bluuebunny/crossref_metadata_2025 huggingface dataset:
Low‐Power Contact Nd: YAG Laser Endoscopy
Authors: MIWA Takeshi , SUZUKI Sohtaro
Published: August 2007

Abstract: Laser application in gastrointestinal endoscopy started with the development of flexible optical fibers in about 1970. Originally, non‐contact irradiation with high power Nd: YAG lasers of 100 watts (W) was used for gastrointestinal hemostasis. It was difficult to achieve safe and reliable irradiation with this method, the quarts fiber tips were susceptible to coagulation damage, and the cost was high. As a result local injections were recognized as an inexpensive and excellent method of producing hemostasis, and became the treatment of first choice. Therefore, the endoscopic use of lasers shifted from hemostasis to the topical treatment of tumors.

In 1984 low‐power Nd: YAG laser irradiation at 1 to 30W became possible using a ceramic contact probe co‐developed by the authors and the Surgical Laser Technology Japan Co. This made photocoagulation, vaporization, cutting and local hyperthermia (Laserthermia) feasible. Improvements in laser irradiation efficiency led to the development of inexpensive equipment, costing less than one‐third of the price of conventional equipment. The application of low‐power contact lasers significantly improved the clinical efficacy of the treatment of minute cancers, but the technique has the same limitations as other endoscopic methods. Furthermore, because laserthermia is still being developed, the best technique has not yet been fully defined.

In the future, treatments that can be used effectively in association with low‐power contact laser therapy need to be identified. Low‐power contact laserthermia, local hyperthermia with microwaves, and photodynamic therapy with excimer dye lasers all need to be studied further. This will contribute to the development of a minimum invasive therapy for gastrointestinal lesions.
Endoscopic and Histopathological Study about 25 Cases of Minute Superficial Depressed Neoplastic Lesions in the Large Intestine
Authors: KATAKURA Shigehiro , SATAKE Yoshiharu , AKSOZ Kadir , SUGIMOTO Hiroyuki , KAMINAGA Norihiro , TUBOMIZU Yoshio , FUJITA Rikiya , SUGATA Fumio
Published: August 2007

Abstract: We studied 25 cases of minute (less than 5 mm in a diameter) superficial depressed neoplastic lesions during the period of March 1990 to September 1991. These depressed neoplastic lesions were recognized by colonoscopy as asteroid redness with surrounding elevation. The thickness and height of the surrounding elevations were modified by air volume. Occasionally, they seemed according to the air volume to be elevated lesions, though their fundamental form was confirmed as being superficial depressed lesions from observations of histopathological sections and using a dissecting microscope. The endoscopic figures were emphasized by sprinkling them with Methylene Blue.

All of the minute depressed neoplastic lesions were histopathologically diagnosed as being tubular adenoma. For the purpose of confirming the histopathological character of the depressed neoplastic lesions (n = 25) and distinguishing them from conventional elevated adenomas (n = 71) of the same diameter, we compared the incidences of glandular crowding, nuclear stratification, nuclear pleomorphism and loss of nuclear polarity in two groups. Glandular crowding and nuclear pleomorphism were recognized significantly more often in the depressed neoplastic lesions than in the elevated adenomas.

Although most of the minute depressed neoplastic lesions were fundamentally adenomas, because of their unique histopathologic character, they could give new insight into the development of colon cancer.
Duodenoscopic Management in Biliary Ascariasis
Authors: KAMIYA Toshiaki , MORISHITA Tetsuo , REREDO Remberto , MARANCENBAUM Carlos , MONTAÑO Carlos
Published: August 2007

Abstract: Ascaris lumbricoides is spreading throughout the entire world. In its adult form it usually lives in the human intestine, but biliary or pancreatic complications due to the worn's infestation are not uncommon in endemic areas like Bolivia and have become a significant problem. Many authors recommended surgical treatment for the removal of the worn.

In this paper we present our experiences with the endoscopic management of bilialy ascariasis.

From June 1985 to August 1991, 38 patients were diagnosed as having biliary ascuriasis by means of an endoscopic retrograde cholungiography. In the duodenoscopic treatment, all of the procedures were performed under fluoroscopic control.

These Ascaris lumbricoides were located in the choledocus and common hepatic ducts in 33 patients (86.8%), 3. patients had them in the gallbladder (7.9%) and 2 patients had them (5.3%) in the intrahepatic ducts.

Endoscopic extractions were successful in 17 out of 20 (85.0%) non‐jaundice patients, in the other 3 cases the woms were removed surgically. In the jaundice cases, 3 of the 6 patients with woms (50.0%) were successfully treated by endoscopic extractions with simultaneous stones prior to an endoscopic sphincterotomy and the rest were treated surgically.

Since no significant complications were observed after this endoscopic treatment method we recommend endoscopic extractions of biliary ascariasis.
Pneumatic Dilatation for the Treatment of Achalasia
Authors: YAMADA Masami , KANEKO Eizo
Published: August 2007

Abstract: A peristalsis of the esophageal body and absent or incomplete lower esophageal sphincter (LES) relaxation on swallowing are the functional hallmarks of achalasia. Its pathogenesis involves loss of intramural neurons, a process that subsequently results in poor LES relaxation and dilatation of the esophageal body. No logical therapeutic concept can be formulated since the cause of this disorder is at present poorly understood. Treatment focuses on pharmacological or mechanical alleviation of LES obstruction. Medical treatment of achalasia has yielded only limited success compared with mechanical dilatation or surgical myotomy. There is no question that pneumatic dilatation is the most effective, nonsurgical treatment available for the management of achalasia. If patients are at low risk, regarding age and cardiorespiratory status, pneumatic dilatation should be considered as the treatment of choice. Repeated dilatations result in a progressively longer remission. Peristaltic sequences may return in response to successful dilatation. It is important to distinguish primary from secondary achalasia as the therapy and prognosis of the two conditions are distinctly different. An endoscopy can demonstrate the absence of organic lesions, especially carcinoma or esophagitis. Achalasia during pregnancy is safely managed by endoscopic dilatation and it does not constitute an indication for the termination of the pregnancy. A major objective of this article is to provide some insight into the usage patterns, results, and complications associated with pneumatic dilatation of achalasia.
Four Cases of Ectopic Sebaceous Glands Confirmed Endoscopically in the Esophagus
Authors: KUMAGAI Yoshiya , MAKUUCHI Hiroyasu , OHMORI Tai , MUKAI Makio
Published: August 2007

