Progress of Digestive Endoscopy
Online ISSN : 2187-4999
Print ISSN : 1348-9844
ISSN-L : 1348-9844
Volume 86 , Issue 1
Showing 1-50 articles out of 76 articles from the selected issue
Technology and instrument
  • Itaru Saito, Satoshi Ono, Yosuke Kataoka, Yoshiki Sakaguchi, Satoki Sh ...
    2015 Volume 86 Issue 1 Pages 40-43
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    OBJECTIVE : We evaluated the usefulness of attachments on the tips of endoscopes for improvement of the range of vision in colonoscopy using a constructed colon model with circular folds built in simulation of haustral folds.
    METHOD : We put (1) no attachment, (2) transparent hood (OLYMPUS) , (3) Endocuff (Arc Medical Design Ltd.) on the tip of an endoscope [PCF-Q260AI (OLYMPUS)] and measured the proximal limitation of the range of vision of the endoscope when evaluating the reverse side of the folds using the colon model. Evaluations were repeated ten times each in six directions.
    RESULTS : Both types of attachments capacitated a significantly wider range of vision in all directions compared to no attachments (p<0.05) . Although the transparent hood capacitates a wider total range of vision than the Endocuff because it is possible to observe through the transparent hood, the view through the transparent hood is distorted and unclear, and this increase in range of vision may not necessarily lead to an increase in detection rate.
    CONCLUSION : Although there are several problems such as the validity of accurate simulation of colonic haustral folds and the validity of clinical application, there is a possibility that this method may be useful for evaluation of the range of vision of colonoscopy.
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Clinical study
  • Yuka Endo, Takashi Fujiwara, Takeo Arakawa, Satomi Koizumi, Makiko Mor ...
    2015 Volume 86 Issue 1 Pages 44-48
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    Pyloric gland adenoma is a rare tumor in which fundus glands differentiate into mucus neck cells at has a predilection for upper and middle body of the stomach but also occures in the duodenum. We retrospectively studied the features of pyloric gland adenomas in the duodenum from August 2010 to June 2014. The study group was comprised of 8 patients (5 males and 3 females) with a mean age of 66 years. Mean diameter of the tumor was 12.5 mm. The locations of the tumor were the bulb (n=6) and the second portion (n=2) . The shape of the tumor were type 0-I (n=7) , and 0-IIa (n=1) . Surface structures were villous (n=6) , and convolute (n=2) . We examined 3 cases with magnifying narrow band imaging. White opaque substance (WOS) was observed in the two cases. Microsurface pattern and microvasicular pattern were observed in 2 cases, width and shape of marginal crypt epithelium (MCE) were heterogeneous, and microvasicular pattern showed caliber variation and angiectopia. Endoscopic treatment was performed in 3 cases [EMR (n=2) , and polypectomy (n=1)], and surgery was done in 2 cases [mucosal resection (n=1) , combined resection with advanced stomach cancer (n=1)], and there was no cases with cancerous foci.
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  • Shuhei Tazaki
    2015 Volume 86 Issue 1 Pages 49-52
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    Viscous mucus of Helicobacter pylori-positive chronic gastritis disturbs endoscopic observation. We evaluated the efficacy of cleaning in the stomach using an oral intestinal lavage solution used in colonoscopy in order to develop a new cleaning method that can be observed without trouble. This research is intended for 40 cases made endoscopic observation more difficult by mucus , bile and residue in the stomach. In addition to the preparation of the oral cleaning solution [proteolytic enzyme (pronase MS) 2 hundred thousand units, sodium bicarbonate 1 g, dimethylpolysiloxane (Gascon) 4 ml with water of 50 ml], we compared and evaluated the efficacy of cleaning on the gastric body greater curvature between the group using the conventional lavage solution (dimethylpolysiloxane with water) 200 ml and the group using the oral intestinal lavage solution (PEG) 200 ml. We scored criteria of mucous in the stomach in 5 steps.
    The result determined that the efficacy of before and after cleaning after 5 minutes was recognized significantly in the group using PEG higher than in the group using the conventional lavage solution.
    If the thickened mucus, bile and residue disturbs endoscopic observation, we considered oral intestinal lavage solution (PEG) method can be expected as a new cleaning method in the stomach.
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  • Yoshinori Sato, Hiroshi Yasuda, Shun-ichiro Ozawa, Yasumasa Matsuo, Fu ...
    2015 Volume 86 Issue 1 Pages 53-57
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    The new guidelines for endoscopic procedures in patients consuming antithrombotic agents have been adopted at our hospital since January 2013. We investigated the safety of endoscopic biopsy performed under continuing antithrombotic agents in upper gastrointestinal endoscopy. Of the 23,473 cases of normal oral upper gastrointestinal endoscopy performed between July 2011 and July 2014 at our hospital, 3,078 cases were taken antithrombotic agents. We investigated the rate of endoscopic biopsy and adverse events. A total of 1,163 cases were examined before the adoption and 1,915 cases were examined after the adoption of the new guidelines. The results before versus after the adoption were as follows : 16 cases (2.3%) vs. 244 cases (17%) ; (p<0.001) for the rate of endoscopic biopsy performed under continuing antithrombotic agents ; 0 case (0%) vs. 1 case (0.4%) for endoscopic hemostasis due to bleeding during examination ; 0 case (0%) vs. 0 case (0%) for post bleeding after biopsy. We were able to safely perform endoscopic biopsy with no increase in accidental bleeding.
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  • Akira Matsui, Kosuke Nomura, Yasutaka Kuribayashi, Akihiro Yamada, Tsu ...
    2015 Volume 86 Issue 1 Pages 58-62
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    Background and Aim : To reduce the risk of thromboembolism with cessation of antithrombotic agents before endoscopic procedures. Guidelines for the management of antithrombotic therapy in patients undergoing endoscopic procedure were published in July 2012. We assessed the delayed bleeding rate of endoscopic biopsy without cessation of antithrombotic agents within the guidelines.
    Methods : This was a single-center cohort study. A total of 3,696 patients (esophagogastroduodenoscopy, n=2,862, colonoscopy and double-balloon endoscopy, n=834) who underwent biopsy for endoscopic findings requiring pathology assessment between April 2013 and March 2014 were enrolled. We evaluated the rate of bleeding complications within a week after endoscopy in all patients.
