Progress of Digestive Endoscopy
Online ISSN : 2187-4999
Print ISSN : 1348-9844
ISSN-L : 1348-9844
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Volume 88, Issue 1
Displaying 1-50 of 67 articles from this issue
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Clinical study
  • A study on parietal cell protrusion in patients taking long−term oral proton pump inhibitor
    Hisafumi Yamagata, Masateru Hataji, Sae Nakayama, Atsuki Moroi, Isao A ...
    2016 Volume 88 Issue 1 Pages 42-45
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_42
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    [Background] Parietal cell protrusion (PCP) developing in patients taking long-term oral proton pump inhibitor (PPI) is a phenomenon that parietal cells protrude towards the lumen because compensatory bulging of parietal cells occurs longitudinally due to hypergastrinemia. Here we verified whether PCP develops due to long-term oral PPI administration.
    [Methods] A biopsy was performed to obtain the mucosa of the gastric corpus from 1399 patients who underwent gastrointestinal endoscopy between January, 2015 and July, 2015. 29 patients who took oral PPI more than 6 months were examined whether PCP developed. Parietal cells which protruded over the line connecting the apical surface of adjacent chief cells were considered PCP positive.
    [Results] 14 out of 29 patients (48.3%) were PCP positive.
    [Discussion] PCP positive findings in patients taking long-term oral PPI indirectly show gastric acid suppression, which means that the PCP-positive rate may be related to genetic polymorphisms of CYP2C19, an enzyme in PPI metabolism. PCP-positive may also indicate a high risk of intestinal infections caused by clostridium difficile toxin, a gastric acid suppression-related risk.
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  • Evaluation of the risk of post-procedure bleeding after endoscopic submucosal dissection with antithrombotic therapies
    Ryoji Hayashi, Kouki Ohkubo, Tatsuto Mizuno, Hiroshi Mino, Hitomi Ikeg ...
    2016 Volume 88 Issue 1 Pages 46-49
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_46
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    We report the current state of anticoagulation and antiplatelet therapy for post-procedure bleeding in 111 cases (esophagus, 4 cases ; stomach, 60 cases ; and colon, 47 cases) where endoscopic submucosal dissection (ESD) was performed in our hospital from April 2013 to March 2015. Post-procedure bleeding was defined as clinically evident bleeding that required emergency endoscopy and/or bleeding corresponding to the Forrest Ia or Ib classification. Post-procedure bleeding occurred in 8 cases (7.2% ; stomach, 6 and colon, 2 cases) , with 4 cases (stomach, 3 and colon, 1) taking antithrombotic drug，therefore, 16.7% of the cases on antithrombotic therapy experienced post-procedure bleeding. Post-procedure bleeding occurred in only 4 cases (4.6%, 4/87) without antithrombotic therapy. In the cases involving antithrombotic therapy, the post-procedure bleeding occurred on day 9 or later, but in the cases without antithrombotic therapy it occurred within 2 days from ESD. It is necessary to accumulate more data on the management of antithrombotic drugs. In this study, patients on antithrombotic therapy had a higher risk and slower onset of post-procedure bleeding, as reported in other studies. In our hospital, we empirically perform second look endoscopy on the day after ESD, but we should consider the timing of second look endoscopy in cases on antithrombotic therapy.
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  • Analysis of the estimated distance between the duodenum and small bowel tumors with capsule endoscopy
    Mitsunori Maeda, Hideyuki Hiraishi
    2016 Volume 88 Issue 1 Pages 50-54
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_50
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    AIM : The aim of this study was to compare the estimated distance using capsule endoscopy (CE) with measurements taken with double balloon endoscopy (DBE) .
    Patients and Methods : This study targeted 15 patients with small bowel tumor who underwent CE and DBE. The estimated distance defined as PD and TD. PD is defined as the value of calculating as “P×small bowel length (SBL) ”. P is %Viewing progress (%Capsule Progress) (%) that may indicate where CE moved from the duodenum by using RAPID software in the v6.5 (v8) . TD is defined as the value of calculating as “T×SBL”. T is the %Time (%SB time) (%) that may indicate when CE moved from the duodenum by using this software. These TD and PD values were compared with measurements taken with DBE (DBE) . SLB was determined as 9m by the coefficient of determination between TD, PD and DBE.
    Results : Mean values for TD, PD, and DBE were 298.1±266.9, 345.0±309.4 and 378.1±346.8 cm respectively, indicating no significant difference between the three groups (P=0.777) . The correlation coefficient between TD and DBE was 0.912, and the coefficient between PD and DBE was 0.965 (P<0.01) .
    Conclusions : The estimated distance exhibited strong correlative relationships with the measurements and may be useful for performing DBE.
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  • Usefulness of peroral direct cholangioscopy for confirmation and removal of residual bile duct stones
    Yousuke Michikawa, Kazunari Nakahara, Ryo Morita, Keigo Suetani, Fumio ...
    2016 Volume 88 Issue 1 Pages 55-59
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_55
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    AIM : We evaluated the treatment outcome of peroral direct cholangioscopy (PDCS) for confirmation and removal of residual bile duct stones after a negative endoscopic retrograde balloon-occluded cholangiography. METHOD : PDCS was attempted for 14 patients in order to confirm the presence of residual stones. 10 patients had normal stomachs, one had Billoth-II (B-II) reconstruction, two had Roux-en-Y (R-Y) reconstruction, and one had pancreatoduodenectomy (PD) . RESULTS : The endoscope could be advanced to the bile duct in 10 patients (71%) , with the patients of normal stomach being the lowest at 60%. In patients with altered gastrointestinal anatomy, insertion of a scope was possible in all patients. The residual stones were observed in 5 patients. The residual stones were successfully extracted directly under PDCS in 4 of these patients (80%) . Early complications occurred in 14% (pancreatitis1, cholangitis1) ; both have improved by conservative treatment. CONCLUSION : PDCS is a useful endoscopic procedure for the evaluation and extraction of residual bile ducts stones, especially in the patients with altered gastrointestinal anatomy.
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  • Evaluation of endoscopic treatment of post−operative bile leaks
    Yuichi Takano, Masatsugu Nagahama, Naotaka Maruoka, Eiichi Yamamura, ...
    2016 Volume 88 Issue 1 Pages 60-64
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_60
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    We retrospectively evaluated seven cases of post-operative bile leaks which were managed by endoscopic treatment. The average age of patients was 67.4 (range, 54-78) years, and the male/female ratio was 6 : 1. Endoscopic nasobiliary drainage (ENBD) was performed for all cases. Success of endoscopic treatment was observed in six of seven cases (86%) , and an average period of ENBD implantation was 12 (range, 6-19) days. No short-term complications were observed, However, bile duct stricture at the leakage site was observed as a long-term complication in one patient 2 months later, which required a second endoscopic treatment (biliary stenting) . In one case in which endoscopic treatment was unsuccessful, the leak occurred because of disconnection between the branch in the anterior segment and the normal bile duct (isolated bile leak) , and reconstructive surgery of the biliary tract was performed. Endoscopic treatment of post-operative bile leak is a safe and effective method. However, it is difficult to perform endoscopic treatment for isolated biliary leaks. Thus, in cases when the leak is not clearly visible on endoscopic retrograde cholangiography, it is important to establish the correct diagnosis by combining the use of magnetic resonance cholangiopancreatography (MRCP) and other methods as well.
