Nippon Shokakibyo Gakkai Zasshi
Online ISSN : 1349-7693
Print ISSN : 0446-6586
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Volume 113, Issue 4
Displaying 1-11 of 11 articles from this issue
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Review article
Monthly report; Cutting edge of pancreatobiliary endoscopy
Round-table discussion
Original article
  • Clinical features and pathophysiology of acute esophageal mucosal lesion
    Yutaro IHARA, Kazuoki HIZAWA, Kouhei FUJITA, Yuichi MATSUNO, Tsutomu S ...
    2016 Volume 113 Issue 4 Pages 642-646
    Published: April 05, 2016
    Released on J-STAGE: April 05, 2016
    DOIhttps://doi.org/10.11405/nisshoshi.113.642
    JOURNAL FREE ACCESS
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    Acute esophageal mucosal lesions (AEMLs) are categorized into black esophagitis (type B) and non-black esophagitis (type NB) on endoscopy. To clarify the distinct pathophysiology, we compared the clinical features and hematological findings at onset among 17 patients with type B esophagitis and 6 patients with type NB esophagitis. In type B esophagitis, time to endoscopy after onset was significantly shorter, and blood levels of lactate, urea nitrogen, creatinine, and glucose were higher than in type NB esophagitis. However, there were no significant intergroup differences in the incidences of other predisposing factors, such as diabetic ketoacidosis or esophageal hernias. These findings suggest that AEMLs are caused by acid reflux and peripheral vascular insufficiency, the latter being more associated with type B esophagitis by its etiology. In addition, blood lactate may indicate the severity of AEML, leading to black esophagitis.
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Case report
  • Comorbid Meckel's diverticulum and omphalomesenteric cyst evaluated by small bowel series under double-balloon enteroscopy:a case report
    Shinichi TSURUTA, Yorinobu SUMIDA, Naohiko HARADA, Yoshitaka HATA, Mak ...
    2016 Volume 113 Issue 4 Pages 647-654
    Published: April 05, 2016
    Released on J-STAGE: April 05, 2016
    DOIhttps://doi.org/10.11405/nisshoshi.113.647
    JOURNAL FREE ACCESS
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    A 59-year-old man was referred to our hospital for examination of intermittent abdominal pain. Computed tomography scan showed a cystic lesion adjoining the ileum, and small bowel series demonstrated a small bowel diverticulum. Double-balloon enteroscopy (DBE) revealed a diverticulum in the ileum and a soft and smooth elevated lesion with a small hole at the base of the diverticulum. Small bowel series under DBE demonstrated that the cystic lesion communicated with the diverticulum through the small hole. The diagnosis was Meckel's diverticulum and an omphalomesenteric cyst. This is the first reported case of a Meckel's diverticulum and omphalomesenteric cyst communicating through a small hole without a fibrous ligament. In addition, precise evaluation was possible by small bowel series and DBE.
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  • A case of a gastrointestinal stromal tumor of the rectum effectively treated with continuously-administered regorafenib after failure of imatinib and sunitinib
    Shinya KAJIURA, Ayumu HOSOKAWA, Sohachi NANJYO, Naokatsu NAKADA, Takay ...
    2016 Volume 113 Issue 4 Pages 655-661
    Published: April 05, 2016
    Released on J-STAGE: April 05, 2016
    DOIhttps://doi.org/10.11405/nisshoshi.113.655
    JOURNAL FREE ACCESS
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    Regorafenib is recommended as a third-line treatment for unresectable gastrointestinal stromal tumors (GIST). It is usually administered in a repeating cycle of three-weeks on and one-week off. We describe a patient with an unresectable GIST in the pelvic cavity who complained of pelvic pain while taking the one-week break from regorafenib administration. Subsequently, we reduced the dosage to one level and regorafenib was continuously administered. As a result, the adverse events were improved and the antitumor effect against the GIST was retained. The continuous administration of reduced-dose regorafenib could be considered a viable dosage adjustment in specific situations.
