外来で安全に粘膜切除を行う方法として，透明EVLを用いる方法を考案して，あらかじめ病理学的診断の確定している7例のadenomaを切除した。用いたEVLはメヂコン社・住友ベークライト社製のものを用いた。病巣付近に生理食塩水を注入し，病巣部を中に吸引して納め，ゴム輪を滑脱させて病巣部をポリープ状とし，そのわずか末梢側を高周波スネアにて切除し，切除標本はフード内に収納して回収した。従来の不透明なものでは，胃内では小病巣は探せないことが多く，実用になりにくかったが，透明なEVLが考案生産されたために，本法は可能になったものと考える。さらに操作が簡単で，over tubeも挿入が容易で危険がなく，頻回の出し入れに大変便利であった。新たに考案されたpneumo-activate EVL deviceはトリップワイヤがないため，鉗子孔が自由に使えて本法に適していた。

抄録全体を表示

　留置スネアは，1989年に蜂巣らにより考案された経内視鏡的結紮装置である。大型の隆起性病変切除の際，出血予防として非常に有用であり，種々の止血処置具としても利用価値が高い。1992年より当科では，大型の胃隆起性病変6症例（過形成ポリープ5例，腺腫1例）に対し内視鏡的切除に留置スネアを使用した。最大径の平均は24mmで，5例は出血予防結紮，1例は止血結紮目的に使用した。留置スネアの後出血予防に対する効果は全例に対して認められた。切除後断端出血に用いた1例では止血に著効した。特に使用に伴う合併症は認めなかった。1例は切除後に脱落を認め，クリップの追加止血を行った。胃ポリペクトミーに伴う偶発症の中で出血が最も多いとされている。特に大型のポリープでは，後出血を考慮する必要がある。留置スネアは安全にポリペクトミーを行う処置具として有用であり，今後適応例には積極的使用が望ましいと思われた。

抄録全体を表示

　クマガイサテライトクリニックにおいては，開設以来15カ月間の総検査件数は上部消化管3,010例で，ポリペクトミー・粘膜切除が156例，全大腸内視鏡検査599例のうちポリペクトミーは270例であった。従来の概念でいえば，入院のうえ切除すべき適応と考えられている大きいポリープを，後出血を予防することにより，外来でも処理できるように種々の方法を考案してきた。その1つとして，1993年9月より蜂巣の開発した留置スネアを用いて食道の平滑筋腫1個，胃の巨大ポリープ2個，盲腸の平滑筋腫1個，結腸のポリープ13個を切除した。それぞれの症例における技術的問題について検討した。また粘膜切除後の人工潰瘍に対して，潰瘍辺縁に数個のクリップを掛けて止血し，更にそのクリップの基部にスネアを掛けて，クリップを1本にまとめ，人工潰瘍の縫合を試みたので報告する。

抄録全体を表示

　食道異所性皮脂腺は極めてまれとされているが，当院で経験した10例について検討した。平均年齢は61.9歳で，性比は7 : 3と男性優位であった。占居部位ではⅠmが高頻度であり，また7例（70％）が多発性病変であった。大きさは最大径1mm未満のものが5例と半数を占め，また5mm以上のものも2例認められた。内視鏡的には黄色調を帯びた白色隆起として認められ，比較的大きなものでは胃黄色腫様の像を呈すが，1mm未満のものでは微小な黄白色斑として認められた。ヨード染色では境界がやや不明瞭な不染，もしくは淡染像を示した。また今回，食道異所性皮脂腺の有無を注意深く検索した2カ月間の通常内視鏡検査774例中6例（0.8％）に発見されており，食道異所性皮脂腺は“極めてまれなもの”ではないことが示唆された。

抄録全体を表示

　1987年10月から1994年11月の期間に施行したEMRのうち，①大きさ30mm以下，②単発性分化型腺癌，③肉眼型 : Ⅰ型，Ⅱa型，Ⅱc型，腺腫内癌，④ひだ集中を認めないの条件を満たす病変（154例）を，一括切除を行っていた1987年10月から1992年6月までの前期（68例）と，分割切除を導入した1992年7月以降の後期（86例）に分けて，治療成績を水平切除断端陰性率，治癒切除率および局所再発の観点で検討した。水平断端癌陰性率は病変全体で前期で57％，後期では71％であった。占拠部位別ではM領域で前期61％，後期78％，A領域で前期50％，後期79％で，分割切除導入により成績が向上した。C領域では前期45％，後期33％で，ともに水平断端癌陰性率が低い傾向にあった。壁在性別では，後期においていずれの領域でも成績の向上が認められたが，小彎においてその傾向が強かった。治癒切除率は前期49％，後期58％であった。水平断端癌陰性のm癌と判定した症例における局所再発を，一括切除（51例）と分割切除（32例）に分けて検討したところ，両者ともに再発は認められなかった。これらの結果より，分割切除における治療成績の向上が示唆され，分割切除を用いた病変の大きさにおける適応拡大の可能性も示唆された。

抄録全体を表示

　内視鏡的粘膜切除を施行し，5年以上経過観察できた24症例27病変で，治療の有用性について局所予後，および外科手術例と対比した生命予後につき検討した。切除検体は，すべて一括切除で得られた高分化型管状腺癌で，粘膜癌が25病変，粘膜下層癌2病変であった。完全切除は18病変（68％）で，5年後他病死した3病変を除く15病変には再発は認められなかった。不完全切除は9病変（32％）であった。このうち2病変（25％）には5年後，再発は認められなかったが，6病変（75％）に再発が認められた。しかし，水平方向の残存癌に対しては，EMRやlaserの追加治療を行うと，局所再発のコントロールは可能であった。生命予後は5年生存率として検討した。外科切除例は2cm以下の高分化型腺癌234例の粘膜癌を対象とした。EMR症例の5年生存率は87.5％，外科切除例は88.6％であり，両者に有意差はなかった。以上よりEMRは，局所予後や生命予後の観点からも有用な治療法であることが確認された。