Abstract: In 1987 a 35‐year‐male undergoing an in‐depth health examination was discovered to have sebaceous glands ectopically situated in the esophagus. This diagnosis was pathologically confirmed by biopsy. During a 5‐year period since this initial case, we came across an additional four patients presenting with similar findings. Ectopic sebaceous glands of the lips, referred to as Fordyce's spots, are a well‐known phenomena. In addition, sebaceous glands have been noted in various ectodermally derived organs including the oral cavity, salivary glands, foreskin and labia. As the esophageal mucosa is endodermally derived, sebaceous glands of this region are regarded to be extremely rare. De La Pava, examining the esophagus of 200 autopsy cases in 1961, coincidentally found ectopic sebaceous glands were present in 4 cases. All were of microscopic dimension. Lesions which were identified macroscopically were reported in 1976 by Zaik, who described sebaceous glands at autopsy as bead‐like, flattened nodules scattered in the middle esophagus. In 1978 Rhamakrishnan reported the first sighting of ectopic sebaceous glands in the esophagus by endoscopy. In Japan Hoshihara29)was the first to report on two patients, followed by the authors’previous communication documenting esophageal sebaceous glands in one patient28). This is therefore the third time that this phenomenon has been reported in Japan. The patients described here represent the 6th, 7th, 8th and 9th cases in the world which were diagnosed endoscopically.
Acquired Fatty Replacement of the Body and Tail of the Pancreas Diagnosed by Endoscopic Ultrasonography —A Case Report—
Authors: HONDA Shoji , FUJIOKA Toshio , FUJIYAMA Kanzo , KUBOTA Toshihiro , MURAKAMI Kazunari , OHKAWARA Hitoshi , NASU Masaru
Published: August 2007

Abstract: A 62‐year old female was admitted for a detailed study of a pancreatic abnormality detected by abdominal ultrasonography. A CT and MRI revealed a fat deposition in the body and tail of the pancreas. An ERCP demonstrated the distal main pancreatic duct as 2 fine branches in the head, and accessory pancreatic ducts were visualized. An endoscopic ultrasonography revealed a swelling of the body. In the tail, a membrane‐like hyperechoic structure was noted, and probably represented the pancreatic capsule. A angiography demonstrated branches of the dorsal and transverse pancreatic artery, and the diagnosis of acquired fatty replacement of the body and tail of the pancreas was confirmed. Endoscopic ultrasonography appears to be a useful method to confirm fatty replacement of the body and tail of the pancreas.
A Case of Chronic Pancreatitis Associated with a Pancreato‐gastric Fistula
Authors: SHINOHARA Yasushi , OHNO Hiroyuki , HORIBE Toshiya , NAKAGAWA Masao , KAWAI Takashi , KAKUTANI Hiroshi , SEKI Tomoyuki , YAMADA Takashi , IKEDA Hajimu , SAITOH Toshihiko
Published: August 2007

Abstract: A 51‐year‐old man presented complaining of frequent diarrhea. An ultrasonography and abdominal CT scan revealed a tumor in the tail of the pancreas. An endoscopic retrograde pancreatography revealed contrast medium flowing over the pancreas through the main pancreatic duct. A balloon cathether was then passed into the pancreatic duct, and the scope alone was retracted to the stomach. Maintaining the stomach under endoscopic observation, ICG was injected through the balloon catheter, whereupon it was seen to flow out from two small depressions in the center of a small elevated lesion in the posterior wall of the upper gastric corpus. Based on these endoscopic findings, a diagnosis of chronic pancreatitis with an associated pancreato‐gastric fistula was made.
Application of a Circular Polarizing Device to an Electronic Endoscope for the Purpose of Prevention of Catch‐Light Phenomenon
Authors: KOBAYASHI Shigeyoshi , UCHIDA Takao , SATO Shinya , YAMADA Takashi , SHIMIZU Masaru , TAKAI Tetsu , TAKAHASHI Yoshiyata , HAYASHI Keiichi
Published: August 2007

Abstract: In recent years the electronic endoscope has been increasingly used by medical practitioners in Japan. However, it has been noted that the problem of too strong light refection, which, not only hampers the procedure but also causes eye exhaustion, at the same time making photographic or computerized image processing difficult, is more frequently experienced and is more serious in magnitude when compared with using a conventional fiberoptic endoscope (catch‐light phenomenon). In order to ameliorate this problem the authors experimented with the use of circularly polarized light. The combined use of a circular polarizing device to the efferent light path and a filter which blocks certain types of Circularly polarized light to the afferent path has proved to be very effective in eliminating the incidence of catch‐light troubles, thus making the endoscopic procedure smooth and efficient.
Efficacy of Prophylactic Endoscopic Variceal Sclerotherapy in Patients with Hepatocellular Carcinoma
Authors: MIYOSHI Hirofumi , ORINO Shin‐ya , MATSUMOTO Akio , OKA Masaki , SUGI Kazunori , MORIKAWA Hiroshi , TANAKA Masaya , SAKAGUCHI Masahiro , YOSHIZUMI Munenori , NAKAJIMA Shyuzou , ITABASHI Tsukasa , HIRATA Ichiro , OHSHIBA Saburo
Published: August 2007

