Fumio Misaki

A new approach to the observation of minute changes of the colonic mucosa by means of magnifying colonoscope, type CF-MB-M (Olympus)

A newly devised magnifying colonoscope (Olympus CF-MB-M) incorporates a capacity to enlarge mucosal surface details by a factor of 10 times. The image of fine surface features is enhanced by applying methylene-blue dye. This report describes the use of the new instrument in 120 normal subjects, in 104 patients with polypoid lesions, and in 60 patients with inflammatory diseases. The magnified, enhanced image, when compared with that obtained by the conventional colonoscope, permits better definition of the stage and severity of inflammatory reactions and correlates with the histologic types of polypoid lesions.

Natural history and epidemiologic studies of peptic ulcer disease in Japan.

Japanese research on the natural history and epidemiology of peptic ulcer disease is presented. Descriptive summaries from several national and regional studies provide information that may be useful for comparison with corresponding information from Western nations.

Pediatric enteroscopy with a sonde-type small intestinal fiberscope (SSIF-type VI)

83° and offers an adequate field of view with excellent optical resolution. The external suction channel requires additional tubing, making the instrument more cumbersome while adding to its weight. Since the instrument is new, it is too early to assess resistance of the bundles to irradiation. The instrument available for evaluation, however, had been used for approximately 150 examinations and the bundles were only slightly yellow. The Pentax lecturescope is very good, adapting both clockwise and counterclockwise to avoid interference to the endoscopist and losing little light. The Pentax endoscope can be easily adapted to any manufacturers light source, again with little light loss. In general, the instrument handled very well and offers an excellent alternative to the other endoscopes.

Growth rates of colorectal carcinoma and adenoma by roentgenologic follow-up observations.

SummaryDuring the last 15 years, seventeen patients with polypoid lesions or carcinoma in the colon or rectum were repeatedly examined with barium enemas. The doubling time of these colorectal tumors was calculated according to Spratt’s theory of the growth rate of neoplasms.The doubling times of 6 carcinomas varied from 92.4 to 1032.2 days with those of early carcinomas being much shorter than those of advanced lesions. Advanced lesions of the proximal colon had a shorter doubling time than those of the distal colon. The doubling times of 6 adenomatous polyps ranged from 146.5 to 398.5 days, thus coinciding with the time interval of the carcinomas. However, 5 other adenomatous polyps did not grow during the follow-up period which ranged from 420 to 816 days. There was no definite correlation between the doubling time and the histology of the tumors. The difference in the doubling time of carcinomas correlated more with location than the histological grade of malignancy.

Endoscopy in pediatric patients with upper gastrointestinal bleeding

In 25 pediatric patients with hematemesis or melena, early or urgent endoscopy was performed with no complications. In children older than 10 years, endoscopy can be done in the same way as in adults. In patients younger than 1 year, both general anesthesia and a small caliber peroral endoscope are necessary. Endoscopy can be done usually without general anesthesia if a small caliber endoscope is used in patients from 2 to 9 years of age.

Endoscopic observation of villi with magnifying enterocolonoscopes

Enteroscopy, using a newly developed enteroscope, type SIF-M (Olympus), and a magnifying colonoscope, type CF-HM (Olympus), was performed in 11 cases. The SIF-M and CF-HM instruments (Table I) permit X10 to x35 magnification, so that villi can be clearly inspected. .By means of the rope guide technique, the magnifYing endoscope was introduced into the small intestine per anus 2 to 5 days after the patient swallowed a Teflon catheter. After complete transintestinal passage, the anal end of the catheter was drawn through the biopsy channel of the endoscope and used as a guide. The introduction of the endoscope into the small intestine was effected by applying tension to the oral and anal ends of the string. The tip of the endoscope was advanced under fluoroscopic control. The SIF-M was used for the observation of the upper small intestine and CF-HM for the ileum. After examination of the small intestine, 10 ml of 0.1% methylene blue solution were sprayed on the mucosa. Then, by adjusting the focus of the magnifying endoscope, the shape and arrangement of the villi were carefully observed. was inferior to that of the normal villi. The villi of granulomatous enteritis were in an irregular leafshaped form with ridged convolutions (Fig. 1C). The absorbency of methylene blue solution of the affected villi was as poor as that of intestinal tuberculosis. The mucosa of the terminal ileum of granulomatous enteritis, which was considered to be free of inflammation by x-ray examination and conventional endoscopy, showed small, round, atrophied finger-shaped villi (Fig. 10). In the mucosa of ileitis, the villi were sporadic or lost, much as the affected villi of tuberculous or granulomatous enteritis were.

