Progress of Digestive Endoscopy
Online ISSN : 2187-4999
Print ISSN : 1348-9844
ISSN-L : 1348-9844
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62 巻, 2 号
選択された号の論文の52件中1～50を表示しています
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臨床研究
  • 酸性水洗浄後に見られた内視鏡外面（コーティング部）変化の検討
    熊谷 義也, 浅岡 力
    2003 年 62 巻 2 号 p. 26-30
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_26
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    　酸性水とグルタールアルデヒドを使用した内視鏡洗浄消毒により内視鏡外面のコーティング部が2,000例を超える頃よりざらざらした手触りの変化が見られたことから，そのざらつきの成分を分析した。1．ざらざらになった内視鏡の表面を50倍のデジタルマイクロスコープにより観察し，新しい内視鏡の表面と比較した。2．内視鏡外面をフーリエ変換赤外線分光光度計により分析して比較した。3．ざらざらになった内視鏡を廃棄して切断しざらざらの部分の表面を走査型電子顕微鏡により50倍，500倍，5,000倍にて観察した。4．剥離された物質の溶解のために有効な物質を検討し，次亜塩素酸ナトリウムが有効であり，劣化物質を溶解して中和，塩析，フリーズドライ法で粉末状として分析した。結論1．次亜塩素酸ナトリウムに溶解された物質は16種類のアミノ酸が定量された。これらの検索により内視鏡表面の硬く層状に重積した被膜は洗浄の際にわずかに残った蛋白質とグルタールアルデヒドが重合したものと考えられた。酸性水がどのように関与したかは判明できなかった。2．この硬い被膜の除去には，次亜塩素酸ナトリウムが有効であり，つやつやしたコーティング面が再現できた。今後は消毒前の洗浄に中性洗剤や酵素洗剤を用いるべきであり，グルタールアルデヒドの使用も見合わせるべきである。
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  • 血液透析患者における上部消化管疾患，Helicobacter pylori感染の観察
    松久 威史, 山田 宣孝, 鈴木 美貴, 薗田 まり子, 安達 敏行, 藤島 悟, 岡本 富美子, 岡本 明彦
    2003 年 62 巻 2 号 p. 31-35
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_31
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    　血液透析患者の上部消化管疾患，Helicobacter pylori（Hp）感染の特徴を観察し，当内視鏡科患者との比較も行った。その際，両群の検討には年齢，性別あるいは年齢，性別，内視鏡診断をマッチさせた。
    　透析患者（透析群）では内視鏡科患者（対照群）に比べ胃炎の頻度が高く（透析群 : 82例中36.6％，対照群 : 11.0％，P＜0.001），消化性潰瘍のそれが低かった（透析群 : 82例中7.3％，対照群 : 42.7％，P＜0.001）。透析群のHp感染率（35例中28.6％）は対照群（71.4％）に比し有意に低値であった（P＜0.001）。透析群のHp感染率を透析導入期間別にみると，透析期間の長いものほどHp感染率が低いのみならず，透析導入3カ月未満の患者においても感染率は31.3％と低値を示した。3点生検により採取した切片の慢性炎症スコア平均値をUpdated Sydney systemに基づき観察すると，Hp陽性透析群，対照群間のスコアに相違はみられなかった（各々1.97，1.90）。一方，Hp陰性透析群の慢性炎症スコア（0.81）はHp陰性対照群のそれ（0.30）に比し有意に高く（P＝0.001），この値は除菌後症例の慢性炎症スコアに近似していた。Hp陽性透析群，対照群の血清抗HpIgG抗体は全例において陽性であった。Hp陰性透析群の抗HpIgG抗体陽性率はHp陰性対照群のそれに比べ有意に高く（各々58.3％，20.0％，P＜0.05），除菌後症例の陽性率に類似していた。これらの成績より，透析患者では慢性腎不全に伴う自然除菌例の存在が示唆された。
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  • 早期胃癌と内視鏡診断された未分化型胃癌の縮小手術適応に関する検討
    鳥海 史樹, 才川 義朗, 熊井 浩一郎, 青木 真彦, 吉水 信就, 吉田 昌, 古川 俊治, 大谷 吉秀, 久保田 哲朗, 向井 萬起男 ...
    2003 年 62 巻 2 号 p. 36-40
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_36
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    　近年，Quality of lifeを考慮した内視鏡的胃粘膜切除術（EMR）・腹腔鏡下胃切除術などの縮小手術が積極的に行われるようになってきた。そこで今回術前に内視鏡診断上早期胃癌と診断された未分化型胃癌の臨床病理学的診断を検討することにより，いまだコンセンサスの得られていない未分化型胃癌の縮小手術の是非について検討した。
    【対象】1994年1月～1997年12月までに当院で早期胃癌と内視鏡診断され切除術が施行された293例のうち未分化型胃癌（por1，por2，sig）91例を対象とした。【結果】深達度診断での正診率は未分化型胃癌では91例中83例，91.2％であった。手術時，肉眼的に切除断端陰性であり，病理組織診断で切除断端陽性であった症例を未分化型胃癌に3例3.3％に認めた。リンパ節転移陽性率は，分化型粘膜内癌の0.7％に対し，未分化型粘膜内癌では6.2％と有意に高値を示した（P＝0.02）。未分化型胃癌で深達度診断が正診された83例中，5例（6.0％）にリンパ節転移を認めた。【結論】肉眼的早期胃癌のうち，未分化型早期胃癌の術前診断における深達度診断・境界診断の困難性と，未分化型粘膜内癌の高率なリンパ節転移率を示した。早期胃癌に対する低侵襲性治療において，未分化型腺癌への適応は慎重に行うべきである。
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  • 出血性胃angiectasiaに対する内視鏡的止血術の検討
    上平 晶一, 吉田 行雄, 宮谷 博幸, 平川 隆一, 澤田 幸久, 浅野 聡, 中島 嘉之, 兵頭 隆史, 藤原 俊文, 井廻 道夫
    2003 年 62 巻 2 号 p. 41-44
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_41
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    　1990年4月から2000年4月までに，当センターで施行された上部消化管内視鏡検査にて170例の胃angiectasiaが認められ，10例が出血性angiectasiaと診断された（5.9％）。検査時に活動性の出血が認められた4例に対し，内視鏡的止血術（クリップ2例，内視鏡的粘膜切除術（EMR）1例，ヒータープローブ1例）が施行され，全例で止血が得られた。このうち，2例で長期の経過観察が可能あった。EMR施行例では，術後7年間angiectasiaの再発を認めなかったが，クリップ施行2年後の症例では，術前と同部位にangiectasiaが存在し，血液検査上貧血を呈していた。クリップ法は，簡便性と安全性の点では非常に優れているが，根治性の点ではangiectasia再発，遺残の可能性が残された。
    　出血性angiectasiaに対する治療法では，内視鏡的止血術が最も重要な位置を占めており，エタノール注入療法，クリップ法，内視鏡的結紮術（EVL），EMRなどの内視鏡的止血術が報告されている。数週から数カ月の短期間の経過観察で，病変の再発なしと判定している報告もあるが，再発の有無の判定は少なくとも1年以上の経過を追ってなされるべきであり，その後も定期的な内視鏡検査の継続が必要と考えられた。
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  • 大腸内視鏡検査における芍薬甘草湯（TJ-68）の腸管収縮抑制効果に関する検討
    相 正人, 山口 武人, 尾高 健夫, 三橋 佳苗, 宍戸 忠幸, 山口 和也, 税所 宏光
    2003 年 62 巻 2 号 p. 45-49
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_45
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    　【目的】大腸内視鏡検査における芍薬甘草湯（TJ-68）の腸管収縮抑制効果を明らかにする。【対象／方法】対象は前投薬未施行で大腸内視鏡検査を行った26例。肛門から約25cmのS状結腸まで内視鏡を挿入し，全体像の把握が可能な収縮輪を規定，内視鏡との距離を保ちビデオ記録を行った。記録はTJ-68散布前3分間と，TJ-68（0.5gを微温湯50mlに溶解）を注射器で緩徐に散布した後の3分間行った。記録開始から30秒毎の計12回の画像から収縮輪内腔面積を画像解析ソフトによりpixel数として計測し，TJ-68散布前後の面積変化をグラフ化した。得られたグラフから散布前後のarea under the curve（AUC）を算出し比較検討した。【結果】TJ-68散布前のAUCは平均で41,057pixels・min，散布後は98,348 pixels・minであり，散布後有意な増大を認めた。【結論】TJ-68の大腸粘膜直接散布により明らかな腸管収縮抑制を認めた。TJ-68が大腸内視鏡検査時の収縮抑制剤となり得ることが示唆された。
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  • ITナイフによる直腸結節集簇様病変一括切除の有用性
    日引 太郎, 浦上 尚之, 小泉 浩一, 千野 晶子, 土田 知宏, 稲葉 良彦, 高橋 寛, 藤田 力也, 畦倉 薫, 武藤 徹一郎, 柳 ...
