Progress of Digestive Endoscopy
Online ISSN : 2187-4999
Print ISSN : 1348-9844
ISSN-L : 1348-9844
最新号
選択された号の論文の37件中1~37を表示しています
原著
  • 樋口 和寿, 後藤 修, 星野 慎太朗, 川見 典之, 小泉 英里子, 桐田 久美子, 野田 啓人, 恩田 毅, 飽本 哲兵, 大森 順, ...
    2020 年 97 巻 1 号 p. 24-27
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    目的:当院では食道運動機能障害に対して2018年10月よりPOEMを開始した.今回,その短期成績を検討した.

    方法:2019年12月までに施行したPOEM 16症例を対象とし,対象疾患,施行時間,筋層切開長,術後入院日数,合併症,POEM前後の食道内圧検査所見及び治療効果について後方視的に解析した.

    結果:原疾患は食道アカラシア(EA)12例,jackhammer esophagus(JE)3例,esophagogastric junction outlet obstruction(EGJOO)1例であった.施行時間は91.0(65-196)分,筋層切開長は8.0(5-21)cmであり,術後の入院日数は3.0(2-5)日間であった.重篤な有害事象は認めなかった.Eckardt scoreは中央値5.5→1.5と有意に改善し(p値=0.005),F scaleも中央値21.0→11.0と改善を認めた(p値=0.004),術後2か月に食道内圧検査を施行した13例中,EA9例とEGJOO1例でIRPが中央値29.6→10.1 mmHgに低下(p値<0.005),JE3例ではDCIが中央値8831.4→849.2 mmHg/s/cmと低下した.

    結語:当院においてもPOEMを安全に導入し,良好な成績を示すことができた.今後さらなる症例の蓄積と長期成績についての検討が必要である.

  • 小畑 美穂, 坂口 賀基, 辻 陽介, 小池 和彦
    2020 年 97 巻 1 号 p. 28-32
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    【目的】Helicobacter pylori(HP)の持続感染による慢性胃炎が胃癌の最大のリスク要因である.2013年よりHP関連胃炎に対する除菌療法が保険収載となり,臨床の場で除菌後胃癌に遭遇する機会が増えているが,除菌後胃癌の特徴に関しては不明な点も多い.当院での除菌後胃癌の特徴につき症例検討を交えて報告する.

    【方法】2013年から2018年に当院で内視鏡的粘膜下層剥離術(ESD)を施行した早期胃癌全症例のうち除菌後胃癌とHP陽性胃癌について比較検討した.

    【結果】早期胃癌1186病変のうち,除菌後胃癌は165病変(13.9%),HP陽性胃癌は243病変(20.5%)であった.名義ロジスティック多変量解析の結果,除菌後胃癌はHP陽性胃癌に比べ陥凹型が多く(67.9 vs 49.4%,p = 0.003),腫瘍径は小さく(13.4±9.7 vs 17.1±10.4 mm,p = 0.036),術時間は長かった(115.0±69.9 vs 110.7±65.3分,p = 0.004).切除径は有意差を認めなかった(37.4±13.0 vs 40.9±12.5 mm,p = 0.551).

    【考察】除菌後胃癌はHP陽性胃癌と比較し,より微小な段階で発見されることが示された.一方術時間が長くなり,治療時病変範囲診断に苦慮したことが影響している可能性がある.

  • 山下 聡, 松井 啓, 菊池 大輔, 布袋屋 修
    2020 年 97 巻 1 号 p. 33-37
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    【背景】さまざまな工夫により大腸ESDはより低侵襲的な治療手技となりつつあるが,その一方で穿孔例も一定の割合で経験する.【目的】当院における大腸ESD穿孔症例の治療後の臨床経過を検討することを目的とした.【対象・方法】2005年4月より2019年12月までに当院において施行した大腸ESD 1780病変のうち,穿孔の認められた40病変,40症例につき後方視的に検討をおこなった.【結果】穿孔例40例のうち術中穿孔は29例(1.7%),遅発性穿孔は11例(0.6%)に認められた.術中穿孔例では29例中病変切除が完遂できたのは25例で,4例は中断し待機的に外科手術を施行した.保存的治療を行った25例のうち3例は腹部所見の悪化が認められ,緊急手術が施行された.遅発性穿孔11例においては術後1日目,2日目にそれぞれ5例,5日目に1例,画像上穿孔所見が認められた.緊急手術を要した症例は11例中5例と,術中穿孔と比較し高い割合で汎発性腹膜炎への移行が認められた.【結論】術中穿孔と比べ,遅発性穿孔は緊急手術を要する症例が多く認められた.遅発性穿孔の予防に関しては今後の課題である.

