M. Tada

Endoscopic sphincterotomy of the ampulla of Vater

Endoscopic sphincterotomy at the papilla of Vater, combining and modifying technics already established for retrograde cannulation and electrosurgical polypectomy, has been successfully performed in 2 patients with removal of stones impacted in the ampulla and proximal common bile duct. The authors caution that further investigation is in order to assure the safety and efficacy of the procedure.

A new approach to the observation of minute changes of the colonic mucosa by means of magnifying colonoscope, type CF-MB-M (Olympus)

A newly devised magnifying colonoscope (Olympus CF-MB-M) incorporates a capacity to enlarge mucosal surface details by a factor of 10 times. The image of fine surface features is enhanced by applying methylene-blue dye. This report describes the use of the new instrument in 120 normal subjects, in 104 patients with polypoid lesions, and in 60 patients with inflammatory diseases. The magnified, enhanced image, when compared with that obtained by the conventional colonoscope, permits better definition of the stage and severity of inflammatory reactions and correlates with the histologic types of polypoid lesions.

Pediatric enteroscopy with a sonde-type small intestinal fiberscope (SSIF-type VI)

83° and offers an adequate field of view with excellent optical resolution. The external suction channel requires additional tubing, making the instrument more cumbersome while adding to its weight. Since the instrument is new, it is too early to assess resistance of the bundles to irradiation. The instrument available for evaluation, however, had been used for approximately 150 examinations and the bundles were only slightly yellow. The Pentax lecturescope is very good, adapting both clockwise and counterclockwise to avoid interference to the endoscopist and losing little light. The Pentax endoscope can be easily adapted to any manufacturers light source, again with little light loss. In general, the instrument handled very well and offers an excellent alternative to the other endoscopes.

Endoscopic observation of villi with magnifying enterocolonoscopes

Enteroscopy, using a newly developed enteroscope, type SIF-M (Olympus), and a magnifying colonoscope, type CF-HM (Olympus), was performed in 11 cases. The SIF-M and CF-HM instruments (Table I) permit X10 to x35 magnification, so that villi can be clearly inspected. .By means of the rope guide technique, the magnifYing endoscope was introduced into the small intestine per anus 2 to 5 days after the patient swallowed a Teflon catheter. After complete transintestinal passage, the anal end of the catheter was drawn through the biopsy channel of the endoscope and used as a guide. The introduction of the endoscope into the small intestine was effected by applying tension to the oral and anal ends of the string. The tip of the endoscope was advanced under fluoroscopic control. The SIF-M was used for the observation of the upper small intestine and CF-HM for the ileum. After examination of the small intestine, 10 ml of 0.1% methylene blue solution were sprayed on the mucosa. Then, by adjusting the focus of the magnifying endoscope, the shape and arrangement of the villi were carefully observed. was inferior to that of the normal villi. The villi of granulomatous enteritis were in an irregular leafshaped form with ridged convolutions (Fig. 1C). The absorbency of methylene blue solution of the affected villi was as poor as that of intestinal tuberculosis. The mucosa of the terminal ileum of granulomatous enteritis, which was considered to be free of inflammation by x-ray examination and conventional endoscopy, showed small, round, atrophied finger-shaped villi (Fig. 10). In the mucosa of ileitis, the villi were sporadic or lost, much as the affected villi of tuberculous or granulomatous enteritis were.

Endoscopic polypectomy for the removal of polyps of the small intestine

SummarySince intussusception is a common complication of the Peutz-Jeghers polyps, laparotomy should be recommended to remove them. However, all of them will not be palpable or discernible during laparotomy. Operative endoscopy was employed for removing polyps of the small intestine of a 22-year-old female who was previously diagnosed as Peutz-Jeghers syndrome. Using a newly designed enteroscope with two channels (SIF-2C, Olympus), four large polyps over 1 cm in size were removed from the ileum and jejunum with safety.Endoscopic polypectomy is one of the rapidly advancing fields and widely spread methods in gastrointestinal endoscopy since the introduction of electrosurgical techniques. Although the endoscopic removal of polyps arising from the esophagus, stomach, duodenum, colon and rectum can be performed with ease and safety, polypectomy for the polyps of the small intestine has never been performed because of the technical difficulties to handle the scope in the small intestine. Two channel enteroscope resolved this problem. Therefore, it is emphasized that double channel enteroscope makes the polypectomy in the small intestine possible and the indication of enteroscopy will be more widely extended.