    2003 年 62 巻 2 号 p. 50-54
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_50
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    　直腸結節集簇様病変の治療方針決定には，病理学的な深達度，脈管浸潤，切除断端の確実な診断が必要であり，これら正確な病理診断のためには内視鏡的一括切除による摘除生検が望ましい。当院では20mm以上の直腸結節集簇様病変に対し，一括切除を効果的に行うため，insulation-tipped electrosurgical knife（ITナイフ）を用いendoscopic mucosal resection（EMR）を行っている。現在までに4病変（最大45mm）の一括切除に成功しており，その後の治療および経過観察の方針決定に寄与するに十分な標本を得ている。2例に拍動性出血を認めたがクリップにて容易に止血し，輸血は必要としなかった。また穿孔は現在までのところ経験していない。現時点でのcutting EMR法（ITナイフ法を含む）による内視鏡的摘除では，術前に深達度m～smの癌と診断された（あるいは形態的に腺腫と癌の混在が疑わしい）20mm以上の直腸結節集簇様病変がよい適応と考える。
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  • 膵管洗浄液細胞診の膵癌診断における有用性―通常型膵管癌の新たな検査法―
    今村 綱男, 吉田 仁, 北村 勝哉, 柳川 達郎, 齋藤 剛, 塙 勝博, 三代川 章雄, 池上 覚俊, 野津 史彦, 高橋 章, 新川 ...
    2003 年 62 巻 2 号 p. 55-59
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_55
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    　通常型膵管癌（以下，膵癌）は消化器癌の中でも極めて悪性度が高く，予後は不良である。膵癌の予後向上のためには上皮内癌の検出など早期診断法の確立が重要であり，従来の方法に比べ鋭敏かつ確実な診断法が必要となる。内視鏡的逆行性膵管造影（ERCP）の手技を用い，直接十二指腸乳頭を介して膵管から採取される純粋膵液の細胞診が行われているが，陽性正診率は30～79％と必ずしも高くなく，正診率の改善が望まれる。本研究は，気管支肺胞洗浄をモデルに，膵癌症例の膵管洗浄液（pancreatic duct lavage fluid ; 以下，PDLF）を回収し，膵癌診断における有用性について検討した。方法はERCPに際し膵管異常部の擦過後，3ルーメンバルーンを膵管内に楔入した。造影ルーメンよりシリンジで滅菌生理食塩水を0.5mlずつ注入し，同時にガイドワイヤールーメンより弱い陰圧で吸引した。膵癌5症例からPDLFを採取し，膵炎などの合併症を認めなかった。PDLF中には大量の剥離細胞が認められ，損傷や変性が少なく細胞形態が保持され，全例に陽性の病理診断を得た。我々の考案したPDLFは，多数の膵癌細胞を安全に回収でき，細胞の損傷が少なく細胞診に有用であり，膵癌の早期診断の向上への寄与が期待できる。本法は，ERCP，細胞診が可能なら新たな設備は不要であり，鋭敏かつ確実な検査法として普及されることを期待する。
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症例
  • APC施行後再発を認めた食道表在癌の2例
    野村 務, 田尻 孝, 宮下 正夫, 牧野 浩司, 丸山 弘, 松谷 毅, 二見 良平, 勝田 美和子, 柏原 元, 笹島 耕二, 山下 精 ...
    2003 年 62 巻 2 号 p. 60-62
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_60
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    　内視鏡的粘膜切除（EMR）が適応外の診断でArgon Plasma Coagulation（APC）を行った食道表在癌患者10例のうち，再発を認めた2例を報告する。症例1は65歳，男性。既往歴は胃癌，肝硬変，食堂静脈瘤。平成11年，胸部中部食道（Mt）の0-Ⅱc病変に放射線治療（60Gy）後再発，平成13年8月，初回APCを施行。さらに再発，平成14年1月に2度目のAPCを施行。症例2は69歳，男性。既往歴は胃癌，糖尿病，狭心症，脳梗塞。Mtの0-Ⅱb病変に対し，平成14年1月初回のAPC施行。6カ月後に再発したため2度目のAPCを行った。2例とも初回と同じ部位の再発であり，癌の遺残である可能性が高く，焼灼の間隔が広かったことがこれらの原因であると推測された。現時点では，特に広範囲の病変ほどEMRによる確実な切除を選択すべきであり，APCはEMRが不可能な症例に限るべきであることが再認識された。
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  • 誤嚥した胃内スプーンを内視鏡を用いて除去した1例
    丸山 祥司, 安藤 昌之, 小林 史枝, 佐久間 郁行, 余 心漢
    2003 年 62 巻 2 号 p. 64-65
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_64
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    We describe the successful endoscopic removal of a foreign body in the stomach by means of a snare technique. An 19-years-old woman ingested a table spoon and came to our hospital. She was under psychotherapy for overeating. An aout 18cm long spoon was noted by the X-ray photograph. We used the two-channel video endoscope and two polypectomy snare loops. The spoon was tied with two snare devices and located parallel to the esophagus. This device is simple to use, versatile, and effective and advances the safe endoscopic removal of a variety of gastroesophageal foreign bodies.
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  • 食道癌術後残存食道のBarrett粘膜化を認めた1例
    二見 良平, 田尻 孝, 野村 務, 牧野 浩司, 笹島 耕二, 山下 精彦, 宮下 正夫
    2003 年 62 巻 2 号 p. 66-67
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_66
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    A 61 years old male with esophageal carcinoma underwent right transthoracic esophagectomy and 3-field (cervix, mediastinum, abdomen) lymph node dissection. Protease inhibitor and a H2-Blocker were prescribed, but postoperative endoscopic findings and a biopsy specimen revealed Grade C esophagitis and patches of Barrett's mucosa at the oral side of the anastomosis.
    Patients undergoing esophagectomy and gastric tube reconstruction may develop Barrett's mucosa, because these patients are exposed to the loss of the mechanism to prevent reflux of tbe gastric contents. We report on a patient whose remnant esophagus was periodically followed up with endoscopy and biopsy for 7 years after surgical resection of esophageal carcinoma, and in whom patches of Barrett's mucosa developed within the remnant esophagus.
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  • 肉眼的に病変範囲の同定が困難であったBarrett食道癌の1例
    塩屋 雄史, 家富 克之, 崎村 恭也, 中島 浩一, 半田 祐一, 宮田 和則, 町野 裕之, 阪 眞, 松原 三郎
    2003 年 62 巻 2 号 p. 68-69
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_68
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    A 73-year-old woman had been made a diagnosis that she had gotten reflux esophagitis and Long-Segment Barrett's Esophagus (LSBE) . However, it turned out to be the cancer due to the re-examination of endoscope after a year and two months from the first diagnosis. Although it had been thought to be mucosal cancer because there had been no unevenness of mucous membrane, histological examination after operation revealed that it was multifocal minimal cancers arised from Barrett's esophagus. Recently, the theory of dysplasia-cancer sequence is worldwidely accepted, in this case it is interesting that we could find out the initial appearance of carcinogenesis in the LSBE. We must take the contrast method with indigocarmine to find out very small cancer.
