Keiko Mochizuki

Combined use of a magnifying endoscope with a narrow band imaging system and a multibending endoscope for en bloc EMR of early stage gastric cancer.

BACKGROUND En bloc EMR is performed in Japan as a curative treatment for early stage gastric cancer. However, current methods of EMR are technically difficult and require proficiency in determining the extent of the cancer. This study assessed the feasibility of a new method to obviate these problems and to facilitate en bloc EMR. METHODS The new method uses two types of endoscopes: a magnifying endoscope with a narrow band imaging system to enhance the definition of mucosal and microcirculatory structure, and an endoscope with multibending tip deflection to maintain orientation during EMR. Forty-two consecutive cases of mucosal gastric cancer treated by EMR were reviewed retrospectively. In 12 of these patients, 12 lesions that fulfilled guideline criteria for EMR were treated by the modified, en bloc EMR method of circumferential incision and snare resection by using the two endoscopes. RESULTS The rate of complete en bloc resection with the new method of EMR was 91.7%, (11/12). There was no major complication. CONCLUSIONS The new en bloc resection method for EMR with two endoscopes described here is feasible and may be a safe and a reliable technique for curative treatment of mucosal gastric cancer.

Effects of probucol and pravastatin on plasma lipids, activities of postheparin lipoprotein lipase, and lecithin cholesterol acyltransferase and apo A-I containing lipoproteins with and without apo A-II in patients with moderate hypercholesterolemia.

In this study, plasma HDL fractions were separated by ultracentrifugation and apo A-I containing lipoproteins (A-I Lp) were then isolated using anti-apo A-I immunoaffinity chromatography. The A-I Lp were further separated into two fractions with the use of anti-apo A-II immunoaffinity chromatography. One fraction, Lp A-I, contained apo A-I without apo A-II, while the other, Lp A-I/A-II, contained both apo A-I and apo A-II. These techniques were applied to investigate the changes in HDL apoprotein composition in hypercholesterolemic subjects treated with either probucol or pravastatin. Treatment with probucol (500 mg/day) or pravastatin (10 mg/day) reduced mean plasma total cholesterol concentrations by 24% (p < 0.01) and 16% (p < 0.05), respectively. Both drugs caused some reduction in lipoprotein lipase activity, but neither had any influence on the activity of hepatic triglyceride lipase or lecithin cholesterol acyltransferase. Their effects on HDL-cholesterol levels and apoprotein composition differed markedly. Probucol significantly decreased the HDL-cholesterol concentration, the plasma apo A-I/apo A-II ratio, and the number of large particles of diameter greater than 10.4 nm. When the ratios of Lp A-I and Lp A-I/A-II for the probucol-treated subjects were compared with those in the normolipidemic controls, and with the ratios before and after administration of probucol, a remarkable decrease in the level of Lp A-I was apparent. It is presumed that the decrease in HLD-cholesterol by prolonged probucol administration reflects the decrease of Lp A-I more than the decrease of Lp A-I/A-II.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopic Detection Rate of Minute Neoplasms in Autopsied Colons

Abstract: This study was designed to determine the actual incidence, distribution and morphology of minute neoplastic polyps, under 5 mm in diameter, in the so‐called normal colon obtained at autopsy. In order to increase the sensitivity of detection of minute lesions, this study was done with the aid of electronic endoscopy using the dye spraying method. The case‐occurrence of minute neoplastic polyps among the 49 autopsy cases was almost 50% and the ratio of cases without adenomas or cancers of the colon was no more than 50%. The ratio of minute neoplastic polyps among the total number of neoplastic polyps, based on electronic endoscopy, was much higher than that of minute polyps of autopsy cases reported previously with macroscopic observation. Regarding the grade of atypia of the minute neoplastic polyps, only one polyp (5 mm in diameter) among 85 lesions was a carcinoma. The results of this study indicate the possibility of considerable numbers of minute neoplastic polyps which are likely to go undetected by endoscopy, probably due to technical difficulties in endoscopic control and the lack of sufficient examination time for each patient.

Adhesive Effect of Ecabet Sodium in a Porcine Gastric Leer Model

Abstract: Protection of the gastric mucosa, based on its high affinity for mucosal lesions, has been reported as one of the antiulcer effects of ecabet sodium. We investigated the adhesive effect of this drug on mucosal lesions in a porcine gastric ulcer model (freshly isolated stomach) and on human mucosal lesions resulting from endoscopic gastric mucosal resection (EMR) and polypectomy. After ulcer lesions had been induced by EMR in the isolated porcine stomach, ecabet sodium and sucralfate suspensions were applied. After washing with citrate buffer, at a pH of 1, 3 or 5, the adhesion of each drug to the gastric mucosa was measured. At pH 1, both drugs showed satisfactory adhesion to the ulcer lesions. When the acidity of the ulcer surfaces was decreased to pH 3 and then to pH 5, the adhesion of sucralfate showed a marked decrease (100%→31→% 13%). while that of ecabet sodium showed only a slight decrease (100%→75%→64%). Futhermore, the activity of thrombin in the ecabet sodium suspension remained high at pH 1, 3 and 5. Since the ecabet sodium suspension produced a satisfactory covering effect on gastric mucosal lesions and this effect was maintained even at low acidity, this drug is considered suitable for endoscopic directsprinkling therapy for gastric mucosal lesions.