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Case report
  • Successful use of Keihito compounds in patients with ulcerative colitis allergic to 5−ASA : 2 cases showing endoscopic mucosal healing over a 5−year follow up
    Kazuhiro Watanabe, Takashi Uchiyama
    2016 Volume 88 Issue 1 Pages 65-68
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_65
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    5-aminosalicylic acid (5-ASA) is extensively used as the first-line treatment for mild to moderate ulcerative colitis (UC) . However, up to 2% of patients develop allergic reactions to 5-ASA ─ such as high fever, nausea, vomiting, bloody diarrhea, and abdominal pain ─ and hence, cannot be treated with it. We describe the cases of two patients who presented with adverse events upon treatment with secondary oral 5-ASA tablets, resulting in exacerbation of the colitis with eosinophilia. Their condition improved by administration of Keihito compounds without other medications. The presence of eosinophilia might be a useful diagnostic indication of 5-ASA allergy in patients with negative drug-induced lymphocyte stimulation test results. Currently, the end-points for patients with UC include induction of remission and mucosal healing (MH) . There were no signs of relapse in our patients for more than 5 years, as detected by endoscopic MH follow-up.
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  • A case of Ischemic colitis occurring in chemotherapy for ovaryian cancer
    Oki Kikuchi, Daisuke Saito, Osamu Ikezaki, Tatsuya Mitsui, Miki Miura, ...
    2016 Volume 88 Issue 1 Pages 69-72
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_69
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    A case was a 60-year-old female patient. Based on the diagnosis of stage IIIc ovarian cancer, combination chemotherapy with paclitaxel and carboplatin (TC therapy) was performed. She had abdominal pain and diarrhea 10 days after the initiation of treatment, and was hospitalized. Contrast-enhanced CT performed at the day of hospitalization demonstrated dilatation of entire colon and accumulation of intestinal fluids, and colonoscopy revealed ulcerative lesions longitudinally scattered from the transverse through descending colon, leading to a diagnosis of ischemic colitis. Ischemic change attributed to paclitaxel treatment was suspected. Fasting and discontinuance of the chemotherapy resulted,in amelioration of the symptoms. Paclitaxel-induced mucosal damage associated with cell cycle arrest of epithelial cells, inhibition of vascular smooth muscle cell proliferation and migration, and inhibition of vascular endothelial cell accumulation are considered as underlying pathogenesis. In case of abdominal symptoms after the introduction of chemotherapy with taxane anticancer agents, it is important to suspect ischemic colitis for an appropriate diagnosis.
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Experience
  • Experience of the laparoscopic surgery for small intestine tumor
    Sayaka Nagao, Yoshihisa Saida, Toshiyuki Enomoto, Emiko Takeshita, Kaz ...
    2016 Volume 88 Issue 1 Pages 73-77
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_73
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    We analyzed 15 small intestine tumors in the past 10 years. 10 of them were malignant and 5 were benign tumors. All cases were symptomatic, and 11 cases were diagnosed before the operation. All benign tumors were revealed by preoperative diagnosis, and laparoscopic surgery was performed. Successful preoperative diagnosis of small intestine tumors has been possible thanks to recent advances in the diagnostic imaging field. Because the small intestine is a flexible organ, when the lesion can be localized, laparoscopic surgery can be easily performed. Among the malign tumors, 1 was a smooth muscle sarcoma, 1 a gastrointestinal stromal tumor, 2 were malignant lymphomas, and 6 were small intestine adenocarcinomas. We performed open surgery in 9 of the 10 malignant tumors, because of the size or invasion of the tumors. Because small intestine malignant tumors have poor prognosis, an early detection is important.
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Clinical study
  • Assessment of morphological diagnosis by EUS and WHO classification in PNET
    Masafumi Watanabe, Kosuke Okuwaki, Mitsuhiro Kida, Hiroshi Yamauchi, S ...
    2016 Volume 88 Issue 1 Pages 78-79
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_78
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    Study objective : We retrospectively studied the relations between the findings of endoscopic ultrasonography (EUS) and the World Health Organization (WHO) classification of pancreatic neuroendocrine tumors (NETs) in our hospital.
    Patients and Methods : We studied 79 lesions in 78 patients with pancreatic NETs diagnosed at Kitasato University Hospital. EUS findings (1. tumor form, 2. tumor margin, 3. internal echo, 4. echogenicity, 5. cystic changes, 6. tumor size) were contrasted with the WHO classification and retrospectively studied on the basis of the patients’ case report forms.
    Results : The results of EUS were as follows : 1. Tumor form round/nodular : 68/11, 2. Tumor margin regular/irregular : 60/19, 3. Internal echo homogeneous/heterogeneous : 49/30, 4. Echogenicity hypoechoic/isoechoic : 58/21, 5. Cystic changes yes/no : 16/63, 6. Tumor size median : 20 mm (2-220 mm) . According to the 2010 WHO classification, grade 2 NETs and neuroendocrine carcinomas were significantly nodular (p<0.01) , more irregular (p<0.01) , more heterogeneous (p<0.01) , and larger (p<0.01) than grade 1 NETs.
    Conclusions : Our findings showed that EUS findings are useful for differentiating grade 1 NETs from grade 2 NETs and neuroendocrine carcinomas.
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Case report
  • A case report : Clinical experience with pemphigus vulgaris initially diagnosed by upper gastrointestinal endoscopy with esophageal Nikolsky phenomenon
    Masahiro Yura, Rieko Nakamura, Tsunehiro Takahashi, Norihito Wada, Hir ...
    2016 Volume 88 Issue 1 Pages 80-81
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_80
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    The patients was 50-year old woman who had feeling of difficulty in swallowing, and she was conveyed first aid to the main complaint by vomiting and vomiting of blood. Esophageal ulcer was detected with first upper gastrointestinal endoscopy (UGE) , and biopsy showed severe dysplasia. Thus, the esophageal carcinoma was doubted initially, and he was introduced to previous medicine for examination and treatment. UGE was performed again in previous medicine, and epithelium detachment of the laryngopharynx epithelium and the hematoma on esophageal mucosa was recognized without contact and easily formed by fiber friction. Because an autoimmune blister symptom was doubted by this Nikolsky phenomenon, he was introduced to department of dermatology of Keio University Hospital. We achieved definitive diagnosis with pemphigus vulgaris (PV) from buccal mucosa biopsy and autoantibody examination. The patients were classified into a mucosal type according to their serum levels of antidesmoglein (Dsg) -1 and Dsg-3 autoantibodies. After dermatology hospitalization, treatment using combination of steroid and immunosuppressant was started, and completely remission was achieved. We report our clinical experience with PV which was initially diagnosed by UGE with esophageal Nikolsly phenomenon.
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  • A patient who developed various chest symptoms caused by atypical esophageal reconstruction
    Kazutake Oguma, Sadanori Kubo, Fumihiko Nozu, Hiroaki Shiraishi, Takes ...
