Progress of Digestive Endoscopy
Online ISSN : 2187-4999
Print ISSN : 1348-9844
ISSN-L : 1348-9844
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Showing 1-46 articles out of 46 articles from the selected issue
  • Tsutomu Takeda, Daisuke Asaoka, Hisanori Utsunomiya, Shotaro Oki, Nobu ...
    2021 Volume 98 Issue 1 Pages 24-28
    Published: June 25, 2021
    Released: July 10, 2021
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    Background: To investigate the association between abdominal symptoms and redness in Linked Color Imaging (LCI) in patients without Helicobacter pylori infection. Methods: Consecutive patients without H. pylori who underwent esophagogastroduodenoscopy using LCI between April 2017 and December 2019 with a patient's profile and symptom questionnaire (Izumo scale, Frequency Scale for Symptoms of Gastroesophageal Reflux Disease [FSSG] score) were selected retrospectively. The association between abdominal symptoms and redness for LCI was analyzed. Results: In total 168 study participants were included, of which 12.5% showed gastric body redness. Gastric body redness in LCI showed significantly higher functional dyspepsia (FD) and FSSG scores (p<0.05). Conclusion: FD score and abdominal symptoms were associated with gastric body redness in LCI of patients without H. pylori infection.

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  • Atsushi Sawada, Kingo Hirasawa, Yuichiro Ozeki, Ryosuke Ikeda, Masafum ...
    2021 Volume 98 Issue 1 Pages 29-33
    Published: June 25, 2021
    Released: July 10, 2021
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    Background: Endoscopic hemostasis for hemorrhagic duodenal ulcer (HDU) is useful, however, some cases still have been difficult due to rebleeding.

    Aim: We investigated treatment outcomes of HDU patients and supposed the optimal management.

    Methods: Sixty-five patients underwent endoscopic hemostasis for HDU were involved between January 2012 and February 2020. We retrospectively analyzed the risk factors for rebleeding and the usefulness of Glasgow-Blatchford Score (GBS) and AIMS65.

    Results: In the refractory group, active bleeding (Forrest classification: Ia or Ib) (82% vs 38%, p<0.001), the proportion of hemodialysis (55 vs 7%, p<0.001), ischemic heart disease (63 vs 18%, p=0.005) and antithrombotic agent (55 vs 28%) were significant. The GBS and AIMS65 score of the refractory group were significantly higher (15.1/11.1, p=0.03), (2.27/1.66, p=0.03). Delayed perforation due to excessive forceps coagulation only occurred in two patients in the refractory group.

    Conclusion: In patients with HDU who had high score by the GBS and AIMS65, we should consider surgical treatment and alternative treatment, such as polyglycolic acid shielding and the over-the-scope clip system at an early stage.

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  • Masanari Sekine, Hirosato Mashima
    2021 Volume 98 Issue 1 Pages 34-38
    Published: June 25, 2021
    Released: July 10, 2021
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    Pancreatobiliary cancer often causes plexus invasion, so diagnosing perivascular invasion is important for deciding the treatment indication. Endoscopic ultrasound (EUS) clearly demonstrates low echoic areas with high spatial resolution, and specimens can be collected via EUS-fine-needle aspiration (FNA) to differentiate benign and malignant lesions. The present study examined the usefulness of EUS-FNA for diagnosing plexus invasion. Twenty-one EUS-FNA procedures in 19 patients diagnosed with perivascular invasion by multi-detector-row computed tomography were selected for our study. The primary lesions were pancreatic cancer in 14 cases, cholangiocarcinoma in 3 cases, gallbladder cancer in 1 case, and residual pancreatic cancer in 1 case. The target puncture sites were low echoic areas around the common hepatic artery in 9 cases, celiac artery in 5 cases, superior mesenteric artery in 3 cases, splenic artery in 2 cases, proper hepatic artery in 1 case, and right hepatic artery in 1 case. The accuracy of diagnosing plexus invasion with EUS-FNA was 76.2% (16/21), and 5 cases failed to reach the diagnosis. The only adverse event was gastrointestinal bleeding in one case. Accurately diagnosing plexus invasion is important, as it is often associated with therapeutic strategies, such as surgical indications and post-chemotherapy evaluations.

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  • Toyotaka Kasai, Koichi Kawabe, Shingo Sato, Hiroyuki Eto, Taro Ogino, ...
    2021 Volume 98 Issue 1 Pages 39-41
    Published: June 25, 2021
    Released: July 10, 2021
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    Observation of the horizontal part of the duodenum by upper gastrointestinal endoscopy is not routinely performed due to the physical burden to patients. Determining in which patients observation of the horizontal part of the duodenum by upper gastrointestinal endoscopy should be attempted remains a challenge. We actively observe the horizontal part of the duodenum by upper gastrointestinal endoscopy in cases in which balloon-assisted endoscopy is considered. We report two patients in whom the horizontal part of the duodenum could be observed by upper gastrointestinal endoscopy combined with manual compression of the umbilical region.

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  • Yoshiaki Kimoto, Yohei Minato, Rin Inamoto, Marie Kurebayashi, Shunya ...
    2021 Volume 98 Issue 1 Pages 42-44
    Published: June 25, 2021
    Released: July 10, 2021
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    In this study, we investigated Clear-Through® (Kewpie, Tokyo) with increased volume type.

    50 patients each were enrolled in group A (Clear-Through® with increased volume type), group B (Clear-Through® with normal type) and group C (no test diet). Quality of colon cleansing in each colon was higher in both groups A and B than in group C. The quality was significantly higher (p<0.05), but there was no difference between the A/B groups. On the other hand, in the A/B group, 70/62% of patients reported that each diet tasted "good" and 76/46% of patients reported that the amount of each diet was "moderate".

    Clear-Through® with increased volume type could have higher patient acceptance while maintaining colon cleansing.

