bluuebunny/crossref_metadata_2025 huggingface dataset:
Confirmation of Dieulafoy's Vascular Lesion by Endoscopic Ultrasonography in Three Cases
Authors: AKAHOSHI Kazuya , CHIJIIWA Yoshiharu , MISAWA Tadashi , AYUKAWA Kusuo , NAKAMURA Kazuo , JIMI Masafumi , AKAMINE Yasuo , NAWATA Hajime
Published: August 2007

Abstract: We investigated the endosonographic findings in 3 patients with Dieulafoy's lesion. The characteristic finding was an elliptical or tortuous anechoic lesion in the submucosal layer that extended to the outer side of the gastric wall. There were no intramural changes suggestive of deep ulcer beyond the Ul‐2. An abnormally large submucosal vessel was observed within 4 cm of the site of bleeding. This vessel was present even in the remnant stomach of a patient who required emergency surgery because an attempt to treat massive bleeding with endoscopic hemostasis failed. These endosonographic findings suggest that Dieulafoy's lesion patients risk rebleeding due to shallow ulceration.
Metastatic Hepatocellular Carcinoma of the Stomach Presenting as a Bleeding Polypoid Lesion
Authors: YOSHIKAWA Ichiro , MURATA Ikuo , TABARU Akinari , OTSUKI Makoto
Published: August 2007

Abstract: This is a report of a case of hepatocellular carcinoma (HCC) with gastric metastasis and a review of 20 cases of gastric metastasis of HCC in Japan. A 67‐year‐old man was diagnosed as having HCC in May 1991, and underwent transcatheter arterial embolization in June 1991 and February 1992. He came to us with hematemesis in November 1992. An endoscopic examination revealed a semipedun‐culated polypoid lesion with bleeding spots at the fornix of the stomach. The polypoid lesion was resected by endoscopic snare polypectomy to prevent rebleeding and in order to make a definitive diagnosis. Histological examination of the resected specimen, 15X10X6 mm in size, revealed well‐differentiated HCC with bile production.
An Evaluation of Endoscopic Color Doppler Ultrasonography in a Gastric Variceal Patient Who Underwent Balloon‐Occluded Retrograde Transvenous Obliteration
Authors: SATO Takahiro , KOITO Kazumitsu , MURASHIMA Yoshio , SUGA Toshihiro , YAOSAKA Toru , IMAMURA Akimichi , FUJINAGA Akira , MIYAKAWA Hiroyuki , TOCHIHARA Masahiro , HIGASHINO Kiyoshi , NATSUI Kiyoto , ANBO Tomonori , NAGAKAWA Tatsuya , KATO Shigeharu , GOTO Manabu
Published: August 2007

Abstract: A 64‐year‐old female was admitted to our hospital with enlarged solitary gastric varices. Cardiofornical varices were seen using an endoscopy. We performed balloon‐occluded retrograde transvenous obliteration (B‐RTO) for gastric varices using 5% ethanolamine oleate. We observed the gastric varices before and after B‐RTO using endoscopic color Doppler ultrasonography (ECDUS). Prior to B‐RTO, the intramural and extramural blood flow coming from gastric varices were detected. The intramural blood flow produced a to and fro color image on ECDUS. The blood flow velocity was 31.2 cm/sec. The amount of blood flow was 2.40 liter/min. Seven days after the B‐RTO, high echo lesions were observed in the gastric varices which indicated that the thrombosis and color flow image had also decreased. Twenty one days after B‐RTO, the color flow image of the gastric varices had nearly disappeared and had completely disappeared after 3 months. In this case, ECDUS was an extremely useful modality for viewing the therapeutic effects of B‐RTO.
Therapeutic Success with the Suppression of Helicobacter pylori of Intractable Gastric Ulcers
Authors: ARAKAWA Tetsuo , KIMURA Shuji , UCHIDA Toshiyuki , HIGUCHI Kazuhide , FUKUDA Takashi , NAKAMURA Hajime , KOBAYASHI Kenzo
Published: August 2007

Abstract: Three patients with a long history of gastric ulcers refractory to treatment first with an H2‐receptor antagonist, then with a prostaglandin Et analogue plus an antagonist, and next with a proton‐pump inhibitor, lansoprazole, were given amoxicillin together with an H2‐receptor antagonist, and the ulcers finally healed. The patients were men aged about 60, and two were smokers. Reduction of gastric acidity by lansoprazole may have been satisfactory in these patients because one dose of the drug raised the gastric pH to more than 3.0 for about 97% of the next 24h in all three of the patients, as by the continuous measurement of intraluminal pH. The gastric mucosa of these patients was found to be infected with Helicobacter pylori when tested at the end of treatment with this inhibitor. Their medication was changed from the proton‐pump inhibitor to amoxicillin plus an H2‐receptor antagonist, and all of the ulcers healed within 6 weeks. H. pylori was not detected at the end of this treatment. These results indicate that reduction of gastric acidity alone was insufficient to cure the ulcers in these patients. H. pylori may be related to some ulcers being refractory to many antiulcer agents, even proton‐pump inhibitors.
Endoscopic Features of Duodenal Metastases from Breast Cancer
Authors: LIN Yue‐Mon , LIU Walter Tsang‐Wu , LIN Hshu‐Hshing , CHEN Chii‐Ming , CHENG Skye Hongiun , HUANG Andrew T. , SUNG Juei‐Low
Published: August 2007