    2016 Volume 88 Issue 1 Pages 82-83
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_82
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    [Case] A 72-year-old female. [Chief complaints] Left back and chest pains and heartburn. [Previous diseases] Received left thoracolaparotomy for esophageal cancer in China at the age of 62. [Present diseases] The patient had complaints after taking meals for one year. CT revealed a reconstructed gastric tube containing residues at the dorsal region of the left thoracic cavity. Bending of the gastric tube at the anastomotic site and stenosis that had been observed by contrast study at the first visit showed some improvement after 4 months. The erosion around the anastomotic site and stenosis with a flat bulge observed by endoscopy at the first visit became less severe after 4 months.
    [Conclusion] This was a case of anastomotic stenosis and obstruction of gastric tube discharge that developed 9 years after left thoracolaparotomy for esophagogastric anastomosis by the left intrathoracic path for esophageal cancer.
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  • Intralesional steroid injections in esophageal strictures resistant to balloon dilatation : A case of post-endoscopic variceal ligation plus argon plasma coagulation
    Hidehiro Kamezaki, Hiroshi Ohyama, Masayoshi Saito, Takeshi Ishihara
    2016 Volume 88 Issue 1 Pages 84-85
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_84
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    An 88-year-old woman who underwent endoscopic variceal ligation (EVL) plus argon plasma coagulation (APC) had an esophageal stricture resistant to balloon dilatation. To avoid inflammatory response which could cause collagen formation, we treated her with dilatation together with intralesional steroid injection. She achieved lasting remission after the treatment. Previous reports suggest that intralesional steroid injection could be effective in peptic strictures or radiation-induced strictures ; however, effectiveness in case of corrosive strictures or anastomotic strictures is questionable. Moreover, only one case intralesional steroid injection for a post-sclerotherapy stricture resistant to dilatation has been reported (Gastrointest Endosc, 41 : 598-601, 1995) , and no case of post-EVL plus APC has been reported. We suggest that intralesional steroid injection is effective in treatment of post-EVL plus APC stricture resistant to dilatation.
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  • A case of early esophageal carcinoma that resulted in metastasis to the mediastinal lymph node after endoscopic treatment
    Yohei Koyama, Shuta Nishinakagawa, Hiroyuki Kojima, Naoyuki Yoshimine, ...
    2016 Volume 88 Issue 1 Pages 86-87
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_86
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    A 70-year-old male underwent two separate endoscopic submucosal dissections for the treatment of two early esophageal carcinomas. Both dissections were pathologically diagnosed as curative resections. At 19 months after the first resection, the patient reported dyspnea.
    Computed tomography (CT) revealed mediastinal lymphadenopathy, which was suspected to be indicative of lymph node metastases of the esophageal cancer. The patient’s respiratory status was improved. Chemoradiotherapy, comprising 5-FU and CDDP with radiotherapy of 60 Gy, was administered. A significant reduction was observed in the metastasis to the mediastinal lymph node. Despite curative resections, the possibility of lymph node metastases was recognized, and it was important to carefully follow-up the patient.
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  • A case of adult gastric duplication cyst that was difficult to diagnose
    Masaru Mizutani, Yousuke Iriguchi, Johji Oda, Tetsurou Yamazato, Akihi ...
    2016 Volume 88 Issue 1 Pages 88-89
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_88
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    A 40-year-old man underwent an endoscopic examination due to epigastric pain. Endoscopy revealed a soft submucosal tumor of about 4 cm in the antral greater curvature. A relatively low luminescent homogeneous tumor mass that was partially filled with a solid component of high luminance mainly located in the submucosal layer was evident on endoscopic ultrasonography. Distal gastrectomy was performed because of possible malignancy. The resected specimen had a cystic structure with a heterotopic pancreas and its wall was incompletely lined with gastric and duodenal mucosa. Noncaseating granuloma was found in the gastric mucosa and perigastric lymph nodes. The final pathological diagnosis was a duplication cyst with heterotopic pancreas of stomach/sarcoidosis of the stomach.
    Gastric duplication cysts are most frequently found in childhood. Thus we experienced a rare case of adult gastric duplication cyst and herein report this case with a literature review.
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  • Two cases of gastric hamartomatous inverted polyp with pedunculated growth pattern
    Hideyuki Takashiro, Takuto Suzuki, Rino Nankinzan, Chiaki Inagaki, Hir ...
    2016 Volume 88 Issue 1 Pages 90-91
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_90
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    A 55-year-old man and a 76-year-old woman were referred to our hospital due to a gastric polyp. In both cases, gastroendoscopy revealed a pedunculated polyp measuring 20mm in diameter at the gastric body. The surfaces of these polyps appeared to be normal with slight depressions. Endoscopic polypectomies were performed. Histopathological examinations established the diagnosis of gastric hamartomatous inverted polyp, which appeared as inverted growth of mucosa and muscularis mucosa into the submucosal layer. Gastric hamartomatous inverted polyps are rare, and most of them have the appearance of submucosal tumors. The pedunculated growth appearances as observed in the two cases are very rare. Herein, we report two cases of pedunculated gastric hamartomatous inverted polyps.
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  • Two successful cases of endoscopic ultrasonography-guided transgastric drainage for abdominal abscesses after distal gastrectomy
    Katsuyoshi Ando, Hiroki Tanabe, Daisuke Suto, Katsuhisa Oota, Eiichiro ...
    2016 Volume 88 Issue 1 Pages 92-93
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_92
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    Case 1 : A 78-year-old man, who had undergone robot-assisted distal gastrectomy (DG) for early gastric cancer, had fever and epigastralgia. Computed tomography (CT) showed an abdominal abscess between the gastric cardia and the dorsal of pancreas. The abscess was punctured from the residual stomach with a 19-gauge needle by endoscopic ultrasonography (EUS) , and a transnasal drainage tube was placed. Twenty-seven days after replacing the internal drainage tube from the stomach, the abscess disappeared.
    Case 2 : A 79-year-old man, who had undergone laparoscopy-assisted DG for advanced gastric cancer, had fever and epigastralgia. CT showed an abdominal abscess between the gastric cardia and the dorsal of pancreas and another around the duodenum. EUS-guided abscess drainage was performed from the residual stomach, and then CT-guided drainage was performed around the duodenum. The abscesses disappeared after the replacement of the internal drainage tube.
    Conclusion : EUS-guided transgastric drainage might be a safe and successful treatment for abdominal abscesses after DG.
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  • Technique of laparoscopy and endoscopy cooperative surgery for gastric submucosal tumor in the cardia and fornix of the stomach
    Ryohei Watanabe, Natsuya Katada, Yasushi Nagaoka, Yoichi Nakamura, Kaz ...
    2016 Volume 88 Issue 1 Pages 94-95
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_94
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    Laparoscopy and endoscopy cooperative surgery (LECS) is widely accepted in Japan for submucosal tumor (SMT) of the gastric cardia and fornix. We modified LECS for SMT of the gastric cardia and fornix by placing supporting sutures at the edge of the remnant gastric wall, making it easier to grasp the remnant gastric wall for the SMT in the cardia. To prevent stenosis because of excessive resection of the esophagogastric junction (EGJ) , we did not perform endoscopic submucosal dissection (ESD) adjacent to EGJ. For the SMT in the gastric fornix, two or three short gastric vessels were divided, and the gastric wall was pulled caudally. These procedures provided a good view of the tumor and adequate tension for ESD.