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  • ヒト免疫不全ウイルス感染患者に認められた穿孔を伴う巨大食道潰瘍の1例
    大村 賢治, 松田 香織, 斉藤 真理, 白井 輝
    2003 年 62 巻 2 号 p. 70-71
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_70
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    We report a case of a 32-year-old man with HIV infection who has an esophageal perforation of an idiopathic ulcer. He had been treated by conservative therapy, and an endoscopic therapy was performed for the closure of the perforation. The HIV infection was well controlled by anti-HIV drugs administration and the ulcer became scared.
    In January 2002, he felt difficulty to swallow and had a high fever. He was admitted and computed tomography (CT) of the chest showed right pyothorax. Drainage of the pyothorax cavity and antibacterial therapy was performed. His blood examination indicated HIV infection.
    Esophagogram showed an esophageal perforation. Endoscopic examination showed giant ulcer that was considered as idiopathic one because cytomegalovirus antigen was not detected in his blood and it was cured without anti-herpes-virus drugs. He was conducted enteral nutrition and medication of anti-HIV drugs through gastoric tube. HIV infection was well controlled and the ulcer got healed progressively, but the perforation remained. So we performed an endoscopic therapy which was a brushing technique with irregular epithelium on inner face of perforation cavity by a pancreatic duct biopsy brush. Successfully the perforation was closed and he could regain to take orally soon. He discharged 152 days after admission and his HIV-infection is controlled as an outpatient.
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  • ポリエチレングリコール服用後に嘔吐し保存的治療にて軽快し得た特発性食道破裂の1例
    真下 利幸, 岩崎 順子, 鈴木 秀行, 猿谷 真也, 鷲田 雄二, 矢端 義弘, 込谷 淳一, 神尾 政志, 岡村 信一, 森 昌朋
    2003 年 62 巻 2 号 p. 72-73
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_72
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    A 76-year-old woman suddenly had epigastralgia and dyspnea after vomiting of polyethylene glycol electrolyte lavage solution in the bowel preparation for colonoscopy. Emergency upper endoscopy showed the laceration at the gastro-esophageal junction and chest CT scan revealed the existence of mediastinal emphysema and bilateral pleural effusions. Consequently, she was diagnosed as having spontaneous esophageal rupture and admitted to our hospital. Conservative therapy was given to her because she had little mediastinal pollution and none of complications such as mediastinal abscess, pneumothrax, and emphysema. After the conservative therapy, the disappearance of the laceration, mediastinal emphysema, and pleural effusions were demonstrated by gastroesophageal fluorography and chest CT scan.
    Here we present this case because spontaneous esophageal rupture due to vomiting is rare. We suggest that conservative therapy may be useful for a patient with spontaneous esophageal rupture if little mediastinal pollution, only slight symptom and inflammation are observed.
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  • 皮膚筋炎患者に発生した食道粘膜剥離症（submucosal dissection of the esophagus）の1例
    三橋 敏武, 村田 宣夫, 鈴木 毅, 山田 博文, 橋本 大定, 吉田 行雄, 三浦 一郎, 糸山 進次
    2003 年 62 巻 2 号 p. 74-75
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_74
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    A 55-year-old male began to feel precordial pain after meals in the end of April, 2001. He was in hospital to receive the steroid therapy for dermatomyositis since December 2000.
    Endoscopic examination showed a large ulcer and mucosal bridges resulting from laceration of the submucosal layer, which produced a false channel throughout the middle and distal esophagus. The patient was first managed conservatively to refrain from any drinks and meals for two weeks. In the middle of May, esophagoscopy showed retention of fluid and food in the false channel of the esophagus. On 28 of May, the mucosal bridge of the esophagus was cut through with a diathermy knife under endoscopic control. The false channel was abolished. The patient was able to drink water 20 days after the endoscopic treatment and to eat meals 26 days after it. Endoscopic examination after 5 months showed almost perfect epitherization of the esophageal mucosal membrane. The endoscopic treatment to open the false channel by cutting the mucosal bridge shortened the admission period. It is recommended that the mucosal bridge should be cut through endoscopy as soon as possible.
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  • 食道癌の食道気管瘻に対してDouble Stentを行い長期生存を認めた1例
    根本 祐太, 嶋尾 仁, 森瀬 昌樹, 片田 夏也, 桜本 信一, 菊池 史郎, 小林 伸行, 柿田 章, 田辺 聡, 西元寺 克禮
    2003 年 62 巻 2 号 p. 76-77
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_76
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    A 68 years old male was admitted for esophageal carcinoma with tracheal invasion. After 2 course of chemotherapy, esophago-tracheal fistula was defined.
    He was received a double stents implantation for trachea (Tracheal Ultraflex coverd 18mm, 4cm) and esophagus (Esophageal Ultraflex covered 17mm, 10cm) . After implantation he could ingest a diet and discharge at home. Although 5 courses of chemotherapy were performed, were evaluated as NC (no change) . After 339 days, he was died of esophageal carcinoma. Due to the development of esophageal stent, long survival cases were reported in literature. But, for esophageal carcinoma with esophago-tracheal fistula, the reports of long survival were rare. Mean survivals of those ranged from 11 to 119 days by the literature. We experienced a long survivals case and conclude that a double stents for esophago-tracheal fistula can be effective therapy for a quality of life.
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  • 胃過形成性ポリープに乳頭腺癌と印環細胞癌がみられた1例
    花井 将彰, 星野 洋一, 町田 守也, 大木 一郎, 栗原 照昌, 高橋 厚, 山田 勲, 荒井 剛, 宮本 幸男, 東郷 庸史, 吉松 ...
    2003 年 62 巻 2 号 p. 78-79
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_78
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    A 58-year-old female was referred to our hospital for endoscopic gatric polypectomy in January, 2002. Endoscopic examination revealed Yamada type IV polyp, 4.5cm in length, on the posterior wall of the middle gastric body. Histological findings of the polypectomied specimen suggested a hyperplastic polyp with cells of papillary adenocarcinoma and signet ring cell carcinoma, respectively, in the polyp. The phenotype of the carcinoma in the polyp was evaluated by immunohistochemicaly with CD10, MUC2 and human gastric mucin (HGM) . The carcinoma and the hyperplastic foveolar epithelium were only positive for HGM. Therefore the carcinoma was classified as gastric type. It is said that this type changed more commonly to undifferentiated type during the course of invasion of the mucosa and/or the submucosa or deeper. This case was thought to be very rare in that signet ring cell carcinoma and papillary adenocarcinoma were developing in a hyperplastic polyp in the stomach.
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  • 胃MALTリンパ腫に早期胃癌を合併した1例
    佐藤 伸悟, 永尾 重昭, 奥平 慶介, 田島 一美, 橋口 一利, 井上 拓也, 宮崎 純一, 松崎 宏治, 川口 淳, 伊藤 和郎, 三 ...
    2003 年 62 巻 2 号 p. 80-81
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_80
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    An 83-year-old male was diagnosed as high-grade MALT lymphoma of the stomach both endoscopically and pathologically. Eradication of Helicobacter pylori with 40mg of omeprazole, 1,500mg of amoxicillin, 400mg of clarithromycin a day for 10 consecutive days at first and 3 courses of anthracyline-based chemotherapy (CHOP ; 650mg of cyclophosphamide, 40mg of doxorubicine hydrochloride, 1.2mg of vincristine sulfate per a course and 50mg of predoninn a day during a course) were done secondly and 40Gy of ratiation therapy was added to them. 2 months after whole therapies done, endoscopic examination was performed to evaluated the effect of whole therapies. A type of IIa + IIc, an early gastric adenocarcinoma, was newly revealed to be located on the lesser curvature of the middle body of the stomach. Endoscopic therapy with semiconductor lazer was performed due to the patient's request instead of surgery. The effect of H. pylori infection on the pathogenesis of gastric neoplasia has not been cleared yet. This case suggested the some carcinogen from H. pylori might cause both MALT lymphoma and adenocarcinoma of the stomach.
