All issues
Predecessor
Volume 69, Issue 10
Displaying 1-13 of 13 articles from this issue
- |<
- <
- 1
- >
- >|
-
2016 Volume 69 Issue 10 Pages 449-450
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSDownload PDF (606K)
Theme I
-
Yasuo Kakugawa, Yutaka Saitou2016 Volume 69 Issue 10 Pages 451-455
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSPillCam COLON capsule endoscopy (CCE) (Given Imaging Ltd., Yoqneam, Israel) is one of the latest diagnostic technologies designed to explore the colorectum. The first generation of CCE was released onto the market in 2006, and the second generation (PillCam COLON 2: CCE-2), with increased sensitivity, was released in 2009. The most unique feature of the CCE-2 is its new adaptive frame rate (AFR) technology. The AFR allows the CCE-2 to capture 35 images per second when in motion and 4 images per second when virtually stationary. The per-patient CCE-2 sensitivity for detecting polyps >6 mm in diameter has been reported as 84<2012>91%. In Japan, we conducted a multicenter study to clarify the sensitivity for clinically significant polyps using CCE-2 and found the sensitivity was 94%. Colon cleanliness is essential for optimal visualization during colon capsule endoscopy. The recent advancements in this modality might offer physicians the option to noninvasively screen for colorectal lesions.View full abstractDownload PDF (710K) -
Kenichi Utano, Daiki Nemoto, Masato Aizawa, Noriyuki Isohata, Kensuke ...2016 Volume 69 Issue 10 Pages 456-462
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSWith the recent increasing prevalence of colorectal cancer, CT colonography using multi-detector CT is noted due to its less invasiveness and shorter procedure time. Since this modality does not require intubation of an endoscope or infusion of barium medium from the anus, patients suffer less psychological stress. Additionally, CT colonography does not need technical expertise, unlike colonoscopy which is influenced even by patient age, gender and history of laparotomy. At present, Japanese medical institutions do not provide sufficient medical resources for colonoscopy. Therefore, CT colonography is expected as another option to screen the colon. Newly emerging techniques, such as reduced-laxative methods and reduced-radiation exposure methods using adaptive statistical iterative reconstruction, have made CT colonography more harmless and improved patient tolerability. In 2012, the Japanese Ministry of Health, Labour and Welfare approved public health insurance coverage for CT colonography. There is an urgent need to compile guidelines and establish a training system for CT colonography.View full abstractDownload PDF (904K) -
Kiyonori Kobayashi, Kaoru Yokoyama, Miwa Sada, Wasaburou Koizumi2016 Volume 69 Issue 10 Pages 463-470
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSThe clinical significance of endoscopic ultrasonography (EUS) for colorectal cancer is to preoperatively evaluate the depth of tumor invasion and lymph-node metastasis and thereby select an appropriate treatment. EUS can depict longitudinal cross-sectional images of tumors, allowing lesions to be objectively diagnosed. In particular, the rate of correct differential diagnosis of lesions indicated for endoscopic resection (pathological Tis cancer to pathological T1a cancer) and lesions indicated for surgery (pathological T1b cancer) was as high as 89% in early colorectal cancer. EUS can thus be used for selecting the treatment of choice. However, the diagnosis of colorectal cancer on EUS has several problems; for example, a large number of lesions are difficult to visualize as compared with other diagnostic endoscopic techniques.
Difficulty in visualizing lesions often depends on tumor location and macroscopic characteristics. In studies of early colorectal cancer, 13% of all lesions were difficult to visualize. Three-dimensional endoscopic ultrasonography (3D-EUS) may be an effective means for evaluating difficult-to-visualize lesions. As compared with conventional imaging techniques, 3D-EUS is associated with a lower rate of difficult-to-visualize lesions, and allows linear visualization of such lesions. To improve the diagnostic accuracy of EUS for colorectal cancer, improvements in instrumentation such as echo-colonoscope are required.View full abstractDownload PDF (899K) -
Masashi Takawa, Kensuke Kumamoto, Suguru Hayase, Shoutaro Fujita, Izum ...2016 Volume 69 Issue 10 Pages 471-479
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSThe treatment of colon cancer has been defined by the staging, and thus accurate staging is important in order to determine the course of treatment. Especially in rectal cancer, if extensive resection was performed, urination and sexual dysfunction may appear, while inadequate function-preserving surgery may lead to local recurrence. With insufficient preoperative examination and adaptation of the surgery, an increase in errors, complications and postoperative local recurrence should not occur. Correct treatment without a proper diagnosis is not possible. The wall depth of invasion is useful information for the treatment of rectal cancer and mesorectum in lymph node metastasis. The diagnostic accuracy of such lateral pelvic lymph node metastasis is expected to be improved by the newly introduced integrated PET/MR in Japan.View full abstractDownload PDF (1343K) -
Yuji Toiyama, Yasuhiro Inoue, Masato Kusunoki2016 Volume 69 Issue 10 Pages 480-488
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSColorectal cancer (CRC) is one of the most prevalent cancers in developed countries including Japan, and yet it is also one of the most curable cancers if it is detected in the early stage through regular colonoscopy. Since CRC develops slowly from precancerous lesions, early detection can reduce both the incidence and mortality of the disease.
