Katsunori Masuda

Primary gastric plasmacytoma refractory to Helicobacter pylori eradication therapy.

A 49‐year‐old woman underwent upper gastrointestinal endoscopic examination for epigastric discomfort, revealing giant folds on the greater curvature of the stomach. Histological examinations of biopsy specimens taken from the giant folds showed signs of chronic inflammation, and Helicobacter pylori was also identified. She underwent first‐step H. pylori eradication. On follow‐up endoscopy, H. pylori was not identified. However, endoscopic findings were unchanged and repeated biopsies showed dense infiltration of atypical plasma cells. No proliferation of centrocyte‐like cells was seen. Immunohistochemically, plasma cells were positive for λ‐chain. Primary gastric plasmacytoma was diagnosed. Total gastrectomy was carried out with splenectomy and regional lymph node dissection. The patient remains disease free as of 6 years postoperatively.

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.

4525 Impact of left gastric vein hemodynamics using color doppler eus in the treatment of esophageal varices.

Background: Endoscopic Variceal Ligation (EVL) is a widely used and accepted prophylactic treatment for esophageal varices (EV)Θ. EVL is often associated with early recurrence of EV, but the recurrence rate appeared to be decreased by repeated endoscopic treatment. However, the hemodynamic changes associated with recurrent EVL treatment are poorly understood. Aim: To analyze changes of hemodynamics and anatomy of LGV caused by the endoscopic treatment for EV. Methods: 48 patients (Pts) with with cirrhosis (Group A: 18 Pts had >1 year follow up after eradication of EV: Group B: 30 Pts with no previous variceal treatment) were enrolled in this study.We used curved linear array echoendoscope (Pentax FG36UX) and Processing Unit (Hitachi EUB655). We analyzed 1) The diameter and blood velocity of trunks of LGV 2) Type of branches of LGV 3) The size of paraesophageal vein (PEV) 4)The detection rate of perforating vein (PV). We classified the types of branches into three groups; Type AD (anterior branch dominant), Type B (bilateral), Type PD (posterior branch dominant).We classified the size of PEV into four grades; Grade 1 (

Combination therapy of diode laser irradiation and submuosal administration of indocyanine green solution.

Combination therapy using a diode laser and indocyanine green(ICG) was evaluated for the endoscopic treatment of gastrointestinal disease. Approximately 10ml of ICG solution with the 1mg/ml concentration was administrated to canine esophageal and colonic submucosa to enhance the tissue absorption for 805nm laser light. We performed the 25W diode laser intermitted radiation with ls duration until the mucosa was removed and the submucosa was exposed. In the case of esophagus, reliable irradiation was difficult owing to the narrow canal space and the heart beat. When the ablation reached to esophageal submucosa, thermal damage also occurred in the proper muscle. Coagulation with/without carbonization sometimes was induced by insufficient irradiation intensity. In this case the thermal damage also affected the proper muscle. We think by using the transparent food and decreasing the laser output, this method may be applicable for the treatment of esophageal cancer, Barrets esophagus and varices. In the case of the colon, the selective ablation and coagulation of the submucosa without proper muscle damage was obtained. This method might be useful for the vilous adenoma and carcinoid tumor as well as early colonic cancer. We think the diode laser therapy using ICG should be one of the useful alternatives for the gastrointestinal disease.