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  • A huge gastrointestinal stromal tumor of the stomach completely resected after neoadjuvant chemotherapy with imatinib : a case report
    Fumiya Nishimoto, Misako Touhata, Tomoki Sato, Tatsuhiro Shoji, Hajime ...
    2016 Volume 88 Issue 1 Pages 96-97
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_96
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    A 53-year-old man was referred to our hospital because of abdominal fullness. Abdominal CT revealed a huge gastric tumor, invading spleen, liver and pancreas. Gastroscopy showed submucosal tumor (SMT) . It was diagnosed GIST by staining positively for c-kit. Administration of imatinib was begun as neoadjuvant chemotherapy during three-month period. As a result we estimated partial response (PR) in accordance with RECIST guideline. After that we underwent total gastrectomy with splenectomy and partial pancreatectomy as a total excision of the huge tumor. A few viable cells were observed in the tumor. He was doing well after surgery. We decided not to give the adjuvant dosage
    after consultation with him. There is no sign of recurrence for ten months after operation. Imatinib as neoadjuvant chemotherapy was effective for huge GIST on this case. We hope to build up further prospective study.
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  • A case of early gastric cancer that changed morphologically after Helicobacter pylori eradication therapy
    Yurika Ikegami, Tomoyuki Yada, Koichi Ito, Naomi Uemura
    2016 Volume 88 Issue 1 Pages 98-99
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_98
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    The patient was a 69 years old man. An esophagogastroduodenoscopy (EGD) performed previously had revealed an elevated, discolored lesion, 15 mm in diameter, located on the posterior wall of the middle gastric body. Since pathological analysis indicated a Group 3 lesion, this was followed up regularly after Helicobacter pylori (H.pylori) eradication therapy. An EGD performed six months after H.pylori eradication revealed the previously elevated lesion had become flat and indistinct ; 12 months later it adopted a depressed morphology. Since the pathological analysis of a biopsy 26 months later indicated a Group 5 lesion, the patient consulted us for an endoscopic submucosal dissection. Histopathological analysis of the removed lesion indicated an adenocarcinoma (tub1) , Type 0-IIc, pT1a (pM) .
    Endoscopists need to remember morphological changes may occur in gastric tumors after H.pylori eradication therapy.
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  • Utility of magnifying endoscopy with narrow-band imaging for detection of gastric cancer in hyperplastic polyps
    Kazuhisa Yamaguchi, Yorimasa Yamamoto, Yusuke Horiuchi, Masami Omae, A ...
    2016 Volume 88 Issue 1 Pages 100-101
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_100
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    A 77-year-old man, who had undergone a distal gastrectomy in 1997 because of advanced gastric cancer, was referred to our hospital for endoscopic resection of a metachronous gastric cancer. Upper gastrointestinal endoscopy revealed a 20-mm reddish polyp located at the greater curvature of the gastrectomy site of the residual stomach.
    Magnifying endoscopy with narrow-band imaging (ME-NBI) revealed a regular structure at the anal side of the polyp, resembling a hyperplastic polyp. Thus, irregular surface and vascular structure were observed at the oral side of polyp, indicating gastric cancer. In addition, we noted a gradual gradation between the hyperplastic lesion and the cancerous lesion by ME-NBI. Considering all these findings, we speculated that the hyperplastic polyp had progressed to adenocarcinoma. Endoscopic mucosal resection was performed, and histological analysis confirmed the diagnosis of adenocarcinoma. Thus, ME-NBI can be useful for detection of gastric cancer developing in hyperplastic polyps.
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  • Early gastric remnant cancer with situs inversus totalis treated by endoscopic submucosal dissection
    Tomoaki Moriyama, Naoko Nagasu, Ichiro Kato, Shunsaku Koriki
    2016 Volume 88 Issue 1 Pages 102-103
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_102
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    A 78-year-old Japanese man was referred to the hospital for treatment of early gastric remnant cancer. He was diagnosed with situs inversus in childhood, and underwent partial gastrectomy and Billroth I anastomosis for gastric ulcer. Chest roentgenogram showed dextrocardia. Abdominal CT revealed transposition of the abdominal organs and no metastasis to the liver and lymph nodes. Upper endoscopic examinations showed a type 0−IIa＋IIc early gastric remnant cancer massively invading the sumucosa. Biopsy specimen disclosed moderately differentiated adenocarcinoma. A diagnosis of early gastric remnant cancer with situs inversus totalis was made. He did not agree to total gastrectomy worrying decline in activity, then endoscopic submucosal dissection was performed in the right decubitus position with change in the arrangement of staffs and equipments and careful usage of the devices.
    Histopathological findings disclosed moderately differentiated tubular adenocarcinoma invading deeply the submucosa. He did not choose addition of the operation.
    An endoscopic treatment for early gastric cancer accompanied by situs inversus totalis is thought suitable and effective in the right decubitus position.
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  • A case of Gastric Inflammatory Fibroid polyp incarcerated into the duodenum caused anemia
    Akinari Takao, Takashi Fujiwara, Kazuhito Yajima, Satomi Shibata, Kazu ...
    2016 Volume 88 Issue 1 Pages 104-105
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_104
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    An 80-years-old woman was admitted to our hospital complaining of feeling uncomfortable bowel distention after eating. Endoscopic examination showed a protruding lesion completely prolapsing into the duodenal bulb.
    After we corrected the incarcerated tumor by 2 channel-double-grasper method, endoscopic examination and upper gastrointestinal series revealed the polyp-like formation which the appearance of the overlying mucosa is smooth and the top is decidualized. Pathological examination of biopsy specimen showed no evidence of malignancy. The tumor was guessed as an inflammatory fibroid polyp (IFP) arising from the anterior wall of pyloric zone. To diagnose the tumor, a distal partial gastrectomy was performed. Pathologically, the 4-cm-diameter tumor was an IFP. We report a suggestive case of IFP of the gastric antrum prolapsing into duodenum.
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  • A case of gastric mucosal prolapse polyp that was difficult to differentiate from duodenal submucosal tumor
    Yousuke Mizutani, Masaru Nakano, Satoko Umeda, Takahiko Toyonaga, Eiko ...
    2016 Volume 88 Issue 1 Pages 106-107
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_106
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    A 62 year-old-man was admitted to our hospital with pancreatitis in 2012. On admission, endoscopy was performed and a polyp that seemed derived from the dundenum was observed. The patient discontinued his hospital visits for a while but on his revisit in 2015, enlargement of the polyp as observed by CT compared to his previous examination was apparent. Distal gastroduodenectomy was performed. The resected specimen derived from the gastric antrum revealed prolapse of the polyp head into the duodenum, and the pathological diagnosis was gastric mucosal prolapse polyp (GPP) . GPP tends to prolapse into the duodenum. It is therefore important for the clinician to consider GPP in the differential diagnosis of duodenal tumors.
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  • A case of Acute Duodenal Diverticulitis with an Enterolith treated with endoscopic therapy
    Maya Suguro, Kei Yamamoto, Yuri Fukazawa, Hideaki Tanabe, Akira Madara ...
