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Volume 60, Issue 10
Displaying 1-14 of 14 articles from this issue
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Theme I
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—In Relation to Newly Published Rome III—Masahiro Takano2007 Volume 60 Issue 10 Pages 889-894
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSIn newly published Rome III, Functional anorectal disorders are divided into 7 disorders. F1 Functional fecal incontinence is divided into staining, soiling, seepage and leakage in the degree and urge and passive incontinences in the dynamics, of which the former is dysfunction of the rectum and the latter of the anus. For the treatment, the most effective is biofeedback therapy (BF). F2 Functional anorectal pain is divided into F2a Chronic proctalgia, F2a1 Levator ani syndrome, F2a2 Unspecified functional anorectal pain and F2b Proctalgia fugax. F2a1 Levator ani syndrome is defined as a pain caused by traction of the levator ani, but in my experience, only 4 (3.5%) among 116 cases accorded to the criteria making us dubious of the definition. As for F2b Proctalgia fugax, the cause has not yet been found. In these two F2a, various treatments are tried without significant effectiveness due perhaps to the unknown pathogenesis which I assume to be the neuralgia of pudendal nerve. F3 Functional defecation disorders consist of F3a Dyssynergic defecation and F3b Inadequate defecatory propulsion of which, the former is caused by paradoxical contraction or inadequate relaxation of the pelvic floor muscles and the latter caused by inadequate propulsive force in defecation. Their treatments are BF and defecatory enforcement.View full abstractDownload PDF (318K) -
T. Yamana, T. Takahashi, M. Seki, R. Sahara2007 Volume 60 Issue 10 Pages 895-900
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSFecal incontinence is a devastating and humiliating symptom that greatly affects patients' quality of life. Several factors are associated with anal continence, such as the internal and external anal sphincter, anorectal angle, rectal reservoir, anal sensation, and stool consistency. The evaluation of fecal incontinence is based on interviews, physical examinations, and anorectal functional tests including anal manometry, anal ultrasound, and pudendal nerve terminal motor latency tests. For patients with occasional passive incontinence, anti-diarrheal drugs such as polycarbophil calcium and lopermide are effective in reducing their symptoms. For some patients who complain of urgency, pelvic floor muscle exercise and biofeedback training are other treatment options. For patients with a previous history of third or fourth degree perineal tear, we prefer overlapping sphincteroplasy preserving the scar and reconstruction of the perineal body. The most challenging part of the treatment of FI is how to treat those patients without sphincter defects (so-called idiopathic FI) who do not respond to medical treatment or biofeedback training. We have performed and investigated since 2001 a novel procedure named the perineal puborectalis sling operation. The preliminary results of the first eight patients reported improving symptoms and QOL scores. The routing technique has been modified to avoid the risk of complications.View full abstractDownload PDF (571K) -
K. Maeda, T. Hanai, H. Sato, K. Masumori, Y. Koide, H. Matuoka, H. Kat ...2007 Volume 60 Issue 10 Pages 901-905
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSImaging diagnosis and treatment for anorectal functional disease are reviewed. Trananal ultrasound, defecography with or without peritoneography, MRI and CT imaging are useful imaging tools for identifying anorectal functional disease. Conservative treatment should be initially selected for the treatment of this disease, then surgical intervention should be carefully considered after evaluating conservative treatment.View full abstractDownload PDF (737K) -
K. Yoshioka, Y. Hata, S. Iwamoto, Y. Nakane2007 Volume 60 Issue 10 Pages 906-910
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSFecal incontinence is a distressing symptom and its treatment requires a multidisciplinary approach. Surgical intervention is one of many therapeutic options. Graciloplasty has been carried out for patients with fecal incontinence who have had unsuccessful surgical treatment and would otherwise need to have a stoma. Various surgical techniques have been carried out although the basic idea of the procedure is simple : mobilization of the muscle and wrapping around the anus in order to gain optimal pressure of the anal canal. Although the rate of postoperative complications is high, the success rate of this operation has been reported to be around 70%. Improvement of squeeze pressure rather than resting anal pressure may provide better functional results. We have carried out this operation in 15 patients with severe fecal incontinence. Post-operative assessments were available in 12 patients. Eight patients achieved good results, 2 fair and 2 poor results.View full abstractDownload PDF (442K) -
Y. Takao, K. Tsujizuka, K. Kikuchi, M. Okuda2007 Volume 60 Issue 10 Pages 911-916
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSUntil quite recently, rectal prolapse was regarded as being a simple condition to treat. Surgical control of the prolapse was largely regarded as a successful outcome. However, recent detailed clinical assessment indicate that many patients have a rectal prolapse which is successfully controlled by surgical operation, yet suffer severe symptoms of disordered defecation, which either persists, or develops as a result of operative treatment. Difficulty with rectal evacuation, persistent incontinence and continuing mucus discharge are recognized as important, despite successful repair of the prolapse itself.
