Katsuya Hirakawa

GI involvement in Henoch-Schönlein purpura

BACKGROUND The diagnosis of Henoch-Schönlein purpura is difficult, especially when abdominal symptoms precede cutaneous lesions. The aim of this study was to determine the distribution of GI involvement in Henoch-Schönlein purpura. METHODS Endoscopic or radiographic findings throughout the entire GI tract were retrospectively reviewed for 7 patients with Henoch-Schönlein purpura. Histopathologic findings were analyzed and correlated with findings at EGD and colonoscopy. OBSERVATIONS The duodenum and small intestine were most frequently involved (6 patients, each site). Contrast radiography of the small intestine demonstrated thickened mucosal folds or small barium flecks. Findings at EGD were multiple irregular ulcers, mucosal redness and petechiae in the duodenum. In 4 patients, the second part of the duodenum was predominantly affected. Ulcerating lesions accompanied by hematoma-like protrusions were detected in 4 patients in whom leukocytoclastic vasculitis was proven histopathologically. CONCLUSIONS EGD appears to have the greatest diagnostic utility in patients suspected to have Henoch-Schönlein purpura with GI involvement.

Comparison of EUS and magnifying colonoscopy for assessment of small colorectal cancers

BACKGROUND Prediction of invasion depth and lymph node metastasis is mandatory when local treatment is considered for small colorectal cancer. The aim of this study was to compare the accuracy of EUS with a catheter probe (probe-EUS) and magnifying colonoscopy for prediction of invasion depth and lymph node metastasis for small colorectal cancer. METHODS Small colorectal cancers were imaged by both probe-EUS and magnifying colonoscopy. Invasion depth by probe-EUS was determined by the presence or absence of distortion of the third sonographic layer. Findings by magnifying colonoscopy were divided into regular, distorted, and amorphous patterns. Histopathologically, depth of invasion was classified as intramucosa/slight or deep invasion. Findings by probe-EUS and magnifying colonoscopy were compared with respect to deep invasion and lymph node metastasis. RESULTS There were 22 small colorectal cancers with intramucosa/slight invasion and 28 with deep invasion. Four of 30 cancers had associated lymph node metastasis. Accuracy for depth of invasion was 91.8% for probe-EUS and 63.3% in magnifying colonoscopy, the difference being statistically significant (p = 0.0013). Negative predictive value of probe-EUS for deep invasion was higher than that for magnifying colonoscopy (respectively, 90.9% vs. 54.1%) in the population studied (prevalence deep invasion 56%). The accuracy for lymph node metastasis was 24.1% for probe-EUS and 72.4% for magnifying colonoscopy, the difference being statistically significant (p < 0.001). Positive predictive value for lymph node metastasis was higher when the amorphous pattern was noted by magnifying colonoscopy compared with the positive predictive value for deep invasion by probe-EUS (respectively, 33.3% vs. 8.7%) in the population studied (prevalence lymph node metastasis 13.3%). CONCLUSIONS Probe-EUS is superior to magnifying colonoscopy for determination of invasion depth in small colorectal cancer. Magnifying colonoscopy may be predictive of lymph node metastasis, thereby suggesting that the procedures provide complementary information with respect to the decision for local versus surgical therapy.

CASE REPORT: Does Metronidazole Cure Cap Polyposis by Its Antiinflammatory Actions Instead of by Its Antibiotic Action?: A Case Study

Cap polyposis (CP), which is histologically characterized by polyps consisting of elongated, tortuous and often distended crypts covered by a ‘cap’ of inflammatory granulation tissue, was first described by Williams et al. (1) in 1985. Some investigators have postulated that abnormal colonic motility leading to mucosal prolapse might cause this condition (2). A possible contribution of infections origin has also been suggested (3), but the precise mechanisms still remain unclear. Herein we describe a case of CP which was refractory to a broad spectrum antibiotic, but responded completely to metronidazole (MNZ).

Management and clinical outcomes of type I gastric carcinoid patients: retrospective, multicenter study in Japan.

Type I gastric carcinoids (TIGC) are associated with chronic atrophic gastritis (CAG) with hypergastrinemia and hyperplasia of enterochromaffin‐like cells. Several treatment options are currently available for these tumors including total gastrectomy, partial resection, antrectomy, endoscopic resection and endoscopic surveillance. The present study evaluated different treatment approaches and clinical outcomes of patients with TIGC in Japan.

