Koji Tsujigami

Ultrasonographic assessment of gastric motility in diabetic gastroparesis before and after attaining glycemic control.

BackgroundGlycemic control is important for maintaining gastric motility in diabetic patients, but gastric motility has not yet been studied ultrasonographically in relation to glycemic control.MethodsWe made such observations before and after establishing glycemic control in diabetic patients with gastroparesis. We studied 30 diabetic patients with upper abdominal digestive symptoms who were hospitalized for correction of poor blood sugar control and who underwent upper digestive tract endoscopy to rule out structural causes such as gastric/duodenal lesions. Gastric motility was evaluated by transabdominal ultrasonography, using a test meal, before and after attainment of glycemic control (within 3 days after admission and 3 days before discharge). Also, upper abdominal digestive symptoms present on admission and at discharge were compared.ResultsAfter glycemic control was established, contractions of the antral region were more frequent than before the attainment of control (8.93 ± 1.17/3 min vs 7.63 ± 2.22/3 min, respectively; P < 0.001). Glycemic control also significantly improved gastric emptying (before glycemic control, 49.2 ± 14.8%; after, 67.1 ± 11.5%; P < 0.001). This was also true for the motility index, concerning antral gastric contractility (before control, 2.97 ± 1.57; after, 3.75 ± 1.09; P < 0.05). Upper abdominal symptom scores were also significantly lower after attainment of control than before (0.47 ± 0.78 vs 3.17 ± 2.00, respectively; P < 0.001).ConclusionsThese findings suggest that attaining glycemic control improves gastric motility and attainments upper abdominal symptoms in diabetic patients with gastroparesis.

Visceral fat predominance is associated with non-alcoholic fatty liver disease in Japanese women with metabolic syndrome.

Metabolic syndrome (MS) is likely to be associated with non‐alcoholic fatty liver disease (NAFLD). The prevalence of NAFLD in visceral fat type MS (V‐type MS) is known to be higher than in subcutaneous fat type MS (S‐type MS) in men with MS, and a larger subcutaneous fat area is reported to be not associated with NAFLD in women. We elucidated differences between V‐type S‐type MS in Japanese women with MS.

Ultrasonographic comparison of gastric motility between diabetic gastroparesis patients with and without metabolic syndrome.

Background and Aims:  Diabetic patients with poor glycemic control or long standing disease often have impaired gastric motility. Recently, metabolic factors such as blood glucose have been reported as influencing gastric motility independently of autonomic neuropathy. Many diabetic patients have metabolic syndrome, which is strongly associated with coronary and other diseases. We investigated whether metabolic syndrome influences diabetic gastroparesis patients.

VASCULAR ECTASIA OF THE COLON TREATED BY ARGON PLASMA COAGULATION : REPORT OF A CASE

A 72‐year‐old woman presented with hematochezia. Colonoscopy revealed branch‐like vasodilation in the ascending colon and chronic hemorrhage from vascular ectasia of the colon was suspected. Argon plasma coagulation was performed. After treatment, epithelialization of the lesion site was noted and her anemia improved. Vascular ectasia of the colon is recognized as the etiology of lower gastrointestinal bleeding with increasing frequency. Infrared ray electronic endoscopy is useful for determining the extent of disease and argon plasma coagulation, a new hemostatic technique, is suitable for treatment of this condition.

Evaluation of solitary and scattered esophageal varices according to infrared endoscopy and endoscopic ultrasonography

Background and Aim:  The aim of this study was to clarify the etiology and clinical significance of solitary and scattered esophageal varices by evaluating their hemodynamics and other characteristics using infrared endoscopy and endoscopic ultrasonography.

7172 Endoscopic ultrasonography for the diagnosis of gallbladder lesions in patients with gallstones.

Purpose: Gallstones are generally considered a risk factor for gallbladder cancer. Since gallbladder cancer has a poor prognosis, accurate qualitative diagnosis of elevated lesions in the gallbladder is needed, even in the presence of gallstones. In this study, the ability of endoscopic ultrasonography (EUS) to detect gallbladder lesions in patients with gallstones was assessed. Patients and Methods: Between April 1992 and September 1999, 62 patients underwent cholecystectomy for an elevated lesion or thickening of the gallbladder wall identified by imaging techniques including EUS. EUS was performed using the Olympus GF-UM20 (7.5MHz) system. The accuracy of EUS was analyzed in relation to the presence or absence of gallstones, the size and number of stones, and presence or absence of acoustic shadowing.The EUS results were compared with histopathologic results. Significance was tested using the chi-square test and the Students t test. Results: The accuracy of EUS was 70.8% in the gallstone group and 89.5% in the gallstone-free group (NS). The diagnostic accuracy was 75.0% in the patients with stones smaller than 5 mm, 33.3% in the patients with stones between 6 and 10 mm in size, and 77.8% in the patients with stones larger than 11 mm (NS). The accuracy was 66.7% in the patients with 1 to 5 stones, and 83.3% in the patients with 6 or more stones (NS). Acoustic shadowing did not affect the diagnostic accuracy of EUS. Conclusions: Gallstones do not affect the diagnostic accuracy of EUS for gallbladder lesions. However, more diagnostic criteria must be established, and new devices need to be introduced that can provide more information about the lesions.