  • 大森 順, 貝瀬 満, 後藤 修, 辰口 篤志, 岩切 勝彦
    2020 年 97 巻 1 号 p. 38-43
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    当院で入院加療された急性下部消化管出血364例のうち急性出血性直腸潰瘍(AHRU)38例の臨床的特徴について検討した.男性20例,女性18例,平均年齢77歳.Performance Status(PS)は3-4が61%.併存疾患として高血圧,糖尿病,悪性腫瘍を多く認めた.患者背景についてAHRU 38例,非AHRU 326例の2群にわけて単変量解析をしたところ,PS≧3以上の症例がAHRU群で有意に多かった.AHRU全38症例に対して大腸内視鏡検査が施行され,52.6%は内視鏡処置が施行され,44.7%は保存加療で経過観察となっていた.初回内視鏡止血処置の割合は,クリップ止血術のみが11例,凝固止血7例,クリップ+凝固止血術1例,クリップ+HSE 1例であった.再出血は29%で認められ,再出血11例と非再出血27例について単変量解析を用いて比較検討したが,有意差はなかった.AHRU 38例のうち入院中に死亡した例は24%で,原疾患や併存疾患などの増悪が主な死因であった.死亡例9例と非死亡例29例について単変量解析による比較検討では有意差はなかった.AHRUを認める例では,非AHRUの例と比較してPS3以上の例が有意に多かったが,ADLの低い重症例が多いことが原因と考えられる.基礎疾患や併存疾患の増悪で死亡する例も多く,内視鏡処置だけでなく,全身状態の把握と偶発症の管理が大事と言える.

症例
  • 岡田 直也, 千葉 秀幸, 山岡 賢治, 山崎 大, 比嘉 愛里, 立川 準, 須藤 拓馬, 有本 純, 河野 直哉, 新倉 利啓, 桑原 ...
    2020 年 97 巻 1 号 p. 44-49
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    出血性十二指腸潰瘍に内視鏡的止血が困難な場合や再発を繰り返す場合,代替治療として血管内治療・手術が検討されるが,全身状態が不安定な症例では代替治療が困難な場合も経験する.今回Over-The-Scope clip(OTSC)により代替治療を回避できた2症例を提示する.症例1:82歳,男性.腎癌術後再発,腎後性腎不全で入院していた.出血性十二指腸潰瘍を認め止血を行うも再出血を繰り返し,6回目の焼灼止血後も再出血を来したためOTSCで潰瘍底を縫縮した.その後再出血せず経過した.症例2:79歳,男性.特発性血小板減少性紫斑病,脳梗塞の既往あり.タール便のため救急搬送となった.出血性十二指腸潰瘍を認めたが一部穿通を伴っており,OTSCで潰瘍底を縫縮した.再発なく第12病日に退院となった.従来法による内視鏡的止血困難例では,より強力かつ広範に組織を把持できるOTSCが新たな選択肢となる可能性がある.

  • 関根 一智, 八木 豊一, 渡邉 亮, 矢田 智之, 上村 直実
    2020 年 97 巻 1 号 p. 50-53
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    症例は84歳女性.統合失調症で他院入院中.当院受診1週間前から黄疸が認められるようになったため当院に精査加療目的に入院となった.血液検査で肝胆道系酵素と炎症反応の高値を認め,腹部造影CTで膵頭部の乏血性腫瘤と肝内胆管・総胆管の著明な拡張を認めた.十二指腸乳頭部からの生検よりadenocarcinomaが認められ,画像所見と合わせて膵頭部癌とそれによる閉塞性黄疸と診断した.腫瘍の浸潤によりERCPでの経乳頭的胆道ドレナージが困難であったためEndoscopic ultrasound-guided hepaticogastrostomy(EUS-HGS)の適応と判断した.当院では,合併症の一つであるguidewire(GW)の逸脱などが起こった際に対応可能なdouble guidewire techniqueを用いてEUS-HGSを行なっている.通常法では,ダイレーターやバルーンを用いて穿刺部位の拡張を行った後2本目のGWの挿入・留置を行なっているが,本症例ではuneven double lumen catheter(UDLC)を用いて一期的に穿刺部位の拡張とGWの挿入・留置を行い手技の簡略化を行なった.EUS-HGSにおいてUDLCの有用性が示唆されたので若干の文献を含め報告する.

原著
  • 高橋 利実, 山本 敏樹, 小川 眞広, 後藤田 卓志, 森山 光彦
    2020 年 97 巻 1 号 p. 54-56
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    We retrospectively investigated the clinical outcomes of endoscopic esophageal foreign body removal. The study included 26 patients diagnosed with esophageal foreign bodies at Nihon University Hospital between October 2015 and February 2020. Esophageal foreign bodies included food loaves (n=10), press-through packages (n=8), fish bones (n=5), dental prostheses (n=2), and drugs (n=1).

    Foreign bodies were endoscopically removed in all patients. Esophageal injury secondary to the aforementioned sharp objects occurred in five patients. Sharp objects such as fish bones, dental prostheses, and press-through packages may injure the esophageal mucosa; therefore, it is important to perform pretreatment imaging using modalities such as computed tomography to rule out perforation.

    Endoscopic treatment was useful for foreign body removal in all patients in this study.

