Progress of Digestive Endoscopy
Online ISSN : 2187-4999
Print ISSN : 1348-9844
ISSN-L : 1348-9844
78 巻, 2 号
選択された号の論文の54件中1~50を表示しています
掲載論文カラー写真集
内視鏡の器械と技術
  • 吉本 和仁, 花村 祥太郎, 山村 詠一, 先山 あゆみ, 阿曽沼 邦央, 猪 聡志, 五味 邦代, 澤田 晋, 黒木 優一郎, 西元 史哉 ...
    2011 年 78 巻 2 号 p. 34-36
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
     今回,内視鏡の送水ボトルにアルカリイオン水を用いて内視鏡レンズの洗浄効果について検討した。平成22年8月から11月までに当院にて上部消化管内視鏡を検査した109名(アルカリイオン水群56名,蒸留水群53名)を対象とした。内視鏡の送水ボトルにアルカリイオン水と蒸留水を用いて上部消化管内視鏡を行い,内視鏡検査の前後に試薬と一体化した検査用綿棒でレンズを拭き取り,アデノシン三リン酸(ATP)を測定した。
     アルカリイオン水群と蒸留水群の患者背景,検査前ATP値に有意差は認めなかったが,検査後ATP値はアルカリイオン水群で有意に低値であった。アルカリイオン水による内視鏡レンズの洗浄の有効性が示唆された。
  • 山口 芳美, 渡邉 摩也, 加藤 雅士, 佐竹 儀治
    2011 年 78 巻 2 号 p. 37-39
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
     従来の大腸内視鏡に比べてより安全で苦痛なく挿入が可能なオリンパス社製のプロトタイプ大腸内視鏡PCF-Y0003-I(以下プロトPCF)を使用する機会を得たので報告する。プロトPCFは受動彎曲部と高伝達挿入機能を兼ね備え,すでに市販されているPCF-PQ260Iに,新たに深部挿入時の再ループ防止を意図して可変機能を搭載した試作機種である。プロトPCFを使用した53例と従来のPCF-Q260AIを使用した41例についてスコープの操作性,被検者の苦痛の有無などを比較検討した。SD移行部の挿入パターン,通過時間,盲腸までの到達時間について両スコープの間で有意差を認めなかった。硬度可変機能の使用頻度に関しても両者に有意差を認めなかった。挿入時の疼痛に関してはプロトPCFで疼痛を認めなかった症例が有意に多かった。SD移行部をより安全に通過できる受動彎曲機能を持ち,硬度可変機能によって腸管の過剰なループ形成を防止することが出来るプロトPCFの有用性が確かめられた。
  • 梅谷 薫, 立松 秀樹, 佐藤晋 一郎, 桑原 智子
    2011 年 78 巻 2 号 p. 40-44
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
     大腸腫瘍に対するESDの新たな手技として,我々は「3チャンネルスコープ法による大腸ESD(以下,3ch法)」を考案・施行している。今回は,その有用性と課題について,ESD従来法との比較検討を行った。本法はcounter―traction method(トラクション法)の一種であり,大腸2チャンネルスコープに,外づけ吊上げ鉗子を装着し,3つのチャンネルから「局注」「吊上げ」「剥離」の操作を施行する方法である。今回はESD従来法との比較を,(1)病変の切除長径,(2)切除所要時間,(3)剥離所要時間,(4)偶発症の有無から比較検討した。対象病変は当院と関連施設における大腸ESD 260例のうち,3ch法46例,従来法79例である。切除長径では両者に有意差はなかったが,平均切除所要時間は,従来法で51.7分,3ch法で31.0分。平均剥離所要時間は従来法で34.6分,3ch法で19.4分と,3ch法の方が有意に短時間で切除可能であった。切除時の穿孔例は,従来法の導入時などに5例(1.9%)認めたが,3ch法では認めなかった。輸血を必要とするような後出血は認めなかった。今後の方向性としては,SBナイフなど穿孔しにくいデバイスとの併用,操作性向上のための細径2チャンネルスコープの開発,病変との位置関係をリアルに把握するための3D画像の導入,将来のロボット手術化などが考えられる。以上のように,本法は大腸ESDを安全かつ迅速に行う方法として,きわめて有用な手技であると判断した。
  • 亀田 亮, 大川 伸一, 上野 誠, 小林 智, 柳田 直毅
    2011 年 78 巻 2 号 p. 45-49
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    【目的】2010年4月より内視鏡的十二指腸ステントが保険収載された。その使用経験を報告する。【対象と方法】対象は切除不能の悪性胃十二指腸狭窄に対し内視鏡的十二指腸ステントを留置した12例。現疾患:膵頭部癌7例/膵体部癌5例。UICC病期:Ⅱ期1例/Ⅲ期1例/Ⅳ期10例。摂食状況はGastric Outlet Obstruction Scoring System(GOOSS) によって評価した。【成績】処置成功率100%。平均手技時間27分。食事可能率91.7%。処置前のGOOSS:0点5例/1点5例/2点2例に対し処置後のGOOSS:0点1例/2点1例/3点10例で有意な改善を認めた。食事可能例の食事開始までの期間は1例を除き1日以内であった。ステント留置後の生存期間の中央値は83日,食事可能な期間の中央値は57日であった。【結論】内視鏡的十二指腸ステントは QOL改善に有効であった。
臨床研究
  • 田中 宏幸, 藤盛 友佳理, 尾形 英生, 志田 陽介, 廣瀬 元彦, 博多 裕子, 山岸 秀嗣, 市川 一仁, 冨田 茂樹, 井村 穣二, ...
    2011 年 78 巻 2 号 p. 50-52
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    【はじめに】大腸鋸歯状病変には,従来の過形成性ポリープ(HP),鋸歯状腺腫(SA) が存在する。2003年,Tolakovicらは,従来のHPの中に増殖能が高い広基性腫瘍類似病変 (SSA/P)について報告している。本稿では従来のHPから樋口らの組織学的所見を用いて狭義のHPとSSA/Pに分類し,免疫組織化学;Ki-67を用いて増殖能の差を明らかにする。【対象と方法】2008年7月から2009年3月までに当教室にて,従来のHPと診断された56症例を対象とした。樋口らの組織学的基準に準じてSSA/Pを診断し,免疫組織化学;Ki-67で増殖能を評価した。評価方法は,Ki-67陽性細胞陰窩内分布及び陽性細胞数(LI)で評価した。【結果】Ki-67陰窩内分布は,狭義のHPで38病変中32病変,SSA/Pで18病変中17病変が評価可能であった。陰窩内分布(レベル1/2/3)は,14/18/0,0/8/9であった。Ki-67 LI は,狭義のHPで38病変中23病変,SSA/Pで18病変中15病変が評価可能であった。LIは,28.0±14.5%,46.1±8.1%であった。いずれも両群に統計学的有意差を認めた(p<0.01)。【結論】樋口らの組織学的所見は,Riddellらの指摘する増殖帯の拡大を特徴とするSSA/Pを診断するに妥当であると考えられた。
  • 久野木 直人, 西山 竜, 中川 太一, 横田 崇, 赤井 祐一, 大谷 豪, 中島 典子, 田中 直英, 森山 光彦, 萩原 謙, 松田 ...
