Progress of Digestive Endoscopy
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88 巻, 1 号
選択された号の論文の67件中1～50を表示しています
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臨床研究
  • PPI長期内服患者の胃壁細胞腫大に関する検討
    山形 寿文, 幡地 正輝, 中山 沙映, 諸井 厚樹, 有馬 功, 竹川 義則, 小松 和人, 池嶋 健一
    2016 年 88 巻 1 号 p. 42-45
    発行日: 2016/06/11
    公開日: 2016/07/01
    DOIhttps://doi.org/10.11641/pde.88.1_42
    ジャーナル フリー
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    【背景】胃壁細胞は高ガストリン血症により代償性に長軸方向へ膨化するため，プロトンポンプ阻害剤（以下PPI）長期内服患者の病理標本で胃壁細胞が管腔側に突出してみえる現象（parietal cell protrusion : 以下PCP）を認めることがある．今回我々はPPI長期投与によるPCPの有無と酸分泌抑制関連合併症の有無を検討した．【方法】2015年1月から7月に実施した上部消化管内視鏡1399例から6カ月以上のPPI内服が確認された体中部胃底腺検体29例を対象とした．PCPの有無並びに酸分泌抑制関連合併症のうち，胃癌，大腸癌，病的骨折，貧血，クロストリジウム・ディフィシル（以下CD）感染症の有無を検討した．隣接する主細胞の上縁を結んだラインよりも突出している壁細胞をPCP陽性とした．【結果】29例中14例にPCPがみられた（48.3％）．胃酸分泌抑制関連合併症はPCP陽性群と陰性群間で有意差のある項目はみられなかった．【考察】PCP陽性率が既報より低い点は比較対象が海外報告に限られている点，PPI内服期間の長短が及ぼす影響を検討したが原因は不明だった．胃酸分泌抑制関連合併症に有意差がない点は検体数が増えることで異なる結果が得られる可能性が考えられた．PPI長期投与患者におけるPCP陽性所見は胃酸分泌抑制の間接的証明と捉えることができるため，PCP陽性者はPPI代謝酵素であるCYP2C19の遺伝子多型がHeteroEMやPMと関連している可能性が示唆される．また，PCP陽性者は酸分泌抑制関連リスクであるCDトキシンによる腸管感染症の高危険群である可能性が示唆される.
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  • 抗血栓薬内服の有無における内視鏡的粘膜下層剥離術後出血の検討と対策
    林 量司, 大久保 恒希, 水野 達人, 味生 洋志, 池谷 仁美, 中村 雄二, 浅野 朗
    2016 年 88 巻 1 号 p. 46-49
    発行日: 2016/06/11
    公開日: 2016/07/01
    DOIhttps://doi.org/10.11641/pde.88.1_46
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    当院にて2013年4月から2015年3月までにESDを施行した111例（食道4例，胃60例，大腸47例）における後出血の抗血栓薬内服の有無を検討した．緊急内視鏡で止血処置を要したものと術後内視鏡にてForrest IaもしくはIbの出血を認めたものを後出血とした．後出血は8例（7.2％，胃6例，大腸2例）で認め，そのうち，4例（胃3例，大腸1例）が抗血栓薬を内服しており，抗血栓薬内服群のうち16.7％（4/24）にまでおよんだ．逆に抗血栓薬非内服群での後出血は0.04％（4/87）に留まっていた．また，抗血栓薬内服群での後出血は術後9日目以降に発症したのに対し，非内服群での後出血は術後2日目以内に発症した．ESD後フォローアップ内視鏡は，後出血改善につながらないという報告がある一方，抗血栓内服症例のフォローアップ内視鏡の有用性の報告もあり，一定のコンセンサスはない．当院での検討では抗血栓薬非内服群での後出血が術後2日目以内に発症しており，抗血栓薬内服の有無に関わらずフォローアップ内視鏡は術後早期に施行する必要があると考えられた．若干の文献的考察を加え報告する．