    Results : Among the 3,696 participants, biopsies were performed for 3,348 (90.6%) , 234 (6.3%) and 82 (2.2%) patients with no antithrombotic agents, with cessation of antithrombotic agents appropriately and without cessation of antithrombotic agents, respectively. No patients who underwent endoscopic biopsy without cessation of antithrombotic agents complained of any bleeding symptoms in the 1-week observation period after biopsy. However, three patients with no antithrombotic agents complained of bleeding symptoms after biopsy.
    Conclusion : The guidelines for the management of antithrombotic therapy in patients undergoing endoscopic biopsy are acceptable.
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  • Toshiyuki Enomoto, Yoshihisa Saida, Kazuhiro Takabayashi, Sayaka Nagao ...
    2015 Volume 86 Issue 1 Pages 63-65
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    Purpose : We have performed intraoperative colonoscopy for colorectal resection with transanal stapled anastomosis to eliminate intra- and postoperative complications. In this study, we report the efficacy of this technique.
    Results : We performed intraoperative colonoscopy in 570 transanal stapled anastomoses from a total of 731 left-side colon or rectal cancer cases in our department between January 2006 and August 2014. A total of 13 (2.3%) patients showed abnormal findings (imperfect anastomosis ; 3, bleeding ; 1, leakage test positive ; 9) and anastomotic leakage occurred in 5 patients.
    Conclusions : Intraoperative colonoscopy is beneficial because the staple line and anastomotic bleeding can be directly observed, we could perform preventative procedures to avoid further abnormalities, postoperative complications or to maintain a good quality of life (QOL) of the patients postoperatively. Our evaluation of intraoperative colonoscopy as reported in this study shows that this technique can decrease postoperative anastomotic complications.
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  • Yuichi Fukami, Sho Watanabe, Keigo Yasuda, Miyuki Kaneshiro, Kenta Tak ...
    2015 Volume 86 Issue 1 Pages 66-69
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    The aim of this study is to identify an effective approach to MLBO, focusing on the choice of SEMS and TDT at the initial stage of the conditions. Patients and Methods : Retrospective reviews were performed on 21 patients who underwent either SEMS (n=10) or TDT (n=11) placement between January 2011 and December 2014. Among the collected data and records, technical success rates and effectiveness of the intervention, subsequent surgical procedures including colostomy, and any severe complications were evaluated. Results : SEMS were successfully inserted in all ten cases among which three went to surgery and seven stayed with palliative therapy. TDT was successsfully placed in ten out of eleven cases while effective decompression was achieved in nine cases. SEMS were may potentially be more effective than TDT in relief of obstruction (p=0.0956) .
    Placement of SEMS is likely to be an effective therapy for MLBO in short-term patency, decompressive effects, and palliative therapy.
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  • Kazuhiro Takabayashi, Yoshihisa Saida, Toshiyuki Enomoto, Sayaka Nagao ...
    2015 Volume 86 Issue 1 Pages 70-73
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    Recently, the incidence of rectal prolapse is increasing with the increase in elderly population. Perineal methods and abdominal methods have been performed for treatment. The formers are less invasive but have a higher rate of recurrence. On the other hand, the latter have a lower rate of recurrence but are more invasive. Recently, the less invasive laparoscopic rectopexy has been performed and its outcome has been reported by many institutions. Briefly, this procedure secures the rectum to the sacrum after mobilization. We performed nine cases of laparoscopic rectopexy for patients with rectal prolapse. The median operation time was 185 (105-478) minutes, the median blood loss was 2 (0-10) ml, and the mean postoperative hospital stay was nine days. There were no serious postoperative complications or recurrence. This procedure yielded adequate patient satisfaction. Laparoscopic rectopexy is relatively safe and can be a good choice of treatment for rectal prolapse.
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  • Kenichi Yoshikawa, Hirokazu Sato, Kazuki Horiuchi, Chihiro Yasue, Akik ...
    2015 Volume 86 Issue 1 Pages 74-78
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    We use MR enterocolonography (MREC) to assess the activity of Crohn's disease (CD) in order to reduce patient's invasiveness. MREC is one method for investigating mucosal condition, and has spread in Europe and the United States in recent years because MREC has the advantages in the point that 1) no radiation exposure, 2) identifying the exact location, and 3) objective comparison between different time point. There are many reports of its high accuracy, thus MREC will spread widely in Japan from now on. Deep mucosal lesions are well detected by MREC from the former reports. We investigated whether MREC could detect less deep lesions in CD patients and its mismatch who received ileocolonoscopy and MREC at the same period. The detection rate by each of MREC finding for endoscopical findings of erosion or redness was not high, but detection rate for erosion became high if we admitted positive when at least one of MREC finding was observed. However, the finding of relative contrast enhancement in MREC admitted comparatively high false positive rate especially in superficial lesions.
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  • Akihiro Yamada, Ken Takeuchi, Tsunetaka Arai, Ryota Iwasa, Rumiko Ishi ...
    2015 Volume 86 Issue 1 Pages 79-82
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    Endoscopic mucosal healing is a recent treatment goal for patients with Crohn's disease (CD) . Currently, cross-sectional imaging in the form of computed tomography/magnetic resonance (CT/MR) enterography (CTE/MRE) is an important tool for simultaneously assessing intestinal and extra-intestinal lesions of Crohn's disease. We assessed predictions related to relapse and the risk of surgery based on CTE findings in CD patients, comparing the simple endoscopic score for Crohn's disease (SES-CD) obtained by balloon enteroscopy (BE) with the novel CTE score. We found a strong relationship between SES-CD using BE and CTE scores. From SES-CD, it was possible to measure the proportion of remissions and surgery-free rates. From CTE scores, we also evaluated clinical outcomes in patients with CD of the proportion in remission. In patient groups assessed with active anal lesions, fistulas, bleeding, and abscesses according to CTE, a higher rate of surgery was evident compared to a group without these findings, similar to predictions based on BE. CTE is comparable to BE for predicting relapse and the risk of surgery in Crohn’s disease.
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  • Tetsuyoshi Iwasaki, Tomohiro Kato, Nobuhiko Komoike, Daisuke Ide, Jimi ...