Abstract: The endoscopic appearance of gastrointestinal metastasis from breast cancer is demonstrated in this report. A patient with breast cancer was found by panendoscope examination to have duodenal metastases. The endoscopic characteristic was that of multiple umbilicated submucosal tumors in the bulb and second portion of the duodenum. The imprint cytology of duodenal biopsy specimens, which revealed malignant cells identical to those found in the breast lump aspiration previously, supported the initial endoscopic diagnosis of metastatic breast cancer. The histology of these lesions subsequently revealed many tumor emboli in the mucosal and submucosal lymphatic channels. A laparotomy conducted to perform an intestinal bypass disclosed a large fixed metastatic tumor in the upper retroperitoneum with extension to the mesentery, the mesocolon of the transverse colon and the third portion of the duodenum. The findings at laparotomy and the histologic evidence of tumor emboli in the lymphatics of the mucosal and submucosal layers indicated a retrograde lymphatic spread of the tumor from the large retroperitoneal mass to the duodenal wall. A literature review in this report discusses the differential diagnosis from metastatic disease to second primary malignancy and benign disease of the gastrointestinal system.
Back Pain in Peptic Ulcer Diseases
Authors: KATOH Yoshihisa , ISHIDA Motoo , HIRAISHI Hideyuki , MASUYAMA Hironori , HARADA Takashi
Published: August 2007

Abstract: The incidence of back pain in patients with peptic ulcers in relation to the location of the ulceration was investigated. One hundred and seventeen patients with gastric ulcers and 35 patients with duodenal ulcers consecutively seen over the past five years were the subjects in this study. The location of the ulceration was assessed by endoscopy in all cases.

Forty‐eight out of 117 (41.0%) and 11 out of 35 (31.4%) patients with gastric and duodenal ulcers respectively complained of back pain with or without other symptoms. Further, there were 7 patients with gastric ulcers and 1 with duodenal ulcers who had only back pain or had back pain with other symptoms other than epigastric pain.

There were no significant differences between the location of ulceration and the symptoms i. e., epigastric and back pain.

Back pain in this study is considered to be a referred pain via visceral afferent pathways, and it may occur more commonly than has been earlier documented.

It should be taken into consideration also that some patients with peptic ulcers complain of back pain as their main symptom. (Dig Endosc 1944; 6 : 17–23)
Role of Preoperative Endoscopic Retrograde Cholangiography in Laparoscopic Cholecystectomy
Authors: OBATA Shinichiro , ARAKI Keisuke , MIZUTANI Junichi , ARAI Mitsuhiro , NAMIKAWA Kazuo , FUJIOKA Yasunari , MAEDA Kazuhiro , KIMURA Keishi
Published: August 2007

Abstract: An endoscopic retrograde cholangiography (ERC) was performed in 303 patients before laparoscopic cholecystectory. The ERC was successful in 275 patients (90.8%). Common bile duct stones were diagnosed in 9 of 275 patients (3.3%). These had not been suspected on the basis of the clinical and laboratory data or ultrasonography results in 8 of them. An endoscopic papilotomy (EPT) was successful in all 9 patients with choledocholithiasis before laparoscopic cholecystectomy. Anatomical variations, such as origin of the cystic duct from the right or left hepatic duct and an accessory bile duct, were detected in 6 patients (2.2%). Preoperative ERC proved useful in determining the biliary anatomy or detecting unsuspected stones. (Dig Endosc 1994; 6 : 24–27)
The Usefulness of Endoscopic Color Doppler Ultrasonography (ECDUS) for Endoscopic Injection Sclerotherapy (EIS)
Authors: SATO Takahiro , KOITO Kazumitsu , NOBUTA Aichiro , NAGAKAWA Tatsuya , NATSUI Kiyoto , HIGASHINO Kiyoshi , TOCHIHARA Masahiro , MIYAKAWA Hiroyuki , FUJINAGA Akira , IMAMURA Akimichi , YAOSAKA Toru , SUGA Toshihiro , MURASHIMA Yoshio
Published: August 2007

Abstract: We studied 12 patients using endoscopic injection sclerotherapy (EIS) guided by endoscopic color Doppler ultrasonography (ECDUS). The ECDUS was performed with a PENTAX FG‐32UA (7.5MH2, convex type) and a HlTACHl EUB 565 as a display machine.

The EIS needle, as well as changes in intramural blood flow before and after EIS were clearly observed with the ECDUS.

When the sclerosant was injected properly into the esophageal varices, the blood flow in the esophageal varices could not be detected with color Doppler flow imaging nor with fast‐Fourier transform (FFT) analysis. Therefore EIS was safely performed with an adequate volume of sclerosant having been accurately injected into the varices.

Of the disadvantages of this technique, the forceps channel was found to be a bit narrow, and the anterior view was somewhat oblique. Even so, EIS guided by ECDUS is surely a promising method for the treatment of esophageal varices, especially once the technical difficulties are overcome. (Dig Endosc 1994; 6 : 39–44)
Endoscopic Stenting for Large Common Duct Stones in Patients with Acute Cholangitis
Authors: ISMAEL Albert E. , LAI Chi‐Wai , Y. SUNG Joseph J. , C. CHUNG Sydney S. , LEUNG Joseph W.
Published: August 2007

Abstract: Twenty‐eight high risk patients with acute cholangitis due to large common bile duct stones underwent endoscopic stenting for biliary drainage. Seventeen patients were subsequently readmitted for stone extraction after a mean interval of 4 months, 13 on an elective basis and 4 because of recurrent cholangitis. Six patients were noted to have spontaneous reduction in stone size and two had complete stone disintegration. Endoscopic stone extraction was successful in 15 patients. Two patients in whom the stone extraction failed had their stents changed. Two patients died of nonbiliary related causes. The remaining patients were asymptomatic during a follow up period of 4 to 19 months. Endoscopic stenting provides effective temporary drainage for acute cholangitis. Elective stone extraction can be performed when sepsis is controlled. In elderly high risk patients, stenting can be used as a definitive treatment for large common duct stones. (Dig Endosc 1994; 6 : 45–48)
Hookworm Infection Diagnosed by Upper Gastrointestinal Endoscopy: —Report of Two Cases with Review of the Literature—
Authors: LEE Tzong‐Hsi , YANG Jyh‐chin , LIN Jaw‐Town , LU Sen‐Chi , WANG Teh‐Hong
Published: August 2007

