Akimichi Chonan

Endoscopic Mucosal Resection (EMR) of Early Gastric Cancer : Usefulness of Aspiration EMR Using a Cap-fitted Scope

Abstract: We conducted this study to clarify the effectiveness of aspiration endoscopic mucosal resection (EMR) using a cap‐fitted scope for early gastric cancer in the C and M regions of the stomach. EMR was performed in 111 early gastric cancer patients with 123 lesions in the C and M regions. The patients were divided into three groups. The EMR‐1CS group consisted of patients who had undergone EMR with a one‐channeled scope, the EMR‐2CS group those who had received EMR in which a two‐channeled scope was utilized. The EMRC group consisted of patients who had undergone aspiration EMR with a cap‐fitted scope.

Preoperative endoscopic ultrasonography-guided tattooing of the pancreas with a minuscule amount of marking solution using a newly designed injector

Recent studies have reported the usefulness of preoperative endoscopic ultrasonography‐guided fiducial tattooing (EUS‐tattooing) of the pancreas. However, problems of proper procedure, including markers and amounts, have not been resolved. The aim of the present study was to evaluate the feasibility of EUS‐tattooing with a minuscule amount of marking solution using a new injector.

Diagnosis of the Depth of Advanced Gastric Cancer Invasion by Endoscopic Ultrasonography

Preoperative endoscopic ultrasonography (EUS) was performed in 272 patients with advanced gastric cancer who underwent gastrectomy between December 1986 and December 1993. We divided the subjects into two groups: group A consisted of patients whose stomachs were filled with water for the EUS examination (water‐filling method: 1986.12–1992. 10) and group B of patients in whom EUS was performed with the water‐filled balloon compression method (balloon‐compression method) in addition to the water‐filling method (1992.11–1993. 12). A comparative study of EUS diagnostic efficacy, as regards the depth of invasion, was made between group A and group B. The following results were obtained:

Spontaneous resolution of intramural gastric abscess without treatment

© 2016 Hellenic Society of Gastroenterology www.annalsgastro.gr A gastric wall abscess is a type of phlegmonous gastritis characterized by inflammation confined to the stomach wall and abscess formation. It is caused by biopsy, polypectomy, cancer and accidental ingestion of foreign objects [1]. Endoscopic drainage has been considered useful [2]. No case of spontaneous alleviation of gastric wall abscess has been reported previously. A 57-year-old man with no previous medical history swallowed a fish bone (flounder). The next day, he complained of epigastric discomfort and fever. He came to our hospital 10 days after the onset of the symptoms, and upper gastrointestinal endoscopy was performed. A submucosal tumor (SMT)-like protrusion was observed in the anterior wall just below the stomach cardia, as well as pus discharge from the top of the lump (Fig. 1A). Contrast-enhanced computed tomography revealed fluid collection in the gastric wall (Fig. 2), and these findings were consistent with that of gastric abscess. On the next day, endoscopy revealed that the protrusion suspected as a gastric wall abscess had clearly shrunk, but pus discharge was observed (Fig. 1B). Endoscopic ultrasound (EUS) showed inhomogeneous lesion of mixed echogenicity located mainly in the submucosal layer with mucosal involvement (Fig. 1C), consistent with the reported features of EUS of gastric wall abscess [3]. Streptococcus spp. was detected on pus culture. Three days after, the subjective symptoms had completely alleviated; the SMT-like protrusion had further shrunk, as observed via endoscopy. The SMT-like protrusion was not observed via upper endoscopy performed 1 month after discharge (Fig. 1D).

Endoscopic Biliary Drainage without Endoscopic Sphincterotomy

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.

A case of a glomus tumor of the stomach resected by laparoscopy endoscopy cooperative surgery.

A 56-year-old woman who was found to have a submucosal tumor (SMT) of the stomach in a medical check-up was admitted to our hospital for a detailed investigation of the SMT. Upper gastrointestinal endoscopy revealed an SMT of 20mm at the anterior wall of the antrum of the stomach. Endoscopic ultrasonography showed a hyperechoic tumor in the fourth layer of the stomach wall. CT examination showed a strongly enhancing tumor on arterial phase images and persistent enhancement on portal venous phase images. Laparoscopy endoscopy cooperative surgery was performed with a diagnosis of SMT of the stomach highly suspicious of a glomus tumor. Immunohistochemistry revealed expression of α-SMA but no expression of desmin, c-kit, CD34, or S-100. The tumor was finally diagnosed as a glomus tumor of the stomach.

