Published: 2022
    Released on J-STAGE: September 20, 2022
    JOURNAL FREE ACCESS FULL-TEXT HTML

    Depth diagnosis is extremely crucial in making a treatment choice between endoscopic resection and surgery in the early stages of cancers. Among several imaging modalities, we use magnifying endoscopy to diagnose lesions by close observation of the findings at mucosal surface layer. In combination with topical staining, magnifying endoscopy enables us to assess the definite pit structure, which referred to as magnifying chromoendoscopy (MCE). The pit pattern classification by MCE was proposed and is now widely accepted as the standard diagnostic criteria for colorectal lesions. Meanwhile, image enhanced endoscopy (IEE) represented by narrow-band imaging was developed to improve the visibility of surface and vascular findings without dyeing. Recent collaborative work performed by endoscopic experts in Japan yielded the unified diagnostic criteria, the Japan NBI Expert Team (JNET) classification, based on the findings of IEE with magnification. In this review, focusing on MCE and IEE with magnification, we aimed to give an outline of the pit pattern classification and the JNET classification, and further discuss their accuracy rate of depth diagnosis of early colorectal lesions by performing a review of the related literature. Both modalities have a high accuracy rate of nearly 90% for depth diagnosis. IEE with magnification is an ideal modality because it helps observe lesions without dye spraying; however, lesions with JNET type 2B have an inadequate diagnostic ability, which should be complemented by MCE. We conclude that accurate diagnosis is possible by examining lesions using both modalities properly to overcome the limitations of each modality.

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