    2011 年 78 巻 2 号 p. 53-56
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
     胃粘膜下腫瘍にはGISTなど手術適応となる疾患が含まれているが,小さな病変に関しては悪性所見がなければ,組織診断が困難なため経過観察されていることも多い。ガイドラインでは病理組織診断法としてEUS-FNABが推奨されているが,現在我々は胃SMTの組織採取の手法として為我井らにより考案された粘膜切開直視下生検法を用いて生検診断を行っている。今回当院でサイズ5cm以下の胃SMTに対し粘膜切開直視下生検を行い,GISTと診断され,外科的に切除した3症例に対して,病理組織学的に生検組織標本と手術組織標本を比較し,診断能と組織学的悪性度を検討した。その結果手術組織標本と生検組織標本の病理組織診断は一致した。また組織学的悪性度をKi-67 indexを用いて比較し,一致した結果を得た。少数例での検討ではあったが,粘膜直視下生検法はGISTの診断に有用であり,悪性度も予測できる可能性があると考えられた。
  • 乾 正幸, 大和田 進, 近藤 裕子, 蘇原 直人, 乾 純和
    2011 年 78 巻 2 号 p. 57-60
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
     大腸内視鏡検査に送気は不可欠であるが,空気による送気では残留空気による腹満感が出現することがある。そこで,今回スクリーニングを含む大腸内視鏡検査における炭酸ガス送気の有用性と経済性を評価することを目的とし臨床研究を行った。対象は2009年9月10日から2009年12月1日までに乾内科クリニックで施行された大腸内視鏡検査(軽処置を含む)101症例にアンケート調査を行った。この間,全例に炭酸ガス送気を用いた。また,大腸内視鏡検査1件あたりの炭酸ガスのランニングコストを,6.6kg一本の炭酸ガスボンベのコストを総検査数で除して算出した。症例の内訳は,男性49名,女性52名,年代の最頻値は60代であった。検査中及び検査後の腹満感については,楽であったと答えた群が大幅に上回った。空気送気による大腸内視鏡検査歴のある被験者で前回の検査と今回の炭酸ガス送気の検査の腹満感の比較でも楽であったとの回答が大幅に上回った。また検査中及び検査後の腹満感について統計学的検討を行ったが腹部手術歴の有無や大腸内視鏡検査歴の有無によらず腹満感は軽減されたことが示された。今回の検討期間内における大腸内視鏡検査1件あたりの炭酸ガス使用量は0.16kgであった。炭酸ガスボンベ一本6.6kgの単価は9,000円であり,1件あたりのランニングコストは227円であった。
  • 野本 朋宏, 竹内 義明, 片桐 敦, 新井 勝人, 村元 喬, 久保田 祐太郎, 下間 祐, 矢野 雄一郎, 小林 祥也, 岩田 朋之, ...
    2011 年 78 巻 2 号 p. 61-66
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    【背景と目的】高齢化社会を迎えた現在,急性出血性直腸潰瘍(Acute hemorrhagic rectal ulcer,AHRU)の報告は増加している。当科にて経験したAHRUの臨床的特徴と内視鏡所見,ならびに内視鏡的止血術について検討した。【対象】2007年4月1日から2010年7月31日の期間,AHRUと診断された20例について後ろ向きに検討を行った。【結果】平均年齢は78.3歳(58~96歳),男女比は7:13で,高血圧や糖尿病,人工透析患者や癌の終末期患者など長期臥床の患者が多い傾向にあった。抗血栓療法は4例で施行されていた。内視鏡検査は血便出現後24時間以内に行われた。14例が多発,6例が単発潰瘍で,形態は13例が不整形潰瘍,5例はDieulafoy型潰瘍であった。20例中11例で露出血管が認められ内視鏡的止血術を行った。内視鏡的止血術の止血成功は9例(82%)であった。治療の内訳は,クリッピング単独が5例,APC焼灼単独が2例,HSE局注+APC焼灼が1例,EVLが1例であった。2例は内視鏡的止血が困難であり,1例は経肛門的に直接縫合が行われ止血が可能であった。もう1例はinterventional radiologyおよび外科的止血術を行ったが,術後他臓器不全に陥り死亡した。【結語】本検討におけるAHRUの臨床的特徴は既報とほぼ合致していたが,女性に多かった。露出血管を伴うAHRUの出血に対して,クリッピングやAPC,EVLによる内視鏡的止血術は有効であり,治療の第一選択になり得ると考えられた。
  • 小山 真一郎, 入口 陽介, 小田 丈二, 水谷 勝, 高柳 聡, 冨野 泰弘, 岸 大輔, 大村 秀俊, 板橋 浩一, 藤田 直哉, 中河 ...
    2011 年 78 巻 2 号 p. 67-69
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
     肛門部病変に対するNBI内視鏡観察の有用性について検討した。対象は,当センターで経験した異型上皮,尖圭コンジローマ,早期扁平上皮癌。肉眼型は,いずれも表面隆起型から平坦型で,わずかに白色調を呈していた。とくに異型上皮は,表面平滑で境界不明瞭なため,通常観察では存在診断が困難であったが,NBI拡大観察では,咽頭や食道の扁平上皮領域の病変に認められる不整な血管所見に類似した所見が明瞭となり,範囲診断においても有用であった。尖圭コンジローマは,光沢のある白色調の微細顆粒状隆起で,NBI拡大観察では,顆粒内に茶色の点状な血管を認め,乳頭状の発育を示していた。早期扁平上皮癌は,微細~小顆粒状で歯状線近傍に存在していたため,腺腫あるいは腺癌との鑑別が困難であった。NBI観察では,血管の口径不同や配列・走行の不整を認めたため,扁平上皮癌と診断した。以上から,これらの肛門病変では,存在診断および質的診断において,NBI拡大観察は有用であった。
症例
  • 寒河江 三太郎, 中村 哲也, 小林 直之, 齋藤 淳一, 永山 愛子, 村田 宏子, 川越 圭, 堀川 ひとみ, 武藤 英知, 斎藤 光浩 ...
    2011 年 78 巻 2 号 p. 70-73
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
     症例は71歳男性。胃体部から前庭部に1cm以下の隆起性病変を8個認めた。胃体中部後壁の10×8mm大の中心陥凹を伴う腫瘍は生検でカルチノイドと診断し,ESDを施行した。病理にて一部粘膜筋板に接する可能性が示唆されたが,細胞異型は軽度,細胞分裂像はわずかだった。他の小ポリープはカルチノイド成分を認めなかった。患者本人の希望もあり,厳重経過観察とし,約2年間再発・転移を認めていない。H. pylori除菌治療にて多発していた過形成ポリープ,炎症性ポリープは消失し,高ガストリン血症も改善した。本症例は特発性であるためにType Ⅲに分類されるが,H. pylori感染に伴う高ガストリン血症によって発生し,Type Ⅰカルチノイドに類似した生物学的悪性度をもつ可能性がある。H. pylori感染及び高ガストリン血症を認める胃カルチノイドに対しては,内視鏡治療のみならず,再発予防にH. pylori除菌を行う意義があると考えられた。
  • 喜多 絵美里, 原 太郎, 中村 奈海, 廣中 秀一, 中村 和貴, 須藤 研太郎, 傳田 忠道, 山口 武人, 伊丹 真紀子
    2011 年 78 巻 2 号 p. 74-77
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    【背景】近年,本邦で新しく導入された膵・胆道内視鏡,スパイグラス(Spyglass:Boston scientific社製)は細径ながら4方向のアングル機能を兼ね備えたDisposable経口膵・胆道内視鏡である。【目的】膵・胆道疾患におけるスパイグラスの病変観察能,生検診断能を検討した。【対象と方法】胆膵疾患精査目的の10例に対し,スパイグラスを用いた膵・胆道内視鏡を行った。内訳は膵管内乳頭粘液腫瘍(intraductal papillary mucinous neoplasm:IPMN)5例,胆管狭窄5例(胆管癌2,膵癌1,良性狭窄2)である。【結果】乳頭切開後症例を含め,全例で乳頭口からの挿入が可能であった。深部挿入に関し,膵管では2例が尾側まで挿入可能,胆管では4例(80.0%)が1次分枝,1例(20.0%)は肝門部まで挿入可能であった。病変観察は全例で行うことができ,また水平進展度診断は胆管癌では1/1例,IPMNでは3/5例(60.0%)で病変範囲の評価が可能であった。
     内視鏡直視下生検は試みた9例中8例(88.9%)で検体採取でき,採取された検体はすべて病理組織診断による診断が可能であった。最終的にスパイグラスにより,9/10例(90%)で診断確定が得られた。【結論】スパイグラスは膵,胆管への深部挿入が容易であり,良好な病変観察能に加え,良質な検体採取が可能であった。今後,IPMN,胆管狭窄の精密な診断に有用であると考えられた。
  • 竹中 由希夫, 掛村 忠義, 佐藤 浩一郎, 根本 夕夏子, 伊藤 紗代, 鴫山 文子, 加藤 充, 北川 智之, 重歳 正和, 平山 圭穂 ...