Abstract: We report here on two cases of hookworm infection diagnosed by upper gastrointestinal endoscopy instead of traditional stool examination for ova. The first case, an 87‐year‐old male patient, presented with severe iron‐deficiency anemia and a panendoscopy revealed several thin worms in the gastric antrum and duodenal bulb. The second case, a 64‐year‐old female patient, suffered from epigastralgia and a panendoscopy revealed a few thin worms in the duodenal bulb; further investigation revealed a pancreatic tumor and the patient died of this malignancy. In both cases, the worms were removed by biopsy forceps, and were identified as being Necator americanus from their characteristic morphology. (Dig Endosc 1994; 6 : 66–72)
A Histopathological Study on Ventral and Dorsal Pancreas Tissues in Patients with Pancreas Divisum
Authors: SUDA Koichi , HIRAI Shu , YAMAMURA Akihiko , ITAKURA Jun , MATSUMOTO Yoshiro , SATO Kazuhiro , ARIYAMA Jo
Published: August 2007

Abstract: Five cases of pancreas divisum, clinically diagnosed by endoscopic retrograde choledochopancreatography (ERCP), were studied histopathologically. They consisted of four biopsied cases and one patient who underwent pancreatoduodenectomy under the diagnosis of a suspected pancreatic carcinoma. Fibrosis was found in three out of the five cases, two cases with fibrosis in the dorsal pancreas and one in the ventral pancreas. In the two dorsal fibrosis pancreas cases, fibrosis was distributed in the intra‐ and interlobular areas and was accompanied by atrophy or disappearance of the acinar cells. These findings were compatible with chronic obstructive pancreatitis, distal to a stricture of the pancreatic duct. In the one ventral fibrosis pancreas case, i. e., the pancreatoduodenectomized case, fibrosis was distributed mainly in the interlobular area associated with hemosiderin deposition. Hemosiderin deposition was also observed in inflammatory foci at the posterior aspect of the ventral pancreas. Hence, such interlobular fibrosis developed in relation to the inflammatory foci, and was not caused by pancreas divisum. Therefore, in pancreas divisum, abnormal findings were observed in the dorsal pancreas tissue, and they were compatible with chronic obstructive pancreatitis. (Dig Endosc 1994; 6 : 74–79)
Clinical Features of Patients with Pancreas Divisum
Authors: SUGA Toshihiro , NAGAKAWA Tatsuya , MIYAKAWA Hiroyuki , ANBO Tomonori , SATO Takahiro , NATSUI Kiyoto , TOCHIHARA Masahiro , HIGASHINO Kiyoshi , KOITO Kazurnitsu , FUJINAGA Akira , IMAMURA Akimichi , YAOSAKA Toru , MURASHIMA Yoshio
Published: August 2007

Abstract: Between 1972 and 1992, 18, 128 ERCPs were performed. Pancreas divisum (PD) was diagnosed in 184 of these patients (1.02%). The clinical features of 108 cases were investigated (M53, F55, average age 54) who were encountered during the last 8 years.

In a morphological study, we examined changes in both the ventral and dorsal ducts. An ERP of the dorsal pancreas demonstrated severe changes (SE) in 2 of 73 patients (3%), moderate changes (MO) in 4 (5%) and minimal changes (MI) in 17 (23%). When the ventral pancreas was examined, SE and MO occurred in one each of the 89 patients (1%), and MI in 5 (6%). The rate of ductal abnormalities in the dorsal pancreas (32%) was significantly higher than the rate in the ventral pancreas (8%). However, the dorsal duct changes did not correlate with alcoholism.

The exocrine or endocrine function in the majority of the patients with PD was normal or slightly disturbed.

An investigation of abdominal pain revealed that patients who complained of pancreatic‐type pain were 33%, and this rate was higher than the rate in the control group without PD (12.8%).

In conclusion, it was suggested that PD was related to mild dorsal pancreatitis. (Dig Endosc 1994; 6: 80–86)
Laparoscopic Cholecystectomy, How We Do It
Authors: JAKIMOWICZ Jack J. , RUTTEN Harm
Published: August 2007

Abstract: Own experience with laparoscopic cholecystectomy is discussed. Indications, contraindications or laparoscopic cholecystectomy are reviewed. Surgery techniques used are presented in detail. The study of our first 500 patients undergoing laparoscopic cholecystectomy lead to the conclusion that if a meticulous and standardized technique is used no major complications are encountered and results are improved in comparison to prior experience with open cholecystectomy.
Application of a Video Microscope to Observe the Gastric Mucosal Surface, Especially in Early Gastric Cancer
Authors: KOBAYASHI Toshihiko , KIMURA Taizo , HARADA Yukio , NAKAMURA Shin‐ichi , KINO Isamu
Published: August 2007

Abstract: The surface of cancerous mucosa in 30 surgically resected cases of early gastric cancer (22 differentiated and 8 undifferentiated adenocarcinoma) was observed through a video microscope. The mucosal surface showed characteristic findings of a pit pattern, composed of elevations and depressions of the surface, as previously reported when a dissecting microscope was used. The pit patterns of the cancerous mucosa were classified into five types under 200 × magnification: oval or round (type I), tubular or slightly branching (type II), irregular sulcus (tupe Ill), mesh‐like (type IV) and non‐structural or destroyed (type V). Most differentiated cancers had type I to 1V pit patterns, in contrast with undifferentiated cancers which mostly had a type V pit pattern. Our observations suggest that a video microscope is useful to observe magnified gastrointestinal mucosal lesions and to recognize the characteristic features of the surface such as the pit pattern.
Three Cases of Sebaceous Glands in the Esophagus
Authors: ISHII Keita , MITSUHASHI Toshiharu , SAIGENJI Katsunori , KAN Tomoya , ATARI Eio
Published: August 2007

Abstract: Three cases of patients with sebaceous glands in the esophagus are described in this study.

Case 1: This patient had suffered from heart burn for several months. An endoscopy disclosed a slightly elevated rounded granular yellowish lesion 5 mm in diameter in the middle esophagus. Multiple rounded yellowish lesions ranging from 1 to 2 mm in size were also recognized at the immediate distal site. A biopsy revealed normal squamous esophageal epithelium with sebaceous glands making up the underlying elevated lesions.