Fecal occult blood test is a widely used non-invasive screening tool for CRC. Although it is simple and cost-effective in screening CRC, there is room for improvement in terms of the accuracy of the test. Genetic and epigenetic dysregulations have been found to play an important role in carcinogenesis and development of CRC. With a better understanding of the molecular basis of CRC, the development of diagnostic tests based on more sensitive and specific molecular markers is expected, and those tests may provide a breakthrough in overcoming the limitations of current screening tests for CRC. In this review, we discuss the commercially available colorectal cancer molecular diagnostic methods, and highlight some of the new candidate molecular markers in stool and blood samples.View full abstractDownload PDF (1368K)
Theme II
-
Masaaki Ito, Norio Saito, Yuji Nishizawa, Takeshi Sasaki, Yuichiro Tsu ...2016 Volume 69 Issue 10 Pages 489-498
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSA multicenter phase II trial of ISR in Japan suggested that 70% of cases had relatively good function with a Wexner score of less than 10 points and that about 10% showed severe incontinence which would not improve over the long term (5 years).
Factors related to poor anal function after ISR were performance of preoperative CRT, male, and extended resection of the anal sphincter muscle. As postoperative complications, anastomotic ischemia was one of the most important complications that influences poor anal function. Operative procedures in ISR should be improved to avoid ischemic changes in the anastomotic site. Since anal function worsens once anastomotic complications have occurred after ISR, therapeutic options for such complications are needed.View full abstractDownload PDF (1166K) -
Susumu Shimomura, Yoshito Akagi, Kotaro Yuge, Tetsushi Kinugasa2016 Volume 69 Issue 10 Pages 499-506
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSComplications after intersphincteric resection related to defecation disorder include increase in stool frequency, urgency of defecation, and fecal incontinence. When the use of an absorbent pad is continued, the defecation function improves over time and then levels out after approximately two years. Anal manometry is used to monitor the defecation function, but there is often a poor correlation between the findings from manometry and the actual defecation situation. Proctectomy preserving the anus has decreased retention and stool storage function, and retention of the intestinal tract contents is difficult. The sphincter muscle of the anus is weakened by ISR, incurring functional disturbance and defecation abnormality with decreased QOL for the patient. Changes in physiological function are caused not only by operative anatomical changes but also by the therapeutic methods including preoperative chemoradiotherapy, reconstruction method, and any complications such as anastomotic leakage. In order to improve the indications for surgery and reduce postoperative functional disorders, further studies and more precise preoperative evaluation methods are needed.View full abstractDownload PDF (904K) -
Keiji Koda, Chihiro Kosugi, Atsushi Hirano, Kiyohiko Shuto, Kenichi Ma ...2016 Volume 69 Issue 10 Pages 507-512
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSIt has been reported that up to 80-90% of patients who receive low anterior resection for rectal cancer experience a change of bowel habit postoperatively. The constellation of such symptoms as increased bowel frequency, urgency, evacuatory dysfunction, or fecal incontinence has been termed low anterior resection syndrome (LARS). When the anastomotic height is closer to the anus like in ISR or very low AR, a higher degree of postoperative defecatory malfunction is commonly seen. The definitive cause of LARS has not been clarified, and it is probably multifactorial.
However, one possible cause is anal sphincter damage during surgery either by mechanical injury to the muscle itself or to its nerve supplies. Another cause may be a malfunction of the neorectum following total removal of the rectum in ISR or very low AR. In this short review, we discuss the possible causes of LARS and some treatment strategies for improving the symptoms following surgery.View full abstractDownload PDF (968K) -
Kazutaka Yamada, Shunji Ogata, Yasumitsu Saiki, Shota Takano, Kazutsug ...2016 Volume 69 Issue 10 Pages 513-520
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSIntersphincter resection (ISR) is the ultimate sphincter-preserving operation for very low rectal cancer. The aim of this study was to assess function after ISR in relation to the degree of resection of the internal and external anal sphincter.
