Katsuro Shirakawa

Successful retrieval of video capsule endoscopy retained at ileal stenosis of Crohn's disease using double-balloon endoscopy.

To the Editor, Video capsule endoscopy (VCE) (Given Imaging, Yoqneam, Israel) is a novel, painless and comparatively non-invasive method for obtaining images of the entire small intestine. Since Iddan et al . 1 reported its successful testing in humans in 2000, VCE has advanced the investigation of small intestinal diseases; with more than 170 000 procedures performed all over the world. Diagnosis of obscure bleeding is the most frequent indication for VCE, and subsequent diagnosis of inflammatory bowel disease such as Crohn’s disease. Several studies have shown that VCE can detect small intestinal lesions such as ulcers in patients with suspected Crohn’s disease. 2

Minimal change oesophagitis: a disease with characteristic differences to erosive oesophagitis

Background : The majority of gastro‐oesophageal reflux disease (GERD) seems to be non‐erosive reflux disease. Nonerosive reflux disease includes minimal change oesophagitis (whitish or reddish, oedematous change and erosion that is not regarded as mucosal break) and no endoscopic abnormalities.

Bleeding polyp in the mid small intestine identified by capsule endoscopy and treated by double-balloon endoscopy

The advent of capsule endoscopy has substantially advanced the diagnosis of small-intestinal disorders. Moreover, the development of a new technique, doubleballoon endoscopy, also allows visualization of the entire small bowel. This system includes an endoscope with a working length of 200 cm and an outer diameter of 8.5 mm. It has a built-in air-insufflation system, which is directly connected to the balloon at the tip of the endoscope. The system also includes a flexible overtube 145 cm in length and 12.2 mm in outer diameter. The endoscope and the overtube are both equipped with soft latex balloons that can be inflated or deflated by means of a balloon-pump controller while monitoring balloon pressure. This report describes a case of GI bleeding in which the diagnosis was made by capsule endoscopy, followed by treatment with the use of double-balloon endoscopy.

Photodynamic therapy of superficial esophageal cancer with a transparent hood

BACKGROUND To improve the effectiveness of photodynamic therapy, the further development of endoscopic devices is essential. For photodynamic therapy of superficial esophageal cancer, a transparent hood was used to obtain precise laser irradiation. METHODS The transparent hood was attached to the tip of an upper endoscope. Forty-eight hours after the injection of porfimer sodium, cancerous lesions were irradiated with an excimer-dye laser (4 mJ, 80 Hz). Twenty-four hours later, additional irradiation was applied to lesions when the response to the initial irradiation appeared insufficient. Fifteen neoplastic lesions in 7 patients were treated. RESULTS The initial size of the lesions ranged from 5 to 30 mm in diameter. Histopathologically, there were 9 squamous-cell carcinomas and 6 high-grade squamous dysplastic lesions. All treated lesions disappeared after the first or the second laser irradiation (total energy range 39.1-193.5 J/cm(2)). During follow-up (range 4-51 months), there was no recurrence of the initial lesion in any patient. There was no severe photodynamic therapy related complication. CONCLUSIONS Photodynamic therapy with a transparent hood is an acceptable option for the treatment of superficial esophageal cancer.

Thérapie photodynamique dans le cancer gastrique

RésuméLa photothérapie dynamique (PTD) est un traitement prometteur de traitement du néoplasme du tractus gastro-intestinal y compris du cancer gastrique. Un essai clinique de PTD (associé aux dérivés de l’hématoporphyrine et au laser argon) a été entrepris en 1979 sur le cancer gastrique au début. La PTD utilisant le porfimère sodé (PHE, Photofrin II lyophilisé), et un laser pulsé excimer (EDL) a été approuvée par le gouvernement japonais en 1996. L’indication de PTD dans les cancer gastriques au début est unique au Japon. La muco-résection endoscopique (ME) est considérée comme le traitement de première intention pour le cancer gastrique au début mais ses indications sont limitées au carcinome intramuqueux. En outre, des complications sévères telles la perforation peuvent survenir. D’autre part, la PTD est une technique sûre, qui améliore la qualité de vie du patient. Le développement de nouveaux photosensibilisateurs et de lasers plus appropriés ainsi que l’amélioration de la technique de PTD rendent les traitements plus efficaces non seulement pour les cancers gastriques au début mais aussi à des stades avancés.SummaryPDT (photodynamic therapy) is a promising treatment for neoplasm in the gastrointestinal tract including gastric cancer. Clinical trial of PDT (combination of hematoporphyrin derivative and an argon dye laser) for early gastric cancer started in 1979. PDT using porfimer sodium (PHE, freeze-dried Photofrin II) and a pulsed excimer dye laser (EDL) was approved by government of Japan in 1996. Early gastric cancer is indicated for PDT only in Japan. Endoscopic mucosal resection (EMR) is considered the first choice treatment in early gastric cancer but its indication is limited to intramucosal carcinoma. Moreover, sometimes serious complications such as perforation occur. On the other hand, PDT has no serious complications and contributes to patient’s quality of life. Development of new photosensitizers and more effective lasers, and improvement of technique in PDT will enable more effective treatment for not only early stage but also advanced gastric cancers.