Hisao Tajiri

Clinical application of an ultra-thin pancreatoscope using a sequential video converter

The main pancreatic duct was studied endoscopically by inserting an ultra-thin pancreatoscope into the normal papilla of Vater. Recently, we developed a new pancreatoscope system and improved the image, the durability, and the ease of use. A special video converter was connected to the head of the pancreatoscope. The sequential electronic endoscope images were observed on a TV monitor. We performed examinations with this new system in 52 cases (8 with pancreatic cancer, 19 with chronic pancreatitis and 25 normal cases). We studied the brightness, color and quality of the images on 35-mm film and on videotape. As a result, it has become clear that the images obtained with this system are much better than those obtained by the conventional method. Although further improvement in the ability to angulate the endoscope is necessary, this new pancreatoscope system should help diagnose diseases of the pancreas.

New Challenges in Gastrointestinal Endoscopy

History and Future Development of Endoscopy The History of Digestive Endoscopy Advances in Endoscopic Imaging and Diagnosis: Toward Molecular Imaging Further Development of Endoscopic Imaging: Era of Light Activities with Optics and Image Processing Technology Future Perspectives for Esophageal and Colorectal Capsule Endoscopy: Dreams or Reality? Oropharynx and Hypopharynx Endoscopic Diagnosis and Treatment of Superfi cial Cancer in the Oropharynx and Hypopharynx Esophagus Diagnosis of Esophageal and Gastric Carcinoma Using Transnasal Ultrathin Esophagogastroduodenoscopy Magnifying Endoscopic Findings with Narrow-Band Imaging System in the Esophagus Current Perspective on Endocytoscopic Diagnosis in the Esophagus Based on the Multicenter Study at the Endoscopic Forum Japan Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy (EUS-FNA) for Mediastinal Abnormalities via the Esophagus Endoscopic Submucosal Dissection for Esophageal Cancer Recent Advances in Diagnostic Endoscopy to Detect Early-Stage Upper GI Cancer and Therapeutic Endoscopy to Establish Minimally Invasive Endoluminal Treatment Barretts Esophagus Endoscopic Diagnosis of Barretts Esophagus and Esophageal Adenocarcinomas Narrow-Band Imaging in the Diagnosis of Barretts Esophagus Magnifying Endoscopy in Combination with Narrow-Band Imaging and Acetic Acid Instillation in the Diagnosis of Barretts Esophagus Stomach Screening for Gastric Cancer in Japan A New Diagnostic VS Classifi cation System Produced by Magnifi cation Endoscopy Plus Narrow-Band Imaging in the Stomach: Microvascular Architecture and Microsurface Structure Diagnosis of Gastric Cancer by Magnifying Endoscopy with Narrow-Band Imaging: Impact and Clinical Feasibility of Narrow-Band Imaging for Accomplishing Endoscopic Pathology Autofl uorescence Imaging Video-Endoscopy System for Diagnosis of Superfi cial Gastric Neoplasia The Diagnosis of Gastric Cancer and Adenoma Using Endocytoscopy Endoscopic Ultrasonography Diagnosis for Depressed Type Early Gastric Cancer: Tissue Characterization in Cases Associated with Fibrosis Indications