Case 2: This patient had suffered with difficulty in swallowing for a month. An endoscopy disclosed multiple rounded granular yellowish lesions ranging from 1 to 2 mm in diameter in the middle esophagus. A biopsy revealed sebaceous glands (similar to case 1).

Case 3: This patient had suffered from epigastric discomfort for a year. An endoscopy disclosed multiple rounded granular yellowish lesions ranging from 1 to 2 mm in diameter in the middle esophagus. A biopsy revealed sebaceous glands.
Endoscopy and Crohn's Disease: Endoscopic Approach to the Pathogenesis of Crohn's Disease
Authors: ASAKURA Hitoshi , HONMA Terasu , NARISAWA Rintaro
Published: August 2007

Abstract: This review describes endoscopic and histopathological findings in Crohn's disease with reference to its pathogenesis. The number of patients with Crohn's disease has markedly and rapidly increased during the last 10 years in Japan. Minute lesions such as aphthoid ulcers as an early lesion in Crohn's disease were at first discussed endoscopically and histopathologically. Recent advances concerning the mechanism of how aphthoid ulcers may occur revealed that they are induced by mucosal ischemia due to vasculitis. Longitudinal ulcers and cobblestone appearance were observed only in advanced Crohn's disease. Finally, the etiology of Crohn's disease was reviewed from the viewpoint of infectious agents and immunological abnormalities which were clarified from the study of endoscopic biopsy specimens.
A New Assessment of Esophageal Varices by Endoscopic Ultrasonography Using a 15/20‐Megahertz Ultrasonic Probe
Authors: NISHIZONO Masatoshi , SAKATA Junichiro , OHASHI Tsuyoshi , HARAGUCHI Yasuaki , ETO Tanenao , KAMIKAWA Hideki , BEKKI Fumitoshi , NAGASAKI Yoshikazu , KOGA Nobuhiko , KOGA Toshihiko , YAMASHITA Yuichi
Published: August 2007

Abstract: We examined esophageal varices using the new technique of endoscopic ultrasonography (EUS) that employed a high‐resolution 15/20 MHz ultrasonic probe. EUS employing the direct contact method, in which the forceps‐channel probe was in direct contact with the lumen, was used in patients with esophageal varices (58 cases) and in control patients without varices (32 cases). Findings were also compared with additional EUS employing the conventional balloon method which was performed on 21 of the patients with esophageal varices.

The direct contact method visualized all the varices (endoscopic Grade 1 varices; 2.0 ± 0.7 mm in diameter (mean ± SD) and 11.9 ± 3.1 cm in length, endoscopic Grade 2 or 3 varices; 5.8 ± 3.2 mm in diameter and 16.3 ± 3.0 cm in length).

In the 21 patients who underwent EUS by the two different methods, varices were displayed by both methods in 9 cases (7 endoscopic Grade 2 varices, and 2 Grade 3 varices). In the other 12 cases (8 endoscopic Grade 1 varices, and 4 Grade 2 varices) varices were displayed only by the direct contact method, and not by the balloon method.

The direct contact method can be regarded as a useful technique for the evaluation of esophageal varices.
Endoscopic Clipping Effective for Papillotomy Bleeding
Authors: AKASHI Ryukichi
Published: August 2007

Abstract: In this study the preliminary results on endoscopic clipping for the treatment of bleeding associated with endoscopic sphincterotomy (ES) are reported. Two patients with melena on the 4th and 5th day after ES were treated by this procedure. The sites of bleeding were recognized respectively as being at the posterior and anterior margin of the endoscopic sphincterotomy. One of the two patients had a large exposed vessel clearly situated near to the previous endoscopic incision. Bleeding was immediately stopped in both cases and no early nor late signs of acute pancreatitis were observed. When this procedure is applied special care to avoid ligation of the pancreatic duct is a must. Moreover in order to facilitate endoscopic manouvers and to promote spontaneous expulsion in 2–3 weeks new smaller clips should be developed.
Application of a Remodeled Stiegmann‐ligator to Esophageal Varix
Authors: INUI Noriaki , BAN Noriyoshi , ARAYA Hideji , SATO Tsutomu , DOI Tadashi , OOTA Kaoru , ODASHIMA Yae , FUJII Shigeyuki , KATUKI Shinichi , HORIMOTO Masayoshi , SANPI Kazumi , KAWANISHI Joji , WATANABE Naoki , NIITU Yoshiro
Published: August 2007

Abstract: The Stiegmann‐ligator has been recently proved to be useful for the treatment of esophageal varices. With those ligators, however, we found difficulty in performing ligation when the pathological change was on the tangent line or relatively large, such as F3, or associated with concentrated RC signs. To overcome these problems, we modified the Stiegmann O‐ring ligator by diagonally cutting the tip of the inner sleeve. Using this ligator, we conducted some animal‐model experiments and clinical trials. In all cases, the remodeled ligator covered a wider range of lesions. We no longer encountered difficulties in performing ligation with the remodeled ligator when pathological changes were on the tangent line. The procedure did not cause any complications apart from temporary chest discomfort after surgery.
A New Method for Measurement of Gastric and Colonic Lesions with an Electronic Endoscope and Image Processor
Authors: MUNAKATA Akihiro , IWANE Satoru , HATADA Yasumasa , TOHNO Hiroshi , BABA Takio , NAKAJIMA Hitoshi , YOSHIDA Yutaka , ITOH Masazumi
Published: August 2007

In order to measure the sizes of gastric and colonic lesions endoscopically, we established a system composed of an electronic endoscope, image processor, and personal computer. The long and short diameter of the lesion were calculated by a program which corrected the curvature radius of the lens of the endoscope and variables. 1) To evaluate its accuracy, we measured a 10 mm scale spherical model at different distances from the lens of the endoscope. The mean value was 9.7 mm, ranging from 9.0 to 10.9 mm. The rate of error was –0.38±4.4 % (mean±SE). 2) Using this system, we measured the sizes of 34 gastric and colonic lesions in 34 patients (3 with gastric cancers, 20 with gastric polyps, and 11 with colonic polyps), and compared them with the real sizes of the resected or polypectomized specimens. The rate of error was–1.1±1.3% (mean±SE). The results showed that our system was useful to evaluate the accurate sizes of gastric and colonic lesions endoscopically.
A Case of Biliary Cystadenocarcinoma Followed up for Five Years
Authors: AJIKI Tetsuo , FUJIMORI Takahiro , NAKAMURA Tetsuya , MAEDA Sakan , SAITO Yoichi , SUEHIRO Itsuo , MIYAZAKI Junko , NAGASAKO Kou
Published: August 2007