    2011 年 78 巻 2 号 p. 78-79
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    We observed a case in which we were able to extract press-through-package (PTP) safely using a silicone rubber-hooded skirt mounted to the tip of an endoscope.
    This is a case of a woman in her nineties who was admitted to the hospital because of accidental ingestion of PTP. During upper gastrointestinal endoscopy, PTP was identified directly below the entrance to the esophagus. As it had passed into the stomach by air supply, we advanced the endoscope into the stomach and grasped PTP using forceps. It was then recovered by removing the endoscope with PTP housed inside the skirt. The size of the recovered PTP was 19×18×5 mm. Adverse consequences such as ruptured membranes, perforation, and bleeding were not observed, and the patient was discharged on the same day. We believe that this device can effectively recover comparatively large and sharp foreign substances such as PTP.
  • 金 民日, 黒田 高明, 吉汲 宏毅, 宮坂 信雄, 仲又 進, 前川 久登, 坂田 宏樹, 豊田 宏之, 小山 広人, 野村 亮介, 東條 ...
    2011 年 78 巻 2 号 p. 80-81
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    An 88 years old woman had suffered from vomiting and appetite loss from June 17, 2010. She was admitted to the hospital diagnosed with pneumonia by chest X-ray and blood test on 18. Endoscopy was performed after admission, because of black fluid drainaged from the Gastric tube. Endoscopic evaluation revealed multiple shallow ulcers in Stomach and Stomach deformity due to Hiatal Hernia which prevented from endoscopy insertion into duodenum. A computed tomography scan showed a severely incarcerated hiatal hernia involving dilated stomach due to obstruction. Reset trial by endoscopy was failed and surgical approach was chosen. The surgical findings showed massive incarceration of the stomach through the hiatal hernia orifice to the mediastinum. It was not easy to reduce the stomach from it, because of adhesion. As the reported mortality of perforated gastric ulcer associated with a hiatal hernia is high, early elective surgery should be performed in patients with incarcerated hiatal hernia especially with gastric ulcers that is resistant to acid-reducing regimen.
  • 大久保 政雄, 山口 肇, 小林 克也, 関川 憲一郎, 光井 洋, 橋本 直明, 岸田 由起子, 田村 浩一
    2011 年 78 巻 2 号 p. 82-83
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 61-year-old man suffered from upper abdominal discomfort and appetite loss. He had underwent surgery of pharyngeal cancer the year before at the other hospital. Endoscopic examinations of upper gastrointestinal tract and colon revealed no abnormal findings. The patient also felt lower abdominal pain and had appendectomy next year. However, discomfort and pain on upper and lower abdomen unchanged and his fecal occult blood test was positive, he visited our hospital to survey metastasis of pharynx cancer by capsule endoscopy. The patient was nutritionally depleted, but immunologically unaffected. Capsule endoscopy showed multiple erosions and ulcers on small intestine. This time, upper abdominal endoscopy demonstrated geographical ulcers and erosions on esophageal mucosa. The biopsy specimens of the esophagus showed “ground glass” nuclei and positively immunostained with anti-herpes simplex virus antibody. According to nutritional improvement, the ulcers of esophagus disappeared endoscopically, together with a relief of upper abdominal discomfort. Simultaneously, the lower abdominal pain resolved and it was speculated that small intestinal lesions were also herpes simplex virus-associated. Because herpes simplex virus could affect all gastrointestinal tract, and the ulcers on capsule endoscopy resembled those on upper gastrointestinal endoscopy, aggressive endoscopic examinations are recommended, especially with longstanding symptom in the abdomen.
  • 福西 昌徳, 宮谷 博幸, 大竹 はるか, 吉川 修平, 新藤 雄司, 池谷 敬, 池田 正俊, 東海 浩一, 牛丸 信也, 松本 吏弘, ...
    2011 年 78 巻 2 号 p. 84-85
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 62-year-old woman who recognized dysphagia for more than ten years was referred from a local doctor to our hospital for consultation. Upper gastrointestinal endoscopy was performed and revealed an esophageal stenosis that the scope insertion was impossible. She was diagnosed as having Plummer-Vinson syndrome by glossitis, perleche, iron deficiency anemia and esophageal stenosis. At first, an esophageal passage of food was improved by endoscopic balloon dilation. Multiple gastric scars and ulcers were also detected by endoscopy. Because H. pylori was positive, eradication therapy was performed. H. pylori was successfully eradicated and all symptoms disappeared. Since then, the condition of the patient became good. In this case, it was speculated that Plummer-Vinson syndrome including iron deficiency anemia was closely related with H. pylori infection.
  • 先山 あゆみ, 澤田 晋, 花村 祥太郎, 阿曽沼 邦夫, 山村 詠一, 猪 聡史, 平田 邦代, 吉本 和仁, 黒木 優一郎, 丸岡 直隆 ...
    2011 年 78 巻 2 号 p. 86-87
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    63 years old man visited our hospital with a chief complaint of tarry stool. We recognized gastric bezoar and gastric ulcer by upper endoscopy. The gastric ulcer was cured by conservative treatment without endoscopic treatment. With a detailed dietary history, it has been revealed that he took in a pack of agar (40g) , and so the bezoar is believed to be “agar bezoar”. As the bezoar on this case was relatively soft, it was possible to crush and remove it by endoscopic measure. Since temperature to be dissolved (melting point) for agar is higher than body temperature once it got set, the bezoar may have been formed by that reason. As agar bezoar reports are few, we report our successful endoscopic treatment experienced in a precious case with review of the relevant literature.
  • 重歳 正和, 掛村 忠義, 佐藤 浩一郎, 富永 健司, 根本 夕夏子, 伊藤 紗代, 鴫山 文子, 北川 智之, 加藤 充, 竹中 由希夫 ...