Usefulness of dilated blood vessels in the tumor periphery for assessing the invasion depth of small-sized depressed colorectal cancer

AbstractThe relationship between dilated blood vessels in the tumor periphery and the tumor invasion depth is unclear. Therefore, the present study aimed to clarify the relationship between dilated blood vessels and the invasion depth of small-sized (<30 mm) colorectal cancer (CRC), and its implications on endoscopic treatment.We performed a single-arm observational study of the diagnostic accuracy of the existence of dilated vessels in the tumor periphery of CRC lesions as an indicator of submucosal deep (SM-d, ≥1000 &mgr;m) carcinomas. Lesions were classified into two groups based on the existence of dilated vessels by two experienced endoscopists. The clinicopathological features, invasion depth, and lymphovascular invasion/poorly differentiated clusters were analyzed in all resected specimens.Four hundred and two consecutive small-sized CRC lesions were included. The dilated vessels were observed in 96/402 (24%) lesions, and most of them (93/96) were found in depressed lesions. In depressed lesions, the histopathological diagnosis of the dilated vessels group showed SM-d or deeper invasion in 84/93 (90%) cases, whereas 3/20 (15%) had SM-d invasion in the nondilated vessels group (P < 0.001). When the dilated vessels were used as an indicator of SM-d or deeper invasion in depressed lesions, the sensitivity was 95.6%, specificity was 66.7%, and accuracy was 90.2%. No correlation was observed between the existence of dilated vessels and the lesion site, lesion diameter, and lymphovascular invasion/poorly differentiated cluster.The existence of dilated blood vessels in the tumor periphery suggests SM-d or deeper invasion in depressed lesions.

Fulminant Hepatosplenic B-Cell Lymphoma Without Hepatitis C Infection.

priate antibiotics.2–4 Finally, the results of this study1 confirm our standpoint. Herewith we also want to include our observations regarding the statement of some authors that “digestive enzymes found in the abdominal fluid in acute pancreatitis were once thought to be active, but are now known to remain largely inactive and likely contribute minimally to injury.”11 It is clear that the level of pancreatic enzymes in peritoneal ascitic fluid is low due to the consequent dilution of pancreatic juice into the abdominal cavity. However, according to our experience, content obtained from pancreatic collections through the catheters placed next to the pancreas always showed as enzyme-rich pancreatic juice collections with extremely high values of pancreatic enzymes, especially at the onset of the disease. Therefore, we think that the relationship between the levels of pancreatic enzymes released from the pancreas to the abdominal cavity during SAP and clinical course of SAP is still not fully clarified. Once again, we think that this is an excellent article and our observations are given with the intention to contribute to the clarification of this important and complex subject. We agree with the authors that further studies are needed to document prospectively both the safety and the value of APD, as well as to determine the patients who might benefit from this intervention.

An Elderly Woman With Facial Erythema and Hematemesis

Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 Question: A 72-year-old woman with a history of schizophrenia presented to our hospital with dysphagia and hematemesis. She had complaints of fever and painful erythema around the mouth for the past 3 days. Her vital signs were normal except body temperature, which was 38.3 C. Physical examination revealed erythema and tenderness around her mouth (Figure A) and mild epigastric tenderness. Laboratory studies showed a white cell count of 25,000 cells/mL and C-reactive protein of 22.68 mg/dL. Contrast-enhanced computed tomography scan showed diffuse wall thickening from the pharynx (Figure B) to the stomach (Figure C), indicating edematous change. Emergent upper endoscopy showed markedly edematous mucosa of the pharyngolarynx (Figure D), diffuse redness from the esophagus to the duodenal bulb (Figure E) and a large gastric erosion with coagulation at the fundus (Figure F). What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. 108 109 110 111 112 113 114 Conflicts of interest The authors disclose no conflicts.

APPLICATION OF MAGNIFYING ENDOSOCPY AND ENDOSCOPIC ULTRASONOGRAPHY TO COLORECTAL NEOPLASTIC LESIONS

to 20 MHz, and 20 MHz probes are commonly used. The probes can scan both linearly and radially, and a combination of these methods is used for 3-D image reconstruction by image processing. Olympus sells a radially scanning dedicated endoscope, model CF-UMQ 230, with two frequencies: 7.5 MHz and 12 MHz or 7.5 MHz and 20 MHz, and the frequency choice can be made by a one-touch function. Because this endoscope has a frequency of 7.5 MHz, it can scan highly protruded lesions and organs adjacent to the colon. However, because the scope is thick, there is still room for improvement in its maneuverability.