We report on a case of an 80‐year‐old male with autopsy‐confirmed biliary cystadenocarcinoma. The tumor's growth was followed up for five years. CT findings on first admission revealed that the cyst walls of the tumor were smooth. However, a CT taken four years later showed large cysts with irregular walls which were growing invasively and expanding beyond the liver. The patient died of liver dysfunction caused by obstructive jaundice due to the liver tumor, and an autopsy was performed. Histologic examination of the autopsy material revealed a multilocular tumor that was identified as being a biliary cystadenocarcinoma and microscopic lung metastases were seen. The character of the multilocular cyst with septations covered by papillary proliferation of atypical columnar epithelium and many remaining portions with low grade dysplasia led us to suspect the tumor was derived from a cystadenoma.
An Attempt to Analyze Color Wavelengths with an Electronic Endoscope
Authors: KATSU Ken‐ichi
Published: August 2007

We attempted to measure the dominant wavelengths of gastric mucosal lesions and to extract and present color differences of the lesions in image form, by converting spectroscopic visual signals (composed of red, green and blue components) obtained from an electronic endoscope into digital color files. The dominant wavelength, as measured from signals input without gamma correction, was significantly shorter in gastric mucosa affected by atrophic gastritis and type lie early gastric cancer than in normal mucosa. This analysis revealed a significant difference in dominant wavelengths between the endoscopically normal mucosa of the stomach and that found to have been affected by early gastric carcinoma and atrophic gastritis. Color difference extraction allowed us to make a morphological characterization of the surface of type lie early gastric cancer, although this was possible in only one case. The results of this study suggest the diagnostic value of digital representation of the mucosal surface features provided by endoscopy. It is suggested that, in the future, analog endoscopic diagnosis will be replaced by digital endoscopic diagnosis and computerized endoscopic diagnosis.
Modified Endoscopic Variceal Ligation
Authors: MASUMORI Koji , ONDA Masahiko , TAJIRI Takashi , KIM Deug Young , TOBA Masahito , UMEHARA Matsuomi , YOSHIDA Hiroshi , MAMADA Yasuhiro , NISHIKUBO Hideki , TANIAI Nobuhiko , KOJIMA Takayuki , MATSUZAKI Sakae , YAMASHITA Kiyohiko
Published: August 2007

Endoscopic variceal ligation (EVL) has been widely adopted because it is technically easy to perform. However, it is not always possible to eradicate varices by the standard ligation method. Therefore, we examined the effectiveness of the intensive ligation method as an alternative for the eradication of varices. In applying this method, rubber bands are used to make ligations much closer to each other, than with the standard method, just above the esophago‐gastric junction (EG‐junction). We also compared the effectiveness of EVL in nine cases undergoing the standard ligation method with that in nine cases treated by the new intensive ligation method. With the standard ligation method, the average number of sessions was 2.2 per week, while the average number of rubber bands used was 9.6 per patient. Varices disappeared in three of nine cases. With the intensive ligation method, the number of sessions was two per week in all cases, while the average number of rubber bands was 19.9 per patient. Varices disappeared in all nine cases. Chest discomfort, as a complication, was experienced by three of nine cases in both groups. It is concluded that the intensive ligation method is a very effective means of achieving early, safe eradication of varices.
Heat‐Probe Coagulation Treatment of Recurrent Intramucosal Venous Dilatation of the Esophagus and Endoscopic Color Doppler Ultrasonographic Follow‐up
Authors: SATO Takahiro , HIGASHINO Kiyoshi , TOYOTA Jouji , KARINO Yoshiyasu , FURUKAWA Tomoyuki , MURASHIMA Yoshio , SUGA Toshihiro , YAOSAKA Tom , IMAMURA Akimichi , FUJINAGA Akira , KOITO Kazumitsu , MTYAKAWA Hiroyuki , TOCHIHARA Masahiro , NATSUI Kiyoto , ANBO Tomonori , NAGAKAWA Tatsuya , SODA Mitsuhiko , KATO Shigeharu , ASO Kazunobu
Published: August 2007

We treated 14 patients with high risk intramucosal venous dilatation (high risk IMVD) of esophageal varices using heat‐probe coagulation. Two of the 14 patients experienced bleeding from the high risk IMVD. We used an Olympus heat‐probe unit CD‐20Z to stop or prevent variceal bleeding. The 14 patients were treated one to four times (mean: 1.9 times) using a total of 450–2100 joules (mean: 1459 joules). The high risk IMVD disappeared with healing of the heat‐probe‐induced ulcers. No severe side effects were recorded. Two patients with bleeding from high risk IMVD were successfully treated by the heat‐probe technique. In addition, we studied the effects of endoscopic heat‐probe coagulation for esophageal varices via endoscopic color Doppler ultrasonography (ECDUS) in six patients. Our ECDUS study was conducted with a PENTAX FG‐32UA, 7.5MHz convex type, and a HITACHI EUB 565 display monitor. Following heat‐probe treatment, the esophageal walls thickened from 5.1 to 8 mm (mean: 6.3 mm) and a low echoic pattern was visualized by ECDUS. Esophageal intramural blood flow was not observed in any of the six patients. Paraesophageal veins and passageways remained patent in all six patients.
Endoscopic Urease Sensor System for Detecting Helicobacter pylori on Gastric Wall Using a pH‐sensitive Field Effect Transistor
Authors: KOHLI Yoshihiro , KATO Takiyi , ITO Shigeji , MIYAJI Hideki , AZUMA Takeshi , TSURUTA Hitoshi , MATSUI Satomi , OKA Keiko , NAKAMURA Michihiro
Published: August 2007