Abstract: A setrospective study to determine the influence of prophylactic endoscopic sclerotherapy on the survival rate of patients with hepatocellular carcinoma complicated by esophageal varices was conducted. The subjects included 132 patients without esophageal varices at the time of diagnosis (NV group), 37 patients with hepatocellular carcinoma for whom prophylactic sclerotherapy had been performed for risky esophageal varices (PS group) and 26 patients with hepatocellular carcinoma and risky varices for whom prophylaxis was not performed (NPS group). Multiple regression analysis was used to identify factors affecting the survival rate of the 132 patients without esophageal varices. A tumor embolus in the primary branch or main trunk of the portal vein adversely affected long‐term survival in these patients. The patients were further divided into 2 subgroups, namely those with (Vp3) and without (Vp0‐Vp2) tumor emboli in the main trunk and primary branch of the portal vein. In the Vp0– Vp2 emboli subgroup, the patients who received prophylactic sclerotherapy and the patients without varices had similar survival rates. Patients without prophylactic sclerotherapy had a significantly shorter survival rate than the group without varices and the prophylactic sclesotherapy group (p<0.01 and p<0.05). A significant bleeding rate was observed in the group without prophylaxis and not in the group with prophylaxis. However, in the Vp3 subgroup, the survival rate in each group was identical. Thus prophylactic variceal sclerotherapy is indicated for patients with hepatocellular carcinoma who do not have tumor emboli in the main trunk or primary branch of portal vein.
Circumferential Zig‐Zag Pattern Suggesting a Superficial Origin of Colorectal Cancer
Authors: SATO Shuichi , NAGASAKO Kou , TAKAHASHI Yoshie , OKA Motoko , SUZUKI Asako , WON Jongsung , ISHII Fumi , IIZUKA Bun‐ei , FUJIMORI Takahiro
Published: August 2007

Abstract: The early stage of colorectal cancer is divided into two morphological types polypoid and superficial. What percentage of advanced cancer is derived from the polypoid or superficial type is a matter of concern. The ratio of superficial variety among of ulcerated cancers was studied using those 2 cm or less in diameter, which often retain mucosal cancer. The existence of horizontal growing mucosal cancer at the marginal area of ulcerated cancer is a hallmark showing the lesion being of superficial origin. Eight (57 %) out of the 14 cases of ulcerated cancer, 2 cm or less, had this finding. This suggests that more than half of smaller colorectal cancers are of superficial origin. A zig‐zag pattern (ZZP) was evident in 3 cases of superficial origin. No cases in the nonsuperficial group had the ZZP. The existence of circumferential ZZP during colonoscopic observation indicates that the cancer is of superficial origin.
Evaluation of the Efficacy of Endoscopic Treatment for Gastric Cancer Considered in Terms of Long‐term Prognosis
Authors: FUKASE Kazutoshi , MATSUDA Toru , SUZUKI Masaki , TODA Hirotaka , OKUYAMA Yoshimi , SAKAI Jun‐ichi , SAITO Hiroshi , SATO Shin‐ichiro , MITO Shogo
Published: August 2007

Abstract: A comparative evaluation was made between the efficacy of endoscopic treatment in 116 cases with that of surgical treatment in 59 cases. Both groups were treated at Yamagata Prefectural Central Hospital during a period from July 1978 up until December 1989. All of the patients had single mucosal adenocarcinoma of a well differentiated type which were not accompanied by ulcer or ulcerative scar with their maximum diameter of foci being less than 20mm. A curve of the survival rate of both groups as of June 30, 1990 was prepared using the Kaplan‐Meier method, and significance in the statistic difference between the two groups was examined using the logrank test. There was no significant difference noted in the results of both groups. This demonstrated that endoscopic treatment can bring about a long‐term prognosis which is comparable to that of surgical treatment.
The “Stent through Stent Technique” for Hilar Malignant Stenosis Complicated with Common Bile Duct Calculi
Authors: MOSQUERA Victor Bracho , AKIYAMA Teteifli , RYO Shomei , KONDO Satoshi , YABUSHTTA Yoshiko , IKEDA Miyuki , NOGUCHI Takayoshi , FURUI Toshifumi , OKITA Kiwamu
Published: August 2007

Abstract: We report here on a patient who had a Bismuth type III hilar malignant stenosis and a primary common bile duct calculi which was an added complication. This stenosis was effectively treated by a “stent through stent technique”, that consisted of two metal stents braided together by expanding a wire gap in the mesh of the first stent and inserting the last one through this former dilated wire gap, achieving bilateral biliary drainage. The primary common bile duct stone was treated by percutaneous cholangioscopically‐guided electrohydraulic lithotripsy. This technique might be applied on a large series of patients with hilar malignant stenosis and in the case of the uncommon association with primary common bile duct calculi electrohydraulic lithotripsy using the percutaneous approach should be considered as a good approach.
Endoscopic Ultrasonography in Ulcerative Colitis
Authors: SHIMIZU Seiji , ISO Akitada , TADA Masahiro , KAWAI Keiichi
Published: August 2007

Abstract: Endoscopic ultrasonography (EUS) was performed in 32 patients with ulcerative colitis. The EUS findings were classified into 5 types based on our criteria. The relationship between the type of EUS finding and clinical severity, endoscopic grading, extent of disease, and therapeutic measures were examined. The type of EUS finding tended to correlate with both the clinical severity and endoscopic grading. There was also a correlation between the extent of the disease and the EUS findings. Therapeutic measures differed according to the type of EUS finding. Consequently, EUS was considered to be useful for the objective assessment and grading of the disease and for predicting prognosis. (Dig Endoc 1994; 6 : 3–6)
Photodynamic Therapy Using a New Photosensitizer Gallium Porphyrin Complex in the Treatment of Experimental Pancreatic Cancer
Authors: TAJIRI Hisao , KUROKI Masahiko , NIWA Hirohumi
Published: August 2007