抄録全体を表示

　われわれが1994年8月までに早期胃癌に対してERHSEを実施した成績をもとに，ERHSEの適応について検討した。症例の内訳は男38例，女24例，平均年齢73.9±8.7歳であった。肉眼型はⅠ型5例，Ⅱa28例，Ⅱb3例，Ⅱc22例，Ⅱa＋Ⅱc2例，Ⅱc＋Ⅱa2例で，組織型は全例分化型であった。深達度はm52例，sm₁ 8例，m，smの判定不能2例であった。病変の長径は平均14mmであった。合併症は狭心症発作1例，出血2例，穿孔4例認めたが，いずれも保存的に治癒した。一括切除は46例74％で，切除断端癌陰性は42例，切除断端癌陽性は3例（うち1例は胃切除で癌遺残なしを確認）で，1例は病変を回収できなかったが，術後130カ月間癌陰性である。分割切除は16例26％で，うち再発例は5例である。従って，初回治療切除率は一括切除例が96％（44/46），分割切除例が69％（11/16）であった。一括切除病変は，深達度を含めた切除断端の病理学的検索が十分にできるが，分割切除病変では不十分となるので，手術可能な患者のERHSEは，一括切除病変に限定するべきと考えられる。長径2cm未満の病変の一括切除率は83％（43/52）で，その初回治癒切除率は96％（50/52）と高率であり，病変内に潰瘍もしくは潰瘍瘢痕のない，長径2cm未満の分化型m癌で，占居部位が一括切除に適していれば，ERHSEによる根治切除の対象としてよいと考えられる。

抄録全体を表示

　われわれは早期胃癌の内視鏡治療として，高分化型で2cm以下の0Ⅱa病変，1cm以下の0Ⅱb病変，1cm未満の0Ⅱc病変，ul（－）を絶対適応，それ以外を相対適応と定め，透明プラスチックキャップを用いた粘膜切除術（endoscopic mucosal resection using a cap-fitted panendoscope : EMRC）とNd-YAGレーザー（MC2100）による治療を行っている。EMRCは1チャンネルの機種で，どの部位でも施行可能で，分割切除も安全に行える。切除標本の大きさはキャップの大きさと吸引圧で決まり，内径13.5mm，深さ10mmのキャップでfull suctionによる一括切除標本の平均径は22mmであった。44例50病変（adenoma 11病変を含む）に行い，出血を4例（全例圧迫やclippingで止血），筋層切除を3例（全例保存的に治癒）に認めた。2例に遺残を認め，レーザー照射を追加したが，1例の他病死を除く全例に現在まで遺残再発を認めていない。レーザー治療に用いたMC2100は，既存の装置の1.06µm波長に加えて，1.32µm波長も有しており，低出力で効果的な照射が可能で，外来通院治療や分割照射が安全に行える。29例29病変中，21例はレーザーが第一選択となった症例（相対適応7例），8例はエタノール局注療法（他院）や粘膜切除後の遺残再発例であった。合併症は認めず，5例（4例が相対適応）に遺残再発（2例手術），5例に他病死を認めた。教室における内視鏡治療の第一選択はEMRCであり，レーザー治療は主に相対適応例や易出血例，他の内視鏡治療後の遺残再発例に対する治療として考えている。

抄録全体を表示

　逆流性食道炎患者に対してNissen手術を腹腔鏡下に施行し，良好な成績を得たので術式を中心に報告する。症例は33歳男性。3年前より逆流性食道炎に対して薬物療法を受けていたが，治療抵抗性のため手術目的により紹介された。全身麻酔下で頭高位，砕石位とし，術者は両脚の間に立ち手術操作を行った。上腹部に5本のトラカールを刺入し，肝左外側区域を圧排鉗子で挙上し，噴門周囲の視野を確保した。胃噴門部を鉗子またはリトラクターで左下方に牽引しつつ，腹部食道を全周性に剥離した。短胃動静脈を切離し，胃底部を授動した。食道を腹側に挙上しつつ，左右の横隔膜脚を2-0非吸収糸で縫合し，食道裂孔を縫縮した。胃底部は食道背側を通し，54Frブジーを経口的に胃内まで挿入したのち，外側胃底部漿筋層，食道筋層，内側胃底部漿筋層の順に2-0非吸収糸を通して4針縫合した。経鼻減圧胃管を胃内まで挿入し，手術を終了した。ISDE-AFP scoreは，術前A₂F₂P₂から術後A₀F₀P₀へ正常化した。

抄録全体を表示

　Acquired immunodeficiency syndrome（AIDS）の合併症は多彩である。その中でも消化管合併症は，AIDS発症の指標としても，また生命予後を左右する病態としても重要である。今回著者らはAIDS患者にCytomegalovirus（CMV）による食道潰瘍を経験したので報告する。症例は28歳男性，血友病。血液製剤によるHIV感染である。吐下血にて来院し緊急内視鏡を施行し，食道下部に露出血管を伴う周堤隆起のほとんどない打ち抜き型巨大潰瘍を認めた。生検検体をPCR法とSouthern blot法を用い，CMVを検出し，CMVによる食道潰瘍と診断した。治療はganciclovirの点滴静注により潰瘍消失がみられた。CMVによる潰瘍は，その発生機序により血管障害が強いため，大出血をきたしやすい。特徴的な内視鏡所見を知り，迅速な診断・治療が必要である。