for Endoscopic Submucosal Dissection of Early Gastric Cancers Features of Therapeutic Devices for Gastric Endoscopic Submucosal Dissection and Basic Techniques Future Prospects of Endoscopic Submucosal Dissection from the Product Development Standpoint Small Intestine Clinical Usefulness of Single-Balloon Enteroscopy for the Diagnosis and Treatment of Small-Intestinal Diseases Cutting Edge Technology in Enteroscopy: Entero Pro, the Endo Capsule Future Perspectives of Small Bowel Capsule Endoscopy Colon Screening for Colorectal Cancer in the Asia-Pacifi c Region: Are We Ready Yet? Establishment of a Standard Curriculum for Colonoscope Insertion Techniques Magnifying Endoscope Diagnosis and NBI Diagnosis in Colorectal Neoplasm Image Enhanced Endoscopy (IEE) Using NBI During Screening Colonoscopy: Usefulness and Application The Effi cacy of Narrow-Band Imaging (NBI) and Autofl uorescence Imaging (AFI) Colonoscopy for Patients with Ulcerative Colitis The Value of Narrow-Band Imaging Colonoscopy and Autofl uorescence Imaging Colonoscopy for Ulcerative Colitis Autofl uorescence Imaging Makes It Easy to Differentiate Neoplastic Lesions from Nonneoplastic Lesions in the Colon Endoscopic Ultrasonography Diagnosis for Colorectal Diseases Endoscopic Mucosal Resection and Endoscopic Piecemeal Mucosal Resection for Colorectal Neoplasia Strategy of Endoscopic Treatment for Colorectal Tumor: Recent Progress and Perspective Pancreatobiliary EST vs EPBD Endoscopic Sphincterotomy and Endoscopic Papillary Balloon Dilatation for Bile Duct Stones Strategy for the Endoscopic Treatment of Common Bile Duct Stones: Should We Cut or Dilate the Papilla? EST, EPBD, and EPLBD (Cut, Stretch, or Both?) Future Prospects of ERCP from the Product Development Standpoint Papillectomy Endoscopic Diagnosis and Resection Therapy of the Tumor of the Major Duodenal Papilla Stenting Indications and Technical Methods of Endoscopic Biliary Stenting Using the Doublelayer Stent Indications and Procedure of Biliary Metallic Stenting Plastic Stent Placement for Unresectable Malignant Extrahepatic Biliary Stricture Indication and Procedure of Pancreatic and Bile Duct Stenting Cholangioscopy and Pancreatoscopy The Role of Peroral Cholangioscopy in the Management of Biliary Tract Diseases Techniques and Indications of Pancreatoscopy Diagnosis of Pancreaticobiliary Diseases Using Cholangioscopy and Pancreatoscopy with Narrow-Band Imaging Utility of Video PTCS for Mucin-Producing Bile Duct Tumors EUS Standardization of Imaging Techniques in the Pancreatobiliary Region Using Radial Scanning EUS New Diagnostic Technique of EUS Using Contrast-Enhanced Agents Standard Scanning Techniques for EUS Examinations with Curved Linear Array Echoendoscopes Present Status and Future Perspectives of Endoscopic Ultrasonography-Guided Fine-Needle Aspiration Clinical Impact of EUS-Guided Fine-Needle Aspiration Development of Three-Dimensional Intraductal Ultrasonography in Diagnosis for Bile Duct Carcinoma Future of EUS Technology Appendix Memories of the Establishment of EFJ (Endoscopy Forum Japan) Endoscopy Forum Japan (EFJ)?History and Contents of the Meetings