Abstract: To determine the therapeutic effect of photodynamic therapy (PDT) using a new photosensitizer 2.4‐bis (1‐decyloxyethyl)‐Ca‐deuteroporphyI diaspartic acid (Ga ‐DP), 20 female Syrian golden hamsters with experimentally induced pancreatic cancer were irradiated with a pulsed Nd : YAG laser with a Q switch after administration of Ga ‐DP. To induce pancreatic cancer, N‐nitroso‐bis‐(2‐oxypropyI) amine (BOP) at 10 mg/kg body weight was injected subcutaneously once a week for eight weeks. Ten of the twenty animals served as a control group. The other ten received laser treatment beginning 20 weeks after BOP administration. Twenty‐four hours after intravenous injection of 3 mg/kg Ga‐DP, pulsed Nd : YAG laser irradiation was performed using a Q switch with 1 W of power output for 3–5 minutes at a frequency of 300 Hz. Elimination or necrosis of the entire tumor resulted with tumors 6–10 mm in diameter in 6 animals. In 3 animals which had tumors more than 12 mm in diameter, cancer cells remained at the margins of the treated area. These results were felt to not only reflect the thermal effect of laser therapy, but also the effect of PDT combined with Ga‐DP. They suggest that Ga‐DP could become a clinically valuable photosensitizer in combination with PDT. (Dig Endosc 1994; 6 : 28–33)
Chronic Pancreatitis as a Complication of Ulcerative Colitis —Report of 2 Cases—
Authors: SAITOH Osamu , NAKAGAWA Ken , HIRATA Ichiro , TOKIOKA Satoshi , OHSHIBA Saburo
Published: August 2007

Abstract: We report on two patients with chronic pancreatitis associated with ulcerative colitis. Both patients had ulcerative colitis involving the entire colon and rectum. The diagnosis of chronic pancreatitis was based on the typical findings of endoscopic retrograde cholangiopancreatography (ERCP) and episodes of hyperamylasemia. The changes in the levels of serum pancreatic enzymes are considered to have paralleled the activity of the colitis. None of the classical etiologies for pancreatitis was found in either case. The time sequence and exclusion of known causes of pancreatitis suggest an association between these two conditions.

These two cases, together with other reported cases, provide some evidence for the hypothesis that chronic pancreatitis may be one of the extraintestinal complications of ulcerative colitis. The symptoms of ulcerative cblitis, such as diarrhea and abdominal pain, may mimic the symptoms of chronic pancreatitis. Pancreatitis and ulcerative colitis are probably mutually exacerbating factors. Therefore, the recognition of this phenomenon contributes substantially to the management of ulcerative colitis. (Dig Endosc 1994; 6 : 59–65)
How I do it — Laparoscopic Cholecystectomy
Authors: LEE Sung‐Gyu , KIM Myung‐Hwan , SUNG Gyu‐Bo , LEE Sung‐Koo , MIN Pyung‐Chul
Published: August 2007

Abstract: One thousand consecutive patients underwent a laparoscopic cholecystectomy from September 1990 to January 1993 at our institution. A total of 435 presented with complications acute cholecystitis (83), common bile duct stones (61), or previous abdominal surgery (321). Of the 1,000 patients, 37 (3.7%) were converted to an open cholecystectomy, usually because of marked inflammation and unclear anatomy. There were no deaths and the total postoperative complication rate was 91 of 1,000 (9.1%). Major complications (1.1%) included 3 bile duct injuries, 2 postoperative bleedings, 5 residual common duct stones and 1 case of peritonitis caused by stone spillage. All bile duct injuries were detected and suspected in the operating room and repaired by a Roux‐en‐Y hepaticojejunostomy. Minor complications occurred in the remaining 80 patients(8.0%). The most common complication encountered was urinary retention (6.1%). Intraoperatively, the two‐hand technique, electrosurgical dissection, selective cholangiography and selective use of closed drainage were used. When common bile duct stones were encountered during the performance of laparoscopic cholecystectomy, they were primarily managed by a simultaneous laparoscopic choledochotomy. These experiences suggested that the immediate detection of operative injury was very important to prevent later serious complications, and wider operative indications can be applied safely and carefully by trained general surgeons.
Pancreatogram of Unfused Pancreatic Duct Systems
Authors: TOKI Fumitake , KOZU Tadahiko , YOSHIDA Kenji , NISHINO Takayoshi , TADOKORO Hiroyuki
Published: August 2007

Abstract: The aim of this study was to indirectly evaluate functional aspects of the accessory papilla, by measuring the diameter of the dorsal duct in non‐fusion (pancreas divisum). In 56 patients with definite non‐fusion, the diameter of the duct on ERCP was measured with a caliper rule, in the ventral duct (V1, V2), in the head of the dorsal duct (Dh1, Dh2), the body (Dbl, Db2), and the tail (Dt1, Dt2). The controls were 61 consecutive patients with a normally fused pancreatic duct system. The mean value ± SD were V1:2.0±1.1, V2:1.7±0.8, Dh1:2.5±0.6, Dh2:2.6±0.8, Dbl:2.7±0.8, Db2: 2.1 ±0.5, Dt1: 1.7±0.5, Dt2: 0.9±0.2 in the non‐fusion group. The values in the control group were 3.4±0.9, 3.0±0.8, 1.0±0.3, 1.3±0.4, 2.6±0.6, 2.3±0.6, 1.6 ± 0.3, 0.9 ± 0.2, respectively. Results showed that the diameter of the pancreatic duct was significantly related to the age of the patient in the body and tail of the non‐fusion group but not in the controls (p<0.05). The diameter of the ventral duct in the control group was related to the age but not in the non‐fusion group (p<0.0001).

In non‐fusion group, mean values of V1 and V2 was smaller (p<0.02), and Dh1 and Dh2 were larger (p<0.05) than those in the controls. While there were no significant differences in the mean values of Db1, Db2, Dt1, and Dt2 in both groups.