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  • カプセル内視鏡による十二指腸から腫瘍病変までの推定距離の検討
    前田 光德, 平石 秀幸
    2016 年 88 巻 1 号 p. 50-54
    発行日: 2016/06/11
    公開日: 2016/07/01
    DOIhttps://doi.org/10.11641/pde.88.1_50
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    【背景】カプセル内視鏡検査（CE）で認めた病変が，ダブルバルーン内視鏡検査（DBE）で検出できないことがしばしばある．DBE前に病変までの距離を推測できれば検出率は向上するが，そういう報告は調べた限りない．【目的】CEによる病変までの推定距離がDBEで測定した病変までの距離と比較検討を行った．【対象と方法】対象は，CE，DBEの両デバイスで腫瘍を確認,距離を測定した15例とした．RAPID Access 6.5（8.0）softwareによるCEの推定位置を表す％表示（8.0では小腸画像表示進歩率＝P）を用いた推定距離をPD（cm）＝P×小腸長，同様にCEの通過時間を表す％時間（小腸通過時間率＝T）による推定距離をTD（cm）＝T×小腸長とし，DBEでの測定値（＝DBE）と比較検討した．P，Tはカプセル内視鏡レポートに記載された数値を使用し，小腸長はTD，PDとDBEの決定係数が最も高値であった9mとした．【結果】TD，PD，DBEの平均値は，各々298.1±266.9，345.0±309.4，378.1±346.8cmであり，有意差を認めなかった（P＝0.777）．またTDとDBE，PDとDBEの相関係数は0.912，0.965と強い相関関係にあった（P＜0.01）．CEによる推定距離はDBE施行時の距離の目安に有用と考えられた．
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  • 遺残胆管結石の確認および除去を目的とした経口的直接胆道鏡の有用性
    路川 陽介, 中原 一有, 森田 亮, 末谷 敬吾, 伊東 文生
    2016 年 88 巻 1 号 p. 55-59
    発行日: 2016/06/11
    公開日: 2016/07/01
    DOIhttps://doi.org/10.11641/pde.88.1_55
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    【目的】遺残胆管結石の確認および残石除去目的に経口的直接胆道鏡（PDCS）を施行した症例の詳細を検証し，その成績を検討した．【方法】対象は通常の総胆管結石治療直後に，遺残結石有無の確認を目的としてPDCSを試みた14例（男女比4 : 10，平均年齢75歳）で，正常胃10例，Billroth-Ⅱ法再建（B-Ⅱ）1例，Roux-en-Y法再建（R-Y）2例，膵頭十二指腸切除術（PD）後1例であった．スコープは細径内視鏡（GIF-XP260 ; Olympus Medical）で，送気にはCO2を用いた．正常胃例およびB-Ⅱ例ではガイドワイヤー下に，R-Y例およびPD後例では小腸鏡用のオーバーチューブを通じてスコープの挿入を行った．検討項目は，胆管内挿入成功率，結石遺残率，結石除去率および除去法，偶発症発生率とした．【結果】胆管内挿入成功率は71％で，正常胃例においては60％と低率であった．結石の遺残は胆管挿入が可能であった10例中5例の50％に認めた．胆道鏡下結石除去率は，遺残結石が認められた5例中4例の80％であった．偶発症発生率は14％（軽症膵炎1，軽症胆管炎1例）であり，いずれも保存的加療のみで改善が得られた．【結語】PDCSによる遺残結石の確認および除去は，特に術後再建腸管例では有用と考える．正常胃例においては，胆管挿入率を上昇させる工夫が今後の課題と思われる．
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  • 術後胆汁瘻に対する内視鏡治療の検討
    高野 祐一, 長濵 正亞, 丸岡 直隆, 山村 詠一, 横溝 和晃, 水上 博喜, 田中 淳一, 上原 なつみ, 中西 徹, 花村 祥太郎, ...