    2011 年 78 巻 2 号 p. 88-89
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 60-year-old man underwent endogastroduodenoscopy because of a close examination of the prostate cancer. Endoscopic examination of the esophagus revealed a spherical elevation that was 3×5 mm in size, colored evenly,and rose up gently. The tumor did not show cushion sign. He was admitted to our hospital for further evaluation and treatment. Physical examination on admission was unremarkable. Laboratory tests on admission revealed normocytic normochromic anemia. Endoscopic ultrasonography (EUS) was performed. Ultrasonic imaging showed a hyperechoic mass in the third layer. The differential diagnoses included leiomyoma, GIST, and lipoma in EUS. The patient desired endoscopic treatment, and endoscopic mucosal resection was performed. Histopathologic examination showed composed of closely packed polygonal cells containing delicate acidophilic granules in the submucosal layer. S-100 was positive,and α-SMA was negative. The tumor was diagnosed as granular cell tumor.
    In our case,the esophageal lesion revealed hyperecoic tumor,although usual GCTs exhibit hypoechoic mass by EUS. We could not figure out the cause of the high echogenecity in spite of close analysis with histopathological evaluation. GCT of higecho is rare. We report a case with esophageal GCT as demonstrated as a hyperechoic mass by EUS, which is rare phenomenon, in addition to a discussion of the relevant literature.
  • 佐藤 慎, 川辺 晃一, 飯塚 勇, 新田 宙, 石川 文彦, 山下 純男, 諏訪 敏一, 山田 拓郎, 草野 元康
    2011 年 78 巻 2 号 p. 90-91
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 78-years-old woman was admitted to our hospital because of massive hematoemesis and clouding of consciousness.The emergency endoscopic examination revealed a huge coagulated mass in the stomach, but the orogin of bleeding was not detected. So over-tube was inserted and hood was attached on the tip of the endoscope for the purpose of removing the coagulated mass. Then a small red spot was detected on the greater curvature of the fornix and was found to be Dieulafoy-ulcer. Clipping and epinephrine injection was performed for hematostasis. Endoscopic Examinations 3 and 10 days later revealed no breeding and no vessel. We confirm that seemingly obscure origins of massive hemorrhage of the upper part of the gastrointestinal tract should increase the suspicion of Dieulafoy-ulcer, prompting careful examination of gastric fundic area and greater curvature.
  • 中村 友里, 新戸 禎哲, 八木 直子, 飯田 努, 西 正孝, 額賀 健治, 春山 邦夫, 原田 容治
    2011 年 78 巻 2 号 p. 92-93
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A patient was a 72-year old man complains of vomiting and anorexia. Upper gastrointestinal endoscopy revealed a type 3 gastric cancer in the gastric antrum with pyloric stenosis. Patient presented with vomiting, anorexia, leading to a markedly impaired quality of life. Recent reports have described stent placements are a desirable alternative to the palliative surgical procedures by bypass anastomosis in patient with gastric outlet obstruction (GOO). Stent placements can enhance patient′s quality of life, as it provides immediate clinical benefit. He had thoracic aortic aneurysm of refused operation, so we selected to treatment for GOO by endoscopic metalic stent placement. Endoscopic metalic stent placement promptly improves oral intake in a majority of inoperable patient with malignant gastric outlet obstruction. We report endoscopic metalic stent placement was successfully treated.
  • 高安 賢太郎, 西山 竜, 杉田 馨里奈, 久野木 直人, 中川 太一, 竜崎 仁美, 小林 駿, 大城 周, 赤井 祐一, 山本 敏樹, ...
    2011 年 78 巻 2 号 p. 94-95
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    The patient was a 69-year-old man who diagnosed as having diabetes mellitus. He was referred to our hospital complaining of bloody stool. The result of laboratory studies and blood gas analysis showed states of diabetic ketosis. Gastrointestinal endoscopy showed a Trench ulcer at the lesser curvature of the gastric upper body. Three days after the endoscopy, he was admitted with bloody stool again.
    As the emergency gastrointestinal endoscopy demonstrated that the breeding and parforated ulcer at the lesser curvature of the gastric body, an emergency surgical operation was performed.
    In some cases, the trench ulcer present with severe ulcer. Although gastrointestinal endoscopic diagnosis proved useful in this case, a careful manipulation of endoscopy in case of the risk for perforation was required.
  • 荒井 潤, 下間 祐, 野本 朋宏, 池上 覚俊, 野津 史彦, 井廻 道夫, 田嶋 勇介, 佐藤 篤, 山崎 公靖, 大塚 耕司, 加藤 ...
    2011 年 78 巻 2 号 p. 96-97
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 62-year old homeless man with poor nutrition was admitted to the Department of Dermatology of our University Hospital with leg edema and abdominal bloating. He had a past history of chronic diarrhea and leg tenderness for 9 months and once saw a doctor, but didn′t take regular medication or clinical check. After the leg edema got better, he was referred to the Division of Gastroenterology because of persisting abdominal bloating. CT scan showed a thickened part of the wall of transverse colon and ascites. The ascites was examined by aspiration and the cytology was class II. Finally with colonoscopy the thickened part was diagnosed as the fistula between stomach and transverse colon. The biopsy of this part revealed to be benign. In order to do the operation, he was moved to the Department of Surgery in January 2010 and soon the fistula was repaired.
    Reports of gastrocolic fistula due to benign ulcer are quite rare. We diagnosed the fistula by using the dye while doing a colonoscopy. This is the first report of the use of this technique. This disease often presents with the trias of diarrhea, loss of weight, and stool-smelling vomit, and in this case we found 2 of them. We conclude that when seeing a patient with continuing diarrhea and weight loss in spite of good appetite, this condition should be investigated.
  • 高木 誠, 小柳 和夫, 俵 英之, 田渕 悟, 永田 耕治, 西村 誠, 喜多 宏人, 小山 勇
    2011 年 78 巻 2 号 p. 98-99
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 42-years-old woman was referred to our hospital for the treatment of submucosal tumor of the stomach which detected by medical examination. Upper gastrointestinal endoscopy showed a submucosal tumor measuring about 2cm at the upper posterior wall of the stomach. The ulcer was accompanied with the center of tumor. Computed tomography (CT) examination was performed and early phase showed that central portion of the mass was enhanced. Positron emission tomography (PET) showed no abnormal accumulation. On endoscopic ultrasonography, submucosal tumor was found in the forth layer and its size was 15×18mm. The color doppler showed blood flow in the tumor. Endoscopic ultrasonography-fine-needle aspiration biopsy was taken. And the histopathological examination showed proliferation of the cells which had oval nuclei and pale eosinophilic cytoplasm. Immunocytochemical staining was positive in the SMA, negative in the c-kit, CD34, S-100. Preoperative diagnosis was the gastric glomus tumor. We performed laparoscopy assisted partial resection of the stomach. The histopathologic findings of the resected specimen were characteristic of glomus tumor. Gastric glomus tumors are basically benign tumor. But preoperative diagnosis of gastric glomus tumor is difficult. In our case, we could diagnose the glomus tumor preoperatively, and less invasive therapy, such as laparoscopic surgery, could be selected.