  • 竹内 努, 三宅 一昌, 谷古宇 康人, 小泉 こず恵, 大野 弘貴, 安良岡 高志, 濱本 達彦, 滝 保彦, 長田 祐二, 住吉 宏樹, ...
    2020 年 97 巻 1 号 p. 57-60
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    Keeping biscous lidocaine solution in the hypopharynx and repeating gargling (group-A) has been used as pharyngeal anesthesia of esophagogastroduodenoscopy in our hospital for many years. Spraying lidocaine spray to the hypopharynx (group-B) is an option with lower risk of aspiration and less physical difficulty. Anesthetic effects should be compared in both methods. Subjects who underwent esophagogastroduodenoscopy were randomly assigned to either group-A or -B. A series of questionnaire survey was set before and after the examination, and the physical and mental stress was evaluated subjectively (i: discomfort during pharynx passage, ii: coughing during the examination, iii: anxiety about the next examination), and objectively. A univariate analysis of the evaluation about the stress caused by esophagogastroduodenoscopy showed no significant difference between group-A (71 cases) and group-B (70 cases). Group-B provided the equivalent anesthesia effect as group-A. It was considered that the physical and mental stress during esophagogastroduodenoscopy was greatly affected by the anxiety before the examination.

症例
  • 林 光希, 萩原 信敏, 野村 務, 松谷 毅, 金沢 義一, 柿沼 大輔, 松野 邦彦, 安藤 文彦, 吉田 寛
    2020 年 97 巻 1 号 p. 61-62
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    Here we report a man in his 60s who underwent surgery for hypopharyngeal cancer 14 years previously, and has since received a combination of endoscopic submucosal dissections (ESDs), CRT and photodynamic therapy (PDT) for metachronous multiple esophageal cancers. His latest esophagogastroduodenoscopy showed mild stenosis and scarring, but no abnormalities, indicating his long-term disease-free status. After CRT, PDT can be currently available for esophageal cancer cases with ineligible factors of ESD and/or surgical resection, such as tumor depth, patient comorbidities and age. PDT was efficacious and minimally invasive for a treatment of superficial esophageal cancer in our inoperable case. Combination of ESD and PDT after CRT, minimally invasive tools, may be good multimodality therapy for metachronous superficial esophageal cancers difficult-to-treat by surgery.

  • 磯部 雄二郎, 中村 理恵子, 松田 諭, 真柳 修平, 入野 誠之, 福田 和正, 和田 則仁, 川久保 博文, 北川 雄光
    2020 年 97 巻 1 号 p. 63-65
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    Background

    The prevalence of ectopic gastric mucosa (EGM) is approximately 11–14.2%. Most EGMs are clinically insignificant;however, they are occasionally known to harbor esophageal cancer.

    Case

    Case 1 was a 64-year-old man diagnosed with esophageal cancer in the EGM, UtCe Type0-IIa tub1 cT1b-SM1 (N0M0) cStageI. We performed endoscopic submucosal dissection (ESD) for diagnostic and therapeutic purposes. Pathological examination revealed a well-differentiated adenocarcinoma arising from the EGM.

    Case 2 was a 47-year-old man diagnosed with CeUt Type0-IIa SCC cT1-MM (N0M0) cStageI. His lesion was sandwiched between two EGMs. It was thought that the lesion might have extended to the EGM. We performed ESD on one of the EGMs to confirm this hypothesis. Pathological examination revealed a squamous cell carcinoma. No lesion was found in the EGM;however, the tumor was present on the borderline of the EGM.

    Conclusion

    We report two cases of esophageal cancer arising from or within EGM treated using ESD. The patients recovered after ESD and did not require further treatment.

  • 原 健三, 鳥羽 崇仁, 岩田 俊太郎, 氏田 亙, 鈴木 啓太, 副島 啓太, 並木 萌子, 若林 宗弘, 藤井 紘大, 榎本 有里, 清 ...
    2020 年 97 巻 1 号 p. 66-68
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 62-year-old male was admitted to hospital the limb sensation and a weakness in the main complain. He had an emergency upper gastrointestinal endoscopy because a result of his blood test was severe anemia, Hb 4.9 ml/dL.

    The endoscopy showed a hemorrhagic gastric ulcer with a huge exposed vessel.

    On treatment with IVR, it was difficult for us to insert a catheter in his vessel because his vessels have abnormal running vessels. Therefore, we decided to insert an intra-aortic balloon occlusion (IABO) catheter on treatment with endoscopy. The IABO helped to control the ulcer bleeding and made an easier for us to complete an endoscopic hemostasis with coagulation.

    Gradually over a period of two months, the ulcer was healed to normal mucosa. Such as this case, it is suggested that IABO is able to be completed an endoscopic hemostasis for a case that be predicted difficulty to hemostasis.

  • 石崎 純郎, 東 瑞智, 久保田 陽, 和田 拓也, 渡辺 晃識, 石戸 謙次, 堅田 親利, 田邉 聡, 小泉 和三郎
    2020 年 97 巻 1 号 p. 69-70
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    The present case was of a 79-year-old man who underwent left nephrectomy for renal cell carcinoma (RCC) 14 years prior. Signs of anemia were observed, prompting an exploratory upper gastrointestinal endoscopy to search for the origin. The anemia was attributed to a hemorrhagic, tumorous lesion discovered in the fornix (size: ~30 mm). Endoscopic mucosal resection was performed to control the anemia. The patient was diagnosed with metastatic gastric cancer secondary to RCC, based on the abundance of clear-cell carcinoma cells in his pathological specimens, which resembled his surgical specimens taken 14 years prior. Late recurrence is not uncommon in RCC, and discoveries of gastric metastasis are often prompted by gastrointestinal bleeding. Such trends mean that clinicians should keep RCC in mind during a patient's examination and treatment if a hemorrhagic lesion (s) is observed in the stomach, even if a long time has passed since the diagnosis of RCC.