抄録全体を表示

　症例は68歳女性。固形物のつかえ感，心窩部痛を主訴に来院。上部消化管内視鏡検査で，滑脱型食道裂孔ヘルニアと随伴する逆流性食道炎を認めた。その後定期的に経過観察していたが，5年後の検査時に食道胃接合部の2°，10°方向に大小の表面粗糙で発赤調の小隆起を認めた。1カ月後，2°方向の病変は消失したが，10°方向の病変は残存し，生検で中分化型腺癌を認め，Ⅱc型早期食道胃境界部領域癌と診断し，外科的手術を施行した。本邦では，食道裂孔ヘルニアと早期食道胃境界部領域癌の合併例の報告は少なく，経過観察中に発症したとの報告例も少ない。食道裂孔ヘルニアが食道，胃噴門部癌発生の一因となることも示唆され，長期にわたる定期的な経過観察の必要性とともに，興味ある内視鏡像を呈した症例と考え報告した。

抄録全体を表示

　症例は68歳女性。平成5年9月頃より体重減少が出現し，次第に著明となったため，平成6年7月精査目的で来院。上部消化管X線および内視鏡検査により，胃体中部から幽門前庭部に及ぶ小彎を中心とした広範な粗糙粘膜と，前庭部前壁に大小不同の結節状隆起を認めた。胃体中部より幽門前庭部に及ぶ広範なⅡc＋Ⅱa型早期胃癌と診断し，胃全摘術を施行した。摘出標本肉眼所見では胃体中部小彎から前庭部前後壁に広がる広範な表層拡大型胃癌であった。組織学的には中分化型管状腺癌を主体とし，粘膜下層では低分化腺癌が認められ，深達度はsmであった。また，ly₃，v₃の脈管侵襲および第2群リンパ節までの転移を認めた。表層拡大型早期胃癌の進展形式を検討する上で興味ある症例と考えられた。

抄録全体を表示

　症例は69歳男性。近医にて便潜血反応陽性を指摘され，当院受診。上部消化管内視鏡検査にて，十二指腸下行脚に多発する炎症性ポリープ様隆起性病変，mucosal bridge，びらん，粗糙粘膜，粘膜下腫瘤様隆起，浮腫状粘膜を認めた。生検組織の検索では，粘膜固有層内，粘膜下の血管周囲および結合組織線維に好酸性の均一な物質が沈着し，コンゴーレッド染色陽性，偏光顕微鏡にても緑黄色の偏光を示した。下部消化管内視鏡検査にて，回腸終末部にも十二指腸と同様な所見を認めた。消化管以外の画像検査および臨床検査所見では異常はみられず，消化管原発性アミロイドーシスと診断した。アミロイドーシスの十二指腸内視鏡所見としては，びらん，粗糙粘膜，小顆粒状隆起，潰瘍があげられているが，本症例のような炎症性ポリープ様隆起性病変，mucosal bridgeの報告はなく，消化管アミロイドーシスとして特異な内視鏡像を呈した症例と思われた。

抄録全体を表示

　症例は50歳男性。吐血を主訴に来院し，食道静脈瘤出血にてクリップ結紮術（EVL-c）と硬化療法（EIS）の併用療法を施行後，経過観察中に上部消化管内視鏡にて十二指腸静脈瘤が疑われ，精査加療目的で入院となった。低緊張性十二指腸造影では，下行脚に表面平滑な孤立性の隆起性病変が認められ，経上腸間膜動脈造影では十二指腸近傍に静脈への還流を認め，超音波内視鏡では十二指腸の壁内外に多数の血管像が描出され，十二指腸静脈瘤と診断された。孤立性の十二指腸静脈瘤に対してEVLを行い，周囲に1％aethoxysklerolを計5ml局注した。後出血もなく，静脈瘤は完全消失した。近年，十二指腸静脈瘤破裂の報告は増加しているが，内科的には治療が難しい。食道静脈瘤硬化療法の既往のある十二指腸静脈瘤も含めて，孤立性の静脈瘤はEVLのよい適応と考えられた。本邦では自験例も含めて，内視鏡的静脈瘤結紮療法を施行したのは2例にすぎず，若干の文献的考察を加え報告する。

抄録全体を表示

　症例は55歳男性。発熱，黄疸を主訴に入院した。腹部超音波，腹部CTスキャンにて胆管拡張が認められ，経皮経肝胆管ドレナージを施行し，下部胆管に閉塞を認めた。十二指腸内視鏡では，乳頭部を中心に凹凸不整な小結節様の隆起病変を全周性に認めた。生検にて乳頭部は腺癌で，その周囲は絨毛腺腫と診断された。手術後の病理所見では，十二指腸病変は乳頭を中心に長軸方向6cmの範囲で，全周性に絨毛状増殖を示し，割面では乳頭部の粘膜病変に隣接して，乳頭部胆管に主座をおく腫瘤を認めた。組織学的には十二指腸粘膜病変は悪性化を伴った絨毛腺腫で，乳頭部の腫瘤は浸潤性増殖を示す中-低分化腺癌であった。またCA 19-9での免疫染色で，両者は明瞭に分離された。以上より本症例は，腫瘍が十二指腸粘膜，乳頭部にそれぞれ存在し，その組織型，免疫染色の違いにより，Vater乳頭部癌に悪性化十二指腸絨毛腺腫が衝突した重複癌と考えられた。