  • 新井 理記, 小野里 康博, 飯塚 春尚, 萩原 聡, 蘇原 直人, 石原 弘, 富沢 直樹, 小川 哲史, 伊藤 秀明, 柿崎 暁
    2011 年 78 巻 2 号 p. 100-101
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    The present case was a 68-year-old female. She had been diagnosed to have a hyperplastic polyp in the posterior wall of the gastric antrum by a routine check-up with transnasal esohagogastroduodenoscopy (EGD) and biopsy. At the 1-year follow-up with EGD, a small elevated lesion with a depressed area supposed to early gastric adenocarcinoma was revealed at same position where the hyperplastic polyp had been detected. The diagnosis based on biopsy specimens was group IV, adenocarcinoma suspected. It was difficult to diagnose the existence and range of the lesion by conventional endoscopy with white-light and/or chromoendoscopy with indigocarmine. However, the modified acetic acid-indigocarmine mixture (AIM) method clearly revealed a small IIc cancerous lesion at the top of the elevated lesion. Magnifying endoscopy with narrow-band imaging showed an irregular mucosal structure, and dilatated irregular vessels demonstrating an unequal caliber. Because early gastric cancer was suspected based on the endoscopic findings, an endoscopic mucosal dissection (ESD) was selected for both diagnostic and treatment purposes. The lesion was completely resected, and there were no complications due to the ESD procedures. A histopathological examination revealed well differentiated intra-mucosal adenocarcinoma without vascular invasion. This case showed us the importance of performing image enhanced endoscopy and magnifying endoscopy to accurately rule out the presence of carcinoma even after biopsy specimens have previously indicated the presence of hyperplastic polyps.
  • 山本 慶郎, 木村 隆輔, 土門 薫, 大塚 隆文, 竹内 基, 菊池 由宣, 中野 茂, 五十嵐 良典, 住野 泰清, 密田 亜希, 根本 ...
    2011 年 78 巻 2 号 p. 102-103
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A patient is 59 years old woman who complained of right lower eyelid swelling, and admitted to our hospital. The tumor is circular small atypical cell in histological findings, and we suspected a metastasis from lobular carcinoma because of ER (+), E cadherin (-), HER2 (1+) by immunohistochemical stains. Upper GI endoscopy was performed and it found the hypertrophy of fold like gastric cancer of type 4. We performed biopsy from the stomach and a mammary grand. Histological findings showed the tumor cell was stained of ER (+), E cadherin (-) and HER2 (1+). We diagnosed that the breast cancer was primary and it metastasized to stomach and orbit. It is very important to perform upper GI endoscopy in case of the breast cancer.
  • 榎本 俊行, 斉田 芳久, 高林 一浩, 大辻 絢子, 道躰 幸二朗, 高橋 亜紗子, 中村 陽一, 片桐 美和, 長尾 さやか, 斉藤 浩 ...
    2011 年 78 巻 2 号 p. 104-105
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    Recently, laparoscopy-assisted endoscopic full-thickness resection for submucosal tumor of stomach has been reported. The procedure is performed firstly endoscopic submucosal dissection to determine the exact resection line of stomach intraluminally, then laparoscopy is used to assist the full-thickness resection. In this study, we report a case of laparoscopy-assisted endoscopic full-thickness resection for submucosal tumor and gallbladder stone with oral extraction of the specimen.
  • 岡林 美紗子, 堀内 亮郎, 古本 洋平, 蕨 雅大, 谷沢 徹, 梅北 信孝, 宮本 勇治, 日比谷 秀爾, 大島 敬, 村山 巌一, 浅 ...
    2011 年 78 巻 2 号 p. 106-107
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 61-year-old man with liver cirrhosis admitted our hospital because of hematemesis. Gastroduodenal endoscopy revealed duodenal ulcer with exposed vessel covered with clot but showed no active bleeding. Since his general condition was poor because of severe liver cirrhosis and hepatic encephalopathy, we did not perform clipping. At the fourth day after admission his consciousness and general condition was improved, thus we reperformed gastroduodenal endoscopy and we found exposed vessel covered with fresh clot at the ulcer. Because it was considered to be a sign of impending bleeding, clipping was performed ; however, severe hemorrhage occurred. Despite of added clips and injection of HSE, bleeding continued. Then sudden cardiopulmonary arrest occurred. The CT for autopsy revealed the gas in the systemic blood vessels. The autopsy revealed duodenoportal fistula and air embolism in the whole body ; however, no intracardiac shunt was found.
    Air embolism during endoscopy is very rare and unpredictable, but once occurred, it is very critical. If the patient status deteriorate during endoscopy, we should be aware of this complication.
  • 高畑 彩子, 城野 文武, 秋本 恵子, 秋山 智之, 藤澤 信隆, 中村 篤志, 小山 茂, 若山 達郎, 窪田 賢輔, 中島 淳
    2011 年 78 巻 2 号 p. 108-109
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 58-year-old man with hepatitis-C-virus-related and alcoholic cirrhosis was admitted to our hospital with fever and abdominal distension. The laboratory data showed his liver functions had been gotten worse than before. Abdominal CT scan showed his duodenum was swelling and ascites was appeared. Upper gastrointestinal endoscopy revealed multiple erosions in the second portion of the duodenum. And also, similar erosions were in his transverse colon and rectum by colonoscopy. Serological tests was positive IgM antibody to cytomegalovirus (CMV) and CMV antigenemia was positive. Biopsy specimen from the duodenum and colon showed the presence of intranuclear inclusion bodies and CMV was demonstrated in biopsy specimen by immunocytochemistry using monoclonal antibody against CMV antigen. He was recovered with antiviral agents for 14days and upper gastrointestinal endoscopy performed 1 month after showed normal duodenal mucosa. CMV associated lesions in the duodenum are rare, especially in a patient with cirrhosis, but some literature said cirrhosis was considered at risk of CMV infection.
  • 細川 貴範, 中西 裕之, 田中 佳祐, 鈴木 雄一朗, 星岡 賢英, 玉城 信治, 加藤 知爾, 安井 豊, 葛谷 貞二, 土谷 薫, 板 ...
    2011 年 78 巻 2 号 p. 110-111
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    The standard treatment for duodenal carcinoid has been surgical resection. This report describes the possibility of endoscopic treatment as an alternative treatment for duodenal carcinoid. The patient was 78 year-old man with partial paralysis. Submucosal tumor in the bulb of duodenum was found during follow-up endoscopic examination after endoscopic mucosal resection of gastric hyperplastic polyp. Biopsy specimens revealed a carcinoid tumor. He had no symptom. Biochemical value and endocrine functions were normal. Computed Tomography did not detect any evident lymph node metastasis and endoscopic ultrasound showed a homogeneously low echoic mass located at the submucosal layer. We suggested surgical resection but he refused. Endoscopic mucosal resection was difficult because carcinoid was close to pylorus. So we performed endoscopic submucosal dissection in our hospital. Histological examination of the resected specimen revealed that horizontal margin were negative and there was no vascular infiltration. Although vertical margin were positive, there has not been the evidence of tumor recurrence after two years. Small carcinoid often has lymph node metastasis so surgical resections are ideal but some cases are inoperable. Our experience in this case shows the possibility of endoscopic submucosal dissection as an alternative treatment.
  • 黒岩 信子, 保阪 政樹, 森重 健二郎, 石川 寛高, 高田 康裕, 浅井 芳人, 木村 祐, 大塚 征爾, 奥山 啓二, 稲垣 恭孝, ...
    2011 年 78 巻 2 号 p. 112-113
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    The patient is a 60 years old woman, She had an epigastric discomfort in late March, 2010. She was admitted to our hospital in 2 April, 2010. The upper gastrointestinal endoscopy was performed in 16 April. It showed hemorrhgic polypoid lesions with a white granulated duodenal papilla. The specimen showed tubulovillous adenoma.Then abdominal CT scan, endoscopic retrograde cholangiopancreatography, intraductal ultrasonography were performed, which not showed the infiltration of the pancreas.Endoscopic snare papillectomy for tumors of the duodenal papilla was performed 20 May, 2010. There were no postoperative complications including pancreatitis, bleeding, perforation. The histopathologic diagnosis was tubulovillous adenoma.