These results may indicate a more prominent influences of age to the caliber changes of pancretic duct when non‐fusion existed.
The Differential Diagnosis of Malignant Lymphoma and Reactive Lymphoreticular Hyperplasia of the Stomach Using Endoscopic Ultrasonography
Authors: BOKU Narikazu , YOSHIDA Shigeaki , OHTSU Atsushi , FUJII Takahiro , ABE Kaoru , HIJIKATA Atsushi , SHIRAO Kuniaki , SAITO Daizo , YAMAGUCHI Hajime , OCHIAI Atsushi , HIROTA Teruyuki
Published: August 2007

Abstract: It is difficult to differentiate between reactive lymphoreticular hyperplasia (RLH) and malignant lymphoma (ML) even with an endoscopic biopsy. We performed endoscopic ultrasonography (EUS) examination on 25 cases histologically diagnosed as being RLH or ML. We classified their EUS findings into three types; protruding, wall‐thickening and superficial types, and examined their ultrasonographic findings. Of the four cases classified as being the protruding type (ML 3, RLH 1), disruption of the third layer was seen in the cases of ML, while it was preserved in the case of RLH. All nine cases of the wall‐thickening type were ML. Twelve cases were classified as being the superficial type (ML 6, RLH 6). Of the five cases of this type without ulcerative changes, thickening of the second layer of the low echoic homogeneous pattern (“Loss of original mucosal structure: OMS”) was seen in all two cases of ML, while the second layer was dotted with low echoic granular particles and looked grossly heterogeneous (“Granular pattern”) in all three cases of RLH. In the other seven cases the lesion looked like an advanced tumor due to ulcerative changes. From observations of the surrounding nonulcerative area, “Loss of OMS” was seen in three of four cases of ML, while a “Granular pattern” was seen in all three cases of RLH. Six of seven cases with only the “Granular pattern” were RLH, and all 16 cases with only the “Tumorous pattern” were ML. Of the two cases with the “Combined pattern” which had the “Tumorous pattern” in the central area and “Granular pattern” in the peripheral area, one was ML and the other was RLH. EUS is thought to be a useful diagnostic technique which provides us with important information to differentiate between ML and RLH.
The Efficacy and Diagnostic Significance of Sodium Thiosulphate Solution Spraying After Iodine Dyeing of the Esophagus
Authors: KAMEYAMA Hideto , MURAKAMI Masahiko , SHIMIZU Yoshinori , FUKOE Yoshihiro , REE Ugen , REE Masahiro , ANDO Susumu , TANIO Noboru , ARAI Kazushige , KUSANO Mitsuo
Published: August 2007

Abstract: Spraying with Sodium Thiosulphate Solution (STSS, Detoxol®) is reported to be useful in reducing the side effects of Iodine dyeing on the esophagus. In order to determine the optimal concentration of STSS and its efficacy, STSS was administered in the following concentrations. Group A: 10% (Original Solution), Group: B 5%. Group C, 2.5%. Group D: 1.7% and Group E: saline with no STSS, and a questionnaire was conducted to assess the side effects. The results showed that the higher the concentration, the less frequent and short lasting the side effects were. The effects of STSS on diagnostic efficacy was also evaluated. After spraying with STSS, the 2.5% solution removed iodine gradually but there were differences in discoloration among the various degrees of inflammation. When iodine dyeing was repeated, clear images with a good contrast were obtained. Excess iodine was neutralized and details of the surface and vascular pattern were more readily observed. Spraying with STSS seemed to increase the diagnostic ability of the procedure.
Changes in Gastric Function During Healing of Gastric Ulcers
Authors: HASEBE Tetsunori , HARASAWA Shigeru , MIWA Takeshi
Published: August 2007

Abstract: To determine changes in pathophysiology during the healing process of gastric ulcers, gastric acid secretion, gastric emptying, fasting gastrin levels (FGL) and the integrated gastrin response (IGR) were studied in normal volunteers and in each stage of gastric ulcers. In a study of patients with gastric ulcers in the lesser curvature of the ventricular angulus including 20 in the active stage, 49 in the healing stage and 11 in the healed (scar) stage, gastric acid secretion (BAO and MAO) and FGL gradually decreased as the patients progressed from the active stage through the healing and healed stages. IGR values did not change, but gastric emptying showed marked prolongation in the active and healing stages although this was alleviated in the healed stage. In 11 of the same gastric ulcer patients who were followed up, gastric acid secretion, especially BAO, was lower in the healed stage than in the active stage. No fixed tendency was seen for gastric emptying and IGR, but FGL showed higher values in the active stage than in the healing stage. These findings indicated that changes in the pathophysiology of the stomach occur during the healing of gastric ulcers, and it was assumed that these changes are closely related to the stage of the ulcer.
Evaluation of Small‐caliber Transnasal Panendoscopes for Upper G‐I Screening Examination
Authors: NOZAKI Ryoichi , FUJIYOSHP Tateshi , TAMURA Masaki , TSUCHIYA Akira , TAKAGI Koichi , TAKANO Masahiro
Published: August 2007

We evaluated two models of small‐caliber panendoscopes for the upper G‐I tract, for their applicability to gastric cancer mass screening or upper G‐I screening; one type is a fiberscope (GIF‐N30; Olympus Optical Co.) with an outer tip diameter of 5.3mm (start date. May, 1993) originally designed for newborns and infants, while the other is a newer electronic videoscope (XGIF‐N200; Olympus) with a tip diameter of 6mm (start date, February, 1994) recently developed to allow transnasal insertion. Both scopes are suitable for transnasal insertion. Of the 658 subjects examined, 403 were randomly selected to undergo transnasal insertion. Conversation between the operator and subject was possible during the procedure. Among those subjects who had previously been examined by means of panendoscopy, 90.3% (224/248) replied that the transnasal insertion was more comfortable than the ordinary peroral insertion, and 89.9% (223/248) stated that they would not mind undergoing transnasal endoscopic examination in the future. The examiners reported no difficulties with manipulation, visual acuity, or obtaining biopsy specimens. The mean examination time with the small‐caliber endoscopes was about five minutes, which is shorter than with previously reported examinations. Transnasal insertion of the small‐caliber panendoscopes is recommended particularly for screening purposes, such as the gastric cancer mass survey. However, the long‐term durability of the instrument must be assessed before widespread application becomes possible.
Endoscopic Biliary Drainage without Endoscopic Sphincterotomy
Authors: KIMURA Katsumi , FUJITA Naotaka , NODA Yutaka , KOBAYASHI Go , YAGO Akio , CHONAN Akimichi , MATSUNAGA Atsuo , ANDO Masao , YUKI Toyohiko , TOMINAGA Gen , NOMURA Mikiko , ISHIDA Kazuhiko , INOUE Shigeru , CHIBA Masaki , KISARA Norihiro , MOCHIZUKI Fukuji
Published: August 2007