  • 黒崎 宏貴, 有賀 啓之, 高屋敷 典生, 水井 恒夫, 鹿志村 純也
    2020 年 97 巻 1 号 p. 71-72
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 72-year-old man was admitted to our hospital because of gastric mucosal irregularity on gastroscopic examination. He was successfully treated for Helicobacter pylori infection at the age of 63 years. Blood examinations, including tumor markers, revealed normal results. Upper gastrointestinal endoscopy revealed a large 0-IIc lesion measuring 10 mm in the gastric body. The biopsy revealed atypical glands. Enhanced computed tomography revealed no metastasis to the lymph nodes or other organs. Therefore, a diagnosis of early gastric cancer was made and endoscopic submucosal dissection (ESD) was performed. The biopsy specimen revealed gastric carcinoma with lymphoid stroma on hematoxylin and eosin staining, Epstein-Barr encoding region in situ hybridization revealed that tumor cells were positive for Epstein-Barr virus (EVB). Hence, the patient was diagnosed with EBV-associated carcinoma with lymphoid stroma.

    Here, we have reported a case of EBV-associated carcinoma with lymphoid stroma that was diagnosed using ESD.

  • 森 貴裕, 佐野 正弥, 杉山 悟, 吉原 四方, 寺邑恵 里香, 門馬 牧子, 水上 創, 中原 史雄, 羽田野 敦子, 藤澤 美亜, 小 ...
    2020 年 97 巻 1 号 p. 73-75
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 22-year-old woman who had abdominal pain and diarrhea from 5 days ago got a CT scan in the hospital of origin and had a tumor about 5 cm in the stomach and bleeding. Upper gastrointestinal endoscopy revealed a large gastric submucosal tumor in pylorus. We considered it a malignant gastric submucosal tumor, and performed surgery, it was diagnosed as gastric plexiform fibromyxoma. Gastric plexiform fibromyxoma is a rare gastric mesenchymal tumor first reported by Takahashi et al. in 2007. Gastric plexiform fibromyxoma usually causes nonspecific symptoms of bleeding signs and is often operated on for that reason. However, surprisingly, plexiform fibromyxoma is a benign tumor with no reports of metastasis or recurrence.

  • 義山 麻衣, 大西 知子, 前田 有紀, 荒川 丈夫, 飯塚 敏郎, 小泉 浩一
    2020 年 97 巻 1 号 p. 76-78
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 73-year-old man was admitted with vomiting and left costal pain.

    He had undergone pylorus-preserving gastrectomy with B-1 reconstruction and was recently eating many persimmons. Physical examination revealed tenderness in the upper abdomen and left-side ribs. Abdominal CT showed a mass containing air in the gastroduodenal anastomosis. Esophagogastroduodenoscopy revealed a bezoar of about 10 cm in diameter in the remnant stomach. It was difficult to crush the bezoar with a grasping forceps and snare. Coca-Cola was locally injected, which softened the bezoar. We could then crush the bezoar with the grasping forceps and snare, and removed the bezoar. Oral administration or nasogastric lavage of Coca-Cola were reported as treatments for bezoars. In our case, the treatment time of a bezoar was significantly shortened by local injection of Coca-Cola and the bezoar could be treated with a small amount of Coca-Cola compared with that in previous reports.

  • 松田 英士, 栗原 直人, 佐々木 康裕, 浅田 祐介, 徳山 丞, 飯田 修平
    2020 年 97 巻 1 号 p. 79-80
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 90-year-old female was admitted to our hospital with hematemesis. Esophagogastroduodenoscopy revealed blood flowing from a submucosal tumor of about 20 mm in diameter with a few erosions on its surface at the greater curvature of the antrum. It was bleeding from one of the erosions and treated by electrocoagulation. The submucosal tumor had initially been detected by esophagogastroduodenoscopy four years previously and was presumed to be a lipoma by computed tomography. To prevent rebleeding, the ESD procedure was performed on the 5th hospital day with the patient's consent. Complete en bloc resection was achieved in 70 min. There were no specific technical difficulties or complications. Pathological examination confirmed that the submucosal tumor was a lipoma. To our knowledge, this is the first report of a hemorrhagic gastric lipoma removed by ESD in a patient in her nineties.

  • 永江 真也, 有泉 健, 花田 亮太, 松原 祥平, 久武 裕太, 井上 健太郎, 高木 英恵, 玉井 博修, 菊池 勇次, 相浦 浩一
    2020 年 97 巻 1 号 p. 81-83
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 75-year-old man was referred to our hospital with suspected gastric cancer. Endoscopy revealed a 10 mm-sized, reddish, depressed lesion in the middle gastric body. Biopsy tissue suggested a poorly differentiated adenocarcinoma. Since submucosal invasion could not be ruled out, the patient underwent laparoscopic distal gastrectomy. Resected specimen showed a poorly differentiated adenocarcinoma with significant lymphocytic infiltrate, and 390 μm of submucosal invasion. There was no lymph node metastasis or lymphovascular invasion. Epstein-Barr virus-encoded RNA in situ hybridization was positive, and the diagnosis of Epstein-Barr virus-associated gastric carcinoma with lymphoid stroma (GCLS) was made. GCLS has a low incidence of lymph node metastasis and a relatively good prognosis. In this case, if we had diagnosed GCLS preoperatively, endoscopic submucosal dissection may have been an option for treatment.