    In recent years, technology in endoscopy has advanced, IDUS and EUS for ampullary lesions has become possible for more diagnostics.Endoscopic therapy appears to be a reasonable alternative to surgery for management of papillary tumors.
  • 松村 知憲, 山根 建樹, 竹田 明彦, 朝蔭 直樹, 諏訪 達志
    2011 年 78 巻 2 号 p. 114-115
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 61-year-old man admitted for melena who was receaving anti coagulant and anti platlet therapy for prosthetic heart valves. Endoscopic examination revealed a large pedunculated poly with erosion on its surface, which arose from the anterior wall of the duodenal bulb. Oozing bleeding was observerd on the erosive region of the polyp. Wafarin and low dose aspirin was interrupted with heparin administration, and proton pump inhibitor and fasting were prescribed. Melena disappeared. To prevent bleeding, we performed endoscopic polypectomy without complication. The resection specimen was 40mm in maximal length.
    Histopathologically, remarkable Brunner's glands hyperplasia was observed in submucosal layer. The polyp was diagnosed as Brunner's gland hyperplasia polyp. Brunner's gland hyperplasia polyp was common benign tumor in the duodenum, but large region or causing gastorointestinal bleeding was rare. We review cases reported in the literature.
  • 白井 告, 磯野 朱里, 三科 友二, 江波戸 直久, 阿部 浩一郎, 安食 元, 山本 貴嗣, 石井 太郎, 久山 泰
    2011 年 78 巻 2 号 p. 116-117
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    The development of new technique against the gastrointestinal tract has revealed that various hemorrhagic lesions exist in the small intestine. Single- or double balloon endoscopy (balloon assisted endoscopy) is essential for the treatment of the lesions as well as making a diagnosis. Here we report on a case of hemorrhagic vascular ectasia successfully treated by single-balloon endoscopy.
    A 85-year-old female with history of chronic heart failure was admitted to our hospital due to severe anemia. Although the upper and lower gastrointestinal endoscopy did not show any lesion causing bleeding, the sintigraphy implicated hemorrhage from the small intestine. Consequently, we performed single-balloon endoscopy which demonstrate hemorrhagic vascular ectasia. Hemostasis was immediately achieved using argon-plasma coagulation, and anemia had not been found after the treatment.
  • 繁田 貴博, 菅原 通子, 岡 政志, 近山 琢, 安藤 さつき, 水野 芳枝, 吉野 廉子, 中尾 雅美, 濱岡 和宏, 本谷 大介, 藤 ...
    2011 年 78 巻 2 号 p. 118-119
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 68-year-old female received upper and lower gastrointestinal endoscopies due to severe anemia, but both studies revealed no lesions that may provoke bleeding. Then, video capsule endoscopy (VCE) was performed followed by double balloon intestinal endoscopy (DBE), and hemorrhage was found in the jejunum by the former examination, while jejunum mucosa showing redness on the surface was seen by the latter examination. DBE was done again 1month later, since progression of anemia was not discontinued, and angiodysplasia with hemorrhage was detected in the jejunum. Although clipping devise was done for the angiodysplasia under DBE, severe anemia complicated with tarry stool was not attenuated. Then, Argon Plasma Coaglation (APC) therapy through DBE was performed for hemorrhage angiodysplasia twice for 1month. However, progression of anemia with tarry stool continued despite of APC therapy and clipping devises repeatedly performed through DBE. Both APC therapy and clipping devise may be effective transiently for the arrest of bleeding from angiodysplasia on intestinal mucosa, but the therapies other than those under DBE, such as medical therapies, should be done in cases showing recurrent hemorrhage.
  • 内田 苗利, 阿部 剛, 和泉 元喜, 美蘭田 純, 阿部 孝広, 山田 英司, 谷田 恵美子, 益井 芳文, 白濱 圭吾, 金崎 章, 阿 ...
    2011 年 78 巻 2 号 p. 120-121
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 65-year-old woman presented at our hospital with the symptom of bloody stool. Esophagogastroduodenoscopy and colonoscopy showed no bleeding lesion. Abdominal CT scan and MRI showed a mass in the pelvic cavity which close to the ileum. Capsule endoscopy revealed hemorrhagic enteritis of the ileum. We considered that the mass is the cause of enteritis of the ileum. The operation was performed to diagnose and treat. The mass was abscess, adhering to the ileum and the right ovary. We peeled adherence to the ileum and extract the abscess and the right ovary. After the operation, anemia and bloody stool were disappeared and capsule endoscopy showed no bleeding lesion in the ileum.
  • 林 康博, 小林 修, 太田 一樹, 宮本 彰俊, 千葉 宙門, 黒田 博之, 加藤 博久, 清水 喜徳, 村井 紀元, 仁科 晴弘, 林 ...
    2011 年 78 巻 2 号 p. 122-123
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    An 83 years old man was admitted with melena. As Oesophagogastroduodenoscopy and colonoscopy provided inconclusive in determining a source of bleeding, capsule endscopy endscopy (CE) was perfomed. The submucosal tumor with ulcer scar was identified in jejunum. Two weeks later double ballon endscopy (DBE) was carried out for tattooing before surgery. The SMT showed marked morphological change accompanied active open ulcer with spontenous bleeding.
  • 福田 将義, 鈴木 伸治, 東 正新, 長沼 誠, 長堀 正和, 土屋 輝一郎, 坂本 直哉, 渡辺 守, 岡田 英理子, 荒木 昭博, 大 ...
    2011 年 78 巻 2 号 p. 124-125
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    We often use capsule endoscopy for examination of OGIB. Vascular lesion, neoplastic lesion, ulcerative lesion are cause of OGIB. Capsule endoscopy is less invasive than double balloon endoscopy. But its′weak point is diagnostic performance about neoplastic lesions, especially submucosal tumor. GIST is the most common cause of submucosal tumor in small intestine. And GIST often occurs in proximal jejunum.
    We experienced a cese of jejunal GIST, which diagnose by double balloon endoscopy but missed by capsule endoscopy. In this paper, we show our facility and reporting policies of the literature on diagnostic strategies for patients with negative capsule endoscopy for OGIB.
  • 道躰 幸二朗, 斉田 芳久, 榎本 俊行, 高林 一浩, 大辻 絢子, 中村 陽一, 片桐 美和, 長尾 さやか, 渡邊 良平, 齋藤 智明 ...
    2011 年 78 巻 2 号 p. 126-127
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    We report acute appendicitis with abscess treated by laparoscopic interval appendectomy (lapIA) after a few months′conservative management. From January 2007 to April 2010, we performed a total of 71 1aparoscopic appendectomies in our department. Five cases of them were associated with abscess and treated by lapIA. No postoperative complication was observed. Therefore, 1apIA for appendicitis with abscess is considered to be a feasible therapeutic procedure.