抄録全体を表示

　症例1は54歳男性。糖尿病と肝機能障害の精査目的にて入院となり，腹腔鏡検査を施行した。肝円索は認めたが，肝鎌状間膜はドーム下に一部残存するものの，大部分が欠損していた。通常の肝鎌状間膜の部位には白色瘢痕を認めた。2年後，HCV抗体陽性にて肝機能の増悪を認めたため，再度腹腔鏡検査を施行したが，肝鎌状間膜欠損に変化は認められなかった。症例2は58歳女性。肝機能障害の精査目的にて入院となり，腹腔鏡検査を施行した。1例目と同様に肝円索は認めたが，肝鎌状間膜はドーム下に一部残存するのみで，大部分が欠損していた。白色瘢痕も同様に認められた。また，横隔膜と肝表面に多数の索状の癒着を認めた。肝鎌状間膜欠損症の報告例は少なく，国内外で28例の報告があるが，そのうち22例はイレウスを発症し，手術にて発見されている。本症例のように，腹腔鏡にて偶然発見されているものは本邦では6例のみであり，まれと考えられ報告する。

抄録全体を表示

We examined the clinical usefulness of newly devised small-caliber electronic endoscope for upper gastrointestinal tract, GIF-P230 (Olympus) . Endoscopists examined the same 34 patients with GIF-P230 and its conventional type GIF-XQ200, and answered a questionnaire concerning scope insertion, and observation.
Results showed that insertion of GIF-P230 into the pharynx and the doudenal bulb were more easy than that of GIF-XQ200, because the outer diameter of the former endoscope was 0.5mm smaller (8.7mm) than that of the latter scope, and the former scope consisted of high elastic polymers. Although this scope has only one light guide channel, the brightness at the TV monitor and photographs was sufficient. These results indicate that GIF-P230 is more useful for endoscopic diagnosis of upper gastrointestinal diseases than by the previous electronic endoscope.

抄録全体を表示

The gastrofiberscopic examination (GFS) has been thought painful for patients. We tried to alleviate patients' pain by the use of midazolam (a sediative) . A dose of 0.08 mg/kg for male and a dose of 0.1mg/kg for female are enough to obtain good results. To prevent staggering and having memories during the examination, the dose of midazolam and the time to start GSF after using it need to be appropriately determind.

抄録全体を表示

For recent 8 months 11 patients were treated by TEM for rectal lesions in our hospital. Eight malignant tumor including 3 residual tumor which were suspected after endoscopic polypectomy and one benign tumor were resected safely and their surgical margins were all negative. TEM is suggested as an effective, accurate and minimally invasive therapeutic procedure.

抄録全体を表示

Bile acids refluxed into the stomach in cases of digestive ulcer were studied. We also studied a relation between results of image process of gastric mucosa using SP-1000 (by Olympus) and concentration of bile acids.
A reflux frequency of bile acids and taurocholic acid into the stomach were the highest in cases of gastric ulcer among digestive ulcers. These concentrations were over twice higher than that of control group (each p<0.01) . We performed image process by electric endoscopic pictures of the posterior wall of the fornix. We got a positive correlation between logarithm of G-signal (log G) and concentration of bile acids (N=55, γ=0.696, p<0.01) .

抄録全体を表示

We tested several methods to Helicobacter pylori (Hp) infection in 10 patients who underwent endoscopic examination.
Serum samples were assayed by EIA for Hp, while tissue specimens of gastric mucosa were examined for Hp by microscopy, culture and PCR. In addition, to obtain informations on Hp infection among 63 medical personnels engaged in endoscopic examination their serum samples were assayed by EIA.
In patients whose Hp was detected by EIA positive for Hp, Hp was detected by microscopy, culture and PCR. Three patient who were underminant by EIA, other three methods failed to detect Hp. ¹³C urea breath test was performed after a therapy. The results of the test did not differ between Hp negative control subject and those cleared Hp, while the value significantly differed in those failed to clear Hp from that in control subjects.
Among 63 medical personnels, those participated in endoscopic examination had serologic evidence of infection with Hp more frequently than those who did not. Percent of Hp infection in medical personnels engaged in endoscopic examinations positivively increased with years.

抄録全体を表示

The effect of Helicobacter pylori (Hp) eradication on duodenal ulcer healing was studied in 24 patients with duodenal ulcer (16 males and 8 females, mean age : 41 years old) . Eradication was done with lansoprazole 30mg/day 6 weeks and amoxicillin 1,500mg/day 2 weeks. Hp infection was detected by serum Hp IgG antibody, rapid urease test, histological examination and ¹³C urea breath test.
The follwing results was obtained.
1) Endoscopic findings at clearance : In total, S₁ stage was 50% and S₂ stage was 50%. S₁ stage was 100% in Hp positive cases and S₁ stage was 33% and S₂ stage was 67% in Hp negative cases.
2) Endoscopic findings at eradication : S₁ stage was 100% in Hp positive cases and S₂ stage was 100% in Hp negative cases.
From these results showed above, it is suggested that Hp eradication effect healing rate to S₂ stage, also in relapsed cases. Because eradication rates was only 50%, however we must consider about the combination of medicine, duration of therapy and so on.

抄録全体を表示

We studied the clinical courses of 22 lesions of the early gastric cancers in inoperable 18 patients, after endoscopic resection. Nine cases refused their surgical therapy and 9 cases were unable to be operated because of their complicated disease. Although 12 out of 22 lesions (55%) were resected completely, 10 out of 22 lesions (45%) were resected incompletely, and were retreated by endoscopic procedure such as additional endoscopic resection, microwave irradiation, local injection of pure ethanol. Six out of 10 lesions (27%) were cured, and remaining 4 lesions are still being treated endoscopically. Repeated endoscopic treatment made the curing rate better from 55% to 82%. We conclude that even if the initial endoscopic resection against an early gastric cancer in inoperative patient is incomplete, secondary treatment shoud be undergone.

抄録全体を表示

We examined 26 cases of IIa-aggregated polypoid type in 2,338 operated cases of early gastric cancer between from 1962 to 1991 in NCCH. We tried to classify 26 cases with regular type and irregular type. And we had the results of the differenciation between both types.