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  • 切開・剥離法にて一括切除した同時性多発早期胃癌の1例
    長島 真美子, 小野里 康博, 饗場 正明, 豊田 満夫, 長沼 篤, 新井 弘隆, 阿部 毅彦, 石原 弘, 富沢 直樹, 小川 哲史, ...
    2003 年 62 巻 2 号 p. 82-83
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_82
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    The presented case is a 78-year-old woman who had three IIa lesions adjacent to each other at the lesser curvature of the gastric anglus. These lesions were all diagnosed as a well-differentiated adenocarcinoma by histopathological examination of the biopsy specimen. The depth of invasion was predicted to be within the mucosal layer by an endoscopic ultrasonography. They could be excised in a lump by endoscopic mucosal resection, following the marginated cutting and exfoliating method using an insulated-tip electrosurgical knife. The resected specimen was measured 45×56 mm in size ; each size of three IIa lesions was 19×11×3 mm, 20×14×4 mm, and 9×8×4 mm, respectively. All three lesions were histopathologically diagnosed as a well-differentiated adenocarcinoma localized within the mucosal layer. The patient had an uneventful postoperative course without development of any complications nor new lesions. As with this case, synchronous multiple early gastric cancers adjacent to each other could be resected in a lump by the marginated cutting and exfoliating method using an insulated-tip electrosurgical knife and this procedure could provide a complete specimen for the histopathological examination.
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  • 同時性・異時性多発胃癌に対してEMR3回および噴門側胃切除術を施行した1例
    青木 真彦, 才川 義朗, 大谷 吉秀, 鳥海 史樹, 吉水 信就, 吉田 昌, 古川 俊治, 久保田 哲朗, 熊井 浩一郎, 北島 政樹
    2003 年 62 巻 2 号 p. 84-85
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_84
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    Seventy-four-year-old male underwent endoscopic mucosal resection (EMR) for double lesions of early gastric cancers. Another elevated lesion at the cardia was pointed out at the time. While strict observation with periodically repeated endoscopic biopsies did not demonstrate malignant change in gastric mucosa in the lesion. Group V was diagnosed by gastric biopsy in the lesion at 8 months after initial EMR. Since endoscopic and radiological examinations suggested invasion into the submucosal layer, whichi increase possibility of lymph node metastasis, proximal gastrectomy with D1＋α lymph node dissection was performed, preserving gastric function. Histopathological findings revealed advanced cancer with invasion into the muscularis propria. One year and two months after the surgery, EMR was performed again against early gastric cancer. We concluded that strict follow-up for metachronously developed gastric cancer will be important, in order to detect cancer at early stage, which will enable to preserve stomach, maintaining QOL, even for quadruple gastric cancers.
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  • TAEにて保存的に治癒した脾動脈瘤胃穿破の1例
    櫻井 隆之, 中村 朗, 吉汲 祐加子, 糸林 詠, 志村 謙次, 浅田 学
    2003 年 62 巻 2 号 p. 86-87
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_86
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    A 61-year-old male was admitted to our hospital because of hematemesis. Emergent gastroendoscopy and CT was performed at once, and they had detected a 4 cm of splenic arterial aneurysm which perforated into his stomach. We performed emergent abdominal operation but couldn't reach the aneurysm because of hard adhesion.
    So we performed Angiography and TAE twice, stuffed aneurysm with metallic coil, and finally success with stop the hemorrhage. 6 months later, gastroendoscopy showed that metallic coil had penetrated into the stomach, but there were no bleeding.
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  • 再除菌療法にて治癒したclarithromycin耐性H．pylori陽性のMALTリンパ腫の1例
    水野 真之, 河合 隆, 川上 浩平, 高垣 信一, 西 正孝, 額賀 健治, 萩原 恭史, 工藤 拓, 堀 高史朗, 安田 有利, 平良 ...
    2003 年 62 巻 2 号 p. 88-89
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_88
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    A 65-year old women visited our hospital for further examination of gastric ulcer lesion. Upper gastrointestinal endoscopy revealed multiple irregular ulcer lesions in the lesser curvature of anglus. Histological examination of biopsy specimens demonstrated diffuse infiltration centrocyte-like cells and formed lymphoepithelial lesions. Helicobacter pylori (H. pylori) was demonstrated by rapid urease test, culture and histological examination. Low grade mucosa-assiciated lymphoid tissue (MALT) lymphoma (stageI) with H. pylori was diagnosis by further examination of endoscopic ultrasonography, Computer tomography and 67Ga scintigraphy. One week eradication therapy (lansoprazole 60mg/day + Amoxicillin (AMPC) 1,500mg/day + clarithromycin (CAM) 800mg/day) unsuccessfully carried out and MALT lymphoma cells were remained. H. pylori strain separated from gastric mucosa after the first line eradication was reveled CAM-resistant strain by susceptibility test. Second line eradication (rabeprazole 20mg/day + AMPC 1,500mg/day + metronidazole 750mg/day 1wk) was carried out successfully and the lesion was regressed endoscopically and histologically.
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  • 自己免疫性肝炎治療中，不明熱にて診断されたサイトメガロウイルス感染による胃潰瘍の1例
    吉岡 篤史, 宮坂 有香, 小野 圭一, 足立 洋祐, 小島 茂, 武田 雄一, 野内 俊彦, 清水 誠一郎
    2003 年 62 巻 2 号 p. 90-91
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_90
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    A patients, 51 years old female had been treated with prednisolone (7.5mg/day) and azathioprin (50mg/day) for autoimmune hepatitis. She had been also treated for duodenal ulcer with famotidine. High grade fever continued for 20 days without the evidence of bacterial infection and blood examination showed high titer of cytomegarovirus (CMV) IgG antibody and CMV antigenemia. After the discontinuation of azathioprine, her body temperature become normal and cytomegarovirus antigenemia disappeared.
    Endoscopic examination revealed an ulcer at the gastric angle, and gastric erosions on the fornix and the greater curvature. CMV inclusion bodies were recognized in the biopsies from the ulcer edge. CMV was not detected from former gastric biopsy samples which were taken for the examination of Helicobactor pylori. CMV disappeared in biopsy samples with the improvement of gastric ulcer. The clinical course and histopathological findings suggested gastric ulcer was induced by CMV infection.
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  • 胃サルコイドーシスの1例
    塩崎 裕士, 田原 利行, 山岸 由幸, 中田 功, 加瀬 建一
    2003 年 62 巻 2 号 p. 92-93
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_92
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    A 50-year-old female was pointed out to have abnormalities by a barium meal for medical checkup and visited our hospital. At the age of 40, she had been pointed out to have mediastinal lymphadenopathy by a chest X ray for medical checkup. At another hospital, biopsy of the lymphnode had been done and the diagnosis of sarcoidosis had been made.
    She was free of gastrointestinal symptoms and her fecal occult blood test was negative. Gastroscopy showed multiple protruding lesions in the fornix, body and angulus. Center of the lesion was yellowish and slightly depressed. Some of the lesions were also accompanied with converging folds. Endoscopic ultrasonography of the lesion showed a thickened hypoechoic area in the second inner layer.
    Biopsy specimens taken from the lesions showed non-caseous epithelioid granulomas with Langhans' giant cells in the lamina propria microscopically.
    Neither tubercle bacillus nor fungus was found. Serological tests of syphilis were also negative. These findings led to the diagnosis of gastric sarcoidosis.
    An ulcer scar with Helicobacter pylori infection was also observed in the stomach, then eradication of H. pylori was preformed. Her gastroscopic finding has not changed during the follow-up period (about 1 year) .
