Etsuo Hoshino

THERAPEUTIC OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION OF UNDIFFERENTIATED-TYPE INTRAMUCOSAL GASTRIC CANCER WITHOUT ULCERATION AND PREOPERATIVELY DIAGNOSED AS 20 MILLIMETRES OR LESS IN DIAMETER

Aim:  The aim of the present study was to examine therapeutic outcomes of endoscopic submucosal dissection (ESD) of undifferentiated‐type intramucosal gastric cancer and the problems of diagnosis.

Diagnosis of undifferentiated type early gastric cancers by magnification endoscopy with narrow-band imaging.

Background and Aims:  The diagnostic use of magnification endoscopy with narrow‐band imaging (ME‐NBI) to assess histopathologically undifferentiated‐type early gastric cancers (UD‐type EGCs) is not well elucidated. The purpose of this study was to examine the comparative relationship between ME‐NBI images and histopathological findings in UD‐type EGCs.

COMPARISON OF THE DIAGNOSTIC UTILITY OF THE ULTRATHIN ENDOSCOPE AND THE CONVENTIONAL ENDOSCOPE IN EARLY GASTRIC CANCER SCREENING

Currently, transnasal esophagogastroduodenoscopy using an ultrathin endoscope is being widely carried out as a screening test for early gastric cancer. We compared the diagnostic utility of ultrathin esophagogastroduodenoscopy with that of conventional esophagogastroduodenoscopy in detecting 42 lesions of early gastric cancer that had a diameter of ≤20 mm. Only 27 lesions (64%) could be accurately diagnosed using ultrathin esophagogastroduodenoscopy. In nine lesions (22%), we failed to discern whether they were malignant. Six lesions (14%) could not even be detected. We found that the diagnostic utility of ultrathin esophagogastroduodenoscopy was inadequate, especially in the case of lesions that were located in the upper third region of the stomach and variegated lesions. In conclusion, the diagnostic utility of ultrathin esophagogastroduodenoscopy might be lower than that of conventional esophagogastroduodenoscopy in terms of screening for early gastric cancer. The disadvantages of ultrathin esophagogastroduodenoscopy should be taken carefully into consideration while examining lesions.

Clinical characterization of gastric lesions initially diagnosed as low-grade adenomas on forceps biopsy.

Aim:  The aim of this study was to elucidate characteristics of gastric lesions that are initially diagnosed as low‐grade adenomas and to establish appropriate treatment.

Lansoprazole versus famotidine in symptomatic reflux esophagitis: a randomized, multicenter study.

We compared the usefulness of lansoprazole and famotidine for treatment of reflux esophagitis. Fifty-four subjects with moderate to severe reflux esophagitis were divided into two groups. The lansoprazole group (LPZ) received lansoprazole 30 mg once daily for 4 weeks, followed by famotidine 20 mg twice daily for 4 weeks. The famotidine group (FAM) received the same medications in the reverse order. Patient evaluation was based on six factors found on endoscopy, and on patient reports of heartburn. Evaluations were done before the start of the study and at 4 and 8 weeks. The improvement rates in the grade of GI classification at 4 weeks were 57.7% in the LPZ group and 38.5% in the FAM group; there was no significant difference between the two groups. However, after drugs were switched, more patients who switched to famotidine experienced a deterioration of their condition than did those who switched to lansoprazole. The percentages of “useful” or “very useful” were not significantly different between the two groups, but the percentage of “very useful” in the LPZ group (46.2%) was significantly higher than that in the FAM group (14.3%) (p<0.05). These results suggest that lansoprazole is the first drug of choice for treatment of moderate to severe reflux esophagitis.

Double Cardia An Unusual Sequela of Reflux Esophagitis with Ulcer

SummaryWe report a patient with acquired “double cardia” (esophagogastric fistula). She was a 76-year-old farmers widow with severe kyphosis. She presented with postprandial heartburn one month after the initiation of nifedipine and isosorbide dinitrate. Radiologic and endoscopic examinations revealed an esophagogastric fistula, short esophagus with hiatal hernia, Barretts esophagus with reflux esophagitis, and ulcer. This case shows that repeated reflux esophagitis and esophageal ulcer, complicated with short esophagus and hiatal hernia, can predispose to the formation of esophagogastric fistula.

