Progress of Digestive Endoscopy
Online ISSN : 2187-4999
Print ISSN : 1348-9844
ISSN-L : 1348-9844
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Volume 60, Issue 2
Displaying 1-30 of 30 articles from this issue
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Technology and instrument
  • A 50-mm rectal tumor treated by en bloc endoscopic mucosal resection
    Shotaro Enomoto, Naohisa Yahagi, Mitsuhiro Fujishiro, Masashi Oka, Hid ...
    2002 Volume 60 Issue 2 Pages 22-24
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_22
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    A 62-year-old man underwent barium enema examination because of a positive occult blood test. It revealed a rectal tumor, so he was admitted to our hospital for treatment. Colonoscopy showed a large elevated tumor, measuring 50mm in size, and endoscopic ultrasonography (EUS) demonstrated that the tumor did not invade the submucosa. Endoscopic mucosal resection (EMR) was performed using an electro-surgical snare (thin type) because strip biopsy was associated with a high risk of piecemeal resection due to the location and size of the tumor. The lesion was resected en bloc by EMR. Histological examination showed a well differentiated adenocarcinoma-in-adenoma with minute invasion of the submucosa. The margin of the specimen was free of tumor invasion along its circumference. Thus, the lesion fulfilled the criteria for curative EMR. This procedure seems to be useful for en bloc resection of relativery large colorectal tumors.
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  • Study on the visibility of the newly developed 7.5MHz 3D ultrasonic probe
    Yousuke Otake, Tsuyoshi Abe, Takashi Kuraoka, Akihiko Ohta, Koichiro S ...
    2002 Volume 60 Issue 2 Pages 25-27
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_25
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    The new 7.5MHz 3D ultrasonic probe developed for increasing the penetration depth of ultrasound. Specifications except frequency of the new probe are the same as those of 3D ultrasonic probes currently employed in clinical use.
    Sonoscaning, using 3D ultrasonic probe (the new 7.5MHz probe and 3D-2R ; 12MHz, Olympus Optical Co.) was performed to a silicon board (a thickness of 1 mm) and a sponge phantom experimentally. The axial resolution of the both probes was enough to demonstrate the silicon board as an ultrasonic image consisting of 3 layers. In visualization of the sponge phantom, the penetration depth of the new 7.5MHz probe was extended for 5 mm in comparison with that of 3D-2R. In clinical study, endoscopic ultrasonography (EUS) by the new 7.5MHz probe was performed in 19 patients (gastric cancer : 2, colorectal cancer : 10, colorectal submucosal tumor : 5, others : 2) . The mean depth of penetration was around 24.9 mm in the ultrasonic images. In 14 of these patients, EUS by 3D-2R was also performed to the same part of each lesion. The mean depth of penetration of the new 7.5MHz probe was around 23.0 mm, and was extended for 6 mm in comparison with that of 3D-2R.
    The newly developed 7.5MHz 3D ultrasonic probe was considered to have the visibility of extraluminal components as lymph nodes. However, the penetration depth and stability of ultrasound should be improved to make this probe a valuable diagnostic device.
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Clinical study
  • Laparoscopic Fundoplication for Reflux Esophagitis of aged patients : Report of Five Cases
    Junichiro Adachi, Yoshihiro Fukoue, Masahiko Murakami, Hiroyuki Hanada ...
    2002 Volume 60 Issue 2 Pages 28-32
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_28
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    We performed laparoscopic fundoplication on five aged patients (mean age was 75.5 years) with reflux esophagitis. Three cases complicated mixed type hiatus hernia. Two patients had grade B, one patient had grade C, and two patients had grade D reflux esophagitis (according to Los Angeles classification) . Nissen fundoplication on Three patients and Toupet fundoplication on two patients were performed with no complication. Mean operation time was 142.5±40.5 minutes. Preoperative symptoms were improved in all patients. The mean follow-up period was 9.4 months between June 1999 and January 2002, and no symptom recurred.
    In conclusion, Laparoscopic fundoplication is useful for aged patients because it is less invasive and provides good result.
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Case report
  • A case of early gastric carcinoma that showed a macroscopic morphological change in a short span of time
    Kenichi Takasuna, Kazushige Nirei, Tatsuhiro Kato, Manabu Nakamura, Yo ...