Endoscopic polypectomy for the removal of polyps of the small intestine

SummarySince intussusception is a common complication of the Peutz-Jeghers polyps, laparotomy should be recommended to remove them. However, all of them will not be palpable or discernible during laparotomy. Operative endoscopy was employed for removing polyps of the small intestine of a 22-year-old female who was previously diagnosed as Peutz-Jeghers syndrome. Using a newly designed enteroscope with two channels (SIF-2C, Olympus), four large polyps over 1 cm in size were removed from the ileum and jejunum with safety.Endoscopic polypectomy is one of the rapidly advancing fields and widely spread methods in gastrointestinal endoscopy since the introduction of electrosurgical techniques. Although the endoscopic removal of polyps arising from the esophagus, stomach, duodenum, colon and rectum can be performed with ease and safety, polypectomy for the polyps of the small intestine has never been performed because of the technical difficulties to handle the scope in the small intestine. Two channel enteroscope resolved this problem. Therefore, it is emphasized that double channel enteroscope makes the polypectomy in the small intestine possible and the indication of enteroscopy will be more widely extended.

Endoscopic studies on the minute structures of colonic mucosa in the follow-up observation of ulcerative colitis

SummaryThirty cases of ulcerative colitis were examined endoscopically by means of magnifying colonoscope with dye spraying method (the combined method), and their minute mucosal structures were classified into four categories endoscopically, which correlated well with the histological findings. By this procedure, it was easy to detect the subsidence of inflammation of the mucosa in the quiescent phase or to reveal the active inflammatory involvement of the bowel. Moreover, inspecting the minute changes of the colonie mucosa detected by the combined method, remission was more correctly decided and rigid control is contributing to the decrease in the recent rate of recurrence of ulcerative colitis.

Dynamic aspects of gastric emptying in patients with peptic ulcer according to ulcer stages.

The pattern and the time of gastric emptying were investigated in 38 patients with peptic ulcer and 7 healthy volunteers using the double-sampling method. The pattern of gastric emptying assumed the following three attitudes, that is, exponential (44%), quadratic (29%) and unclassified (27%) pattern. These patterns appeared to depend on the distance from the gastric angle to the pyloric ring measured from X-ray pictures in the upright position. There was no significant difference in the gastric emptying time in patients with peptic ulcer according to its site. During follow-up observations of the same case, the gastric emptying time had a tendency to shorten in patients with duodenal ulcer while it showed no definite variation in patients with gastric ulcer.

Differential diagnosis of polypoid lesion of stomach

ConclusionIn 82 surgically resected cases of elevated lesions of the stomach, we have evaluated and discussed the findings in malignant lesions and their morphology according to our classification of protruding lesions. We can summarize as follows :1.All cases of the dish-like type are early gastric cancers. And when this lesion has a depression on its surface, cancerous changes usually infiltrate to the submucosa.2.There is no malignancy in smooth elevated lesion except in a few case of sacroma.3.All lesions of the spherical non-pedunculated type over 2 centimeters in diameter are malignant.4.In the spherical pedunculated type, the malignancy rate is high, when the diameter of the lesion is over 3 centimeters.5.Advanced cancer is found in lesions with a large nodular surface.