GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
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Displaying 1-16 of 16 articles from this issue
  • Katsuaki KATO
    2023 Volume 65 Issue 1 Pages 5-18
    Published: 2023
    Released on J-STAGE: January 20, 2023
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    The gastrointestinal endoscopic screening was recently approved for implementation as a population-based gastric cancer screening in 2016. However, in the case of population-based gastric endoscopic screening, forceps biopsy, which is conducted subsequently while screening, is treated as a precision examination and double-checking of recorded images is mandatory. This causes significant confusion for clinicians participating in the screening. The complexity of the screening algorithm compared to other screening methods is a major problem for accuracy control. Concerning workplace-cancer screening, which plays a central role in cancer screening for the working age population, standardization of screening programs, equalization of testing accuracy, and development of an accuracy management infrastructure have not progressed. For gastrointestinal endoscopic screening, the accuracy management infrastructure should be developed to enable unified data management in the future, aiming to realize organized gastric cancer screening that combines regional and occupational cancer screening. Screening-certified physicians who know the difference between medical treatment and screening are expected to play a key role in making gastric endoscopic screening more accurate and precise in general.

  • Takeshi MIZUKAMI, Shinya SUGIMOTO
    2023 Volume 65 Issue 1 Pages 19-28
    Published: 2023
    Released on J-STAGE: January 20, 2023
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    The sigmoid colon tends to form loops and bends easily and is therefore considered a difficult site for colonoscope insertion. Inexperienced trainees may accidentally dilate the sigmoid colon following excessive air insufflation, and colonoscope insertion is challenging in such cases even with the use of the axis-retaining shortening method. The water infusion method developed in Japan involves injection of a small amount of water, which facilitates shortening and straightening. The collapse-submergence method, which includes a combination of degassing at the sigmoid colon and the water infusion method, is an improved technique that eliminates the water-air interface to provide a better field of view. The water immersion method can be easily learned even by trainees and is shown to improve the cecal intubation rate and suppress loop formation, which minimizes patient discomfort. This method is also utilized to perform detorsion of sigmoid volvulus and evaluation of irritable bowel syndrome and intestinal morphological abnormalities. Water-aided colonoscopy is popular in the U.S. and Europe, and studies have reported improved adenoma detection rates using “water exchange.” This innovative method is not only useful for endoscope insertion but also aids with underwater endoscopic mucosal resection. Water infusion-related techniques put to advantage the characteristics of water and overcome the limitations encountered with air insufflation methods and are expected to become increasingly popular in the future.

  • Yuichi TANAKA, Shoutai TAKEDA, Susumu HOSHI, Tomoko HOSHI, Kyosuke GOH ...
    2023 Volume 65 Issue 1 Pages 29-35
    Published: 2023
    Released on J-STAGE: January 20, 2023
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    An 85-year-old man was admitted due to cerebral hemorrhage. The next day, hematemesis developed with multiple deep-seated esophageal ulcers, confirmed by EGD. Suspecting esophageal perforation, we observed the patient till the upper thoracic esophagus. Chest computed tomography performed immediately after EGD revealed subcutaneous and mediastinal emphysemas. Thus, esophageal perforation was diagnosed. Emergency surgery involving esophagectomy, esophagostomy, and enterostomy was performed. The extracted specimens revealed extensive long-segment Barrettʼs esophagus (LSBE) as the underlying cause of the multiple esophageal ulcers. Moreover, the entire region was recognized to be malignant. However, the condition was classified as an acute, non-cancerous ulcer after determining that the cells had only invaded up to T1b-SM and muscle layer invasion of the cancer cells had not occurred in any ulcer base. On day 57 postoperatively, the esophagogastric junction (EGJ) was identified at 17 cm from the incisor, and the biopsy revealed remnants of Barrettʼs esophageal cancer. On day 77 postoperatively, gastrointestinal reconstruction (esophagogastrostomy) was performed for a thorough resection of remnant esophageal cancer. Considering the operations performed, Barrettʼs esophageal cancer was extremely extensive as it exceeded 18 cm. In this report, we have described an unusual case of pathological combination of extensive Barrettʼs esophageal cancer, with LSBE as the underlying etiology and multiple acute deep esophageal ulcers following a cerebral hemorrhage.

  • Aya HIRAOKA, Yuji MIZUKAMI, Yoshinori TANAKA, Yuri TABO, Kanako NOZAKI ...
    2023 Volume 65 Issue 1 Pages 36-42
    Published: 2023
    Released on J-STAGE: January 20, 2023
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    A 93-year-old man was diagnosed with acute obstructive cholangitis due to choledocholithiasis. Endoscopic papillary balloon dilatation was performed after ERCP. At the time of endoscopic bile duct stone removal, the basket catheter might have injured the cystic duct. The patient experienced abdominal pain 4 hours after ERCP. The following morning, a CT showed air in the cystic duct and the portal branches of the right hepatic lobe. The patient was diagnosed with hepatic portal venous gas (HPVG) and cholecystitis. An enhanced CT 1 hour later showed no signs of intestinal necrosis, and the portal venous gas decreased. Consequently, conservative treatment was performed for HPVG and percutaneous transhepatic gallbladder drainage was performed for cholecystitis. A follow-up CT 24 hours later showed marked resolution of the HPVG, and the patient recovered well. Although HPVG is the rarest complication of ERCP, it should be considered when the patient experiences post-procedural abdominal pain.