  • 大石 千歳, 竹内 義明, 新井 勝人, 井廻 道夫
    2011 年 78 巻 2 号 p. 128-129
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 22-year-old man who had been suffering from ulcerative colitis (UC) was admitted to our hospital because of complains of fever and chest pain on swallowing in November in 2006. Because he was refractory to 5-aminosalycylates and corticosteroids, immunosuppressive therapy with 6-mericaptopurine (6-MP) was introduced 2 months prior to the presentation. At the time of presentation, he was malaise and had dysphagia. Laboratory tests showed mild anemia and inflammatory responses. Serological assays for viruses including herpes simplex, cytomegalo, varicella, and Epstein-Bar did not demonstrate primary infection. Esophagogastroduodenoscopy revealed multiple ulcers and vesicles with normal-appearing intervening mucosa. Histologic findings were infiltration of inflammatory cells in the epithelia and no specific information for diagnosis was noted. Although clinical evidence of viral infection was not confirmed, he was immunocompromised by 6-MP and endoscopy findings were similar to those of herpes esophagitis. Thus, we administered acyclovir for 7 days. Though oropharyngeal aphtha temporarily appeared, symptomatic and endoscopic resolutions were obtained thereafter. Because symptoms related to UC including bowel frequency, hematochezia and rectal urgency never changed throughout the above period, we concluded that the esophageal lesion was not a part of UC but superimposition of viral infection. Because esophageal involvement in UC is very rare and Crohn's disease affects upper gastrointestinal tract more preferably than UC, we have been following up him carefully.
  • 市川 欧子, 神野 彰, 菅野 真理子, 金野 朗, 櫻井 則男, 山田 俊夫
    2011 年 78 巻 2 号 p. 130-131
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    Divercular bleeding is one of the common origins in cases of hemorrhage from the lower bowel. Colonoscopy is performed to detect a bleeding source and to treat it with a clip. Sometime it is difficult to find out the source, because of natural hemostasis or poor preparation. Long time examination suffers both patients and doctors. Enhanced abdominal CT is useful to find out the point of bleeding. Technetium scintigraphy is also useful. These two typical cases demonstrate the validity of radiological diagnosis before colonoscopy, reducing patient's pain and doctor's burden.
  • 神山 博彦, 永易 希一, 丹羽 浩一郎, 小野 誠吾, 石山 隼, 杉本 起一, 柳沼 行宏, 高橋 玄, 小島 豊, 五藤 倫敏, 仙石 ...
    2011 年 78 巻 2 号 p. 132-133
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
     症例は52歳男性。便潜血反応陽性のため大腸内視鏡検査を施行したところ,虫垂開口部にポリープを認めた。悪性を疑わせる所見は認められなかったが,腫瘍の全貌を観察することができなかったため,内視鏡的切除は不可能と判断し,後日,外科手術を施行した。単孔式腹腔鏡下手術により盲腸の根部を含めて虫垂を切除した。病変は12×15mmの軽度から高度の異型を伴う管状線腫であった。大腸内視鏡検査で発見され,小さいが内視鏡的な切除が困難な病変に対し,単孔式腹腔鏡下手術を施行し,良好な成績が得られたので,本邦における虫垂線腫の文献的考察を加えて報告する。
  • 猪 聡志, 遠藤 豊, 花村 祥太郎, 阿曽沼 邦央, 先山 あゆみ, 山村 詠一, 平田 邦代, 吉本 和仁, 澤田 晋, 黒木 優一郎, ...
    2011 年 78 巻 2 号 p. 134-135
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 71-year-old woman with polymyalgia rheumatica developed diarrhea 6 months after starting lansoprazole (LPZ) and predonisolone. Colonoscopy was performed and showed numerous crowded blood vessels in the transverse and descending colon (Color 1) and a linear ulcer scar in the sigmoid colon (Color 2) . The pathologic examination of the biopsy specimen revealed thickening of the epithelial collagen layer, and intraepithelial infiltration with inflammatory cells. Ten days after she stopped LPZ, the diarrhea ceased. Therefore her disease was diagnosed as a LPZ-associated collagenous colitis.
    A 67-year-old man with reflux esophagitis developed diarrhea 7 months after starting lansoprazole (LPZ) . Colonoscopy was performed and showd numerous crowded blood vessels in the ascending and transverse colon. The pathologic examination of the biopsy specimen revealed thickening of the epithelial collagen layer, and intraepitherial infiltration with inflammatory cells. His disease was daiagnosed as a collagenous colitis.
    In addition, we analyzed the colonoscopic findings of our experienced 12 cases of collagenous colitis including the two cases in 2009 and 2010. The results were summarized in Table 1.
  • 加藤 充, 掛村 忠義, 富永 健司, 佐藤 浩一郎, 根本 夕夏子, 伊藤 紗代, 鴫山 文子, 北川 智之, 重歳 正和, 斎藤 倫寛, ...
    2011 年 78 巻 2 号 p. 136-137
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 60-year-old female underwent total colonoscopy in February 2010 for a positive fecal occult blood test. A long pedunculated polyp 20 mm in size was observed in the descending colon. It lacked apparent rising in the neck and the head was reddish and swollen like a club. Normal mucosa extended beyond the neck and magnified views after crystal violet staining revealed the mass Pit (so-calledIIIs pit pattern) in some parts of the top of the mass. Endoscopic ultrasonography demonstrated a low-echoic cystic mass with inner high-echoic spots from the head to the neck. Pedunculated mucosal polyp was suspected by endoscopy and was resected endoscopically from the base because pseudoinvasion of adenoma or cancer invasion to the mucosal lake was differentially diagnosed by magnified endoscopy and ultrasonography. Pathohistology revealed tubular adenoma that comprised epithelial cells with homogeneously dark-stained oval nucleus and developed branched tubular structure. At the top of the polyp, in particular, inverted growth of adenoma (so-called pseudoinvasion) was observed with marked mucus retention in some parts. At the neck, on the other hand, relatively large blood vessels accompanying wall thickening and hyalinization were present.
    We here report a case of adenoma with pseudoinvasion which was difficult to differentiate from a pedunculated mucosal polyp.
  • 春田 明子, 宇野 昭毅, 岩本 真帆, 石川 清一, 腰塚 康揚, 永井 晋太郎, 堀内 裕太, 上原 俊樹, 中村 仁美, 宮本 俊八, ...
    2011 年 78 巻 2 号 p. 138-139
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 19-year-old woman visited to common doctor complainting of low grade fever of the first half of between 37 to 38℃ and bloody stool. As continuing bloody stool ten times per day after taking antibiotics and medicine for intestinal disorders, she was referred to our hospital. Colonoscopy revealed ulcerative colitis on all colon type, and a subpedunclated polyp about 6mm of ascending colon, histopathological findings showed hyperplastic polyp. The symptoms has improved her by administering mesalazine 3000mg per day, attending our hospital regularly for a while. After one year, colonoscopy revealed a pedunclated polyp enlarged about 15mm of ascending colon, so EMR was done. The polyp was 15×14mm in diameter, subpedunclated type with superficial redness and erosion. Magnifyied endoscopy with crystal-violet staining showed I and II pit patterns with wide interstitial tissue, not showed neoplastic pit patterns on IV and Vpit patterns. Histopathological findings showed the polyp with superficial redness and erosions, was made for severe inflammatory cells infiltration and expanded cystic glands. So we diagnosisd juvenile polyp, and ulcerative colitis was in remission.
  • 高木 馨, 渡辺 一宏, 成田 明子, 倉田 勇, 藤原 直人, 安藤野 須子, 水野 卓, 小池 幸宏, 岡 輝明, 川瀬 建夫
    2011 年 78 巻 2 号 p. 140-141
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 45-year-old woman was admitted to our hospital due to bilateral hydronephrosis with vomiting and back pain. On admission, hematological study showed normal CEA (2.9ng/ml) but, PET-CT revealed FDG uptake in the sigmoid colon. Barium enema and colonoscopy demonstrated segmental irregular narrowing of sigmoid loop with diffuse mural thickening showing cobblestone appearance. We attempted to do chemotherapy with FOLFOX4 for down staging. Nevertheless, we could not continue for 2 courses because of her death. Gross finding of the sigmoid colon showed typical cobblestone appearance with mural narrowing caused by submucosal as well as severe subserosal fibrosis due to lymphangitic carcinomatosa. The endoscopic images such as cobblestone appearance completely correlated with autopsy findings such as scirrhous infiltration of cancer cells and massive fibrosis.