    2002 Volume 60 Issue 2 Pages 34-36
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_34
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    A 62-year-old male patient complaining of epigastric pain was administered an antacid and his progress was watched. The symptom did not improve and upper gastrointestinal endoscopy showed early gastric carcinoma of Type 0-IIa＋IIc. In preoperative examinations, metastasis to lymph nodes was suspected from abdominal CT but there was no evidence of metastasis to other organs. About a month later, Barium meal examination showed a protuberant lesion with marginal fold convergence on the posterior middle body of the stomach, but there was no excavation and a diagnosis of Type I was given. Then gastrointestinal endoscopy was again performed. A protuberant lesion with fold convergence was observed and a diagnosis of Type 0-I was given. Next gastropylorectomy was performed and the endoscopic diagnosis of early gastric carcinoma of Type 0-I was confirmed. This was a case of carcinoma developing a remarkable morphological change from excavation to protuberance, which was considered as a deviation of morphological change from the malignant cycle. The antacid might have been responsible for this change and its potent anti-ulcer effect was suspected to have caused a rapid hyperplasia of the tissue. However, early gastric carcinoma developing a macroscopic change in a period of just about a month is an extremely rare case and the type of factors that accelerated such a protuberant proliferation is yet to be known. It is hoped to elucidate the mechanism in the future.
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  • A case of diffuse esophageal spasm diagnosed after computed tomography and endosonography
    Kenji Shimura, Akira Nakamura, Naoto Murakosi, Manabu Asada
    2002 Volume 60 Issue 2 Pages 38-39
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_38
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    We report a case of diffuse esophageal spasm diagnosed after computed tomography and endosonography. A 46-year-old male was referred to our hospital because of nausea. Recurrent upper abdominal pain lasted for 10 years, and coronary angiography had disclosed a normal finding five years ago. After admission, computed tomography and endoscopic ultasonography revealed the wall thickening of the lower-half esophagus, and endoscope showed spastic contactions of the same part of esophageal wall. X-ray study showed the“rosary bead”appearance, and manometory at 3cm，8cm，and 13cm above the LES revealed the simultaneous contractions. The patient did not wish surgical procedure, and the combination of recurrent hydrostatic balloon-dilation of lower esophagus and medication of nifedipine, lorazepam, and famotidine leaded to symptom improvement.
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  • A case of spontaneous esophageal rupture improved by conservative treatment and followed up by endoscopy
    Takashige Masuo, Yasuhiro Onozato, Hiroshi Ishihara, Ichiro Sakamoto, ...
    2002 Volume 60 Issue 2 Pages 40-41
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_40
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    A 56-year-old man was admitted to our hospital because of vomiting after drinking and subsequently a fever and anterior chest pain at swallowing. Endoscopic picture showed longitudinal laceration at the posterior wall of the lower esophagus. Chest CT scan revealed inflammatory esophageal wall thickness and a small amount of pleural effusion. According to the clinical course, endoscopic findings and CT findings, spontaneous esophageal rupture was diagnosed. The patient's physical condition was good even after 24 hours following the onset. Chest pain occurred only during swallowing. In addition, CT scan did not detect mediastinitis or mediastinal emphysema. Thus, we performed conservative treatment. Symptoms and test results showed improvement, he was discharged from the hospital on the 28th day. Surgery is the primary treatment of spontaneous esophageal rupture, however, conservative treatment is applicable in cases that the rupture is limited in the mediastinum and the physical condition of the patient is good.
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  • A case of traumatic esophageal stricture treated by temporary flexible artificial esophagus
    Hiroyuki Takahashi, Akira Ichihara, Tetsu Ikeuchi, Minoru Ukaji, Kazuh ...
    2002 Volume 60 Issue 2 Pages 42-43
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_42
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    A 16-year-old male injured in his mouth by firework. 2 month later, esophageal stricture developed and esophageal dilatation using a dilater tube was performed every 2 weeks and 48 times in total. But esophageal dilatation could not be preserved. A flexible artificial esophagus is easy of insert and release, so we tried insertion of this artificial esophagus. 2 month later, we released this artificial esophagus from his esophagus. Since this treatment, his symptom has improved. Treatment of esophageal dilatation using a flexible artificial esophagus is useful for benign esophageal stricture because of easy of insert and release.
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  • A case of transient global amnesia precipitated by gastrointestinal endoscopy
    Yukihisa Sawada, Masakazu Kamihira, Ryuichi Hirakawa, Yukio Yosida, Mi ...