  • Ryo NAKANISHI, Noriko KINUKAWA, Hiroki INOUE, Kouhei MISHIMA, Takahiro ...
    2023 Volume 65 Issue 1 Pages 43-48
    Published: 2023
    Released on J-STAGE: January 20, 2023
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    A 73-year-old man was admitted to our hospital with abdominal pain and distension. Abdominal contrast-enhanced computed tomography (CT) showed intestinal intussusception from the cecum to the ascending colon. CT revealed terminal ileum intussusception. After endoscopic repositioning, laparoscopic ileocecal resection was performed. Pathological findings showed intestinal intussusception caused by small intestinal leiomyosarcoma. The postoperative CS revealed an elevated lesion, which was treated by endoscopic mucosal resection. Pathologically, colonic leiomyoma was identified. We report this case since it is rare for both small intestinal leiomyosarcoma and colorectal leiomyoma to occur concurrently.

  • Shinya SUTO, Manabu SAWAYA, Tetsuya TATSUTA, Hidezumi KIKUCHI, Daisuke ...
    2023 Volume 65 Issue 1 Pages 49-55
    Published: 2023
    Released on J-STAGE: January 20, 2023
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    A 19-year-old man visited our hospital with palpitations and bloody stools. We performed CS, which revealed a polypoid lesion with papillary structures adjacent to the dentate line. The patient was diagnosed with mucosal prolapse syndrome (MPS). EGD and capsule endoscopy did not reveal the cause of bleeding; therefore, anemia was believed to have been caused by bleeding of MPS. ESD was performed, and his anemia improved after the procedure. A follow-up CS performed six months later showed no recurrence. ESD is considered a minimally invasive treatment to resect refractory MPS. This lesion also had characteristics of cap polyposis, such as hypoproteinemia, white spots, Helicobacter pylori infection, and crypt hyperplasia.

  • Kengo KASUGA, Dan ZENNYOJI, Toshio URAOKA
    2023 Volume 65 Issue 1 Pages 56-62
    Published: 2023
    Released on J-STAGE: January 20, 2023
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    PuraStat—a self-assembling peptide solution—has been recently approved and marketed in Japan as a hemostatic agent for gastrointestinal endoscopy. It is an artificial synthetic peptide consisting of three amino acids: arginine (R), alanine (A), and aspartic acid (D). After coming in contact with body fluids, the peptides change from acidic to neutral, self-assembling into gel aggregates and acting as a medical device for pressure hemostasis of bleeding points. PuraStat is ineffective against spurting bleeding and can only be used for oozing. However, compared with the conventional hemostatic agents, PuraStat has the following advantages: stays as a gel for a long time at the application site; is a transparent substance easily removable by washing, and therefore, does not interfere with subsequent procedures after application; and has a low risk of infection. PuraStat can help with hemostasis of intraoperative bleeding in ESD, prevent postoperative bleeding, promote wound healing, and act as a hemostatic agent for gastrointestinal bleeding. This article outlines an endoscopic hemostatic technique using PuraStat.

  • Takeshi YAMAMURA, Masanao NAKAMURA, Hiroki KAWASHIMA
    2023 Volume 65 Issue 1 Pages 63-75
    Published: 2023
    Released on J-STAGE: January 20, 2023
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    Studies report that endoscopic resection of adenomatous polyps lowers the risk of colorectal cancer (CRC) and death. Therefore, colonoscopy plays a key role in preventing CRCs. In addition, high-quality colonoscopy is required to fulfill its role effectively and improve the adenoma detection rate for endoscopists. In contrast, since most post-colonoscopy CRCs (PCCRC) are caused by missed lesions, missed lesions as well as new lesions should be evaluated henceforth. Imaged-enhanced endoscopy (IEE) utilizing the optical digital method can be performed with a single click without using other devices or staining. Recent advances in endoscopic technology and the development of new IEEs have demonstrated the usefulness of IEEs in the detection and prevention of missed lesions in addition to their characterization. In this article, we describe the current state of colorectal polyp detection as well as the procedure and evidence for IEE observation during a colonoscopy. It is necessary to pursue the optimal observation method using IEE.

  • Teruyuki TAKEDA, Masahiro KISHI, Noritaka TAKATSU, Yasumichi TAKADA, T ...
    2023 Volume 65 Issue 1 Pages 76-86
    Published: 2023
    Released on J-STAGE: January 20, 2023
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    Supplementary material

    Background and aims: Efficacy of endoscopic balloon dilation (EBD) for intestinal strictures in patients with Crohnʼs disease (CD) receiving anti-tumor necrosis factor alpha antibodies (anti-TNF) as maintenance therapy is unclear. We investigated the long-term efficacy and safety of EBD for intestinal strictures in patients with CD receiving anti-TNF.

    Methods: We retrospectively analyzed data from patients with CD who received anti-TNF as maintenance therapy from 2008 to 2017, underwent EBD, and were followed up for ≥ 6 months. The primary endpoint was the cumulative surgery-free rate. The main secondary endpoints were technical success, repeat EBD rate, risk factors affecting surgical outcomes, and safety.

    Results: Seventy-two patients with CD were assessed. The median observation period after EBD was 50 months. The technical success rate was 67%. The 3 - and 5 -year cumulative surgery-free rates were 81.1% and 73.5%, respectively. The repeat EBD rate was 74%. Multivariable analyses showed that risk factors affecting surgical outcomes were age at disease onset ≤16 years (hazard ratio 3.69; 95% confidence interval 1.36-10.01; P = 0.011). Serious complications requiring surgery developed in three patients.

    Conclusions: Endoscopic balloon dilation was an effective and safe short-term treatment and a useful long-term treatment for CD patients with intestinal strictures receiving anti-TNF as maintenance therapy.

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