Atsuo Matsunaga

Solid cystic tumor of the pancreas: report of six cases and a review of the Japanese literature

Although many cases of solid cystic tumor of the pancreas (SCT) have been reported, its nature and histogenesis remain controversial. We herein report six cases of SCT, including three cases of noncystic type. A review of 22 cases of noncystic type SCT, including our 3 cases, was carried out to compare their features with those of 173 cases of classic SCT reported in Japan. Noncystic type SCTs tend to occur in male patients and are smaller in size and less frequently symptomatic, although they show histological characteristics similar to those of classic SCTs. The developmental process might be a cause of cyst formation. The accumulation and analysis of many, at present, “atypical” cases for clarification of its nature, will, it is hoped, lead to a new nomenclature for this condition that adequately describes its biological origin.

Handmade outer flushing channel for safe endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is rapidly becoming widespread as an excellent method for the treatment of intramucosal tumors, especially the superficially spreading type, of the digestive tract. In contrast, of great concern are the complications that may arise when the procedure is prolonged due to such factors as bleeding during mucosal cutting and submucosal dissection. To realize safe performance of ESD, we have developed and have been using a handmade outer channel for flushing with excellent results. Mounting the outer channel for flushing provides an effective flushing function without costly investment and contributes to maintaining a clear endoscopic view during the procedure. This device enables some extended indications for endoscopic procedures, including hemostasis of hemorrhagic peptic ulcers and rupture of esophagogastric varices.

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:

DIAGNOSIS OF GASTRIC MUCINOUS CARCINOMA BY ENDOSCOPIC ULTRASONOGRAPHY

Background:  Biopsy diagnosis of gastric mucinous carcinoma (GMC) is sometimes difficult. Endoscopic ultrasonography (EUS) can visualize the change in the gastric wall in detail. We reviewed the EUS images and histological findings of cases of GMC and evaluated the correlation between them to identify the characteristic findings of GMC on EUS.

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.

6958 Daignosis of submucosal carcinomatous infiltration by microscanner in early colorectal cancer.

AIM: To evaluate the efficacy of the microscanner (MS) in diagnosing the depth of submucosal invasion in early colorectal cancer. PATIENTS: One hundred seventy-four patients with colorectal cancers including 80 protruding lesions (mucosal cancer (m) 41, submucosal cancer (sm) 39) and 94 superficial lesions (m, 41; sm, 52). METHODS: The diagnostic accuracy of depth of invasion in early colorectal cancer by MS was analyzed. The MS diagnosis was made based on the extent of a tumor echo into the third hyperechoic layer of the bowel wall which is considered to be the submucosa. Carcinomas which showed involvement of the submucosal layer were divided into two groups according to the histological degree of invasion: sm1, a group in which the depth of invasion was 1/3 of the submucosal layer or less; sm2-3, a group in which the depth of invasion of the submucosa was over 1/3. The MS diagnosis was compared with the histological diagnosis of the depth of invasion in each lesion. RESULTS: 1) Visualization of the lesion by MS was possible in 87% (152/174) of the lesions, i.e., 81% in protruding lesions and 92% in superficial lesions. 2) The accuracy of MS in diagnosing the depth of invasion in all lesions, in protruding lesions, and in superficial lesions was 93%, 88%, and 95%, respectively. 3) Diagnostic accuracy of MS as to the degree of submucosal invasion was 91% in m and sm1 cancer and 96% in sm2-3 cancer. CONCLUSIONS: MS is useful for the diagnosis of the depth of invasion in early colorectal cancers. Improvement of the accuracy in diagnosing protruding lesions is required.