    2015 Volume 86 Issue 1 Pages 83-86
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    In surveillance colonoscopy (SC) for patients with chronic ulcerative colitis (UC) , many endoscopic procedures have been performed, but reliable endoscopic detection methods still remain uncertain. Recently, photodynamic diagnosis (PDD) has been utilized clinically, especially in neurosurgical and urological procedures, to detect the extent of neoplasm. 5-Aminolevulinic acid (5-ALA) is converted intracellularly into the sensitizer protoporphyrin IX (PpIX) , which accumulates selectively in neoplastic tissue, allowing detection. As there are few reports regarding the use of 5-ALA for UC surveillance, its effectiveness and the 5-ALA-induced fluorescence pattern are still unclear. We previously reported the PpIX expression in dysplastic lesions, which was induced in a mouse model of colitis-associated cancer or dysplasia (CCD) . The aim of this study was to evaluate the fluorescence pattern after sensitization with 5-aminolevulinic acid (5-ALA) by using autofluorescence endoscopy (AFE) . Strong PpIX fluorescence signal was observed in both high- and low-grade dysplasia, especially at the margin of the low-grade dysplasia. AFE after 5-ALA sensitization offers the possibility of detecting CCD lesions by characteristic shape and color enhancement. Although the number of patients enrolled in this study was limited, our experience indicates that AFE is a promising method for detecting CCD lesions during UC surveillance.
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  • Toshiaki Narasaka, Yuji Mizokami, Daisuke Akutsu, Yusuke Seyama, Natsu ...
    2015 Volume 86 Issue 1 Pages 87-89
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    Colonic diverticular hemorrhage is the most common cause of lower intestinal bleeding. Endoscopic clipping and endoscopic band ligation (EBL) are both reported treatment methods. However, the re-bleeding rate after endoscopic clipping is considerably high; EBL is often required to re-insert the colonoscope to attach the ligation device on the scope tip. We developed a novel endoscopic hemostatic method, detachable snare ligation, to solve these issues, and studied its safety and efficacy. Six patients with bleeding colonic diverticulum were treated with detachable snare ligation from November 2013 to May 2014. Sustained hemostasis was achieved in five patients (83.3%) . No complications were noted in any patient. Hemostasis with detachable snare ligation is a safe and effective treatment method for hemorrhage from the colonic diverticulum.
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  • Masayuki Inui, Yoshikatsu Inui, Susumu Ohwada, Yuko Kondo, Naondo Soha ...
    2015 Volume 86 Issue 1 Pages 90-93
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    This study examined the diagnostic accuracy of magnifying endoscopy with narrow-band imaging (ME-NBI) in the diagnosis of colorectal polyps of approximately 10 mm for adaptation in day surgery and evaluated its usefulness in the clinical setting. Subjects included those who underwent endoscopic resection, amounting to 112 lesions, in our clinic from January 2013 to June 2014. Vascular pattern was classified as normal, faint, network, dense, irregular, sparse, and others. When analyzing the correlation between vascular pattern and pathological diagnosis, we found the sensitivity, specificity, and diagnostic accuracy of a faint pattern, as an indicator of hyperplastic polyps, to be 81.8%, 97.9%, and 92.0%, respectively. Similarly, these values for the network and dense patterns, as an indicator of neoplastic lesions, were 94.6%, 73.7%, and 91.1%, respectively. In conclusion, ME-NBI showed a high diagnostic accuracy for diagnosing colorectal polyps and can therefore be considered an effective modality to increase the accuracy of screening colonoscopy in a clinic.
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  • Yoshiaki Kawaguchi, Makiko Dekiden, Aya Kawanishi, Yohei Kawashima, At ...
    2015 Volume 86 Issue 1 Pages 94-98
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    The number of patients with pancreatobiliary disease is increasing along with the aging population, and we often encounter patients requiring emergency bile duct drainage, such as those with acute cholangitis. In some cases, bile duct intubation cannot be performed despite the performance of endoscopic retrograde cholangiopancreatography (ERCP) , eventually leading to post-ERCP pancreatitis. Not all patients can be transferred to a high-level healthcare institution ; therefore, educational institutions should establish a method for teaching pancreatobiliary endoscopy (related to ERCP and endoscopic ultrasonography) so that it can be performed safely by appropriate staff in, to some extent, any place. However, advisory doctors are present in only a few educational institutions. The pancreatobiliary endoscopy educational method followed at our institution includes : 1) enabling physicians to experience work as an ERCP assistant and operator as frequently as possible ; 2) facilitating the understanding of diagnosis and treatment of pancreatobiliary disease through inpatients ; 3) developing image diagnostic skills by describing ECRP findings ; 4) educating through mini lectures ; and 5) educating using a simulator.
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  • Ryunosuke Hakuta, Hiroyuki Isayama, Natsuyo Yamamoto, Hirofumi Kogure, ...
    2015 Volume 86 Issue 1 Pages 99-103
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    ERCP requires high technical skills and sometimes induces serious complication. Therefore it is important for trainees to undergo adequate training of procedure. However there is no written curriculum which is widely used in Japan. The aim of report was as to introduce current situation of education in our institution.
    Trainees must be learned preprocedural management, which include correct diagnosis, indication of treatment, complication, appropriate informed consent before performing ERCP. Trainees learn to perform ERCP step by step according to our own curriculum. An expert endoscopist stands by a trainee during ERCP, frequently picks up an endoscope from a trainee, and provides advices ("pick-up education") . Trainees can review the videotapes of procedure after ERCP. All the procedural reports are checked by attending expert endoscopists.
    One of the problems of high volume centers with many trainees, numbers of experienced cases per trainee may smaller. However, the qualified training can be achieved by our own curriculum and coaching of expert endoscopists.
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  • Hirotoshi Iwano, Shomei Ryozawa, Kumiko Taba, Yuki Tanisaka, Hiroko Sa ...
    2015 Volume 86 Issue 1 Pages 104-107
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    We studied the results of endoscopic biliary drainage (EBD) for malignant hilar biliary obstruction using unilateral drainage.
    We examined the first and last EBD, drainage period, and chemotherapy rate in 43 patients with malignant hilar biliary obstruction.
    The initial EBD in 18 patients in whom resection was possible before drainage was unilateral drainage in 17 patients (endoscopic nasobiliary drainage : ENBD : in 3, plastic stent : PS : in 14) and bilateral PS placements in 1 patient. Thirteen patients (72.2%) eventually underwent unilateral drainage ; the mean preoperative drainage period was 9.3 days. The initial EBD in 25 patients who had not undergone resection was unilateral drainage in 22 patients (PS in 17, metallic stent (MS) in 5) and bilateral drainage in 3 (PS in 2, MS in 1) . Seventeen patients (68%) eventually underwent unilateral drainage. Drainage could be performed in 18 of 24 patients (75%) scheduled to undergo chemotherapy ; the mean drainage period was 24.7 days.
    Unilateral drainage was effective in many patients.
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Case report
  • Eisaku Ito, Hironori Ohdaira, Nobuhiro Saito, Shunjin Ryu, Norihiko Su ...
