Jun Matsumoto

99mTc-DTPA-galactosyl-human-serum-albumin liver scintigraphy for evaluating hepatic functional reserve before hepatectomy in a patient with indocyanine green excretory defect: report of a case.

A 78-year-old woman with indocyanine green (ICG) excretory defect underwent left hepatectomy for cystadenocarcinoma. The retention rate of ICG at 15u2009min (ICGR15) was high, at 79.3%, despite all other liver function tests showing normal values. Conversely, 99mTc-DTPA-galactosyl-human-serum-albumin (GSA) liver scintigraphy showed a reduced accumulation of GSA in the left lateral lobe, the hepatic uptake ratio of the GSA scintigraphy was 0.96, and the arterial ketone body ratio was 1.67. Based on these results, we judged that the hepatic functional reserve of this patient was adequate for left hepatectomy, which was subsequently performed uneventfully. Histopathological examination of the resected liver showed neither fibrosis nor inflammatory cell infiltration. Thus, we consider that GSA liver scintigraphy is the best diagnostic modality for evaluating hepatic functional reserve in a patient with ICG excretory defect.

Diagnosis of Chronic Pancreatitis by Endoscopic Ultrasonography

Abstract: This study evaluates the usefulness of endoscopic ultrasonography in the diagnosis of chronic pancreatitis. 52 patients with chronic pancreatitis, which included 15 cases of mild pancreatitis, 19 cases of moderate pancreatitis and 18 cases of advanced pancreatitis, were diagnosed by endoscopic retrograde cholangiopancreatography and further investigated by endoscopic ultrasonography. The 4 main findings of 1) dilatation of the main pancreatic duct, 2) irregularity of the main pancreatic duct, 3) inhomogeneity of the pancreatic parenchyma and, 4) irregular configuration of the pancreas were reviewed. In all of the 18 cases of advanced pancreatitis, irregularity of the main pancreatic duct, inhomogeneity of the pancreatic parenchyma and irregular configuration of the pancreas were seen. 89% of these patients had dilatation of the main pancreatic duct. In the patients with moderate pancreatitis, on the other hand, all 4 findings occurred with a frequency of between 58% to 95%. In the patients with mild pancreatitis, irregularity of the main pancreatic duct, inhomogeneity of the pancreatic parenchyma and irregular configuration of the pancreas occurred at a rate of 40% to 93%, and dilatation of the main pancreatic duct occurred rarely in only 13% of the patients. We were able to detect abnormalties in the pancreatic parenchyma by endoscopic ultrasonography even in the early stages of chronic pancreatitis, and this suggests that this technique may be useful in the diagnosis of mild pancreatitis, which usually causes quite minor abnormal changes in the main pancreatic duct.

Clinical Evaluation of Endoscopic Gastric Mucosal Resection

Abstract: Endoscopic gastric mucosal resection (EGMR), by which a large specimen can be obtained, has been developed for the diagnosis and treatment of the borderline lesion (B. L.) or early gastric cancer (EGC), since biopsy specimens obtained by conventional techniques are too small to make an accurate diagnosis in number of cases. Thirty‐eight lesions in 35 cases (26 lesions in 23 cases with B. L. and 12 lesions in 12 cases with EGC) were resected for the purpose of treatment by EGMR, and 24 lesions (6 submucosal tumors, 3 B. L. s, 14 cases of EGC and 1 malignant lymphoma) for the purpose of diagnosis. By means of histological examination of the bite biopsy specimens following EGMR, twenty‐three lesions in 26 cases (89%) with a B. L. and 8 in 12 cases (67%) with EGC for treatment by EGMR were found to have been completely resected.

Relationship between perivaterian diverticulum and biliary tract disease

SummaryThe findings in 107 cases of perivaterian diverticulum diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) were discussed in relation to complicated biliary tract disease.1)The incidence of abnormality in both gallbladder and bile duct, especially in extrahepatic bile ducts, was more frequent in cases of perivaterian diverticuli more than 11 mm in diameter.2)Perivaterian diverticuli was most frequently located on the oral side of papilla. Cases with papilla in a diverticulum showed more frequent biliary tract abnormality.3)Abnormal findings of the distal portion of common bile duct, such as flexion, compression and tapering, were noted in 31% of 107 cases. These findings were seen more frequently in cases with papilla in a diverticulum or with a diverticulum more than 11 mm in diameter. It is considered that these data suggest a mechanism of occurrence of biliary tract disease in cases with perivaterian diverticulum.