  • 麻 興華, 飯田 智広, 竝川 昌司, 井上 照基, 新井 洋佑, 菅間 一乃, 椎名 啓介, 村上 立真, 浦岡 俊夫
    2020 年 97 巻 1 号 p. 84-86
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    We report a case of a hyperplastic polyp that underwent malignant transformation after eradication therapy. The patient was a 76-year-old man who had a 15-mm sized polyp in the fornix of the gastric body. Histologic examination of a biopsy specimen revealed that the lesion was a hyperplastic polyp. Helicobacter pylori infection was confirmed by examining Helicobacter pylori antibodies. After eradication therapy for five months, the polyp decreased to 10 mm in size. After eradication therapy for fourteen months, endoscopy revealed that the polyp had significantly decreased in size, but was accompanied by a localized erosion (IIa+IIc), and biopsy examination showed Group V. Total gastrectomy was performed and the diagnosis of hyperplastic polyp with malignant transformation was confirmed histologically. Our clinical experience and lessons from this case are discussed.

  • 矢野 剛司, 熊谷 一秀
    2020 年 97 巻 1 号 p. 87-89
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    In our hospital, percutaneous transesophageal gastro-tubing (PTEG) has been performed for patients with dysphagia in whom percutaneous endoscopic gastrostomy (PEG) would be challenging. We herein report a patient with a high risk of self-removal of the PTEG tube in whom percutaneous endoscopic duodenostomy (PED) was performed. A 62-year-old woman suffered cerebral infarction. She had undergone distal gastrectomy and Billroth-I reconstruction (BI) for early gastric cancer at the age of 56 years. PEG was not performed because the gastric remnant was found below the costal arch by transillumination. Instead, PED was performed by the pull method. PED and PTEG each have advantages and disadvantages. Hence, it is necessary to select the appropriate nutrition route depending on the characteristics of each case.

  • 塩田 香織, 貝瀬 満, 野田 啓人, 小泉 英里子, 桐田 久美子, 樋口 和寿, 大森 順, 飽本 哲兵, 後藤 修, 岩切 勝彦
    2020 年 97 巻 1 号 p. 90-92
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 72-year-old man, having a past history of H. pylori eradication 7 years ago, underwent esophagogastroduodenoscopy (EGD) at a clinic. A depressed lesion on the gastric angle was detected and its pathological diagnosis was adenocarcinoma. Magnifying endoscopy with NBI (ME-NBI) demonstrated that the red depression, 20×8 mm in diameter, had regular microvascular/microsurface patterns, and the diagnosis was noncancer. Endocytoscopy (ECS), an ultra-magnifying endoscopy, showed that a part of the lesion had high-grade ECS atypia, and the diagnosis was cancer. The pathological diagnosis of the ESD specimen was 0-IIc, 3 mm, tub1, pT1a. H. pylori-eradicated cancers are often covered with epithelium with low grade atypia, which causes the difficulty of endoscopic diagnosis. In this case, ME-NBI could not show cancerous findings, but ECS could demonstrated cancerous findings, suggesting that ECS may be useful in the diagnosis of H. pylori-eradicated cancer.

  • 石井 菖太郎, 貝瀬 満, 小泉 英里子, 桐田 久美子, 樋口 和寿, 野田 啓人, 飽本 哲兵, 大森 順, 後藤 修, 岩切 勝彦
    2020 年 97 巻 1 号 p. 93-95
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 60-year-old man was successfully eradicated 5 years ago for Helicobacter pylori infection. In April 20XX, upper gastrointestinal endoscopy (EGD) showed mild gastric atrophy (C1) and a small erosion in the gastric antrum. In July of the same year, biopsy of the lesion was performed, and was diagnosed as signet-ring cell carcinoma. He was referred to our hospital, and the diagnosis of endoscopic work-up was early gastric cancer; 6 mm, 0-IIc, sig, cT1a, UL-. The 4-point biopsy was negative for cancer, and endoscopic submucosal dissection (ESD) was performed. The pathological result was noncurative resection; adenocarcinoma (por2> sig), pT1b2 (900 μm), pUL0, Ly0, V0, pHM0, pVM1. Thus, distal gastrectomy was additionally done. The postoperative pathological result was scirrhous gastric cancer with extensive cancer invasion in the muscularis propria centering on the ESD scar. As shown in this case, we need to keep in mind that poorly differentiated adenocarcinoma can develop in the Helicobacter pylori-eradicated gastric mucosa with mild atrophy without intestinal metaplasia.

  • 野田 淳, 髙野 祐一, 浅見 哲史, 小林 孝弘, 新谷 文崇, 遠藤 利行, 五味 邦代, 黒木 優一郎, 山本 頼正, 長濵 正亞
    2020 年 97 巻 1 号 p. 96-99
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    An 87-year-old man was diagnosed with ampullary adenoma based on an upper gastrointestinal endoscopy screening. Endoscopic papillectomy was recommended, but the patient refused. Six years later, he visited the hospital presenting with symptoms of cholangitis, and an upper gastrointestinal endoscopy revealed an enlarged ampullary tumor. We performed a biopsy and diagnosed the patient with an adenocarcinoma. Since he did not agree to a surgery, we performed palliative endoscopic biliary drainage using a self-expandable metallic stent (SEMS).