  • 岡田 典倫, 石橋 敬一郎, 大澤 智徳, 傍島 潤, 桑原 公亀, 石畝 亨, 天野 邦彦, 幡野 哲, 外間 尚子, 田島 雄介, 伊藤 ...
    2011 年 78 巻 2 号 p. 142-143
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    We report our initial experience of single-incision laparoscopy-assisted (SILS) colectomy in patients who underwent segmental colectomy for colon tumor as an additional procedure after colonoscopic treatment. The key points of our SILS colectomy are (1) placing a 3/4-circumferential peruimbilical skin incision with multiple radial splits if necessary, and (2) using a multiport channel system with a surgical glove. There were 3 men and 2 women, with a median age of 68 (range : 59-72) years. The median patients′body mass index was 21.9 (range : 19.1-22.8) kg/m2. The reasons for additional colectomy included non-lifting sign in two patients, endoscopically unresectable lesion in one patient, positive resective margin in one patient, and massive invasion to the submucosa in two patients with positive vertical margin in one patient. The location of tumor was transverse colon in three patients and sigmoid colon in two patients. Segmental colectomy with D2-lymph node dissection was successfully performed in all patients. The median operative time was 155 (range : 135-230) minutes and median blood loss was 60 (range : 20-90) mL. Pathological examination revealed adenoma with severe atypia in one patient, pTNM stageI adenocarcinoma in the remaining 4 patients. Wound infection occurred in one patient. At the median follow-up period of 13.3 (range : 6.1-15.2) months, there have been no recurrence or late wound complications. Therese results suggest that our SILS colectomy seems feasible, safe, and could be a minimally invasive alternative in selective patients with colon tumor.
  • 朝蔭 直樹, 諏訪 達志, 山根 建樹
    2011 年 78 巻 2 号 p. 144-145
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    Angiectasia is one of the diseases that should be considered in lower gastrointestinal haemorrhaging in elderly people. This article details our experience with a case of rectal angiectasia with myelodysplastic syndrome (hereafter referred to as MDS) as the underlying disease, where the identification of the source of haemorrhaging and diagnosis were difficult. The patient was an 81 year-old male diagnosed with MDS. The patient was diagnosed with sigmoid colon diverticulitis on the basis of left lower abdominal pain and the appearance of melena. As the melena continued even after signs of swelling improved, a colonoscopy was conducted. Oozing from the angiectasia was detected immediately above the dentate line and stopped with APC. Although it is believed that colonic angiectasia usually occurs on the right side of the abdomen, we concluded that it is important to thoroughly examine the recto-anal area as well.
  • 北川 智之, 佐藤 浩一郎, 掛村 忠義, 富永 健司, 根本 夕夏子, 伊藤 紗代, 鴫山 文子, 加藤 充, 重歳 正和, 竹中 由希夫 ...
    2011 年 78 巻 2 号 p. 146-147
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    A 77-year-old man was referred to our hospital for workup of multiple liver metastases. The endoscopic view showed the submucosal tumor (SMT) of 9mm in a diameter, which was located in the rectum. There was no depression of surface on the SMT. EUS imaging showed a hypoechoic mass in the third layer. Biopsy specimen revealed carcinoid. An abdominal ultrasonograpy and CT demonstrated multiple masses of the liver. As there was no metastasis in other organs with further examinations, we suspected the liver tumors were metastases from the carcionid. Rectal carcinoid tumor less than 10mm in diameter with liver metastasis is rare. When SMT has a depression of central part in the tumor, the rate of metastasis become higher compared to that without the sign. Eighteen cases of rectal carcinoid tumors less than 10 mm that caused liver metastasis have been reported in the Japanese literature.
    We should be aware that even the rectal carcinoid less than 10 mm in diameter without depression in central part has the possibility of the distant metastasis.
  • 金井 美絵, 徳永 徹二, 宮地 隆史, 岡田 千津子, 三谷 圭二, 青野 茂昭, 小針 伸一, 箱崎 幸也
    2011 年 78 巻 2 号 p. 148-149
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    It is difficult to evaluate the infiltration of early protruding colorectal cancer in the anal canal in many cases due to the regional specificity. In particular, rectal lesions may be overestimated employing standard-light observation with retroflex observation.
    Furthermore, it is very difficult to assess the degree of infiltration by using endosonography. In this study, we report a patient with early rectal cancer in whom the degree of infiltration was regarded as mucosa, although colonoscopy, including magnified narrow band imaging, digital rectal examination, and endosonography findings, as well as an extremely high serum CEA level, suggested massive infiltration in the submucosal layer.
  • 池田 廉, 安田 卓, 鎌田 一寿, 浅野 聡, 紫藤 和久, 藤野 幸夫, 増尾 光樹, 望月 智行
    2011 年 78 巻 2 号 p. 150-151
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    We experienced a case of ESD-resected retum-origin MALT-lymphoma. A 74-years old female visited our hospital for intestinal examination. The total colonoscopy revealed a rectal polyp with tubular adenoma diagnosis. 3-months later, the patient admitted to our hospital for polyp resection. The rectal polyp feature had changed, resembling carcinoid appearance. The polyp was resected by ESD method for definite diagnosis, and was diagnosed as MALT-lymphoma. We have planned PET-examination, and Helicobacter pylori eradication in future.
  • 西村 誠, 庄野 孝, 落合 康利, 外川 修, 中尾 将光, 石川 恵子, 新井 晋, 喜多 宏人
    2011 年 78 巻 2 号 p. 152-153
    発行日: 2011/06/10
    公開日: 2013/07/19
    ジャーナル フリー
    EUS-guided fine needle aspiration (EUS-FNA) has widely accepted as a reliable diagnostic procedure in many countries. In this article, we report a case of B-cell type malignant lymphoma with huge abdominal mass and diffuse venous thrombus, diagnosed by EUS-FNA. 48 year old male complained epigastralgia, and noted a huge abdominal mass and diffuse venous thrombus by CT scan. The patient was referred to our department for evaluation. EUS revealed heterogenisity-echoic abdominal mass, and EUS-FNA was performed with 22 gauge needle. Cytology results showed B-cell type malignant lymphoma, and Flow Cytometry showed the feature of CD10+, CD19+, CD20+, κ-ch+, λ-ch-. Gene analysis showed evidence of gene point mutation at 3 genes. Pathological results strongly suggested diffuse large B cell type lymphoma (DLBCL) . Therefore, the patient had underwent Cyclo-BEAP-R regimens, and the patient had compete response (CR) and the venous thrombosis was also good controlled with anticoagrant therapy.
    EUS-FNA allows abdominal or retroperitoneal evaluation pathologically without surgery. Since we started EUS-FNA in 2009, because of the high accuracy of the pathological results, the number of surgery for pathological evaluation is decreasing. Especially, EUS-FNA allows not only cytology but also Flow Cytometry, gene transmutation nor pathological results by immune stain, which is indispensable for correct diagnosis and further treatment for malignant lymphoma.
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