    2015 Volume 86 Issue 1 Pages 108-112
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    Case 1 refers to a 53-year-old man who developed obstruction of the gastric tube due to recurrence in the mediastinal lymph nodes after surgery for advanced esophageal cancer. Percutaneous trans-esophageal gastro-tubing (PTEG) was placed and radiotherapy was performed, reducing the lymph metastasis. PTEG was subsequently able to be removed. Case 2 relates to a 76-year-old woman who developed stenosis at the cardia due to gallbladder cancer invasion. PTEG was placed with the objectives of allowing percutaneous transgastric jejunostomy and reducing pressure. However, since the patient frequently vomited viscous saliva and showed poor drainage of PTEG, a Clio Drain Vac (Sumitomo Bakelite Co., Ltd.) was connected to the PTEG. Tube obstruction was not observed and queasiness and vomiting also disappeared. We performed PTEG in patients with malignant stenosis of the cardia or lower esophageal stenosis, and achieved removal of tubing after radiotherapy in 1 case and symptom control with application of negative pressure to the tube in the other. Here, we report our experience with these cases, along with a review of the literature.
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  • Yu Kigasawa, Rieko Nakamura, Tai Omori, Tsunehiro Takahashi, Norihito ...
    2015 Volume 86 Issue 1 Pages 114-115
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    We experienced a patient with superficial hypopharyngeal cancer in whom a steroid injection effectively prevented postoperative adhesions and stenosis. The patient was a 59-year-old man who had undergone an esophagectomy for esophageal cancer and was diagnosed with superficial hypopharyngeal cancer 1 year later. He underwent endoscopic laryngo-pharyngeal surgery after a detailed examination. No postoperative adhesions or stenosis occurred after the steroid injection. Steroids inhibit postoperative adhesions and stenosis through their anti-inflammatory and fibrosis-inhibiting effects. A steroid injection is easier than other procedures, such as endoscopic balloon dilation or incision, and causes little pain or risk for patients. A steroid injection is effective and useful for preventing postoperative adhesions and stenosis in a patient with superficial hypopharyngeal cancer.
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  • Ryo Nakanishi, Masaru Kimata, Hiroki Ozawa, Hinako Maeda, Yuko Kumagay ...
    2015 Volume 86 Issue 1 Pages 116-117
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    The patient was a woman in her 50s who experienced abdominal pain after eating a sea bream. Her symptoms persisted, so she visited our hospital. Computed tomography showed a high-density linear shadow below the tracheal bifurcation and elevated concentration of fatty tissue surrounding this, leading to the diagnosis of an esophageal foreign body thought to be a fish bone. The patient underwent emergency hospitalization for endoscopic examination. A granulomatous polyp was observed in the esophagus, but there was no indication of a fish bone, so the patient was followed up. During a subsequent follow-up endoscopy approximately 1 month later, the fish bone became visible and was removed with a snare.
    We report a case that we encountered in which a fish bone penetrated and became impacted in the esophageal mucosa.
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  • Masato Endo, Naoyuki Hasegawa, Ryota Naito, Yuji Mizokami, Ichinosuke ...
    2015 Volume 86 Issue 1 Pages 118-119
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    Before mediastinal surgery, identification of thoracic duct by image diagnosis is important for reducing the risk of chylothorax. A 40s woman had an abnormal findings in the left upper lung field on a chest X-ray film. CT and MRI revealed a 25 mm sized oval cyst which located on the top of aortic arch and dorsal esophagus in the posterior mediastinum. Using EUS, thoracic duct was visualized as a 3 mm of tubular structure without Doppler flow between the cyst and esophagus. Thoracoscopic resection was performed. Because we could confirm that thoracic duct existed in contact with the cyst by EUS before surgery, we paid close attention to thoracic duct during surgery. The surgery was completed without complication of chylothorax. EUS is useful for understanding anatomical relation between thoracic duct and the posterior mediastinal cyst, and avoiding thoracic duct injury during surgery.
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  • Hitomi Fukushima, Yoshio Hoshihara
    2015 Volume 86 Issue 1 Pages 120-121
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    Eosinophilic esophagitis (EoE) is rarely reported in Japan. We experienced two cases of EoE in one year.
    Case 1 : A 55-year-old woman with an allergic rhinitis complained of heart burn. Endoscopy revealed that esophageal mucosa was so thick as to be unable to observe the vessels, and white exudates and longitudinal furrows were found in the esophagus. Its caliber was slightly narrow.
    Case 2 : A 40-year-old man complained of nausea with no history of allergic disease. About one-third of the circumference in the middle esophagus, mucosal thickening and longitudinal furrows were observed during endoscopy, where the vessels were obscured. In both cases, histological examination of biopsy specimens revealed marked eosinophil infiltration in the esophageal mucosa, more than 20 per high-power field (HPF) .
    These patients were diagnosed with EoE based on the diagnostic guideline, but their histories and endoscopic findings were considerably different. It will be necessary to elucidate what brought about the differences.
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  • Yoshihiro Sasaki, Maiko Harada, Yukihiro Kiya, Takeshi Kamijyo, Yusuke ...
    2015 Volume 86 Issue 1 Pages 122-123
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 62 year-old man visited our hospital because of chest discomfort and chest pain. He had no abnormality by cardiovascular examination. Thoracic CT study revealed edematous wall thickening of middle to lower part of the esophagus, suggesting eosinophilic esophagitis (EoE) . But esophagogastrodupdenoscopy (EGD) revealed no specific findings of EoE, except white spot in the middle to lower part of the esophagus, and biopsy samples were non-specific.
    His symptoms continued, and EGD was performed again one month later. EGD findings were the same, but the diagnosis of EoE was done by biopsy samples.
    After he was administered predonisolone, his condition was improved.
    EoE is said to caused by the chronic stimulation of the antigens such as meals.
    The prevalence of EoE is estimated as 1/5,000 by some report, but the real one is uncertain. It is possible that more people are not properly diagnosed as EoE. Biopsy should be done for patients complaining chest discomfort, even if there is no specific findings of EoE on EGD.
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  • Tomoyuki Yada, Daizo Saito, Koichi Ito, Koki Okubo, Tsuyoshi Ishida, N ...