    2002 Volume 60 Issue 2 Pages 44-46
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_44
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    A 71-year-old woman suffering from liver cirrhosis, underwent gastrointestinal endoscopy. Just after the examination, she had lost the memory of having undergone the examination due to retrograde amnesia, and was disoriented in regard to time and place. She asked a nurse repeatedly in bewilderment,“What am I doing?”“Why am I in this hospital?”. Her situation was explained to her, and was understood, but the answer provided was forgotten within moments due to anterograde amnesia, and once again repeatedly asked the same questions. She could answer her name, birthday, and the name of her physician in charge correctly. But she had lost her memory between the evening before and the moment she finished the examination. Her consciousness was clear, and neurological examinations were normal. Then transient global amnesia (TGA) , presumed to be precipitated by gastrointestinal endoscopy, was diagnosed. The next morning, about 19 hours after the examination, she recovered form TGA. But ultimately, she had lost her memory of about half of the day she underwent the examination, with no neurological deficits. TGA is usually related to physical, emotional stress, and gastrointestinal endoscopy is a stressful examination for examinees. We must therefore be aware that gastrointestinal endoscopy is one of the precipitating events in TGA, and prepare examination circumstances such that nervousness felt by examinees can be significantly reduced.
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  • A case report of the malignant lymphoma of the duodenum
    Kouki Kuwabara, Hirofumi Yamada, Hideyuki Ishida, Daisuke Sakaguchi, Y ...
    2002 Volume 60 Issue 2 Pages 48-49
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_48
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    A very rare case of malignant lymphoma of the duodenum is reported. A 67-year-old woman was found to have a cobble stone-like lesion around the papillar of Vater by screening gastroduodenalscope. Histopathology revealed follicular malignant lymphoma. Pylorus preserving pancreatoduodenectomy was successfully performed. The patient has been alive without tumor recurrence since 24 mouths postoperatively. There have been 70 cases of malignant lymphoma of the duodenum in the Japanese reports. And then, follicular lymphoma of the duodenum was detected three cases. Two of them were cobble stone-like appearance endoscopically.
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  • A case of multiple gastrointestinal hemangiomas
    Katsuyuki Sasaki, Kazuhiko Fujiki, Toshio Suzuki, Mamoru Watanabe
    2002 Volume 60 Issue 2 Pages 50-51
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_50
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    The patient was a 40-year-old woman. She visited our hospital because of hoarseness and difficulty of breathing. A computed tomographic (CT) scan of the chest revealed isodensity mass of esophagus with some calcifications. Endoscopic examination showed a bluish submucosal tumor (SMT) at the upper thoracic esophagus with some calcifications. It also showed two SMTs in stomach and two SMTs at the duodenum. These were similar color to the esophgeal lesion. A magnetic resonance imaging (MRI) of the chest showed the esophageal tumor that was very high intensity on T2-weighted. We suspected these SMTs hemangiomas. In other studys there was one hemangioma of the liver.
    Many cases of bleeding of the gastrointestinal hemangioma are reported, therefore it is necessary for this patient screening of small and large intestin. But it is not done yet because of her rejection.
    Gastrointestinal hemangioma is a benign tumor comparatively rare. We report a very rare case which had been susupected multiple hemangiomas at the upper gastrointestinaltruct.
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  • A case of early duodenal cancer at the opposite side of the papilla Vater, resected by endoscopic mucosal resection
    Keiji Koshibu, Torahiko Jinta, Minako Yoshida, Shinsuke Tokoi, Hideaki ...
    2002 Volume 60 Issue 2 Pages 52-53
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_52
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    A 73-year-old male visited our hospital with a complaint of appetite loss in 2001. Endoscopic examination showed a semipedunculated polypoid lesion, about 7 mm in size, at the opposite side of the papilla Vater. Endoscopic biopsy revealed adenocarcinoma. Endoscopic mucosal resection was performed after confirmation of negative non-lifting sign, because the lesion was measured less 10 mm in largest diameter. The resected specimen was 7×7×6 mm in dimensions and histologically consisted of tubular adenocarcinoma limited to the superficial layer of the duodenal mucosa (m, ly 0, v 0) . Cut-end of the lesion was free of carcinoma. Duodenal malignant lesion is relatively rare, especially early cancer. Meanwhile, there are many borderline cases of epithelial tumors between benignancy and malignancy in the duodenum. Therefore, complete excisional biopsy such as endoscopic mucosal resection is recommended.