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  • Jejunal duplication in an adult presenting with hematochezia
    Kazuhiko INOUE, Toshio SAKIYAMA, Kanae SETOYAMA, Yuji IWASHITA, Seiya ...
    2016 Volume 113 Issue 4 Pages 662-671
    Published: April 05, 2016
    Released on J-STAGE: April 05, 2016
    DOIhttps://doi.org/10.11405/nisshoshi.113.662
    JOURNAL FREE ACCESS
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    A 56-year-old man was admitted to our hospital with appetite loss, palpitations, orthostatic syncope, and hematochezia. Contrast-enhanced abdominal computed tomography (CT) revealed a proximal jejunal diverticulum with contrast extravasation. We immediately performed transoral double balloon enteroscopy (DBE) to treat the bleed in the jejunum, and this revealed a small ulcer with an exposed vessel at the opening of the jejunal diverticulum. Hemostasis was achieved endoscopically with argon plasma coagulation (APC) and hemoclips. During subsequent surgery, the diverticulum was found on the mesenteric side of the jejunum. We performed laparoscopy-assisted partial resection of the jejunum, and pathological examination showed that the diverticulum shared a common proper muscle layer with the jejunum and was covered by jejunal mucosa with no ectopic mucosa. Therefore, we diagnosed jejunal duplication. After hospital discharge, the patient had no recurrence of hematochezia or anemia. We report a rare case of jejunal duplication presenting with hematochezia, which was diagnosed as jejunal diverticular bleeding by CT and DBE before surgery. Pathological analysis confirmed jejunal duplication after surgery. We suggest that intestinal diverticular bleeding, as well as duplication of the gastrointestinal tract, should be considered as part of the differential diagnosis of obscure gastrointestinal bleeding.
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  • Bile duct injury and severe bleeding after endoscopic papillary large balloon dilation without sphincterotomy: a case report
    Mitsuru OKUNO, Seiji ADACHI, Yohei HORIBE, Tomohiko OHNO, Osamu YAMAUC ...
    2016 Volume 113 Issue 4 Pages 672-679
    Published: April 05, 2016
    Released on J-STAGE: April 05, 2016
    DOIhttps://doi.org/10.11405/nisshoshi.113.672
    JOURNAL FREE ACCESS
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    We report the case of an 80-year-old woman with multiple choledocholithiasis who suffered severe bleeding after endoscopic papillary large balloon dilation (EPLBD). Astriction by balloon tamponade and a covered, self-expandable, metallic stent failed. However, embolization using a transcatheter arterial coil stopped the bleeding. After hemostasis was achieved, a bile duct injury was observed. We presume that a bile duct stone, which had remained in the lower common bile duct, entered the balloon and the bile duct and caused the bile duct injury. This case emphasizes the need for careful attention during EPLBD.
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  • Rupture of a pancreaticoduodenal artery aneurysm into the common bile duct secondary to chronic pancreatitis: a case report
    Tatsuto SHIMIZU, Haruhiko SHUGO, Yuji HODO, Manabu YONESHIMA
    2016 Volume 113 Issue 4 Pages 680-686
    Published: April 05, 2016
    Released on J-STAGE: April 05, 2016
    DOIhttps://doi.org/10.11405/nisshoshi.113.680
    JOURNAL FREE ACCESS
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    A 57-year-old man with a history of excessive drinking presented to our emergency department complaining of chest discomfort. He had been attending a clinic for diabetes mellitus and hypertension, at which he had been informed that he had anemia that was worsening. Computed tomography (CT) of the abdomen revealed hemobilia and chronic pancreatitis. Due to complicated cholangitis, endoscopic nasobiliary drainage was performed, and a contrast-enhanced abdominal CT scan showed a pancreaticoduodenal aneurysm close to the common bile duct. We diagnosed a ruptured pancreaticoduodenal artery aneurysm causing hemobilia, and performed selective transcatheter arterial embolization with intravascular microcoils. Complete occlusion of the aneurysm was confirmed on follow-up CT.
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