The sample for this study consisted of 178 consecutive patients with low rectal cancer between 2001 and 2013. In this time period the following procedures were performed: curative partial ISR (97 patients), subtotal ISR (44 patients), total ISR (19 patients), and partial ESR (18 patients). Partial ESR is categorized as the range of combined partial resection of the external sphincter muscle. Defecatory function was relatively satisfactory at 1 year after ISR and good continence (Kirwan grade 1, 2) was observed in 64.9% of all cases. However, the results of manometry and anal mucosal sensitivity after total ISR and partial ESR revealed that patients who underwent these two procedures had a less favorable outcome than the patients who underwent partial ISR. Therefore, the indications for total ISR and partial ESR should strictly take into account the preoperative sphincter function.View full abstractDownload PDF (1143K) -
Toshihiro Noake, Yasumi Araki, Keiko Matono, Hiroyuki Ozasa, Tomoko Ir ...2016 Volume 69 Issue 10 Pages 521-528
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSSeveral operative procedures are now available in Japan for treating hemorrhoids, including sclerotherapy, rubber-band ligation, the procedure for prolapsing hemorrhoids (PPH), and ligation-with-excision. The decision on which operative procedure to use depends on the severity of the hemorrhoid, the patient's own wants or needs, the facilities available at the specific hospital, and the surgeons' skills. Each procedure is related to different degrees of postoperative pain, different recovery periods, as well as different incidences of complications and recurrence rates. In this report, we review the main functional disorders in defecation after hemorrhoid surgery according to each operative procedure, together with the respective postoperative anal function.View full abstractDownload PDF (1161K) -
Kinya Okamoto, Yasuo Kobayashi, Satoka Nasu, Takuya Nakada, Kouji Mori ...2016 Volume 69 Issue 10 Pages 529-539
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSSurgery for perianal fistula cannot avoid invasion of the anal sphincter muscle. It is required to achieve both conservation of anal function and curability. The methods are classified into the lay-open method, sphincter-preserving method, and seton method. Though the lay-open method has an advantage in curability, it has a high risk of anal dysfunction. The anal sphincter-preserving method might effectively maintain anal function, but is followed by a higher rate of recurrence. Seton is a well-balanced method that satisfies both curability and conservation of anal function but it requires a longer period to cure. It is important to consider the state of the disease and the wishes of the patient when performing surgery for perianal fistula to achieve high curability, low incidence of anal dysfunction and early recovery. Anal dysfunction may occur after inappropriate sphincterotomy, and impairs the patient's quality of life by causing fecal incontinence and soiling. The first choice in cases with anal incontinence is bowel control and training of the sphincter muscle. If this fails, surgery such as sphincter repair and posterior sphincteroplasty could be effective. Surgery without postoperative complaints is expected for perianal fistula, as a benign disease.View full abstractDownload PDF (1023K) -
Soichi Tanaka, Yasuhide Matsuda, Satoshi Matsuda, Kazuhiko Kawakami, K ...2016 Volume 69 Issue 10 Pages 540-548
Published: 2016
Released on J-STAGE: November 07, 2016
JOURNAL FREE ACCESSManual anal dilatation (AD), lateral internal sphincterotomy (LSIS, etc.), and advancement skin graft (SSG: sliding skin graft, etc.) are widely performed surgeries for chronic anal fissure in Japan. AD can be regarded as blunt dilatation of the anus and both LSIS and SSG can be regarded as sharp cutting of internal sphincter muscle on the lateral side or on the posterior side of the sphincter. This paper reviewed Japanese articles describing functional outcomes after surgical intervention for chronic anal fissure. We found 3 papers for AD, 4 for LSIS, and 8 for advancement skin graft surgery.
Incontinence rate by AD, by LSIS, and by advancement skin graft surgery was 0.6%, 0.5-17.1%, and 0-22.2%, respectively. Similarly, recurrence rate was 6.1-18.1%, 2.1-24.1%, and 0-8.2%, respectively. The functional outcome after AD in Japan seems to be acceptable, though this surgical procedure is not recommended overseas. More evidence with well-planned and managed prospective comparative studies in Japan is needed.View full abstractDownload PDF (805K)
- |<
- <
- 1
- >
- >|