A synthetic peptide of human apoprotein E with antibacterial activity

In recent years, several endogenous mammalian antibacterial peptides have been described. An amphipathic cationicalpha-helix is a common feature in many cases; therefore, other peptides with this characteristic might also possess antibiotic activity. In fact, a 30-mer peptide of apoprotein E 133-162 (LRVRLASHLRKLRKRLLRDADDLQKRLAVY) was found to have antibiotic activity comparable to those of a classic antibiotic (Gentamicin) and a neutrophil-derived antibiotic peptide (CAP18). Calculation of cationicity, hydrophobicity, and hydrophobic moment and the helical wheel diagram of apoprotein E 133-162 revealed close similarities to CAP18.

Protein kinase C-dependent anti-apoptotic mechanism that is associated with high sensitivity to anti-Fas antibody in ovarian cancer cell lines

We compared the sensitivities to apoptosis via anti-Fas antibody of two human ovarian cancer cell lines, NOS4 and SKOV-3, both of which strongly express the Fas antigen on their cell surface. Treatment with anti-Fas antibody induced extensive DNA fragmentation in NOS4 cells but none in SKOV-3 cells. However; both cell lines underwent apoptosis in response to calcium ionophore A23187 or sphingomyelinase, demonstrating that the latter cell line is capable of DNA fragmentation. DNA fragmentation was not induced in either cell line by treatment with PKC activator PMA, however treatment with protein kinase C (PKC) inhibitor H-7 induced extensive DNA fragmentation in NOS4 cells, but again none in SKOV-3 cells. Protein kinase A inhibitor HA1004 treatment did not induce DNA fragmentation in either cell line. Correspondingly, treatment of cells with PMA before anti-Fas antibody or A23187 treatment partially inhibited induction of DNA fragmentation in NOS4 cells but not in SKOV-3 cells. Both NOS4 and SKOV-3 cell lines expressed isozymes of PKC at comparable levels. These results suggest the presence of a PKC-dependent anti-apoptotic mechanism in association with high sensitivity to anti-Fas antibody in these ovarian cancer cell lines.

Inhibition of complement-mediated immune hemolysis by peptides derived from the constant domain of immunoglobulin.

High-dose administration of intravenous immunoglobulin is reported to be useful for inhibiting complement-dependent immune cytolysis. We have found that, among the proposed C1q-binding sites of the Fc portion of human IgG1, only residues 282-292 inhibited pig red blood cell lysis by human serum. Moreover, a hexadecemeric multiple antigen peptide of residues 282-292 from IgG showed significantly greater activity in suppressing complement-mediated immune cytolysis and can be used in place of high-dose intravenous immunoglobulin, which is extracted from donors and thus is expensive.

Indocyanine green enhanced diode laser ablation for porcine gastric wall with ablation depth monitoring using scattering light

We developed laser ablation depth monitoring using scattering light on indocyanine green (ICG) enhanced diode laser ablation for gastric wall. We have developed selective diode laser ablation for ICG stained submucosa to treat submucosal gastric cancer. To prevent gastric perforation, real-time ablation depth monitoring should be applied to this treatment even though the ablation depth can be roughly judged through gastric endoscope by ablation surface color change. The backscattered light spectrum of the diode laser from the ablation area may be influenced by surface absorption and plume absorption. We observed the scattering light spectrum and found a small spectral dip at the ICG absorption wavelength. We demonstrated that this dip depth corresponded to the remained ICG stained submucosal layer thickness. We concluded that simple spectral monitoring may be effective to prevent gastric perforation during ICG enhanced diode laser ablation therapy.

Diode-laser ablation therapy for submucosal gastric cancer using indocyanine-green solution injection to the submucosa

A 805-nm diode laser ablation therapy with indocyanine green (ICG) was studied for the endoscopic treatment of early gastric cancer. The ICG solution with 1mg/ml was administrated to the submucosa of the resected porcine and anesthetized canine stomach for the purpose of enhancing the tissue absorption to the laser light. We established complete removal of the mucosa and the submucosa with laser power of 12 or 25 watts. The proper muscle was intact because the ICG solution prevents the laser light penetration to the proper muscle. An ablated depth could be easily recognized by observing the ablated surface color. Our results showed that the combination of the 805 nm diode laser irradiation and the submucosal injection of the ICG solution might provide selective and controllable endoscopic treatment for early gastric cancer.

Photodynamic Therapy Using a New Photosensitizer Gallium Porphyrin Complex in the Treatment of Experimental Pancreatic Cancer