A case of tuberculosis of the ileum diagnosed by a sonde-type small intestinal fiberscope

mucosal erosions in 6, and deformity of the ileocecal valve in 4. The most difficult differentiation is that from Crohns disease, the destruction of the ileocecal valve strongly favoring the diagnosis of tuberculosis. Our case displayed all the features described by Aoki et al. 6 Final proof was given by histology and positive tissue culture. Although perforation, abscesses, and fistulas as well as obstruction and stenosis are indications for operation,S the present case demonstrates that even in the presence of an endoscopic stenosis a nonsurgical treatment may be attempted as long as no clinical signs of obstruction occur. Our patient showed a considerable improvement in symptoms and in endoscopic as well as radiographic appearances after 8 months of chemotherapy.

Endoscopic studies on the minute structures of colonic mucosa in the follow-up observation of ulcerative colitis

SummaryThirty cases of ulcerative colitis were examined endoscopically by means of magnifying colonoscope with dye spraying method (the combined method), and their minute mucosal structures were classified into four categories endoscopically, which correlated well with the histological findings. By this procedure, it was easy to detect the subsidence of inflammation of the mucosa in the quiescent phase or to reveal the active inflammatory involvement of the bowel. Moreover, inspecting the minute changes of the colonie mucosa detected by the combined method, remission was more correctly decided and rigid control is contributing to the decrease in the recent rate of recurrence of ulcerative colitis.

Situation actuelle de l’entéroscopie

Les explora t ions radiologiques et endoscopiques en pathologie gas t roin tes t ina le du c61on sont entr6es dans la rou t ine en raison des progr~s accomplis dans ces deux d o m a i n e s techniques. N6anmoins , en prat ique couran te , le diagnost ic pr6op6ratoire d une affect ion de l in tes t in gr61e demeure n o n r6solu. A u cours des 10 ann6es 6coul6es, nous avons prat iqu6 dans not re cent re hospital ier , u n n o m b r e total d examens c o m p o r t a n t 82 000 endoscopies du tractus digestif sup6rieur , 5 000 E R C P et plus de 6 000 coloscopies.

A case of carcinoma of the ileocecal valve

SummaryA rare case of carcinoma of the ileocecal valve is reported, which is endoscopically confirmed by the colonofiberscope (Olympus CF-LB type apparatus) and a biopsy examination. The characteristic endoscopical findings of this tumor reveals an irregularly shaped tumor with superficial depression circumscribed at the ileocecal valve and the lack of peristalsis. Colonofiberscopy is of value in the differential diagnosis of the ileocecal lesions when carried out in the combination with roentgenographic studies and histological examination using biopsy specimens.

A newly improved sliding tube for colonoscopy for keeping the sigmoid colon in a straight condition.

SummaryAlthough a sliding tube made of plastics is very effective to keep the sigmoid colon in a straight position, there is some difficulty in handling the colonoscope, being restricted by the length of the scope. For the purpose of covering the demerits of the conventional sliding tube, a new slit sliding tube which is made up of three parts was devised by us. After straightening the sigmoidal loop, the three parts of the apparatus are joined together. Then the slit sliding tube is inserted into the descending colon with safety and ease. By using the slit sliding tube, handling of the colonoscope is scarcely restricted and becomes easy. Moreover, the slit sliding tube can be used even for the shorter scopes, by which the distal parts of the colon can be more easily examined in comparison with conventional techniques.