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  • A case of gastrointestinal lipomatosis coexistent with metastatic tumors
    Nobuhiro Ikeda, Tatsuya Mizuno, Hisashi Harada, Kazuko Beppu, Toshiaki ...
    2002 Volume 60 Issue 2 Pages 54-55
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_54
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    A 52-year-old male, who had been on follow-up for his multiple submucosal tumors of the stomach in other clinic since 1988, was referred to our department for further investigation of the tumors showing increase in size and number in August, 2000. The initial x-ray and endoscopic examinations of the gastrointestinal tract detected multiple gently sloping tumors in the stomach, small and large intestine. He, however, was found to have newly developed polypoid lesions in the stomach and cecum at gastroscopy and colonoscopy performed 4 months later than the initial examinations. Biopsy specimens taken from the newly developed lesion were reported as showing carcinoid tumor.
    Soon after the examinations, he suddenly developed unconsciousness due to multiple metastatic tumors of the brain, and he died one month later. Autopsy disclosed a primary lung cancer of small cell type with muitiple secondary deposits in the stomach, small intestine and colon together with other organs. Retrospectively, newly developed polypoid lesions are endoscopically different from carcinoid tumor, which was reported as showing on the biopsied specimen by a pathologist.
    There have been no reports on gastrointestinal lipomatosis co-existent with multiple foci of metastatic lung cancer. Careful analyses of endoscopic findings, however, are considerd to be extremely important to make a diagnosis even in very rare case.
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  • Endoscopic lucent skirt protector for safe removal of dental prosthesis in the fourth part of the duodenum
    Sayaka Tomizawa, Keiko Minashi, Osamu Kawamura, Masaki Maeda, Yasuyuki ...
    2002 Volume 60 Issue 2 Pages 56-57
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_56
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    Endoscopic removal of sharp and pointed foreign bodies in the upper gastrointestnal tract still poses technical difficulties. We present here our experience with a new endoscopic end lucent skirt protector having the unique characteristic of maintaining its bell portion inverted during the progression of the scope through the gut and flipping back to its shape during withdrawal through the lower esophageal sphincter. This prevents exposure of the esophageal and pharyngeal wall to injuries from the edges of the foreign body. We used this device to remove large sharp and pointed dental prosthesis in the fourth part of the duodenum. We belived that this device enhance the safe removal of a wide variety of potentially dangerous gastroesophageal foreign bodies.
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  • A case of hemostasis achieved endoscopically for the bleeding from the saddle of a bicephalic duodenal diverticulum
    Maria Yonezawa, Norihiko Ide, Eiji Miyazaki, Nobuko Tsuchihashi, Hitom ...
    2002 Volume 60 Issue 2 Pages 58-59
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_58
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    A 64-year-old male suffering from anemia and tarry stools was comfirmed gastric erosions and duodenitis by endoscopic examination in 1998. Subsequently, he was beewing monitered with prescribed oral H2 blockers.
    However in May 2000, the patient complained of tarry stools just like the previous conditions. No special findings were found to show the source of the bleeding.
    On December 15th 2000, the patient was admitted into our hospital, due to his complaint of tarry stools. The urgent endoscopic examination revealed the bicephalic diverticulum on the adoral papilla. There was palsatile bleeding found on the saddle which placed inbetween the two chambers consisting of the bicephalic diverticulum.
    Even after the treatment of electric-coagulation, the bleeding reoccurred twice. However after using the additional clipping, that condition was completely under control.
    We present this as being extremely interesting case.
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  • A Case of Carcinoma of the Third Portion of the Duodenum Developed Severe Electrolyte Abnormality
    Yukihiro Akiya, Shigehiko Yokoyama, Kunihiko Hao, Takayuki Kojima, Ken ...
    2002 Volume 60 Issue 2 Pages 60-61
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_60
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    A 61-year-old man was admitted with the chief complaints of nausea and vomiting. Abdominal CT revealed dilatation of the second and third portions of the duodenum, and a tumor compressing the inferior vena cava. Duodenography revealed obstruction at the third portion of the duodenum. Endoscopy revealed a type 2 tumor causing stenosis of the third portion of the duodenum. The distance between the papilla of Vater and the tumor was 10mm. Biopsy revealed a moderately differentiated adenocarcinoma.
