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Volume 68, Issue 10
Displaying 1-14 of 14 articles from this issue
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Theme I
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Kazuo Tamura, Nagahide Matsubara, Naohiro Tomita2015 Volume 68 Issue 10 Pages 871-877
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSFamilial adenomatous polyposis (FAP) is a disorder in which multiple adenomatous polyps develop in the gastrointestinal tract, especially in the large intestine with hereditary factor. The gene responsible for classical FAP is the APC gene encoding a molecule that controls the Wnt signal transduction pathway restrainingly. MUTYH is another causal gene, and is a base excision repair gene that encodes α-glycosylase involved in the removal of adenine residues mispaired with 8-oxo-7, 8-dihydro2'deoxyguanosine (8-OHG), the oxidized form of guanine residue. Biallelic mutations of the MUTYH gene cause multiple adenomatous polyps in the large intestine. This genetic condition is called MUTYH-associated polyposis (MAP). Furthermore, a recent study clarified that some alterations of the two genes, which encode different DNA polymerase, cause multiple colorectal polyps. Genetic testing is possible based on this knowledge, and it is thought that molecular biological development may lead to more appropriate medical treatment.View full abstractDownload PDF (1096K) -
Tatsuro Yamaguchi, Hideki Ueno, Koichi Koizumi, Hideyuki Ishida, Takeo ...2015 Volume 68 Issue 10 Pages 878-882
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSTo clarify the clinicopathological features of familial adenomatous polyposis (FAP), which is a rare disease, national registration and multicenter studies are necessary. The first national investigation of FAP in Japan started in 1961, and continued to the second national investigation. The national registration of FAP in Japan, which started in 1976, revealed many important epidemiological and oncological results, and the “JSCCR Guidelines 2012 for the Clinical Practice of Hereditary Colorectal Cancer” were based on these data. However, the Guidelines cite few Japanese articles, and most of them were published before 2000. The Multicenter Retrospective Cohort Study of Familial Adenomatous Polyposis in Japan is under way to clarify the characteristics of Japanese FAP patients. Moreover, a multicenter study is in progress to establish a method for diagnosing hereditary gastrointestinal tract cancer syndromes by next-generation sequencing technology.View full abstractDownload PDF (647K) -
Hideki Ishikawa2015 Volume 68 Issue 10 Pages 883-889
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSUntil recently, total colectomy was the only option to prevent the progression from familial adenomatous polyposis (FAP) to colon cancer. In order to avoid colectomy or prolongation of the time to surgery, studies have been conducted regarding chemoprevention therapy for suppressing the growth of colorectal polyps and endoscopic polypectomy.
This report presents the results of clinical studies with non-steroidal anti-inflammatory drugs for chemical prophylaxis (such as sulindac, celecoxib and aspirin) on progression from FAP to colon cancer, and the recent progress of our research on thorough endoscopic polypectomy.
Chemoprevention therapy and endoscopic polypectomy have not been studied enough for clinical use in FAP, but may become practical options for the treatment of some types of FAP in the near future.View full abstractDownload PDF (1111K) -
Kiyoshi Tsukamoto, Nagahide Matsubara, Masafumi Noda, Tomoki Yamano, M ...2015 Volume 68 Issue 10 Pages 890-899
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSFor patients with familial adenomatous polyposis (FAP), the occurrence of colorectal cancer is a major problem, and (sub) total proctocolectomy has been recognized as the standard surgical treatment to prevent such cancer. There are several options for the surgical procedure, each of which is selected according to the characteristics of the procedure and the patient. Recently, the number of cases of laparoscopic surgery for FAP patients is increasing. There are several matters regarding the selection of surgical options for eliminating the risk of cancer, including safety, bowel function, cosmetic outcome, and cost. It is important to select the optimal type of surgery for each patient by taking all these matters into account.View full abstractDownload PDF (922K) -
Masahiro Tajika, Tsutomu Tanaka, Makoto Ishihara, Nobumasa Mizuno, Kaz ...2015 Volume 68 Issue 10 Pages 900-907
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSRestorative proctocolectomy with the formation of an ileal pouch-anal anastomosis has become the most common surgical option for patients with familial adenomatous polyposis (FAP). However, adenomas may develop in the ileal pouch mucosa over time, and even carcinoma in the pouch has been reported. We therefore reviewed the prevalence, nature, and treatment of adenomas and carcinoma that develop after proctocolectomy in the ileal pouch mucosa in patients with FAP. In 36 reports that were reviewed, the incidence of adenomas in the ileal pouch varied from 6.7% to 73.9%. The risk appears to be 7% to 16% after 5 years, 35% to 42% after 10 years, and 75% after 15 years. On the other hand, only 22 cases of ileal pouch carcinoma have been recorded in the literature to date. The diagnosis of pouch carcinoma was made between 3 to 23.6 years (median, 10 years) after pouch construction. Although the risk of malignant transformation in ileal pouches is probably low, it is not negligible, and the long-term risk cannot be well quantified at present. Regular endoscopic surveillance, especially under optimal bowel preparation and using chromoendoscopy, are recommended.View full abstractDownload PDF (3380K) -