    The origin of the ampullary adenoma remains unclear. We experienced a case in which an adenoma developed into cancer over a long period of 6 years. We will eventually report the case along with a review of literature.

  • 渡部 主樹, 芳賀 祐規, 神戸 美千代, 酒井 美帆, 西村 光司, 新行内 綾子, 宮村 達雄, 伊藤 健治, 阿部 朝美, 金田 暁, ...
    2020 年 97 巻 1 号 p. 100-102
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    An 84-year-old man was admitted to our hospital with anemia. He had undergone right nephrectomy for renal cell carcinoma (RCC) 5 years ago. Upper gastrointestinal endoscopy revealed a protuberance with oozing hemorrhage in the descending part of the duodenum. Visceral angiography identified extravasation from a branch of the gastroduodenal artery (GDA). Coil embolization was performed on two branches of the GDA, and progression of anemia slowed down. After 2 months, he died from renal dysfunction and an autopsy was performed. Results showed metastasis from RCC in the descending part of the duodenum, myocardium, pancreas, and both lungs. Duodenal metastasis from RCC is mostly diagnosed in the wake of a bleeding episode, and sometimes presents as a submucosal tumor.

  • 江﨑 航大, 松田 康里, 菅原 悠輝, 小野 晋治, 小野山 裕亮, 千谷 菜花, 吉留 佑太, 鈴木 晴也, 溝口 明範, 和田 晃典, ...
    2020 年 97 巻 1 号 p. 103-105
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 70-year-old asymptomatic man presented with a growing submucosal tumor in the duodenal bulb; and despite two EUS-FNA procedures, a diagnosis could not be confirmed. Since the mass was stalked and enlarged to 40 mm in size, the patient underwent endoscopic resection with grasping scissor forceps, while traction was applied for diagnostic treatment, considering the risk of gastrointestinal obstruction. The pathological diagnosis was Brunner's gland hyperplasia, and the patient was followed up with annual upper gastrointestinal endoscopy. Here, we report a case of endoscopic resection of a large duodenal submucosal tumor using a traction device.

  • 金子 桂士, 中河原 浩史, 山田 康嗣, 菊田 大一郎, 堤 菜津子, 藤川 博敏, 桂 義久
    2020 年 97 巻 1 号 p. 106-107
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A woman in her 80s underwent surgery for ascending colon cancer about four years ago; she had a positive surgical margin. However, chemotherapy was not given according to the patient's wish. Abdominal computed tomography three years after surgery revealed a mass lesion in the descending part of the duodenum. A submucosal (mesenchymal) tumor was suspected on endoscopic ultrasonography. However, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology revealed adenocarcinoma, with findings similar to pathological findings at the time of surgery four years earlier. The patient was therefore diagnosed with a duodenal recurrence of her prior ascending colon cancer. EUS-FNA is minimally invasive and is useful for the diagnosis of tumor-like lesions in the submucosa.

  • 石井 亮佑, 池宮城 秀和, 申 貴広, 普天間 朝久, 原 英展, 杉山 勇太, 町田 智世, 米本 有輝, 伊東 詩織, 深見 裕一, ...
    2020 年 97 巻 1 号 p. 108-109
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 65-year-old man taking dual antiplatelet therapy (DAPT) on maintenance dialysis for chronic renal insufficiency was rescued to our hospital by chief complaint of bloody stool in 2019. Contrast-enhanced CT showed extravasation of the contrast agent into the ileum, and he was hospitalized with a diagnosis of small intestinal bleeding. Blood stool disappeared after discontinuation of DAPT. Small intestinal endoscopy revealed a 25 mm-sized polyp with erosion in the ileum, which was considered a bleeding source. Based on the risk of rebleeding due to DAPT resumption, EMR was performed, and Peutz-Jeghers type polyp was diagnosed. With the aging, the number of patients taking DAPT is expected to increase. Small intestinal polyps, which had previously been asymptomatic, may cause gastrointestinal bleeding due to oral administration of DAPT, which may increase the frequency of detection. In gastrointestinal bleeding from the small intestine of patients receiving DAPT, it was considered important to remind bleeding from polyps such as in this case.

  • 岡田 健太, 有賀 啓之, 熊倉 有里, 鹿志村 純也
    2020 年 97 巻 1 号 p. 110-111
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    In 2012, treatment using Self-Expandable Metallic Stent (SEMS) for colorectal cancer bowel obstruction started being covered under insurance in Japan. In addition to being effective for Bridge To Surgery (BTS), the use of SEMS involved a good success rate and symptom improvement rate. We analyzed 11 patients (seven men and four women, average age; 70 years) for whom SEMS insertion was performed at our hospital for BTS from January 1, 2016 to December 31, 2018.

    The stenosis site was the transverse colon in four patients, the descending colon in four patients, and the sigmoid colon in three patients. All cases of SEMS insertion were successful. The colon obstruction score improved in all patients, and primary anastomosis became possible. In addition to the high safety and good short-term results of metal stenting for BTS, there was no statistically significant difference in reports comparing long-term prognosis with emergency surgery. These results suggest that the use of SEMS for BTS is effective in the treatment of malignant colorectal stenosis.

