Keizo Tanaka

Diagnosis of Chronic Pancreatitis by Endoscopic Ultrasonography

Abstract: This study evaluates the usefulness of endoscopic ultrasonography in the diagnosis of chronic pancreatitis. 52 patients with chronic pancreatitis, which included 15 cases of mild pancreatitis, 19 cases of moderate pancreatitis and 18 cases of advanced pancreatitis, were diagnosed by endoscopic retrograde cholangiopancreatography and further investigated by endoscopic ultrasonography. The 4 main findings of 1) dilatation of the main pancreatic duct, 2) irregularity of the main pancreatic duct, 3) inhomogeneity of the pancreatic parenchyma and, 4) irregular configuration of the pancreas were reviewed. In all of the 18 cases of advanced pancreatitis, irregularity of the main pancreatic duct, inhomogeneity of the pancreatic parenchyma and irregular configuration of the pancreas were seen. 89% of these patients had dilatation of the main pancreatic duct. In the patients with moderate pancreatitis, on the other hand, all 4 findings occurred with a frequency of between 58% to 95%. In the patients with mild pancreatitis, irregularity of the main pancreatic duct, inhomogeneity of the pancreatic parenchyma and irregular configuration of the pancreas occurred at a rate of 40% to 93%, and dilatation of the main pancreatic duct occurred rarely in only 13% of the patients. We were able to detect abnormalties in the pancreatic parenchyma by endoscopic ultrasonography even in the early stages of chronic pancreatitis, and this suggests that this technique may be useful in the diagnosis of mild pancreatitis, which usually causes quite minor abnormal changes in the main pancreatic duct.

Clinical Evaluation of Endoscopic Gastric Mucosal Resection

Abstract: Endoscopic gastric mucosal resection (EGMR), by which a large specimen can be obtained, has been developed for the diagnosis and treatment of the borderline lesion (B. L.) or early gastric cancer (EGC), since biopsy specimens obtained by conventional techniques are too small to make an accurate diagnosis in number of cases. Thirty‐eight lesions in 35 cases (26 lesions in 23 cases with B. L. and 12 lesions in 12 cases with EGC) were resected for the purpose of treatment by EGMR, and 24 lesions (6 submucosal tumors, 3 B. L. s, 14 cases of EGC and 1 malignant lymphoma) for the purpose of diagnosis. By means of histological examination of the bite biopsy specimens following EGMR, twenty‐three lesions in 26 cases (89%) with a B. L. and 8 in 12 cases (67%) with EGC for treatment by EGMR were found to have been completely resected.

Clinical Evaluation of Endoscopic Ultrasonogrphy in Diagnosis of Submucosal Tumor of the Upper Alimentray Tract

Abstract: The usefulness and the problems of endoscopic ultrasonograpy (EUS) in the diagnosis of submucosal tumors (SMT) of the upper alimentary tract were evaluated in this study. EUS was carried out in 86 cases with SMT of the stomach. Tumors of 13 cases was confirmed histologically (leiomyoma in 7 cases, leiomyosarcoma in one, lipoma in 2, gastric cyst in one, aberrant pancreas in one and Schwannoma in one case). In only one out of 22 cases with SMT of the esophagus, the tumor was surgically resected and a pathological examination revealed leiomyoma

Abstracts of selected papers presented at the 30th Annual meeting of the Japanese Society of Gastroenterology

S OF SELECTED PAPERS PRESENTED AT THE 30TH ANNUAL MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY October 20-22, 1988 -Kagoshima, Japan Chairman: Shuji HASHIMOTO, M.D.

Gastric mucosal blood flow in hemodialysis patients

血液透析患者の胃粘膜病変の発生機序解明のため血液透析患者の胃粘膜血流量を内視鏡下で測定した. 対象は, 血液透析患者28名 (男性14名, 女性14名, 年齢27-81歳) で, コントロール群として胃粘膜病変を認めなかった健康者25名 (男性12名, 女性13名, 年齢39-78歳) の胃粘膜血流量を測定した. 血液透析患者の胃粘膜血流量は, 胃体上部大弯19.8±6.4ml/min/100g, 胃体下部小弯18.7±5.9ml/min/100g, 前庭部小弯20.4±6.8ml/min/100g, 前庭部大弯19.0±8.3ml/min/100gであった. これに対してコントロール群では, 胃体上部大弯26.2±8.5ml/min/100g, 胃体下部小弯24.4±8.1ml/min/100g, 前庭部小弯23.0±7.1ml/min/100g, 前庭部大弯19.2±5.9ml/min/100gであった. すなわち血液透析患者ではコントロール群に比して胃体部で胃粘膜血流量の低下がみられ (胃体上部大弯p<0.01胃体下部小弯p<0.05) ストレス性の病変が起こりやすい状態にあると考えられた. しかし, 血液透析患者の胃粘膜病変の多くは胃前庭部に発生しており, このことは胃粘膜血流量では説明できず今後の検討が必要だと考えられた.胃粘膜血流量に影響を与える因子としては, 血液透析患者では, 加齢により胃体部, 前庭部共に胃粘膜血流量の低くなる傾向がみられたが, 性別, 病変の有無による胃粘膜血流量の差はみられなかった.