Hideyuki Ishida, Yuichiro Watanabe, Noriyasu Chika, Yusuke Tajima, Oki ...2015 Volume 68 Issue 10 Pages 908-920
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSA prophylactic gastrectomy is not indicated for patients with familial adenomatous polyposis (FAP) because of the low malignant potential of fundic gland polyposis and gastric adenomas, but it should be kept in mind that the risk of gastric cancer is higher in FAP patients than in the general populations in East Asian countries. Since duodenal carcinoma, including ampullary carcinoma, is a leading cause of death after a prophylactic (procto) colectomy, the management of such premalignant lesions is important. Meticulous endoscopic surveillance or surgical interventions, such as a pancreas-preserving duodenectomy, should be considered in patients with Spigelman stage IV duodenal polyposis, in whom the malignant potential is significantly increased. A transduodenal or endoscopic papillectomy is an alternative approach to adenomas of the duodenal papilla. Desmoid tumors (DTs) frequently occur after a (procto) colectomy. Surgical resection is the preferred approach for intra-abdominal wall DTs. The classification proposed by Church and coworkers is useful for making a decision regarding the management of intraabdominal DTs. Cytotoxic chemotherapy (dacarbazine plus doxorubicin) is a useful regimen for Church stage III/IV disease.View full abstractDownload PDF (4424K)
Theme II
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Yoshihiko Takao2015 Volume 68 Issue 10 Pages 921-927
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSDespite its prevalence and deleterious impact on patients and families, the clinical strategy for the diagnosis and treatment for fecal incontinence (FI) has not yet been clearly established in Japan, whereas several guidelines for FI have already been published in Europe and the United States. Therefore, a project is underway in Japan to create our own guideline for FI. This feature issue is intended to facilitate the standardization of clinical practice for patients with FI. It illustrates the key points and concepts of the global-standard clinical practice for FI by experts.View full abstractDownload PDF (720K) -
Toshiki Mimura2015 Volume 68 Issue 10 Pages 928-939
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSAppropriate management of fecal incontinence requires its standardization by a guideline, which ought to be useful and reliable based upon international standards. The International Consultation on Incontinence (ICI) is an international consensus meeting for urinary and fecal incontinence, which has been held every 3 or 4 years since 1998. It has proposed various guidelines regarding the management of urinary and fecal incontinence. Upon preparing a clinical practice guideline for the management of fecal incontinence in Japan for the first time, it would be extremely valuable to utilize the ICI guideline for reference, although there might be some differences in disease structure, culture and medical system. Therefore, this paper introduces the latest guideline for the management of fecal incontinence, which was agreed at the 5th ICI in Paris, 2012. However, some recommendations for examinations and therapies might have to be altered according to recent evidence because 3 years have already passed since the last ICI. Recently, the American Society of Colon and Rectal Surgeons (ASCRS) has published a “Clinical Practice Guideline for the Treatment of Fecal Incontinence” based on the latest evidence. The recommendations of the ASCRS are presented in this paper as well as those of the ICI.View full abstractDownload PDF (2083K) -
Tomoko Takahashi, Akira Tsunoda2015 Volume 68 Issue 10 Pages 940-945
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSSpecialized testing for fecal incontinence includes anorectal manometry, rectal sensation, rectal compliance, neurophysiological inspection, ultrasonography, and magnetic resonance imaging (MRI). Anorectal manometry is used to evaluate the function of the internal and external anal sphincter. It should be noted that the kind of catheter used, age, or gender may have an influence on the measured value. Abnormality of rectal sensation is associated with the urge for fecal incontinence, but the measured values are not consistent according to the technique. Ultrasonography imaging has been established as a useful examination for the diagnosis of fecal incontinence. Anal sphincter damages can be detected by endoanal ultrasonography. In the same way, the pelvic floor structure can be detected by endovaginal ultrasonography, and puborectalis muscle contraction and pelvic organ prolapse by transperineal ultrasonography. MRI can identify atrophy of the anal sphincter muscles. Rectal intussuception is one of the causes of fecal incontinence, and is diagnosed by defecography. Anatomical correction of the intussusception by surgery may improve fecal incontinence. Surface electromyography can be used for biofeedback.View full abstractDownload PDF (958K) -