抄録全体を表示

The aim of this study was to demonstrate the feature and the treatment on hemorrhage after colonoscopic polypectomy in our hospital. Immediate hemorrhage after colonoscopic polypectomy was seen in 0.08% (7/8,358 cases) . Delayed hemorrhage was seen in 0.31% (26/8,358 cases) .
Delayed hemorrhage occurred 1 to 9 days after polypectomy. The causes of delayed hemorrhage were alcohol intake (9%) , excessive physical exercise (9%) , bathing (3%) and anticoagulant drugs (3%) . In cases of endoscopic mucosal resection (EMR) , both immediate and delayed hemorrhage were seen in 0.4%. On the other hand, immediate hemorrhage occurred in 0.09% and delayed hemorrhage in 0.6% of patients with snare polypectomy. As for the treatment of hemorrhages after colonoscopic polypectomy, endoscopic hemoclipping and heat probe were useful for complete hemostasis. However, open laparotomy was needed in one patient.
In conclusion, it is important to take a rest at least for 7 days after colonoscopic polypectomy, and to avoid anticoagulants and alcohol. Under the condition of hemorrhage after colonoscopic polypectomy, endoscopic hemoclipping is the most useful maneuver for complete hemostasis.

抄録全体を表示

The aim of this study is to demonstrate the endoscopic findings of early colorectal cancer (9 lesions) and adenoma (28 lesions) with superficial depressed type. Sixty-six percent of early cancers and 93% of adenomas were detected through the careful endoscopic observations for the color of the tumor and the changes of the fold. Most of early cancers were located in the sigmoid (44%) and ascending (33%) colon, whereas adenomas were located in the transverse (50%) and sigmoid (33%) colon. Thirteen lesions of 5 mm in diameter or less were adenomas, however, 3 lesions larger than 15 mm showed early cancers.
It is important to observe the depressed area, edge and consistency of the tumor carefully. In this study, clear continuity of the edge of the depressed area was observed in early cancers, whereas only 18% of adenomas showed continuity of the edge. Invasive cancers showed the following characteristics, such as irregular tumor edge (80%) , hardness (49%) , irregularity of the depressed area (80%) , however, these findings were not found in focal cancers and adenomas.
In conclusion, it is possible to make a diagnosis of the early cancers and adenomas through the endoscopic findings.

抄録全体を表示

We evaluated the association between portal hypertensive gastropathy and portal hemodynamics. The subjects were 35 patients with liver cirrhosis complicated by esophageal varices in whom the clinical course were observed for 3 years. They were classified into the group who developed a spleno-renal shunt during the course and that who did not. The incidence of portal hypertensive gastropathy before observation was similar between the two groups.
Changes in portal hypertensive gastropathy during the course were slighter in the spleno-renal shunt group than the non-shunt group. Since no difference were observed in the size of spleen, the diameter of the main trunk of the portal vein, or blood biochemical findings between the two groups during the observation period, the development of the spleno-renal shunt, ie, the state of the development of the collateral circulation seems to be involved in the development of portal hypertensive gastropathy.

抄録全体を表示

A 47-year-old man came to our hospital with a chief complaint of discomfort in swallowing. He ate fish 4 days ago. We examined his esophagus and stomach endoscopically and found a large fish bone stabbing into the esophageal wall. The CT picture showed a free air and gastrographine which localized in the posterior mediastinum. There is no diffused mediastinitis. Then, we picked out large fish bone endoscopically. We followed him up conservatively without surgical therapy for 20 days until his discharge.

抄録全体を表示

Corrosive esophagitis is mostly due to ingestion of acid and alkaline medicines, and one due to organic solvent is very rare. We have recently experienced one patient with esophageal ulcer caused by a binding agent containing toluene.
A 34-year-old man was found lying after ingestion of a binding agent containing toluene, and admitted to the psychiatry ward. He complained of retrosternal pain when eating foods, and vomitted coffee ground material on Aug 16. Endoscopy was carried out, and an ulcer of the esophagus was found ; it was covered by a broad band of white coat in the region 33 cm from the upper teeth to the EC junction.
There were luekocytosis and increased CRP suggestive of inflammation. Serum levels of total protein were reduced suggesting a reduced nutrition state. Biopsy histology of the esophagus demonstrated abundant capillaries, proliferating fibroblasts and inflammatory cell infiltration. A diagnosis of esophageal ulcer of Rosenow grade III was made. He was treated canservatively with an H₂ recepter antagonist and recovered almot fully on Sept 21.
It is generally believed that organic solvent is not very damaging to the esophageal mucosa, but toluene, has a strong central nerve suppressing effect, leading sometime to death. In patients who have ingested an organic solvent, endoscopy is recommended because of possible corrosive esophagitis.

抄録全体を表示

A 49-year-old male was admitted to our hospital with the chief complaint of dysphagia. Endoscopic examination revealed a submucosal tumor about 3.0cm in diameter with lobulated surface at the lower esophagus. One month later, an endoscopic examination showed the tumor growing to about 5.0cm in diameter. Endoscopic ultrasonographic examination revealed the low echoic lobulated area with calcification.
According to those findings, the tumor was suspected to be a leiomyosarcoma. Excision of the lower portion of the esophagus was performed on June 21, 1994. Pathological examination showed a leiomyoma.
A leiomyoma of the esophagus is rare. It generally has a smooth surface and grows very slow. But our case was diagnosed a leiomyosarcoma before the operation, because it had a lobulated surface and grew comparatively fast.