    A stomach tube was inserted after admission. The volume of drainage from the stomach tube was about 5000-8000ml/day, and consequently, the patient developed marked hypochloremia. To correct this electrolyte abnormality, we performed percutaneous endoscopic gastrostomy and enterostomy via a laparotomy, and connected the two so as to allow the digestive juices to flow from the stomach into the intestinal tract. After two weeks, the marked hypochloremia was corrected. Pyloruspreserving pancreaticoduodenectomy was then performed. The resected specimen revealed a type 3 carcinoma in the third portion of the duodenum. Histopathological findings revealed a moderately differentiated adenocarcinoma. No postoperative complications occurred.
    Thus, connecting the gastrostomy with the enterostomy so as to allow the digestive juices to flow from the stomach into the small intestine proved to be a very useful measure to correct the electrolyte abnormality.
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  • A Case Report of Ischemic Colitis Followed by Mesenteric Panniculitis
    Atsuto Nagoshi, Yoshihiro Tei, Kenichiro Hishikawa, Hiroto Tajima, Tet ...
    2002 Volume 60 Issue 2 Pages 62-63
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_62
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    A case of male of ischemic colitis followed by mesenteric panniculitis is reported. The patient complained of hematochezia and lower abdominal pain. Laboratory findings on admission were increased WBC and positive CRP. Colonoscopy showed mucosal edema, and multiple erosions and ulcers in sigmoid colon. The patient was diagnosed as ischemic colitis and we treated him conservatively with intravenous drip infusion of antibiotics. His symptoms were promptly improved. After he started oral intakes, he complained of abdominal pain, and laboratory findings revealed further increased WBC and CRP. Abdominal roentgenogram showed a“stepladder”sign as ileus. Colonoscopy showed mucosal edema and narrowing without erosions and ulcerations in the sigmoid colon. Contrast-enhanced CT image demonstrated wall-thickning of the sigmoid colon surrounded by high density which suggests inflammation in soft tissues around sigmoid colon. Under the diagnosis of ischemic colitis followed with mesenteric panniculitis, he was treated with total parenteral nutrition and prednisolone. Clinical symptoms were improved and laboratory findings turned to be normal.
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  • A case of ischemic colitis occurred due to pyosalpinx
    Yositaka Fukushima, Nozomi Yoshikawa, Yuichi Kumano, Yuuji Aoyagi, Tak ...
    2002 Volume 60 Issue 2 Pages 64-65
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_64
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    A 67-year-old woman admitted with a chief complaint of fever and left lower abdominal pain. Abdominal enhanced CT demonstrated an inhomogenous density mass in left iliac lesion. Six days on admission, she suddenly had bloody stool. Colonoscopic findings showed the edematous and easy-bleeding mucosa with multiple erosions and longitudinal ulcers in the sigmoid to descending colon. Histological findings of uterine tube revealed the infiltration of inflammatory cells mainly including neutrophils and the proliferation of fibrosis due to pyosalpinx. Colonoscopic findings after surgical treatment showed deformities of the internal wall and normal mucosa in the sigmoid to descending colon. It is rare that pyosalpinx was complicated with ischemic colitis, which would be precious to discuss the pathogenesis.
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  • Two Cases of Hemorrhagic Colitis Due to Enterohemorrhagic Escherichia coli : O-157
    Jun Mitsuhashi, Masahiro Igarashi, Shigeru Adachi, Shigeru Yoshizawa, ...
    2002 Volume 60 Issue 2 Pages 66-67
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_66
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    We experienced two cases of hemorrhagic colitis due to Enterohemorrhagic Escherichia coli : O-157 (EHEC : O-157) diagnosed by endoscopy.
    A 45 year old woman was admitted to our hospital because of abdominal pain and bloody watery diarrhea. Abdominal echogram showed edema and swelling of the right-sided colon. Emergent colonoscopy revealed severe hemorrhagic colitis extending from the transverse colon to the ascending colon. Multiple ulcers and erosions, and severe edema were seen at the colon. EHEC : O-157 and verotoxin were confirmed by stool. She was given fosfomycin during 7 days.
    A-26-year old man was admitted to our hospital because of abdominal pain and bloody watery diarrhea. Abdominal echogram showed swelling of the colonic wall of the right-sided colon. Emergent colonoscopy revealed severe hemorrhagic colitis with severe edema and erosion extending from the ascending colon to the cecum. EHEC : O-157 and verotoxin were confirmed by stool. Fosfomycin was effective and he left the hospital after 10 days.
    It is concluded that abdominal echogram, emergent colonoscopy and stool culture are useful for the diagnosis of hemorrhagic colitis due to EHEC : O-157.