Shota Takano, Yasumi Araki, Yoriyuki Tsuji, Kazutaka Yamada2015 Volume 68 Issue 10 Pages 946-953
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSConservative management in the treatment of fecal incontinence includes dietary manipulation, medical treatment and biofeedback. However, medical treatment is usually the first choice. This paper examines the existing guidelines and reviews from the major journals in the West. The guidelines and reviews classify fecal incontinence drugs into the following three categories: antidiarrheal drugs, sphincter-enhancing drugs and drugs for constipation. They strongly recommend using antidiarrheal drugs, especially loperamide, for fecal incontinence caused by liquid stool. Loperamide reduces diarrhea and fecal incontinence and increases anal tone. Some studies in Japan have found that calcium polycarbophil (CP) is also effective. CP absorbs water and increases stool bulk and is used for irritable bowel disease, but there is little evidence of its ability to effectively treat fecal incontinence.View full abstractDownload PDF (737K) -
Toshihiro Noake, Yasumi Araki, Keiko Matono, Masataka Ushijima, Hiroyu ...2015 Volume 68 Issue 10 Pages 954-960
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSThe aim of this review is to reveal the current status of biofeedback therapy for fecal incontinence. In ROME III, fecal incontinence is defined as “Recurrent uncontrolled passage of fecal material in an individual with a developmental age of at least 4 years.” The prevalence of fecal incontinence in adults is 2.2%. Many reports have suggested that biofeedback therapy improves the function of the voluntary striated muscle of the external anal sphincter, but has little effect on the involuntary smooth muscle of the internal anal sphincter. Although biofeedback has been reported to be an effective treatment for fecal incontinence, the effectiveness of biofeedback therapy alone is questionable. It is reported that biofeedback with pelvic floor exercises is superior to pelvic floor exercises alone in randomized controlled trials. We report a conservative therapy involving diagnosis, assessment before treatment, education, biofeedback by manometer, pelvic floor exercises, and biofeedback by balloon inflation in our hospital. If these treatments fail, we consider surgical treatment. Biofeedback therapy should always be considered as an important therapeutic option for patients with fecal incontinence, regardless of patient age, etiology and progression of the disorder.View full abstractDownload PDF (3550K) -
Tetsuo Yamana2015 Volume 68 Issue 10 Pages 961-969
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSSphincteroplasty is one option for the treatment of traumatic anal sphincter dysfunction for those complaining of fecal incontinence. The most common cause is a third-degree perineal tear during childbirth. Anal surgeries such as fistulotomy for complicated anal fistulas or lateral sphincterotomy for anal fissures are also possible causes. Among these, childbirth injury is the most consistent indicator for sphincteroplasty. Anal ultrasound is usually performed to evaluate a sphincter defect preoperatively. The overlapping method is more utilized than direct methods. Scar tissue is dissected and transected, and both ends are overlapped and sutured. Additionally, the author prefers to add perineal body reconstruction to strengthen the repair. Preoperative mechanical bowel preparation and postoperative diet restriction are not necessary, so early hospital discharge is possible. Symptoms of fecal incontinence improve by more than 50% on the Wexner score. Likewise, physiological parameters, including maximum squeeze pressure levels, are significantly higher. Unfortunately, continence outcomes may be found to deteriorate with long-term follow-up.View full abstractDownload PDF (1027K) -
Kazuhiko Yoshioka, Kazuyoshi Nakatani, Katsuji Tokuhara, Masanori Kwon2015 Volume 68 Issue 10 Pages 970-977
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSFecal incontinence is a socially and psychologically distressing disease for patients who may be too embarrassed to tell their family members about their symptoms. Sacral nerve modulation has been carried out as one of the treatments mainly in Europe and the United States. National insurance has covered this treatment in Japan since April 2014. One of the features of this treatment is that it is possible to evaluate its efficacy by using an extracorporeal stimulator. The other feature is that the surgical procedure is less invasive than other surgical treatments. The operation is carried out in two stages. In the first stage a lead is introduced near the sacral nerve and the effectiveness is assessed using an extracorporeal stimulator. If the symptom is found to be improved, in the second stage a permanent stimulator is inserted into the subcutaneous region on the back. Reports from abroad about this treatment have been promising so far. Although its efficacy and safety have been approved according to the government approval protocol in Japan, we need to collect more data and assess the long-term results of the treatment. Sacral nerve modulation, which is already a world standard, could also become the standard treatment in Japan.View full abstractDownload PDF (3462K) -
[in Japanese], [in Japanese]2015 Volume 68 Issue 10 Pages 978-979
Published: 2015
Released on J-STAGE: October 31, 2015
JOURNAL FREE ACCESSDownload PDF (552K)
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