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  • 内視鏡的粘膜切除術にて切除し得た幽門輪直下十二指腸カルチノイドの1例
    岡本 直子, 谷 雅夫, 海山 智隆, 佐伯 伊知郎, 斎藤 直也, 河野 辰幸, 竹下 公矢
    2003 年 62 巻 2 号 p. 94-95
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_94
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    The case was a 64-year-old male who was noted to have a submucosal tumor. 6 mm in size, at the duodenal balb. Biopsy taken by endoscopy showed the presence of carcinoid tumor. But he had no symptoms of carcinoid syndrome.
    The tumor was resected successfully with no complication by endoscopic mucosal resection using a cap-fitted panendscope (EMRC) . Histopathologically, there was no carcinoid invasion to the resected margins and to the vessels.
    We suggested that EMRC is a safe and effective procedure for treatment of such small lesions in the duodenum.
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  • 吐血を契機に発見した人蛔虫症の1例
    岩瀬 滋, 阿南 英明, 松枝 利恵, 赤坂 理, 上野 誠, 保利 敦, 中村 三郎
    2003 年 62 巻 2 号 p. 96-97
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_96
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    Case was a 63-year-old female. She was admitted to hospital because of hematoemesis. Laboratory data showed slight anemia, increasing data of eosinophil and IgG. No pathological findings were recognized by chest plain X-ray films and abdominal CT scan, At first, we suspected rupture of esophago-gastric varices, portal hypertensive gastropathy and so on, because she attended our hospital for Primary biliary cirrhosis. Upper GI endoscopy performed in an emergency showed oozing from multiple erosions in the stomach.
    She was hospitalized by the diagnosis of acute gastric mucosal lesion. We performed 2nd upper GI endoscopy on 3 hospitalized days for checking the state of affairs. Endoscopic pictures showed a white roundworm in 2nd portion of the duodenum. This worm could be removed by grasping forceps led to the diagnosis of Ascaris lumbricoides. And then, She was cured of this disease by taking Pyrantel pamoate.
    In recent years, the Incidence of Ascaris lumbricoides has been decreasing because of improved public hygiene and living standards in Japan. However, there is a slight increasing in number of cases due to the natural foods boom and increasing contact with foreign countries. In this case, the origin was natural foods. It is necessary for clinicians to be able to take parasitosis into consideration.
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  • 出血性ショックをきたした感染が原因と考えられた十二指腸病変の1例
    住吉 賢, 小森山 広幸, 戸部 直孝, 濱谷 昌弘, 金子 英彰, 田中 圭一, 萩原 優, 品川 俊人, 岩本 正彦
    2003 年 62 巻 2 号 p. 98-99
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_98
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    A case of a 35-year-old woman who was hospitalized at near clinic because of fervescence after abroad traveling. Laboratory data showed slight liver dysfunction and a high level of CRP. We suspected that she had a common cold and administrated her with antibiotics but no defervescence was observed. The results of tests denied the possibilities of collagen disease, meningitis, and imported infection. Abdominal CT showed mural tylosis of pars descendens duodeni, and the superior endoscopic image showed ulcers and multiple polyps dotted at pars descendens duodeni. She was moved to our hospital because of suspicion of duodenum Crohn's disease and aim of exact examination of fever unaccounted for. Five days after removal, sudden hematemesis induced Hb5.0 and hemorrhagic shock. We had to operate coil embolization in superior pancreaticoduodenal artery for hemostasis because she didn't response to blood transfusion. Multiple polyps dotted at duodenum tended to be cured but existed, but pathological observation suggested inflammatory reproductive polyp and denied Crohn's disease. We will report our experience of duodenal lesion unaccounted for with a discussion about the literatures.
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  • 内視鏡下生検で診断しえた十二指腸下行部カルチノイドの1例
    井口 幹崇, 矢作 直久, 近藤 慎太郎, 角嶋 直美, 小林 克也, 橋本 拓平, 藤城 光弘, 岡 政志, 三好 秀征, 森山 義和, ...
    2003 年 62 巻 2 号 p. 100-101
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_100
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    A 51-year-old male was admitted to our hospital for the treatment of a laterally spreading tumor in the rectum. A protrusion with bridging folds, which suggested a SMT was found in the second part of the duodenum by screening endoscopy for preoperative check up. The lesion had slightly reddish and erosive surface, and several biopsy specimens were taken from the eroded area. The diagnosis of carcinoid tumor was made, since these specimens demonstrated positive reactions to chromogranin A, synaptophysin and Grimelius stain. Endoscopic ultrasography revealed that the tumor was mainly located in the submucosal layer, and the tumor size was 15mm in diameter. It is reported that the risk of metastasis depends on its size, and since large tumors more than 10mm are judged to be high risk, the patient underwent laparotomy. Operative findings showed no obvious metastatic lesions in the liver, no lymph node swelling or disseminated lesions in the peritoneum, therefore partial duodenectomy was performed. The resected specimen revealed that the tumor was originated from the submucosa and the surgical margin was negative for carcinoid.
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  • 手術前に内視鏡で確認できた小腸GISTの1例
    紅露 剛史, 渡辺 摩也, 宇津木 秀彦, 田原 久美子, 荒木 正雄, 片桐 次郎, 河野 誠, 榎本 あき矢, 佐藤 好信, 高野 靖悟 ...
    2003 年 62 巻 2 号 p. 102-103
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_102
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    A 68 years old woman was admitted to our hospital with chief complaint of tarry stool. She was administrated the anti coagulant for hypertension and atrial fibrillation. The gastrofiberscopy was done to examine with tarry stool on the day of hospitalization. We did not found bleeding point by the gastrofiberscopy and colonoscopy, except for a gastric ulcer scar. However we found the dark red stool when we inserted to the terminal ileum. She had tarry stool at the 4th hospitalized day once again. We performed the small intestine fiberscopy and inserted to the jejunum. The submucousal tumor that had the ulcer with the bleeding from the visible vessel was recognized. We injected 1/10,000 epinephrine for hemostasis. We judged that the possibility of bleeding is high, and then an emergent operation was carried out. The histological examination reviewed small intestine GIST. We experienced the case of small intestine GIST that was able to find out a lesion by the small intestine fiberscopy. As long as we had reviewed in the literature, only four cases had been reported.
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  • Double-balloon methodを用いた小腸内視鏡にて止血しえた悪性リンパ腫の1例
    橋本 明子, 山本 博徳, 矢野 智則, 橋本 紀子, 喜多 宏人, 川上 訓, 宮田 知彦, 砂田 圭二郎, 大西 展樹, 岩本 美智子, ...
    2003 年 62 巻 2 号 p. 104-105
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_104
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    A 69 year-old woman was admitted to our hospital because of a tarry stool and severe anemia. She was diagnosed with small bowel bleeding due to malignant lymphoma distributed from the distal portion of the duodenum to the ileum by using double-balloon enteroscopy. Then, she became hypovolemic shock due to large blood loss from the gastrointestinal tract. 99mTcO4-scintigraphy indicated bleeding from the small intestine. In order to control bleeding from the small intestine, double-balloon enteroscopy was carried out in emergency and the electrocoagulation therapy was performed after the identification of the bleeding lesion. While the technique of endoscopy usually provides visualization of the most proximal and distal end of the gut. The small bowel is among the most difficult part of the gastrointestinal tract to access. Both small bowel radiograophy and capsule endoscopy are useful for the diagnosis of the small intestine, but interventional capabilities are totally absent in these methods. Conventional push enteroscopy provides tremendous discomfort to the patient, and cannot access to the entire small bowel as well. The double-balloon method is a new technique capable of accessing entire small intestine with intervention capabilities. We have demonstrated a case in which double-balloon enteroscope was very helpful not only for the diagnosis of small bowel tumors but also for the control of bleeding from the tumor in the small intestine.
