Kunihide Yoshino

A new simplified technique of endoscopic esophageal mucosal resection using a cap-fitted panendoscope (EMRC)

We have previously reported on our novel esophageal mucosal resection technique using a specially devised tube (EMRT) for early-stage esophageal cancer [1, 2]. Acquired specimens lent themselves well to accurate histopathological diagnosis, such as the depth of cancer invasion, type of cancer, grade of differentiation, and vascular involvement. EMRT has been confirmed to be a safe and reliable procedure. There has been no experience of perforation or massive bleeding in six early esophageal cancer cases demonstrated, though EMRT demands a certain degree of skill from the endoscopist. A considerably simplified technique is thus expected to be established only as a therapeutic measure

Ultra-high Magnification Endoscopic Observation of Carcinoma in situ of the Esophagus

Abstract: Super‐zooming observation of carcinoma in situ of the esophagus was achieved utilizing an ultra‐high magnification endoscope which has a 150X magnification capacity. Superficial flat and slightly depressed lesions (O‐llb and O‐llc according to the Japanese classification of esophageal cancer), usually observed as a well‐demarcated reddish patch, were revealed to be a composite of scattered red dots and a pinkish homogeneous background. Those red dots were disclosed to be intrapapillary capillary loop changes such as dilatation, meandering and caliber irregularities. These changes were never observed in normal mucosa or in the setting of esophagitis. These characteristic findings were confirmed histologically in the resected specimen.

Ultra‐high Magnification Endoscopy of the Normal Esophageal Mucosa

Abstract: The normal esophageal mucosa was observed in detail using ultra‐high magnification endoscopy (UHM endoscopy). The UHM endoscope has a magnification capacity ranging from eight to 150x. High‐quality UHM endoscopic pictures can be continuously obtained by attaching a 2‐mm depth soft distal attachment to the tip of the UHM endoscope. The vascular architecture, which extends from the submucosal vessels through the proper mucosal layer, can be continuously visualized, thereby demonstrating the characteristic fine‐vascular network pattern, and the intrapapillary capillaries in the epithelium. With UHM endoscopy, intrapapillary capillaries can be clearly demonstrated as single loop vessels which we have termed “intrapapillary loops.” These structures cannot be observed with an ordinary magnifying endoscope which is capable of only 35x magnification. We conclude that a technique for obtaining high‐resolution endoscopic pictures has been established. The images obtained are useful for elucidating the microstructure of the esophageal mucosa, especially the fine‐vascular network and the newly recognized intrapapillary loop.

Endoscopic resection of early-stage esophageal cancer

SummaryEarly-stage esophageal cancerous lesions in four clinical cases were endoscopically resected via a newly developed procedure, endoscopic esophageal mucosal resection using a transparent tube (EMRT). In the complete resection of cancer-bearing mucosa, more than half of the circumferential mucosal resections did not involve major complications such as perforation or massive bleeding. Large ulcers artificially induced by this procedure disappeared within 3 weeks, exhibiting no stenotic changes. Resected specimens contributed well to microscopic examination for histological classification and determination of the depth of cancer invasion and possible vascular involvement. No signs of recurrence were observed during the 15-month follow-up period. We conclude that EMRT is a safe and minimally invasive local treatment for early-stage esophageal cancer that also provides specimens that are suitable for accurate histopathological diagnosis.

Analysis of 1.125 cases of early esophageal carcinoma in Japan

A total of 1.384 Tl and Tis cases of cancer of the esophagus resected between January, 1984 and December, 1989 at 208 institutions throughout Japan were analyzed. Of these, 1.123 (71%) were classified as stage 1 carcinoma (Tl N0 MQ) and stage 0 carcinoma (Tis N0 MQ), and studied according to various factors. The long-term results in Tl and Tis cancer were examined: the presence or absence of lymph node metastasis, m cancer and sm cancer and lymph vessel invasion, showed significant differences in respect of the five-year survival rate. The low incidence (4%) of lymph node metastasis in m cancer suggests that it can be considered as true early cancer, treatable for cure.

Intraoral free flap monitoring with a laser doppler flowmeter

The blood flow in 37 free flaps used for intraoral reconstruction was measured by laser Doppler flowmetry before and after elevation of the flap during surgery, immediately after the completion of reconstruction and on the 1st, 2nd and 3rd postoperative days (1 POD, 2 POD, 3 POD). Although the blood flow decreased temporarily after the flap elevation, it began to increase immediately after reconstruction and continued a gradual increase thereafter, reaching a peak on 2 POD. The flap survived in all cases where the blood flow on 3 POD was equal to or greater than that before flap elevation. Total necrosis of the flap occurred in one patient, and partial necrosis in another. In both patients, abnormal laser flowmetric measurements preceded the manifestation of the clinical signs. Using laser Doppler flowmetry to monitor free flaps both during surgery and for three days thereafter is thus a useful way of determining their viability. MICROSURGERY 17:337–340 1996

A new technique for endoscopic esophageal mucosectomy using a transparent overtube with intraluminal negative pressure (np-EEM)

Abstract: We devised a new technique for endoscopic esophageal mucosectomy using a transparent overtube (OT) with intraluminal negative pressure (np‐EEM) (Figs. 1,2). Basic studies were performed on six dogs. The following two methods were utilized in the np‐EEM technique in line with standard approaches used for mucosal resection: (1) A “snare” method was used in which the esophageal mucosa protruded, similar to a polyp, through the slit of the OT and was resected by an electro‐snare passing through the endoscope biopsy channel or the injection channel of the OT. A high‐frequency current was used for the resection (Figs. 2‐a 2‐b, Fig. 3, Color). (2) A “cutter” method was used in which the mucosal protrusion was resected by a recently developed electro‐cutter (Figs. 2‐a, 2‐c, 2‐d, Fig. 3, Color).

Endoscopic resection of carcinoma in situ of the esophagus accompanied by esophageal varices

SummaryA case of carcinoma in situ of the esophagus accompanied by esophageal varices was treated by endoscopic mucosal resection using a transparent tube (EMRT) following eradication of the varices via injection sclerotherapy (EIS). Intravariceal injection sclerotherapy was performed for esophageal varices, and after eradication of the varices had been achieved, half of the circumferential esophageal mucosal resection of the cancer lesion was carried out. No serious complication such as perforation or mass bleeding was observed. Cancer-involved mucosa was completely resected and all specimens contributed well to accurate histopathological study, being diagnosed as intraepithelial squamous-cell carcinoma. The artificial ulcer recovered completely, showing no stenotic changes. Our conclusion from this experience is that EIS + EMRT is a valuable and minimally invasive treatment for patients exhibiting this disease, providing an accurate histopathological diagnosis.

Oesophagoscopy for the diagnosis of superficial oesophageal cancer.

SummaryThe endoscopic findings and the surgical results of 131 resected cases of superficial oesophageal cancer are described. Of these 131 cases 24 (18%) had mucosal cancer. Twenty-one (88%) of 24 cases of mucosal cancer of the oesophagus had neither nodal involvement nor vascular invasion, and therefore excellent long-term results can be anticipated. In order to obtain good results in the treatment of mucosal cancer of the oesophagus, the role of oesophagoscopy is extremely important in the early diagnosis of this cancer.

Diagnosis and Treatment of Early Esophageal Cancer

According to the descriptive guidelines of the Japanese Society for Esophageal Diseases [1], cancer in which invasion is limited to the submucosa is defined as superficial cancer and superficial cancer without metastasis is defined as early cancer of the esophagus.