    2016 年 88 巻 1 号 p. 60-64
    発行日: 2016/06/11
    公開日: 2016/07/01
    DOIhttps://doi.org/10.11641/pde.88.1_60
    ジャーナル フリー
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    胆汁瘻は胆汁が正常胆管外に漏出する病態で，肝胆道系手術において注意すべき合併症である．近年，内視鏡治療の有用性が報告されているが，標準的治療は確立されていない．2009年〜2015年まで当院で内視鏡治療を行った術後胆汁瘻7例を後ろ向きに検討した．平均年齢67.4歳（54〜78歳），男性 : 女性＝6 : 1，原疾患は胆石胆囊炎4例，転移性肝腫瘍3例であった．全例で内視鏡的経鼻胆管ドレナージ（endoscopic nasobiliary drainage : ENBD）が行われた．胆汁瘻の閉鎖は6/7例（86％）でみられ，ENBD留置期間は平均12日（6-19日）であった．短期合併症（膵炎・出血・穿孔）は認めなかった．長期合併症として1例に2カ月後にleak部の胆管狭窄を来し，再度の内視鏡治療（胆管ステント留置）を必要とした．内視鏡治療が不成功であった1例は，前区域枝が正常胆管と交通がない状態でleakしており（離断型胆汁瘻），胆道再建術を施行した．術後胆汁瘻に対する内視鏡治療は安全で有用な治療法である．しかし離断型胆汁瘻では内視鏡治療は困難であり，胆管造影でleakが明らかでない場合，MRCPなどを併用し適切な診断に努めるべきである．長期合併症としてleak部の狭窄に注意する必要がある．
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症例
  • 5-ASAアレルギーを伴う潰瘍性大腸炎の寛解維持に啓脾湯を投与し内視鏡的粘膜治癒を長期観察し得た2例
    渡辺 一宏, 内山 崇
    2016 年 88 巻 1 号 p. 65-68
    発行日: 2016/06/11
    公開日: 2016/07/01
    DOIhttps://doi.org/10.11641/pde.88.1_65
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    5-aminosalicylic acid（5-ASA）は潰瘍性大腸炎の第一選択薬である．その2％程度に出現する5-ASAアレルギーは，診断に苦慮するだけでなく治療の根幹を揺るがす問題となる．自験2症例では多施設での5-ASA再投与により好酸球増多症と腸炎悪化から結果的にチャレンジテスト陽性となり5-ASAアレルギーと診断した．5-ASA休薬後にステロイド静脈注射にて寛解導入後に患者の希望から啓脾湯の単独継続投与を行った．今回の潰瘍性大腸炎の啓脾湯治療は2例のみの報告であり，プラセボ効果を完全に否定できるものではないが，5年以上啓脾湯投与で長期寛解維持を観察し得た貴重な症例と思われ報告する．
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  • 卵巣癌に対する化学療法中に発症した虚血性大腸炎の1例
    菊地 翁輝, 齋藤 大祐, 池崎 修, 三井 達也, 三浦 みき, 櫻庭 彰人, 林田 真理, 徳永 健吾, 小山 元一, 森 秀明, 久松 ...
    2016 年 88 巻 1 号 p. 69-72
    発行日: 2016/06/11
    公開日: 2016/07/01
    DOIhttps://doi.org/10.11641/pde.88.1_69
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    症例は60歳代女性．卵巣癌stageⅢcの診断にてパクリタキセルとカルボプラチンの投与による化学療法（TC療法）が施行されたが，投与10日後より腹痛・下痢が出現し，投与12日後に入院となった．入院時に施行した造影CT検査では全結腸の拡張および腸液の貯留を認め，大腸内視鏡検査では横行結腸から下行結腸にかけて縦走する潰瘍性病変が散見され，虚血性大腸炎と診断した．成因としてパクリタキセルによる血流障害が疑われ，絶食および抗癌剤再投与中止により症状は改善した．発症機序として，薬剤による上皮細胞の分裂・増殖停止に伴う粘膜障害や，血管平滑筋細胞の増殖・遊走・新生内膜集積の阻害に伴う血管障害の関与が考慮されている．タキサン系抗癌剤を含む化学療法の導入後に出現した腹部症状においては，虚血性大腸炎の発症に留意し診断を行う必要がある．
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経験
  • 小腸腫瘍に対する腹腔鏡手術の経験
    長尾 さやか, 斉田 芳久, 榎本 俊行, 竹下 惠美子, 高林 一浩, 片田 夏也, 渡邉 良平, 永岡 康史, 新妻 徹, 森山 穂高, ...