    2015 Volume 86 Issue 1 Pages 124-125
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    We report the case of an 83-year-old man with localized fluorodeoxyglucose uptake in the gastroesophageal junction on positron emission tomography (PET) . Esophagogastroduodenoscopy revealed a 15 mm torose lesion in the right wall under the squamocolumnar junction and a 10 mm flat area of rough mucosa on the posterior wall of the lesion. Biopsy results indicated adenocarcinoma. Endoscopic submucosal dissection was performed ; the lesion was resected en bloc. The pathological results revealed Barrett’s esophageal adenocarcinoma (tub1>tub2) of Type 0-Is+0-IIb, 24×15 mm, pT1a (SMM) , ly0, v0, pHM0, and pVM0, which was curatively resected.
    Cases of Barrett’s esophageal adenocarcinoma being recommended for endoscopic treatment following diagnoses by PET are rare making this case highly significant.
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  • Masashi Takahashi, Tai Ohmori, Rieko Nakamura, Kenjiro Ishii, Yusuke U ...
    2015 Volume 86 Issue 1 Pages 126-127
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    The patient was a 60s-year-old man without any symptoms. Screening by esophagogram and endoscopy revealed an esophageal tumor. A biopsy specimen revealed squamous cell carcinoma. The diagnosis was cT1b, cN0, cM0, cStage I, and he underwent a curative esophagectomy with three field lymphadenectomy. A histological examination revealed squamous cell carcinoma with basaloid component,pT1b (sm3) , infb, ie (+) , ly1, v0, pN0. In case of basaloid cell carcinoma, a preoperative tissue diagnosis is very difficult.
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  • Kana Yamamoto, Maiko Kishino, Ayako Kobayashi, Hirotaka Yamamoto, Kazu ...
    2015 Volume 86 Issue 1 Pages 128-129
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 77-year-old man underwent endoscopic submucosal dissection (ESD) for early gastric cancer. One week after ESD, he was admitted to our hospital for tarry stool. Laboratory data on admission showed marked anemia. Urgent upper gastrointestinal endoscopy showed no bleeding, but anisakis tapeworm attached to the ESD-gastric ulcers. The nematode was immediately removed using the biopsy forceps of the endoscope. The patient recovered well and consumption of a bowl of rice topped with sashimi two days after endoscopy did not trigger abdominal pain. While gastric anisakiasis is relatively common in Japanese who eat raw seafood, anisakis infestation of gastric ulcer lesions, especially ESD-related ulcers, is rare.
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  • Yoichi Saegusa, Shizuka Mihara, Aya Kato, Natsuko Yoshizawa, Katsunori ...
    2015 Volume 86 Issue 1 Pages 130-131
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    The growth of the elderly population has led to an increased prevalence of dysphagia. Percutaneous endoscopic gastrostomy (PEG) performed by gastroendoscopists is indicated for severe dysphagia. The indications for PEG must be based on an appropriate evaluation of swallowing, now more important because of the revised medical payment system. Swallowing function is often evaluated by otolaryngologists, but many small and medium-sized hospitals have no otolaryngologists. In our hospital, gastroendoscopists use videoendoscopic evaluation of swallowing (VE) to evaluate swallowing function.
    VE was performed in patients with suspected dysphagia. VE images were evaluated using Hyodo’s scoring system to determine indications for PEG.
    Accurate swallowing evaluations enabled appropriate indications for PGE to be determined. The remuneration for PEG has decreased from 10,070 to 6,070 points. However, when PEG was performed after VE and esophagogastroduodenoscopy, the remuneration increased to 9,710 points, nearly equivalent to the previous value.
    Gastroendoscopists are proficient in endoscopic examinations and can easily master VE techniques. VE is useful for determining the indications for PEG and may be necessary from the viewpoint of healthcare economics. Gastroenterologists should evaluate swallowing function.
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  • Yasushi Nagaoka, Ryohei Watanabe, Yoichi Nakamura, Asako Takahashi, Sa ...
    2015 Volume 86 Issue 1 Pages 132-133
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    We have reported a case who underwent stomach fixation by percutaneous endoscopic gastrostomy for upside down stomach. An 86-year-old woman was admitted to our hospital because of vomiting and loss of appetite. On upper gastrointestinal imaging the stomach had herniated into the mediastinum with mesenteroaxial torsion. Esophageal hiatal hernia with upside down stomach was diagnosed, and repositioning by endoscopy was performed. After the treatment the patient could eat, and discharged. However after a few days she admitted again because of recurrence. Because of the condition relapsed, we performed percutaneous endoscopic gastrostomy. The postoperative course was uneventful, and the patient discharged on postoperative day 10. Percutaneous endoscopic gastrostomy for upside down stomach is technically simple, safe, minimally invasive and curative treatment.
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  • Takashi Kurosawa, Teitetsu Niido, Kenta Iida, Shinobu Yamaguchi, Runa ...
    2015 Volume 86 Issue 1 Pages 134-135
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 87-year-old woman with a medical history of chronic cardiac failure and Alzheimer’s dementia was admitted to our hospital with left femoral fracture. The 23rd hospitalization day, she presented with repeated vomiting. CT revealed prolapse of the stomach fundus-body into the thoracic cavity, and chest radiography showed gastrointestinal tract gas overlapping the cardiac shadow.
    On the basis of the above findings, gastric volvulus associated with esophageal hiatus hernia was suspected. On the 25th day, upper gastrointestinal endoscopic reduction was attempted. Organoaxial volvulus of the stomach was observed and reduction was performed. Following the treatment, a contrast radiography showed smooth flow of the contrast media into the duodenum. Thereafter, the vomiting resolved. On the 74th day, she died of aggravated cardiac failure.
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  • Toru Kuniyoshi, Yasumi Katayama, Yuko Ono, Masaya Tamano
    2015 Volume 86 Issue 1 Pages 136-137
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 49-year-old woman visited our hospital with chief complaints of nausea, vomiting, stomachache, and diarrhea that had been appearing every few months for 5 years. Computed tomography (CT) showed thickening of the gastric and small intestinal walls, as well as pleural effusion and ascites. The results of clinical tests showed increased levels of peripheral blood leukocytes and eosinophils, and increased eosinophil levels were also seen in ascitic fluid. Esophagogastroduodenoscopy did not show any clear abnormalities, but pathologically, eosinophil infiltration into the mucosa of the esophagus, stomach, and duodenum was observed. Based on these results, eosinophilic gastroenteritis was diagnosed. Treatment with predonisolone (PSL) at 30 mg/day was initiated and resulted in improvement of symptoms as well as decreases in peripheral blood eosinophils, improvement of thickening of the walls of the gastrointestinal tract on CT, and disappearance of pleural effusion and ascites. PSL was discontinued 4 months later because symptoms appeared to have resolved, but recurrence then occurred twice at approximately 1-year intervals, requiring PSL dose increases. At present, the patient is continuing to receive PSL at 2.5 mg/day, with no recurrence for a year. Eosinophilic gastroenteritis cannot be diagnosed based on endoscopic findings alone, and biopsy must be performed. Follow-up is also important, as recurrence can occur even after steroid-induced remission.