3560 Evaluation of solitary and scattered esophageal varices by infrared-ray endoscopy and endoscopic ultrasonography.

Objective: Solitary esophageal varices (SoV) sporadically develop in the upper and middle esophagus, while scattered esophageal varices (ScV) consist of more than two variceal lesions. It is considered that both SoV and ScV differ from portal hypertensive esophageal varices or so-called down hill varices. However, the etiology and clinical significance of SoV and ScV remain unclear. In the present study, using both IRE and EUS, we evaluated the internal characteristics and hemodynamics of SoV and ScV. Subjects and Methods: The subjects consisted of 44 lesions in 28 patients in whom SoV or ScV were detected by visible ray endoscopy (VRE). These lesions were evaluated by IRE and EUS. During IRE, the intensity of blueblack color was evaluated using GIF-Q200IR (Olympus Co., Ltd.). Subsequently, 2 mg/kg of ICG was rapidly injected intravenously to evaluate the degree of stainability by three stages. During EUS, the major location and echo patterns of SoV and ScV were observed using an ultrasonic miniprobe. Echo patterns were classified as follows: homogeneous low echo, mixed echoes, and homogeneous high echo. Results: When the relationship between the size of SoV or ScV and the degree of stainability during IRE was evaluated in densely stained lesions, the diameter of SoV or ScV was significantly smaller in lesions that showed stronger stainability than in those that showed weaker stainability. When the relationship between the size of SoV or ScV and echo patterns observed by EUS was evaluated, the diameter was significantly smaller in lesions that showed homogeneous low echo than in those that showed mixed echoes. When the relationship between echo patterns observed by EUS and the degree of stainability during IRE was evaluated, lesions that showed homogeneous high echo showed the weakest stainability, followed by lesions that showed mixed echoes and those that showed homogeneous low echo in ascending order. Conclusion: Concomitant i.v. injection of ICG was useful for observing hemodynamics of SoV and ScV during IRE, as well as observing the major location or morphology of these variceal lesions during EUS. SoV and ScV with larger diameters were stained later when hemodynamics were evaluated by IRE, and showed a mixture of low and high echo areas when the morphology was evaluated by EUS. These observations suggested that internal blood flow of SoV or ScV was arrested, and the severity of extravasation of blood increased with the diameter of variceal lesions.

7234 Usefulness of three-dimensional expression by endoscopic ultrasonography in the diagnosis of gastric cancer invasion.

Objective: Many studies have reported the usefulness of endoscopic ultrasonography (EUS) in the diagnosis of gastric cancer invasion. However, the diagnostic capacity of EUS should be further improved. In this study, we examined the usefulness of three-dimensional expression by EUS in the diagnosis of gastric cancer invasion. Subjects and Methods: In 54 gastric cancer lesions that were histologically diagnosed after April 1995 by EUS using an ultrasonic miniprobe in our department, the rate of accurately diagnosing invasion was compared between period A and period B. The period between April 1995 and October 1996, when examination of threedimensional expression was started at our department, was regarded as period A (35 lesions) , while the period from October 1996 to date was regarded as period B (19 lesions). Furthermore, the usefulness of threedimensional expression was examined in l9 lesions during period B. In the three-dimensional expression, we pulled ultrasonic miniprobe out at definite speed manually, and recorded the images on VTR.We connected VTR output to images processing equipment (IndigO 2 , Silicon Graphics), and compressed each tomographic image (30 frame/sec) by EUS by Motion JPEG method. We selected necessary frames from the images, and converted them into volume data by the three-dimensional image processing software (Medical Design Composer 1.0) which we developed. We determined arbitrary cross sections and the external form on volume data, and observed the lesions spatially. Result: The rate of accurate diagnosis of invasion by EUS was 77.8% (42/54) , overall. Percentages were 74.3% (26/35: T1-m 71.4%, T1-sm 83.3%, T2-pm 50%) during period A and 84.2% (6/19: T1-m 87.5%, T1-sm 66.7%) during period B. During period B, the whole lesion was scanned in each direction for three-dimensional expression. Furthermore, more detailed examination could be performed by expressing random cross sections from three-dimensional data, improving the diagnostic capacity of this procedure. In 8 of 19 patients, superficial expression was possible. In these lesions, the rate of accurately diagnosed invasion was 100% (8/8). Although these patients were selected based on lesion size and the absence of the influence of heart beats, it was suggested that three-dimensional expression contributes to improving the diagnosis of invasion. Conclusion: Three-dimensional expression of EUS findings in patients with gastric cancer may improve the diagnosis of invasion.