There are two major theory of the pathology ; circumferential intussusception and sliding hernia. However, many other multifarious factors are concomitant with the condition. These factors often need to be balanced against one another. Usually, a single surgical procedure will not be able to solve the problems. Therefore, the choice of treatment tailored for the individual patient.View full abstractDownload PDF (625K) -
M. Oya2007 Volume 60 Issue 10 Pages 917-922
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSCombination of symptoms such as frequent bowel movement, minor fecal incontinence, defecatory urgency, and evacuation difficulty are common after sphincter-preserving surgery for rectal cancer. A number of factors including loss of reservoir function of the rectum and impaired function of the internal anal sphincter are thought to be causative of symptoms. Presentation of impaired anal function before operation, anastomosis close to the anal margin, and anastomotic leakage are known to be associated with poor postoperative function. Colonic J-pouch reconstruction and coloplasty used as methods to increase the neorectal capacity and compensate the loss of reservoir function have been reported to improve postoperative defecatory function. Neoadjuvant radiotherapy and neoadjuvant chemoradiotherapy are known to enhance the severity of impaired defecatory function. In patients who have undergone intersphincteric resection for very low rectal cancer, fecal incontinence is common but is improved with the use of colonic J-pouch reconstruction.View full abstractDownload PDF (378K) -
H. Matsufuji, A. Nakamura, M. Nakagawa, I. Kusakawa2007 Volume 60 Issue 10 Pages 923-927
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSBowel frequency was investigated in 206 infants (95 female, 111 male infants) at 1 month, 3 months, 6 months, 9 months, and 1 year of age health check up, sucsseively. The mean bowel frequency in 1-month-old infants was 4.84 times a day and decreased to 1.8 times a day at 1 year of age. In St. Luke's International Hospital Tokyo, 1,058 patients had been diagnosed as constipation by a pediatrician during the period from 2004 to 2006, most of the patients had a self limited condition, and the number of children with constipation decreased as the children grew older. A small number of patients with serious constipation were referred to the department of pediatric surgery for further investigation and treatment. More extensive study is needed in order to develop diagnostic and treatment guidelines for Japanese children with constipation.View full abstractDownload PDF (644K)
Theme II
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M. Iida2007 Volume 60 Issue 10 Pages 928-932
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSRadiological examination of the small intestine is classified into barium meal study, double-contrast study, and retrograde ileography, based on the method of barium administration. Nowadays in Japan, the former two procedures are widely used. On the other hand, endoscopic examination of the small intestine had a good chance of realization since the development of two types of fiberscope (SIF and FIS) in 1970. Subsequently, various techniques including the push type, ropeway type, and zonde type were performed without wide clinical use. Diagnostic procedures for small intestinal diseases underwent a great change with the development of capsule endoscopy in 2000 and double-balloon enteroscopy in 2001. While diagnostic examination of the small intestine usually relied only on radiological examination before 2000, the combination of capsule endoscopy, double-balloon enteroscopy and X-ray study has been used for small intestinal diagnosis since 2001. This revolution can be expected to spur remarkable progress in knowledge and clinical research of the small intestinal diseases with an increase in interest by many clinicians.View full abstractDownload PDF (437K) -
T. Matsui, F. Hirai, Y. Ono, R. Nakasima2007 Volume 60 Issue 10 Pages 933-939
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSRecently, new endoscopic techniques (capsule endoscopy and double balloon endoscopy) were invented and have been used often to scrutinize lesions of small intestinal diseases. Conventional method of radiography for small intestinal lesions has been used for long time period and still has a definite role to diagnose even subtle and small intestinal lesions. Radiography can diagnose stenotic lesion which is hardly accessible by new endoscopy. However, new endoscopy can diagnose flat and hemorrhagic lesions which can not be diagnosed by radiography. Both radiography and endoscopy should be used properly and rationally for small intestinal diseases. In this review recent advances in endoscopy and radiography will be discussed comparatively.View full abstractDownload PDF (1342K) -
T. Yano, H. Yamamoto2007 Volume 60 Issue 10 Pages 940-946
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSThe advent of video capsule endoscopy and double balloon endoscopy has been changing the diagnostic algorithm for small bowel diseases whose main diagnostic modality has been barium examination. The double balloon endoscopy uses two balloons, one attached to the tip of an endoscope and another at the distal end of an overtube. By using these balloons to grip the intestinal wall, the endoscope can be inserted further without forming redundant loops in the intestines. The double balloon endoscopy technique enables endoscopic scrutiny, biopsy and treatments in any part of the small bowel in the same way as in the stomach and the colon. The authors describe the principle of insertion, characteristics, selection of endoscope type and insertion route, as well as practical insertion procedures using both the oral and anal routes.View full abstractDownload PDF (1304K) -