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  • 虫垂重積症の1例
    野中 英臣, 新村 光司, 根上 直樹, 佐藤 雅彦, 大久保 剛, 前川 勝治郎, 佐藤 英章
    2003 年 62 巻 2 号 p. 106-107
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_106
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    The case involved a 64-year-old woman referred to our department with a chief complaint of uncomfortable feeling in the right lower quadrant. Abdominal CT examination showed a mass-like lesion with a laminated appearance in the ileocecal area. Barium enema findings include a filling defect, size 2×1cm, and a sharply marginated mass within the cecum with no visible appendix. At colonoscopy, a steeply rising and subpedunculated mass with smooth surface was noted in the cecum. These examination findings diagnosed the patient with appendiceal intussusception and laparoscopic appendectomy involving removal of part of the cecal wall was subsequently carried out. In the excised specimen, the appendix protruded and inverted into the cecum.
    We experienced a case of appendiceal intussusception, a rare disease found in the ileocecal area, and here report it.
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  • 早期病変から進行癌へ進展した虫垂粘液囊胞腺癌の1例
    遠藤 和洋, 堀江 久永, 冨樫 一智, 岡田 真樹, 永井 秀雄, 堀口 潤
    2003 年 62 巻 2 号 p. 108-109
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_108
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    Mucinous cystadenocarcinoma of the appendix is rare. Some cases of early carcinoma were reported, but many of them were diagnosed incidentally. In this case, We report a unique picture of the vermiform appendix supposed to be early lesion. A 89-year-old man visited Tochigi Cancer Center complaining of lower abdominal pain. Colonoscopic examination showed the elevated lesion and circular fold around the opening of the vermiform appendix with discharge of mucin. At that time, pathologic examination of the biopsy specimen revealed adenoma. He refused to undergo a surgical resection. Three years later, he was admitted to Jichi Medical School Hospital with the diagnosis of cecal tumor. Colonoscopic examination showed the large tumor covered with mucin and blood in the cecum. He underwent ileocecal resection, and the pathological diagnosis was mucinous cystadenocarcinoma of the appendix. We supposed that such colonoscopic findings as the elevated lesion and circular fold around the opening of the vermiform appendix with discharge of mucin showed early stage of mucinous cystadenocarcinoma of the appendix.
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  • 拡大内視鏡にて観察し得た原発性虫垂癌の1例
    飯塚 賢一, 工藤 智洋, 真下 利幸, 湯浅 圭一朗, 山田 昇司, 猪瀬 崇徳, 家田 敬輔, 内田 信之, 笹本 肇, 塩島 正之
    2003 年 62 巻 2 号 p. 110-111
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_110
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    We presented the case of 73-year-old man with the chief complaint of the constipation and lower abdominal pain. Colonoscopic examination showed the slight elevated lesion at the bottom of the cecum without the appendical orifice. Magnifying endoscopic examination revealed type VN pit pattern surrounded by the lesion with type I pit pattern. Histological findings of specimen from the lesion with type VN pit pattern was mucinous adenocarcinoma. It is difficult to make a definite diagnosis of the carcinoma of the appendix, which is very rare. before surgery. It is useful to observe the cecum in detail.
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  • 保存的に軽快し得た医原性大腸穿通症の1例
    高瀬 真, 斉田 芳久, 炭山 嘉伸, 長尾 二郎, 中村 陽一, 中村 寧, 浦松 雅史, 片桐 美和, 長尾 さやか, 掛村 忠義
    2003 年 62 巻 2 号 p. 112-113
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_112
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    Recently. polypectomy using colonoscopy has been becoming general procedure. But colonoscopy has some complications of bleeding and perforation. We report a case of iatrogenic colon penetration recovering by conservative treatment. A 61-year-old male was admitted to our hospital for treatment of transverse colon tumor. Lower GI series, colonoscopy and Endoscopic ultrasoundsonography showed a giant large intestinal lipoma in Transverse colon. The spherical lesion was 50mm in diameter with a stalk. Polypectomy using colonoscopy was performed. Penetration was suspected by abdominal X-ray immediately after polypectomy. But abdominal pain was localized and the inflammatory change was not increased rapidly. Therefore penetration was treated conservatively. The extra colon gas was existed in the mesenterium and retroperitoneum, but fluid collection was not observed in the abdomen by computed tomography. The change of the extra colon gas observating by abdominal X-ray and computed tomography was decrease from 2nd days after polypectomy using colonoscopy. The inflammatory change was in the normal range after 4th postpolypectomy day, and the patient could begin drinking after 6th postpolypectomy day and eating the foods after 8th postpolypectmy day. After that, the course was uneventful, the patient was discharged from hospital on 12th postplypectomy day. The penetration was successfully treated conservatively. We considered that treatment of penetration in colon was not always surgical operation.
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  • 下痢原性大腸菌O-166陽性で発症した潰瘍性大腸炎の1例
    佐藤 徹也, 櫛田 知志, 藤野 幸夫, 林 剛一, 増尾 光樹, 望月 智行
    2003 年 62 巻 2 号 p. 114-115
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_114
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    A 42-year-old woman was consulted to our hospital due to abdominal pain, diarrhea, and hematochezia. Laboratory tests showed leukocytosis, elevated CRP level, and Escheria coli (serum type O-166) was detected. First we diagnosed infectious colitis, so prescribed antibiotics. But her symptoms still continued. Colonoscopy and barium enema study revealed the total colitis type of ulcerative colitis, and it was comfirmed pathologically. We continued medical therapy with total parenteral nutrition, salazosulfapyridine, and prednisolone. After these treatment the patient condition improved. Follow up study by colonoscopy showed that the erosion, and pseudopolyposis remained, but inflammatory findings were improved markedly.
    The special type of Escheria coli caused infectious enterocolitis including diarrhea and gastroenteritis.
    It is concluded that emergent colonoscopy and stool culture are important for the diagnosis and treatment of ulceraive colitis.
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  • 長径11mm大の扁平隆起型大腸MP癌の1例
    山根 天道, 堀田 総一, 鴨志田 敏郎, 平井 信二, 岡 裕爾, 日下部 将史, 上田 和光, 佐藤 宗勝, 奥村 稔, 下釜 達朗, ...
    2003 年 62 巻 2 号 p. 116-117
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_116
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    A 64-year-old man visited us to undergo further detailed examination for the sigmoid colon tumor which had been revealed by endoscopic examination in Otashiro Clinic. Colonoscopic examination revealed a 11mm-sized flat elevated lesion which was well demarcated and the type VI pit pattern was observed by magnifying endoscopic examination. This lesion was also observed positive non-lifting sign and the histopathological diagnosis of the biopsied specimen was well differentiated adenocarcinoma. Double contrast barium enema showed semilunar deformity in the lateral view of the lesion. Our diagnosis was sigmoid colon cancer invading deep submucosal layer or muscularis propria.
    Laparoscopic assisted sigmoidectomy was carried out. Macroscopic examination revealed a well demarcated flat elevated lesion which size was 11×8×2mm. Stereomicroscopic examination of the lesion revealed type VI pit pattern. Histopathological diagnosis was well differentiated adenocarcioma, mp3, ly1, v0, n0.
    According to the previous reports, a small advanced colorectal cancer of flat elevated type (IIa-like) is considered to be rare and that with type VI pit pattern is considered to be very rare.
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  • 大腸ポリペクトミー後，後腹膜気腫をきたした1例
    高橋 睦長, 森本 勝, 金城 喜哉
    2003 年 62 巻 2 号 p. 118-119
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_118
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    Endoscopic colorectal polypectomies were performed for multiple polyp of colon in the 59 years old male. However, pneumoretroperitoneum occurred after multiple clippings for hemostasis and defect closure after EMR of Isp type polyp near the SD junction. It is considered that muscle layer was injured by clipping procedure. Therefore, careful procedure should be requied in clipping. Fortunately, post EMR mucosal defect was finally closed and recovered by conservative therapies in this case.