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Case report
  • Kanae Metoki, Takashi Fujii, Yuki Morita, Yoshihiro Tashiro, Eiko Okam ...
    2021 Volume 98 Issue 1 Pages 45-47
    Published: June 25, 2021
    Released: July 10, 2021
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    A 78-year-old man underwent esophagogastroduodenoscopy which revealed a subcircumferential 0-IIb lesion in the cervical to thoracic esophagus. On NBI magnified observation, the invasion depth was EP/LPM. Biopsy examination revealed carcinoma in situ, and endoscopic submucosal dissection (ESD) was performed. Considering that the risk of postoperative stenosis was high, as preventive measures, local steroid injection (160 mg) was administered, and prednisolone (PSL) 30 mg/day was started on the day after ESD for 8 weeks. Because postoperative stenosis was observed on the 63rd day after ESD, endoscopic balloon dilatation was performed and PSL at 30 mg/day was again administered orally for 8 weeks. The stenosis resolved without any obstruction. Currently, there is no established method for preventing stenosis after esophageal ESD, and it is necessary to accumulate more cases in the future.

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  • Hideki Nagumo, Mitsuko Inuyama, Motofumi Ueda, Keita Soejima, Shinya O ...
    2021 Volume 98 Issue 1 Pages 48-50
    Published: June 25, 2021
    Released: July 10, 2021
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    In May 202X, a 29-year-old man was transported by ambulance to his previous doctor with a complaint of black stool and chest pain. The patient was transferred to our hospital after chest computed tomography revealed mediastinal emphysema and esophagogastroduodenoscopy revealed a hemorrhagic duodenal ulcer. A hemoglobin level of 6.2 g/dL indicated anemia. The duodenal ulcer was clipped on endoscopy to achieve hemostasis. Mallory-Weiss tears with signs of healing were observed, without any visible vessels or perforations. Thereafter, a blood transfusion was required due to worsening anemia, and endoscopy was repeated. The Mallory-Weiss tears had worsened, and visible vessels were observed. These were sutured using the clip method. Following that, the patient's condition improved. Mediastinal emphysema also disappeared and he was discharged from the hospital. Increased alveolar and intra-abdominal pressures from abdominal muscle training using a medicine ball may have contributed to the onset of the disease.

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  • Shunsuke Imamura, Kenji Nakamura, Sakiko Takarabe, Kyoko Arahata, Tada ...
    2021 Volume 98 Issue 1 Pages 51-53
    Published: June 25, 2021
    Released: July 10, 2021
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    We present a case of mediastinal diffuse large B-cell lymphoma (DLBCL) diagnosed using EUS-FNA. An 85-year-old man with a history of surgery for hepatocellular carcinoma (HCC) and chemotherapy for prostate carcinoma underwent regular follow-up for HCC using contrast CT. CT revealed a contrasted mass with an irregular marginal outline and a clear border, located mainly in the superior mediastinum. The lesion had increased from 1.7-cm to 5-cm. PET-CT showed high standardized uptake value, suggesting a malignant tumor. EUS-FNA using a 19-gauge needle was performed to obtain the pathological evidence. EUS could not visualize the lesion clearly in the left-lateral position. However, after turning the position from lateral to prone, EUS visualized the lesion closely and clearly. The pathological diagnosis of DLBCL was made.

    Postural change may be a simple alternative technique for mediastinal lesions where transesophageal puncture is difficult.

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  • Chie Kawanishi, Kuniyo Gomi, Erika Yoshida, Yorimasa Yamamoto, Takashi ...
    2021 Volume 98 Issue 1 Pages 54-57
    Published: June 25, 2021
    Released: July 10, 2021
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    Endoscopic submucosal dissection was performed to treat a 68-year-old man who was diagnosed with cervical esophageal adenocarcinoma. Pathological examination revealed a cervical esophageal adenocarcinoma Ce, left wall to posterior wall side 2/3 circumference, 35 mm, 0-IIb+I type, adenocarcinoma (pap>tub1), pT1a-LPM, INFb, Ly0, V0, pHM0, pVM0, cN0, cM0, and stage 0, which was judged as curative resection.

    This tumor was considered to be an esophageal adenocarcinoma originating from the ectopic gastric mucosa, because it was contiguous with it and showed mucinous traits with gastric type predominance. With early detection, esophageal adenocarcinomas originating from the ectopic gastric mucosa may be curable by endoscopic treatment. The cervical esophagus is prone to inadequate observation, and careful observation is necessary not only during insertion, but also during endoscope removal.

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  • Kei Nakajima, Yuichi Morohoshi, Takaoki Hayakawa, Hisakuni Tomonari, T ...
    2021 Volume 98 Issue 1 Pages 58-60
    Published: June 25, 2021
    Released: July 10, 2021
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    An 89-year-old woman with scoliosis and kyphosis was admitted to our hospital for morning dyspnea. Computed tomography showed compression of the right bronchus by a dilated esophagus and right-sided aortic arch. Non-sustained ventricular tachycardia (NSVT) occurred suddenly and spontaneously resolved. Endoscopic examination revealed esophageal stenosis in two sites. The symptom improved by dietary and posture counseling.

    The dilated esophagus compressed the bronchus and heart, eventually causing dyspnea and NSVT. It is established that scoliosis and kyphosis occasionally cause a fatal condition due to dilation of the gastrointestinal tract; however, esophageal dilation is rarely reported.

    The right-sided descending aorta may be one of the reasons of the esophageal stenosis. Our report suggests deformity of the spine or aorta could result in esophageal stenosis and lead to airway constriction and arrhythmia.

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  • Jumpei Ikeda, Hirofumi Kawakubo, Hiroki Ozawa, Satoru Matsuda, Shuhei ...
    2021 Volume 98 Issue 1 Pages 61-63
    Published: June 25, 2021
    Released: July 10, 2021
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    A woman in her 70s referred to a clinic with neck discomfort manifesting one day after ingesting a soft-shelled-turtle. Laryngoscopy was performed and the findings were negative for esophageal foreign body impaction. Four days later, the patient visited another clinic due to worsening neck pain.