  • 上田 孝, 五十嵐 宗喜, 伊藤 彩乃, 中村 淳, 仁品 玲子, 青木 純, 杉山 朋子, 白石 光一, 鈴木 秀和
    2020 年 97 巻 1 号 p. 112-113
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    61-year-old woman. She was in remission for ulcerative colitis with mesalazine, azathioprine and infliximab treatment. Psoriasiform dermatitis developed 3 years after the administration of infliximab, and it was diagnosed as a paradoxical reaction due to anti-TNF-α antibody therapy. After switching from infliximab to vedolizumab, psoriasiform dermatitis was markedly improved. In the treatment of intractable psoriasiform dermatitis, changing to a molecular target agent with a different mechanism of action could be considered as one of therapeutic options.

  • 葛西 豊高, 川辺 晃一, 江藤 宏幸, 荻野 太郎, 村松 誠司, 中原 守康, 宮原 庸介, 伊藤 博
    2020 年 97 巻 1 号 p. 114-116
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 70-year-old man with bloody stools was emergently transported to our hospital by ambulance. Abdominal/pelvic CT with contrast revealed blood extravasation in his transverse colon, and he was hospitalized due to suspected colonic diverticular bleeding. Lower gastrointestinal endoscopy revealed a diverticulum with erosion and redness in the transverse colon. The diverticulum was thought to be the responsible lesion, and endoscopic band ligation (EBL) was performed. After EBL, an exposed vessel was found in the inverted diverticulum. Endoscopic findings of active hemorrhage, non-hemorrhagic exposed vessels, or adherent blood clot are indications for hemostasis of colonic diverticular bleeding. Diverticular bleeding in which the inside of the responsible diverticulum cannot be observed by endoscopy, would be a good indication for EBL because it would be difficult to perform clip hemostasis through the direct approach.

  • 柿本 年春, 山口 俊和, 藤原 和史
    2020 年 97 巻 1 号 p. 117-119
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    Colonoscopy is very useful for diagnosing and treating colorectal diseases. Bowel preparation with polyethylene glycol (PEG) or magnesium citrate has been widely performed and is considered to be safe, but it can sometimes cause severe electrolyte disturbances.

    A 74-year-old man was admitted to our hospital for a planned colonoscopy. He had no history of neurological diseases. He was taking no medications. He was given oral administration of 1.8 L magnesium citrate. While he was waiting to undergo colonoscopy, he began to respond slowly and consciousness disorder developed. Brain computed tomography showed no abnormalities. Laboratory examination showed a serum sodium level of 119 mEq/L. He was diagnosed with severe symptomatic hyponatremia and treated with hypertonic saline infusion. Colonoscopy was cancelled. The next day, the sodium level increased to 127 mEq/L and his consciousness level recovered to normal. If a patient shows neurological disturbance at the time of colonoscopy, serum electrolytes should be checked and treatment should be started promptly.

  • 草野 昌男, 土佐 正規, 高橋 靖, 池田 智之, 高橋 成一, 池谷 伸一, 中山 晴夫
    2020 年 97 巻 1 号 p. 120-121
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 57-year-old man, who was administered methotrexate for rheumatoid arthritis seven years prior, experienced lower abdominal pain and diarrhea for one year; therefore, he visited our hospital for further examination. Colonoscopic examination revealed an Is-type polyp in the anal side of the ileocecal valve and Is-like elevated lesion in the ascending colon, which were then removed endoscopically. Narrow-band imaging revealed a type II open pit pattern like in the center of the lesion and a type VN pit pattern like in the periphery of the lesion. The former histopathological findings indicated low-grade tubular adenoma; the latter indicated early colonic cancer with submucosal invasion in the peripheral lesion and a hyperplastic polyp with a serrated pattern in the center of the lesion in the ascending colon. He is currently undergoing regular follow-up.

  • 草野 昌男, 土佐 正規, 高橋 靖, 池田 智之, 高橋 成一, 池谷 伸一, 中山 晴夫
    2020 年 97 巻 1 号 p. 122-124
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    We report 3 cases of juvenile polyps treated with endoscopic resection. The first case was a 30-year-old man with a 1-week history of lower abdominal pain; hence, he was transferred to our hospital. Colonoscopy revealed a pedunculated polyp in the sigmoid colon. The polyp was removed endoscopically and was histologically diagnosed as a juvenile polyp. The second case was a 41-year-old man who presented to our hospital with a 1-month history of bloody stools. Colonoscopy revealed a pedunculated polyp in the sigmoid colon. The polyp was removed endoscopically and was histologically diagnosed as a juvenile polyp. The third case was 55-year-old woman who presented to our hospital with a 1-month history of lower abdominal pain and mild diarrhea. Colonoscopy revealed a pedunculated polyp in the sigmoid colon. The polyp was removed endoscopically and was histologically diagnosed as a juvenile polyp. Their symptoms were improved before colonoscopic examination.