Endoscopic biliary drainage (EBD) is usually performed after endoscopic sphincterotomy (EST). In some patients, however, EBD without EST, so‐called nonEST‐EBD, is also effective.

Thirty‐four patients treated from 1983 to the present, were investigated to estimate the usefulness, safety, and drawbacks of nonEST‐EBD.

First, the reasons for adopting nonEST‐EBD were reviewed in each patient. The most common reason was to reduce jaundice so as to preserve the function of the papilla of Vater in patients with choledocholithiasis who were to undergo surgery. However, such patients were treated in the early period of the investigation, and most would have undergone EST just after endoscopic retrograde cholangiography (ERC), had they been treated more recently. The most important reason, at present, was, thus, to avoid bleeding in patients with general or local hemorrhagic diathesis, who accounted for 20.6% (7/34 of our subjects).

Next, the effect of drainage was examined. Drainage in seven patients was judged to be excellent, while that in 15 patients was determined to be effective. In 10 patients without jaundice, nonEST‐EBD was performed to prevent jaundice. Therefore, in 91.7% of patients (22/24), nonEST‐EBD was considered to be useful.

Changes in the serum amylase level were investigated to estimate the safety of nonEST‐EBD. Twenty‐seven patients with nonEST‐EBD, in whom the serum amylase level was within normal limits before treatment, and 57 patients with EBD after EST were evaluated. No statistically significant difference was recognized between these two groups in the degree of serum amylase elevation after drainage.

NonEST‐EBD is concluded to be an effective and safe method of reducing jaundice, if appropriate patients are selected.
A Case of Giant Gastric Folds with Hypoalbuminemia Healed by Helicobacter pylori Eradication
Authors: SHIMOYAMA Tadashi , FUKUDA Shinsaku , MIKAMI Tatsuya , MUNAKATA Akihiro , YOSHIDA Yutaka , KAMATA Yoshimasa
Published: August 2007

A 66‐year‐old man with hypoalbuminemia was found to have diffuse giant mucosal folds in the body of the stomach. Helicobacter pylori (H pylori) status was evaluated by several examinations, all of which showed positive results. To eradicate H pylori, he was treated with clarithromycin (200mg b. i. d.), lansoprazole (30mg q. d.) and plaunotol (80mg t. i. d.). By two weeks, the serum albumin concentration had risen to 3.4g per dl. Four weeks after finishing clarithromycin therapy, endoscopy was repeated and H pylori status was evaluated as before. All examinations showed negative results and the giant mucosal folds had improved markedly. Before treatment, histological specimens showed irregular elongation of pits with inflammatory infiltrates. After treatment, the architecture of pits returned to its normal form with decreased inflammatory infiltrates. In this case, giant gastric folds and hypoalbuminemia were improved by H pylori eradication, suggesting that H pylori infection may play a role in the giant gastric folds associated with hypoalbuminemia.
Risk Factors For Duodenal Ulcer Recurrence: Three‐year Follow‐up during Famotidine Maintenance Therapy
Authors: SAIGENJI Katsunori , HARASAWA Shigeru , IWASAKI Ariyoshi , ASAKA Masahiro , ASAKI Shigeru , FUKUTOMI Hisayuki , KANEKO Eizo , TSUKAMOTO Yoshihisa , INOUE Masaki , MIWA Takeshi , MATSUO Yutaka , OKABE Haruya , MIYOSHI Akima
Published: August 2007

The recurrence‐free rate and factors related to recurrence after healing were investigated in duodenal ulcer patients on H2‐blocker maintenance therapy with famotidine. Famotidine maintenance therapy (20 or 40 mg once a day before bedtime) was performed in 488 evaluable patients after endoscopically‐proven healing of ulcers (S1 or S2). The cumulative recurrence‐free rates were 81.1%, 65.1% and 58.2%, respectively, after one, two and three years of maintenance therapy. Among various background factors, those which have been suggested to be closely associated with ulcer recurrence were compared on the basis of their relation to the recurrence‐free rate. These factors included a past history of duodenal ulcer, smoking, alcohol use, bulbar deformation, the endoscopic stage of ulcer healing, concomitant drugs and compliance with famotidine therapy. Recurrence correlated most significantly with a past history of duodenal ulcer and with compliance. Compliance was categorized as excellent, good, fair or poor. The recurrence‐free rate was significantly lower in patients with excellent compliance than in any other compliance group. A famotidine dose of 40 mg/day (the standard dose), versus the half dose of 20 mg/day, produced no significant difference in the cumulative recurrence‐free rate and it was therefore suggested that 20 mg/day of famotidine is comparable to 40 mg/day in its preventive effect on duodenal ulcer recurrence.