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  • Maiko Suzuki, Osamu Kobayashi, Kazuki Ohta, Yasuhiro Hayashi, Takuto K ...
    2015 Volume 86 Issue 1 Pages 138-139
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 69-year-old female who complained of melena was diagnosed HHT when she had undergone upper gastrointestinal endoscopy (GI) . As treatment, argon plasma coagulation (APC) was performed for all of gastric angioectasia.
    She admitted to our hospital due to recurrent of tarry stool and severe anemia. Upper GI revealed a number of bleeding red spots on lesser curvature of stomach body. APC was performed for only bleeding lesions but gastric bleeding recurrence was recognized within 54 days. Repeated treatment with APC not only hemorrhagic lesions but also all of the angioectasia led to no recurrence of bleeding.
    In conclusion, repeating endoscopic hemostasis for all dilated capillary vessels could be effective in preventing relapse of stomach hemorrhage for HHT over the mid-and-long term.
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  • Tadakuni Monma, Junichi Iwamoto, Naoki Konishi, Masashi Murakami, Syoi ...
    2015 Volume 86 Issue 1 Pages 140-141
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 79-year-old man was aware of the swelling of the groin was admitted to our hospital in April 2014. Systemic computed tomography showed a lung tumor and inguinal lymph node swelling. The lung tumor was diagnosed with adenocarcinoma. He was transported to our hospital in May because he fell from the stairs. The laboratory tests revealed anemia and a large open of BUN/Cre ratio. Therefore he was suspected gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed two submucosal tumors with central ulceration in gastoric corpus. They were diagnosed with metastatic gastric tumors. He was performed a blood transfusion and then discharged. But nine days after he died in hemorrhagic shock. We report a case of metastatic gastric tumor that became a clinical problem.
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  • Masaru Mizutani, Yosuke Iriguchi, Joji Oda, Tetsuro Yamazato, Akihiko ...
    2015 Volume 86 Issue 1 Pages 142-143
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 70-year-old woman, who was treated by distal gastrectomy 25 years ago, underwent an endoscopic examination. A slightly white-colored protruding tumor with an awkward shape was found in the posterior wall of the stomach near anastomosis site, and discolored and depressed lesions were located around the tumor. She was diagnosed as undifferentiated-type submucosal invasive gastric cancer of Type 0-I+IIc and underwent remnant gastrectomy. Pathologically, invasion of gastric signet-ring carcinoma cells in the submucosal layer was found over a large area of the depressed lesions. Muscularis mucosae projected out and partially raptured in a protruding part, and protruded mucosa was found in an area of the medullary growth of gastric signet-ring cell carcinoma. Carcinomatous cells slightly broke through the lamina propria in the deepest part. The etiology of protruded mucosa was thought to be a solid growth with maintenance of gastric signet-ring carcinoma cell binding.
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  • Hisashi Hosaka, Misa Iijima, Toshikazu Akiya
    2015 Volume 86 Issue 1 Pages 144-145
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 62-year-old woman with gastric cancer was referred to our hospital for treatment. An esophagogastroduodenoscopy (EGD) revealed a depressed, discolored region 10 mm in diameter at the greater curvature of the lower gastric body. Fundic gland polyps were seen mainly in the middle and upper gastric body, but no atrophy was noted in the background gastric mucosa. The rapid urease test was negative, serum anti-H. pylori antibody was negative (<3.0 U/ml) , and microscopic examination for H. pylori was also negative. These findings suggested carcinogenesis in the absence of H. pylori infection. She was diagnosed with early gastric cancer, type 0-IIc, and underwent laparoscopic-assisted distal gastrectomy. The histopathological diagnosis was signet-ring cell carcinoma, Type 0-IIc, 8×8 mm, pT1a (M) , ly0, v0, pN0 (0/25) , PM0, DM0. In conclusion, almost no atrophic changes occur in the gastric mucosa with fundic polyps, which are very rarely complicated by gastric cancer. However, the occurrence of H. pylori-negative gastric cancer should be kept in mind.
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  • Nana Yamashiro, Takuji Gotoda, Masakazu Abe, Maya Suguro, Mikinori Kog ...
    2015 Volume 86 Issue 1 Pages 146-147
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    This case was 70 year-old male. He was received eradication therapy of H. pylori to treat duodenal ulcer. Sixteen years after H. pylori eradication, a redness area was revealed at the lesser curvature of gastric antrum by esophagogastroduodenoscopy. The lesion was revealed moderate differentiated adenocarcinoma via biopsy specimens, and treated by endoscopic submucosal dissection. The histological findings showed that its border was flat and indistinct, and normal columnar epithelium appeared on the surface of cancers. This is a case to suggest characteristics of endoscopic and histological findings of early gastric cancer developed after H. pylori eradication.
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  • Yuumi Cho, Chikako Tokoro, Yoshihiro Kaneta, Katsuyuki Sanga, Kimihiro ...
    2015 Volume 86 Issue 1 Pages 148-149
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    The patient was a 75-year-old woman. An esophagogastroduodenoscopy (EGD) performed for examination of an anemia revealed an elevated and faded lesion (type 0-IIa) of 20-mm diameter located on the anterior wall of the upper gastric body. The EGD before the endoscopic submucosal dissection (ESD) performed 10 weeks later showed that the lesion had changed to a reddened and depressed lesion (type 0-IIc) . The ESD was performed another one week later, pathological examination of the removed lesion revealed that the mucosa was omitted mostly and almost no cancer cell existed in the depressed lesion and cancer cells existed in only the part of the surrounding protuberance part. Thereby we suggested that the protuberant part of the tumor was spontaneously fallen off.
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  • Takahiro Ajihara, Yukiko Takayama, Tomoko Kuriyama, Kenta Nagao, Shini ...
    2015 Volume 86 Issue 1 Pages 150-151
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A patient in his 50's was referred to our hospital for the treatment of infected WON. He had been diagnosed with severe acute pancreatitis 3 months before. EUS-guided drainage with placement of a straight PS and nasal cystic drainage tube was performed, but the straight PS migrated proximally into the WON during the procedure. A metallic stent was placed 10 days later, and it reduced the size of the cavity. The metallic stent was retrieved 2 weeks later, and three pigtail PSs were inserted. He was referred to our hospital again with abdominal pain 11 months later. CT revealed penetration of the straight PS, which had originally been inserted through the horizontal part of the duodenum, and the three PSs through the duodenal bulb. The migrated straight PS and 2 of the 3 pigtail PSs were retrieved.