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  • A case of sm invasive adenocarcinoma which was deduced to have originated from serrated adenoma
    Riki Okubo, Touzou Hosoi, Yousuke Iriguchi, Teiko Nakai, Eita Nakahash ...
    2002 Volume 60 Issue 2 Pages 68-69
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_68
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    A 62 years-old male visited us to undergo further detailed examination following the positive fecal occult blood test. Type-Ip lesion revealing a fine villous structure at the top was discerned endoscopically which resulted in the diagnosis of serrated adenoma. EMR (endoscopic mucosal resection) was well indicated. At the second endoscopic examination for EMR, however, in the lower part of the lesion, an irregularly-shaped concavity, endoscopically rigid, revealing the loss of villous structure was present, leading to the suspect diagnosis of sm2 invasive cancer in adenoma. Accordingly, the treatment was switched from EMR to surgical operation. Furthermore, through endoscopy just before the surgical operation, the concavity deepened along with the whitish coating, which was strongly indicative of sm2 cancer.
    Laparoscopic assisted partial resection was carried out in the ascending colon. Pathologically diagnosed as moderately differentiated adenocarcinoma in serrated adenoma, sm2, ly2, v2, n0. The malignant potential of serrated adenoma is considered to be almost equal to that of ordinary adenoma. Taking into consideration that the larger the diameter of a lesion becomes, the greater the malignant incidence grows, and that there actually exists sm invasive cancer originating from serrated adenoma requiring surgical operation, we are expected to scrutinize the lesion of serrated adenoma through endoscopy as to whether it is cancerous or not.
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  • A Case of Malignant Lymphoma of the Rectum
    Yasuyuki Anazawa, Miwa Sada, Jyunko Okuno, Shigeru Yoshizawa, Kiyonori ...
    2002 Volume 60 Issue 2 Pages 70-71
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_70
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    A 68-year-old woman was admitted to our hospital because of bloody stool and submucosal tumor of the rectum. Colonoscopic examination and barium enema revealed hemisphere-like protruded submucosal tumor 5.6 cm in diameter in the lower rectum. Endoscopic ultrasonography shows that the lesion was low echoic mass and extraluminal proturuded, that finding was suggested a1 to a2 invasion. Histological findings of the biopsied specimens showed that it was a non-Hodgkin's, diffuse, small to medium sized cell, B-cell type of malignant lymphoma and that origened to mucosa-associated lymphoid tissue type (MALT) lymphoma.
    After four courses by CHOP therapy, the bloody stool had disappeared, and colonoscopic examination revealed that submucosal tumor comprised of malignant lymphoma had disappeared. The patient has had no recurrence of the disease during 7 months since the last chemotherapy.
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  • A case of stercoraceous ulcer with making inflammatory glanulation tissue elevation
    Yasuhiro Funatsu, Yutaka Endo, Ikuma Yoshida, Susumu Tokunaga, Yuichir ...
    2002 Volume 60 Issue 2 Pages 72-73
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_72
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    A 74-year-female was admitted to our hospital complaining of lower abdominal pain and hematochezia. A large and deep ulcer was observed at rectosigmoid junction by emergency colonoscopy. After one week TPN therapy, follow up study was performed. The ulcer was altered into elevated lesion with lobulation like laterally spreading tumor granular type (LST-G) . A small ulcer was also detected at the margin of the elevation. The endoscopic diagnosis was confused whether neoplastic tumor or stercoraceous ulcer. The initial endoscopy was performed in poor preparation. Large faeces interrupted observation and only a part of the ulcer was seen. However, there was no pit on the surface of the elevated lesion in magnification. The biopsy revealed the elevation consisting of inflammatory granulation tissue. The elevation was disappeared completely and only ulcer scar was observed after 4 month later. The inflammatory Granulomatous elevation appears in gastric ulcer healing processes, especially treated with PPI. There was no case report of stercoraceous ulcer making inflammatory Granulomatous elevation in Japanese literature. And it is also very rare colonic ulcer making inflammatory Granulomatous elevation. This case is very rare.
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  • “Press-through package”-induced colon hemorrhage
    Shinji Morishita, Masahiro Kawabata, Masao Matsumoto, Akiko Nakamura, ...