    2016 Volume 88 Issue 1 Pages 108-109
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_108
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    A 67-year old man was admitted for evaluation of two days of epigastric pain. Abdominal CT scan showed fluid collection around the horizontal duodenum and a diverticulum with focal calcification, which suggested duodenal diverticulitis with a presence of Enterolith. Initial treatment consisted of fluid resuscitation, broad-spectrum antibiotics began. Initial endoscopy on hospital day three revealed a large diverticulum with an impacted enterolith in the diverticular cavity. After removal of the enterolith using gripping forceps, a significant amount of pus was expressed, revealing a deep ulcer at the base of the diverticulum. Follow-up endoscopy on hospital day eight revealed normal-appearing diverticulum and a reduction of the ulcer. This case demonstrates that in the absence of perforation, endoscopic therapies are effective for Duodenal Diverticulitis. However, early diagnosis and attentive technique is needed.
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  • A case of duodenal lipoma treated by endoscopic submuosal dissection
    Akira Kanamori, Masakazu Nakano, Mari Iwasaki, Hitoshi Kino, Yoshihito ...
    2016 Volume 88 Issue 1 Pages 110-111
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_110
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    A 57-year-old man, complaining of anorexia, was referred to our hospital for treatment of duodenal submuosal tumor (SMT) . The lesion was diagnosed as duodenal lipoma measuring 3 cm, based on the findings of esophagogastroduodenoscopy, endoscopic ultrasonography, and magnetic resonance imaging. Endoscopic submucosal dissection (ESD) for duodenal lipoma was performed, leading to local complete resection of the SMT, and the diagnosis of lipoma was confirmed histopathologically. There has been only one case report of duodenal lipoma undergoing ESD in the literature. Accumulation of such case is awaited to determine the efficacy of ESD for duodenal lipoma.
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  • A case of duodenal diverticulum hemorrhage treated by endoscopic methods
    Sho Onodera, Masazumi Ogawa, Satoshi Kusayanagi, Natsuko Nakazaki, Shi ...
    2016 Volume 88 Issue 1 Pages 112-113
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_112
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    A 68-year-old man was admitted to our hospital with the chief complaint of melena. At 64 and 67 years of age, he was diagnosed with duodenal hemorrhage, but endoscopic operations were not performed because the bleeding point could not be detected. This time, the bleeding point could not be identified using a front-viewing endoscopic examination. However, by changing the method to a side-viewing endoscopic examination, the bleeding point was detected in a duodenal diverticulum. After attaching a transparent hood to the front-viewing endoscope, endoscopic clipping was successfully performed.
    For the identification of the bleeding point, in our case a side-viewing endoscope and a transparent hood were useful. Among the endoscopic hemostatic methods, the introduction of a hemostatic clip is the procedure with lowest risks. In our case, hemostasis was achieved with the effective use of endoscopic devices, and apparent complications were avoided.
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  • A case of adult onset Henoch-schönlein Purpura with abdominal pain preceding purpura
    Natsuko Nakazaki, Sho Onodera, Shinichi Kato, Rena Kaneko, Minil Kim, ...
    2016 Volume 88 Issue 1 Pages 114-115
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_114
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    A 21-year-old man was admitted to our hospital because of severe abdominal pain.
    Abdominal computed tomography scanning revealed an edematous wall extending from the duodenum through the jejunum. The patient reported progressive worsening of abdominal discomfort. After 4 days of hospitalization, purpura of the ankle was observed. Investigation by esophagogastroduodenoscopy (EGD) demonstrated the edematous wall, as well as erosion and ulceration of the duodenum ; therefore we diagnosed him as Henoch-schönlein Purpura (HSP) .
    Treatment with high-dose steroids led to rapid alleviation of symptoms. The steroid dose was gradually tapered, and the patient was discharged from hospital 35 days after admission.
    Adult HSP in not popular because HSP is generally occurred in a childhood.
    EGD can be useful in the diagnosis of adult HSP, especially for patients without the typical skin rash.
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  • A case report on a muco-submucosal elongated polyp of the duodenum treated with endoscopic resection
    Yoko Kashima, Naoto Kurihara, Masashi Takeuchi, Yasuhiro Sasaki, Shou ...
    2016 Volume 88 Issue 1 Pages 116-117
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_116
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    Colonic muco-submucosal elongated polyps (MSEPs) are a new clinical entity first reported in 1994. The existence of long and slender polypoid lesion like an MSEP in the duodenum is rare. A 76-year-old man who complained of epigastralgia was diagnosed via endoscopy as having an elongated polyp in the duodenum with a head part resembling a half-sized sumo referee’s fan.. Endoscopic polypectomy with the snaring technique was performed after the injection of epinephrine-saline into the neck of the polyp. Bleeding from exposed blood vessels was controlled with clips. Histological findings of resected specimen were compatible for the features of MSEP, and the polyp was covered with edematous mucosa and submucosa with dilated blood vessels and lymphangiectasia. Although the mechanism of the development of such polyps remains unknown in general, elongation in this case may have been caused by the polyp form and gastroduodenal motion.
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  • Giant Brunner’s gland adenoma with intestinal obstruction arising from duodenal bulb, resected by ESD : A Case report
    Ayako Ochiai, Shigetaka Tounou, Hiroyuki Fukazawa, Yousuke Muraki, Tom ...
    2016 Volume 88 Issue 1 Pages 118-119
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_118
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    An 80-year-old man was diagnosed as having a duodenal submucosal tumor located at the anterior wall of the duodenal bulb in CT performed as a pre-operative examination for bladder cancer. The size of the tumor was presumed to be about 40 mm.
    The tumor blocked the second portion of the duodenum and obstructive symptoms occurred. ESD was performed to resect the duodenal submucosal tumor.
    The size of the tumor was 47×27×29 mm and histological examination showed it to be Brunner’s gland adenoma. The treatment for Brunner’s gland adenoma is endoscopic resection or surgical resection. The method of endoscopic resection is generally polypectomy using a snare or EMR. ESD is one of the therapeutic procedures used, but it is technically difficult and indications have to be carefully considered.
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  • A Case of duodenal ampullary adenoma with acute gallstone cholangitis
    Takehiro Ishii, Hiroyuki Miyatani, Yoshiyuki Nakashima, Hirosato Mashi ...
    2016 Volume 88 Issue 1 Pages 120-121
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_120
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    Increasing numbers of cases of duodenal ampullary adenoma have been detected by screening upper endoscopy without any symptom in recent days. Cases of duodenal ampullary adenoma with acute gallstone cholangitis are rare. We experienced a case of 58-year-old male patient who was diagnosed as duodenal ampullary adenoma that was incidentally found by ERCP for acute gallstone cholangitis. There is no case report in Japan in which both endoscopic papillectomy (EP) for ampullary adenoma and endoscopic extraction for bile duct stone were performed. It is reported that recurrence rates after EP for duodenal ampullary adenoma range from 0-33%. Complete resection is important to avoid recurrence. So we decided to perform EP prior to endoscopic extraction. After 12 days from EP for ampullary adenoma, we performed balloon dilating of the bile duct and safely completed endoscopic extraction of the bile duct stone.
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  • A case of primary mucosal cancer of duodenum bulb
    Kengo Furutani, Tomoji Katoh, Wakiko Kitamura, Masao Okubo, Katsuya Ko ...