Multiple granular cell tumors of the esophagus removed endoscopically: a case report

Granular cell tumors (GCT) are relatively rare neoplasms found mainly in the tongue, skin, and breast.1-4 However, in 1% to 8 % of cases GCT occur in the gastrointestinal tract,2,3 usually as solitary tumors.5 We describe a patient with four synchronous esophageal GCT, all successfully treated without complications by endoscopic removal. We review the literature concerning multiple esophageal GCT with particular attention to management.

A case of pyogenic granuloma in the duodenum: successful treatment by endoscopic snare polypectomy

Pyogenic granuloma, a polypoid form of capillary hemangioma, commonly occurs on the skin and mucosal surfaces,1 but only rarely in portions of the gastrointestinal (GI) tract other than the oral cavity.2 We herein report a case of duodenal pyogenic granuloma with bleeding, which was successfully treated by endoscopic snare polypectomy. To our knowledge, although 11 cases of GI pyogenic granuloma have been reported,2-9 this is the first description of such a tumor occurring in the duodenum.

Helicobacter pylori status and esophagogastroduodenal mucosal lesions in patients with end-stage renal failure on maintenance hemodialysis

ObjectivesThe aim of this study was to elucidate the impact of Helicobacter pylori infection on esophagogastroduodenal mucosal lesions in patients with end-stage renal failure on maintenance hemodialysis (HD).MethodsAn upper endoscopy and the 13C-urea breath test were performed in 198 patients on maintenance HD. Clinical features, serum pepsinogen levels and esophagogastroduodenal mucosal lesions were compared between H. pylori-positive and H. pylori-negative patients. Risk factors associated with esophagogastroduodenal mucosal lesion were determined by multivariate analyses.ResultsThe upper endoscopy revealed that gastric erosion was the most frequent (58%) type of esophagogastroduodenal mucosal lesion, followed by duodenal erosion (18%), gastric ulcer (14%), gastroesophageal reflux disease (10%), and duodenal ulcer (7%). Of the 198 patients enrolled in the study, 81 were positive and 117 patients were negative for H. pylori infection. The time duration after the introduction of HD was significantly longer and serum pepsinogen I/II ratio was significantly higher in H. pylori-negative patients than in H. pylori-positive patients. Multivariate analyses revealed that the H. pylori infection was an independent, protective factor for gastric erosion (odds ratio 0.38; 95% confidence interval 0.21–0.70), while the infection was unrelated to other mucosal lesions.ConclusionsThe most common mucosal lesion observed in our study cohort, all of whom were patients on maintenance HD, was gastric erosion. The high prevalence of this type of lesion may be explained partly by the cure of H. pylori infection during the clinical course of maintenance HD.

The diagnostic yield of colonoscopy and the therapeutic value of intraduodenal amidotrizoic acid injection in intestinal Diphyllobothrium latum infection: report of a case.

The diagnostic yield of colonoscopy and the therapeutic value of intraduodenal amidotrizoic acid injection in intestinal diphyllobothrium latum infection: report of a case

PYOGENIC GRANULOMA IN THE ILEUM

Pyogenic granuloma, a polypoid form of capillary hemangioma, commonly occurs on the skin and mucosal surfaces but only rarely in portions of the gastrointestinal (GI) tract other than the oral cavity. We report the case of a 75‐year‐old woman who suffered from recurring fatigue and had anemia. Double‐contrast radiography revealed a sessile tumor of the ileum, and endoscopy during surgery revealed a polypoid lesion in the ileum, 150 cm from Bauhins valve. The histological features were consistent with those of pyogenic granuloma.

SMALL EARLY GASTRIC CANCER OCCURRING IN A YOUNG WOMAN WITH NODULAR GASTRITIS

We found a small gastric cancer in a 25‐year‐old woman with nodular gastritis. Endoscopically, the cancer was identified as a whitish area in the gastric antrum. There was also a miliary pattern in the gastric antrum and corpus. In addition, serology and histology revealed the patient to have been infected by Helicobacter pylori. Histological examination of the resected stomach showed that the cancer was poorly differentiated adenocarcinoma with signet‐ring cell restricted to the mucosal layer. In the surrounding mucosa, there were chronic inflammatory cell infiltrates and enlarged lymphoid follicles with germinal centers. Our case suggests that nodular gastritis may be at a high risk for the development of gastric cancer of poorly differentiated type.