Madoka Nakao

Optical biopsy of early gastroesophageal cancer by catheter-based reflectance-type laser-scanning confocal microscopy

Magnified endoscopic observation of the gastrointestinal tract has become possible. However, such observation at the cellular level remains difficult. Laser-scanning confocal microscopy (LCM) is a novel, noninvasive optical imaging method that provides instant microscopic images of untreated tissue under endoscopy. We compare prototype catheter-based reflectance-type LCM images in vivo and histologic images of early gastroesophageal cancer to assess the usefulness of LCM in diagnosing such cancer. 20 sites in the esophagus and 40 sites in the stomach are examined by LCM under endoscopy prior to endoscopic or surgical resection. A prototype catheter LCM system, equipped with a semiconductor laser that oscillates at 685 nm and analyzes reflected light (Mauna Kea Technologies, Paris, France; Fujinon, Saitama, Japan) is used in vivo without fluorescent agent. In all normal esophageal mucosa and esophageal cancers, the nuclei are visualized. In nine of the ten normal esophageal mucosa, cell membranes are visualized, and in five of the ten esophageal cancers, cell membranes are visualized. In all normal gastric mucosa, nuclei and cell membranes are not visualized, but in ten of the 20 gastric cancers, nuclei are visualized. This novel method will aid in immediate diagnosis under endoscopy without the need for biopsy.

Small-Intestinal Peutz-Jeghers Polyps Resected by Endoscopic Polypectomy with Double-Balloon Enteroscopy and Removal Confirmed by Ultrasonography

Ultrasonography (US) is easy to use and noninvasive, and there are many reports of its usefulness for diagnosing various gastrointestinal diseases [1]. The “multiple concentric ring sign” is the most typical US sign of intussusception [2]. The most common causes of small-intestinal intussusception in adults are cancer, Meckel diverticulum, and Peutz-Jeghers syndrome (PJS) polyps [3], and US is useful for detecting intussusception due to these conditions [4]. Two new technological developments, capsule enteroscopy (CE) and double-balloon enteroscopy (DBE), have revolutionized small intestinal endoscopy [5]. DBE in particular makes possible not only examination of the whole small bowel but also treatment of the disease detected. We report herein the case of a patient with PJS who underwent resection of two polyps by means of interventional DBE at one procedure. In addition, US was useful for screening intussusception in this patient and confirming whether the polyps had been removed completely.

Famotidine prevents canine gastric blood flow reduction by NSAIDs

Aim : To investigate the effect of famotidine on gastric blood flow reduction induced by diclofenac sodium, a common non‐steroidal anti‐inflammatory drug in Japan, using laser Doppler flowmetry in the canine stomach.

Gastrointestinal Stromal Tumor in Jejunum: Diagnosis Using Contrast-Enhanced Ultrasonography and Double-Balloon Enteroscopy

Gastrointestinal stromal tumors (GISTs) in the small intestine are rare and are sometimes incidentally detected by sudden gastrointestinal bleeding. The patients often undergo surgery without an accurate diagnosis, because most of these lesions are inaccessible by conventional endoscopy. Ultrasonography (US) has become an effective diagnostic modality for gastrointestinal diseases. In addition, recent studies have revealed that the microcirculation of the gastrointestinal wall can be assessed by contrastenhanced imaging using the agent SHU 508A (Levovist; Schering, Berlin, Germany) (1, 2). However, there have been few reports of the sonographic features of GISTs. We report a patient with GIST in the jejunum that was diagnosed by US as a screening tool and that was confirmed preoperatively by double-balloon enteroscopy.

Evaluation of colon cancer vascularity by flash echo imaging.

Objective. Tumor vascularity is strongly related to the prognoses of patients with various malignant primary tumors, including colorectal cancer. The aim of this study was to confirm the usefulness of harmonic flash echo imaging (H-FEI) for the preoperative evaluation of tumor vascularity in colorectal cancer by comparison with CD34 staining of resected specimens. Material andmethods. Seventeen patients undergoing surgical resection for advanced colorectal cancer (9 M, 8 F) were enrolled in this study. An ultrasound system transmitting ultrasound pulses at 2.3 MHz and receiving them at 4.6 MHz (second harmonic) was used for H-FEI. After intravenous injection of ultrasonic contrast medium (SHU 508A), intermittent harmonic scanning was carried out for 120 s at intervals of 4 s. On the tumor image of the strongest enhancement in each patient, 5 regions of interest were taken to decide the mean echo intensity of the tumor. Immunohistochemistry using antibodies against CD34 was carried out on resected specimens. The mean microvessel density was decided by counting microvessels on 5 fields (×400) of CD34-stained specimens. Results. The mean value of H-FEI intensity was 5.44±1.10, and the mean microvessel count with CD34 staining was 35.0±7.95. A significant positive linear correlation was observed between the intensity of H-FEI determined preoperatively and the microvessel count in CD34-stained specimens (r=0.741, p=0.0006). Conclusion. Vascularity of colon cancer can be evaluated non-invasively using H-FEI.

Initial experience with catheter probe US when using a multibending endoscope.

BACKGROUND High-frequency catheter probe US provides detailed images when the scanning plane is perpendicular to the area of interest and the latter is within the focal zone. A multibending endoscope has been developed that has two bending sections that can be deflected independently. The aim of this study was to determine whether this new endoscope enhances high-frequency catheter probe US. METHODS High-frequency catheter probe US was performed with the multibending endoscope in 33 patients with upper-GI lesions. The endoscope was carefully maneuvered until the scanning plane was perpendicular to the area of interest and the target area was within the focal zone of the probe. The effects of deflecting the second bending section on the image and on the rotating elements in the probe were evaluated. RESULTS For 28 lesions, no improvement was observed with use of both bending sections. However, for 5 lesions, the US image was improved by use of the second bending section. These lesions were located in the stomach on the lesser or greater curve. In no instance did deflection of both bending sections result in uneven rotation of the mechanical elements in the probe. CONCLUSIONS For certain lesions, US images obtained with a catheter probe can be improved by using an endoscope with a second bending section.