An endoscopic tube‐tip type urease sensor was developed for the purpose of on‐site detection of Helicobacter pylori (H. pylori) using a pH‐sensitive field effect transistor (pH‐FET). The sensor is composed of an endoscopic‐tube connected to a feed pump with a urea solution and a pH‐FET attached to a sensor holder at the open end of the tube. The urease activity on the gastric wall can be measured by bringing the sensor into contact with the gastric wall just after replacing gastric juice with the urea solution. The presence of H. pylori causes a pH change in the urea solution inside the sensor holder in 20 seconds due to the strong urease activity of this bacterial species. After measurement, the sensor is detached from the wall, and washed with urea solution by turning on the urea pump. A measurement at one site is completed within 30 seconds. Repetition of the procedure makes multi‐site measurements possible. In preliminary evaluations, it was found that clinical sensitivity and specificity were 89% and 86%, respectively, using standard bacteriological testing results as a reference.
Colonic Mucosal Blood Flow in Ischemic Colitis
Authors: YAMAKADO Susumu , TATSUGUCHI Atsushi , SATO Jun , FUJIMORI Shunji , MEVAMI Sadamu , TAGUCHI Fumihiko , TAMAGAWA Yasuhito , KISHIDA Teruyuki , YOSHIDA Yutaka , KOBAYASHI Masafumi
Published: August 2007

Altered colonic mucosal blood flow (CMBF) is thought to be involved in the onset mechanism of ischemic colitis (IC). This study was designed to clarify the features of CMBF in six patients with IC (average age, 61 yr) and 10 control subjects (44.6yr). In the IC patients, CMBF was measured at both the affected site (ulcer margin and surrounding mucosa) and at a normal appearing site, during the active, healing, or recovery phase, by the laser doppler method. In the control group, CMBF was measured in various segments of the colon. The CMBF around the ulcer site during the active phase was significantly lower than that at the homologous segment in normal controls, while CMBF at normal sites in IC patients did not differ markedly from that of normal controls. CMBF in reddened portions of the ulcer margin in IC patients was significantly higher than that of the surrounding mucosa. A significant increase in CMBF was also observed during PGEi administration as compared to that before administration. This evidence clearly indicates that decreased CMBF is involved in the pathogenic mechanism of IC. The CMBF at sites of active mucosal restoration was somewhat increased. Continuous intravenous administration of PGEi was found to increase CMBF in IC patients.
Electronic‐endoscopic Observation of ET‐1 Induced Mucosal Ischemia and Preventive Effect of ETA Recepter Selective Antagonist, FR139317, in Rat Distal Colon
Authors: HOSOKAWA Masaya , TOMINAGA Masayuki , UEDA Syunji , TANIGUCHI Takao , NAKAMURA Hiroshi , TSUKADA Hideaki , OKUMA Mimoru , SAKAI Masahiko
Published: August 2007

For investigation of the effects of Endothelin‐1 (ET‐1) on colonic mucosa, ET‐1 (10–160 nmol/kg) was sprinkled on rat colonic mucosa under observation with a new electronic endoscopic system (TOSHIBA TRE‐3000, Japan). A high dose of ET‐1 induced complete obstruction of submucosal arterioles, but not venules, without affecting arterial blood pressure. The ET‐1 ‐induced contraction of both vessel types was maintained for 50 min and was followed by intramucosal dot hemorrhages. In this experimental model, the effects of ET‐1 on the mucosal microcirculation were further analyzed with a laser doppler blood flowmeter (LDF) during endoscopic observation. The maximum decrease in mucosal blood flow was to 20 % of the control value and this decrease was maintained for 20 min at a dose of 80 nmol/kg. An ETA receptor selective antagonist, FR139317 (800 nmol/kg), inhibited ET‐1 ‐induced changes in endoscopic findings and LDF, shifting the concentration‐response curve of LDF to the right. FR139317 is a potentially useful new therapy for inflammatory bowel diseases, conditions which have been reported to be associated with high local concentrations of ET‐1. Our electronic‐endoscopic system was demonstrated to be a useful basic research tool for studying gastrointestinal pathophysiology.
Efficacy of Endoscopic Prosthesis in T4 Cancer of the Intrathoracic Esophagus
Authors: YAMADA Akira , KUROKI Yoshito , SAKAMOTO Takashi , YAMASHITA Iwao , NOMURA Naoki , SAITO Mitsukazu , SHIMIZU Tetsuro , TAZAWA Kenji , FUJIMAKI Masao
Published: August 2007

No remarkable improvement has yet been achieved in the survival of patients with advanced intrathoracic esophageal cancer. In particular, patients with complications such as esophago‐bronchial fistula or invasion into the mediastinum have an especially miserable prognosis, even with surgical treatment. To improve the quality of life (QOL) of such patients, extensive palliative therapy should be provided. Thus, we have introduced an endoscopic esophageal intubation technique for the treatment of stenosis or perforation in patients with T4 esophageal cancer.

Nine patients with unresectable intrathoracic esophageal cancer, complicated by stenosis or perforation, were treated with an endoscopic esophageal prosthesis. Four cases had an esophago‐bronchial fistula, and in three the tumor had perforated the mediastinum. The prosthesis was successfully placed under endoscopic guidance in all nine cases. Six patients (66.7%) subsequently resumed oral intake without discomfort, while two had reasonably good outcomes in this regard (efficacy rate; 88.9%). Complications were seen in three patients: mainly chest discomfort, reflux esophagitis and migration of the prosthesis in one patient each. Six patients required prolonged administration of chemotherapeutic agents following prosthesis placement. Mean survival was 123.4±77.0 days. Four of the nine patients died in the hospital. Palliative endoscopic esophageal prosthesis was considered to be useful for patients with advanced esophageal cancer. With this technique, an improvement in QOL was achieved, as sufficient oral intake was facilitated and pulmonary and mediastinal complications due to perforation were diminished.
Spontaneous Resolution of Chronic Hepatitis C – A Case Report
Authors: SAKAI Shino , WATANABE Makoto , SATO Shuichi , KOHGE Naruaki , AKAGI Shuji , FUKUMOTO Shiro
Published: August 2007

We experienced a case of chronic hepatitis C showing spontaneous resolution. The patient was diagnosed as having chronic hepatitis with moderate activity, non‐A non‐B type, after laparoscopy with liver histology in 1982, and was followed up thereafter at our out‐patient clinic. His aspartate aminotransferase (AST)and alanine aminotransferase (ALT) levels fluctuated but had stabilized by 1990.