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  • Masaki Hataji, Hisafumi Yamagata, Sae Nakayama, Atsuki Moroi, Isao Ari ...
    2015 Volume 86 Issue 1 Pages 152-153
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    An 85-year-old woman with a history of coronary stent placement for angina pectoris who was regularly taking aspirin and clopidogrel sulfate presented to our emergency department after noticing tarry stools in the morning. Pale bulbar conjunctiva and epigastric tenderness were suggestive of upper gastrointestinal hemorrhage and endoscopy was performed, revealing fresh bleeding from a diverticulum near the Vater papilla, in which an active bleeding point was identified. Hemostasis was achieved by clipping the bleeding point. After the procedure, she resumed eating and was discharged home with no signs of hemorrhage. This report describes a case of gastrointestinal hemorrhage from a duodenal diverticulum that was safely managed by endoscopic hemostatic clipping without postoperative complications such as perforation.
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  • Tomohiro Fukuda, Satoshi Imamura, Yuya Tsunoda, Tsuyoshi Ito, Toshihid ...
    2015 Volume 86 Issue 1 Pages 154-155
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    The patient was an approximately 50-year-old woman with cirrhosis of the liver non-alcoholic steatohepatitis. She underwent gallbladder surgery for calculous cholecystitis. Postcholecystectomy, her fever and inflammatory response continued. Abdominal computed tomography showed a duodenal fistula and right subphrenic abscess. Following antibiotic treatment and intravenous infusion after fasting, her symptoms gradually improved. On hospitalization day10, fluoroscopy showed duodenal fistula. We attempted endoscopic closure of the duodenal fistula using an Over-The-Scope Clip (OTSC) system, and closure was completed endoscopically and fluoroscopically. Subsequently, she steadily progressed without clinical symptoms and no exacerbation of laboratory findings.
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  • Tomoe Watanabe, Jun Koike, Hirohiko Nakae, Jin Imai, Shingo Tsuda, Jun ...
    2015 Volume 86 Issue 1 Pages 156-157
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 65-year-old man admitted for melena who was receiving anticoagulant and antiplatlet therapy for prosthetic heart val‑ves. A giant pedunculated polyp with erosion on its surface in the duodenal bulb was found by upper gastrointestinal examination and revealed hemorrhagic state. This polyp was resected by endoscopic technique. The resected specimen revealed 28×18 mm in size and pathologically diagnosed as a Brunner's gland hyperplasia.
    Brunner’s gland hyperplastic polyp was common benign tumor in the duodenum,but rarely it causes gastorointestinal bleeding. This case was reported in addition with the literature.
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  • Takashi Shinomiya, Hideki Ohgo, Minoru Yamaoka, Takeru Kusano, Keigo A ...
    2015 Volume 86 Issue 1 Pages 158-159
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 40-years-old male was pointed out a duodenal polyp by the screening esophagogastroduodenoscopy (EGD) . and he was introduced to another hospital. Because the pedunculated polyp had a stalk and was covered by the normal mucosa1.5 cm in diameter, he was introduced for endoscopic mucosal resection EMR) to ourhospital. EGD showed mushroom-like pedunculated polyps with small depressed lesions 20 mm in diameter in the duodenal anterior wall. Endoscopic ultrasonography showed an echogenic lesion with small anechoic lesions in the second and third layer. We performed EMR for this leison. Pathologic findings showed hyperplasia of the Brunner’s glands without atypical cells in the lamina propria mucosae and submucosal layer covered by the epithelium with intestinal metaplasia. He was diagnosed of Brunner’s glands hyperplasia. We herein reported the rare case of Brunner’s glands hyperplasia with mushroom-like form in the duodenum.
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  • Osamu Sugita, Takuto Suzuki, Rino Nankinzan, Hiroyuki Arai, Emiri Kita ...
    2015 Volume 86 Issue 1 Pages 160-161
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 55-year-old female was introduced to our hospital for a further evaluation of the duodenal lesion.
    Esophago-gastro-duodenal-endoscopy (EGD) demonstrated the pedunculated polyp about 30mm in diameter at superior duodenal angulus (SDA) . The lesion had several red depressed areas, and image-enhanced magnified endoscopy by Blue LASER Imaging (BLI) showed regular micro-surface and micro-vascular pattern indicating a benign lesion. Biopsies was taken from the depressed area, but the definitive diagnosis was not provided.
    Considering a malignant lesion, we resected the lesion by polypectomy. Histo-pathological findings showed Brunner’s gland hyperplasia, and microscopic examination demonstrated the surface of the depressed lesion was covered by regenerated epithelial cell with non-atypical glands hyperplasia.
    We speculated this unique lesion was developed by a mechanical stimulation.
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  • Koki Okubo, Tomoyuki Yada, Koichi Ito, Tsuyoshi Ishida, Naomi Uemura
    2015 Volume 86 Issue 1 Pages 162-163
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 62-year-old man was referred to our hospital for additional examination of a duodenal tumor. Esophagogastroduodenoscopy revealed a 30 mm-sized submucosal tumor located immediately below the major vater of the second part of the duodenum. Endoscopic ultrasonography showed the heterogeneous echoic tumor was located in the submucosa. An abdominal CT scan did not delineate any metastatic lesions. Endoscopic polypectomy using a loop snare was performed without any complications. Histologically, the tumor was diagnosed as a gangliocytic paraganglioma. Clinically, a submucosal tumor may be recognized as a gangliocytic paraganglioma if the tumor is located near the ampullary region and is visualized as an heterogeneous tumor by endoscopic ultrasonography. As a gangliocytic paraganglioma is generally considered to be a benign tumor, the tumor should be resected using a less invasive method, such as endoscopic resection.
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  • Akihiko Ikura, Yukishige Okamura, Tatsuto Mizuno, Yuta Yamamoto, Naofu ...