Lansoprazole for maintenance therapy of peptic ulcer disease: weekend full-dose or everyday half-dose administration?

Seventy-one patients with peptic ulcer (44 gastric ulcer and 27 duodenal ulcer patients) were enrolled in this study. After the ulcers had healed with 2 months of treatment with lansoprazole (LPZ) 30 mg/day, patients were divided into two groups: 43 in the half-dose q.d. group and 28 in the weekend full-dose group. Fourteen (23%) of the 43 patients in the half-dose q.d. group and 14 of the 28 (50%) in the weekend full-dose group failed to continue taking the drug for 6 months owing to poor compliance (p < 0.05). None of the 30 patients who continued to take the maintenance dose of LPZ experienced ulcer recurrence during the 6-month follow-up period, whereas 71% of the patients who stopped taking LPZ experienced recurrence (p < 0.01). In conclusion, maintenance therapy using the half-dose q.d. administration schedule was superior to weekend full-dose administration because of the better patient compliance and a lower ulcer recurrence rate.

Case Report: Acidic Glycosaminoglycans of Abdominal Mucin in a Case of Pseudomyxoma Peritonei Caused by Appendiceal Cancer

Although the use of intraperitoneal mucolytic agents is useful in the management of pseudomyxoma peritonei, effective removal of mucin is difficult even by repeated mucolysis in cases with massive ascites. To establish mucolytic therapy as a further effective procedure, biochemical analysis of mucin is required in greater detail. We reported here a case of pseudomyxoma peritonei caused by primary appendiceal cancer with biochemical analysis of mucin. The abdominal cavity in this case was filled with massive mucinous ascites. Although the mucolytic therapy was performed repeatedly, it was not effective in preventing mechanical ileus which was followed by surgical exclusion. Biochemical study of mucin showed that the mucin contained a small amount of hyaluronic acid, as characterized by electrophoretic study. These data led us to the hypothesis that the hyaluronic acid component plays a role in the pathogenesis of the replacement of mucin in the abdominal cavity.

A Case of Schistosomiasis Suspected by Circumoval Precipitin Test and Diagnosed by Rectal Biopsy

A forty-year-old female from Brazil was admitted to Teikyo Hospital because of easy fatigability, fullness of the abdomen and left hyochondralgia. She was anxious about Schistosoma mansoni infection, because three of her relatives died of the infection. Physical examinations revealed a tenderness at the left hypochondrium. Laboratory data showed no abnormal finding. No egg of S. mansoni was found in the stool. A circumoval precipitin test (COPT) with the serum showed a deposite around the egg. Enzyme-linked immunosorbent assay (ELISA) revealed the presence of antibody against S. mansoni in the serum. A colonoscopy showed no abnormal finding macroscopically. The rectal biopsy showed the existence of mild procitis. The diagnosis was made by finding the characteristic lateral-spined eggs in the biopsy specimens from the rectum. Treatment of 3 g of prazicantel per day for three days was started. She complained of mild nausea at the first dosing. A month later, another three-day-treatment was given. In the case where there are no eggs found in the stool, COPT and ELISA are usefull in detecting the disease, and colonoscopy is recommended in diagnosing the disease.

A Case of Extensive Gastrointestinal Involvement of Malignant Lymphoma Associated with Early Gastric Carcinoma

Abstract: Described is a 59 year old Japanese man With malignant lymphoma involving the stomach, duodenum, terminal ileum, colon and rectum, who developed early gastric carcinoma. Repeated gastroduodenoscopy revealed various appearances of the gastrointestinal involvement in malignant lymphoma, such as giant folds, polypoid lesions, and ulcerations, in addition to a depressed lesion of early gastric carcinoma. Colonoscopy also showed multiple polypoid lesions throughout the large bowel. Though the gastrointestinal involvement in malignant lymphoma is not rare, diffuse multiple polypoid lesions in the entire large bowel as seen in our case have rarely been endoscopically described.