    Computed tomography imaging was suggestive for foreign body impaction in the cervical esophagus and the patient was then transferred to our hospital. With the suspicion of cervical esophagus perforation and paraesophageal abscess formation, emergency endoscopy was performed to remove the foreign body. Endoscopy findings revealed a 3 cm-long bone penetrating both sides of the esophageal wall, which was then removed. After the procedure, the patient was managed with nil-per-os and was treated with antibiotics. The treatment was continued for a total of seven days. Follow-up endoscopy demonstrated the epithelialization of the perforation site. The patient was discharged on the twelfth day after the first procedure. Although esophageal perforation due to a soft-shelled-turtle ingestion is relatively rare, the awareness of the physician is important for quick and efficient treatment.

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  • Yoshinori Hiroshima, Daisuke Suganuma
    2021 Volume 98 Issue 1 Pages 64-65
    Published: June 25, 2021
    Released: July 10, 2021
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    A male patient in his 80s was refferd to our hospital because of epigastralgia. Contrast-enhanced computed tomography revealed that the stomach was extended and rotated on the short axis. We performed reduction of gastric volvulus by using endoscopy, and we were able to avoid surgical teatment. After discharge, there has been no recurrence of gastric volvulus.

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  • Hisashi Matsumoto, Yoshikazu Tsuzuki, Kazuya Miyaguchi, Keigo Ashitani ...
    2021 Volume 98 Issue 1 Pages 66-68
    Published: June 25, 2021
    Released: July 10, 2021
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    A 60-year-old man was admitted to our hospital because of gastric submucosal tumor on upper gastrointestinal endoscopy. He was successfully treated for Helicobacter pylori infection at 57 years old. Contrast CT revealed a mass in the gastric body without metastasis to the lymph nodes nor other organs. EGD showed a submucosal tumor with depressed area on the top in the greater curvature of gastric lower body about 2 cm in diameter. Ultrasound endoscopy showed a uniform hypoechoic mass in the third layer. Biopsy specimens revealed no atypical cells but lymphocyte infiltration. Endoscopic submucosal dissection was performed for the purpose of diagnostic treatment. Pathological findings showed the tumor covered by the normal mucosa was mainly located in the submucosal layer. Poorly differentiated adenocarcinoma was observed with B cell-based lymphocyte infiltration. Immunohistochemical staining showed that the tumor cells were positive for EBER. The horizontal and vertical margin were negative with no lymphovascular infiltration. He underwent additional laparoscopic distal gastrectomy with no residual tumor or lymph node metastasis. Here, we report a case of EBV-associated early gastric carcinoma with lymphoid stoma diagnosed by ESD.

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  • Kenta Machida, Hiroshi Shinozaki, Yusuke Kawamura, Suguru Yamamoto, Me ...
    2021 Volume 98 Issue 1 Pages 69-71
    Published: June 25, 2021
    Released: July 10, 2021
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    This paper discusses two cases of collagenous gastritis. The patient in Case 1 was an 18-year-old male referred to our hospital for the investigation of iron-deficiency anemia. Endoscopic examination revealed a granular mucosa and island-like nodule in the gastric body. The pathological examination of the depressed mucosa revealed a thickened subepithelial collagen band, and collagenous gastritis was diagnosed. The patient in Case 2, a 14-year-old boy diagnosed with gastric polyposis at the age of 10 years, was referred to our pediatric surgery department to investigate iron-deficiency anemia. An endoscopic examination revealed granular mucosa and island-like nodule in the gastric antrum and body. Pathological examination of the depressed mucosa revealed a thickened subepithelial collagen band, and collagenous gastritis was diagnosed.

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  • Hiroyuki Eto, Moriyasu Nakahara, Toyotaka Kasai, Taro Ogino, Seiji Mur ...
    2021 Volume 98 Issue 1 Pages 72-74
    Published: June 25, 2021
    Released: July 10, 2021
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    A woman in her 80s underwent placement of a self-expandable metal stent (SEMS) for malignant gastric outlet obstruction due to advanced gastric cancer. A fracture in the SEMS was observed by esophagogastroduodenoscopy and abdominal radiograph 98 days after SEMS placement, and a second SEMS was placed. She died of the primary disease 117 days after placement of the initial SEMS. Fracture of a SEMS is a relatively rare event that occurs in 0.5-0.6% of cases. Previously, it was thought to be caused by a fault in the manufacturing process or deterioration over time. In our case, when fracture of the SEMS was found, Virchow lymph node metastasis and peritoneal dissemination were also observed. External physical force due to progression of the primary lesion may cause fracture of SEMS.

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  • Momoko Yamamoto, Kohei Matsumoto, Hisanori Utsunomiya, Daiki Abe, Atsu ...
    2021 Volume 98 Issue 1 Pages 75-77
    Published: June 25, 2021
    Released: July 10, 2021
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    An 80-year-old woman with a past history of Helicobacter pylori eradication underwent esophagogastroduodenoscopy for screening. A whitish-elevated lesion with submucosal tumor-like shape, 15 mm in size, was detected on the upper third of the stomach. A reddish depressed area was observed in the central part of the lesion. Magnifying endoscopy with narrow-band imaging (M-NBI) revealed an irregular microvascular/ microsurface pattern with a demarcation line in the reddish depressed area, and a regular microvascular/ microsurface (circular marginal crypt epithelium, dilatation of the intervening part) pattern without a demarcation line in the whitish elevated area. The pathological diagnosis of the ESD specimen was gastric adenocarcinoma of fundic-gland mucosa type (GA-FGM), pT1b/SM1 (50 μm). M-NBI may be useful for preoperative diagnosis of GA-FGM.

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  • Jun Noda, Yorimasa Yamamoto, Naoki Miyao, Fumitake Jono, Yuichi Takano ...
    2021 Volume 98 Issue 1 Pages 78-80
    Published: June 25, 2021
    Released: July 10, 2021
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    Case 1 : As part of a regular examination, a 38-year-old woman underwent an endoscopy. An upper gastrointestinal endoscopy revealed a 5-mm, whitish elevated lesion in the upper gastric body. Endoscopic findings revealed a suspected fundic gland gastric adenocarcinoma, and an endoscopic mucosal resection, with a cap-fitted panendoscope (EMR-C) was performed. Pathological examination confirmed gastric adenocarcinoma of the fundic gland.