    2015 Volume 86 Issue 1 Pages 164-165
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    The patient was a 65-year-old man with a chief complaint of right-sided abdominal discomfort. He had been undergoing yearly upper gastrointestinal endoscopy after receiving endoscopic therapy for early-stage gastric cancer in 2006. An upper gastrointestinal endoscopy performed in 2012 detected white granular lesions that had accumulated near the papilla of Vater at the descending part of the duodenum. Based on the results of a biopsy, the patient was diagnosed with follicular lymphoma and was admitted for detailed examination. Systemic computed tomography performed after admission found no swelling of the lymph nodes or metastasis to other organs, and scintigraphy showed no abnormal accumulation of gallium. Therefore, the patient was classified as Stage I according to the Lugano International Conference classification. A total of six courses of single-agent chemotherapy with rituximab were administered and completed without serious adverse reactions. The duodenal lesions subsequently disappeared, and no tumor cells were identified within biopsy specimens obtained in the follow-up upper gastrointestinal endoscopy. It is necessary to check the presence of recurrence of follicular lymphoma by periodic upper gastrointestinal endoscopy.
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  • Satoshi Adachi, Toshio Arai, Toshikazu Yamaguchi
    2015 Volume 86 Issue 1 Pages 166-167
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 77-year-old woman underwent pancreaticoduodenectomy (PD) with modified Child reconstruction for pancreatic carcinoma. Seven months postoperatively, she developed high-grade fever and right upper abdominal pain. The clinical diagnosis was suppurative cholangitis. Abdominal contrast-enhanced computed tomography showed afferent loop obstruction due to residual tumor. An intestinal tube was inserted using a guidewire placed by single-balloon enteroscopy and her clinical condition improved quickly. On the 10th day after insertion, the tube was removed and a self-expanding metallic stent (Wall Flex duodenal stent) was placed across the stricture. The patient did well and had an improved quality of life until she died 45 days later.
    In conclusion, endoscopic stenting appears to be a useful procedure for malignant afferent loop obstruction after PD because it is less invasive.
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  • Yuki Yamazaki, Shun-ichiro Ozawa, Yoshinori Sato, Yasumasa Matsuo, Hir ...
    2015 Volume 86 Issue 1 Pages 168-169
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    Henoch-Schönlein purpura (HSP) is a disease that often results in gastrointestinal bleeding, but it is sometimes difficult to identify the bleeding source. Here we present a case of an ulcer of the terminal ileum, caused by HSP, that was successfully evaluated by capsule endoscopy (CE) . A 50-year-old man presented to our hospital with melena for one week after the start of diarrhea, and with developing purpura on his lower extremities. A skin biopsy from the purpura was consistent with HSP. An abdominal, contrast-enhanced computed tomography (CT) scan showed an extravasation into the ileal lumen, where it was inaccessible to standard endoscopy. The melena was resolved after the administration of prednisolone. CE revealed an ulcer in the ileum, which was consistent with CT evaluation. The location of the ulcer was further confirmed during balloon endoscopy. Capsule endoscopy can successfully locate an ulcer of the terminal ileum, caused by Henoch-Schönlein purpura, consistent with the results of CT and balloon endoscopy.
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  • Haruka Otake, Hiroyuki Miyatani, Masahiro Hiruta, Yukio Yoshida
    2015 Volume 86 Issue 1 Pages 170-171
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    Inflammatory fibroid polyp (IFP) is submucosal tumor-like benign tumor and often detected after abdominal pain due to intussusception. It is rare that IFP is diagnosed before surgery. We experienced a 70-year-old female patient who showed right lower abdominal pain and elevated serum C-reactive protein. CT scan revealed thickened and edematous wall of ileum and colonoscopy revealed pedunculated lesion with defected mucosa in the terminal ileum. Histopathological exam showed granulation tissue of the ileum that provided a diagnosis as IFP of the ileum. Laparoscopic assisted ilectomy was performed and no relapse has been seen. The lesion located at the ileocecal area and chronic physical stimulation resulted in mucosal defection that gave us a rare chance to preoperative histopathological diagnosis of IFP of the small intestine.
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  • Yukinobu Watanabe, Akitake Uno, Natsuko Tsutsumi, Yuki Nakamura, Mayum ...
    2015 Volume 86 Issue 1 Pages 172-173
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 64-year-old man was admitted to our hospital complaining of melena and anemia. Gastrointestinal endoscopy and colonoscopy were performed, but the source of hemorrhage was not detected. Abdominal computed tomography showed enhanced mass in pelvis, that seemed to develop from the small bowel. Capsule endoscopy and single balloon endoscopy were performed, and a submucosal tumor with erosion and redness was found. A partial resection of small intestine was performed. Histopathologically, the tumor cells were spindle-shaped. Immunopathological study of tumor was positive for c-kit and CD-34, so we finally diagnosed with small intestinal gastrointestinal stromal tumor (GIST) . The postoperative course was uneventful. It is considered that CE and BE may be useful to diagnose the small intestinal GIST.
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  • Miki Miura, Daisuke Saito, Sotaro Tokunaga, Mari Hayashida, Kengo Toku ...
    2015 Volume 86 Issue 1 Pages 174-175
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 50-year-old woman visited a clinic with fever for 2 weeks. A urinary tract infection was suspected. In spite of antibiotics administration, high fever was persisting. Therefore she visited our hospital. She had a temperature of 38 degrees, anemia, and hypoalbuminemia. In spite of various inspections, we could not find the cause of high fever. Because of the lower abdominal pain had persisted, CT was re-examined, and small-bowel wall thickening was detected.
    A stenosing ulceration of small- bowel detected by DBE was diagnosed as endocrine cell carcinoma. The chemotherapy with CPT-11+CDDP was performed after small-bowel resection.
    However small-bowel tumor is a rare focus of undetermined fever, it is necessary to be considered as a differential diagnosis.
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  • Akihiro Hatano, Teppei Nakanome, Kazuho Uehara, Takafumi Yano, Miyuki ...
    2015 Volume 86 Issue 1 Pages 176-177
    Published: June 18, 2015
    Released: June 23, 2015
    JOURNAL FREE ACCESS
    A 69-year-old man was referred to us in March 2014 because of a positive fecal occult-blood test. He had accidentally swallowed a press-through package (PTP) 4 days previously. Computed tomography showed multiple sigmoid colon diverticula, with the PTP nearby. Lower gastrointestinal endoscopy was attempted, but scope insertion was precluded by strictures caused by the diverticula. An upper endoscope (GIF-XQ240) was inserted. The PTP was found proximal to the stricture, but was difficult to remove endoscopically. The patient was transferred to the Department of Surgery to undergo laparoscopic sigmoidectomy. An accidentally swallowed PTP is often detected as an esophageal foreign body, with increasing frequency. A PTP rarely reaches the colon. PTP in the colon is often diagnosed after perforation. Invention of a better shape of PTP is desired, and medical staff should also pay attention.
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