  • 小川 祐太郎, 松田 明久, 山田 岳史, 大森 順, 星本 相理, 進士 誠一, 園田 寛道, 太田 竜, 高橋 吾郎, 岩井 拓磨, 武 ...
    2020 年 97 巻 1 号 p. 125-127
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A woman in her 60s was referred to our hospital with a suspicious finding of obstructive transverse colon cancer. Contrast-enhanced CT also revealed multiple lung, liver, and ovarian metastases, resulting in the diagnosis of cT4aN1bM1c2 cStage IVc obstructive colorectal cancer. Adhesion by huge ovarian tumor and hyperextension of sigmoid colon made it difficult to observe the front view of the transverse colonic tumor by conventional colonoscopy. Therefore, short-type double-balloon enteroscopy was used and enabled us to place colonic stent safely and easily. We underwent primary and ovarian tumors resection without stoma creation. Systemic chemotherapy with bevacizumab was introduced after a good postoperative course. The double-balloon enteroscopy is useful to place colonic stent in a difficult case with conventional colonoscopy.

  • 磯 直樹, 有賀 啓之, 水井 恒夫, 鹿志村 純也
    2020 年 97 巻 1 号 p. 128-129
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 45-year-old man visited our hospital for unrelenting abdominal pain since the day before presentation. Physical examination showed right upper abdominal tenderness. Blood tests revealed evidence of an inflammatory response; however, no other abnormalities were detected. Computed tomography revealed intussusception (telescoping of the small intestine into the ascending colon). A cystic lesion was detected near the root of the appendix in the advanced region. We performed colonoscopy, which revealed a submucosal tumor in the vicinity of the hepatic curve in the advanced region, and we performed ileocolic resection. Histopathological examination of the resected specimen showed an edematous lesion with inflammatory cell infiltration, and we also observed a submucosal abscess. Previous studies have reported that approximately 50% of the lesions were malignant, and 90% of patients underwent operation in cases of cecal intussusception. We report a rare case of intussusception secondary to a cecal submucosal abscess.

  • 箕輪 真寿美, 恩田 毅, 濱窪 亮平, 肥田 舞, 吉田 祐士, 大久保 知美, 西本 崇良, 糸川 典夫, 辰口 篤志, 藤森 俊二, ...
    2020 年 97 巻 1 号 p. 130-132
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    Here we report a 74-year-old man with squamous cell lung cancer who was administered pembrolizumab. The patient was admitted to our hospital because of frequent diarrhea and abdominal pain after 31 cycles of pembrolizumab. Given the clinical, radiological, endoscopic, and pathological findings, the patient was diagnosed with irAE colitis. The patient's symptoms improved with prednisolone after cessation of pembrolizumab. However, he developed aspiration pneumonia. After cessation of prednisolone and treating with antibiotics, he had pseudomembranous colitis and CMV colitis. Both metronidazole and ganciclovir were initiated. Then irAE colitis had recurred and oral 5-ASA was administered. Thereafter, the patient's general condition has improved and colonoscopy showed a slight rough mucosa but improved visible vascular pattern 6 months after the treatment of 5-ASA.

  • 山脇 將貴, 千葉 誠也, 望月 清孝, 加藤 礼, 角 一弥, 吉澤 宗大, 石原 明, 長濵 正亞
    2020 年 97 巻 1 号 p. 133-135
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    An 86-year-old female visited an emergency department for epigastric pain and fever. She had received Billroth II gastrectomy due to gastric cancer 32 years ago. Laboratory tests revealed elevated levels of hepatobiliary enzymes. Computed tomography showed a common bile duct stone with a diameter of 20 mm. We performed endoscopic retrograde cholangiopancreatography. In the first session, endoscopic needle-knife sphincterotomy under the biliary stent was performed. In the second session, stone removal was completed after endoscopic papillary large balloon dilation. There were no complications associated with the procedure.

    We successfully performed endoscopic papillary large balloon dilation with endoscopic sphincterotomy in a patient with previous Billroth II gastrectomy.

  • 福田 壮馬, 遠藤 壮登, 福田 邦明, 辻 実季, 小野田 翼, 丹下 善隆, 新里 悠輔, 寺崎 正彦, 長谷川 直之, 橋本 諒典, ...
    2020 年 97 巻 1 号 p. 136-138
    発行日: 2020/12/18
    公開日: 2021/01/08
    ジャーナル 認証あり

    A 72-year-old man, with a history of proton beam therapy, transcatheter arterial chemoembolization (TACE), and radiofrequency ablation for hepatocellular carcinoma (HCC), presented to the emergency department of a hospital with abdominal pain and jaundice. Contrast-enhanced computed tomography revealed dilated intrahepatic bile ducts and hyperdense contents in the common bile duct. Endoscopic retrograde cholangiopancreatography (ERCP) revealed hemobilia, although the source of bleeding could not be detected because of multiple blood clots. He was referred to our hospital, and we performed contrast-enhanced magnetic resonance imaging and angiography. However, we could not identify the bleeding source; therefore, he was followed up. Four months later, he was readmitted to our hospital for abdominal pain. A second ERCP was performed, which revealed a filling defect in the left hepatic duct. Peroral cholangioscopy showed a polypoid lesion in the left hepatic duct, which bled easily on contact. The mass was considered to be the cause of hemobilia. Biopsy was performed, and the pathological analysis led to the diagnosis of a bile duct tumor thrombus of HCC. He underwent TACE, and recovered without recurrence of hemobilia.

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