H. Ogata, T. Hibi2007 Volume 60 Issue 10 Pages 947-951
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSCurrent limitations of the commercially available capsule endoscopy device include sub-optimal image resolution and sharpness. A new capsule endoscope has been developed with the following features : 1) higher resolution, depth of field, and brightness of the image, by improving the optical system, 2) automatic brightness control which progressively adjusts illumination to maintain optimal image brightness and clarity, and 3) real-time image viewer, which allows clear real-time image interpretation on an LCD display, and which could be useful for detecting gastric transit abnormality as well as for increasing the likelihood of a complete small-bowel examination in patients undergoing capsule endoscopy. Representative cases include angiodysplasia-induced obscure small intestinal bleeding with chronic renal failure, A-V malformation, as well as mucosal lesions by inflammatory bowel disease or tumor lesions. Thus this new capsule provides excellent visualization of the precise construction of small intestinal villi ; in some cases even a small erosion can be found which can hardly be detected by barium X-ray. By combination with double-balloon enteroscopy, this device will provide new insight into the field of diagnosis and therapy of small bowel involvement.View full abstractDownload PDF (629K) -
T. Matsumoto, M. Iida2007 Volume 60 Issue 10 Pages 952-957
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSGastrointestinal bleeding of obscure origin (OGIB) is the most frequent indication for enteroscopy. With the widespread use of video-capsule endoscopy (VCE), it has become evident that the procedure identifies positive findings in 40-60% of patients with OGIB. It has also been shown that vascular lesions are the most frequent source of bleeding in Western countries. In contrast, it has recently been reported that VCE identified ulcers or erosions more frequently than vascular lesions in a multicenter study in Japan. Double-balloon endoscopy (DBE) also contributes greatly to the diagnosis of OGIB, with the positive diagnostic yield of 50-80%. What is more significant for the procedure is that it allows therapeutic interventions immediately after the diagnosis. Substantial data showing the superiority of VCE to conventional radiography and to push enteroscopy have been accumulated. There have been a few clinical trials which compared the diagnostic yield between VCE and DBE in patients with OGIB. In those investigations, the positive rate was slightly higher in the former than in the latter. These observations suggest that VCE and DBE are complementary to each other for the diagnosis and management of OGIB.View full abstractDownload PDF (552K) -
K. Watanabe, S. Hosomi, N. Hirata, T. Suekane, K. Aomatsu, N. Kamata, ...2007 Volume 60 Issue 10 Pages 958-963
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSRecently, the capsule endoscope (CE) and double balloon endoscope (DBE) have been well developed as enteroscopic devices for the small intestine. CE and DBE are very useful for evaluation of patients with small bowel pathologies of inflammatory bowel disease, especially Crohn's disease (CD). CE is very comfortable for the patients and can perform a total enteroscopy. Typical CD cases showed a transition of endoscopic findings from aphtha to erosion, small ulcers, or longitudinal ulcers, which moved from the upper side of the jejunum to the terminal ileum. This transition of endoscopic findings was very useful for differential diagnosis of other inflammatory bowel diseases. However, CE has a risk of retention. The detection of ileal strictures due to CD in the small pelvis is important for avoidance of CE retention, especially for asymptomatic patients with CD. The Agile™ patency capsule is useful to predict the risk of retention. DBE is very useful for taking a biopsy and performing endoscopic balloon dilatation therapy. Attention must be paid to perforations, in cases of severe active disease or balloon dilatation, to strictures with active ulcers. Additionally, in cases of anal route insertion for patients with CD, deep insertion of DBE beyond the lower part of the ileum is difficult, due to adhesions or active ulcers with CD in about 40% of cases. However, about 20% of the main lesions in the small bowel of patients with CD were located in the oral side of the middle of the ileum. The detection of mucosal healing will become more important with increased usage of immunomodulators.View full abstractDownload PDF (531K) -
Y. Jinno, S. Nakamura, T. Arakawa, T. Matsumoto2007 Volume 60 Issue 10 Pages 964-969
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSThe diagnosis and the therapy in the small intestinal area are extremely difficult, so until now we have depended on surgical procedure.
But we can treat by non-surgical procedure in the area with double balloon enteroscope which is recently developed. Various endoscopic therapies are performed with double balloon enteroscope using the conventional experience of endoscopic therapy.
Practically balloon dilatation, removal of small intestinal tumor, removal of the foreign object and the endoscopic therapy in the chole-pancreatic area add to the small intestinal bleeding are performed in the small intestinal area. In this contribution we describe the fact with the basic knowledge of the specification about apparatus and the scope and the attention and complication.View full abstractDownload PDF (533K)
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