Abstract: To determine the therapeutic effect of photodynamic therapy (PDT) using a new photosensitizer 2.4‐bis (1‐decyloxyethyl)‐Ca‐deuteroporphyI diaspartic acid (Ga ‐DP), 20 female Syrian golden hamsters with experimentally induced pancreatic cancer were irradiated with a pulsed Nd : YAG laser with a Q switch after administration of Ga ‐DP. To induce pancreatic cancer, N‐nitroso‐bis‐(2‐oxypropyI) amine (BOP) at 10 mg/kg body weight was injected subcutaneously once a week for eight weeks. Ten of the twenty animals served as a control group. The other ten received laser treatment beginning 20 weeks after BOP administration. Twenty‐four hours after intravenous injection of 3 mg/kg Ga‐DP, pulsed Nd : YAG laser irradiation was performed using a Q switch with 1 W of power output for 3–5 minutes at a frequency of 300 Hz. Elimination or necrosis of the entire tumor resulted with tumors 6–10 mm in diameter in 6 animals. In 3 animals which had tumors more than 12 mm in diameter, cancer cells remained at the margins of the treated area. These results were felt to not only reflect the thermal effect of laser therapy, but also the effect of PDT combined with Ga‐DP. They suggest that Ga‐DP could become a clinically valuable photosensitizer in combination with PDT. (Dig Endosc 1994; 6 : 28–33)

Endoscopic mucosal incision by diode laser for early cancer treatment in the alimentary tract: effect of submucosal indocyanine green solution injection

Mucosal incision technique by diode laser ablation was studied to ensure the operation of endoscopic mucosal resection (EMR), which is gold standard method for early gastric cancer with little/no risk of lymphnode metastasis. Our method was designed to facilitate grasping a large lesion by hitching the snaring wire on the incised mucosal groove around the lesion. We employed local submucosal injection of indocyanine green (ICG) solution. ICG solution was used to prevent direct laser light penetration to the muscularis propriae owing to strong absorption of 805nm light (absorption coefficent at 805 nm is about 200cm-1). We used diode laser radiation with an output of 25W by contact (0.1, 0.5, 1.0 kg/cm2) and non-contact irradiation methods. In the preliminary experiment with resected porcine stomach, muscularis propriae was intact by the 60s non-contact irradiation or the 8s contact irradiation with contact pressure of 1kg/cm2. In the endoscopic experiment we used 3 dogs. Using conical contact probe, we successfully demonstrated 3cm diameter circular incision with sharp groove in 10 minutes. We could place the snaring wire on the incised groove. Histology of the endoscopically incised canine stomach revealed that the submucosal layer welled up to 6mm in thickness and the bottom of the incision groove reached 1.9mm at deepest below the mucosal muscle. The thickness of the coagulation layer around the incised groove was up to 1.8mm. No damage was seen a the muscularis propriae. We demonstrate easy as well as sure snaring by using our laser incision technique. We think our technique may be available to enhance the efficacy of EMR for early gastric cancer including the lesion over 2cm in diameter.

Endoscopic laser-induced steam generator: a new method of treatment for early gastric cancer

The minimum invasive endoscopic treatment for early gastric cancer has been popular in Japan. The endoscopic mucosal resection and laser coagulation by Nd:YAG laser irradiation has been the popular treatment method in this field. However, the submucosal cancer has not been successfully treated by these methods. To treat the submucosal cancer endoscopically, we developed a new coagulation therapy using hot steam generated by Nd:YAG laser. The steam of which temperature was over 10 deg. in Celsius was generated by the laser power of 30 W with 5 ml/min. of saline. The steam was emitted to canine gastric wall under laparotomy or endoscopy for 50 s respectively. Follow up endoscopy was performed on 3, 7, 14, 28 days after the treatment. Histological examination was studied on 7, 28 days, and just after the emission. In the acute observation, the submucosal layer was totally coagulated. On the 7th day, ulceration with white coat was seen. The mucosal defect, submucosal coagulation, and marked edema without muscle degeneration were found by the histological study. On the 14th day, the ulcer advanced in the scar stage. On the 28th day, it completely healed into white scar with mucosal regeneration and mucosal muscle thickening. We could obtain reproducible coagulation up to deep submucosal layer with large area in a short operation time. Moreover there were no degeneration of proper muscle. This treatment effectiveness could be easily controlled by the steam temperature and emission duration. We think that this method can be applied to early gastric cancer including the submucosal cancer, in particular poor risk case for operation. Further study should be done to apply this method to clinical therapy.