    Case 2 : For a regular follow-up, an 81-year-old man underwent an endoscopy. Upper gastrointestinal endoscopy showed a 5-mm, reddish elevated lesion in the middle of the gastric body.

    A fundic gland gastric adenocarcinoma was suspected and an endoscopic submucosal dissection (ESD) was performed. Pathological examination indicated gastric adenocarcinoma of fundic gland mucosa. In cases of fundic mucosal gastric cancer, malignancy potential is high ; therefore, the need for additional treatment should be determined by careful consideration of the pathological findings.

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  • Masahiro Yamanaka, Yurika Ikegami, Tomoyuki Yada, Haruka Ito, Ryo Wata ...
    2021 Volume 98 Issue 1 Pages 81-82
    Published: June 25, 2021
    Released: July 10, 2021
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    Reports of H. pylori (HP) -uninfected gastric cancer have been increasing recently, but the number of HP-uninfected advanced gastric cancers remains small. Here we describe a case of HP-uninfected poorly differentiated advanced gastric cancer.

    A 71-year-old woman presented with black stool. Gastroscopy (GS) revealed a type 0-IIc+III lesion on the posterior wall of the lower gastric body approximately 60 mm in size with non-atrophic background mucosa. We performed laparoscopy-assisted distal gastrectomy. The surgical specimen revealed a tumor spreading wider in the submucosal layer than the gross tumor range. The horizontal margin was positive. The final diagnosis after additional gastrectomy was poorly differentiated adenocarcinoma, Type3, pT4a (SE), INFc, Ly0, V0, pN3b, pPM0, pDM0, pStageIIIC (pT4aN3bM0). Physicians performing a GS should be aware that gastric cancer in an HP-uninfected patient could be advanced.

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  • Madoka Ikeda, Fumihiko Nozu, Yumi Otoyama, Toshihiro Noguchi, Atsushi ...
    2021 Volume 98 Issue 1 Pages 83-84
    Published: June 25, 2021
    Released: July 10, 2021
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    A man in his 60s came to our hospital with reduced sensation of his right extremities, as well as a disordered sense of taste, and appetite loss. A red smooth tongue was observed that suggested Hunter's glossitis. Laboratory data revealed macrocytic anemia with vitamin B12 deficiency and hypergastrinemia. Parietal cell antibody and intrinsic factor antibody were positive. Helicobacter pylori IgG antibody was negative. Endoscopic findings showed atrophic change of the fundus and corpus. Endocrine cell micronests were identified by immunohistochemical staining. From these findings, he was diagnosed with autoimmune gastritis with pernicious anemia. Oral vitamin B12 1500 μg daily was effective for the physical findings and anemia. Because autoimmune gastritis is a risk factor for gastric cancer and neuroendocrine tumor, periodical endoscopic surveillance should be performed.

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  • Kento Inada, Hiroyuki Nakanishi, Sakura Kirino, Koji Yamashita, Leona ...
    2021 Volume 98 Issue 1 Pages 85-87
    Published: June 25, 2021
    Released: July 10, 2021
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    Dilated (D-) vessels identified by magnifying endoscopy with narrow-band imaging (M-NBI) may be useful for predicting submucosal invasion of early gastric cancer. Here, we report two typical patients. Case 1 : An 82-year-old man admitted with a 10 mm early gastric cancer in the middle of the gastric body. M-NBI revealed D-vessels in the anal side of the lesion. Case 2 : A 68-year-old man admitted for treatment of a 25 mm early gastric cancer in the cardia. M-NBI revealed a D-vessel on the raised area of the depressed lesion. In both cases, endoscopic submucosal dissection (ESD) was performed. The pathological diagnosis was adenocarcinoma of the stomach with minimal submucosal invasion (SM1).

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  • Hiroaki Matsumoto, Hanako Shishido, Ryohei Kobayashi, Yumi Nakamura, K ...
    2021 Volume 98 Issue 1 Pages 88-90
    Published: June 25, 2021
    Released: July 10, 2021
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    Gastric lipomas, one of the benign gastric submucosal tumors, rarely require therapeutic intervention. We report two cases of surgically treated gastric lipoma with hemorrhage. Case 1 presented with tarry stool. Emergency endoscopy was performed and hemostatic clips were applied on ulcerative gastric lipoma. Case 2 presented with the complaint of persistent exertional dyspnea. She was anemic and a fat-density mass was detected in the gastric antrum in the abdominal CT scan. An endoscopic examination found ulcerative submucosal tumor as the bleeding source. Both cases are on either antiplatelet or anticoagulant agent. Laparoscopy and endoscopy cooperative surgery (LECS) and partial gastric resection were performed on individual cases. LECS may be useful and less invasive method for symptomatic gastric lipoma in the future.

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  • Miho Sakai, Yuki Haga, Michiyo Kambe, Koji Nishimura, Ayako Shingyouch ...
    2021 Volume 98 Issue 1 Pages 91-92
    Published: June 25, 2021
    Released: July 10, 2021
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    A 59-year-old man presented to our institution with complaints of anorexia and nausea. He had malignant pleural mesothelioma and had received nivolumab five months prior to presentation. An esophagogastroduodenoscopy (EGD) demonstrated diffuse erythema and edema of the gastric and duodenal bulb mucosa. Mucosal biopsy revealed inflammatory cells, mucosal erosion on HE-staining, and a predominance of CD8-positive intraepithelial lymphocytes on immunostaining. A diagnosis of immune-related adverse effect (irAE) diffuse gastritis was made and treatment with intravenous prednisolone was initiated. Thereafter, his anorexia and nausea improved. EGD was repeated on the 34th day of admission and improvement in mucosal erythema and edema were observed. Herein, we report a case of irAE gastritis where corticosteroid therapy was effective in ameliorating symptoms and endoscopic findings.