    2016 年 88 巻 1 号 p. 73-77
    発行日: 2016/06/11
    公開日: 2016/07/01
    DOIhttps://doi.org/10.11641/pde.88.1_73
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    過去10年間に当科で手術を施行した小腸腫瘍は15例，そのうち悪性疾患は10例，良性疾患は5例であった．すべての症例が有症状，術前に診断がついた症例は11例であった．良性疾患は全例術前診断がつき，腹腔鏡手術を完遂した．近年の画像診断の進歩により従来発見が困難であった小腸腫瘍の診断が可能となっている．小腸は可動性に富む臓器であり局在診断がついていれば比較的容易に鏡視下手術が施行できる．悪性疾患は6例が小腸癌，2例が悪性リンパ腫，1例が平滑筋肉腫，1例がGISTであった．9例に開腹手術，小腸癌の1例に腹腔鏡手術を施行した．進行して発見された小腸悪性疾患の予後は悪く早期発見が課題であると考える．
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臨床研究
  • 膵神経内分泌腫瘍の悪性度診断におけるEUSの有用性の検討
    渡辺 真郁, 奥脇 興介, 木田 光広, 山内 浩史, 宮澤 志朗, 岩井 知久, 今泉 弘, 小泉 和三郎
    2016 年 88 巻 1 号 p. 78-79
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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症例
  • 上部消化管内視鏡検査におけるNikolsky現象から診断に至った尋常性天疱瘡の1例
    由良 昌大, 中村 理恵子, 高橋 常浩, 和田 則仁, 川久保 博文, 竹内 裕也, 亀山 香織, 大森 泰, 門馬 久美子, 北川 雄光
    2016 年 88 巻 1 号 p. 80-81
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 特殊な食道再建法により多様な胸部症状を呈した1例
    小熊 一豪, 久保 定徳, 野津 史彦, 白石 廣照, 矢野 剛司, 相原 成昭, 福田 充, 松川 正明, 熊谷 一秀
    2016 年 88 巻 1 号 p. 82-83
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 食道狭窄拡張術にステロイド局所注入療法併用が有用であった静脈瘤治療後の1例
    亀崎 秀宏, 大山 広, 齊藤 将喜, 石原 武
    2016 年 88 巻 1 号 p. 84-85
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 内視鏡切除後に縦隔リンパ節転移を来した早期食道癌の1例
    小山 洋平, 西中川 秀太, 小嶋 啓之, 吉峰 尚幸, 武田 悠希, 植木 紳夫, 伊藤 謙, 平野 直樹, 大場 信之, 児島 辰也
    2016 年 88 巻 1 号 p. 86-87
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 診断に苦慮した成人胃重複症の1例
    水谷 勝, 入口 陽介, 小田 丈二, 山里 哲郎, 山村 彰彦
    2016 年 88 巻 1 号 p. 88-89
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 有茎性発育を呈した胃Hamartomatous inverted polypの2例
    高城 秀幸, 鈴木 拓人, 南金山 理乃, 稲垣 千晶, 今関 洋, 喜多 絵美里, 北川 善康, 須藤 研太郎, 中村 和貴, 原 太郎, ...