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  • 直腸sm癌EMR後の右下肢腫脹で発見された広範なリンパ節再発の1例
    小野 千尋, 八重樫 寛治
    2003 年 62 巻 2 号 p. 120-121
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_120
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    A 51-year-old female referred to our hospital because of a swelling of the right lower extremity on April in 2002. She underwent endoscopic mucosal resection for lower rectal cancer measuring 14mm 4 years and 8 months ago. Though the resected specimen revealed well differentiated adenocarcinoma invading massively into the submucosal layer, no lymphvascular invasion was detected. Surgical resection was not performed and she was followed up for 3 years and 5 months. After admission, wide spreading lymph node metastasis was disclosed by abdominal and pelvic CT scan and MRI, which caused the extrinsic compression of the right common and an external iliacvein. Lymphadenectomy and postoperative combined chemoradiotherapy was performed. Patients with submucosal invasive carcinoma having adverse prognostic factors should be treated with colorectal resection and lymphnode dissection, but otherwise, meticulous follow up is necessary for long period.
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  • 上行結腸内分泌細胞癌の1例
    石戸 保典, 城田 繁, 内田 陽介, 岩瀬 博之, 卜部 元道, 黒田 博之, 安間 嗣郎, 鈴木 不二彦
    2003 年 62 巻 2 号 p. 122-123
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_122
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    A 68-year-old man was seen at the hospital because of right abdominal palpable mass. A barium enema study showed an apple-core-sign of the ascending colon, and an abdominal CT showed multiple liver metastases and mass of right lower abdomen. Due to appearing of ileus, right hemicolectomy was performed with a diagnosis of the ascending colon cancer with multiple liver metastases. Histlogically, the tumor consisted of polygonal-shaped cells and grew in a solid pattern without grand formation. Immnohistochemically, tumor cells were positive for Chromogranine A and NSE. Electron-microscopically, these cells contained abundant neuroendocrine granules in cytoplasm, and diagnosis of endocrine carcinoma was made. Histologically, in addition to operation, intestive treatment with chemotherapy and radiotherapy are necessary for patients with colorectal endocrine cell carcinoma.
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  • Cronkhite Canada症候群に大腸癌を合併した1例
    竹川 幸男, 佐藤 秀樹, 楡井 和重, 岩崎 良和, 中村 仁美, 青木 宏, 蓮沼 理, 栗原 竜一, 加藤 公敏, 川村 洋, 松井 ...
    2003 年 62 巻 2 号 p. 124-125
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_124
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    We report here in a rare case of Cronkhite Canada Syndorome associated with early stage of colon cancer. Historical and genetic background of polyposis was moleculary investigated in terms of mutations in APC, K-ras and p53 genes.
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  • エタノール散布療法が奏効した術後再発ステロイド抵抗性単純性潰瘍の1例
    岩瀬 恭子, 矢島 知治, 芹澤 宏, 常松 令, 渡辺 憲明, 熊谷 直樹, 土本 寛二, 日比 紀文, 石井 裕正
    2003 年 62 巻 2 号 p. 126-127
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_126
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    A 55-years-old male with simple ulcer resistant to sulfasalazopyrine and steroid therapy admitted to our hospital for lower abdominal pain. Ileocecal resection had been performed because of ileal perforation 9 years before. His symptom became a little better once after increase of prednisolone up to 40mg/day and total parenteral nutrition, however, oral diet induced worsening of abdominal pain again. Colonoscopy showed a deep and geographical ulcer at anastomotic site. Absolute ethanol spraying through endoscope at 20ml directly for the anastomotic ulcer was performed and pain was relieved a few days later. Colonoscopy after two weeks revealed that the size of the ulcer was remarkably reduced, and absolute ethanol spraying was repeated at 20ml. Lower abdominal pain has been relieved even after starting a meal. Absolute ethanol spraying through endoscope is easy to be performed and should be considered in the case of simple ulcer which is resistant to medical therapy.
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  • 大腸内視鏡検査（粘膜切除）にて直腸癌と鑑別に苦慮した孤立性直腸潰瘍症候群の1例
    永嶋 裕司, 沖浜 裕司, 松田 健, 平本 義浩, 前田 昭太郎, 江上 格, 田尻 孝
    2003 年 62 巻 2 号 p. 128-129
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_128
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    A Case Report of solitary ulcer syndrome of rectum to differentiate from rectal cancer by colonscopy is reported. The patient was 40 years-old, male. He visited our hospital with complaint of occult blood of stool in 1997. Colonscopy was performed. It shows solitary ulcer in rectum. Biopsy is no malignancy. 4 years after (2001) he visited again with same complaint. Colonscopy shows tumor (like type 2 rectal carcinoma) with ulcer in rectum. Biopsy is no malignancy, but we highly suspected rectal cancer. We performed rectal biopsy 2 times, and huge specimen by snear. These show no malignancy in this rectal tumor. Then, we diagnose this case as solitary ulcer syndrome of rectum.
    It is important to perform biopsys frequently, suspected solitary ulcer syndrome of rectum.
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  • 悪性リンパ腫に合併したサイトメガロ直腸炎の1例
    米田 啓三, 和田 建彦, 坂本 啓彰, 小方 二郎, 加藤 孝一郎, 青木 達哉, 小柳 泰久
    2003 年 62 巻 2 号 p. 130-131
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_130
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    A 87-year-old man was admitted with right chest pain and an abnormal chest density on the chest X-ray examination or chest CT examination. A malignant tumor was diagnosed by CT guided needle biopsy. Radiotherapy was given for the lung tumor. Twelve days after radiotherapy, colonoscopy was performed and an ulcer in the rectum was recognized, performed. Because hemorrhage did not continue, he was treated with IVH with no sustenance by mouth. After about 2 weeks, colonoscopic findings showed extensive erosion occupying the entire lumen in the lower rectum. Microscopic findings of biopsy specimens obtained from the ulcers showed cytomegalic inclusion bodies, and we obtained positive stains by a immunohistochemical technique using a monoclonal antibody to CMV. The bloody discharge disappeared following treatment with ganciclovir for two weeks, but he died of respiratory failure due to his original illness after one month.
    The lung tumor was diagnosed as a malignant lymphoma and the rectal ulcer had disappeared on autopsy. This was a case of CMV enterocolitis associated with malignant lymphoma. CMV colitis should be included in the differential diagnosis of colitis of unknown etiology in immunocompromised hosts.
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  • 経肛門的に自然排出された腹腔内異物の1例
    西中川 秀太, 福澤 誠克, 平出 綾子, 沖津 幹, 大場 信之, 水口 泰宏, 児島 辰也, 吉田 友彦, 竹田 泰, 川口 実
    2003 年 62 巻 2 号 p. 132-133
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_132
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    A 71-year-old female patient underwent an abdominal simple panhysterectomy with bilateral adnexectomy and received radiation therapy for carcinoma of the corpus uteri in January 2000. She began having repeated alternate episodes of diarrhea and constipation six months after the operation, and pain in the lower quadrants of the abdomen also developed. As the symptoms were persistent the patient was examined by colonoscopy in March 2002. The examination disclosed in the sigmoid colon the presence of a net-like foreign body partly embedded in the intestinal mucosa and unexcisable endoscopically. The foreign body was considered to be a Marlex mesh that had been applied to an area of peritoneal defect during a previous operation and probably perforated into the intestine. After two months, the foreign body was spontaneously excreted on bowel evacuation. While endoceliac foreign bodies, such as retained surgical gauze, sometimes form granulomas and are subjected to surgical extirpation, reports of spontaneous excretion of a foreign body perrectum have been as few as 3 cases in Japan, including the one documented herein. The underlying mechanism is assumed to be that the segment of intestine adhering to the periphery of the mesh became necrotized due to inflammation caused by radiation therapy, so that the mesh perforated into the colon and was gradually dragged into the intestinal lumen by peristalsis.