    2002 Volume 60 Issue 2 Pages 74-75
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_74
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    A 80-year-old woman was admitted because of abdominal pain. On the third day of admission, she had bloody stool with increasing abdominal pain. Colonoscopy revealed that a press-through package (PTP) was lodged in the sigmoid colon and ulcers were present adjacent to sharp edge. The package was removed by endoscopic forceps and the patient was discharged in good capsules. PTPs are rapidly becoming popular as packages for tablets and capsules. Reports of accidental swallowing of a PTP have been increasing but progression of PTPs to the colon is rare. We were able to remove it endoscopically. We propose that drugs should not be dispended in PTPs especially to elderly patients. It is also important to inform patients that accidental swallowing of PTPs is disastrus and warn them not to swallow PTPs. Collaboration of co-medical staff such as a pharmacist is necessary.
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  • Cytomegalovirus Infection in a Patient With Steroid-Resistant Ulcerative Colitis
    Naomi Kakushima, Mitsuhiro Fujishiro, Naohisa Yahagi, Makoto Okamoto, ...
    2002 Volume 60 Issue 2 Pages 76-77
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_76
    JOURNAL FREE ACCESS
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    A 56-year-old Japanese man with ulcerative colitis was admitted because of being judged as resistance to treatment with intravenous prednisolone (60-100 mg/day) and oral sulfasalazine (3 g/day) over 1.5 months at another hospital. Colonoscopy at our hospital showed multiple punched-out ulcers from the cecum to the descending colon without active inflammation in the rectum. Although cytomegalovirus superinfection after long-term steroid administration was highly suspected and the treatment for it was planned, he developed massive bleeding and progressive clinical deterioration that necessitated emergency total colectomy in several days after the colonoscopic examination. Histopathologically, cytomegalic inclusion bodies were identified on the ulcer rim and base, while the activity of ulcerative colitis was kept under control with steroid. Because the antigenemia of cytomegalovirus continued positive even after colectomy, ganciclovir was administered until the antigenemia was turned into negative. The present case showed that cytomegalovirus superinfection should be considered in patients with inflammatory bowel disease having long-term steroid administration and immediate serological and histological investigation should be performed when the clinical course is unusual.
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  • A Case of Inflammatory Bowel Disease with Large Colonic Ulcers and Punched-Out Esophageal Ulcers in which Making the Definite Diagnosis was Difficult
    Tateki Yamane, Kan Uchiyama, Makoto Nakamura, Takayuki Ishii, Yasuhiro ...
    2002 Volume 60 Issue 2 Pages 78-79
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_78
    JOURNAL FREE ACCESS
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    A 21-year-old female entered our hospital complaining of diarrhea, abdominal pain and body weight loss. Colonoscopic examination revealed multiple small and middle sized discrete ulcers throughout the whole colon and two large and deep ulcers in the ascending colon. Biopsy specimens taken from the small ulcers of the left sided colon showed non-caseating epithelioid cell granuloma histologically. And upper gastrointesinal endoscopic examination revealed multiple punched-out ulcers in the middle and lower segments of the esophagus. Granuloma was not evident in biopsy specimens taken from the esophageal ulcers. Though the large colonic ulcers and punched-out esophageal ulcers suggested Behçet's disease or simple ulcer, we suspected her illness as Crohn's disease due to detection of granuloma and prescribed her Prednisolone. Then, she recovered and follow-up endoscopic examination showed improvement of the ulcers. This case was difficult to make definite diagnosis.
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  • Laparoscopic radiofrequency ablation using a sector ultrasonic probe for hepatocelular carcinoma on the liver surface
    Kosei Hamano, Namiki Izumi, Hisanobu Kawamura, Hyuman Suzuki, Kaoru Tu ...
    2002 Volume 60 Issue 2 Pages 80-81
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_80
    JOURNAL FREE ACCESS
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    Laparoscopic radiofrequency ablation is considered first-line therapy especially for liver cancer on the liver surface and located in the subphrenic area. We have recently used a sector ultrasonic probe for laparoscopic treatement with a guiding tract to obtain accurate ablation of targeting HCC nodule.
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  • A Case of Endoscopically Collected Cholelith with Cholecystogastric Fistula
    Katsuharu Boku, Hideaki Suzuki, Takashi Sugawara, Seima Saito, Makoto ...
    2002 Volume 60 Issue 2 Pages 82-83
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_82
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    A 74-year-old man, who had a history of choledocho-lelithiasis with obstructive jaundice treated by endoscopic papillary balloon-dilation method, admitted to our hospital, because of treatment of diabetes mellitus.