抄録全体を表示

A case of an esophageal sessile lipoma is herein reported. A 55-year-old male visited our hospital complaining of mild dysphagia. The endoscopic examination showed a sessile yellowish submucosal tumor (SMT) at the lower portion of the esophagus (33cm from the incisor) .
An esophagography showed a sessile SMT (5cm in size) . This tumor was comfirmed to be a lipoma by the endoscopic ultrasonography (EUS) , magnetic resonance image (MRI) , and computed tomography (CT) examination. EUS showed a homogenous high echoic SMT and sagittal MRI showed a high intensity tumor in T₁-weighted. Because it was sessile and too large for endoscopic polypectomy, surgical resection was performed. The fresh specimen was 5.2×2.8×2.0cm in size, and diagnosed pathologically as a lipoma.
Twenty-eight cases of esophageal lipoma have been reported in Japan. With a review of the literature, lipomas of esophagus often arise at cervical esophagus, whose majority have stalks. Seven cases of the lipoma removed by endoscopic polypectomy have been reported. It is necessary to examine the site, size, stalk and the general condition for endoscopic polypectomy. EUS, CT and MRI examinations are quite useful for diagnosing esophageal lipoma.

抄録全体を表示

A 64-year-old man was admitted to our hospital because of an abnormal finding of the esophagus detected by a barium meal examination on a medical check up. Barium meal study revealed a slightly elevated lesion at the middle esophagus, but no finding at the stomach. By an endoscopic examination, this elevated lesion was surrounded by a slightly reddish mucosa, which was not stained by the Lugol application.
Endoscopic examination of the stomach showed a depressed lesion at the posterior wall of the lesser curvature at the upper stomach. Biopsied specimens of the esophageal lesion showed squamous cell carcinoma and those of the stomach were tubular adenocarcinoma. Pathological examination revealed superficial elevated type associated with superficial flat type limited to the mucosal layer at the esophagus (IIa+IIb type, 4.7×4.7cm in diameter) and superficial depressed type limited to the mucosal layer at the stomach (IIc type, 0.8×0.8cm in diameter) .
The occurrence of ealry esophageal carcinoma with early stomach carcinoma is rare. Only 36 cases have been reported in Japan. This case was diagnosed as the early esophageal carcinoma and the early gastric carcinoma before the operation was performed.

抄録全体を表示

A 52-year-old male with 4 month-long periumbilical discomfort, dull pain, and weight loss of 10kg in four months was admitted for examinations. On admission he had periumbilical tenderness and marked eosinophilia (59% of 16,900/mm³ peripheral leukocyte count) .
Endoscopic examination showed mucosal roughness and indistinct vascular pattern of esophagus, enlargement of Kerckring's folds and redness at 2nd portion of duodenum, and biopsy specimens taken from these lesions revealed prominent infiltration of eosinophils. Stomach and colon mucosa were almost endoscopically normal, and their specimens showed mild infiltration of eosinophils. Abdominal CT and US indicated swelling of gall bladder.
He was observed without specific treatment, such as steroids or anti-allergic agents, however, his symptoms improved gradually and laboratory findings normalized. After 6 months, he was symptomless.

抄録全体を表示

A 56-year-old female with epigastralgia, was diagnosed with submucosal tumor with ulceration in the antrum of the stomach by endoscopy. Although the diagnosis was submucosal tumor, due to her continuing symptoms, we treated her with H₂-receptor antagonist. This treatment was not effective. Therefore, the tumor was surgically removed. Histologically, her gastric tumor was diagnosed as inflammatory fibroid polyp (IFP) . Gastric IFP is rare, and it is very difficult to differentiate between IFP and other submucosal tumors.
We reported a case of gastric IFP, that showed the same symptoms as gastric ulcer.

抄録全体を表示

We report a case of 44-year-old female with gastric polyposis accompanied by iron deficiency anemia. She was referred to our hospital due to abnormal radiogram of the stomach and severe anemia in a mass examination.
Gastroduodenal endoscopy revealed gastric polyposis mostly spreading in the body of stomach. Biopsy specimens showed marked inflammatory cell infiltration in the whole gastric mucosa, though neither hyperplastic nor atrophic changes were observed. Peripheral blood cell count and chemistry showed severe iron deficiency anemia, whereas serum Vit B₁₂ and folic acid were within a normal level. Anti-parietal cell antibody and anti-intrinsic factor antibody were negative. Serum gastrin level slightly increased (280pg/ml) with decreased basal acid output (0.3mEq/h) . As gastric polyposis became flattened after the iron therapy completed, these changes of stomach were considered to have correlation with iron deficiency anemia.

抄録全体を表示

A 68-year-old woman visited our hospital with a complainted of epigastralgia. Upper GI endoscopy revealed a prominent lesion associated with bridging folds of the posterior wall of the antrum. Endoscopic ultrasonography (EUS) showed a hyperechoic mass in the fourth layer. The inside echo was not uniform. Abdominal CT showed the mass to be continuous high density area. These findings led to the suspition of a leiomyoma or carcinoid tumor, lesions that are rich in bloody vessels. As the possibility of malignancy could not be ruled out, gastrectomy was performed. Histologically, the lesion was diagnosed to be a glomus tumor.
The EUS findings of only five cases of the stomach have been reported in Japan. All reported tumors were round or oval and were located from the submucosa to the muscularis propria. The EUS findings of this case were very similar to those previously reported. Histologically, the tumor contained numerous blood vessels, which were partly responsible for the non-uniform echoic pattern inside of the lesion.