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  • 腹腔鏡で診断された可動性に富む肝腫瘤の1例
    藤野 幸夫, 望月 智行, 佐藤 徹也, 櫛田 知志, 清水 浩二
    2003 年 62 巻 2 号 p. 134-135
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_134
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    In recent years, diagnostic laparoscopy has widely been used in gastroenterological surgery, gynecology, urology and pediatric surgery. In this present study, we experienced a case of hepatic tumor which was difficult to make preoperative diagnosis due to iodine allergy and the history of surgery but finally diagnosed by laparoscopy. In this case, hand-assisted laparoscopic surgery (hereinafter abbreviated as HALS) was useful for resection.
    The case was a 30-year-old woman whose tumor was palpated in a left epigastric region in a standing position and a sitting position. In a right lateral position, the tumor exceeded a median line and moved to the right side. No definite diagnosis was made by gastroscopy, abdominal ultrasonography and abdominal CT scan, and the tumor was laparoscopically diagnosed as exophytic one originating from the lateral segment of the liver. The tumor was resected using the HALS by inducing it to the outside of abdominal cavity. The tumor was pathologically diagnosed as focal nodular hyperplasia.
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  • 膵管内乳頭腫瘍の1切除例
    宇津木 秀彦, 渡辺 摩也, 荒木 正雄, 紅露 剛史, 田原 久美子, 野口 聡子, 河野 悟, 片桐 次郎, 河野 誠, 高野 靖悟, ...
    2003 年 62 巻 2 号 p. 136-137
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_136
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    A 53-year-old female complaining with epigastralgia was raferred to our hospital. She was recognized hyperglycemia and a rise of pancreatic enzyme in peripheral blood examination. Abdominal US showed the solid and cystic tumor which was size of 41×37×32mm in pancreas head and the obvious dilatation of MPD which was 22mm of in diameter. Abdominal CT showed the pancreas head tumor with enhancement. EUS revealed the obvious dilatation of MPD and papillary tumor inside of MPD at pancreas head. ERCP showed wide opening of the MPD with mucous exudates and the dilatation of MPD. Cytological diagnosis of pancreatic juice was definite malignancy (ClassV) . The patient was underwent surgical operation. Pathological diagnosis for resected specimen was IPMT, borderline malignancy. We reported a case of an intraductal papillary mucinous tumor, with summary of IPMT literature in Japan.
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  • ERCP時胆管末端部での造影にて内視鏡上明らかになったcholedochoceleの1例
    神澤 輝実, 江川 直人, 中嶋 均, 雨宮 こずえ, 門馬 久美子
    2003 年 62 巻 2 号 p. 138-139
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_138
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    A 71-year-old female was admitted to our hospital because of advanced cholangiocellular carcinoma. She underwent endoscopic retrograde cholangiopancreatography for evaluation of the tumor. Endoscopically, the longitudinal fold of the major duodenal papilla was slightly swelling but readily compressible with a smooth appearance before cannulating. Cholangiography in the initial phase showed no abnormal findings in the terminal common bile duct. The mucosa proximal to the orifice bulged endoscopically into the duodenum, during contrast injection from the cannulating catheter situated in the terminal common bile duct near the orifice. Cholangiography demonstrated a round contrast-filled structure adjacent to the termination of the common bile duct.
    In conclusion, choledochocele could be diagnosed by duodenoscopic and cholangiographic findings during ERCP. Ballooning of the papilla during contrast injection is a clue to the presence of a choledochocele. It might be a sign which should alert the endoscopist to the presence of a choledochocele.
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  • 経乳頭的膵管ドレナージが奏効した巨大膵仮性囊胞の1例
    小野 仁志, 今村 綱男, 柳川 達郎, 小西 一男, 塙 勝博, 三代川 章雄, 野村 瑞樹, 鈴木 孝幸, 吉田 仁, 野津 史彦, 新 ...
    2003 年 62 巻 2 号 p. 140-141
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_140
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    A 65-year-old male had been previously diagnosed as having alcoholic chronic pancreatitis with pancreatic stones at 40 year-old. In April 2002, he was admitted to another hospital for relapse of chronic pancreatitis. He was initially treated conservatively, however he was consulted our hospital for complication with a 15-cm giant pancreatic pseudocyst. Abdominal computed tomography (CT) and ultrasonography showed formation of multiple pseudocysts, and severe dilatation of the main pancreatic duct. Endoscopic retrograde pancreatography visualized 1-cm-stenosis in length of the main pancreatic duct at the head and severe dilatation of the main pancreatic duct at the tail. We judged that the stenosis was caused by chronic pancreatitis, and performed endoscopic naso-pancreatic drainage. After treatment, abdominal CT scan showed reduction of size of pseudocysts, then we exchanged the drainage to a 10 Fr 7-cm pancreatic stent. On his discharge, pancreatic pseudocysts vanished and dilatation of the main pancreatic duct improved. Our experience suggests that endoscopic transpapillary pancreatic drainage is one of the effective treatments for pancreatic pseudocyst.
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  • 膵胆管完全分離開口を伴った総胆管結石症の1例
    井上 淳, 鹿志村 純也, 遠藤 克哉, 佐藤 勝久
    2003 年 62 巻 2 号 p. 142-145
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_142
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    A 53-year-old man admitted to our hospital with a complaint of epigastralgia. Ultrasonography showed some small stones in the gallbladder. Magnetic resonance cholangiopancreatography (MRCP) revealed two stones, about 5mm in diameter, in the common bile duct (CBD) . Endoscopic examination showed two separated papillae which had each orifice, and the oral papilla was located inside the diverticulum. Endoscopic retrograde cholangiopancreatography (ERCP) revealed two stones, 5mm in diameter, in CBD and couldn't prove the existence of choledocoduodenal fistura. From these findings, we diagnosed as CBD stones with the completely separation of CBD and the main pancreatic duct (MPD) . Endoscopic papillary balloon dilatation (EPBD) was performed and CBD stones were completely removed by a balloon catheter endoscopically. After that, laparoscopic cholecystectomy was performed for cholecystolithiasis.
    The completely separated orifices of CBD and MPD is rare, reported to be lower than 4% in Japan. EPBD is thought to be safe and useful for the treatment of CBD stones in the patient with the complete separation of CBD and MPD, especially the orifice of CBD was located inside the diverticulum.
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  • 原発性硬化性胆管炎の限局性胆管狭窄に内視鏡的バルーン拡張術を行った1例
    柳川 達郎, 今村 綱男, 吉田 仁, 小野 仁志, 塙 勝博, 三代川 章雄, 小西 一男, 野津 史彦, 柴田 実, 三田村 圭二
    2003 年 62 巻 2 号 p. 144-145
    発行日: 2003/05/31
    公開日: 2014/04/03
    DOIhttps://doi.org/10.11641/pde.62.2_144
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    A 59 year-old man was diagnosed as having primary sclerosing cholangitis (PSC) according to elevated serum ALP and IgG levels, biliary stricture and irregularity evaluated by endoscopic retrograde cholangiopaucreatography (ERCP) , inflammatory cell infiltration and fibrosis not only surrounding interlobular bile ducts but within periportal parenchyma on histologic features 10 months before admission to our hospital. Although he had been treated well with oral administration of 600mg/day ursodeoxycholic acid (UDCA) , he suffered from cholangitis on admission March 2002 due to dominant stricture of the common bile ducts (CBD) . Since bile ducts carcinoma and syndromic autoimmune pancreatitis were ruled out by biliary exofoliative cytology, ERCP and CT, we safely repeated endoscopic balloon dilation of dominant stricture in the CBD 3 times at 6 atm for 60 seconds and administered 900mg/day UDCA and bezafibrate for peripheral biliary stenosis. After the treatment, appearance of dominant stricture of the CBD diminished and serum ALP and IgG levels decreased. Endoscopic treatment and medication presumably render him free of cholangitis symptom for 10 months.
    Our successful experience indicated that endoscopic balloon dilation is an effective and noninvasive treatment for dominant strictures in the extrahepatic bile ducts with PSC.
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