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  • Norio Yamaguchi, Masayuki Shibata, Akihiko Tsuchiya, Keishi Oe, Kei Na ...
    2021 Volume 98 Issue 1 Pages 93-95
    Published: June 25, 2021
    Released: July 10, 2021
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    A 51-year-old man presented to the department of urology for hematuria caused by vesical vasodilation. However, an abdominal contrast-enhanced computed tomography revealed a 35-mm hemispherical gastric submucosal tumor. The patient was then referred to our department, where upper GI endoscopy revealed a 35-mm submucosal tumor in the gastric fornix. Boring biopsy of the gastric tumor performed for diagnostic purpose revealed bleeding at the biopsy site. We attempted to stop the bleeding using clips. However, the bleeding continued for 4 days. We performed hemostatic treatment with argon plasma coagulation, following which the bleeding subsided. Pathological diagnosis of the biopsy specimen revealed gastrointestinal stromal tumor (GIST), and the patient underwent laparoscopic partial gastrectomy. While boring biopsy was useful in diagnosing GIST, it must be performed with care to avoid bleeding.

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  • Naoyuki Yoshimine, Yusuke Nishikawa, Tsunetaka Arai, Makoto Amanuma, Y ...
    2021 Volume 98 Issue 1 Pages 96-98
    Published: June 25, 2021
    Released: July 10, 2021
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    A 40-year-old woman was admitted to our emergency department with chief complaints of lower abdominal pain and frequent diarrhea. Abdominal computed tomography (CT) showed edematous thickening of the entire small intestine, and lower gastrointestinal endoscopy showed irregular and map-like ulcers in the ileum. Biopsy showed inflammatory changes, with no findings of collagen bands, vasculitis, or amyloidosis. However, her symptoms did not improve, and abdominal contrast-enhanced CT showed exacerbation of the edematous changes. We suspected familial Mediterranean fever because blood tests revealed elevated serum amyloid S levels. We administered colchicine was administered as diagnostic treatment, but symptoms did not improve. Given the edematous changes in the small intestine seen on abdominal contrast-enhanced CT, we suspected drug-induced enteritis. Once vonoprazan was discontinued, her symptoms gradually improved and she was discharged without recurrence of abdominal symptoms. Subsequent outpatient abdominal CT showed improvement of the edematous changes in the small intestine.

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  • Yuki Morita, Takashi Fujii, Marie Shuto, Kanae Metoki, Yoshihiro Tashi ...
    2021 Volume 98 Issue 1 Pages 99-101
    Published: June 25, 2021
    Released: July 10, 2021
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    A 66-year-old man underwent colonoscopy for the purpose of examining bloody stools, accidentally revealed a reddish 0-Isp polyp of 15 mm in diameter in the terminal ileum. On narrow-band imaging (NBI) magnified observation, the vessel pattern was uniform and regular, and the surface pattern was well-ordered, which indicated a type 2A colorectal lesion according to the classification of the Japan NBI Expert Team (JNET). EMR was performed. The pathological diagnosis was high-grade tubular adenoma, and the resection margin was negative.

    The JNET classification was useful in this case. The endoscopic diagnostic method in the colorectum may also be used in the small intestine. And keeping in mind small intestine tumor may contribute to improvement of prognosis by early detection and endoscopic treatment.

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  • Shoko Watanabe, Mimari Kanazawa, Takanao Tanaka, Keiichi Tominaga, Mas ...
    2021 Volume 98 Issue 1 Pages 102-103
    Published: June 25, 2021
    Released: July 10, 2021
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    A 40-year-old man was referred to our hospital for examination of a hypervascular small mass in the pelvic small intestine incidentally noted on abdominal CT. Small bowel capsule endoscopy revealed an elevated lesion in the pelvic small intestine that was suspected to be a subepitherial lesion (SEL). Transanal small bowel endoscopy showed a 20 mm SEL in the ileum. Although histological diagnosis was not obtained, surgical operation (partial ileal resection) was done because gastrointestinal stromal tumor could not be denied from the imaging findings. The histological examination revealed as ectopic pancreas (Heinrich type I). The diagnostic and therapeutic strategy of SEL in the small intestine should be carefully considered.

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  • Keiichi Inoue, Yoshiro Yamamoto, Jyunji Tanaka, Nanako Inoue, Tsutowo ...
    2021 Volume 98 Issue 1 Pages 104-106
    Published: June 25, 2021
    Released: July 10, 2021
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    A 78-year-old man was referred to our hospital for suspected small intestinal cancer with pleural effusion on computed tomography. We performed colonoscopy and found some ulcers in the terminal ileum, but pathological examination showed no malignant findings. We suspected tuberculous pleural effusion and small bowel tuberculosis because of a positive T-SPOT result. We performed repeat colonoscopy and examination of the pleural effusion with an added culture test. The patient was started on anti-tuberculosis drugs, though polymerase chain reaction was negative for acid-fast bacillus. However, Mycobacterium tuberculosis were cultured after 8 weeks. We diagnosed tuberculous pleural effusion and small bowel tuberculosis, and colonoscopy 6 months later showed that the ulcers had improved. Small bowel tuberculosis has become rare, but it is important as a differential diagnosis.

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  • Yuya Hagiwara, Yoshinori Hiroshima, Daisuke Suganuma
    2021 Volume 98 Issue 1 Pages 107-109
    Published: June 25, 2021
    Released: July 10, 2021
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    A 44-year-old man with Takayasu's arteritis, who was treated with tocilizumab and prednisolone, was admitted to our hospital with hematochezia. Serum blood analysis revealed mild anemia, hypoalbuminemia, human leukocyte antigen (HLA) -B51 positivity, and HLA-B52 positivity. Stool culture demonstrated normal flora. Endoscopy revealed an ulcerative lesion in the ileocecal region. Pathological examination of biopsy samples from this lesion revealed nonspecific inflammation. Computed tomography (CT) depicted wall thickening in the ileocecal region. Because of the ileocecal ulcer, tocilizumab therapy was discontinued. Various test results confirmed a diagnosis of simple ulcer. Treatment for Crohn's disease was initiated with azathioprine, budesonide, mesalazine, and infliximab. Colonoscopy performed one month after the start of treatment demonstrated persistence of the ulcer, but the ulcer appeared to have improved 4 months later. Three months after the start of treatment, CT also demonstrated improvement in ileocecal wall thickening. Takayasu's arteritis did not worsen after the discontinuation of tocilizumab, and the simple ulcer did not recur 6 months after the start of treatment.

