Atsuhiko Murata

Prospective randomized trial of transnasal versus peroral endoscopy using an ultrathin videoendoscope in unsedated patients

Aim:  The aim of this study was to compare the acceptance and tolerance of transnasal and peroral esophagogastroduodenoscopy (EGD) using an ultrathin videoendoscope in unsedated patients.

Prospective comparative study on the acceptability of unsedated transnasal endoscopy in younger versus older patients

Goals The aim of this prospective study was to compare the acceptance and tolerance for unsedated transnasal esophagogastroduodenoscopy (EGD) between younger and older patients. Background Little information is available on comparisons of younger and older patients with regard to acceptance and tolerance of transnasal EGD. Study A total of 260 patients were referred for unsedated transnasal EGD and divided into 2 groups according to their age: less than 60 years of age (group A, n=160) and 60 years of age and older (group B, n=100). A questionnaire for tolerance was completed by each patient (a validated 0 to 10 scale where “0” represents no discomfort/well tolerated and “10” represents severe discomfort/poorly tolerated). Results In 94.4% of group A and 95.0% of group B, insertions were successfully completed (P>0.05). Between groups A and B, discomfort during nasal anesthesia (1.7±0.2 vs. 1.6±0.2) and overall tolerance during procedure (1.7±0.2 vs. 1.5±0.2) were similar (P>0.05). However, discomfort during insertion was significantly greater in group A than in group B (2.5±0.2 vs. 1.9±0.2, P=0.02). Of all, 97.4% of group A and 94.7% of group B were willing to undergo unsedated transnasal EGD in the future (P>0.05). Conclusions There was no significant difference in acceptability between younger and older patients for unsedated transnasal EGD. Otherwise, younger patients experienced significantly more discomfort during insertion than did older patients.

Pedunculated Duodenal Lipoma Treated with Endoscopic Polypectomy with a Detachable Snare

We report endoscopic polypectomy with a detachable snare in a patient with a hemorrhagic pedunculated duodenal lipoma. A 67-year-old man with a history of spinal canal stenosis was admitted to our hospital because of recurrent tarry stools and anemia. Esophagogastroduodenoscopy revealed a pedunculated submucosal tumor measuring approximately 4 cm, in the second part of the duodenum. The tumor had a slightly yellowish coloration, and longitudinal erosion was noted on the surface of the tumor. There were no significant findings in the esophagus, stomach and bulbs. Barium study revealed a pedunculated submucosal tumor measuring 40 x 12 mm in the second portion of the duodenum. We judged that the submucosal tumor may have been the hemorrhagic source, and removed it by endoscopic snare polypectomy with a detachable snare. No complications occurred during endoscopic procedures. Histopathological examination revealed that the tumor was composed of mature adipose tissue in the submucosa, which was consistent with a diagnosis of lipoma In our experience, endoscopic polypectomy with a detachable snare is useful for the treatment of hemorrhagic pedunculated duodenal lipoma.

Newly developed all in one EUS system: one cart system, forward-viewing optics type 360 degrees electronic radial array echoendoscope and oblique-viewing type convex array echoendoscope.

Most endosonographers use radial scanning instruments for diagnostic imaging, and use longitudinal scanning instruments primarily for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The use of two separate instruments for radial and longitudinal scanning means 2 different echoendoscopes are required, each with its own dedicated US processing unit. Currently available electronic radial echoendoscopes and linear instruments made by the same company require the same other brand US unit. Furthermore, no forward-viewing optics type 360 degrees electronic radial echoendoscope currently exists. We have developed an all-in-one one cart EUS system that saves space and is available for both the forward-viewing type 360 degrees radial electronic echoendoscope and the oblique-viewing type convex echoendoscope. These scopes have a transducer with variable frequency (5.0, 7.5, 10.0, 12.0 MHz) and color and power Doppler flow mapping capabilities. We performed a clinical development test for thirteen patients with sixteen lesions (Radial EUS on 8 lesions and EUS-FNA on 8 lesions) using this new EUS system. These new instruments provided satisfactory US and endoscopic images. The forward-viewing optics of the prototype enhanced intubation and instrument advancement. The radial scanning prototype provided an adequate diagnosis in 8 (100%) out of 8 lesions for EUS. The convex type achieved successful puncture in 8 (100%) out of 8 lesions and collection of adequate specimen for diagnosis of EUS-FNA in 4 (50%) out of 8 lesions. There were no complications in this series. This new system appears to be an attractive alternative for efficient EUS.

Successful Endoscopic Hemostasis for Bleeding from an Acquired Ileal Diverticulum

We herein report successful endoscopic hemostasis in a patient with a bleeding from acquired ileal diverticulum. A 65-year-old woman was introduced to our hospital after the sudden onset of painless hematochezia. When emergency colonoscopy was performed, the site of bleeding could not be identified because of extensive blood pooling in the colon and ileocecal region. After admission, repeat colonoscopy with a transparent hood device after bowel preparation disclosed oozing of blood from an ileal diverticulum approximately 15 cm proximal to the ileocecal junction. We performed endoscopic therapy with injection of a hypertonic saline-epinephrine solution and placement of additional hemoclips in the diverticulum. Since the latter treatment, the patient had no recurrent hematochezia, and occult blood tests in stool had been negative. In cases of lower gastrointestinal bleeding, bleeding from an acquired ileal diverticulum should be considered and the terminal ileum carefully observed.