A second laparoscopy with liver histology, conducted in 1993, revealed non‐specific reactive hepatitis. Serum hepatitis C virus RNA (HCV‐RNA) had been strongly positive in 1982 but was negative in 1990. Interferon therapy may not be indicated in such cases.
Combination of Preoperative EST, Laparoscopic Cholecystectomy with Choledochotomy, and Postoperative Cholangioscopy in the Treatment of Common Bile Duct Stones
Authors: KANO Nobuyasu , KASUGAI Hisashi , HONDA Hiraku , YAMAKAWA Tatsuo
Published: August 2007

A case of common duct stones, successfully managed with a combination of preoperative EST, laparoscopic choledochotomy and postoperative choledochoscopic stone extraction, is reported. A 32‐year‐old man was admitted to our hospital because of jaundice and right hypochon‐dralgia of several‐days' duration. CT, US and ERCP revealed stones in the gallbladder and common bile duct. EST was performed to remove the stones in the common bile duct prior to laparoscopic cholecystectomy. However, the patient developed pancreatitis as a complication of EST, which was successfully managed by conservative therapy. Though some stones remained in the common duct following the first trial of EST, the patient rejected a second round of EST. Laparoscopic cholecystectomy and choledochotomy were performed to remove the gallbladder and the stones remaining in the common bile duct. A T tube was placed in the incised common bile duct for management of possible retained stones. Twenty days after the surgery, successful postoperative cholangioscopy was performed, and the stones remaining in the common duct were removed. Hyperamylasemia and pancreatitis are relatively common complications of EST occurring in about 7% of cases, but only 3% of these patients experience severe pancreatitis, requiring hospitalization. Conservative therapy is always the treatment of choice. In our particular patient, pancreatitis caused by EST was successfully managed by decompression with ENBD and administration of ulinastatin. Residual stones in the CBD were completely removed by laparoscopic common bile duct exploration following EST and postoperative cholangioscopy through the T tube fistula.
A Case of CholangioDuodenal Fistula Formation After Metallic Stenting for Malignant Biliary Stricture
Authors: RYOZAWA Shomei , AKIYAMA Tetsiyi , IKEDA Miyuki , FURUI Toshifumi , YABUSHTTA Yoshiko , KONDO Satoshi , NOGUCHI Takayoshi , NOJIMA Shinji , OKITA Kiwamu
Published: August 2007

A 68‐year‐old man presented with melena in June 1993, and was diagnosed as having adenocarcinoma of the rectum with liver metastasis. He underwent anterior resection of the rectum and was given weekly chemotherapy. In October 1993, he developed jaundice due to severe stricture of the middle to lower common bile duct caused by metastatic spread to the lymph nodes around the pancreatic head. A 10mm wide, 51mm long WallstentTM (Schneider) was inserted into the lower end of the bile duct through the papilla, resulting in rapid normalization of the serum bilirubin level. Three months later, the Wallstent eroded through the duodenal wall, causing massive fatal hemorrhage. We, therefore, emphasize the necessity of being alert to the potential for such complications in cases involving placement of a self‐expanding metallic stent for malignant biliary stricture.
Laparoscopic Cholecystectomy: Treatment o Choice in Elderly Patients
Authors: REY Samuel , YAMAKAWA Tatsuo , KANO Nobuyasu , ISHIKAWA Yasuro , HAKEEM Rachit , SHA Muneyaso , KOISHI Keiko
Published: August 2007

Abstract: The application of laparoscopic] cholecystectomy, first reported in 1987, has grown rapidly worldwide, replacing the open cholecystectomy. This trend is attributable to the benefits of minimal surgical access, i. e. a smaller incision, less postoperative pain and faster recovery. However, doubts persist concerning the role of laparoscopic cholecystectomy in elderly patients. The purpose of this study was to assess morbidity and mortality in elderly patients who underwent laparoscopic cholecystectomy at Teikyo University Hospital at Mizonokuchi. Forty‐eight patients, 65 years or older, underwent attempted or successful laparoscopic cholecystectomy. To assess operative risk in these patients, the American Society of Anesthesiologist's Surgical Risk (A. S. A.) category was used. The risk ranged from 1 to 3 with a median of 2. Twenty‐five percent of the patients were defined as A. S. A. I, 61% as A. S. A. II and 14% as A. S. A. III. Four patients required intraoperative conversion of the procedure to open cholecystectomy (conversion rate of 8.3%). The indications for conversion in three patients were severe adhesion and thickened gallbladder wall and in the other were secondary to gallbladder bed oozing. This conversion rate is similar to that reported in other series. The conversion was not related to the surgical risk. The morbidity rate was 4.5%. the mortality rate zero. These results compared favorably with those reported for open cholecystectomy in elderly patients and with the overall published morbidity‐mortality rate of laparoscopic cholecystectomy in large series. We conclude that laparoscopic cholecystectomy is a suitable procedure for elderly patients.
Evaluation of Endoscopic Characteristics in a New Gastritis Classification System
Authors: KATOH Mototsugu , ASAKA Masahiro , KUDOH Mineo , SUKEGAWA Makoto , KATAGIRI Masaki , SASAKI Yuri , KOSHIYAMA Tatsumi , KAGAYA Hidetoshi , NISHIKAWA Keiko , HOKARI Kaku , OHAE Yoshiyuki , TAKEDA Hiroshi , YOSHIDA Junichi
Published: August 2007