    2016 Volume 88 Issue 1 Pages 122-123
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_122
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    A 67-year-old man was referred to our hospital for follow-up after colonoscopy. Screening endoscopy showed a small (8mm) elevated lesion at the anterior wall of duodenum bulb. Magnifying view with Narrow Band Imaging (NBI) showed abnormal micro vessels. The biopsy tissue was diagnosed as group 4, and Endoscopic Mucosal Resection using a cap-fitted panendascope was performed. The resected specimen was finally diagnosed as well differentiated (papillary) adenocarcinoma, with horizontal positive margin. Therefore, careful follow up is necessary.
    Primary duodenal cancer was very rare and difficult to distinguish from adenoma. Magnifying view with NBI was effective.
    We show 12 cases of past duodenal cancer in 2005-2015. In most of the cases, tumors were located in duodenal bulbs and morphological type was IIa.
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  • Duodenal cancer EUS-FNA was useful in diagnosis : a case report
    Tomoko Umakoshi, Naoki Okano, Yuui Kishimoto, Teppei Matsui, Yoshinori ...
    2016 Volume 88 Issue 1 Pages 124-125
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_124
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    A 76 years old woman, transcatheter arterial embolization was performed in October 2010 and an extended right hepatic lobectomy was performed in January 2011 for hepatocellular carcinoma. CA19-9, DUPAN-II and Span-1 were high in May 2013. Abdominal contrast enhanced CT findings showed the thickness of duodenal wall. However there was no evidence of abnormal findings by upper gastrointestinal endoscopy and FDG-PET. After that the tumor markers have been getting higher. CT showed augmentation of the thickness of duodenal wall and the mass with the ulcer was recognized in a pylorus ring from the antrum of stomach by upper gastrointestinal endoscopy. We took the biopsy specimen, however the malignant findings were absent. Therefore we performed EUS-FNA, the result was ClassV : adenocarcinoma, we diagnosed of the duodenal carcinoma. We carried distal gastrectomy and duodenal segmental resection in September 2013. The pathological diagnosis was moderately differentiated tubular adenocarcinoma of the duodenum. In this case, EUS-FNA was useful for preoperative clinicopathological diagnosis of the duodenal carcinoma.
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  • A case of an ileal neuroendocrine tumor with lymph node metastasis
    Taira Sato, Ryo Chinzei, Iichiro Ohtsu, Hirosato Doi, Masanori Takahas ...
    2016 Volume 88 Issue 1 Pages 126-127
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_126
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    A 57-year-old female was referred to our hospital for further examination of a neuroendocrine tumor (NET) located in the terminal ileum. Colonoscopy revealed a yellowish submucosal tumor of 8 mm in diameter, and magnifying narrow band imaging showed dilated cyan-colored vessels. Abdominal computed tomography showed an enlargement of the ileocolic lymph node 13 mm in diameter. A laparoscopy-assisted ileocecal resection with lymph node dissection was performed. Histological results showed that the invasion of tumor cells was located above the muscularis propria with venous invasion. The mitotic rate was low and the Ki-67 labeling index was less than 2%. The tumor was diagnosed as NET grade 1 with a lymph node metastasis (#202) . No local remnant lesion and metastasis was found during follow-up of 12 months. Small intestinal NET has a high metastatic potential despite its small size. Therefore, radical ileocecal resection and regional lymphadenectomy is recommended according to the consensus guidelines.
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  • A case of cavernous hemangioma in jejunum with severe anemia
    Risa Miyauchi, Kenji Tominaga, Yoshinori Saigusa, Makiko Mori, Yuki Yo ...
    2016 Volume 88 Issue 1 Pages 128-129
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_128
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    A 30-year-old male came to the hospital because of unsteady walking. Blood examination revealed severe anemia. Esophagogastroduodenoscopy (EGD) revealed no lesion. Colonoscopy revealed no lesion, but blood was present in the ascending colon. Double-balloon enteroscopy revealed a 50-mm elevated lesion in the jejunum. The surface of the lesion had a white and red granular pattern, which indicated cavernous lymphangioma. A laparoscopic small bowel resection was performed. The resected specimen showed a 75×50 mm-sized tumor. Pathological findings showed proliferation of blood vessels in the submucosa and lymphatic hyperplasia in the lamina propria mucosae. The main pathological finding was proliferation of blood vessels in the submucosa. Therefore, the lesion was diagnosed as cavernous hemangioma.
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  • A case of small intestinal GIST with GI bleeding which could be diagnosed by capsule endoscopy and single-balloon enteroscopy
    Tetsuro Fujii, Akitake Uno, Syuhei Arima, Mayumi Komatsu, Natsuko Tsut ...
    2016 Volume 88 Issue 1 Pages 130-131
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_130
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    A 58 years old man was admitted with melena. Gastroscopy and colonoscopy couldn’t determine the source of bleeding. Capsule endoscopy demonstrates a submucosal tumor in jejunum. Single-balloon enteroscopy showed a submucosal tumor with active bleeding. Laparoscopy-assisted partial resection of small intestine was performed. Surgical resected specimens showed submucosal tumor with ulceration. Histopathologically, the tumor cells were spindle-shaped. Immunohistochemically, C-kit was positive so we finally diagnosed with small intestinal gastrointestinal stromal tumor (GIST) . This case suggest that patients with OGIB should be examined both by CE and BE.
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  • A case of severe anemia which lead to the detection of malignant melanoma metastasis to the gastrointestinal tract
    Ryutaro Aoyagi, Minoru Yamaoka, Hideki Ohgo, Keigo Ashitani, Takaya Ic ...
    2016 Volume 88 Issue 1 Pages 132-133
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_132
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    The 77-year-old men underwent resection for the malignant melanoma of the right buccal region. Six months later, it recurred in a cervical lymph node and he underwent lymphadenectomy. One year later, he was complained of left lower quadrant pain, appetite loss and weight loss. He consulted neighboring doctor’s office. A blood test revealed anemia. He was admitted to our hospital to undergo treatment. Contrast enhanced abdominal CT showed expansion of the proximal jejunum to a diameter 63×60mm size in left kidney ventral aspect.
    Double balloon endoscopy showed lesions similar to the submucosal tumor in the duodenum and proximal jejunum. We diagnosed gastrointestinal metastasis of malignant melanoma from histopathology findings and a history of malignant melanoma. Malignant melanoma has few cases that gastrointestinal metastasis is found in during the life time. Approximately half of patients with malignant melanoma who held an autopsy metastasized to gastrointestinal tract particularly a small intestine. When we detected the lesion similar to the submucosal tumor occurring frequently at endoscopy, we think about a malignant melanoma first, and it is necessary to perform the hearing of the medical history and a pathological search.
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  • A lipoma diagnosed by endoscopic excision : a case report
    Isao Arima, Hisafumi Yamagata, Masateru Hataji, Sae Nakayama, Atsuki M ...
    2016 Volume 88 Issue 1 Pages 134-135
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_134
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    Progressive anemia was found in a 73-year-old man with an old myocardial infarction who was seeing a cardiovascular internist regularly. Because a fecal occult blood test showed a positive result, we performed a colonoscopy and observed a pedunculated tumor mass with a diameter of 40 mm in the presence of blood clots on the surface of its tumor mass. We judged that this tumor mass was the cause of the bleeding and therefore performed endoscopic excision. The tumor mass was histopathologically diagnosed as a lipoma. A colonic lipoma is a benign non-epithelial tumor, with a frequency around 3% of autopsy cases ; it is relatively rare in clinical practice.