    2016 年 88 巻 1 号 p. 90-91
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 幽門側胃切除術後に合併した腹腔内膿瘍に対して超音波内視鏡下経胃的ドレナージ術が奏功した2例
    安藤 勝祥, 田邊 裕貴, 須藤 大輔, 太田 勝久, 一石 英一郎, 佐藤 貴一, 大竹 孝明, 大平 寛典, 鈴木 裕, 高後 裕
    2016 年 88 巻 1 号 p. 92-93
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 胃噴門部および穹隆部の粘膜下腫瘍に対するLECS手技の工夫
    渡邊 良平, 片田 夏也, 永岡 康志, 中村 陽一, 高林 一浩, 長尾 さやか, 竹下 惠美子, 榎本 俊行, 斉田 芳久, 草地 信也 ...
    2016 年 88 巻 1 号 p. 94-95
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 術前補助療法で縮小し完全切除しえた胃GISTの1例
    西元 史哉, 東畑 美幸子, 佐藤 知己, 庄司 達弘, 宮地 孟, 細川 恭佑, 増田 勇毅, 嘉悦 勉
    2016 年 88 巻 1 号 p. 96-97
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • H.pylori除菌により形態変化がみられた早期胃癌の1例
    池上 友梨佳, 矢田 智之, 伊藤 光一, 上村 直実
    2016 年 88 巻 1 号 p. 98-99
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • NBI併用拡大内視鏡で診断できた胃過形成性ポリープ由来の早期胃癌の1例
    山口 和久, 山本 頼正, 堀内 祐介, 大前 雅実, 石山 晃世志, 平澤 俊明, 由雄 敏之, 土田 知宏, 藤崎 順子, 五十嵐 正広
    2016 年 88 巻 1 号 p. 100-101
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 完全内臓逆位症に併発した早期残胃癌に対してESDを行った1例
    森山 友章, 長主 直子, 加藤 一郎, 高力 俊策
    2016 年 88 巻 1 号 p. 102-103
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 十二指腸に嵌頓し貧血の原因となった胃Inflammatory fibroid polypの1例
    高雄 暁成, 藤原 崇, 矢島 和人, 柴田 理美, 千葉 和朗, 田畑 拓久, 来間 佐和子, 桑田 剛, 大西 知子, 藤原 純子, 荒 ...
    2016 年 88 巻 1 号 p. 104-105
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 十二指腸粘膜下腫瘍との鑑別が困難であったGastric mucosal prolapse polypの1例
    水谷 洋佑, 中野 雅, 梅田 智子, 豊永 貴彦, 斎藤 詠子, 小林 拓, 樋口 肇, 常松 令, 芹澤 宏, 渡辺 憲明, 土本 寛二 ...
    2016 年 88 巻 1 号 p. 106-107
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 腸石嵌頓性十二指腸憩室炎に対し内視鏡的腸石除去術にて治療し得た1例
    勝呂 麻弥, 山本 圭, 深澤 友里, 田邊 秀聡, 班目 明, 竹内 眞美, 田部井 弘一, 森安 史典
    2016 年 88 巻 1 号 p. 108-109
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 内視鏡的粘膜下層剥離術を施行した十二指腸脂肪腫の1例
    金森 瑛, 中野 正和, 岩崎 茉莉, 紀 仁, 金子 仁人, 土田 知恵子, 土田 幸平, 吉竹 直人, 富永 圭一, 笹井 貴子, 山岸 ...
    2016 年 88 巻 1 号 p. 110-111
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 十二指腸憩室出血を先端フード装着直視内視鏡で止血し得た1例
    小野寺 翔, 小川 正純, 草柳 聡, 中崎 奈都子, 嘉戸 慎一, 金子 麗奈, 佐藤 譲
    2016 年 88 巻 1 号 p. 112-113
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 腹部症状が先行した成人Henoch-schönlein紫斑病の1例
    中崎 奈都子, 小野寺 翔, 嘉戸 慎一, 金子 麗奈, 金 民日, 草柳 聡, 小川 正純, 佐藤 譲
    2016 年 88 巻 1 号 p. 114-115
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 十二指腸球部のmuco-submucosal elongated polypを内視鏡的に切除した1例
    加嶋 洋子, 栗原 直人, 竹内 優志, 佐々木 康祐, 遠藤 翔, 高木 めぐみ, 木村 裕子, 松田 英士, 森 一世, 市原 明子, ...