抄録全体を表示

The patient was 64-year-old male with a chief complaint of epigastric discomfort. Upper GI X-ray and endoscopic examinations revealed a superficial spreading type of early gastric cancer (IIc type) on the lesser curvature of the middle body of the stomach. Total gastrectomy was performed.
Histological findings showed that the IIc type lesion diagnosed preoperatively consisted of two independent lesions, and besides there were three other lesions of IIc type of early gastric cancers undetected by examination. The two independent lesions on the lesser curvature of the middle body were a IIc type of early gastric cancer (tub₂, m, ly₀, v₀, 22×10mm) and a IIc like type of advanced gastric cancer (muc, se, ly₁, v₂, 50×35mm) . Concerning the depth of invasion of three other lesions, the IIc type lesion on the anterior wall of the upper body was confined to submucosa (tub₂, ly₂, v₀, 22×10mm) , the IIc type lesion on the anterior wall of the fornix was confined to submucosa (tub₂, ly₀, v₀, 10×9mm) and the IIc type lesion on the posterior wall of the fornix was limited in mucosa (tub₂, ly₀, v₀, 18×15mm) .
We reported a rare case of multiple gastric cancer with 5 lesions of which two lesions looked like a single superficial spreading IIc type of early gastric cancer.

抄録全体を表示

The patient was a 50-years-old man. An abnormality of the stomach was found by mass survey. When endoscopic examination done by local doctor, he was found to have an elevated lesion with a central ulceration surrounded by an irregular margin in the lower part of the gastric body. When examined by endsocopy 2 months later, the lesion was demonstrated as a submucosal tumor with a fissure-like depression in the center at the anterior aspect of the lower body. When examined 3 months later, the lesion changed to a IIc-like appearance with converging folds. About 4 months later, the lesion looked like scarred multiple ulcers.
Though pathologic appearance of the specimen taken by the local doctor were cosistent with malignant lymphoma, there have been no findings of malignancy, thereafter, since the tumor resolved by itself, the patient was placed under clinical observation. He has shown no sign of recurrence for 2 years and half.

抄録全体を表示

A 73-year-old man with early gastric cancer was admitted to our hospital on April 13, 1994. Endoscopic and X-ray examination was IIc in the small curvature of the gastric angle. Biopsy specimen showed tubular adenocarcinoma. But DIP, abdominal echo showed the right hydronephrosis, and so, retrograde pyelography showed the stenotic lesion from L₅ to S₁ level and abdominal CT showed the low density area of the right ureter. So under the diagnosis of the ureteral tumor, the patient had undergone the right nephrouretectomy with partialcystectomy. Pathological diagnosis was tubular adenocarcinoma, ly (-) , v (+) .
After this operation, subtotal gastrectomy was performed. Pathological diagnosis of the gastric cancer was double early cancers, IIc, tubular adenocarcinoma, ly (-) , v (-) in small curvature of the gastric angle and IIc, tubular adenocarcinoma, ly (-) , v (-) in the anterior wall of the middle portion. The ureteral tumor was suggested to be the metastasis of this gastric cancer from pathologically and no other abnomal lesions.

抄録全体を表示

We experienced a case of duodenal varices. A 62-year-old male with liver cirrhosis who was hospitalized for melena. Gastrointestinal endoscopy showed nodular varices with red plug in the descending portion of the duodenum. We considered that this case was rupture of duodenal varices.
We performed endoscopic injection sclerotherapy (EIS) with 1% polidocanol 9ml and thrombin (50U/ml) 2ml to duodenal varices. Duodenal varices of this case was thought to be caused by portal hypertension due to liver cirrhosis and adhesion in upper abdomen due to operation of cholecystectomy. Therefore it is necessary to observe the descending portion of the duodenum, in the case of portal hypertension with post EIS of esophageal varices or post operation of abdomen.

抄録全体を表示

A 60-year-old man was admitted to our hospital because of a flat lesion at the anal side of supra duodenal angle. This lesion was pointed out by screening upper GI endoscopy. The follow-up examination showed the adenoma with severe atypia.
Tumor was 15×10mm in size with eroded surface. After spraying indigocalmin, this lesion was clearly identified. Endoscopic ultrasonograpy revealed the adenoma was located within duodenal mucosa.
The endoscopic mucosal resection (EMR) was successfully done, the resected specimen was 18×15×3mm in size and histological examination revealed 7×3mm flat type of adenoma. The over expression of p53 by using immunohistochemistry was not observed in the tissue.
Reported case of flat adenoma was relatively rare. There was 6 cases in Japanese literature (during 1956-1993 period) .

抄録全体を表示

We reported a case of duodenal carcinoid evaluated by ultrasonic probe (USP) . A 59-year-old man was admitted to our hospital in May 1994 with epigastralgia. A filling defect was detected on routine upper gastrointentestinal X-ray examination, and endoscopic finding showed a small elevated lesion on the anterior wall of the duodenal bulb. Biopsy revealed typical features of carcinoid tumor. USP revealed a hypoechoic tumor with regular margin in the 2nd-3rd layer of the wall. The tumor, measuring 7×8mm in size, was removed by surgical operation. The tumor was located in the duodenal submucosa. USP with miniature probe was thought to be useful for the diagnosis of the extent and depth of invasion of a small duodenal carcinoid tumor.

抄録全体を表示

A 50-year-old woman admitted to our hospital with melena. Upper GI endoscopy and colonoscopy did not show any particular abnormality. Celiac and superior mesenteric angiography also failed to diagnosis. One hundred ml barium meal study of small intestine and hypotonic duodenography revealed duodenal tumor at its ascending part. Tumor was resected operatively and was 2cm in size with 5cm-long stalk. Pathologically this tumor was carcinoid, argyrophil-positive and argentaffin-negative. Histologic type by Soga-classification was A+C mixed type.
This case was characterized by bleeding, its shape and its location. Melena is recognized in 9% of duodenal carcinoids in Japan but carcinoid with 5cm-long stalk and originated from ascending part of duodenum is very rare.
Diagnosis of gastrointestinal bleeding, endoscopic and angiographic failed to, is difficult. In such a case barium meal study and compression method is important to detect the lesion.

