Kazuhiko Hattori

Clinical significance of anomalous pancreaticobiliary union

Anomalous pancreaticobiliary union was found in nine cases among 300 consecutive adult patients examined by endoscopic retrograde cholangiopancreatography. Three had congenital choledochal cysts: one had a cyst of the choledochus associated with a cyst of the intrahepatic bile duct, another had a fusiform dilation of the choledochus, and the third had a choledochal diverticulum. Five of the nine patients had biliary malignancies (55.6%): four carcinomas of the gallbladder and one carcinoma of the choledochus. On the other hand, 18 of 291 patients without anomalous pancreaticobiliary union had biliary malignancies (6.2%): four carcinomas of the gallbladder and 14 carcinomas of the choledochus. When anomalous pancreaticobiliary union is detected, biliary malignancy, especially carcinoma of the gallbladder, should be considered as a possible complication.

Endoscopic sampling for tissue diagnosis in gastrointestinal malignancy

Tissue sampling for histopathologic and cytologic diagnosis through fiberoptic endoscopy can be performed in almost every patient with endoscopically visualized lesions or suspected areas. These procedures were performed in 150 patients with proven final diagnoses of gastrointestinal malignancy. The overall accuracy of biopsy was 73% and of brushing exfoliative cytology, 85%; 93% accuracy was achieved when these diagnostic procedures could be performed in combination. Inappropriate or inadequate sampling has been the most common cause for false negative diagnoses. The advantageous routine use of combined brushing cytology and biopsy under direct vision during fiberoptic endoscopy is emphasized.

Endoscopic diagnosis of esophageal inflammation

The histologic appearance of biopsy specimens, taken from the distal esophagus of 10 normal subjects and 57 patients with endoscopic evidence of esophagitis, has been reviewed. While only 10% of normal subjects demonstrated a polymorphonuclear leukocyte infiltrate of the mucosa or lamina propria, such an infiltrate was present in more than 80% of patients with an esophageal mucosa of abnormal appearance. Mononuclear cell infiltrates of the lamina propria were seen in both normal and esophagitis patients and their presence does not seem to be a useful criterion for the diagnosis of esophagitis. Careful inspection of the vascular pattern of the distal esophagus with the Olympus GIF endoscope is helpful in detecting cases of mild esophagitis, and a fine nodularity of the mucosa on close inspection is also a useful sign of esophageal inflammation.

Endoscopic Nd:YAG laser therapy for gastric borderline lesions

Endoscopic Nd:YAG laser treatment was used to eradicate 14 broad-based protruded borderline lesions of the stomach in which snare excision might be difficult and hazardous. Multiple pulse irradiations of Nd:YAG laser with a power of 40 to 50 W ablated all the lesions. During and after laser treatments, no complications were recognized. The laser-induced ulcers healed within 4 to 7 weeks after the last procedure, and the biopsy material taken from the sites of the scars showed regenerative epithelium without evidence of atypical cells. These encouraging results suggest that endoscopic laser treatment is the method of choice for therapy of the gastric borderline lesions where snare excision is not feasible.

Early cancer of the esophagus and stomach.

H. Early gastric cancer: excavated type A 60-year-old man complained of epigastric discomfort of 1-week duration. Gastroscopy revealed a benign appearing ulcer with a white base on the anterior aspect of the gastric angulus. An irregular erythema was found in the vicinity of the ulcer, raising a suspicion of early gastric cancer. Biopsy showed cancer cells. Microscopically, there was an intramucosal carcinoma limited to the margin of the ulcer where the erythema was seen. No cancer cells were present at the base of the ulcer.