    2016 年 88 巻 1 号 p. 116-117
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 閉塞症状を呈しESDにて切除した十二指腸巨大Brunner腺腫の1例
    落合 彩子, 東納 重隆, 深澤 弘行, 村木 洋介, 道田 知樹
    2016 年 88 巻 1 号 p. 118-119
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 胆石性胆管炎を契機に診断された十二指腸乳頭部腺腫の1例
    石井 剛弘, 宮谷 博幸, 中島 嘉之, 眞嶋 浩聡
    2016 年 88 巻 1 号 p. 120-121
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 原発性十二指腸球部粘膜内癌の1例
    古谷 建悟, 加藤 知爾, 北村 和貴子, 大久保 政雄, 小林 克也, 関川 憲一郎, 光井 洋, 山口 肇, 橋本 直明, 岸田 由起子 ...
    2016 年 88 巻 1 号 p. 122-123
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • EUS-FNAが診断に有用であった十二指腸癌の1例
    馬越 智子, 岡野 直樹, 岸本 有為, 松井 哲平, 五十嵐 良典, 吉田 公彦, 前田 徹也, 大塚 由一郎, 小林 純子, 栃木 直文 ...
    2016 年 88 巻 1 号 p. 124-125
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • リンパ節転移を伴った回腸NETの1例
    佐藤 平, 鎮西 亮, 大津 威一郎, 土井 浩達, 高橋 正憲, 笹島 圭太
    2016 年 88 巻 1 号 p. 126-127
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 貧血が契機となり発見された空腸海綿状血管腫の1例
    宮内 倫沙, 富永 健司, 三枝 善伯, 森 麻紀子, 吉田 有輝, 牧野 敏之, 高橋 厚子, 日原 大輔, 長尾 さやか, 榎本 俊行, ...
    2016 年 88 巻 1 号 p. 128-129
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 消化管出血を契機にカプセル内視鏡・バルーン小腸内視鏡で診断された小腸GISTの1例
    藤井 徹朗, 宇野 昭毅, 有間 修平, 小松 まゆみ, 堤 菜津子, 三浦 隆生, 藤川 博敏, 桂 義久, 窪田 賢輔, 中島 淳, 松 ...
    2016 年 88 巻 1 号 p. 130-131
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 高度貧血で発見された悪性黒色腫の胃小腸転移の1例
    青柳 龍太郎, 山岡 稔, 大庫 秀樹, 芦谷 啓吾, 市村 隆也, 山田 健人, 中村 光彦, 寺本 由紀子, 橋本 正良, 宮川 義隆, ...
    2016 年 88 巻 1 号 p. 132-133
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 内視鏡的切除により診断が得られた脂肪腫の1例
    有馬 功, 山形 寿文, 幡地 正輝, 中山 沙映, 諸井 厚樹, 小松 和人
    2016 年 88 巻 1 号 p. 134-135
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 潰瘍性大腸炎非典型例と鑑別を要したDiverticular colitisの1例
    草野 昌男, 駒沢 大輔, 伊藤 広通, 土佐 正規, 池田 智之, 高橋 成一, 池谷 伸一, 中山 晴夫, 樋渡 信夫
    2016 年 88 巻 1 号 p. 136-137
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • サイトメガロウイルス腸炎の発症を契機に診断しえた重症潰瘍性大腸炎の1例
    深澤 友里, 田部井 弘一, 勝呂 麻弥, 班目 明, 田邉 秀聡, 竹内 眞美, 山本 圭, 二階堂 孝
    2016 年 88 巻 1 号 p. 138-139
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 自然寛解後に再燃したcollagenous colitisの1例
    財部 紗基子, 岸川 浩, 荒畑 恭子, 伊藤 麻子, 木村 佳代子, 貝田 将郷, 西田 次郎
    2016 年 88 巻 1 号 p. 140-141
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • S状結腸憩室穿孔・腹腔内膿瘍に対して内視鏡治療を施行した1例
    高木 将, 小串 勝昭, 中尾 聡, 濱中 潤, 岡 裕之, 岡崎 博
    2016 年 88 巻 1 号 p. 142-143
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 大腸巨大憩室から脱落した腸石性腸閉塞を内視鏡的に治療し得た1例
    谷田貝 昂, 村上 敬, 坂本 直人, 廣本 貴史, 立之 英明, 上山 浩也, 石川 大, 浅岡 大介, 澁谷 智義, 長田 太郎, 渡辺 ...