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  • A case of diverticular colitis which should be differentiated from atypical ulcerative colitis
    Masao Kusano, Daisuke Komazawa, Hiromichi Ito, Masaki Tosa, Tomoyuki I ...
    2016 Volume 88 Issue 1 Pages 136-137
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_136
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    We describ the case of a 73-year-old man with diverticular colitis, a newly established disorder of chronic segmental colitis associated with diverticulosis. At the age of 63 years, the patient was admitted to our hospital for a hemorrhagic gastric ulcer. At the age of 67 years, he was diagnosed with anemia. A colonoscopy revealed segmental inflammation of the ascending colon. Histopathological examination showed nonspecific colitis. At the age of 68 years, another colonoscopy revealed redness and vascular pattern loss of the ascending colon ; however the rectum was not involved. Histopathological examination showed inflammatory cell infiltration with crypt abscess. He was diagnosed with atypical ulcerative colitis. Mesalazine therapy was started at an initial dose of 4000mg/day and gradually tapered. At the age of 73 years, another colonoscopy revealed deterioration of mucosal inflammation. After further examination, he was diagnosed with diverticular colitis. Another course of mesalazine therapy was started, with a dose of 3600mg/day, which was gradually tapered. After a year of treatment, the latest colonoscopy revealed mucosal healing ; the patient is still being followed up regularly.
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  • A case of severe ulcerative colitis diagnosed by outbreak of cytomegalovirus enteritis
    Yuri Fukasawa, Kouichi Tabei, Maya Suguro, Akira Madarame, Hidesato Ta ...
    2016 Volume 88 Issue 1 Pages 138-139
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_138
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    A 51-year-old man was admitted to our hospital because of fever, stomachache, and bloody diarrhea. The symptoms and colonoscopy alluded severe ulcerative colitis (UC) , but the biopsy result of the colonoscopy suggested cytomegalovirus (CMV) enteritis. The patient was treated according to severe UC and CMV enteritis diagnosis ; therefore fluid replacement, mesalazine, and ganciclovir were administered. As his health improved, he was discharged ; however, he was admitted again because the symptoms reappeared. Our diagnosis, confirmed by a colon biopsy, was severe UC once more. After ratifying that there was no active infection of CMV, we started a treatment with steroid infusion. Then, his condition has improved. As in this case, it is rare that patients with no underlying disease or immune compromised state will develop CMV enteritis. But, if severe UC is suspected and an active infection of CMV resulted negetive, it may be desirable to start steroid therapy quickly without waiting for the biopsy result.
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  • A rare case of relapsed collagenous colitis after spontaneous remission
    Sakiko Takarabe, Hiroshi Kishikawa, Kyoko Arahata, Asako Ito, Kayoko K ...
    2016 Volume 88 Issue 1 Pages 140-141
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_140
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    A man aged in his 70s presented with diarrhea for two months. Colonoscopy revealed mucosal edema in the left colon. A biopsy specimen revealed inflammatory cell infiltration and a typical collagen band. Collagenous colitis was diagnosed and the symptoms spontaneously resolved. However, the diarrhea relapsed two months later and several medications including 5-aminosalicylic acid had no effect. He was admitted for further evaluation and treatment. Exacerbation of collagenous colitis was suspected, and 30 mg of oral prednisolone significantly improved the diarrhea thereafter. We described rare case of collagenous colitis with characteristic deterioration after the spontaneous remission. Clinicians should correctly diagnose collagenous colitis even when spontaneous remission is evident.
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  • A case of intraperitoneal abscess resulting from perforation of a sigmoid colon diverticulum managed by Over the Scope Clip system
    Sho Takagi, Katsuaki Ogushi, Satoshi Nakao, Jun Hamanaka, Hiroyuki Oka ...
    2016 Volume 88 Issue 1 Pages 142-143
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_142
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    A 90-year-old man was admitted to our hospital with abdominal distension. There was chronic heart failure and vaculitis in history. Abdominal CT scan revealed multiple diverticula of the sigmoid colon and an approximately 7 cm low-density region with air-fluid levels in the pelvic cavity. The diagnosis was thus an intraperitoneal abscess resulting from perforation of a sigmoid colon diverticulum. We considered surgery with general anesthesia, but decided not go ahead because of the patient’s super-aging, poor heart function and prolonged steroid use. Percutaneous abscess drainage was performed instead under ultrasonographic guidance. Four days after drainage, we performed endoscopic closure of the perforation of a sigmoid colon diverticulum using an Over the Scope Clip (OTSC) system. At 24 days after the closure,it was confirmed that there was no contrast agent outflow from the fistula to the sigmoid colon. We believe that endoscopic closure with percutaneous drainage procedure is a useful option for the high risk patients with intraperitoneal abscess resulting from diverticular perforation.
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  • A case of enterolith ileus successfully treated with colonoscopy
    Noboru Yatagai, Takashi Murakami, Naoto Sakamoto, Takashi Hiromoto, Hi ...
    2016 Volume 88 Issue 1 Pages 144-145
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_144
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    A 72-year-old man was admitted to hospital with abdominal pain and constipation. Physical examination revealed abdominal distension and mild tenderness in the periumbilical area. Abdominal X-ray and computed tomography (CT) showed dilated bowel loops and air-fluid levels accompanied by a calcified mass of approximately 40mm in diameter located in the descending colon. About 9 months previously, abdominal CT had demonstrated stone impaction of a similar size in the cecum, but this was not observed on abdominal CT at admission. Bowel obstruction related to the enterolith was suspected, and an emergency colonoscopy was performed. The enterolith was endoscopically fractured and removed from the descending colon, using grasping forceps and a polypectomy snare. In addition, gastrografin enema led to the detection of a giant diverticulum in the cecum. The final diagnosis was bowel obstruction due to an enterolith expelled from a giant cecal diverticulum. There have been few reports of enterolith ileus successfully treated with colonoscopy, and this case suggests that endoscopy may be an effective, non-invasive treatment option for enteroliths.
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  • A case of intussusception associated with pneumatosis cystoides interstinalis in an adult that was successfully treated with colonoscopy
    Valentyna Ostapenko, Kiyoshi Terai, Kiyoshi Yokoyama, Yasuhiro Takemot ...
    2016 Volume 88 Issue 1 Pages 146-147
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_146
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    A patient was 43-year-old woman presented with sudden right abdominal pain. Contrast enhanced abdominal CT revealed intussusception of ascending colon and air-filled cysts along the abdominal wall. Colonoscopy performed immediately after examination showed multiple elevated lesions with smooth surface shaped as clusters of grapes in the leading part of intussusception. Invaginated part of colon appeared to be edematous but not necrotic. From these findings, intussusception associated with pneumatosis cystoides interstinalis (PCI) was diagnosed. Intussusception was relived with colonoscopy. After colonoscopy, the abdominal pain of the patient was improved. Blood tests were normal except to slight increase of C reactive protein. Further clinical course was uneventful. Secondary colonoscopy on day 5 demonstrated mild non-specific inflammatory change in cecum. Patient was discharged after 9 days in a hospital. PCI caused intussusception in adult is a rare condition that may require surgical treatment. In our case patient remains to be symptom free 6 months after colonoscopy.