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  • Mitsuhiro Nakao, Osamu Ikezaki, Tomoya Hiratsuka, Mayumi Ide, Ryusuke ...
    2021 Volume 98 Issue 1 Pages 110-112
    Published: June 25, 2021
    Released: July 10, 2021
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    A UC patient in his 40s was revisited to our department due to bloody stools. So, colonoscopy was performed to find out his UC condition. He detected an elevated lesion in the cecum that did not see six months ago. A biopsy revealed adenocarcinoma, and operation was performed. The distinction between CAC and SA has a significant effect on the treatment and subsequent quality of life. We reported on these distinguishing points including a review of the literature.

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  • Norimasa Matsushita, Yukinori Toyoshima, Yasuhiro Hibi, Yasuhiro Sudo, ...
    2021 Volume 98 Issue 1 Pages 113-114
    Published: June 25, 2021
    Released: July 10, 2021
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    A 43-year-old woman was seen at our hospital for blood attached to the stool. Endoscopy of the lower gastrointestinal tract revealed a 20-mm-sized pedunculated polyp in the sigmoid colon. A juvenile polyp was first suspected, but the polyp was suspected of being a source of bleeding. An endoscopic polypectomy was performed. Pathologically, inflammatory cell infiltration and bleeding were partially observed in the specimen. Hyperplastic glands were observed, and some of the glands were cystically dilated. The head of the polyp was demarcated by smooth muscle bundles. The polyp was pathologically identified as an inflammatory myoglandular polyp (IMGP). IMGP is a relatively rare polyp first reported as a nonneoplastic polyp in 1992. Endoscopic resection is often performed in instances where the polyp is thought to be a source of bleeding or the polyp needs to be distinguished from neoplastic polyps. IMGP needs to be understood in the future.

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  • Eriko Noma, Akinari Takao, Ryoko Shimizuguchi, Satomi Shibata, Shinich ...
    2021 Volume 98 Issue 1 Pages 115-117
    Published: June 25, 2021
    Released: July 10, 2021
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    A 46-year-old, female patient was admitted to our hospital after testing positive on a fecal occult blood test. Colonoscopy revealed a submucosal tumor in the lower rectum with poor extension. Computed tomography and magnetic resonance imaging revealed a 23-mm, extramural mass with homogeneous enhancement. Endoscopic ultrasound showed an heterogeneous, hypo-echoic, extramural growth, mainly in the fourth layer of the intestinal mucosa. For definitive diagnosis, a mucosal cutting biopsy was performed using a disposable endo-knife. Pathological analysis of the biopsy specimen revealed endometrial cells that were positive for estrogen receptors. Based on this finding, intestinal endometriosis was diagnosed.

    Mucosal cutting biopsy can be used in conjunction with EUS to obtain a sufficient amount of tissue safely and is a useful diagnostic method for submucosal tumors such as in the present case.

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  • Masao Kusano, Masaki Tosa, Tomoyuki Ikeda, Seiichi Takahashi, Shinichi ...
    2021 Volume 98 Issue 1 Pages 118-120
    Published: June 25, 2021
    Released: July 10, 2021
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    A 60-year-old man, who visited our hospital for further examination of atrophic gastritis on gastric roentgenography and positive of fecal occult blood test on physical examination. Esophagogastroduodenoscopy revealed open-type atrophic gastritis and Helicobacter pylori was positive on urea breath test. Therefore, eradication therapy was performed and successfully eradicated for H.pylori infection. Colonoscopy revealed a submucosal tumor-like elevated lesion in the rectosigmoid colon. The histopathological findings showed chronic inflammation with severe lymphocyte infiltration. After three years and one month, the histopathological findings revealed mucosa-associated lymphoid tissue lymphoma; however, accumulation rate was higher than that on the previous fluorodeoxyglucose-positron emission tomography; hence, we recommended surgery. Laparoscopic partial rectosigmoidectomy was performed, and the diagnosis was diffuse large B-cell lymphoma with lymph node metastasis. Hence, chemotherapy with 3 courses of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone, was administered. The patient is being followed up.

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  • Mana Yamamoto, Yutaka Mitsunaga, Takayuki Okamura, Yorinari Ochiai, Ju ...
    2021 Volume 98 Issue 1 Pages 121-122
    Published: June 25, 2021
    Released: July 10, 2021
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    A 60-year-old woman underwent lower gastrointestinal endoscopy and a yellowish submucosal tumor of 5 mm in size was found on the contralateral side of the ileocecal valve. The tumor was diagnosed as a granular cell tumor by endoscopic ultrasonography (EUS) and biopsy examination. ESD was carefully conducted after injection of glycerol. On pathological examination, a tumor consisting of round cells filled with eosinophilic granular spores was found in the submucosa. The spores were strongly positive for S100 protein.

    To our knowledge, this is the first report to describe successful treatment of a cecal granular cell tumor by ESD.

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  • Shun Kato, Shinei Kudo, Naoya Toyoshima, Masashi Misawa, Miyuki Kanesh ...
    2021 Volume 98 Issue 1 Pages 123-124
    Published: June 25, 2021
    Released: July 10, 2021
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    A 60-year-old woman underwent laparoscopic pyloric gastrectomy for advanced gastric cancer. Colonoscopy was performed for post-surgical surveillance thirty months later.

    Colonoscopy showed a 10-mm flat lesion in the transverse colon.