    2016 年 88 巻 1 号 p. 144-145
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 内視鏡的整復により回復した腸管囊腫様気腫症による成人腸重積の1例
    オスタペンコ バレンチナ, 寺井 潔, 横山 潔, 竹本 安宏, 小沢 正幸
    2016 年 88 巻 1 号 p. 146-147
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 術前診断し得た6mm大の大腸SM浸潤癌
    松尾 海, 浦上 尚之, 小城原 傑, 磯﨑 正典, 阿曽沼 邦央, 保母 貴宏, 有馬 秀英, 野津 史彦, 横山 登, 熊谷 一秀, 松 ...
    2016 年 88 巻 1 号 p. 148-149
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 内視鏡治療後1年で局所再発した直腸SM癌の1例
    市川 亮介, 茂木 俊介, 牧野 有里香, 盧 尚志, 高橋 里奈, 丹羽 浩一郎, 石山 隼, 神山 博彦, 小見山 博光, 高橋 玄, ...
    2016 年 88 巻 1 号 p. 150-151
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 自然退縮した上行結腸癌の1例
    伊藤 翔子, 小林 修, 太田 一樹, 小島 拓人, 橋本 周太郎, 三好 由里子, 渡辺 大地, 黒田 博之, 澁谷 智義, 坂本 直人, ...
    2016 年 88 巻 1 号 p. 152-153
    発行日: 2016/06/11
    公開日: 2016/07/01
    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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  • 子宮体部未分化癌の大腸血管浸潤が原因であった虚血性腸炎の1例
    牧野 曉嗣, 栗原 直人, 筒井 りな, 市原 明子, 松浦 芳文, 井上 聡, 知念 克也, 飯田 修平
    2016 年 88 巻 1 号 p. 154-155
    発行日: 2016/06/11
    公開日: 2016/07/01
    DOIhttps://doi.org/10.11641/pde.88.1_154
    ジャーナル フリー
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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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  • バルーン拡張の反復で解除しえたS状結腸癌術後吻合部狭窄の1例
    鈴木 雄一朗, 永山 和宜, 川井 麻央, 安田 圭吾, 渡辺 翔, 金城 美幸, 池宮城 秀和, 吉野 耕平, 先田 信哉, 有村 明彦
    2016 年 88 巻 1 号 p. 156-157
    発行日: 2016/06/11
    公開日: 2016/07/01
    DOIhttps://doi.org/10.11641/pde.88.1_156
    ジャーナル フリー
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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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  • 大腸海綿状血管腫を合併した内痔核に対して内視鏡下ALTA療法を施行した1例
    青木 順, 塚本 亮一, 市川 亮介, 呉 一眞, 本庄 薫平, 岡澤 裕, 水越 幸輔, 河野 眞吾, 宗像 慎也, 嵩原 一裕, 河合 ...
    2016 年 88 巻 1 号 p. 158-159
    発行日: 2016/06/11
    公開日: 2016/07/01
    DOIhttps://doi.org/10.11641/pde.88.1_158
    ジャーナル フリー
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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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