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  • A colonic cancer with submucosal massive invasion diagnosed with endoscopy before operation
    Kai Matsuo, Naoyuki Uragami, Suguru Ogihara, Masayuki Isozaki, Kunio A ...
    2016 Volume 88 Issue 1 Pages 148-149
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_148
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    A 75-year-old man visited our hospital with a colonic lesion. Colonoscopy revealed a 0-Is lesion of the sigmoid colon. Although the size was 6mm, the top surface broke off and the submucosa seemed thick. Magnifying endoscopy with narrow band imaging (NBI) revealed a Type 2B lesion according to the Japan NBI Expert Team classification, and chromoendoscopy revealed VI high irregularity in the pit pattern. By endocytoscopy (EC) the lesion was classified as EC3b. We diagnosed it as an adenocarcinoma with submucosal (SM) massive invasion and performed laparoscopic sigmoidectomy. Pathological findings were the following : moderately differentiated adenocarcinoma (tub2) , pT1b (SM3000µm) , ly0, v1, pN0 (0/10) , pPM0, pDM0, budding grade 3.
    This was a very small lesion with SM massive invasion that we could diagnose without endoscopic resection because of close inspection by endoscopy.
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  • A case of a local recurrence of adenocarcinoma of the rectum in 1 year after endoscopic polypectomy
    Ryosuke Ichikawa, Shunsuke Motegi, Yurika Makino, Hisashi Ro, Rina Tak ...
    2016 Volume 88 Issue 1 Pages 150-151
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_150
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    A 78-year-old male underwent polypectomy due to a IIa lesion (10 mm in diameter) in the lower rectum at another hospital. Histopathological examination showed adenocarcinoma with adenoma, 8 mm, tub1, T1b (SM, 1,500 am) , ly1, v0, budding grade 1, HM0, VM0. He was referred to our hospital for additional surgery. However, he did not wish to undergo radical surgery. After about 1 year, bleeding on defecation occurred, and endoscopy was performed. There was a recurrent lesion (15 mm in diameter, Is) at the previous resection site. He did not wish to undergo surgery including bowel resection. Therefore, transanal minimally invasive surgery (TAMIS) was performed for tumor resection. Histopathological examination showed well-moderate differentiated adenocarcinoma, Rb, 0-Is, 18×16 mm, pT1b (SM 5,000 µm) , int, INFb, ly0, v2, budding grade 1, pHM0, pVM0.
    In consideration of recurrence after TAMIS, careful observation is required.
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  • Spontaneous regression of ascending colon cancer : Case report
    Shoko Ito, Osamu Kobayashi, Kazuki Ohta, Takuto Kojima, Shutaro Hashim ...
    2016 Volume 88 Issue 1 Pages 152-153
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_152
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    A 73-year-old man underwent colonoscopy for fecal occult blood. A flat elevated lesion with slight depression measuring 7mm in diameter with converging folds was observed in the ascending colon. Biopsy was performed and pathological findings showed moderately differentiated adenocarcinoma. Colonoscopy performed 55 days after the initial colonoscopy showed that the lesion had disappeared and changed to a scar. Biopsy showed no carcinoma cells. As deep submucosal invasion was suspected based on the findings of the initial colonoscopy, laparoscopic right colectomy was performed 79 days after the initial colonoscopy. The resected specimen showed only a scar, and no cancerous tissue was found histologically. The colon cancer seems to have regressed spontaneously. The patient is alive with no evidence of recurrence 6 months after surgery.
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  • A case of ischemic colitis caused by colonic vascular invasion by undifferentiated uterine body carcinoma
    Akitsugu Makino, Naoto Kurihara, Rina Tsutsui, Akiko Ichihara, Yoshifu ...
    2016 Volume 88 Issue 1 Pages 154-155
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_154
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    An 84-year-old female was referred to our hospital complaining of lower abdominal pain. She had undergone surgery for sigmoid-colon cancer a year ago. Abdominal CT revealed enlargement of the uterine body. Colonoscopy revealed only an inflammatory polyp in the anastomosis, and no evidence of other inflammation or recurrence was observed. Ultrasonography and cervical cytology revealed no evidence of malignancy. Since the lower abdominal pain was persistent, we repeated the colonoscopy one week later, which revealed erosion, redness and necrosis of the mucous membrane over the entire circumference of the descending colon. Based on the findings, the patient was diagnosed as having ischemic colitis. Subsequently, the patient died of acute renal failure, and we requested permission for autopsy to determine the cause of death. Autopsy revealed the death as being due to undifferentiated carcinoma of the uterine body, and that the ischemic colitis was caused by infiltration of the colonic wall vessels by the uterine body cancer. This case serves to emphasize that in the etiopathogenesis of ischemic colitis, possible involvement of a malignant tumor must not be overlooked.
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  • A case of anastomotic stricture after sigmoidectomy successfully treated with repeated endoscopic balloon dilation
    Yuichiro Suzuki, Kazuyoshi Nagayama, Mao Kawai, Keigo Yasuda, Sho Wata ...
    2016 Volume 88 Issue 1 Pages 156-157
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_156
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    A 68-year-old man who underwent sigmoidectomy for sigmoid colon cancer in October 2014 visited our hospital because of low abdominal pain and nausea in April 2015. He was diagnosed with a large intestine ileus caused by an anastomotic stricture. He was admitted to our hospital and treated with a trans-anal ileus tube. After the ileus symptoms were improved, we performed a balloon dilation 11 times over a 4-month period. We gradually increased the dilation size until a sharp pain occurred (at a diameter of 9 mm) , and the balloon was then dilated up to 20 mm. After balloon dilation, the symptoms resolved and the patient received a follow-up examination. This case study reports that repeated balloon dilation is indicated as a safe treatment for subjective symptoms.
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  • A case of internal hemorrhoid with diffuse cavernous hemangioma of the colon treated with endoscopic sclerotherapy with ALTA
    Jun Aoki, Ryoichi Tsukamoto, Ryosuke Ichikawa, Kazumasa Kure, Kumpei H ...
    2016 Volume 88 Issue 1 Pages 158-159
    Published: June 11, 2016
    Released on J-STAGE: July 01, 2016
    DOIhttps://doi.org/10.11641/pde.88.1_158
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    A male patient in his 20s consulted a nearby clinic because of physical weariness and melena on October 2010. He was referred to our hospital for the treatment of internal hemorrhoid and severe anemia. We performed colonoscopy for colorectal screening, and sclerotherapy with aluminum potassium sulfate and tannic acid (ALTA) for the hemorrhoid. The colonoscopy showed a diffuse cavernous hemangioma with no findings of bleeding and reddish hemorrhoids in the whole anal circumference. Consequently, we considered that the melena was caused by hemorrhoidal bleeding. We performed endoscopic ALTA injection on the hemorrhoid which promptly improved the anemia. Nevertheless, after 4 years and 4 months, the patient revisited to our hospital because of melena recurrence. We performed retreatment with endoscopic ALTA injection for the hemorrhagic hemorrhoid, and found a diffuse cavernous hemangioma with no bleeding similar to the previous condition. The treatment with ALTA injection improved the symptom again. He is currently being closely observed as an outpatient. We report a case of internal hemorrhoid with diffuse cavernous hemangioma of the colon that was successfully treated with endoscopic sclerotherapy with ALTA.
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