    Endocytoscopy of the lesion revealed glandular ductal openings that were clearly smaller than those in the surrounding normal mucosa. There was a cluster of mildly enlarged nuclei, stained darkly with methylene blue, around the gland duct orifices. The colorectal lesion was resected.

    Immunohistological examination of the resected lesion revealed positivity for MUC5AC in shallow layers, and positivity for MUC6 in deep layers. This is similar to the distribution in gastric mucosa.

    The mucus traits mimicked those of the epithelium of the gastric fossa, and other immunostains were consistent with gastric cancer. The final pathological diagnosis was poorly differentiated adenocarcinoma in the colonic mucosa compatible with metastatic gastric cancer.

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  • Yutaro Kamei, Toshiyuki Suzuki, Kohei Tajima, Nana Mamuro, Misuzu Yama ...
    2021 Volume 98 Issue 1 Pages 125-127
    Published: June 25, 2021
    Released: July 10, 2021
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    An 84-year-old woman presented to our hospital with complains of abdominal distension, fever, and nausea. Abdominal computed tomography (CT) showed multiple diverticula, localized bowel wall thickening in the sigmoid colon, and intestinal dilation. A transanal ileus tube could not be inserted ; therefore, a transverse colon stoma was constructed on the same day. Later on, a sigmoid colectomy was performed.

    The cause of bowel obstruction in this patient was sigmoid diverticulitis. Although colorectal diverticulitis is a relatively common disease, it rarely leads to bowel obstruction that require surgical intervention. Surgery is often performed in cases of obstructive colorectal cancer. This may result in overtreatment in surgery, and careful judgment is required during the surgical procedure.

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  • Yoshizumi Deguchi, Takayuki Sato
    2021 Volume 98 Issue 1 Pages 128-129
    Published: June 25, 2021
    Released: July 10, 2021
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    We report two cases of rectal foreign bodies inserted for sexual stimulation, one requiring hospitalization and the other only a minimally invasive extraction procedure as an outpatient. Case 1 involved a 43-year-old man who had inserted a rubber ball into his anus for sexual stimulation the previous night. He was unable to remove the ball and was taken to the emergency room because of abdominal pain. Transanal foreign body extraction was performed under general anesthesia by grasping the rubber ball with Kochel endoscopically. Case 2 involved a 27-year-old man. He visited our emergency department after inserting a rubber ball into his anus for sexual stimulation, but was unable to remove it. Under emergency colonoscopy, we pierced the rubber ball with a 25-G needle tip catheter and sucked air out of the ball with a 20-ml syringe connected to the catheter. We extracted the collapsed ball using foreign-body forceps. No complications were encountered.

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  • Kazuki Nakamura, Hiroyuki Ariga, Junya Kashimura
    2021 Volume 98 Issue 1 Pages 130-132
    Published: June 25, 2021
    Released: July 10, 2021
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    A 70-year-old man was referred to our hospital for continuous abdominal pain. He had undergone cholecystectomy for acute cholecystitis at another hospital and was being followed up for percutaneous drainage due to a postoperative biliary fistula. Computed tomography revealed a common bile duct (CBD) stone and a cystic lesion on the duodenal papilla. The CBD and cyst were connected. Endoscopic retrograde cholangiopancreatography was performed, and cystic dilation was identified in the duodenal papilla and diagnosed as a choledochal cyst. Endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) were performed, followed by CBD stone removal without complications. Choledochocele is a rare disease characterized by saccular dilatation at the end of the CBD in the duodenal wall. There are few reports of endoscopic treatment of CBD stones. The results suggest that EST and EPBD are effective treatment strategies for choledochocele.

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  • Toshiharu Kakimoto, Toshikazu Yamaguchi, Kazuhito Fujihara
    2021 Volume 98 Issue 1 Pages 133-135
    Published: June 25, 2021
    Released: July 10, 2021
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    Cannulation to the duodenal ampulla within the diverticulum is sometimes difficult.

    A 91-year old man presented with acute cholangitis. ERCP was performed. The duodenal papilla was located within the diverticulum and the orifice of bile duct was not seen. When the papilla was pulled out of the diverticulum with the catheter tip, we could see the orifice. However, it returned to its original position soon after the catheter moved off and mechanical traction was withdrawn. Several attempts were made but failed. We therefore decided to use endoscopic clip to pull out the papilla outside the diverticulum and fix it onto the distal duodenal mucosa. After endoscopic clipping was successfully made, the orifice was clearly visible and the cannulation performed without difficulty.

    Endoscopic clipping is one of the useful techniques to make the orifice visible and cannulate when a duodenal papilla is located within the diverticulum.

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  • Naoki Tamai, Yuichi Takano, Jun Noda, Masataka Yamawaki, Tetsushi Azam ...
    2021 Volume 98 Issue 1 Pages 136-138
    Published: June 25, 2021
    Released: July 10, 2021
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    Endoscopic biliary stenting is widely used, but cases in which stent removal was forgotten and long-term stent placement was required were reported. The present case was a 42-year-old woman who underwent endoscopic stone removal for common bile duct stones and biliary plastic stent placement 10 years before. She self-interrupted her visit; thus, the stent was left in place. The patient developed acute cholangitis 10 years later and was urgently hospitalized. After removal of the stent, cholangiography revealed numerous stones filling the bile ducts. Complete stone extraction was performed endoscopically. This case demonstrates that long-term stent placement can cause multiple stone formation, and stents should always be removed when no longer necessary.