In addition, because recurrence was more common in patients who had previously experienced recurrence, a past history of ulcer was suggested to be a significant risk factor for ulcer recurrence.
Correlation Between Peritoneoscopic Findings and Response to Interferon in Patients with Chronic Hepatitis C
Authors: KASAHARA Akinori , HAYASHI Norio , OSHITA Masahide , HLJIOKA Taizou , KATAYAMA Kazuhiro , MITA Eiji , KATO Michio , MASUZAWA Manabu , YOSHIHARA Harumasa , TATSUMI Tomohide , MUKUDA Tomoyuki , ITOH Akihiko , KASHIWAGI Toru , FUSAMOTO Hideyuki , KAMADA Takenobu
Published: August 2007

This study was designed to investigate the correlation between peritoneoscopic liver surface findings and the alanine aminotransferase (ALT) response to interferon, and to identify peritoneoscopic findings potentially useful as predictors of interferon responsiveness, in chronic hepatitis C. In all, 119 patients with hepatitis C viremia and histological evidence of chronic hepatitis received interferon alpha, in total doses of 258 to 660 million units (MU). A sustained response was seen in 29 cases (24%), a transient response with ALT relapse after therapy completion in 41 (35%) and no response in 49 (41%). Among 64 type 1 b cases, 8 (13%) showed sustained, 27 (42%) transient and 29 (45%) no response. The sustained response rate was higher with Shimada's code 200 than with code 300 or 400, even for type 1b. Interferon therapy was ineffective in more than 50% with code 300 or 400, especially in type 1b, suggesting that interferon efficacy decreases with disease progression. The sustained response rate was significantly higher, and that of no response significantly lower, in patients without reddish liver surface markings than in those with such markings (p<0.05), even in type lb. About 50% of those with reddish markings showed no response, indicating that absence of reddish markings may be a useful predictor of sustained response. The liver fibrosis score was significantly higher in the no response than in the transient and sustained response groups (p<0.02).

In summary, patients with reddish liver surface markings and/or advanced fibrosis do not show a good response to interferon.
Diagnostic Accuracy of Laparoscopic Liver Biopsy in Chronic Liver Diseases, Comparison of Laparoscopic and US‐Guided Liver Biopsy Results
Authors: ITO Toshio , UKIDA Minora , YAMAMOTO Kazuhide , KOBASHI Haruhiko , MORIMOTO Youichi , MIKAMI Masayuki , OMOTO Masaki , NAKANISHI Sousuke , SHINMEN Kanji , NAGANO Takuya , MATSUMOTO Seiji , NAKAMURA Masaki , OKAMOTO Ryoichi , FUJIOKA Shin‐ichi , OMORI Nobuhiko , UJIKE Kozo , SHIRAHA Hidenori , TSUJI Takao
Published: August 2007

Liver biopsies were carried out using three different needles, a Vim‐Silverman needle 2.5 mm in outer caliber, an 18‐Gauge (18G) Majima needle, and a 17‐Gauge (17G) Majima needle. The biopsies were obtained from nearby locations on the liver surface under laparoscopic observation, to ascertain differences in histological diagnosis according to the size of the biopsy specimen. The biopsy specimens obtained with the Vim‐Silverman needle were wider than those obtained with the other two needles. The agreement in histological diagnoses of the liver, obtained with the Vim‐Silverman needle versus the 18G Majima needle, was 26.0%, while that between the Vim‐Silverman needle and the 17G Majima needle was 40.0%. Histological diagnosis tended to be underestimated in small biopsy specimens in advanced chronic liver diseases. A questionnaire survey, conducted in 92 hospitals affiliated with Okayama University Medical School, revealed US‐guided liver biopsy to be the practice of choice in 57 of 92 (62.0%) hospitals, and 18G needles were used in US‐guided liver biopsy in 35 of 78 (45.2%) hospitals.
A New Peroral Cholecystoscopy Method Utilizing a Shape Memory Alloy Bending Catheter‐Report of Two Cases
Authors: YAMAO Kenji , NAKAZAWA Saburo , YOSHINO Jyunji , EVUI Kazuo , YAMACHIKA Hitoshi , KANEMAKI Naoto , FUJDIOTO Masao , MIYOSHI Hironao , IWASE Teruhiko , TAKI Norihito
Published: August 2007

For the purpose of improving the ease and reliability of catheter insertion into the cystic duct and gallbladder, we developed a new combination method utilizing an ultrathin fiberscope (miniscope, 0.8 mm), a guidewire (0.25 inches) and a shape memory alloy, bendable, catheter (SMA catheter, 2.6 mm). The main feature of the SMA catheter, which incorporates a micro‐actuator, is that its tip can be bent by remote control as desired. The SMA catheter could be inserted successfully into the cystic duct using a guide‐wire under direct miniscope vision in two patients with gallbladder lesions.

Moreover, after the miniscope had been inserted through the SMA catheter into the gallbladder, its maneuverability enhanced observation of the mucosa. This combination method should afford new diagnostic and therapeutic approaches to gallbladder disease.
Analysis of the Layer Structure of the Gallbladder Wall Delineated by Endoscopic Ultrasound Using the Pinning Method
Authors: FUJITA Naotaka , NODA Yutaka , KOBAYASHI Go , KIMURA Katsumi , YAGO Akio , MOCHIZUKI Fukuji
Published: August 2007

Abstract: The gallbladder is a suitable target of endoscopic ultrasound (EUS). However, the interpretation of the layer structure of the gallbladder wall delineated by EUS is still controversial. To confirm the relationship between the layers demonstrated by EUS and the histological structure, we performed a study using the pinning method. In most slices, the gallbladder wall was demonstrated to be a two‐or three‐layer structure, consisting of a low echoic layer, sometimes with an overlying hyperechoic layer, and a high echoic layer from the mucosal side. The slices were pierced with pins at random depths. Among the twelve pin echoes demonstrated in the low echoic layer, four were located in the muscularis propria, two in the border between the muscularis propria and the subserosa, three in the fibrous layer of the upper portion of the subserosa, and three in the adipose layer of the lower portion of the subserosa. The three sites where the pin echoes were seen at the border between the low echoic and high echoic layers were located in the fibrous layer, the border between the fibrous layer and the adipose layer, and in the adipose layer, respectively. The twelve sites at which pin echoes were observed in the high echoic layer were confirmed to be in the adipose layer. These results indicate that the inner hypoechoic layer includes not only the muscularis propria but also the fibrous layer of the subserosa. This should be kept in mind when assessing the depth of invasion of a gallbladder carcinoma.
Adhesive Effect of Ecabet Sodium in a Porcine Gastric Leer Model
Authors: NAKADA Shuji , KAGAMI Akihiko , IWASAKI Masafumi , MOCHIZUKI Keiko , KINOSHITA Tomoko , NISHIDE Ryoichi , TANAMURA Akira , USUI Toshiro , ISHIKI Motoo , TANAKA Yoshihiro , TAKEUCHI Yukihiro , SUZUKI Hiroaki , MOCHIZUKI Seibu
Published: August 2007