抄録全体を表示

A case of duodenal carcinoid tumor producing gastrin in a 81-year-old woman is reported, and a brief review of the literature is presented.
The tumor was located in the anterior wall of duodenal bulb. Histologically, the tumor was a argyrophil carcinoid and resected under epidural anesthesia. Preoperative level of serum gastrin was about four-fold of normal upper limit and postoperative level was within normal limits. Furthermore, the tumor cells showed strong immuno-reactivity for gastrin. Photomicrograph of the tumor using a hematoxylin eosin stain showed a turavecular or ribbon-like structure. The tumor cells located in the muscularis mucosa and submucosal layer and had middle-sized egg-shaped nuclei. So we diagnosed the case as a carcinoid tumor producing gastrin.
Carcinoid tumor develops from the deep layer of mucosa, so preoperative diagnosis of this tumor is difficult. We could preoperatively diagnose the tumor as carcinoid tumor by typical histological pattern of bioptic specimen. The average age of these patients was about 50 years. Carcinoid tumors sometimes secrete hormone or its related substance. There have been few reports on the active substance. This case is a rare case because of demonstration of its biological activity.

抄録全体を表示

The patient is a 61-year-old-man who complained of headache and diziness. Brain CT showed homogenous enhanced mass lesions in the left frontal lobe and right occipital lobe. In the operation, brain tumor was diagnosed metastatic malignant melanoma originated on the left heel. Endoscopic finding showed Borrmann type 2-like lesion in the second portion of the duodenum. Histological finding of biopsy specimen revealed metastatic duodenal malignant melanoma.●改行● The patient was treated with ACNU and VCR after the resection of the original cancerous lesion. Follow-up endoscopic examination, performed 8 weeks after chemotherapy, revealed the features like ulcer scar lesion and histological diagnosis was group II. We reported a rare case of metastatic duodenal malignant melanoma with remarkable response to anti-cancer chemotherapy.

抄録全体を表示

A polypoid lesion (11×12mm) was found in the second portion of the duodenum in an otherwise healthy 61-year-old male by upper GI endoscopy. The histopathological examination on biopsy specimen revealed group III atypia. Subsequently, endoscopic polypectomy was performed and the histopathological examination on the resected specimen revealed tubulopapillar adenocarcinoma embedded in tubular adenoma. The carcinoma cells were found only inside the lamina propria mucosa and no invasion into blood and lymphatic vessels was detected. The resection edge was free of adenoma and adenocarcinoma cells. Following examination has shown neither local recurrence of neoplasm nor metastatic events.

抄録全体を表示

Carcinoma of the small intestine is comparatively rare. A 29-year-old man was admitted to the hospital because of vomiting and left abdominal pain. Iieus was suspected by a scout film of the abdomen. Small intestinal barium meal examination revealed a Borrmann type 2 elevated lesion.
The endoscopy of small intestine using push way style fiberscope (Olympus SIF10) was performed and biopsy was done. But, biopsy was negative. Operation was done on 20th hospital day. The tumor was located in the jejunum anally about 140 cm from the ligament of Treitz. The resected specimen showed well differentiated papillotubular adenocarcinoma of the jejunum, 2.5 by 2.0 by 1.0cm in size. But, the dissemination to the vesicorectal pouch and mesenteric lymphnodes were diagnosed at operation and finally confirmed by pathological examination.
In Japan, push way style small intestinal fiberscope is widely employed rather than ropeway and sonde method. In the literature, 58 cases are reported for various small intestinal diseases until now. Our case is the deepest one which is observed successfully by endoscopy. This technic is very useful for the preoperative evaluation of the small intestinal mass.

抄録全体を表示

A 53-year-old female was admitted to this hospital because of a painful abdominal mass and leukocytosis. Physical examination on admission revealed a painful mass of the right lower quadrant. Initial laboratory data included a white blood cell count of 13,600 mm³ and a CRP of 12.2mg/dl. She was given intravenous fluids, and placed on antibiotic therapy. As clinical observations and laboratory data pointed to inflammation of the right-sided colon, ultrasonography and CT scanning suggested a penetrating carcinoma of the ascending colon. Barium enema revealed narrowing of the ascending colon with“accordion sign”. Colonoscopy disclosed an edematous elevated lesion, 5cm long, without ulceration. The biopsy specimens revealed colitis. On the 9th hospital day there was no palpable abdominal mass and she denied tenderness on physical examination. On the 15th hospital day the elevated lesion decreased in size and obvious diverticula of the ascending colon were noted on colonoscopy. In this case the endoscopic examination was helpful for the definite diagnosis of deverticulitis.

抄録全体を表示

Case 1 was a 46-year-old male with a few year history of bloody stool. He had dark red bloody stool in Nov 1994 and underwent lower GI endoscopy. Diverticulum stained with a clot was revealed and clip ligation was carried out for hemostasis.
Case 2 was a 53-year-old female. Diverticulosis had been diagnosed for 10 years. She had dark red bloody stool in Aug 1994. Lower GI endoscopy was performed, which showed diverticulum with a clot. Clip ligation was employed successfully for hemostasis.
Case 3 was a 77-year-old female. Dark red bloody stool occurred in Oct 1990. Lower GI endoscopy failed to identify the source of hemorrhage. The patient was admitted for a detailed examination of anemia in Aug 1994. After admission, scarlet bloody stool occurred. Lower GI endoscopy revealed exudative hemorrhage from diverticulum, and hemostasis was done by clip ligation.
These 3 patients with hemorrhage from colonic diverticulum in whom clip ligation for hemostasis was successful are reported in this paper.

抄録全体を表示