Clinical Evaluation of Endoscopic Ultrasonogrphy in Diagnosis of Submucosal Tumor of the Upper Alimentray Tract

Abstract: The usefulness and the problems of endoscopic ultrasonograpy (EUS) in the diagnosis of submucosal tumors (SMT) of the upper alimentary tract were evaluated in this study. EUS was carried out in 86 cases with SMT of the stomach. Tumors of 13 cases was confirmed histologically (leiomyoma in 7 cases, leiomyosarcoma in one, lipoma in 2, gastric cyst in one, aberrant pancreas in one and Schwannoma in one case). In only one out of 22 cases with SMT of the esophagus, the tumor was surgically resected and a pathological examination revealed leiomyoma

7022 One uniform endosonographic layer reflects a thin subserosal adipose tissue of the normal gallbladder wall.

Introduction and aim: Endoscopic ultrasonography (EUS) plays a major role in diagnosis of the gallbladder lesions. The normal gallbladder wall has been demonstrated to consist of 3 layers on EUS images. It is generally accepted that the 2nd and the 3rd layers include the muscularis propria and subserosal fibrous tissue, and the subserosal adipose tissue, respectively. However these 3 layers cannot be seen in some normal gallbladder by EUS images. Therefore this study was aimed to clarify the cause of these 2 different EUS images seen normal gallbladder by histological study of the gallbladder wall performed simultaneously. Materials and methods: Gallbladder specimens from 12 autopsy cases without biliary tract disorders, 6 with the three EUS layers (goup A) and 6 with one uniform layer (group B), were enrolled in this study. Two needles were stabbed into the gallbladder wall from the mucosa to perform EUS and histological study for the same area of the specimen. For this study an Olympus GFUMQ 240 with a frequency of 7.5MHz was used. Results: Histology of the specimens were summarized in the table. The thickness of the muscularis propria and fibrous layer showed no significant differences between group A and B. While the thickness of the adipose layer of group B was determined to be one half of group A. Conclusions: This study indicates that the one uniform layer seen in normal gallbladder on EUS images reflects a thin subserosal adipose layer.

7165 Less association of adenomyomatosis with cancer of the gallbladder even if the presence of pancreaticobiliary ductal maljunction.

AIMS: Pancreaticobiliary ductal maljunction(PBM) is associated with several pancreatobiliary diseases including pancreatitis and carcinoma. Relation between adenomyomatosis (ADM) of the gallbladder and malignancy is not clear because of lacking of the data. However patients with ADM but free from abdominal symptoms are usually followed as benign proliferative disease although it is hard to differentiate from gallbladder cancer. To clarify the relation, histological studies were conducted for specimens obtained by surgical resection of the gall bladder from patients with ADM including those with both ADM and PBM. SUBJECTS AND METHODS: Four patients, 1 male and 3 females, with gallbladder ADM associated with PBM and 32 patients, 21 males and 11 females, with gallbladder ADM but free from PBM were enrolled in this study. In 13 patients without symptoms related to the pancreatobiliary area ADM was found by transabdominal ultrasonography performed for the other purposes. ADM were divided into 3 subtypes, segmental, fundal and diffused types. PBM and ADM were diagnosed by endoscopic retrograde cholangiopancreatography and histological study for the surgical specimen respectively. RESULTS: Among 32 patients with ADM free from PBM, totally 21 (65.6%), consisting of 14 (66.7%) segmental type, 2 (66.7%) fundal type and 5 (62.5%) diffused type had clinical symptoms. Of these 24 (75.0%) patients, consisting of 16 (76.2%) segmental type, 2 (66.7%) fundal type, 6 (75.0%) diffused type were complicated by gallbladder stones. However there was no significant clinical difference among the subtypes. Two out of 4 patients (50%) with ADM associating with PBM, belonging to segmental type, had symptoms. However none of the four patients were complicated with gallbladder stones. None of the thirty-six patients with ADM were complicated with gallbladder cancer at all. CONCLUSION: None of 36 patients with ADM including 4 patients associated with PBM are not complicated with gallbladder cancer.

7221 Endoscopic variceal sclerotherapy or ligation for cirrhotic patients results in early esophageal peristaltic dysfunction.

AIM: Transient time is delayed and gastroesophageal reflux is common in cirrhotic patients with esophageal varices. Band ligation appears to have little impact on esophageal motility and injection sclerotherapy spares the lower esophageal sphincter (LES) but data are limited. The aim of this study is to clarify such early abnormalities by measuring esophageal pH and motility after endoscopic therapy for esophageal varices (EET). PATIENTS AND METHODS: Twelve cirrhotic patients who have no previous interventional therapy or EET were enrolled in this study. Manometric and pH monitoring measurements by Micro Digitrapper 4Mb (Sweden Synectics Medical) were performed before EET and average of 12.7 days after the eradication of varices. A solid state pressure-sensing catheter was nasally passed into the esophagus and channels were fixed at LES, 5 cm and 10 cm above LES. A monocrystalline antimony electrode of the Micro Digitrapper 4Mb was placed at 5 cm above LES. The catheter and recorder were worn by the patients for up to 24-hours. RESULTS: The esophageal contraction rates at 5 cm and 10 cm above LES were significantly decreased after EET(p