Abstract: The Sydney System is a relatively new classification system for gastritis that includes two divisions: histological and endoscopic. To evaluate the endoscopic division, we assessed the endoscopic appearance of the gastric mucosa according to the Sydney System. One thousand seventeen cases of gastritis were diagnosed endoscopically from July 1992 through June 1993. According to the eight categories of endoscopic gastritis used in the Sydney System, 58.8% of cases were diagnosed as atrophic gastritis, 18.7% as erythematous gastritis, 7.8% as raised erosive gastritis, 5.0% as flat erosive gastritis, 5.0% as hemorrhagic gastritis, 3.1% as congestive gastropathy, and 1.5% as enterogastric reflux gastritis. The topography of atrophic gastritis correlated significantly with the extent of endoscopic atrophy, while the severity of the atrophic gastritis grading correlated significantly with the histological severity of atrophy. Although some difficulties remain with regard to the description of endoscopic gastritis in the Sydney System, these issues could be resolved by modifying a few parts of the descriptive definition of gastritis. Our results indicate that the endoscopic division of the Sydney System is applicable to the classification of gastritis in Japanese patients.
Morphological and Functional Evaluation of Gastric Ulcer Healing and Recurrence by Endoscopic Ultrasonography
Authors: MIYATA Akihiro , NIWA Yasumasa , GOTO Hidemi , HASE Satoshi , HAYAKAWA Tetsuo , TSUKAMOTO Yoshihisa , SEGAWA Kose
Published: August 2007

Abstract: The aim of this study was the evaluation of gastric ulcer healing and recurrence, from the viewpoints of morphology and function, by means of endoscopic ultrasonography (EUS). We determined ulcer depth by EUS and quantified ulcer size in EUS images. In addition, we measured the total gastric juice acid content after fasting and the macromolecular glycoprotein weight in antral biopsies. First, we examined 22 patients receiving initial therapy during the active ulcer stage. Fourteen of these patients were reexamined after healing. The ulcer area diminished significantly, as did the total acid content, during the scarring stage. Then, another 22 patients on maintenance therapy were followed for recurrence over a 10 month period. The recurrence rate in UI‐IV ulcers was significantly higher than those in UI‐II or III ulcers. The ulcer area was greater and the macromolecular glycoprotein content lower in patients experiencing recurrence. In conclusion, morphological and functional factors (ulcer depth and ulcer area; total acid content and macromolecular glycoprotein weight), which could be assessed easily and simultaneously using an EUS fiberscope with a biopsy channel, were useful for evaluating gastric ulcer healing and recurrence.
Effect of Acetyl Salicylic Acid and Cetraxate on Human Gastric Mucosal Blood Flow: Clinical Application of Laser Doppler Measurement
Authors: USUI Hiroko
Published: August 2007

Abstract: The effects of acetyl salicylic acid and cetraxate on gastric mucosal blood flow (GMBF) were examined in human subjects. GMBF was determined endoscopically using a laser Doppler flowmeter. The normal value in 16 adults ranged from 1.7 ± 0.8 volts (mean ± SD) at the lesser curvature of the antrum to 3.72 ± 0.79 volts at the greater curvature of the body. In four normal volunteers, the time course of GMBF was measured after the oral intake of 0.5 g acetyl salicylic acid with or without cetraxate. GMBF was significantly lower after intake of acetyl salicylic acid at 15 min at the lesser curvature of the body (3.6 ± 1.0 to 2.3 ± 0.7, P<0.05) and at 20 min at the lesser curvature of the antrum (2.7 ± 0.6 to 1.4 ± 0.2, P<0.05), as compared with the values at 5 min. This adverse effect of acetyl salicylic acid on GMBF was inhibited by concomitant administration of 0.8 g cetraxate. It was concluded that cetraxate prevented the acetyl salicylic acid induced decrease in GMBF.
Laparoscopic and Histopathologic Features of the Liver in Severe Chronic Active Epstein‐Barr Virus Infection Syndrome: A Case Report
Authors: KOUNOURA Kiyoshi , OMAGARI Katsuhisa , IKUNO Nobuhiro , MATSUO Isao , KOMATSU Kohei , EGAWA Ichiei , TOKUNAGA Masaki , IMANISHI Takeo , MAKIYAMA Kazuya , HARA Kohei
Published: August 2007

Abstract: A 40‐year‐old man was admitted to our hospital with persistent fever, generalized lymphadenopathy and hepatosplenoamegaly. Immunological examination demonstrated high titers of several anti‐Epstein‐Barr virus (EBV) antibodies, including anti‐viral capsid antigens 1gG‐antibody 1: 20, 480, anti‐early antigens‐DR IgG‐antibody 1: 5, 120, and reduced activity of EBV‐specific cytotoxic T lymphocytes. Laparoscopic features resembled those of chronic active viral hepatitis, including an uneven surface appearance and diffuse hepatic enlargement. Histopathological examination of a liver biopsy specimen showed inflammatory cell infiltration along sinusoidal surfaces (single file appearance) and enlarged portal areas with intralobular punched‐out necrosis. The diagnosis was confirmed by detecting the EB viral genome in serum. Despite treatments with natural alpha‐interferon, adenosine arabinocide and recombinant human interleukin‐2, the patient died of progressive hepatic failure.
A Case Report of Choledochocele (type III choledochal cyst of the Alonso‐Lej classification)
Authors: KASAHARA Hiroshi , ISHIDA Hidefumi , YAMAMOTO Masahiro , SAITOH Yoichi
Published: August 2007

Abstract: The case of a 33‐year‐old woman with a rare type of choledochal cyst (Choledochocele; Alonso‐Lej's type III) is described. The patient had undergone prior cholecystectomy. Hypotonic duodenography showed a smooth defect in the duodenum. Endoscopic retrograde cholangiopancreato‐graphy (ERCP) showed a cystic dilatation of the terminal portion of the common bile duct. Endoscopic ultrasonography (EUS) showed a cystic lesion at the same site. This case was preoperatively diagnosed by ERCP and EUS. Transduodenal sphincteroplasty was done and good results were obtained.