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  • Shogo Sunaga, Yukishige Okamura, Mayuko Kondo, Kiyohiro Kitagawa, Mari ...
    2021 Volume 98 Issue 1 Pages 139-141
    Published: June 25, 2021
    Released: July 10, 2021
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    An 86-year-old woman with obstructive jaundice presented with high serum CA19-9 concentrations and stenosis of the common bile duct with intrahepatic bile duct dilation. Despite the lack of evidence of pathological malignant findings, we diagnosed the patient with distal cholangiocarcinoma based on the clinical findings. We placed a covered-type self-expandable metallic stent (SEMS) (10×70 mm) inside the common bile duct, and her symptoms improved. She underwent chemotherapy with S-1 for 10 months, but her CA19-9 concentration gradually increased. Computed tomography showed intrahepatic bile duct dilation and the resolution of pneumobilia, suggesting dysfunction of the SEMS. Although we performed endoscopic retrograde cholangiography, the SEMS had disappeared from her body with no symptoms. We speculated that the SEMS migrated from the common bile duct and was excreted asymptomatically. The covered-type SEMS is recommended for the drainage of malignant biliary obstruction for the prevention of tumor ingrowth; however, it migrates more frequently than the uncovered-type SEMS and causes clinical problems. We, thus, report a rare case of asymptomatic migration and disappearance of a SEMS.

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  • Yosuke Mizukami, Hajime Higuchi, Mikinori Kataoka, Naomi Morikubo, Rum ...
    2021 Volume 98 Issue 1 Pages 142-144
    Published: June 25, 2021
    Released: July 10, 2021
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    A 62-year-old man was referred to our hospital with the upper abdominal pain and the elevation of the biliary duct enzymes. The patient has the history of removal of the left parotid gland, which was diagnosed with salivary duct carcinoma ten years ago. Computed Tomography and IDUS showed entire obstruction of the middle bile duct, caused by an extraductal mass and its infiltration. Biliary biopsy was performed, and the histological findings revealed adenocarcinoma cells which were positive for HER2 and AR. We placed a full-covered metallic stent in the common bile duct and confirmed decline of the biliary duct enzymes. This is a rare case of parotid gland cancer metastasis to the common bile duct. An accurate diagnosis may be possible by considering the possibility of metastatic parotid gland cancer and comprehensive evaluation of the medical history and the histological features.

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  • Aya Kawanishi, Yohei Kawashima, Toshiki Kodama, Yoko Yamaji, Taro Mash ...
    2021 Volume 98 Issue 1 Pages 145-147
    Published: June 25, 2021
    Released: July 10, 2021
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    A 71-year-old man was admitted to seek a diagnosis for a 20 mm-diameter nodule at the pancreatic body which revealed no enhancement in dynamic CT scan. Under the suspected diagnosis of pancreatic cancer, we performed laparotomy to resect the tumor. As two hepatic nodules were incidentally detected and their pathological diagnosis during surgery suggested adenocarcinoma, we closed the abdomen without resection. However, the final pathological diagnosis turned out to be neuroendocrine cancer (NEC). We performed endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for the pancreatic tumor, which revealed adenocarcinoma. Therefore, we finally made a diagnosis of a mixed neuroendocrine-non-neuroendocrine neoplasm of pancreas.

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  • Yasutoshi Akasaki, Ryuichi Yamamoto
    2021 Volume 98 Issue 1 Pages 148-149
    Published: June 25, 2021
    Released: July 10, 2021
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    A 60-year-old man complaing of abdominal pain was diagnosed huge pancreatic pseudocyst. Endoscopic ultrasonography-guided pseudocyst drainage with Hot AXIOS™ was successfully percase of formed under general anesthesia. Here, we report huge pancreatic pseudocyst associated with severe pancreatitis that was successfully treated with endoscopic pseudocyst drainage under general anesthesia.

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  • Toyotaka Kasai, Koichi Kawabe, Shingo Sato, Hiroyuki Eto, Taro Ogino, ...
    2021 Volume 98 Issue 1 Pages 150-152
    Published: June 25, 2021
    Released: July 10, 2021
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    A 38-year-old man with fever and right hip pain presented to our hospital. Abdominal ultrasound and abdominal magnetic resonance imaging revealed multiple pancreatic masses and he was admitted to our hospital. Thoraco-abdominopelvic computed tomography revealed pericardial effusion, left ureteral dilatation, a large mass on the left iliopsoas muscle, and right iliac bone erosion. Malignant lymphoma was suspected due to the elevated level of soluble IL-2 receptors. Since there was no evidence of superficial lymph node enlargement, endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) of the pancreatic masses was performed and the diagnosis of peripheral T-cell lymphoma (not otherwise specified) was made. EUS-FNB is considered to be useful for the diagnosis of malignant lymphoma.

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  • Taisuke Higuchi, Seiya Suzuki, Shin Nishii, Nanoka Chiya, Yuta Yoshido ...
    2021 Volume 98 Issue 1 Pages 153-155
    Published: June 25, 2021
    Released: July 10, 2021
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    A man in his 40s with a history of hospitalization for acute exacerbation of chronic pancreatitis presented with dyspnea. Chest radiography revealed left pleural effusion, and he was hospitalized for further evaluation and treatment. Thoracentesis was performed, and we suspected pancreatic pleural effusion based on high pancreatic enzyme levels in the effusion. Endoscopic retrograde pancreatography revealed stenosis of the main pancreatic duct and a pancreaticopleural fistula, which led to a diagnosis of pancreatic pleural effusion. Endoscopic pancreatic drainage was performed, and thoracentesis was repeated on five occasions. The pleural effusion gradually decreased, and the patient was discharged on the 28th day. We report successful treatment of pancreatic pleural effusion using endoscopic pancreatic drainage and thoracentesis.

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  • Emi Komobuchi, Yuichi Takano, Masataka Yamawaki, Jun Noda, Tetsushi Az ...
    2021 Volume 98 Issue 1 Pages 156-158
    Published: June 25, 2021
    Released: July 10, 2021
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    Splenosis is an ectopic growth of splenic tissue disseminated by splenectomy or trauma. We report a case of splenosis occurring in the pelvis and diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The case was a 52-year-old man with a past history of splenectomy and left nephrectomy due to traffic trauma. Abdominal computed tomography revealed a 38-mm mass lesion on the left side of the rectum. Endoscopic ultrasonography was performed, and a mass with a well-aligned margin and uniform hypoechoicity was found outside the rectum. EUS-FNA was performed. Pathological results showed a collection of lymphocytes and erythrocytes with no atypia. A diagnosis of splenosis was made.

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