Abstract: Protection of the gastric mucosa, based on its high affinity for mucosal lesions, has been reported as one of the antiulcer effects of ecabet sodium. We investigated the adhesive effect of this drug on mucosal lesions in a porcine gastric ulcer model (freshly isolated stomach) and on human mucosal lesions resulting from endoscopic gastric mucosal resection (EMR) and polypectomy. After ulcer lesions had been induced by EMR in the isolated porcine stomach, ecabet sodium and sucralfate suspensions were applied. After washing with citrate buffer, at a pH of 1, 3 or 5, the adhesion of each drug to the gastric mucosa was measured. At pH 1, both drugs showed satisfactory adhesion to the ulcer lesions. When the acidity of the ulcer surfaces was decreased to pH 3 and then to pH 5, the adhesion of sucralfate showed a marked decrease (100%→31→% 13%). while that of ecabet sodium showed only a slight decrease (100%→75%→64%). Futhermore, the activity of thrombin in the ecabet sodium suspension remained high at pH 1, 3 and 5. Since the ecabet sodium suspension produced a satisfactory covering effect on gastric mucosal lesions and this effect was maintained even at low acidity, this drug is considered suitable for endoscopic directsprinkling therapy for gastric mucosal lesions.
A Large Juvenile Polyp Successfully Treated by Endoscopic Polypectomy with a Detachable Snare
Authors: ITO Yoshiyuki , SHIMIZU Seiji , TADA Masahiro
Published: August 2007

Abstract: A 43‐year‐old man was referred to our hospital because of a three week history of intermittent hematochezia. Barium enema study and colonoscopy revealed a large pedunculated polyp measuring 35 mm in diameter in the descending colon. Endoscopic polypectomy was performed using a detachable snare as an auxiliary device to ensure hemostasis. The detachable snare was considered useful in performing endoscopic polypectomy for this pedunculated polyp which had a particularly thick stalk. Furthermore, we consider this device to potentially play an important role in widening the indications for endoscopic polypectomy.
Colonic Angiomyolipoma
Authors: AKEDO Ikuko , KUROKAWA Masanori , NISHIKAWA Masahiro , SUGIMACHI Masamitsu , HIRAOKA Shintaro , YONEZAWA Tuyoshi , SHIMOMUKAI Hiromi , ISHIGURO Shingo
Published: August 2007

Abstract: Angiomyolipoma is a rare benign tumor which usually occurs in the kidney with tuberous sclerosis. We encountered a case of angiomyolipoma of the cecum not associated with tuberous sclerosis. To our knowledge, this is only the third case reported in the international literature.
Efficacy of Endoscopic Ultrasonography in the Diagnosis of Lateral Lymphatic Spread in Rectal Cancer
Authors: TAZUMA Susumu , FUJITAKA Tsuguo , TERAMEN Kazushi , KAWAGUCHP Hiroyuki , TSUCHIMOTO Denya , MIYAKE Hiroaki , OKAJIMA Masazumi , ASAHARA Toshimasa , KAJIYAMA Goro , DOHI Kiyohiko , ITO Katsuhide
Published: August 2007

Abstract: In rectal cancer, lateral lymphatic spread is considered to worsen the prognosis. Therefore, accurate determination of lymph node involvement preoperatively is helpful in assessing the malignant character of the tumor and in determining resectability. The present study was performed to evaluate the accuracy, limitations, and usefulness of endoluminal ultrasonography in preoperatively diagnosing the localization of lymph node metastasis in rectal cancer. Seventy‐six patients with rectal cancer underwent preoperative endoscopic ultrasonography. Three of these patients had lateral lymphatic spread and all could be distinguished on endoscopic ultrasonography by the detection of involvement of lymph nodes in the anterior rectal space. These findings suggest that endoscopic ultrasonography plays a potentially useful role in the strategy for dealing with rectal cancer prior to surgery.
A Rare Case of Biliobiliary Fistula
Authors: SATO Hideki , KANEMASA Kazuyuki , TANINO Masamichi , KIMURA Tsugihiro , MAENOU Kenji , MITSUFUJI Shouji , MARUYAMA Kyouhei , KODAMA Tadashi , KASHIMA Kei , TERAMAE Naoki , FUKUI Susumu , KAGAWA Keizo
Published: August 2007

Abstract: Biliobiliary fistula is a rare clinical entity. The case of a 72 year old female, who presented with epigastric pain and jaundice, is detailed herein. Endoscopic retrograde cholangiopancreatography (ERCP) revealed two stones, one each in the common bile duct and the gallbladder. Continuous endoscopic nasobiliary drainage (ENBD) was performed to relieve obstructive jaundice. Further study with contrast medium administered via the ENBD tube revealed a fistula between the neck of the gallbladder and the common bile duct. The cystic duct was intact. A stone was considered to have migrated into the common bile duct through the fistula. A diagnosis of biliobiliary fistula, Corlette type I was made. However, in this particular case, a biliobiliary fistula was noted at a site below the junction of the cystic duct and common bile duct. Removal of the gallbladder stones was followed by cholecystectomy. The common bile duct was then repaired by utilizing a T‐tube. No evidence of malignancy was recognized in the resected gallbladder specimen. In the one year to date since surgery, the patient has been asymptomatic and without signs of biliary disease.