    Abdominal CT showed cholelithiasis and wall thickening of the gallbladder. We suspected gallbladder cancer, and performed endoscopic retrograde cholangiography (ERC) . When we inserted endoscope, cholelith was found in the antrum of the stomach, and ERC visualized common bile duct (CBD) , atrophic gallbladder and also the stomach. We found fistula on the greater curvature of the antrum, and injected contrast agents under balloon-occlusion, therefore atrophic gallbladder and CBD was seen, and made confirmation as cholecystogastric fistula. Then we collected cholelith endoscopically. Surgical operation was performed with a diagnosis of chronic cholecystitis.
    Cholecystogastric fistula is very rare among the spontaneous internal biliary fistulae. It is difficult to make a preoperative diagnosis of cholecystogastric fistula, but in our case, we timely performed an examination of ERC, therefore we found cholelith and fistula in the stomach, and were able to confirm as cholecystogastric fistula.
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  • Invasive Carcinoma Derived from Intraductal Papillary Carcinoma of the Pancreas Manifested in the Follow-up of Branch-type Mucin Producing Pancreatic Tumor
    Terumi Kamisawa, Takashi Fujiwara, Mizuka Suzuki, Kozue Amemiya, Naoto ...
    2002 Volume 60 Issue 2 Pages 84-85
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_84
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    A 72-year-old man had been followed up for branch-type mucin producing pancreatic tumor for three years. Endoscopic retrograde cholangiopancreatography (January, 1998) showed a 1.5 cm-sized irregular cystic lesion in the neck of the pancreas, and amorphous filling defects of mucin in the main pancreatic duct. Though the patient had been asymtomatic, endoscopic retrograde cholangiopancreatography (February, 2001) showed the main pancreatic duct obstructed near the origin of the inferior branch. Magnetic resonance cholangiopancreatography showed cluster of cyst near the obstructed main pancreatic duct, and irregular dilatation of upstream main pancreatic duct. Pylorus preserving pancreaticoduodenectomy was performed. Histologically, 1.1-sized invasive carcinoma derived from intraductal papillary carcinoma was detected around the main pancreatic duct near the cyst. In follow-up of the branch-type mucin producing pancreatic tumor, it is necessary to note the possibility of the tumor in the main pancreatic duct near the cyst.
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  • A Case of Intrasplenically Grown Non-functioning Pancreatic Endocrine Tumor
    Nozomu Nakagawa, Takuji Yamada, Kazuko Sugiyama, Hirofumi Okuda, Kenji ...
    2002 Volume 60 Issue 2 Pages 86-87
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_86
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    A 62 year-old male was admitted to our hospital for detailed examinations of a low density mass in the spleen by abdominal CT scan at a physical checkup. Abdominal CT scan also demonstrated portal obstruction and collateral veins around pancreatic head. Furthermore, abdominal angiograhy showed a hypovascular lesion in the spleen. Upper gastroendoscopy demonstrated esophageal varices, which were eradicated after EVL. The above examinations, however, could not make the definitive diagnosis, therefore splenectomy was carried out on 5 July 2000.
    The tumor size of the cut surface was 4×5cm in diameter. Histopathological diagnosis was non-functioning pancreatic endocrine tumor. The patient remains well with no evidence of recurrence one year and seven months after the operation.
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  • A Case of Chronic Pancreatitis with Pancreatic Stones Successfully Treated with Endoscopic Minor Papilla Sphincterotomy for Pancreas Divisum
    Tsunao Imamura, Masashi Sakamoto, Akitoshi Ikegami, Junichi Eguchi, Ta ...
    2002 Volume 60 Issue 2 Pages 88-89
    Published: June 05, 2002
    Released on J-STAGE: May 22, 2014
    DOIhttps://doi.org/10.11641/pde.60.2_88
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    A 65-year-old male was admitted to our hospital because of repeated abdominal pain. The patient had been previously diagnosed as having chronic pancreatitis with pancreatic stones on the basis of finding of abdominal computed tomography (CT) . Endoscopic retrograde pancreatography revealed pancreas divisum and chronic pancreatitis with pancreatic stones. We judged that chronic dorsal pancreatitis was caused by insufficiency of pancreatic juice drainage from minor papilla, so we performed endoscopic minor papilla sphincterotomy for the improvement of pancreatic juice drainage. After the treatment, the patient has been free of episode of abdominal pain. Our experience suggests that endoscopic minor papilla sphincterotomy is one of the effective and noninvasive treatments of chronic dorsal pancreatitis with pancreas divisum.
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